Novato Community Hospital by e51r8Xi

VIEWS: 89 PAGES: 315

									                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

2627685   S CATH BLN DILATE NOVSC             116            26
5400015   STATISTICAL TRACKING                               54
2900033   CPLX GENRL ANES ADD 15M             657            29             ANESTHESIA SERVICES
2900025   CPLX GENRL ANES FIRST 30M          1227            29             ANESTHESIA SERVICES
2960359   CS DIFF MD ADD 15M                  130            29             ANESTHESIA SERVICES
2960342   CS DIFF MD GT5YR 0-30M              454            29             ANESTHESIA SERVICES
2960334   CS DIFF MD LT5YR 0-30M              454            29             ANESTHESIA SERVICES
2960326   CS SAME MD ADD 15M                  130            29             ANESTHESIA SERVICES
2960318   CS SAME MD GT5YR 0-30M              472            29             ANESTHESIA SERVICES
2960300   CS SAME MD LT5YR 0-30M              454            29             ANESTHESIA SERVICES
2960011   D51/2NS 1000ML                      206            29             ANESTHESIA SERVICES
2960151   D51/2NS 500ML                       206            29             ANESTHESIA SERVICES
2960029   D51/4NS 1000ML                      206            29             ANESTHESIA SERVICES
2960037   D51/4NS 500ML                       206            29             ANESTHESIA SERVICES
2960235   D5LR 1000ML                         206            29             ANESTHESIA SERVICES
2960045   D5LR 1000ML                         206            29             ANESTHESIA SERVICES
2960052   D5NS 1000ML                         130            29             ANESTHESIA SERVICES
2960276   D5W 1000ML                          206            29             ANESTHESIA SERVICES
2960201   D5W 1000ML                          206            29             ANESTHESIA SERVICES
2960292   D5W 100ML                           206            29             ANESTHESIA SERVICES
2960185   D5W 100ML                           206            29             ANESTHESIA SERVICES
2960169   D5W 250ML                           206            29             ANESTHESIA SERVICES
2960193   D5W 500ML                           206            29             ANESTHESIA SERVICES
2960060   LACTATED RINGERS 1000               206            29             ANESTHESIA SERVICES
2960243   LACTATED RINGERS 500                206            29             ANESTHESIA SERVICES
2960078   LACTATED RINGERS 500                206            29             ANESTHESIA SERVICES
2900058   MAC/REG ADD 15M                     500            29             ANESTHESIA SERVICES
2900041   MAC/REG FIRST 30M                  1034            29             ANESTHESIA SERVICES
2960086   MANNITOL IV 20% 500 CC              206            29             ANESTHESIA SERVICES
2960003   NA CL 0.45% 1000ML                  130            29             ANESTHESIA SERVICES
2960268   NA CL 0.9% 1000ML                   206            29             ANESTHESIA SERVICES
2960102   NA CL 0.9% 1000ML                   206            29             ANESTHESIA SERVICES
2960284   NA CL 0.9% 100ML                    206            29             ANESTHESIA SERVICES
2960144   NA CL 0.9% 100ML                    206            29             ANESTHESIA SERVICES
2960250   NA CL 0.9% 250ML                    206            29             ANESTHESIA SERVICES
2960110   NA CL 0.9% 250ML                    206            29             ANESTHESIA SERVICES
2960128   NA CL 0.9% 500ML                    206            29             ANESTHESIA SERVICES
2960227   NA CL 0.9% 50ML                     130            29             ANESTHESIA SERVICES
2960177   NA CL 5% 500ML                      206            29             ANESTHESIA SERVICES
2960094   NORMOSOL R 1000ML                   206            29             ANESTHESIA SERVICES
2960136   PLASMA-LYTE 148/D5W1000             206            29             ANESTHESIA SERVICES
2930584   S CATH DRAINAGE                      13            29             ANESTHESIA SERVICES
2930576   S CATH DRAINAGE                      13            29             ANESTHESIA SERVICES
2930568   S CATH DRAINAGE                      13            29             ANESTHESIA SERVICES
2930253   S CATH DRAINAGE                      15            29             ANESTHESIA SERVICES
2930360   S CATH INFSN NO HD                  235            29             ANESTHESIA SERVICES
2930329   S CATH INFSN NO HD                  279            29             ANESTHESIA SERVICES
2930097   S CATH INFSN NO HD                  157            29             ANESTHESIA SERVICES
2930139   S CATH INTRASPINAL                  193            29             ANESTHESIA SERVICES
2930352   S INTRO GDE FXD CRV PLAWY           264            29             ANESTHESIA SERVICES
2930014   S NSTRL LRYNGEAL MSK ARWY            79            29             ANESTHESIA SERVICES
2930006   S NSTRL PRESS INFUSOR BAG           160            29             ANESTHESIA SERVICES
2930519   S NSTRL TRANS BREATH CIRC            63            29             ANESTHESIA SERVICES
2930055   S NSTRL WRMTCH FULL BODY             72            29             ANESTHESIA SERVICES
2930030   S NSTRL WRMTCH LOWR BODY             69            29             ANESTHESIA SERVICES




                                                 Page 1
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

2930048   S NSTRL WRMTCH UPPER BODY            92            29             ANESTHESIA SERVICES
2930246   S STRL ANES MISC CHARGE                            29             ANESTHESIA SERVICES
2930279   S STRL ARTERIAL LINE                289            29             ANESTHESIA SERVICES
2930196   S STRL BLOCK NDL STIMUPLX            91            29             ANESTHESIA SERVICES
2930105   S STRL BLOOD FILTER                  27            29             ANESTHESIA SERVICES
2930709   S STRL CATH SCTN W/CNTRL              6            29             ANESTHESIA SERVICES
2930691   S STRL CATH SCTN W/CNTRL              6            29             ANESTHESIA SERVICES
2930683   S STRL CATH SCTN W/CNTRL              6            29             ANESTHESIA SERVICES
2930592   S STRL CATH SCTN W/O CNTR             6            29             ANESTHESIA SERVICES
2930717   S STRL CATH,IV 14G1-1/4 N            19            29             ANESTHESIA SERVICES
2930725   S STRL CATH,IV 16G1-1/4 N            19            29             ANESTHESIA SERVICES
2930733   S STRL CATH,IV 18G1-1/4 N            19            29             ANESTHESIA SERVICES
2930741   S STRL CATH,IV 20G1-1/4 N            19            29             ANESTHESIA SERVICES
2930758   S STRL CATH,IV 22G 1"NONL            19            29             ANESTHESIA SERVICES
2930766   S STRL CATH,IV HMA IIBLD            122            29             ANESTHESIA SERVICES
2930311   S STRL CELL SAVER SUPP             2100            29             ANESTHESIA SERVICES
2930295   S STRL CELL SAVR CLTN SET           139            29             ANESTHESIA SERVICES
2930303   S STRL CELL SVR INIT SUPP           883            29             ANESTHESIA SERVICES
2930774   S STRL CTH CONT OUTPUT             1185            29             ANESTHESIA SERVICES
2930337   S STRL CVP TRANSDUCER               271            29             ANESTHESIA SERVICES
2930162   S STRL DOUBLE LUMEN ET              537            29             ANESTHESIA SERVICES
2930527   S STRL DRN PNRS 1/2*8"                6            29             ANESTHESIA SERVICES
2930154   S STRL ENDOTRACHEAL TUBE             19            29             ANESTHESIA SERVICES
2930386   S STRL FLUID SET LEVEL I            482            29             ANESTHESIA SERVICES
2930238   S STRL FLUID WARMER SET             136            29             ANESTHESIA SERVICES
2930410   S STRL INFSN NOHEMODIALYS           174            29             ANESTHESIA SERVICES
2930402   S STRL INFSN NOHEMODIALYS           321            29             ANESTHESIA SERVICES
2930378   S STRL INFSN NOHEMODIALYS          1204            29             ANESTHESIA SERVICES
2930345   S STRL INFSN NOHEMODIALYS          1393            29             ANESTHESIA SERVICES
2930287   S STRL L T A KIT                     35            29             ANESTHESIA SERVICES
2930204   S STRL LASR ENDOTRCHLTUBE           564            29             ANESTHESIA SERVICES
2930220   S STRL MDICUT ANGIO NDL              26            29             ANESTHESIA SERVICES
2930188   S STRL MICROPORE BLD FLTR            39            29             ANESTHESIA SERVICES
2930675   S STRL NDL SPNL 24G 4 3/4           133            29             ANESTHESIA SERVICES
2930493   S STRL NDL,SPNL18G*2 1/2             19            29             ANESTHESIA SERVICES
2930501   S STRL NDL,SPNL18G*3 1/2             15            29             ANESTHESIA SERVICES
2930485   S STRL NDL,SPNL19G*3 1/2             15            29             ANESTHESIA SERVICES
2930477   S STRL NDL,SPNL20G*2 1/2             13            29             ANESTHESIA SERVICES
2930469   S STRL NDL,SPNL20G*3 1/2             15            29             ANESTHESIA SERVICES
2930451   S STRL NDL,SPNL22G*1 1/2             15            29             ANESTHESIA SERVICES
2930444   S STRL NDL,SPNL22G*2 1/2             15            29             ANESTHESIA SERVICES
2930436   S STRL NDL,SPNL22G*3 1/2             15            29             ANESTHESIA SERVICES
2930428   S STRL NDL,SPNL25G*2 1/2             15            29             ANESTHESIA SERVICES
2930543   S STRL PLASMA SEQUESTRATI           611            29             ANESTHESIA SERVICES
2930170   S STRL RAE ENDO TUBE                164            29             ANESTHESIA SERVICES
2930071   S STRL RETROGRD INTUB ST            359            29             ANESTHESIA SERVICES
2930121   S STRL SPINALTRAY 25GA DI           154            29             ANESTHESIA SERVICES
2930063   S STRL STETH ESOPH TEMP             112            29             ANESTHESIA SERVICES
2930535   S STRL STETH TEMP PROBE M            38            29             ANESTHESIA SERVICES
2930212   S STRL STETH TEMP PROBE M            38            29             ANESTHESIA SERVICES
2930394   S STRL THERMOSET                    113            29             ANESTHESIA SERVICES
2930022   S STRL TRANS BREATH CIRC             63            29             ANESTHESIA SERVICES
2930089   S STRL TUBE CVP MANOMETER            89            29             ANESTHESIA SERVICES
2930667   S STRL TUBE ET INTERMD H-            17            29             ANESTHESIA SERVICES
2930659   S STRL TUBE ET INTERMD H-            17            29             ANESTHESIA SERVICES




                                                 Page 2
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

2930642   S STRL TUBE ET INTERMD H-            17            29             ANESTHESIA SERVICES
2930634   S STRL TUBE ET INTERMD H-            17            29             ANESTHESIA SERVICES
2930626   S STRL TUBE ET INTERMED H            17            29             ANESTHESIA SERVICES
2930618   S STRL TUBE ET INTERMED H            16            29             ANESTHESIA SERVICES
2930600   S STRL TUBE ET INTERMED H            17            29             ANESTHESIA SERVICES
2930550   S STRL TUBE ET MAGILL 3.5            25            29             ANESTHESIA SERVICES
2900017   STND GENRL ANES ADD 15M             529            29             ANESTHESIA SERVICES
2900009   STND GENRL ANES FIRST 30M          1068            29             ANESTHESIA SERVICES
2960219   WATER IJ 1000ML                     206            29             ANESTHESIA SERVICES
3700002   EKG 12 LEAD TRACING                 278            37             CARDIOLOGY/CARDIOVASCULAR
3700028   EKG 3 LEAD TRACING                  137            37             CARDIOLOGY/CARDIOVASCULAR
3665650   S STRL                               88            36             CARDIOLOGY/CARDIOVASULAR
0225052   AA 8.5%/D50W 1000ML                 151            02             CENTRAL SUPPLY
0223180   AMINO ACIDS 8.5% 1000ML             151            02             CENTRAL SUPPLY
0223198   AMINO ACIDS 8.5% 500ML              151            02             CENTRAL SUPPLY
0222919   BENZOCAINE SPRAY (DERMOPL            31            02             CENTRAL SUPPLY
0223230   D10NS 1000ML                        151            02             CENTRAL SUPPLY
0223313   D10W 1000ML                         151            02             CENTRAL SUPPLY
0262998   D10W 1000ML                          92            02             CENTRAL SUPPLY
0223412   D10W 250ML                          151            02             CENTRAL SUPPLY
0223248   D10W 500ML                          151            02             CENTRAL SUPPLY
0262972   D5 0.225 NACL 1000ML                 91            02             CENTRAL SUPPLY
0262956   D5 0.45 NACL 1000ML                  92            02             CENTRAL SUPPLY
0223370   D50W 1000ML                         151            02             CENTRAL SUPPLY
0222943   D51/2NS 1000ML                      151            02             CENTRAL SUPPLY
0222950   D51/2NS 1000ML/KCL 20               151            02             CENTRAL SUPPLY
0222968   D51/2NS 1000ML/KCL 30               151            02             CENTRAL SUPPLY
0222976   D51/2NS 1000ML/KCL 40               151            02             CENTRAL SUPPLY
0223255   D51/2NS 500ML                       151            02             CENTRAL SUPPLY
0222984   D51/4NS 1000ML                      151            02             CENTRAL SUPPLY
0222992   D51/4NS 1000ML/KCL 20               151            02             CENTRAL SUPPLY
0223388   D51/4NS 500ML                       151            02             CENTRAL SUPPLY
0223008   D5LR 1000ML                         151            02             CENTRAL SUPPLY
0262980   D5LR 1000ML                          92            02             CENTRAL SUPPLY
0223206   D5LR 500 ML                         151            02             CENTRAL SUPPLY
0223016   D5NS 1000ML                         151            02             CENTRAL SUPPLY
0223032   D5NS 1000ML/KCL 20                  151            02             CENTRAL SUPPLY
0223024   D5NS 1000ML/KCL 20                  151            02             CENTRAL SUPPLY
0223040   D5NS 500ML                          151            02             CENTRAL SUPPLY
0202424   D5NS 500ML 33% IV                   151            02             CENTRAL SUPPLY
0223362   D5W 1000ML                          151            02             CENTRAL SUPPLY
0223057   D5W 1000ML/KCL 20                   151            02             CENTRAL SUPPLY
0223339   D5W 100ML                           151            02             CENTRAL SUPPLY
0263046   D5W 100ML                            92            02             CENTRAL SUPPLY
0202580   D5W 100ML ADVNTG 2565               151            02             CENTRAL SUPPLY
0223396   D5W 150ML                           151            02             CENTRAL SUPPLY
0223271   D5W 250ML                           151            02             CENTRAL SUPPLY
0223263   D5W 250ML                           151            02             CENTRAL SUPPLY
0262881   D5W 250ML                            91            02             CENTRAL SUPPLY
0223354   D5W 500ML                           151            02             CENTRAL SUPPLY
0223347   D5W 500ML                           151            02             CENTRAL SUPPLY
0262899   D5W 500ML                            91            02             CENTRAL SUPPLY
0223321   D5W 50ML                            151            02             CENTRAL SUPPLY
0263038   D5W 50ML                             92            02             CENTRAL SUPPLY
0223289   D70W 1000ML                         151            02             CENTRAL SUPPLY




                                                 Page 3
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0260315   DIANEAL/DEXT 1.5%                    151            02             CENTRAL SUPPLY
0260166   DIANEAL/DEXT 1.5%                    151            02             CENTRAL SUPPLY
0224964   DIANEAL/DEXT 1.5% 2L/3L              108            02             CENTRAL SUPPLY
0224980   DIANEAL/DEXT 2.5%                    132            02             CENTRAL SUPPLY
0224956   DIANEAL/DEXT 2.5% 2L/3L              132            02             CENTRAL SUPPLY
0250308   DIANEAL/DEXT 4.25%                   144            02             CENTRAL SUPPLY
0224949   DIANEAL/DEXT 4.25% 2L/3L             151            02             CENTRAL SUPPLY
0202861   GLYCINE 1.5 IRRG 3L SOLN              45            02             CENTRAL SUPPLY
0261883   HIP PELV/THRUST BEAR LOCK                           02             CENTRAL SUPPLY
0250340   INSTITUTIONAL:IV SET NCH              19            02             CENTRAL SUPPLY
0223222   IONOSOL-T/D5W 1000ML                 151            02             CENTRAL SUPPLY
0223214   IONOSOL-T/D5W 500 ML                 151            02             CENTRAL SUPPLY
0223065   LACTATED RINGERS 1000                151            02             CENTRAL SUPPLY
0262964   LACTATED RINGERS 1000                 91            02             CENTRAL SUPPLY
0224824   LACTATED RINGERS 1000 24              19            02             CENTRAL SUPPLY
0224808   LACTATED RINGERS 3000 SOL             55            02             CENTRAL SUPPLY
0223073   LACTATED RINGERS 500                 151            02             CENTRAL SUPPLY
0202713   LIDOCAINE 4% LARYNG-O-JET             33            02             CENTRAL SUPPLY
0223081   MANNITOL IV 20% 500CC                151            02             CENTRAL SUPPLY
0202358   NA CL .09% SYRNG 10ML IRR              5            02             CENTRAL SUPPLY
0222927   NA CL 0.45% 1000ML                   151            02             CENTRAL SUPPLY
0262865   NA CL 0.45% 1000ML                    91            02             CENTRAL SUPPLY
0222935   NA CL 0.45% 500ML                    151            02             CENTRAL SUPPLY
0223115   NA CL 0.9% 1000ML                    151            02             CENTRAL SUPPLY
0223172   NA CL 0.9% 100ML                     151            02             CENTRAL SUPPLY
0223123   NA CL 0.9% 150ML                     151            02             CENTRAL SUPPLY
0223131   NA CL 0.9% 250ML                     151            02             CENTRAL SUPPLY
0223149   NA CL 0.9% 500ML                     151            02             CENTRAL SUPPLY
0223156   NA CL 0.9% 50ML                      151            02             CENTRAL SUPPLY
0250001   NA CL 10ML SOLN                        5            02             CENTRAL SUPPLY
0223297   NA CL 3% 500ML                       151            02             CENTRAL SUPPLY
0223305   NA CL 5% 500ML                       151            02             CENTRAL SUPPLY
0224873   NA CL IRRIG 1000ML                     6            02             CENTRAL SUPPLY
0262949   NA CL IRRIG 1000ML                   121            02             CENTRAL SUPPLY
0224881   NA CL IRRIG 1500ML                    10            02             CENTRAL SUPPLY
0213553   NA CL IRRIG 2000ML                    27            02             CENTRAL SUPPLY
0224899   NA CL IRRIG 500ML                      5            02             CENTRAL SUPPLY
0224865   NA CL IRRIG 500ML                      6            02             CENTRAL SUPPLY
0223099   NORMOSOL R 1000ML                    151            02             CENTRAL SUPPLY
0223107   NORMOSOL R/D5W 1000ML                151            02             CENTRAL SUPPLY
0260018   PLASMA-LYTE 148/D5W1000              151            02             CENTRAL SUPPLY
0260174   PLASMA-LYTE 148/D5W1000              151            02             CENTRAL SUPPLY
0209676   S CATH DRAINAGE                      528            02             CENTRAL SUPPLY
0216416   S CATH DRAINAGE 10FR W/PG            528            02             CENTRAL SUPPLY
0216424   S CATH DRAINAGE 12FR W/PG            565            02             CENTRAL SUPPLY
0216432   S CATH DRAINAGE 14FR W/PG            565            02             CENTRAL SUPPLY
0216515   S CATH DRAINAGE 22FR                 314            02             CENTRAL SUPPLY
0216390   S CATH DRAINAGE 6FR W/PGT            528            02             CENTRAL SUPPLY
0216408   S CATH DRAINAGE 8FR W/PGT            528            02             CENTRAL SUPPLY
0209833   S CATH DRAINAGE FRM 10/35            478            02             CENTRAL SUPPLY
0214973   S CATH DRAINAGE PLERL KIT           1550            02             CENTRAL SUPPLY
0216473   S CATH DRAINAGE TUBE 14F             314            02             CENTRAL SUPPLY
0216481   S CATH DRAINAGE TUBE 16FR            314            02             CENTRAL SUPPLY
0216499   S CATH DRAINAGE TUBE 18FR            314            02             CENTRAL SUPPLY
0223925   S CATH DRAINAGE ULT4.0-38            681            02             CENTRAL SUPPLY




                                                  Page 4
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0217067   S CATH DRAINAGE WOGS 1200           987            02             CENTRAL SUPPLY
0217075   S CATH DRAINAGE WOGS 1400          1034            02             CENTRAL SUPPLY
0216788   S CATH DRAINAGE5-19-10YUE           164            02             CENTRAL SUPPLY
0214767   S CATH DRAINAGE5-19-15YUE           164            02             CENTRAL SUPPLY
0223933   S CATH DRAINAGELT10.2-382           681            02             CENTRAL SUPPLY
0216507   S CATH DRAINAGER 20FR               314            02             CENTRAL SUPPLY
0215301   S CATH GUIDING 2 7FR UCSF           164            02             CENTRAL SUPPLY
0223826   S CATH GUIDING 6F*100              1250            02             CENTRAL SUPPLY
0215988   S CATH HD SHORT TERM 11.5           351            02             CENTRAL SUPPLY
0215970   S CATH HD SHORT TERM 11.5           351            02             CENTRAL SUPPLY
0215962   S CATH HD SHORT TERM 11.5           359            02             CENTRAL SUPPLY
0215632   S CATH HD SHORT TERM 15CM           798            02             CENTRAL SUPPLY
0215624   S CATH HD SHORT TERM 20CM           798            02             CENTRAL SUPPLY
0215954   S CATH HD SHORT TERM11.5*           360            02             CENTRAL SUPPLY
0222687   S CATH HD/PERTNL LNG TRM           2297            02             CENTRAL SUPPLY
0221143   S CATH HD/PERTNL LNG TRM           2022            02             CENTRAL SUPPLY
0221135   S CATH HD/PERTNL LNG TRM           2022            02             CENTRAL SUPPLY
0220517   S CATH HD/PERTNL LNG TRM           2189            02             CENTRAL SUPPLY
0220509   S CATH HD/PERTNL LNG TRM           2189            02             CENTRAL SUPPLY
0215657   S CATH HD/PERTNL LNG TRM           1672            02             CENTRAL SUPPLY
0215640   S CATH HD/PERTNL LNG TRM           2080            02             CENTRAL SUPPLY
0263517   S CATH INFSN NO HD                   59            02             CENTRAL SUPPLY
0217299   S CATH INFSN NO HD 5F100/           667            02             CENTRAL SUPPLY
0217315   S CATH INFSN NO HD 5F135/           667            02             CENTRAL SUPPLY
0215665   S CATH INFSN NO HD 5FR SN           461            02             CENTRAL SUPPLY
0217323   S CATH INFSN NO HD 5FR65/           667            02             CENTRAL SUPPLY
0215996   S CATH INFSN NO HD MCIS5.           665            02             CENTRAL SUPPLY
0215095   S CATH OCCLUSION BLN8.5/5          1192            02             CENTRAL SUPPLY
0215780   S CATH OCCLUSION EMBLCTMY           435            02             CENTRAL SUPPLY
0263509   S CATH SP/CYSTOSCOPIC                53            02             CENTRAL SUPPLY
0214684   S CATH THROMB/EMBOLCTMY            1267            02             CENTRAL SUPPLY
0223891   S CATH TRNSML ANG NOLSR            1630            02             CENTRAL SUPPLY
0223883   S CATH TRNSML ANG NOLSR            1599            02             CENTRAL SUPPLY
0223875   S CATH TRNSML ANG NOLSR            1599            02             CENTRAL SUPPLY
0223867   S CATH TRNSML ANG NOLSR            1308            02             CENTRAL SUPPLY
0223677   S CATH TRNSML ANG NOLSR            1630            02             CENTRAL SUPPLY
0223651   S CATH TRNSML ANG NOLSR            1599            02             CENTRAL SUPPLY
0219642   S CATH TRNSML ANG NOLSR            1648            02             CENTRAL SUPPLY
0219048   S CATH TRNSML ANG NOLSR            1837            02             CENTRAL SUPPLY
0217968   S CATH TRNSML ANG NOLSR            1726            02             CENTRAL SUPPLY
0217950   S CATH TRNSML ANG NOLSR            1726            02             CENTRAL SUPPLY
0217620   S CATH TRNSML ANG NOLSR            1690            02             CENTRAL SUPPLY
0217257   S CATH TRNSML ANG NOLSR            1599            02             CENTRAL SUPPLY
0217240   S CATH TRNSML ANG NOLSR            1599            02             CENTRAL SUPPLY
0217232   S CATH TRNSML ANG NOLSR            1690            02             CENTRAL SUPPLY
0217224   S CATH TRNSML ANG NOLSR            1690            02             CENTRAL SUPPLY
0217216   S CATH TRNSML ANG NOLSR            1690            02             CENTRAL SUPPLY
0217182   S CATH TRNSML ANG NOLSR            2319            02             CENTRAL SUPPLY
0217174   S CATH TRNSML ANG NOLSR            2319            02             CENTRAL SUPPLY
0217166   S CATH TRNSML ANG NOLSR            2319            02             CENTRAL SUPPLY
0217158   S CATH TRNSML ANG NOLSR            2168            02             CENTRAL SUPPLY
0217133   S CATH TRNSML ANG NOLSR            2168            02             CENTRAL SUPPLY
0217125   S CATH TRNSML ANG NOLSR            1690            02             CENTRAL SUPPLY
0217117   S CATH TRNSML ANG NOLSR            1648            02             CENTRAL SUPPLY
0217109   S CATH TRNSML ANG NOLSR            1599            02             CENTRAL SUPPLY




                                                 Page 5
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0217091   S CATH TRNSML ANG NOLSR             1599            02             CENTRAL SUPPLY
0217083   S CATH TRNSML ANG NOLSR             2091            02             CENTRAL SUPPLY
0215772   S CATH TRNSML ANG NOLSR             1599            02             CENTRAL SUPPLY
0215277   S CATH TRNSML ANG NOLSR             1599            02             CENTRAL SUPPLY
0215269   S CATH TRNSML ANG NOLSR             1575            02             CENTRAL SUPPLY
0215251   S CATH TRNSML ANG NOLSR             1575            02             CENTRAL SUPPLY
0215244   S CATH TRNSML ANG NOLSR             2053            02             CENTRAL SUPPLY
0215137   S CATH TRNSML ANG NOLSR             1648            02             CENTRAL SUPPLY
0215087   S CATH TRNSML ANG NOLSR             1599            02             CENTRAL SUPPLY
0215079   S CATH TRNSML ANG NOLSR             1648            02             CENTRAL SUPPLY
0215061   S CATH TRNSML ANG NOLSR             1550            02             CENTRAL SUPPLY
0215053   S CATH TRNSML ANG NOLSR             1550            02             CENTRAL SUPPLY
0215046   S CATH TRNSML ANG NOLSR             1672            02             CENTRAL SUPPLY
0215020   S CATH TRNSML ANG NOLSR             1672            02             CENTRAL SUPPLY
0215012   S CATH TRNSML ANG NOLSR             1169            02             CENTRAL SUPPLY
0214965   S CATH TRNSML ANG NOLSR             1599            02             CENTRAL SUPPLY
0214957   S CATH TRNSML ANG NOLSR             1648            02             CENTRAL SUPPLY
0214700   S CATH TRNSML ANG NOLSR             1623            02             CENTRAL SUPPLY
0211284   S CATH TRNSML ANG NOLSR             1690            02             CENTRAL SUPPLY
0216663   S CATH URETERAL 10/25TT              658            02             CENTRAL SUPPLY
0209619   S CATH URETERAL 12FR                 631            02             CENTRAL SUPPLY
0209627   S CATH URETERAL 14FR                 631            02             CENTRAL SUPPLY
0216655   S CATH URETERAL 8FR                  631            02             CENTRAL SUPPLY
0222893   S DEVICE CLOSURE VASC 6FR           1429            02             CENTRAL SUPPLY
0220525   S DEVICE CLOSURE VASC 8FR           1429            02             CENTRAL SUPPLY
0216465   S DEVICE RETRIEVAL                  1672            02             CENTRAL SUPPLY
0208207   S DEVICE RETRIEVAL                  1672            02             CENTRAL SUPPLY
0220343   S FILTER VENA CAVA 12FR             2951            02             CENTRAL SUPPLY
0220236   S FILTER VENA CAVA BNF75            3188            02             CENTRAL SUPPLY
0220368   S FILTER VENA CAVA FEMRL            3323            02             CENTRAL SUPPLY
0221168   S FILTER VENA CAVA SIMON            3501            02             CENTRAL SUPPLY
0221150   S FILTER VENA CAVA SIMON            3551            02             CENTRAL SUPPLY
0221176   S FILTER VENA CAVA TECH             3008            02             CENTRAL SUPPLY
0220376   S FILTER VENA CAVA TITAN            3012            02             CENTRAL SUPPLY
0214866   S FILTER VENA CAVA TRAPES           3431            02             CENTRAL SUPPLY
0221390   S FILTER VENA CAVA TULIP            3758            02             CENTRAL SUPPLY
0220251   S IMP ANGIO-SEAL 8FR CLOS           1295            02             CENTRAL SUPPLY
0222901   S IMP COATD WO DEL SYS              3111            02             CENTRAL SUPPLY
0221671   S IMP COATD WO DEL SYS              4224            02             CENTRAL SUPPLY
0221515   S IMP COATD WO DEL SYS              6034            02             CENTRAL SUPPLY
0221507   S IMP COATD WO DEL SYS              6034            02             CENTRAL SUPPLY
0221499   S IMP COATD WO DEL SYS              6034            02             CENTRAL SUPPLY
0221481   S IMP COATD WO DEL SYS              6034            02             CENTRAL SUPPLY
0221473   S IMP COATD WO DEL SYS              6034            02             CENTRAL SUPPLY
0221093   S IMP COATD WO DEL SYS              5406            02             CENTRAL SUPPLY
0221085   S IMP COATD WO DEL SYS              4224            02             CENTRAL SUPPLY
0221077   S IMP COATD WO DEL SYS              4224            02             CENTRAL SUPPLY
0220202   S IMP COATD WO DEL SYS              6591            02             CENTRAL SUPPLY
0220194   S IMP COATD WO DEL SYS              4220            02             CENTRAL SUPPLY
0220186   S IMP COATD WO DEL SYS              5983            02             CENTRAL SUPPLY
0220178   S IMP COATD WO DEL SYS              5039            02             CENTRAL SUPPLY
0208827   S IMP COIL CMPLX PLAT                247            02             CENTRAL SUPPLY
0208819   S IMP COIL CMPLX PLAT6CM3            247            02             CENTRAL SUPPLY
0209742   S IMP COIL FCL 3MMX30MM12            265            02             CENTRAL SUPPLY
0209734   S IMP COIL FCL 4MMX30MM12            265            02             CENTRAL SUPPLY




                                                  Page 6
                                      c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                   SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                         AMOUNT AMOUNT CODE

0212183   S IMP COIL FIBRD 5MMX50MM                324            02             CENTRAL SUPPLY
0223735   S IMP COIL PLAT.035/3MM/2               1368            02             CENTRAL SUPPLY
0223743   S IMP COIL PLAT.035/4MM/3               1672            02             CENTRAL SUPPLY
0223750   S IMP COIL PLAT.035/5MM/3               1368            02             CENTRAL SUPPLY
0223768   S IMP COIL PLAT.035/6MM/4               1300            02             CENTRAL SUPPLY
0223776   S IMP COIL PLAT.035/9MM/6               1368            02             CENTRAL SUPPLY
0209528   S IMP COIL PLAT2MM/10MM F                265            02             CENTRAL SUPPLY
0215756   S IMP COIL VRTX DIAM2MM/3                586            02             CENTRAL SUPPLY
0215764   S IMP COIL VRTX DIAM2MM/4                586            02             CENTRAL SUPPLY
0215731   S IMP COIL VRTX35 2MM/4MM                408            02             CENTRAL SUPPLY
0215749   S IMP COIL VRTX35 3MM/6MM                408            02             CENTRAL SUPPLY
0222620   S IMP DUAL CHAMBER                     42558            02             CENTRAL SUPPLY
0220392   S IMP FILTER VENA CAVA                  2344            02             CENTRAL SUPPLY
0220384   S IMP FILTER VENA CAVA                  2513            02             CENTRAL SUPPLY
0220277   S IMP FILTER VENA CAVA                  1522            02             CENTRAL SUPPLY
0250316   S IMP HD/PERITNL LNG TRM                 648            02             CENTRAL SUPPLY
0220442   S IMP HD/PERITNL LNG TRM                 648            02             CENTRAL SUPPLY
0221465   S IMP NOCOAT WDEL SYS                   4374            02             CENTRAL SUPPLY
0221457   S IMP NOCOAT WDEL SYS                   4374            02             CENTRAL SUPPLY
0221440   S IMP NOCOAT WDEL SYS                   4374            02             CENTRAL SUPPLY
0221432   S IMP NOCOAT WDEL SYS                   4374            02             CENTRAL SUPPLY
0221424   S IMP NOCOAT WDEL SYS                   4374            02             CENTRAL SUPPLY
0221416   S IMP NOCOAT WDEL SYS                   4374            02             CENTRAL SUPPLY
0221408   S IMP NOCOAT WDEL SYS                   4374            02             CENTRAL SUPPLY
0221218   S IMP NOCOAT WDEL SYS                   4094            02             CENTRAL SUPPLY
0221200   S IMP NOCOAT WDEL SYS                   4094            02             CENTRAL SUPPLY
0221192   S IMP NOCOAT WDEL SYS                   4094            02             CENTRAL SUPPLY
0220467   S IMP NOCOAT WDEL SYS                   4094            02             CENTRAL SUPPLY
0250332   S IMP NOCOAT WO DEL SYS                  333            02             CENTRAL SUPPLY
0222885   S IMP NOCOAT WO DEL SYS                  243            02             CENTRAL SUPPLY
0222679   S IMP NOCOAT WO DEL SYS                 4409            02             CENTRAL SUPPLY
0222661   S IMP NOCOAT WO DEL SYS                 4409            02             CENTRAL SUPPLY
0222588   S IMP NOCOAT WO DEL SYS                 4398            02             CENTRAL SUPPLY
0222570   S IMP NOCOAT WO DEL SYS                 4398            02             CENTRAL SUPPLY
0222562   S IMP NOCOAT WO DEL SYS                 4241            02             CENTRAL SUPPLY
0222554   S IMP NOCOAT WO DEL SYS                 4241            02             CENTRAL SUPPLY
0222547   S IMP NOCOAT WO DEL SYS                 4241            02             CENTRAL SUPPLY
0222539   S IMP NOCOAT WO DEL SYS                 4809            02             CENTRAL SUPPLY
0222521   S IMP NOCOAT WO DEL SYS                 4525            02             CENTRAL SUPPLY
0222513   S IMP NOCOAT WO DEL SYS                 4185            02             CENTRAL SUPPLY
0222505   S IMP NOCOAT WO DEL SYS                 4185            02             CENTRAL SUPPLY
0222497   S IMP NOCOAT WO DEL SYS                 4468            02             CENTRAL SUPPLY
0222489   S IMP NOCOAT WO DEL SYS                 4468            02             CENTRAL SUPPLY
0222471   S IMP NOCOAT WO DEL SYS                 5092            02             CENTRAL SUPPLY
0222463   S IMP NOCOAT WO DEL SYS                 4185            02             CENTRAL SUPPLY
0222455   S IMP NOCOAT WO DEL SYS                 4185            02             CENTRAL SUPPLY
0222448   S IMP NOCOAT WO DEL SYS                 5887            02             CENTRAL SUPPLY
0222430   S IMP NOCOAT WO DEL SYS                 5887            02             CENTRAL SUPPLY
0222422   S IMP NOCOAT WO DEL SYS                 5887            02             CENTRAL SUPPLY
0222414   S IMP NOCOAT WO DEL SYS                 5887            02             CENTRAL SUPPLY
0222406   S IMP NOCOAT WO DEL SYS                 5320            02             CENTRAL SUPPLY
0222398   S IMP NOCOAT WO DEL SYS                 5320            02             CENTRAL SUPPLY
0222380   S IMP NOCOAT WO DEL SYS                 5320            02             CENTRAL SUPPLY
0222372   S IMP NOCOAT WO DEL SYS                 5320            02             CENTRAL SUPPLY
0222364   S IMP NOCOAT WO DEL SYS                 4468            02             CENTRAL SUPPLY




                                                      Page 7
                                    c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                 SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                       AMOUNT AMOUNT CODE

0222356   S IMP NOCOAT WO DEL SYS               4468            02             CENTRAL SUPPLY
0222349   S IMP NOCOAT WO DEL SYS               4468            02             CENTRAL SUPPLY
0222331   S IMP NOCOAT WO DEL SYS               4468            02             CENTRAL SUPPLY
0222323   S IMP NOCOAT WO DEL SYS               5995            02             CENTRAL SUPPLY
0222315   S IMP NOCOAT WO DEL SYS               5396            02             CENTRAL SUPPLY
0222307   S IMP NOCOAT WO DEL SYS               5396            02             CENTRAL SUPPLY
0222299   S IMP NOCOAT WO DEL SYS               4788            02             CENTRAL SUPPLY
0222281   S IMP NOCOAT WO DEL SYS               4788            02             CENTRAL SUPPLY
0222273   S IMP NOCOAT WO DEL SYS               4788            02             CENTRAL SUPPLY
0222265   S IMP NOCOAT WO DEL SYS               6170            02             CENTRAL SUPPLY
0222257   S IMP NOCOAT WO DEL SYS               6170            02             CENTRAL SUPPLY
0222240   S IMP NOCOAT WO DEL SYS               6170            02             CENTRAL SUPPLY
0222232   S IMP NOCOAT WO DEL SYS               6170            02             CENTRAL SUPPLY
0222224   S IMP NOCOAT WO DEL SYS               5462            02             CENTRAL SUPPLY
0222216   S IMP NOCOAT WO DEL SYS               5462            02             CENTRAL SUPPLY
0222208   S IMP NOCOAT WO DEL SYS               5462            02             CENTRAL SUPPLY
0222190   S IMP NOCOAT WO DEL SYS               5462            02             CENTRAL SUPPLY
0222182   S IMP NOCOAT WO DEL SYS               4525            02             CENTRAL SUPPLY
0222174   S IMP NOCOAT WO DEL SYS               4525            02             CENTRAL SUPPLY
0222166   S IMP NOCOAT WO DEL SYS               4525            02             CENTRAL SUPPLY
0222158   S IMP NOCOAT WO DEL SYS               4525            02             CENTRAL SUPPLY
0222141   S IMP NOCOAT WO DEL SYS               3955            02             CENTRAL SUPPLY
0222133   S IMP NOCOAT WO DEL SYS               5754            02             CENTRAL SUPPLY
0222125   S IMP NOCOAT WO DEL SYS               2648            02             CENTRAL SUPPLY
0222117   S IMP NOCOAT WO DEL SYS               4218            02             CENTRAL SUPPLY
0222109   S IMP NOCOAT WO DEL SYS               4100            02             CENTRAL SUPPLY
0222091   S IMP NOCOAT WO DEL SYS               3955            02             CENTRAL SUPPLY
0222083   S IMP NOCOAT WO DEL SYS               3955            02             CENTRAL SUPPLY
0222075   S IMP NOCOAT WO DEL SYS               3955            02             CENTRAL SUPPLY
0222067   S IMP NOCOAT WO DEL SYS               5754            02             CENTRAL SUPPLY
0222059   S IMP NOCOAT WO DEL SYS               5895            02             CENTRAL SUPPLY
0222042   S IMP NOCOAT WO DEL SYS               5754            02             CENTRAL SUPPLY
0222034   S IMP NOCOAT WO DEL SYS               5092            02             CENTRAL SUPPLY
0222026   S IMP NOCOAT WO DEL SYS               5092            02             CENTRAL SUPPLY
0222018   S IMP NOCOAT WO DEL SYS               5092            02             CENTRAL SUPPLY
0222000   S IMP NOCOAT WO DEL SYS               4484            02             CENTRAL SUPPLY
0221994   S IMP NOCOAT WO DEL SYS               4484            02             CENTRAL SUPPLY
0221986   S IMP NOCOAT WO DEL SYS               4484            02             CENTRAL SUPPLY
0221978   S IMP NOCOAT WO DEL SYS               4218            02             CENTRAL SUPPLY
0221960   S IMP NOCOAT WO DEL SYS               4218            02             CENTRAL SUPPLY
0221952   S IMP NOCOAT WO DEL SYS               4218            02             CENTRAL SUPPLY
0221945   S IMP NOCOAT WO DEL SYS               4100            02             CENTRAL SUPPLY
0221937   S IMP NOCOAT WO DEL SYS               4100            02             CENTRAL SUPPLY
0221929   S IMP NOCOAT WO DEL SYS               4100            02             CENTRAL SUPPLY
0221911   S IMP NOCOAT WO DEL SYS               4560            02             CENTRAL SUPPLY
0221903   S IMP NOCOAT WO DEL SYS               4560            02             CENTRAL SUPPLY
0221895   S IMP NOCOAT WO DEL SYS               4390            02             CENTRAL SUPPLY
0221887   S IMP NOCOAT WO DEL SYS               4223            02             CENTRAL SUPPLY
0221879   S IMP NOCOAT WO DEL SYS               4560            02             CENTRAL SUPPLY
0221861   S IMP NOCOAT WO DEL SYS               4560            02             CENTRAL SUPPLY
0221853   S IMP NOCOAT WO DEL SYS               4525            02             CENTRAL SUPPLY
0221846   S IMP NOCOAT WO DEL SYS               4053            02             CENTRAL SUPPLY
0221812   S IMP NOCOAT WO DEL SYS               3417            02             CENTRAL SUPPLY
0221804   S IMP NOCOAT WO DEL SYS               3417            02             CENTRAL SUPPLY
0221796   S IMP NOCOAT WO DEL SYS               3417            02             CENTRAL SUPPLY




                                                    Page 8
                                      c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                   SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                         AMOUNT AMOUNT CODE

0221788   S IMP NOCOAT WO DEL SYS                 3325            02             CENTRAL SUPPLY
0221770   S IMP NOCOAT WO DEL SYS                 3325            02             CENTRAL SUPPLY
0221762   S IMP NOCOAT WO DEL SYS                 3325            02             CENTRAL SUPPLY
0221754   S IMP NOCOAT WO DEL SYS                 3325            02             CENTRAL SUPPLY
0221747   S IMP NOCOAT WO DEL SYS                 3123            02             CENTRAL SUPPLY
0221739   S IMP NOCOAT WO DEL SYS                 3123            02             CENTRAL SUPPLY
0221721   S IMP NOCOAT WO DEL SYS                 3123            02             CENTRAL SUPPLY
0221713   S IMP NOCOAT WO DEL SYS                 3123            02             CENTRAL SUPPLY
0221705   S IMP NOCOAT WO DEL SYS                 3123            02             CENTRAL SUPPLY
0221697   S IMP NOCOAT WO DEL SYS                 2922            02             CENTRAL SUPPLY
0221689   S IMP NOCOAT WO DEL SYS                 2922            02             CENTRAL SUPPLY
0221663   S IMP NOCOAT WO DEL SYS                 3664            02             CENTRAL SUPPLY
0221655   S IMP NOCOAT WO DEL SYS                 3664            02             CENTRAL SUPPLY
0221648   S IMP NOCOAT WO DEL SYS                 3664            02             CENTRAL SUPPLY
0221630   S IMP NOCOAT WO DEL SYS                 4215            02             CENTRAL SUPPLY
0221622   S IMP NOCOAT WO DEL SYS                 3664            02             CENTRAL SUPPLY
0221614   S IMP NOCOAT WO DEL SYS                 4676            02             CENTRAL SUPPLY
0221606   S IMP NOCOAT WO DEL SYS                 5599            02             CENTRAL SUPPLY
0221598   S IMP NOCOAT WO DEL SYS                 3567            02             CENTRAL SUPPLY
0221580   S IMP NOCOAT WO DEL SYS                 3567            02             CENTRAL SUPPLY
0221572   S IMP NOCOAT WO DEL SYS                 3567            02             CENTRAL SUPPLY
0221564   S IMP NOCOAT WO DEL SYS                 3567            02             CENTRAL SUPPLY
0221556   S IMP NOCOAT WO DEL SYS                 4450            02             CENTRAL SUPPLY
0221549   S IMP NOCOAT WO DEL SYS                 3134            02             CENTRAL SUPPLY
0221531   S IMP NOCOAT WO DEL SYS                 3134            02             CENTRAL SUPPLY
0221523   S IMP NOCOAT WO DEL SYS                 3134            02             CENTRAL SUPPLY
0221069   S IMP NOCOAT WO DEL SYS                 4525            02             CENTRAL SUPPLY
0221051   S IMP NOCOAT WO DEL SYS                 3477            02             CENTRAL SUPPLY
0220624   S IMP NOCOAT WO DEL SYS                 3351            02             CENTRAL SUPPLY
0220616   S IMP NOCOAT WO DEL SYS                 3567            02             CENTRAL SUPPLY
0220608   S IMP NOCOAT WO DEL SYS                 4252            02             CENTRAL SUPPLY
0220590   S IMP NOCOAT WO DEL SYS                 3351            02             CENTRAL SUPPLY
0220582   S IMP NOCOAT WO DEL SYS                 3134            02             CENTRAL SUPPLY
0220566   S IMP NOCOAT WO DEL SYS                 4252            02             CENTRAL SUPPLY
0220558   S IMP NOCOAT WO DEL SYS                 3717            02             CENTRAL SUPPLY
0220541   S IMP NOCOAT WO DEL SYS                 3351            02             CENTRAL SUPPLY
0220533   S IMP NOCOAT WO DEL SYS                 4525            02             CENTRAL SUPPLY
0220632   S IMP NOCOR WODEL SYS TM                4566            02             CENTRAL SUPPLY
0212993   S IMP PLATE SEMI TUB 5 H                 606            02             CENTRAL SUPPLY
0220574   S IMP PORT INDWELLING                   2783            02             CENTRAL SUPPLY
0222612   S IMP SNGL CHAMBER                     36010            02             CENTRAL SUPPLY
0222604   S IMP SNGL CHAMBER                     19652            02             CENTRAL SUPPLY
0215327   S IMP STNT *2 3.5X9MM BES               4751            02             CENTRAL SUPPLY
0220749   S IMP STNT BLARY 7*40*75F               3766            02             CENTRAL SUPPLY
0220640   S IMP STNT BLARY5*10*75XT               3276            02             CENTRAL SUPPLY
0220657   S IMP STNT BLARY5*16*75XT               3386            02             CENTRAL SUPPLY
0220665   S IMP STNT BLARY6*10*75XT               3276            02             CENTRAL SUPPLY
0220673   S IMP STNT BLARY6*16*75XT               3386            02             CENTRAL SUPPLY
0220681   S IMP STNT BLARY6*27*75XT               3512            02             CENTRAL SUPPLY
0220699   S IMP STNT BLARY6*40*75FL               3766            02             CENTRAL SUPPLY
0220707   S IMP STNT BLARY6*60*75FL               4019            02             CENTRAL SUPPLY
0220715   S IMP STNT BLARY7*10*75XT               3276            02             CENTRAL SUPPLY
0220772   S IMP STNT BLARY7*100*75F               4015            02             CENTRAL SUPPLY
0220723   S IMP STNT BLARY7*15*75XT               3386            02             CENTRAL SUPPLY
0220731   S IMP STNT BLARY7*27*75FL               3512            02             CENTRAL SUPPLY




                                                      Page 9
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0220756   S IMP STNT BLARY7*59*75FL           4019            02             CENTRAL SUPPLY
0220764   S IMP STNT BLARY7*78*75FL           3890            02             CENTRAL SUPPLY
0220798   S IMP STNT BLARY8*26*75FL           3512            02             CENTRAL SUPPLY
0220780   S IMP STNT BLARY8*39*75FL           3766            02             CENTRAL SUPPLY
0220806   S IMP STNT BLARY8*59*75FL           4019            02             CENTRAL SUPPLY
0220814   S IMP STNT BLARY8*77*75FL           3890            02             CENTRAL SUPPLY
0220822   S IMP STNT BLARY8*97*75FL           4015            02             CENTRAL SUPPLY
0220830   S IMP STNT BLARY9*25*75FL           3512            02             CENTRAL SUPPLY
0220848   S IMP STNT BLARY9*38*75FL           3766            02             CENTRAL SUPPLY
0220855   S IMP STNT BLARY9*59*75FL           4019            02             CENTRAL SUPPLY
0220863   S IMP STNT BLIARY10*24*75           3512            02             CENTRAL SUPPLY
0220871   S IMP STNT BLIARY10*37*75           3639            02             CENTRAL SUPPLY
0220889   S IMP STNT BLIARY10*56*75           4019            02             CENTRAL SUPPLY
0221275   S IMP STNT CORINTHIAN5/15           3867            02             CENTRAL SUPPLY
0221283   S IMP STNT CORINTHIAN5/18           3867            02             CENTRAL SUPPLY
0221291   S IMP STNT CORINTHIAN6/15           3867            02             CENTRAL SUPPLY
0221309   S IMP STNT CORINTHIAN6/18           3867            02             CENTRAL SUPPLY
0221317   S IMP STNT CORINTHIAN6/29           4036            02             CENTRAL SUPPLY
0221325   S IMP STNT CORINTHIAN6/39           4374            02             CENTRAL SUPPLY
0221358   S IMP STNT CORINTHIAN8/29           4036            02             CENTRAL SUPPLY
0221333   S IMP STNT CORINTHIAN8/29           4036            02             CENTRAL SUPPLY
0221366   S IMP STNT CORINTHIAN8/39           4374            02             CENTRAL SUPPLY
0221341   S IMP STNT CORINTHIAN8/39           4374            02             CENTRAL SUPPLY
0220350   S IMP STNT NEPH INT10FR*2            686            02             CENTRAL SUPPLY
0220269   S IMP STNT NEPH INT10FR29            369            02             CENTRAL SUPPLY
0220145   S IMP STNT NEPH INT10X242            530            02             CENTRAL SUPPLY
0220137   S IMP STNT NEPH INT8F28 2            669            02             CENTRAL SUPPLY
0220152   S IMP STNT NEPH INT8FR248            686            02             CENTRAL SUPPLY
0220160   S IMP STNT PALMAZ39*6(SF)           3197            02             CENTRAL SUPPLY
0220897   S IMP STNT PALMAZ5F4MM*75           3428            02             CENTRAL SUPPLY
0220905   S IMP STNT PALMAZ5F5MM*15           3428            02             CENTRAL SUPPLY
0220913   S IMP STNT PALMAZ5F5MM*20           3197            02             CENTRAL SUPPLY
0220921   S IMP STNT PALMAZ5F5MM*29           3197            02             CENTRAL SUPPLY
0220947   S IMP STNT PALMAZ5F6MM*15           3428            02             CENTRAL SUPPLY
0220939   S IMP STNT PALMAZ5F7MM*39           3428            02             CENTRAL SUPPLY
0221119   S IMP STNT PARAMNT 5/16MM           4053            02             CENTRAL SUPPLY
0222596   S IMP STNT PARAMNT 6/12MM           4053            02             CENTRAL SUPPLY
0221127   S IMP STNT PARAMNT 8/16MM           4053            02             CENTRAL SUPPLY
0221101   S IMP STNT PARAMNT 8/36MM           4053            02             CENTRAL SUPPLY
0221226   S IMP STNT PARAMNT5/16/75           3779            02             CENTRAL SUPPLY
0221234   S IMP STNT PARAMNT6/16/75           3779            02             CENTRAL SUPPLY
0221242   S IMP STNT PARAMNT6/36/75           3779            02             CENTRAL SUPPLY
0221259   S IMP STNT PARAMNT7/16/75           3779            02             CENTRAL SUPPLY
0221267   S IMP STNT PARAMNT7/36/75           3779            02             CENTRAL SUPPLY
0221374   S IMP STNT PRTGE7FR8MMX40           4560            02             CENTRAL SUPPLY
0221382   S IMP STNT PRTGE7FR8MMX60           4560            02             CENTRAL SUPPLY
0220426   S IMP STNT SET BLIARY 10-            545            02             CENTRAL SUPPLY
0220434   S IMP STNT SET BLIARY10-9            545            02             CENTRAL SUPPLY
0220954   S IMP STNT WALSTNT5MM*20M           3813            02             CENTRAL SUPPLY
0221838   S IMP VASO SEAL CLOSURE S           1185            02             CENTRAL SUPPLY
0250050   S INTR NOINTRACRD NOLSR              552            02             CENTRAL SUPPLY
0217364   S INTR NOINTRACRD NOLSR              165            02             CENTRAL SUPPLY
0216978   S INTR NOINTRACRD NOLSR              175            02             CENTRAL SUPPLY
0216960   S INTR NOINTRACRD NOLSR              280            02             CENTRAL SUPPLY
0216952   S INTR NOINTRACRD NOLSR              280            02             CENTRAL SUPPLY




                                                  Page 10
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0216937   S INTR NOINTRACRD NOLSR              336            02             CENTRAL SUPPLY
0216580   S INTR NOINTRACRD NOLSR             2319            02             CENTRAL SUPPLY
0214932   S INTR NOINTRACRD NOLSR              467            02             CENTRAL SUPPLY
0214924   S INTR NOINTRACRD NOLSR              482            02             CENTRAL SUPPLY
0214833   S INTR NOINTRACRD NOLSR              604            02             CENTRAL SUPPLY
0211904   S INTR NOINTRACRD NOLSR              280            02             CENTRAL SUPPLY
0211722   S INTR NOINTRACRD NOLSR              280            02             CENTRAL SUPPLY
0210302   S INTR NOINTRACRD NOLSR              175            02             CENTRAL SUPPLY
0210005   S INTR NOINTRACRD NOLSR              204            02             CENTRAL SUPPLY
0209395   S INTR NOINTRACRD NOLSR              175            02             CENTRAL SUPPLY
0209387   S INTR NOINTRACRD NOLSR              175            02             CENTRAL SUPPLY
0208314   S INTR NOINTRACRD NOLSR              175            02             CENTRAL SUPPLY
0200683   S INTR NOINTRACRD NOLSR             2211            02             CENTRAL SUPPLY
0250035   S INTRO GDE FXD CRV PLAWY            364            02             CENTRAL SUPPLY
0219345   S INTRO GDE FXD CRV PLAWY            363            02             CENTRAL SUPPLY
0216945   S INTRO GDE FXD CRV PLAWY            365            02             CENTRAL SUPPLY
0216911   S INTRO GDE FXD CRV PLAWY            364            02             CENTRAL SUPPLY
0216903   S INTRO GDE FXD CRV PLAWY            364            02             CENTRAL SUPPLY
0216895   S INTRO GDE FXD CRV PLAWY            365            02             CENTRAL SUPPLY
0216887   S INTRO GDE FXD CRV PLAWY            365            02             CENTRAL SUPPLY
0216879   S INTRO GDE FXD CRV PLAWY            350            02             CENTRAL SUPPLY
0216861   S INTRO GDE FXD CRV PLAWY            365            02             CENTRAL SUPPLY
0216853   S INTRO GDE FXD CRV PLAWY            350            02             CENTRAL SUPPLY
0216846   S INTRO GDE FXD CRV PLAWY            364            02             CENTRAL SUPPLY
0220079   S LD PCR 7F/110CM NOTV VD            664            02             CENTRAL SUPPLY
0220087   S LD PCR NOTV VDD SNGL PS           2627            02             CENTRAL SUPPLY
0220129   S LD PCR TV VDD SNGL PASS           4724            02             CENTRAL SUPPLY
0220103   S LD PCR TV VDD SNGL PASS           2456            02             CENTRAL SUPPLY
0220061   S LD PCR TV VDD SNGL PASS            363            02             CENTRAL SUPPLY
0220095   S LD PCR/ICD COMBO                 15402            02             CENTRAL SUPPLY
0200006   S NSTRL                               33            02             CENTRAL SUPPLY
0201681   S NSTRL AEROCHAMBER                   38            02             CENTRAL SUPPLY
0200139   S NSTRL ANTECUBITAL                  102            02             CENTRAL SUPPLY
0201996   S NSTRL BAG DIAL DRN 3.5L             63            02             CENTRAL SUPPLY
0200105   S NSTRL BAG DRAIN PST TUR             59            02             CENTRAL SUPPLY
0201715   S NSTRL BAG RESUS ADLT                98            02             CENTRAL SUPPLY
0200113   S NSTRL BAG, DRAIN URINE              23            02             CENTRAL SUPPLY
0200063   S NSTRL BAG, URINE LEG LG             14            02             CENTRAL SUPPLY
0200097   S NSTRL BAG,BILE                      42            02             CENTRAL SUPPLY
0200055   S NSTRL BAG,URINE LEG MD              14            02             CENTRAL SUPPLY
0200576   S NSTRL BAGS CPR INF MERC            127            02             CENTRAL SUPPLY
0200568   S NSTRL BAGS, CPR CHILD M            117            02             CENTRAL SUPPLY
0202085   S NSTRL BARRIER, SKIN                 27            02             CENTRAL SUPPLY
0202077   S NSTRL BARRIER, SKIN 8X8             76            02             CENTRAL SUPPLY
0201822   S NSTRL BG,DRNG AERO TRCH              9            02             CENTRAL SUPPLY
0200295   S NSTRL BREST PMP KT 1368             93            02             CENTRAL SUPPLY
0201673   S NSTRL CAN 0XYGEN NASAL               5            02             CENTRAL SUPPLY
0201830   S NSTRL CAN OXYGN NASL20'             15            02             CENTRAL SUPPLY
0200824   S NSTRL CAST SHOE LG                  45            02             CENTRAL SUPPLY
0200816   S NSTRL CAST SHOE MD                  45            02             CENTRAL SUPPLY
0200808   S NSTRL CAST SHOE SM                  45            02             CENTRAL SUPPLY
0201848   S NSTRL CATH NEONATL PRSS            104            02             CENTRAL SUPPLY
0202234   S NSTRL CATH SCBR5-38-40             258            02             CENTRAL SUPPLY
0202101   S NSTRL CLAMP, POUCH                  13            02             CENTRAL SUPPLY
0201145   S NSTRL CLAVICL SPLINT MD             25            02             CENTRAL SUPPLY




                                                  Page 11
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0201533   S NSTRL COLLES FOREARM LG            26            02             CENTRAL SUPPLY
0201319   S NSTRL COLOPLAST BAG EAC             9            02             CENTRAL SUPPLY
0202259   S NSTRL CUP, VACM ASST OB           172            02             CENTRAL SUPPLY
0200303   S NSTRL CUSHION, VNYL RNG            32            02             CENTRAL SUPPLY
0200014   S NSTRL DEFIB PAD 2346 LG            38            02             CENTRAL SUPPLY
0201475   S NSTRL DERMABOND SKIN AD           159            02             CENTRAL SUPPLY
0201442   S NSTRL ELCT NDM BCK-P889           646            02             CENTRAL SUPPLY
0200584   S NSTRL ELCT,STM PAD12330           243            02             CENTRAL SUPPLY
0200600   S NSTRL ELECT DEFIB 12366           178            02             CENTRAL SUPPLY
0202051   S NSTRL ELECT MULTI                 225            02             CENTRAL SUPPLY
0200725   S NSTRL FEMOSTOP-15263              516            02             CENTRAL SUPPLY
0202465   S NSTRL GI LVN 12F TUBE              12            02             CENTRAL SUPPLY
0202473   S NSTRL GI LVN 16F TUBE               5            02             CENTRAL SUPPLY
0202481   S NSTRL GI LVN 18F K-11               5            02             CENTRAL SUPPLY
0202499   S NSTRL GI SLM SUMP 14X48            12            02             CENTRAL SUPPLY
0202507   S NSTRL GI SLM SUMP 16X48            12            02             CENTRAL SUPPLY
0202515   S NSTRL GI SLM SUMP 18X48            12            02             CENTRAL SUPPLY
0200634   S NSTRL H PUNCH HP-94               106            02             CENTRAL SUPPLY
0200535   S NSTRL HALO, CROWN LG             2771            02             CENTRAL SUPPLY
0201335   S NSTRL HLTR BELT LG 710             43            02             CENTRAL SUPPLY
0201327   S NSTRL HLTR BELT MED 709            43            02             CENTRAL SUPPLY
0200881   S NSTRL IMMOB, KNEE 24               85            02             CENTRAL SUPPLY
0201640   S NSTRL IMMOB, KNEE UNV              94            02             CENTRAL SUPPLY
0201624   S NSTRL IMMOB, SHLD VEL              18            02             CENTRAL SUPPLY
0201947   S NSTRL IMMOB,SHLDR UNIVE            85            02             CENTRAL SUPPLY
0201632   S NSTRL IMMOB,SHLDR VELME            18            02             CENTRAL SUPPLY
0200857   S NSTRL KNEE IMMMOB 12              127            02             CENTRAL SUPPLY
0200865   S NSTRL KNEE IMMOB 16                84            02             CENTRAL SUPPLY
0200873   S NSTRL KNEE IMMOB 20                70            02             CENTRAL SUPPLY
0201798   S NSTRL MASK O2 ADLT L               16            02             CENTRAL SUPPLY
0201749   S NSTRL MASK PARTCLT RES             59            02             CENTRAL SUPPLY
0201772   S NSTRL MASK PEDI AEROCHA           113            02             CENTRAL SUPPLY
0201814   S NSTRL MASK, BILIRUBIN T            26            02             CENTRAL SUPPLY
0201699   S NSTRL MASK, O2 ADLT                13            02             CENTRAL SUPPLY
0201665   S NSTRL METER FLOW ADULT             77            02             CENTRAL SUPPLY
0201855   S NSTRL MSK O2MD CONCENTR             5            02             CENTRAL SUPPLY
0201988   S NSTRL MSK O2W/CUSH ADLT            26            02             CENTRAL SUPPLY
0263731   S NSTRL NASAL TAMPON                156            02             CENTRAL SUPPLY
0201889   S NSTRL NEBLZR HI FLW 60             41            02             CENTRAL SUPPLY
0201707   S NSTRL NEBULIZER                     6            02             CENTRAL SUPPLY
0201392   S NSTRL OSTMY CLCTR SM              117            02             CENTRAL SUPPLY
0201350   S NSTRL OSTMY DRAIN CLTR            130            02             CENTRAL SUPPLY
0201343   S NSTRL OSTMY PREMM POUCH            16            02             CENTRAL SUPPLY
0201384   S NSTRL OSTMY TRANS POUCH           195            02             CENTRAL SUPPLY
0201368   S NSTRL OSTY BAG CLAMP               11            02             CENTRAL SUPPLY
0201376   S NSTRL OSTY, LOOP BRDG              18            02             CENTRAL SUPPLY
0263665   S NSTRL OXISENSOR INFANT            111            02             CENTRAL SUPPLY
0200089   S NSTRL OXISENSR NEONAT             151            02             CENTRAL SUPPLY
0200071   S NSTRL OXISENSR, INFNT             135            02             CENTRAL SUPPLY
0202309   S NSTRL OXYGEN SENSOR               129            02             CENTRAL SUPPLY
0202432   S NSTRL PAD ELEC PED MLTI           408            02             CENTRAL SUPPLY
0200311   S NSTRL PAD HOT INST MAT            166            02             CENTRAL SUPPLY
0200261   S NSTRL PAD HYPOTHM 14*20            45            02             CENTRAL SUPPLY
0200279   S NSTRL PAD HYPOTHM 18*24            55            02             CENTRAL SUPPLY
0200246   S NSTRL PAD HYPOTHM 24*60           129            02             CENTRAL SUPPLY




                                                 Page 12
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0200253   S NSTRL PAD HYPOTHRM SM               67            02             CENTRAL SUPPLY
0201525   S NSTRL PAD K-THERM 12*17             44            02             CENTRAL SUPPLY
0202366   S NSTRL PADS MULTI ZOLL              225            02             CENTRAL SUPPLY
0202119   S NSTRL PASTE, KARAYA 2OZ             56            02             CENTRAL SUPPLY
0201426   S NSTRL PEEP VLVE 1222 DI             52            02             CENTRAL SUPPLY
0202531   S NSTRL PERCUSTAY                     92            02             CENTRAL SUPPLY
0201954   S NSTRL PLSTR RLL, UNV 2             295            02             CENTRAL SUPPLY
0200733   S NSTRL PLSTRROLL 3X3                 14            02             CENTRAL SUPPLY
0200741   S NSTRL PLSTRROLL 4X5 774             21            02             CENTRAL SUPPLY
0202135   S NSTRL POUCH OPEN 1-1/2              14            02             CENTRAL SUPPLY
0202143   S NSTRL POUCH OPEN 1-3/4              13            02             CENTRAL SUPPLY
0202168   S NSTRL POUCH OPEN 2-1/2              14            02             CENTRAL SUPPLY
0202127   S NSTRL POUCH OSTY 1                  41            02             CENTRAL SUPPLY
0202150   S NSTRL POUCH OSTY 2                  14            02             CENTRAL SUPPLY
0202184   S NSTRL POUCH OSTY 2 3/4              10            02             CENTRAL SUPPLY
0202093   S NSTRL POUCH OSTY 2 PC               13            02             CENTRAL SUPPLY
0202176   S NSTRL POUCH, OSTOMY 3"              14            02             CENTRAL SUPPLY
0200717   S NSTRL PROBE RECTAL                  41            02             CENTRAL SUPPLY
0201053   S NSTRL PST-OP SHOE WMN M             42            02             CENTRAL SUPPLY
0202317   S NSTRL PUMP SPIKE WO/CLR             12            02             CENTRAL SUPPLY
0202218   S NSTRL PVA PRTCL 200-300            689            02             CENTRAL SUPPLY
0202556   S NSTRL RECTAL TUBE 24F               92            02             CENTRAL SUPPLY
0202564   S NSTRL RECTAL TUBE 28F               92            02             CENTRAL SUPPLY
0202549   S NSTRL RECTAL TUBE 32FR              97            02             CENTRAL SUPPLY
0201863   S NSTRL RT, OXISENSR R-15            151            02             CENTRAL SUPPLY
0260182   S NSTRL S.T.I.C SET                  513            02             CENTRAL SUPPLY
0260026   S NSTRL S.T.I.C SET                  513            02             CENTRAL SUPPLY
0201970   S NSTRL SCOPE SIGMD SPEC              15            02             CENTRAL SUPPLY
0263608   S NSTRL SENSOR O2 ADULT               85            02             CENTRAL SUPPLY
0263657   S NSTRL SENSOR OXIMETER N            111            02             CENTRAL SUPPLY
0200659   S NSTRL SET CAPD TRANSFER            232            02             CENTRAL SUPPLY
0202200   S NSTRL SET GASTJEJUNOSTY           2366            02             CENTRAL SUPPLY
0200543   S NSTRL SET HALO TRCTN SM           2771            02             CENTRAL SUPPLY
0202457   S NSTRL SET PUMP W/EZ 1L              16            02             CENTRAL SUPPLY
0200709   S NSTRL SET,CATH H/S 7FR             181            02             CENTRAL SUPPLY
0201517   S NSTRL SHLD IMMOB SM                 28            02             CENTRAL SUPPLY
0201038   S NSTRL SHOE PST-OP M/ LG             42            02             CENTRAL SUPPLY
0201020   S NSTRL SHOE PST-OP M/ MD             42            02             CENTRAL SUPPLY
0201046   S NSTRL SHOE PST-OP W/SM              42            02             CENTRAL SUPPLY
0201061   S NSTRL SHOE PST-OP WM LG             59            02             CENTRAL SUPPLY
0200642   S NSTRL SLEEVE THIGH                 285            02             CENTRAL SUPPLY
0200204   S NSTRL SLEEVE THIGH                 337            02             CENTRAL SUPPLY
0200196   S NSTRL SLEEVE,. KNEE                211            02             CENTRAL SUPPLY
0201087   S NSTRL SLING ARM MUSLIN              42            02             CENTRAL SUPPLY
0201103   S NSTRL SLING ARM W/PAD M             14            02             CENTRAL SUPPLY
0201129   S NSTRL SLING STRAP XLG               19            02             CENTRAL SUPPLY
0201137   S NSTRL SLING SWATHE SHLD             44            02             CENTRAL SUPPLY
0201079   S NSTRL SLING TRIANG 312              14            02             CENTRAL SUPPLY
0202408   S NSTRL SPINCTEROTOME, H-            980            02             CENTRAL SUPPLY
0201210   S NSTRL SPLINT 1 FNGR                 11            02             CENTRAL SUPPLY
0201228   S NSTRL SPLINT 2 FNGR                 11            02             CENTRAL SUPPLY
0201236   S NSTRL SPLINT FNGR VELCR             39            02             CENTRAL SUPPLY
0201186   S NSTRL SPLINT FROG SM                11            02             CENTRAL SUPPLY
0201152   S NSTRL SPLINT PLSTLM AB1              5            02             CENTRAL SUPPLY
0201160   S NSTRL SPLINT PLSTLM AB2              5            02             CENTRAL SUPPLY




                                                  Page 13
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0201178   S NSTRL SPLINT PLSTLM AB7            10            02             CENTRAL SUPPLY
0201566   S NSTRL SPLINT WRIST LT              31            02             CENTRAL SUPPLY
0201616   S NSTRL SPLINT WRIST RT              31            02             CENTRAL SUPPLY
0201582   S NSTRL SPLINT WRIST RT              31            02             CENTRAL SUPPLY
0201244   S NSTRL SPLINT WRIST LT              41            02             CENTRAL SUPPLY
0201251   S NSTRL SPLINT WRIST RT              41            02             CENTRAL SUPPLY
0201574   S NSTRL SPLINT WRST LT LG            49            02             CENTRAL SUPPLY
0201541   S NSTRL SPLINT WRST LT SM            31            02             CENTRAL SUPPLY
0201558   S NSTRL SPLINT WRST RT SM            31            02             CENTRAL SUPPLY
0201277   S NSTRL SPLNT 4-ARM LT MD            26            02             CENTRAL SUPPLY
0260190   S NSTRL SPLNT FNGER PLAST             6            02             CENTRAL SUPPLY
0260067   S NSTRL SPLNT FNGER PLAST             6            02             CENTRAL SUPPLY
0201285   S NSTRL SPLNT FORARM L LG            26            02             CENTRAL SUPPLY
0201269   S NSTRL SPLNT FORARM L SM            26            02             CENTRAL SUPPLY
0201202   S NSTRL SPLNT MASN-ALLN S           163            02             CENTRAL SUPPLY
0201194   S NSTRL SPLT, FNGR FRG LG            11            02             CENTRAL SUPPLY
0200691   S NSTRL ST TRNSJGLR ROSCH          1383            02             CENTRAL SUPPLY
0200477   S NSTRL STKNG ELAS LG/LNG            53            02             CENTRAL SUPPLY
0200469   S NSTRL STKNG ELAS LG/REG            49            02             CENTRAL SUPPLY
0200444   S NSTRL STKNG ELAS MD/LNG            49            02             CENTRAL SUPPLY
0200337   S NSTRL STKNG ELAS MD/REG            28            02             CENTRAL SUPPLY
0200436   S NSTRL STKNG ELAS MD/RG             53            02             CENTRAL SUPPLY
0200428   S NSTRL STKNG ELAS MD/SHT            49            02             CENTRAL SUPPLY
0200519   S NSTRL STKNG ELAS SM/LNG            49            02             CENTRAL SUPPLY
0200501   S NSTRL STKNG ELAS SM/REG            49            02             CENTRAL SUPPLY
0200386   S NSTRL STKNG ELAS XL/REG            30            02             CENTRAL SUPPLY
0200329   S NSTRL STKNG, ELAS                  28            02             CENTRAL SUPPLY
0200410   S NSTRL STKNG, ELAS 3039             68            02             CENTRAL SUPPLY
0200493   S NSTRL STKNG, ELAS 3071             49            02             CENTRAL SUPPLY
0200485   S NSTRL STKNG, ELAS 3144             68            02             CENTRAL SUPPLY
0200402   S NSTRL STKNG, ELAS 3221             72            02             CENTRAL SUPPLY
0200451   S NSTRL STKNG, ELAS 3634             53            02             CENTRAL SUPPLY
0200352   S NSTRL STKNG, ELAS 7339             28            02             CENTRAL SUPPLY
0200360   S NSTRL STKNG, ELAS 7480             30            02             CENTRAL SUPPLY
0200378   S NSTRL STKNG, ELAS 7594             28            02             CENTRAL SUPPLY
0200394   S NSTRL STKNG, ELAS 7802             30            02             CENTRAL SUPPLY
0200345   S NSTRL STKNG, ELAS KNEE             30            02             CENTRAL SUPPLY
0201111   S NSTRL STRP SLNG, ARM LG            14            02             CENTRAL SUPPLY
0201095   S NSTRL STRP SLNG, ARM SM            19            02             CENTRAL SUPPLY
0202267   S NSTRL SUCTN DVICE,INFNT            76            02             CENTRAL SUPPLY
0200675   S NSTRL SYS EXTERNAL DRNG           872            02             CENTRAL SUPPLY
0201897   S NSTRL TAMPON, NASL MD              86            02             CENTRAL SUPPLY
0201731   S NSTRL THERMOVENT 1200              17            02             CENTRAL SUPPLY
0202572   S NSTRL TRACH CARE KIT 14           171            02             CENTRAL SUPPLY
0201491   S NSTRL TRACH CLEANING TR            23            02             CENTRAL SUPPLY
0202382   S NSTRL TRACH TALKER OLMP           171            02             CENTRAL SUPPLY
0200667   S NSTRL TRANSDCR HEMODIAL             5            02             CENTRAL SUPPLY
0201723   S NSTRL TRANSDUCER, OXYGE           104            02             CENTRAL SUPPLY
0202192   S NSTRL TRAY THORACNTISIS           411            02             CENTRAL SUPPLY
0201301   S NSTRL TRIPPI-WELLS TONG          3107            02             CENTRAL SUPPLY
0202341   S NSTRL TUBE, CHILLI KIT            365            02             CENTRAL SUPPLY
0202523   S NSTRL VALVE SALEM SUMP             45            02             CENTRAL SUPPLY
0200147   S NSTRLCFF,DINAMAP 5 2235            55            02             CENTRAL SUPPLY
0200212   S NSTRLDRNPNRSE1/4X18 982             5            02             CENTRAL SUPPLY
0201400   S NSTRLOSTMY WND EX AB280            21            02             CENTRAL SUPPLY




                                                 Page 14
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0201293   S NSTRLTRCTION BOOT, BCKS            99            02             CENTRAL SUPPLY
0262337   S ORTHO                              71            02             CENTRAL SUPPLY
0262386   S ORTHO                             403            02             CENTRAL SUPPLY
0261909   S ORTHO                              71            02             CENTRAL SUPPLY
0262329   S ORTHO BOOT WALKING SAMS            95            02             CENTRAL SUPPLY
0200840   S ORTHO BRACE AIR STIRRUP           162            02             CENTRAL SUPPLY
0225003   S ORTHO BRACE,BACK                                 02             CENTRAL SUPPLY
0225045   S ORTHO BRACE,EXTREMITY                            02             CENTRAL SUPPLY
0225037   S ORTHO BRACE,FRACTURE                             02             CENTRAL SUPPLY
0225011   S ORTHO BRACE,HALO                                 02             CENTRAL SUPPLY
0225029   S ORTHO BRACE,NECK                                 02             CENTRAL SUPPLY
0201004   S ORTHO HEAD HALTER 326             188            02             CENTRAL SUPPLY
0201012   S ORTHO SHOE PST-OP MNSML            42            02             CENTRAL SUPPLY
0201962   S ORTHO SHOE PST-OP WMNLG            60            02             CENTRAL SUPPLY
0262089   S OT ADD AK SOFT INTERFC            262            02             CENTRAL SUPPLY
0260620   S OT ADD BK SOFT INTERFC            494            02             CENTRAL SUPPLY
0260752   S OT ADD HALO MRI COMP             2663            02             CENTRAL SUPPLY
0260612   S OT ADD PLAS SHOE INSERT           584            02             CENTRAL SUPPLY
0260976   S OT ADD SPINAL ORTHO NOS           496            02             CENTRAL SUPPLY
0260810   S OT ADJ MOTION KNEE JNT            996            02             CENTRAL SUPPLY
0260794   S OT AF TIBIAL FRAC RIGID          2500            02             CENTRAL SUPPLY
0260588   S OT AFO PLASTIC PREFAB            1335            02             CENTRAL SUPPLY
0260596   S OT AFO PTR SLD ANK PLS           1952            02             CENTRAL SUPPLY
0263723   S OT ANK ORTHOSIS PREFAB            156            02             CENTRAL SUPPLY
0260786   S OT ANTERIOR THORACIC EX           993            02             CENTRAL SUPPLY
0260893   S OT CARBN GRAPHT LAMINAT           509            02             CENTRAL SUPPLY
0263574   S OT CERV COLLAR 2PC SRGD            77            02             CENTRAL SUPPLY
0260448   S OT CERV COLLAR 2PC SRGD           696            02             CENTRAL SUPPLY
0260216   S OT CERV COLLAR 2PC SRGD            54            02             CENTRAL SUPPLY
0260208   S OT CERV COLLAR 2PC SRGD            54            02             CENTRAL SUPPLY
0260133   S OT CERV COLLAR 2PC SRGD            54            02             CENTRAL SUPPLY
0260125   S OT CERV COLLAR 2PC SRGD            54            02             CENTRAL SUPPLY
0201608   S OT CERV COLLAR 2PC SRGD            87            02             CENTRAL SUPPLY
0201590   S OT CERV COLLAR 2PC SRGD            87            02             CENTRAL SUPPLY
0200956   S OT CERV COLLAR 2PC SRGD            87            02             CENTRAL SUPPLY
0200949   S OT CERV COLLAR 2PC SRGD            87            02             CENTRAL SUPPLY
0200931   S OT CERV COLLAR 2PC SRGD            87            02             CENTRAL SUPPLY
0200915   S OT CERV COLLAR 2PC SRGD            87            02             CENTRAL SUPPLY
0200832   S OT CERV COLLAR 2PC SRGD            87            02             CENTRAL SUPPLY
0260703   S OT CRV COL FOAM THOR EX          1206            02             CENTRAL SUPPLY
0260729   S OT CRV COL OM BAR THOR          25052            02             CENTRAL SUPPLY
0260711   S OT CRV MP COL OCC MAN            1564            02             CENTRAL SUPPLY
0260745   S OT CTLS APL CNTRL W INT          4913            02             CENTRAL SUPPLY
0260737   S OT DEWALL POSTUR PROTCT          4181            02             CENTRAL SUPPLY
0261008   S OT DVC REPAIR EA 15MN            1828            02             CENTRAL SUPPLY
0260919   S OT FEMORALSOCK FX/EQUAL           281            02             CENTRAL SUPPLY
0263285   S OT FM COLLAR CERV FLEX             23            02             CENTRAL SUPPLY
0201921   S OT FM COLLAR CERV FLEX             26            02             CENTRAL SUPPLY
0201913   S OT FM COLLAR CERV FLEX             26            02             CENTRAL SUPPLY
0200923   S OT FM COLLAR CERV FLEX             26            02             CENTRAL SUPPLY
0200907   S OT FM COLLAR CERV FLEX             29            02             CENTRAL SUPPLY
0200899   S OT FM COLLAR CERV FLEX             31            02             CENTRAL SUPPLY
0262097   S OT FO FINGER K/B                  128            02             CENTRAL SUPPLY
0260539   S OT HALO CERV BODY JKT            4783            02             CENTRAL SUPPLY
0260521   S OT HALO CERV JKT VEST            6819            02             CENTRAL SUPPLY




                                                 Page 15
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0260547   S OT HALO CERV MILWAUKEE           9102            02             CENTRAL SUPPLY
0260760   S OT HALO REPL LINER/INTR           926            02             CENTRAL SUPPLY
0260877   S OT HIP ADJ FLX EX ABDCT          1466            02             CENTRAL SUPPLY
0260869   S OT HIP JNT ADJ FLEXION           1353            02             CENTRAL SUPPLY
0260554   S OT HO POST OP JNTS PF            2670            02             CENTRAL SUPPLY
0262402   S OT KAFO FEM FX CST SEMI          2699            02             CENTRAL SUPPLY
0262394   S OT KAFO FEM FX CST THER          3145            02             CENTRAL SUPPLY
0260604   S OT KAFO FX FEMORAL CUS           4747            02             CENTRAL SUPPLY
0260570   S OT KO ADJ KNEE JT RGD            1913            02             CENTRAL SUPPLY
0260562   S OT KO IMMOB CNVS LONG             437            02             CENTRAL SUPPLY
0260836   S OT LO EX PLASTIC PADDED           876            02             CENTRAL SUPPLY
0260679   S OT LS POST RIGID PANEL            683            02             CENTRAL SUPPLY
0260695   S OT LS S/C SHELL/PANEL            2802            02             CENTRAL SUPPLY
0260687   S OT LS SAGIT RIGID PANEL          2802            02             CENTRAL SUPPLY
0262436   S OT LSO SAG RIG PNL CUS           3954            02             CENTRAL SUPPLY
0260802   S OT LTD MOTION KNEE JNT            929            02             CENTRAL SUPPLY
0250019   S OT PLS CLR CERV SMI-RGD           140            02             CENTRAL SUPPLY
0200980   S OT PLS CLR CERV SMI-RGD           140            02             CENTRAL SUPPLY
0200972   S OT PLS CLR CERV SMI-RGD           140            02             CENTRAL SUPPLY
0260828   S OT PLV BND/BLT THI FLNG          1572            02             CENTRAL SUPPLY
0260885   S OT PLV CNT BAND/BELT UN          1092            02             CENTRAL SUPPLY
0260646   S OT PNEU WALKING SPLINT           1064            02             CENTRAL SUPPLY
0260778   S OT PROTECT BODY SOCK EA           551            02             CENTRAL SUPPLY
0262428   S OT QUADRILATERAL BRIM             627            02             CENTRAL SUPPLY
0260661   S OT SI FLX PELVSAC PRFAB           138            02             CENTRAL SUPPLY
0260984   S OT SPINAL ORTHOSIS NOS            272            02             CENTRAL SUPPLY
0260653   S OT STATIC AFO PF                  643            02             CENTRAL SUPPLY
0260851   S OT THI W/B NAR M-L BRM           2231            02             CENTRAL SUPPLY
0260844   S OT THI W/B QUAD LAT BRM          2231            02             CENTRAL SUPPLY
0260901   S OT TIBIAL SOCK FX/EQUAL           326            02             CENTRAL SUPPLY
0260935   S OT TLS RIGID PLASTIC             3626            02             CENTRAL SUPPLY
0260497   S OT TLSO 1 PC W LINER             4050            02             CENTRAL SUPPLY
0260505   S OT TLSO 2 PC RGD SACROC          4699            02             CENTRAL SUPPLY
0260513   S OT TLSO 2 PC W LINER             5005            02             CENTRAL SUPPLY
0262568   S OT TLSO 4 MDLR SCAPULAR          1353            02             CENTRAL SUPPLY
0260471   S OT TLSO HYPEREXT RGD PF          1831            02             CENTRAL SUPPLY
0260463   S OT TLSO RGD SCAPULAR PF          2239            02             CENTRAL SUPPLY
0260455   S OT TLSO SYMP STRN NTCH           2553            02             CENTRAL SUPPLY
0262410   S OT VARUS/VALGAS STRAP             150            02             CENTRAL SUPPLY
0260638   S OT WHO COCK-UP NON MOLD           582            02             CENTRAL SUPPLY
0220012   S PCR 1 CHMBR RATE RESP           13227            02             CENTRAL SUPPLY
0220004   S PCR 1 CHMBR RATE RESP           12345            02             CENTRAL SUPPLY
0220020   S PCR 2 CHMBR RATE RESP           15469            02             CENTRAL SUPPLY
0220053   S PCR OTHER THN SNGL/DUAL         24565            02             CENTRAL SUPPLY
0214916   S PORT INDWELLING                  2925            02             CENTRAL SUPPLY
0260927   S PR SHRINKER ABOVE KNEE            706            02             CENTRAL SUPPLY
0263137   S SRG DRS ADAPTIC                    12            02             CENTRAL SUPPLY
0262808   S SRG DRS ADAPTIC                     5            02             CENTRAL SUPPLY
0262923   S SRG DRS VASELINE                    5            02             CENTRAL SUPPLY
0263004   S SRG DRS XEROFORM                    7            02             CENTRAL SUPPLY
0262857   S SRG DRS XEROFORM                    5            02             CENTRAL SUPPLY
0262824   S SRG DRS XEROFORM                    5            02             CENTRAL SUPPLY
0222877   S STNT COATED WDEL SYS             5269            02             CENTRAL SUPPLY
0221036   S STNT COATED WDEL SYS             5269            02             CENTRAL SUPPLY
0250324   S STNT NOCOAT WDEL SYS             5088            02             CENTRAL SUPPLY




                                                 Page 16
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0222851   S STNT NOCOAT WDEL SYS             3859            02             CENTRAL SUPPLY
0222844   S STNT NOCOAT WDEL SYS             3859            02             CENTRAL SUPPLY
0222836   S STNT NOCOAT WDEL SYS             4393            02             CENTRAL SUPPLY
0222828   S STNT NOCOAT WDEL SYS             3859            02             CENTRAL SUPPLY
0222810   S STNT NOCOAT WDEL SYS             3859            02             CENTRAL SUPPLY
0222802   S STNT NOCOAT WDEL SYS             3859            02             CENTRAL SUPPLY
0222794   S STNT NOCOAT WDEL SYS             3859            02             CENTRAL SUPPLY
0222786   S STNT NOCOAT WDEL SYS             4237            02             CENTRAL SUPPLY
0222778   S STNT NOCOAT WDEL SYS             3859            02             CENTRAL SUPPLY
0222760   S STNT NOCOAT WDEL SYS             3859            02             CENTRAL SUPPLY
0222752   S STNT NOCOAT WDEL SYS             3859            02             CENTRAL SUPPLY
0222745   S STNT NOCOAT WDEL SYS             3859            02             CENTRAL SUPPLY
0222737   S STNT NOCOAT WDEL SYS             3859            02             CENTRAL SUPPLY
0222729   S STNT NOCOAT WDEL SYS             3859            02             CENTRAL SUPPLY
0222711   S STNT NOCOAT WDEL SYS             3859            02             CENTRAL SUPPLY
0222703   S STNT NOCOAT WDEL SYS             3859            02             CENTRAL SUPPLY
0221044   S STNT NOCOAT WDEL SYS             3808            02             CENTRAL SUPPLY
0221028   S STNT NOCOAT WDEL SYS             5089            02             CENTRAL SUPPLY
0221010   S STNT NOCOAT WDEL SYS             3966            02             CENTRAL SUPPLY
0221002   S STNT NOCOAT WDEL SYS             3966            02             CENTRAL SUPPLY
0220988   S STNT NOCOAT WDEL SYS             3698            02             CENTRAL SUPPLY
0220970   S STNT NOCOAT WDEL SYS             3813            02             CENTRAL SUPPLY
0220962   S STNT NOCOAT WDEL SYS             3966            02             CENTRAL SUPPLY
0220418   S STNT NOCOAT WDEL SYS             3698            02             CENTRAL SUPPLY
0220400   S STNT NOCOAT WDEL SYS             3698            02             CENTRAL SUPPLY
0220491   S STNT NOCOR WDEL SYS TMP          1115            02             CENTRAL SUPPLY
0220483   S STNT NOCOR WDEL SYS TMP          1047            02             CENTRAL SUPPLY
0220475   S STNT NOCOR WDEL SYS TMP          1047            02             CENTRAL SUPPLY
0220459   S STNT NOCOR WDEL SYS TMP           697            02             CENTRAL SUPPLY
0220335   S STNT NOCOR WDEL SYS TMP           563            02             CENTRAL SUPPLY
0220327   S STNT NOCOR WDEL SYS TMP           563            02             CENTRAL SUPPLY
0220319   S STNT NOCOR WDEL SYS TMP           563            02             CENTRAL SUPPLY
0220301   S STNT NOCOR WDEL SYS TMP           563            02             CENTRAL SUPPLY
0220285   S STNT NOCOR WDEL SYS TMP           632            02             CENTRAL SUPPLY
0220244   S STNT NOCOR WDEL SYS TMP           563            02             CENTRAL SUPPLY
0261958   S STRL                              127            02             CENTRAL SUPPLY
0261941   S STRL                              128            02             CENTRAL SUPPLY
0261933   S STRL                               26            02             CENTRAL SUPPLY
0261925   S STRL                              108            02             CENTRAL SUPPLY
0261917   S STRL                             1232            02             CENTRAL SUPPLY
0225987   S STRL                              143            02             CENTRAL SUPPLY
0225979   S STRL                               94            02             CENTRAL SUPPLY
0224113   S STRL 3PRT MANIFOLDS1175           146            02             CENTRAL SUPPLY
0205757   S STRL 6F PIG CATH 2557             114            02             CENTRAL SUPPLY
0263210   S STRL 6V VAG SPECULM LAM            18            02             CENTRAL SUPPLY
0223974   S STRL ADAPTR INSTTUTNAL              5            02             CENTRAL SUPPLY
0262238   S STRL ADPTR UROSTOMY DRN             8            02             CENTRAL SUPPLY
0263541   S STRL ADULT AND PEDI L-P            68            02             CENTRAL SUPPLY
0202994   S STRL ADVANCR, ROTABLATR          1216            02             CENTRAL SUPPLY
0201483   S STRL AMNIOCNTSIS TRY 50            83            02             CENTRAL SUPPLY
0209718   S STRL AMPLATZ RT II 7FR             77            02             CENTRAL SUPPLY
0209403   S STRL AMPLATZ SUPR 7F L1           557            02             CENTRAL SUPPLY
0202663   S STRL ANGIO-SAC BAG NAMC            44            02             CENTRAL SUPPLY
0213116   S STRL ARTHROGRAM TRAY               89            02             CENTRAL SUPPLY
0262154   S STRL BAG COL FECAL MGMT            15            02             CENTRAL SUPPLY




                                                 Page 17
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0263269   S STRL BAG URINARY DRNG               21            02             CENTRAL SUPPLY
0263335   S STRL BAG URINE LEG MED              26            02             CENTRAL SUPPLY
0202952   S STRL BAG, DRNG URINEMTR             64            02             CENTRAL SUPPLY
0214247   S STRL BAG, RESUS DSP PED            133            02             CENTRAL SUPPLY
0202945   S STRL BAG, URINE DRNG                26            02             CENTRAL SUPPLY
0223842   S STRL BALLOON,OPTIXT 6/4           1308            02             CENTRAL SUPPLY
0223859   S STRL BALLOON,OPTIXT 7/4           1308            02             CENTRAL SUPPLY
0217943   S STRL BALN,ULTRA THIN SD           1690            02             CENTRAL SUPPLY
0262543   S STRL BASIC BIOPSY TRAY             256            02             CENTRAL SUPPLY
0221184   S STRL BCKSTP FNL ASSMBLY             67            02             CENTRAL SUPPLY
0262105   S STRL BELT OSTY MED                  10            02             CENTRAL SUPPLY
0212829   S STRL BIOPSY NDL 17G BRA            278            02             CENTRAL SUPPLY
0205997   S STRL BIOPSY SYS 18G*10             356            02             CENTRAL SUPPLY
0205989   S STRL BIOPSY SYS 18G*21             356            02             CENTRAL SUPPLY
0214858   S STRL BIOPSY SYS ASAP               446            02             CENTRAL SUPPLY
0224303   S STRL BLAKEMORE TUBE 20F           1405            02             CENTRAL SUPPLY
0213710   S STRL BLD ELECT EXTENSIO             35            02             CENTRAL SUPPLY
0224162   S STRL BLD FLTR GESCO 999             27            02             CENTRAL SUPPLY
0202390   S STRL BLD SPK GESCO TUBE             14            02             CENTRAL SUPPLY
0212175   S STRL BLN TIS DSCT NOVSC           1764            02             CENTRAL SUPPLY
0210724   S STRL BLN TIS DSCT NOVSC            633            02             CENTRAL SUPPLY
0210674   S STRL BLN TIS DSCT NOVSC           1764            02             CENTRAL SUPPLY
0209577   S STRL BLN TIS DSCT NOVSC           2027            02             CENTRAL SUPPLY
0207209   S STRL BLN TIS DSCT NOVSC           1300            02             CENTRAL SUPPLY
0206920   S STRL BLN TIS DSCT NOVSC           1300            02             CENTRAL SUPPLY
0206912   S STRL BLN TIS DSCT NOVSC           1672            02             CENTRAL SUPPLY
0206581   S STRL BLN TIS DSCT NOVSC           1183            02             CENTRAL SUPPLY
0205898   S STRL BLN TIS DSCT NOVSC           1040            02             CENTRAL SUPPLY
0204081   S STRL BLN TIS DSCT NOVSC           1385            02             CENTRAL SUPPLY
0203463   S STRL BLN TIS DSCT NOVSC           1183            02             CENTRAL SUPPLY
0203083   S STRL BLN TIS DSCT NOVSC            143            02             CENTRAL SUPPLY
0203067   S STRL BLN TIS DSCT NOVSC           1304            02             CENTRAL SUPPLY
0224154   S STRL BLOOD COLLECTN SET             13            02             CENTRAL SUPPLY
0214452   S STRL BNDG ESMARK 6*9 FT             57            02             CENTRAL SUPPLY
0213132   S STRL BONE BIOPSY JMS TR            246            02             CENTRAL SUPPLY
0262311   S STRL BOOT ANKLE CONTRAC            127            02             CENTRAL SUPPLY
0209312   S STRL BPS6.5-38-65-MNSC3             98            02             CENTRAL SUPPLY
0208462   S STRL BPS6.5-38-80MNSRIM             94            02             CENTRAL SUPPLY
0209288   S STRL BPS7.3-38-65-MNSC1             98            02             CENTRAL SUPPLY
0208454   S STRL BPS7.3-38-65MNSRIM             94            02             CENTRAL SUPPLY
0209338   S STRL BPS7.3-38-80-MNSC2             98            02             CENTRAL SUPPLY
0208470   S STRL BPS7.3-38-80MNSRC2             94            02             CENTRAL SUPPLY
0200774   S STRL BPSY HWKINS 20G5CM            144            02             CENTRAL SUPPLY
0200766   S STRL BPSY HWKN 20G7.5CM            137            02             CENTRAL SUPPLY
0200782   S STRL BPSY JMSHD BONE MR            160            02             CENTRAL SUPPLY
0262501   S STRL BREAST LESION LOC              38            02             CENTRAL SUPPLY
0262493   S STRL BREAST MARKER                 231            02             CENTRAL SUPPLY
0202275   S STRL BREAST PUMP KIT               203            02             CENTRAL SUPPLY
0202010   S STRL BUTTN TRACH 10*40             679            02             CENTRAL SUPPLY
0202028   S STRL BUTTN TRACH 11*27             679            02             CENTRAL SUPPLY
0202036   S STRL BUTTN TRACH 12*27             686            02             CENTRAL SUPPLY
0202044   S STRL BUTTN TRACH 12*40             679            02             CENTRAL SUPPLY
0223727   S STRL CABLE 6FT W/ALLIGT            171            02             CENTRAL SUPPLY
0209551   S STRL CABLE,4 PIN 120CM             432            02             CENTRAL SUPPLY
0217265   S STRL CAN STIFFING 3CM               76            02             CENTRAL SUPPLY




                                                  Page 18
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0217273   S STRL CAN STIFFING 5CM               76            02             CENTRAL SUPPLY
0217281   S STRL CAN STIFFING 7CM               76            02             CENTRAL SUPPLY
0262790   S STRL CANNULA NASAL                   5            02             CENTRAL SUPPLY
0260224   S STRL CANNULA,TRACH#4 DI             33            02             CENTRAL SUPPLY
0260158   S STRL CANNULA,TRACH#4DSP             33            02             CENTRAL SUPPLY
0201871   S STRL CANULA CNTRLR TRCH             57            02             CENTRAL SUPPLY
0224022   S STRL CAPD ADPT TIIUN              1081            02             CENTRAL SUPPLY
0214874   S STRL CAPILLARY DIALYZER            163            02             CENTRAL SUPPLY
0262550   S STRL CASSI ROTATIONAL              639            02             CENTRAL SUPPLY
0215699   S STRL CAT BRACH SEED ADM           8918            02             CENTRAL SUPPLY
0215681   S STRL CAT BRACH SEED ADM           8918            02             CENTRAL SUPPLY
0210963   S STRL CATH 10.2-38-20-P-            345            02             CENTRAL SUPPLY
0207407   S STRL CATH 18-1.55HILA              271            02             CENTRAL SUPPLY
0211755   S STRL CATH 2 X30 PRIMS             2158            02             CENTRAL SUPPLY
0211763   S STRL CATH 2.25/20 FORCE           2110            02             CENTRAL SUPPLY
0206102   S STRL CATH 2.5 RX PERF             1258            02             CENTRAL SUPPLY
0206136   S STRL CATH 2.5F RX ALPHA           1258            02             CENTRAL SUPPLY
0206169   S STRL CATH 2.5HARTZ ACXI           1213            02             CENTRAL SUPPLY
0207134   S STRL CATH 21GA X 15                 99            02             CENTRAL SUPPLY
0208421   S STRL CATH 2WY 30CC 22F              35            02             CENTRAL SUPPLY
0211508   S STRL CATH 3 TEN                   2189            02             CENTRAL SUPPLY
0213942   S STRL CATH 3 WAY 18F 30              91            02             CENTRAL SUPPLY
0209254   S STRL CATH 3*4 (3.8) 80            2243            02             CENTRAL SUPPLY
0206144   S STRL CATH 3.5F RX ALPHA           1258            02             CENTRAL SUPPLY
0203794   S STRL CATH 30CC 22F 210             123            02             CENTRAL SUPPLY
0208405   S STRL CATH 30CC 26 F LX              35            02             CENTRAL SUPPLY
0206110   S STRL CATH 3F PERF 3393            1268            02             CENTRAL SUPPLY
0203760   S STRL CATH 3WY 30CC 22F              85            02             CENTRAL SUPPLY
0203778   S STRL CATH 3WY 30CC 24F              85            02             CENTRAL SUPPLY
0209262   S STRL CATH 4*4 (3.8) 80            1885            02             CENTRAL SUPPLY
0206193   S STRL CATH 4F HARTZ 3403           1213            02             CENTRAL SUPPLY
0209379   S STRL CATH 4X4 75CM                1064            02             CENTRAL SUPPLY
0207241   S STRL CATH 5*4*120CM               1135            02             CENTRAL SUPPLY
0215590   S STRL CATH 5/35/65/P/2S             119            02             CENTRAL SUPPLY
0215863   S STRL CATH 5/35/65/P/NS             157            02             CENTRAL SUPPLY
0215871   S STRL CATH 5/38/65/P/2S             151            02             CENTRAL SUPPLY
0207902   S STRL CATH 563880PNSVAD3            118            02             CENTRAL SUPPLY
0214841   S STRL CATH 5F IMA 100CM              81            02             CENTRAL SUPPLY
0217976   S STRL CATH 5F JL 3.5                 90            02             CENTRAL SUPPLY
0217984   S STRL CATH 5F JL 4                   90            02             CENTRAL SUPPLY
0218354   S STRL CATH 6F 115CM W/2              90            02             CENTRAL SUPPLY
0206029   S STRL CATH 6F 23CM 2760             218            02             CENTRAL SUPPLY
0218115   S STRL CATH 6F AL2                    90            02             CENTRAL SUPPLY
0218099   S STRL CATH 6F AR1                    92            02             CENTRAL SUPPLY
0218107   S STRL CATH 6F AR2                    90            02             CENTRAL SUPPLY
0218081   S STRL CATH 6F FL3.5                  90            02             CENTRAL SUPPLY
0218040   S STRL CATH 6F FR5                    92            02             CENTRAL SUPPLY
0224352   S STRL CATH 6F JL4.OI 100             81            02             CENTRAL SUPPLY
0218065   S STRL CATH 6F LCB                    90            02             CENTRAL SUPPLY
0218057   S STRL CATH 6F RCB                    90            02             CENTRAL SUPPLY
0205682   S STRL CATH 7FR23CM 2761             194            02             CENTRAL SUPPLY
0206011   S STRL CATH 8FR24CM 2762             194            02             CENTRAL SUPPLY
0206086   S STRL CATH ACE 1.5F 3389           1581            02             CENTRAL SUPPLY
0206060   S STRL CATH ACE 2.5F 3387           1837            02             CENTRAL SUPPLY
0206052   S STRL CATH ACE 20F 3001            1231            02             CENTRAL SUPPLY




                                                  Page 19
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0206078   S STRL CATH ACE 3F 3388             2127            02             CENTRAL SUPPLY
0205518   S STRL CATH ADVANCE 3               1513            02             CENTRAL SUPPLY
0205765   S STRL CATH ALI 6F 2560              119            02             CENTRAL SUPPLY
0212092   S STRL CATH AMPLTZ LT I 7             77            02             CENTRAL SUPPLY
0208538   S STRL CATH ANCHOR 10F               478            02             CENTRAL SUPPLY
0208546   S STRL CATH ANCHOR 12F               521            02             CENTRAL SUPPLY
0203364   S STRL CATH ANCHOR 14F               327            02             CENTRAL SUPPLY
0208520   S STRL CATH ANCHOR 8F                327            02             CENTRAL SUPPLY
0214742   S STRL CATH ANGIO ROYAL F            858            02             CENTRAL SUPPLY
0211409   S STRL CATH ANGIOPLS PEM             937            02             CENTRAL SUPPLY
0212035   S STRL CATH ANGLD PIGTAIL             77            02             CENTRAL SUPPLY
0205781   S STRL CATH AR 6F 2563               119            02             CENTRAL SUPPLY
0203125   S STRL CATH ART FEM                  268            02             CENTRAL SUPPLY
0203109   S STRL CATH ART PMSY 400             283            02             CENTRAL SUPPLY
0203117   S STRL CATH ART PMSY 500             148            02             CENTRAL SUPPLY
0203141   S STRL CATH ART PRESS 3FR             91            02             CENTRAL SUPPLY
0207787   S STRL CATH AXM5-35-80-84            760            02             CENTRAL SUPPLY
0211524   S STRL CATH BALLN INTRO 6            324            02             CENTRAL SUPPLY
0210096   S STRL CATH BERNSTEIN 5FR            141            02             CENTRAL SUPPLY
0210047   S STRL CATH BERNSTEIN 7FR            199            02             CENTRAL SUPPLY
0205484   S STRL CATH BPS 6.5 38 12            137            02             CENTRAL SUPPLY
0207324   S STRL CATH BPS-6.5MNS               108            02             CENTRAL SUPPLY
0208082   S STRL CATH BPS653865MNSR             98            02             CENTRAL SUPPLY
0207712   S STRL CATH BPS653880MNSR             94            02             CENTRAL SUPPLY
0207571   S STRL CATH BPS7338100MNS             98            02             CENTRAL SUPPLY
0208074   S STRL CATH BPS733865MNSR             98            02             CENTRAL SUPPLY
0204990   S STRL CATH BRACH COR A-I            102            02             CENTRAL SUPPLY
0205021   S STRL CATH BRACH COR B-I            125            02             CENTRAL SUPPLY
0203240   S STRL CATH BRACH NIH 100            108            02             CENTRAL SUPPLY
0203257   S STRL CATH BRACH NIH 80C            102            02             CENTRAL SUPPLY
0205005   S STRL CATH BRACHL 7F                125            02             CENTRAL SUPPLY
0204537   S STRL CATH BRACHL COR 2              99            02             CENTRAL SUPPLY
0203232   S STRL CATH CAVH 7F 3515             235            02             CENTRAL SUPPLY
0217307   S STRL CATH CHONG 2 HNBR5            157            02             CENTRAL SUPPLY
0207811   S STRL CATH COAXIAL 8FR*1            333            02             CENTRAL SUPPLY
0209015   S STRL CATH COBRA 9098               110            02             CENTRAL SUPPLY
0202770   S STRL CATH COONS AMP DIL            913            02             CENTRAL SUPPLY
0205575   S STRL CATH COPE INTRO SE            564            02             CENTRAL SUPPLY
0213595   S STRL CATH COUDE 12F 5               89            02             CENTRAL SUPPLY
0203554   S STRL CATH COUDE 2WY 16F             99            02             CENTRAL SUPPLY
0203562   S STRL CATH COUDE 2WY 18F             99            02             CENTRAL SUPPLY
0203570   S STRL CATH COUDE 2WY 20F             99            02             CENTRAL SUPPLY
0214502   S STRL CATH COUDE 5CC 22F             89            02             CENTRAL SUPPLY
0203596   S STRL CATH COUNCIL 2WY 1            121            02             CENTRAL SUPPLY
0203588   S STRL CATH COUNCIL 2WY 1            121            02             CENTRAL SUPPLY
0203604   S STRL CATH COUNCIL 2WY 2            121            02             CENTRAL SUPPLY
0210807   S STRL CATH CRNRY 3.7*25            1351            02             CENTRAL SUPPLY
0208231   S STRL CATH CURRY INTRAVA            557            02             CENTRAL SUPPLY
0208223   S STRL CATH CURRY INTRAVA            531            02             CENTRAL SUPPLY
0208132   S STRL CATH CUSS10.230AMP            486            02             CENTRAL SUPPLY
0207779   S STRL CATH CX9384OP32SBC            283            02             CENTRAL SUPPLY
0209031   S STRL CATH DBL CUFF CURL            531            02             CENTRAL SUPPLY
0203539   S STRL CATH DC 7F LNG                937            02             CENTRAL SUPPLY
0219576   S STRL CATH DECA 65CM 6FR            811            02             CENTRAL SUPPLY
0210849   S STRL CATH DIL ACS 2.5             1250            02             CENTRAL SUPPLY




                                                  Page 20
                                      c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                   SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                         AMOUNT AMOUNT CODE

0206755   S STRL CATH DIL VSL 40352                 33            02             CENTRAL SUPPLY
0205559   S STRL CATH DIL VSL TEF 7                 36            02             CENTRAL SUPPLY
0210823   S STRL CATH DILTR VESL 11                 56            02             CENTRAL SUPPLY
0210831   S STRL CATH DILTR VESL 18                 50            02             CENTRAL SUPPLY
0250027   S STRL CATH DILTR VESL 6F                 44            02             CENTRAL SUPPLY
0209841   S STRL CATH DILTR VESL 6F                 36            02             CENTRAL SUPPLY
0203281   S STRL CATH DILTR VESL 6F                 36            02             CENTRAL SUPPLY
0207290   S STRL CATH DILTR VSL22                   50            02             CENTRAL SUPPLY
0205435   S STRL CATH DOUBLE 3523                  403            02             CENTRAL SUPPLY
0214791   S STRL CATH DRAIN PIGTAIL                632            02             CENTRAL SUPPLY
0250258   S STRL CATH DRAINAGE                      41            02             CENTRAL SUPPLY
0223669   S STRL CATH DRAINAGE                     119            02             CENTRAL SUPPLY
0216382   S STRL CATH DRAINAGE                     577            02             CENTRAL SUPPLY
0216374   S STRL CATH DRAINAGE                     826            02             CENTRAL SUPPLY
0216366   S STRL CATH DRAINAGE                     492            02             CENTRAL SUPPLY
0215194   S STRL CATH DRAINAGE                     171            02             CENTRAL SUPPLY
0214981   S STRL CATH DRAINAGE                    2432            02             CENTRAL SUPPLY
0214429   S STRL CATH DRAINAGE                      65            02             CENTRAL SUPPLY
0214163   S STRL CATH DRAINAGE                     130            02             CENTRAL SUPPLY
0213462   S STRL CATH DRAINAGE                      60            02             CENTRAL SUPPLY
0213447   S STRL CATH DRAINAGE                      41            02             CENTRAL SUPPLY
0212381   S STRL CATH DRAINAGE                     624            02             CENTRAL SUPPLY
0209411   S STRL CATH DRAINAGE                     518            02             CENTRAL SUPPLY
0209023   S STRL CATH DRAINAGE                     652            02             CENTRAL SUPPLY
0208835   S STRL CATH DRAINAGE                     491            02             CENTRAL SUPPLY
0208090   S STRL CATH DRAINAGE                     460            02             CENTRAL SUPPLY
0207845   S STRL CATH DRAINAGE                     394            02             CENTRAL SUPPLY
0207373   S STRL CATH DRAINAGE                     367            02             CENTRAL SUPPLY
0205963   S STRL CATH DRAINAGE                     278            02             CENTRAL SUPPLY
0205666   S STRL CATH DRAINAGE                     661            02             CENTRAL SUPPLY
0205617   S STRL CATH DRAINAGE                     432            02             CENTRAL SUPPLY
0205609   S STRL CATH DRAINAGE                     557            02             CENTRAL SUPPLY
0205591   S STRL CATH DRAINAGE                     557            02             CENTRAL SUPPLY
0205583   S STRL CATH DRAINAGE                     894            02             CENTRAL SUPPLY
0205302   S STRL CATH DRAINAGE                      16            02             CENTRAL SUPPLY
0205294   S STRL CATH DRAINAGE                     130            02             CENTRAL SUPPLY
0205286   S STRL CATH DRAINAGE                     130            02             CENTRAL SUPPLY
0205278   S STRL CATH DRAINAGE                     130            02             CENTRAL SUPPLY
0205260   S STRL CATH DRAINAGE                     130            02             CENTRAL SUPPLY
0205252   S STRL CATH DRAINAGE                     130            02             CENTRAL SUPPLY
0205245   S STRL CATH DRAINAGE                      41            02             CENTRAL SUPPLY
0205237   S STRL CATH DRAINAGE                      41            02             CENTRAL SUPPLY
0205229   S STRL CATH DRAINAGE                      41            02             CENTRAL SUPPLY
0205211   S STRL CATH DRAINAGE                      41            02             CENTRAL SUPPLY
0205203   S STRL CATH DRAINAGE                      41            02             CENTRAL SUPPLY
0205195   S STRL CATH DRAINAGE                      41            02             CENTRAL SUPPLY
0205187   S STRL CATH DRAINAGE                      60            02             CENTRAL SUPPLY
0205179   S STRL CATH DRAINAGE                      60            02             CENTRAL SUPPLY
0205161   S STRL CATH DRAINAGE                      60            02             CENTRAL SUPPLY
0203992   S STRL CATH DRAINAGE                     657            02             CENTRAL SUPPLY
0203984   S STRL CATH DRAINAGE                     374            02             CENTRAL SUPPLY
0207936   S STRL CATH DVSNS-100                    166            02             CENTRAL SUPPLY
0207035   S STRL CATH ET HF ST AL2                 482            02             CENTRAL SUPPLY
0203380   S STRL CATH EXTERNAL 36                   12            02             CENTRAL SUPPLY
0203372   S STRL CATH EXTERNAL MD                   12            02             CENTRAL SUPPLY




                                                      Page 21
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0203398   S STRL CATH EXTERNAL SM               12            02             CENTRAL SUPPLY
0203455   S STRL CATH FELLIF 4FR               111            02             CENTRAL SUPPLY
0203471   S STRL CATH FILL SPIRL 5F            276            02             CENTRAL SUPPLY
0203489   S STRL CATH FILL SPIRL 6F            234            02             CENTRAL SUPPLY
0203406   S STRL CATH FILLIF 3F                234            02             CENTRAL SUPPLY
0203414   S STRL CATH FILLIF 4F                 27            02             CENTRAL SUPPLY
0203422   S STRL CATH FILLIF 5F                 65            02             CENTRAL SUPPLY
0203430   S STRL CATH FILLIF 6F                 77            02             CENTRAL SUPPLY
0212159   S STRL CATH FILLIF STR 6             234            02             CENTRAL SUPPLY
0203802   S STRL CATH FLWR HEYMN 10            133            02             CENTRAL SUPPLY
0203810   S STRL CATH FLWR HEYMN 12            102            02             CENTRAL SUPPLY
0203828   S STRL CATH FLWR HEYMN 14            133            02             CENTRAL SUPPLY
0203836   S STRL CATH FLWR HEYMN 16            102            02             CENTRAL SUPPLY
0203844   S STRL CATH FLWR HEYMN 18            133            02             CENTRAL SUPPLY
0203851   S STRL CATH FLWR HEYMN 20            102            02             CENTRAL SUPPLY
0203869   S STRL CATH FLWR HEYMN 22            133            02             CENTRAL SUPPLY
0203620   S STRL CATH FOLEY 2WY 10F             30            02             CENTRAL SUPPLY
0203638   S STRL CATH FOLEY 2WY 12F             26            02             CENTRAL SUPPLY
0203646   S STRL CATH FOLEY 2WY 14F             29            02             CENTRAL SUPPLY
0203653   S STRL CATH FOLEY 2WY 16F             29            02             CENTRAL SUPPLY
0203661   S STRL CATH FOLEY 2WY 18F             26            02             CENTRAL SUPPLY
0203679   S STRL CATH FOLEY 2WY 20F             29            02             CENTRAL SUPPLY
0212134   S STRL CATH FOLEY 2WY 22F            121            02             CENTRAL SUPPLY
0203687   S STRL CATH FOLEY 2WY 22F             29            02             CENTRAL SUPPLY
0212167   S STRL CATH FOLEY 2WY 24F             35            02             CENTRAL SUPPLY
0203695   S STRL CATH FOLEY 2WY 24F             29            02             CENTRAL SUPPLY
0203612   S STRL CATH FOLEY 2WY 8F              30            02             CENTRAL SUPPLY
0213934   S STRL CATH FOLEY 3/30 16             91            02             CENTRAL SUPPLY
0213561   S STRL CATH FOLEY 30CC 12             38            02             CENTRAL SUPPLY
0213579   S STRL CATH FOLEY 30CC 14             38            02             CENTRAL SUPPLY
0203752   S STRL CATH FOLEY 3WY 20F             85            02             CENTRAL SUPPLY
0203786   S STRL CATH FOLEY 3WY 26F             85            02             CENTRAL SUPPLY
0263483   S STRL CATH FOLEY PEDI                52            02             CENTRAL SUPPLY
0263350   S STRL CATH FOLEY SIL                 27            02             CENTRAL SUPPLY
0211565   S STRL CATH FORCE PROPEL            2110            02             CENTRAL SUPPLY
0219295   S STRL CATH GUIDING                  373            02             CENTRAL SUPPLY
0219287   S STRL CATH GUIDING                  373            02             CENTRAL SUPPLY
0219279   S STRL CATH GUIDING                  373            02             CENTRAL SUPPLY
0219261   S STRL CATH GUIDING                  373            02             CENTRAL SUPPLY
0219253   S STRL CATH GUIDING                  373            02             CENTRAL SUPPLY
0219246   S STRL CATH GUIDING                  373            02             CENTRAL SUPPLY
0219071   S STRL CATH GUIDING                  421            02             CENTRAL SUPPLY
0218412   S STRL CATH GUIDING                  386            02             CENTRAL SUPPLY
0218339   S STRL CATH GUIDING                  421            02             CENTRAL SUPPLY
0218123   S STRL CATH GUIDING                  421            02             CENTRAL SUPPLY
0217059   S STRL CATH GUIDING                  777            02             CENTRAL SUPPLY
0217042   S STRL CATH GUIDING                  777            02             CENTRAL SUPPLY
0217034   S STRL CATH GUIDING                  777            02             CENTRAL SUPPLY
0217026   S STRL CATH GUIDING                  777            02             CENTRAL SUPPLY
0217018   S STRL CATH GUIDING                  777            02             CENTRAL SUPPLY
0217000   S STRL CATH GUIDING                  777            02             CENTRAL SUPPLY
0216135   S STRL CATH GUIDING                  258            02             CENTRAL SUPPLY
0216127   S STRL CATH GUIDING                  215            02             CENTRAL SUPPLY
0216085   S STRL CATH GUIDING                  642            02             CENTRAL SUPPLY
0216077   S STRL CATH GUIDING                  710            02             CENTRAL SUPPLY




                                                  Page 22
                                c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION             SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                   AMOUNT AMOUNT CODE

0216069   S STRL CATH GUIDING                642            02             CENTRAL SUPPLY
0215806   S STRL CATH GUIDING                403            02             CENTRAL SUPPLY
0215798   S STRL CATH GUIDING                434            02             CENTRAL SUPPLY
0215574   S STRL CATH GUIDING                373            02             CENTRAL SUPPLY
0215541   S STRL CATH GUIDING                373            02             CENTRAL SUPPLY
0215533   S STRL CATH GUIDING                373            02             CENTRAL SUPPLY
0215483   S STRL CATH GUIDING                373            02             CENTRAL SUPPLY
0215467   S STRL CATH GUIDING                373            02             CENTRAL SUPPLY
0215442   S STRL CATH GUIDING                373            02             CENTRAL SUPPLY
0215426   S STRL CATH GUIDING                373            02             CENTRAL SUPPLY
0215418   S STRL CATH GUIDING                373            02             CENTRAL SUPPLY
0215376   S STRL CATH GUIDING                373            02             CENTRAL SUPPLY
0215335   S STRL CATH GUIDING                373            02             CENTRAL SUPPLY
0215319   S STRL CATH GUIDING                373            02             CENTRAL SUPPLY
0215202   S STRL CATH GUIDING                386            02             CENTRAL SUPPLY
0214817   S STRL CATH GUIDING                642            02             CENTRAL SUPPLY
0214718   S STRL CATH GUIDING                434            02             CENTRAL SUPPLY
0212399   S STRL CATH GUIDING                201            02             CENTRAL SUPPLY
0212290   S STRL CATH GUIDING                460            02             CENTRAL SUPPLY
0212241   S STRL CATH GUIDING                460            02             CENTRAL SUPPLY
0212233   S STRL CATH GUIDING                460            02             CENTRAL SUPPLY
0212225   S STRL CATH GUIDING                460            02             CENTRAL SUPPLY
0212217   S STRL CATH GUIDING                460            02             CENTRAL SUPPLY
0211953   S STRL CATH GUIDING                201            02             CENTRAL SUPPLY
0211888   S STRL CATH GUIDING                201            02             CENTRAL SUPPLY
0211870   S STRL CATH GUIDING                201            02             CENTRAL SUPPLY
0211730   S STRL CATH GUIDING                201            02             CENTRAL SUPPLY
0211672   S STRL CATH GUIDING                201            02             CENTRAL SUPPLY
0211664   S STRL CATH GUIDING               1300            02             CENTRAL SUPPLY
0211656   S STRL CATH GUIDING                633            02             CENTRAL SUPPLY
0211649   S STRL CATH GUIDING                201            02             CENTRAL SUPPLY
0211631   S STRL CATH GUIDING                201            02             CENTRAL SUPPLY
0211623   S STRL CATH GUIDING                201            02             CENTRAL SUPPLY
0211615   S STRL CATH GUIDING                201            02             CENTRAL SUPPLY
0211607   S STRL CATH GUIDING                201            02             CENTRAL SUPPLY
0211599   S STRL CATH GUIDING                201            02             CENTRAL SUPPLY
0211581   S STRL CATH GUIDING                201            02             CENTRAL SUPPLY
0211474   S STRL CATH GUIDING                486            02             CENTRAL SUPPLY
0211425   S STRL CATH GUIDING                460            02             CENTRAL SUPPLY
0211268   S STRL CATH GUIDING                482            02             CENTRAL SUPPLY
0210880   S STRL CATH GUIDING                557            02             CENTRAL SUPPLY
0210872   S STRL CATH GUIDING                531            02             CENTRAL SUPPLY
0210864   S STRL CATH GUIDING                557            02             CENTRAL SUPPLY
0210856   S STRL CATH GUIDING                557            02             CENTRAL SUPPLY
0210542   S STRL CATH GUIDING                557            02             CENTRAL SUPPLY
0210179   S STRL CATH GUIDING               1095            02             CENTRAL SUPPLY
0210161   S STRL CATH GUIDING               1095            02             CENTRAL SUPPLY
0210088   S STRL CATH GUIDING                557            02             CENTRAL SUPPLY
0210070   S STRL CATH GUIDING                482            02             CENTRAL SUPPLY
0210021   S STRL CATH GUIDING                406            02             CENTRAL SUPPLY
0210013   S STRL CATH GUIDING                406            02             CENTRAL SUPPLY
0209486   S STRL CATH GUIDING                821            02             CENTRAL SUPPLY
0209007   S STRL CATH GUIDING                486            02             CENTRAL SUPPLY
0208728   S STRL CATH GUIDING                147            02             CENTRAL SUPPLY
0208496   S STRL CATH GUIDING                486            02             CENTRAL SUPPLY




                                                Page 23
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0208488   S STRL CATH GUIDING                  603            02             CENTRAL SUPPLY
0207498   S STRL CATH GUIDING                  460            02             CENTRAL SUPPLY
0207175   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0207167   S STRL CATH GUIDING                  486            02             CENTRAL SUPPLY
0207126   S STRL CATH GUIDING                  102            02             CENTRAL SUPPLY
0207084   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0207043   S STRL CATH GUIDING                  542            02             CENTRAL SUPPLY
0207027   S STRL CATH GUIDING                 1040            02             CENTRAL SUPPLY
0207019   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0207001   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206995   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206599   S STRL CATH GUIDING                  324            02             CENTRAL SUPPLY
0206573   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206565   S STRL CATH GUIDING                  531            02             CENTRAL SUPPLY
0206524   S STRL CATH GUIDING                  644            02             CENTRAL SUPPLY
0206490   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206482   S STRL CATH GUIDING                  486            02             CENTRAL SUPPLY
0206474   S STRL CATH GUIDING                  486            02             CENTRAL SUPPLY
0206466   S STRL CATH GUIDING                  486            02             CENTRAL SUPPLY
0206458   S STRL CATH GUIDING                  486            02             CENTRAL SUPPLY
0206441   S STRL CATH GUIDING                  486            02             CENTRAL SUPPLY
0206433   S STRL CATH GUIDING                  486            02             CENTRAL SUPPLY
0206425   S STRL CATH GUIDING                  486            02             CENTRAL SUPPLY
0206417   S STRL CATH GUIDING                  491            02             CENTRAL SUPPLY
0206409   S STRL CATH GUIDING                  486            02             CENTRAL SUPPLY
0206391   S STRL CATH GUIDING                  486            02             CENTRAL SUPPLY
0206367   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206359   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206342   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206334   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206326   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206318   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206300   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206292   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206284   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206276   S STRL CATH GUIDING                  201            02             CENTRAL SUPPLY
0206268   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206250   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206243   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206235   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206227   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206219   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0206201   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0204628   S STRL CATH GUIDING                  227            02             CENTRAL SUPPLY
0204610   S STRL CATH GUIDING                  227            02             CENTRAL SUPPLY
0203315   S STRL CATH GUIDING                  482            02             CENTRAL SUPPLY
0203034   S STRL CATH GUIDING                  373            02             CENTRAL SUPPLY
0203026   S STRL CATH GUIDING                  373            02             CENTRAL SUPPLY
0203018   S STRL CATH GUIDING                  373            02             CENTRAL SUPPLY
0208058   S STRL CATH HBP63880MNSRL            137            02             CENTRAL SUPPLY
0204958   S STRL CATH HEMAQUET 6FR             110            02             CENTRAL SUPPLY
0204966   S STRL CATH HEMAQUET 8FR             108            02             CENTRAL SUPPLY
0203877   S STRL CATH HEYMAN 24F               133            02             CENTRAL SUPPLY
0207738   S STRL CATH HIFLOWEXPJL45            108            02             CENTRAL SUPPLY
0206649   S STRL CATH HINCK HEADHNT            100            02             CENTRAL SUPPLY




                                                  Page 24
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0210260   S STRL CATH HLO 5F 90*038            170            02             CENTRAL SUPPLY
0205815   S STRL CATH HN 503870 PIG            143            02             CENTRAL SUPPLY
0207662   S STRL CATH HN403570M10SP            137            02             CENTRAL SUPPLY
0207050   S STRL CATH HN43590M105PI            151            02             CENTRAL SUPPLY
0203513   S STRL CATH HN503870M10SP            105            02             CENTRAL SUPPLY
0211979   S STRL CATH HN5-35-90-M-1            143            02             CENTRAL SUPPLY
0210039   S STRL CATH HN5-38-65-M-1            143            02             CENTRAL SUPPLY
0207605   S STRL CATH HN53870,MSSO,            154            02             CENTRAL SUPPLY
0206946   S STRL CATH HN5-38-70-M-N            137            02             CENTRAL SUPPLY
0207589   S STRL CATH HN53870MNSC1             137            02             CENTRAL SUPPLY
0207597   S STRL CATH HN53870MNSC2             173            02             CENTRAL SUPPLY
0205823   S STRL CATH HN53890M20SPI            102            02             CENTRAL SUPPLY
0215889   S STRL CATH HNB 5/38/65/P            151            02             CENTRAL SUPPLY
0206045   S STRL CATH HNB 538100 MC            151            02             CENTRAL SUPPLY
0205476   S STRL CATH HNB5038-80-MC            137            02             CENTRAL SUPPLY
0207142   S STRL CATH HNB503880MCNS            137            02             CENTRAL SUPPLY
0207720   S STRL CATH HNB535100MCNS            102            02             CENTRAL SUPPLY
0215814   S STRL CATH HNB5-35-100-N            151            02             CENTRAL SUPPLY
0207696   S STRL CATH HNB53565MCNSR            132            02             CENTRAL SUPPLY
0208066   S STRL CATH HNB53580MNSRC            137            02             CENTRAL SUPPLY
0208041   S STRL CATH HNB53580MNSRH            137            02             CENTRAL SUPPLY
0215822   S STRL CATH HNB5-38-100-M            151            02             CENTRAL SUPPLY
0211177   S STRL CATH HNB5-38-100-M            151            02             CENTRAL SUPPLY
0207068   S STRL CATH HNB538100MCNS            151            02             CENTRAL SUPPLY
0211144   S STRL CATH HNB5-38-65-M-            151            02             CENTRAL SUPPLY
0211151   S STRL CATH HNB5-38-80-M-            154            02             CENTRAL SUPPLY
0210898   S STRL CATH HNB5-38-80-MC            143            02             CENTRAL SUPPLY
0206698   S STRL CATH HNB53880MCNSR            151            02             CENTRAL SUPPLY
0215855   S STRL CATH HNBR 5/35/65/            157            02             CENTRAL SUPPLY
0215830   S STRL CATH HNBR 5/35/65/            157            02             CENTRAL SUPPLY
0215848   S STRL CATH HNBR 5/38/65/            157            02             CENTRAL SUPPLY
0217414   S STRL CATH HNBR 5-35-100            119            02             CENTRAL SUPPLY
0217398   S STRL CATH HNBR -NS-JB1             154            02             CENTRAL SUPPLY
0217406   S STRL CATH HNBR -NS-JB2             151            02             CENTRAL SUPPLY
0217422   S STRL CATH HNBR -NS-SIM             151            02             CENTRAL SUPPLY
0217430   S STRL CATH HNBR -NS-SM2             157            02             CENTRAL SUPPLY
0217448   S STRL CATH HNBR -NS-SM3             151            02             CENTRAL SUPPLY
0215897   S STRL CATH HNR 5/38/100/            157            02             CENTRAL SUPPLY
0215905   S STRL CATH HNR5-35-70-P             157            02             CENTRAL SUPPLY
0215913   S STRL CATH HNR5-35-90-P             119            02             CENTRAL SUPPLY
0215921   S STRL CATH HNR5-38-70-P-            157            02             CENTRAL SUPPLY
0210567   S STRL CATH ILLMEN 8 AL 2            557            02             CENTRAL SUPPLY
0210559   S STRL CATH ILLMEN 8 AR 2            557            02             CENTRAL SUPPLY
0205443   S STRL CATH INT-M 2574               121            02             CENTRAL SUPPLY
0214023   S STRL CATH INTRAUTERINE             239            02             CENTRAL SUPPLY
0205500   S STRL CATH INTRD 9F 3366            206            02             CENTRAL SUPPLY
0214072   S STRL CATH INTRD SHTH 8F             85            02             CENTRAL SUPPLY
0205492   S STRL CATH INTRDCR 8F LN            206            02             CENTRAL SUPPLY
0204818   S STRL CATH INTRO PERV LE            230            02             CENTRAL SUPPLY
0224212   S STRL CATH IRRG/INTRM TU             26            02             CENTRAL SUPPLY
0213157   S STRL CATH IRRIG TRAY                13            02             CENTRAL SUPPLY
0263145   S STRL CATH IV                        13            02             CENTRAL SUPPLY
0213363   S STRL CATH IV 14G 3 1/4               5            02             CENTRAL SUPPLY
0214494   S STRL CATH IV 16*2                    5            02             CENTRAL SUPPLY
0213983   S STRL CATH IV 16*3-1/4               16            02             CENTRAL SUPPLY




                                                  Page 25
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0213843   S STRL CATH IV 16G 1 1/4              17            02             CENTRAL SUPPLY
0204735   S STRL CATH IV 18G*1 1/4              12            02             CENTRAL SUPPLY
0213330   S STRL CATH IV 20G 2                   5            02             CENTRAL SUPPLY
0204727   S STRL CATH IV ANGIO 18G               5            02             CENTRAL SUPPLY
0204743   S STRL CATH IV ANGIO 20G              17            02             CENTRAL SUPPLY
0204768   S STRL CATH IV ANGIO 22G              12            02             CENTRAL SUPPLY
0202622   S STRL CATH IV SAF 20*1               14            02             CENTRAL SUPPLY
0202648   S STRL CATH IV SAF 22*1               17            02             CENTRAL SUPPLY
0214510   S STRL CATH IV SAF 22*3/4             27            02             CENTRAL SUPPLY
0214544   S STRL CATH IV SAF 24*3/4             27            02             CENTRAL SUPPLY
0202655   S STRL CATH IV SAF 24*3/4             18            02             CENTRAL SUPPLY
0214536   S STRL CATH IV SAF-Y 18*1             27            02             CENTRAL SUPPLY
0214528   S STRL CATH IV SAF-Y 20*1             27            02             CENTRAL SUPPLY
0203950   S STRL CATH JL 4 100CM 7F            114            02             CENTRAL SUPPLY
0212043   S STRL CATH JL5 7F PROFLO             77            02             CENTRAL SUPPLY
0212050   S STRL CATH JL6 7F PROFLO             77            02             CENTRAL SUPPLY
0212068   S STRL CATH JR4 7F PROFLO             77            02             CENTRAL SUPPLY
0212076   S STRL CATH JR5 7F PROFLO             77            02             CENTRAL SUPPLY
0212084   S STRL CATH JR6 7F PROFLO             77            02             CENTRAL SUPPLY
0202846   S STRL CATH LANDMARK 20GA            172            02             CENTRAL SUPPLY
0202838   S STRL CATH LANDMARK 22GA            201            02             CENTRAL SUPPLY
0205773   S STRL CATH LCB 6F 2562              119            02             CENTRAL SUPPLY
0208504   S STRL CATH MALCT 20FR               278            02             CENTRAL SUPPLY
0214353   S STRL CATH MALCT ST 28FR             93            02             CENTRAL SUPPLY
0214379   S STRL CATH MALCT ST 32FR             93            02             CENTRAL SUPPLY
0214320   S STRL CATH MALCT ST 34FR             93            02             CENTRAL SUPPLY
0214338   S STRL CATH MALCT ST 36FR             93            02             CENTRAL SUPPLY
0214346   S STRL CATH MALCT STR 26F             93            02             CENTRAL SUPPLY
0214361   S STRL CATH MALCT STR 30F             69            02             CENTRAL SUPPLY
0214395   S STRL CATH MALCT STR38FR             62            02             CENTRAL SUPPLY
0208124   S STRL CATH MALCT TUBE24F            278            02             CENTRAL SUPPLY
0210104   S STRL CATH MICRO XLP2.75           2196            02             CENTRAL SUPPLY
0212118   S STRL CATH MLTPUR 7F B1              77            02             CENTRAL SUPPLY
0212126   S STRL CATH MLTPUR 7F B2              77            02             CENTRAL SUPPLY
0212019   S STRL CATH MLTPUR 7FR                78            02             CENTRAL SUPPLY
0204784   S STRL CATH MLTPUR 8F                102            02             CENTRAL SUPPLY
0205039   S STRL CATH MLTPUR A1 7F             102            02             CENTRAL SUPPLY
0205047   S STRL CATH MLTPUR A2 7F             102            02             CENTRAL SUPPLY
0205054   S STRL CATH MLTPUR A2 8F             102            02             CENTRAL SUPPLY
0218073   S STRL CATH MODEL D 6F IM             90            02             CENTRAL SUPPLY
0224345   S STRL CATH MONITOR 2L*7F            303            02             CENTRAL SUPPLY
0207464   S STRL CATH MONORL PIC/FR           2196            02             CENTRAL SUPPLY
0207399   S STRL CATH MWCE18102HILA            271            02             CENTRAL SUPPLY
0207381   S STRL CATH MWCE183010HIL            356            02             CENTRAL SUPPLY
0209866   S STRL CATH MWCE-38-5-5              170            02             CENTRAL SUPPLY
0204602   S STRL CATH MYLER BIOPOLA            861            02             CENTRAL SUPPLY
0203331   S STRL CATH N-3-21-139               129            02             CENTRAL SUPPLY
0208413   S STRL CATH N5-38-70-M-10            102            02             CENTRAL SUPPLY
0206615   S STRL CATH N-6-38-130               129            02             CENTRAL SUPPLY
0207985   S STRL CATH NEPH SYS 75F/           1008            02             CENTRAL SUPPLY
0207894   S STRL CATH OLBRT5.8F8X4            1550            02             CENTRAL SUPPLY
0207548   S STRL CATH P338100M6S PI             87            02             CENTRAL SUPPLY
0207621   S STRL CATH P4132-65M4SPE             98            02             CENTRAL SUPPLY
0205468   S STRL CATH P5.OB 38 80 M            108            02             CENTRAL SUPPLY
0207639   S STRL CATH P65-38-80-M-N             77            02             CENTRAL SUPPLY




                                                  Page 26
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0210914   S STRL CATH P8.3G-38-100             93            02             CENTRAL SUPPLY
0207530   S STRL CATH P83-NT-4-P-NS            77            02             CENTRAL SUPPLY
0204826   S STRL CATH PAC BPL 5F US           510            02             CENTRAL SUPPLY
0204891   S STRL CATH PAC ELECT J 5           521            02             CENTRAL SUPPLY
0204917   S STRL CATH PAC TAPE LG             583            02             CENTRAL SUPPLY
0204909   S STRL CATH PAC TAPE MD             583            02             CENTRAL SUPPLY
0204925   S STRL CATH PAC TRIPOL 7F           744            02             CENTRAL SUPPLY
0204842   S STRL CATH PACE ELECTR 4           642            02             CENTRAL SUPPLY
0204859   S STRL CATH PACE ELECTR 5           710            02             CENTRAL SUPPLY
0204933   S STRL CATH PACE THROMBO            878            02             CENTRAL SUPPLY
0204792   S STRL CATH PACING KIT 4F           319            02             CENTRAL SUPPLY
0204800   S STRL CATH PACING KIT 5F           319            02             CENTRAL SUPPLY
0204834   S STRL CATH PACING MYLER            861            02             CENTRAL SUPPLY
0207563   S STRL CATH PBS7338100MNS            98            02             CENTRAL SUPPLY
0207704   S STRL CATH PBS733880MNSC            94            02             CENTRAL SUPPLY
0207852   S STRL CATH PEG1438651582           535            02             CENTRAL SUPPLY
0206953   S STRL CATH PERCUTANEOUS9           162            02             CENTRAL SUPPLY
0213405   S STRL CATH PEZZER 24FR              64            02             CENTRAL SUPPLY
0213413   S STRL CATH PEZZER 26FR              64            02             CENTRAL SUPPLY
0203885   S STRL CATH PHILLIPS 10F             67            02             CENTRAL SUPPLY
0203893   S STRL CATH PHILLIPS 12F             85            02             CENTRAL SUPPLY
0203901   S STRL CATH PHILLIPS 14F            122            02             CENTRAL SUPPLY
0203919   S STRL CATH PHILLIPS 16F            113            02             CENTRAL SUPPLY
0203927   S STRL CATH PHILLIPS 18F            113            02             CENTRAL SUPPLY
0203935   S STRL CATH PHILLIPS 20F            140            02             CENTRAL SUPPLY
0212027   S STRL CATH PIGTAIL PROFL            77            02             CENTRAL SUPPLY
0207217   S STRL CATH PLVW83830VAD5           356            02             CENTRAL SUPPLY
0204222   S STRL CATH PLW 6 38 1300           340            02             CENTRAL SUPPLY
0203133   S STRL CATH PMSY 300                268            02             CENTRAL SUPPLY
0206003   S STRL CATH POB 38 80 M N           165            02             CENTRAL SUPPLY
0208173   S STRL CATH PROFLX 7X2125          1183            02             CENTRAL SUPPLY
0208181   S STRL CATH PROFLX 8X375C          1183            02             CENTRAL SUPPLY
0204206   S STRL CATH PU8.5-38-40BC           297            02             CENTRAL SUPPLY
0207761   S STRL CATH PU853825P4SNC           258            02             CENTRAL SUPPLY
0211516   S STRL CATH RCB 6F                  119            02             CENTRAL SUPPLY
0216051   S STRL CATH RED RUBBER              165            02             CENTRAL SUPPLY
0207860   S STRL CATH RMS1618SCH2             376            02             CENTRAL SUPPLY
0207282   S STRL CATH RTAN6.3-38-18           230            02             CENTRAL SUPPLY
0216093   S STRL CATH SCB5-38-40-P-           215            02             CENTRAL SUPPLY
0211433   S STRL CATH SCHWARTEN 2            1672            02             CENTRAL SUPPLY
0204586   S STRL CATH SCNMKR MLT 7F            77            02             CENTRAL SUPPLY
0204594   S STRL CATH SCNMKR MLT 8F           114            02             CENTRAL SUPPLY
0208157   S STRL CATH SEAL,9F 3WAY            642            02             CENTRAL SUPPLY
0203497   S STRL CATH SHEATH 5FR10            111            02             CENTRAL SUPPLY
0204677   S STRL CATH SHEATH8.5                46            02             CENTRAL SUPPLY
0205658   S STRL CATH SIALIGRAM SET           157            02             CENTRAL SUPPLY
0205641   S STRL CATH SIALIGRAM SET           166            02             CENTRAL SUPPLY
0216101   S STRL CATH SIZING AORTA            833            02             CENTRAL SUPPLY
0206789   S STRL CATH SLALOM 2.5DC2          2189            02             CENTRAL SUPPLY
0210351   S STRL CATH SM VESL                1264            02             CENTRAL SUPPLY
0203208   S STRL CATH SONES B100CM7            39            02             CENTRAL SUPPLY
0212548   S STRL CATH ST + 7F 1M               72            02             CENTRAL SUPPLY
0212498   S STRL CATH ST + 7F AL1              72            02             CENTRAL SUPPLY
0212506   S STRL CATH ST + 7F AL11             72            02             CENTRAL SUPPLY
0212514   S STRL CATH ST + 7F AL111            72            02             CENTRAL SUPPLY




                                                 Page 27
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0212480   S STRL CATH ST + 7F ARMOD             72            02             CENTRAL SUPPLY
0212423   S STRL CATH ST + 7F JL3.5             72            02             CENTRAL SUPPLY
0212431   S STRL CATH ST + 7F JL4               72            02             CENTRAL SUPPLY
0212449   S STRL CATH ST + 7F JL5               72            02             CENTRAL SUPPLY
0212456   S STRL CATH ST + 7F JL6               72            02             CENTRAL SUPPLY
0212407   S STRL CATH ST + 7F JR4               72            02             CENTRAL SUPPLY
0212415   S STRL CATH ST + 7F JR5               72            02             CENTRAL SUPPLY
0212530   S STRL CATH ST + 7F LCB               72            02             CENTRAL SUPPLY
0212464   S STRL CATH ST + 7F MPA2              72            02             CENTRAL SUPPLY
0212472   S STRL CATH ST + 7F MPB2              72            02             CENTRAL SUPPLY
0212522   S STRL CATH ST + 7F RCB               72            02             CENTRAL SUPPLY
0212563   S STRL CATH STDRD 8F JL4              70            02             CENTRAL SUPPLY
0212571   S STRL CATH STDRD 8F JL5              70            02             CENTRAL SUPPLY
0212555   S STRL CATH STDRD 8F JR4              70            02             CENTRAL SUPPLY
0207993   S STRL CATH STELLAR5X4125            946            02             CENTRAL SUPPLY
0208009   S STRL CATH STELLAR6X2125            946            02             CENTRAL SUPPLY
0208017   S STRL CATH STELLR 6*275             946            02             CENTRAL SUPPLY
0208199   S STRL CATH STELR 8X375              946            02             CENTRAL SUPPLY
0214262   S STRL CATH STR 14 FR                 29            02             CENTRAL SUPPLY
0205112   S STRL CATH STR COUDE 16F             30            02             CENTRAL SUPPLY
0208256   S STRL CATH STW 5FR6X2              1335            02             CENTRAL SUPPLY
0205146   S STRL CATH SUCT W/20 14F             16            02             CENTRAL SUPPLY
0213603   S STRL CATH SUCTN 10F                  5            02             CENTRAL SUPPLY
0213629   S STRL CATH SUCTN 14F                  5            02             CENTRAL SUPPLY
0213611   S STRL CATH SUCTN 8FR                  5            02             CENTRAL SUPPLY
0213587   S STRL CATH SUCTN 12FR                 5            02             CENTRAL SUPPLY
0207233   S STRL CATH SUCTN 5FRX141              5            02             CENTRAL SUPPLY
0213280   S STRL CATH SUCTN KIT 14               9            02             CENTRAL SUPPLY
0224436   S STRL CATH SUCTN REPLOGL             71            02             CENTRAL SUPPLY
0211862   S STRL CATH SUPER 7F LT              460            02             CENTRAL SUPPLY
0207670   S STRL CATH SUPER7FAMPLTZ            557            02             CENTRAL SUPPLY
0207688   S STRL CATH SUPER7FAMPR1             557            02             CENTRAL SUPPLY
0216119   S STRL CATH SZNG VENACAVA            249            02             CENTRAL SUPPLY
0207613   S STRL CATH T3SNT-90MCNS              98            02             CENTRAL SUPPLY
0208215   S STRL CATH T93880MNSVAD             175            02             CENTRAL SUPPLY
0211417   S STRL CATH TEG ST 5X4CM            1335            02             CENTRAL SUPPLY
0224014   S STRL CATH TENCHOFF ADLT            359            02             CENTRAL SUPPLY
0214387   S STRL CATH THRML DILTN 7            632            02             CENTRAL SUPPLY
0204131   S STRL CATH TONGUE DEVICE             48            02             CENTRAL SUPPLY
0219469   S STRL CATH TRANSSEPTAL 6           1115            02             CENTRAL SUPPLY
0219543   S STRL CATH TRANSSEPTAL 8           1155            02             CENTRAL SUPPLY
0202929   S STRL CATH TRAY 14 W/MTR            122            02             CENTRAL SUPPLY
0202887   S STRL CATH TRAY 16 FOLEY             64            02             CENTRAL SUPPLY
0202903   S STRL CATH TRAY 16 W/MTR            122            02             CENTRAL SUPPLY
0202895   S STRL CATH TRAY 18 FOLEY             64            02             CENTRAL SUPPLY
0202911   S STRL CATH TRAY 18 W/MTR            122            02             CENTRAL SUPPLY
0260257   S STRL CATH TRIPLE LUMEN             718            02             CENTRAL SUPPLY
0260240   S STRL CATH TRIPLE LUMEN             718            02             CENTRAL SUPPLY
0260232   S STRL CATH TRIPLE LUMEN             718            02             CENTRAL SUPPLY
0260117   S STRL CATH TRIPLE LUMEN             718            02             CENTRAL SUPPLY
0260109   S STRL CATH TRIPLE LUMEN             718            02             CENTRAL SUPPLY
0260091   S STRL CATH TRIPLE LUMEN             718            02             CENTRAL SUPPLY
0213827   S STRL CATH TROCAR 20FR              130            02             CENTRAL SUPPLY
0206664   S STRL CATH ULT 10.2/38/2            302            02             CENTRAL SUPPLY
0206656   S STRL CATH ULT/12/38/25/            417            02             CENTRAL SUPPLY




                                                  Page 28
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0210971   S STRL CATH ULT8.5-38-20            345            02             CENTRAL SUPPLY
0207076   S STRL CATH ULT853825P4SN           523            02             CENTRAL SUPPLY
0213876   S STRL CATH UMBI VESL 3.             43            02             CENTRAL SUPPLY
0213884   S STRL CATH UMBI VESL 5F             60            02             CENTRAL SUPPLY
0207886   S STRL CATH USS102628PIGC           314            02             CENTRAL SUPPLY
0205534   S STRL CATH UT 5F                  1368            02             CENTRAL SUPPLY
0208264   S STRL CATH UT 5F 6X4X120          1040            02             CENTRAL SUPPLY
0206631   S STRL CATH UT/4-2/5/120           1040            02             CENTRAL SUPPLY
0203505   S STRL CATH UT/4-2/5/754*           969            02             CENTRAL SUPPLY
0208249   S STRL CATH UT5FR8X2X75CM           969            02             CENTRAL SUPPLY
0205328   S STRL CATH UTIL ST 10F               5            02             CENTRAL SUPPLY
0205336   S STRL CATH UTIL ST 12F               5            02             CENTRAL SUPPLY
0205344   S STRL CATH UTIL ST 14F               5            02             CENTRAL SUPPLY
0205351   S STRL CATH UTIL ST 16F               5            02             CENTRAL SUPPLY
0205369   S STRL CATH UTIL ST 18F               5            02             CENTRAL SUPPLY
0205377   S STRL CATH UTIL ST 20F               5            02             CENTRAL SUPPLY
0205310   S STRL CATH UTIL ST 8F                5            02             CENTRAL SUPPLY
0213454   S STRL CATH UTILITY 22 FR            32            02             CENTRAL SUPPLY
0213348   S STRL CATH UTILITY 24FR             32            02             CENTRAL SUPPLY
0213819   S STRL CATH UTILITY 26FR             32            02             CENTRAL SUPPLY
0213926   S STRL CATH UTILITY 28 FR            32            02             CENTRAL SUPPLY
0207878   S STRL CATH UUS8.5-6-28-P           314            02             CENTRAL SUPPLY
0204578   S STRL CATH VAN TASSEL AN           125            02             CENTRAL SUPPLY
0204560   S STRL CATH VANTASS ANG+P            77            02             CENTRAL SUPPLY
0210989   S STRL CATH VONSONNENBERG           485            02             CENTRAL SUPPLY
0207266   S STRL CATH VSLL12/35LOOP           515            02             CENTRAL SUPPLY
0207274   S STRL CATH VSLL14/35 LOO           515            02             CENTRAL SUPPLY
0208710   S STRL CATH VSS-4-18 NEFF            94            02             CENTRAL SUPPLY
0209825   S STRL CATH VSSW 11-38-30           172            02             CENTRAL SUPPLY
0206748   S STRL CATH VTCB BIL SYS            478            02             CENTRAL SUPPLY
0206730   S STRL CATH VTCB BIL SYS            348            02             CENTRAL SUPPLY
0206722   S STRL CATH VTCB BILARY S           348            02             CENTRAL SUPPLY
0208363   S STRL CATH VTCB BILSYS14           348            02             CENTRAL SUPPLY
0263707   S STRL CATH, BARTHOLIN GL           150            02             CENTRAL SUPPLY
0260398   S STRL CATH, PICC 3FR SNG           535            02             CENTRAL SUPPLY
0260380   S STRL CATH,PICC 4FR SNGL           535            02             CENTRAL SUPPLY
0260372   S STRL CATH,PICC 5FR DBL            735            02             CENTRAL SUPPLY
0207100   S STRL CATH1.5 9CS10 2482          2189            02             CENTRAL SUPPLY
0211771   S STRL CATH1.5/20 SOLO W/          2189            02             CENTRAL SUPPLY
0211276   S STRL CATH3 ACS OMEGA             1216            02             CENTRAL SUPPLY
0211920   S STRL CATH30/20 SOLO W/P          1268            02             CENTRAL SUPPLY
0211912   S STRL CATH40/30 FORCE W/          2127            02             CENTRAL SUPPLY
0207910   S STRL CATH573880PNSVAD45           118            02             CENTRAL SUPPLY
0210682   S STRL CATH71-2048H                 710            02             CENTRAL SUPPLY
0210690   S STRL CATH7F 4 X 2CM               659            02             CENTRAL SUPPLY
0210708   S STRL CATH7F 5 X 2CM               659            02             CENTRAL SUPPLY
0210716   S STRL CATH7F 6 X 2CM               734            02             CENTRAL SUPPLY
0210732   S STRL CATHBPS6.5-38-100-            94            02             CENTRAL SUPPLY
0210740   S STRL CATHBPS6.5-38-65-M            94            02             CENTRAL SUPPLY
0210781   S STRL CATHBPS6.5-38-80-M            94            02             CENTRAL SUPPLY
0210773   S STRL CATHBPS6.5-38-80-M            94            02             CENTRAL SUPPLY
0210765   S STRL CATHBPS6.5-38-80-M            94            02             CENTRAL SUPPLY
0210757   S STRL CATHBPS6.5-38-80-M            94            02             CENTRAL SUPPLY
0210799   S STRL CATHBPS7.3-38-100-           102            02             CENTRAL SUPPLY
0208447   S STRL CATHBPS7.3-38-65-M            94            02             CENTRAL SUPPLY




                                                 Page 29
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0204545   S STRL CATHBRACHL COR 3              99            02             CENTRAL SUPPLY
0203356   S STRL CATHEPDRL 20G                 48            02             CENTRAL SUPPLY
0263129   S STRL CATHETAR SUCTION K            12            02             CENTRAL SUPPLY
0211110   S STRL CATHINTERNAL MAMMO           108            02             CENTRAL SUPPLY
0204685   S STRL CATHINTRO GRD 2002            57            02             CENTRAL SUPPLY
0210930   S STRL CATHSIMMS-2                   94            02             CENTRAL SUPPLY
0210948   S STRL CATHSIMMS-3                   94            02             CENTRAL SUPPLY
0209908   S STRL CATHSLALOM 3                2189            02             CENTRAL SUPPLY
0211292   S STRL CATHSM VESL 3X4             1656            02             CENTRAL SUPPLY
0211235   S STRL CATHSM VESL 4X4             1561            02             CENTRAL SUPPLY
0203216   S STRL CATHSONES A80CM7F             39            02             CENTRAL SUPPLY
0203190   S STRL CATHSONES C80C 8F             39            02             CENTRAL SUPPLY
0205096   S STRL CATHSTR COUDE 12F            107            02             CENTRAL SUPPLY
0205104   S STRL CATHSTR COUDE 14F             30            02             CENTRAL SUPPLY
0205120   S STRL CATHSTR COUDE 18F             33            02             CENTRAL SUPPLY
0205153   S STRL CATHSUCT 10F759                5            02             CENTRAL SUPPLY
0211854   S STRL CATHSUPER 7F RT              460            02             CENTRAL SUPPLY
0209817   S STRL CATHT6.3-40-20-P-4           108            02             CENTRAL SUPPLY
0210955   S STRL CATHT-9-38-80-P-NS            94            02             CENTRAL SUPPLY
0263475   S STRL CAUTERY, HI-TEMP F            48            02             CENTRAL SUPPLY
0224840   S STRL CFFD FEN SHLY4 612           283            02             CENTRAL SUPPLY
0213520   S STRL CHOLANGIOCATH OPER           181            02             CENTRAL SUPPLY
0260075   S STRL CIRC DEVCE 1.3MMDI            18            02             CENTRAL SUPPLY
0260265   S STRL CIRC DEVCE1.3MMDIS            18            02             CENTRAL SUPPLY
0224006   S STRL CLAMP, OUTPUT CAPD            40            02             CENTRAL SUPPLY
0262352   S STRL CLEANER OINTMT ALO            13            02             CENTRAL SUPPLY
0262212   S STRL CLEANSER WOUND SEA            12            02             CENTRAL SUPPLY
0262345   S STRL CLNSR ALOE VESTA 3            12            02             CENTRAL SUPPLY
0224089   S STRL CNTAINR,EVAC 500CC            10            02             CENTRAL SUPPLY
0207746   S STRL COIL PUSHER 16               432            02             CENTRAL SUPPLY
0224071   S STRL CONTAINER BAG 3L              30            02             CENTRAL SUPPLY
0224105   S STRL CONTAINER, EVAC 1L             6            02             CENTRAL SUPPLY
0224097   S STRL CONTAINER, VACM 2L            57            02             CENTRAL SUPPLY
0224063   S STRL CONTNR,EVAC BAG250            10            02             CENTRAL SUPPLY
0250290   S STRL CO-SET SYS CVS DKE           104            02             CENTRAL SUPPLY
0212944   S STRL CPAP BAG574                  111            02             CENTRAL SUPPLY
0213009   S STRL CRVD KELLY DISP               28            02             CENTRAL SUPPLY
0206151   S STRL CTH 2HRTZ ACII3399          1213            02             CENTRAL SUPPLY
0206185   S STRL CTH 3.5F HRTZ 3402          1213            02             CENTRAL SUPPLY
0210609   S STRL CTH 3/30 FRCE W/PP          1223            02             CENTRAL SUPPLY
0202226   S STRL CTH 5FR LEAD TAP E          1642            02             CENTRAL SUPPLY
0224493   S STRL CTH 8F W/PGTAIL GP           374            02             CENTRAL SUPPLY
0263616   S STRL CTH ART BRC KT PMS            89            02             CENTRAL SUPPLY
0203166   S STRL CTH ART RD20GX13/4            69            02             CENTRAL SUPPLY
0204529   S STRL CTH COR FM LT B 7F           102            02             CENTRAL SUPPLY
0205013   S STRL CTH DBL LUMN 5F638           178            02             CENTRAL SUPPLY
0200592   S STRL CTH DIL ACS4.0 123          1250            02             CENTRAL SUPPLY
0220293   S STRL CTH EXTRNL 48X25CM            57            02             CENTRAL SUPPLY
0212142   S STRL CTH FOL2WY30CC20FR            35            02             CENTRAL SUPPLY
0204776   S STRL CTH HEMQ WIRDBL 7F           108            02             CENTRAL SUPPLY
0203265   S STRL CTH HF FM LT CRNRY           108            02             CENTRAL SUPPLY
0206938   S STRL CTH HN538-100-MNSO           132            02             CENTRAL SUPPLY
0208736   S STRL CTH HNB5-35-100MNS           132            02             CENTRAL SUPPLY
0205807   S STRL CTH INTR HMOSTASIS           162            02             CENTRAL SUPPLY
0204719   S STRL CTH IV ANGIO 16G71             5            02             CENTRAL SUPPLY




                                                 Page 30
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0204750   S STRL CTH IV ANGIO24G264             12            02             CENTRAL SUPPLY
0202598   S STRL CTH IV SAF14*1 1/4             17            02             CENTRAL SUPPLY
0202606   S STRL CTH IV SAF16*1 1/4             17            02             CENTRAL SUPPLY
0202614   S STRL CTH IV SAF18*1 1/4             17            02             CENTRAL SUPPLY
0202630   S STRL CTH IV SAF20*1 1/4             17            02             CENTRAL SUPPLY
0203158   S STRL CTH JL4 100C SH 7F            130            02             CENTRAL SUPPLY
0204669   S STRL CTH JUDKN RT A5 8F             98            02             CENTRAL SUPPLY
0220210   S STRL CTH MAHURKAR KIT              710            02             CENTRAL SUPPLY
0210112   S STRL CTH MCROSFTRAC XLP           2196            02             CENTRAL SUPPLY
0209205   S STRL CTH N5-38-70M10S-O            102            02             CENTRAL SUPPLY
0208587   S STRL CTH P10-NT-4-P-NS0             77            02             CENTRAL SUPPLY
0211219   S STRL CTH P6-38-100MNS-O             91            02             CENTRAL SUPPLY
0204883   S STRL CTH PAC ELECT6F395            552            02             CENTRAL SUPPLY
0204867   S STRL CTH PACE4F8153 397            440            02             CENTRAL SUPPLY
0220228   S STRL CTH PERM 2048 DIAL            588            02             CENTRAL SUPPLY
0204974   S STRL CTH PGTAIL 110CM8F            114            02             CENTRAL SUPPLY
0211466   S STRL CTH PROBNG 4FRX125            568            02             CENTRAL SUPPLY
0212001   S STRL CTH PROPEL JL5 7FR            111            02             CENTRAL SUPPLY
0208983   S STRL CTH PTZ7X4X90 3360           1216            02             CENTRAL SUPPLY
0200527   S STRL CTH RPARI KIT HICK            235            02             CENTRAL SUPPLY
0205138   S STRL CTH SCTN INFNT10FR             11            02             CENTRAL SUPPLY
0214551   S STRL CTH SCTN KT 10F CS             14            02             CENTRAL SUPPLY
0216143   S STRL CTH SFTVU5FR*65*35            171            02             CENTRAL SUPPLY
0216150   S STRL CTH SFTVU5FR*90*35            171            02             CENTRAL SUPPLY
0211482   S STRL CTH SLALM 2 2CM TP           2189            02             CENTRAL SUPPLY
0211490   S STRL CTH SLALM 3 2CM TP           2189            02             CENTRAL SUPPLY
0211458   S STRL CTH STELLR 5X2 125            946            02             CENTRAL SUPPLY
0211441   S STRL CTH STELLR 6X4 145            946            02             CENTRAL SUPPLY
0211748   S STRL CTH STERI SCTN14FR             75            02             CENTRAL SUPPLY
0205872   S STRL CTH TEG ST5X2 3201           1335            02             CENTRAL SUPPLY
0221820   S STRL CTH TRAY MAHURKAR             667            02             CENTRAL SUPPLY
0202291   S STRL CTH UMBILICAL VESS            107            02             CENTRAL SUPPLY
0214882   S STRL CTH,GLD MLTI5F100C            434            02             CENTRAL SUPPLY
0219568   S STRL CTH,HNBR5.8-38-80-            119            02             CENTRAL SUPPLY
0212100   S STRL CTHAMPLTZ LT II7FR             77            02             CENTRAL SUPPLY
0205526   S STRL CTHAXM-53580821242            760            02             CENTRAL SUPPLY
0204875   S STRL CTHPACE 5F8154 396            606            02             CENTRAL SUPPLY
0210922   S STRL CTHRENL5FRX65CMX38            403            02             CENTRAL SUPPLY
0208025   S STRL CTHTEG ST6X4CM3585           1335            02             CENTRAL SUPPLY
0224196   S STRL CUFF W/TBE BLD WRM            135            02             CENTRAL SUPPLY
0224857   S STRL CUFFD FEN SHILEY 6            320            02             CENTRAL SUPPLY
0214288   S STRL CUP OB VAC LINED              164            02             CENTRAL SUPPLY
0224238   S STRL CVP MANOMETER 4338             77            02             CENTRAL SUPPLY
0208876   S STRL CX10.2-38-25P4SNCL            264            02             CENTRAL SUPPLY
0208892   S STRL CX10.2-38-40-P-32S            374            02             CENTRAL SUPPLY
0208884   S STRL CX-12--38-25P4SNCL            264            02             CENTRAL SUPPLY
0208900   S STRL CX12-38-40-P-32S-             264            02             CENTRAL SUPPLY
0208918   S STRL CX14.38-40-P-32S-             264            02             CENTRAL SUPPLY
0224311   S STRL DENNIS GI TUBE 701            157            02             CENTRAL SUPPLY
0211094   S STRL DIALYSIS,MINI-CAP              28            02             CENTRAL SUPPLY
0209239   S STRL DILATION 5F 4*2CM             798            02             CENTRAL SUPPLY
0208306   S STRL DILATION 5F 5X2 75            937            02             CENTRAL SUPPLY
0207829   S STRL DILATION 7F                  1155            02             CENTRAL SUPPLY
0205427   S STRL DILTR 10F 2390                 44            02             CENTRAL SUPPLY
0205393   S STRL DILTR 12F 2393                 50            02             CENTRAL SUPPLY




                                                  Page 31
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0205401   S STRL DILTR 14F 2392                 50            02             CENTRAL SUPPLY
0205419   S STRL DILTR 16F 2391                 50            02             CENTRAL SUPPLY
0216200   S STRL DILTR JCD 18-38-20             85            02             CENTRAL SUPPLY
0214726   S STRL DILTR MINI STICK 5            340            02             CENTRAL SUPPLY
0211334   S STRL DILTR VSL 4F 21*19             33            02             CENTRAL SUPPLY
0203349   S STRL DILTR, JCD 9-38-20             44            02             CENTRAL SUPPLY
0216176   S STRL DILTR, JCD13-38-20             73            02             CENTRAL SUPPLY
0216184   S STRL DILTR, JCD14-38-20             85            02             CENTRAL SUPPLY
0216192   S STRL DILTR, JCD16-38-20             85            02             CENTRAL SUPPLY
0216218   S STRL DILTR, JCD20-38-20            107            02             CENTRAL SUPPLY
0216234   S STRL DILTR, JCD24-38-20             82            02             CENTRAL SUPPLY
0216242   S STRL DILTR, NCD-4-35-20             53            02             CENTRAL SUPPLY
0216168   S STRL DILTR, TJCD8-38-20             42            02             CENTRAL SUPPLY
0214478   S STRL DILTR, VESL                    29            02             CENTRAL SUPPLY
0208355   S STRL DILTR,JCD1238COON              85            02             CENTRAL SUPPLY
0216226   S STRL DILTR,JCD22-38-20C            107            02             CENTRAL SUPPLY
0212985   S STRL DISP IRIS SCISSOR              28            02             CENTRAL SUPPLY
0213256   S STRL DISP UMBI TRAY                379            02             CENTRAL SUPPLY
0206607   S STRL DRAIN CHEST AUTOTR            511            02             CENTRAL SUPPLY
0205633   S STRL DRAIN SET 20-500              297            02             CENTRAL SUPPLY
0205625   S STRL DRAIN SET 20-503              297            02             CENTRAL SUPPLY
0223917   S STRL DRAINAGE,ULT12.0-3            681            02             CENTRAL SUPPLY
0224329   S STRL DREILING TUBE GI              933            02             CENTRAL SUPPLY
0212696   S STRL DRESS,MICRODON 5X4              5            02             CENTRAL SUPPLY
0212704   S STRL DRESS,MICRODON 5X8              9            02             CENTRAL SUPPLY
0200220   S STRL DRN 1/2*18STER PEN              5            02             CENTRAL SUPPLY
0200238   S STRL DRN 3/4*18STER PEN              5            02             CENTRAL SUPPLY
0213959   S STRL DRN BULB 10                   208            02             CENTRAL SUPPLY
0213314   S STRL DRN BULB SYS 4M               194            02             CENTRAL SUPPLY
0209916   S STRL DRN CHEST TRNS KIT            484            02             CENTRAL SUPPLY
0213751   S STRL DRN FLAT 10 J P                54            02             CENTRAL SUPPLY
0213744   S STRL DRN FLAT 7, JP                 54            02             CENTRAL SUPPLY
0213850   S STRL DRN HEMOVAC 400 15             87            02             CENTRAL SUPPLY
0208967   S STRL DRN MUELLER EMPYNA            340            02             CENTRAL SUPPLY
0213801   S STRL DRN PENROSE 1*12               14            02             CENTRAL SUPPLY
0213777   S STRL DRN PENROSE 1/2*12             11            02             CENTRAL SUPPLY
0213769   S STRL DRN PENROSE 1/4*12              5            02             CENTRAL SUPPLY
0213785   S STRL DRN PENROSE 3/4*12             11            02             CENTRAL SUPPLY
0213793   S STRL DRN PENROSE 7/8*12              5            02             CENTRAL SUPPLY
0263764   S STRL DRN PLEUR EVAC (DR            247            02             CENTRAL SUPPLY
0213264   S STRL DRN TBE TLS10.5 (6            152            02             CENTRAL SUPPLY
0216358   S STRL DRNG, ABSCESS EVAC            102            02             CENTRAL SUPPLY
0262139   S STRL DRSG AQUACEL AG WN             67            02             CENTRAL SUPPLY
0262121   S STRL DRSG AQUACEL SLVR              28            02             CENTRAL SUPPLY
0212746   S STRL DRSG COMF LG 42SQ              58            02             CENTRAL SUPPLY
0212738   S STRL DRSG COMF SM 24SQ              30            02             CENTRAL SUPPLY
0212753   S STRL DRSG COMF ULCER4X4             25            02             CENTRAL SUPPLY
0212720   S STRL DRSG COMFL 2.X2.75             14            02             CENTRAL SUPPLY
0212712   S STRL DRSG COMFL 3.5X5.5             27            02             CENTRAL SUPPLY
0212639   S STRL DRSG DUODERM 6X6               38            02             CENTRAL SUPPLY
0213397   S STRL DRSG IDOF 1                    30            02             CENTRAL SUPPLY
0213694   S STRL DRSG IDOF 2                    42            02             CENTRAL SUPPLY
0214015   S STRL DRSG IODOF 1/2                 27            02             CENTRAL SUPPLY
0213488   S STRL DRSG IODOF 1/2                 38            02             CENTRAL SUPPLY
0213470   S STRL DRSG IODOF 1/4                 26            02             CENTRAL SUPPLY




                                                  Page 32
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0212761   S STRL DRSG NASAL SLING              12            02             CENTRAL SUPPLY
0208397   S STRL DRSG POLYMEM4X5               35            02             CENTRAL SUPPLY
0208389   S STRL DRSG POLYMEN6X6               42            02             CENTRAL SUPPLY
0262113   S STRL DRSG WND AQUACEL H            12            02             CENTRAL SUPPLY
0225938   S STRL DRSG WND VAC LRG             242            02             CENTRAL SUPPLY
0225946   S STRL DRSG WND VAC MED             120            02             CENTRAL SUPPLY
0225953   S STRL DRSG WND VAC SMLL            159            02             CENTRAL SUPPLY
0214213   S STRL DRSG XEROF 1*8                 5            02             CENTRAL SUPPLY
0214049   S STRL DRSG XEROF 2X2                 5            02             CENTRAL SUPPLY
0224725   S STRL DRSGNEG PRSS W/PMP           191            02             CENTRAL SUPPLY
0212936   S STRL DRSGTEGADERM 8*12             16            02             CENTRAL SUPPLY
0214056   S STRL DRSGXEROF 5X9                  5            02             CENTRAL SUPPLY
0260406   S STRL DRSNG FOAM 4X4                36            02             CENTRAL SUPPLY
0260422   S STRL DRSNG FOAM 5.5X6              44            02             CENTRAL SUPPLY
0260414   S STRL DRSNG FOAM 8X8               146            02             CENTRAL SUPPLY
0204503   S STRL DUOSTAT3434                  234            02             CENTRAL SUPPLY
0214411   S STRL EAR WICK, 15 LONG             19            02             CENTRAL SUPPLY
0219709   S STRL ELECT DEFIB TZ PAD           211            02             CENTRAL SUPPLY
0213439   S STRL ELECT, NDL                    12            02             CENTRAL SUPPLY
0214064   S STRL ELECT, PACING ADLT           356            02             CENTRAL SUPPLY
0212845   S STRL EMER INF NDLE 442            157            02             CENTRAL SUPPLY
0213223   S STRL EMERG CARDIOPULMON            31            02             CENTRAL SUPPLY
0213215   S STRL EMERG INTUBATN TRY            31            02             CENTRAL SUPPLY
0224253   S STRL ENDOTRCH TBE 7 852            14            02             CENTRAL SUPPLY
0224279   S STRL ENDOTRCH TBE 8 850            14            02             CENTRAL SUPPLY
0263699   S STRL ENT TRAY                     148            02             CENTRAL SUPPLY
0219592   S STRL EP ABLTN 3D VCT MP          6144            02             CENTRAL SUPPLY
0219584   S STRL EP ABLTN 3D VCT MP          6144            02             CENTRAL SUPPLY
0211078   S STRL EP ABLTN NOCOOL TP           137            02             CENTRAL SUPPLY
0223701   S STRL EP DX NO3D MP GT19          3405            02             CENTRAL SUPPLY
0209536   S STRL EP DX NO3D MP LT20          2189            02             CENTRAL SUPPLY
0209544   S STRL EP DX NO3D MP LT21          1155            02             CENTRAL SUPPLY
0210245   S STRL EP DX NO3D MP LT22          1155            02             CENTRAL SUPPLY
0217489   S STRL EP DX NO3D MP LT23          2674            02             CENTRAL SUPPLY
0217497   S STRL EP DX NO3D MP LT24           632            02             CENTRAL SUPPLY
0217505   S STRL EP DX NO3D MP LT25          1185            02             CENTRAL SUPPLY
0217513   S STRL EP DX NO3D MP LT26          1703            02             CENTRAL SUPPLY
0217521   S STRL EP DX NO3D MP LT27          1976            02             CENTRAL SUPPLY
0217539   S STRL EP DX NO3D MP LT28          4053            02             CENTRAL SUPPLY
0217547   S STRL EP DX NO3D MP LT29          2280            02             CENTRAL SUPPLY
0217554   S STRL EP DX NO3D MP LT30          6161            02             CENTRAL SUPPLY
0217570   S STRL EP DX NO3D MP LT32          1824            02             CENTRAL SUPPLY
0217588   S STRL EP DX NO3D MP LT33           586            02             CENTRAL SUPPLY
0217596   S STRL EP DX NO3D MP LT34           811            02             CENTRAL SUPPLY
0217604   S STRL EP DX NO3D MP LT35          3242            02             CENTRAL SUPPLY
0217612   S STRL EP DX NO3D MP LT36          3242            02             CENTRAL SUPPLY
0219352   S STRL EP DX NO3D MP LT37          7295            02             CENTRAL SUPPLY
0219360   S STRL EP DX NO3D MP LT38          3023            02             CENTRAL SUPPLY
0219378   S STRL EP DX NO3D MP LT39          3023            02             CENTRAL SUPPLY
0219626   S STRL EP DX NO3D MP LT40          6161            02             CENTRAL SUPPLY
0219683   S STRL EP DX NO3D MP LT41          2594            02             CENTRAL SUPPLY
0205799   S STRL ER HEIMLICH SET              535            02             CENTRAL SUPPLY
0211532   S STRL ESMARK, DISP 4                40            02             CENTRAL SUPPLY
0250225   S STRL EXCHNG TRNSFSN DSP           419            02             CENTRAL SUPPLY
0207977   S STRL EXTRACTOR,HELIC3W/           550            02             CENTRAL SUPPLY




                                                 Page 33
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0213066   S STRL EXTRACTR STPL 1360             18            02             CENTRAL SUPPLY
0263186   S STRL EXTRACTR STPL 1360             14            02             CENTRAL SUPPLY
0224527   S STRL FILTER PF2000 542              14            02             CENTRAL SUPPLY
0263434   S STRL FILTER, BLOOD                  46            02             CENTRAL SUPPLY
0224170   S STRL FILTER,TRANSFUSION             35            02             CENTRAL SUPPLY
0262170   S STRL FLNG CONVEX EXTEND              9            02             CENTRAL SUPPLY
0203547   S STRL FOLEY 2WY 5CC 14FR             99            02             CENTRAL SUPPLY
0224600   S STRL FOME-CUFF TRACH9-9            669            02             CENTRAL SUPPLY
0211938   S STRL FORCD, BYCP PC 2.2           1484            02             CENTRAL SUPPLY
0263343   S STRL FORCEP, MOSQUITO C             27            02             CENTRAL SUPPLY
0218529   S STRL FORCEPS BX 2.2*100           1484            02             CENTRAL SUPPLY
0211557   S STRL FORCPS BIOPSY GSTR            528            02             CENTRAL SUPPLY
0219717   S STRL GDE FXD CRV NOPL              811            02             CENTRAL SUPPLY
0219618   S STRL GDE FXD CRV NOPL              187            02             CENTRAL SUPPLY
0219519   S STRL GDE FXD CRV NOPL               85            02             CENTRAL SUPPLY
0219501   S STRL GDE FXD CRV NOPL               85            02             CENTRAL SUPPLY
0219493   S STRL GDE FXD CRV NOPL               85            02             CENTRAL SUPPLY
0219485   S STRL GDE FXD CRV NOPL               85            02             CENTRAL SUPPLY
0219477   S STRL GDE FXD CRV NOPL             1115            02             CENTRAL SUPPLY
0218305   S STRL GDE FXD CRV NOPL              123            02             CENTRAL SUPPLY
0216994   S STRL GDE FXD CRV NOPL              333            02             CENTRAL SUPPLY
0216986   S STRL GDE FXD CRV NOPL              283            02             CENTRAL SUPPLY
0209775   S STRL GDE FXD CRV NOPL              123            02             CENTRAL SUPPLY
0209510   S STRL GDE FXD CRV NOPL              162            02             CENTRAL SUPPLY
0209502   S STRL GDE FXD CRV NOPL              162            02             CENTRAL SUPPLY
0208553   S STRL GDE FXD CRV NOPL              111            02             CENTRAL SUPPLY
0208371   S STRL GDE FXD CRV NOPL              111            02             CENTRAL SUPPLY
0207225   S STRL GDE FXD CRV NOPL             2319            02             CENTRAL SUPPLY
0206805   S STRL GDE FXD CRV NOPL              108            02             CENTRAL SUPPLY
0212365   S STRL GDE FXD CRV PLAWY             333            02             CENTRAL SUPPLY
0212357   S STRL GDE FXD CRV PLAWY             333            02             CENTRAL SUPPLY
0212340   S STRL GDE FXD CRV PLAWY             340            02             CENTRAL SUPPLY
0208348   S STRL GDE FXD CRV PLAWY             364            02             CENTRAL SUPPLY
0209783   S STRL GDEWR INTRO NDL18G             18            02             CENTRAL SUPPLY
0209882   S STRL GDWIRE HTF                    845            02             CENTRAL SUPPLY
0207514   S STRL GDWIRE,INTRD 3186              28            02             CENTRAL SUPPLY
0223834   S STRL GDWIRE,STEERABLE .            632            02             CENTRAL SUPPLY
0213900   S STRL GEL, DERMAL WOUND              27            02             CENTRAL SUPPLY
0202762   S STRL GSTR ENTRC 18F2457           1014            02             CENTRAL SUPPLY
0223958   S STRL GUARDWIRE PLUS 200           5106            02             CENTRAL SUPPLY
0223966   S STRL GUARDWIRE PLUS 300           5106            02             CENTRAL SUPPLY
0211086   S STRL GUN,BIOPSY AUTO 13            777            02             CENTRAL SUPPLY
0209353   S STRL HBP5.5-38-65MNSRC1             98            02             CENTRAL SUPPLY
0209221   S STRL HBP5.5-38-65MNSRDC             98            02             CENTRAL SUPPLY
0209320   S STRL HBP5.5-38-80-MNSC2             98            02             CENTRAL SUPPLY
0209304   S STRL HBP5.5-38-80-MNSC3             98            02             CENTRAL SUPPLY
0209270   S STRL HBP5.5-38-80MNSRDC             98            02             CENTRAL SUPPLY
0203224   S STRL HD/PRITNL SHRT TRM            611            02             CENTRAL SUPPLY
0202705   S STRL HEIMLICH CHEST VLV             81            02             CENTRAL SUPPLY
0202747   S STRL HELC EXTRCTR4W2452            550            02             CENTRAL SUPPLY
0214635   S STRL HEMOFILTER .60M2              485            02             CENTRAL SUPPLY
0202853   S STRL HEMOSPHL FLTR 3514            804            02             CENTRAL SUPPLY
0209171   S STRL HN 6-35-90-M-10S-             137            02             CENTRAL SUPPLY
0209155   S STRL HN 6-38-65-M-10S-             137            02             CENTRAL SUPPLY
0209163   S STRL HN 6-38-80-M-10S-             137            02             CENTRAL SUPPLY




                                                  Page 34
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0209189   S STRL HN6-38-100M10S-PIG            137            02             CENTRAL SUPPLY
0208678   S STRL HNB5-35-65-MCNSRC1            132            02             CENTRAL SUPPLY
0209296   S STRL HNB5-35-80-MC-NS-C            137            02             CENTRAL SUPPLY
0209346   S STRL HNB5-35-80-M-NS-RC            137            02             CENTRAL SUPPLY
0205690   S STRL HYSTO/SALPINGO CAT            159            02             CENTRAL SUPPLY
0219337   S STRL ICP MNTR W/V BOLT            2216            02             CENTRAL SUPPLY
0216812   S STRL IMAGNG MR INSRTBLE           1185            02             CENTRAL SUPPLY
0216572   S STRL IMAGNG MR INSRTBLE            946            02             CENTRAL SUPPLY
0207308   S STRL IMMB,SHLD VLCRO LG             27            02             CENTRAL SUPPLY
0204156   S STRL INDEFLATOR + 20               595            02             CENTRAL SUPPLY
0204404   S STRL INDEFLATOR 2995               675            02             CENTRAL SUPPLY
0202739   S STRL INFLATION PRO 2459            406            02             CENTRAL SUPPLY
0209361   S STRL INFLTN DVICE 20/20            632            02             CENTRAL SUPPLY
0250241   S STRL INFSN NOHEMODIALYS              6            02             CENTRAL SUPPLY
0250233   S STRL INFSN NOHEMODIALYS              6            02             CENTRAL SUPPLY
0219329   S STRL INFSN NOHEMODIALYS            276            02             CENTRAL SUPPLY
0217877   S STRL INFSN NOHEMODIALYS           1047            02             CENTRAL SUPPLY
0217869   S STRL INFSN NOHEMODIALYS            276            02             CENTRAL SUPPLY
0217455   S STRL INFSN NOHEMODIALYS            285            02             CENTRAL SUPPLY
0217380   S STRL INFSN NOHEMODIALYS           1047            02             CENTRAL SUPPLY
0216648   S STRL INFSN NOHEMODIALYS            602            02             CENTRAL SUPPLY
0216044   S STRL INFSN NOHEMODIALYS            577            02             CENTRAL SUPPLY
0216036   S STRL INFSN NOHEMODIALYS            623            02             CENTRAL SUPPLY
0216028   S STRL INFSN NOHEMODIALYS            577            02             CENTRAL SUPPLY
0216010   S STRL INFSN NOHEMODIALYS            665            02             CENTRAL SUPPLY
0216002   S STRL INFSN NOHEMODIALYS            644            02             CENTRAL SUPPLY
0215947   S STRL INFSN NOHEMODIALYS            644            02             CENTRAL SUPPLY
0215939   S STRL INFSN NOHEMODIALYS            521            02             CENTRAL SUPPLY
0214734   S STRL INFSN NOHEMODIALYS            256            02             CENTRAL SUPPLY
0214643   S STRL INFSN NOHEMODIALYS            577            02             CENTRAL SUPPLY
0212266   S STRL INFSN NOHEMODIALYS            460            02             CENTRAL SUPPLY
0212258   S STRL INFSN NOHEMODIALYS            460            02             CENTRAL SUPPLY
0211359   S STRL INFSN NOHEMODIALYS            460            02             CENTRAL SUPPLY
0210450   S STRL INFSN NOHEMODIALYS            557            02             CENTRAL SUPPLY
0210427   S STRL INFSN NOHEMODIALYS            557            02             CENTRAL SUPPLY
0210419   S STRL INFSN NOHEMODIALYS            557            02             CENTRAL SUPPLY
0210229   S STRL INFSN NOHEMODIALYS           1489            02             CENTRAL SUPPLY
0210211   S STRL INFSN NOHEMODIALYS            254            02             CENTRAL SUPPLY
0209700   S STRL INFSN NOHEMODIALYS            117            02             CENTRAL SUPPLY
0209569   S STRL INFSN NOHEMODIALYS           1467            02             CENTRAL SUPPLY
0207258   S STRL INFSN NOHEMODIALYS           1040            02             CENTRAL SUPPLY
0206714   S STRL INFSN NOHEMODIALYS            464            02             CENTRAL SUPPLY
0206623   S STRL INFSN NOHEMODIALYS           1489            02             CENTRAL SUPPLY
0206557   S STRL INFSN NOHEMODIALYS             76            02             CENTRAL SUPPLY
0206540   S STRL INFSN NOHEMODIALYS             72            02             CENTRAL SUPPLY
0206532   S STRL INFSN NOHEMODIALYS           1258            02             CENTRAL SUPPLY
0206516   S STRL INFSN NOHEMODIALYS            887            02             CENTRAL SUPPLY
0206508   S STRL INFSN NOHEMODIALYS            887            02             CENTRAL SUPPLY
0205906   S STRL INFSN NOHEMODIALYS            734            02             CENTRAL SUPPLY
0204636   S STRL INFSN NOHEMODIALYS           1184            02             CENTRAL SUPPLY
0212951   S STRL INST DSP CATRY 491             54            02             CENTRAL SUPPLY
0213017   S STRL INST DSP CRV MOSQT             32            02             CENTRAL SUPPLY
0213058   S STRL INST DSP NDLE HOLD             35            02             CENTRAL SUPPLY
0213041   S STRL INST DSP ST MOSQT              32            02             CENTRAL SUPPLY
0213033   S STRL INST DSP THUMB FOR             24            02             CENTRAL SUPPLY




                                                  Page 35
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0213025   S STRL INST DSP TSSE FRCP             26            02             CENTRAL SUPPLY
0262816   S STRL INST YANKAUER REG               5            02             CENTRAL SUPPLY
0211680   S STRL INST, CHST CLMP 6              48            02             CENTRAL SUPPLY
0204644   S STRL INTRACATH 16GX880              39            02             CENTRAL SUPPLY
0204651   S STRL INTRACTH22 X 8 78              36            02             CENTRAL SUPPLY
0224733   S STRL INTRASPINAL                  2578            02             CENTRAL SUPPLY
0218800   S STRL INTRASPINAL                    90            02             CENTRAL SUPPLY
0218792   S STRL INTRASPINAL                    90            02             CENTRAL SUPPLY
0218784   S STRL INTRASPINAL                    90            02             CENTRAL SUPPLY
0218776   S STRL INTRASPINAL                    90            02             CENTRAL SUPPLY
0218768   S STRL INTRASPINAL                    90            02             CENTRAL SUPPLY
0218750   S STRL INTRASPINAL                    90            02             CENTRAL SUPPLY
0218743   S STRL INTRASPINAL                    90            02             CENTRAL SUPPLY
0218735   S STRL INTRASPINAL                    90            02             CENTRAL SUPPLY
0218727   S STRL INTRASPINAL                   324            02             CENTRAL SUPPLY
0218719   S STRL INTRASPINAL                  3458            02             CENTRAL SUPPLY
0217901   S STRL INTRASPINAL                  3351            02             CENTRAL SUPPLY
0216689   S STRL INTRASPINAL                  2578            02             CENTRAL SUPPLY
0212969   S STRL INTRAUTERINE KIT              174            02             CENTRAL SUPPLY
0219238   S STRL INTRAVASCULAR US             3134            02             CENTRAL SUPPLY
0219220   S STRL INTRAVASCULAR US             3134            02             CENTRAL SUPPLY
0203000   S STRL INTRAVASCULAR US             3134            02             CENTRAL SUPPLY
0219436   S STRL INTRD 14C 10.5FR              483            02             CENTRAL SUPPLY
0219410   S STRL INTRD 14CM 9.5FR              483            02             CENTRAL SUPPLY
0219444   S STRL INTRD 14CM F 11F              483            02             CENTRAL SUPPLY
0219428   S STRL INTRD 14CM/10F                483            02             CENTRAL SUPPLY
0224485   S STRL INTRD 6F HEMAQT TS             70            02             CENTRAL SUPPLY
0214569   S STRL INTRD ACCUSTICK II            364            02             CENTRAL SUPPLY
0206763   S STRL INTRD B KIT 9FR               190            02             CENTRAL SUPPLY
0214809   S STRL INTRD MCRPNCTRE ST            211            02             CENTRAL SUPPLY
0219402   S STRL INTRD SEAL-AWAY 14            483            02             CENTRAL SUPPLY
0219394   S STRL INTRD SEAL-AWAY 14            483            02             CENTRAL SUPPLY
0219386   S STRL INTRD SEAL-AWAY 14            483            02             CENTRAL SUPPLY
0219675   S STRL INTRDCR TRANS 8.5F            632            02             CENTRAL SUPPLY
0224402   S STRL INTRO HEMDIAL CATH            388            02             CENTRAL SUPPLY
0262220   S STRL IRR SYSTEM VISI FL             92            02             CENTRAL SUPPLY
0203273   S STRL JCD5 38 20 5F                  44            02             CENTRAL SUPPLY
0203307   S STRL JCD8 38 20 8F                  44            02             CENTRAL SUPPLY
0203299   S STRL JCDF 38 20 7F                  44            02             CENTRAL SUPPLY
0262147   S STRL KIST FECAL MGMT SY           1232            02             CENTRAL SUPPLY
0215491   S STRL KIT ACES 20/30 M              373            02             CENTRAL SUPPLY
0263152   S STRL KIT ACTH 8FR                   13            02             CENTRAL SUPPLY
0217851   S STRL KIT ANGIO 6FR                 186            02             CENTRAL SUPPLY
0263749   S STRL KIT CATH MLUM CVC             172            02             CENTRAL SUPPLY
0217836   S STRL KIT CT INJECTR SYR             73            02             CENTRAL SUPPLY
0205716   S STRL KIT CUSTOM TRNSDCR             84            02             CENTRAL SUPPLY
0214486   S STRL KIT GASTRIC LAVAGE            144            02             CENTRAL SUPPLY
0263491   S STRL KIT GASTRIC LAVAGE             53            02             CENTRAL SUPPLY
0211698   S STRL KIT GU GUIDE                  139            02             CENTRAL SUPPLY
0214577   S STRL KIT INTRD 8.5FR               283            02             CENTRAL SUPPLY
0205971   S STRL KIT INTRO 8F 3307             112            02             CENTRAL SUPPLY
0262204   S STRL KIT IRR COMBO CONE             45            02             CENTRAL SUPPLY
0215673   S STRL KIT IRRIGATION WIT            161            02             CENTRAL SUPPLY
0213975   S STRL KIT LAVAGE GASTRIC             57            02             CENTRAL SUPPLY
0212910   S STRL KIT OSTY IRRIGATOR            282            02             CENTRAL SUPPLY




                                                  Page 36
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0202820   S STRL KIT SPECIALS TUBE            172            02             CENTRAL SUPPLY
0262832   S STRL KIT SUCTION                    5            02             CENTRAL SUPPLY
0219634   S STRL KIT TRANSPAC IV 3             77            02             CENTRAL SUPPLY
0263566   S STRL KIT TRANSPAC IV 3             77            02             CENTRAL SUPPLY
0223941   S STRL KIT TRAUMA CVP DIS          1446            02             CENTRAL SUPPLY
0202796   S STRL KIT TWIST DRILL             1332            02             CENTRAL SUPPLY
0214031   S STRL KIT UNIV BRST PUMP           161            02             CENTRAL SUPPLY
0224410   S STRL KIT VAGINAL IRRIG             14            02             CENTRAL SUPPLY
0202804   S STRL KT ICP MNTRNG 2434          2264            02             CENTRAL SUPPLY
0260273   S STRL KT PRSRE MONTR H-P           132            02             CENTRAL SUPPLY
0260083   S STRL KT PRSRE MONTR H-P           132            02             CENTRAL SUPPLY
0210633   S STRL KT RESDL CHLOR TST           164            02             CENTRAL SUPPLY
0224535   S STRL KT TRNSDCER/ARTERL            79            02             CENTRAL SUPPLY
0263624   S STRL LAC TRAY                      94            02             CENTRAL SUPPLY
0250282   S STRL LENS MORGN THRAPTI           133            02             CENTRAL SUPPLY
0208165   S STRL LEVEENINFLATW/GAUG          1278            02             CENTRAL SUPPLY
0213165   S STRL LMBRPUNC ADLT TRAY           117            02             CENTRAL SUPPLY
0213173   S STRL LMBRPUNC PEDI TRAY           116            02             CENTRAL SUPPLY
0224576   S STRL M/M PRSS TBE48690             12            02             CENTRAL SUPPLY
0262485   S STRL MAMMOTOME VACUUM              46            02             CENTRAL SUPPLY
0263079   S STRL MASK NONREBREATHER            10            02             CENTRAL SUPPLY
0214254   S STRL MASK, TRACH AERO              11            02             CENTRAL SUPPLY
0261891   S STRL MICROPORE BLD FLTR            39            02             CENTRAL SUPPLY
0225961   S STRL MITYVAC BRST PUMP            136            02             CENTRAL SUPPLY
0263673   S STRL MORGAN EYE IRG LNS           116            02             CENTRAL SUPPLY
0213181   S STRL MYLOGRM 22G TRY517            92            02             CENTRAL SUPPLY
0217331   S STRL NDL 14G 11CM                 281            02             CENTRAL SUPPLY
0217349   S STRL NDL 14G 9CM                  281            02             CENTRAL SUPPLY
0216705   S STRL NDL ADN-18-7                  58            02             CENTRAL SUPPLY
0209445   S STRL NDL AMPLZ SL 12266            50            02             CENTRAL SUPPLY
0202374   S STRL NDL A-V FISTULA16X             5            02             CENTRAL SUPPLY
0212803   S STRL NDL BIOP BRST21X3C           122            02             CENTRAL SUPPLY
0212787   S STRL NDL BPSY BNE 16X2             52            02             CENTRAL SUPPLY
0250142   S STRL NDL BPSY CHIBA 22G            48            02             CENTRAL SUPPLY
0210344   S STRL NDL BREAST 20*71/2           122            02             CENTRAL SUPPLY
0212779   S STRL NDL BX CHIBA 20G 6           141            02             CENTRAL SUPPLY
0212811   S STRL NDL BX CHIBA 22-20            83            02             CENTRAL SUPPLY
0216721   S STRL NDL BX QC18-15-20T           256            02             CENTRAL SUPPLY
0216739   S STRL NDL BX QC20-15-20T           272            02             CENTRAL SUPPLY
0216762   S STRL NDL COAXIAL QCS18-           370            02             CENTRAL SUPPLY
0214759   S STRL NDL COAXIAL QCS20-           370            02             CENTRAL SUPPLY
0212589   S STRL NDL CORE BIOPSY 16           245            02             CENTRAL SUPPLY
0216713   S STRL NDL CORE BX 18G*9            272            02             CENTRAL SUPPLY
0216770   S STRL NDL COURND MOD 18G            26            02             CENTRAL SUPPLY
0214692   S STRL NDL DCHN 25-15 CVD           360            02             CENTRAL SUPPLY
0207944   S STRL NDL DLPN406RG 9174           251            02             CENTRAL SUPPLY
0214775   S STRL NDL DSCOGRPHY 25G             75            02             CENTRAL SUPPLY
0209791   S STRL NDL FISTLA ULT17GA             5            02             CENTRAL SUPPLY
0224741   S STRL NDL INTRD ORTC 17            320            02             CENTRAL SUPPLY
0219659   S STRL NDL KIT GUIDE 21G            113            02             CENTRAL SUPPLY
0202879   S STRL NDL KOPANS 21G*5             151            02             CENTRAL SUPPLY
0214783   S STRL NDL NERVE BLOCK               32            02             CENTRAL SUPPLY
0216796   S STRL NDL ONEWALL S18G*             26            02             CENTRAL SUPPLY
0216804   S STRL NDL PAKTER LONG SP           347            02             CENTRAL SUPPLY
0214460   S STRL NDL POTTS-COURNAND            38            02             CENTRAL SUPPLY




                                                 Page 37
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0223784   S STRL NDL QC/14/9/20T               264            02             CENTRAL SUPPLY
0212852   S STRL NDL SPNL 18G*3-1/2             14            02             CENTRAL SUPPLY
0216820   S STRL NDL SPNL 18G*8                129            02             CENTRAL SUPPLY
0212860   S STRL NDL SPNL 19G*3-1/2             14            02             CENTRAL SUPPLY
0212878   S STRL NDL SPNL 20G*3-1/2             14            02             CENTRAL SUPPLY
0213868   S STRL NDL SPNL 22G 5                 33            02             CENTRAL SUPPLY
0216838   S STRL NDL SPNL 22G*10               129            02             CENTRAL SUPPLY
0250209   S STRL NDL SPNL 22G*1-1/2             14            02             CENTRAL SUPPLY
0212886   S STRL NDL SPNL 22G*3-1/2             14            02             CENTRAL SUPPLY
0214585   S STRL NDL SPNL 25G*2-1/2             14            02             CENTRAL SUPPLY
0250092   S STRL NDL SPNL22G*1-1/2              14            02             CENTRAL SUPPLY
0217844   S STRL NDL SPROTTE SPNL              119            02             CENTRAL SUPPLY
0214122   S STRL NDL SPRT 25*4-1/16             78            02             CENTRAL SUPPLY
0214130   S STRL NDL SPRTE 25*3-1/2             65            02             CENTRAL SUPPLY
0219527   S STRL NDL TRANSSEPTAL BR           1368            02             CENTRAL SUPPLY
0219451   S STRL NDL TRANSSEPTAL BR           1368            02             CENTRAL SUPPLY
0219535   S STRL NDL TRANSSEPTL BRK           1368            02             CENTRAL SUPPLY
0260059   S STRL NDL,BPSY 22G WESC              77            02             CENTRAL SUPPLY
0260281   S STRL NDL,BPSY DCHN 20G*             85            02             CENTRAL SUPPLY
0260042   S STRL NDL,BPSY DCHN 20G*             85            02             CENTRAL SUPPLY
0250183   S STRL NDL,SPNL 22G*2-1/2             14            02             CENTRAL SUPPLY
0250191   S STRL NDL,SPNL 25G*3-1/2             14            02             CENTRAL SUPPLY
0262907   S STRL NEB MICROMIST HAND              5            02             CENTRAL SUPPLY
0262774   S STRL NEEDLE, 30G 1"                  5            02             CENTRAL SUPPLY
0260299   S STRL NEEDLE,BIOPSY WESC             77            02             CENTRAL SUPPLY
0224337   S STRL NET 2.5 ROT RETRV             373            02             CENTRAL SUPPLY
0224386   S STRL NOINTRACARD NOLSR             175            02             CENTRAL SUPPLY
0223792   S STRL NOINTRACARD NOLSR             756            02             CENTRAL SUPPLY
0216929   S STRL NOINTRACARD NOLSR             306            02             CENTRAL SUPPLY
0210328   S STRL NOINTRACARD NOLSR             251            02             CENTRAL SUPPLY
0209437   S STRL NOINTRACARD NOLSR             300            02             CENTRAL SUPPLY
0209429   S STRL NOINTRACARD NOLSR             308            02             CENTRAL SUPPLY
0202788   S STRL NOINTRACARD NOLSR             175            02             CENTRAL SUPPLY
0208330   S STRL OATH,OLBRT4X4 90CM           1672            02             CENTRAL SUPPLY
0213249   S STRL OB DEL INSTS                  171            02             CENTRAL SUPPLY
0206961   S STRL OBTURATOR, 7F 3229             10            02             CENTRAL SUPPLY
0223800   S STRL OCCLUSION                     630            02             CENTRAL SUPPLY
0205955   S STRL OCCLUSION                    1014            02             CENTRAL SUPPLY
0208322   S STRL OLBRT 5.8 4X4 90CM           1216            02             CENTRAL SUPPLY
0212902   S STRL OSTMY, PREM PASTE              56            02             CENTRAL SUPPLY
0213496   S STRL PAD GROUND PEDI                39            02             CENTRAL SUPPLY
0263756   S STRL PAD MULTI FUNCTION            193            02             CENTRAL SUPPLY
0213298   S STRL PENCIL ESU                     28            02             CENTRAL SUPPLY
0214221   S STRL PENCIL ESU HAND                30            02             CENTRAL SUPPLY
0214197   S STRL PENCIL ESU HAND 2              23            02             CENTRAL SUPPLY
0205914   S STRL PERC INTRO 8F                  85            02             CENTRAL SUPPLY
0213231   S STRL PERICARD TRAY                 823            02             CENTRAL SUPPLY
0202960   S STRL PINS, SKULL                  1103            02             CENTRAL SUPPLY
0263384   S STRL PKG IODOFORM                   31            02             CENTRAL SUPPLY
0263251   S STRL PKG PLN 1                      20            02             CENTRAL SUPPLY
0250118   S STRL PLSTR,ROLL 2"*3YDS             12            02             CENTRAL SUPPLY
0250126   S STRL PLSTR,ROLL 5"*5YDS             26            02             CENTRAL SUPPLY
0250134   S STRL PLSTR,ROLL 6"*5YDS             29            02             CENTRAL SUPPLY
0263640   S STRL PLUMSET BLOOD W/CL            111            02             CENTRAL SUPPLY
0202721   S STRL PORT-A-CTH TRY1868             49            02             CENTRAL SUPPLY




                                                  Page 38
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0207555   S STRL POSTR CURV 15X13X4           186            02             CENTRAL SUPPLY
0262253   S STRL POUCH CLAMP                    5            02             CENTRAL SUPPLY
0262378   S STRL POUCH CTF UROSTOMY             9            02             CENTRAL SUPPLY
0262162   S STRL POUCH OSTOMY CPL 2             5            02             CENTRAL SUPPLY
0262360   S STRL POUCH OSTOMY CUT T             8            02             CENTRAL SUPPLY
0262246   S STRL POUCH PREMIER DRNA            55            02             CENTRAL SUPPLY
0262188   S STRL POUCH UROSTOMY                 5            02             CENTRAL SUPPLY
0262196   S STRL POUCH UROSTOMY PRE            13            02             CENTRAL SUPPLY
0262519   S STRL PROBE GUIDE                   20            02             CENTRAL SUPPLY
0202002   S STRL PUMPSET W/COL BAG           1368            02             CENTRAL SUPPLY
0216598   S STRL PVA PRTCL 300-500            689            02             CENTRAL SUPPLY
0216606   S STRL PVA PRTCL 500-700            689            02             CENTRAL SUPPLY
0216614   S STRL PVA PRTCL 700-1000           664            02             CENTRAL SUPPLY
0212308   S STRL RESERVOIR 100CC               49            02             CENTRAL SUPPLY
0213306   S STRL RESERVOIR, JP                104            02             CENTRAL SUPPLY
0207332   S STRL RHINO ROCKT NSL PK           168            02             CENTRAL SUPPLY
0216457   S STRL RSRVR 1L SUCT DRN            171            02             CENTRAL SUPPLY
0216440   S STRL RSRVR 500ML SUCT             151            02             CENTRAL SUPPLY
0202986   S STRL RTABLTR TRQUE15882            90            02             CENTRAL SUPPLY
0200618   S STRL S.T.I.C. QUICK SET           513            02             CENTRAL SUPPLY
0263467   S STRL SCLP NBR 10,11 15             48            02             CENTRAL SUPPLY
0214619   S STRL SET BLOOD PUMP               108            02             CENTRAL SUPPLY
0214007   S STRL SET BLOOD PUMP Y              16            02             CENTRAL SUPPLY
0224204   S STRL SET BLOOD-Y TUBE              14            02             CENTRAL SUPPLY
0216671   S STRL SET COPE CWGE-100            559            02             CENTRAL SUPPLY
0213686   S STRL SET DECANTING                 11            02             CENTRAL SUPPLY
0208744   S STRL SET DRN EMPYEMA              308            02             CENTRAL SUPPLY
0214403   S STRL SET FLUID WARMING             85            02             CENTRAL SUPPLY
0263681   S STRL SET FLUID WARMING            120            02             CENTRAL SUPPLY
0263376   S STRL SET IRR CYSTOSCOPY            27            02             CENTRAL SUPPLY
0224220   S STRL SET IRRG EXT CYSTO            13            02             CENTRAL SUPPLY
0214312   S STRL SET IRRIG CYSTO               33            02             CENTRAL SUPPLY
0213702   S STRL SET IRRIG TUR Y               56            02             CENTRAL SUPPLY
0208975   S STRL SET RENAL DIL 3329          1230            02             CENTRAL SUPPLY
0214627   S STRL SET TBG PUMP BLOOD           129            02             CENTRAL SUPPLY
0263772   S STRL SET, CHRICOTHYROTO           676            02             CENTRAL SUPPLY
0260307   S STRL SET, NEBULIZER                25            02             CENTRAL SUPPLY
0212332   S STRL SET,CATH H/S 7FR             181            02             CENTRAL SUPPLY
0260034   S STRL SET,NEBULIZER                 25            02             CENTRAL SUPPLY
0207969   S STRL SET,NEPH.MALCT14F            652            02             CENTRAL SUPPLY
0207183   S STRL SET,SIMP/LOCK NEPH           777            02             CENTRAL SUPPLY
0207191   S STRL SET,THERMOSET INLI           100            02             CENTRAL SUPPLY
0209684   S STRL SHEATH, OBTUR 5F              18            02             CENTRAL SUPPLY
0209692   S STRL SHEATH, OBTUR 6F              10            02             CENTRAL SUPPLY
0210237   S STRL SHEATH,OBTRATR 9FR            50            02             CENTRAL SUPPLY
0210393   S STRL SHEATH,PTCA8FX11CM           163            02             CENTRAL SUPPLY
0223909   S STRL SHEATH,SAFE INTRO            438            02             CENTRAL SUPPLY
0219303   S STRL SHELL, BREAST STRL            73            02             CENTRAL SUPPLY
0207340   S STRL SHETH/LND4.8F11963            71            02             CENTRAL SUPPLY
0263400   S STRL SHOE CAST LG (POST            37            02             CENTRAL SUPPLY
0263533   S STRL SINUS PK,DOYLE SLM            65            02             CENTRAL SUPPLY
0219667   S STRL SLEEVE,STRL PACMKR           143            02             CENTRAL SUPPLY
0207654   S STRL SMRTNDL ASBLY12176           632            02             CENTRAL SUPPLY
0205740   S STRL SP/CYSTOSCOPIC               221            02             CENTRAL SUPPLY
0205732   S STRL SP/CYSTOSCOPIC               221            02             CENTRAL SUPPLY




                                                 Page 39
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0213728   S STRL SPEAR, SURG EYE               12            02             CENTRAL SUPPLY
0214189   S STRL SPEC, VAG MD ILLUM            11            02             CENTRAL SUPPLY
0262782   S STRL SPEC, VAG SM ILLUM             5            02             CENTRAL SUPPLY
0263194   S STRL SPECULUM VAG MED D            14            02             CENTRAL SUPPLY
0263095   S STRL SPINAL NEEDLES                11            02             CENTRAL SUPPLY
0216697   S STRL SPINE NDL 17G*19             320            02             CENTRAL SUPPLY
0262303   S STRL SPLNT SCOTCH CAST             36            02             CENTRAL SUPPLY
0262295   S STRL SPLNT SCOTCH CAST             29            02             CENTRAL SUPPLY
0262287   S STRL SPLNT SCOTCH CAST             10            02             CENTRAL SUPPLY
0262279   S STRL SPLNT SCOTCH CAST             28            02             CENTRAL SUPPLY
0262261   S STRL SPLNT SCOTCH CAST              6            02             CENTRAL SUPPLY
0214601   S STRL ST BLOOD W/HND PMP            25            02             CENTRAL SUPPLY
0207522   S STRL ST,ENTERAL TBE1850           427            02             CENTRAL SUPPLY
0213322   S STRL STETHOSCPE ESOPH 1            32            02             CENTRAL SUPPLY
0210252   S STRL STIC INDWELL CATH            353            02             CENTRAL SUPPLY
0262527   S STRL STIFFENING CANNULA            22            02             CENTRAL SUPPLY
0224121   S STRL STOPCK LL 3-WY W/              9            02             CENTRAL SUPPLY
0263558   S STRL STPLR SKIN                    69            02             CENTRAL SUPPLY
0263103   S STRL STRAINER URINARY              11            02             CENTRAL SUPPLY
0213108   S STRL SUT SILK 3-0                  13            02             CENTRAL SUPPLY
0213082   S STRL SUT SILK 3-0                   9            02             CENTRAL SUPPLY
0213090   S STRL SUT SILK 4-0                   9            02             CENTRAL SUPPLY
0216622   S STRL SUT, POLYSORB 4-0             11            02             CENTRAL SUPPLY
0211060   S STRL SUT,VICRYL 4                  11            02             CENTRAL SUPPLY
0250274   S STRL SUTR,MONOSF 3-0C-1             9            02             CENTRAL SUPPLY
0250266   S STRL SUTR,POLYDEK O 6-9            31            02             CENTRAL SUPPLY
0263228   S STRL SUTURES                       18            02             CENTRAL SUPPLY
0222695   S STRL SYRNG 500-700 2ML           1278            02             CENTRAL SUPPLY
0251082   S STRL SYRNG,INJCTR 150ML            36            02             CENTRAL SUPPLY
0213892   S STRL TBE GI FEEDNG 5X15             5            02             CENTRAL SUPPLY
0224543   S STRL TBE PRSS MON F/M48            12            02             CENTRAL SUPPLY
0224188   S STRL TBE SPKE CNTRST LG            27            02             CENTRAL SUPPLY
0224584   S STRL TESIS SET TUBE 800            19            02             CENTRAL SUPPLY
0202689   S STRL THORA-FLX CHST DRN           301            02             CENTRAL SUPPLY
0202697   S STRL THORA-KLEX PEDI              333            02             CENTRAL SUPPLY
0217372   S STRL THROMB/EMBOLECTOMY          4620            02             CENTRAL SUPPLY
0215004   S STRL THROMB/EMBOLECTOMY          3242            02             CENTRAL SUPPLY
0214999   S STRL THROMB/EMBOLECTOMY          3242            02             CENTRAL SUPPLY
0262733   S STRL TICK NIPPERS                  49            02             CENTRAL SUPPLY
0204024   S STRL TORQUE DEVICE 1651            71            02             CENTRAL SUPPLY
0215608   S STRL TORQUE DEVICE OTD             70            02             CENTRAL SUPPLY
0224626   S STRL TRACH *8 SHILY 477           275            02             CENTRAL SUPPLY
0224667   S STRL TRACH 8 N/CFF FN             343            02             CENTRAL SUPPLY
0214270   S STRL TRACH BALLARD                171            02             CENTRAL SUPPLY
0224139   S STRL TRACH BUTN OLY 10X           679            02             CENTRAL SUPPLY
0202069   S STRL TRACH BUTTN 13*27            679            02             CENTRAL SUPPLY
0224634   S STRL TRACH SHILEY 10              298            02             CENTRAL SUPPLY
0224691   S STRL TRACH SHLY IN/CN 6            29            02             CENTRAL SUPPLY
0224709   S STRL TRACH SHLY IN/CN 8            29            02             CENTRAL SUPPLY
0250076   S STRL TRACH TUBE HOLDER             19            02             CENTRAL SUPPLY
0210203   S STRL TRACH TUBE HOLDER             19            02             CENTRAL SUPPLY
0224642   S STRL TRACH,SHILEY FENST           296            02             CENTRAL SUPPLY
0224618   S STRL TRACHEOTOMY SHILEY           339            02             CENTRAL SUPPLY
0202416   S STRL TRANS BREATH CIRC             56            02             CENTRAL SUPPLY
0213124   S STRL TRAY BASIC BIOPSY             99            02             CENTRAL SUPPLY




                                                 Page 40
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0213967   S STRL TRAY CATH VEIN CNT            131            02             CENTRAL SUPPLY
0219311   S STRL TRAY CIRCMCISN,DSP            113            02             CENTRAL SUPPLY
0212209   S STRL TRAY EPDRL BURRON             170            02             CENTRAL SUPPLY
0202937   S STRL TRAY FOLY CATH INS             16            02             CENTRAL SUPPLY
0260430   S STRL TRAY I&D                       54            02             CENTRAL SUPPLY
0214114   S STRL TRAY INTRO PERCU C            221            02             CENTRAL SUPPLY
0214080   S STRL TRAY LUMBAR PUNCTU            117            02             CENTRAL SUPPLY
0214304   S STRL TRAY SPNL 25G DISP            111            02             CENTRAL SUPPLY
0213538   S STRL TRAY SPNL EPDRL               170            02             CENTRAL SUPPLY
0213207   S STRL TRAY THORACENTISIS            166            02             CENTRAL SUPPLY
0263202   S STRL TRAY URET CATH                 15            02             CENTRAL SUPPLY
0260364   S STRL TRAY,PICC LINE INS            234            02             CENTRAL SUPPLY
0213272   S STRL TRAYCTH URTHRL15FR             17            02             CENTRAL SUPPLY
0224147   S STRL TRCH BTTN OLY11*40            679            02             CENTRAL SUPPLY
0224675   S STRL TRCH CFF FEN8 2335            298            02             CENTRAL SUPPLY
0224659   S STRL TRCH SHILY FENSTR6            321            02             CENTRAL SUPPLY
0250084   S STRL TRNSLML ANGI NOLSR           1216            02             CENTRAL SUPPLY
0250068   S STRL TRNSLML ANGI NOLSR           2027            02             CENTRAL SUPPLY
0250043   S STRL TRNSLML ANGI NOLSR           2027            02             CENTRAL SUPPLY
0223644   S STRL TRNSLML ANGI NOLSR           1308            02             CENTRAL SUPPLY
0223628   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223610   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223602   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223594   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223586   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223578   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223560   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223552   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223545   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223537   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223529   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223511   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223503   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223495   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223487   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223479   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223461   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223453   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223446   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223438   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0223420   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0219980   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0219972   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0219964   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0219956   S STRL TRNSLML ANGI NOLSR           1744            02             CENTRAL SUPPLY
0219949   S STRL TRNSLML ANGI NOLSR           1744            02             CENTRAL SUPPLY
0219931   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0219923   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0219915   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0219907   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0219899   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0219881   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0219873   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0219865   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0219857   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY




                                                  Page 41
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0219840   S STRL TRNSLML ANGI NOLSR           1744            02             CENTRAL SUPPLY
0219832   S STRL TRNSLML ANGI NOLSR           1744            02             CENTRAL SUPPLY
0219824   S STRL TRNSLML ANGI NOLSR           1744            02             CENTRAL SUPPLY
0219816   S STRL TRNSLML ANGI NOLSR           1744            02             CENTRAL SUPPLY
0219808   S STRL TRNSLML ANGI NOLSR           1744            02             CENTRAL SUPPLY
0219790   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0219782   S STRL TRNSLML ANGI NOLSR           1744            02             CENTRAL SUPPLY
0219774   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0219766   S STRL TRNSLML ANGI NOLSR           1744            02             CENTRAL SUPPLY
0219758   S STRL TRNSLML ANGI NOLSR           1744            02             CENTRAL SUPPLY
0219741   S STRL TRNSLML ANGI NOLSR           1744            02             CENTRAL SUPPLY
0219733   S STRL TRNSLML ANGI NOLSR           1744            02             CENTRAL SUPPLY
0219725   S STRL TRNSLML ANGI NOLSR           2128            02             CENTRAL SUPPLY
0219204   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0219196   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0219188   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0219170   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0219162   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0219154   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0219147   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0219139   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0219121   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0219113   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0219105   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0219097   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0219089   S STRL TRNSLML ANGI NOLSR           1837            02             CENTRAL SUPPLY
0219063   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0219055   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0219030   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0219022   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0219014   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0219006   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218990   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218982   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218974   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218966   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218958   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218941   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218933   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218925   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218917   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0218909   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218891   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218883   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0218875   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0218867   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0218859   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0218842   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0218834   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0218826   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0218818   S STRL TRNSLML ANGI NOLSR           1642            02             CENTRAL SUPPLY
0218701   S STRL TRNSLML ANGI NOLSR           1824            02             CENTRAL SUPPLY
0218693   S STRL TRNSLML ANGI NOLSR           1824            02             CENTRAL SUPPLY
0218685   S STRL TRNSLML ANGI NOLSR           2594            02             CENTRAL SUPPLY
0218677   S STRL TRNSLML ANGI NOLSR           2594            02             CENTRAL SUPPLY




                                                  Page 42
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0218669   S STRL TRNSLML ANGI NOLSR           2594            02             CENTRAL SUPPLY
0218651   S STRL TRNSLML ANGI NOLSR           2594            02             CENTRAL SUPPLY
0218644   S STRL TRNSLML ANGI NOLSR           2594            02             CENTRAL SUPPLY
0218636   S STRL TRNSLML ANGI NOLSR           2594            02             CENTRAL SUPPLY
0218628   S STRL TRNSLML ANGI NOLSR           2594            02             CENTRAL SUPPLY
0218610   S STRL TRNSLML ANGI NOLSR           2594            02             CENTRAL SUPPLY
0218602   S STRL TRNSLML ANGI NOLSR           2594            02             CENTRAL SUPPLY
0218594   S STRL TRNSLML ANGI NOLSR           2594            02             CENTRAL SUPPLY
0218586   S STRL TRNSLML ANGI NOLSR           2594            02             CENTRAL SUPPLY
0218578   S STRL TRNSLML ANGI NOLSR           2594            02             CENTRAL SUPPLY
0218560   S STRL TRNSLML ANGI NOLSR           2594            02             CENTRAL SUPPLY
0218552   S STRL TRNSLML ANGI NOLSR           2594            02             CENTRAL SUPPLY
0218545   S STRL TRNSLML ANGI NOLSR           2594            02             CENTRAL SUPPLY
0218537   S STRL TRNSLML ANGI NOLSR           2594            02             CENTRAL SUPPLY
0218420   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0218404   S STRL TRNSLML ANGI NOLSR           1837            02             CENTRAL SUPPLY
0218396   S STRL TRNSLML ANGI NOLSR           1837            02             CENTRAL SUPPLY
0218388   S STRL TRNSLML ANGI NOLSR           1837            02             CENTRAL SUPPLY
0218370   S STRL TRNSLML ANGI NOLSR           1837            02             CENTRAL SUPPLY
0218362   S STRL TRNSLML ANGI NOLSR           1837            02             CENTRAL SUPPLY
0218321   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218313   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218297   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218289   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218271   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218263   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218255   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218248   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218230   S STRL TRNSLML ANGI NOLSR           1837            02             CENTRAL SUPPLY
0218222   S STRL TRNSLML ANGI NOLSR           1837            02             CENTRAL SUPPLY
0218214   S STRL TRNSLML ANGI NOLSR           1837            02             CENTRAL SUPPLY
0218206   S STRL TRNSLML ANGI NOLSR           1837            02             CENTRAL SUPPLY
0218198   S STRL TRNSLML ANGI NOLSR           1837            02             CENTRAL SUPPLY
0218180   S STRL TRNSLML ANGI NOLSR           1837            02             CENTRAL SUPPLY
0218172   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0218164   S STRL TRNSLML ANGI NOLSR           1970            02             CENTRAL SUPPLY
0218156   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0218149   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0218131   S STRL TRNSLML ANGI NOLSR           1642            02             CENTRAL SUPPLY
0217893   S STRL TRNSLML ANGI NOLSR           1837            02             CENTRAL SUPPLY
0217828   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0217810   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0217802   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0217794   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0217786   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0217778   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0217760   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0217752   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0217745   S STRL TRNSLML ANGI NOLSR           1642            02             CENTRAL SUPPLY
0217737   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0217729   S STRL TRNSLML ANGI NOLSR           1642            02             CENTRAL SUPPLY
0217711   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0217703   S STRL TRNSLML ANGI NOLSR           1642            02             CENTRAL SUPPLY
0217695   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0217687   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY




                                                  Page 43
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0217679   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0217661   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0217653   S STRL TRNSLML ANGI NOLSR           1642            02             CENTRAL SUPPLY
0217646   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0217638   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0217208   S STRL TRNSLML ANGI NOLSR           2264            02             CENTRAL SUPPLY
0217190   S STRL TRNSLML ANGI NOLSR           2264            02             CENTRAL SUPPLY
0217141   S STRL TRNSLML ANGI NOLSR           2168            02             CENTRAL SUPPLY
0215616   S STRL TRNSLML ANGI NOLSR           2594            02             CENTRAL SUPPLY
0215582   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0215566   S STRL TRNSLML ANGI NOLSR           1696            02             CENTRAL SUPPLY
0215558   S STRL TRNSLML ANGI NOLSR           1824            02             CENTRAL SUPPLY
0215525   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0215517   S STRL TRNSLML ANGI NOLSR           1459            02             CENTRAL SUPPLY
0215400   S STRL TRNSLML ANGI NOLSR           1520            02             CENTRAL SUPPLY
0215392   S STRL TRNSLML ANGI NOLSR           1520            02             CENTRAL SUPPLY
0215384   S STRL TRNSLML ANGI NOLSR            632            02             CENTRAL SUPPLY
0215343   S STRL TRNSLML ANGI NOLSR           1520            02             CENTRAL SUPPLY
0215293   S STRL TRNSLML ANGI NOLSR           1648            02             CENTRAL SUPPLY
0215285   S STRL TRNSLML ANGI NOLSR           1690            02             CENTRAL SUPPLY
0215236   S STRL TRNSLML ANGI NOLSR           1280            02             CENTRAL SUPPLY
0215228   S STRL TRNSLML ANGI NOLSR           1489            02             CENTRAL SUPPLY
0215210   S STRL TRNSLML ANGI NOLSR           1489            02             CENTRAL SUPPLY
0215186   S STRL TRNSLML ANGI NOLSR           1550            02             CENTRAL SUPPLY
0215178   S STRL TRNSLML ANGI NOLSR           1550            02             CENTRAL SUPPLY
0215160   S STRL TRNSLML ANGI NOLSR           1550            02             CENTRAL SUPPLY
0215152   S STRL TRNSLML ANGI NOLSR           1685            02             CENTRAL SUPPLY
0215145   S STRL TRNSLML ANGI NOLSR           1550            02             CENTRAL SUPPLY
0215129   S STRL TRNSLML ANGI NOLSR           1550            02             CENTRAL SUPPLY
0215111   S STRL TRNSLML ANGI NOLSR           1685            02             CENTRAL SUPPLY
0215103   S STRL TRNSLML ANGI NOLSR           1550            02             CENTRAL SUPPLY
0215038   S STRL TRNSLML ANGI NOLSR           1225            02             CENTRAL SUPPLY
0211961   S STRL TRNSLML ANGI NOLSR           2189            02             CENTRAL SUPPLY
0211946   S STRL TRNSLML ANGI NOLSR           1764            02             CENTRAL SUPPLY
0211839   S STRL TRNSLML ANGI NOLSR           1764            02             CENTRAL SUPPLY
0211821   S STRL TRNSLML ANGI NOLSR           2189            02             CENTRAL SUPPLY
0211813   S STRL TRNSLML ANGI NOLSR           2189            02             CENTRAL SUPPLY
0211805   S STRL TRNSLML ANGI NOLSR           1216            02             CENTRAL SUPPLY
0211797   S STRL TRNSLML ANGI NOLSR           1764            02             CENTRAL SUPPLY
0211540   S STRL TRNSLML ANGI NOLSR           1183            02             CENTRAL SUPPLY
0211391   S STRL TRNSLML ANGI NOLSR           1183            02             CENTRAL SUPPLY
0211342   S STRL TRNSLML ANGI NOLSR           1040            02             CENTRAL SUPPLY
0211326   S STRL TRNSLML ANGI NOLSR           1064            02             CENTRAL SUPPLY
0211318   S STRL TRNSLML ANGI NOLSR           1550            02             CENTRAL SUPPLY
0211300   S STRL TRNSLML ANGI NOLSR           1879            02             CENTRAL SUPPLY
0211250   S STRL TRNSLML ANGI NOLSR           1764            02             CENTRAL SUPPLY
0211243   S STRL TRNSLML ANGI NOLSR           2127            02             CENTRAL SUPPLY
0211136   S STRL TRNSLML ANGI NOLSR            922            02             CENTRAL SUPPLY
0211128   S STRL TRNSLML ANGI NOLSR            913            02             CENTRAL SUPPLY
0210906   S STRL TRNSLML ANGI NOLSR           1550            02             CENTRAL SUPPLY
0210815   S STRL TRNSLML ANGI NOLSR             94            02             CENTRAL SUPPLY
0210625   S STRL TRNSLML ANGI NOLSR           1250            02             CENTRAL SUPPLY
0210575   S STRL TRNSLML ANGI NOLSR           2027            02             CENTRAL SUPPLY
0210534   S STRL TRNSLML ANGI NOLSR           2110            02             CENTRAL SUPPLY
0210526   S STRL TRNSLML ANGI NOLSR           1216            02             CENTRAL SUPPLY




                                                  Page 44
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0210518   S STRL TRNSLML ANGI NOLSR           1216            02             CENTRAL SUPPLY
0210500   S STRL TRNSLML ANGI NOLSR           1339            02             CENTRAL SUPPLY
0210484   S STRL TRNSLML ANGI NOLSR           1764            02             CENTRAL SUPPLY
0210476   S STRL TRNSLML ANGI NOLSR           1764            02             CENTRAL SUPPLY
0210468   S STRL TRNSLML ANGI NOLSR           1764            02             CENTRAL SUPPLY
0210435   S STRL TRNSLML ANGI NOLSR           2047            02             CENTRAL SUPPLY
0210401   S STRL TRNSLML ANGI NOLSR           2189            02             CENTRAL SUPPLY
0210385   S STRL TRNSLML ANGI NOLSR           2110            02             CENTRAL SUPPLY
0210294   S STRL TRNSLML ANGI NOLSR           2110            02             CENTRAL SUPPLY
0210286   S STRL TRNSLML ANGI NOLSR           2110            02             CENTRAL SUPPLY
0210195   S STRL TRNSLML ANGI NOLSR           2027            02             CENTRAL SUPPLY
0210187   S STRL TRNSLML ANGI NOLSR           2027            02             CENTRAL SUPPLY
0210153   S STRL TRNSLML ANGI NOLSR           2110            02             CENTRAL SUPPLY
0210146   S STRL TRNSLML ANGI NOLSR           1258            02             CENTRAL SUPPLY
0210120   S STRL TRNSLML ANGI NOLSR           2173            02             CENTRAL SUPPLY
0210062   S STRL TRNSLML ANGI NOLSR           2027            02             CENTRAL SUPPLY
0209973   S STRL TRNSLML ANGI NOLSR             77            02             CENTRAL SUPPLY
0209965   S STRL TRNSLML ANGI NOLSR            117            02             CENTRAL SUPPLY
0209957   S STRL TRNSLML ANGI NOLSR           1185            02             CENTRAL SUPPLY
0209940   S STRL TRNSLML ANGI NOLSR           1550            02             CENTRAL SUPPLY
0209932   S STRL TRNSLML ANGI NOLSR           2027            02             CENTRAL SUPPLY
0209924   S STRL TRNSLML ANGI NOLSR           1300            02             CENTRAL SUPPLY
0209759   S STRL TRNSLML ANGI NOLSR           2027            02             CENTRAL SUPPLY
0209726   S STRL TRNSLML ANGI NOLSR           2027            02             CENTRAL SUPPLY
0209601   S STRL TRNSLML ANGI NOLSR           1339            02             CENTRAL SUPPLY
0209593   S STRL TRNSLML ANGI NOLSR           1339            02             CENTRAL SUPPLY
0209585   S STRL TRNSLML ANGI NOLSR           2110            02             CENTRAL SUPPLY
0209049   S STRL TRNSLML ANGI NOLSR            108            02             CENTRAL SUPPLY
0208991   S STRL TRNSLML ANGI NOLSR           1250            02             CENTRAL SUPPLY
0208793   S STRL TRNSLML ANGI NOLSR           1300            02             CENTRAL SUPPLY
0208785   S STRL TRNSLML ANGI NOLSR           1300            02             CENTRAL SUPPLY
0208777   S STRL TRNSLML ANGI NOLSR           1672            02             CENTRAL SUPPLY
0208769   S STRL TRNSLML ANGI NOLSR           2047            02             CENTRAL SUPPLY
0208751   S STRL TRNSLML ANGI NOLSR           2047            02             CENTRAL SUPPLY
0208033   S STRL TRNSLML ANGI NOLSR           1148            02             CENTRAL SUPPLY
0207837   S STRL TRNSLML ANGI NOLSR           1183            02             CENTRAL SUPPLY
0207647   S STRL TRNSLML ANGI NOLSR           1231            02             CENTRAL SUPPLY
0207449   S STRL TRNSLML ANGI NOLSR            861            02             CENTRAL SUPPLY
0207357   S STRL TRNSLML ANGI NOLSR           2000            02             CENTRAL SUPPLY
0207159   S STRL TRNSLML ANGI NOLSR           1501            02             CENTRAL SUPPLY
0207118   S STRL TRNSLML ANGI NOLSR           1368            02             CENTRAL SUPPLY
0206987   S STRL TRNSLML ANGI NOLSR           1258            02             CENTRAL SUPPLY
0206870   S STRL TRNSLML ANGI NOLSR           1672            02             CENTRAL SUPPLY
0206862   S STRL TRNSLML ANGI NOLSR           1672            02             CENTRAL SUPPLY
0206094   S STRL TRNSLML ANGI NOLSR           2127            02             CENTRAL SUPPLY
0205880   S STRL TRNSLML ANGI NOLSR           1672            02             CENTRAL SUPPLY
0205856   S STRL TRNSLML ANGI NOLSR           1216            02             CENTRAL SUPPLY
0205849   S STRL TRNSLML ANGI NOLSR            861            02             CENTRAL SUPPLY
0205542   S STRL TRNSLML ANGI NOLSR           1216            02             CENTRAL SUPPLY
0204073   S STRL TRNSLML ANGI NOLSR           1183            02             CENTRAL SUPPLY
0203075   S STRL TRNSLML ANGI NOLSR           2467            02             CENTRAL SUPPLY
0203059   S STRL TRNSLML ANGI NOLSR           2467            02             CENTRAL SUPPLY
0203042   S STRL TRNSLML ANGI NOLSR           1824            02             CENTRAL SUPPLY
0217919   S STRL TRNSLMNL ATHR DRCT           5414            02             CENTRAL SUPPLY
0224477   S STRL TRNSLMNL ATHR RTNL           3551            02             CENTRAL SUPPLY




                                                  Page 45
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0224469   S STRL TRNSLMNL ATHR RTNL           3551            02             CENTRAL SUPPLY
0224451   S STRL TRNSLMNL ATHR RTNL           3551            02             CENTRAL SUPPLY
0224444   S STRL TRNSLMNL ATHR RTNL           3551            02             CENTRAL SUPPLY
0218511   S STRL TRNSLMNL ATHR RTNL           2902            02             CENTRAL SUPPLY
0218503   S STRL TRNSLMNL ATHR RTNL           2902            02             CENTRAL SUPPLY
0218495   S STRL TRNSLMNL ATHR RTNL           2902            02             CENTRAL SUPPLY
0218487   S STRL TRNSLMNL ATHR RTNL           2902            02             CENTRAL SUPPLY
0218479   S STRL TRNSLMNL ATHR RTNL           2902            02             CENTRAL SUPPLY
0218461   S STRL TRNSLMNL ATHR RTNL           2902            02             CENTRAL SUPPLY
0218453   S STRL TRNSLMNL ATHR RTNL           2902            02             CENTRAL SUPPLY
0217935   S STRL TRNSLMNL ATHR RTNL           2902            02             CENTRAL SUPPLY
0260356   S STRL TRY 2-LUMN CNTRL V            557            02             CENTRAL SUPPLY
0225920   S STRL TRY 2-LUMN CNTRL V            557            02             CENTRAL SUPPLY
0206839   S STRL TRY ICN CIRCMS3537             99            02             CENTRAL SUPPLY
0224394   S STRL TRY SHTH INTRD 6FR            249            02             CENTRAL SUPPLY
0213918   S STRL T-TUBE 8FR                     45            02             CENTRAL SUPPLY
0211995   S STRL TUBE BRNCH LT 41FR            417            02             CENTRAL SUPPLY
0213504   S STRL TUBE ET 5 MRPH CUF             19            02             CENTRAL SUPPLY
0213637   S STRL TUBE ET 5.5 MRPH               17            02             CENTRAL SUPPLY
0213645   S STRL TUBE ET 8.5 MRPH               16            02             CENTRAL SUPPLY
0214593   S STRL TUBE ET 9 MRPH CFF             13            02             CENTRAL SUPPLY
0213652   S STRL TUBE ET 9.5 MURPY              33            02             CENTRAL SUPPLY
0224246   S STRL TUBE ET MAGILL 2.5             17            02             CENTRAL SUPPLY
0224295   S STRL TUBE ET MAGILL 3               18            02             CENTRAL SUPPLY
0201806   S STRL TUBE ET4.5MM MURP              19            02             CENTRAL SUPPLY
0201764   S STRL TUBE ET5.0MM MRPHY             33            02             CENTRAL SUPPLY
0210583   S STRL TUBE FEED 12F 36               43            02             CENTRAL SUPPLY
0210591   S STRL TUBE FEEDNG 8F 45              58            02             CENTRAL SUPPLY
0263715   S STRL TUBE GASTRIC LAVAG            152            02             CENTRAL SUPPLY
0224428   S STRL TUBE GI FEED 8*15               5            02             CENTRAL SUPPLY
0216523   S STRL TUBE JEJUNAL 16FR             777            02             CENTRAL SUPPLY
0216531   S STRL TUBE JEJUNAL 18FR             777            02             CENTRAL SUPPLY
0212605   S STRL TUBE JUNJEAL 14FR             777            02             CENTRAL SUPPLY
0263111   S STRL TUBE NG SALEM                  11            02             CENTRAL SUPPLY
0263087   S STRL TUBE NG SALEM                  11            02             CENTRAL SUPPLY
0213421   S STRL TUBE NG SLM SMP 10             13            02             CENTRAL SUPPLY
0213512   S STRL TUBE NG SLM SMP 12             13            02             CENTRAL SUPPLY
0224550   S STRL TUBE PRESS M/F 12              15            02             CENTRAL SUPPLY
0224568   S STRL TUBE PRESS M/M 6               23            02             CENTRAL SUPPLY
0214205   S STRL TUBE PRESS MONT/IN             39            02             CENTRAL SUPPLY
0213736   S STRL TUBE SUCTN COAG                75            02             CENTRAL SUPPLY
0216556   S STRL TUBE TRNSGSTRC 18            1185            02             CENTRAL SUPPLY
0216549   S STRL TUBE TRNSGSTRC 22            1185            02             CENTRAL SUPPLY
0214098   S STRL TUBE, VENTILATOR               44            02             CENTRAL SUPPLY
0260323   S STRL TUBE,ET MAGILL 3.5             18            02             CENTRAL SUPPLY
0260141   S STRL TUBE,ET MAGILL 3.5             18            02             CENTRAL SUPPLY
0224519   S STRL URET                           79            02             CENTRAL SUPPLY
0206904   S STRL URET                          922            02             CENTRAL SUPPLY
0206896   S STRL URET                          969            02             CENTRAL SUPPLY
0206888   S STRL URET                         1459            02             CENTRAL SUPPLY
0212928   S STRL UROSTY POUCH 1-3/4            260            02             CENTRAL SUPPLY
0261966   S STRL VAC Y CONNECTOR                 5            02             CENTRAL SUPPLY
0204123   S STRL VALVE ROTAT HMSTTC            187            02             CENTRAL SUPPLY
0262535   S STRL VAR APERTURE SLEEV             42            02             CENTRAL SUPPLY
0212662   S STRL VASELINE GZE 1*8                5            02             CENTRAL SUPPLY




                                                  Page 46
                                      c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                   SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                         AMOUNT AMOUNT CODE

0212670   S STRL VASELINE GZE 3*9                    5            02             CENTRAL SUPPLY
0202754   S STRL VEIN CARRIER,JUGLR               1155            02             CENTRAL SUPPLY
0211052   S STRL VITACUFF 7FR                      219            02             CENTRAL SUPPLY
0212688   S STRL VSELN GZE 3*18239                   5            02             CENTRAL SUPPLY
0205724   S STRL WDGVNT34-1267 2438                595            02             CENTRAL SUPPLY
0212837   S STRL WESCOT 22G*3.5                     69            02             CENTRAL SUPPLY
0224378   S STRL WIRE GUIDE                         53            02             CENTRAL SUPPLY
0224360   S STRL WIRE GUIDE                        154            02             CENTRAL SUPPLY
0223719   S STRL WIRE GUIDE                        243            02             CENTRAL SUPPLY
0223685   S STRL WIRE GUIDE                       1520            02             CENTRAL SUPPLY
0223636   S STRL WIRE GUIDE                       2270            02             CENTRAL SUPPLY
0219691   S STRL WIRE GUIDE                       4053            02             CENTRAL SUPPLY
0219600   S STRL WIRE GUIDE                       3242            02             CENTRAL SUPPLY
0219550   S STRL WIRE GUIDE                         85            02             CENTRAL SUPPLY
0219212   S STRL WIRE GUIDE                        483            02             CENTRAL SUPPLY
0218446   S STRL WIRE GUIDE                        946            02             CENTRAL SUPPLY
0218438   S STRL WIRE GUIDE                        669            02             CENTRAL SUPPLY
0218347   S STRL WIRE GUIDE                        421            02             CENTRAL SUPPLY
0218032   S STRL WIRE GUIDE                        557            02             CENTRAL SUPPLY
0218024   S STRL WIRE GUIDE                        557            02             CENTRAL SUPPLY
0218016   S STRL WIRE GUIDE                        557            02             CENTRAL SUPPLY
0218008   S STRL WIRE GUIDE                        557            02             CENTRAL SUPPLY
0217992   S STRL WIRE GUIDE                        557            02             CENTRAL SUPPLY
0217885   S STRL WIRE GUIDE                        669            02             CENTRAL SUPPLY
0217471   S STRL WIRE GUIDE                         64            02             CENTRAL SUPPLY
0216333   S STRL WIRE GUIDE                        505            02             CENTRAL SUPPLY
0216283   S STRL WIRE GUIDE                        446            02             CENTRAL SUPPLY
0216275   S STRL WIRE GUIDE                        446            02             CENTRAL SUPPLY
0215509   S STRL WIRE GUIDE                        586            02             CENTRAL SUPPLY
0215475   S STRL WIRE GUIDE                        669            02             CENTRAL SUPPLY
0215459   S STRL WIRE GUIDE                        586            02             CENTRAL SUPPLY
0215434   S STRL WIRE GUIDE                        595            02             CENTRAL SUPPLY
0215368   S STRL WIRE GUIDE                        595            02             CENTRAL SUPPLY
0215350   S STRL WIRE GUIDE                        635            02             CENTRAL SUPPLY
0214676   S STRL WIRE GUIDE                        157            02             CENTRAL SUPPLY
0214668   S STRL WIRE GUIDE                        147            02             CENTRAL SUPPLY
0214650   S STRL WIRE GUIDE                        151            02             CENTRAL SUPPLY
0212621   S STRL WIRE GUIDE                        595            02             CENTRAL SUPPLY
0212613   S STRL WIRE GUIDE                        201            02             CENTRAL SUPPLY
0212373   S STRL WIRE GUIDE                        230            02             CENTRAL SUPPLY
0212282   S STRL WIRE GUIDE                        633            02             CENTRAL SUPPLY
0212274   S STRL WIRE GUIDE                        125            02             CENTRAL SUPPLY
0211896   S STRL WIRE GUIDE                        486            02             CENTRAL SUPPLY
0211789   S STRL WIRE GUIDE                        878            02             CENTRAL SUPPLY
0211201   S STRL WIRE GUIDE                         77            02             CENTRAL SUPPLY
0211193   S STRL WIRE GUIDE                         69            02             CENTRAL SUPPLY
0211185   S STRL WIRE GUIDE                         60            02             CENTRAL SUPPLY
0211045   S STRL WIRE GUIDE                         91            02             CENTRAL SUPPLY
0211037   S STRL WIRE GUIDE                        161            02             CENTRAL SUPPLY
0211029   S STRL WIRE GUIDE                        608            02             CENTRAL SUPPLY
0211011   S STRL WIRE GUIDE                       3377            02             CENTRAL SUPPLY
0211003   S STRL WIRE GUIDE                         87            02             CENTRAL SUPPLY
0210666   S STRL WIRE GUIDE                        136            02             CENTRAL SUPPLY
0210492   S STRL WIRE GUIDE                        878            02             CENTRAL SUPPLY
0210443   S STRL WIRE GUIDE                       1017            02             CENTRAL SUPPLY




                                                      Page 47
                              c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION           SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                 AMOUNT AMOUNT CODE

0210377   S STRL WIRE GUIDE                710            02             CENTRAL SUPPLY
0210369   S STRL WIRE GUIDE                710            02             CENTRAL SUPPLY
0210336   S STRL WIRE GUIDE                557            02             CENTRAL SUPPLY
0210138   S STRL WIRE GUIDE                743            02             CENTRAL SUPPLY
0210054   S STRL WIRE GUIDE                710            02             CENTRAL SUPPLY
0209809   S STRL WIRE GUIDE                 85            02             CENTRAL SUPPLY
0209635   S STRL WIRE GUIDE                557            02             CENTRAL SUPPLY
0209460   S STRL WIRE GUIDE               1206            02             CENTRAL SUPPLY
0209452   S STRL WIRE GUIDE                557            02             CENTRAL SUPPLY
0209148   S STRL WIRE GUIDE                836            02             CENTRAL SUPPLY
0209130   S STRL WIRE GUIDE                 73            02             CENTRAL SUPPLY
0209122   S STRL WIRE GUIDE                980            02             CENTRAL SUPPLY
0209114   S STRL WIRE GUIDE                 84            02             CENTRAL SUPPLY
0209098   S STRL WIRE GUIDE                 93            02             CENTRAL SUPPLY
0209080   S STRL WIRE GUIDE                104            02             CENTRAL SUPPLY
0209072   S STRL WIRE GUIDE                151            02             CENTRAL SUPPLY
0209056   S STRL WIRE GUIDE               1250            02             CENTRAL SUPPLY
0208868   S STRL WIRE GUIDE                107            02             CENTRAL SUPPLY
0208850   S STRL WIRE GUIDE                 60            02             CENTRAL SUPPLY
0208843   S STRL WIRE GUIDE                113            02             CENTRAL SUPPLY
0208801   S STRL WIRE GUIDE                922            02             CENTRAL SUPPLY
0208702   S STRL WIRE GUIDE                 65            02             CENTRAL SUPPLY
0208694   S STRL WIRE GUIDE                 54            02             CENTRAL SUPPLY
0208686   S STRL WIRE GUIDE                 65            02             CENTRAL SUPPLY
0208660   S STRL WIRE GUIDE                 96            02             CENTRAL SUPPLY
0208652   S STRL WIRE GUIDE                135            02             CENTRAL SUPPLY
0208645   S STRL WIRE GUIDE                 62            02             CENTRAL SUPPLY
0208637   S STRL WIRE GUIDE                113            02             CENTRAL SUPPLY
0208629   S STRL WIRE GUIDE                 69            02             CENTRAL SUPPLY
0208611   S STRL WIRE GUIDE                 73            02             CENTRAL SUPPLY
0208603   S STRL WIRE GUIDE                171            02             CENTRAL SUPPLY
0208595   S STRL WIRE GUIDE                171            02             CENTRAL SUPPLY
0208579   S STRL WIRE GUIDE                 73            02             CENTRAL SUPPLY
0208561   S STRL WIRE GUIDE                 50            02             CENTRAL SUPPLY
0208512   S STRL WIRE GUIDE                632            02             CENTRAL SUPPLY
0208439   S STRL WIRE GUIDE                271            02             CENTRAL SUPPLY
0208298   S STRL WIRE GUIDE                632            02             CENTRAL SUPPLY
0208280   S STRL WIRE GUIDE                632            02             CENTRAL SUPPLY
0207456   S STRL WIRE GUIDE                201            02             CENTRAL SUPPLY
0207092   S STRL WIRE GUIDE                 87            02             CENTRAL SUPPLY
0206979   S STRL WIRE GUIDE                486            02             CENTRAL SUPPLY
0206847   S STRL WIRE GUIDE                185            02             CENTRAL SUPPLY
0206821   S STRL WIRE GUIDE                603            02             CENTRAL SUPPLY
0206813   S STRL WIRE GUIDE                603            02             CENTRAL SUPPLY
0206797   S STRL WIRE GUIDE                845            02             CENTRAL SUPPLY
0206706   S STRL WIRE GUIDE                468            02             CENTRAL SUPPLY
0206672   S STRL WIRE GUIDE                111            02             CENTRAL SUPPLY
0206383   S STRL WIRE GUIDE                675            02             CENTRAL SUPPLY
0206375   S STRL WIRE GUIDE                669            02             CENTRAL SUPPLY
0206037   S STRL WIRE GUIDE                374            02             CENTRAL SUPPLY
0205948   S STRL WIRE GUIDE                108            02             CENTRAL SUPPLY
0205930   S STRL WIRE GUIDE                108            02             CENTRAL SUPPLY
0205922   S STRL WIRE GUIDE                117            02             CENTRAL SUPPLY
0205864   S STRL WIRE GUIDE                251            02             CENTRAL SUPPLY
0205070   S STRL WIRE GUIDE                 72            02             CENTRAL SUPPLY




                                              Page 48
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0205062   S STRL WIRE GUIDE                    72            02             CENTRAL SUPPLY
0204511   S STRL WIRE GUIDE                    64            02             CENTRAL SUPPLY
0204495   S STRL WIRE GUIDE                   482            02             CENTRAL SUPPLY
0204487   S STRL WIRE GUIDE                   460            02             CENTRAL SUPPLY
0204479   S STRL WIRE GUIDE                   486            02             CENTRAL SUPPLY
0204461   S STRL WIRE GUIDE                   482            02             CENTRAL SUPPLY
0204453   S STRL WIRE GUIDE                    64            02             CENTRAL SUPPLY
0204438   S STRL WIRE GUIDE                    53            02             CENTRAL SUPPLY
0204420   S STRL WIRE GUIDE                    86            02             CENTRAL SUPPLY
0204396   S STRL WIRE GUIDE                   669            02             CENTRAL SUPPLY
0204388   S STRL WIRE GUIDE                    64            02             CENTRAL SUPPLY
0204370   S STRL WIRE GUIDE                   104            02             CENTRAL SUPPLY
0204362   S STRL WIRE GUIDE                   104            02             CENTRAL SUPPLY
0204354   S STRL WIRE GUIDE                    67            02             CENTRAL SUPPLY
0204321   S STRL WIRE GUIDE                   107            02             CENTRAL SUPPLY
0204313   S STRL WIRE GUIDE                   669            02             CENTRAL SUPPLY
0204297   S STRL WIRE GUIDE                   356            02             CENTRAL SUPPLY
0204289   S STRL WIRE GUIDE                   408            02             CENTRAL SUPPLY
0204271   S STRL WIRE GUIDE                   249            02             CENTRAL SUPPLY
0204263   S STRL WIRE GUIDE                   340            02             CENTRAL SUPPLY
0204255   S STRL WIRE GUIDE                   349            02             CENTRAL SUPPLY
0204248   S STRL WIRE GUIDE                   108            02             CENTRAL SUPPLY
0204230   S STRL WIRE GUIDE                   632            02             CENTRAL SUPPLY
0204180   S STRL WIRE GUIDE                    62            02             CENTRAL SUPPLY
0204149   S STRL WIRE GUIDE                   351            02             CENTRAL SUPPLY
0204115   S STRL WIRE GUIDE                   743            02             CENTRAL SUPPLY
0204107   S STRL WIRE GUIDE                   531            02             CENTRAL SUPPLY
0204099   S STRL WIRE GUIDE                   595            02             CENTRAL SUPPLY
0204065   S STRL WIRE GUIDE                    87            02             CENTRAL SUPPLY
0204032   S STRL WIRE GUIDE                   181            02             CENTRAL SUPPLY
0204016   S STRL WIRE GUIDE                   777            02             CENTRAL SUPPLY
0204008   S STRL WIRE GUIDE                   137            02             CENTRAL SUPPLY
0203968   S STRL WIRE GUIDE                    44            02             CENTRAL SUPPLY
0200790   S STRL WSTCTT 22G5 1/2 1             69            02             CENTRAL SUPPLY
0208140   S STRLAMPLTZ,RENALDL12233           811            02             CENTRAL SUPPLY
0205450   S STRLBALN EXTN-0182 2310            48            02             CENTRAL SUPPLY
0205088   S STRLBP6.5-125M-NSCN2519           157            02             CENTRAL SUPPLY
0212795   S STRLBRSTBIPDKBL20-5 755           159            02             CENTRAL SUPPLY
0203521   S STRLCT HBP7-38-100 3044           165            02             CENTRAL SUPPLY
0207951   S STRLCTDMCN6.7-19-229129           283            02             CENTRAL SUPPLY
0210617   S STRLCTH 3.5/30FRCE W/PP          1223            02             CENTRAL SUPPLY
0206177   S STRLCTH 3HRTZ ACXII3401          1213            02             CENTRAL SUPPLY
0203091   S STRLCTH ART BRCHL4F PMS           154            02             CENTRAL SUPPLY
0210278   S STRLCTH BERNSTEIN5F65CM           107            02             CENTRAL SUPPLY
0204982   S STRLCTH BRCH COR ART 7F           102            02             CENTRAL SUPPLY
0204552   S STRLCTH COR BYPS RT1 8F           114            02             CENTRAL SUPPLY
0205567   S STRLCTH DLTR TEF5FR3611            28            02             CENTRAL SUPPLY
0214239   S STRLCTH FOL30CC LUBR18F            42            02             CENTRAL SUPPLY
0214106   S STRLCTH FOL5CC LUBR26FR            30            02             CENTRAL SUPPLY
0214148   S STRLCTH FOL5CC SILI14FR            21            02             CENTRAL SUPPLY
0210310   S STRLCTH HBP7-38-100M12S           105            02             CENTRAL SUPPLY
0203943   S STRLCTH HF FEM PGTAIL7F           108            02             CENTRAL SUPPLY
0204941   S STRLCTH HMAQUET INTRO6F           108            02             CENTRAL SUPPLY
0206854   S STRLCTH HN53880MNS02123           137            02             CENTRAL SUPPLY
0211987   S STRLCTH HNB503865MNSRDC           173            02             CENTRAL SUPPLY




                                                 Page 49
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0210641   S STRLCTH ILL 8F W/FLXGRD           557            02             CENTRAL SUPPLY
0204701   S STRLCTH IV ANGIO14G1686             5            02             CENTRAL SUPPLY
0204693   S STRLCTH JDKNS FEM LTA8F           102            02             CENTRAL SUPPLY
0203182   S STRLCTH JL6 100CM8F1193            99            02             CENTRAL SUPPLY
0203174   S STRLCTH JR6 100CM8F1192            99            02             CENTRAL SUPPLY
0207795   S STRLCTH MWCE25-3-5 1168           170            02             CENTRAL SUPPLY
0207365   S STRLCTH MWCE38-4-3 1840           170            02             CENTRAL SUPPLY
0207753   S STRLCTH MWCE38-5-8 1861           170            02             CENTRAL SUPPLY
0209858   S STRLCTH N538-90M10S-PIG           106            02             CENTRAL SUPPLY
0211847   S STRLCTH2.75/20 SOL S/PD          2189            02             CENTRAL SUPPLY
0206128   S STRLCTH3.5F RX PERF3394          1268            02             CENTRAL SUPPLY
0211573   S STRLCTH3/40FRCE PRO/PEL          2127            02             CENTRAL SUPPLY
0208272   S STRLCTH5F 6X4 75CM12214           937            02             CENTRAL SUPPLY
0207506   S STRLCTHACXII3.5HRT11824          1213            02             CENTRAL SUPPLY
0211227   S STRLCTHBPS7-38100M-NS-S           102            02             CENTRAL SUPPLY
0207472   S STRLCTHDILACS2PRSM12038          1250            02             CENTRAL SUPPLY
0207480   S STRLCTHDILACS3PRSM12039          1250            02             CENTRAL SUPPLY
0203323   S STRLCTHDILTR TEF5FR1843            44            02             CENTRAL SUPPLY
0203703   S STRLCTHFOL2WY30CC18F962            28            02             CENTRAL SUPPLY
0203711   S STRLCTHFOL2WY30CC20F865            26            02             CENTRAL SUPPLY
0203729   S STRLCTHFOL2WY30CC22F867            27            02             CENTRAL SUPPLY
0203737   S STRLCTHFOL2WY30CC24F866            27            02             CENTRAL SUPPLY
0203745   S STRLCTHFOL2WY30CC26F864            27            02             CENTRAL SUPPLY
0205831   S STRLCTHHNB50 35 65 3096           132            02             CENTRAL SUPPLY
0207415   S STRLCTHMWCE25-1.2-2 357           170            02             CENTRAL SUPPLY
0207803   S STRLCTHMWCE25-2.2-2 358           185            02             CENTRAL SUPPLY
0208116   S STRLCTHTR5FR65CM3812198           755            02             CENTRAL SUPPLY
0208108   S STRLCTHTR5FR90CM3812199           755            02             CENTRAL SUPPLY
0224261   S STRLEND TRCH TBE7.5 851            13            02             CENTRAL SUPPLY
0263525   S STRLL PEAK FLOWMETER               63            02             CENTRAL SUPPLY
0209643   S STRLMLTI TRQUE VCE12347           194            02             CENTRAL SUPPLY
0205385   S STRLNASLCTH EPISTAX2120           356            02             CENTRAL SUPPLY
0216747   S STRLNDL COAXL BIOPSY14G           283            02             CENTRAL SUPPLY
0216754   S STRLNDL COAXL BIOPSY16G           283            02             CENTRAL SUPPLY
0212597   S STRLNDLCORE BPSY16GX9CM           264            02             CENTRAL SUPPLY
0209494   S STRLROTATNGHEMOVLV12291           219            02             CENTRAL SUPPLY
0213678   S STRLTBEPRS MONT/INJ M/F            48            02             CENTRAL SUPPLY
0213660   S STRLTBEPRS MONT/INJ M/M            48            02             CENTRAL SUPPLY
0216630   S STRLTOUY BORST,Y LG BRE           162            02             CENTRAL SUPPLY
0224592   S STRLTRCH JCKSN METL N-D            17            02             CENTRAL SUPPLY
0224717   S STRLTRCH SHLY IN/CNLA10            30            02             CENTRAL SUPPLY
0212654   S STRLVSLNE GZE1/2*72 242            10            02             CENTRAL SUPPLY
0262469   S TISS LOCAL EXCSN DEVICE           723            02             CENTRAL SUPPLY
0223818   S TISSUE CONNCTV HUMAN              501            02             CENTRAL SUPPLY
0262477   S TISSUE MARKER                     231            02             CENTRAL SUPPLY
0215723   S WIRE GUIDE .014TRNS EX           1183            02             CENTRAL SUPPLY
0209874   S WIRE GUIDE .018X180CM             487            02             CENTRAL SUPPLY
0204305   S WIRE GUIDE .035 145 KAZ          1223            02             CENTRAL SUPPLY
0216259   S WIRE GUIDE .035*145SS             254            02             CENTRAL SUPPLY
0214890   S WIRE GUIDE .38/150CM              422            02             CENTRAL SUPPLY
0216564   S WIRE GUIDE 0.18MICRO EX          2485            02             CENTRAL SUPPLY
0215715   S WIRE GUIDE 150/10/2TIP           1976            02             CENTRAL SUPPLY
0209767   S WIRE GUIDE 1800 12381UL           669            02             CENTRAL SUPPLY
0207316   S WIRE GUIDE 3009EXCHANGE           402            02             CENTRAL SUPPLY
0204057   S WIRE GUIDE 35-140 1997            108            02             CENTRAL SUPPLY




                                                 Page 50
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0204339   S WIRE GUIDE 35-145 2055            102            02             CENTRAL SUPPLY
0204347   S WIRE GUIDE 35-145 2056            102            02             CENTRAL SUPPLY
0204446   S WIRE GUIDE 35-145 2058             94            02             CENTRAL SUPPLY
0204040   S WIRE GUIDE 35-40-31996            116            02             CENTRAL SUPPLY
0204164   S WIRE GUIDE 38-125 2057            227            02             CENTRAL SUPPLY
0209650   S WIRE GUIDE 46-316                 450            02             CENTRAL SUPPLY
0217356   S WIRE GUIDE ACCUSTICK KT           595            02             CENTRAL SUPPLY
0203976   S WIRE GUIDE ANGLD 35/150           300            02             CENTRAL SUPPLY
0203448   S WIRE GUIDE ANGLD 35/150           422            02             CENTRAL SUPPLY
0216267   S WIRE GUIDE COPE MANDRIL           333            02             CENTRAL SUPPLY
0215707   S WIRE GUIDE CTH FASTRCKR          1368            02             CENTRAL SUPPLY
0207928   S WIRE GUIDE F2502BRWN/ML           364            02             CENTRAL SUPPLY
0223693   S WIRE GUIDE FAS DASHER            1183            02             CENTRAL SUPPLY
0216341   S WIRE GUIDE RPC-35-145 R           190            02             CENTRAL SUPPLY
0204198   S WIRE GUIDE TDW 38-145-1           227            02             CENTRAL SUPPLY
0209106   S WIRE GUIDE THSCF 35 145           108            02             CENTRAL SUPPLY
0216291   S WIRE GUIDE THSCF-35-260           162            02             CENTRAL SUPPLY
0214940   S WIRE GUIDE THSCF35-80-1           102            02             CENTRAL SUPPLY
0206680   S WIRE GUIDE THSF 35-145-           151            02             CENTRAL SUPPLY
0204172   S WIRE GUIDE THSF 35-145A           175            02             CENTRAL SUPPLY
0216309   S WIRE GUIDE THSF-35-180-           162            02             CENTRAL SUPPLY
0210658   S WIRE GUIDE THSF-35-260            227            02             CENTRAL SUPPLY
0209064   S WIRE GUIDE TSCF 035 145           102            02             CENTRAL SUPPLY
0204214   S WIRE GUIDE TSF B-35-260           175            02             CENTRAL SUPPLY
0216317   S WIRE GUIDE TSF-35-50 SH            76            02             CENTRAL SUPPLY
0211169   S WIRE GUIDE TSFB 35 145            137            02             CENTRAL SUPPLY
0216325   S WIRE GUIDE ULT .018/80N          1185            02             CENTRAL SUPPLY
0224816   SORBITOL IRRG FLX 3L                 53            02             CENTRAL SUPPLY
0213835   SORBITOL IRRIG MANNIT                43            02             CENTRAL SUPPLY
0212647   SURGICEL 8X12                       111            02             CENTRAL SUPPLY
0261875   TH/WGHT BEAR NAR M-L BRIM                          02             CENTRAL SUPPLY
0201657   TUCKS JR PAD                         14            02             CENTRAL SUPPLY
0212316   WATER 10ML SOLN                       5            02             CENTRAL SUPPLY
0214296   WATER CONCHA W/CART SOLN             93            02             CENTRAL SUPPLY
0223404   WATER IJ 1000ML                     151            02             CENTRAL SUPPLY
0224907   WATER IRRIG 1000ML                    5            02             CENTRAL SUPPLY
0224782   WATER IRRIG 1000ML FLX 1L            16            02             CENTRAL SUPPLY
0263053   WATER IRRIG 1500ML                  116            02             CENTRAL SUPPLY
0213546   WATER IRRIG 2000ML                   27            02             CENTRAL SUPPLY
0263327   WATER IRRIG 2000ML                  131            02             CENTRAL SUPPLY
0224774   WATER IRRIG 2000ML FLX 2L            57            02             CENTRAL SUPPLY
0224790   WATER IRRIG 3000ML FLX 3L            38            02             CENTRAL SUPPLY
0224766   WATER IRRIG 3000ML FLX 3L            42            02             CENTRAL SUPPLY
0224758   WATER SLN INHAL 2L STER 2            29            02             CENTRAL SUPPLY
6800023   DIAB TRNG SVCS IND EA 30            168            68             DIABETES SERVICES OUTPATI
6800007   MED NUTR TX EA 15                    75            68             DIABETES SERVICES OUTPATI
6800015   MED NUTR TX REASMNT EA 15            82            68             DIABETES SERVICES OUTPATI
0880104   CON GAD 11-20ML                      56            08             DIAGNOSIC IMAGING SUPPLIE
0880096   CON GAD 11-20ML                      42            08             DIAGNOSIC IMAGING SUPPLIE
0873000   CON GAD-BASE MR 1ML IJ              446            08             DIAGNOSIC IMAGING SUPPLIE
0880120   CON HOCM 150-199MG/ML 1ML            12            08             DIAGNOSIC IMAGING SUPPLIE
0880070   CON LOCM 200-249S I 1ML              55            08             DIAGNOSIC IMAGING SUPPLIE
0880088   CON LOCM 300-349S I 1ML              77            08             DIAGNOSIC IMAGING SUPPLIE
0880062   CON LOCM 300-349S I 1ML                            08             DIAGNOSIC IMAGING SUPPLIE
0880005   CON LOCM 300-349S I 1ML             262            08             DIAGNOSIC IMAGING SUPPLIE




                                                 Page 51
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0880013   CON LOCM 300-349S I 1ML             411            08             DIAGNOSIC IMAGING SUPPLIE
0872002   CON LOCM 300-349S I 1ML             163            08             DIAGNOSIC IMAGING SUPPLIE
0840785   CON LOCM 300-349S I 1ML             156            08             DIAGNOSIC IMAGING SUPPLIE
0840397   CT 3D RENDER W/O POSTPROS          1752            08             DIAGNOSIC IMAGING SUPPLIE
0840355   CT ABD W/CON                       3645            08             DIAGNOSIC IMAGING SUPPLIE
0840348   CT ABD W/O CON                     3039            08             DIAGNOSIC IMAGING SUPPLIE
0840363   CT ABD W-W/O CON                   4491            08             DIAGNOSIC IMAGING SUPPLIE
0840801   CT BONE LENGTH STDY                 436            08             DIAGNOSIC IMAGING SUPPLIE
0840090   CT BRAIN W CON                     3029            08             DIAGNOSIC IMAGING SUPPLIE
0840082   CT BRAIN W/O CON                   2509            08             DIAGNOSIC IMAGING SUPPLIE
0840108   CT BRAIN W-W/O CON                 3760            08             DIAGNOSIC IMAGING SUPPLIE
0840371   CT DRN W CATH PLACE PRC            1778            08             DIAGNOSIC IMAGING SUPPLIE
0840322   CT EXT LOW W CON                   3159            08             DIAGNOSIC IMAGING SUPPLIE
0840314   CT EXT LOW W/O CON                 2669            08             DIAGNOSIC IMAGING SUPPLIE
0840330   CT EXT LOW W-W/O CON               3926            08             DIAGNOSIC IMAGING SUPPLIE
0840306   CT EXT UPP W CON                   3159            08             DIAGNOSIC IMAGING SUPPLIE
0840298   CT EXT UPP W/O CON                 2669            08             DIAGNOSIC IMAGING SUPPLIE
0840389   CT GUIDE NDL PLACEMENT             3456            08             DIAGNOSIC IMAGING SUPPLIE
0840124   CT MAXILLOFACIAL W/O CON           2554            08             DIAGNOSIC IMAGING SUPPLIE
0840165   CT NEC W CON                       3069            08             DIAGNOSIC IMAGING SUPPLIE
0840157   CT NEC W/O CON                     2579            08             DIAGNOSIC IMAGING SUPPLIE
0840140   CT ORBIT SELLA FOSA W-W/O          3790            08             DIAGNOSIC IMAGING SUPPLIE
0840132   CT ORBIT SELLA FOSSA W             3069            08             DIAGNOSIC IMAGING SUPPLIE
0840116   CT ORBIT/SELLA/FOSSA W/O           2579            08             DIAGNOSIC IMAGING SUPPLIE
0840272   CT PELV W CON                      3625            08             DIAGNOSIC IMAGING SUPPLIE
0840264   CT PELV W/O CON                    3149            08             DIAGNOSIC IMAGING SUPPLIE
0840280   CT PELV W-W/O CON                  4461            08             DIAGNOSIC IMAGING SUPPLIE
0840215   CT SPINE CERV W CON                3750            08             DIAGNOSIC IMAGING SUPPLIE
0840207   CT SPINE CERV W/O CON              3159            08             DIAGNOSIC IMAGING SUPPLIE
0840256   CT SPINE LUMB W CON                3750            08             DIAGNOSIC IMAGING SUPPLIE
0840249   CT SPINE LUMB W/O CON              3159            08             DIAGNOSIC IMAGING SUPPLIE
0840231   CT SPINE THOR W CON                3750            08             DIAGNOSIC IMAGING SUPPLIE
0840223   CT SPINE THOR W/O CON              3159            08             DIAGNOSIC IMAGING SUPPLIE
0840181   CT THORAX W CON                    3755            08             DIAGNOSIC IMAGING SUPPLIE
0840173   CT THORAX W/O CON                  3159            08             DIAGNOSIC IMAGING SUPPLIE
0840199   CT THORAX W-W/O                    4672            08             DIAGNOSIC IMAGING SUPPLIE
0840488   CTA ABD W RUNOFF W-W/O             8387            08             DIAGNOSIC IMAGING SUPPLIE
0840470   CTA ABD W-W/O CON                  6349            08             DIAGNOSIC IMAGING SUPPLIE
0840454   CTA CHST NOCORO W-W/O CON          4860            08             DIAGNOSIC IMAGING SUPPLIE
0840439   CTA HEAD W-W/O CON                 4320            08             DIAGNOSIC IMAGING SUPPLIE
0840447   CTA NEC W-W/O CON                  4320            08             DIAGNOSIC IMAGING SUPPLIE
0840462   CTA PELV W-W/O CON                 6339            08             DIAGNOSIC IMAGING SUPPLIE
0840595   CTC ABSCSS CYST LIVER PRC          6026            08             DIAGNOSIC IMAGING SUPPLIE
0840553   CTC ABSCSS DRN PERITNL             6835            08             DIAGNOSIC IMAGING SUPPLIE
0840561   CTC ABSCSS DRN RETROPE              621            08             DIAGNOSIC IMAGING SUPPLIE
0840678   CTC ABSCSS DRN SUBDIAP             9799            08             DIAGNOSIC IMAGING SUPPLIE
0840603   CTC ASP RENL CYST                   320            08             DIAGNOSIC IMAGING SUPPLIE
0840702   CTC BREAST NDL WIRE                1432            08             DIAGNOSIC IMAGING SUPPLIE
0840793   CTC BRONCHOSCOPY DX                2377            08             DIAGNOSIC IMAGING SUPPLIE
0840066   CTC BX ABD RETROPE                 1557            08             DIAGNOSIC IMAGING SUPPLIE
0840017   CTC BX BONE DEEP                   2529            08             DIAGNOSIC IMAGING SUPPLIE
0840686   CTC BX BONE SUPER                  2288            08             DIAGNOSIC IMAGING SUPPLIE
0840645   CTC BX HIP                         1347            08             DIAGNOSIC IMAGING SUPPLIE
0840587   CTC BX LIVER                       1891            08             DIAGNOSIC IMAGING SUPPLIE
0840512   CTC BX LIVER W MAJOR               2172            08             DIAGNOSIC IMAGING SUPPLIE




                                                 Page 52
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0840579   CTC BX LUNG MEDIASTNM              1218            08             DIAGNOSIC IMAGING SUPPLIE
0840009   CTC BX MUSCLE                      1630            08             DIAGNOSIC IMAGING SUPPLIE
0840041   CTC BX PANCREAS                    3991            08             DIAGNOSIC IMAGING SUPPLIE
0840546   CTC BX PLEURA                      1067            08             DIAGNOSIC IMAGING SUPPLIE
0840074   CTC BX PROSTATE                    2103            08             DIAGNOSIC IMAGING SUPPLIE
0840694   CTC BX THYROID                      701            08             DIAGNOSIC IMAGING SUPPLIE
0840405   CTC DRN APPNCL ABSCSS PRC           575            08             DIAGNOSIC IMAGING SUPPLIE
0840611   CTC DRN LIVER LESION               4211            08             DIAGNOSIC IMAGING SUPPLIE
0840413   CTC DRN PANC PSEUDOCYST             673            08             DIAGNOSIC IMAGING SUPPLIE
0840538   CTC DRN RENL ABSCSS                3885            08             DIAGNOSIC IMAGING SUPPLIE
0840660   CTC EXCHANGE DRN CATH              5400            08             DIAGNOSIC IMAGING SUPPLIE
0840637   CTC INC GALLBLADDER                2794            08             DIAGNOSIC IMAGING SUPPLIE
0840421   CTC INJ CON ABSCSS                  226            08             DIAGNOSIC IMAGING SUPPLIE
0840652   CTC INJ NRV BLK LUMB THOR          2579            08             DIAGNOSIC IMAGING SUPPLIE
0840496   CTC INJ NRV ILIOINGUINAL            687            08             DIAGNOSIC IMAGING SUPPLIE
0840629   CTC PARACENT ABD INI               1998            08             DIAGNOSIC IMAGING SUPPLIE
0840058   CTC PARACENT ABD SUBSQ             1297            08             DIAGNOSIC IMAGING SUPPLIE
0840504   CTC PNMNSTOMY W DRN PRC             668            08             DIAGNOSIC IMAGING SUPPLIE
0840025   CTC THORACENTESIS                  4401            08             DIAGNOSIC IMAGING SUPPLIE
0840033   CTC THORACENTESIS W TUBE           1612            08             DIAGNOSIC IMAGING SUPPLIE
0840520   CTC TUBE THORACOSTOMY              3192            08             DIAGNOSIC IMAGING SUPPLIE
0840744   CTC UNLISTED MUSCULOSKEL            915            08             DIAGNOSIC IMAGING SUPPLIE
0840736   CTC VERTEPLASTY EA ADD             6097            08             DIAGNOSIC IMAGING SUPPLIE
0840728   CTC VERTEPLASTY LUMB PRC           6097            08             DIAGNOSIC IMAGING SUPPLIE
0840710   CTC VERTEPLASTY THOR PRC           7028            08             DIAGNOSIC IMAGING SUPPLIE
0880112   NA BICARB                             5            08             DIAGNOSIC IMAGING SUPPLIE
0870410   NM INFUSE RADIOELMNT SOLN           729            08             DIAGNOSIC IMAGING SUPPLIE
0870170   RP F-18 FDG DX DS 45MCI             725            08             DIAGNOSIC IMAGING SUPPLIE
0870030   RP GALLIUM GA-67 DX 1 MCI           139            08             DIAGNOSIC IMAGING SUPPLIE
0870287   RP I123 CAP DX 100UCI               243            08             DIAGNOSIC IMAGING SUPPLIE
0870048   RP IN111 DTPA/0.5MCI               2210            08             DIAGNOSIC IMAGING SUPPLIE
0870485   RP IN111 IBRITUM DX 5MCI          10393            08             DIAGNOSIC IMAGING SUPPLIE
0870063   RP IN111 OXYQIN DX 0.5MCI          2085            08             DIAGNOSIC IMAGING SUPPLIE
0870071   RP P32 SODIUM PHO RX 1MCI          2391            08             DIAGNOSIC IMAGING SUPPLIE
0870089   RP SR89 TX PER MCI                11050            08             DIAGNOSIC IMAGING SUPPLIE
0870386   RP TC99M MAA DX 10MCI                81            08             DIAGNOSIC IMAGING SUPPLIE
0870105   RP TC99M MAA DX 10MCI                57            08             DIAGNOSIC IMAGING SUPPLIE
0870097   RP TC99M MAA DX 10MCI                57            08             DIAGNOSIC IMAGING SUPPLIE
0870451   RP TC99M MDP 1-30MCI                 89            08             DIAGNOSIC IMAGING SUPPLIE
0870295   RP TC99M MEBROFN DX 15MCI           261            08             DIAGNOSIC IMAGING SUPPLIE
0870337   RP TC99M MERTIAT DX 15MCI           782            08             DIAGNOSIC IMAGING SUPPLIE
0870113   RP TC99M MYOVIEW DX 40MCI           417            08             DIAGNOSIC IMAGING SUPPLIE
0870162   RP TC99M OXIDRON DX 30MCI            89            08             DIAGNOSIC IMAGING SUPPLIE
0870121   RP TC99M PYROPHO DX 25MCI            54            08             DIAGNOSIC IMAGING SUPPLIE
0870378   RP TC99M RBC/TAG DX 30MCI           382            08             DIAGNOSIC IMAGING SUPPLIE
0870147   RP TC99M RBC/TAG DX 30MCI           108            08             DIAGNOSIC IMAGING SUPPLIE
0870139   RP TC99M RBC/TAG DX 30MCI           108            08             DIAGNOSIC IMAGING SUPPLIE
0870469   RP TC99M SESTMBI DX 40MCI           799            08             DIAGNOSIC IMAGING SUPPLIE
0870493   RP TC99M SULFR/C DX 20MCI           139            08             DIAGNOSIC IMAGING SUPPLIE
0870329   RP TC99M SULFR/C DX 20MCI            57            08             DIAGNOSIC IMAGING SUPPLIE
0870022   RP TL-201 DX PER MCI                122            08             DIAGNOSIC IMAGING SUPPLIE
0870444   RP TX I-131 CAP PER MCI             478            08             DIAGNOSIC IMAGING SUPPLIE
0870436   RP TX I-131 CAP PER MCI              81            08             DIAGNOSIC IMAGING SUPPLIE
0870154   RP XE133 DX 10MCI                   167            08             DIAGNOSIC IMAGING SUPPLIE
0870477   RP Y90 IBRITUM RX 40MCI           78304            08             DIAGNOSIC IMAGING SUPPLIE




                                                 Page 53
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0879361   S NSTRL                              38            08             DIAGNOSIC IMAGING SUPPLIE
0800003   S STRL CATHETER KIT                  99            08             DIAGNOSIC IMAGING SUPPLIE
0800011   S STRL COPE INTRD SET               490            08             DIAGNOSIC IMAGING SUPPLIE
0800029   S STRL DILTR - ANY SIZE              55            08             DIAGNOSIC IMAGING SUPPLIE
0800052   S STRL NDL-CORE BIOPSY              199            08             DIAGNOSIC IMAGING SUPPLIE
0800060   S STRL NDL-SKINNY BIOPSY            166            08             DIAGNOSIC IMAGING SUPPLIE
0800086   S STRL TRAY SALPINGOGRAM            107            08             DIAGNOSIC IMAGING SUPPLIE
0800094   S STRL TRAY SIALOGRAM               107            08             DIAGNOSIC IMAGING SUPPLIE
0800045   S STRL WIRE GUIDE                    89            08             DIAGNOSIC IMAGING SUPPLIE
0880054   XR FLUORO GUIDE SPINE INJ          1025            08             DIAGNOSIC IMAGING SUPPLIE
0631101   CA CARDIAC STRES TEST              1082            06             DIAGNOSTIC IMAGING PROCED
0631002   CA CARDIAC STRES TEST              1082            06             DIAGNOSTIC IMAGING PROCED
0670984   CA CARDIAC STRES TEST              1082            06             DIAGNOSTIC IMAGING PROCED
0671057   CA ECHO 2D CMPL                    1668            06             DIAGNOSTIC IMAGING PROCED
0671073   CA ECHO DPPLER CMPL                 735            06             DIAGNOSTIC IMAGING PROCED
0671040   CA ECHO DPPLER COLOR FLOW          1162            06             DIAGNOSTIC IMAGING PROCED
0671065   CA ECHO TRANSESOPHAGEAL            1810            06             DIAGNOSTIC IMAGING PROCED
0671008   EKG NO SCAN 24HR ANLY/RPT           404            06             DIAGNOSTIC IMAGING PROCED
0670992   EKG NO SCAN 24HR RCRD               404            06             DIAGNOSTIC IMAGING PROCED
0661629   IR ABSCSS FIST SIN TRACT                           06             DIAGNOSTIC IMAGING PROCED
0661314   IR ANGIO ADD VESSEL EA                             06             DIAGNOSTIC IMAGING PROCED
0661322   IR ANGIO AVS SHUNT                                 06             DIAGNOSTIC IMAGING PROCED
0661157   IR ANGIO CAROTD CERE BIL                           06             DIAGNOSTIC IMAGING PROCED
0661140   IR ANGIO CAROTD CERE UNI                           06             DIAGNOSTIC IMAGING PROCED
0661124   IR ANGIO CAROTD XTL UNI                            06             DIAGNOSTIC IMAGING PROCED
0661207   IR ANGIO EXT UNI                                   06             DIAGNOSTIC IMAGING PROCED
0661447   IR ANGIO FU EXISTING CATH                          06             DIAGNOSTIC IMAGING PROCED
0661272   IR ANGIO PELV SELECT                               06             DIAGNOSTIC IMAGING PROCED
0661231   IR ANGIO RENL BIL                                  06             DIAGNOSTIC IMAGING PROCED
0661181   IR ANGIO VERTEBRAL                                 06             DIAGNOSTIC IMAGING PROCED
0661249   IR ANGIO VISC                                      06             DIAGNOSTIC IMAGING PROCED
0661108   IR AORTOGRAM ABD BIL EXT                           06             DIAGNOSTIC IMAGING PROCED
0661090   IR AORTOGRAM ABD W SER                             06             DIAGNOSTIC IMAGING PROCED
0661082   IR AORTOGRAM THOR W SER                            06             DIAGNOSTIC IMAGING PROCED
0660944   IR ARTHRO SHOULDER                                 06             DIAGNOSTIC IMAGING PROCED
0661900   IR BILE STONE EXTRACTION                           06             DIAGNOSTIC IMAGING PROCED
0661017   IR BILI DUCT DILATE PRC                            06             DIAGNOSTIC IMAGING PROCED
0661058   IR CATH RENL PELV PRC                              06             DIAGNOSTIC IMAGING PROCED
0661033   IR CYSTOGRAM 3V OR MORE                            06             DIAGNOSTIC IMAGING PROCED
0661074   IR DILATE NEPHROSTOMY                              06             DIAGNOSTIC IMAGING PROCED
0660928   IR DISKOGRAM CERV THOR                             06             DIAGNOSTIC IMAGING PROCED
0660936   IR DISKOGRAM LUMB                                  06             DIAGNOSTIC IMAGING PROCED
0661587   IR DRN W CATH PLACE PRC                            06             DIAGNOSTIC IMAGING PROCED
0661009   IR ENTEROCLYSIS TUBE PRC                           06             DIAGNOSTIC IMAGING PROCED
0662072   IR EPIDUROGRAM                                     06             DIAGNOSTIC IMAGING PROCED
0661959   IR EXCHNGE INTRAVAS CATH                           06             DIAGNOSTIC IMAGING PROCED
0663500   IR FALLOPN TUBE TRANSCERV                          06             DIAGNOSTIC IMAGING PROCED
0663427   IR FLUOR CVC PLC/RMV/RPR                           06             DIAGNOSTIC IMAGING PROCED
0661967   IR FLUORO GUIDE SPINE INJ                          06             DIAGNOSTIC IMAGING PROCED
0661611   IR FLUORO NDL PLACE                                06             DIAGNOSTIC IMAGING PROCED
0663336   IR G TUBE PRC                                      06             DIAGNOSTIC IMAGING PROCED
0663377   IR GI TUBE INSERT LONG                             06             DIAGNOSTIC IMAGING PROCED
0661454   IR IVC FILTER PLACE                                06             DIAGNOSTIC IMAGING PROCED
0662221   IR NDL PLACE                                       06             DIAGNOSTIC IMAGING PROCED
0661041   IR RENL CYST STDY                                  06             DIAGNOSTIC IMAGING PROCED




                                                 Page 54
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0661470   IR RETRIEVAL VASCULAR FB                           06             DIAGNOSTIC IMAGING PROCED
0661637   IR SEDATION IV/IM/INH                              06             DIAGNOSTIC IMAGING PROCED
0661645   IR SEDATION PO/PR/INASAL                           06             DIAGNOSTIC IMAGING PROCED
0661330   IR SHUNTOGRAM NONVASC                              06             DIAGNOSTIC IMAGING PROCED
0660910   IR SIALOGRAM                                       06             DIAGNOSTIC IMAGING PROCED
0661462   IR STENT NOCORO/CAR/VERT                           06             DIAGNOSTIC IMAGING PROCED
0661579   IR TUBE CATH CHNG                                  06             DIAGNOSTIC IMAGING PROCED
0661561   IR TUBE CATH CHNG                                  06             DIAGNOSTIC IMAGING PROCED
0661066   IR URETERAL STENT PRC                              06             DIAGNOSTIC IMAGING PROCED
0661025   IR UROGRAM ANTEGRADE                               06             DIAGNOSTIC IMAGING PROCED
0663419   IR US VASC ACCESS ADD ON                           06             DIAGNOSTIC IMAGING PROCED
0661355   IR VENOGRAM EXT BIL                                06             DIAGNOSTIC IMAGING PROCED
0661348   IR VENOGRAM EXT UNI                                06             DIAGNOSTIC IMAGING PROCED
0661363   IR VENOGRAM IVC                                    06             DIAGNOSTIC IMAGING PROCED
0661397   IR VENOGRAM RENL BIL                               06             DIAGNOSTIC IMAGING PROCED
0661389   IR VENOGRAM RENL UNI                               06             DIAGNOSTIC IMAGING PROCED
0661926   IR VENOGRAM SIN JUGULAR                            06             DIAGNOSTIC IMAGING PROCED
0662015   IR VRTPLSTY EA BDY FLUORO                          06             DIAGNOSTIC IMAGING PROCED
0660647   IRC ABSCSS DRN PERITNL                             06             DIAGNOSTIC IMAGING PROCED
0660670   IRC ABSCSS DRN RENL                                06             DIAGNOSTIC IMAGING PROCED
0660654   IRC ABSCSS DRN RETROPE                             06             DIAGNOSTIC IMAGING PROCED
0661850   IRC ASP BLADDER SP CATH                            06             DIAGNOSTIC IMAGING PROCED
0660696   IRC ASP RENL CYST                                  06             DIAGNOSTIC IMAGING PROCED
0660308   IRC AVS DIAL SHUNT                                 06             DIAGNOSTIC IMAGING PROCED
0660597   IRC BILI CATH CHNG                                 06             DIAGNOSTIC IMAGING PROCED
0660662   IRC BX ABD RETROPE                                 06             DIAGNOSTIC IMAGING PROCED
0660530   IRC BX LIVER                                       06             DIAGNOSTIC IMAGING PROCED
0660134   IRC BX LUNG MEDIASTNM                              06             DIAGNOSTIC IMAGING PROCED
0660639   IRC BX PANCREAS                                    06             DIAGNOSTIC IMAGING PROCED
0660126   IRC BX PLEURA                                      06             DIAGNOSTIC IMAGING PROCED
0660688   IRC BX RENL                                        06             DIAGNOSTIC IMAGING PROCED
0660365   IRC CATH ABD LOW 1ST                               06             DIAGNOSTIC IMAGING PROCED
0661769   IRC CHNG GT TUBE                                   06             DIAGNOSTIC IMAGING PROCED
0662031   IRC CYSTO TUBE CHNG CMPLX                          06             DIAGNOSTIC IMAGING PROCED
0661884   IRC DESTRUCT NRV L/S                               06             DIAGNOSTIC IMAGING PROCED
0661868   IRC DISKECTOMY LUMB PRC                            06             DIAGNOSTIC IMAGING PROCED
0661827   IRC DRN ABD ABSCSS OPN              948            06             DIAGNOSTIC IMAGING PROCED
0660464   IRC EMBOL OCC NONHEAD NEC                          06             DIAGNOSTIC IMAGING PROCED
0661835   IRC EXCHANGE DRN CATH                              06             DIAGNOSTIC IMAGING PROCED
0661751   IRC EXCHNGE INTRAVAS CATH                          06             DIAGNOSTIC IMAGING PROCED
0660076   IRC INJ ARTHRO HIP                                 06             DIAGNOSTIC IMAGING PROCED
0660068   IRC INJ ARTHRO SHOULDER                            06             DIAGNOSTIC IMAGING PROCED
0660555   IRC INJ CHOL TRANSHEPAT                            06             DIAGNOSTIC IMAGING PROCED
0660563   IRC INJ CHOL VIA CATH                              06             DIAGNOSTIC IMAGING PROCED
0660779   IRC INJ CYSTO VCUG                  431            06             DIAGNOSTIC IMAGING PROCED
0660837   IRC INJ DISKOGRAM CERV                             06             DIAGNOSTIC IMAGING PROCED
0660829   IRC INJ DISKOGRAM LUMB                             06             DIAGNOSTIC IMAGING PROCED
0662288   IRC INJ EPID L/S                                   06             DIAGNOSTIC IMAGING PROCED
0660217   IRC INJ EXT VENOGRAM                               06             DIAGNOSTIC IMAGING PROCED
0660845   IRC INJ FACET C/T ADD LVL                          06             DIAGNOSTIC IMAGING PROCED
0660852   IRC INJ FACET L/S 1 LVL                            06             DIAGNOSTIC IMAGING PROCED
0660860   IRC INJ FACET L/S ADD LVL                          06             DIAGNOSTIC IMAGING PROCED
0660761   IRC INJ ILEAL CONDUIT                              06             DIAGNOSTIC IMAGING PROCED
0660050   IRC INJ MAJOR JNT BURSA                            06             DIAGNOSTIC IMAGING PROCED
0660720   IRC INJ NEPHROGRAM                                 06             DIAGNOSTIC IMAGING PROCED




                                                 Page 55
                                c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION             SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                   AMOUNT AMOUNT CODE

0660878   IRC INJ NRV BLK C/T 1 LVL                         06             DIAGNOSTIC IMAGING PROCED
0660886   IRC INJ NRV BLK C/T ADD                           06             DIAGNOSTIC IMAGING PROCED
0660894   IRC INJ NRV BLK L/S 1 LVL                         06             DIAGNOSTIC IMAGING PROCED
0660902   IRC INJ NRV BLK L/S ADD                           06             DIAGNOSTIC IMAGING PROCED
0661876   IRC INJ NRV BLK LUMB THOR                         06             DIAGNOSTIC IMAGING PROCED
0661678   IRC INJ SI JNT ANES/STRD                          06             DIAGNOSTIC IMAGING PROCED
0660506   IRC INJ SIALOGRAM                                 06             DIAGNOSTIC IMAGING PROCED
0660043   IRC INJ SINOGRAM                                  06             DIAGNOSTIC IMAGING PROCED
0661660   IRC INJ/ASP JNT/BURSA                             06             DIAGNOSTIC IMAGING PROCED
0663393   IRC INS NON-TUN CV CATH5+                         06             DIAGNOSTIC IMAGING PROCED
0663484   IRC INS PICC W/O PORT 5+                          06             DIAGNOSTIC IMAGING PROCED
0663716   IRC INS PICC W/PORT 5+YRS        12447            06             DIAGNOSTIC IMAGING PROCED
0663682   IRC INS TUN CV NO PRT LT5         4736            06             DIAGNOSTIC IMAGING PROCED
0663435   IRC INS TUNN CV NO PORT5+                         06             DIAGNOSTIC IMAGING PROCED
0660316   IRC INTRO CATH AORTA                              06             DIAGNOSTIC IMAGING PROCED
0660571   IRC INTRO CATH BILI DRN                           06             DIAGNOSTIC IMAGING PROCED
0663492   IRC INTRO CATH FALLOPN                            06             DIAGNOSTIC IMAGING PROCED
0660225   IRC INTRO CATH IVC /SVC                           06             DIAGNOSTIC IMAGING PROCED
0660258   IRC INTRO CATH PULM                               06             DIAGNOSTIC IMAGING PROCED
0660704   IRC INTRO CATH RENL PELV                          06             DIAGNOSTIC IMAGING PROCED
0660290   IRC INTRO EXT ART                                 06             DIAGNOSTIC IMAGING PROCED
0660514   IRC INTRO G TUBE                                  06             DIAGNOSTIC IMAGING PROCED
0660522   IRC INTRO G TUBE LONG                             06             DIAGNOSTIC IMAGING PROCED
0660738   IRC INTRO NEPHROSTOMY                             06             DIAGNOSTIC IMAGING PROCED
0660712   IRC INTRO STENT CATH URET                         06             DIAGNOSTIC IMAGING PROCED
0660456   IRC IVCH RETRIEVE FB                              06             DIAGNOSTIC IMAGING PROCED
0660811   IRC LUMBAR PUNCTURE DX                            06             DIAGNOSTIC IMAGING PROCED
0660746   IRC NEPHROSTOMY MANOMETRY                         06             DIAGNOSTIC IMAGING PROCED
0660753   IRC NEPHROSTOMY TUBE CHNG                         06             DIAGNOSTIC IMAGING PROCED
0660167   IRC PTA AORTIC                                    06             DIAGNOSTIC IMAGING PROCED
0660159   IRC PTA RENL VISC                                 06             DIAGNOSTIC IMAGING PROCED
0661777   IRC REPOSITION G TUBE                             06             DIAGNOSTIC IMAGING PROCED
0663450   IRC REPR CV CATH W/O PORT                         06             DIAGNOSTIC IMAGING PROCED
0661710   IRC REPS PREV PLC CV CATH                         06             DIAGNOSTIC IMAGING PROCED
0663476   IRC RPLC CMP TUN PICC W/O                         06             DIAGNOSTIC IMAGING PROCED
0663468   IRC RPLC COMP NON-TUNN CV                         06             DIAGNOSTIC IMAGING PROCED
0663385   IRC RPLC COMP TUN CV CATH                         06             DIAGNOSTIC IMAGING PROCED
0660241   IRC SELECT CATH 2ND VEN                           06             DIAGNOSTIC IMAGING PROCED
0660092   IRC THORACENTESIS                                 06             DIAGNOSTIC IMAGING PROCED
0660100   IRC THORACENTESIS W TUBE                          06             DIAGNOSTIC IMAGING PROCED
0661975   IRC THROMBECTOMY AVS FIST                         06             DIAGNOSTIC IMAGING PROCED
0660118   IRC TUBE THORACOSTOMY                             06             DIAGNOSTIC IMAGING PROCED
0663708   IRC TUNN CV W/PORT 2CATH         19930            06             DIAGNOSTIC IMAGING PROCED
0650424   MR ABD W CON                      3469            06             DIAGNOSTIC IMAGING PROCED
0650267   MR ABD W/O CON                    2891            06             DIAGNOSTIC IMAGING PROCED
0650432   MR ABD W-W/O CON                  6343            06             DIAGNOSTIC IMAGING PROCED
0650069   MR BRAIN W STEM W CON             3474            06             DIAGNOSTIC IMAGING PROCED
0650051   MR BRAIN W STEM W/O CON           2894            06             DIAGNOSTIC IMAGING PROCED
0650077   MR BRAIN W STEM W-W/O CON         6353            06             DIAGNOSTIC IMAGING PROCED
0650309   MR BREAST BIL W-W/O CON           2901            06             DIAGNOSTIC IMAGING PROCED
0650440   MR BREAST UNI W-W/O CON           2361            06             DIAGNOSTIC IMAGING PROCED
0650291   MR CARDIAC W CON                  2933            06             DIAGNOSTIC IMAGING PROCED
0650283   MR CARDIAC W/O CON                2904            06             DIAGNOSTIC IMAGING PROCED
0650366   MR CHEST W CON                    3469            06             DIAGNOSTIC IMAGING PROCED
0650085   MR CHEST W/O CON                  2891            06             DIAGNOSTIC IMAGING PROCED




                                                Page 56
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0650580   MR CHEST W-W/O CON                 6343            06             DIAGNOSTIC IMAGING PROCED
0650002   MR DENTAL PARTIAL EXAM             2894            06             DIAGNOSTIC IMAGING PROCED
0650408   MR EXT LOW JNT W CON               3459            06             DIAGNOSTIC IMAGING PROCED
0650416   MR EXT LOW JNT W-W/O CON           6336            06             DIAGNOSTIC IMAGING PROCED
0650259   MR EXT LOW JT W/O CON              2881            06             DIAGNOSTIC IMAGING PROCED
0650549   MR EXT LOW NO JNT W CON            3459            06             DIAGNOSTIC IMAGING PROCED
0650390   MR EXT LOW W/O CON                 2881            06             DIAGNOSTIC IMAGING PROCED
0650234   MR EXT LOW W-W/O CON               6333            06             DIAGNOSTIC IMAGING PROCED
0650382   MR EXT UPP JNT W CON               3459            06             DIAGNOSTIC IMAGING PROCED
0650226   MR EXT UPP JNT W/O CON             2881            06             DIAGNOSTIC IMAGING PROCED
0650473   MR EXT UPP JNT W-W/O CON           6336            06             DIAGNOSTIC IMAGING PROCED
0650465   MR EXT UPP NO JNT W/CON            3462            06             DIAGNOSTIC IMAGING PROCED
0650457   MR EXT UPP NO JNT W/O CON          2881            06             DIAGNOSTIC IMAGING PROCED
0650556   MR EXT UPP NO JNT W-W/O            6336            06             DIAGNOSTIC IMAGING PROCED
0650317   MR ORBIT FACE NEC W CON            3459            06             DIAGNOSTIC IMAGING PROCED
0650010   MR ORBIT FACE NEC W/O CON          2881            06             DIAGNOSTIC IMAGING PROCED
0650325   MR ORBIT FACE NEC W-W/O            6336            06             DIAGNOSTIC IMAGING PROCED
0650200   MR PELV W CON                      3469            06             DIAGNOSTIC IMAGING PROCED
0650374   MR PELV W/O CON                    2891            06             DIAGNOSTIC IMAGING PROCED
0650572   MR PELV W-W/O CON                  6343            06             DIAGNOSTIC IMAGING PROCED
0650119   MR SPINE CERV W CON                3486            06             DIAGNOSTIC IMAGING PROCED
0650101   MR SPINE CERV W/O CON              2904            06             DIAGNOSTIC IMAGING PROCED
0650168   MR SPINE CERV W-W/O CON            6370            06             DIAGNOSTIC IMAGING PROCED
0650150   MR SPINE LUMB W CON                3476            06             DIAGNOSTIC IMAGING PROCED
0650143   MR SPINE LUMB W/O CON              3202            06             DIAGNOSTIC IMAGING PROCED
0650184   MR SPINE LUMB W-W/O                6353            06             DIAGNOSTIC IMAGING PROCED
0650135   MR SPINE THOR W CON                3484            06             DIAGNOSTIC IMAGING PROCED
0650127   MR SPINE THOR W/O CON              3212            06             DIAGNOSTIC IMAGING PROCED
0650176   MR SPINE THOR W-W/O                6368            06             DIAGNOSTIC IMAGING PROCED
0650275   MRA ABD W-W/O CON                  2059            06             DIAGNOSTIC IMAGING PROCED
0650093   MRA CHEST W-W/O CON                2045            06             DIAGNOSTIC IMAGING PROCED
0650564   MRA EXT LOW W/O CON                1675            06             DIAGNOSTIC IMAGING PROCED
0650036   MRA HEAD W CON                     2869            06             DIAGNOSTIC IMAGING PROCED
0650028   MRA HEAD W/O CON                   2872            06             DIAGNOSTIC IMAGING PROCED
0650044   MRA HEAD W-W/O CON                 5694            06             DIAGNOSTIC IMAGING PROCED
0650341   MRA NEC W CON                      2869            06             DIAGNOSTIC IMAGING PROCED
0650333   MRA NEC W/O CON                    2869            06             DIAGNOSTIC IMAGING PROCED
0650358   MRA NEC W-W/O CON                  5694            06             DIAGNOSTIC IMAGING PROCED
0650218   MRA PELV W-W/O CON                 2769            06             DIAGNOSTIC IMAGING PROCED
0650192   MRA SPNAL CANAL W-W/O CON          3200            06             DIAGNOSTIC IMAGING PROCED
0670927   NI AORTA IVC IL CMPL               1325            06             DIAGNOSTIC IMAGING PROCED
0670943   NI DIAL ACCES                      1172            06             DIAGNOSTIC IMAGING PROCED
0670877   NI DPPLER EXT VEINS BIL             821            06             DIAGNOSTIC IMAGING PROCED
0670919   NI DUPLEX ABD PELV CMPL            2242            06             DIAGNOSTIC IMAGING PROCED
0670836   NI DUPLEX EXT LOW BIL              1993            06             DIAGNOSTIC IMAGING PROCED
0670844   NI DUPLEX EXT LOW UNI              1190            06             DIAGNOSTIC IMAGING PROCED
0670851   NI DUPLEX EXT UPP BIL              1574            06             DIAGNOSTIC IMAGING PROCED
0670869   NI DUPLEX EXT UPP UNI              1023            06             DIAGNOSTIC IMAGING PROCED
0670885   NI DUPLEX EXT VEINS BIL            1542            06             DIAGNOSTIC IMAGING PROCED
0670901   NI DUPLEX EXT VEINS UNI            1055            06             DIAGNOSTIC IMAGING PROCED
0670893   NI DUPLEX EXT VEINS UNI            1055            06             DIAGNOSTIC IMAGING PROCED
0670810   NI DUPLEX EXTRACRAN BIL            1633            06             DIAGNOSTIC IMAGING PROCED
0670828   NI DUPLEX EXTRACRAN UNI            1029            06             DIAGNOSTIC IMAGING PROCED
0670950   NI EXT ART 1 LVL BIL LTD            788            06             DIAGNOSTIC IMAGING PROCED
0670968   NI EXT ART MULTI BIL LTD           1184            06             DIAGNOSTIC IMAGING PROCED




                                                 Page 57
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0670976   NI EXT LOW W STRES LTD             1407            06             DIAGNOSTIC IMAGING PROCED
0670935   NI PENILE VESSELS CMPL              838            06             DIAGNOSTIC IMAGING PROCED
0630426   NM ABSCSS LOC LTD                  1399            06             DIAGNOSTIC IMAGING PROCED
0630434   NM ABSCSS LOC WB                   2576            06             DIAGNOSTIC IMAGING PROCED
0630483   NM AUTO DATA GEN GT 30             1020            06             DIAGNOSTIC IMAGING PROCED
0630194   NM BONE SCAN MULTI AREAS           1509            06             DIAGNOSTIC IMAGING PROCED
0630228   NM BONE SCAN W SPECT               2404            06             DIAGNOSTIC IMAGING PROCED
0630202   NM BONE SCAN WB                    1746            06             DIAGNOSTIC IMAGING PROCED
0630210   NM BONE THREE PHASE                1960            06             DIAGNOSTIC IMAGING PROCED
0630178   NM BOWEL (MECKELS)                 1257            06             DIAGNOSTIC IMAGING PROCED
0630327   NM BRAIN CISTERNOGRAM              2018            06             DIAGNOSTIC IMAGING PROCED
0630301   NM BRAIN CMPL W FLOW               1563            06             DIAGNOSTIC IMAGING PROCED
0630319   NM BRAIN CMPL W SPECT              2675            06             DIAGNOSTIC IMAGING PROCED
0630335   NM BRAIN CSF SHUNT EVAL            1387            06             DIAGNOSTIC IMAGING PROCED
0630145   NM GASTRIC EMPTYING                1681            06             DIAGNOSTIC IMAGING PROCED
0630160   NM GI BLEEDING SCAN                1991            06             DIAGNOSTIC IMAGING PROCED
0630491   NM HEART GATED SNGL                2243            06             DIAGNOSTIC IMAGING PROCED
0630251   NM HEART MI PLANAR                 1039            06             DIAGNOSTIC IMAGING PROCED
0630244   NM HEART MP MULTI W SPECT          4716            06             DIAGNOSTIC IMAGING PROCED
0630236   NM HEART MP SNGL W SPEC            2855            06             DIAGNOSTIC IMAGING PROCED
0630277   NM HEART MP W EF                    680            06             DIAGNOSTIC IMAGING PROCED
0630269   NM HEART MP WALL MOTION             684            06             DIAGNOSTIC IMAGING PROCED
0630111   NM HEPATOBILIARY DUCTAL            1509            06             DIAGNOSTIC IMAGING PROCED
0631085   NM INFUSE RADIOELMNT SOLN           441            06             DIAGNOSTIC IMAGING PROCED
0630509   NM K FLOW/FUNCT MULTIPLE           1892            06             DIAGNOSTIC IMAGING PROCED
0630350   NM K FLOW/FUNCT W/DRUG             1869            06             DIAGNOSTIC IMAGING PROCED
0630343   NM K FLOW/FUNCT W/O DRG            1834            06             DIAGNOSTIC IMAGING PROCED
0630095   NM LIVER SPLEEN STATIC             1188            06             DIAGNOSTIC IMAGING PROCED
0630103   NM LIVER SPLEEN W FLOW             1406            06             DIAGNOSTIC IMAGING PROCED
0630087   NM LIVER W VASCULAR FLOW           1169            06             DIAGNOSTIC IMAGING PROCED
0630285   NM LUNG PERF                       1410            06             DIAGNOSTIC IMAGING PROCED
0631143   NM LUNG QUAN DIFF FNCTN            2870            06             DIAGNOSTIC IMAGING PROCED
0630079   NM LYMPHATIC PATHWAY               1716            06             DIAGNOSTIC IMAGING PROCED
0631150   NM MONOCLONAL AB IV INFSN          1976            06             DIAGNOSTIC IMAGING PROCED
0630053   NM PARATHYROID                     1743            06             DIAGNOSTIC IMAGING PROCED
0630525   NM RBC BLOOD VOLUME                 458            06             DIAGNOSTIC IMAGING PROCED
0630137   NM SALIVARY GLND W SER             1284            06             DIAGNOSTIC IMAGING PROCED
0630129   NM SALIVARY GLND W SER             1284            06             DIAGNOSTIC IMAGING PROCED
0630368   NM TESTICULR IMGNG W FLOW          1318            06             DIAGNOSTIC IMAGING PROCED
0630038   NM THYROID IMAG ONLY                749            06             DIAGNOSTIC IMAGING PROCED
0630020   NM THYROID IMAG UPT MULTI          1051            06             DIAGNOSTIC IMAGING PROCED
0630012   NM THYROID IMAG UPT SNGL            974            06             DIAGNOSTIC IMAGING PROCED
0630046   NM THYROID METS WB                 2193            06             DIAGNOSTIC IMAGING PROCED
0630004   NM THYROID UPTAKE SNGL              394            06             DIAGNOSTIC IMAGING PROCED
0630418   NM TUMOR LOC SPECT W RP            2656            06             DIAGNOSTIC IMAGING PROCED
0630400   NM TUMOR LOC WB SNGL DAY           2232            06             DIAGNOSTIC IMAGING PROCED
0631135   NM TX RADIOPHARM IV ADM            1261            06             DIAGNOSTIC IMAGING PROCED
0630475   NM TX RADIOPHARM IV ADM            1261            06             DIAGNOSTIC IMAGING PROCED
0630467   NM TX RADIOPHARM ORAL ADM          1234            06             DIAGNOSTIC IMAGING PROCED
0630459   NM TX RADIOPHARM ORAL ADM          1234            06             DIAGNOSTIC IMAGING PROCED
0630442   NM TX RADIOPHARM ORAL ADM          1234            06             DIAGNOSTIC IMAGING PROCED
0630293   NM VENT/PER REBRTH/WASHOU          2300            06             DIAGNOSTIC IMAGING PROCED
0630152   NM VIT B12 COMBINED                 925            06             DIAGNOSTIC IMAGING PROCED
0630186   NM VP SHUNT PATENCY                1288            06             DIAGNOSTIC IMAGING PROCED
0631119   NM WHOLE BODY 2+ DAYS              4379            06             DIAGNOSTIC IMAGING PROCED




                                                 Page 58
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0680207   PS BRAIN METBLC EVAL                6592            06             DIAGNOSTIC IMAGING PROCED
0680215   PS HEART METBLC EVAL                6592            06             DIAGNOSTIC IMAGING PROCED
0680132   PS TUMOR FULL BODY                  5831            06             DIAGNOSTIC IMAGING PROCED
0680124   PS TUMOR FULL BODY                  5831            06             DIAGNOSTIC IMAGING PROCED
0680116   PS TUMOR FULL BODY                  5831            06             DIAGNOSTIC IMAGING PROCED
0680108   PS TUMOR FULL BODY                  6592            06             DIAGNOSTIC IMAGING PROCED
0680090   PS TUMOR FULL BODY                  5831            06             DIAGNOSTIC IMAGING PROCED
0680082   PS TUMOR FULL BODY                  5831            06             DIAGNOSTIC IMAGING PROCED
0680033   PS TUMOR FULL BODY                  5831            06             DIAGNOSTIC IMAGING PROCED
0680249   PS TUMOR LIMITED AREA               4538            06             DIAGNOSTIC IMAGING PROCED
0680231   PS TUMOR LIMITED AREA               4538            06             DIAGNOSTIC IMAGING PROCED
0680199   PS TUMOR LIMITED AREA               4538            06             DIAGNOSTIC IMAGING PROCED
0680181   PS TUMOR LIMITED AREA               4538            06             DIAGNOSTIC IMAGING PROCED
0680173   PS TUMOR LIMITED AREA               4538            06             DIAGNOSTIC IMAGING PROCED
0680165   PS TUMOR LIMITED AREA               4538            06             DIAGNOSTIC IMAGING PROCED
0680157   PS TUMOR LIMITED AREA               4538            06             DIAGNOSTIC IMAGING PROCED
0680140   PS TUMOR LIMITED AREA               4538            06             DIAGNOSTIC IMAGING PROCED
0680074   PS TUMOR LIMITED AREA               4538            06             DIAGNOSTIC IMAGING PROCED
0680066   PS TUMOR LIMITED AREA               4538            06             DIAGNOSTIC IMAGING PROCED
0680025   PS TUMOR LIMITED AREA               4538            06             DIAGNOSTIC IMAGING PROCED
0680009   PS TUMOR LIMITED AREA               4538            06             DIAGNOSTIC IMAGING PROCED
0680058   PS TUMOR SKULL TO THIGH             5623            06             DIAGNOSTIC IMAGING PROCED
0680041   PS TUMOR SKULL TO THIGH             5623            06             DIAGNOSTIC IMAGING PROCED
0680017   PS TUMOR SKULL TO THIGH             5623            06             DIAGNOSTIC IMAGING PROCED
0631069   RP TC99M MDP 1-30MCI                  35            06             DIAGNOSTIC IMAGING PROCED
0630566   RP TC99M PERTEC DX EA MCI              2            06             DIAGNOSTIC IMAGING PROCED
0630582   RP TC99M SC FLT DX 20MCI             350            06             DIAGNOSTIC IMAGING PROCED
0631044   RP TX I-131 CAP PER MCI               82            06             DIAGNOSTIC IMAGING PROCED
0631036   RP TX I-131 CAP PER MCI               13            06             DIAGNOSTIC IMAGING PROCED
0631028   RP TX I-131 CAP PER MCI              315            06             DIAGNOSTIC IMAGING PROCED
0626523   STATISTICAL TRACKING                                06             DIAGNOSTIC IMAGING PROCED
0670794   STATISTICAL TRACKING                                06             DIAGNOSTIC IMAGING PROCED
0670513   US ABD CMPL                         1117            06             DIAGNOSTIC IMAGING PROCED
0670679   US AMNIOCENTESIS                     824            06             DIAGNOSTIC IMAGING PROCED
0670596   US BIO PROFILE W NONSTRES            962            06             DIAGNOSTIC IMAGING PROCED
0670505   US BREAST UNI OR BIL                 343            06             DIAGNOSTIC IMAGING PROCED
0670497   US CHEST                             739            06             DIAGNOSTIC IMAGING PROCED
0670463   US DRN W CATH PLACE PRC             1762            06             DIAGNOSTIC IMAGING PROCED
0670521   US ECHO ABD LTD                      799            06             DIAGNOSTIC IMAGING PROCED
0670752   US ECHO INF HIPS                     873            06             DIAGNOSTIC IMAGING PROCED
0670471   US ENCEPHALOGRAM                     824            06             DIAGNOSTIC IMAGING PROCED
0670653   US EXT NONVASCULAR                   799            06             DIAGNOSTIC IMAGING PROCED
0670687   US GUIDANCE INTRAOP                 1504            06             DIAGNOSTIC IMAGING PROCED
0670778   US GUIDE ART PSEUDOANEUR            3459            06             DIAGNOSTIC IMAGING PROCED
0670489   US HEAD & NEC SFT TISSUE             794            06             DIAGNOSTIC IMAGING PROCED
0670760   US NDL PLACE                         706            06             DIAGNOSTIC IMAGING PROCED
0671099   US OB 1ST TRI 1 GEST                1216            06             DIAGNOSTIC IMAGING PROCED
0671081   US OB 1ST TRI EA GEST                665            06             DIAGNOSTIC IMAGING PROCED
0670554   US OB AFTR 1ST TRI 1 GEST           1250            06             DIAGNOSTIC IMAGING PROCED
0670562   US OB AFTR 1ST TRI EA GES           1322            06             DIAGNOSTIC IMAGING PROCED
0670588   US OB FU/REEVAL EA FETUS             742            06             DIAGNOSTIC IMAGING PROCED
0670570   US OB LTD 1/MORE FETUSES            1204            06             DIAGNOSTIC IMAGING PROCED
0671115   US OB MID CEREBRAL ARTERY            933            06             DIAGNOSTIC IMAGING PROCED
0671107   US OB UMBILLICAL ARTERY              893            06             DIAGNOSTIC IMAGING PROCED
0670620   US PELV CMPL NONOB                   868            06             DIAGNOSTIC IMAGING PROCED




                                                  Page 59
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0670638   US PELV LTD FU NONOB                577            06             DIAGNOSTIC IMAGING PROCED
0670661   US PERICARDIOCENT                   878            06             DIAGNOSTIC IMAGING PROCED
0670539   US RETROPE CMPL                    1102            06             DIAGNOSTIC IMAGING PROCED
0670612   US SAL INFN SONOHYSTERGHY           878            06             DIAGNOSTIC IMAGING PROCED
0670265   US SPECIMEN SURGICAL                233            06             DIAGNOSTIC IMAGING PROCED
0670547   US SPINAL CANAL                     873            06             DIAGNOSTIC IMAGING PROCED
0670646   US TESTICULAR SCROTUM               859            06             DIAGNOSTIC IMAGING PROCED
0670604   US TRANSVAGINAL                     892            06             DIAGNOSTIC IMAGING PROCED
0670364   USC ABSCSS CYST LIVER PRC          5973            06             DIAGNOSTIC IMAGING PROCED
0670372   USC ABSCSS DRN PERITNL             1244            06             DIAGNOSTIC IMAGING PROCED
0670380   USC ABSCSS DRN RETROPE              617            06             DIAGNOSTIC IMAGING PROCED
0670448   USC AMNIOCENTESIS DX               1927            06             DIAGNOSTIC IMAGING PROCED
0670745   USC ASP BLADDER SP CATH            1562            06             DIAGNOSTIC IMAGING PROCED
0670281   USC ASP BREAST ADD                  819            06             DIAGNOSTIC IMAGING PROCED
0670273   USC ASP BREAST CYST                 819            06             DIAGNOSTIC IMAGING PROCED
0670299   USC BREAST NDL WIRE                1419            06             DIAGNOSTIC IMAGING PROCED
0670414   USC BX ABD RETROPE                 1543            06             DIAGNOSTIC IMAGING PROCED
0670711   USC BX BREAST W IMAG               1906            06             DIAGNOSTIC IMAGING PROCED
0670356   USC BX LIVER                       1875            06             DIAGNOSTIC IMAGING PROCED
0670349   USC BX LUNG MEDIASTNM              1208            06             DIAGNOSTIC IMAGING PROCED
0670307   USC BX MUSCLE                      1615            06             DIAGNOSTIC IMAGING PROCED
0670331   USC BX PLEURA                      1182            06             DIAGNOSTIC IMAGING PROCED
0670422   USC BX RENL                        1980            06             DIAGNOSTIC IMAGING PROCED
0670455   USC BX THYROID                      695            06             DIAGNOSTIC IMAGING PROCED
0670729   USC DRN APPNCL ABSCSS PRC           457            06             DIAGNOSTIC IMAGING PROCED
0670737   USC DRN PANC PSEUDOCYST             668            06             DIAGNOSTIC IMAGING PROCED
0670786   USC FNA W IMAG GUIDANCE            1265            06             DIAGNOSTIC IMAGING PROCED
0670398   USC PARACENT ABD INI               1980            06             DIAGNOSTIC IMAGING PROCED
0670406   USC PARACENT ABD SUBSQ             1285            06             DIAGNOSTIC IMAGING PROCED
0670802   USC PSEUDOANEURYSM INJ             1424            06             DIAGNOSTIC IMAGING PROCED
0670430   USC SAL INFN SONOHYSTER            1573            06             DIAGNOSTIC IMAGING PROCED
0670315   USC THORACENTESIS                  4362            06             DIAGNOSTIC IMAGING PROCED
0670323   USC THORACENTESIS W TUBE           1598            06             DIAGNOSTIC IMAGING PROCED
0626002   XR ABD 1V AP                        407            06             DIAGNOSTIC IMAGING PROCED
0626564   XR ABD CMPL DECUB ERECT             499            06             DIAGNOSTIC IMAGING PROCED
0626010   XR ABD CMPL W 1V CHEST              583            06             DIAGNOSTIC IMAGING PROCED
0626374   XR ABSCSS FIST SIN TRACT            864            06             DIAGNOSTIC IMAGING PROCED
0625681   XR AC JNT                           520            06             DIAGNOSTIC IMAGING PROCED
0626549   XR ANGIO EXT UNI                   9150            06             DIAGNOSTIC IMAGING PROCED
0625939   XR ANKLE 2V                         379            06             DIAGNOSTIC IMAGING PROCED
0625947   XR ANKLE 3V OR MORE                 414            06             DIAGNOSTIC IMAGING PROCED
0625954   XR ARTHRO ANKLE                    1608            06             DIAGNOSTIC IMAGING PROCED
0625723   XR ARTHRO ELBOW                    1615            06             DIAGNOSTIC IMAGING PROCED
0625830   XR ARTHRO HIP                      1608            06             DIAGNOSTIC IMAGING PROCED
0625905   XR ARTHRO KNEE                     1966            06             DIAGNOSTIC IMAGING PROCED
0625673   XR ARTHRO SHOULDER                 1608            06             DIAGNOSTIC IMAGING PROCED
0625764   XR ARTHRO WRIST                    1236            06             DIAGNOSTIC IMAGING PROCED
0626101   XR BE                              1355            06             DIAGNOSTIC IMAGING PROCED
0626580   XR BE THRP                         2268            06             DIAGNOSTIC IMAGING PROCED
0626119   XR BE W AIR CON                    1798            06             DIAGNOSTIC IMAGING PROCED
0626309   XR BONE AGE STDY                    407            06             DIAGNOSTIC IMAGING PROCED
0626325   XR BONE LENGTH STDY                 611            06             DIAGNOSTIC IMAGING PROCED
0626341   XR BONE SURVEY CMPL                1138            06             DIAGNOSTIC IMAGING PROCED
0600148   XR BONE SURVEY CMPL                                06             DIAGNOSTIC IMAGING PROCED
0626358   XR BONE SURVEY INF                  674            06             DIAGNOSTIC IMAGING PROCED




                                                 Page 60
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

0626333   XR BONE SURVEY LTD                   808            06             DIAGNOSTIC IMAGING PROCED
0601096   XR CAD SCRN MAMMO DIG                 24            06             DIAGNOSTIC IMAGING PROCED
0626515   XR CAD SCRN MAMMO DIG                 24            06             DIAGNOSTIC IMAGING PROCED
0625988   XR CALCANEOUS 2V OR MORE             365            06             DIAGNOSTIC IMAGING PROCED
0625327   XR CHEST 1V                          372            06             DIAGNOSTIC IMAGING PROCED
0625335   XR CHEST 2V                          485            06             DIAGNOSTIC IMAGING PROCED
0625343   XR CHEST 2V W AP LORDOTIC            576            06             DIAGNOSTIC IMAGING PROCED
0625350   XR CHEST 2V W FLUORO                 639            06             DIAGNOSTIC IMAGING PROCED
0625368   XR CHEST 4V CMPL                     618            06             DIAGNOSTIC IMAGING PROCED
0626143   XR CHOL EXISTING CATH                646            06             DIAGNOSTIC IMAGING PROCED
0626135   XR CHOL IN OR                        702            06             DIAGNOSTIC IMAGING PROCED
0626150   XR CHOL TRANSHEPAT PRC              2346            06             DIAGNOSTIC IMAGING PROCED
0626127   XR CHOLECYSTOGRAM ORAL               583            06             DIAGNOSTIC IMAGING PROCED
0625632   XR CLAVICLE CMPL                     400            06             DIAGNOSTIC IMAGING PROCED
0610048   XR CS DIFF MD ADD 15M                225            06             DIAGNOSTIC IMAGING PROCED
0610030   XR CS DIFF MD GT5YR 0-30M            506            06             DIAGNOSTIC IMAGING PROCED
0610022   XR CS DIFF MD LT5YR 0-30M            611            06             DIAGNOSTIC IMAGING PROCED
0610014   XR CS SAME MD ADD 15M                225            06             DIAGNOSTIC IMAGING PROCED
0610006   XR CS SAME MD GT5YR 0-30M            562            06             DIAGNOSTIC IMAGING PROCED
0629998   XR CS SAME MD LT5YR 0-30M            667            06             DIAGNOSTIC IMAGING PROCED
0626200   XR CYSTOGRAM 3V OR MORE              808            06             DIAGNOSTIC IMAGING PROCED
0626473   XR DEXA APPEN                        583            06             DIAGNOSTIC IMAGING PROCED
0626366   XR DEXA AXIAL SKELETON               593            06             DIAGNOSTIC IMAGING PROCED
0601112   XR DIAG MAMMO DIG BILAT              281            06             DIAGNOSTIC IMAGING PROCED
0601104   XR DIAG MAMMO DIG UNILAT             281            06             DIAGNOSTIC IMAGING PROCED
0601088   XR DIAG MAMMO DIG W COMP              24            06             DIAGNOSTIC IMAGING PROCED
0626531   XR DIAG MAMMO DIG W COMP              24            06             DIAGNOSTIC IMAGING PROCED
0625707   XR ELBOW 2V                          400            06             DIAGNOSTIC IMAGING PROCED
0625715   XR ELBOW 3V OR MORE                  442            06             DIAGNOSTIC IMAGING PROCED
0626168   XR ERCP BILI PANC DUCT              2423            06             DIAGNOSTIC IMAGING PROCED
0626028   XR ESOPH                             941            06             DIAGNOSTIC IMAGING PROCED
0625921   XR EXT INF LOW LES 1YR               379            06             DIAGNOSTIC IMAGING PROCED
0625160   XR EYE FOR FB                        337            06             DIAGNOSTIC IMAGING PROCED
0625228   XR FACIAL BONE 3V OR MORE            604            06             DIAGNOSTIC IMAGING PROCED
0625210   XR FACIAL BONE LES 3V                478            06             DIAGNOSTIC IMAGING PROCED
0626291   XR FB LOC CHLD                       407            06             DIAGNOSTIC IMAGING PROCED
0625855   XR FEMUR 2V                          442            06             DIAGNOSTIC IMAGING PROCED
0625798   XR FINGER(S) 2V OR MORE              323            06             DIAGNOSTIC IMAGING PROCED
0629931   XR FLUORO 1-2 HRS                   2788            06             DIAGNOSTIC IMAGING PROCED
0601070   XR FLUORO 1-2 HRS                    218            06             DIAGNOSTIC IMAGING PROCED
0626267   XR FLUORO 1HR OR LES                 955            06             DIAGNOSTIC IMAGING PROCED
0629949   XR FLUORO 2-3 HRS                   2998            06             DIAGNOSTIC IMAGING PROCED
0601039   XR FLUORO 2-3 HRS                    281            06             DIAGNOSTIC IMAGING PROCED
0629956   XR FLUORO 3-4 HRS                   3209            06             DIAGNOSTIC IMAGING PROCED
0601047   XR FLUORO 3-4 HRS                    281            06             DIAGNOSTIC IMAGING PROCED
0629964   XR FLUORO 4-5 HRS                   3419            06             DIAGNOSTIC IMAGING PROCED
0601054   XR FLUORO 4-5 HRS                    281            06             DIAGNOSTIC IMAGING PROCED
0629972   XR FLUORO 5-6 HRS                   3630            06             DIAGNOSTIC IMAGING PROCED
0601062   XR FLUORO 5-6 HRS                    218            06             DIAGNOSTIC IMAGING PROCED
0626283   XR FLUORO NDL PLACE                 1039            06             DIAGNOSTIC IMAGING PROCED
0625962   XR FOOT 2V                           379            06             DIAGNOSTIC IMAGING PROCED
0625970   XR FOOT 3V OR MORE                   414            06             DIAGNOSTIC IMAGING PROCED
0625731   XR FOREARM 2V                        400            06             DIAGNOSTIC IMAGING PROCED
0600361   XR GALACTOGRAM 1 DUCT                               06             DIAGNOSTIC IMAGING PROCED
0625772   XR HAND 2V                           379            06             DIAGNOSTIC IMAGING PROCED




                                                  Page 61
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0625780   XR HAND 3V OR MORE                  414            06             DIAGNOSTIC IMAGING PROCED
0625848   XR HIP OR                           435            06             DIAGNOSTIC IMAGING PROCED
0625806   XR HIP UNI 1V                       372            06             DIAGNOSTIC IMAGING PROCED
0625814   XR HIP UNI 2V OR MORE               449            06             DIAGNOSTIC IMAGING PROCED
0625822   XR HIPS BIL 2V W PELV               534            06             DIAGNOSTIC IMAGING PROCED
0625699   XR HUMERUS 2V OR MORE               442            06             DIAGNOSTIC IMAGING PROCED
0626234   XR HYSTEROSALPINGOGRAM             1011            06             DIAGNOSTIC IMAGING PROCED
0626176   XR IVP W-W/O TOMOGRAM              1292            06             DIAGNOSTIC IMAGING PROCED
0625863   XR KNEE 1 OR 2V                     407            06             DIAGNOSTIC IMAGING PROCED
0625871   XR KNEE 3V                          442            06             DIAGNOSTIC IMAGING PROCED
0625889   XR KNEE 4V OR MORE                  485            06             DIAGNOSTIC IMAGING PROCED
0625897   XR KNEES STANDING AP                386            06             DIAGNOSTIC IMAGING PROCED
0626390   XR MAMMO BIL                        281            06             DIAGNOSTIC IMAGING PROCED
0626416   XR MAMMO GDE NDL EA LES             603            06             DIAGNOSTIC IMAGING PROCED
0626382   XR MAMMO UNI                        281            06             DIAGNOSTIC IMAGING PROCED
0625186   XR MANDIBLE 4V OR MORE              492            06             DIAGNOSTIC IMAGING PROCED
0625178   XR MANDIBLE LES 4V                  407            06             DIAGNOSTIC IMAGING PROCED
0625202   XR MASTOIDS 3V OR MORE              625            06             DIAGNOSTIC IMAGING PROCED
0625194   XR MASTOIDS LES 3V                  610            06             DIAGNOSTIC IMAGING PROCED
0625590   XR MYELOGRAM CERV                  3546            06             DIAGNOSTIC IMAGING PROCED
0625616   XR MYELOGRAM LUMB                  3041            06             DIAGNOSTIC IMAGING PROCED
0625608   XR MYELOGRAM THOR                  3237            06             DIAGNOSTIC IMAGING PROCED
0625624   XR MYELOGRM 1 OR MORE REG          4593            06             DIAGNOSTIC IMAGING PROCED
0625236   XR NASAL BONES 3V OR MORE           407            06             DIAGNOSTIC IMAGING PROCED
0625293   XR NEC SOFT TISSUE                  337            06             DIAGNOSTIC IMAGING PROCED
0625376   XR PACEMAKER INSERT                1327            06             DIAGNOSTIC IMAGING PROCED
0625558   XR PELV 1 OR 2V                     407            06             DIAGNOSTIC IMAGING PROCED
0625566   XR PELV 3V OR MORE                  520            06             DIAGNOSTIC IMAGING PROCED
0626457   XR PELV HIP 2V INF CHLD             449            06             DIAGNOSTIC IMAGING PROCED
0625392   XR RIBS BIL 3V                      611            06             DIAGNOSTIC IMAGING PROCED
0625384   XR RIBS UNI 2V                      449            06             DIAGNOSTIC IMAGING PROCED
0625582   XR SACRUM COCCYX 2 V MORE           442            06             DIAGNOSTIC IMAGING PROCED
0625301   XR SALIVARY GLAND CALC              513            06             DIAGNOSTIC IMAGING PROCED
0625640   XR SCAPULA CMPL                     407            06             DIAGNOSTIC IMAGING PROCED
0626408   XR SCRN MAMMO                       218            06             DIAGNOSTIC IMAGING PROCED
0601120   XR SCRN MAMMO DIG BILAT             218            06             DIAGNOSTIC IMAGING PROCED
0625657   XR SHOULDER 1V                      365            06             DIAGNOSTIC IMAGING PROCED
0625665   XR SHOULDER 2V OR MORE              442            06             DIAGNOSTIC IMAGING PROCED
0625574   XR SI JNT 3V OR MORE                478            06             DIAGNOSTIC IMAGING PROCED
0625319   XR SIALOGRAM                       1341            06             DIAGNOSTIC IMAGING PROCED
0625251   XR SIN PARA 3V OR MORE              604            06             DIAGNOSTIC IMAGING PROCED
0625244   XR SIN PARA LES 3V                  478            06             DIAGNOSTIC IMAGING PROCED
0625277   XR SKULL 4V OR MORE                 702            06             DIAGNOSTIC IMAGING PROCED
0625269   XR SKULL LES 4V                     492            06             DIAGNOSTIC IMAGING PROCED
0626093   XR SM BOWEL ENTEROCLYSIS           1081            06             DIAGNOSTIC IMAGING PROCED
0626085   XR SM BOWEL SERIES                 1025            06             DIAGNOSTIC IMAGING PROCED
0626424   XR SPECIMEN SURGICAL                505            06             DIAGNOSTIC IMAGING PROCED
0625467   XR SPINE C 4V & FLEX/EXT            878            06             DIAGNOSTIC IMAGING PROCED
0625442   XR SPINE CERV 2-3V                  471            06             DIAGNOSTIC IMAGING PROCED
0625459   XR SPINE CERV 4V OR MORE            695            06             DIAGNOSTIC IMAGING PROCED
0625517   XR SPINE LUMB 2-3V                  520            06             DIAGNOSTIC IMAGING PROCED
0625525   XR SPINE LUMB 4V OR MORE            709            06             DIAGNOSTIC IMAGING PROCED
0625533   XR SPINE LUMB 4V W BEND             920            06             DIAGNOSTIC IMAGING PROCED
0625541   XR SPINE LUMB BEND ONLY             674            06             DIAGNOSTIC IMAGING PROCED
0625475   XR SPINE SCOLIOSIS STNDNG           400            06             DIAGNOSTIC IMAGING PROCED




                                                 Page 62
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

0625434   XR SPINE SNGL V CERV                330            06             DIAGNOSTIC IMAGING PROCED
0626481   XR SPINE SNGL V LUMB                330            06             DIAGNOSTIC IMAGING PROCED
0626499   XR SPINE SNGL V THOR                330            06             DIAGNOSTIC IMAGING PROCED
0625426   XR SPINE SURVEY ENTIRE              822            06             DIAGNOSTIC IMAGING PROCED
0625483   XR SPINE THOR 2V                    506            06             DIAGNOSTIC IMAGING PROCED
0625491   XR SPINE THOR 3V                    562            06             DIAGNOSTIC IMAGING PROCED
0625509   XR SPINE THOR LUMB 2V               520            06             DIAGNOSTIC IMAGING PROCED
0625418   XR STERNOCLAVIC 3V MORE             548            06             DIAGNOSTIC IMAGING PROCED
0625400   XR STERNUM 2V OR MORE               506            06             DIAGNOSTIC IMAGING PROCED
0626036   XR SWALLOWING FNCTN                1039            06             DIAGNOSTIC IMAGING PROCED
0625913   XR TIBIA FIBULA 2V                  407            06             DIAGNOSTIC IMAGING PROCED
0625285   XR TMJ BIL                          646            06             DIAGNOSTIC IMAGING PROCED
0625996   XR TOE(S) 2V OR MORE                323            06             DIAGNOSTIC IMAGING PROCED
0626069   XR UGI W AIR CON KUB               1341            06             DIAGNOSTIC IMAGING PROCED
0626077   XR UGI W AIR CON SM BOWEL          2022            06             DIAGNOSTIC IMAGING PROCED
0626044   XR UGI W KUB                       1208            06             DIAGNOSTIC IMAGING PROCED
0626051   XR UGI W SM BOWEL                  1889            06             DIAGNOSTIC IMAGING PROCED
0626218   XR URETHROCYSTOGRAM                1103            06             DIAGNOSTIC IMAGING PROCED
0626226   XR URETHROCYSTOGRAM VOID           1187            06             DIAGNOSTIC IMAGING PROCED
0626192   XR UROGRAM ANTEGRADE               1004            06             DIAGNOSTIC IMAGING PROCED
0626184   XR UROGRAM RETRO                   1931            06             DIAGNOSTIC IMAGING PROCED
0626259   XR VENOGRAM EXT BIL                1285            06             DIAGNOSTIC IMAGING PROCED
0626242   XR VENOGRAM EXT UNI                 829            06             DIAGNOSTIC IMAGING PROCED
0626465   XR VENOGRAM SIN JUGULAR            1219            06             DIAGNOSTIC IMAGING PROCED
0629980   XR VRTPLSTY EA BDY FLUORO          2662            06             DIAGNOSTIC IMAGING PROCED
0625749   XR WRIST 2V                         379            06             DIAGNOSTIC IMAGING PROCED
0625756   XR WRIST 3V OR MORE                 414            06             DIAGNOSTIC IMAGING PROCED
0625103   XRC ASP RENL CYST                   449            06             DIAGNOSTIC IMAGING PROCED
0625038   XRC BREAST NDL WIRE                 603            06             DIAGNOSTIC IMAGING PROCED
0625046   XRC BREAST NDL WIRE ADD             775            06             DIAGNOSTIC IMAGING PROCED
0660001   XRC BX BONE SUPER                                  06             DIAGNOSTIC IMAGING PROCED
0625020   XRC BX BREAST W IMAG                991            06             DIAGNOSTIC IMAGING PROCED
0626507   XRC FNA W IMAG GUIDANCE            1791            06             DIAGNOSTIC IMAGING PROCED
0625095   XRC INJ ARTHRO ANKLE               2479            06             DIAGNOSTIC IMAGING PROCED
0625053   XRC INJ ARTHRO ELBOW               2556            06             DIAGNOSTIC IMAGING PROCED
0625079   XRC INJ ARTHRO HIP                 3139            06             DIAGNOSTIC IMAGING PROCED
0625087   XRC INJ ARTHRO KNEE                2619            06             DIAGNOSTIC IMAGING PROCED
0625061   XRC INJ ARTHRO WRIST               2423            06             DIAGNOSTIC IMAGING PROCED
0660027   XRC INJ FACET C/T 1 LVL                            06             DIAGNOSTIC IMAGING PROCED
0625129   XRC INJ ILEAL CONDUIT              1285            06             DIAGNOSTIC IMAGING PROCED
0625152   XRC INJ MYELOGRAM                  3490            06             DIAGNOSTIC IMAGING PROCED
0625111   XRC INJ NEPHROGRAM                 1889            06             DIAGNOSTIC IMAGING PROCED
0625145   XRC LUMBAR PUNCTURE DX             2107            06             DIAGNOSTIC IMAGING PROCED
0626440   XRC REPS PREV PLC CV CATH          1692            06             DIAGNOSTIC IMAGING PROCED
0625137   XRC SAL INFN SONOHYSTER            2226            06             DIAGNOSTIC IMAGING PROCED
5000013   DIALYS HEMO IP                     4560            50             DIALYSIS/RENAL SERVICES
5000005   DIALYS HEMO IP                     3508            50             DIALYSIS/RENAL SERVICES
3800000   EEG AWAKE AND ASLEEP               1312            38             EEG/NEURO DIAGNOSTICS
3800018   EEG AWAKE AND DROWSY                962            38             EEG/NEURO DIAGNOSTICS
3800059   EEG CEREBRAL DEATH EVAL            1181            38             EEG/NEURO DIAGNOSTICS
3800034   EEG GT 1 HR                        1346            38             EEG/NEURO DIAGNOSTICS
3800042   EEG SLEEP                          1718            38             EEG/NEURO DIAGNOSTICS
3800026   EEG UP TO 1HR                       364            38             EEG/NEURO DIAGNOSTICS
5500434   ADMIN IMMUN EA ADD VACC              97            55             EMERGENCY SERVICES
5500426   ADMIN IMMUN SGL VACC                 93            55             EMERGENCY SERVICES




                                                 Page 63
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

5500475   AEROSOL TX DEMO/EVAL                 309            55             EMERGENCY SERVICES
5500442   AEROSOL TX DEMO/EVAL                 309            55             EMERGENCY SERVICES
5500483   AEROSOL TX SUBSQ                     158            55             EMERGENCY SERVICES
5500459   AEROSOL TX SUBSQ                     158            55             EMERGENCY SERVICES
5500392   BLOOD TRANSFUSN 2-4 HR              1659            55             EMERGENCY SERVICES
5500376   BLOOD TRANSFUSN LT 2 HR              949            55             EMERGENCY SERVICES
5500293   CARDIOVERT ELECTIVE EXT             1747            55             EMERGENCY SERVICES
5500251   CPR                                  351            55             EMERGENCY SERVICES
5530126   D5LR 1000ML                          107            55             EMERGENCY SERVICES
5570239   ED CC 1ST 30-74 MN                  2566            55             EMERGENCY SERVICES
5570221   ED CC 1ST 30-74 MN                  2566            55             EMERGENCY SERVICES
5570254   ED CC EA ADD 30 MN                   852            55             EMERGENCY SERVICES
5570031   ED LEVEL 1                           193            55             EMERGENCY SERVICES
5570023   ED LEVEL 1                           193            55             EMERGENCY SERVICES
5570072   ED LEVEL 2                           697            55             EMERGENCY SERVICES
5570064   ED LEVEL 2                           697            55             EMERGENCY SERVICES
5570114   ED LEVEL 3                          1161            55             EMERGENCY SERVICES
5570106   ED LEVEL 3                          1161            55             EMERGENCY SERVICES
5570098   ED LEVEL 3                          1161            55             EMERGENCY SERVICES
5570155   ED LEVEL 4                          1778            55             EMERGENCY SERVICES
5570148   ED LEVEL 4                          1778            55             EMERGENCY SERVICES
5570130   ED LEVEL 4                          1778            55             EMERGENCY SERVICES
5570197   ED LEVEL 5                          2131            55             EMERGENCY SERVICES
5570189   ED LEVEL 5                          2131            55             EMERGENCY SERVICES
5570296   ED PROC MAJOR                       1003            55             EMERGENCY SERVICES
5570270   ED PROC MINOR                        418            55             EMERGENCY SERVICES
5570262   ED PROC MINOR                        418            55             EMERGENCY SERVICES
5500236   GASTRIC LAVAGE                       611            55             EMERGENCY SERVICES
5500228   GASTRIC LAVAGE                       611            55             EMERGENCY SERVICES
5500210   GI INTUB CONT HEM                   1403            55             EMERGENCY SERVICES
5500202   GI INTUB CONT HEM                   1403            55             EMERGENCY SERVICES
5500103   HYDRATION INFSN 0-60 MN              627            55             EMERGENCY SERVICES
5500111   HYDRATION INFSN 0-60MN               546            55             EMERGENCY SERVICES
5500467   HYDRATION INFSN 0-60MN               546            55             EMERGENCY SERVICES
5500491   HYDRATN INFSN EA ADD HR            195.47           55             EMERGENCY SERVICES
5500137   HYDRATN INFSN EA ADD HR              381            55             EMERGENCY SERVICES
5500129   INFSN W-W/O MED EA ADD HR            438            55             EMERGENCY SERVICES
5500517   INFUSION W/MED 0-60MN                431            55             EMERGENCY SERVICES
5500178   INJ IVP SNGL/INIT DRG                191            55             EMERGENCY SERVICES
5500194   INJECTION IM/SQ EA                   240            55             EMERGENCY SERVICES
5500152   INJECTION IM/SQ EA                   240            55             EMERGENCY SERVICES
5570304   MEDICAL SCREENING                    127            55             EMERGENCY SERVICES
5500061   OCCLT BLD STL QL MULT SPC              43           55             EMERGENCY SERVICES
5500053   OCCULT BLD GASTRIC QL                  43           55             EMERGENCY SERVICES
5500046   OCCULT BLD GASTRIC QL                  43           55             EMERGENCY SERVICES
5500020   PREGNANCY SCRN UR                      79           55             EMERGENCY SERVICES
5530001   S NSTRL BAG, ADLT RESUS                76           55             EMERGENCY SERVICES
5530019   S NSTRL BAG, PEDI RESUS              123            55             EMERGENCY SERVICES
5530068   S NSTRL BLNKT FULL BODY                45           55             EMERGENCY SERVICES
5530084   S NSTRL ELECT, STIM PAD              141            55             EMERGENCY SERVICES
5530043   S NSTRL KIT LAVAGE 34F                 46           55             EMERGENCY SERVICES
5530027   S NSTRL PEAK FLOW METER              114            55             EMERGENCY SERVICES
5530035   S NSTRL SENSOR, OXYGEN               104            55             EMERGENCY SERVICES
5530050   S NSTRL SHIELD FULLER                  49           55             EMERGENCY SERVICES
5530498   S ORTHO CERV COLLAR PHIL             130            55             EMERGENCY SERVICES




                                                  Page 64
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

5530597   S ORTHO IMMOB, SHLD                   94           55             EMERGENCY SERVICES
5530506   S ORTHO KNEE IMMOB                   162           55             EMERGENCY SERVICES
5530530   S ORTHO POST-OP SHOE                  52           55             EMERGENCY SERVICES
5530514   S ORTHO SLING AND SWATHE              98           55             EMERGENCY SERVICES
5530605   S ORTHO SLING ARM MUSLIN              33           55             EMERGENCY SERVICES
5530522   S ORTHO SPLINT-WRIST                  77           55             EMERGENCY SERVICES
5530613   S OT AFO PLASTIC PREFAB              173           55             EMERGENCY SERVICES
5530555   S OT ANK ORTHOSIS PREFAB             130           55             EMERGENCY SERVICES
5530563   S OT FM COLLAR CERV FLEX              21           55             EMERGENCY SERVICES
5530571   S OT PLS CLR CERV SMI-RGD            113           55             EMERGENCY SERVICES
5530548   S OT THORACIC RIB BELT                29           55             EMERGENCY SERVICES
5530639   S STRL                             67.57           55             EMERGENCY SERVICES
5530092   S STRL BURETROL                       96           55             EMERGENCY SERVICES
5530407   S STRL CATH BARTH GLAND              121           55             EMERGENCY SERVICES
5530399   S STRL CATH COUDE 5CC FR              81           55             EMERGENCY SERVICES
5530381   S STRL CATH DRAINAGE                  32           55             EMERGENCY SERVICES
5530183   S STRL CATH EPISTAXIS X              294           55             EMERGENCY SERVICES
5530472   S STRL CATH GUIDING                  291           55             EMERGENCY SERVICES
5530290   S STRL CATH GUIDING                  285           55             EMERGENCY SERVICES
5530191   S STRL CAUTRY FINE TIP                44           55             EMERGENCY SERVICES
5530118   S STRL DETCTR C02 END-TID             69           55             EMERGENCY SERVICES
5530621   S STRL DRN PLR-EVAC ADULT            315           55             EMERGENCY SERVICES
5530373   S STRL DRN THORAKLX, PEDI            296           55             EMERGENCY SERVICES
5530589   S STRL FIBERGLASS CASTING            107           55             EMERGENCY SERVICES
5530357   S STRL HEIMLICH VALVE                 64           55             EMERGENCY SERVICES
5530324   S STRL INFSN NOHEMODIALYS            203           55             EMERGENCY SERVICES
5530100   S STRL INFSN NOHEMODIALYS             62           55             EMERGENCY SERVICES
5530340   S STRL KIT HEIMLICH VLV              440           55             EMERGENCY SERVICES
5530332   S STRL MANOMETER, CVP                 63           55             EMERGENCY SERVICES
5530449   S STRL MORGAN EYE IRG LNS            116           55             EMERGENCY SERVICES
5530365   S STRL RESERVOIR,CHST DRN            240           55             EMERGENCY SERVICES
5530142   S STRL SET BLOOD PUMPX                89           55             EMERGENCY SERVICES
5530134   S STRL SET LVL I FLD WARM            160           55             EMERGENCY SERVICES
5530209   S STRL STAPLER SKIN X                 54           55             EMERGENCY SERVICES
5530217   S STRL SUTX                           21           55             EMERGENCY SERVICES
5530225   S STRL TAMPON,MEROCEL NSL             52           55             EMERGENCY SERVICES
5530167   S STRL TRACH TUBE 4, 6               271           55             EMERGENCY SERVICES
5530175   S STRL TRACH TUBE PEDI 2             208           55             EMERGENCY SERVICES
5530423   S STRL TRAY CATH W/METER              99           55             EMERGENCY SERVICES
5530415   S STRL TRAY CATH WITH BAG             52           55             EMERGENCY SERVICES
5530308   S STRL TRAY CNTRL LIN DRS             30           55             EMERGENCY SERVICES
5530233   S STRL TRAY EPISTAXIS                143           55             EMERGENCY SERVICES
5530241   S STRL TRAY I&D                       54           55             EMERGENCY SERVICES
5530258   S STRL TRAY LACERATION ER             72           55             EMERGENCY SERVICES
5530266   S STRL TRAY THORACENTESIS            133           55             EMERGENCY SERVICES
5530316   S STRL TRAY, CTH CNTRL VN            135           55             EMERGENCY SERVICES
5530282   S STRL TRAY, LP ADULT                 94           55             EMERGENCY SERVICES
5530274   S STRL TRAY, LP PEDI                  93           55             EMERGENCY SERVICES
5530464   S STRL TRAY, MAHURKAR                602           55             EMERGENCY SERVICES
5530431   S STRL TRAYFOLY TMP SNSNG            228           55             EMERGENCY SERVICES
5530480   S STRL TRY PRITONEAL LVAG            186           55             EMERGENCY SERVICES
5560016   SEDATION IV/IM                       514           55             EMERGENCY SERVICES
5590005   STATISTICAL TRACKING/HR                            55             EMERGENCY SERVICES
5500277   TEMP TRANSCUTANEOUS PACE            553            55             EMERGENCY SERVICES
5500319   THROMBOLYSIS CORO IV               2227            55             EMERGENCY SERVICES




                                                 Page 65
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

5500012   URNALYSIS MAN W/O MICRO              33                55         EMERGENCY SERVICES
5500095   VENIPUNCTURE                         27                55         EMERGENCY SERVICES
5670138   PULSE OXIMETRY - SINGLE              97                56         EMERGENCY SERVICES TRAUMA
9400045   BLOOD TRANSFUSN 2-4 HR             1021                94         IV INFUSION THERAPY SERVI
9400052   BLOOD TRANSFUSN 4-6 HR             1605                94         IV INFUSION THERAPY SERVI
9400060   BLOOD TRANSFUSN GT 6HR             1974                94         IV INFUSION THERAPY SERVI
9400037   BLOOD TRANSFUSN LT 2 HR             584                94         IV INFUSION THERAPY SERVI
9400086   BX BM NDL/TROCAR                    610                94         IV INFUSION THERAPY SERVI
9400227   CARDIOVERT ELECTIVE EXT            1075                94         IV INFUSION THERAPY SERVI
9400177   CHEMO OTHER THAN INFUSN             773                94         IV INFUSION THERAPY SERVI
9400359   CPR                                 216                94         IV INFUSION THERAPY SERVI
9400219   DIRECT ADMIT OBSERVATION            712                94         IV INFUSION THERAPY SERVI
9400326   GLUCOSE FINGERSTICK                  18                94         IV INFUSION THERAPY SERVI
9400136   INFUSN CHEMO 0-60 MN                501                94         IV INFUSION THERAPY SERVI
9400144   INFUSN CHEMO EA ADD HR              294                94         IV INFUSION THERAPY SERVI
9400300   INJ IVP SNGL/INIT DRG               109                94         IV INFUSION THERAPY SERVI
9400128   INJECTION IM/SQ EA                  102                94         IV INFUSION THERAPY SERVI
9400235   INS PICC W/O PORT 5+                897                94         IV INFUSION THERAPY SERVI
9400094   INTRO G TUBE LONG                    43                94         IV INFUSION THERAPY SERVI
9400268   LEVEL 1 EST PATIENT                 174                94         IV INFUSION THERAPY SERVI
9400193   LEVEL 1 EST PATIENT                                    94         IV INFUSION THERAPY SERVI
9400201   LEVEL 2 EST PATIENT                 202                94         IV INFUSION THERAPY SERVI
9400110   LUMBAR PUNCTURE DX                  206                94         IV INFUSION THERAPY SERVI
9400334   OBS BLADDER IRRIG SMPL              352                94         IV INFUSION THERAPY SERVI
9400078   OBS COLL BLD VNS ACCS DVC           151                94         IV INFUSION THERAPY SERVI
9400367   OBS DECLOT VASC DEVICE              363                94         IV INFUSION THERAPY SERVI
9400011   OBS HYDRAT INF EA ADD HR            162                94         IV INFUSION THERAPY SERVI
9400003   OBS HYDRATN INFSN 0-60MN            178                94         IV INFUSION THERAPY SERVI
9400276   OBS INJ IVP SNGL/INIT DRG           118                94         IV INFUSION THERAPY SERVI
9400102   PARACENT ABD INI                    521                94         IV INFUSION THERAPY SERVI
9400185   PHLEBOTOMY THERAPEUTIC              248                94         IV INFUSION THERAPY SERVI
9400151   REFILL/MAINT PORTABL PUMP           306                94         IV INFUSION THERAPY SERVI
9400250   REPR CV CATH W/O PORT               476                94         IV INFUSION THERAPY SERVI
9400169   RFL/MAINT IMP PMP SYSTMC            306                94         IV INFUSION THERAPY SERVI
9400243   RPLC COMP NON-TUN CV CATH           816                94         IV INFUSION THERAPY SERVI
9400029   THORACENTESIS                      1493                94         IV INFUSION THERAPY SERVI
9400292   VENIPUNCTURE                         17                94         IV INFUSION THERAPY SERVI
4900072   AFP MATERNAL                                           49         LAB SERVICES
4900015   ARTERIAL PUNCTURE                   254          78    49         LAB SERVICES
4900064   SPEC HANDL FEE                       27                49         LAB SERVICES
4900056   SPEC HANDL FEE                       27                49         LAB SERVICES
4900031   SPEC HANDL FEE                       39                49         LAB SERVICES
4900049   STATISTICAL TRACKING                                   49         LAB SERVICES
4900007   STATISTICAL TRACKING                                   49         LAB SERVICES
4900023   VENIPUNCTURE                          27               49         LAB SERVICES
4196481   AB ELUTION                          213          103   41         LAB SERVICES-BLOOD
4196143   AB ELUTION                          240                41         LAB SERVICES-BLOOD
4190559   AB ELUTION                        103.57     51.79     41         LAB SERVICES-BLOOD
4180147   AB ELUTION                          240                41         LAB SERVICES-BLOOD
4199576   AB ID                               433          210   41         LAB SERVICES-BLOOD
4189064   AB ID                               160                41         LAB SERVICES-BLOOD
4189056   AB ID                               160                41         LAB SERVICES-BLOOD
4199683   AB ID                               320          320   41         LAB SERVICES-BLOOD
4196408   AB ID                               433          210   41         LAB SERVICES-BLOOD
4196168   AB ID                               433                41         LAB SERVICES-BLOOD




                                                 Page 66
                                     c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                  SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                        AMOUNT AMOUNT CODE

4196150   AB ID                                    160              41          LAB SERVICES-BLOOD
4196119   AB ID                                    160              41          LAB SERVICES-BLOOD
4190476   AB ID                                 163.97     81.99    41          LAB SERVICES-BLOOD
4190211   AB ID                                     75              41          LAB SERVICES-BLOOD
4180154   AB ID                                    160              41          LAB SERVICES-BLOOD
4180113   AB ID                                    160              41          LAB SERVICES-BLOOD
4199584   AB ID 2                                  172        84    41          LAB SERVICES-BLOOD
4196416   AB ID 2                                  172        84    41          LAB SERVICES-BLOOD
4190484   AB ID 2                               163.97     81.99    41          LAB SERVICES-BLOOD
4189007   AB SCRN                                  100              41          LAB SERVICES-BLOOD
4196002   AB SCRN                                  100              41          LAB SERVICES-BLOOD
4180014   AB SCRN                                  100              41          LAB SERVICES-BLOOD
4199527   AB SCRN 2                                194        94    41          LAB SERVICES-BLOOD
4196341   AB SCRN 2                                194        94    41          LAB SERVICES-BLOOD
4190419   AB SCRN 2                             131.33     65.67    41          LAB SERVICES-BLOOD
4199535   AB SCRN 3                                194        94    41          LAB SERVICES-BLOOD
4196358   AB SCRN 3                                194        94    41          LAB SERVICES-BLOOD
4190427   AB SCRN 3                             131.33     65.67    41          LAB SERVICES-BLOOD
4199592   AB TTR                                   193        93    41          LAB SERVICES-BLOOD
4189049   AB TTR                                   250              41          LAB SERVICES-BLOOD
4196424   AB TTR                                   193         93   41          LAB SERVICES-BLOOD
4196366   AB TTR                                   193         93   41          LAB SERVICES-BLOOD
4196069   AB TTR                                   250              41          LAB SERVICES-BLOOD
4190492   AB TTR                                124.51     62.26    41          LAB SERVICES-BLOOD
4190435   AB TTR                                124.51     62.26    41          LAB SERVICES-BLOOD
4180063   AB TTR                                   250              41          LAB SERVICES-BLOOD
4199543   ABO TYP                                   99         48   41          LAB SERVICES-BLOOD
4186011   ABO TYP                                   35              41          LAB SERVICES-BLOOD
4189015   ABO TYP                                   32              41          LAB SERVICES-BLOOD
4198172   ABO TYP                                   99         99   41          LAB SERVICES-BLOOD
4198040   ABO TYP                                   15         15   41          LAB SERVICES-BLOOD
4196515   ABO TYP                                   99         48   41          LAB SERVICES-BLOOD
4196374   ABO TYP                                   99         48   41          LAB SERVICES-BLOOD
4196010   ABO TYP                                   32              41          LAB SERVICES-BLOOD
4190583   ABO TYP                                62.27     31.14    41          LAB SERVICES-BLOOD
4190443   ABO TYP                                54.72     27.36    41          LAB SERVICES-BLOOD
4180022   ABO TYP                                   32              41          LAB SERVICES-BLOOD
4196325   AG SCRN PER UNIT PT SPEC                 137        66    41          LAB SERVICES-BLOOD
4190393   AG SCRN PER UNIT PT SPEC              124.95     62.48    41          LAB SERVICES-BLOOD
4196333   AG SCRN PER UNIT RGNT                     53        25    41          LAB SERVICES-BLOOD
4196192   AG SCRN PER UNIT RGNT                     60              41          LAB SERVICES-BLOOD
4190401   AG SCRN PER UNIT RGNT                  54.72     37.36    41          LAB SERVICES-BLOOD
4190252   AG SCRN PER UNIT RGNT                     50              41          LAB SERVICES-BLOOD
4180188   AG SCRN PER UNIT RGNT                     60              41          LAB SERVICES-BLOOD
4196473   AG TYP PT RBC EA                         100        49    41          LAB SERVICES-BLOOD
4190542   AG TYP PT RBC EA                        54.7     27.35    41          LAB SERVICES-BLOOD
4190351   AT PS                                    232              41          LAB SERVICES-BLOOD
4190229   AT PS                                    232              41          LAB SERVICES-BLOOD
4190195   AT PS                                    150              41          LAB SERVICES-BLOOD
4190187   AT PS                                    150              41          LAB SERVICES-BLOOD
4190179   AT PS                                    150              41          LAB SERVICES-BLOOD
4190112   AT PS                                    150              41          LAB SERVICES-BLOOD
4110094   AT PS                                    251              41          LAB SERVICES-BLOOD
4110086   AT PS                                    251              41          LAB SERVICES-BLOOD
4110078   AT PS                                    251              41          LAB SERVICES-BLOOD




                                                     Page 67
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

4110060   AT PS                                 251               41         LAB SERVICES-BLOOD
4110052   AT PS                                 251               41         LAB SERVICES-BLOOD
4110045   AT PS                                 251               41         LAB SERVICES-BLOOD
4196218   CMV AB                                 25               41         LAB SERVICES-BLOOD
4190278   CMV AB                                 25               41         LAB SERVICES-BLOOD
4180204   CMV AB                                 25               41         LAB SERVICES-BLOOD
4199501   COMPATIBILITY TEST AHG                221         107   41         LAB SERVICES-BLOOD
4189072   COMPATIBILITY TEST AHG                100               41         LAB SERVICES-BLOOD
4188074   COMPATIBILITY TEST AHG                100               41         LAB SERVICES-BLOOD
4187076   COMPATIBILITY TEST AHG                100               41         LAB SERVICES-BLOOD
4196309   COMPATIBILITY TEST AHG                221         107   41         LAB SERVICES-BLOOD
4196184   COMPATIBILITY TEST AHG                100               41         LAB SERVICES-BLOOD
4190377   COMPATIBILITY TEST AHG              65.61     32.81     41         LAB SERVICES-BLOOD
4190245   COMPATIBILITY TEST AHG                 75               41         LAB SERVICES-BLOOD
4180170   COMPATIBILITY TEST AHG                100               41         LAB SERVICES-BLOOD
4199634   COMPATIBILITY TEST INCUB              142        69     41         LAB SERVICES-BLOOD
4199519   COMPATIBILITY TEST INCUB              142        69     41         LAB SERVICES-BLOOD
4196507   COMPATIBILITY TEST INCUB              142        69     41         LAB SERVICES-BLOOD
4196317   COMPATIBILITY TEST INCUB              142        69     41         LAB SERVICES-BLOOD
4190575   COMPATIBILITY TEST INCUB              112     56.32     41         LAB SERVICES-BLOOD
4190385   COMPATIBILITY TEST INCUB              112     21.91     41         LAB SERVICES-BLOOD
4199642   COMPATIBILITY TEST IS                 300      145      41         LAB SERVICES-BLOOD
4196564   COMPATIBILITY TEST IS                 300      145      41         LAB SERVICES-BLOOD
4196556   COMPATIBILITY TEST IS                 300      145      41         LAB SERVICES-BLOOD
4196549   COMPATIBILITY TEST IS                 300      145      41         LAB SERVICES-BLOOD
4196531   COMPATIBILITY TEST IS                 300      145      41         LAB SERVICES-BLOOD
4196523   COMPATIBILITY TEST IS                 300      145      41         LAB SERVICES-BLOOD
4190633   COMPATIBILITY TEST IS              214.29    107.15     41         LAB SERVICES-BLOOD
4190625   COMPATIBILITY TEST IS              214.29    107.15     41         LAB SERVICES-BLOOD
4190617   COMPATIBILITY TEST IS              214.29    107.15     41         LAB SERVICES-BLOOD
4190609   COMPATIBILITY TEST IS              214.29    107.15     41         LAB SERVICES-BLOOD
4190591   COMPATIBILITY TEST IS              214.29    107.15     41         LAB SERVICES-BLOOD
4199600   COOMBS DIRECT C3                      136        66     41         LAB SERVICES-BLOOD
4196432   COOMBS DIRECT C3                      136        66     41         LAB SERVICES-BLOOD
4190500   COOMBS DIRECT C3                       31        37     41         LAB SERVICES-BLOOD
4199618   COOMBS DIRECT IG                      136        66     41         LAB SERVICES-BLOOD
4189031   COOMBS DIRECT IG                       50               41         LAB SERVICES-BLOOD
4188033   COOMBS DIRECT IG                       50               41         LAB SERVICES-BLOOD
4187035   COOMBS DIRECT IG                       50               41         LAB SERVICES-BLOOD
4196440   COOMBS DIRECT IG                      136         66    41         LAB SERVICES-BLOOD
4196044   COOMBS DIRECT IG                       50               41         LAB SERVICES-BLOOD
4190518   COOMBS DIRECT IG                       31         37    41         LAB SERVICES-BLOOD
4180055   COOMBS DIRECT IG                       50               41         LAB SERVICES-BLOOD
4199568   COOMBS DIRECT POLY                    136         66    41         LAB SERVICES-BLOOD
4196390   COOMBS DIRECT POLY                    136         66    41         LAB SERVICES-BLOOD
4190468   COOMBS DIRECT POLY                   75.2         37    41         LAB SERVICES-BLOOD
4199691   COOMBS INDIRECT QL                     50         50    41         LAB SERVICES-BLOOD
4190963   CRYO PS                               150               41         LAB SERVICES-BLOOD
4190948   CRYO PS                               750               41         LAB SERVICES-BLOOD
4190864   CRYO PS                               150               41         LAB SERVICES-BLOOD
4110342   CRYO PS                               162               41         LAB SERVICES-BLOOD
4110326   CRYO PS                               810               41         LAB SERVICES-BLOOD
4110250   CRYO PS                               162               41         LAB SERVICES-BLOOD
4110011   CRYO PS                                86               41         LAB SERVICES-BLOOD
4110003   EMER RELEASE AUTH BY PATH              57         28    41         LAB SERVICES-BLOOD




                                                  Page 68
                                      c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                   SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                         AMOUNT AMOUNT CODE

4199659   FETAL RBC SCRN ROSETTE                    111         54 41            LAB SERVICES-BLOOD
4196606   FETAL RBC SCRN ROSETTE                    111         54 41            LAB SERVICES-BLOOD
4190674   FETAL RBC SCRN ROSETTE                     50         25 41            LAB SERVICES-BLOOD
4196671   FF PLASMA 8-24 HRS COLLCT                 151            41            LAB SERVICES-BLOOD
4110375   FF PLASMA 8-24 HRS COLLCT                  78            41            LAB SERVICES-BLOOD
4190955   FFP PS                                    200            41            LAB SERVICES-BLOOD
4190880   FFP PS                                    140            41            LAB SERVICES-BLOOD
4110334   FFP PS                                    216            41            LAB SERVICES-BLOOD
4110276   FFP PS                                    151            41            LAB SERVICES-BLOOD
4110268   FFP PS                                    151            41            LAB SERVICES-BLOOD
4196093   FRZN BLD FREEZE & THAW                    200            41            LAB SERVICES-BLOOD
4180097   FRZN BLD FREEZE & THAW                    432            41            LAB SERVICES-BLOOD
4180006   FRZN BLD FREEZE & THAW                    100            41            LAB SERVICES-BLOOD
4199675   FRZN BLD FREEZING W PREP                  100            41            LAB SERVICES-BLOOD
4190989   IG RHO D MINI 50MCG IJ                  75.04            41            LAB SERVICES-BLOOD
4190039   IG RHO D MINI 50MCG IJ                 133.06            41            LAB SERVICES-BLOOD
4170031   IG RHO D MINI 50MCG IJ                  75.04            41            LAB SERVICES-BLOOD
4170023   IG RHO D MINI 50MCG IJ                 133.06            41            LAB SERVICES-BLOOD
4196226   IRRADIATION BLD PROD EA                    50            41            LAB SERVICES-BLOOD
4190286   IRRADIATION BLD PROD EA                 52.68            41            LAB SERVICES-BLOOD
4180212   IRRADIATION BLD PROD EA                   130            41            LAB SERVICES-BLOOD
4196614   MISC LAB PROC                             400            41            LAB SERVICES-BLOOD
4190906   MISC LAB PROC                                            41            LAB SERVICES-BLOOD
4196622   MISC LAB PROC EMER RLSE                   53          26 41            LAB SERVICES-BLOOD
4196200   MISC TS PROC                              50             41            LAB SERVICES-BLOOD
4190369   MISC TS PROC                                             41            LAB SERVICES-BLOOD
4190344   MISC TS PROC                               25            41            LAB SERVICES-BLOOD
4190336   MISC TS PROC                              100            41            LAB SERVICES-BLOOD
4190328   MISC TS PROC                              100            41            LAB SERVICES-BLOOD
4190260   MISC TS PROC                            14.29            41            LAB SERVICES-BLOOD
4190237   MISC TS PROC                               75            41            LAB SERVICES-BLOOD
4190153   MISC TS PROC                              300            41            LAB SERVICES-BLOOD
4190146   MISC TS PROC                               75            41            LAB SERVICES-BLOOD
4180279   MISC TS PROC                               25            41            LAB SERVICES-BLOOD
4180261   MISC TS PROC                              100            41            LAB SERVICES-BLOOD
4180253   MISC TS PROC                              100            41            LAB SERVICES-BLOOD
4180196   MISC TS PROC                               50            41            LAB SERVICES-BLOOD
4180162   MISC TS PROC                               75            41            LAB SERVICES-BLOOD
4180139   MISC TS PROC                              390            41            LAB SERVICES-BLOOD
4180121   MISC TS PROC                               75            41            LAB SERVICES-BLOOD
4196291   MISC TS PROC                                             41            LAB SERVICES-BLOOD
4196283   MISC TS PROC                              40             41            LAB SERVICES-BLOOD
4196275   MISC TS PROC                             100             41            LAB SERVICES-BLOOD
4196267   MISC TS PROC                             100             41            LAB SERVICES-BLOOD
4196176   MISC TS PROC                              75             41            LAB SERVICES-BLOOD
4196135   MISC TS PROC                             390             41            LAB SERVICES-BLOOD
4196127   MISC TS PROC                              75             41            LAB SERVICES-BLOOD
4190724   PHER L/D CMV NEG PS                      900             41            LAB SERVICES-BLOOD
4110144   PHER L/D CMV NEG PS                      972             41            LAB SERVICES-BLOOD
4190898   PHER L/D HLA MATCHED PS                 1200             41            LAB SERVICES-BLOOD
4110284   PHER L/D HLA MATCHED PS                 1296             41            LAB SERVICES-BLOOD
4190708   PHER L/D IRRADIATED PS                   750             41            LAB SERVICES-BLOOD
4110128   PHER L/D IRRADIATED PS                   810             41            LAB SERVICES-BLOOD
4110383   PHER L/D PS                             1067             41            LAB SERVICES-BLOOD
4190732   PHER L/D PS                              750             41            LAB SERVICES-BLOOD




                                                      Page 69
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

4110151   PHER L/D PS                          810               41         LAB SERVICES-BLOOD
4190849   PHER PS                              340               41         LAB SERVICES-BLOOD
4190807   PHER PS                              750               41         LAB SERVICES-BLOOD
4110219   PHER PS                              810               41         LAB SERVICES-BLOOD
4190914   PLTC IRRADIATED PS                   750               41         LAB SERVICES-BLOOD
4110292   PLTC IRRADIATED PS                   810               41         LAB SERVICES-BLOOD
4190757   PLTC L/D PS                       157.29               41         LAB SERVICES-BLOOD
4190856   PLTC PS                           137.74               41         LAB SERVICES-BLOOD
4196580   POOLING BLD PROD                     157        76     41         LAB SERVICES-BLOOD
4196572   POOLING BLD PROD                     157        76     41         LAB SERVICES-BLOOD
4190658   POOLING BLD PROD                   68.92     34.46     41         LAB SERVICES-BLOOD
4190641   POOLING BLD PROD                   78.19      39.1     41         LAB SERVICES-BLOOD
4110391   RBC DG PS                            162               41         LAB SERVICES-BLOOD
4110227   RBC DG PS                            432               41         LAB SERVICES-BLOOD
4190716   RBC L/D IRRADIATED PS                400               41         LAB SERVICES-BLOOD
4190690   RBC L/D IRRADIATED PS                400               41         LAB SERVICES-BLOOD
4110136   RBC L/D IRRADIATED PS                432               41         LAB SERVICES-BLOOD
4110110   RBC L/D IRRADIATED PS                432               41         LAB SERVICES-BLOOD
4196663   RBC L/D PS                           432               41         LAB SERVICES-BLOOD
4190971   RBC L/D PS                           325               41         LAB SERVICES-BLOOD
4190930   RBC L/D PS                           325               41         LAB SERVICES-BLOOD
4190922   RBC L/D PS                           325               41         LAB SERVICES-BLOOD
4190799   RBC L/D PS                           100               41         LAB SERVICES-BLOOD
4190781   RBC L/D PS                           325               41         LAB SERVICES-BLOOD
4190740   RBC L/D PS                           500               41         LAB SERVICES-BLOOD
4190682   RBC L/D PS                           325               41         LAB SERVICES-BLOOD
4110359   RBC L/D PS                           351               41         LAB SERVICES-BLOOD
4110318   RBC L/D PS                           351               41         LAB SERVICES-BLOOD
4110300   RBC L/D PS                           351               41         LAB SERVICES-BLOOD
4110201   RBC L/D PS                           108               41         LAB SERVICES-BLOOD
4110169   RBC L/D PS                           540               41         LAB SERVICES-BLOOD
4110102   RBC L/D PS                           351               41         LAB SERVICES-BLOOD
4196085   RBC PRETRTMT CHEM/DRG                160               41         LAB SERVICES-BLOOD
4180089   RBC PRETRTMT CHEM/DRG                160               41         LAB SERVICES-BLOOD
4196234   RBC PRETRTMT DENSITY GRAD            400               41         LAB SERVICES-BLOOD
4190294   RBC PRETRTMT DENSITY GRAD            200               41         LAB SERVICES-BLOOD
4180220   RBC PRETRTMT DENSITY GRAD            180               41         LAB SERVICES-BLOOD
4196051   RBC PRETRTMT ENZYME                  239               41         LAB SERVICES-BLOOD
4190997   RBC PS                               100               41         LAB SERVICES-BLOOD
4110367   RBC PS                               108               41         LAB SERVICES-BLOOD
4199626   RH PHENOTYP COMPLETE                  34         17    41         LAB SERVICES-BLOOD
4189023   RH PHENOTYP COMPLETE                 120               41         LAB SERVICES-BLOOD
4188025   RH PHENOTYP COMPLETE                 120               41         LAB SERVICES-BLOOD
4187027   RH PHENOTYP COMPLETE                 120               41         LAB SERVICES-BLOOD
4196499   RH PHENOTYP COMPLETE                  34         17    41         LAB SERVICES-BLOOD
4196028   RH PHENOTYP COMPLETE                 120               41         LAB SERVICES-BLOOD
4190567   RH PHENOTYP COMPLETE               73.62     36.81     41         LAB SERVICES-BLOOD
4180030   RH PHENOTYP COMPLETE                 120               41         LAB SERVICES-BLOOD
4199550   RH TYP                                83          40   41         LAB SERVICES-BLOOD
4198198   RH TYP                                83          83   41         LAB SERVICES-BLOOD
4198180   RH TYP                                83          83   41         LAB SERVICES-BLOOD
4196382   RH TYP                                83          40   41         LAB SERVICES-BLOOD
4190450   RH TYP                               120          60   41         LAB SERVICES-BLOOD
4196465   SER PRETRTMT ABSORB                  218         109   41         LAB SERVICES-BLOOD
4196259   SER PRETRTMT ABSORB                  350               41         LAB SERVICES-BLOOD




                                                 Page 70
                                     c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                  SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                        AMOUNT AMOUNT CODE

4196101   SER PRETRTMT ABSORB                      360               41         LAB SERVICES-BLOOD
4196036   SER PRETRTMT ABSORB                      400               41         LAB SERVICES-BLOOD
4190534   SER PRETRTMT ABSORB                   218.39     109.2     41         LAB SERVICES-BLOOD
4190310   SER PRETRTMT ABSORB                      150               41         LAB SERVICES-BLOOD
4180246   SER PRETRTMT ABSORB                      350               41         LAB SERVICES-BLOOD
4180105   SER PRETRTMT ABSORB                      360               41         LAB SERVICES-BLOOD
4180048   SER PRETRTMT ABSORB                      400               41         LAB SERVICES-BLOOD
4196077   SER PRETRTMT INC/INHIB                   180               41         LAB SERVICES-BLOOD
4180071   SER PRETRTMT INC/INHIB                   180               41         LAB SERVICES-BLOOD
4196242   SER PRETRTMT INCUB/ DRG                  500               41         LAB SERVICES-BLOOD
4190302   SER PRETRTMT INCUB/ DRG                  375               41         LAB SERVICES-BLOOD
4180238   SER PRETRTMT INCUB/ DRG                  500               41         LAB SERVICES-BLOOD
4189080   SICKLE CL SCRN                            15               41         LAB SERVICES-BLOOD
4188082   SICKLE CL SCRN                            15               41         LAB SERVICES-BLOOD
4187084   SICKLE CL SCRN                            15               41         LAB SERVICES-BLOOD
4196598   SICKLE CL SCRN                            15               41         LAB SERVICES-BLOOD
4190666   SICKLE CL SCRN                            15               41         LAB SERVICES-BLOOD
4180287   SICKLE CL SCRN                            15               41         LAB SERVICES-BLOOD
4196648   THAWING FRZN BLD                         108               41         LAB SERVICES-BLOOD
4198164   THAWING PROD PER UNIT                     50         50    41         LAB SERVICES-BLOOD
4196655   THAWING PROD PER UNIT                     79               41         LAB SERVICES-BLOOD
4196630   TRNSFUS RXN INVESTIGATE                  116         56    41         LAB SERVICES-BLOOD
4196457   TRW HEMOLYSIS                             19               41         LAB SERVICES-BLOOD
4190526   TRW HEMOLYSIS                          18.77               41         LAB SERVICES-BLOOD
4110409   WASHED RBC PS                            432               41         LAB SERVICES-BLOOD
4190831   WB PS                                    375               41         LAB SERVICES-BLOOD
4190823   WB PS                                    325               41         LAB SERVICES-BLOOD
4190773   WB PS                                    110               41         LAB SERVICES-BLOOD
4190765   WB PS                                    325               41         LAB SERVICES-BLOOD
4110243   WB PS                                    405               41         LAB SERVICES-BLOOD
4110235   WB PS                                    351               41         LAB SERVICES-BLOOD
4110185   WB PS                                    119               41         LAB SERVICES-BLOOD
4110177   WB PS                                    351               41         LAB SERVICES-BLOOD
4210431   ACETAMINOPHEN                            484         149   42         LAB SERVICES-CHEMISTRY
4219937   AFP TUMOR MARKER                         111               42         LAB SERVICES-CHEMISTRY
4210464   ALBUMIN                                  118         36    42         LAB SERVICES-CHEMISTRY
4210472   ALCOHOL (ETHANOL)                        261         80    42         LAB SERVICES-CHEMISTRY
4219523   ALK PHOS ISOENZYMES                      354               42         LAB SERVICES-CHEMISTRY
4211397   ALK PHOSPHATASE                          124         38    42         LAB SERVICES-CHEMISTRY
4219648   ALLERGEN SPECIFIC IGE QN                  38               42         LAB SERVICES-CHEMISTRY
4219333   ALLERGEN SPECIFIC IGE QN                  38               42         LAB SERVICES-CHEMISTRY
4211587   ALT (SGPT)                               124          38   42         LAB SERVICES-CHEMISTRY
4210480   AMMONIA                                  348         107   42         LAB SERVICES-CHEMISTRY
4219721   AMYLASE                                  167               42         LAB SERVICES-CHEMISTRY
4210498   AMYLASE                                  437         135   42         LAB SERVICES-CHEMISTRY
4210506   AMYLASE FLD                              451         139   42         LAB SERVICES-CHEMISTRY
4210514   AMYLASE UR 2HR                           341         105   42         LAB SERVICES-CHEMISTRY
4221594   ANTI DNA DBL STRAND                                   38   42         LAB SERVICES-CHEMISTRY
4221669   ANTI RNP AB                                           38   42         LAB SERVICES-CHEMISTRY
4219747   ASPERGILLUS AB                           26                42         LAB SERVICES-CHEMISTRY
4211579   AST (SGOT)                              124          38    42         LAB SERVICES-CHEMISTRY
4210001   BASIC METABOLIC PNL                     205          57    42         LAB SERVICES-CHEMISTRY
4213161   BENZODIAZEPINE SCRN                      86                42         LAB SERVICES-CHEMISTRY
4221271   BILIRUBIN DIRECT                        118          36    42         LAB SERVICES-CHEMISTRY
4210548   BILIRUBIN TOTAL                         118          36    42         LAB SERVICES-CHEMISTRY




                                                     Page 71
                                      c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                   SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                         AMOUNT AMOUNT CODE

4210530   BILIRUBIN TOTAL                          118           36   42         LAB SERVICES-CHEMISTRY
4210522   BILIRUBIN TOTAL                          118           36   42         LAB SERVICES-CHEMISTRY
4221230   BLD GAS ART                              466          144   42         LAB SERVICES-CHEMISTRY
4210886   BLD GAS ART                              466          144   42         LAB SERVICES-CHEMISTRY
4212999   B-TYP NATRIURETIC PEPTIDE                313          151   42         LAB SERVICES-CHEMISTRY
4211652   BUN                                       93           29   42         LAB SERVICES-CHEMISTRY
4220372   C REACTIVE PROTEIN HS                     85                42         LAB SERVICES-CHEMISTRY
4216628   CA 19 9                                  213                42         LAB SERVICES-CHEMISTRY
4210589   CALCIUM                                  124          38    42         LAB SERVICES-CHEMISTRY
4213823   CALCIUM IONIZED                          125          67    42         LAB SERVICES-CHEMISTRY
4210605   CALCIUM UR RAN                           143          44    42         LAB SERVICES-CHEMISTRY
4219804   CANDIDA AB                                49                42         LAB SERVICES-CHEMISTRY
4219259   CANDIDA AB                                49                42         LAB SERVICES-CHEMISTRY
4210100   CARBAMAZEPINE TOTAL                      348          107   42         LAB SERVICES-CHEMISTRY
4210621   CARBON MONOXIDE                          298           92   42         LAB SERVICES-CHEMISTRY
4210639   CEA                                      222          108   42         LAB SERVICES-CHEMISTRY
4217931   CHLAMYDIA CULT                           472                42         LAB SERVICES-CHEMISTRY
4221222   CHLORIDE                                 112          34    42         LAB SERVICES-CHEMISTRY
4210654   CHLORIDE UR                              118          36    42         LAB SERVICES-CHEMISTRY
4210647   CHLORIDE UR 24HR                         118          36    42         LAB SERVICES-CHEMISTRY
4210670   CHOLESTEROL                              106          33    42         LAB SERVICES-CHEMISTRY
4219655   CHRMOSOM CNT/KARY                       2291                42         LAB SERVICES-CHEMISTRY
4218723   CHRMOSOM CNT/KARY                       1874                42         LAB SERVICES-CHEMISTRY
4218715   CHRMOSOM CNT/KARY                       2291                42         LAB SERVICES-CHEMISTRY
4218707   CHRMOSOM CNT/KARY                       2291                42         LAB SERVICES-CHEMISTRY
4230173   CK MB FRACTION                           279                42         LAB SERVICES-CHEMISTRY
4221313   CK MB FRACTION                           279           86   42         LAB SERVICES-CHEMISTRY
4221305   CK TOTAL                                 155           48   42         LAB SERVICES-CHEMISTRY
4210613   CO2 (BICARBONATE)                        118           36   42         LAB SERVICES-CHEMISTRY
4210027   COMPR MET PNL                            255           78   42         LAB SERVICES-CHEMISTRY
4221503   CORTISOL TOTAL                           391          121   42         LAB SERVICES-CHEMISTRY
4219838   COXSACKIE AB TYP A                        10                42         LAB SERVICES-CHEMISTRY
4219283   C-REACTIVE PROTEIN HS                    310                42         LAB SERVICES-CHEMISTRY
4210753   CREATININE                               124          38    42         LAB SERVICES-CHEMISTRY
4210795   CREATININE CLEARANCE                     223          69    42         LAB SERVICES-CHEMISTRY
4210761   CREATININE FLD                           124          38    42         LAB SERVICES-CHEMISTRY
4210779   CREATININE UR                            124          38    42         LAB SERVICES-CHEMISTRY
4210803   CRYOFIBRINOGEN                           205                42         LAB SERVICES-CHEMISTRY
4219432   CRYOGLOBULIN QN                          223                42         LAB SERVICES-CHEMISTRY
4219424   CRYOGLOBULIN QN                          223                42         LAB SERVICES-CHEMISTRY
4219382   CRYOGLOBULIN QN                          223                42         LAB SERVICES-CHEMISTRY
4219366   CRYOGLOBULIN QN                          223                42         LAB SERVICES-CHEMISTRY
4230017   CULT CMV                                 627                42         LAB SERVICES-CHEMISTRY
4219895   CYCLOSPORINE                             120                42         LAB SERVICES-CHEMISTRY
4219796   CYTOPLASMIC AB PROTNASE                  310                42         LAB SERVICES-CHEMISTRY
4210118   DIGOXIN                                  317           98   42         LAB SERVICES-CHEMISTRY
4210092   DRG SCRN QL CHROM EA                     348          107   42         LAB SERVICES-CHEMISTRY
4219358   EBV VCA AB IGM                            54                42         LAB SERVICES-CHEMISTRY
4210019   ELECTROLYTE PNL                          168          52    42         LAB SERVICES-CHEMISTRY
4221677   ENA AB                                                44    42         LAB SERVICES-CHEMISTRY
4219614   ENA AB                                   428                42         LAB SERVICES-CHEMISTRY
4221487   ESTRADIOL (E2)                           184          67    42         LAB SERVICES-CHEMISTRY
4212767   FAT STAIN QL                             106                42         LAB SERVICES-CHEMISTRY
4219945   FERRITIN                                  90                42         LAB SERVICES-CHEMISTRY
4230074   FETAL FIBRONECTIN                       1158          350   42         LAB SERVICES-CHEMISTRY




                                                      Page 72
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

4219853   FLM FLUOR POLAR                     453              42           LAB SERVICES-CHEMISTRY
4219473   FOLATE                              354           27 42           LAB SERVICES-CHEMISTRY
4215638   FREE T4                             127              42           LAB SERVICES-CHEMISTRY
4211553   FREE T4                             127           67 42           LAB SERVICES-CHEMISTRY
4211132   FSH                                 447          138 42           LAB SERVICES-CHEMISTRY
4210134   GENTAMICIN PK                       391          121 42           LAB SERVICES-CHEMISTRY
4210142   GENTAMICIN RAN                      391          121 42           LAB SERVICES-CHEMISTRY
4210183   GENTAMICIN TR                       391          121 42           LAB SERVICES-CHEMISTRY
4211124   GGT                                 174           56 42           LAB SERVICES-CHEMISTRY
4211009   GLUC PRENAT 50 GM SCRN              112           34 42           LAB SERVICES-CHEMISTRY
4221438   GLUCOSE                              93           29 42           LAB SERVICES-CHEMISTRY
4210951   GLUCOSE CSF                          93           29 42           LAB SERVICES-CHEMISTRY
4210985   GLUCOSE FINGERSTICK                  56           17 42           LAB SERVICES-CHEMISTRY
4210944   GLUCOSE FLD                          93           29 42           LAB SERVICES-CHEMISTRY
4221727   GLUCOSE POST GLUCOSE DOSE                        112 42           LAB SERVICES-CHEMISTRY
4221289   GTT 2HR 1ST 3 SPEC                  310           96 42           LAB SERVICES-CHEMISTRY
4213062   GTT 2HR 1ST 3 SPEC                  310           96 42           LAB SERVICES-CHEMISTRY
4211033   GTT 2HR 1ST 3 SPEC                  310           96 42           LAB SERVICES-CHEMISTRY
4211074   GTT ADDED SAMPLE                     93           29 42           LAB SERVICES-CHEMISTRY
4211272   HDL CHOLESTEROL                     199           61 42           LAB SERVICES-CHEMISTRY
4211165   HEMOGLOBIN F (APT)                  143           44 42           LAB SERVICES-CHEMISTRY
4211173   HEMOGLOBIN GLYCOSYLTD A1C           105           51 42           LAB SERVICES-CHEMISTRY
4211207   HEMOGLOBIN UR                       109           34 42           LAB SERVICES-CHEMISTRY
4210076   HEPATIC FUNCTION PNL                199           61 42           LAB SERVICES-CHEMISTRY
4221735   HEPATITIS PNL ACUTE                 321          321 42           LAB SERVICES-CHEMISTRY
4219481   HGB ELECTRO                         404              42           LAB SERVICES-CHEMISTRY
4221651   HISTONE AB                           76              42           LAB SERVICES-CHEMISTRY
4221644   HISTONE AB                                        38 42           LAB SERVICES-CHEMISTRY
4220000   HISTONE AB                           33              42           LAB SERVICES-CHEMISTRY
4214482   HOMOCYSTINE                         302              42           LAB SERVICES-CHEMISTRY
4211215   HOMOCYSTINE                         302          124 42           LAB SERVICES-CHEMISTRY
4220026   IGA                                 223              42           LAB SERVICES-CHEMISTRY
4210845   IGA                                 223              42           LAB SERVICES-CHEMISTRY
4220109   IGD                                  75              42           LAB SERVICES-CHEMISTRY
4219671   IGG                                 223              42           LAB SERVICES-CHEMISTRY
4219630   IGG                                 223              42           LAB SERVICES-CHEMISTRY
4219572   IGG                                 223              42           LAB SERVICES-CHEMISTRY
4219341   IGG                                 223              42           LAB SERVICES-CHEMISTRY
4210852   IGG                                 223              42           LAB SERVICES-CHEMISTRY
4220034   IGM                                 223              42           LAB SERVICES-CHEMISTRY
4219374   IGM                                 223              42           LAB SERVICES-CHEMISTRY
4210860   IGM                                 223              42           LAB SERVICES-CHEMISTRY
4220182   IMMUNOASSAY NONINFECT               314              42           LAB SERVICES-CHEMISTRY
4219325   IRON                                155           48 42           LAB SERVICES-CHEMISTRY
4211249   IRON BINDING CAPACITY               211           65 42           LAB SERVICES-CHEMISTRY
4221628   JO 1 AB                                           38 42           LAB SERVICES-CHEMISTRY
4210449   KETONES QL                          106           33 42           LAB SERVICES-CHEMISTRY
4210456   KETONES QN                          199           61 42           LAB SERVICES-CHEMISTRY
4221560   LA (SS B) AB                                      38 42           LAB SERVICES-CHEMISTRY
4214599   LACTIC ACID                         255           78 42           LAB SERVICES-CHEMISTRY
4211256   LDH                                 143           44 42           LAB SERVICES-CHEMISTRY
4211264   LDH FLD                             143           44 42           LAB SERVICES-CHEMISTRY
4219507   LDH ISOENZYMES                        6              42           LAB SERVICES-CHEMISTRY
4211140   LH                                  447          138 42           LAB SERVICES-CHEMISTRY
4214664   LIPASE                              168           52 42           LAB SERVICES-CHEMISTRY




                                                 Page 73
                                      c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                   SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                         AMOUNT AMOUNT CODE

4210043   LIPID PNL                                229          111   42         LAB SERVICES-CHEMISTRY
4210191   LITHIUM                                  161           50   42         LAB SERVICES-CHEMISTRY
4211280   MAGNESIUM                                161           50   42         LAB SERVICES-CHEMISTRY
4211181   METHEMOGLOBIN                            174           54   42         LAB SERVICES-CHEMISTRY
4221529   METHOTREXATE                              73                42         LAB SERVICES-CHEMISTRY
4221461   MICROALBUMIN UR 24HR                      38          14    42         LAB SERVICES-CHEMISTRY
4221479   MICROALBUMIN UR SEMI QN                   31          11    42         LAB SERVICES-CHEMISTRY
4219465   MICROSOMAL AB                            348                42         LAB SERVICES-CHEMISTRY
4221321   MISC CHEM TEST                                              42         LAB SERVICES-CHEMISTRY
4230108   MOL DX AMP NA MLTIP EA SQ                 59                42         LAB SERVICES-CHEMISTRY
4230140   MOL DX ENZ DIGESTION                      26                42         LAB SERVICES-CHEMISTRY
4214813   MOL DX ENZ DIGESTION                      93                42         LAB SERVICES-CHEMISTRY
4230132   MOL DX EXTRACTION                         93                42         LAB SERVICES-CHEMISTRY
4219788   MOL DX EXTRACTION                         93                42         LAB SERVICES-CHEMISTRY
4219564   MOL DX EXTRACTION                         93                42         LAB SERVICES-CHEMISTRY
4214771   MOL DX EXTRACTION                         93                42         LAB SERVICES-CHEMISTRY
4230082   MOL DX EXTRACTION HI PUR                  11                42         LAB SERVICES-CHEMISTRY
4230116   MOL DX GEL ELECTRO SEP                    26                42         LAB SERVICES-CHEMISTRY
4214904   MOL DX GEL ELECTRO SEP                   109                42         LAB SERVICES-CHEMISTRY
4214896   MOL DX GEL ELECTRO SEP                   109                42         LAB SERVICES-CHEMISTRY
4214888   MOL DX GEL ELECTRO SEP                   109                42         LAB SERVICES-CHEMISTRY
4230124   MOL DX INTERP & RPT                       11                42         LAB SERVICES-CHEMISTRY
4215125   MOL DX INTERP & RPT                       24                42         LAB SERVICES-CHEMISTRY
4230090   MOL DX NUC ACID PRB                       11                42         LAB SERVICES-CHEMISTRY
4214961   MOL DX NUC ACID PRB                       93                42         LAB SERVICES-CHEMISTRY
4214953   MOL DX NUC ACID PRB                       93                42         LAB SERVICES-CHEMISTRY
4215117   MOL DX REV TRANSCRIPT                    387                42         LAB SERVICES-CHEMISTRY
4219820   MYCOPLAS AB                              317                42         LAB SERVICES-CHEMISTRY
4219408   MYELIN BASIC PROTEIN CSF                 410                42         LAB SERVICES-CHEMISTRY
4214730   MYOGLOBIN                                164          96    42         LAB SERVICES-CHEMISTRY
4230165   MYOGLOBIN SCRN BLD                        63                42         LAB SERVICES-CHEMISTRY
4211298   MYOGLOBIN SCRN UR                        310          30    42         LAB SERVICES-CHEMISTRY
4221537   NATRIURETIC PEPTIDE                      114          57    42         LAB SERVICES-CHEMISTRY
4210936   O2 SAT VEN                               211          65    42         LAB SERVICES-CHEMISTRY
4210555   OCCLT BLD STL QL MULT SPC                 81          25    42         LAB SERVICES-CHEMISTRY
4210571   OCCULT BLD GASTRIC QL                     81          25    42         LAB SERVICES-CHEMISTRY
4211322   OSMOLALITY SER                           161          50    42         LAB SERVICES-CHEMISTRY
4211330   OSMOLALITY UR                            161          50    42         LAB SERVICES-CHEMISTRY
4219416   PARVOVIRUS B19 AB                        360                42         LAB SERVICES-CHEMISTRY
4210878   PH BLD                                   205          63    42         LAB SERVICES-CHEMISTRY
4221198   PH FLD                                    87                42         LAB SERVICES-CHEMISTRY
4211355   PH FLD                                    87                42         LAB SERVICES-CHEMISTRY
4210209   PHENOBARBITAL                            273          84    42         LAB SERVICES-CHEMISTRY
4218962   PHENOTHIAZINE                             45                42         LAB SERVICES-CHEMISTRY
4219903   PHENYTOIN FREE                            29                42         LAB SERVICES-CHEMISTRY
4210217   PHENYTOIN TOTAL                          317          98    42         LAB SERVICES-CHEMISTRY
4211405   PHOSPHORUS (PO4)                         112          34    42         LAB SERVICES-CHEMISTRY
4215323   PHOSPHORUS UR 24HR                       124                42         LAB SERVICES-CHEMISTRY
4221255   POTASSIUM                                112           34   42         LAB SERVICES-CHEMISTRY
4211413   POTASSIUM UR 24 HR                       106           33   42         LAB SERVICES-CHEMISTRY
4211421   POTASSIUM UR RAN                         106           33   42         LAB SERVICES-CHEMISTRY
4221545   PREALBUMIN                               348          107   42         LAB SERVICES-CHEMISTRY
4211702   PREG TEST QN BLD                         360          111   42         LAB SERVICES-CHEMISTRY
4211710   PREGNANCY TEST SER QL                    180           56   42         LAB SERVICES-CHEMISTRY
4210035   PRENATAL PNL                             218          106   42         LAB SERVICES-CHEMISTRY




                                                      Page 74
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

4221495   PROGESTERONE                        138           50 42           LAB SERVICES-CHEMISTRY
4215380   PROLACTIN                           351              42           LAB SERVICES-CHEMISTRY
4211439   PROLACTIN                           466          144 42           LAB SERVICES-CHEMISTRY
4219887   PROTEIN ELECTRO CSF                  19              42           LAB SERVICES-CHEMISTRY
4211314   PROTEIN NEPHELOMET                  372              42           LAB SERVICES-CHEMISTRY
4211470   PROTEIN TOTAL BLOOD                  87           27 42           LAB SERVICES-CHEMISTRY
4211462   PROTEIN TOTAL CSF                    87           27 42           LAB SERVICES-CHEMISTRY
4211454   PROTEIN TOTAL FLD                    87           27 42           LAB SERVICES-CHEMISTRY
4230181   PROTEIN TOTAL URINE                 125           55 42           LAB SERVICES-CHEMISTRY
4211488   PROTEIN UR QN 24 HR                  87           60 42           LAB SERVICES-CHEMISTRY
4215422   PSA FREE                            441          136 42           LAB SERVICES-CHEMISTRY
4211447   PSA TOTAL DIAG                      220          107 42           LAB SERVICES-CHEMISTRY
4215265   PTH INTACT                          740              42           LAB SERVICES-CHEMISTRY
4215257   PTH INTACT                          740              42           LAB SERVICES-CHEMISTRY
4211348   PTH INTACT                          740          140 42           LAB SERVICES-CHEMISTRY
4219911   QUINIDINE                            96              42           LAB SERVICES-CHEMISTRY
4212957   REDUCING SUBSTANCE FECAL             75              42           LAB SERVICES-CHEMISTRY
4210068   RENAL FUNCTION PNL                  211           65 42           LAB SERVICES-CHEMISTRY
4218988   RIBOFLAVIN                           82              42           LAB SERVICES-CHEMISTRY
4221552   RO(SS A) AB                                       38 42           LAB SERVICES-CHEMISTRY
4210241   SALICYLATE                          168           52 42           LAB SERVICES-CHEMISTRY
4221610   SCL 70 AB                                         38 42           LAB SERVICES-CHEMISTRY
4221511   SEX HORMONE BIND GLOB               107           54 42           LAB SERVICES-CHEMISTRY
4221602   SMITH AB                                          38 42           LAB SERVICES-CHEMISTRY
4221263   SODIUM                              118           36 42           LAB SERVICES-CHEMISTRY
4211512   SODIUM UR RAN                       118           36 42           LAB SERVICES-CHEMISTRY
4211504   SODIUM UR RAN                       118           36 42           LAB SERVICES-CHEMISTRY
4211520   SPEC GRAVITY FLD                     62           19 42           LAB SERVICES-CHEMISTRY
4219028   SPECTROPHOTOMETRY                   190              42           LAB SERVICES-CHEMISTRY
4219689   T LYMPH TOT CNT                      27              42           LAB SERVICES-CHEMISTRY
4221180   T3 FREE                             302           93 42           LAB SERVICES-CHEMISTRY
4219929   TACROLIMUS (FK506)                   90              42           LAB SERVICES-CHEMISTRY
4219663   TESTOSTERONE FREE                   608          188 42           LAB SERVICES-CHEMISTRY
4211538   TESTOSTERONE TOTAL                  227          108 42           LAB SERVICES-CHEMISTRY
4210258   THEOPHYLLINE                        341          105 42           LAB SERVICES-CHEMISTRY
4215661   THYR STIM IG                        913              42           LAB SERVICES-CHEMISTRY
4218657   TISSUE CULT LYMPH                   623              42           LAB SERVICES-CHEMISTRY
4210266   TOBRAMYCIN PK                       385          119 42           LAB SERVICES-CHEMISTRY
4210274   TOBRAMYCIN RAN                      385          119 42           LAB SERVICES-CHEMISTRY
4210316   TOBRAMYCIN TR                       385          119 42           LAB SERVICES-CHEMISTRY
4211595   TRIGLYCERIDE                        137           42 42           LAB SERVICES-CHEMISTRY
4211603   TRIGLYCERIDE BDY FLD                137           42 42           LAB SERVICES-CHEMISTRY
4230157   TROPONIN I QL                        38              42           LAB SERVICES-CHEMISTRY
4221206   TROPONIN I QN                       178           73 42           LAB SERVICES-CHEMISTRY
4211561   TSH                                 197           95 42           LAB SERVICES-CHEMISTRY
4211678   URIC ACID                           106           33 42           LAB SERVICES-CHEMISTRY
4210423   URNALYSIS VOL MEASURE                75           23 42           LAB SERVICES-CHEMISTRY
4210126   VALPROIC ACID                       323          100 42           LAB SERVICES-CHEMISTRY
4210324   VANCOMYCIN PK                       279          135 42           LAB SERVICES-CHEMISTRY
4210332   VANCOMYCIN RAN                      279          135 42           LAB SERVICES-CHEMISTRY
4210340   VANCOMYCIN TR                       279          135 42           LAB SERVICES-CHEMISTRY
4219606   VITAMIN B12                         360           27 42           LAB SERVICES-CHEMISTRY
4230025   VZV AB                              310              42           LAB SERVICES-CHEMISTRY
4700225   CYTO CL BLK 5 CNT/1 KARY            129              47           LAB SERVICES-CYTOLOGY
4700100   CYTO CL BLK 5 CNT/1 KARY            129              47           LAB SERVICES-CYTOLOGY




                                                 Page 75
                                c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION             SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                   AMOUNT AMOUNT CODE

4700084   CYTO CL BLK 5 CNT/1 KARY         156.94               47         LAB SERVICES-CYTOLOGY
4700043   CYTOLOGY CONCENTRATION             353                47         LAB SERVICES-CYTOLOGY
4700068   CYTOLOGY FLD                       195                47         LAB SERVICES-CYTOLOGY
4700431   CYTOLOGY OTHER SOURCE              297                47         LAB SERVICES-CYTOLOGY
4700449   CYTOLOGY SEL CELL ENHANCE          254                47         LAB SERVICES-CYTOLOGY
4700126   DECALCIFICATION                    168                47         LAB SERVICES-CYTOLOGY
4700027   FNA ADEQUACY EVAL                  255                47         LAB SERVICES-CYTOLOGY
4700001   FNA INTERP & RPT                   250                47         LAB SERVICES-CYTOLOGY
4700241   IMMUNOHISTOCHEMISTRY               267                47         LAB SERVICES-CYTOLOGY
4700498   INTRAOP CYTOPATH CON ADDL            37               47         LAB SERVICES-CYTOLOGY
4700480   INTRAOP CYTOPATH CON INIT            60               47         LAB SERVICES-CYTOLOGY
4700381   PATH FRZN SECTION 1 BLK            347                47         LAB SERVICES-CYTOLOGY
4700399   PATH FRZN SECTION ADD              187                47         LAB SERVICES-CYTOLOGY
4700407   SPEC STAIN GRP I MICROORG          126                47         LAB SERVICES-CYTOLOGY
4700423   SPEC STAIN GRP II                  132                47         LAB SERVICES-CYTOLOGY
4700258   SURG PATH LVL I                    279                47         LAB SERVICES-CYTOLOGY
4700266   SURG PATH LVL II                   187                47         LAB SERVICES-CYTOLOGY
4700274   SURG PATH LVL III                  174                47         LAB SERVICES-CYTOLOGY
4700282   SURG PATH LVL IV                   303                47         LAB SERVICES-CYTOLOGY
4700290   SURG PATH LVL V                    400                47         LAB SERVICES-CYTOLOGY
4700308   SURG PATH LVL VI                   854                47         LAB SERVICES-CYTOLOGY
4700472   TUMOR IMMUNOHISTOCHEM MAN          135                47         LAB SERVICES-CYTOLOGY
4300018   BLD SMR EXAM W MAN DIFF              81         25    43         LAB SERVICES-HEMATOLOGY
4300125   CBC AUTO                           155          48    43         LAB SERVICES-HEMATOLOGY
4300042   CBC AUTO W AUTO DIFF WBC           186          57    43         LAB SERVICES-HEMATOLOGY
4300182   D DIMER QN                         242          75    43         LAB SERVICES-HEMATOLOGY
4300141   D DIMER SEMI QN/QL                 174          54    43         LAB SERVICES-HEMATOLOGY
4300117   FETAL RBC SMR (K B)                186          57    43         LAB SERVICES-HEMATOLOGY
4300133   FIBRINOGEN                         205          63    43         LAB SERVICES-HEMATOLOGY
4300026   HEMATOCRIT                           56         17    43         LAB SERVICES-HEMATOLOGY
4300034   HEMOGLOBIN                           56         17    43         LAB SERVICES-HEMATOLOGY
4300208   HEPARIN ASSAY                      317          98    43         LAB SERVICES-HEMATOLOGY
4300471   NIACIN                               54               43         LAB SERVICES-HEMATOLOGY
4300091   PLT CNT AUTO                       106          33    43         LAB SERVICES-HEMATOLOGY
4300158   PROTHROMBIN TIME                     93         32    43         LAB SERVICES-HEMATOLOGY
4300166   PTT PLAS OR WB                     143          38    43         LAB SERVICES-HEMATOLOGY
4300174   PTT SUBSTITUTION EA                155          48    43         LAB SERVICES-HEMATOLOGY
4300059   RETICULOCYTE AUTO                    93         29    43         LAB SERVICES-HEMATOLOGY
4300067   RETICULOCYTE MAN                   106          33    43         LAB SERVICES-HEMATOLOGY
4300109   SEDIMENTATION RATE MAN               87         27    43         LAB SERVICES-HEMATOLOGY
4300190   SICKLE CL SCRN                       36               43         LAB SERVICES-HEMATOLOGY
4300075   WBC CNT AUTO                         62         19    43         LAB SERVICES-HEMATOLOGY
4500104   ANA (ANTI NUCLEAR AB)              124          45    45         LAB SERVICES-IMMUNOLOGY
4500294   ANA TTR                              73               45         LAB SERVICES-IMMUNOLOGY
4500211   ASO TTR                            174           54   45         LAB SERVICES-IMMUNOLOGY
4500344   C REACTIVE PROTEIN                   94          38   45         LAB SERVICES-IMMUNOLOGY
4500302   C REACTIVE PROTEIN HS                85          31   45         LAB SERVICES-IMMUNOLOGY
4500112   CA 125                             137           50   45         LAB SERVICES-IMMUNOLOGY
4500351   CA 15 3 (27.29)                    218          106   45         LAB SERVICES-IMMUNOLOGY
4500369   COMPLEMENT C3                                    75   45         LAB SERVICES-IMMUNOLOGY
4500377   COMPLEMENT C4                                    75   45         LAB SERVICES-IMMUNOLOGY
4500047   CRYPTOCOCCAL AG TTR AGGL           303          151   45         LAB SERVICES-IMMUNOLOGY
4500229   H PYLORI AB TOTAL                  348           48   45         LAB SERVICES-IMMUNOLOGY
4500146   HAV AB IGM                          89                45         LAB SERVICES-IMMUNOLOGY
4500138   HAV AB TOTAL                        89                45         LAB SERVICES-IMMUNOLOGY




                                                Page 76
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

4500161   HB CORE AB IGM                        89                45         LAB SERVICES-IMMUNOLOGY
4500153   HB CORE AB TOTAL                      80                45         LAB SERVICES-IMMUNOLOGY
4500179   HBS AB                                70                45         LAB SERVICES-IMMUNOLOGY
4500187   HCV AB                                89                45         LAB SERVICES-IMMUNOLOGY
4500096   HIV 1 AB                             211           65   45         LAB SERVICES-IMMUNOLOGY
4500070   HIV 1/HIV 2 AB                       329          101   45         LAB SERVICES-IMMUNOLOGY
4500195   IMMUNOFIX UR                          45                45         LAB SERVICES-IMMUNOLOGY
4500005   MALARIA AB                            70           35   45         LAB SERVICES-IMMUNOLOGY
4500021   MONO TEST SCRN                       124           38   45         LAB SERVICES-IMMUNOLOGY
4500054   RHEUMATOID FCTR QL                   137           42   45         LAB SERVICES-IMMUNOLOGY
4500062   RHEUMATOID FCTR QN                   137           42   45         LAB SERVICES-IMMUNOLOGY
4500039   RPR QL                                99           31   45         LAB SERVICES-IMMUNOLOGY
4500088   RUBELLA AB IGG                       348          107   45         LAB SERVICES-IMMUNOLOGY
4500328   SKIN TEST ANERGY                     114           56   45         LAB SERVICES-IMMUNOLOGY
4500336   SKIN TEST CANDIDA                    217           67   45         LAB SERVICES-IMMUNOLOGY
4500310   SKIN TEST TB                         155                45         LAB SERVICES-IMMUNOLOGY
4500245   TOXOPLAS AB IGG                      348          48    45         LAB SERVICES-IMMUNOLOGY
4500252   TOXOPLAS AB IGM                      348          48    45         LAB SERVICES-IMMUNOLOGY
4500237   VIRUS AB NOT SPEC                    310          48    45         LAB SERVICES-IMMUNOLOGY
4500260   VZV AB IGG                           310          48    45         LAB SERVICES-IMMUNOLOGY
4600615   AFB CULT                              72          26    46         LAB SERVICES-MICROBIOLOGY
4600607   AFB CULT BLD                          72          26    46         LAB SERVICES-MICROBIOLOGY
4600094   C DIFFICILE TOXIN EIA                286          88    46         LAB SERVICES-MICROBIOLOGY
4600722   CANDIDA DNA DIR PROBE                 70          35    46         LAB SERVICES-MICROBIOLOGY
4600664   CHLAMYDIA TRACH AMP PRB              232          84    46         LAB SERVICES-MICROBIOLOGY
4600649   CHLAMYDIA TRACH AMP PRB              232          84    46         LAB SERVICES-MICROBIOLOGY
4600755   CRYPTOSPORIDIUM AG EIA               286          88    46         LAB SERVICES-MICROBIOLOGY
4600540   CULT BACT AEROBIC ID                 192          59    46         LAB SERVICES-MICROBIOLOGY
4600532   CULT BACT AEROBIC ID                 192          59    46         LAB SERVICES-MICROBIOLOGY
4600524   CULT BACT AEROBIC ID                 192          59    46         LAB SERVICES-MICROBIOLOGY
4600128   CULT BACT AEROBIC ID                 192          59    46         LAB SERVICES-MICROBIOLOGY
4600847   CULT BACT AEROBIC ID                  15                46         LAB SERVICES-MICROBIOLOGY
4600557   CULT BACT ANAEROBIC ID               192          59    46         LAB SERVICES-MICROBIOLOGY
4600250   CULT BLD BACTERIA                    248          77    46         LAB SERVICES-MICROBIOLOGY
4600458   CULT CATHETER TIP                    205          63    46         LAB SERVICES-MICROBIOLOGY
4600375   CULT CSF                             205          63    46         LAB SERVICES-MICROBIOLOGY
4600854   CULT ENVIRONMENT                      27                46         LAB SERVICES-MICROBIOLOGY
4600870   CULT FLUID                           205           63   46         LAB SERVICES-MICROBIOLOGY
4600771   CULT FUNG SKIN HAIR NAIL             216          108   46         LAB SERVICES-MICROBIOLOGY
4600391   CULT FUNGUS BLD                      217           67   46         LAB SERVICES-MICROBIOLOGY
4600565   CULT FUNGUS MOLD ID                  248           77   46         LAB SERVICES-MICROBIOLOGY
4600821   CULT FUNGUS MOLD ID                   27                46         LAB SERVICES-MICROBIOLOGY
4600318   CULT FUNGUS OTHER SOURCE             199          61    46         LAB SERVICES-MICROBIOLOGY
4600797   CULT FUNGUS YEAST ID                 248                46         LAB SERVICES-MICROBIOLOGY
4600219   CULT GC SCRN                         161          50    46         LAB SERVICES-MICROBIOLOGY
4600441   CULT GENITAL                         205          63    46         LAB SERVICES-MICROBIOLOGY
4600474   CULT GRP B STREP SCRN                161          50    46         LAB SERVICES-MICROBIOLOGY
4600284   CULT MISC                            205          63    46         LAB SERVICES-MICROBIOLOGY
4600839   CULT MRSA SCRN                       161          50    46         LAB SERVICES-MICROBIOLOGY
4600292   CULT QN ANAEROBIC                    223          69    46         LAB SERVICES-MICROBIOLOGY
4600383   CULT SPUTUM                          205          63    46         LAB SERVICES-MICROBIOLOGY
4600680   CULT STL CAMPHYLOB EA PLT            223          43    46         LAB SERVICES-MICROBIOLOGY
4600581   CULT STL E COLI EA PLATE             223          43    46         LAB SERVICES-MICROBIOLOGY
4600268   CULT STL SALM & SHIG                 223          43    46         LAB SERVICES-MICROBIOLOGY
4600706   CULT STL VIBRIO EA PLATE             151          76    46         LAB SERVICES-MICROBIOLOGY




                                                  Page 77
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

4600698   CULT STL YERSINIA EA PLT             151        76 46             LAB SERVICES-MICROBIOLOGY
4600425   CULT THROAT                          205        63 46             LAB SERVICES-MICROBIOLOGY
4600276   CULT THROAT                          205        63 46             LAB SERVICES-MICROBIOLOGY
4600813   CULT TYP (SHIGELLA)                  124           46             LAB SERVICES-MICROBIOLOGY
4600573   CULT TYP AGGL                        124           46             LAB SERVICES-MICROBIOLOGY
4600714   CULT TYP BY NA PRB                   361           46             LAB SERVICES-MICROBIOLOGY
4600805   CULT TYP SALMONELLA                  124           46             LAB SERVICES-MICROBIOLOGY
4600672   CULT UR COLONY CT ONLY               192        59 46             LAB SERVICES-MICROBIOLOGY
4600482   CULT UR ID EACH ISOLATE              192        59 46             LAB SERVICES-MICROBIOLOGY
4600730   GARDNER VAG DNA DIR PROBE             70        35 46             LAB SERVICES-MICROBIOLOGY
4600656   GC AMP PRB                            39        14 46             LAB SERVICES-MICROBIOLOGY
4600763   GIARDIA AG EIA                       286        88 46             LAB SERVICES-MICROBIOLOGY
4600060   HBS AG                                62           46             LAB SERVICES-MICROBIOLOGY
4600243   INDIA INK PREP CSF                    99        31 46             LAB SERVICES-MICROBIOLOGY
4600516   INFLUENZA AG A OR B EACH             286        88 46             LAB SERVICES-MICROBIOLOGY
4600235   KOH PREP SKIN HAIR NAIL               99        31 46             LAB SERVICES-MICROBIOLOGY
4600086   LEGIONELLA PNEUMO DFA                286        88 46             LAB SERVICES-MICROBIOLOGY
4600334   OVA & PARASITES W CONC               211        65 46             LAB SERVICES-MICROBIOLOGY
4600342   PINWORM CELLOPHANE TAPE               99        31 46             LAB SERVICES-MICROBIOLOGY
4600862   RSV AG EIA                           124      124 46              LAB SERVICES-MICROBIOLOGY
4600623   SMR AFB STAIN                         36           46             LAB SERVICES-MICROBIOLOGY
4600151   SMR FUNGUS FLUORESCENT               130        40 46             LAB SERVICES-MICROBIOLOGY
4600201   SMR GRAM STAIN                        99        31 46             LAB SERVICES-MICROBIOLOGY
4600011   SMR MALARIA                          242        75 46             LAB SERVICES-MICROBIOLOGY
4600185   SMR WET MOUNT                         99        31 46             LAB SERVICES-MICROBIOLOGY
4600045   STL FOR WBC'S                         45           46             LAB SERVICES-MICROBIOLOGY
4600409   STREP GRP A AG EIA                   286        88 46             LAB SERVICES-MICROBIOLOGY
4600193   SUSCEPT BY MIC                       205        63 46             LAB SERVICES-MICROBIOLOGY
4600490   SUSCEPT KB DISK <=12                 168        52 46             LAB SERVICES-MICROBIOLOGY
4600748   TRICHOMONAS VAG DRCT DNA              70        35 46             LAB SERVICES-MICROBIOLOGY
4890026   CELL CNT FLD W/ DIFF                 130        40 48             LAB SERVICES-PATHOLOGY
4890042   CRYSTAL ID TISS/FLD NO UR            273        84 48             LAB SERVICES-PATHOLOGY
4890133   CYTOLOGY CYTOSPIN                    133           48             LAB SERVICES-PATHOLOGY
4890018   EOSINPHILS SMR NASAL                 112        35 48             LAB SERVICES-PATHOLOGY
4890034   FAT STAIN QL                         106        33 48             LAB SERVICES-PATHOLOGY
4870036   PREGNANCY SCRN UR                    149        46 48             LAB SERVICES-PATHOLOGY
4890083   SEM MOT/CNT (NO HUHNER)              205        63 48             LAB SERVICES-PATHOLOGY
4890125   SEMEN ANALYSIS COMPLETE              292        90 48             LAB SERVICES-PATHOLOGY
4890117   SEMEN PRESENCE/MOT POST              211        65 48             LAB SERVICES-PATHOLOGY
4890158   SPEC STAIN GRP I MICROORG            126        39 48             LAB SERVICES-PATHOLOGY
4890141   SPEC STAIN GRP II                    132        41 48             LAB SERVICES-PATHOLOGY
4870044   SPECIFIC GRAVITY UR                   78        19 48             LAB SERVICES-PATHOLOGY
4870002   URNALYSIS MAN W/O MICRO               62        19 48             LAB SERVICES-PATHOLOGY
4034021   17 OH CORTICOSTERIODS                 14           40             LAB SERVICES-REFERENCE
4034047   17 OH PROGESTRONE                  24.75           40             LAB SERVICES-REFERENCE
4042024   21-HYDROXYLASE ANTIBODY             96.3           40             LAB SERVICES-REFERENCE
4034039   5 HIAA UR                           15.6           40             LAB SERVICES-REFERENCE
4034328   5 NUCLEOTIDASE                     37.61     37.61 40             LAB SERVICES-REFERENCE
4033551   ACE (ANGIOTN CONVR ENZ)               12        12 40             LAB SERVICES-REFERENCE
4038279   ACETOMINOPHEN SCRN                     5           40             LAB SERVICES-REFERENCE
4038568   ACETYLCHOLINE BLK AB                  48           40             LAB SERVICES-REFERENCE
4038576   ACETYLCHOLINE MODULE AB               59           40             LAB SERVICES-REFERENCE
4034500   ACETYLCHOLINE RECEPT AB               45           40             LAB SERVICES-REFERENCE
4034401   ACID PHOS PROSTATIC                 9.75           40             LAB SERVICES-REFERENCE
4033403   ACTH                                  25           40             LAB SERVICES-REFERENCE




                                                 Page 78
                                     c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                  SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                        AMOUNT AMOUNT CODE

4037537   ADENO ENTERIC 40/41 EIA                 22.5           40             LAB SERVICES-REFERENCE
4037610   ADENOVIRUS AB                           5.07           40             LAB SERVICES-REFERENCE
4037602   ADENOVIRUS AB                           5.04           40             LAB SERVICES-REFERENCE
4034674   ADH (VASOPRESSIN)                         25           40             LAB SERVICES-REFERENCE
4038394   ADRENAL AB SCRN                           25           40             LAB SERVICES-REFERENCE
4035184   ADRENAL AB TTR                            13           40             LAB SERVICES-REFERENCE
4060109   AFB CULT BLD                           39.85           40             LAB SERVICES-REFERENCE
4033494   AFP TUMOR MARKER                          11           40             LAB SERVICES-REFERENCE
4037479   AG DETECT EIA MULT STEP                   24           40             LAB SERVICES-REFERENCE
4040044   ALBUMIN                                 7.09           40             LAB SERVICES-REFERENCE
4040002   ALBUMIN                                 6.94           40             LAB SERVICES-REFERENCE
4033411   ALBUMIN                                 6.75           40             LAB SERVICES-REFERENCE
4040200   ALBUMIN FLD                             6.75           40             LAB SERVICES-REFERENCE
4033437   ALBUMIN FLD                             7.09           40             LAB SERVICES-REFERENCE
4033429   ALBUMIN FLD                             6.94           40             LAB SERVICES-REFERENCE
4033445   ALCOHOL (ETHANOL) UR                   16.31           40             LAB SERVICES-REFERENCE
4038402   ALCOHOL (ETHANOL) WB                    26.5           40             LAB SERVICES-REFERENCE
4033452   ALDOLASE                                 8.5           40             LAB SERVICES-REFERENCE
4033460   ALDOSTERONE                               27           40             LAB SERVICES-REFERENCE
4033478   ALDOSTERONE UR 24HR                       39           40             LAB SERVICES-REFERENCE
4036471   ALK PHOS ISOENZYMES                    11.22     11.22 40             LAB SERVICES-REFERENCE
4034419   ALK PHOSPHATASE                         5.78           40             LAB SERVICES-REFERENCE
4041745   ALLERGEN SPECIFIC IGE QN                5.93           40             LAB SERVICES-REFERENCE
4041737   ALLERGEN SPECIFIC IGE QN                5.93           40             LAB SERVICES-REFERENCE
4041729   ALLERGEN SPECIFIC IGE QN                5.81           40             LAB SERVICES-REFERENCE
4041711   ALLERGEN SPECIFIC IGE QN                5.81           40             LAB SERVICES-REFERENCE
4041703   ALLERGEN SPECIFIC IGE QN                5.81           40             LAB SERVICES-REFERENCE
4041695   ALLERGEN SPECIFIC IGE QN                5.81           40             LAB SERVICES-REFERENCE
4041687   ALLERGEN SPECIFIC IGE QN                5.81           40             LAB SERVICES-REFERENCE
4041679   ALLERGEN SPECIFIC IGE QN                6.23           40             LAB SERVICES-REFERENCE
4041661   ALLERGEN SPECIFIC IGE QN                6.23           40             LAB SERVICES-REFERENCE
4040309   ALLERGEN SPECIFIC IGE QN                5.93           40             LAB SERVICES-REFERENCE
4039236   ALLERGEN SPECIFIC IGE QN                5.93           40             LAB SERVICES-REFERENCE
4039228   ALLERGEN SPECIFIC IGE QN                5.93           40             LAB SERVICES-REFERENCE
4039103   ALLERGEN SPECIFIC IGE QN                5.93           40             LAB SERVICES-REFERENCE
4039095   ALLERGEN SPECIFIC IGE QN                5.93           40             LAB SERVICES-REFERENCE
4034906   ALLERGEN SPECIFIC IGE QN               10.87           40             LAB SERVICES-REFERENCE
4033486   ALPHA 1 ANTITRYPSIN                    13.25           40             LAB SERVICES-REFERENCE
4041471   ALUMINUM                                  22           40             LAB SERVICES-REFERENCE
4040721   ALUMINUM                                  22           40             LAB SERVICES-REFERENCE
4043030   ALUMINUM                                46.5           40             LAB SERVICES-REFERENCE
4035655   AMEBIC AB                                 19           40             LAB SERVICES-REFERENCE
4038428   AMIKACIN PK                               15           40             LAB SERVICES-REFERENCE
4038436   AMIKACIN TR                               15           40             LAB SERVICES-REFERENCE
4033502   AMINO ACIDS MULT QL                       19           40             LAB SERVICES-REFERENCE
4033536   AMINO ACIDS PLAS >5 QN                  96.5           40             LAB SERVICES-REFERENCE
4030763   AMINO ACIDS UR >5 QN                     131           40             LAB SERVICES-REFERENCE
4030748   AMIODARONE                                29           40             LAB SERVICES-REFERENCE
4036737   AMITRIPTYLINE                             23           40             LAB SERVICES-REFERENCE
4031902   AMMONIA UR 24HR                        20.02           40             LAB SERVICES-REFERENCE
4033239   AMPHETAMINE CONF                       48.22           40             LAB SERVICES-REFERENCE
4030532   AMYLASE                                    9           40             LAB SERVICES-REFERENCE
4035036   ANA (ANTI NUCLEAR AB)                     19           40             LAB SERVICES-REFERENCE
4035028   ANA (ANTI NUCLEAR AB)                   7.27           40             LAB SERVICES-REFERENCE
4041026   ANCA IBD TITER                         31.26           40             LAB SERVICES-REFERENCE




                                                     Page 79
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

4033544   ANDROSTENEDIONE                        21               40         LAB SERVICES-REFERENCE
4037289   ANTABUSE                             73.7               40         LAB SERVICES-REFERENCE
4035135   ANTI DNA DBL STRAND                  12.5               40         LAB SERVICES-REFERENCE
4034997   ANTINEUTROPHILIC AB                 15.29               40         LAB SERVICES-REFERENCE
4037149   APOLIPOPROTEIN A1                      11               40         LAB SERVICES-REFERENCE
4036208   APOLIPOPROTEIN B                       14               40         LAB SERVICES-REFERENCE
4033569   ARSENIC BLD                            19               40         LAB SERVICES-REFERENCE
4040101   ARSENIC UR                             12               40         LAB SERVICES-REFERENCE
4033577   ARSENIC UR                             10               40         LAB SERVICES-REFERENCE
4036174   ASCORBIC ACID                          14               40         LAB SERVICES-REFERENCE
4035044   ASO SCRN                             9.44               40         LAB SERVICES-REFERENCE
4036638   ASPERGILLUS AB                       6.17               40         LAB SERVICES-REFERENCE
4035275   ASPERGILLUS AB                       6.17               40         LAB SERVICES-REFERENCE
4035267   ASPERGILLUS AB                       6.17               40         LAB SERVICES-REFERENCE
4039640   AT3 ACTIVITY                           19               40         LAB SERVICES-REFERENCE
4034807   AT3 ACTIVITY                           19               40         LAB SERVICES-REFERENCE
4040945   AVIAN FLU RNA QL PCR                292.5               40         LAB SERVICES-REFERENCE
4041059   B CELLS TOTAL CNT                   13.56               40         LAB SERVICES-REFERENCE
4040143   B CELLS TOTAL CNT                      25               40         LAB SERVICES-REFERENCE
4036075   B CELLS TOTAL CNT                    24.5               40         LAB SERVICES-REFERENCE
4035861   B PERTUSSIS/PARAPERT DFA               10         10    40         LAB SERVICES-REFERENCE
4043428   B/P-PERTUSSIS DNA QUL PCR              85         85    40         LAB SERVICES-REFERENCE
4038014   BARBITURATES CONF                   48.75               40         LAB SERVICES-REFERENCE
4033593   BARBITURATES QN                     79.83               40         LAB SERVICES-REFERENCE
4033189   BARBITURATES SCRN                      39               40         LAB SERVICES-REFERENCE
4039939   BARTONELLA AB IGG                    6.25               40         LAB SERVICES-REFERENCE
4039947   BARTONELLA AB IGM                    6.25               40         LAB SERVICES-REFERENCE
4038287   BENZODIAZEPINE SCRN                     5               40         LAB SERVICES-REFERENCE
4040416   BENZODIAZEPINES                        33               40         LAB SERVICES-REFERENCE
4038022   BENZODIAZEPINES                    102.37               40         LAB SERVICES-REFERENCE
4030664   BENZODIAZEPINES                      16.5               40         LAB SERVICES-REFERENCE
4040333   BENZOYLECGONINE SCRN                12.55               40         LAB SERVICES-REFERENCE
4041794   BETA 2 GLYCOPROTN I AB EA           27.25               40         LAB SERVICES-REFERENCE
4041786   BETA 2 GLYCOPROTN I AB EA           27.25               40         LAB SERVICES-REFERENCE
4041778   BETA 2 GLYCOPROTN I AB EA           27.25               40         LAB SERVICES-REFERENCE
4037305   BETA HCG QN                            11               40         LAB SERVICES-REFERENCE
4033601   BETA2 MICROGLOBULIN                 19.95               40         LAB SERVICES-REFERENCE
4038162   B-HEXOSAMINIDASE EA ASSAY          123.68               40         LAB SERVICES-REFERENCE
4033619   BILE ACIDS SER FRAC                 142.5               40         LAB SERVICES-REFERENCE
4037099   BLD CNT RBC AUTO                        4      2.42     40         LAB SERVICES-REFERENCE
4042057   BORDETELLA AB                          20               40         LAB SERVICES-REFERENCE
4042040   BORDETELLA AB                          20               40         LAB SERVICES-REFERENCE
4042032   BORDETELLA AB                          20               40         LAB SERVICES-REFERENCE
4043436   BORELLIA BURG AMP PRB                 125         125   40         LAB SERVICES-REFERENCE
4041760   BRUCELLA AB                          10.5               40         LAB SERVICES-REFERENCE
4041752   BRUCELLA AB                          10.5               40         LAB SERVICES-REFERENCE
4035317   BRUCELLA AB                          9.44               40         LAB SERVICES-REFERENCE
4035309   BRUCELLA AB                          10.5               40         LAB SERVICES-REFERENCE
4032041   BRUCELLA AB                          10.5               40         LAB SERVICES-REFERENCE
4038964   BUPROPION                              35               40         LAB SERVICES-REFERENCE
4034716   C PEPTIDE                              21               40         LAB SERVICES-REFERENCE
4039301   C1 EST INHIB PROTEIN QNT               17               40         LAB SERVICES-REFERENCE
4035119   C1 ESTERASE INHIBITOR               22.18               40         LAB SERVICES-REFERENCE
4035218   CA 15 3 (27.29)                        15               40         LAB SERVICES-REFERENCE
4035226   CA 19 9                              15.3               40         LAB SERVICES-REFERENCE




                                                  Page 80
                                      c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                   SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                         AMOUNT AMOUNT CODE

4043022   CADMIUM                                    50              40          LAB SERVICES-REFERENCE
4037206   CADMIUM                                    10              40          LAB SERVICES-REFERENCE
4037198   CADMIUM                                    51              40          LAB SERVICES-REFERENCE
4039111   CAFFEINE                                   20              40          LAB SERVICES-REFERENCE
4037214   CAFFEINE                                 37.8              40          LAB SERVICES-REFERENCE
4033643   CALC ANALYSIS CHEM QN                   17.82         25   40          LAB SERVICES-REFERENCE
4040382   CALC ANALYSIS INFRARED                     25              40          LAB SERVICES-REFERENCE
4033635   CALCITONIN                               27.5              40          LAB SERVICES-REFERENCE
4031837   CALCIUM UR 24HR                           7.7              40          LAB SERVICES-REFERENCE
4040713   CANDIDA AB                              14.56              40          LAB SERVICES-REFERENCE
4036281   CANDIDA AB                                 15              40          LAB SERVICES-REFERENCE
4032082   CANDIDA AB                              14.55              40          LAB SERVICES-REFERENCE
4039129   CANDIDA AG LA                            28.1              40          LAB SERVICES-REFERENCE
4033205   CANNABINOID SCRN                        31.63              40          LAB SERVICES-REFERENCE
4036950   CANNABINOIDS CONF                          25              40          LAB SERVICES-REFERENCE
4041851   CARDIOLIPIN AB                           17.5              40          LAB SERVICES-REFERENCE
4039384   CARDIOLIPIN AB                          26.13              40          LAB SERVICES-REFERENCE
4041844   CARDIOLIPIN IGG AB                       17.5              40          LAB SERVICES-REFERENCE
4041836   CARDIOLIPIN IGM AB                       17.5              40          LAB SERVICES-REFERENCE
4033650   CARNITINE FREE & TOTAL                     31              40          LAB SERVICES-REFERENCE
4033668   CAROTENE                                   15              40          LAB SERVICES-REFERENCE
4036943   CATECHOL FRAC PLAS                       27.5      27.5    40          LAB SERVICES-REFERENCE
4033676   CATECHOL FRAC UR                         27.5              40          LAB SERVICES-REFERENCE
4040317   CEA FLUID                               39.75              40          LAB SERVICES-REFERENCE
4037222   CEFTRIAXONE                             52.05              40          LAB SERVICES-REFERENCE
4040531   CELL MARKR INTERPRET 9-15               40.58              40          LAB SERVICES-REFERENCE
4040523   CELL MARKR TECH EA ADDL                 10.69              40          LAB SERVICES-REFERENCE
4043196   CELL MARKR TECH ONLY 1ST                   75         75   40          LAB SERVICES-REFERENCE
4040515   CELL MARKR TECH ONLY 1ST                23.51              40          LAB SERVICES-REFERENCE
4033684   CERULOPLASMIN                            9.75      9.75    40          LAB SERVICES-REFERENCE
4040341   CHAGAS IGG                              16.25              40          LAB SERVICES-REFERENCE
4040358   CHAGAS IGM                              16.25              40          LAB SERVICES-REFERENCE
4038626   CHLAMYDIA AB                              8.5              40          LAB SERVICES-REFERENCE
4035325   CHLAMYDIA AB                              8.5              40          LAB SERVICES-REFERENCE
4038618   CHLAMYDIA AB IGG                          8.5              40          LAB SERVICES-REFERENCE
4038758   CHLAMYDIA AB IGM                         8.33              40          LAB SERVICES-REFERENCE
4035366   CHLAMYDIA AB IGM                         8.33              40          LAB SERVICES-REFERENCE
4032108   CHLAMYDIA AB IGM                         8.33              40          LAB SERVICES-REFERENCE
4032090   CHLAMYDIA AB IGM                         8.33              40          LAB SERVICES-REFERENCE
4035879   CHLAMYDIA AG DFA                           15              40          LAB SERVICES-REFERENCE
4036893   CHLAMYDIA CULT                             10              40          LAB SERVICES-REFERENCE
4035804   CHLAMYDIA CULT                           16.1              40          LAB SERVICES-REFERENCE
4036984   CHLAMYDIA CULT RESP                     35.88              40          LAB SERVICES-REFERENCE
4035333   CHLAMYDIA PNEUMO AB                       8.5              40          LAB SERVICES-REFERENCE
4032116   CHLAMYDIA PNEUMO AB                       8.5              40          LAB SERVICES-REFERENCE
4031076   CHLAMYDIA PNEUMO AB                       8.5              40          LAB SERVICES-REFERENCE
4035341   CHLAMYDIA TRACH AB                        8.5              40          LAB SERVICES-REFERENCE
4035986   CHLAMYDIA TRACH AMP PRB                    31         30   40          LAB SERVICES-REFERENCE
4035978   CHLAMYDIA TRACH DIR PRB                    15              40          LAB SERVICES-REFERENCE
4031845   CHLORIDE UR 24HR                          7.7              40          LAB SERVICES-REFERENCE
4037248   CHOLINESTERASE RBC                      12.38              40          LAB SERVICES-REFERENCE
4037255   CHOLINESTERASE SER                        6.2              40          LAB SERVICES-REFERENCE
4037230   CHOLINESTERASE SER                      12.37              40          LAB SERVICES-REFERENCE
4039798   CHRMOSOM ADD KARY EA                     49.5              40          LAB SERVICES-REFERENCE
4038352   CHRMOSOM ADD KARY EA                    31.83              40          LAB SERVICES-REFERENCE




                                                      Page 81
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

4036158   CHRMOSOM ADD KARY EA               28.96              40          LAB SERVICES-REFERENCE
4038345   CHRMOSOM ANALYZE 20-25             127.3              40          LAB SERVICES-REFERENCE
4041521   CHRMOSOM CNT/KARY                 169.05              40          LAB SERVICES-REFERENCE
4038774   CHRMOSOM CNT/KARY                   96.9              40          LAB SERVICES-REFERENCE
4036570   CHRMOSOM CNT/KARY                 161.13              40          LAB SERVICES-REFERENCE
4036141   CHRMOSOM CNT/KARY                  207.9              40          LAB SERVICES-REFERENCE
4036133   CHRMOSOM CNT/KARY                 348.07              40          LAB SERVICES-REFERENCE
4036125   CHRMOSOM CNT/KARY                  150.6              40          LAB SERVICES-REFERENCE
4041539   CHRMOSOM HI RESD BND               72.45              40          LAB SERVICES-REFERENCE
4039772   CHROMOSOME AMNIOTIC FLUID          126.7              40          LAB SERVICES-REFERENCE
4033692   CITRATE UR 24HR                       12              40          LAB SERVICES-REFERENCE
4031910   CITRATE UR 24HR                     38.5              40          LAB SERVICES-REFERENCE
4033353   CLOZAPINE                             26              40          LAB SERVICES-REFERENCE
4037636   CMV AB IGG                          3.38              40          LAB SERVICES-REFERENCE
4037628   CMV AB IGG                          3.36              40          LAB SERVICES-REFERENCE
4035416   CMV AB IGG                            11              40          LAB SERVICES-REFERENCE
4035408   CMV AB IGG                            11              40          LAB SERVICES-REFERENCE
4037651   CMV AB IGM                          3.38              40          LAB SERVICES-REFERENCE
4037644   CMV AB IGM                          3.36              40          LAB SERVICES-REFERENCE
4039509   CMV AMP PRB                         87.5              40          LAB SERVICES-REFERENCE
4039517   CMV DNA QN                           109              40          LAB SERVICES-REFERENCE
4035994   CMV DNA QN                          29.4         109 40           LAB SERVICES-REFERENCE
4038030   COCAINE QN                         56.87              40          LAB SERVICES-REFERENCE
4038998   COCCI AB COMP FIX                     38              40          LAB SERVICES-REFERENCE
4038980   COCCI IMMUNO DIFFUSION                32              40          LAB SERVICES-REFERENCE
4043139   COENZYME Q10 SERUM (T34)                           90 40          LAB SERVICES-REFERENCE
4039988   COL CHROM/MASS SPEC QNT               35              40          LAB SERVICES-REFERENCE
4035077   COMPLEMENT C2                      25.02              40          LAB SERVICES-REFERENCE
4035069   COMPLEMENT C2                      20.77              40          LAB SERVICES-REFERENCE
4040770   COMPLEMENT C3                       7.36              40          LAB SERVICES-REFERENCE
4038485   COMPLEMENT C3                          8              40          LAB SERVICES-REFERENCE
4035085   COMPLEMENT C3                          8              40          LAB SERVICES-REFERENCE
4040788   COMPLEMENT C4                       7.38              40          LAB SERVICES-REFERENCE
4038493   COMPLEMENT C4                          8              40          LAB SERVICES-REFERENCE
4035093   COMPLEMENT C4                          8              40          LAB SERVICES-REFERENCE
4035101   COMPLEMENT C5                         17              40          LAB SERVICES-REFERENCE
4037180   COMPLEMENT C6                      33.25              40          LAB SERVICES-REFERENCE
4040796   COMPLEMENT TOT (CH50)                                 40          LAB SERVICES-REFERENCE
4035127   COMPLEMENT TOT (CH50)                 11              40          LAB SERVICES-REFERENCE
4033718   COPPER                              76.2              40          LAB SERVICES-REFERENCE
4033700   COPPER                                15              40          LAB SERVICES-REFERENCE
4037271   COPPER UR 24HR                        18              40          LAB SERVICES-REFERENCE
4033726   CORTISOL FREE SER                  11.14              40          LAB SERVICES-REFERENCE
4033734   CORTISOL FREE UR                   21.25              40          LAB SERVICES-REFERENCE
4030912   CORTISOL TOTAL                        10              40          LAB SERVICES-REFERENCE
4036729   COXSACKIE AB TYP A                  7.83              40          LAB SERVICES-REFERENCE
4037669   COXSACKIE AB TYP B                  7.56              40          LAB SERVICES-REFERENCE
4035424   COXSACKIE AB TYP B                  7.78              40          LAB SERVICES-REFERENCE
4032199   COXSACKIE AB TYP B                  7.78              40          LAB SERVICES-REFERENCE
4032181   COXSACKIE AB TYP B                  7.78              40          LAB SERVICES-REFERENCE
4032173   COXSACKIE AB TYP B                  7.78              40          LAB SERVICES-REFERENCE
4032165   COXSACKIE AB TYP B                  5.81              40          LAB SERVICES-REFERENCE
4036299   C-REACTIVE PROTEIN HS               22.5              40          LAB SERVICES-REFERENCE
4043279   CREATININE UR                        4.5          4.5 40          LAB SERVICES-REFERENCE
4041455   CREATININE UR                      14.16              40          LAB SERVICES-REFERENCE




                                                 Page 82
                                      c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                   SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                         AMOUNT AMOUNT CODE

4041422   CREATININE UR 24HR                       6.95           40             LAB SERVICES-REFERENCE
4038154   CREATININE UR 24HR                          6           40             LAB SERVICES-REFERENCE
4038113   CREATININE UR 24HR                          6           40             LAB SERVICES-REFERENCE
4038105   CREATININE UR 24HR                          6           40             LAB SERVICES-REFERENCE
4038097   CREATININE UR 24HR                          6           40             LAB SERVICES-REFERENCE
4031829   CREATININE UR 24HR                        7.7           40             LAB SERVICES-REFERENCE
4036406   CRYOGLOBULIN QN                         13.21           40             LAB SERVICES-REFERENCE
4036398   CRYOGLOBULIN QN                          7.67           40             LAB SERVICES-REFERENCE
4036356   CRYOGLOBULIN QN                            22           40             LAB SERVICES-REFERENCE
4036331   CRYOGLOBULIN QN                             6           40             LAB SERVICES-REFERENCE
4033858   CRYOGLOBULIN QN                            34           40             LAB SERVICES-REFERENCE
4033841   CRYOGLOBULIN QN                         13.21           40             LAB SERVICES-REFERENCE
4033833   CRYOGLOBULIN QN                          7.67           40             LAB SERVICES-REFERENCE
4037123   CRYPTO AG DFA                            22.2           40             LAB SERVICES-REFERENCE
4036992   CRYPTO NEOFORMANS EIA                   13.75           40             LAB SERVICES-REFERENCE
4036919   CRYPTOCOCCUS AB                            25           40             LAB SERVICES-REFERENCE
4035929   CRYPTOSPORIDIUM AG EIA                  20.75           40             LAB SERVICES-REFERENCE
4037529   CULT ADENOVIRUS                            30           40             LAB SERVICES-REFERENCE
4035820   CULT BLD FOR CMV                           34           40             LAB SERVICES-REFERENCE
4033098   CULT C DIFFICILE SCRN                      30           40             LAB SERVICES-REFERENCE
4036836   CULT CMV                                34.04           40             LAB SERVICES-REFERENCE
4032215   CULT CMV                                   15           40             LAB SERVICES-REFERENCE
4035838   CULT HERPES                                37           40             LAB SERVICES-REFERENCE
4030094   CULT HERPES                                21           40             LAB SERVICES-REFERENCE
4035770   CULT LEGIONELLA                          32.2           40             LAB SERVICES-REFERENCE
4035846   CULT RSV                                   65           40             LAB SERVICES-REFERENCE
4035762   CULT SCRN B PERTUSSUS                      30           40             LAB SERVICES-REFERENCE
4036968   CULT TYP FLUORESCENT                    15.37           40             LAB SERVICES-REFERENCE
4039442   CULT TYP GLC METHOD                        33           40             LAB SERVICES-REFERENCE
4035853   CULTVIRAL                                  30           40             LAB SERVICES-REFERENCE
4038063   CYCLIC CITRUNILATED PEPTI                  45           40             LAB SERVICES-REFERENCE
4033262   CYCLOSPORINE                             32.1     25.35 40             LAB SERVICES-REFERENCE
4043121   CYSTINE UR QN                                        49 40             LAB SERVICES-REFERENCE
4033510   CYSTINE UR QN                              49           40             LAB SERVICES-REFERENCE
4041547   CYTGNTC INTERP/RPRT                     72.45           40             LAB SERVICES-REFERENCE
4040887   CYTGNTC INTERP/RPRT                     72.45           40             LAB SERVICES-REFERENCE
4040762   CYTGNTC INTERP/RPRT                        15           40             LAB SERVICES-REFERENCE
4039806   CYTGNTC INTERP/RPRT                     74.25           40             LAB SERVICES-REFERENCE
4039780   CYTGNTC INTERP/RPRT                     61.54           40             LAB SERVICES-REFERENCE
4038782   CYTGNTC INTERP/RPRT                     33.91           40             LAB SERVICES-REFERENCE
4038360   CYTGNTC INTERP/RPRT                     31.82           40             LAB SERVICES-REFERENCE
4036687   CYTOPLASMIC AB PROTNASE                 30.59           40             LAB SERVICES-REFERENCE
4033528   DELTA ALA                                  28           40             LAB SERVICES-REFERENCE
4040739   DEOXYRIBNUCLEASE AB                        16           40             LAB SERVICES-REFERENCE
4033296   DESIPRAMINE                             18.25           40             LAB SERVICES-REFERENCE
4033759   DHEA                                       12           40             LAB SERVICES-REFERENCE
4037263   DIBUCAINE NUMBER                          9.3           40             LAB SERVICES-REFERENCE
4043071   DIHYDROTESTOSTERONE                                  30 40             LAB SERVICES-REFERENCE
4042065   DIPTHERIA AB                            30.25           40             LAB SERVICES-REFERENCE
4037420   DISOPYRAMIDE                               15           40             LAB SERVICES-REFERENCE
4040754   DNA PRB CYTGNTC 10 30                     153           40             LAB SERVICES-REFERENCE
4040747   DNA PRB CYTGNTC EA                       82.5           40             LAB SERVICES-REFERENCE
4033304   DOXEPIN                                    22           40             LAB SERVICES-REFERENCE
4036885   DRG SCRN BLD VOLATILES                  30.21           40             LAB SERVICES-REFERENCE
4038261   DRG SCRN QL CHROM EA                        5           40             LAB SERVICES-REFERENCE




                                                      Page 83
                                      c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                   SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                         AMOUNT AMOUNT CODE

4033171   DRG SCRN QL CHROM EA                    30.96           40             LAB SERVICES-REFERENCE
4033163   DRG SCRN QL CHROM EA                    30.96           40             LAB SERVICES-REFERENCE
4039848   E HISTOLYTICA GRP EIA                    44.5           40             LAB SERVICES-REFERENCE
4039814   EBV AB EBNA                              5.07           40             LAB SERVICES-REFERENCE
4035440   EBV VCA AB IGG                             12           40             LAB SERVICES-REFERENCE
4035432   EBV VCA AB IGG                             12           40             LAB SERVICES-REFERENCE
4036323   EBV VCA AB IGM                             25           40             LAB SERVICES-REFERENCE
4035473   EBV VCA AB IGM                             12           40             LAB SERVICES-REFERENCE
4035465   EBV VCA AB IGM                           7.22           40             LAB SERVICES-REFERENCE
4035457   EBV VCA AB IGM                             12           40             LAB SERVICES-REFERENCE
4037966   ECHO TYPE 4 AB                           8.64           40             LAB SERVICES-REFERENCE
4039913   EHRLICHIA AB IGG                        22.12           40             LAB SERVICES-REFERENCE
4039921   EHRLICHIA AB IGM                        22.12           40             LAB SERVICES-REFERENCE
4043188   ELISA IGA MOD ANTI-CCOMPC               110.7     110.7 40             LAB SERVICES-REFERENCE
4036547   ENA AB                                     18           40             LAB SERVICES-REFERENCE
4035143   ENA AB                                     18           40             LAB SERVICES-REFERENCE
4031308   ENA AB                                     33           40             LAB SERVICES-REFERENCE
4037859   ENCEPHALITIS CALIF                       5.07           40             LAB SERVICES-REFERENCE
4037842   ENCEPHALITIS CALIF                       5.04           40             LAB SERVICES-REFERENCE
4037834   ENCEPHALITIS EAST EQUINE                 5.07           40             LAB SERVICES-REFERENCE
4037826   ENCEPHALITIS EAST EQUINE                 5.04           40             LAB SERVICES-REFERENCE
4037818   ENCEPHALITIS ST LOUIS                    5.07           40             LAB SERVICES-REFERENCE
4037800   ENCEPHALITIS ST LOUIS                    5.04           40             LAB SERVICES-REFERENCE
4037792   ENCEPHALITIS WEST EQUINE                 5.07           40             LAB SERVICES-REFERENCE
4037784   ENCEPHALITIS WEST EQUINE                 5.04           40             LAB SERVICES-REFERENCE
4039269   ENDOMYSIAL AB SCRN                         43           40             LAB SERVICES-REFERENCE
4039277   ENDOMYSIAL AB TTR                         144           40             LAB SERVICES-REFERENCE
4037958   ENTEROVIRUS AB                           3.36           40             LAB SERVICES-REFERENCE
4037941   ENTEROVIRUS AB                           3.38           40             LAB SERVICES-REFERENCE
4041323   ENZYME CELL ACT NON-RAD                   235           40             LAB SERVICES-REFERENCE
4032975   ERYTHROPOIETIN                             22        22 40             LAB SERVICES-REFERENCE
4033775   ESTRADIOL (E2)                          19.55           40             LAB SERVICES-REFERENCE
4033791   ESTRIOL                                    17           40             LAB SERVICES-REFERENCE
4033783   ESTROGEN TOTAL                             26           40             LAB SERVICES-REFERENCE
4030920   ESTRONE                                  15.5           40             LAB SERVICES-REFERENCE
4036224   ETHCHLORVYNOL                           30.89           40             LAB SERVICES-REFERENCE
4036216   ETHCHLORVYNOL                              39           40             LAB SERVICES-REFERENCE
4038295   ETHCHLORVYNOL SCRN                          5           40             LAB SERVICES-REFERENCE
4037297   ETHOSUXIMIDE                             20.5           40             LAB SERVICES-REFERENCE
4039491   FAT STL QL                                 23           40             LAB SERVICES-REFERENCE
4039624   FAT STL QN                               44.8           40             LAB SERVICES-REFERENCE
4041505   FATTY ACIDS MULT ANALY                 169.76           40             LAB SERVICES-REFERENCE
4034781   FCTR IX                                  67.5           40             LAB SERVICES-REFERENCE
4039137   FCTR VII                                   59           40             LAB SERVICES-REFERENCE
4039723   FCTR VIII                                  45           40             LAB SERVICES-REFERENCE
4036851   FCTR VIII                                  45           40             LAB SERVICES-REFERENCE
4034757   FCTR VIII                               56.24           40             LAB SERVICES-REFERENCE
4034765   FCTR VIII VW                            56.24           40             LAB SERVICES-REFERENCE
4039731   FCTR VIII VW AG                            59           40             LAB SERVICES-REFERENCE
4034773   FCTR VIII VW AG                         56.24           40             LAB SERVICES-REFERENCE
4039764   FCTR VIII VW MULTIMER                      69           40             LAB SERVICES-REFERENCE
4037404   FCTR VIII VW MULTIMER                     103           40             LAB SERVICES-REFERENCE
4034799   FCTR X                                     59           40             LAB SERVICES-REFERENCE
4034880   FEBRILE AGGLUTINS                       36.35           40             LAB SERVICES-REFERENCE
4033809   FERRITIN                                 8.25      8.25 40             LAB SERVICES-REFERENCE




                                                      Page 84
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

4033817   FETAL FIBRONECTIN                     212           40             LAB SERVICES-REFERENCE
4033361   FLECAINIDE                           20.1      20.1 40             LAB SERVICES-REFERENCE
4036745   FLM FLUOR POLAR                    112.59           40             LAB SERVICES-REFERENCE
4030615   FLUPHENAZINE                        68.75           40             LAB SERVICES-REFERENCE
4036430   FOLATE                                  6      6.03 40             LAB SERVICES-REFERENCE
4033825   FOLATE RBC                           19.9           40             LAB SERVICES-REFERENCE
4040168   FRANCISELLA TULARENSIS AB              24           40             LAB SERVICES-REFERENCE
4034567   FREE T4                               8.3           40             LAB SERVICES-REFERENCE
4043253   FRUCTOSAMINE                        10.25     10.25 40             LAB SERVICES-REFERENCE
4041919   FRUCTOSAMINE                        10.25           40             LAB SERVICES-REFERENCE
4033932   FSH                                 10.87           40             LAB SERVICES-REFERENCE
4039392   FSH PEDI 3RD GENE                    28.5           40             LAB SERVICES-REFERENCE
4039699   FTA ABS (TPPA)                       8.85           40             LAB SERVICES-REFERENCE
4039319   FUNCTIONAL C1 INHIB EIA                17           40             LAB SERVICES-REFERENCE
4037495   FUNCTIONAL C1 INHIB EIA                17           40             LAB SERVICES-REFERENCE
4033924   G6PD QN                                14           40             LAB SERVICES-REFERENCE
4033379   GABAPENTIN                             25           40             LAB SERVICES-REFERENCE
4036703   GANGLIOSIDE GMI AUTO AB              28.8           40             LAB SERVICES-REFERENCE
4043204   GASTRIC PARIETAL CELL AB               26        26 40             LAB SERVICES-REFERENCE
4043410   GASTRIC PARIETAL CELL AB                         17 40             LAB SERVICES-REFERENCE
4033916   GASTRIN                                15           40             LAB SERVICES-REFERENCE
4034054   GBM AB                                 42           40             LAB SERVICES-REFERENCE
4036059   GC AMP PRB                             31           40             LAB SERVICES-REFERENCE
4036042   GC DIR PRB                             15           40             LAB SERVICES-REFERENCE
4037107   GIARDIA AG EIA                      21.25           40             LAB SERVICES-REFERENCE
4041877   GLIADIN AB IGA                      14.25           40             LAB SERVICES-REFERENCE
4038386   GLIADIN AB IGA                      14.25           40             LAB SERVICES-REFERENCE
4041869   GLIADIN AB IGG                      14.25           40             LAB SERVICES-REFERENCE
4038378   GLIADIN AB IGG                      14.25           40             LAB SERVICES-REFERENCE
4042016   GLUT ACID DECARB AUTO AB               69           40             LAB SERVICES-REFERENCE
4038444   GROWTH HORMONE                       12.5           40             LAB SERVICES-REFERENCE
4033957   GROWTH HORMONE                       12.5           40             LAB SERVICES-REFERENCE
4040978   H PYLORI AB IGA                     13.86           40             LAB SERVICES-REFERENCE
4040275   H PYLORI AB IGA                     13.86           40             LAB SERVICES-REFERENCE
4040960   H PYLORI AB IGG                     17.07           40             LAB SERVICES-REFERENCE
4040267   H PYLORI AB IGG                     17.07           40             LAB SERVICES-REFERENCE
4033056   H PYLORI AB IGG                        10           40             LAB SERVICES-REFERENCE
4040986   H PYLORI AB IGM                     17.07           40             LAB SERVICES-REFERENCE
4040283   H PYLORI AB IGM                     17.07           40             LAB SERVICES-REFERENCE
4039426   H PYLORI STL EIA                       53           40             LAB SERVICES-REFERENCE
4033312   HALOPERIDOL                         35.87        22 40             LAB SERVICES-REFERENCE
4033965   HAPTOGLOBIN QN                         10           40             LAB SERVICES-REFERENCE
4041372   HAV AB IGM                           8.48           40             LAB SERVICES-REFERENCE
4035598   HAV AB IGM                             10           40             LAB SERVICES-REFERENCE
4041364   HB CORE AB IGM                       9.54           40             LAB SERVICES-REFERENCE
4035564   HB CORE AB IGM                      11.25           40             LAB SERVICES-REFERENCE
4035556   HB CORE AB TOTAL                       10           40             LAB SERVICES-REFERENCE
4035580   HBE AB                                 10           40             LAB SERVICES-REFERENCE
4035945   HBE AG                                 10           40             LAB SERVICES-REFERENCE
4035572   HBS AB                                8.3           40             LAB SERVICES-REFERENCE
4041356   HBS AG                                6.1           40             LAB SERVICES-REFERENCE
4035937   HBS AG                               7.49           40             LAB SERVICES-REFERENCE
4041380   HCV AB                              13.52           40             LAB SERVICES-REFERENCE
4035739   HCV AB                               9.74           40             LAB SERVICES-REFERENCE
4035747   HCV AB CONF                            66           40             LAB SERVICES-REFERENCE




                                                  Page 85
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

4035507   HDV (DELTA) AB                        25        25 40             LAB SERVICES-REFERENCE
4041638   HEAVY METAL SCRN BLD                  39           40             LAB SERVICES-REFERENCE
4033973   HEAVY METAL SCRN BLD               31.27           40             LAB SERVICES-REFERENCE
4041489   HEAVY METALS BLD QN EA                19           40             LAB SERVICES-REFERENCE
4041463   HEAVY METALS BLD QN EA                81           40             LAB SERVICES-REFERENCE
4043048   HEAVY METALS UR QN EA                 81           40             LAB SERVICES-REFERENCE
4033981   HEAVY METALS UR QN EA              27.83           40             LAB SERVICES-REFERENCE
4030573   HEAVY METALS UR QN EA              27.83           40             LAB SERVICES-REFERENCE
4037081   HEMATOCRIT                             4      4.56 40             LAB SERVICES-REFERENCE
4037073   HEMOGLOBIN                             4      1.82 40             LAB SERVICES-REFERENCE
4043212   HEMOGLOBIN FRACTION QN                30        30 40             LAB SERVICES-REFERENCE
4037065   HEMOGLOBIN FRACTION QN                13           40             LAB SERVICES-REFERENCE
4034831   HEMOLYSIN ACID (HAM'S)              26.9      42.5 40             LAB SERVICES-REFERENCE
4036000   HEP B PCR QN                      104.98    104.98 40             LAB SERVICES-REFERENCE
4043063   HEP C VIRAL RNA GENOTYPE          145.35           40             LAB SERVICES-REFERENCE
4041034   HEP C VIRUS AMP PRB                  200           40             LAB SERVICES-REFERENCE
4032892   HEP C VIRUS AMP PRB               145.35           40             LAB SERVICES-REFERENCE
4036018   HEP C VIRUS BDNA QN                  112      112 40              LAB SERVICES-REFERENCE
4043378   HEP C VIRUS BDNA QN                           168 40              LAB SERVICES-REFERENCE
4040077   HEP C VIRUS PCR QN                 92.86           40             LAB SERVICES-REFERENCE
4040069   HEPARIN ASSAY                       76.5           40             LAB SERVICES-REFERENCE
4042081   HERPES VIRUS 6 AB                   17.5           40             LAB SERVICES-REFERENCE
4042073   HERPES VIRUS 6 AB                   17.5           40             LAB SERVICES-REFERENCE
4037925   HEXAGONAL PHASE NEUTRALIZ           49.5           40             LAB SERVICES-REFERENCE
4036448   HGB ELECTRO                        28.17           40             LAB SERVICES-REFERENCE
4033999   HGB ELECTRO                        28.16           40             LAB SERVICES-REFERENCE
4039897   HGE AB IGG                         16.25           40             LAB SERVICES-REFERENCE
4039905   HGE AB IGM                         16.25           40             LAB SERVICES-REFERENCE
4039707   HISTAMINE                           17.9           40             LAB SERVICES-REFERENCE
4034005   HISTAMINE                           66.5           40             LAB SERVICES-REFERENCE
4038469   HISTO CAPSULATUM AG EIA               72           40             LAB SERVICES-REFERENCE
4036778   HISTONE AB                            20           40             LAB SERVICES-REFERENCE
4036646   HISTOPLAS AB                           9           40             LAB SERVICES-REFERENCE
4035549   HISTOPLAS AB                        22.5           40             LAB SERVICES-REFERENCE
4037412   HIV 1 AMP PRB                        125           40             LAB SERVICES-REFERENCE
4039863   HIV 1 GENOTYPE                       385           40             LAB SERVICES-REFERENCE
4032884   HIV 1 GENOTYPE                       396           40             LAB SERVICES-REFERENCE
4039871   HIV 1 PHENO 1ST 10 DRGS              400           40             LAB SERVICES-REFERENCE
4039889   HIV 1 PHENO EA ADDL DRG               50           40             LAB SERVICES-REFERENCE
4037453   HIV 1 QN BDNA                     136.94           40             LAB SERVICES-REFERENCE
4036034   HIV 1 QN PCR                      113.05           40             LAB SERVICES-REFERENCE
4032413   HIV 1 QN PCR ULTRA                 84.15           40             LAB SERVICES-REFERENCE
4040184   HIV 1 RNA VIRAL LOAD PCR           79.24           40             LAB SERVICES-REFERENCE
4035499   HIV AB CONF WESTERN BLOT              23           40             LAB SERVICES-REFERENCE
4035952   HIV P24 AG                          23.5           40             LAB SERVICES-REFERENCE
4035754   HLA B27                             25.8        25 40             LAB SERVICES-REFERENCE
4037917   HSV 1 AB                            5.07           40             LAB SERVICES-REFERENCE
4037909   HSV 1 AB                            5.04           40             LAB SERVICES-REFERENCE
4043352   HSV 1 AB IGG                                 14.25 40             LAB SERVICES-REFERENCE
4037693   HSV 2 AB IGG                        5.07           40             LAB SERVICES-REFERENCE
4037685   HSV 2 AB IGG                        5.04           40             LAB SERVICES-REFERENCE
4035523   HSV 2 AB IGG                       10.74           40             LAB SERVICES-REFERENCE
4035531   HSV 2 AB IGM                       14.25           40             LAB SERVICES-REFERENCE
4035515   HSV AB                              24.1           40             LAB SERVICES-REFERENCE
4037875   HSV AB IGM                          5.07           40             LAB SERVICES-REFERENCE




                                                 Page 86
                                c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION             SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                   AMOUNT AMOUNT CODE

4037867   HSV AB IGM                         17.1            40            LAB SERVICES-REFERENCE
4036877   HSV AB IGM                           14            40            LAB SERVICES-REFERENCE
4036026   HSV AMP PRB                      109.25            40            LAB SERVICES-REFERENCE
4035887   HSV TYP 1 DFA                     15.46            40            LAB SERVICES-REFERENCE
4038642   HSV TYPE 1 REFLEX ADDL               36            40            LAB SERVICES-REFERENCE
4038659   HSV TYPE 2 REFLEX ADDL               36            40            LAB SERVICES-REFERENCE
4035481   HTLV 1 AB                            25            40            LAB SERVICES-REFERENCE
4030656   HYDROXYPROLINE TOTAL              50.98         54 40            LAB SERVICES-REFERENCE
4040366   IGA                                7.92            40            LAB SERVICES-REFERENCE
4036786   IGA                                   8            40            LAB SERVICES-REFERENCE
4033866   IGA                               10.58            40            LAB SERVICES-REFERENCE
4040226   IGA CSF                           10.89            40            LAB SERVICES-REFERENCE
4036802   IGD                                  21            40            LAB SERVICES-REFERENCE
4038683   IGE                                6.25            40            LAB SERVICES-REFERENCE
4033890   IGE                                6.25            40            LAB SERVICES-REFERENCE
4038451   IGFBP 2                            54.4            40            LAB SERVICES-REFERENCE
4038675   IGFBP 3                              29            40            LAB SERVICES-REFERENCE
4040192   IGG                                8.74            40            LAB SERVICES-REFERENCE
4040051   IGG                                7.07            40            LAB SERVICES-REFERENCE
4040010   IGG                                6.94            40            LAB SERVICES-REFERENCE
4036596   IGG                                8.16            40            LAB SERVICES-REFERENCE
4036554   IGG                                6.75            40            LAB SERVICES-REFERENCE
4036505   IGG                                   8            40            LAB SERVICES-REFERENCE
4036315   IGG                                6.75            40            LAB SERVICES-REFERENCE
4033874   IGG                                10.9            40            LAB SERVICES-REFERENCE
4040218   IGG CSF                           11.22            40            LAB SERVICES-REFERENCE
4040036   IGG CSF                            7.09            40            LAB SERVICES-REFERENCE
4040028   IGG CSF                            6.92            40            LAB SERVICES-REFERENCE
4033908   IGG SUBCLASSES                     8.74            40            LAB SERVICES-REFERENCE
4037461   IGM                                5.68            40            LAB SERVICES-REFERENCE
4036794   IGM                                   8            40            LAB SERVICES-REFERENCE
4036349   IGM                                7.92            40            LAB SERVICES-REFERENCE
4033882   IGM                               10.58            40            LAB SERVICES-REFERENCE
4040234   IGM CSF                           10.89            40            LAB SERVICES-REFERENCE
4033320   IMIPRAMINE                           22            40            LAB SERVICES-REFERENCE
4038501   IMMUNE COMPLEX CD3 CIRC           48.75            40            LAB SERVICES-REFERENCE
4039327   IMMUNE COMPLEX DETECTION          16.25            40            LAB SERVICES-REFERENCE
4038519   IMMUNE COMPLEX RAJII CL           16.25            40            LAB SERVICES-REFERENCE
4038717   IMMUNOAS SCRN HOUSE DUST          11.87            40            LAB SERVICES-REFERENCE
4039681   IMMUNOASSAY NONINFECT                13            40            LAB SERVICES-REFERENCE
4036810   IMMUNOASSAY NONINFECT             14.25            40            LAB SERVICES-REFERENCE
4035051   IMMUNOASSAY NONINFECT             26.13            40            LAB SERVICES-REFERENCE
4038691   IMMUNOASSAY SCRN ANIMALS          11.87            40            LAB SERVICES-REFERENCE
4038709   IMMUNOASSAY SCRN GRASSES1         11.87            40            LAB SERVICES-REFERENCE
4038725   IMMUNOASSAY SCRN MOLDS            11.87            40            LAB SERVICES-REFERENCE
4038733   IMMUNOASSAY SCRN TREES 2          11.87            40            LAB SERVICES-REFERENCE
4038741   IMMUNOASSAY SCRN WEEDS 1          11.87            40            LAB SERVICES-REFERENCE
4043170   IMMUNOASSAY TUM AG EA                29         29 40            LAB SERVICES-REFERENCE
4041885   IMMUNOASSAY TUM AG EA             93.75            40            LAB SERVICES-REFERENCE
4040325   IMMUNOASSAY TUM AG EA                31            40            LAB SERVICES-REFERENCE
4035234   IMMUNOELCTRO IEP SER               7.67            40            LAB SERVICES-REFERENCE
4032421   IMMUNOELCTRO IEP UR                23.6            40            LAB SERVICES-REFERENCE
4041406   IMMUNOFIX UR                       34.5            40            LAB SERVICES-REFERENCE
4036414   IMMUNOFIX UR                      36.98            40            LAB SERVICES-REFERENCE
4030136   IMMUNOFIX UR                      30.25            40            LAB SERVICES-REFERENCE




                                                Page 87
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

4037719   INFLUENZA A AB                      5.07              40          LAB SERVICES-REFERENCE
4037701   INFLUENZA A AB                      5.04              40          LAB SERVICES-REFERENCE
4034070   INSULIN                             10.5              40          LAB SERVICES-REFERENCE
4037313   INSULIN FREE                          29              40          LAB SERVICES-REFERENCE
4039418   INTRINSIC FCTR AB                     23              40          LAB SERVICES-REFERENCE
4033585   IRON LIVER TISS (AT ABS)           82.55              40          LAB SERVICES-REFERENCE
4040374   IRON TISSUE                        67.55              40          LAB SERVICES-REFERENCE
4038535   JO 1 AB                               31              40          LAB SERVICES-REFERENCE
4040929   KAPPA CHAIN                           60              40          LAB SERVICES-REFERENCE
4040242   KAPPA CHAIN                         8.95              40          LAB SERVICES-REFERENCE
4033395   KETONES QN                         13.67              40          LAB SERVICES-REFERENCE
4036182   KETOSTEROIDS 17 TOTAL                 19              40          LAB SERVICES-REFERENCE
4034120   L/S RATIO                             97              40          LAB SERVICES-REFERENCE
4034112   L/S RATIO                            100              40          LAB SERVICES-REFERENCE
4034088   LACTIC ACID                           15              40          LAB SERVICES-REFERENCE
4040937   LAMBDA CHAIN                          60              40          LAB SERVICES-REFERENCE
4040259   LAMBDA CHAIN                        8.96              40          LAB SERVICES-REFERENCE
4041893   LAMOTRIGINE                           25              40          LAB SERVICES-REFERENCE
4040390   LDH                                  5.9              40          LAB SERVICES-REFERENCE
4036455   LDH ISOENZYMES                      8.95              40          LAB SERVICES-REFERENCE
4034096   LDH ISOENZYMES                         5      8.85    40          LAB SERVICES-REFERENCE
4039954   LDL SUBPARTICLES                    61.2              40          LAB SERVICES-REFERENCE
4040424   LEAD BLD                            8.08              40          LAB SERVICES-REFERENCE
4040085   LEAD BLD                            8.08              40          LAB SERVICES-REFERENCE
4034104   LEAD BLD                           10.43              40          LAB SERVICES-REFERENCE
4040119   LEAD UR                                6              40          LAB SERVICES-REFERENCE
4036463   LEAD UR                               10              40          LAB SERVICES-REFERENCE
4037156   LEGIONELLA AB IGM                     35              40          LAB SERVICES-REFERENCE
4035895   LEGIONELLA PNEUMO DFA                 35              40          LAB SERVICES-REFERENCE
4039285   LEPTIN                             63.75              40          LAB SERVICES-REFERENCE
4035606   LEPTOSPIRA AN                         32              40          LAB SERVICES-REFERENCE
4034849   LEUK ALK PHOS                         15              40          LAB SERVICES-REFERENCE
4042099   LEVETIRACETAM                      32.62              40          LAB SERVICES-REFERENCE
4033940   LH                                    15              40          LAB SERVICES-REFERENCE
4039400   LH PEDI 3RD GENE                    16.5              40          LAB SERVICES-REFERENCE
4030607   LIDOCAINE                          19.25              40          LAB SERVICES-REFERENCE
4034138   LIPASE                               6.5              40          LAB SERVICES-REFERENCE
4032926   LIPOPROTEIN (A)                    14.25              40          LAB SERVICES-REFERENCE
4040408   LIPOPROTEIN (A) AB                 14.25              40          LAB SERVICES-REFERENCE
4037131   LIPOPROTEIN BLD                      100     14.52    40          LAB SERVICES-REFERENCE
4038972   LIPOPROTEIN ELECTROPHORES             34              40          LAB SERVICES-REFERENCE
4039244   LIPROPROT BLD HI FRAC/QNT          33.25              40          LAB SERVICES-REFERENCE
4032868   LIPROPROT BLD HI FRAC/QNT             32              40          LAB SERVICES-REFERENCE
4033387   LORAZEPAM                          42.65              40          LAB SERVICES-REFERENCE
4043162   LP-PLA2 (PLAC[TM])                          151.75    40          LAB SERVICES-REFERENCE
4032447   LSD LEVEL URINE SCRN                  19              40          LAB SERVICES-REFERENCE
4036661   LYME DISEASE AB                    11.63              40          LAB SERVICES-REFERENCE
4036612   LYME DISEASE AB                    18.18              40          LAB SERVICES-REFERENCE
4035283   LYME DISEASE AB IGG                18.18              40          LAB SERVICES-REFERENCE
4039079   LYME DISEASE AB IGG WB             22.73              40          LAB SERVICES-REFERENCE
4043360   LYME DISEASE AB IGG WB                           25   40          LAB SERVICES-REFERENCE
4039087   LYME DISEASE AB IGM WB             22.72              40          LAB SERVICES-REFERENCE
4037891   LYMPH CHORIOMENINGITIS AB           5.07              40          LAB SERVICES-REFERENCE
4037883   LYMPH CHORIOMENINGITIS AB           5.04              40          LAB SERVICES-REFERENCE
4035812   MACRO EXAM ARTHROPOD                  34              40          LAB SERVICES-REFERENCE




                                                 Page 88
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

4041620   MAG AB                                 49           40             LAB SERVICES-REFERENCE
4039210   MAGNESIUM RBC                       29.75           40             LAB SERVICES-REFERENCE
4034146   MAGNESIUM UR                         6.72           40             LAB SERVICES-REFERENCE
4031852   MAGNESIUM UR 24HR                    9.24           40             LAB SERVICES-REFERENCE
4041653   MANGANESE SERUM                        45           40             LAB SERVICES-REFERENCE
4041497   MASS SPECT/TANDEM QN NES            59.51           40             LAB SERVICES-REFERENCE
4040127   MERCURY                                12           40             LAB SERVICES-REFERENCE
4040093   MERCURY                                18           40             LAB SERVICES-REFERENCE
4038121   MERCURY                                10           40             LAB SERVICES-REFERENCE
4031001   MERCURY                             16.67           40             LAB SERVICES-REFERENCE
4043220   METANEPHRINES BLOOD                 118.4     118.4 40             LAB SERVICES-REFERENCE
4034153   METANEPHRINES UR                       28     26.25 40             LAB SERVICES-REFERENCE
4034690   METHANOL BLD                           10           40             LAB SERVICES-REFERENCE
4037321   METHOTREXATE                           25           40             LAB SERVICES-REFERENCE
4034377   METHYLMALONIC ACID QN               63.75           40             LAB SERVICES-REFERENCE
4041448   METHYLMALONIC ACID UR               44.84           40             LAB SERVICES-REFERENCE
4037339   MEXILETINE                           48.5           40             LAB SERVICES-REFERENCE
4030904   MICROALBUMIN UR 24HR                   10           40             LAB SERVICES-REFERENCE
4040994   MICROSOMAL AB                          15           40             LAB SERVICES-REFERENCE
4039061   MICROSOMAL AB                        9.11           40             LAB SERVICES-REFERENCE
4036422   MICROSOMAL AB                        8.88           40             LAB SERVICES-REFERENCE
4030805   MISC CHEM TEST                                      40             LAB SERVICES-REFERENCE
4030714   MISC CHEM TEST                                      40             LAB SERVICES-REFERENCE
4039038   MISC CHEM TEST AMYLASE IS              20           40             LAB SERVICES-REFERENCE
4038410   MITOCHONDRIAL AB SCRN                  11           40             LAB SERVICES-REFERENCE
4035192   MITOCHONDRIAL AB TTR                 11.5           40             LAB SERVICES-REFERENCE
4041307   MOL DX AMP NA MLTIP EA SQ           17.81           40             LAB SERVICES-REFERENCE
4041208   MOL DX AMP NA MLTIP EA SQ            67.5           40             LAB SERVICES-REFERENCE
4039533   MOL DX AMP NA MLTIP EA SQ           42.39           40             LAB SERVICES-REFERENCE
4039475   MOL DX AMP NA MLTIP EA SQ           26.85           40             LAB SERVICES-REFERENCE
4039343   MOL DX AMP NA MLTIP EA SQ            38.5           40             LAB SERVICES-REFERENCE
4038881   MOL DX AMP NA MLTIP EA SQ            32.4           40             LAB SERVICES-REFERENCE
4038840   MOL DX AMP NA MLTIP EA SQ            19.2           40             LAB SERVICES-REFERENCE
4038220   MOL DX AMP NA MLTIP EA SQ           35.63           40             LAB SERVICES-REFERENCE
4038196   MOL DX AMP NA MLTIP EA SQ              99           40             LAB SERVICES-REFERENCE
4037776   MOL DX AMP NA MLTIP EA SQ            15.5           40             LAB SERVICES-REFERENCE
4041596   MOL DX AMP PT N ACD EA SQ           76.95           40             LAB SERVICES-REFERENCE
4041588   MOL DX AMP PT N ACD EA SQ           76.95           40             LAB SERVICES-REFERENCE
4041570   MOL DX AMP PT N ACD EA SQ           76.95           40             LAB SERVICES-REFERENCE
4038931   MOL DX AMP PT N ACD EA SQ               8           40             LAB SERVICES-REFERENCE
4038873   MOL DX AMP PT N ACD EA SQ            32.4           40             LAB SERVICES-REFERENCE
4038089   MOL DX AMP PT N ACD EA SQ           49.88           40             LAB SERVICES-REFERENCE
4037032   MOL DX AMP PT N ACD EA SQ              39           40             LAB SERVICES-REFERENCE
4034294   MOL DX AMP PT N ACD EA SQ           18.49           40             LAB SERVICES-REFERENCE
4030557   MOL DX AMP PT N ACD EA SQ           22.11           40             LAB SERVICES-REFERENCE
4030540   MOL DX AMP PT N ACD EA SQ           22.11           40             LAB SERVICES-REFERENCE
4030565   MOL DX AMP PT N ACD EA SQ           22.11           40             LAB SERVICES-REFERENCE
4037024   MOL DX DOT/SLOT BLOT                   10           40             LAB SERVICES-REFERENCE
4041240   MOL DX ENZ DIGESTION                                40             LAB SERVICES-REFERENCE
4041232   MOL DX ENZ DIGESTION                  9.5           40             LAB SERVICES-REFERENCE
4041083   MOL DX ENZ DIGESTION                 13.5           40             LAB SERVICES-REFERENCE
4041075   MOL DX ENZ DIGESTION                 13.5           40             LAB SERVICES-REFERENCE
4040440   MOL DX ENZ DIGESTION                  9.5           40             LAB SERVICES-REFERENCE
4039541   MOL DX ENZ DIGESTION                 21.2           40             LAB SERVICES-REFERENCE
4039350   MOL DX ENZ DIGESTION                   11           40             LAB SERVICES-REFERENCE




                                                  Page 89
                                     c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                  SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                        AMOUNT AMOUNT CODE

4038808   MOL DX ENZ DIGESTION                      16           40             LAB SERVICES-REFERENCE
4038238   MOL DX ENZ DIGESTION                   21.38           40             LAB SERVICES-REFERENCE
4034229   MOL DX ENZ DIGESTION                   18.49           40             LAB SERVICES-REFERENCE
4034211   MOL DX ENZ DIGESTION                   22.11           40             LAB SERVICES-REFERENCE
4036679   MOL DX EXTRACTION                      22.15           40             LAB SERVICES-REFERENCE
4036497   MOL DX EXTRACTION                      76.71           40             LAB SERVICES-REFERENCE
4034203   MOL DX EXTRACTION                      25.64           40             LAB SERVICES-REFERENCE
4041554   MOL DX EXTRACTION HI PUR                               40             LAB SERVICES-REFERENCE
4041224   MOL DX EXTRACTION HI PUR                7.13           40             LAB SERVICES-REFERENCE
4041067   MOL DX EXTRACTION HI PUR                13.5           40             LAB SERVICES-REFERENCE
4040432   MOL DX EXTRACTION HI PUR                7.13           40             LAB SERVICES-REFERENCE
4039525   MOL DX EXTRACTION HI PUR                21.2           40             LAB SERVICES-REFERENCE
4039459   MOL DX EXTRACTION HI PUR               11.51           40             LAB SERVICES-REFERENCE
4039335   MOL DX EXTRACTION HI PUR                16.5           40             LAB SERVICES-REFERENCE
4038923   MOL DX EXTRACTION HI PUR                   2           40             LAB SERVICES-REFERENCE
4038865   MOL DX EXTRACTION HI PUR                6.48           40             LAB SERVICES-REFERENCE
4038790   MOL DX EXTRACTION HI PUR                12.8           40             LAB SERVICES-REFERENCE
4038212   MOL DX EXTRACTION HI PUR               21.38           40             LAB SERVICES-REFERENCE
4038170   MOL DX EXTRACTION HI PUR                29.7           40             LAB SERVICES-REFERENCE
4037768   MOL DX EXTRACTION HI PUR                7.75           40             LAB SERVICES-REFERENCE
4037057   MOL DX EXTRACTION HI PUR                   9           40             LAB SERVICES-REFERENCE
4032942   MOL DX EXTRACTION HI PUR               11.97           40             LAB SERVICES-REFERENCE
4041257   MOL DX GEL ELECTRO SEP                 17.81           40             LAB SERVICES-REFERENCE
4041091   MOL DX GEL ELECTRO SEP                  13.5           40             LAB SERVICES-REFERENCE
4040457   MOL DX GEL ELECTRO SEP                 17.81           40             LAB SERVICES-REFERENCE
4039558   MOL DX GEL ELECTRO SEP                 35.33           40             LAB SERVICES-REFERENCE
4039368   MOL DX GEL ELECTRO SEP                    22           40             LAB SERVICES-REFERENCE
4038816   MOL DX GEL ELECTRO SEP                    16           40             LAB SERVICES-REFERENCE
4038246   MOL DX GEL ELECTRO SEP                  28.5           40             LAB SERVICES-REFERENCE
4037560   MOL DX GEL ELECTRO SEP                 14.54           40             LAB SERVICES-REFERENCE
4037040   MOL DX GEL ELECTRO SEP                     9           40             LAB SERVICES-REFERENCE
4034252   MOL DX GEL ELECTRO SEP                 18.49           40             LAB SERVICES-REFERENCE
4034245   MOL DX GEL ELECTRO SEP                 22.11           40             LAB SERVICES-REFERENCE
4034237   MOL DX GEL ELECTRO SEP                 25.64           40             LAB SERVICES-REFERENCE
4041612   MOL DX INTERP & RPT                     16.2           40             LAB SERVICES-REFERENCE
4041315   MOL DX INTERP & RPT                    14.24           40             LAB SERVICES-REFERENCE
4041216   MOL DX INTERP & RPT                     13.5           40             LAB SERVICES-REFERENCE
4039566   MOL DX INTERP & RPT                    21.19           40             LAB SERVICES-REFERENCE
4039483   MOL DX INTERP & RPT                    23.01           40             LAB SERVICES-REFERENCE
4039376   MOL DX INTERP & RPT                       22           40             LAB SERVICES-REFERENCE
4038956   MOL DX INTERP & RPT                        2           40             LAB SERVICES-REFERENCE
4038915   MOL DX INTERP & RPT                     8.64           40             LAB SERVICES-REFERENCE
4038857   MOL DX INTERP & RPT                       32           40             LAB SERVICES-REFERENCE
4038253   MOL DX INTERP & RPT                    14.23           40             LAB SERVICES-REFERENCE
4038204   MOL DX INTERP & RPT                     29.7           40             LAB SERVICES-REFERENCE
4038071   MOL DX INTERP & RPT                    13.96           40             LAB SERVICES-REFERENCE
4037586   MOL DX INTERP & RPT                    10.61           40             LAB SERVICES-REFERENCE
4037008   MOL DX INTERP & RPT                        9           40             LAB SERVICES-REFERENCE
4034310   MOL DX INTERP & RPT                    18.49           40             LAB SERVICES-REFERENCE
4041299   MOL DX NUC ACID PRB                    10.69           40             LAB SERVICES-REFERENCE
4041281   MOL DX NUC ACID PRB                    10.69           40             LAB SERVICES-REFERENCE
4041273   MOL DX NUC ACID PRB                    10.69           40             LAB SERVICES-REFERENCE
4041265   MOL DX NUC ACID PRB                    10.69           40             LAB SERVICES-REFERENCE
4041190   MOL DX NUC ACID PRB                     13.5           40             LAB SERVICES-REFERENCE
4041182   MOL DX NUC ACID PRB                     13.5           40             LAB SERVICES-REFERENCE




                                                     Page 90
                                      c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                   SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                         AMOUNT AMOUNT CODE

4041174   MOL DX NUC ACID PRB                      13.5              40          LAB SERVICES-REFERENCE
4041166   MOL DX NUC ACID PRB                      13.5              40          LAB SERVICES-REFERENCE
4041158   MOL DX NUC ACID PRB                      13.5              40          LAB SERVICES-REFERENCE
4041141   MOL DX NUC ACID PRB                      13.5              40          LAB SERVICES-REFERENCE
4041133   MOL DX NUC ACID PRB                      13.5              40          LAB SERVICES-REFERENCE
4041125   MOL DX NUC ACID PRB                      13.5              40          LAB SERVICES-REFERENCE
4041117   MOL DX NUC ACID PRB                      13.5              40          LAB SERVICES-REFERENCE
4041109   MOL DX NUC ACID PRB                      13.5              40          LAB SERVICES-REFERENCE
4040465   MOL DX NUC ACID PRB                     10.69              40          LAB SERVICES-REFERENCE
4039467   MOL DX NUC ACID PRB                      7.67              40          LAB SERVICES-REFERENCE
4038949   MOL DX NUC ACID PRB                         2              40          LAB SERVICES-REFERENCE
4038907   MOL DX NUC ACID PRB                      6.48              40          LAB SERVICES-REFERENCE
4038832   MOL DX NUC ACID PRB                        16              40          LAB SERVICES-REFERENCE
4038188   MOL DX NUC ACID PRB                      19.8              40          LAB SERVICES-REFERENCE
4037578   MOL DX NUC ACID PRB                      1.94              40          LAB SERVICES-REFERENCE
4037016   MOL DX NUC ACID PRB                         9              40          LAB SERVICES-REFERENCE
4034278   MOL DX NUC ACID PRB                      6.48              40          LAB SERVICES-REFERENCE
4034260   MOL DX NUC ACID PRB                      6.48              40          LAB SERVICES-REFERENCE
4030813   MOL DX NUC ACID PRB                     11.97              40          LAB SERVICES-REFERENCE
4038824   MOL DX NUC ACID TRANSFER                   16              40          LAB SERVICES-REFERENCE
4041562   MOL DX REV TRANSCRIPT                    64.8              40          LAB SERVICES-REFERENCE
4038899   MOL DX REV TRANSCRIPT                   25.92              40          LAB SERVICES-REFERENCE
4034302   MOL DX REV TRANSCRIPT                   25.92              40          LAB SERVICES-REFERENCE
4037735   MUMPS AB                                 5.07              40          LAB SERVICES-REFERENCE
4037727   MUMPS AB                                 5.04              40          LAB SERVICES-REFERENCE
4035622   MUMPS AB                                   12              40          LAB SERVICES-REFERENCE
4035614   MUMPS AB                                17.25              40          LAB SERVICES-REFERENCE
4034856   MURAMIDASE                                 18              40          LAB SERVICES-REFERENCE
4041604   MUTATION ID BY SEQ EA SEG               76.95              40          LAB SERVICES-REFERENCE
4036711   MYCOPLAS AB                                15              40          LAB SERVICES-REFERENCE
4035630   MYCOPLAS AB IGG                            15              40          LAB SERVICES-REFERENCE
4035796   MYCOPLAS CULT                              28         30   40          LAB SERVICES-REFERENCE
4035788   MYCOPLAS CULT                              30              40          LAB SERVICES-REFERENCE
4036372   MYELIN BASIC PROTEIN CSF                18.04              40          LAB SERVICES-REFERENCE
4034161   MYELIN BASIC PROTEIN CSF                   19              40          LAB SERVICES-REFERENCE
4043113   MYELOPEROXIDASE AB                                16.62    40          LAB SERVICES-REFERENCE
4039053   MYELOPEROXIDASE AB                      16.62              40          LAB SERVICES-REFERENCE
4033130   MYOGLOBIN SCRN BLD                         75      26.5    40          LAB SERVICES-REFERENCE
4032991   MYOGLOBIN SCRN UR                          15              40          LAB SERVICES-REFERENCE
4039657   NATURAL KILLER CELLS                     37.4              40          LAB SERVICES-REFERENCE
4037438   NATURAL KILLER CELLS                       20              40          LAB SERVICES-REFERENCE
4043147   NEOPTERIN RIA TECHNIQ                             60.65    40          LAB SERVICES-REFERENCE
4043097   NEUTRALIZATION TEST                              694.25    40          LAB SERVICES-REFERENCE
4043055   NORTRIPTYLINE                            16.4              40          LAB SERVICES-REFERENCE
4043154   NOVOVIRUS RNA PCR                                 193.8    40          LAB SERVICES-REFERENCE
4032850   NTELOPEPTIDE UR                         25.45              40          LAB SERVICES-REFERENCE
4034351   OLIGOCLONAL BANDS CSF                    17.5              40          LAB SERVICES-REFERENCE
4034344   OLIGOCLONAL BANDS CSF                   17.12              40          LAB SERVICES-REFERENCE
4034336   OLIGOCLONAL BANDS CSF                   16.76              40          LAB SERVICES-REFERENCE
4033221   OPIATES CONF                               25              40          LAB SERVICES-REFERENCE
4034369   ORGANIC ACIDS QN TOTAL                    125              40          LAB SERVICES-REFERENCE
4031944   OSMOLALITY UR                             7.7              40          LAB SERVICES-REFERENCE
4032496   OSTEOCALCIN                                30              40          LAB SERVICES-REFERENCE
4043287   OXALATE UR                                5.5       5.5    40          LAB SERVICES-REFERENCE
4043261   OXALATE UR                               10.5      10.5    40          LAB SERVICES-REFERENCE




                                                      Page 91
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

4030888   OXALATE UR                              6               40         LAB SERVICES-REFERENCE
4031928   OXALATE UR 24HR                     18.48               40         LAB SERVICES-REFERENCE
4039012   OXYCARBAZEPINE                         12               40         LAB SERVICES-REFERENCE
4043105   PANCREATIC ELASTASE                               168   40         LAB SERVICES-REFERENCE
4036380   PARVOVIRUS B19 AB                      15               40         LAB SERVICES-REFERENCE
4035648   PARVOVIRUS B19 AB IGM                  15               40         LAB SERVICES-REFERENCE
4037347   PCP SCRN                            39.49               40         LAB SERVICES-REFERENCE
4038048   PHENCYCLIDINE CONF                     54               40         LAB SERVICES-REFERENCE
4040473   PHENCYCLIDINE GCMS URINE               40               40         LAB SERVICES-REFERENCE
4033338   PHENOBARBITAL                       23.43               40         LAB SERVICES-REFERENCE
4036232   PHENOTHIAZINE                        77.1       20      40         LAB SERVICES-REFERENCE
4043295   PHENYLALANINE BLOOD                            37.5     40         LAB SERVICES-REFERENCE
4041828   PHOSPHOLIPID AB                        24               40         LAB SERVICES-REFERENCE
4041810   PHOSPHOLIPID AB                        24               40         LAB SERVICES-REFERENCE
4041802   PHOSPHOLIPID AB                        24               40         LAB SERVICES-REFERENCE
4039632   PHOSPHOLIPID AB                        24               40         LAB SERVICES-REFERENCE
4037933   PHOSPHOLIPID NEUTRALIZATN            41.6      41.6     40         LAB SERVICES-REFERENCE
4034427   PHOSPHORUS UR 24HR                   6.35               40         LAB SERVICES-REFERENCE
4031860   PHOSPHORUS UR 24HR                    7.7               40         LAB SERVICES-REFERENCE
4041901   PLSMG                               23.75               40         LAB SERVICES-REFERENCE
4035010   PLT AB DIR IGG                         49               40         LAB SERVICES-REFERENCE
4040135   PLT AB DRG INDUCED                     70               40         LAB SERVICES-REFERENCE
4035002   PLT AB DRG INDUCED                     60               40         LAB SERVICES-REFERENCE
4041331   PLT AB HEPARIN                         60               40         LAB SERVICES-REFERENCE
4037164   PLT AB HEPARIN                         60               40         LAB SERVICES-REFERENCE
4031399   PNEUMOCOCCAL AB                      8.25               40         LAB SERVICES-REFERENCE
4037677   POLIO AB                             6.48               40         LAB SERVICES-REFERENCE
4039020   PORPHOBILINOGEN QN                     25               40         LAB SERVICES-REFERENCE
4030631   PORPHOBILINOGEN QN                     25               40         LAB SERVICES-REFERENCE
4037354   PORPHYRINS UR QN&FX                  21.5               40         LAB SERVICES-REFERENCE
4037172   PORPHYRINS UR QN&FX                 30.23               40         LAB SERVICES-REFERENCE
4031878   POTASSIUM UR 24HR                    6.16               40         LAB SERVICES-REFERENCE
4039608   PREALBUMIN                           9.75               40         LAB SERVICES-REFERENCE
4039152   PREGNENOLONE                         36.5               40         LAB SERVICES-REFERENCE
4030599   PRIMIDONE                              15               40         LAB SERVICES-REFERENCE
4034443   PROLACTIN                              10               40         LAB SERVICES-REFERENCE
4034435   PROPHOBILINOGEN UR QL                   8               40         LAB SERVICES-REFERENCE
4039574   PROTEIMASE 3                        16.62               40         LAB SERVICES-REFERENCE
4039046   PROTEIMASE 3                        16.62               40         LAB SERVICES-REFERENCE
4034815   PROTEIN C ACTIVITY                  33.25               40         LAB SERVICES-REFERENCE
4036752   PROTEIN ELECTRO CSF                  7.67               40         LAB SERVICES-REFERENCE
4036489   PROTEIN ELECTRO CSF                 26.85               40         LAB SERVICES-REFERENCE
4034468   PROTEIN ELECTRO CSF                  6.42               40         LAB SERVICES-REFERENCE
4040481   PROTEIN ELECTRO SER                     8               40         LAB SERVICES-REFERENCE
4034476   PROTEIN ELECTRO SER                 12.25               40         LAB SERVICES-REFERENCE
4041430   PROTEIN ELECTRO UR                  20.15               40         LAB SERVICES-REFERENCE
4041398   PROTEIN ELECTRO UR                  14.56               40         LAB SERVICES-REFERENCE
4039665   PROTEIN ELECTRO UR                  20.15               40         LAB SERVICES-REFERENCE
4034195   PROTEIN NEPHELOMET                  13.21               40         LAB SERVICES-REFERENCE
4034187   PROTEIN NEPHELOMET                   7.68               40         LAB SERVICES-REFERENCE
4034179   PROTEIN NEPHELOMET                   6.45               40         LAB SERVICES-REFERENCE
4034823   PROTEIN S ACTIVITY                     35               40         LAB SERVICES-REFERENCE
4040499   PROTEIN TOTAL BLOOD                     2               40         LAB SERVICES-REFERENCE
4039855   PROTEIN TOTAL BLOOD                     2               40         LAB SERVICES-REFERENCE
4043402   PROTEIN TOTAL CSF                    9.15      9.15     40         LAB SERVICES-REFERENCE




                                                  Page 92
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

4041414   PROTEIN UR QN 24 HR                    5           40             LAB SERVICES-REFERENCE
4039673   PROTEIN UR QN 24 HR                 4.25           40             LAB SERVICES-REFERENCE
4038584   PROTEIN WESTERN BLOT                 100           40             LAB SERVICES-REFERENCE
4038477   PROTEIN WESTERN BLOT                 180           40             LAB SERVICES-REFERENCE
4039293   PROTEIN ZERO (P0)                    100           40             LAB SERVICES-REFERENCE
4036190   PROTOPORPHYRIN RBC                 15.65           40             LAB SERVICES-REFERENCE
4034450   PSA FREE                           10.09           40             LAB SERVICES-REFERENCE
4038055   PSA TOTAL DIAG                        20           40             LAB SERVICES-REFERENCE
4034393   PTH INTACT                          9.73           40             LAB SERVICES-REFERENCE
4034385   PTH INTACT                            15           40             LAB SERVICES-REFERENCE
4032983   PTH RELATED PROTEIN                   55           40             LAB SERVICES-REFERENCE
4039715   PTT PLAS OR WB                         8           40             LAB SERVICES-REFERENCE
4037594   PTT PLAS OR WB                      11.6           40             LAB SERVICES-REFERENCE
4043238   PURKINJE CL AB                     41.75     41.75 40             LAB SERVICES-REFERENCE
4034492   PYRUVATE BLD                          15           40             LAB SERVICES-REFERENCE
4041950   Q FEVER AB                          7.14           40             LAB SERVICES-REFERENCE
4041943   Q FEVER AB                          7.14           40             LAB SERVICES-REFERENCE
4041935   Q FEVER AB                          7.14           40             LAB SERVICES-REFERENCE
4041927   Q FEVER AB                          7.14           40             LAB SERVICES-REFERENCE
4035390   Q FEVER AB                           7.5           40             LAB SERVICES-REFERENCE
4030730   QN DRG MISC FLUOXETINE LE           20.5           40             LAB SERVICES-REFERENCE
4030755   QN DRG MISC MAPROTILINE L          29.26           40             LAB SERVICES-REFERENCE
4038634   RAPID HSV CX W/REFLEX                 21           40             LAB SERVICES-REFERENCE
4039202   RECEPT ASSAY TBII                     44           40             LAB SERVICES-REFERENCE
4034518   RENIN                                 18           40             LAB SERVICES-REFERENCE
4036240   RIBOFLAVIN                            55           40             LAB SERVICES-REFERENCE
4041976   RICKETTSIA AB                      16.89           40             LAB SERVICES-REFERENCE
4041968   RICKETTSIA AB                      13.82           40             LAB SERVICES-REFERENCE
4039749   RISTOCETIN COFACTOR                   60           40             LAB SERVICES-REFERENCE
4039145   RISTOCETIN COFACTOR                   60           40             LAB SERVICES-REFERENCE
4035960   ROTAVIRUS AG EIA                      20           40             LAB SERVICES-REFERENCE
4033114   RSV AG EIA                            14           40             LAB SERVICES-REFERENCE
4037750   RUBEOLA AB                          5.07           40             LAB SERVICES-REFERENCE
4037743   RUBEOLA AB                          5.04           40             LAB SERVICES-REFERENCE
4036828   RUBEOLA AB                          8.08           40             LAB SERVICES-REFERENCE
4035671   RUBEOLA AB IGM                      9.96           40             LAB SERVICES-REFERENCE
4035663   RUBEOLA AB IGM                     11.57           40             LAB SERVICES-REFERENCE
4038006   RUSSELL VIPER VENOM DILU           29.25     29.25 40             LAB SERVICES-REFERENCE
4034864   RUSSELL VIPER VENOM DILU              15           40             LAB SERVICES-REFERENCE
4041018   SACCHAROMYC CEREVISIAE AB             60           40             LAB SERVICES-REFERENCE
4041000   SACCHAROMYC CEREVISIAE AB             60           40             LAB SERVICES-REFERENCE
4040291   SACCHAROMYC CEREVISIAE AB             60           40             LAB SERVICES-REFERENCE
4038303   SALICYLATE SCRN                        5           40             LAB SERVICES-REFERENCE
4038527   SCLERODERMA AB                        18           40             LAB SERVICES-REFERENCE
4035150   SCLERODERMA AB                        31           40             LAB SERVICES-REFERENCE
4037362   SELENIUM                            25.5           40             LAB SERVICES-REFERENCE
4034526   SEROTONIN BLD                         49           40             LAB SERVICES-REFERENCE
4038543   SIROLIMUS                             55           40             LAB SERVICES-REFERENCE
4035168   SJOGRENS AB                         11.5           40             LAB SERVICES-REFERENCE
4031167   SJOGRENS AB                         11.5           40             LAB SERVICES-REFERENCE
4038550   SMITH AB                              18           40             LAB SERVICES-REFERENCE
4035200   SMOOTH MUSCLE AB TTR                22.5           40             LAB SERVICES-REFERENCE
4032694   SMR GRAM STAIN                                     40             LAB SERVICES-REFERENCE
4039996   SMR INCL BODIES PARASITE           25.87           40             LAB SERVICES-REFERENCE
4031886   SODIUM UR 24HR                      6.16           40             LAB SERVICES-REFERENCE




                                                 Page 93
                                c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION             SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                   AMOUNT AMOUNT CODE

4041042   SOL TRANSFERRIN RECEPTOR             52           40             LAB SERVICES-REFERENCE
4038667   SOMATOMEDIN C                        25           40             LAB SERVICES-REFERENCE
4034534   SOMATOMEDIN C                        25           40             LAB SERVICES-REFERENCE
4037115   SPEC CONCENTRATION                 14.8           40             LAB SERVICES-REFERENCE
4036166   SPEC CONCENTRATION                 8.63           40             LAB SERVICES-REFERENCE
4037990   SPEC HANDL TO REF LAB                15           40             LAB SERVICES-REFERENCE
4037552   SPECTROPH ADENO DEAMINASE          97.5           40             LAB SERVICES-REFERENCE
4036257   SPECTROPHOTOMETRY                    15           40             LAB SERVICES-REFERENCE
4035176   STRIATED MUSCLE AB SCRN              17           40             LAB SERVICES-REFERENCE
4031936   SULFATE UR 24HR                     7.7           40             LAB SERVICES-REFERENCE
4060117   SUSCEPT BY MIC                       40           40             LAB SERVICES-REFERENCE
4060141   SUSCEPT MYCOBACT PROPORT           15.7           40             LAB SERVICES-REFERENCE
4060133   SUSCEPT MYCOBACT PROPORT           35.8           40             LAB SERVICES-REFERENCE
4060125   SUSCEPT MYCOBACT PROPORT          13.91           40             LAB SERVICES-REFERENCE
4060083   SUSCEPT MYCOBACT PROPORT          28.89           40             LAB SERVICES-REFERENCE
4060091   SUSPECT BY MACROBROTH DIL         32.14           40             LAB SERVICES-REFERENCE
4040812   T LYMPH CD4/8 CNT&RATIO           13.57           40             LAB SERVICES-REFERENCE
4040176   T LYMPH CD4/8 CNT&RATIO              35           40             LAB SERVICES-REFERENCE
4035242   T LYMPH CD4/8 CNT&RATIO           24.75           40             LAB SERVICES-REFERENCE
4032876   T LYMPH CD4/8 CNT&RATIO           61.75           40             LAB SERVICES-REFERENCE
4040804   T LYMPH TOT CNT                   13.97           40             LAB SERVICES-REFERENCE
4037370   T LYMPH TOT CNT                    24.5           40             LAB SERVICES-REFERENCE
4036604   T LYMPH TOT CNT                   24.75           40             LAB SERVICES-REFERENCE
4036364   T LYMPH TOT CNT                   20.35           40             LAB SERVICES-REFERENCE
4036067   T LYMPH TOT CNT                      20           40             LAB SERVICES-REFERENCE
4034617   T3 FREE                           18.26           40             LAB SERVICES-REFERENCE
4034625   T3 REVERSE                           29           40             LAB SERVICES-REFERENCE
4034609   T3 TOTAL                             10           40             LAB SERVICES-REFERENCE
4039970   TESTOSTERONE FREE                  9.81           40             LAB SERVICES-REFERENCE
4036588   TESTOSTERONE FREE                 25.88           40             LAB SERVICES-REFERENCE
4039962   TESTOSTERONE TOTAL                11.99           40             LAB SERVICES-REFERENCE
4034542   TESTOSTERONE TOTAL                13.06           40             LAB SERVICES-REFERENCE
4032918   TETANUS AB                           20           40             LAB SERVICES-REFERENCE
4043246   THIOCYANATE                       28.75     28.75 40             LAB SERVICES-REFERENCE
4037487   THROMBIN TIME                        15           40             LAB SERVICES-REFERENCE
4037396   THYR STIM IG                      71.25           40             LAB SERVICES-REFERENCE
4034575   THYR STIM IG                      63.09           40             LAB SERVICES-REFERENCE
4039582   THYROGLOBULIN                      9.88           40             LAB SERVICES-REFERENCE
4036521   THYROGLOBULIN                      8.04      9.88 40             LAB SERVICES-REFERENCE
4039590   THYROGLOBULIN AB                   9.87           40             LAB SERVICES-REFERENCE
4039251   THYROGLOBULIN AB                   8.08           40             LAB SERVICES-REFERENCE
4036901   THYROGLOBULIN AB                   7.45           40             LAB SERVICES-REFERENCE
4035721   THYROGLOBULIN AB                   8.08           40             LAB SERVICES-REFERENCE
4039004   THYROXINE (T4)                      6.5           40             LAB SERVICES-REFERENCE
4036091   TISSUE CULT AMNIO/CVS             144.8           40             LAB SERVICES-REFERENCE
4036109   TISSUE CULT AMNIO/CVS            163.35           40             LAB SERVICES-REFERENCE
4038337   TISSUE CULT BM/BLD                127.3           40             LAB SERVICES-REFERENCE
4036117   TISSUE CULT BM/BLD               161.12           40             LAB SERVICES-REFERENCE
4041513   TISSUE CULT LYMPH                169.05           40             LAB SERVICES-REFERENCE
4038766   TISSUE CULT LYMPH                111.44           40             LAB SERVICES-REFERENCE
4036083   TISSUE CULT LYMPH                 150.6           40             LAB SERVICES-REFERENCE
4043089   TOPIRAMATE                                     35 40             LAB SERVICES-REFERENCE
4037388   TOPIRAMATE                         47.5           40             LAB SERVICES-REFERENCE
4037446   TOXOPLAS AB IGG                    7.26           40             LAB SERVICES-REFERENCE
4035689   TOXOPLAS AB IGM                   10.24           40             LAB SERVICES-REFERENCE




                                                Page 94
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

4034591   TRANSFERRIN                            11           40             LAB SERVICES-REFERENCE
4043394   TRANSGLUTAMINASE AB                 14.25     14.25 40             LAB SERVICES-REFERENCE
4043386   TRANSGLUTAMINASE AB                 14.25     14.25 40             LAB SERVICES-REFERENCE
4030698   TRAZODONE (DESYREL)                    24           40             LAB SERVICES-REFERENCE
4038311   TRICYCLIC SCRN                          5           40             LAB SERVICES-REFERENCE
4043014   TULAREMIA                                           40             LAB SERVICES-REFERENCE
4038592   TYPE II COLLAGEN AB                    80           40             LAB SERVICES-REFERENCE
4041992   TYPHUS FEVER AB SC IGG              16.89           40             LAB SERVICES-REFERENCE
4039160   TYPHUS FEVER AB SC IGG               13.5           40             LAB SERVICES-REFERENCE
4041984   TYPHUS FEVER AB SC IGM              13.82           40             LAB SERVICES-REFERENCE
4039186   TYPHUS FEVER AB SC IGM                 23           40             LAB SERVICES-REFERENCE
4039178   TYPHUS FEVER AB SC IGM               16.5           40             LAB SERVICES-REFERENCE
4039194   TYPHUS FEVER AV TITER                25.5           40             LAB SERVICES-REFERENCE
4043303   TYROSINE                                       37.5 40             LAB SERVICES-REFERENCE
4033148   UNLISTED MICRO PROC                    16           40             LAB SERVICES-REFERENCE
4034633   UR NITROGEN UR 24HR                     9           40             LAB SERVICES-REFERENCE
4038147   URIC ACID UR 24 HR                      5           40             LAB SERVICES-REFERENCE
4031894   URIC ACID UR 24 HR                   6.16           40             LAB SERVICES-REFERENCE
4034641   URIC ACID UR RAN                      5.5           40             LAB SERVICES-REFERENCE
4031951   URNALYSIS PH                         3.08           40             LAB SERVICES-REFERENCE
4034666   VASOACT INTEST PEPT (VIP)              49           40             LAB SERVICES-REFERENCE
4035259   VDRL CSF QL                             6           40             LAB SERVICES-REFERENCE
4039830   VIRUS CULT SHELL VIAL                  25           40             LAB SERVICES-REFERENCE
4036976   VIRUS CULT SHELL VIAL                33.5           40             LAB SERVICES-REFERENCE
4036927   VIRUS CULT SHELL VIAL                33.5           40             LAB SERVICES-REFERENCE
4033015   VISCOSITY                              15           40             LAB SERVICES-REFERENCE
4034682   VITAMIN A                           15.77           40             LAB SERVICES-REFERENCE
4034559   VITAMIN B1 (THIAMINE)                  38           40             LAB SERVICES-REFERENCE
4036539   VITAMIN B12                           5.4           40             LAB SERVICES-REFERENCE
4033742   VITAMIN B12 BINDING CAP                15        15 40             LAB SERVICES-REFERENCE
4040952   VITAMIN B5                             51           40             LAB SERVICES-REFERENCE
4034484   VITAMIN B6                             28           40             LAB SERVICES-REFERENCE
4033767   VITAMIN D (125 DI HYDROX)           29.69           40             LAB SERVICES-REFERENCE
4033627   VITAMIN D 25HYDROXY                  25.5           40             LAB SERVICES-REFERENCE
4034583   VITAMIN E                           15.75           40             LAB SERVICES-REFERENCE
4040507   VITAMIN K                              60           40             LAB SERVICES-REFERENCE
4034658   VMA UR                               7.75           40             LAB SERVICES-REFERENCE
4038329   VOLATILES SCRN                          5           40             LAB SERVICES-REFERENCE
4039756   VW FACTOR COLL BIND ASSAY             110           40             LAB SERVICES-REFERENCE
4037982   VZV AB                               3.36           40             LAB SERVICES-REFERENCE
4037974   VZV AB                               3.38           40             LAB SERVICES-REFERENCE
4036844   VZV AB                              12.19           40             LAB SERVICES-REFERENCE
4035697   VZV AB                              11.88           40             LAB SERVICES-REFERENCE
4040150   VZV AB IGM                           12.5           40             LAB SERVICES-REFERENCE
4035705   VZV AB IGM                          12.19           40             LAB SERVICES-REFERENCE
4035903   VZV DFA                                23           40             LAB SERVICES-REFERENCE
4040820   WBC CNT AUTO                         20.7           40             LAB SERVICES-REFERENCE
4034740   WBC CNT AUTO                        18.63           40             LAB SERVICES-REFERENCE
4034732   WBC CNT AUTO                        14.72           40             LAB SERVICES-REFERENCE
4034724   WBC CNT AUTO                         16.5           40             LAB SERVICES-REFERENCE
4037511   WEST NILE CSF                          56           40             LAB SERVICES-REFERENCE
4037503   WEST NILE SEROLOGY                     49           40             LAB SERVICES-REFERENCE
4042008   WEST NILE VIRUS RNA PCR               293           40             LAB SERVICES-REFERENCE
4034708   ZINC                                   13           40             LAB SERVICES-REFERENCE
4040846   ZINC RBC                            28.06           40             LAB SERVICES-REFERENCE




                                                  Page 95
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

4039616   ZONISAMIDE (ZONEGRAN[TM])           49.5           40             LAB SERVICES-REFERENCE
8748188   AEROSOL TX DEMO/EVAL                 309           87             OP CLINIC
8748196   AEROSOL TX SUBSQ                     158           87             OP CLINIC
8748113   D5W 100ML                             92           87             OP CLINIC
8748170   LACTATED RINGERS 1000                 91           87             OP CLINIC
8746471   NA CL 0.9% 1000ML UC SOL               5           87             OP CLINIC
8746455   NA CL 0.9% 250ML UC SOL               10           87             OP CLINIC
8746463   NA CL 0.9% 500ML UC SOL               10           87             OP CLINIC
8746430   NA CL IRRIG 1000ML .9% UC             76           87             OP CLINIC
8781643   PULSE OXIMETRY - SINGLE               97           87             OP CLINIC
8749194   PULSE OXIMETRY SINGLE                 97           87             OP CLINIC
8748006   S NSTRL PEAK FLOW METER              114           87             OP CLINIC
8748014   S NSTRL PROBE RECTAL                  41           87             OP CLINIC
8747297   S ORTHO                               16           87             OP CLINIC
8746612   S ORTHO ANKLE BRACE (STIR            184           87             OP CLINIC
8747461   S ORTHO BACK BRCE                    261           87             OP CLINIC
8747438   S ORTHO BACK BRCE LRG                179           87             OP CLINIC
8747420   S ORTHO BACK BRCE MED                179           87             OP CLINIC
8747412   S ORTHO BACK BRCE SML                179           87             OP CLINIC
8747446   S ORTHO BACK BRCE X-LRG              179           87             OP CLINIC
8747404   S ORTHO BACK BRCE X-SML              179           87             OP CLINIC
8747453   S ORTHO BACK BRCE XX-LRG             179           87             OP CLINIC
8746695   S ORTHO CERVCL COLLAR                 29           87             OP CLINIC
8747131   S ORTHO FNGR SPLNT                    23           87             OP CLINIC
8747149   S ORTHO FNGR SPLNT #2                 14           87             OP CLINIC
8747156   S ORTHO FNGR SPLNT #3                 14           87             OP CLINIC
8747164   S ORTHO FNGR SPLNT #4                 14           87             OP CLINIC
8747172   S ORTHO FNGR SPLNT #5                 14           87             OP CLINIC
8747180   S ORTHO FNGR SPLNT #5-1/2             14           87             OP CLINIC
8747198   S ORTHO FNGR SPLNT #6                 14           87             OP CLINIC
8747271   S ORTHO FNGR SPLNT 2.25PL             57           87             OP CLINIC
8747289   S ORTHO FNGR SPLNT 3.25PL              6           87             OP CLINIC
8747305   S ORTHO FNGR SPLNT 5.25PL             10           87             OP CLINIC
8747313   S ORTHO FNGR SPLNT 6.25PL             10           87             OP CLINIC
8747321   S ORTHO FNGR SPLNT 7.25PL             11           87             OP CLINIC
8747206   S ORTHO FNGR SPLNT COT                11           87             OP CLINIC
8747222   S ORTHO FNGR SPLNT COT XL              6           87             OP CLINIC
8747214   S ORTHO FNGR SPLNT COT#3              11           87             OP CLINIC
8747263   S ORTHO FNGR SPLNT PLSTLM             18           87             OP CLINIC
8747255   S ORTHO FNGR SPLNT PRGRS              12           87             OP CLINIC
8747248   S ORTHO FNGR SPLNT PRGRS              12           87             OP CLINIC
8747230   S ORTHO FNGR SPLNT PRGRS              12           87             OP CLINIC
8747370   S ORTHO KIT TRCTN W/REPR             261           87             OP CLINIC
8747123   S ORTHO KNEE SPPRT ELSTC              32           87             OP CLINIC
8747115   S ORTHO KNEE SPPRT ELSTC              32           87             OP CLINIC
8747107   S ORTHO KNEE SPPRT ELSTC              32           87             OP CLINIC
8747099   S ORTHO KNEE SPPRT ELSTC              32           87             OP CLINIC
8747537   S ORTHO NEOPRENE WRAP UNI            139           87             OP CLINIC
8746620   S ORTHO SHOULDER IMMOBILI             46           87             OP CLINIC
8747396   S ORTHO SLNG ARM ELAVTOR              44           87             OP CLINIC
8747388   S ORTHO SPLNT TENNS ELBOW             29           87             OP CLINIC
8747339   S ORTHO THMB SPLNT LFT SM            123           87             OP CLINIC
8747362   S ORTHO THMB SPLNT RGHT M            123           87             OP CLINIC
8747354   S ORTHO THMB SPLNT RGHT S            123           87             OP CLINIC
8747347   S ORTHO THMB SPLNT SPICA             123           87             OP CLINIC




                                                 Page 96
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8746661   S ORTHO WRST SPLNT 6"                 33            87             OP CLINIC
8746943   S OT AFO GAUNTLET PREFAB             147            87             OP CLINIC
8746935   S OT AFO GAUNTLET PREFAB             147            87             OP CLINIC
8746927   S OT AFO GAUNTLET PREFAB             147            87             OP CLINIC
8746919   S OT AFO GAUNTLET PREFAB             147            87             OP CLINIC
8746901   S OT AFO GAUNTLET PREFAB             147            87             OP CLINIC
8746893   S OT AFO GAUNTLET PREFAB             147            87             OP CLINIC
8746885   S OT AFO GAUNTLET PREFAB             147            87             OP CLINIC
8746877   S OT AFO GAUNTLET PREFAB             147            87             OP CLINIC
8746869   S OT AFO GAUNTLET PREFAB             147            87             OP CLINIC
8746851   S OT AFO GAUNTLET PREFAB             147            87             OP CLINIC
8746844   S OT AFO SNGL UPRT W/ADJ             288            87             OP CLINIC
8746984   S OT ANK ORTHOSIS PREFAB              31            87             OP CLINIC
8746976   S OT ANK ORTHOSIS PREFAB              31            87             OP CLINIC
8746968   S OT ANK ORTHOSIS PREFAB              31            87             OP CLINIC
8746950   S OT ANK ORTHOSIS PREFAB              31            87             OP CLINIC
8746752   S OT CERV COLLAR 2PC SRGD             94            87             OP CLINIC
8746745   S OT CERV COLLAR 2PC SRGD             90            87             OP CLINIC
8746737   S OT CERV COLLAR 2PC SRGD             94            87             OP CLINIC
8747909   S OT KO IMMOB CNVS LONG              163            87             OP CLINIC
8747883   S OT KO IMMOB CNVS LONG              163            87             OP CLINIC
8747784   S OT METACARPL FX PREFAB             282            87             OP CLINIC
8747529   S OT METACARPL FX PREFAB             282            87             OP CLINIC
8747511   S OT METACARPL FX PREFAB             282            87             OP CLINIC
8747503   S OT METACARPL FX PREFAB             282            87             OP CLINIC
8747495   S OT METACARPL FX PREFAB             282            87             OP CLINIC
8747479   S OT METACARPL FX PREFAB             282            87             OP CLINIC
8747073   S OT WHO WRST EXTN C-UP              100            87             OP CLINIC
8747081   S OT WHO WRST EXTN C-UP              100            87             OP CLINIC
8747065   S OT WHO WRST EXTN C-UP              100            87             OP CLINIC
8747057   S OT WHO WRST EXTN C-UP              100            87             OP CLINIC
8747040   S OT WHO WRST EXTN C-UP              100            87             OP CLINIC
8747032   S OT WHO WRST EXTN C-UP              100            87             OP CLINIC
8747024   S OT WHO WRST EXTN C-UP              100            87             OP CLINIC
8747016   S OT WHO WRST EXTN C-UP              100            87             OP CLINIC
8747008   S OT WHO WRST EXTN C-UP              100            87             OP CLINIC
8746992   S OT WHO WRST EXTN C-UP              100            87             OP CLINIC
8747545   S OT WO EL PREFAB WRSTLET             83            87             OP CLINIC
8746554   S STRL 6V VAG SPECULM LAM             18            87             OP CLINIC
8746224   S STRL BAG RESUS AMBU ADL             97            87             OP CLINIC
8746190   S STRL CANNLA NASAL 7"               168            87             OP CLINIC
8746588   S STRL CATH SET CRICTHROT            652            87             OP CLINIC
8748162   S STRL CATH, BARTHOLIN GL            150            87             OP CLINIC
8746265   S STRL CATH,IV 18GX1 1/4              27            87             OP CLINIC
8746109   S STRL CATH,IV 20GX1 1/4              10            87             OP CLINIC
8746091   S STRL CATH,IV 22GX1"                 10            87             OP CLINIC
8748048   S STRL CAUTRY FINE TIP                44            87             OP CLINIC
8746372   S STRL CNSTR SUC 1500CC D             14            87             OP CLINIC
8746547   S STRL CNT LNE TRY7FR3LMN            202            87             OP CLINIC
8746414   S STRL CTH COUDE FOLY 16F            107            87             OP CLINIC
8746422   S STRL CTH COUDE FOLY 18F            107            87             OP CLINIC
8746604   S STRL CTH IV 16GX1 1/4               19            87             OP CLINIC
8746125   S STRL CTH KT F MINI W/GL             16            87             OP CLINIC
8748063   S STRL DRN PNRSE1/4*18"ST              5            87             OP CLINIC
8748055   S STRL DRN PNRSE3/4*18"ST              5            87             OP CLINIC




                                                  Page 97
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8748071   S STRL DRSG IODOF 1/4                26            87             OP CLINIC
8747966   S STRL DRSG XEROF 1*8                 5            87             OP CLINIC
8747958   S STRL DRSG XEROF 2X2                 5            87             OP CLINIC
8748022   S STRL DRSG XEROF 5X9                 5            87             OP CLINIC
8747990   S STRL EAR WICK, 15 LONG             19            87             OP CLINIC
8748139   S STRL EXTRACTR STPL 1360            14            87             OP CLINIC
8746133   S STRL FLEY TRY 18FR W/DR            70            87             OP CLINIC
8746141   S STRL FLEY TRY CTH 16FR             70            87             OP CLINIC
8748154   S STRL FORCEP, MOSQUITO C            27            87             OP CLINIC
8746760   S STRL HCV SURVW PREG KIT            18            87             OP CLINIC
8748097   S STRL INST YANKAUER REG              5            87             OP CLINIC
8746596   S STRL KIT BIRTH ON ARRIV           163            87             OP CLINIC
8748105   S STRL KIT SUCTION                    5            87             OP CLINIC
8746364   S STRL MASK NON-REBREATHE            13            87             OP CLINIC
8747974   S STRL MORGAN EYE IRG LNS           116            87             OP CLINIC
8746034   S STRL NASAL TAMPN 4.5CM             52            87             OP CLINIC
8746042   S STRL NASAL TAMPN 8.0CM             63            87             OP CLINIC
8746257   S STRL NASAL TAMPN MED               90            87             OP CLINIC
8746067   S STRL NDL SPNL 18GX3 1/2            11            87             OP CLINIC
8746075   S STRL NDL SPNL 20GX3 1/2            11            87             OP CLINIC
8746083   S STRL NDL SPNL 22GX3 1/2            11            87             OP CLINIC
8746216   S STRL NEB MCROMST HND HL            12            87             OP CLINIC
8748089   S STRL NEEDLE, 30G 1"                 5            87             OP CLINIC
8748030   S STRL PACK GZE ADAPTC 1             27            87             OP CLINIC
8746158   S STRL PAD MLTI FNCTN STA           189            87             OP CLINIC
8748147   S STRL PKG PLN 1                     20            87             OP CLINIC
8747891   S STRL POST OP SHOE                  50            87             OP CLINIC
8746059   S STRL RHINO RCKT LG 78MM           105            87             OP CLINIC
8746505   S STRL SCALPEL #10 DSPSBL            53            87             OP CLINIC
8746497   S STRL SCALPEL #11 DSPSBL             5            87             OP CLINIC
8746489   S STRL SCALPEL #15 DISPBL             5            87             OP CLINIC
8746349   S STRL SENSOR OXIMETER              113            87             OP CLINIC
8746356   S STRL SENSOR OXIMETER AD            89            87             OP CLINIC
8746026   S STRL SOL NC SYR 10MM               10            87             OP CLINIC
8746018   S STRL SPECULUM VAG MED D            14            87             OP CLINIC
8746273   S STRL SPLNT 1X15 FBRGLS            269            87             OP CLINIC
8746281   S STRL SPLNT 2X15 FBRGLS            364            87             OP CLINIC
8746299   S STRL SPLNT 3X15 FBRGLS            411            87             OP CLINIC
8746307   S STRL SPLNT 4X15 FBRGLS            686            87             OP CLINIC
8746315   S STRL SPLNT 5X15 FBRGLS            686            87             OP CLINIC
8746323   S STRL SPLNT 6X15 FBRGLS            822            87             OP CLINIC
8746778   S STRL STAPLR SKIN 35WIDE            69            87             OP CLINIC
8746117   S STRL STRAP CATH LEG                26            87             OP CLINIC
8747875   S STRL SUTURE                        18            87             OP CLINIC
8747941   S STRL TICK NIPPERS                  49            87             OP CLINIC
8746000   S STRL TRAY I&D                      54            87             OP CLINIC
8746513   S STRL TRAY LACERATION               94            87             OP CLINIC
8746570   S STRL TRAY LUMBAR PUNCTU            94            87             OP CLINIC
8746562   S STRL TRAY LUMBAR PUNCTU            90            87             OP CLINIC
8746331   S STRL TRAY URET CATH                 6            87             OP CLINIC
8746232   S STRL TRY ENT NSEBLD               148            87             OP CLINIC
8748121   S STRL TUBE NG SALEM                 11            87             OP CLINIC
8746380   S STRL TUBE SALEM SUMP 14            13            87             OP CLINIC
8746398   S STRL TUBE SALEM SUMP 16            26            87             OP CLINIC
8746406   S STRL TUBE SALEM SUMP 18            13            87             OP CLINIC




                                                 Page 98
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8746539   S STRL URINARY STRAINER               11            87             OP CLINIC
8747982   S STRL VASELINE GZE 3*9                5            87             OP CLINIC
8741571   UC ADMIN INFLUENZA VACC               29            87             OP CLINIC
8741100   UC BUN                                20            87             OP CLINIC
8741514   UC CARDIOVERT ELECTV EXT             535            87             OP CLINIC
8741092   UC CHLORIDE                           24            87             OP CLINIC
8740482   UC CLS TX MED MALL FX WO             386            87             OP CLINIC
8740896   UC CNT NSL HEM PKS/CT INI            297            87             OP CLINIC
8740904   UC CNT NSL HEM PKS/CT SUB            297            87             OP CLINIC
8740888   UC CNT NSL HEMORR ANT CPL            297            87             OP CLINIC
8740870   UC CNT NSL HEMORR ANT SMP            297            87             OP CLINIC
8741076   UC CO2 (BICARBONATE)                  25            87             OP CLINIC
8740250   UC CPR                               107            87             OP CLINIC
8741522   UC EKG 12 LEAD TRACING                71            87             OP CLINIC
8741530   UC EKG 3 LEAD TRACING                 35            87             OP CLINIC
8740912   UC GASTRIC LAVAGE                    187            87             OP CLINIC
8741050   UC GLUCOSE                            20            87             OP CLINIC
8741084   UC HEMATOCRIT                         12            87             OP CLINIC
8741027   UC HEMOGLOBIN PLAS                    38            87             OP CLINIC
8740011   UC IMMUN ADMIN EA ADD VAC             28            87             OP CLINIC
8740144   UC IMMUN ADMIN SGL VACCNE             28            87             OP CLINIC
8740946   UC INFSN W/MED EA ADD HR             180            87             OP CLINIC
8747917   UC INFUSION W/MED 0-60MN             240            87             OP CLINIC
8740938   UC INFUSION W/MED 0-60MN             240            87             OP CLINIC
8741498   UC INJ IVP SNGL/INIT DRG              59            87             OP CLINIC
8740037   UC INJECTION IM/SQ EA                 74            87             OP CLINIC
8740029   UC INJECTION IM/SQ EA                 74            87             OP CLINIC
8740672   UC INTUBATION EMERGENCY               48            87             OP CLINIC
8740847   UC LAC I/F,E,N 12.6-20CM             340            87             OP CLINIC
8740854   UC LAC I/F,E,N 20.1-30CM             340            87             OP CLINIC
8740839   UC LAC I/F,E,N 7.6-12.5CM            340            87             OP CLINIC
8741233   UC LAC INT/F,E,N 2.5CM/LS            340            87             OP CLINIC
8740821   UC LAC INT/F,E,N 5.1-7.5C            340            87             OP CLINIC
8740862   UC LAC INT/F,E,N GT 30CM            1048            87             OP CLINIC
8740730   UC LAC INTM 12.6-20.0 CM             340            87             OP CLINIC
8740706   UC LAC INTM 2.5CM/LESS               340            87             OP CLINIC
8740714   UC LAC INTM 2.6-7.5 CM               340            87             OP CLINIC
8740748   UC LAC INTM 20.1-30.0 CM             340            87             OP CLINIC
8740722   UC LAC INTM 7.6-12.5 CM              340            87             OP CLINIC
8740755   UC LAC INTM GT 30.0 CM              1048            87             OP CLINIC
8740698   UC LAC S F,E,N 7.6-12.5CM            340            87             OP CLINIC
8740680   UC LAC SMP/F,E,N 5.1-7.5C            340            87             OP CLINIC
8740201   UC LEVEL 1 EST PATIENT               105            87             OP CLINIC
8740094   UC LEVEL 1 EST PATIENT               105            87             OP CLINIC
8740151   UC LEVEL 1 NEW PATIENT               117            87             OP CLINIC
8740045   UC LEVEL 1 NEW PATIENT               117            87             OP CLINIC
8740219   UC LEVEL 2 EST PATIENT               166            87             OP CLINIC
8740102   UC LEVEL 2 EST PATIENT               166            87             OP CLINIC
8740169   UC LEVEL 2 NEW PATIENT               202            87             OP CLINIC
8740052   UC LEVEL 2 NEW PATIENT               202            87             OP CLINIC
8740227   UC LEVEL 3 EST PATIENT               258            87             OP CLINIC
8740110   UC LEVEL 3 EST PATIENT               258            87             OP CLINIC
8740177   UC LEVEL 3 NEW PATIENT               295            87             OP CLINIC
8740060   UC LEVEL 3 NEW PATIENT               295            87             OP CLINIC
8740235   UC LEVEL 4 EST PATIENT               258            87             OP CLINIC




                                                  Page 99
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8740128   UC LEVEL 4 EST PATIENT              258            87             OP CLINIC
8740185   UC LEVEL 4 NEW PATIENT              295            87             OP CLINIC
8740078   UC LEVEL 4 NEW PATIENT              295            87             OP CLINIC
8740243   UC LEVEL 5 EST PATIENT              381            87             OP CLINIC
8740136   UC LEVEL 5 EST PATIENT              381            87             OP CLINIC
8740193   UC LEVEL 5 NEW PATIENT              417            87             OP CLINIC
8740086   UC LEVEL 5 NEW PATIENT              417            87             OP CLINIC
8740987   UC OCC BLD STL QL MLT SPC             17           87             OP CLINIC
8740953   UC OCCULT BLD OTHER QL                13           87             OP CLINIC
8741043   UC POTASSIUM                          24           87             OP CLINIC
8741019   UC PREGNANCY SCRN UR                  32           87             OP CLINIC
8747925   UC PROC MAJOR                      1030            87             OP CLINIC
8747933   UC PROC MINOR                       309            87             OP CLINIC
8740656   UC REM FB EMBED EYELID              194            87             OP CLINIC
8740649   UC RMV/RPR F ARM/LEG CAST           221            87             OP CLINIC
8740763   UC RPR I N/FT/GEN2.6-7.5C           340            87             OP CLINIC
8740789   UC RPR N/FT/GEN 12.6-20CM           340            87             OP CLINIC
8740797   UC RPR N/FT/GEN 20.1-30CM           340            87             OP CLINIC
8740771   UC RPR N/FT/GEN 7.5-12.5C           340            87             OP CLINIC
8740805   UC RPR N/FT/GEN GT 30.0CM          1048            87             OP CLINIC
8741506   UC SLIT LAMP PROCEDURE                55           87             OP CLINIC
8741068   UC SODIUM                             25           87             OP CLINIC
8740631   UC STRAPPING TOES                   221            87             OP CLINIC
8741001   UC STREP QUICK CHECK                  52           87             OP CLINIC
8747834   UC THROMBOLYSIS CORO IV             682            87             OP CLINIC
8741621   UC THROMBOLYSIS CORO IV             682            87             OP CLINIC
8740979   UC TMP TRNSCUTANEOUS PACE           224            87             OP CLINIC
8740995   UC URNALYSIS MAN WO MICRO             13           87             OP CLINIC
8741563   UC VENIPUNCTURE                       11           87             OP CLINIC
8740664   UC WND CLOSE TISSUE ADHSV           127            87             OP CLINIC
8746448   WATER IRRIG 1000ML UC SOL             10           87             OP CLINIC
0150003   BLOOD TRANSFUSN 2-4 HR             1772            01             OTHER NURSING
0150029   BLOOD TRANSFUSN GT 6HR             2954            01             OTHER NURSING
0150037   BLOOD TRANSFUSN LT 2 HR            1182            01             OTHER NURSING
0130294   CPR                                 489            01             OTHER NURSING
0190025   DIRECT ADMIT OBSERVATION            201            01             OTHER NURSING
0150078   DIRECT ADMIT OBSERVATION            201            01             OTHER NURSING
0110031   INFUSN CHEMO 0-60 MN                787            01             OTHER NURSING
0110049   INFUSN CHEMO EA ADD HR              605            01             OTHER NURSING
0130039   OBS BLADDER IRRIG SMPL            326.26           01             OTHER NURSING
0130336   OBS DECLOT VASC DEVICE              604            01             OTHER NURSING
0130112   OBS PLACE NEEDLE IN VEIN            194            01             OTHER NURSING
0190074   OBSERVATION PER HOUR                184            01             OTHER NURSING
0190066   OBSERVATION PER HOUR                184            01             OTHER NURSING
0190058   OBSERVATION PER HOUR                184            01             OTHER NURSING
0190041   OBSERVATION PER HOUR                184            01             OTHER NURSING
0150110   OBSERVATION PER HOUR                184            01             OTHER NURSING
0150094   OBSERVATION PER HOUR                184            01             OTHER NURSING
0150128   OBSERVATION PER HOUR                184            01             OTHER NURSING
0150060   STATISTICAL TRACKING                               01             OTHER NURSING
8542524   CALCITONIN                                         85             PHARMACY SERVICES
8412702   CIPRO                                              84             PHARMACY SERVICES
8412694   K PHOSA                                            84             PHARMACY SERVICES
8542532   LIDOCAINE                                          85             PHARMACY SERVICES
8412660   LORAZEPAM 2MG IJ                                   84             PHARMACY SERVICES




                                                Page 100
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8412710   SACCHAROMYCES BOUL                   0.01           84             PHARMACY SERVICES
8412652   VX TETANUS TOXOID                                   84             PHARMACY SERVICES
8370009   AA 3%/ELECTRO-TPN 1000ML              50            83             PHARMACY SERVICES-INJECTI
8370017   AA 4.25%/D10W 1000ML                  50            83             PHARMACY SERVICES-INJECTI
8370025   AA 4.25%/D25W 1000ML                                83             PHARMACY SERVICES-INJECTI
8319139   ABATACEPT 10MG IJ                    0.01           83             PHARMACY SERVICES-INJECTI
8350027   ABCIXIMAB 10MG IJ                   2449            83             PHARMACY SERVICES-INJECTI
8350696   ACAMPROSATE CALCIUM                                 83             PHARMACY SERVICES-INJECTI
8350589   ACARBOSE                                            83             PHARMACY SERVICES-INJECTI
8304057   ACETATE IN TPN                        87            83             PHARMACY SERVICES-INJECTI
8300030   ACETAZOLAMIDE 500MG INJ              107            83             PHARMACY SERVICES-INJECTI
8310781   ACETAZOLAMIDE OP DIAMOX 5             21            83             PHARMACY SERVICES-INJECTI
8318636   ACETYLCYSTEINE 100MG INJ                            83             PHARMACY SERVICES-INJECTI
8370488   ACYCLOVIR 5 MG IJ                    0.01           83             PHARMACY SERVICES-INJECTI
8300048   ACYCLOVIR 5 MG IJ                     114           83             PHARMACY SERVICES-INJECTI
8313454   ACYCLOVIR 5 MG IJ                                   83             PHARMACY SERVICES-INJECTI
8328999   ADENOSINE 6 MG RX IJ                                83             PHARMACY SERVICES-INJECTI
8318503   ADENOSINE 6 MG RX IJ                                83             PHARMACY SERVICES-INJECTI
8318495   ADENOSINE DX 30 MG IJ                               83             PHARMACY SERVICES-INJECTI
8310104   ADVAIR DISKUS 100/50MG IN            331            83             PHARMACY SERVICES-INJECTI
8310328   ADVAIR DISKUS 250/50MG IN            364            83             PHARMACY SERVICES-INJECTI
8310807   ADVAIR DISKUS 500/50MG IN            525            83             PHARMACY SERVICES-INJECTI
8310187   ALBUMIN 25%/50ML                     248            83             PHARMACY SERVICES-INJECTI
8300105   ALBUMIN 25%/50ML                     366            83             PHARMACY SERVICES-INJECTI
8300097   ALBUMIN 25%/50ML                     234            83             PHARMACY SERVICES-INJECTI
8300121   ALBUMIN 5%/250ML                     109            83             PHARMACY SERVICES-INJECTI
8300113   ALBUMIN 5%/250ML                      93            83             PHARMACY SERVICES-INJECTI
8300139   ALBUMIN 5%/50ML IV                    84            83             PHARMACY SERVICES-INJECTI
8300154   ALDESLEUKIN/SGL DOSE IJ              595            83             PHARMACY SERVICES-INJECTI
8318420   ALEMTUZUMAB 10MG IV                                 83             PHARMACY SERVICES-INJECTI
8310757   ALEMTUZUMAB 10MG IV                 1850            83             PHARMACY SERVICES-INJECTI
8300162   ALEMTUZUMAB 10MG IV                 4604            83             PHARMACY SERVICES-INJECTI
8303893   ALFENTANIL 1000MCG/2ML IJ            108            83             PHARMACY SERVICES-INJECTI
8303901   ALFENTANIL 2500MCG/5ML IJ            127            83             PHARMACY SERVICES-INJECTI
8303919   ALFENTANIL 500MCG/ML AMP              11            83             PHARMACY SERVICES-INJECTI
8318404   ALLOPURINOL                                         83             PHARMACY SERVICES-INJECTI
8300170   ALPROSTADIL PEDI 500MCG/M            134            83             PHARMACY SERVICES-INJECTI
8350035   ALTEPLASE 1MG IJ                    7264            83             PHARMACY SERVICES-INJECTI
8313462   ALTEPLASE 1MG IJ                                    83             PHARMACY SERVICES-INJECTI
8310625   ALTEPLASE 1MG IJ                     229            83             PHARMACY SERVICES-INJECTI
8309312   ALTEPLASE 1MG IJ                    7264            83             PHARMACY SERVICES-INJECTI
8300212   ALTEPLASE 1MG IJ                      84            83             PHARMACY SERVICES-INJECTI
8300204   ALTEPLASE 1MG IJ                    1531            83             PHARMACY SERVICES-INJECTI
8300196   ALTEPLASE 1MG IJ                     141            83             PHARMACY SERVICES-INJECTI
8300246   AMIFOSTINE 500MG IJ                 1592            83             PHARMACY SERVICES-INJECTI
8312480   AMIKACIN 100MG IJ                    131            83             PHARMACY SERVICES-INJECTI
8300253   AMIKACIN 100MG IJ                     66            83             PHARMACY SERVICES-INJECTI
8370173   AMINO ACIDS 5% 1000ML D20                           83             PHARMACY SERVICES-INJECTI
8370132   AMINO ACIDS 8.5% 500ML                              83             PHARMACY SERVICES-INJECTI
8370181   AMINO ACIDS M 3.5% LYTES                            83             PHARMACY SERVICES-INJECTI
8300279   AMINOCAPROIC AC 5GM IJ                16            83             PHARMACY SERVICES-INJECTI
8300337   AMINOPHYLLINE 250MG IJ                30            83             PHARMACY SERVICES-INJECTI
8300303   AMINOPHYLLINE 250MG IJ                 1            83             PHARMACY SERVICES-INJECTI
8313470   AMIODARONE HCL 30 MG IJ                             83             PHARMACY SERVICES-INJECTI
8300360   AMIODARONE HCL 30 MG IJ              104            83             PHARMACY SERVICES-INJECTI




                                                 Page 101
                                      c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                   SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                         AMOUNT AMOUNT CODE

8300345   AMIODARONE HCL 30 MG IJ                    77           83             PHARMACY SERVICES-INJECTI
8312647   AMOXICILLIN 400MG/5ML SUS                  34           83             PHARMACY SERVICES-INJECTI
8300394   AMPHO B LIPOSOME 10MG IJ                4482            83             PHARMACY SERVICES-INJECTI
8300378   AMPHO B LIPOSOME 10MG IJ                  151           83             PHARMACY SERVICES-INJECTI
8300386   AMPHOTERICIN B 50 MG IJ                   158           83             PHARMACY SERVICES-INJECTI
8300493   AMPICILLIN 500MG IJ                       137           83             PHARMACY SERVICES-INJECTI
8300451   AMPICILLIN 500MG IJ                         7           83             PHARMACY SERVICES-INJECTI
8300444   AMPICILLIN 500MG IJ                       118           83             PHARMACY SERVICES-INJECTI
8300436   AMPICILLIN 500MG IJ                         3           83             PHARMACY SERVICES-INJECTI
8300410   AMPICILLIN 500MG IJ                         4           83             PHARMACY SERVICES-INJECTI
8300402   AMPICILLIN 500MG IJ                       116           83             PHARMACY SERVICES-INJECTI
8370512   AMPICILLIN 500MG IJ                      0.01           83             PHARMACY SERVICES-INJECTI
8370504   AMPICILLIN 500MG IJ                      0.01           83             PHARMACY SERVICES-INJECTI
8370496   AMPICILLIN 500MG IJ                      0.01           83             PHARMACY SERVICES-INJECTI
8300501   AMPICILLIN 500MG IJ                         7           83             PHARMACY SERVICES-INJECTI
8310237   AMPICILLIN/SULB 1.5GM IJ                  131           83             PHARMACY SERVICES-INJECTI
8310229   AMPICILLIN/SULB 1.5GM IJ                  117           83             PHARMACY SERVICES-INJECTI
8300527   AMPICILLIN/SULB 1.5GM IJ                   14           83             PHARMACY SERVICES-INJECTI
8300550   AMRINONE 100MG AMP                         38           83             PHARMACY SERVICES-INJECTI
8300568   ANA-KIT EMERG TREAT KI                     15           83             PHARMACY SERVICES-INJECTI
8319238   ANIDULAFUNGIN 1MG IJ                     0.01           83             PHARMACY SERVICES-INJECTI
8319220   ANIDULAFUNGIN 1MG IJ                     0.01           83             PHARMACY SERVICES-INJECTI
8300576   ANTIVENIN BLACK WIDOW                      20           83             PHARMACY SERVICES-INJECTI
8300584   ANTIVENIN BLACK WIDOW INJ                 101           83             PHARMACY SERVICES-INJECTI
8300592   ANTIVENIN POLYVALENT 10M                  138           83             PHARMACY SERVICES-INJECTI
8300600   ANTIVENIN RATTLESNAKE INJ               2717            83             PHARMACY SERVICES-INJECTI
8310609   APAP/COD     300/30MG                      29           83             PHARMACY SERVICES-INJECTI
8300618   APROTININ 10,000 KIU IJ                   209           83             PHARMACY SERVICES-INJECTI
8313488   ARGATROBAN 5MG IJ                                       83             PHARMACY SERVICES-INJECTI
8312399   ARGATROBAN 5MG IJ                        764            83             PHARMACY SERVICES-INJECTI
8312357   ASCORBIC ACID                             12            83             PHARMACY SERVICES-INJECTI
8310559   ASCORBIC ACID                             29            83             PHARMACY SERVICES-INJECTI
8300634   ATRACURIUM 100MG/10ML INJ                 81            83             PHARMACY SERVICES-INJECTI
8300642   ATRACURIUM 10MG/ML 5ML                    68            83             PHARMACY SERVICES-INJECTI
8304065   ATRACURIUM 10MG/ML MDV                    47            83             PHARMACY SERVICES-INJECTI
8304073   ATROPINE SO4 0.3MG IJ                     60            83             PHARMACY SERVICES-INJECTI
8300717   ATROPINE SO4 0.3MG IJ                     58            83             PHARMACY SERVICES-INJECTI
8300709   ATROPINE SO4 0.3MG IJ                     58            83             PHARMACY SERVICES-INJECTI
8300683   ATROPINE SO4 0.3MG IJ                     63            83             PHARMACY SERVICES-INJECTI
8300659   ATROPINE SO4 0.3MG IJ                                   83             PHARMACY SERVICES-INJECTI
8310443   AUGMENTIN 400MG/5ML SUSP                  197           83             PHARMACY SERVICES-INJECTI
8320723   AUGMENTIN 600MG/5ML SUSP                  197           83             PHARMACY SERVICES-INJECTI
8313785   AZACITIDINE 1 MG IJ                     1556            83             PHARMACY SERVICES-INJECTI
8370470   AZITHROMYCIN 500MG IJ                    0.01           83             PHARMACY SERVICES-INJECTI
8300725   AZITHROMYCIN 500MG IJ                     146           83             PHARMACY SERVICES-INJECTI
8370520   AZTREONAM 500MG IJ                       0.01           83             PHARMACY SERVICES-INJECTI
8370033   AZTREONAM 500MG IJ                         86           83             PHARMACY SERVICES-INJECTI
8300733   AZTREONAM 500MG IJ                        153           83             PHARMACY SERVICES-INJECTI
8300758   BACITRACIN 50,000U IJ                     140           83             PHARMACY SERVICES-INJECTI
8300766   BACITRACIN 50000U VIAL                      9           83             PHARMACY SERVICES-INJECTI
8311094   BACITRACIN 50000U VIAL                      9           83             PHARMACY SERVICES-INJECTI
8310286   BACITRACIN OPTH OINT                       80           83             PHARMACY SERVICES-INJECTI
8310682   BACITRACIN ZINC OINT 1/32                  12           83             PHARMACY SERVICES-INJECTI
8300808   BENZTROPINE MESYL 1MG IJ                   75           83             PHARMACY SERVICES-INJECTI
8301483   BETAMETHASONE                             119           83             PHARMACY SERVICES-INJECTI




                                                     Page 102
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8380669   BEVACIZUMAB PER 10MG IJ             6617            83             PHARMACY SERVICES-INJECTI
8313496   BEVACIZUMAB PER 10MG IJ                             83             PHARMACY SERVICES-INJECTI
8312746   BEVACIZUMAB PER 10MG IJ              765            83             PHARMACY SERVICES-INJECTI
8300857   BICALUTAMIDE 50MG TAB                 14            83             PHARMACY SERVICES-INJECTI
8328957   BISMUTH SUBSALICYLATE                               83             PHARMACY SERVICES-INJECTI
8300881   BIVALIRUDIN 1MG IJ                   445            83             PHARMACY SERVICES-INJECTI
8380016   BLEOMYCIN 15U IJ                    1174            83             PHARMACY SERVICES-INJECTI
8380008   BLEOMYCIN 15U IJ                     203            83             PHARMACY SERVICES-INJECTI
8380610   BLEOMYCIN 15U IJ                                    83             PHARMACY SERVICES-INJECTI
8380768   BLEOMYCIN 15U IJ                                    83             PHARMACY SERVICES-INJECTI
8380453   BORTEZOMIB PER 0.1MG IJ             1331            83             PHARMACY SERVICES-INJECTI
8313231   BOTULINUM TOX A/U IJ                  14            83             PHARMACY SERVICES-INJECTI
8300899   BOTULINUM TOX B/100U IJ              382            83             PHARMACY SERVICES-INJECTI
8300907   BRETYLIUM TOSYL                       78            83             PHARMACY SERVICES-INJECTI
8300915   BRETYLIUM TOSYL 500MG/10M             26            83             PHARMACY SERVICES-INJECTI
8310773   BRIMONIDINE 0.15% OPTH SO            194            83             PHARMACY SERVICES-INJECTI
8300949   BUMETANIDE 0.5MG IJ                   70            83             PHARMACY SERVICES-INJECTI
8300931   BUMETANIDE 0.5MG IJ                   61            83             PHARMACY SERVICES-INJECTI
8303968   BUPI/FEN/NS EPI                       55            83             PHARMACY SERVICES-INJECTI
8303950   BUPI/FEN/NS EPI                       55            83             PHARMACY SERVICES-INJECTI
8319055   BUPI/FEN/NS EPI                                     83             PHARMACY SERVICES-INJECTI
8313801   BUPI/FEN/NS EPI                      169            83             PHARMACY SERVICES-INJECTI
8313793   BUPI/FEN/NS EPI                      176            83             PHARMACY SERVICES-INJECTI
8304271   BUPIV/DEXT                            67            83             PHARMACY SERVICES-INJECTI
8304289   BUPIV/EPI                             67            83             PHARMACY SERVICES-INJECTI
8304297   BUPIV/EPI .25% 50ML                   76            83             PHARMACY SERVICES-INJECTI
8304099   BUPIV/EPI 0.25% 30M                    3            83             PHARMACY SERVICES-INJECTI
8304107   BUPIV/EPI 0.25% INJ                    6            83             PHARMACY SERVICES-INJECTI
8304305   BUPIV/EPI 0.5% 10ML                   68            83             PHARMACY SERVICES-INJECTI
8304115   BUPIV/EPI 0.5% 30ML                    6            83             PHARMACY SERVICES-INJECTI
8304321   BUPIV/EPI 0.5% IJ 30ML                79            83             PHARMACY SERVICES-INJECTI
8304313   BUPIV/EPI 0.5% IJ 50ML                86            83             PHARMACY SERVICES-INJECTI
8304123   BUPIV/EPI 0.75% 30M                    8            83             PHARMACY SERVICES-INJECTI
8304248   BUPIVACAINE 30ML IJ                   67            83             PHARMACY SERVICES-INJECTI
8304230   BUPIVACAINE 30ML IJ                   82            83             PHARMACY SERVICES-INJECTI
8304206   BUPIVACAINE 30ML IJ                    5            83             PHARMACY SERVICES-INJECTI
8304180   BUPIVACAINE 30ML IJ                    7            83             PHARMACY SERVICES-INJECTI
8304156   BUPIVACAINE 30ML IJ                   67            83             PHARMACY SERVICES-INJECTI
8304149   BUPIVACAINE 30ML IJ                   80            83             PHARMACY SERVICES-INJECTI
8304131   BUPIVACAINE 30ML IJ                   66            83             PHARMACY SERVICES-INJECTI
8320889   BUPRENORPHINE 0.1MG IJ                              83             PHARMACY SERVICES-INJECTI
8309536   BUPRENORPHINE 0.1MG IJ                  3           83             PHARMACY SERVICES-INJECTI
8313504   BUTORPHANOL TART 1MG IJ                             83             PHARMACY SERVICES-INJECTI
8300956   BUTORPHANOL TART 1MG IJ                 4           83             PHARMACY SERVICES-INJECTI
8312001   CA CARB 500MG                           2           83             PHARMACY SERVICES-INJECTI
8319022   CA CL                                               83             PHARMACY SERVICES-INJECTI
8300964   CA CL 10% SYR 10ML                    43            83             PHARMACY SERVICES-INJECTI
8301020   CA CL 10% SYRINGE                     37            83             PHARMACY SERVICES-INJECTI
8300972   CA CL 10% SYRINGE                      7            83             PHARMACY SERVICES-INJECTI
8301053   CA GLUCONATE                                        83             PHARMACY SERVICES-INJECTI
8318867   CA GLUCONATE 1OML IJ                                83             PHARMACY SERVICES-INJECTI
8301038   CA GLUCONATE 1OML IJ                  59            83             PHARMACY SERVICES-INJECTI
8300998   CAFF NA BENZ 0.5GM AM                               83             PHARMACY SERVICES-INJECTI
8312209   CALCITONIN                           259            83             PHARMACY SERVICES-INJECTI
8301004   CALCITONIN 200U VIAL                  32            83             PHARMACY SERVICES-INJECTI




                                                 Page 103
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8301012   CALCITONIN 400U IJ                   144            83             PHARMACY SERVICES-INJECTI
8301061   CANDIDA SKN TST                       80            83             PHARMACY SERVICES-INJECTI
8313389   CAPECITABINE 150MG PO                               83             PHARMACY SERVICES-INJECTI
8313249   CAPREOMYCIN 1GM VIAL                   29           83             PHARMACY SERVICES-INJECTI
8301079   CARBAMAZEPINE 200MG/10ML               32           83             PHARMACY SERVICES-INJECTI
8380826   CARBOPLATIN 50MG IJ                  0.01           83             PHARMACY SERVICES-INJECTI
8380065   CARBOPLATIN 50MG IJ                   728           83             PHARMACY SERVICES-INJECTI
8380057   CARBOPLATIN 50MG IJ                   616           83             PHARMACY SERVICES-INJECTI
8380040   CARBOPLATIN 50MG IJ                   206           83             PHARMACY SERVICES-INJECTI
8380032   CARBOPLATIN 50MG IJ                 2090            83             PHARMACY SERVICES-INJECTI
8380024   CARBOPLATIN 50MG IJ                 1635            83             PHARMACY SERVICES-INJECTI
8380073   CARBOPROST 250MCG/ML INJ              257           83             PHARMACY SERVICES-INJECTI
8350043   CARDIOPLGIC SOL 1L                     26           83             PHARMACY SERVICES-INJECTI
8301087   CARMUSTINE 100MG IJ                    55           83             PHARMACY SERVICES-INJECTI
8310211   CARVEDILOL 25MG TAB                    17           83             PHARMACY SERVICES-INJECTI
8310336   CARVEDILOL 3.125MG UD                  18           83             PHARMACY SERVICES-INJECTI
8313512   CASPOFUNGIN/5MG IJ                                  83             PHARMACY SERVICES-INJECTI
8301103   CASPOFUNGIN/5MG IJ                  1260            83             PHARMACY SERVICES-INJECTI
8301095   CASPOFUNGIN/5MG IJ                  1004            83             PHARMACY SERVICES-INJECTI
8301152   CEFAZOLIN 500MG IJ                    128           83             PHARMACY SERVICES-INJECTI
8301111   CEFAZOLIN 500MG IJ                    121           83             PHARMACY SERVICES-INJECTI
8370462   CEFAZOLIN 500MG IJ                   0.01           83             PHARMACY SERVICES-INJECTI
8318487   CEFEPIME HCL 500MG IJ                               83             PHARMACY SERVICES-INJECTI
8312761   CEFEPIME HCL 500MG IJ                205            83             PHARMACY SERVICES-INJECTI
8312779   CEFOTAXIME 1GM IJ                                   83             PHARMACY SERVICES-INJECTI
8301194   CEFOTAXIME 1GM IJ                      13           83             PHARMACY SERVICES-INJECTI
8301244   CEFOTETAN 500MG IJ                    134           83             PHARMACY SERVICES-INJECTI
8301236   CEFOTETAN 500MG IJ                     25           83             PHARMACY SERVICES-INJECTI
8301210   CEFOTETAN 500MG IJ                     13           83             PHARMACY SERVICES-INJECTI
8301202   CEFOTETAN 500MG IJ                    140           83             PHARMACY SERVICES-INJECTI
8301319   CEFTAZIDIME 500MG IJ                  177           83             PHARMACY SERVICES-INJECTI
8301301   CEFTAZIDIME 500MG IJ                   33           83             PHARMACY SERVICES-INJECTI
8301293   CEFTAZIDIME 500MG IJ                  146           83             PHARMACY SERVICES-INJECTI
8301277   CEFTAZIDIME 500MG IJ                   17           83             PHARMACY SERVICES-INJECTI
8301418   CEFTRIAXONE 250MG IJ                   63           83             PHARMACY SERVICES-INJECTI
8301392   CEFTRIAXONE 250MG IJ                  345           83             PHARMACY SERVICES-INJECTI
8301376   CEFTRIAXONE 250MG IJ                  150           83             PHARMACY SERVICES-INJECTI
8301368   CEFTRIAXONE 250MG IJ                  227           83             PHARMACY SERVICES-INJECTI
8301327   CEFTRIAXONE 250MG IJ                  231           83             PHARMACY SERVICES-INJECTI
8370454   CEFTRIAXONE 250MG IJ                 0.01           83             PHARMACY SERVICES-INJECTI
8370447   CEFTRIAXONE 250MG IJ                 0.01           83             PHARMACY SERVICES-INJECTI
8301384   CEFTRIAXONE 250MG VIAL                  9           83             PHARMACY SERVICES-INJECTI
8301426   CEFUROXIME                                          83             PHARMACY SERVICES-INJECTI
8310823   CEFUROXIME 125MG/5ML SUSP            187            83             PHARMACY SERVICES-INJECTI
8301467   CEFUROXIME NA 750MG IJ                 8            83             PHARMACY SERVICES-INJECTI
8301459   CEFUROXIME NA 750MG IJ               129            83             PHARMACY SERVICES-INJECTI
8301434   CEFUROXIME NA 750MG IJ               145            83             PHARMACY SERVICES-INJECTI
8380818   CETUXIMAB PER 10MG IJ                               83             PHARMACY SERVICES-INJECTI
8380628   CETUXIMAB PER 10MG IJ                 668           83             PHARMACY SERVICES-INJECTI
8301491   CHLORAMPHENICOL 1GM IJ                127           83             PHARMACY SERVICES-INJECTI
8319121   CHLOROPROCAINE 30ML IJ               0.01           83             PHARMACY SERVICES-INJECTI
8304396   CHLOROPROCAINE 30ML IJ                 91           83             PHARMACY SERVICES-INJECTI
8304388   CHLOROPROCAINE 30ML IJ                 89           83             PHARMACY SERVICES-INJECTI
8331001   CHLOROPROCAINE 30ML IJ                              83             PHARMACY SERVICES-INJECTI
8301509   CHLOROTHIAZIDE 500MG IJ               81            83             PHARMACY SERVICES-INJECTI




                                                 Page 104
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8301541   CHLORPROMAZINE 50MG IJ                 67           83             PHARMACY SERVICES-INJECTI
8301525   CHLORPROMAZINE 50MG IJ                  1           83             PHARMACY SERVICES-INJECTI
8301566   CIPRO 200MG PB                       0.01           83             PHARMACY SERVICES-INJECTI
8310724   CIPRO 250MG TABLET                     27           83             PHARMACY SERVICES-INJECTI
8301590   CIPROFLOXA 400MG/D5W 200M            0.01           83             PHARMACY SERVICES-INJECTI
8312712   CISATRACURIUM 10MG VIAL                22           83             PHARMACY SERVICES-INJECTI
8380727   CISPLATIN 10MG IJ                                   83             PHARMACY SERVICES-INJECTI
8380099   CISPLATIN 10MG IJ                   1023            83             PHARMACY SERVICES-INJECTI
8380081   CISPLATIN 10MG IJ                    124            83             PHARMACY SERVICES-INJECTI
8380776   CISPLATIN 10MG IJ                                   83             PHARMACY SERVICES-INJECTI
8380719   CLADRIBINE/1MG IJ                                   83             PHARMACY SERVICES-INJECTI
8380107   CLADRIBINE/1MG IJ                    626            83             PHARMACY SERVICES-INJECTI
8380701   CLADRIBINE/1MG IJ B                                 83             PHARMACY SERVICES-INJECTI
8301608   CLINDAMYCIN 300MG AD-VT                69           83             PHARMACY SERVICES-INJECTI
8370363   CLINDAMYCIN 300MG IJ                 0.01           83             PHARMACY SERVICES-INJECTI
8370355   CLINDAMYCIN 300MG IJ                 0.01           83             PHARMACY SERVICES-INJECTI
8318941   CLINDAMYCIN 300MG IJ                                83             PHARMACY SERVICES-INJECTI
8318933   CLINDAMYCIN 300MG IJ                                83             PHARMACY SERVICES-INJECTI
8318925   CLINDAMYCIN 300MG IJ                                83             PHARMACY SERVICES-INJECTI
8301665   CLINDAMYCIN 300MG IJ                 138            83             PHARMACY SERVICES-INJECTI
8301640   CLINDAMYCIN 300MG IJ                 123            83             PHARMACY SERVICES-INJECTI
8301624   CLINDAMYCIN 600MG AD-VT                5            83             PHARMACY SERVICES-INJECTI
8301673   CLINDAMYCIN 900MG AD-VT                7            83             PHARMACY SERVICES-INJECTI
8311763   CLOTRI/BETAMETH       L               96            83             PHARMACY SERVICES-INJECTI
8320004   COCAINE 4% SOLN 4 ML                  12            83             PHARMACY SERVICES-INJECTI
8320012   COCAINE HCL 10% 4ML SOLUT            151            83             PHARMACY SERVICES-INJECTI
8320020   CODEINE 30MG IJ                        4            83             PHARMACY SERVICES-INJECTI
8350639   COLESTIPOL                                          83             PHARMACY SERVICES-INJECTI
8301699   COLFOSCERIL 10ML                     662            83             PHARMACY SERVICES-INJECTI
8329005   COLISTIMETHATE 150MG IJ                             83             PHARMACY SERVICES-INJECTI
8308538   CON HOCM 150-199MG/ML 1ML              71           83             PHARMACY SERVICES-INJECTI
8360059   CON LOCM >= 400S I 1ML               0.01           83             PHARMACY SERVICES-INJECTI
8308686   CON LOCM >= 400S I 1ML                120           83             PHARMACY SERVICES-INJECTI
8309502   CON LOCM >= 400S I 1ML                 66           83             PHARMACY SERVICES-INJECTI
8308868   CON LOCM >= 400S I 1ML                179           83             PHARMACY SERVICES-INJECTI
8308736   CON LOCM >= 400S I 1ML                 70           83             PHARMACY SERVICES-INJECTI
8308702   CON LOCM >= 400S I 1ML                108           83             PHARMACY SERVICES-INJECTI
8308678   CON LOCM >= 400S I 1ML                 77           83             PHARMACY SERVICES-INJECTI
8308660   CON LOCM >= 400S I 1ML                114           83             PHARMACY SERVICES-INJECTI
8308652   CON LOCM >= 400S I 1ML                152           83             PHARMACY SERVICES-INJECTI
8308637   CON LOCM >= 400S I 1ML                211           83             PHARMACY SERVICES-INJECTI
8360034   CON LOCM 300-349S I 1ML                             83             PHARMACY SERVICES-INJECTI
8308843   CON LOCM 300-349S I 1ML               138           83             PHARMACY SERVICES-INJECTI
8308835   CON LOCM 300-349S I 1ML               190           83             PHARMACY SERVICES-INJECTI
8360067   CON LOCM 350-399S I 1ML              0.01           83             PHARMACY SERVICES-INJECTI
8308645   CON LOCM 350-399S I 1ML               180           83             PHARMACY SERVICES-INJECTI
8360042   CON PERFLUTREN LIP MIC ML                           83             PHARMACY SERVICES-INJECTI
8319170   CONIVAPTAN                           0.01           83             PHARMACY SERVICES-INJECTI
8301707   COSYNTROPIN 0.25MG IJ                 100           83             PHARMACY SERVICES-INJECTI
8301723   CYANIDE KIT                           668           83             PHARMACY SERVICES-INJECTI
8301756   CYANOCOBALAMIN 1000MCG IJ              58           83             PHARMACY SERVICES-INJECTI
8380438   CYCLOPHOS LYPHZD 100MG IJ              42           83             PHARMACY SERVICES-INJECTI
8318537   CYCLOPHOS LYPHZD 100MG IJ                           83             PHARMACY SERVICES-INJECTI
8380487   CYCLOPHOSPHAMID 100MG IJ                            83             PHARMACY SERVICES-INJECTI
8313405   CYCLOPHOSPHAMID 100MG IJ                            83             PHARMACY SERVICES-INJECTI




                                                 Page 105
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8390098   CYCLOPHOSPHAMIDE 25MG PO                           83             PHARMACY SERVICES-INJECTI
8312787   CYCLOSPORINE 250MG IJ                              83             PHARMACY SERVICES-INJECTI
8380495   CYTARABINE 100MG IJ                                83             PHARMACY SERVICES-INJECTI
8370272   D10W 250ML                                         83             PHARMACY SERVICES-INJECTI
8370157   D40W 500ML                                         83             PHARMACY SERVICES-INJECTI
8370165   D5 0.45 NACL 500ML IV                              83             PHARMACY SERVICES-INJECTI
8312241   D5NS 1000ML/KCL 20MEQ                 95           83             PHARMACY SERVICES-INJECTI
8312365   D5W 100ML                              4           83             PHARMACY SERVICES-INJECTI
8370421   D5W 100ML                           0.01           83             PHARMACY SERVICES-INJECTI
8318693   D5W 250ML                                          83             PHARMACY SERVICES-INJECTI
8312068   D5W 50ML                             133           83             PHARMACY SERVICES-INJECTI
8312050   D5W 50ML                               3           83             PHARMACY SERVICES-INJECTI
8370439   D5W 50ML                            0.01           83             PHARMACY SERVICES-INJECTI
8370074   D70W 500ML                                         83             PHARMACY SERVICES-INJECTI
8380834   DACTINOMYCIN 0.5MG IJ               0.01           83             PHARMACY SERVICES-INJECTI
8301764   DANTROLENE 20MG VIAL                  37           83             PHARMACY SERVICES-INJECTI
8301772   DANTROLENE 20MG/ML INJ               660           83             PHARMACY SERVICES-INJECTI
8312688   DAPTOMYCIN 1MG IJ                    510           83             PHARMACY SERVICES-INJECTI
8313520   DARBEPOETIN 1MCG IJ ESRD                           83             PHARMACY SERVICES-INJECTI
8313538   DARBEPOETIN 1MCG NON-ESRD                          83             PHARMACY SERVICES-INJECTI
8301798   DEFEROXAMINE 500MG IJ                74            83             PHARMACY SERVICES-INJECTI
8313546   DESMOPRESSIN ACET 1MCG IJ                          83             PHARMACY SERVICES-INJECTI
8301848   DESMOPRESSIN ACET 1MCG IJ           234            83             PHARMACY SERVICES-INJECTI
8301830   DESMOPRESSIN ACET 1MCG IJ           108            83             PHARMACY SERVICES-INJECTI
8301822   DESMOPRESSIN ACET 1MCG IJ             2            83             PHARMACY SERVICES-INJECTI
8301871   DEXAMETHASONE 0.25MG PO              34            83             PHARMACY SERVICES-INJECTI
8301897   DEXAMETHASONE PHOS 1MG IJ            59            83             PHARMACY SERVICES-INJECTI
8301855   DEXAMETHASONE PHOS 1MG IJ            62            83             PHARMACY SERVICES-INJECTI
8318990   DEXAMETHASONE PHOS 1MG IJ                          83             PHARMACY SERVICES-INJECTI
8318982   DEXAMETHASONE PHOS 1MG IJ                          83             PHARMACY SERVICES-INJECTI
8312605   DEXRAZOXANE/250MG IJ                 314           83             PHARMACY SERVICES-INJECTI
8312597   DEXRAZOXANE/250MG IJ                 176           83             PHARMACY SERVICES-INJECTI
8301947   DEXTRAN 40/D5W 500ML                 410           83             PHARMACY SERVICES-INJECTI
8301939   DEXTRAN 40/NS 500ML                   32           83             PHARMACY SERVICES-INJECTI
8303927   DIAZEPAM 5MG IJ                       87           83             PHARMACY SERVICES-INJECTI
8301988   DICYCLOMINE 20MG IJ                   97           83             PHARMACY SERVICES-INJECTI
8302051   DIGOXIN                                3           83             PHARMACY SERVICES-INJECTI
8302028   DIGOXIN 0.5MG IJ                      61           83             PHARMACY SERVICES-INJECTI
8302044   DIGOXIN IMM FAB VIAL IJ            1716            83             PHARMACY SERVICES-INJECTI
8302002   DIGOXIN IMM FAB VIAL IJ               71           83             PHARMACY SERVICES-INJECTI
8302085   DIHYDROERGOTAMINE 1MG IJ             162           83             PHARMACY SERVICES-INJECTI
8370330   DILTIAZEM                           0.01           83             PHARMACY SERVICES-INJECTI
8302093   DILTIAZEM 25MG/5ML INJ                37           83             PHARMACY SERVICES-INJECTI
8302101   DILTIAZEM 25MG/5ML VIAL               12           83             PHARMACY SERVICES-INJECTI
8302119   DILTIAZEM 50MG/10ML VIAL              25           83             PHARMACY SERVICES-INJECTI
8302127   DILTIAZEM INJ 100MG MONOV             57           83             PHARMACY SERVICES-INJECTI
8302143   DIMERCAPROL 100MG IJ                 305           83             PHARMACY SERVICES-INJECTI
8302192   DIPHENHYDRAMINE 50MG IJ                1           83             PHARMACY SERVICES-INJECTI
8318974   DIPYRIDAMOLE/10MG IJ                               83             PHARMACY SERVICES-INJECTI
8302200   DIPYRIDAMOLE/10MG IJ                 30            83             PHARMACY SERVICES-INJECTI
8302226   DOBUTAMINE 250MG IJ                  38            83             PHARMACY SERVICES-INJECTI
8380602   DOCETAXEL 20MG IJ                                  83             PHARMACY SERVICES-INJECTI
8310302   DOLASETRON 100MG PO                 266            83             PHARMACY SERVICES-INJECTI
8302259   DOLASETRON/10 MG IJ                  43            83             PHARMACY SERVICES-INJECTI
8302242   DOLASETRON/10 MG IJ                 101            83             PHARMACY SERVICES-INJECTI




                                                Page 106
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8302234   DOLASETRON/10 MG IJ                   26            83             PHARMACY SERVICES-INJECTI
8350415   DOPAMINE 400MG/D5W 250ML              24            83             PHARMACY SERVICES-INJECTI
8313066   DOPAMINE HCL 40 MG IJ                               83             PHARMACY SERVICES-INJECTI
8302267   DOPAMINE HCL 40 MG IJ                 38            83             PHARMACY SERVICES-INJECTI
8313553   DOPAMINE HCL 40 MG IJ                               83             PHARMACY SERVICES-INJECTI
8310450   DORZOLAMIDE 2% OPH SOLN 5            150            83             PHARMACY SERVICES-INJECTI
8313074   DOXAPRAM 400MG/20ML                                 83             PHARMACY SERVICES-INJECTI
8310476   DOXAZOSIN MESYLATE 2MG                15            83             PHARMACY SERVICES-INJECTI
8380156   DOXORUBICIN 10MG IJ                  610            83             PHARMACY SERVICES-INJECTI
8380131   DOXORUBICIN 10MG IJ                                 83             PHARMACY SERVICES-INJECTI
8380115   DOXORUBICIN 10MG IJ                  587            83             PHARMACY SERVICES-INJECTI
8380735   DOXORUBICIN LIPID 10MG IJ                           83             PHARMACY SERVICES-INJECTI
8380149   DOXORUBICIN LIPID 10MG IJ             841           83             PHARMACY SERVICES-INJECTI
8370348   DOXYCYCLINE                          0.01           83             PHARMACY SERVICES-INJECTI
8350431   DOXYCYCLINE 100MG CAP UD               15           83             PHARMACY SERVICES-INJECTI
8380180   DOXYCYCLINE 100MG VIAL                 25           83             PHARMACY SERVICES-INJECTI
8311169   DOXYCYCLINE 100MG VIAL                 24           83             PHARMACY SERVICES-INJECTI
8380198   DOXYCYCLINE 100MG/PWD INJ             146           83             PHARMACY SERVICES-INJECTI
8302283   DROPERIDOL 5MG IJ                      42           83             PHARMACY SERVICES-INJECTI
8302317   DROTRECOGIN 20MG VIAL               2436            83             PHARMACY SERVICES-INJECTI
8302325   DROTRECOGIN 5MG VIAL                  280           83             PHARMACY SERVICES-INJECTI
8310732   DUONEB INHALATION SOLUTIO              74           83             PHARMACY SERVICES-INJECTI
8319030   EDROPHONIUM                                         83             PHARMACY SERVICES-INJECTI
8302333   EDROPHONIUM 100MG/10ML IN            104            83             PHARMACY SERVICES-INJECTI
8302341   EDROPHONIUM 10MG/ML                   15            83             PHARMACY SERVICES-INJECTI
8302358   EDROPHONIUM 10MG/ML INJ               67            83             PHARMACY SERVICES-INJECTI
8302366   EDROPHONIUM CL 10MG/ML                12            83             PHARMACY SERVICES-INJECTI
8302374   ENALAPRILAT 1.25MG/ML INJ             92            83             PHARMACY SERVICES-INJECTI
8302382   ENALAPRILAT 2.5MG/2ML INJ            128            83             PHARMACY SERVICES-INJECTI
8302390   ENALAPRILAT INJ 125MG/ML              22            83             PHARMACY SERVICES-INJECTI
8312175   ENOXAPARIN 10MG IJ                   184            83             PHARMACY SERVICES-INJECTI
8302424   ENOXAPARIN 10MG IJ                   104            83             PHARMACY SERVICES-INJECTI
8302416   ENOXAPARIN 10MG IJ                   215            83             PHARMACY SERVICES-INJECTI
8302457   ENOXAPARIN 40MG/.4ML INJE            120            83             PHARMACY SERVICES-INJECTI
8302473   ENOXAPARIN 60MG/0.6ML SYR            152            83             PHARMACY SERVICES-INJECTI
8302515   EPHEDRINE 50MG/ML AMP                 38            83             PHARMACY SERVICES-INJECTI
8302523   EPHEDRINE 50MG/ML INJ                 30            83             PHARMACY SERVICES-INJECTI
8302531   EPHEDRINE50MG/MLAMP1M                  1            83             PHARMACY SERVICES-INJECTI
8304404   EPINEPHRINE 1:1000 30MG/3             70            83             PHARMACY SERVICES-INJECTI
8302564   EPINEPHRINE 1MG/10ML SYRN             62            83             PHARMACY SERVICES-INJECTI
8302606   EPINEPHRINE 1ML AMP IJ                58            83             PHARMACY SERVICES-INJECTI
8380206   EPIRUBICIN 2MG IJ                   3182            83             PHARMACY SERVICES-INJECTI
8380511   EPIRUBICIN 2MG IJ                                   83             PHARMACY SERVICES-INJECTI
8330995   EPOETIN 1000U ESRD <10000            164            83             PHARMACY SERVICES-INJECTI
8313561   EPOETIN 1000U ESRD >10000                           83             PHARMACY SERVICES-INJECTI
8328932   EPOETIN NON-ESRD/1000U IJ                           83             PHARMACY SERVICES-INJECTI
8328924   EPOETIN NON-ESRD/1000U IJ                           83             PHARMACY SERVICES-INJECTI
8328916   EPOETIN NON-ESRD/1000U IJ                           83             PHARMACY SERVICES-INJECTI
8302663   EPOETIN NON-ESRD/1000U IJ             35            83             PHARMACY SERVICES-INJECTI
8302655   EPOETIN NON-ESRD/1000U IJ            146            83             PHARMACY SERVICES-INJECTI
8302648   EPOETIN NON-ESRD/1000U IJ                           83             PHARMACY SERVICES-INJECTI
8302630   EPOETIN NON-ESRD/1000U IJ                           83             PHARMACY SERVICES-INJECTI
8302622   EPOETIN NON-ESRD/1000U IJ                           83             PHARMACY SERVICES-INJECTI
8319063   EPOPROSTENOL 0.5MG IJ                               83             PHARMACY SERVICES-INJECTI
8302689   EPOPROSTENOL 0.5MG IJ                 34            83             PHARMACY SERVICES-INJECTI




                                                 Page 107
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8302671   EPOPROSTENOL 0.5MG IJ               104            83             PHARMACY SERVICES-INJECTI
8313397   EPTIFIBATIDE 5MG IJ                                83             PHARMACY SERVICES-INJECTI
8302721   EPTIFIBATIDE 5MG IJ                  611           83             PHARMACY SERVICES-INJECTI
8302713   EPTIFIBATIDE 5MG IJ                  196           83             PHARMACY SERVICES-INJECTI
8302705   EPTIFIBATIDE 5MG IJ                  196           83             PHARMACY SERVICES-INJECTI
8302697   EPTIFIBATIDE 5MG IJ                   63           83             PHARMACY SERVICES-INJECTI
8302739   ERGONOVINE MAL 0.2MG IJ                1           83             PHARMACY SERVICES-INJECTI
8302747   ERTAPENEM 500MG IJ                   228           83             PHARMACY SERVICES-INJECTI
8370322   ERTAPENEM 500MG IJ                  0.01           83             PHARMACY SERVICES-INJECTI
8302796   ERYTHROMYCIN LAC 500MG IJ            124           83             PHARMACY SERVICES-INJECTI
8302788   ERYTHROMYCIN LAC 500MG IJ             14           83             PHARMACY SERVICES-INJECTI
8302770   ERYTHROMYCIN LAC 500MG IJ            131           83             PHARMACY SERVICES-INJECTI
8370314   ERYTHROMYCIN LAC 500MG IJ           0.01           83             PHARMACY SERVICES-INJECTI
8370306   ERYTHROMYCIN LAC 500MG IJ           0.01           83             PHARMACY SERVICES-INJECTI
8302812   ESMOLOL 100MG/10ML                    50           83             PHARMACY SERVICES-INJECTI
8304420   ESMOLOL 100MG/10ML INJECT            156           83             PHARMACY SERVICES-INJECTI
8302838   ESMOLOL 100MG/ML VIAL                 12           83             PHARMACY SERVICES-INJECTI
8302846   ESMOLOL 2.5GM/10ML INJECT            286           83             PHARMACY SERVICES-INJECTI
8302853   ESMOLOL 250MG/ML INJ 10M              27           83             PHARMACY SERVICES-INJECTI
8318719   ESOMEPRAZOLE SOD                                   83             PHARMACY SERVICES-INJECTI
8313082   ESTRADIOL VAL 10MG IJ                              83             PHARMACY SERVICES-INJECTI
8302879   ESTROGEN CONJ 25 MG IJ               19            83             PHARMACY SERVICES-INJECTI
8302861   ESTROGEN CONJ 25 MG IJ              209            83             PHARMACY SERVICES-INJECTI
8350654   ESTROPIPATE                                        83             PHARMACY SERVICES-INJECTI
8302895   ETHACRYNIC ACID 50MG VIAL            15            83             PHARMACY SERVICES-INJECTI
8313579   ETHANOLOMINE 100MG IJ                              83             PHARMACY SERVICES-INJECTI
8300147   ETOH DEYD 98% 1ML NF*                46            83             PHARMACY SERVICES-INJECTI
8312795   ETOH ETHANOL 98% AMPUL                             83             PHARMACY SERVICES-INJECTI
8390080   ETOMIDATE                                          83             PHARMACY SERVICES-INJECTI
8302911   ETOMIDATE 20MG/10ML INJ              90            83             PHARMACY SERVICES-INJECTI
8302929   ETOMIDATE 2MG/ML 20ML                25            83             PHARMACY SERVICES-INJECTI
8304453   ETOPOSIDE 10MG IJ                    96            83             PHARMACY SERVICES-INJECTI
8304446   ETOPOSIDE 10MG IJ                   799            83             PHARMACY SERVICES-INJECTI
8318545   ETOPOSIDE 10MG IJ                                  83             PHARMACY SERVICES-INJECTI
8313595   ETOPOSIDE 10MG IJ                                  83             PHARMACY SERVICES-INJECTI
8313587   ETOPOSIDE 10MG IJ                                  83             PHARMACY SERVICES-INJECTI
8318602   ETOPOSIDE 50MG PO                                  83             PHARMACY SERVICES-INJECTI
8318800   EXENATIDE 1.2ML PEN                                83             PHARMACY SERVICES-INJECTI
8310534   EYE LUBE                               2           83             PHARMACY SERVICES-INJECTI
8350845   FACILITY SPEC DESCRIPTION                          83             PHARMACY SERVICES-INJECTI
8318834   FACTOR 7A RECM/1.2MG IJ                            83             PHARMACY SERVICES-INJECTI
8312944   FACTOR 8 HUMAN/IU IJ               1856            83             PHARMACY SERVICES-INJECTI
8302945   FACTOR 8 HUMAN/IU IJ               1253            83             PHARMACY SERVICES-INJECTI
8302937   FACTOR 8 HUMAN/IU IJ                 14            83             PHARMACY SERVICES-INJECTI
8350480   FACTOR 8 RECM/IU IJ                                83             PHARMACY SERVICES-INJECTI
8319246   FACTOR 9 CMPLX/IU IJ                0.01           83             PHARMACY SERVICES-INJECTI
8320855   FACTOR COMP HUMAN PER IU                           83             PHARMACY SERVICES-INJECTI
8302978   FAMOTIDINE 20MG IJ                   67            83             PHARMACY SERVICES-INJECTI
8302986   FAMOTIDINE 20MG/50ML NS             104            83             PHARMACY SERVICES-INJECTI
8312803   FENOLDOPAM MESYLATE 10MG/                          83             PHARMACY SERVICES-INJECTI
8304032   FENTANYL                             87            83             PHARMACY SERVICES-INJECTI
8304016   FENTANYL                             61            83             PHARMACY SERVICES-INJECTI
8303976   FENTANYL 0.1MG IJ                                  83             PHARMACY SERVICES-INJECTI
8303984   FENTANYL 100MCG/2ML SYR                            83             PHARMACY SERVICES-INJECTI
8304008   FENTANYL 250MCG/5ML INJ              92            83             PHARMACY SERVICES-INJECTI




                                                Page 108
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8350670   FEXOFENADINE                                       83             PHARMACY SERVICES-INJECTI
8310641   FEXOFENADINE 60 MG CAPSUL            15            83             PHARMACY SERVICES-INJECTI
8303000   FILGRASTIM 300MCG IJ                519            83             PHARMACY SERVICES-INJECTI
8302994   FILGRASTIM 300MCG IJ                162            83             PHARMACY SERVICES-INJECTI
8318875   FILGRASTIM 480MCG IJ                               83             PHARMACY SERVICES-INJECTI
8303026   FLUCONAZOL 200MG/100ML NS            90            83             PHARMACY SERVICES-INJECTI
8380214   FLUDARABINE 50MG IJ                 217            83             PHARMACY SERVICES-INJECTI
8303034   FLUMAZENIL 0.1MG/ML VIAL             29            83             PHARMACY SERVICES-INJECTI
8303042   FLUMAZENIL 1MG/10ML INJ             371            83             PHARMACY SERVICES-INJECTI
8303059   FLUORESCEIN 10% 5ML AMP               7            83             PHARMACY SERVICES-INJECTI
8380230   FLUOROURACIL 500MG IJ               504            83             PHARMACY SERVICES-INJECTI
8303067   FLUPHENAZINE DECA 25MG IJ            28            83             PHARMACY SERVICES-INJECTI
8303075   FOLIC ACID 5MG/ML 10ML               12            83             PHARMACY SERVICES-INJECTI
8303083   FOLIC ACID 5MG/ML 10ML IN            56            83             PHARMACY SERVICES-INJECTI
8350548   FOMEPIZOLE 15MG IJ                                 83             PHARMACY SERVICES-INJECTI
8313355   FONDAPARINUX 0.5MG IJ               112            83             PHARMACY SERVICES-INJECTI
8370082   FOSCARNET SOD 1000 MG IJ                           83             PHARMACY SERVICES-INJECTI
8318669   FOSPHENYTOIN 50MG IJ                               83             PHARMACY SERVICES-INJECTI
8303166   FUROSEMIDE 20MG IJ                   59            83             PHARMACY SERVICES-INJECTI
8303133   FUROSEMIDE 20MG IJ                   59            83             PHARMACY SERVICES-INJECTI
8303117   FUROSEMIDE 20MG IJ                   62            83             PHARMACY SERVICES-INJECTI
8313124   GANCICLOVIR                         208            83             PHARMACY SERVICES-INJECTI
8310518   GATIFLOXACIN 400MG TABLET            43            83             PHARMACY SERVICES-INJECTI
8380263   GEMCITABINE 200MG IJ               2044            83             PHARMACY SERVICES-INJECTI
8380255   GEMCITABINE 200MG IJ                805            83             PHARMACY SERVICES-INJECTI
8310146   GEMCITABINE 200MG IJ               1073            83             PHARMACY SERVICES-INJECTI
8303257   GENTAMICIN 80MG IJ                  117            83             PHARMACY SERVICES-INJECTI
8303240   GENTAMICIN 80MG IJ                  116            83             PHARMACY SERVICES-INJECTI
8303216   GENTAMICIN 80MG IJ                  117            83             PHARMACY SERVICES-INJECTI
8370041   GENTAMICIN 80MG/100ML NS              7            83             PHARMACY SERVICES-INJECTI
8310468   GLIPIZIDE XL 5MG TABLET              13            83             PHARMACY SERVICES-INJECTI
8303281   GLUCAGON HCL 1MG IJ                  19            83             PHARMACY SERVICES-INJECTI
8350662   GLYCOPYRROLATE                                     83             PHARMACY SERVICES-INJECTI
8319048   GLYCOPYRROLATE                                     83             PHARMACY SERVICES-INJECTI
8303315   GLYCOPYRROLATE .2MG/ML 1M            64            83             PHARMACY SERVICES-INJECTI
8303323   GLYCOPYRROLATE .2MG/ML 5M            40            83             PHARMACY SERVICES-INJECTI
8303331   GLYCOPYRROLATE 0.2MG/ML               3            83             PHARMACY SERVICES-INJECTI
8303307   GLYCOPYRROLATE 1MG/5ML IJ            81            83             PHARMACY SERVICES-INJECTI
8306045   GOSERELIN/3.6MG IMPLNT                             83             PHARMACY SERVICES-INJECTI
8303349   GRANISETRON 100MCG IJ                261           83             PHARMACY SERVICES-INJECTI
8303372   HALOPERIDOL 5MG IJ                    74           83             PHARMACY SERVICES-INJECTI
8303380   HALOPERIDOL DECA 50MG IJ              24           83             PHARMACY SERVICES-INJECTI
8319196   HEP LOCK FLUSH 10U IJ               0.01           83             PHARMACY SERVICES-INJECTI
8328940   HEP LOCK FLUSH 10U IJ                              83             PHARMACY SERVICES-INJECTI
8304503   HEPARIN 1000U IJ                     58            83             PHARMACY SERVICES-INJECTI
8304479   HEPARIN 1000U IJ                     60            83             PHARMACY SERVICES-INJECTI
8303620   HEPARIN 1000U IJ                     59            83             PHARMACY SERVICES-INJECTI
8303513   HEPARIN 1000U IJ                     59            83             PHARMACY SERVICES-INJECTI
8303505   HEPARIN 1000U IJ                                   83             PHARMACY SERVICES-INJECTI
8370140   HEPARIN 1MU/NS500 0.9%                             83             PHARMACY SERVICES-INJECTI
8312415   HETASTARCH 500ML                     47            83             PHARMACY SERVICES-INJECTI
8318750   HYALURONIDASE 150U IJ                              83             PHARMACY SERVICES-INJECTI
8313330   HYALURONIDASE 150U IJ               124            83             PHARMACY SERVICES-INJECTI
8303695   HYDRALAZINE 20MG IJ                  99            83             PHARMACY SERVICES-INJECTI
8303737   HYDROCORT NA SUC 100MG IJ             7            83             PHARMACY SERVICES-INJECTI




                                                Page 109
                                c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION             SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                   AMOUNT AMOUNT CODE

8303729   HYDROCORT NA SUC 100MG IJ           65            83             PHARMACY SERVICES-INJECTI
8303711   HYDROCORT NA SUC 100MG IJ           60            83             PHARMACY SERVICES-INJECTI
8320863   HYDROMORPHONE                                     83             PHARMACY SERVICES-INJECTI
8320780   HYDROMORPHONE 0.4MG/1ML P                         83             PHARMACY SERVICES-INJECTI
8320830   HYDROMORPHONE 4MG IJ                87            83             PHARMACY SERVICES-INJECTI
8320772   HYDROMORPHONE 4MG IJ                              83             PHARMACY SERVICES-INJECTI
8320764   HYDROMORPHONE 4MG IJ                              83             PHARMACY SERVICES-INJECTI
8320749   HYDROMORPHONE 4MG IJ                              83             PHARMACY SERVICES-INJECTI
8303794   HYDROMORPHONE 4MG IJ               181            83             PHARMACY SERVICES-INJECTI
8303786   HYDROMORPHONE 4MG IJ                 2            83             PHARMACY SERVICES-INJECTI
8303778   HYDROMORPHONE 4MG IJ                 1            83             PHARMACY SERVICES-INJECTI
8303752   HYDROMORPHONE 4MG IJ                 4            83             PHARMACY SERVICES-INJECTI
8303745   HYDROMORPHONE 4MG IJ                87            83             PHARMACY SERVICES-INJECTI
8350068   HYDROMORPHONE 6MG/60ML PC           14            83             PHARMACY SERVICES-INJECTI
8303869   HYDROXYZINE HCL                                   83             PHARMACY SERVICES-INJECTI
8303851   HYDROXYZINE HCL 25MG IJ                           83             PHARMACY SERVICES-INJECTI
8303810   HYDROXYZINE HCL 25MG IJ             59            83             PHARMACY SERVICES-INJECTI
8303836   HYDROXYZINE HCL 25MG/MLVL                         83             PHARMACY SERVICES-INJECTI
8303885   HYSKON SOLUTION 100ML 24H           133           83             PHARMACY SERVICES-INJECTI
8318784   IBANDRONATE 1MG IJ                 0.01           83             PHARMACY SERVICES-INJECTI
8380289   IBUTILIDE FUMAR 1 MG IJ             700           83             PHARMACY SERVICES-INJECTI
8312829   IC GREEN 25MG VIAL                                83             PHARMACY SERVICES-INJECTI
8380305   IFOSFAMIDE/1GM IJ                   87            83             PHARMACY SERVICES-INJECTI
8380297   IFOSFAMIDE/1GM IJ                  563            83             PHARMACY SERVICES-INJECTI
8380420   IFOSFAMIDE/1GM IJ                 4802            83             PHARMACY SERVICES-INJECTI
8303448   IG HEPATITIS B HUMAN IM                           83             PHARMACY SERVICES-INJECTI
8303430   IG HEPATITIS B HUMAN IM            387            83             PHARMACY SERVICES-INJECTI
8303398   IG HEPATITIS B HUMAN IM            959            83             PHARMACY SERVICES-INJECTI
8306094   IG IMMUNE GLOB 1CC IJ                             83             PHARMACY SERVICES-INJECTI
8306060   IG IMMUNE GLOB 1CC IJ                             83             PHARMACY SERVICES-INJECTI
8370249   IG IVIG LYOPHILIZD 500MG                          83             PHARMACY SERVICES-INJECTI
8370231   IG IVIG LYOPHILIZD 500MG                          83             PHARMACY SERVICES-INJECTI
8370223   IG IVIG LYOPHILIZD 500MG                          83             PHARMACY SERVICES-INJECTI
8370215   IG IVIG LYOPHILIZD 500MG                          83             PHARMACY SERVICES-INJECTI
8318479   IG IVIG LYOPHILIZD 500MG                          83             PHARMACY SERVICES-INJECTI
8318461   IG IVIG LYOPHILIZD 500MG                          83             PHARMACY SERVICES-INJECTI
8318453   IG IVIG LYOPHILIZD 500MG                          83             PHARMACY SERVICES-INJECTI
8318446   IG IVIG LYOPHILIZD 500MG                          83             PHARMACY SERVICES-INJECTI
8318438   IG IVIG LYOPHILIZD 500MG                          83             PHARMACY SERVICES-INJECTI
8380800   IG RABIES HEATED IM/SUBCU                         83             PHARMACY SERVICES-INJECTI
8318560   IG RABIES HEATED IM/SUBCU                         83             PHARMACY SERVICES-INJECTI
8312142   IG RABIES IM/SUBCU                 245            83             PHARMACY SERVICES-INJECTI
8309361   IG RABIES IM/SUBCU                 434            83             PHARMACY SERVICES-INJECTI
8318586   IG TETANUS 250 IU IJ                              83             PHARMACY SERVICES-INJECTI
8350092   IMIGLUCERASE/U IJ                  586            83             PHARMACY SERVICES-INJECTI
8318412   IMIPENEM/CILAST 250MG IJ                          83             PHARMACY SERVICES-INJECTI
8312076   IMIPENEM/CILAST 250MG IJ            188           83             PHARMACY SERVICES-INJECTI
8308215   IMIPENEM/CILAST 250MG IJ             25           83             PHARMACY SERVICES-INJECTI
8370397   IMIPENEM/CILAST 250MG IJ           0.01           83             PHARMACY SERVICES-INJECTI
8308983   INDIGO CARMINE .8% 5ML IN            76           83             PHARMACY SERVICES-INJECTI
8304552   INDIGO CARMINE 5ML AMP                5           83             PHARMACY SERVICES-INJECTI
8350100   INDOMETHACIN 1MG IJ                  33           83             PHARMACY SERVICES-INJECTI
8350118   INFLIXIMAB 10MG IJ                  770           83             PHARMACY SERVICES-INJECTI
8310674   INFLIXIMAB 10MG IJ                  823           83             PHARMACY SERVICES-INJECTI
8307084   INFLIXIMAB 10MG IJ                1823            83             PHARMACY SERVICES-INJECTI




                                               Page 110
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8330946   INSULIN 5 UNITS IJ                     15           83             PHARMACY SERVICES-INJECTI
8313843   INSULIN 5 UNITS IJ                   0.01           83             PHARMACY SERVICES-INJECTI
8311664   INSULIN 5 UNITS IJ                    125           83             PHARMACY SERVICES-INJECTI
8311656   INSULIN 5 UNITS IJ                    125           83             PHARMACY SERVICES-INJECTI
8311649   INSULIN 5 UNITS IJ                    125           83             PHARMACY SERVICES-INJECTI
8309478   INSULIN 5 UNITS IJ                    266           83             PHARMACY SERVICES-INJECTI
8309460   INSULIN 5 UNITS IJ                     53           83             PHARMACY SERVICES-INJECTI
8313611   INTERFERON A-2B 1000KU IJ                           83             PHARMACY SERVICES-INJECTI
8312845   INTERFERON A-2B 1000KU IJ                           83             PHARMACY SERVICES-INJECTI
8309569   INTERFERON A-2B 1000KU IJ            760            83             PHARMACY SERVICES-INJECTI
8313629   INTERFERON B-1A 11MCG IM                            83             PHARMACY SERVICES-INJECTI
8312852   INTERFERON B-1A 11MCG IM                            83             PHARMACY SERVICES-INJECTI
8312738   INTERFERON B-1A 11MCG IM             356            83             PHARMACY SERVICES-INJECTI
8318651   INTERFERON B-1B O.25MG IJ                           83             PHARMACY SERVICES-INJECTI
8312035   IPRATROPIUM .02% 2.5ML IN             17            83             PHARMACY SERVICES-INJECTI
8380461   IRINOTECAN 20MG IJ                   373            83             PHARMACY SERVICES-INJECTI
8308991   IRON DEXTRAN 267 50 MG IJ            112            83             PHARMACY SERVICES-INJECTI
8309445   IRON SUCROSE 1MG IJ                  182            83             PHARMACY SERVICES-INJECTI
8308926   ISOETHERINE 1% 0.5ML                   1            83             PHARMACY SERVICES-INJECTI
8308934   ISOFLURANE 100ML                      70            83             PHARMACY SERVICES-INJECTI
8309007   ISOFLURANE 100ML INH SLN              85            83             PHARMACY SERVICES-INJECTI
8308298   ISOPROTERENOL 1MG/5ML AM               3            83             PHARMACY SERVICES-INJECTI
8304842   ISOPROTERENOL 5ML ADD SY               8            83             PHARMACY SERVICES-INJECTI
8310765   ISOSULFAN BLUE 1% INJ NF             480            83             PHARMACY SERVICES-INJECTI
8307100   ISOSULFAN BLUE 1% INJ NF             194            83             PHARMACY SERVICES-INJECTI
8309577   ISOSULFAN BLUE 1% VIAL                70            83             PHARMACY SERVICES-INJECTI
8313637   ITRACONAZOLE 50 MG IJ                               83             PHARMACY SERVICES-INJECTI
8313090   ITRACONAZOLE 50 MG IJ                               83             PHARMACY SERVICES-INJECTI
8307118   ITRACONAZOLE 50 MG IJ                585            83             PHARMACY SERVICES-INJECTI
8311862   K ACET                                              83             PHARMACY SERVICES-INJECTI
8311854   K ACET 40MEQ/20ML                     61            83             PHARMACY SERVICES-INJECTI
8311672   K ACET 40MEQ/20ML IJ                  34            83             PHARMACY SERVICES-INJECTI
8311680   K CL /2MEQ INJ                        28            83             PHARMACY SERVICES-INJECTI
8312027   K CL 10% LIQ UD                       15            83             PHARMACY SERVICES-INJECTI
8308819   K CL 10MEQ/WATER 100ML PB             50            83             PHARMACY SERVICES-INJECTI
8390064   K CL 20MEQ PKT                                      83             PHARMACY SERVICES-INJECTI
8330086   K IODIDE SOLN 30ML                     4            83             PHARMACY SERVICES-INJECTI
8311706   K PHOS 3MM/ML 15ML IJ                 29            83             PHARMACY SERVICES-INJECTI
8330094   K PHOS 3MM/ML INJ                     56            83             PHARMACY SERVICES-INJECTI
8330102   K PHOS 3MM/ML VIAL                     4            83             PHARMACY SERVICES-INJECTI
8310294   KALETRA CAPSULE                       35            83             PHARMACY SERVICES-INJECTI
8310989   KANAMYCIN 500MG IJ                    25            83             PHARMACY SERVICES-INJECTI
8308306   KETAMINE 100MG/ML 5ML                 59            83             PHARMACY SERVICES-INJECTI
8304883   KETAMINE 100MG/ML VIAL                16            83             PHARMACY SERVICES-INJECTI
8309510   KETAMINE 50MG/ML 10ML                 17            83             PHARMACY SERVICES-INJECTI
8311698   KETAMINE HCL 50MG 10ML IN             92            83             PHARMACY SERVICES-INJECTI
8304933   KETOROLAC 15MG IJ                     66            83             PHARMACY SERVICES-INJECTI
8304925   KETOROLAC 15MG IJ                      7            83             PHARMACY SERVICES-INJECTI
8304891   KETOROLAC 15MG IJ                     57            83             PHARMACY SERVICES-INJECTI
8330458   LABETALOL 100MG/20ML INJ                            83             PHARMACY SERVICES-INJECTI
8330169   LABETALOL 100MG/20ML INJ                            83             PHARMACY SERVICES-INJECTI
8309601   LABETALOL 100MG/20ML VIA              75            83             PHARMACY SERVICES-INJECTI
8309619   LABETALOL 200MG/20ML VIA              57            83             PHARMACY SERVICES-INJECTI
8370058   LACTATED RINGERS 1000ML               88            83             PHARMACY SERVICES-INJECTI
8310815   LAMIVUDINE 150MG TAB                  21            83             PHARMACY SERVICES-INJECTI




                                                 Page 111
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8318701   LANSOPRAZOLE                                        83             PHARMACY SERVICES-INJECTI
8310310   LANSOPRAZOLE 15MG CAPSL               26            83             PHARMACY SERVICES-INJECTI
8350142   LEUCOVORIN/50MG IJ                    39            83             PHARMACY SERVICES-INJECTI
8312498   LEUPROLIDE 30MG DEPOT               3048            83             PHARMACY SERVICES-INJECTI
8312886   LEUPROLIDE 7.5MG IJ                                 83             PHARMACY SERVICES-INJECTI
8312860   LEUPROLIDE 7.5MG IJ                                 83             PHARMACY SERVICES-INJECTI
8318826   LEUPROLIDE/3.75MG IJ                                83             PHARMACY SERVICES-INJECTI
8312878   LEUPROLIDE/3.75MG IJ                                83             PHARMACY SERVICES-INJECTI
8319071   LEVETIRACETAM 250MG IJ               0.01           83             PHARMACY SERVICES-INJECTI
8309635   LEVOCARNITINE 1GM VIAL                 44           83             PHARMACY SERVICES-INJECTI
8312472   LEVOFLOX 250MG/50ML D5W               164           83             PHARMACY SERVICES-INJECTI
8308876   LEVOFLOX 250MG/50ML D5W                25           83             PHARMACY SERVICES-INJECTI
8309452   LEVOFLOX 500MG/100ML D5W              215           83             PHARMACY SERVICES-INJECTI
8308884   LEVOFLOX 500MG/100ML D5W               50           83             PHARMACY SERVICES-INJECTI
8313736   LEVOFLOX 750MG/150ML D5W                            83             PHARMACY SERVICES-INJECTI
8350464   LEVOFLOXACIN 0.5% SOLUTI             134            83             PHARMACY SERVICES-INJECTI
8309387   LEVOFLOXACIN 250MG IJ                 98            83             PHARMACY SERVICES-INJECTI
8330466   LEVOTHYROXINE 200MCG INJ              74            83             PHARMACY SERVICES-INJECTI
8309650   LEVOTHYROXINE 200MCG VIAL             53            83             PHARMACY SERVICES-INJECTI
8308561   LIDO/DEXTROSE 2GM 250ML               13            83             PHARMACY SERVICES-INJECTI
8311722   LIDO/DEXTROSE 5% 7.5% 2ML             63            83             PHARMACY SERVICES-INJECTI
8309668   LIDO/DEXTROSE 5% W/DEXT 2              3            83             PHARMACY SERVICES-INJECTI
8309676   LIDO/EPI 0.5% 50M                      3            83             PHARMACY SERVICES-INJECTI
8311730   LIDO/EPI 0.5% 50ML IJ                 87            83             PHARMACY SERVICES-INJECTI
8309684   LIDO/EPI 1% 30ML                       1            83             PHARMACY SERVICES-INJECTI
8309692   LIDO/EPI 1% 30ML D                     5            83             PHARMACY SERVICES-INJECTI
8309700   LIDO/EPI 1% 30ML D2                    6            83             PHARMACY SERVICES-INJECTI
8330292   LIDO/EPI 1% 50ML INJ                  62            83             PHARMACY SERVICES-INJECTI
8330490   LIDO/EPI 1% 50ML INJ                                83             PHARMACY SERVICES-INJECTI
8305187   LIDO/EPI 1% INJ 10ML                  63            83             PHARMACY SERVICES-INJECTI
8330508   LIDO/EPI 1% INJ 10ML                                83             PHARMACY SERVICES-INJECTI
8331043   LIDO/EPI 1% INJ 30ML                                83             PHARMACY SERVICES-INJECTI
8309718   LIDO/EPI 1.5% 30M                       6           83             PHARMACY SERVICES-INJECTI
8330979   LIDO/EPI 1:100000                                   83             PHARMACY SERVICES-INJECTI
8309726   LIDO/EPI 2% 20ML                       7            83             PHARMACY SERVICES-INJECTI
8309023   LIDO/EPI 2% 20ML STERI SD            230            83             PHARMACY SERVICES-INJECTI
8309734   LIDO/EPI 2% 30ML                       1            83             PHARMACY SERVICES-INJECTI
8305195   LIDO/EPI 2% 50ML INJ                  59            83             PHARMACY SERVICES-INJECTI
8330516   LIDO/EPI 2% 50ML INJ                                83             PHARMACY SERVICES-INJECTI
8307175   LIDO/EPI 25 INJ                       60            83             PHARMACY SERVICES-INJECTI
8309031   LIDO/EPI MPF 2% 20ML                  90            83             PHARMACY SERVICES-INJECTI
8312225   LIDOCAINE                             49            83             PHARMACY SERVICES-INJECTI
8312019   LIDOCAINE          1                  89            83             PHARMACY SERVICES-INJECTI
8309742   LIDOCAINE 0.5% 50ML MDV                6            83             PHARMACY SERVICES-INJECTI
8308314   LIDOCAINE 0.5% 50ML SDV               30            83             PHARMACY SERVICES-INJECTI
8330474   LIDOCAINE 1% 10ML INJ                               83             PHARMACY SERVICES-INJECTI
8307183   LIDOCAINE 1% 2ML INJ                                83             PHARMACY SERVICES-INJECTI
8305039   LIDOCAINE 1% 2ML VIAL                  1            83             PHARMACY SERVICES-INJECTI
8305047   LIDOCAINE 1% 30ML AMP                  7            83             PHARMACY SERVICES-INJECTI
8305054   LIDOCAINE 1% 5ML VIAL                 23            83             PHARMACY SERVICES-INJECTI
8310898   LIDOCAINE 1% 5ML VIAL                 23            83             PHARMACY SERVICES-INJECTI
8350522   LIDOCAINE 10MG IV                                   83             PHARMACY SERVICES-INJECTI
8331035   LIDOCAINE 10MG IV                                   83             PHARMACY SERVICES-INJECTI
8330250   LIDOCAINE 10MG IV                       6           83             PHARMACY SERVICES-INJECTI
8319204   LIDOCAINE 10MG IV                    0.01           83             PHARMACY SERVICES-INJECTI




                                                 Page 112
                                      c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                   SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                         AMOUNT AMOUNT CODE

8319113   LIDOCAINE 10MG IV                        0.01           83             PHARMACY SERVICES-INJECTI
8318776   LIDOCAINE 10MG IV                                       83             PHARMACY SERVICES-INJECTI
8313108   LIDOCAINE 10MG IV                                       83             PHARMACY SERVICES-INJECTI
8313041   LIDOCAINE 10MG IV                                       83             PHARMACY SERVICES-INJECTI
8313033   LIDOCAINE 10MG IV                                       83             PHARMACY SERVICES-INJECTI
8312894   LIDOCAINE 10MG IV                                       83             PHARMACY SERVICES-INJECTI
8311748   LIDOCAINE 10MG IV                         59            83             PHARMACY SERVICES-INJECTI
8309783   LIDOCAINE 10MG IV                          4            83             PHARMACY SERVICES-INJECTI
8309759   LIDOCAINE 10MG IV                          1            83             PHARMACY SERVICES-INJECTI
8309015   LIDOCAINE 10MG IV                         62            83             PHARMACY SERVICES-INJECTI
8305179   LIDOCAINE 10MG IV                         58            83             PHARMACY SERVICES-INJECTI
8305112   LIDOCAINE 10MG IV                         63            83             PHARMACY SERVICES-INJECTI
8305096   LIDOCAINE 10MG IV                          8            83             PHARMACY SERVICES-INJECTI
8305062   LIDOCAINE 10MG IV                         48            83             PHARMACY SERVICES-INJECTI
8305013   LIDOCAINE 10MG IV                                       83             PHARMACY SERVICES-INJECTI
8309767   LIDOCAINE 2%                               4            83             PHARMACY SERVICES-INJECTI
8305088   LIDOCAINE 2% 100MG/5ML SY                 85            83             PHARMACY SERVICES-INJECTI
8310831   LIDOCAINE 2% 10ML AMP                      8            83             PHARMACY SERVICES-INJECTI
8309775   LIDOCAINE 2% 30ML MDV                      1            83             PHARMACY SERVICES-INJECTI
8311714   LIDOCAINE 2% 50ML FTOP IN                 69            83             PHARMACY SERVICES-INJECTI
8309296   LIDOCAINE 2% JELLY 5ML UD                 34            83             PHARMACY SERVICES-INJECTI
8307191   LIDOCAINE 2% MPF INJ 5ML                  76            83             PHARMACY SERVICES-INJECTI
8305120   LIDOCAINE 2GM VIAL 50ML                    3            83             PHARMACY SERVICES-INJECTI
8305211   LIDOCAINE 4% 1GM/25ML INJ                 59            83             PHARMACY SERVICES-INJECTI
8305161   LIDOCAINE MPF 1% 30ML INJ                105            83             PHARMACY SERVICES-INJECTI
8330482   LIDOCAINE MPF 1% 30ML INJ                116            83             PHARMACY SERVICES-INJECTI
8307209   LIDOCAINE PF 1% 5ML INJ                                 83             PHARMACY SERVICES-INJECTI
8305021   LIDOCAINE1% 2ML INJ                        74           83             PHARMACY SERVICES-INJECTI
8350167   LINEZOLID/200MG IJ                         80           83             PHARMACY SERVICES-INJECTI
8312316   LINEZOLID/200MG IJ                        126           83             PHARMACY SERVICES-INJECTI
8310419   LINEZOLID/200MG IJ                        303           83             PHARMACY SERVICES-INJECTI
8309049   LIPID EMULSION 10% 500ML                  112           83             PHARMACY SERVICES-INJECTI
8308553   LIPID EMULSION 10% 500ML                   45           83             PHARMACY SERVICES-INJECTI
8308629   LIPID EMULSION 120ML                        3           83             PHARMACY SERVICES-INJECTI
8309056   LIPID EMULSION 20% 500ML                  152           83             PHARMACY SERVICES-INJECTI
8330300   LORAZEPAM 2MG IJ                          223           83             PHARMACY SERVICES-INJECTI
8329013   LORAZEPAM 2MG IJ                         0.01           83             PHARMACY SERVICES-INJECTI
8311755   LORAZEPAM 2MG IJ                           91           83             PHARMACY SERVICES-INJECTI
8310799   LOVASTATIN 20MG TAB                        20           83             PHARMACY SERVICES-INJECTI
8312118   MAG ALOH SIMETH                             7           83             PHARMACY SERVICES-INJECTI
8350613   MAG GLUC                                                83             PHARMACY SERVICES-INJECTI
8350605   MAG HYDROXIDE                                           83             PHARMACY SERVICES-INJECTI
8311813   MAG SO4                                   54            83             PHARMACY SERVICES-INJECTI
8308322   MAG SO4 50% 10ML                           3            83             PHARMACY SERVICES-INJECTI
8313165   MAG SO4 50% 1GM 2ML VIAL                  89            83             PHARMACY SERVICES-INJECTI
8311771   MAG SO4 50% 5G/10ML IJ                    55            83             PHARMACY SERVICES-INJECTI
8311789   MAG SO4 IN PPN                                          83             PHARMACY SERVICES-INJECTI
8312340   MAG SO4 IN TPN                                          83             PHARMACY SERVICES-INJECTI
8312720   MAGNESIUM SO4 500MG IJ                      1           83             PHARMACY SERVICES-INJECTI
8308892   MAGNESIUM SO4 500MG IJ                                  83             PHARMACY SERVICES-INJECTI
8318958   MAGNESIUM SO4 500MG IJ                                  83             PHARMACY SERVICES-INJECTI
8308231   MANNITOL 12.5GM/50ML VIA                   2            83             PHARMACY SERVICES-INJECTI
8308249   MANNITOL 20% 500ML                        62            83             PHARMACY SERVICES-INJECTI
8305302   MANNITOL 20% 500ML INJ BA                128            83             PHARMACY SERVICES-INJECTI
8305310   MANNITOL 25% 50ML IJ                      33            83             PHARMACY SERVICES-INJECTI




                                                     Page 113
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8307225   MANNITOL 25% 50ML INJECT                           83             PHARMACY SERVICES-INJECTI
8380594   MECHLORETHAMINE 10MG IJ                            83             PHARMACY SERVICES-INJECTI
8390072   MEDROXYPROGESTER 50MG IJ             30            83             PHARMACY SERVICES-INJECTI
8309064   MEDROXYPROGESTER 50MG IJ            188            83             PHARMACY SERVICES-INJECTI
8313645   MEDROXYPROGESTER 50MG IJ                           83             PHARMACY SERVICES-INJECTI
8309379   MEGESTROL ACETATE 2OMG PO            16            83             PHARMACY SERVICES-INJECTI
8320624   MEPERIDINE 100MG IJ                  23            83             PHARMACY SERVICES-INJECTI
8307266   MEPERIDINE 100MG IJ                  59            83             PHARMACY SERVICES-INJECTI
8307258   MEPERIDINE 100MG IJ                  59            83             PHARMACY SERVICES-INJECTI
8307241   MEPERIDINE 100MG IJ                                83             PHARMACY SERVICES-INJECTI
8307233   MEPERIDINE 100MG IJ                  87            83             PHARMACY SERVICES-INJECTI
8320632   MEPERIDINE 100MG IJ                  23            83             PHARMACY SERVICES-INJECTI
8318966   MEPERIDINE 100MG IJ                                83             PHARMACY SERVICES-INJECTI
8330326   MEPIVACAINE 10ML IJ                   5            83             PHARMACY SERVICES-INJECTI
8330318   MEPIVACAINE 10ML IJ                  75            83             PHARMACY SERVICES-INJECTI
8331019   MEPIVACAINE 10ML IJ                                83             PHARMACY SERVICES-INJECTI
8313652   MEROPENEM 100 MG IJ                                83             PHARMACY SERVICES-INJECTI
8307282   MEROPENEM 100 MG IJ                  29            83             PHARMACY SERVICES-INJECTI
8307274   MEROPENEM 100 MG IJ                 253            83             PHARMACY SERVICES-INJECTI
8380321   MESNA 200MG IJ                     5925            83             PHARMACY SERVICES-INJECTI
8350175   MESNA 200MG IJ                       13            83             PHARMACY SERVICES-INJECTI
8312217   MESNA 200MG IJ                     4802            83             PHARMACY SERVICES-INJECTI
8310245   MESNA 200MG IJ                     6528            83             PHARMACY SERVICES-INJECTI
8305351   MESNA 200MG IJ                      923            83             PHARMACY SERVICES-INJECTI
8350555   MESNA 200MG IJ                                     83             PHARMACY SERVICES-INJECTI
8310401   MESNA 200MG IJ                     4330            83             PHARMACY SERVICES-INJECTI
8307308   METHACHOLINE 100MG INJ              176            83             PHARMACY SERVICES-INJECTI
8320319   METHADONE 10 MG IJ                   14            83             PHARMACY SERVICES-INJECTI
8311805   METHOHEXITAL 500MG 50ML I                          83             PHARMACY SERVICES-INJECTI
8309817   METHOHEXITAL 500MG VIAL               9            83             PHARMACY SERVICES-INJECTI
8380370   METHOTREXATE 5MG IJ                 532            83             PHARMACY SERVICES-INJECTI
8350183   METHOTREXATE 5MG IJ                 565            83             PHARMACY SERVICES-INJECTI
8309825   METHOTREXATE 5MG IJ                  36            83             PHARMACY SERVICES-INJECTI
8318859   METHYLDOPATE 250MG IJ                              83             PHARMACY SERVICES-INJECTI
8309098   METHYLENE BLUE 1ML IJ                55            83             PHARMACY SERVICES-INJECTI
8305419   METHYLENE BLUE 1ML IJ                 3            83             PHARMACY SERVICES-INJECTI
8309072   METHYLERGONOVINE 0.2MG IJ            68            83             PHARMACY SERVICES-INJECTI
8309122   METHYLPRED ACET 20MG IJ              86            83             PHARMACY SERVICES-INJECTI
8309114   METHYLPRED ACET 20MG IJ              75            83             PHARMACY SERVICES-INJECTI
8319006   METHYLPRED ACET 80MG IJ                            83             PHARMACY SERVICES-INJECTI
8312423   METHYLPRED SUCC 125MG IJ             36            83             PHARMACY SERVICES-INJECTI
8309080   METHYLPRED SUCC 125MG IJ                           83             PHARMACY SERVICES-INJECTI
8307316   METHYLPRED SUCC 125MG IJ                           83             PHARMACY SERVICES-INJECTI
8309106   METHYLPRED SUCC 40MG IJ              62            83             PHARMACY SERVICES-INJECTI
8350688   METIPRANOLOL                                       83             PHARMACY SERVICES-INJECTI
8309130   METOCLOPRAMIDE 10MG IJ               60            83             PHARMACY SERVICES-INJECTI
8305484   METOPROLOL 1MG/ML AMP 5M              4            83             PHARMACY SERVICES-INJECTI
8309841   METOPROLOL 5MG/5ML AMP               42            83             PHARMACY SERVICES-INJECTI
8307324   METOPROLOL 5MG/5ML INJ                             83             PHARMACY SERVICES-INJECTI
8305500   METOPROLOL 5MG/5ML INJ                67           83             PHARMACY SERVICES-INJECTI
8309148   METRONIDAZOLE 500MG IJ               120           83             PHARMACY SERVICES-INJECTI
8319154   METRONIDAZOLE 500MG IJ              0.01           83             PHARMACY SERVICES-INJECTI
8320756   MIDAZOLAM 1MG IJ                     311           83             PHARMACY SERVICES-INJECTI
8320343   MIDAZOLAM 1MG IJ                                   83             PHARMACY SERVICES-INJECTI
8320335   MIDAZOLAM 1MG IJ                       7           83             PHARMACY SERVICES-INJECTI




                                                Page 114
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8311821   MIDAZOLAM 1MG IJ                                    83             PHARMACY SERVICES-INJECTI
8310435   MIDAZOLAM 1MG IJ                       93           83             PHARMACY SERVICES-INJECTI
8320822   MIDAZOLAM 50MG/10ML VIAL              316           83             PHARMACY SERVICES-INJECTI
8319105   MILRINONE/5MG IJ                     0.01           83             PHARMACY SERVICES-INJECTI
8308827   MILRINONE/5MG IJ                                    83             PHARMACY SERVICES-INJECTI
8310690   MIRTAZAPINE 15MG TAB                  21            83             PHARMACY SERVICES-INJECTI
8307340   MISC INJECTION                        22            83             PHARMACY SERVICES-INJECTI
8350423   MISC OTHER DRUG                                     83             PHARMACY SERVICES-INJECTI
8350852   MISC OTHER DRUG                      0.01           83             PHARMACY SERVICES-INJECTI
8380685   MITOMYCIN 5MG IJ                                    83             PHARMACY SERVICES-INJECTI
8380677   MITOMYCIN 5MG IJ                     780            83             PHARMACY SERVICES-INJECTI
8380529   MITOMYCIN 5MG IJ                    1163            83             PHARMACY SERVICES-INJECTI
8380792   MITOMYCIN 5MG IJ                                    83             PHARMACY SERVICES-INJECTI
8350209   MITOXANTRONE/5MG IJ                  672            83             PHARMACY SERVICES-INJECTI
8305534   MIVACURIUM 2MG/ML VIAL                48            83             PHARMACY SERVICES-INJECTI
8350217   MORPHINE 10MG IJ                      14            83             PHARMACY SERVICES-INJECTI
8328965   MORPHINE 10MG IJ                                    83             PHARMACY SERVICES-INJECTI
8320798   MORPHINE 10MG IJ                                    83             PHARMACY SERVICES-INJECTI
8320566   MORPHINE 10MG IJ                      14            83             PHARMACY SERVICES-INJECTI
8320558   MORPHINE 10MG IJ                       4            83             PHARMACY SERVICES-INJECTI
8320442   MORPHINE 10MG IJ                     685            83             PHARMACY SERVICES-INJECTI
8320434   MORPHINE 10MG IJ                      59            83             PHARMACY SERVICES-INJECTI
8320426   MORPHINE 10MG IJ                      87            83             PHARMACY SERVICES-INJECTI
8320418   MORPHINE 10MG IJ                      87            83             PHARMACY SERVICES-INJECTI
8309866   MORPHINE 10MG IJ                       1            83             PHARMACY SERVICES-INJECTI
8320392   MORPHINE 10MG/5ML SOL UD              87            83             PHARMACY SERVICES-INJECTI
8320459   MORPHINE 20MG/ML ORAL SOL             86            83             PHARMACY SERVICES-INJECTI
8320871   MORPHINE LIPO                                       83             PHARMACY SERVICES-INJECTI
8320491   MORPHINE PCA 50MG/50ML SY            167            83             PHARMACY SERVICES-INJECTI
8320848   MORPHINE PF 10MG IJ                  109            83             PHARMACY SERVICES-INJECTI
8320525   MORPHINE PF 10MG IJ                  158            83             PHARMACY SERVICES-INJECTI
8320574   MORPHINE SOLN 20MG/ML                               83             PHARMACY SERVICES-INJECTI
8312159   MORRHUATE 5% 30ML                     195           83             PHARMACY SERVICES-INJECTI
8310260   MVI-12                                 44           83             PHARMACY SERVICES-INJECTI
8305542   MVI-12 10ML VIAL                        2           83             PHARMACY SERVICES-INJECTI
8313256   MYCOPHENOLATE 500MG VIAL               41           83             PHARMACY SERVICES-INJECTI
8312449   NA ACET                                80           83             PHARMACY SERVICES-INJECTI
8311896   NA ACET                                91           83             PHARMACY SERVICES-INJECTI
8307787   NA ACET 2MEQ/ML INJEC                  62           83             PHARMACY SERVICES-INJECTI
8319147   NA BICARB                            0.01           83             PHARMACY SERVICES-INJECTI
8311920   NA BICARB 50MEQ/50ML                   58           83             PHARMACY SERVICES-INJECTI
8311904   NA BICARB 4.2% SYRNG                   64           83             PHARMACY SERVICES-INJECTI
8305559   NA BICARB 4.2% 10ML SYR                 6           83             PHARMACY SERVICES-INJECTI
8313819   NA BICARB 4.2% VIAL                                 83             PHARMACY SERVICES-INJECTI
8306664   NA BICARB 7.5% 50ML SYRI              66            83             PHARMACY SERVICES-INJECTI
8305567   NA BICARB 8.4% 10ML SYR                             83             PHARMACY SERVICES-INJECTI
8308256   NA BICARB 8.4% 50ML SDV                2            83             PHARMACY SERVICES-INJECTI
8305591   NA BICARB 8.4% 50ML SYR               13            83             PHARMACY SERVICES-INJECTI
8305583   NA BICARB 8.4% 50ML SYR               49            83             PHARMACY SERVICES-INJECTI
8306672   NA BICARB INJ 50MEQ/50ML              75            83             PHARMACY SERVICES-INJECTI
8311987   NA BIPHOSPHATE                                      83             PHARMACY SERVICES-INJECTI
8311946   NA BIPHOSPHATE                        97            83             PHARMACY SERVICES-INJECTI
8330581   NA BIPHOSPHATE                        32            83             PHARMACY SERVICES-INJECTI
8309874   NA BIPHOSPHATE 3MM/ML VL               4            83             PHARMACY SERVICES-INJECTI
8350530   NA CL                                               83             PHARMACY SERVICES-INJECTI




                                                 Page 115
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8319014   NA CL                                              83             PHARMACY SERVICES-INJECTI
8309320   NA CL 0.9% 100ML                     88            83             PHARMACY SERVICES-INJECTI
8307795   NA CL 0.9% 100ML                     60            83             PHARMACY SERVICES-INJECTI
8370256   NA CL 0.9% 100ML                                   83             PHARMACY SERVICES-INJECTI
8313181   NA CL 0.9% 250ML BAG ADDV             6            83             PHARMACY SERVICES-INJECTI
8312282   NA CL 0.9% 500ML                    359            83             PHARMACY SERVICES-INJECTI
8370298   NA CL 0.9% 500ML                                   83             PHARMACY SERVICES-INJECTI
8370264   NA CL 0.9% 50ML                                    83             PHARMACY SERVICES-INJECTI
8305609   NA CL 0.9% INJ 10ML VIA                1           83             PHARMACY SERVICES-INJECTI
8306698   NA CL 10% SOL 15ML UD                 15           83             PHARMACY SERVICES-INJECTI
8308801   NA CL 1000ML/KCL 20                   84           83             PHARMACY SERVICES-INJECTI
8310716   NA CL IRRIG 500ML                     74           83             PHARMACY SERVICES-INJECTI
8309437   NA CL IRRIG 500ML                    118           83             PHARMACY SERVICES-INJECTI
8310583   NA CL SODIUM CHLORIDE 4ME             32           83             PHARMACY SERVICES-INJECTI
8303877   NA HYALURON/CHRON                     27           83             PHARMACY SERVICES-INJECTI
8305666   NA HYALURONATE HEALON5               174           83             PHARMACY SERVICES-INJECTI
8303653   NA HYALURONATE HEALON5               446           83             PHARMACY SERVICES-INJECTI
8311557   NAFCILLIN 1GM AD-VT                    9           83             PHARMACY SERVICES-INJECTI
8370389   NAFCILLIN 2GM IJ                    0.01           83             PHARMACY SERVICES-INJECTI
8370371   NAFCILLIN 2GM IJ                    0.01           83             PHARMACY SERVICES-INJECTI
8311573   NAFCILLIN 2GM IJ                      18           83             PHARMACY SERVICES-INJECTI
8308157   NAFCILLIN 2GM IJ                      18           83             PHARMACY SERVICES-INJECTI
8308132   NAFCILLIN 2GM IJ                       9           83             PHARMACY SERVICES-INJECTI
8305716   NALBUPHINE 10MG IJ                     3           83             PHARMACY SERVICES-INJECTI
8318396   NALMEFENE                                          83             PHARMACY SERVICES-INJECTI
8330375   NALOXONE 1MG IJ                     156            83             PHARMACY SERVICES-INJECTI
8305781   NALOXONE 1MG IJ                      60            83             PHARMACY SERVICES-INJECTI
8305773   NALOXONE 1MG IJ                      68            83             PHARMACY SERVICES-INJECTI
8310484   NAPHAZOLONE                          83            83             PHARMACY SERVICES-INJECTI
8313660   NATALIZUMAB 1MG INJ                                83             PHARMACY SERVICES-INJECTI
8313298   NATALIZUMAB 1MG INJ                2515            83             PHARMACY SERVICES-INJECTI
8305807   NEOSPORIN GU IRRIG                  134            83             PHARMACY SERVICES-INJECTI
8309155   NEOSTIGMINE 0.5 MG IJ                68            83             PHARMACY SERVICES-INJECTI
8318511   NESIRITIDE 0.1 MG IJ                               83             PHARMACY SERVICES-INJECTI
8313678   NESIRITIDE 0.1 MG IJ                               83             PHARMACY SERVICES-INJECTI
8307407   NESIRITIDE 0.1 MG IJ               1158            83             PHARMACY SERVICES-INJECTI
8305823   NICARDIPINE 2.5MG/ML VIAL            75            83             PHARMACY SERVICES-INJECTI
8312951   NICARDIPINE 25MG AMPULE             109            83             PHARMACY SERVICES-INJECTI
8350647   NITAZOXANIDE                                       83             PHARMACY SERVICES-INJECTI
8310856   NITROPRUSSIDE 50MG VIAL               2            83             PHARMACY SERVICES-INJECTI
8309940   NITROPRUSSIDE 50MG VIAL               2            83             PHARMACY SERVICES-INJECTI
8308389   NITROPRUSSIDE 50MG/2ML                6            83             PHARMACY SERVICES-INJECTI
8311839   NITROPRUSSIDE SOD 50MG IN            65            83             PHARMACY SERVICES-INJECTI
8309957   NOREPINEPHRINE 4MG AMP                5            83             PHARMACY SERVICES-INJECTI
8309171   NOREPINEPHRINE 4MG/4ML IN            81            83             PHARMACY SERVICES-INJECTI
8308363   NTG 50MG/10ML                         8            83             PHARMACY SERVICES-INJECTI
8309163   NTG 50MG/10ML I                      60            83             PHARMACY SERVICES-INJECTI
8308371   NTG 8MG/10ML                          7            83             PHARMACY SERVICES-INJECTI
8313686   OCTREOTIDE NON DEPO 25MCG                          83             PHARMACY SERVICES-INJECTI
8312100   OCTREOTIDE NON DEPO 25MCG           541            83             PHARMACY SERVICES-INJECTI
8307423   OCTREOTIDE NON DEPO 25MCG             9            83             PHARMACY SERVICES-INJECTI
8305906   OCTREOTIDE NON DEPO 25MCG           173            83             PHARMACY SERVICES-INJECTI
8305880   OCTREOTIDE NON DEPO 25MCG           100            83             PHARMACY SERVICES-INJECTI
8312753   OLANZAPINE 2.5MG IJ                  25            83             PHARMACY SERVICES-INJECTI
8350597   OLOPATADINE                                        83             PHARMACY SERVICES-INJECTI




                                                Page 116
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8318792   OMALIZUMAB PER 5MG IJ                               83             PHARMACY SERVICES-INJECTI
8330953   ONDANSETRON/1MG IJ                   278            83             PHARMACY SERVICES-INJECTI
8313694   ONDANSETRON/1MG IJ                                  83             PHARMACY SERVICES-INJECTI
8307456   ONDANSETRON/1MG IJ                    82            83             PHARMACY SERVICES-INJECTI
8305914   ONDANSETRON/1MG IJ                   117            83             PHARMACY SERVICES-INJECTI
8390056   OPIUM TINCTURE TINCTURE                             83             PHARMACY SERVICES-INJECTI
8310427   OPRELVEKIN 5MG IJ                    738            83             PHARMACY SERVICES-INJECTI
8307480   OPRELVEKIN 5MG IJ                    281            83             PHARMACY SERVICES-INJECTI
8307472   OPRELVEKIN 5MG IJ                    354            83             PHARMACY SERVICES-INJECTI
8305930   ORPHENADRINE 60MG IJ                 140            83             PHARMACY SERVICES-INJECTI
8380636   OXALIPLATIN 0.5MG IJ                4922            83             PHARMACY SERVICES-INJECTI
8380784   OXALIPLATIN 0.5MG IJ                                83             PHARMACY SERVICES-INJECTI
8380743   OXALIPLATIN 0.5MG IJ                                83             PHARMACY SERVICES-INJECTI
8305948   OXYTOCIN 1OU IJ                       59            83             PHARMACY SERVICES-INJECTI
8380545   PACLITAXEL 30MG IJ                                  83             PHARMACY SERVICES-INJECTI
8380537   PACLITAXEL 30MG IJ                                  83             PHARMACY SERVICES-INJECTI
8350225   PACLITAXEL 30MG IJ                   218            83             PHARMACY SERVICES-INJECTI
8307522   PACLITAXEL 30MG IJ                   876            83             PHARMACY SERVICES-INJECTI
8307514   PACLITAXEL 30MG IJ                  1768            83             PHARMACY SERVICES-INJECTI
8350571   PACLITAXEL 30MG IJ                                  83             PHARMACY SERVICES-INJECTI
8350563   PACLITAXEL 30MG IJ                                  83             PHARMACY SERVICES-INJECTI
8350241   PALIVIZUMAB/50MG IJ                  835            83             PHARMACY SERVICES-INJECTI
8350233   PALIVIZUMAB/50MG IJ                 1470            83             PHARMACY SERVICES-INJECTI
8350506   PALIVIZUMAB/50MG IJ                                 83             PHARMACY SERVICES-INJECTI
8312670   PALONOSETRON INJ 25 MCG              360            83             PHARMACY SERVICES-INJECTI
8313132   PAMIDRONATE/30MG IJ                                 83             PHARMACY SERVICES-INJECTI
8312126   PAMIDRONATE/30MG IJ                  364            83             PHARMACY SERVICES-INJECTI
8318529   PAMIDRONATE/30MG IJ                                 83             PHARMACY SERVICES-INJECTI
8308405   PANCURONIUM 2MG/ML 2ML                 6            83             PHARMACY SERVICES-INJECTI
8308413   PANCURONIUM 2MG/ML 5ML                51            83             PHARMACY SERVICES-INJECTI
8306003   PANCURONIUM 2MG/ML VIAL               14            83             PHARMACY SERVICES-INJECTI
8309189   PANCURONIUM 4MG/ML 2ML IN             64            83             PHARMACY SERVICES-INJECTI
8307530   PANTOPRAZOLE/VIAL IJ                 124            83             PHARMACY SERVICES-INJECTI
8306029   PAPAVERINE 60MG IJ                     1            83             PHARMACY SERVICES-INJECTI
8300865   PCN G BENZ 600,000U IJ               127            83             PHARMACY SERVICES-INJECTI
8311300   PCN G BENZ CR 1.2MU IJ                 6            83             PHARMACY SERVICES-INJECTI
8311284   PCN G K 600,000U IJ                    4            83             PHARMACY SERVICES-INJECTI
8311326   PCN G PROC 600,000U IJ                 3            83             PHARMACY SERVICES-INJECTI
8311318   PCN G PROC 600,000U IJ                 2            83             PHARMACY SERVICES-INJECTI
8380750   PEMETREXED PER 10MG IJ                              83             PHARMACY SERVICES-INJECTI
8380644   PEMETREXED PER 10MG IJ              5921            83             PHARMACY SERVICES-INJECTI
8306037   PENTAMIDINE 300MG IJ                2312            83             PHARMACY SERVICES-INJECTI
8318818   PENTOBARBITAL                                       83             PHARMACY SERVICES-INJECTI
8380446   PENTOSTATIN/10MG IJ                 2629            83             PHARMACY SERVICES-INJECTI
8311847   PHENOBARBITAL 120MG IJ                89            83             PHARMACY SERVICES-INJECTI
8309981   PHENOBARBITAL 120MG IJ                 1            83             PHARMACY SERVICES-INJECTI
8307563   PHENTOLAMINE 5 MG IJ                 121            83             PHARMACY SERVICES-INJECTI
8306086   PHENYLEPHRINE 1ML IJ                  36            83             PHARMACY SERVICES-INJECTI
8306128   PHENYTOIN 50MG IJ                     39            83             PHARMACY SERVICES-INJECTI
8306102   PHENYTOIN 50MG IJ                     32            83             PHARMACY SERVICES-INJECTI
8309197   PHENYTOIN LIQ 100MG/4ML S             16            83             PHARMACY SERVICES-INJECTI
8306144   PHYSOSTIGMINE 1MG/2ML INJ             78            83             PHARMACY SERVICES-INJECTI
8310955   PHYSOSTIGMINE 1MG/2ML INJ             98            83             PHARMACY SERVICES-INJECTI
8308587   PHYSOSTIGMINE 1MG/ML                   3            83             PHARMACY SERVICES-INJECTI
8306169   PHYSOSTIGMINE 2ML AMP                  4            83             PHARMACY SERVICES-INJECTI




                                                 Page 117
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8309205   PHYTONADIONE 1MG IJ                   63            83             PHARMACY SERVICES-INJECTI
8306193   PHYTONADIONE 1MG IJ                   69            83             PHARMACY SERVICES-INJECTI
8310005   PIPECURONIUM 10MG VIAL                88            83             PHARMACY SERVICES-INJECTI
8309213   PLASMA PROT FRACT 5% 50ML            175            83             PHARMACY SERVICES-INJECTI
8307621   POLYMYXIN B SULF INJECT              133            83             PHARMACY SERVICES-INJECTI
8306243   PRALIDOXIME 1GM IJ                   298            83             PHARMACY SERVICES-INJECTI
8306250   PREDNISOLONE 5MG PO                   38            83             PHARMACY SERVICES-INJECTI
8350621   PREGABALIN                                          83             PHARMACY SERVICES-INJECTI
8308462   PROCAINAMIDE 1GM IJ                   12            83             PHARMACY SERVICES-INJECTI
8306284   PROCAINAMIDE 1GM IJ                   32            83             PHARMACY SERVICES-INJECTI
8306292   PROCAINE 10% 2ML VIAL                  5            83             PHARMACY SERVICES-INJECTI
8313207   PROCAINE 2ML AMP                                    83             PHARMACY SERVICES-INJECTI
8309239   PROCHLORPERAZINE 10MG IJ              78            83             PHARMACY SERVICES-INJECTI
8306326   PROCHLORPERAZINE 5MG PO               74            83             PHARMACY SERVICES-INJECTI
8313744   PROMETHAZINE 12.5MG PO                15            83             PHARMACY SERVICES-INJECTI
8309247   PROMETHAZINE 12.5MG PO                27            83             PHARMACY SERVICES-INJECTI
8306367   PROMETHAZINE 50 MG IJ                 59            83             PHARMACY SERVICES-INJECTI
8306342   PROMETHAZINE 50 MG IJ                 62            83             PHARMACY SERVICES-INJECTI
8308918   PROPARACINE 0.5% 15ML                  8            83             PHARMACY SERVICES-INJECTI
8306391   PROPOFOL 1000MG/100ML INJ            101            83             PHARMACY SERVICES-INJECTI
8306409   PROPOFOL 100ML VIAL                   89            83             PHARMACY SERVICES-INJECTI
8306425   PROPOFOL 10MG/ML AMP 20M              12            83             PHARMACY SERVICES-INJECTI
8306417   PROPOFOL 10MG/ML AMP 20M              51            83             PHARMACY SERVICES-INJECTI
8306433   PROPOFOL 200MG/20ML INJ                             83             PHARMACY SERVICES-INJECTI
8306441   PROPOFOL 500MG/50ML INJ               89            83             PHARMACY SERVICES-INJECTI
8306458   PROPRANOLOL 1MG IJ                    42            83             PHARMACY SERVICES-INJECTI
8307712   PROTAMINE 10MG IJ                     66            83             PHARMACY SERVICES-INJECTI
8308470   PROTAMINE 10MG IJ                     20            83             PHARMACY SERVICES-INJECTI
8318842   PROTEINASE INHB 10MG IJ                             83             PHARMACY SERVICES-INJECTI
8311870   PYRAZINAMIDE 500 MG                   18            83             PHARMACY SERVICES-INJECTI
8308595   PYRIDOSTIGMINE 10MG/2ML                1            83             PHARMACY SERVICES-INJECTI
8309254   PYRIDOSTIGMINE 10MG/2ML I             61            83             PHARMACY SERVICES-INJECTI
8308488   PYRIDOSTIGMINE 5MG/ML AM               1            83             PHARMACY SERVICES-INJECTI
8308546   PYRIDOXINE HCL 100 MG IJ               3            83             PHARMACY SERVICES-INJECTI
8306540   PYRIDOXINE HCL 100 MG IJ              61            83             PHARMACY SERVICES-INJECTI
8309353   QUINIDINE GLUC 80 MG/ML I            142            83             PHARMACY SERVICES-INJECTI
8331050   RANITIDINE 15MG/ML                                  83             PHARMACY SERVICES-INJECTI
8370199   RANITIDINE 25MG IJ                   126            83             PHARMACY SERVICES-INJECTI
8308504   RANITIDINE 25MG IJ                     4            83             PHARMACY SERVICES-INJECTI
8310658   RETEPLASE 18.1MG IJ                 1583            83             PHARMACY SERVICES-INJECTI
8309411   RETEPLASE 18.1MG IJ                 1583            83             PHARMACY SERVICES-INJECTI
8310617   RIFAMPIN 600MG IJ                    369            83             PHARMACY SERVICES-INJECTI
8312167   RIFAMPIN 600MG IJ                    369            83             PHARMACY SERVICES-INJECTI
8311037   RIFAMPIN 600MG VIAL                   65            83             PHARMACY SERVICES-INJECTI
8310047   RIFAMPIN 600MG VIAL                   65            83             PHARMACY SERVICES-INJECTI
8313702   RISPERIDONE LA 0.5MG IJ                             83             PHARMACY SERVICES-INJECTI
8312662   RISPERIDONE LA 0.5MG IJ              309            83             PHARMACY SERVICES-INJECTI
8350274   RITUXIMAB 100MG IJ                   525            83             PHARMACY SERVICES-INJECTI
8350266   RITUXIMAB 100MG IJ                  2626            83             PHARMACY SERVICES-INJECTI
8307738   RITUXIMAB 100MG IJ                                  83             PHARMACY SERVICES-INJECTI
8306615   RITUXIMAB 100MG IJ                  1670            83             PHARMACY SERVICES-INJECTI
8306623   ROCURONIUM 10MG/ML VIAL                             83             PHARMACY SERVICES-INJECTI
8313199   ROCURONIUM 50MG/5ML                  242            83             PHARMACY SERVICES-INJECTI
8306631   ROCURONIUM BR 1OMG/ML INJ            128            83             PHARMACY SERVICES-INJECTI
8328890   ROPIVACAINE 1MG IJ                                  83             PHARMACY SERVICES-INJECTI




                                                 Page 118
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8319097   ROPIVACAINE 1MG IJ                   0.01           83             PHARMACY SERVICES-INJECTI
8319089   ROPIVACAINE 1MG IJ                   0.01           83             PHARMACY SERVICES-INJECTI
8370280   ROPIVACAINE 1MG IJ                                  83             PHARMACY SERVICES-INJECTI
8328973   ROPIVACAINE 1MG IJ                   0.01           83             PHARMACY SERVICES-INJECTI
8328908   ROPIVACAINE 1MG IJ                                  83             PHARMACY SERVICES-INJECTI
8318891   ROPIVACAINE 1MG IJ                   0.01           83             PHARMACY SERVICES-INJECTI
8318883   ROPIVACAINE 1MG IJ                                  83             PHARMACY SERVICES-INJECTI
8313322   ROPIVACAINE 1MG IJ                     87           83             PHARMACY SERVICES-INJECTI
8329039   ROPIVACAINE WITH FENTANYL            0.01           83             PHARMACY SERVICES-INJECTI
8328981   ROPIVACAINE WITH FENTANYL                           83             PHARMACY SERVICES-INJECTI
8310385   ROSIGLITAZONE 4MG TAB                 20            83             PHARMACY SERVICES-INJECTI
8310054   SARGRAMOSTIM 50MCG IJ                214            83             PHARMACY SERVICES-INJECTI
8307753   SCOPOLAMINE 0.4MG INJ                  1            83             PHARMACY SERVICES-INJECTI
8308603   SCOPOLAMINE 0.4MG/ML VIA               1            83             PHARMACY SERVICES-INJECTI
8310633   SEVELAMER         RE                   8            83             PHARMACY SERVICES-INJECTI
8307761   SINCALIDE 5MCG IJ                    133            83             PHARMACY SERVICES-INJECTI
8312910   SMZ/TMP 10ML IJ                                     83             PHARMACY SERVICES-INJECTI
8318768   SOD PHENYL / BENZ IV                                83             PHARMACY SERVICES-INJECTI
8318677   SOMATROPIN 1MG IJ                                   83             PHARMACY SERVICES-INJECTI
8312555   STREPTOKINASE/250KIU IJ               104           83             PHARMACY SERVICES-INJECTI
8319212   STREPTOMYCIN 1GM IJ                  0.01           83             PHARMACY SERVICES-INJECTI
8307829   STREPTOZOCIN 1GM IJ                   161           83             PHARMACY SERVICES-INJECTI
8307837   SUCCINYLCHOLINE 20MG IJ                             83             PHARMACY SERVICES-INJECTI
8310062   SUFENTANIL 250MCG/5ML AM              40            83             PHARMACY SERVICES-INJECTI
8360026   SUFENTANIL 50MCG/ML AMP               12            83             PHARMACY SERVICES-INJECTI
8311953   SUFENTANIL CIT 50MCG/ML               99            83             PHARMACY SERVICES-INJECTI
8306755   SUMATRIPTAN 6MG IJ                   197            83             PHARMACY SERVICES-INJECTI
8306748   SUMATRIPTAN O.5ML VIAL                36            83             PHARMACY SERVICES-INJECTI
8350282   SYNERCID 500 MG IJ                                  83             PHARMACY SERVICES-INJECTI
8306763   TAC SOLUTION 3ML                     316            83             PHARMACY SERVICES-INJECTI
8350449   TAKE HOME DRUGS                       21            83             PHARMACY SERVICES-INJECTI
8350498   TALC 5GM/BUPIV .17%/SALIN                           83             PHARMACY SERVICES-INJECTI
8309403   TENECTEPLASE/50MG IJ                6362            83             PHARMACY SERVICES-INJECTI
8308850   TENECTEPLASE/50MG IJ                3206            83             PHARMACY SERVICES-INJECTI
8309262   TERBUTALINE 1MG IJ                   129            83             PHARMACY SERVICES-INJECTI
8331126   TERIPARATIDE 10MCG IJ                               83             PHARMACY SERVICES-INJECTI
8311102   TESTOSTERONE CYP 100MG IJ             28            83             PHARMACY SERVICES-INJECTI
8310575   TETRACAINE 0.5% SOLUTION              41            83             PHARMACY SERVICES-INJECTI
8313371   TETRACAINE 1% 10MG/ML AMP             69            83             PHARMACY SERVICES-INJECTI
8306797   TETRACAINE 1% 2ML AMP                  3            83             PHARMACY SERVICES-INJECTI
8304537   TETRACAINE 1% AMP-2ML                               83             PHARMACY SERVICES-INJECTI
8313850   TETRACAINE 1% AMPUL 2ML                             83             PHARMACY SERVICES-INJECTI
8312654   TETRACAINE 1% AMPULE                   6            83             PHARMACY SERVICES-INJECTI
8330425   TETRACAINE 2% 30ML SOLN               13            83             PHARMACY SERVICES-INJECTI
8306813   THIAMINE HCL 100 MG IJ                60            83             PHARMACY SERVICES-INJECTI
8306805   THIAMINE HCL 100 MG IJ                 1            83             PHARMACY SERVICES-INJECTI
8320616   THIOPENTAL 2.5% SYR 25ML               4            83             PHARMACY SERVICES-INJECTI
8312092   THIOPENTAL 500MG INJ KIT              60            83             PHARMACY SERVICES-INJECTI
8307878   THIOPENTAL 500MG INJ KIT              63            83             PHARMACY SERVICES-INJECTI
8307886   THIOPENTAL SOD 500MG INJ              65            83             PHARMACY SERVICES-INJECTI
8350308   THIOTEPA 15MG IJ                     118            83             PHARMACY SERVICES-INJECTI
8312084   THIOTEPA 15MG IJ                     482            83             PHARMACY SERVICES-INJECTI
8307894   THIOTEPA 15MG IJ                     770            83             PHARMACY SERVICES-INJECTI
8313009   THIOTEPA 15MG IJ                                    83             PHARMACY SERVICES-INJECTI
8318552   THIOTEPA 15MG IJ                                    83             PHARMACY SERVICES-INJECTI




                                                 Page 119
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8309270   THROMBIN 5000U KIT                   213            83             PHARMACY SERVICES-INJECTI
8350316   THYROTROPIN 1.1MG VL IJ              695            83             PHARMACY SERVICES-INJECTI
8307902   TICARCILLIN       TI                  70            83             PHARMACY SERVICES-INJECTI
8318644   TIGECYCLINE 1MG IJ                                  83             PHARMACY SERVICES-INJECTI
8308777   TOBRAMYCIN                            47            83             PHARMACY SERVICES-INJECTI
8310542   TOBRAMYCIN 40MG/30ML INJ             276            83             PHARMACY SERVICES-INJECTI
8350472   TOBRAMYCIN 80MG IJ                   359            83             PHARMACY SERVICES-INJECTI
8307910   TOBRAMYCIN 80MG IJ                   461            83             PHARMACY SERVICES-INJECTI
8310369   TOLTERODINE 2MG TAB                   18            83             PHARMACY SERVICES-INJECTI
8350324   TOPOTECAN 4MG IJ                     741            83             PHARMACY SERVICES-INJECTI
8307928   TOPOTECAN 4MG IJ                    2542            83             PHARMACY SERVICES-INJECTI
8311995   TRACE ELEMENTS                        33            83             PHARMACY SERVICES-INJECTI
8307936   TRANEXAMIC ACID 100MG INJ             18            83             PHARMACY SERVICES-INJECTI
8313710   TRASTUZUMAB 10MG IJ                                 83             PHARMACY SERVICES-INJECTI
8308769   TRASTUZUMAB 10MG IJ                 2518            83             PHARMACY SERVICES-INJECTI
8307951   TRIAMCINOLONE ACE 10MG IJ             135           83             PHARMACY SERVICES-INJECTI
8306862   TRIAMCINOLONE ACE 10MG IJ             174           83             PHARMACY SERVICES-INJECTI
8312191   TRIAMCINOLONE AQ NASAL IN             194           83             PHARMACY SERVICES-INJECTI
8310567   TRIAMCINOLONE NASAL INHAL             267           83             PHARMACY SERVICES-INJECTI
8312456   TRIMETHOPRIM/POLYMIXIN B               66           83             PHARMACY SERVICES-INJECTI
8307852   TROMETHAMINE IJ .3% 500ML             542           83             PHARMACY SERVICES-INJECTI
8329021   TUBERCULN SKIN TEST INTRA            0.01           83             PHARMACY SERVICES-INJECTI
8309528   TUBERCULN SKIN TEST INTRA               6           83             PHARMACY SERVICES-INJECTI
8309288   TUBERCULN SKIN TEST INTRA              61           83             PHARMACY SERVICES-INJECTI
8308520   TUBOCURARINE 3MG/ML                    43           83             PHARMACY SERVICES-INJECTI
8306904   TUBOCURARINE 3MG/ML INJ                60           83             PHARMACY SERVICES-INJECTI
8306912   TUBOCURARINE 3MG/ML VIAL               14           83             PHARMACY SERVICES-INJECTI
8312928   UROKINASE 250K IU IJ                                83             PHARMACY SERVICES-INJECTI
8350332   VALPROATE 500MG IJ                    11            83             PHARMACY SERVICES-INJECTI
8306920   VALPROATE 500MG/5ML INJ               76            83             PHARMACY SERVICES-INJECTI
8318685   VANCOMYCIN 500MG IJ                                 83             PHARMACY SERVICES-INJECTI
8312290   VANCOMYCIN 500MG IJ                  133            83             PHARMACY SERVICES-INJECTI
8311045   VANCOMYCIN 500MG IJ                   45            83             PHARMACY SERVICES-INJECTI
8307993   VANCOMYCIN 500MG IJ                   23            83             PHARMACY SERVICES-INJECTI
8306946   VASOPRESSIN 20U/ML AMP                 9            83             PHARMACY SERVICES-INJECTI
8306961   VASOPRESSIN 20U/ML INJ                72            83             PHARMACY SERVICES-INJECTI
8310088   VECURONIUM 10MG VIAL                  22            83             PHARMACY SERVICES-INJECTI
8308017   VECURONIUM BR 10MG INJ                81            83             PHARMACY SERVICES-INJECTI
8310591   VENLAFAXINE                           18            83             PHARMACY SERVICES-INJECTI
8306979   VERAPAMIL 5MG/2ML AMP                 41            83             PHARMACY SERVICES-INJECTI
8306987   VERAPAMIL 5MG/2ML INJ                 59            83             PHARMACY SERVICES-INJECTI
8306995   VERAPAMIL 5MG/2ML VIAL                 4            83             PHARMACY SERVICES-INJECTI
8350340   VINBLASTINE 1MG IJ                    46            83             PHARMACY SERVICES-INJECTI
8350514   VINCRISTINE 1MG IJ                   581            83             PHARMACY SERVICES-INJECTI
8350357   VINCRISTINE 1MG IJ                    41            83             PHARMACY SERVICES-INJECTI
8380412   VINORELBINE/10MG IJ                  761            83             PHARMACY SERVICES-INJECTI
8350373   VINORELBINE/10MG IJ                  446            83             PHARMACY SERVICES-INJECTI
8350381   VINORELBINE/10MG IJ                   89            83             PHARMACY SERVICES-INJECTI
8310096   VORICONAZOLE 10 MG IJ                357            83             PHARMACY SERVICES-INJECTI
8312969   VX BCG IVSCL PER INSTILL                            83             PHARMACY SERVICES-INJECTI
8300782   VX BCG IVSCL PER INSTILL              201           83             PHARMACY SERVICES-INJECTI
8302168   VX DT DIP/TETTOX LT 7YRS                2           83             PHARMACY SERVICES-INJECTI
8303356   VX DTAP-HIB DTAP-HEMOPH B              29           83             PHARMACY SERVICES-INJECTI
8319162   VX DTP DIP/TETTOX /PERTUS            0.01           83             PHARMACY SERVICES-INJECTI
8331118   VX FLU SPLIT 6-35MOS IM                             83             PHARMACY SERVICES-INJECTI




                                                 Page 120
                                c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION             SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                   AMOUNT AMOUNT CODE

8331084   VX FLU SPLIT 6-35MOS IM                           83             PHARMACY SERVICES-INJECTI
8313223   VX FLU SPLIT 6-35MOS IM             77            83             PHARMACY SERVICES-INJECTI
8331092   VX FLU SPLIT GT=3YRS IM                           83             PHARMACY SERVICES-INJECTI
8331076   VX FLU SPLIT GT=3YRS IM                           83             PHARMACY SERVICES-INJECTI
8313215   VX FLU SPLIT GT=3YRS IM             80            83             PHARMACY SERVICES-INJECTI
8318610   VX HEP A ADULT IM                                 83             PHARMACY SERVICES-INJECTI
8313025   VX HEP A ADULT IM                  208            83             PHARMACY SERVICES-INJECTI
8303455   VX HEP B ADULT IM                  223            83             PHARMACY SERVICES-INJECTI
8303489   VX HEP B PED/ADOL 3 DOSE           124            83             PHARMACY SERVICES-INJECTI
8318743   VX MEASLES SUBCU                                  83             PHARMACY SERVICES-INJECTI
8312936   VX MENINGOCOCCAL POLYSACC          252            83             PHARMACY SERVICES-INJECTI
8311797   VX MMR                             158            83             PHARMACY SERVICES-INJECTI
8309221   VX PNMOCOCCL PLYSAC GT 2Y           78            83             PHARMACY SERVICES-INJECTI
8318628   VX POLIOVIRUS INACTIV INJ                         83             PHARMACY SERVICES-INJECTI
8309346   VX RABIES INTRAMUSCULAR            425            83             PHARMACY SERVICES-INJECTI
8311888   VX RUBELLA                          99            83             PHARMACY SERVICES-INJECTI
8302150   VX TET DIPTOX GT 7Y IM              68            83             PHARMACY SERVICES-INJECTI
8311961   VX TETANUS TOXOID                   64            83             PHARMACY SERVICES-INJECTI
8318594   VX VARICELLA VIRUS LIVE                           83             PHARMACY SERVICES-INJECTI
8309395   VX VARICELLA VIRUS LIVE            225            83             PHARMACY SERVICES-INJECTI
8312464   WARFARIN 5MG INJ                   143            83             PHARMACY SERVICES-INJECTI
8308033   WARFARIN INJ 5MG                   105            83             PHARMACY SERVICES-INJECTI
8307001   WATER FOR INJ 100ML VIAL             2            83             PHARMACY SERVICES-INJECTI
8307019   WATER FOR INJ 10ML VIAL                           83             PHARMACY SERVICES-INJECTI
8306706   WATER STERILE 100ML INJ                           83             PHARMACY SERVICES-INJECTI
8306714   WATER STERILE INJ 10ML                            83             PHARMACY SERVICES-INJECTI
8350407   WINRHO 100IU IJ                   1203            83             PHARMACY SERVICES-INJECTI
8313264   ZIDOVUDINE 10MG IJ                                83             PHARMACY SERVICES-INJECTI
8318735   ZINC                                              83             PHARMACY SERVICES-INJECTI
8308066   ZIPRASIDONE MESYL 10MG IJ          163            83             PHARMACY SERVICES-INJECTI
8313728   ZIPRASIDONE MESYL 10MG IJ                         83             PHARMACY SERVICES-INJECTI
8310740   ZOLEDRONIC ACID 1MG INJ           1006            83             PHARMACY SERVICES-INJECTI
8308082   ZOLEDRONIC ACID 1MG INJ           1019            83             PHARMACY SERVICES-INJECTI
8308074   ZOLEDRONIC ACID 1MG INJ           2151            83             PHARMACY SERVICES-INJECTI
8370413   ZOSYN 1GM / 0.125GM IJ             0.01           83             PHARMACY SERVICES-INJECTI
8370405   ZOSYN 1GM / 0.125GM IJ             0.01           83             PHARMACY SERVICES-INJECTI
8313876   ZOSYN 1GM / 0.125GM IJ                            83             PHARMACY SERVICES-INJECTI
8312506   ZOSYN 1GM / 0.125GM IJ              13            83             PHARMACY SERVICES-INJECTI
8308108   ZOSYN 1GM / 0.125GM IJ             154            83             PHARMACY SERVICES-INJECTI
8308090   ZOSYN 1GM / 0.125GM IJ             141            83             PHARMACY SERVICES-INJECTI
8123101   ABACAVIR 300MG TABLET                             81             PHARMACY SERVICES-ORAL
8124141   ACARBOSE 25MG TAB                     1           81             PHARMACY SERVICES-ORAL
8110066   ACEBUTOLOL 200MG CAPSULE              1           81             PHARMACY SERVICES-ORAL
8100026   ACETAZOLAMIDE 250MG TAB                           81             PHARMACY SERVICES-ORAL
8100034   ACETAZOLAMIDE 500MG CAP             18            81             PHARMACY SERVICES-ORAL
8124158   ACIDOPHILUS PEC                      1            81             PHARMACY SERVICES-ORAL
8124364   ACIDOPHILUS PEC CAP                               81             PHARMACY SERVICES-ORAL
8100075   ACYCLOVIR 200MG CAP UD              17            81             PHARMACY SERVICES-ORAL
8100083   ACYCLOVIR 800MG TAB UD 24           23            81             PHARMACY SERVICES-ORAL
8124810   ADEFOVIR DIPIV                                    81             PHARMACY SERVICES-ORAL
8122616   ADVAIR DISKUS 100/50                92            81             PHARMACY SERVICES-ORAL
8122624   ADVAIR DISKUS 250/50               114            81             PHARMACY SERVICES-ORAL
8122632   ADVAIR DISKUS 500/50               161            81             PHARMACY SERVICES-ORAL
8124000   ALBENDAZOLE 200MG TAB                             81             PHARMACY SERVICES-ORAL
8180002   ALBUTEROL 2MG/5ML SYRUP             15            81             PHARMACY SERVICES-ORAL




                                               Page 121
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8180010   ALBUTEROL SYRUP 0.4MG/ML                            81             PHARMACY SERVICES-ORAL
8110108   ALENDRONATE 10MG TAB UD               20            81             PHARMACY SERVICES-ORAL
8121675   ALENDRONATE 70MG TAB                  57            81             PHARMACY SERVICES-ORAL
8100117   ALKA SELTZER TAB                                    81             PHARMACY SERVICES-ORAL
8100158   ALLOPURINOL 100MG TAB                               81             PHARMACY SERVICES-ORAL
8100133   ALLOPURINOL 100MG TAB D                             81             PHARMACY SERVICES-ORAL
8100166   ALLOPURINOL 100MG TAB UD              15            81             PHARMACY SERVICES-ORAL
8100141   ALLOPURINOL 300MG TAB                               81             PHARMACY SERVICES-ORAL
8100125   ALLOPURINOL 300MG TAB D                             81             PHARMACY SERVICES-ORAL
8140311   ALOH 600MG/30ML UD                     3            81             PHARMACY SERVICES-ORAL
8180028   ALOH CONC 6 OZ                         2            81             PHARMACY SERVICES-ORAL
8180036   ALOH CONC 60Z                          2            81             PHARMACY SERVICES-ORAL
8141350   ALOH GEL ALUMN HYDRXIDE               69            81             PHARMACY SERVICES-ORAL
8141509   ALOH/MAG/SIMETH 30ML GENE              1            81             PHARMACY SERVICES-ORAL
8100265   ALPRAZOLAM .5MG TABLET UD             30            81             PHARMACY SERVICES-ORAL
8100257   ALPRAZOLAM 0.25MG TAB UD              29            81             PHARMACY SERVICES-ORAL
8160160   ALPRAZOLAM 0.5MG TABLET                             81             PHARMACY SERVICES-ORAL
8100174   ALPRAZOLAM 1MG TABLET D                 1           81             PHARMACY SERVICES-ORAL
8141665   ALUM HYDROXIDE                                      81             PHARMACY SERVICES-ORAL
8100281   AMANTADINE 100MG CAP UD               16            81             PHARMACY SERVICES-ORAL
8141418   AMANTADINE PER ML SYRUP                             81             PHARMACY SERVICES-ORAL
8140329   AMANTADINE SYRUP 10MG/ML                            81             PHARMACY SERVICES-ORAL
8100299   AMILORIDE HCL 5MG TABLET                            81             PHARMACY SERVICES-ORAL
8107823   AMILORIDE/HCTZ                                      81             PHARMACY SERVICES-ORAL
8100315   AMINOCAPROIC AC 500MG TAB             19            81             PHARMACY SERVICES-ORAL
8123499   AMINOPHYLLINE 100MG TAB                             81             PHARMACY SERVICES-ORAL
8123507   AMINOPHYLLINE 200MG TAB                             81             PHARMACY SERVICES-ORAL
8100349   AMIODARONE 200MG TAB UD               22            81             PHARMACY SERVICES-ORAL
8100406   AMITRIPTYLINE 100MG TAB                             81             PHARMACY SERVICES-ORAL
8100448   AMITRIPTYLINE 10MG TAB UD             15            81             PHARMACY SERVICES-ORAL
8100455   AMITRIPTYLINE 25MG TAB UD                           81             PHARMACY SERVICES-ORAL
8100380   AMITRIPTYLINE 50MG TAB                              81             PHARMACY SERVICES-ORAL
8100372   AMITRIPTYLINE 75MG TAB                              81             PHARMACY SERVICES-ORAL
8124018   AMLODIPINE 10MG TAB                                 81             PHARMACY SERVICES-ORAL
8100489   AMLODIPINE 5MG TABLET UD                            81             PHARMACY SERVICES-ORAL
8100497   AMOXAPINE 50MG TABLET                   1           81             PHARMACY SERVICES-ORAL
8126203   AMOXICILLIN                          0.01           81             PHARMACY SERVICES-ORAL
8141673   AMOXICILLIN                                         81             PHARMACY SERVICES-ORAL
8126120   AMOXICILLIN                          0.01           81             PHARMACY SERVICES-ORAL
8100570   AMOXICILLIN 250MG CAP UD                            81             PHARMACY SERVICES-ORAL
8100521   AMOXICILLIN 500MG CAPSUL                            81             PHARMACY SERVICES-ORAL
8122798   AMOXICILLIN 875MG TAB                 17            81             PHARMACY SERVICES-ORAL
8180044   AMOXICILLIN SUSP 125MG/5M             33            81             PHARMACY SERVICES-ORAL
8180069   AMOXICILLIN SUSP 250MG/5M             39            81             PHARMACY SERVICES-ORAL
8180085   AMOXICILLIN SUSP 25MG/ML               7            81             PHARMACY SERVICES-ORAL
8180077   AMOXICILLIN SUSP 25MG/ML               8            81             PHARMACY SERVICES-ORAL
8180135   AMOXICILLIN SUSP 50MG/ML              12            81             PHARMACY SERVICES-ORAL
8180127   AMOXICILLIN SUSP 50MG/ML              11            81             PHARMACY SERVICES-ORAL
8180168   AMOXICILLINSU200MG/5ML5ML              2            81             PHARMACY SERVICES-ORAL
8180176   AMOXICILLINSU400MG/5ML5ML              3            81             PHARMACY SERVICES-ORAL
8123515   AMPHETAMINE 5MG TAB                                 81             PHARMACY SERVICES-ORAL
8141657   AMPICILLIN                                          81             PHARMACY SERVICES-ORAL
8100604   AMPICILLIN 250MG CAP                                81             PHARMACY SERVICES-ORAL
8110173   AMPICILLIN 500MG CAPSULE                            81             PHARMACY SERVICES-ORAL
8100596   AMPICILLIN 500MG CAPSULE                            81             PHARMACY SERVICES-ORAL




                                                 Page 122
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8180184   AMPICILLIN SUSP 50MG/ML                             81             PHARMACY SERVICES-ORAL
8119570   AMYLASE PANCREASE EC 4500             15            81             PHARMACY SERVICES-ORAL
8124109   ANAGRELIDE 0.5MG CAP                  28            81             PHARMACY SERVICES-ORAL
8122970   ANASTROZOLE 1MG PO                    34            81             PHARMACY SERVICES-ORAL
8181521   APAP 1500MG/15ML DROP                               81             PHARMACY SERVICES-ORAL
8110181   APAP 325MG TAB                                      81             PHARMACY SERVICES-ORAL
8100646   APAP 325MG X2 UD TAB                                81             PHARMACY SERVICES-ORAL
8100638   APAP 325MG/10ML UD                     8            81             PHARMACY SERVICES-ORAL
8140337   APAP 80MG/.8ML 15ML                    7            81             PHARMACY SERVICES-ORAL
8180234   APAP ACETAMINOP ELX 160/5              2            81             PHARMACY SERVICES-ORAL
8180242   APAP ELIX 120ML                        1            81             PHARMACY SERVICES-ORAL
8130593   APAP/COD     300/30MG                 13            81             PHARMACY SERVICES-ORAL
8100737   APAP/COD #3 TAB X3                    29            81             PHARMACY SERVICES-ORAL
8100745   APAP/COD #3 TAB X6                    36            81             PHARMACY SERVICES-ORAL
8130486   APAP/COD 120-12/5ML ELI U             29            81             PHARMACY SERVICES-ORAL
8130528   APAP/COD 12MG/5M                      68            81             PHARMACY SERVICES-ORAL
8170003   APAP/COD 12MG/5ML EL                                81             PHARMACY SERVICES-ORAL
8160186   APAP/COD 15MG TABLET                                81             PHARMACY SERVICES-ORAL
8130288   APAP/COD 15MG TABLET                  29            81             PHARMACY SERVICES-ORAL
8130296   APAP/COD 30MG TAB UD                   7            81             PHARMACY SERVICES-ORAL
8160194   APAP/COD 30MG TABLET                                81             PHARMACY SERVICES-ORAL
8160202   APAP/COD 60MG TABLET                                81             PHARMACY SERVICES-ORAL
8130304   APAP/COD 60MG TABLET                  29            81             PHARMACY SERVICES-ORAL
8170029   APAP/CODEINE ELX 5ML                                81             PHARMACY SERVICES-ORAL
8100752   APAP/HYDROCOD                                       81             PHARMACY SERVICES-ORAL
8126096   APAP/OXYCOD                          0.01           81             PHARMACY SERVICES-ORAL
8100794   APAP/OXYCOD 5/325 TA                                81             PHARMACY SERVICES-ORAL
8170037   APAP/OXYCOD SOLN                                    81             PHARMACY SERVICES-ORAL
8160012   APAP/PROPOX NAP                       30            81             PHARMACY SERVICES-ORAL
8160004   APAP/PROPOX NAP                       29            81             PHARMACY SERVICES-ORAL
8121881   APRACLONIDINE HCL 0.25ML              13            81             PHARMACY SERVICES-ORAL
8123903   APREPITANT 80 MG CAP                                81             PHARMACY SERVICES-ORAL
8121683   APREPITANT ORAL 5MG                  123            81             PHARMACY SERVICES-ORAL
8123895   APREPITANT TRIFOLD PACK                             81             PHARMACY SERVICES-ORAL
8126062   ARIPIPRAZOLE                                        81             PHARMACY SERVICES-ORAL
8110199   ARIPIPRAZOLE 10MG TAB                 12            81             PHARMACY SERVICES-ORAL
8110215   ARIPIPRAZOLE 15MG TAB                 12            81             PHARMACY SERVICES-ORAL
8101008   ASA (BABY) 81MG TAB                                 81             PHARMACY SERVICES-ORAL
8101099   ASA 325MG TAB UD                        1           81             PHARMACY SERVICES-ORAL
8101081   ASA CHEW 81MG TAB UD                    2           81             PHARMACY SERVICES-ORAL
8101073   ASA EC 325MG TAB UD                     1           81             PHARMACY SERVICES-ORAL
8101107   ASA EC 81MG TAB UD*                     1           81             PHARMACY SERVICES-ORAL
8101040   ASA ENT-COATED 81MG                                 81             PHARMACY SERVICES-ORAL
8124232   ASA/APAP/CAFF EX STRENGTH              2            81             PHARMACY SERVICES-ORAL
8100919   ASA/DIPYR                             19            81             PHARMACY SERVICES-ORAL
8130197   ASA/OXYCOD         PE                 15            81             PHARMACY SERVICES-ORAL
8100943   ASCORBIC ACID 500MG TAB                1            81             PHARMACY SERVICES-ORAL
8123911   ATAZANAVIR 100MG CAP                                81             PHARMACY SERVICES-ORAL
8123929   ATAZANAVIR 150MG CAP                                81             PHARMACY SERVICES-ORAL
8101164   ATENOLOL 25MG TAB UD                  16            81             PHARMACY SERVICES-ORAL
8101156   ATENOLOL 50MG TABLET UD               17            81             PHARMACY SERVICES-ORAL
8124802   ATOMOXETINE                                         81             PHARMACY SERVICES-ORAL
8124026   ATOMOXETINE 40MG CAP                                81             PHARMACY SERVICES-ORAL
8124224   ATOMOXETINE 60MG CAP                  22            81             PHARMACY SERVICES-ORAL
8101230   ATORVASTATIN 10MG TAB 24H             20            81             PHARMACY SERVICES-ORAL




                                                 Page 123
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8101172   ATORVASTATIN 20MG TABLET               3           81             PHARMACY SERVICES-ORAL
8110264   ATORVASTATIN 40MG TAB                  4           81             PHARMACY SERVICES-ORAL
8101198   ATORVASTATIN 80MG TABLET               3           81             PHARMACY SERVICES-ORAL
8141681   ATOVAQUONE                                         81             PHARMACY SERVICES-ORAL
8180267   ATOVAQUONE 750MG/5MLSU PO              3           81             PHARMACY SERVICES-ORAL
8181687   AUGMENTIN                           0.01           81             PHARMACY SERVICES-ORAL
8180275   AUGMENTIN 125MG/5ML SUSP              79           81             PHARMACY SERVICES-ORAL
8180283   AUGMENTIN 200MG/5ML 100MG             35           81             PHARMACY SERVICES-ORAL
8101271   AUGMENTIN 250MG TABLET                 2           81             PHARMACY SERVICES-ORAL
8180309   AUGMENTIN 250MG/5ML SUSP             125           81             PHARMACY SERVICES-ORAL
8180325   AUGMENTIN 400/57 100ML                63           81             PHARMACY SERVICES-ORAL
8180333   AUGMENTIN 400/57 50 ML                33           81             PHARMACY SERVICES-ORAL
8141558   AUGMENTIN 400/57 75ML                              81             PHARMACY SERVICES-ORAL
8180358   AUGMENTIN 400MG/5ML SUSP            131            81             PHARMACY SERVICES-ORAL
8101305   AUGMENTIN 500MG TAB UD               23            81             PHARMACY SERVICES-ORAL
8180366   AUGMENTIN 600MG/5ML SUSP            111            81             PHARMACY SERVICES-ORAL
8101313   AUGMENTIN 875MG TABLET UD            25            81             PHARMACY SERVICES-ORAL
8180374   AUGMENTIN ES-600 75ML SUS            43            81             PHARMACY SERVICES-ORAL
8141319   AUGMENTIN SUSP 25MG/ML                             81             PHARMACY SERVICES-ORAL
8180382   AUGMENTIN SUSP 50MG/ML               22            81             PHARMACY SERVICES-ORAL
8101321   AURANOFIN 3MG CAPSULE                 1            81             PHARMACY SERVICES-ORAL
8105041   AZATHIOPRINE ORAL 50MG               17            81             PHARMACY SERVICES-ORAL
8180424   AZITHROMYCIN                        104            81             PHARMACY SERVICES-ORAL
8180416   AZITHROMYCIN 100MG/5ML SU            30            81             PHARMACY SERVICES-ORAL
8180408   AZITHROMYCIN 100MG/5ML SU            30            81             PHARMACY SERVICES-ORAL
8101362   AZITHROMYCIN 250MG CAP UD            33            81             PHARMACY SERVICES-ORAL
8101347   AZITHROMYCIN 600MG TABLET            18            81             PHARMACY SERVICES-ORAL
8104812   BACLOFEN 10MG TAB N                  15            81             PHARMACY SERVICES-ORAL
8181448   BACTRIM                              28            81             PHARMACY SERVICES-ORAL
8101370   BACTRIM 160/800MG TB TMX              1            81             PHARMACY SERVICES-ORAL
8180432   BACTRIM SUSP                                       81             PHARMACY SERVICES-ORAL
8180457   BACTRIM SUSP 20ML                      1           81             PHARMACY SERVICES-ORAL
8190068   BALSALAZIDE 750MG CAPSULE              1           81             PHARMACY SERVICES-ORAL
8121907   BALSALAZIDE 750MG CAPSULE              1           81             PHARMACY SERVICES-ORAL
8121899   BALSALAZIDE 750MG CAPSULE              1           81             PHARMACY SERVICES-ORAL
8101453   BENAZEPRIL 10MG TABLET UD                          81             PHARMACY SERVICES-ORAL
8101412   BENAZEPRIL 20MG TABLET                1            81             PHARMACY SERVICES-ORAL
8121915   BENAZEPRIL 5MG TABLET                 1            81             PHARMACY SERVICES-ORAL
8180473   BENZOIN CMPD TIN LQ60ML              36            81             PHARMACY SERVICES-ORAL
8180481   BENZOIN COMP TINC 60ML                2            81             PHARMACY SERVICES-ORAL
8181489   BENZOIN COMP TINC 60ML                2            81             PHARMACY SERVICES-ORAL
8180499   BENZOIN COMP TINC SPRAY               3            81             PHARMACY SERVICES-ORAL
8101479   BENZONATATE 100MG CAP UD             17            81             PHARMACY SERVICES-ORAL
8101461   BENZONATATE 100MG CAPSUL                           81             PHARMACY SERVICES-ORAL
8101537   BENZTROPINE 1MG TABLET UD            15            81             PHARMACY SERVICES-ORAL
8181497   BETAMETHASONE DIP 0.05% C             9            81             PHARMACY SERVICES-ORAL
8101578   BICALUTAMIDE 50MG TABLET             48            81             PHARMACY SERVICES-ORAL
8119935   BISACODYL EC 5MG TAB                               81             PHARMACY SERVICES-ORAL
8101594   BISACODYL EC 5MG TAB UD               2            81             PHARMACY SERVICES-ORAL
8141251   BOTULINUM TOX B/100U IJ             382            81             PHARMACY SERVICES-ORAL
8181463   BSS SOLN 15ML                         6            81             PHARMACY SERVICES-ORAL
8123010   BUDESONIDE EC 3MG CAPSULE                          81             PHARMACY SERVICES-ORAL
8101636   BUMETANIDE 1MG TABLET UD             15            81             PHARMACY SERVICES-ORAL
8121923   BUPREN/NALOXONE 8MG-2MG               5            81             PHARMACY SERVICES-ORAL
8121691   BUPRENORPHINE 2/ 0.5MG TA             3            81             PHARMACY SERVICES-ORAL




                                                Page 124
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8123465   BUPROPION 150MG PO                    3            81             PHARMACY SERVICES-ORAL
8101701   BUPROPION 150MG PO                   17            81             PHARMACY SERVICES-ORAL
8101677   BUPROPION SR 150MG PO                 2            81             PHARMACY SERVICES-ORAL
8101651   BUPROPION SR 150MG PO                17            81             PHARMACY SERVICES-ORAL
8101644   BUPROPION SR 150MG PO                              81             PHARMACY SERVICES-ORAL
8101750   BUSPIRONE 5MG TABLET UD              16            81             PHARMACY SERVICES-ORAL
8105058   BUSULFAN 2MG PO                      20            81             PHARMACY SERVICES-ORAL
8170318   BUTORPHANOL NASAL 0.25MCG            84            81             PHARMACY SERVICES-ORAL
8115222   CA ACET                              15            81             PHARMACY SERVICES-ORAL
8114795   CA CARB                               2            81             PHARMACY SERVICES-ORAL
8110371   CA CARB 1250MG PO UD                 15            81             PHARMACY SERVICES-ORAL
8101776   CA CARB 500MG TAB                                  81             PHARMACY SERVICES-ORAL
8101784   CA CARB 500MG TABLET                               81             PHARMACY SERVICES-ORAL
8120479   CA CARB/VIT D 250MG TAB                            81             PHARMACY SERVICES-ORAL
8122905   CA CARB/VIT D OSCAL-D TAB                          81             PHARMACY SERVICES-ORAL
8140006   CA GLUBIONATE SYRUP                                81             PHARMACY SERVICES-ORAL
8101800   CA GLUCONATE 500MG TAB                             81             PHARMACY SERVICES-ORAL
8101818   CAFERGOT TABLET                        1           81             PHARMACY SERVICES-ORAL
8141624   CAFF CITRATE 5MG IJ                                81             PHARMACY SERVICES-ORAL
8126161   CAFFEINE                            0.01           81             PHARMACY SERVICES-ORAL
8101826   CALCITRIOL 0.25MCG PO                  1           81             PHARMACY SERVICES-ORAL
8141384   CALFACTANT 35MG/ML VIAL                            81             PHARMACY SERVICES-ORAL
8101842   CANDESARTAN 16MG TAB                   8           81             PHARMACY SERVICES-ORAL
8122640   CANDESARTAN 8MG TABLET                 2           81             PHARMACY SERVICES-ORAL
8125056   CAPECITABINE 150MG PO                              81             PHARMACY SERVICES-ORAL
8101867   CAPTOPRIL 12.5MG TABLET                            81             PHARMACY SERVICES-ORAL
8110405   CAPTOPRIL 12.5MG TABLET U            16            81             PHARMACY SERVICES-ORAL
8101909   CAPTOPRIL 12.5MG TABLET U             8            81             PHARMACY SERVICES-ORAL
8101875   CAPTOPRIL 25MG TABLET                              81             PHARMACY SERVICES-ORAL
8101859   CAPTOPRIL 25MG TABLET D                            81             PHARMACY SERVICES-ORAL
8101917   CAPTOPRIL 25MG TABLET UD             15            81             PHARMACY SERVICES-ORAL
8101891   CAPTOPRIL 50MG TABLET                 1            81             PHARMACY SERVICES-ORAL
8122590   CARBACHOL 0.01% 1.5ML                26            81             PHARMACY SERVICES-ORAL
8122582   CARBACHOL 3% 15ML                    13            81             PHARMACY SERVICES-ORAL
8124190   CARBAMAZEPINE 100MG TAB S            15            81             PHARMACY SERVICES-ORAL
8180515   CARBAMAZEPINE 100MG/5ML                            81             PHARMACY SERVICES-ORAL
8101958   CARBAMAZEPINE 200MG TAB U            15            81             PHARMACY SERVICES-ORAL
8121709   CARBAMAZEPINE SA 200MG CA             1            81             PHARMACY SERVICES-ORAL
8121931   CARBAMAZEPINE SA 300MG TA             1            81             PHARMACY SERVICES-ORAL
8121717   CARBAMAZEPINE SA 300MG TA             1            81             PHARMACY SERVICES-ORAL
8122053   CARBAMIDE PEROX OTIC GTTS             4            81             PHARMACY SERVICES-ORAL
8101974   CARBIDOPA 25MG/250MG TAB              1            81             PHARMACY SERVICES-ORAL
8101982   CARISOPRODOL 350MG TAB                             81             PHARMACY SERVICES-ORAL
8102055   CARVEDILOL 25MG TAB                  18            81             PHARMACY SERVICES-ORAL
8102006   CARVEDILOL 3.125MG TABLET             2            81             PHARMACY SERVICES-ORAL
8130619   CARVEDILOL 3.125MG UD                17            81             PHARMACY SERVICES-ORAL
8141541   CASTOR OIL 60ML                                    81             PHARMACY SERVICES-ORAL
8181638   CEFUROXIME                                         81             PHARMACY SERVICES-ORAL
8124471   CEFUROXIME                                         81             PHARMACY SERVICES-ORAL
8180531   CEFUROXIME 125MG/5ML SUSP           187            81             PHARMACY SERVICES-ORAL
8110447   CEFUROXIME 250MG TABLET U            26            81             PHARMACY SERVICES-ORAL
8122368   CEFUROXIME 250MG TABLET U            27            81             PHARMACY SERVICES-ORAL
8102113   CEFUROXIME 500MG TABLET U            37            81             PHARMACY SERVICES-ORAL
8102147   CELECOXIB 100MG CAPSULE              19            81             PHARMACY SERVICES-ORAL
8110017   CEPACOL LOZENGE                       2            81             PHARMACY SERVICES-ORAL




                                                Page 125
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8180549   CEPHALEXIN 125MG/5ML SUSP            62            81             PHARMACY SERVICES-ORAL
8110462   CEPHALEXIN 250MG CAP UD              16            81             PHARMACY SERVICES-ORAL
8180556   CEPHALEXIN 250MG/5ML SUSP            97            81             PHARMACY SERVICES-ORAL
8102204   CEPHALEXIN 500MG CAPSULE              1            81             PHARMACY SERVICES-ORAL
8180564   CEPHALEXIN SUSP 25MG/ML                            81             PHARMACY SERVICES-ORAL
8180580   CEPHALEXIN SUSP 50MG/ML                            81             PHARMACY SERVICES-ORAL
8102212   CETIRIZINE 10MG TABLET                 2           81             PHARMACY SERVICES-ORAL
8126088   CEVIMEINE                           0.01           81             PHARMACY SERVICES-ORAL
8140352   CHARCOAL 25GM/120ML SUS               51           81             PHARMACY SERVICES-ORAL
8190019   CHARCOAL 50GM                          4           81             PHARMACY SERVICES-ORAL
8140360   CHARCOAL/SORB 25GM-120ML              55           81             PHARMACY SERVICES-ORAL
8140378   CHARCOAL/SORB 50GM                                 81             PHARMACY SERVICES-ORAL
8160558   CHLORAL HYDRATE 500MG SOF                          81             PHARMACY SERVICES-ORAL
8170045   CHLORAL HYDRATE SYP 100MG                          81             PHARMACY SERVICES-ORAL
8140022   CHLORAL HYDRATE SYR 100MG                          81             PHARMACY SERVICES-ORAL
8131674   CHLORAMBUCIL 2MG PO                 0.01           81             PHARMACY SERVICES-ORAL
8102238   CHLORAMBUCIL 2MG PO                   19           81             PHARMACY SERVICES-ORAL
8181612   CHLORASEPTIC SPRAY 180ML               7           81             PHARMACY SERVICES-ORAL
8181604   CHLORHEX GLUC 16OZ                    25           81             PHARMACY SERVICES-ORAL
8102303   CHLOROTHIAZIDE 250MG TAB               3           81             PHARMACY SERVICES-ORAL
8110512   CHLORPHENIRAMIN 4MG TAB               15           81             PHARMACY SERVICES-ORAL
8102311   CHLORPHENIRAMIN 4MG TAB                            81             PHARMACY SERVICES-ORAL
8102329   CHLORPHENIRAMIN 4MG TAB                            81             PHARMACY SERVICES-ORAL
8180606   CHLORPROMAZINE PO 10MG                4            81             PHARMACY SERVICES-ORAL
8105074   CHLORPROMAZINE PO 10MG               15            81             PHARMACY SERVICES-ORAL
8104887   CHLORPROMAZINE PO 10MG               15            81             PHARMACY SERVICES-ORAL
8104853   CHLORPROMAZINE PO 10MG                             81             PHARMACY SERVICES-ORAL
8104846   CHLORPROMAZINE PO 10MG                             81             PHARMACY SERVICES-ORAL
8102337   CHLORPROPAMIDE 100MG TAB                           81             PHARMACY SERVICES-ORAL
8102345   CHLORPROPAMIDE 250MG TAB                           81             PHARMACY SERVICES-ORAL
8102360   CHLORTHALIDONE 25MG TAB                            81             PHARMACY SERVICES-ORAL
8102352   CHLORTHALIDONE 50MG TAB                            81             PHARMACY SERVICES-ORAL
8121725   CHLORTHALIDONE HYGROTON 2                          81             PHARMACY SERVICES-ORAL
8180622   CHOLESTYRAMINE 4GM PKT               33            81             PHARMACY SERVICES-ORAL
8123937   CILOSTAZOL 100MG TAB                               81             PHARMACY SERVICES-ORAL
8102378   CIMETIDINE 300MG TABLET U              8           81             PHARMACY SERVICES-ORAL
8102386   CIMETIDINE 400MG TABLET U              8           81             PHARMACY SERVICES-ORAL
8124307   CINACALCET 30MG TAB                                81             PHARMACY SERVICES-ORAL
8102428   CIPRO 250MG TAB                       2            81             PHARMACY SERVICES-ORAL
8102485   CIPRO 250MG TABLET                   21            81             PHARMACY SERVICES-ORAL
8102410   CIPRO 500MG TAB                       2            81             PHARMACY SERVICES-ORAL
8102394   CIPRO 750MG TAB                       4            81             PHARMACY SERVICES-ORAL
8102402   CIPRO 750MG TAB D                     4            81             PHARMACY SERVICES-ORAL
8102469   CIPROFLOXACIN 500MG TAB U            22            81             PHARMACY SERVICES-ORAL
8110553   CITALOPRAM 20MG TAB                  20            81             PHARMACY SERVICES-ORAL
8102493   CITALOPRAM 20MG TABLET                2            81             PHARMACY SERVICES-ORAL
8140345   CITRIC ACID                          16            81             PHARMACY SERVICES-ORAL
8180630   CITRIC ACID LIQUID                                 81             PHARMACY SERVICES-ORAL
8180648   CITRIC ACID LIQUID 15ML                            81             PHARMACY SERVICES-ORAL
8126302   CLARITHROMYCIN                      0.01           81             PHARMACY SERVICES-ORAL
8121949   CLARITHROMYCIN 250MG TAB               3           81             PHARMACY SERVICES-ORAL
8102543   CLARITHROMYCIN 500MG TAB              25           81             PHARMACY SERVICES-ORAL
8121956   CLARITHROMYCIN 500MG TAB               3           81             PHARMACY SERVICES-ORAL
8141640   CLINDAMYCIN                                        81             PHARMACY SERVICES-ORAL
8102592   CLINDAMYCIN 150MG CAP UD             17            81             PHARMACY SERVICES-ORAL




                                                Page 126
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8102626   CLOFAZIMINE 50MG CAP 24HR            15            81             PHARMACY SERVICES-ORAL
8102733   CLONAZEPAM 0.5MG TABLET U            16            81             PHARMACY SERVICES-ORAL
8102741   CLONAZEPAM 1MG TABLET UD             16            81             PHARMACY SERVICES-ORAL
8160491   CLONAZEPAM 1MG WAFER                  1            81             PHARMACY SERVICES-ORAL
8160509   CLONAZEPAM 2MG WAFER                  2            81             PHARMACY SERVICES-ORAL
8121964   CLONAZEPAM WAFER 0.5MG                1            81             PHARMACY SERVICES-ORAL
8190027   CLONIDINE                                          81             PHARMACY SERVICES-ORAL
8102816   CLONIDINE 0.1MG TABLET UD            15            81             PHARMACY SERVICES-ORAL
8102840   CLOPIDOGREL 75MG TABLE UD            17            81             PHARMACY SERVICES-ORAL
8110587   CLOTRIMAZOLE 10MG TRCH UD            19            81             PHARMACY SERVICES-ORAL
8190035   COCAINE HCL 5GM FLAKY POW           294            81             PHARMACY SERVICES-ORAL
8160020   CODEINE SO4 30MG TAB                               81             PHARMACY SERVICES-ORAL
8160038   CODEINE SO4 60MG TAB                  1            81             PHARMACY SERVICES-ORAL
8160046   CODEINE SULF 30MG TABLET              8            81             PHARMACY SERVICES-ORAL
8102907   COLCHICINE 0.6MG TABLET U            15            81             PHARMACY SERVICES-ORAL
8190043   COLESTIPOL 5GM GRAN PAK              16            81             PHARMACY SERVICES-ORAL
8190050   COLESTIPOL 5GM PACKET                 1            81             PHARMACY SERVICES-ORAL
8140394   COLYTE IP # 33174604                               81             PHARMACY SERVICES-ORAL
8140402   COLYTE SOLN 4800ML                                 81             PHARMACY SERVICES-ORAL
8180812   COLYTE SOLUTION 4L                   63            81             PHARMACY SERVICES-ORAL
8124117   COMBIVIR TABLET                      42            81             PHARMACY SERVICES-ORAL
8123440   CON GASTROGRAF 120ML                               81             PHARMACY SERVICES-ORAL
8122095   CORTISPORIN OPH OINT                  9            81             PHARMACY SERVICES-ORAL
8122079   CORTISPORIN OPH SUSP 7.5             10            81             PHARMACY SERVICES-ORAL
8124877   CYANOCOBALAMIN                                     81             PHARMACY SERVICES-ORAL
8123945   CYANOCOBALAMIN 500MCG TAB                          81             PHARMACY SERVICES-ORAL
8103046   CYCLOBENZAPRINE 10MG TAB             17            81             PHARMACY SERVICES-ORAL
8105108   CYCLOPHOSPHAMIDE 25MG PO             19            81             PHARMACY SERVICES-ORAL
8105116   CYCLOSPORINE 100MG PO                              81             PHARMACY SERVICES-ORAL
8104903   CYCLOSPORINE 25MG PO                   2           81             PHARMACY SERVICES-ORAL
8104895   CYCLOSPORINE 25MG PO                   2           81             PHARMACY SERVICES-ORAL
8124695   CYTARABINE LIPO 10MG IJ                            81             PHARMACY SERVICES-ORAL
8124554   DANAZOL                                            81             PHARMACY SERVICES-ORAL
8110611   DANAZOL 200MG CAPSULE                              81             PHARMACY SERVICES-ORAL
8103061   DANTROLENE 25MG CAPSULE                            81             PHARMACY SERVICES-ORAL
8123523   DANTROLENE 50MG CAP                                81             PHARMACY SERVICES-ORAL
8103095   DAPSONE 100MG TABLET 24HR            15            81             PHARMACY SERVICES-ORAL
8141608   DELSYM 6MG/ML SUSPENSION                           81             PHARMACY SERVICES-ORAL
8103129   DEMECLOCYCLINE 300MG TAB             57            81             PHARMACY SERVICES-ORAL
8103152   DESIPRAMINE 10MG TABLET              15            81             PHARMACY SERVICES-ORAL
8103160   DESIPRAMINE 25MG TAB UD              15            81             PHARMACY SERVICES-ORAL
8126054   DESLORATADINE                                      81             PHARMACY SERVICES-ORAL
8124885   DESMOPRESSIN                                       81             PHARMACY SERVICES-ORAL
8124869   DESMOPRESSIN                                       81             PHARMACY SERVICES-ORAL
8141442   DEXAMETHASONE 0.25MG PO                            81             PHARMACY SERVICES-ORAL
8123234   DEXAMETHASONE 0.25MG PO                            81             PHARMACY SERVICES-ORAL
8103244   DEXAMETHASONE 0.25MG PO              16            81             PHARMACY SERVICES-ORAL
8103236   DEXAMETHASONE 0.25MG PO              15            81             PHARMACY SERVICES-ORAL
8103186   DEXAMETHASONE 0.25MG PO                            81             PHARMACY SERVICES-ORAL
8103178   DEXAMETHASONE 0.25MG PO                            81             PHARMACY SERVICES-ORAL
8140410   DEXAMETHASONE ELX 0.1MG/M                          81             PHARMACY SERVICES-ORAL
8123705   DEXTROAMPHETAMINE 5MG PO                           81             PHARMACY SERVICES-ORAL
8141392   DEXTROSE 31GM INSTA-GLUCO                          81             PHARMACY SERVICES-ORAL
8123754   DEXTROSE 5GM TAB BD GLUCO             2            81             PHARMACY SERVICES-ORAL
8103327   DIAZEPAM 2MG TABLET UD               29            81             PHARMACY SERVICES-ORAL




                                                Page 127
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8103335   DIAZEPAM 5MG TABLET UD               29            81             PHARMACY SERVICES-ORAL
8170052   DIAZEPAM 5MG/ML SOLN                 18            81             PHARMACY SERVICES-ORAL
8103343   DICLOFENAC 75MG TABLET UD            17            81             PHARMACY SERVICES-ORAL
8103400   DICLOXACILLIN 250MG CAP U            16            81             PHARMACY SERVICES-ORAL
8121980   DICLOXACILLIN 500MG CAP               2            81             PHARMACY SERVICES-ORAL
8140436   DICLOXACILLIN 62.5/5ML                             81             PHARMACY SERVICES-ORAL
8141459   DICYCLOMINE                                        81             PHARMACY SERVICES-ORAL
8140444   DICYCLOMINE 10MG/5ML SYRU            27            81             PHARMACY SERVICES-ORAL
8121998   DICYCLOMINE 20MG TABLET                            81             PHARMACY SERVICES-ORAL
8103434   DICYCLOMINE 20MG TABLET U            15            81             PHARMACY SERVICES-ORAL
8124851   DIDANOSINE                                         81             PHARMACY SERVICES-ORAL
8123028   DIDANOSINE 25MG PO                                 81             PHARMACY SERVICES-ORAL
8103459   DIDANOSINE 25MG PO                   20            81             PHARMACY SERVICES-ORAL
8140451   DIGOXIN 0.05MG/ML 60ML EL            12            81             PHARMACY SERVICES-ORAL
8103525   DIGOXIN 0.125MG TABLET UD            15            81             PHARMACY SERVICES-ORAL
8103533   DIGOXIN 0.25MG TABLET UD             15            81             PHARMACY SERVICES-ORAL
8124463   DILTIAZEM                                          81             PHARMACY SERVICES-ORAL
8103699   DILTIAZEM 30MG TABLET UD             15            81             PHARMACY SERVICES-ORAL
8131591   DILTIAZEM 5MG/ML 25ML VL                           81             PHARMACY SERVICES-ORAL
8103657   DILTIAZEM CD 120MG CAPS               1            81             PHARMACY SERVICES-ORAL
8103673   DILTIAZEM-CD 120MG CAP               17            81             PHARMACY SERVICES-ORAL
8103681   DILTIAZEM-CD 180MG CAP               18            81             PHARMACY SERVICES-ORAL
8140469   DIPHENHYDRAMINE 12.5MGL 5            17            81             PHARMACY SERVICES-ORAL
8140477   DIPHENHYDRAMINE 50MG IJ                            81             PHARMACY SERVICES-ORAL
8181695   DIPHENHYDRAMINE 50MG PO             0.01           81             PHARMACY SERVICES-ORAL
8125072   DIPHENHYDRAMINE 50MG PO                            81             PHARMACY SERVICES-ORAL
8104952   DIPHENHYDRAMINE 50MG PO                2           81             PHARMACY SERVICES-ORAL
8104945   DIPHENHYDRAMINE 50MG PO                2           81             PHARMACY SERVICES-ORAL
8140485   DIPHENHYDRAMINE ELX 2.5MG                          81             PHARMACY SERVICES-ORAL
8110710   DIPYRIDAMOLE/10MG IJ                 89            81             PHARMACY SERVICES-ORAL
8103764   DISOPYRAMIDE CR 150MG CAP            18            81             PHARMACY SERVICES-ORAL
8122384   DISOPYRAMIDE CR 150MG CAP            15            81             PHARMACY SERVICES-ORAL
8110728   DISULFIRAM 250MG TABLET                            81             PHARMACY SERVICES-ORAL
8124901   DIVALPROEX                                         81             PHARMACY SERVICES-ORAL
8123952   DIVALPROEX 125MG CAP SPRN                          81             PHARMACY SERVICES-ORAL
8103798   DIVALPROEX 125MG TAB                               81             PHARMACY SERVICES-ORAL
8103814   DIVALPROEX 500MG TAB EC                1           81             PHARMACY SERVICES-ORAL
8123135   DIVALPROEX 500MG TAB SOD                           81             PHARMACY SERVICES-ORAL
8103863   DIVALPROEX EC 250MG TAB U            17            81             PHARMACY SERVICES-ORAL
8130015   DOCETAXEL 20MG IJ                  1335            81             PHARMACY SERVICES-ORAL
8140493   DOCUSATE 100MG/10ML LIQ U             2            81             PHARMACY SERVICES-ORAL
8141582   DOCUSATE 150MG/15ML-25ML             16            81             PHARMACY SERVICES-ORAL
8103897   DOCUSATE NA 100MG CAP D                            81             PHARMACY SERVICES-ORAL
8140501   DOCUSATE NA 10MG/ML LIQ                1           81             PHARMACY SERVICES-ORAL
8103947   DOCUSATE SOD 100MG CAP UD              2           81             PHARMACY SERVICES-ORAL
8103954   DOCUSATE SOD 250MG CAP UD              2           81             PHARMACY SERVICES-ORAL
8141376   DOCUSATE SODIUM 10MG/MLUD              1           81             PHARMACY SERVICES-ORAL
8103970   DOFETILIDE 0.125MG CAP                 2           81             PHARMACY SERVICES-ORAL
8105132   DOLASETRON 100MG PO                  184           81             PHARMACY SERVICES-ORAL
8104002   DONEPEZIL 10MG TABLET                  4           81             PHARMACY SERVICES-ORAL
8104010   DONEPEZIL 5MG TAB 24HR UD             25           81             PHARMACY SERVICES-ORAL
8140519   DONNAGEL SUSP 4 OZ                     2           81             PHARMACY SERVICES-ORAL
8170342   DONNATAL                            0.01           81             PHARMACY SERVICES-ORAL
8181539   DONNATAL 120ML ELIXIR                              81             PHARMACY SERVICES-ORAL
8140527   DONNATAL EL 3.24MG/ML                              81             PHARMACY SERVICES-ORAL




                                                Page 128
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8140535   DONNATAL ELIXIR 5ML UD                27            81             PHARMACY SERVICES-ORAL
8140543   DONNATAL ELX 3.24MG/ML                 1            81             PHARMACY SERVICES-ORAL
8104028   DONNATAL TABLET                        5            81             PHARMACY SERVICES-ORAL
8104036   DONNATAL TABLET UD                    15            81             PHARMACY SERVICES-ORAL
8104044   DOXAZOSIN 2MG TABLET                   1            81             PHARMACY SERVICES-ORAL
8110744   DOXAZOSIN MESYLATE 2MG                16            81             PHARMACY SERVICES-ORAL
8104093   DOXEPIN 10MG CAPSULE UD               15            81             PHARMACY SERVICES-ORAL
8104101   DOXEPIN 25MG CAPSULE UD               15            81             PHARMACY SERVICES-ORAL
8104150   DOXYCYCLINE 100MG CAP UD              17            81             PHARMACY SERVICES-ORAL
8104127   DOXYCYCLINE 100MG CAPSUL               1            81             PHARMACY SERVICES-ORAL
8160566   DRONABINOL 2.5MG PO                   40            81             PHARMACY SERVICES-ORAL
8105157   DRONABINOL 2.5MG PO                    4            81             PHARMACY SERVICES-ORAL
8131542   DULOXETINE 20MG CAPSULE                3            81             PHARMACY SERVICES-ORAL
8124034   DULOXETINE 30MG CAP                                 81             PHARMACY SERVICES-ORAL
8131658   DUTASTERIDE                                         81             PHARMACY SERVICES-ORAL
8104184   DYAZIDE 25MG TAB                                    81             PHARMACY SERVICES-ORAL
8123853   DYAZIDE 37.5/25 CAP                                 81             PHARMACY SERVICES-ORAL
8141038   EES/SULFISOX PDZL 100ML S             54            81             PHARMACY SERVICES-ORAL
8140550   EES/SULFISOX SUSP 40/120/             15            81             PHARMACY SERVICES-ORAL
8110751   EFAVIRENZ 200MG CAP                   26            81             PHARMACY SERVICES-ORAL
8122871   EFAVIRENZ 200MG CAPSULE                6            81             PHARMACY SERVICES-ORAL
8124042   EFAVIRENZ 600MG TAB                                 81             PHARMACY SERVICES-ORAL
8130403   ELECTROLYTE ORAL                        6           81             PHARMACY SERVICES-ORAL
8124596   ELETRIPTAN                                          81             PHARMACY SERVICES-ORAL
8131526   EMTRICITABINE 200MG CAP               12            81             PHARMACY SERVICES-ORAL
8104325   ENALAPRIL 2.5MG TAB UD                16            81             PHARMACY SERVICES-ORAL
8104317   ENALAPRIL 5MG TABLET UD               17            81             PHARMACY SERVICES-ORAL
8104341   ENTCAPONE 200MG TAB 24HR              19            81             PHARMACY SERVICES-ORAL
8131575   EPLERENONE 25MG TABLET                 4            81             PHARMACY SERVICES-ORAL
8124265   ERGOCALCIFEROL 400U TAB               13            81             PHARMACY SERVICES-ORAL
8110769   ERGOCALCIFEROL 50000U CAP                           81             PHARMACY SERVICES-ORAL
8140568   ERGOCALCIFEROL GTT 8KU/ML             16            81             PHARMACY SERVICES-ORAL
8110777   ERGOLOID MESYLS 1MG TAB                             81             PHARMACY SERVICES-ORAL
8130668   ERGONOVINE MAL 0.2MG IJ               97            81             PHARMACY SERVICES-ORAL
8141699   ERYTHROMYCIN                                        81             PHARMACY SERVICES-ORAL
8126138   ERYTHROMYCIN                         0.01           81             PHARMACY SERVICES-ORAL
8141483   ERYTHROMYCIN 100ML ORAL S                           81             PHARMACY SERVICES-ORAL
8140576   ERYTHROMYCIN 250/5ML SUSP             38            81             PHARMACY SERVICES-ORAL
8123796   ERYTHROMYCIN 250MG FT STE                           81             PHARMACY SERVICES-ORAL
8123804   ERYTHROMYCIN 500MG FT STE                           81             PHARMACY SERVICES-ORAL
8104408   ERYTHROMYCIN BASE 250MG T             15            81             PHARMACY SERVICES-ORAL
8104358   ERYTHROMYCIN BASE 250MG T                           81             PHARMACY SERVICES-ORAL
8140584   ERYTHROMYCIN ETH SUSP 200                           81             PHARMACY SERVICES-ORAL
8110785   ERYTHROMYCIN LAC 500MG IJ            122            81             PHARMACY SERVICES-ORAL
8122251   ERYTHROMYCIN OPH OINT                  1            81             PHARMACY SERVICES-ORAL
8110793   ESCITALOPRAM 10MG TAB                 20            81             PHARMACY SERVICES-ORAL
8181588   ESCITALOPRAM 240ML SOL                              81             PHARMACY SERVICES-ORAL
8104440   ESTRADIOL 0.5MG TABLET                              81             PHARMACY SERVICES-ORAL
8104416   ESTRADIOL 1MG TABLET                                81             PHARMACY SERVICES-ORAL
8110835   ESTRADIOL 1MG TABLET UD               15            81             PHARMACY SERVICES-ORAL
8125080   ESTROGENS                                           81             PHARMACY SERVICES-ORAL
8102998   ESTROGENS CON .625MG TAB              17            81             PHARMACY SERVICES-ORAL
8102980   ESTROGENS CONJ 0.3MG TAB              17            81             PHARMACY SERVICES-ORAL
8124521   ESZOPICLONE                                         81             PHARMACY SERVICES-ORAL
8123531   ETHAMBUTOL 100MG TAB                                81             PHARMACY SERVICES-ORAL




                                                 Page 129
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8104515   ETHAMBUTOL 400MG TABLET               1            81             PHARMACY SERVICES-ORAL
8104531   ETHAMBUTOL 400MG TABLET U            19            81             PHARMACY SERVICES-ORAL
8110868   ETIDRONATE 200MG TABLET U            22            81             PHARMACY SERVICES-ORAL
8105009   ETIDRONATE 200MG TABLET U            11            81             PHARMACY SERVICES-ORAL
8170060   ETOH (1ML)                            7            81             PHARMACY SERVICES-ORAL
8170078   ETOH 95%                              1            81             PHARMACY SERVICES-ORAL
8123960   EXEMESTANE 25MG PO                                 81             PHARMACY SERVICES-ORAL
8122277   EYE IRRIG 1 OZ                        6            81             PHARMACY SERVICES-ORAL
8121733   EZETIMIBE 10MG TAB                    3            81             PHARMACY SERVICES-ORAL
8104598   FAMOTIDINE 20MG TABLET UD            18            81             PHARMACY SERVICES-ORAL
8124430   FE POLYSACCH                                       81             PHARMACY SERVICES-ORAL
8180655   FE SO4 300MG/5ML LI                                81             PHARMACY SERVICES-ORAL
8104663   FE SO4 324MG TAB UD                   1            81             PHARMACY SERVICES-ORAL
8180697   FE SO4 75MG/.6ML DROPS               12            81             PHARMACY SERVICES-ORAL
8180663   FE SO4 ELX 44MG/ML                                 81             PHARMACY SERVICES-ORAL
8180671   FE SO4 GTT                             8           81             PHARMACY SERVICES-ORAL
8122004   FELODIPINE 2.5MG TAB                   1           81             PHARMACY SERVICES-ORAL
8121741   FELODIPINE 2.5MG TAB                   1           81             PHARMACY SERVICES-ORAL
8124356   FELODIPINE 5MG TABLET                              81             PHARMACY SERVICES-ORAL
8123978   FENOFIBRATE 145MG TAB                              81             PHARMACY SERVICES-ORAL
8124240   FENOFIBRATE 48MG TAB                 16            81             PHARMACY SERVICES-ORAL
8123333   FENOFIBRATE 54MG TAB                               81             PHARMACY SERVICES-ORAL
8160517   FENTANYL ACTIQ 200MCG LOZ             9            81             PHARMACY SERVICES-ORAL
8160525   FENTANYL ACTIQ 400MCG LOZ            12            81             PHARMACY SERVICES-ORAL
8180705   FERRIC GLUC SOLN 30ML                 1            81             PHARMACY SERVICES-ORAL
8180713   FERRIC SUBSULF SOLUTION              47            81             PHARMACY SERVICES-ORAL
8123747   FERROUS FUMAR 150MG COMPL            15            81             PHARMACY SERVICES-ORAL
8124711   FEXOFENADINE                                       81             PHARMACY SERVICES-ORAL
8104689   FEXOFENADINE 60 MG CAPSUL            17            81             PHARMACY SERVICES-ORAL
8104705   FINASTERIDE 5MG PO                   21            81             PHARMACY SERVICES-ORAL
8121758   FIORINAL CAP                                       81             PHARMACY SERVICES-ORAL
8160210   FIORINAL TABLET                                    81             PHARMACY SERVICES-ORAL
8123002   FISH OIL CAPSULE                                   81             PHARMACY SERVICES-ORAL
8104721   FLECAINIDE 50MG TABLET 24            19            81             PHARMACY SERVICES-ORAL
8140030   FLEET                                 1            81             PHARMACY SERVICES-ORAL
8181430   FLEET      PHOSPHO-SOD               87            81             PHARMACY SERVICES-ORAL
8181422   FLEET PHOSPHO-SODA 45ML             298            81             PHARMACY SERVICES-ORAL
8180721   FLEET SALINE ENEMA                    5            81             PHARMACY SERVICES-ORAL
8180739   FLEET SALINE LAX 3 OZ                 1            81             PHARMACY SERVICES-ORAL
8180747   FLEET SALINE LAX 8 OZ                 2            81             PHARMACY SERVICES-ORAL
8124406   FLUCONAZOLE                                        81             PHARMACY SERVICES-ORAL
8104739   FLUCONAZOLE 100MG TAB                 7            81             PHARMACY SERVICES-ORAL
8104762   FLUCONAZOLE 100MG TAB UD             34            81             PHARMACY SERVICES-ORAL
8104747   FLUCONAZOLE 200MG TABLET             13            81             PHARMACY SERVICES-ORAL
8122897   FLUCYTOSINE 500MG CAPSULE             9            81             PHARMACY SERVICES-ORAL
8110959   FLUDROCORTISONE 0.1MG TAB            16            81             PHARMACY SERVICES-ORAL
8140600   FLUORESCEIN SOD 10% 5ML I            61            81             PHARMACY SERVICES-ORAL
8122293   FLUORESCEIN STRIPS #300              31            81             PHARMACY SERVICES-ORAL
8110975   FLUORIDE NA 2.2MG TA                               81             PHARMACY SERVICES-ORAL
8110934   FLUOXETINE 20MG CAPSULE              20            81             PHARMACY SERVICES-ORAL
8123549   FLUOXYMESTERONE 10MG TAB                           81             PHARMACY SERVICES-ORAL
8180762   FLUPHENAZINE                                       81             PHARMACY SERVICES-ORAL
8180788   FLUPHENAZINE DECA 25MG IJ            48            81             PHARMACY SERVICES-ORAL
8111072   FLURAZEPAM 30MG CAPSULE                            81             PHARMACY SERVICES-ORAL
8122301   FLURBIPROFEN .03% OPH SUS            16            81             PHARMACY SERVICES-ORAL




                                                Page 130
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8111080   FLUTAMIDE 125MG PO                    20            81             PHARMACY SERVICES-ORAL
8111098   FLUVASTATIN 20MG CAPSULE                            81             PHARMACY SERVICES-ORAL
8111106   FLUVASTATIN 40MG CAP                                81             PHARMACY SERVICES-ORAL
8123739   FLUVASTATIN XL 80MG TAB               19            81             PHARMACY SERVICES-ORAL
8111155   FOLIC ACID 1MG TABLET UD              15            81             PHARMACY SERVICES-ORAL
8130718   FOLTX TABLET                                        81             PHARMACY SERVICES-ORAL
8126104   FOSAMPRENAVIR                        0.01           81             PHARMACY SERVICES-ORAL
8111171   FOSINOPRIL NA 10MG TAB                              81             PHARMACY SERVICES-ORAL
8131641   FROVATRIPTAN                                        81             PHARMACY SERVICES-ORAL
8126146   FUROSEMIDE                           0.01           81             PHARMACY SERVICES-ORAL
8111213   FUROSEMIDE 20MG TABLET UD              15           81             PHARMACY SERVICES-ORAL
8111221   FUROSEMIDE 40MG TAB UD                 15           81             PHARMACY SERVICES-ORAL
8180796   FUROSEMIDE 40MG/5ML SOL                18           81             PHARMACY SERVICES-ORAL
8111288   FUROSEMIDE 80MG TABLET UD              16           81             PHARMACY SERVICES-ORAL
8111304   GABAPENTIN 100MG CAP UD                16           81             PHARMACY SERVICES-ORAL
8122889   GABAPENTIN 100MG CAPSULE                1           81             PHARMACY SERVICES-ORAL
8111320   GABAPENTIN 300MG CAP UD                18           81             PHARMACY SERVICES-ORAL
8111353   GABAPENTIN 400MG CAPSULE                            81             PHARMACY SERVICES-ORAL
8122939   GALANTAMINE HBR 4MG TAB                 3           81             PHARMACY SERVICES-ORAL
8123036   GANCICLOVIR 250MG CAPSULE                           81             PHARMACY SERVICES-ORAL
8111395   GATIFLOXACIN 200MG/TAB                              81             PHARMACY SERVICES-ORAL
8111437   GATIFLOXACIN 400MG TABLET                           81             PHARMACY SERVICES-ORAL
8180804   GAVISCON SUSPENSION                                 81             PHARMACY SERVICES-ORAL
8122988   GAVISCON TABLET                                     81             PHARMACY SERVICES-ORAL
8111445   GEMFIBROZIL 600MG TAB UD              17            81             PHARMACY SERVICES-ORAL
8122319   GENTAMICIN OPH GTTS 5ML                5            81             PHARMACY SERVICES-ORAL
8122863   GLIMEPIRIDE 2MG TABLET                 1            81             PHARMACY SERVICES-ORAL
8111502   GLIPIZIDE 5MG TABLET UD               15            81             PHARMACY SERVICES-ORAL
8111528   GLIPIZIDE XL 5MG TAB                                81             PHARMACY SERVICES-ORAL
8111536   GLIPIZIDE XL 5MG TABLET               16            81             PHARMACY SERVICES-ORAL
8124372   GLUCOSE CHEW TAB                                    81             PHARMACY SERVICES-ORAL
8124570   GLYBURIDE                                           81             PHARMACY SERVICES-ORAL
8111551   GLYBURIDE 2.5MG TABLET                              81             PHARMACY SERVICES-ORAL
8111585   GLYBURIDE 2.5MG TABLET UD             15            81             PHARMACY SERVICES-ORAL
8111627   GLYBURIDE 5MG TABLET UD               16            81             PHARMACY SERVICES-ORAL
8123150   GLYBURIDE MICRNZD 3MG PRE                           81             PHARMACY SERVICES-ORAL
8111635   GRANISETRON 1MG PO                                  81             PHARMACY SERVICES-ORAL
8170219   GUAIF/COD                             29            81             PHARMACY SERVICES-ORAL
8180820   GUAIF/COD SYRP (ML                     7            81             PHARMACY SERVICES-ORAL
8180846   GUAIF/CODEINE ELX 5ML                               81             PHARMACY SERVICES-ORAL
8141533   GUAIF/DM 100 10-10ML                                81             PHARMACY SERVICES-ORAL
8181596   GUAIF/DM 100 10-118ML                               81             PHARMACY SERVICES-ORAL
8141525   GUAIF/DM 100 10-5ML                                 81             PHARMACY SERVICES-ORAL
8180853   GUAIF/DM ELX (1ML)                                  81             PHARMACY SERVICES-ORAL
8170094   GUAIF/HYDROCOD                         27           81             PHARMACY SERVICES-ORAL
8126195   GUAIFENESIN                          0.01           81             PHARMACY SERVICES-ORAL
8126187   GUAIFENESIN                          0.01           81             PHARMACY SERVICES-ORAL
8140618   GUAIFENESIN 100MG/5 ML UD                           81             PHARMACY SERVICES-ORAL
8140626   GUAIFENESIN 100MG/5ML UD                2           81             PHARMACY SERVICES-ORAL
8180861   GUAIFENESIN 20MG/ML ELIX                            81             PHARMACY SERVICES-ORAL
8111643   GUAIFENESIN LA 600MG TAB              13            81             PHARMACY SERVICES-ORAL
8121766   GUAIFENESIN SA 600MG TAB                            81             PHARMACY SERVICES-ORAL
8111668   GUANFACINE 1MG TABLET                               81             PHARMACY SERVICES-ORAL
8130577   GUAR GUM FIBERSOURCE                  70            81             PHARMACY SERVICES-ORAL
8111684   HALOPERIDOL 0.5MG TABLET                            81             PHARMACY SERVICES-ORAL




                                                 Page 131
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8111676   HALOPERIDOL 0.5MG TABLET                           81             PHARMACY SERVICES-ORAL
8111700   HALOPERIDOL 10MG TABLET                            81             PHARMACY SERVICES-ORAL
8111718   HALOPERIDOL 1MG TABLET                             81             PHARMACY SERVICES-ORAL
8111734   HALOPERIDOL 1MG TABLET UD            15            81             PHARMACY SERVICES-ORAL
8111775   HALOPERIDOL 5MG TABLET UD                          81             PHARMACY SERVICES-ORAL
8122400   HALOPERIDOL 5MG TABLET UD            14            81             PHARMACY SERVICES-ORAL
8180879   HALOPERIDOL CON 2MG/ML15M            11            81             PHARMACY SERVICES-ORAL
8180887   HALOPERIDOL CONC 2MG/ML              39            81             PHARMACY SERVICES-ORAL
8140634   HALOPERIDOL LAC 2MG/ML CO            18            81             PHARMACY SERVICES-ORAL
8111940   HCTZ 25 UD                           15            81             PHARMACY SERVICES-ORAL
8122012   HCTZ/SPIRON 25/25MG TAB                            81             PHARMACY SERVICES-ORAL
8123713   HIV EXPOSURE KIT                                   81             PHARMACY SERVICES-ORAL
8122327   HOMATROPINE 5% 5ML                     9           81             PHARMACY SERVICES-ORAL
8170086   HYCODAN SYR                                        81             PHARMACY SERVICES-ORAL
8111874   HYDRALAZINE 10MG TABLET U            15            81             PHARMACY SERVICES-ORAL
8111908   HYDRALAZINE 25MG TABLET U            16            81             PHARMACY SERVICES-ORAL
8122020   HYDROCOD/APAP                        13            81             PHARMACY SERVICES-ORAL
8130189   HYDROCOD/APAP        P               30            81             PHARMACY SERVICES-ORAL
8160236   HYDROCOD/APAP *OP LORTAB             37            81             PHARMACY SERVICES-ORAL
8160228   HYDROCOD/APAP *OP LORTAB             16            81             PHARMACY SERVICES-ORAL
8160244   HYDROCOD/APAP 10/325                  1            81             PHARMACY SERVICES-ORAL
8160392   HYDROCOD/APAP 10/500 TAB             17            81             PHARMACY SERVICES-ORAL
8160269   HYDROCOD/APAP 5MG TABLET                           81             PHARMACY SERVICES-ORAL
8170102   HYDROCOD/APAP EL2.5MG/5ML                          81             PHARMACY SERVICES-ORAL
8160400   HYDROCOD/ASA                         36            81             PHARMACY SERVICES-ORAL
8123218   HYDROCOD/IBUPR 200/7.5 TA                          81             PHARMACY SERVICES-ORAL
8160277   HYDROCODONE/APAP 5/500 #6              4           81             PHARMACY SERVICES-ORAL
8170110   HYDROCODONE/APAP ELX 15ML              4           81             PHARMACY SERVICES-ORAL
8123457   HYDROCORT                                          81             PHARMACY SERVICES-ORAL
8170276   HYDROCORT CRM 1OZ                    12            81             PHARMACY SERVICES-ORAL
8111973   HYDROCORTISONE 5MG TAB               15            81             PHARMACY SERVICES-ORAL
8180903   HYDROCORTISONE ENEMA 60ML            58            81             PHARMACY SERVICES-ORAL
8111981   HYDROMORPHONE 2MG TAB UD             29            81             PHARMACY SERVICES-ORAL
8130049   HYDROXYUREA 500MG PO                 17            81             PHARMACY SERVICES-ORAL
8112062   HYDROXYZINE HCL 10MG TAB                           81             PHARMACY SERVICES-ORAL
8112047   HYDROXYZINE HCL 10MG TAB             15            81             PHARMACY SERVICES-ORAL
8112070   HYDROXYZINE HCL 25MG CAP                           81             PHARMACY SERVICES-ORAL
8112054   HYDROXYZINE HCL 25MG TAB             15            81             PHARMACY SERVICES-ORAL
8123432   HYDROXYZINE PAM 25MG PO                            81             PHARMACY SERVICES-ORAL
8112096   HYDROXYZINE PAM 25MG PO                            81             PHARMACY SERVICES-ORAL
8112120   HYOSCYAMNE .125MG TAB                              81             PHARMACY SERVICES-ORAL
8112112   HYOSCYAMNE 0.125MG TAB               15            81             PHARMACY SERVICES-ORAL
8124604   IBUPROFEN                                          81             PHARMACY SERVICES-ORAL
8112146   IBUPROFEN 200MG TABLET                             81             PHARMACY SERVICES-ORAL
8112179   IBUPROFEN 200MG TABLET UD              2           81             PHARMACY SERVICES-ORAL
8112187   IBUPROFEN 300MG TABLET                             81             PHARMACY SERVICES-ORAL
8112211   IBUPROFEN 400MG TABLET UD           0.01           81             PHARMACY SERVICES-ORAL
8112260   IBUPROFEN 600MG TABLET UD             15           81             PHARMACY SERVICES-ORAL
8140642   IBUPROFEN SUS 100MG/5ML 1             17           81             PHARMACY SERVICES-ORAL
8140659   IBUPROFEN SUSP 100MG/5ML                           81             PHARMACY SERVICES-ORAL
8124679   IMATINIB                                           81             PHARMACY SERVICES-ORAL
8122533   IMIPENEM/CILAST 500MG AD-             25           81             PHARMACY SERVICES-ORAL
8126112   IMIPRAMINE                          0.01           81             PHARMACY SERVICES-ORAL
8119810   INDINAVIR 400MG CAP UD                28           81             PHARMACY SERVICES-ORAL
8118838   INDINAVIR 400MG CAPSULE               28           81             PHARMACY SERVICES-ORAL




                                                Page 132
                                c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION             SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                   AMOUNT AMOUNT CODE

8118085   INDOMETHACIN 25MG CAP                             81             PHARMACY SERVICES-ORAL
8119471   INDOMETHACIN 25MG CAP UD            16            81             PHARMACY SERVICES-ORAL
8118069   INDOMETHACIN 50MG CAP                             81             PHARMACY SERVICES-ORAL
8118077   INDOMETHACIN SR 75MG CAP             1            81             PHARMACY SERVICES-ORAL
8140675   IPECAC 30ML SYRUP UD                32            81             PHARMACY SERVICES-ORAL
8140683   IPECAC SYRUP 30ML                    1            81             PHARMACY SERVICES-ORAL
8112336   IRBESARTAN 150MG TABLET             18            81             PHARMACY SERVICES-ORAL
8124539   IRON COMPLEX                                      81             PHARMACY SERVICES-ORAL
8126294   ISONIAZID                          0.01           81             PHARMACY SERVICES-ORAL
8112351   ISONIAZID 300MG TAB UD               15           81             PHARMACY SERVICES-ORAL
8122426   ISONIAZID 300MG TAB UD               11           81             PHARMACY SERVICES-ORAL
8122038   ISOPTO TEARS 15ML                     6           81             PHARMACY SERVICES-ORAL
8112377   ISOSORBIDE 10MG TABLET UD            15           81             PHARMACY SERVICES-ORAL
8122442   ISOSORBIDE 10MG TABLET UD            11           81             PHARMACY SERVICES-ORAL
8112385   ISOSORBIDE 20MGH TAB                  1           81             PHARMACY SERVICES-ORAL
8112393   ISOSORBIDE 30MG TAB                   1           81             PHARMACY SERVICES-ORAL
8121337   ISOSORBIDE DIN 10MG TA                            81             PHARMACY SERVICES-ORAL
8121774   ISOSORBIDE DIN 10MG TA D                          81             PHARMACY SERVICES-ORAL
8121329   ISOSORBIDE DIN 20MG TA                            81             PHARMACY SERVICES-ORAL
8121352   ISOSORBIDE DIN 40MG TA                            81             PHARMACY SERVICES-ORAL
8121345   ISOSORBIDE DINIT 20MG TA                          81             PHARMACY SERVICES-ORAL
8130510   ISOSORBIDE MONO ER 60MG T           17            81             PHARMACY SERVICES-ORAL
8190266   ISOSORBIDE MONO ER 60MG T           16            81             PHARMACY SERVICES-ORAL
8122723   ISOSORBIDE60MGERMNVD                 1            81             PHARMACY SERVICES-ORAL
8190175   ISOSORBIDE60MGERMNVD                 1            81             PHARMACY SERVICES-ORAL
8124588   ISRADIPINE                                        81             PHARMACY SERVICES-ORAL
8124505   ISRADIPINE                                        81             PHARMACY SERVICES-ORAL
8118093   ISRADIPINE 2.5MG CAPSULE                          81             PHARMACY SERVICES-ORAL
8118119   ITRACONAZOLE 100MG CAP               5            81             PHARMACY SERVICES-ORAL
8119885   ITRACONAZOLE 100MG CAPSUL           36            81             PHARMACY SERVICES-ORAL
8181570   ITRACONAZOLE 50 MG IJ                             81             PHARMACY SERVICES-ORAL
8118432   K ACID PHOS CAP                                   81             PHARMACY SERVICES-ORAL
8119604   K CL 10MEQ CAP U                    15            81             PHARMACY SERVICES-ORAL
8112468   K CL 20MEQ CR TAB UD                16            81             PHARMACY SERVICES-ORAL
8190290   K CL 20MEQ PKT                                    81             PHARMACY SERVICES-ORAL
8112435   K CL 20MEQ TAB D                                  81             PHARMACY SERVICES-ORAL
8122814   K CL SR 20MEQ TAB                    1            81             PHARMACY SERVICES-ORAL
8181174   K IODIDE       SS                   43            81             PHARMACY SERVICES-ORAL
8119919   KALETRA CAPSULE                     23            81             PHARMACY SERVICES-ORAL
8181547   KAOLIN-PECTIN 180ML SUSPE                         81             PHARMACY SERVICES-ORAL
8140931   KAOLIN-PECTIN 30ML                                81             PHARMACY SERVICES-ORAL
8141129   KAOLIN-PECTIN SUSP 30ML              2            81             PHARMACY SERVICES-ORAL
8112476   KETOCONAZOLE 200MG TAB               1            81             PHARMACY SERVICES-ORAL
8112492   KETOROLAC 10MG TABLET               16            81             PHARMACY SERVICES-ORAL
8112500   KETOROLAC 10MG TABLET UD            16            81             PHARMACY SERVICES-ORAL
8112526   LABETALOL 100MG TABLET UD           16            81             PHARMACY SERVICES-ORAL
8123986   LACTASE 3000U CAPLET                              81             PHARMACY SERVICES-ORAL
8124927   LACTOBACILLUS                                     81             PHARMACY SERVICES-ORAL
8124919   LACTOBACILLUS                                     81             PHARMACY SERVICES-ORAL
8123762   LACTOBACILLUS CAP                     1           81             PHARMACY SERVICES-ORAL
8190167   LACTOBACILLUS GRAN PKT                            81             PHARMACY SERVICES-ORAL
8190340   LACTSE/MONOHYDRT PWDR 30G                         81             PHARMACY SERVICES-ORAL
8126179   LACTULOSE                          0.01           81             PHARMACY SERVICES-ORAL
8181372   LACTULOSE 20GM/30ML LIQ U            21           81             PHARMACY SERVICES-ORAL
8141293   LACTULOSE 20GM/30ML LIQ U            21           81             PHARMACY SERVICES-ORAL




                                               Page 133
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8140949   LACTULOSE LIQ 30ML                    2            81             PHARMACY SERVICES-ORAL
8112575   LAMIVUDINE 150MG TAB                 15            81             PHARMACY SERVICES-ORAL
8112583   LAMIVUDINE 150MG TAB/ZIDO            41            81             PHARMACY SERVICES-ORAL
8141491   LAMIVUDINE 240ML SOL                224            81             PHARMACY SERVICES-ORAL
8112591   LAMOTRIGINE 100MG TABLET             22            81             PHARMACY SERVICES-ORAL
8112617   LAMOTRIGINE 25MG TAB 24H             22            81             PHARMACY SERVICES-ORAL
8181307   LANSOPRAZOLE 150MG/50ML C            51            81             PHARMACY SERVICES-ORAL
8118937   LANSOPRAZOLE 15MG CAP                 4            81             PHARMACY SERVICES-ORAL
8119901   LANSOPRAZOLE 15MG CAPSL              25            81             PHARMACY SERVICES-ORAL
8124083   LANSOPRAZOLE 15MG SOLUTAB                          81             PHARMACY SERVICES-ORAL
8119927   LANSOPRAZOLE 30MG CAP UD              12           81             PHARMACY SERVICES-ORAL
8118879   LANSOPRAZOLE 30MG CAPSULE              4           81             PHARMACY SERVICES-ORAL
8122962   LANSOPRAZOLE 30MG SOLUTAB              5           81             PHARMACY SERVICES-ORAL
8112641   LETROZOLE 2.5MG TABLET                34           81             PHARMACY SERVICES-ORAL
8112690   LEUCOVORIN 5MG TABLET UD              21           81             PHARMACY SERVICES-ORAL
8170326   LEVETIRACETAM                       0.01           81             PHARMACY SERVICES-ORAL
8112716   LEVETIRACETAM 500MG TAB               20           81             PHARMACY SERVICES-ORAL
8122350   LEVOBUNOLOL OPH 0.5% 5ML              12           81             PHARMACY SERVICES-ORAL
8124455   LEVODOPA                                           81             PHARMACY SERVICES-ORAL
8118135   LEVODOPA 250MG CAPSULE                             81             PHARMACY SERVICES-ORAL
8121667   LEVOFLOXACIN 500MG TAB               39            81             PHARMACY SERVICES-ORAL
8112757   LEVOFLOXACIN 250MG TAB UD            36            81             PHARMACY SERVICES-ORAL
8112765   LEVOFLOXACIN 500MG TABLET             8            81             PHARMACY SERVICES-ORAL
8123861   LEVOFLOXACIN 750MG TAB               24            81             PHARMACY SERVICES-ORAL
8126021   LEVONORGESTREL                                     81             PHARMACY SERVICES-ORAL
8123556   LEVORPHANAL 2MG TAB                                81             PHARMACY SERVICES-ORAL
8112781   LEVOTHYROXINE .1MG TAB                             81             PHARMACY SERVICES-ORAL
8122046   LEVOTHYROXINE .1MG TABLET                          81             PHARMACY SERVICES-ORAL
8112807   LEVOTHYROXINE .2MG TAB                             81             PHARMACY SERVICES-ORAL
8112823   LEVOTHYROXINE 0.025MG TAB                          81             PHARMACY SERVICES-ORAL
8112864   LEVOTHYROXINE 0.05MG TAB             15            81             PHARMACY SERVICES-ORAL
8112856   LEVOTHYROXINE 0.05MG TAB                           81             PHARMACY SERVICES-ORAL
8112849   LEVOTHYROXINE 0.05MG TAB                           81             PHARMACY SERVICES-ORAL
8112898   LEVOTHYROXINE 0.125MG TAB                          81             PHARMACY SERVICES-ORAL
8112930   LEVOTHYROXINE 0.1MG TAB U            15            81             PHARMACY SERVICES-ORAL
8121782   LEVOTHYROXINE 0.3MG TAB                            81             PHARMACY SERVICES-ORAL
8112955   LEVOTHYROXINE 112MCG TAB                           81             PHARMACY SERVICES-ORAL
8112971   LEVOTHYROXINE 88MCG TAB                            81             PHARMACY SERVICES-ORAL
8141749   LIDOCAINE                           0.01           81             PHARMACY SERVICES-ORAL
8131567   LIDOCAINE 2% VISC 100ML                            81             PHARMACY SERVICES-ORAL
8141020   LIDOCAINE VISC 2% 20ML UD            17            81             PHARMACY SERVICES-ORAL
8112997   LINEZOLID 600MG TABLET              158            81             PHARMACY SERVICES-ORAL
8113011   LIOTHYRONINE 5MCG TABLET                           81             PHARMACY SERVICES-ORAL
8113052   LISINOPRIL 10MG TABLET UD            17            81             PHARMACY SERVICES-ORAL
8122061   LISINOPRIL 5MG TABLET                 1            81             PHARMACY SERVICES-ORAL
8113110   LISINOPRIL 5MG TABLET UD             17            81             PHARMACY SERVICES-ORAL
8118143   LITHIUM CARB 300MG CAP                             81             PHARMACY SERVICES-ORAL
8118150   LITHIUM CARB 300MG CAP D                           81             PHARMACY SERVICES-ORAL
8119489   LITHIUM CARB 300MG CAP UD            15            81             PHARMACY SERVICES-ORAL
8121360   LITHIUM CARB SR 300MG TA                           81             PHARMACY SERVICES-ORAL
8141152   LITHIUM CIT SYRP 300MG/5M                          81             PHARMACY SERVICES-ORAL
8180937   LOMOTIL 2.5MG/5ML SOLUTIO            14            81             PHARMACY SERVICES-ORAL
8113169   LOMOTIL TABLET UD                    16            81             PHARMACY SERVICES-ORAL
8118168   LOPERAMIDE 2MG CAPSULE                             81             PHARMACY SERVICES-ORAL
8119497   LOPERAMIDE 2MG CAPSULE UD              3           81             PHARMACY SERVICES-ORAL




                                                Page 134
                                c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION             SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                   AMOUNT AMOUNT CODE

8140741   LOPERAMIDE 2MG/10ML SOL U             4           81             PHARMACY SERVICES-ORAL
8181224   LOPERAMIDE LIQ 0.2MG/ML                           81             PHARMACY SERVICES-ORAL
8113177   LORATADINE 10MG TABLET UD             8           81             PHARMACY SERVICES-ORAL
8160285   LORAZEPAM 0.5MG TABLET                            81             PHARMACY SERVICES-ORAL
8160293   LORAZEPAM 0.5MG TABLET D                          81             PHARMACY SERVICES-ORAL
8160319   LORAZEPAM 0.5MG TABLET UD           29            81             PHARMACY SERVICES-ORAL
8160327   LORAZEPAM 1MG TABLET                              81             PHARMACY SERVICES-ORAL
8160335   LORAZEPAM 1MG TABLET D                            81             PHARMACY SERVICES-ORAL
8160350   LORAZEPAM 1MG TABLET UD             30            81             PHARMACY SERVICES-ORAL
8160368   LORAZEPAM 2MG TABLET                 1            81             PHARMACY SERVICES-ORAL
8160376   LORAZEPAM 2MG TABLET D               1            81             PHARMACY SERVICES-ORAL
8113185   LOSARTAN 25MG TABLET                 1            81             PHARMACY SERVICES-ORAL
8113193   LOSARTAN 50MG TAB 24HR UD           18            81             PHARMACY SERVICES-ORAL
8113227   LOVASTATIN 20MG TAB                 20            81             PHARMACY SERVICES-ORAL
8118176   LOXAPINE 10MG CAPSULE                             81             PHARMACY SERVICES-ORAL
8118184   LOXAPINE 25MG CAPSULE                 1           81             PHARMACY SERVICES-ORAL
8141004   LOXAPINE 25MG/ML CONC 1ML             3           81             PHARMACY SERVICES-ORAL
8123564   LOXAPINE 5MG CAP                                  81             PHARMACY SERVICES-ORAL
8180952   MAG CIT SOLD 300ML                  30            81             PHARMACY SERVICES-ORAL
8126039   MAG CL                                            81             PHARMACY SERVICES-ORAL
8141400   MAG HYDROXIDE 30ML SUSPEN                         81             PHARMACY SERVICES-ORAL
8124398   MAG OXIDE                                         81             PHARMACY SERVICES-ORAL
8113276   MAG OXIDE 400MG TAB                 15            81             PHARMACY SERVICES-ORAL
8141434   MAGIC MOUTHWASH 200ML                             81             PHARMACY SERVICES-ORAL
8131666   MAPROTILINE                                       81             PHARMACY SERVICES-ORAL
8122137   MAXITROL OPH OINT                   11            81             PHARMACY SERVICES-ORAL
8122236   MAXITROL SUSP 5ML                   11            81             PHARMACY SERVICES-ORAL
8113300   MAXZIDE-25 (DYAZIDE) TAB            16            81             PHARMACY SERVICES-ORAL
8113318   MEBENDAZOLE 100MG TAB 24H           26            81             PHARMACY SERVICES-ORAL
8121790   MECLIZINE 25MG TABLET D                           81             PHARMACY SERVICES-ORAL
8113359   MECLIZINE 25MG TABLET D                           81             PHARMACY SERVICES-ORAL
8113375   MECLIZINE 25MG TABLET UD              2           81             PHARMACY SERVICES-ORAL
8121378   MEDROXYPROGEST 10MG TA                            81             PHARMACY SERVICES-ORAL
8121386   MEDROXYPROGEST 2.5MG TA                           81             PHARMACY SERVICES-ORAL
8190324   MEDROXYPROGESTER 50MG IJ            56            81             PHARMACY SERVICES-ORAL
8130361   MEDROXYPROGESTERONE 2.5MG           15            81             PHARMACY SERVICES-ORAL
8118192   MEFENAMIC ACID 250MG CAP                          81             PHARMACY SERVICES-ORAL
8113383   MEFLOQUINE 250MG TAB 24H            43            81             PHARMACY SERVICES-ORAL
8141590   MEGESTROL ACETATE 2OMG PO                         81             PHARMACY SERVICES-ORAL
8113417   MEGESTROL ACETATE 2OMG PO           17            81             PHARMACY SERVICES-ORAL
8130056   MELPHALAN 2MG PO                    20            81             PHARMACY SERVICES-ORAL
8123481   MEMANTINE 10MG TABLET               19            81             PHARMACY SERVICES-ORAL
8122913   MEMANTINE 5MG TABLET                 3            81             PHARMACY SERVICES-ORAL
8113433   MEPERIDINE 50MG TABLET D                          81             PHARMACY SERVICES-ORAL
8124638   MERCAPTOPURINE 50MG PO                            81             PHARMACY SERVICES-ORAL
8130502   MERCUROCHROME                       30            81             PHARMACY SERVICES-ORAL
8124661   MESALAMINE                                        81             PHARMACY SERVICES-ORAL
8113482   MESALAMINE 400MG TABLET U           19            81             PHARMACY SERVICES-ORAL
8140956   MESALAMINE ENEMA 4GM/60ML            7            81             PHARMACY SERVICES-ORAL
8113565   METFORMIN 500MG TABLET UD           16            81             PHARMACY SERVICES-ORAL
8122525   METFORMIN 500MG TABLET UD           13            81             PHARMACY SERVICES-ORAL
8113573   METFORMIN 850 MG TABLET             17            81             PHARMACY SERVICES-ORAL
8170144   METHADONE 5MG PO                     3            81             PHARMACY SERVICES-ORAL
8170136   METHADONE 5MG PO                    86            81             PHARMACY SERVICES-ORAL
8160434   METHADONE 5MG PO                                  81             PHARMACY SERVICES-ORAL




                                               Page 135
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8160418   METHADONE 5MG PO                     29            81             PHARMACY SERVICES-ORAL
8124059   METHAZOLAMIDE 25MG TAB                             81             PHARMACY SERVICES-ORAL
8122756   METHAZOLAMIDE 50MG TAB                             81             PHARMACY SERVICES-ORAL
8113607   METHIMAZOLE 10MG TABLET              14            81             PHARMACY SERVICES-ORAL
8113615   METHIMAZOLE 5MG TABLET                             81             PHARMACY SERVICES-ORAL
8122087   METHOCARBAMOL 750MG TAB                            81             PHARMACY SERVICES-ORAL
8130064   METHOTREXATE 2.5MG PO                23            81             PHARMACY SERVICES-ORAL
8122129   METHYLDOPA 250MG TABLET                            81             PHARMACY SERVICES-ORAL
8121402   METHYLERGONOVIN 0.2MG TA                           81             PHARMACY SERVICES-ORAL
8122145   METHYLERGONOVIN 0.2MG TA                           81             PHARMACY SERVICES-ORAL
8121394   METHYLERGONOVIN O.2MG TA                           81             PHARMACY SERVICES-ORAL
8122160   METHYLERGONOVIN O.2MG TA                           81             PHARMACY SERVICES-ORAL
8123572   METHYLPHENIDATE 10MG TAB                           81             PHARMACY SERVICES-ORAL
8160442   METHYLPHENIDATE 20MG TAB                           81             PHARMACY SERVICES-ORAL
8160459   METHYLPHENIDATE 5MG TAB                            81             PHARMACY SERVICES-ORAL
8124133   METHYLPREDNISOLONE 4MG PO            16            81             PHARMACY SERVICES-ORAL
8113714   METOCLOPRAMIDE 10MG TAB                            81             PHARMACY SERVICES-ORAL
8113748   METOCLOPRAMIDE 10MG TAB U            15            81             PHARMACY SERVICES-ORAL
8141137   METOCLOPRAMIDE 10MG/10ML             16            81             PHARMACY SERVICES-ORAL
8141178   METOCLOPRAMIDE SYRP 1MG/M                          81             PHARMACY SERVICES-ORAL
8113789   METOLAZONE 2.5MG TABLET U            18            81             PHARMACY SERVICES-ORAL
8113813   METOLAZONE 5MG TABLET UD             19            81             PHARMACY SERVICES-ORAL
8122855   METOPROLOL 25MG TABLET                1            81             PHARMACY SERVICES-ORAL
8113821   METOPROLOL 50MG TABLET                             81             PHARMACY SERVICES-ORAL
8113839   METOPROLOL 50MG TABLET D                           81             PHARMACY SERVICES-ORAL
8113854   METOPROLOL 50MG TABLET UD            16            81             PHARMACY SERVICES-ORAL
8131534   METOPROLOL XL 25MG TABLET             1            81             PHARMACY SERVICES-ORAL
8113862   METOPROLOL XL 50MG TAB               16            81             PHARMACY SERVICES-ORAL
8130650   METRONIDAZOLE 500MG TABLE            17            81             PHARMACY SERVICES-ORAL
8119505   MEXILETINE 150MG CAP UD              14            81             PHARMACY SERVICES-ORAL
8118218   MEXILETINE 150MG CAPSULE                           81             PHARMACY SERVICES-ORAL
8118200   MEXILETINE 200MG CAPSULE               1           81             PHARMACY SERVICES-ORAL
8123580   MEXILETINE 250MG CAP                               81             PHARMACY SERVICES-ORAL
8170151   MIDAZOLAM SYRUP 2MG/ML 11            40            81             PHARMACY SERVICES-ORAL
8125049   MIDODRINE                                          81             PHARMACY SERVICES-ORAL
8130700   MIDODRINE 5MG TABLET                   3           81             PHARMACY SERVICES-ORAL
8118226   MIDRIN CAPSULE                                     81             PHARMACY SERVICES-ORAL
8126260   MILK THISTLE                        0.01           81             PHARMACY SERVICES-ORAL
8181323   MINERAL OIL                            1           81             PHARMACY SERVICES-ORAL
8181380   MINERAL OIL 180ML                      5           81             PHARMACY SERVICES-ORAL
8140048   MINERAL OIL ENEMA FLEET                6           81             PHARMACY SERVICES-ORAL
8141087   MINERAL OIL LIGHT 10ML                30           81             PHARMACY SERVICES-ORAL
8141517   MINERAL OIL LIGHT 25ML TO             33           81             PHARMACY SERVICES-ORAL
8123044   MINOCYCLINE 100MG CAPSULE                          81             PHARMACY SERVICES-ORAL
8123598   MINOXIDIL 10MG PO                                  81             PHARMACY SERVICES-ORAL
8113938   MINOXIDIL 10MG PO                    16            81             PHARMACY SERVICES-ORAL
8113987   MIRTAZAPINE 15MG TABLET              21            81             PHARMACY SERVICES-ORAL
8113953   MIRTAZAPINE 15MG TABLET               2            81             PHARMACY SERVICES-ORAL
8113961   MIRTAZAPINE 30MG TABLET               2            81             PHARMACY SERVICES-ORAL
8130692   MISC CONTROLLED ORAL                               81             PHARMACY SERVICES-ORAL
8122707   MISC O/P RX                                        81             PHARMACY SERVICES-ORAL
8190225   MISC O/P RX                                        81             PHARMACY SERVICES-ORAL
8141186   MISC ORAL LIQUID                                   81             PHARMACY SERVICES-ORAL
8140253   MISC ORAL SOLID                        3           81             PHARMACY SERVICES-ORAL
8122715   MISC ORAL SOLID                                    81             PHARMACY SERVICES-ORAL




                                                Page 136
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8190159   MISC ORAL SOLID                                     81             PHARMACY SERVICES-ORAL
8130684   MISC OTHER DRUG                                     81             PHARMACY SERVICES-ORAL
8122202   MISC OTHER DRUG                       15            81             PHARMACY SERVICES-ORAL
8114019   MISOPROSTOL 200MCG PO                  1            81             PHARMACY SERVICES-ORAL
8114001   MISOPROSTOL 200MG PO                  16            81             PHARMACY SERVICES-ORAL
8124067   MISOPROSTOL 25MCG TAB                               81             PHARMACY SERVICES-ORAL
8123606   MODAFINIL 200MG TAB                                 81             PHARMACY SERVICES-ORAL
8123119   MOLINDONE 50MG TABLET                               81             PHARMACY SERVICES-ORAL
8141095   MOM 15ML UD                            2            81             PHARMACY SERVICES-ORAL
8141111   MOM/CASCARA 15ML                      13            81             PHARMACY SERVICES-ORAL
8140964   MOM/CASCARA CONC 15ML                               81             PHARMACY SERVICES-ORAL
8114084   MONTELUKAST 10MG TAB UD                21           81             PHARMACY SERVICES-ORAL
8114100   MORICIZINE 200MG TB UD 24              17           81             PHARMACY SERVICES-ORAL
8170334   MORPHINE                             0.01           81             PHARMACY SERVICES-ORAL
8130072   MORPHINE 60MG SR TAB UD                38           81             PHARMACY SERVICES-ORAL
8130080   MORPHINE CONT 100MG TAB                 5           81             PHARMACY SERVICES-ORAL
8130106   MORPHINE CONTIN 30MG TAB                1           81             PHARMACY SERVICES-ORAL
8130098   MORPHINE CONTIN 30MG TAB                1           81             PHARMACY SERVICES-ORAL
8130130   MORPHINE CONTIN 60MG TAB                2           81             PHARMACY SERVICES-ORAL
8130122   MORPHINE CONTIN 60MG TAB                2           81             PHARMACY SERVICES-ORAL
8130155   MORPHINE SR 100MG TAB UD               32           81             PHARMACY SERVICES-ORAL
8130163   MORPHINE SR 15MG TAB UD                30           81             PHARMACY SERVICES-ORAL
8130171   MORPHINE SR 30MG TAB UD                33           81             PHARMACY SERVICES-ORAL
8124331   MOXIFLOXACIN 400MG TAB                              81             PHARMACY SERVICES-ORAL
8126237   MVI                                  0.01           81             PHARMACY SERVICES-ORAL
8124448   MVI                                                 81             PHARMACY SERVICES-ORAL
8181455   MVI LIQUID 120ML                        2           81             PHARMACY SERVICES-ORAL
8181620   MVI PEDI                                            81             PHARMACY SERVICES-ORAL
8114142   MVI PRENATAL TAB PO                                 81             PHARMACY SERVICES-ORAL
8140972   MVI THERAPEUTIC LIQ 5ML                             81             PHARMACY SERVICES-ORAL
8141335   MVI THERAPEUTIC LQ 120M                 4           81             PHARMACY SERVICES-ORAL
8114159   MVI THERAPEUTIC TAB                                 81             PHARMACY SERVICES-ORAL
8130379   MVI UD                                  2           81             PHARMACY SERVICES-ORAL
8141343   MVI/FE GTT                                          81             PHARMACY SERVICES-ORAL
8114134   MVI/MIN                                 2           81             PHARMACY SERVICES-ORAL
8121428   MVI/MIN TA                                          81             PHARMACY SERVICES-ORAL
8130601   MVI-12                                99            81             PHARMACY SERVICES-ORAL
8123051   MYCOPHENOLATE 250MG PO                              81             PHARMACY SERVICES-ORAL
8126252   MYCOPHENOLATE 250MG PO               0.01           81             PHARMACY SERVICES-ORAL
8105025   NA ACET                                             81             PHARMACY SERVICES-ORAL
8116642   NA BICARB 650MG TABLE                 15            81             PHARMACY SERVICES-ORAL
8141194   NA BICARB 8.4% 10ML SYR                6            81             PHARMACY SERVICES-ORAL
8114225   NA CL 1GM TAB                         15            81             PHARMACY SERVICES-ORAL
8181406   NA CL NASAL SPRAY 45ML                 7            81             PHARMACY SERVICES-ORAL
8181331   NA CL NASAL WASH 45ML                  2            81             PHARMACY SERVICES-ORAL
8130353   NA CL NASAL WASH 45ML                  2            81             PHARMACY SERVICES-ORAL
8124968   NABILONE 1MG PO                                     81             PHARMACY SERVICES-ORAL
8131633   NABUMETONE                                          81             PHARMACY SERVICES-ORAL
8125098   NABUMETONE                                          81             PHARMACY SERVICES-ORAL
8114308   NADOLOL 40MG TABLET                    1            81             PHARMACY SERVICES-ORAL
8114365   NAPROXEN 250MG TABLET UD               3            81             PHARMACY SERVICES-ORAL
8114407   NAPROXEN 375MG TABLET UD              17            81             PHARMACY SERVICES-ORAL
8124380   NEDOCROMIL                                          81             PHARMACY SERVICES-ORAL
8114456   NEFAZODONE 150MG TABLET                 1           81             PHARMACY SERVICES-ORAL
8123143   NEFAZODONE 200MG TABLET                             81             PHARMACY SERVICES-ORAL




                                                 Page 137
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8114472   NELFINAVIR 250MG TABLET               20            81             PHARMACY SERVICES-ORAL
8114514   NEOMYCIN 500MG TABLET UD              16            81             PHARMACY SERVICES-ORAL
8122467   NEOMYCIN 500MG TABLET UD              12            81             PHARMACY SERVICES-ORAL
8122392   NEOSPORIN OPH SOLN 10ML                8            81             PHARMACY SERVICES-ORAL
8118549   NEUTRA-PHOS-K CAP                     12            81             PHARMACY SERVICES-ORAL
8123226   NEVIRAPINE 200MG TABLET               25            81             PHARMACY SERVICES-ORAL
8126013   NIACIN                                              81             PHARMACY SERVICES-ORAL
8124992   NIACIN                                              81             PHARMACY SERVICES-ORAL
8114548   NIACIN 500MG TABLET                                 81             PHARMACY SERVICES-ORAL
8114563   NIACIN 500MG TABLET UD                  1           81             PHARMACY SERVICES-ORAL
8123812   NIACINAMIDE 100MG TAB                               81             PHARMACY SERVICES-ORAL
8123838   NIACINAMIDE 500MG TAB                               81             PHARMACY SERVICES-ORAL
8123614   NICARDIPINE 20MG CAP                                81             PHARMACY SERVICES-ORAL
8118234   NICARDIPINE 30MG CAPSULE                            81             PHARMACY SERVICES-ORAL
8130387   NICOTINE GUM                          14            81             PHARMACY SERVICES-ORAL
8118259   NIFEDIPINE 10MG CAPSULE                             81             PHARMACY SERVICES-ORAL
8117947   NIFEDIPINE 10MG CAPSULE                 1           81             PHARMACY SERVICES-ORAL
8121808   NIFEDIPINE 10MG CAPSULE                             81             PHARMACY SERVICES-ORAL
8118242   NIFEDIPINE 10MG CAPSULE                             81             PHARMACY SERVICES-ORAL
8119513   NIFEDIPINE 10MG CAPSULE U                           81             PHARMACY SERVICES-ORAL
8114571   NIFEDIPINE ER 30MG TABLET              1            81             PHARMACY SERVICES-ORAL
8114621   NIFEDIPINE XL 30MG TAB UD             18            81             PHARMACY SERVICES-ORAL
8119521   NIMODIPINE 30MG CAP UD                33            81             PHARMACY SERVICES-ORAL
8118267   NIMODIPINE 30MG CAPSULE                5            81             PHARMACY SERVICES-ORAL
8124422   NISOLDIPINE                                         81             PHARMACY SERVICES-ORAL
8124414   NISOLDIPINE                                         81             PHARMACY SERVICES-ORAL
8122806   NITROFURANTOIN 100MG CAP                2           81             PHARMACY SERVICES-ORAL
8118283   NITROFURANTOIN 100MG CAP                1           81             PHARMACY SERVICES-ORAL
8118275   NITROFURANTOIN 100MG CAP                1           81             PHARMACY SERVICES-ORAL
8118309   NITROFURANTOIN 50MG CAP                             81             PHARMACY SERVICES-ORAL
8118291   NITROFURANTOIN 50MG CAP                             81             PHARMACY SERVICES-ORAL
8119547   NITROFURANTOIN 50MG CAP U             16            81             PHARMACY SERVICES-ORAL
8118770   NIZATIDINE 150MG CAPSULE               2            81             PHARMACY SERVICES-ORAL
8118317   NORTRIPTYLINE 10MG CAP                              81             PHARMACY SERVICES-ORAL
8118325   NORTRIPTYLINE 25MG CAP                              81             PHARMACY SERVICES-ORAL
8114647   NTG 0.4MG TAB UD                      28            81             PHARMACY SERVICES-ORAL
8123622   NTG 0.6MG TAB SUBL                                  81             PHARMACY SERVICES-ORAL
8130395   NTG 1/200 .3MG TAB                    28            81             PHARMACY SERVICES-ORAL
8119539   NTG 2.5MG CAP UD                      12            81             PHARMACY SERVICES-ORAL
8122731   NTG 6.5MG CA D                                      81             PHARMACY SERVICES-ORAL
8119554   NTG 6.5MG CAP UD                      12            81             PHARMACY SERVICES-ORAL
8123630   NYSTATIN 500,000U TAB                               81             PHARMACY SERVICES-ORAL
8181505   NYSTATIN 5ML SUSPENSION               68            81             PHARMACY SERVICES-ORAL
8181398   NYSTATIN 60ML SUSPENSION                            81             PHARMACY SERVICES-ORAL
8181232   NYSTATIN SUSP 100000U/ML               7            81             PHARMACY SERVICES-ORAL
8114696   NYSTATIN VAGINAL TAB                  17            81             PHARMACY SERVICES-ORAL
8130569   OLANZAPINE 2.5MG TAB                  27            81             PHARMACY SERVICES-ORAL
8114712   OLANZAPINE 5MG TAB UD                 29            81             PHARMACY SERVICES-ORAL
8114753   OLANZAPINE ZYDIS 5MG TAB                            81             PHARMACY SERVICES-ORAL
8126211   OLMESARTAN MED                       0.01           81             PHARMACY SERVICES-ORAL
8124778   OLMESARTAN MED                                      81             PHARMACY SERVICES-ORAL
8119562   OMEPRAZOLE 20MG CAP UD                12            81             PHARMACY SERVICES-ORAL
8118341   OMEPRAZOLE 20MG CAPSULE                3            81             PHARMACY SERVICES-ORAL
8118333   OMEPRAZOLE 20MG CAPSULE                3            81             PHARMACY SERVICES-ORAL
8131617   ONDANSETRON 8MG PO                                  81             PHARMACY SERVICES-ORAL




                                                 Page 138
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8123879   ONDANSETRON 8MG PO                                 81             PHARMACY SERVICES-ORAL
8114761   ONDANSETRON 8MG PO                   96            81             PHARMACY SERVICES-ORAL
8170300   OPIUM TINCTURE 10% 1ML               28            81             PHARMACY SERVICES-ORAL
8170292   OPIUM TINCTURE DILUT 1:25                          81             PHARMACY SERVICES-ORAL
8170284   OPIUM TINCTURE TINCTURE                            81             PHARMACY SERVICES-ORAL
8181562   ORAL SUSPENSION VEHICLE                            81             PHARMACY SERVICES-ORAL
8124612   OSELTAMIVIR                                        81             PHARMACY SERVICES-ORAL
8114829   OVRAL TAB PO                         28            81             PHARMACY SERVICES-ORAL
8160533   OXANDROLONE 10MG TAB                 20            81             PHARMACY SERVICES-ORAL
8190217   OXANDROLONE 10MG TAB                 20            81             PHARMACY SERVICES-ORAL
8118853   OXAZEPAM 10MG CAPSULE UD              1            81             PHARMACY SERVICES-ORAL
8118804   OXAZEPAM 15 MG CAPSULE                             81             PHARMACY SERVICES-ORAL
8131625   OXCARBAZEPINE 300MG TAB                            81             PHARMACY SERVICES-ORAL
8114845   OXYBUTYNIN 5MG TABLET UD             11            81             PHARMACY SERVICES-ORAL
8122699   OXYBUTYNIN XL 10MG TABLET             3            81             PHARMACY SERVICES-ORAL
8114852   OXYBUTYNIN XL 5MG TAB UD             22            81             PHARMACY SERVICES-ORAL
8122749   OXYBUTYNIN XL 5MG TABLET              3            81             PHARMACY SERVICES-ORAL
8160483   OXYCODONE                                          81             PHARMACY SERVICES-ORAL
8190209   OXYCODONE                                          81             PHARMACY SERVICES-ORAL
8190191   OXYCODONE                                          81             PHARMACY SERVICES-ORAL
8160467   OXYCODONE 10MG CTRL REL T              1           81             PHARMACY SERVICES-ORAL
8160475   OXYCODONE 20MG TABLET SA                           81             PHARMACY SERVICES-ORAL
8181414   OXYMETAZOLINE .05% 15ML S             36           81             PHARMACY SERVICES-ORAL
8122152   OXYMETAZOLINE 0.05% GTT                4           81             PHARMACY SERVICES-ORAL
8122178   OXYMETAZOLINE 0.05% SPRA               4           81             PHARMACY SERVICES-ORAL
8126245   PALIPERIDONE                        0.01           81             PHARMACY SERVICES-ORAL
8126229   PALIPERIDONE                        0.01           81             PHARMACY SERVICES-ORAL
8114951   PANCRELIPASE 8000U TAB                             81             PHARMACY SERVICES-ORAL
8123697   PANTOPRAZOLE 20MG TAB DR                           81             PHARMACY SERVICES-ORAL
8114977   PANTOPRAZOLE 40MG TABLET             23            81             PHARMACY SERVICES-ORAL
8118358   PAPAVERINE 150MG CAPSULE                           81             PHARMACY SERVICES-ORAL
8131583   PAPAVERINE 30MG/ML IJ                72            81             PHARMACY SERVICES-ORAL
8141475   PAREGORIC 480ML LIQUID                             81             PHARMACY SERVICES-ORAL
8126278   PARICALCITOL                        0.01           81             PHARMACY SERVICES-ORAL
8124349   PAROMOMYCIN 250MG CAPSULE                          81             PHARMACY SERVICES-ORAL
8124620   PAROXETINE                                         81             PHARMACY SERVICES-ORAL
8122848   PAROXETINE 10MG TABLET                3            81             PHARMACY SERVICES-ORAL
8115016   PAROXETINE 20MG TABLET               16            81             PHARMACY SERVICES-ORAL
8115008   PAROXETINE 20MG TABLET                2            81             PHARMACY SERVICES-ORAL
8123770   PAROXETINE CR 12.5MG TAB              3            81             PHARMACY SERVICES-ORAL
8122947   PAROXETINE CR 25MG TABLET             3            81             PHARMACY SERVICES-ORAL
8141053   PCN G K 600,000U IJ                 221            81             PHARMACY SERVICES-ORAL
8141046   PCN V K 125MG/5ML 10                 32            81             PHARMACY SERVICES-ORAL
8115073   PCN V K 250MG TAB UD                 15            81             PHARMACY SERVICES-ORAL
8141061   PCN V K 250MG/5ML 10                 33            81             PHARMACY SERVICES-ORAL
8140980   PCN V K SUSP 100ML                                 81             PHARMACY SERVICES-ORAL
8118366   PENICILLAMINE 250MG CAP                            81             PHARMACY SERVICES-ORAL
8121436   PENTAZOC/NALOX 50MG TA                             81             PHARMACY SERVICES-ORAL
8118382   PENTOBARBITAL 100MG CAP                            81             PHARMACY SERVICES-ORAL
8118374   PENTOBARBITAL 50MG CAP                             81             PHARMACY SERVICES-ORAL
8115099   PENTOXIFYLLINE 400MG TAB             16            81             PHARMACY SERVICES-ORAL
8124794   PERINDOPRIL                                        81             PHARMACY SERVICES-ORAL
8124786   PERINDOPRIL                                        81             PHARMACY SERVICES-ORAL
8121477   PHENAZOPYRIDINE 100MG TA                           81             PHARMACY SERVICES-ORAL
8121451   PHENAZOPYRIDINE 100MG TA                           81             PHARMACY SERVICES-ORAL




                                                Page 139
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8115180   PHENAZOPYRIDINE 100MG TAB            16            81             PHARMACY SERVICES-ORAL
8121469   PHENAZOPYRIDINE 200MG TA                           81             PHARMACY SERVICES-ORAL
8121444   PHENAZOPYRIDINE 200MG TA               1           81             PHARMACY SERVICES-ORAL
8130254   PHENOBARBITAL                                      81             PHARMACY SERVICES-ORAL
8130205   PHENOBARBITAL 100MG TAB                            81             PHARMACY SERVICES-ORAL
8130221   PHENOBARBITAL 15MG TAB                             81             PHARMACY SERVICES-ORAL
8130239   PHENOBARBITAL 30MG TAB                             81             PHARMACY SERVICES-ORAL
8130247   PHENOBARBITAL 30MG TAB UD            15            81             PHARMACY SERVICES-ORAL
8170250   PHENOBARBITAL ELX 20MG/5M                          81             PHARMACY SERVICES-ORAL
8170268   PHENOBARBITAL ELX 4MG/ML                           81             PHARMACY SERVICES-ORAL
8170235   PHENOBARBITAL ELX 4MG/ML                           81             PHARMACY SERVICES-ORAL
8119588   PHENOXYBENZAMINE 10MG CAP            29            81             PHARMACY SERVICES-ORAL
8124943   PHENYTOIN                                          81             PHARMACY SERVICES-ORAL
8118408   PHENYTOIN 100MG CAPSULE                            81             PHARMACY SERVICES-ORAL
8118390   PHENYTOIN 100MG CAPSULE                            81             PHARMACY SERVICES-ORAL
8119596   PHENYTOIN 100MG CAPSULE U            15            81             PHARMACY SERVICES-ORAL
8122681   PHENYTOIN 30MG CAPSULE                             81             PHARMACY SERVICES-ORAL
8115214   PHENYTOIN 50MG CHEWTAB                             81             PHARMACY SERVICES-ORAL
8140881   PHENYTOIN SUSP 125MG/5ML                           81             PHARMACY SERVICES-ORAL
8140899   PHENYTOIN SUSP 25MG/ML                             81             PHARMACY SERVICES-ORAL
8130494   PHOSPHORUS 250MG PCKT                15            81             PHARMACY SERVICES-ORAL
8115230   PHOSPHORUS NEUTRAL TABLET                          81             PHARMACY SERVICES-ORAL
8115248   PHYTONADIONE 5MG TABLET                            81             PHARMACY SERVICES-ORAL
8115255   PHYTONADIONE 5MG TABLET U            16            81             PHARMACY SERVICES-ORAL
8122418   PILOCARPINE 1% 15ML                   8            81             PHARMACY SERVICES-ORAL
8122434   PILOCARPINE 2% 15ML                   8            81             PHARMACY SERVICES-ORAL
8122459   PILOCARPINE 2% 1ML                    4            81             PHARMACY SERVICES-ORAL
8122780   PILOCARPINE 2% DRP                   53            81             PHARMACY SERVICES-ORAL
8122475   PILOCARPINE 4% 15ML                   9            81             PHARMACY SERVICES-ORAL
8122491   PILOCARPINE 6% 15ML                   8            81             PHARMACY SERVICES-ORAL
8122194   PILOCARPINE OPH GEL                  14            81             PHARMACY SERVICES-ORAL
8115263   PIMOZIDE 2MG TABLET                   1            81             PHARMACY SERVICES-ORAL
8115289   PINDOLOL 5MG TABLET                   8            81             PHARMACY SERVICES-ORAL
8115271   PINDOLOL 5MG TABLET                                81             PHARMACY SERVICES-ORAL
8180507   PINK BISMUTH SUBSALICYLAT              6           81             PHARMACY SERVICES-ORAL
8181240   PINK BISMUTH SUSP 120ML                            81             PHARMACY SERVICES-ORAL
8115297   PIOGLITAZONE 15MG TAB                 3            81             PHARMACY SERVICES-ORAL
8115313   PIOGLITAZONE 30MG TABLET              5            81             PHARMACY SERVICES-ORAL
8121816   PIOGLITAZONE 45MG TAB                 5            81             PHARMACY SERVICES-ORAL
8118416   PIROXICAM 10MG CAPSULE                1            81             PHARMACY SERVICES-ORAL
8118424   PIROXICAM 20MG CAPSULE                1            81             PHARMACY SERVICES-ORAL
8112039   PLAQUENIL                            17            81             PHARMACY SERVICES-ORAL
8121311   PLAQUENIL 200MG TA                                 81             PHARMACY SERVICES-ORAL
8181646   POLYCITRA                                          81             PHARMACY SERVICES-ORAL
8124828   POLYCITRA-K                                        81             PHARMACY SERVICES-ORAL
8141426   POLYETHYLENE 4000ML SOLUT                          81             PHARMACY SERVICES-ORAL
8141707   POLYSTYRENE                                        81             PHARMACY SERVICES-ORAL
8181216   POLYSTYRENE 250MG/ML                               81             PHARMACY SERVICES-ORAL
8131500   POLYSTYRENE 60M                      70            81             PHARMACY SERVICES-ORAL
8115347   PRAMIPEXOLE 0.25MG TAB               17            81             PHARMACY SERVICES-ORAL
8115354   PRAMIPEXOLE 0.25MG TABLET             1            81             PHARMACY SERVICES-ORAL
8115362   PRAMIPEXOLE 1MG TABLET                2            81             PHARMACY SERVICES-ORAL
8115370   PRAMIPEXOLE HCL 1.5MG TAB             2            81             PHARMACY SERVICES-ORAL
8115388   PRAVASTATIN 20MG TAB UD               2            81             PHARMACY SERVICES-ORAL
8115396   PRAVASTATIN 20MG TABLET U            22            81             PHARMACY SERVICES-ORAL




                                                Page 140
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8123168   PRAZIQUANTEL 600MG TABLET                          81             PHARMACY SERVICES-ORAL
8119612   PRAZOSIN 1MG CAP UD 24H              15            81             PHARMACY SERVICES-ORAL
8118440   PRAZOSIN 1MG CAPSULE                               81             PHARMACY SERVICES-ORAL
8118465   PRAZOSIN 2MG CAPSULE                               81             PHARMACY SERVICES-ORAL
8119620   PRAZOSIN 5MG CAP UD 24H              16            81             PHARMACY SERVICES-ORAL
8118457   PRAZOSIN 5MG CAPSULE                               81             PHARMACY SERVICES-ORAL
8141012   PRED/SULFACET 5ML                      9           81             PHARMACY SERVICES-ORAL
8141301   PRED/SULFACET 5ML                      9           81             PHARMACY SERVICES-ORAL
8122210   PREDNISOLONE 1% OPH GTT                9           81             PHARMACY SERVICES-ORAL
8140915   PREDNISOLONE 5MG PO                                81             PHARMACY SERVICES-ORAL
8115404   PREDNISOLONE 5MG PO                                81             PHARMACY SERVICES-ORAL
8141103   PREDNISONE 5MG PO                    29            81             PHARMACY SERVICES-ORAL
8115529   PREDNISONE 5MG PO                    15            81             PHARMACY SERVICES-ORAL
8115487   PREDNISONE 5MG PO                                  81             PHARMACY SERVICES-ORAL
8115461   PREDNISONE 5MG PO                                  81             PHARMACY SERVICES-ORAL
8115453   PREDNISONE 5MG PO                    15            81             PHARMACY SERVICES-ORAL
8115420   PREDNISONE 5MG PO                                  81             PHARMACY SERVICES-ORAL
8124729   PREGABALIN                                         81             PHARMACY SERVICES-ORAL
8124653   PREGABALIN                                         81             PHARMACY SERVICES-ORAL
8122954   PRIMAQUINE 15MG TABLET                1            81             PHARMACY SERVICES-ORAL
8115560   PRIMAQUINE 26.3MG TABLET             15            81             PHARMACY SERVICES-ORAL
8141145   PRIMIDONE 250 MG/5ML SUSP            16            81             PHARMACY SERVICES-ORAL
8115578   PRIMIDONE 250 TABLET UD              16            81             PHARMACY SERVICES-ORAL
8115586   PRIMIDONE 250MG TABLET                             81             PHARMACY SERVICES-ORAL
8115594   PRIMIDONE 50MG TABLET                              81             PHARMACY SERVICES-ORAL
8115610   PROBENECID 500MG TABLET                            81             PHARMACY SERVICES-ORAL
8115602   PROBENECID 500MG TABLET              19            81             PHARMACY SERVICES-ORAL
8118481   PROCAINAMIDE 250MG CAP                             81             PHARMACY SERVICES-ORAL
8119638   PROCAINAMIDE 250MG CAP UD            12            81             PHARMACY SERVICES-ORAL
8118473   PROCAINAMIDE 500MG CAP                             81             PHARMACY SERVICES-ORAL
8121642   PROCAINAMIDE ER 500 MG TA            15            81             PHARMACY SERVICES-ORAL
8121501   PROCAINAMIDE SR 500MG TA                           81             PHARMACY SERVICES-ORAL
8121485   PROCAINAMIDE SR 500MG TA                           81             PHARMACY SERVICES-ORAL
8121493   PROCAINAMIDE SR 750MG TA                           81             PHARMACY SERVICES-ORAL
8123648   PROCARBAZINE 50MG PO                               81             PHARMACY SERVICES-ORAL
8130338   PROCHLORPERAZIN 5MG PO                             81             PHARMACY SERVICES-ORAL
8115636   PROCHLORPERAZINE 10MG TAB                          81             PHARMACY SERVICES-ORAL
8115644   PROCHLORPERAZINE 5MG PO                            81             PHARMACY SERVICES-ORAL
8115628   PROCHLORPERAZINE 5MG PO              16            81             PHARMACY SERVICES-ORAL
8118978   PROGESTERONE 100MG CAP                1            81             PHARMACY SERVICES-ORAL
8170243   PROMETH/COD 5ML LI                   30            81             PHARMACY SERVICES-ORAL
8170193   PROMETH/COD SYR 5ML                   1            81             PHARMACY SERVICES-ORAL
8141202   PROMETH/COD SYRUP                                  81             PHARMACY SERVICES-ORAL
8115693   PROMETHAZINE 12.5MG PO               16            81             PHARMACY SERVICES-ORAL
8115669   PROMETHAZINE 25MG TAB                              81             PHARMACY SERVICES-ORAL
8115677   PROMETHAZINE 25MG TAB D                            81             PHARMACY SERVICES-ORAL
8115701   PROMETHAZINE 50MG TAB                              81             PHARMACY SERVICES-ORAL
8141210   PROMETHAZINE SYRP 1.25MG/                          81             PHARMACY SERVICES-ORAL
8124547   PROPAFENONE                                        81             PHARMACY SERVICES-ORAL
8115719   PROPAFENONE 150MG TAB                18            81             PHARMACY SERVICES-ORAL
8115727   PROPAFENONE 150MG TABLET              1            81             PHARMACY SERVICES-ORAL
8122509   PROPANTHELINE 15MG TAB               13            81             PHARMACY SERVICES-ORAL
8115735   PROPANTHELINE 15MG TAB 24            16            81             PHARMACY SERVICES-ORAL
8160541   PROPOXYPHENE 65MG CA                               81             PHARMACY SERVICES-ORAL
8118499   PROPOXYPHENE 65MG CAPSUL                           81             PHARMACY SERVICES-ORAL




                                                Page 141
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8115743   PROPRANOLOL 10MG TAB UD              15            81             PHARMACY SERVICES-ORAL
8122483   PROPRANOLOL 10MG TAB UD              11            81             PHARMACY SERVICES-ORAL
8115768   PROPRANOLOL 10MG TABLET                            81             PHARMACY SERVICES-ORAL
8115750   PROPRANOLOL 10MG TABLET                            81             PHARMACY SERVICES-ORAL
8123069   PROPRANOLOL 160MG CAPSULE                          81             PHARMACY SERVICES-ORAL
8115784   PROPRANOLOL 20MG TABLET                            81             PHARMACY SERVICES-ORAL
8115776   PROPRANOLOL 20MG TABLET                            81             PHARMACY SERVICES-ORAL
8115818   PROPRANOLOL 40MG TABLET                            81             PHARMACY SERVICES-ORAL
8115800   PROPRANOLOL 40MG TABLET                            81             PHARMACY SERVICES-ORAL
8115826   PROPRANOLOL 80MG TABLET                            81             PHARMACY SERVICES-ORAL
8115834   PROPRANOLOL LA 120MG CAP              1            81             PHARMACY SERVICES-ORAL
8119646   PROPRANOLOL LA 60 MG CAP             17            81             PHARMACY SERVICES-ORAL
8118507   PROPRANOLOL LA 60MG CAP               1            81             PHARMACY SERVICES-ORAL
8115859   PROPRANOLOL LA 80MG CAP                            81             PHARMACY SERVICES-ORAL
8121519   PROPYLTHIOURACL 50MG TA                            81             PHARMACY SERVICES-ORAL
8115867   PROPYLTHIOURACL 50MG TAB             15            81             PHARMACY SERVICES-ORAL
8123127   PSEUD/TRIP ACTIFED TAB                             81             PHARMACY SERVICES-ORAL
8124752   PSEUDOEPHEDRINE                                    81             PHARMACY SERVICES-ORAL
8115875   PSEUDOEPHEDRINE 30MG TAB                           81             PHARMACY SERVICES-ORAL
8115909   PSEUDOEPHEDRINE 60MG TAB             15            81             PHARMACY SERVICES-ORAL
8115883   PSEUDOEPHEDRINE 60MG TAB                           81             PHARMACY SERVICES-ORAL
8190183   PSYLLIUM INST 3.5GM PKT                            81             PHARMACY SERVICES-ORAL
8130411   PSYLLIUM POWDER PACKET                2            81             PHARMACY SERVICES-ORAL
8115917   PYRAZINAMIDE 500MG TABLET             1            81             PHARMACY SERVICES-ORAL
8115933   PYRIDOSTIGMINE 60MG TAB              16            81             PHARMACY SERVICES-ORAL
8115925   PYRIDOSTIGMINE 60MG TAB                            81             PHARMACY SERVICES-ORAL
8117715   PYRIDOXINE                             1           81             PHARMACY SERVICES-ORAL
8115941   PYRIDOXINE 25MG TABLET                             81             PHARMACY SERVICES-ORAL
8115958   PYRIDOXINE 50MG TABLET                             81             PHARMACY SERVICES-ORAL
8115966   PYRIMETHAMINE 25MG TAB 24            16            81             PHARMACY SERVICES-ORAL
8115974   QUETIAPINE 100MG TABLET               2            81             PHARMACY SERVICES-ORAL
8115990   QUETIAPINE 100MG/TAB                 21            81             PHARMACY SERVICES-ORAL
8116006   QUETIAPINE 200MG TABLET               6            81             PHARMACY SERVICES-ORAL
8116014   QUETIAPINE 25MG TABLET               17            81             PHARMACY SERVICES-ORAL
8116022   QUINAPRIL 10MG TABLET                 1            81             PHARMACY SERVICES-ORAL
8116048   QUINAPRIL 20MG TABLET                 1            81             PHARMACY SERVICES-ORAL
8131609   QUINIDINE                                          81             PHARMACY SERVICES-ORAL
8124489   QUINIDINE                                          81             PHARMACY SERVICES-ORAL
8116063   QUINIDINE 200MG TAB                                81             PHARMACY SERVICES-ORAL
8116071   QUINIDINE 300MG TAB                                81             PHARMACY SERVICES-ORAL
8116055   QUINIDINE EXTANTAB 300MG             14            81             PHARMACY SERVICES-ORAL
8116089   QUINIDINE EXTENTAB 300MG                           81             PHARMACY SERVICES-ORAL
8116113   QUINIDINE GLUC 324MG TAB             16            81             PHARMACY SERVICES-ORAL
8116105   QUINIDINE GLUC 324MG TAB                           81             PHARMACY SERVICES-ORAL
8116097   QUINIDINE GLUC 324MG TAB                           81             PHARMACY SERVICES-ORAL
8116121   QUINIDINE SULF 200MG TAB             15            81             PHARMACY SERVICES-ORAL
8122517   QUINIDINE SULF 200MG TAB             11            81             PHARMACY SERVICES-ORAL
8116139   QUINIDINE SULF 300MG TAB             13            81             PHARMACY SERVICES-ORAL
8118515   QUININE 200MG CAPSULE                              81             PHARMACY SERVICES-ORAL
8118523   QUININE 300MG CAPSULE                              81             PHARMACY SERVICES-ORAL
8122772   QUININE 325MG CAPSULE                              81             PHARMACY SERVICES-ORAL
8119653   QUININE SULF 325 MG CAP U            16            81             PHARMACY SERVICES-ORAL
8118903   QUININE SULFATE 200MG CAP                          81             PHARMACY SERVICES-ORAL
8122996   RALOXIFENE 60MG TABLET                 3           81             PHARMACY SERVICES-ORAL
8123077   RAMIPRIL 1.25MG CAPSULE                            81             PHARMACY SERVICES-ORAL




                                                Page 142
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8118911   RAMIPRIL 2.5MG CAPSULE                 1           81             PHARMACY SERVICES-ORAL
8122228   RAMIPRIL 2.5MG CAPSULE                 1           81             PHARMACY SERVICES-ORAL
8118929   RAMIPRIL 5MG CAPSULE                   1           81             PHARMACY SERVICES-ORAL
8116162   RANITIDINE 150MG TABLET                1           81             PHARMACY SERVICES-ORAL
8116154   RANITIDINE 150MG TABLET                1           81             PHARMACY SERVICES-ORAL
8116147   RANITIDINE 150MG TABLET                6           81             PHARMACY SERVICES-ORAL
8141616   RANITIDINE 150MG/ML-10ML                           81             PHARMACY SERVICES-ORAL
8126047   REPAGLINIDE                                        81             PHARMACY SERVICES-ORAL
8116188   RESERPINE 0.25MG TABLET                            81             PHARMACY SERVICES-ORAL
8119661   RIFABUTIN 150MG CAP 24HR              30           81             PHARMACY SERVICES-ORAL
8126070   RIFAMPIN                            0.01           81             PHARMACY SERVICES-ORAL
8119679   RIFAMPIN 300 MG CAPSULE               19           81             PHARMACY SERVICES-ORAL
8118531   RIFAMPIN 300MG CAPSULE                 1           81             PHARMACY SERVICES-ORAL
8124703   RIFAXIMIN                                          81             PHARMACY SERVICES-ORAL
8123846   RIFAXIMIN 200MG TABLET               22            81             PHARMACY SERVICES-ORAL
8124687   RISEDRONATE                                        81             PHARMACY SERVICES-ORAL
8123473   RISEDRONATE 35MG TABLET              55            81             PHARMACY SERVICES-ORAL
8124216   RISPERIDONE                          24            81             PHARMACY SERVICES-ORAL
8124208   RISPERIDONE                          30            81             PHARMACY SERVICES-ORAL
8122244   RISPERIDONE 0.5MG M-TAB               4            81             PHARMACY SERVICES-ORAL
8121824   RISPERIDONE 0.5MG M-TAB               4            81             PHARMACY SERVICES-ORAL
8124075   RISPERIDONE 0.5MG TAB                              81             PHARMACY SERVICES-ORAL
8122269   RISPERIDONE 1 MG M-TAB                5            81             PHARMACY SERVICES-ORAL
8121832   RISPERIDONE 1 MG M-TAB                5            81             PHARMACY SERVICES-ORAL
8116204   RISPERIDONE 1MG TAB 24 HR            22            81             PHARMACY SERVICES-ORAL
8116212   RISPERIDONE 1MG TABLET                2            81             PHARMACY SERVICES-ORAL
8181315   RISPERIDONE 1MG/ML LIQUID             4            81             PHARMACY SERVICES-ORAL
8122285   RISPERIDONE 2 MG M-TAB                7            81             PHARMACY SERVICES-ORAL
8121840   RISPERIDONE 2 MG M-TAB                7            81             PHARMACY SERVICES-ORAL
8116238   RISPERIDONE 2MG TABLET                3            81             PHARMACY SERVICES-ORAL
8116246   RISPERIDONE 3MG TABLET                4            81             PHARMACY SERVICES-ORAL
8124745   RISPERIDONE LA 0.5MG IJ                            81             PHARMACY SERVICES-ORAL
8119869   RITONAVIR 100MG CAP                  38            81             PHARMACY SERVICES-ORAL
8118895   RITONAVIR 100MG CAPSULE               2            81             PHARMACY SERVICES-ORAL
8181299   RIVASTIGMINE 2MG/ML LIQ               2            81             PHARMACY SERVICES-ORAL
8123788   RIVASTIGMINE 3MG CAPSULE              3            81             PHARMACY SERVICES-ORAL
8116261   RIZATRIPTAN 10MG TAB UD              71            81             PHARMACY SERVICES-ORAL
8116279   ROFECOXIB 12.5MG TABLET               3            81             PHARMACY SERVICES-ORAL
8116287   ROFECOXIB 25MG TAB                    3            81             PHARMACY SERVICES-ORAL
8130551   ROFECOXIB 25MG TABLET                21            81             PHARMACY SERVICES-ORAL
8116303   ROPINIROLE 0.25MG TAB                18            81             PHARMACY SERVICES-ORAL
8116311   ROPINIROLE 1MG TAB                    1            81             PHARMACY SERVICES-ORAL
8116329   ROPINIROLE 1MG TAB                                 81             PHARMACY SERVICES-ORAL
8116337   ROPINIROLE HCL 0.25MG TAB             1            81             PHARMACY SERVICES-ORAL
8116345   ROSIGLITAZONE 4MG TAB                21            81             PHARMACY SERVICES-ORAL
8116352   ROSIGLITAZONE 4MG TABLET              3            81             PHARMACY SERVICES-ORAL
8124893   ROSUVASTATIN                                       81             PHARMACY SERVICES-ORAL
8190233   S NSTRL AERO CHAMBER                 35            81             PHARMACY SERVICES-ORAL
8141244   S STRL WESCODYNE CONC GAL            14            81             PHARMACY SERVICES-ORAL
8181513   SACC 0.05% SOL 500ML                               81             PHARMACY SERVICES-ORAL
8130429   SALIVA SUBSTITE                      21            81             PHARMACY SERVICES-ORAL
8181257   SALIVA SUBSTITE 120ML                 3            81             PHARMACY SERVICES-ORAL
8116360   SALSALATE 500MG TAB UD 24            13            81             PHARMACY SERVICES-ORAL
8116378   SALSALATE 500MG TABLET                             81             PHARMACY SERVICES-ORAL
8123655   SALSALATE 750MG TAB                                81             PHARMACY SERVICES-ORAL




                                                Page 143
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8119802   SAQUINAVIR 200MG PO                   9            81             PHARMACY SERVICES-ORAL
8116394   SELEGILINE 5MG TABLET                19            81             PHARMACY SERVICES-ORAL
8116386   SELEGILINE 5MG TABLET                 2            81             PHARMACY SERVICES-ORAL
8116436   SENNA                                 2            81             PHARMACY SERVICES-ORAL
8116402   SENNA TABLET                                       81             PHARMACY SERVICES-ORAL
8116410   SENNA TABLET D                                     81             PHARMACY SERVICES-ORAL
8116428   SENNA TABLET DD                        2           81             PHARMACY SERVICES-ORAL
8123408   SERTRALINE 100MG TAB                               81             PHARMACY SERVICES-ORAL
8116469   SERTRALINE 50MG TABLET                2            81             PHARMACY SERVICES-ORAL
8116477   SERTRALINE 50MG TABLET UD            21            81             PHARMACY SERVICES-ORAL
8116170   SEVELAMER         RE                 18            81             PHARMACY SERVICES-ORAL
8123416   SEVELAMER 403MG CAP                                81             PHARMACY SERVICES-ORAL
8116493   SEVELAMER 800MG TAB                    1           81             PHARMACY SERVICES-ORAL
8116501   SEVELAMER 800MG TAB                                81             PHARMACY SERVICES-ORAL
8124513   SILDENAFIL 25MG PO                                 81             PHARMACY SERVICES-ORAL
8124497   SILDENAFIL 25MG PO                                 81             PHARMACY SERVICES-ORAL
8181281   SIMETHICONE 40MG/0.6ML DR              3           81             PHARMACY SERVICES-ORAL
8116519   SIMETHICONE 80MG CHEW TAB              1           81             PHARMACY SERVICES-ORAL
8116535   SIMETHICONE 80MG TABLET                            81             PHARMACY SERVICES-ORAL
8116527   SIMETHICONE 80MG TABQ                              81             PHARMACY SERVICES-ORAL
8116543   SIMVASTATIN 10MG TABLET               2            81             PHARMACY SERVICES-ORAL
8190274   SIMVASTATIN 20MG TAB                 27            81             PHARMACY SERVICES-ORAL
8122665   SIMVASTATIN 20MG TABLET              25            81             PHARMACY SERVICES-ORAL
8116550   SIMVASTATIN 20MG TABLET               4            81             PHARMACY SERVICES-ORAL
8116576   SINEMET 10/100 TABLET UD             16            81             PHARMACY SERVICES-ORAL
8116584   SINEMET 25/100 TABLET UD             16            81             PHARMACY SERVICES-ORAL
8116592   SINEMET 25/250 TABLET UD             17            81             PHARMACY SERVICES-ORAL
8116600   SINEMET 25MG/100MG TAB                1            81             PHARMACY SERVICES-ORAL
8116618   SINEMET 25MG/100MG TAB D                           81             PHARMACY SERVICES-ORAL
8116626   SINEMET 50/200 CR TAB ID             19            81             PHARMACY SERVICES-ORAL
8116634   SINEMET CR 50/200 TAB                 2            81             PHARMACY SERVICES-ORAL
8121857   SINEMET CR 50MG/200MG TA              1            81             PHARMACY SERVICES-ORAL
8124646   SIROLIMUS/1MG PO                                   81             PHARMACY SERVICES-ORAL
8124760   SODIUM BENZOATE                                    81             PHARMACY SERVICES-ORAL
8141731   SODIUM CITRATE CITRIC ACD           0.01           81             PHARMACY SERVICES-ORAL
8181166   SORBITOL 70% SOLN 480ML               77           81             PHARMACY SERVICES-ORAL
8141368   SORBITOL 70% SOLUTION 30M             29           81             PHARMACY SERVICES-ORAL
8116659   SOTALOL 80 MG TABLET                  20           81             PHARMACY SERVICES-ORAL
8116667   SOTALOL 80MG TABLET                    2           81             PHARMACY SERVICES-ORAL
8116683   SPIRONOLACTONE 25MG TAB                            81             PHARMACY SERVICES-ORAL
8116675   SPIRONOLACTONE 25MG TAB                            81             PHARMACY SERVICES-ORAL
8116709   SPIRONOLACTONE 25MG TAB U            15            81             PHARMACY SERVICES-ORAL
8130536   STAVUDINE 20MG CAP NF                48            81             PHARMACY SERVICES-ORAL
8118796   STAVUDINE 20MG CAPSULE                4            81             PHARMACY SERVICES-ORAL
8118861   STAVUDINE 30MG CAPSULE                5            81             PHARMACY SERVICES-ORAL
8123424   STAVUDINE 40MG CAP                                 81             PHARMACY SERVICES-ORAL
8104770   SUCCIMER 100MG CAP                   28            81             PHARMACY SERVICES-ORAL
8141715   SUCRALFATE                                         81             PHARMACY SERVICES-ORAL
8116717   SUCRALFATE 1GM TABLET                  1           81             PHARMACY SERVICES-ORAL
8116733   SUCRALFATE 1MG TABLET                              81             PHARMACY SERVICES-ORAL
8116725   SUCRALFATE 1MG TABLET UD             16            81             PHARMACY SERVICES-ORAL
8141327   SUCRALFATE 1MG/10ML SUSP             38            81             PHARMACY SERVICES-ORAL
8140998   SUCRALFATE SUS 1GM/10ML                            81             PHARMACY SERVICES-ORAL
8116741   SULFADIAZINE 500MG TAB               18            81             PHARMACY SERVICES-ORAL
8116758   SULFADIAZINE 500MG TABLET                          81             PHARMACY SERVICES-ORAL




                                                Page 144
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8130437   SULFAMETHOXAZOL                     132            81             PHARMACY SERVICES-ORAL
8116444   SULFAMETHOXAZOL                      17            81             PHARMACY SERVICES-ORAL
8121535   SULFASALAZINE                                      81             PHARMACY SERVICES-ORAL
8116782   SULFASALAZINE 500MG TAB                            81             PHARMACY SERVICES-ORAL
8116774   SULFASALAZINE 500MG TB 24            15            81             PHARMACY SERVICES-ORAL
8118556   SULFINPYRAZONE 200MG CAP                           81             PHARMACY SERVICES-ORAL
8123176   SULINDAC 150MG TABLET                              81             PHARMACY SERVICES-ORAL
8116790   SULINDAC 200MG TAB                     1           81             PHARMACY SERVICES-ORAL
8126153   SUMATRIPTAN                         0.01           81             PHARMACY SERVICES-ORAL
8123184   SUMATRIPTAN 25MG TABLET                            81             PHARMACY SERVICES-ORAL
8116808   SUMATRIPTAN 50MG TABLET              56            81             PHARMACY SERVICES-ORAL
8116816   SUMATRIPTAN SUCC 50MG TAB            18            81             PHARMACY SERVICES-ORAL
8125064   TACROLIMUS/1MG PO                                  81             PHARMACY SERVICES-ORAL
8123085   TACROLIMUS/1MG PO                                  81             PHARMACY SERVICES-ORAL
8190316   TALC USP 5MG                         22            81             PHARMACY SERVICES-ORAL
8116832   TAMOXIFEN 10MG PO                    19            81             PHARMACY SERVICES-ORAL
8116840   TAMSULOSIN .4MG TAB UD               19            81             PHARMACY SERVICES-ORAL
8118887   TAMSULOSIN 0.4MG CAPSULE              2            81             PHARMACY SERVICES-ORAL
8122921   TEGASEROD 6MG TABLET                  3            81             PHARMACY SERVICES-ORAL
8118598   TEMAZEPAM 15MG CAPSULE                             81             PHARMACY SERVICES-ORAL
8118572   TEMAZEPAM 15MG CAPSULE                             81             PHARMACY SERVICES-ORAL
8119687   TEMAZEPAM 15MG CAPSULE UD            30            81             PHARMACY SERVICES-ORAL
8118580   TEMAZEPAM 30MG CAPSULE                             81             PHARMACY SERVICES-ORAL
8118564   TEMAZEPAM 30MG CAPSULE                             81             PHARMACY SERVICES-ORAL
8119695   TEMAZEPAM 30MG CAPSULE UD            29            81             PHARMACY SERVICES-ORAL
8118820   TEMAZEPAM 7.5 MG CAPSULE              1            81             PHARMACY SERVICES-ORAL
8119786   TEMAZEPAM 7.5MG CAPSULE              30            81             PHARMACY SERVICES-ORAL
8131518   TEMOZOLOMIDE 5MG PO                                81             PHARMACY SERVICES-ORAL
8123887   TEMOZOLOMIDE 5MG PO                                81             PHARMACY SERVICES-ORAL
8116857   TENOFOVIR 300MG TAB                  48            81             PHARMACY SERVICES-ORAL
8130643   TERAZOSIN       5MG                  18            81             PHARMACY SERVICES-ORAL
8116865   TERAZOSIN 1MG TABLET                  1            81             PHARMACY SERVICES-ORAL
8116873   TERAZOSIN 1MG TABLET UD              18            81             PHARMACY SERVICES-ORAL
8116881   TERAZOSIN 2MG TABLET                  1            81             PHARMACY SERVICES-ORAL
8116899   TERAZOSIN 5MG TABLET                  1            81             PHARMACY SERVICES-ORAL
8116915   TERBUTALINE 2.5MG TABLET                           81             PHARMACY SERVICES-ORAL
8116931   TERBUTALINE 5MG TABLET                             81             PHARMACY SERVICES-ORAL
8119703   TETRACYCLINE 250 MG CAP              15            81             PHARMACY SERVICES-ORAL
8118614   TETRACYCLINE 250MG CAP                4            81             PHARMACY SERVICES-ORAL
8118606   TETRACYCLINE 500MG CAP                             81             PHARMACY SERVICES-ORAL
8181679   TETRACYCLINE IJ                                    81             PHARMACY SERVICES-ORAL
8141228   TETRAHYDROZOLIN 15ML                  3            81             PHARMACY SERVICES-ORAL
8116949   THEOPHYLLINE 100MG TAB UD            16            81             PHARMACY SERVICES-ORAL
8116956   THEOPHYLLINE 200MG TAB                             81             PHARMACY SERVICES-ORAL
8116964   THEOPHYLLINE 300MG TAB UD            12            81             PHARMACY SERVICES-ORAL
8141079   THEOPHYLLINE 80MG/15ML EL            28            81             PHARMACY SERVICES-ORAL
8121568   THEOPHYLLINE SR 100MG TA                           81             PHARMACY SERVICES-ORAL
8121543   THEOPHYLLINE SR 100MG TA                           81             PHARMACY SERVICES-ORAL
8121576   THEOPHYLLINE SR 200MG TA                           81             PHARMACY SERVICES-ORAL
8121584   THEOPHYLLINE SR 300MG TA                           81             PHARMACY SERVICES-ORAL
8121550   THEOPHYLLINE SR 300MG TA                           81             PHARMACY SERVICES-ORAL
8116972   THIAMINE 100MG TABLET                              81             PHARMACY SERVICES-ORAL
8116980   THIAMINE 100MG TABLET UD               2           81             PHARMACY SERVICES-ORAL
8116998   THIAMINE 50MG TABLET                               81             PHARMACY SERVICES-ORAL
8117004   THIAMINE 50MG TABLET UD                7           81             PHARMACY SERVICES-ORAL




                                                Page 145
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8117012   THIOGUANINE 40MG TAB 24H              26            81             PHARMACY SERVICES-ORAL
8117020   THIORIDAZINE 100MG TAB                              81             PHARMACY SERVICES-ORAL
8117038   THIORIDAZINE 100MG TAB D                            81             PHARMACY SERVICES-ORAL
8117046   THIORIDAZINE 10MG TAB UD              15            81             PHARMACY SERVICES-ORAL
8121865   THIORIDAZINE 10MG TABLET                            81             PHARMACY SERVICES-ORAL
8117061   THIORIDAZINE 200MG TABLE                            81             PHARMACY SERVICES-ORAL
8117079   THIORIDAZINE 25MG TAB UD              16            81             PHARMACY SERVICES-ORAL
8117087   THIORIDAZINE 25MG TABLET                            81             PHARMACY SERVICES-ORAL
8117103   THIORIDAZINE 50MG TABLET                            81             PHARMACY SERVICES-ORAL
8117095   THIORIDAZINE 50MG TABLET                            81             PHARMACY SERVICES-ORAL
8119794   THIOTHIXENE 10MG CAP 24HR              8            81             PHARMACY SERVICES-ORAL
8118622   THIOTHIXENE 10MG CAPSULE               1            81             PHARMACY SERVICES-ORAL
8119711   THIOTHIXENE 1MG CAP 24H               12            81             PHARMACY SERVICES-ORAL
8123663   THIOTHIXENE 2MG CAP                                 81             PHARMACY SERVICES-ORAL
8118630   THIOTHIXENE 5MG CAPSULE                             81             PHARMACY SERVICES-ORAL
8181182   THIOTHIXENE 5MG/ML SOL 24             14            81             PHARMACY SERVICES-ORAL
8181265   THIOTHIXENE CONC 5MG/ML               11            81             PHARMACY SERVICES-ORAL
8124935   THYROID                                             81             PHARMACY SERVICES-ORAL
8122764   THYROID 120MG TABLET                                81             PHARMACY SERVICES-ORAL
8117111   THYROID 120MG TABLET                                81             PHARMACY SERVICES-ORAL
8117129   THYROID 180MG TABLET                                81             PHARMACY SERVICES-ORAL
8117137   THYROID 30MG TABLET                                 81             PHARMACY SERVICES-ORAL
8117145   THYROID 30MG TABLET D                               81             PHARMACY SERVICES-ORAL
8117152   THYROID 60MG TABLET                                 81             PHARMACY SERVICES-ORAL
8117160   THYROID 60MG TABLET UD                15            81             PHARMACY SERVICES-ORAL
8123192   TIAGABINE 4MG TABLET                  18            81             PHARMACY SERVICES-ORAL
8117178   TICLOPIDINE 250MG TAB UD              18            81             PHARMACY SERVICES-ORAL
8117186   TICLOPIDINE 250MG TABLET               1            81             PHARMACY SERVICES-ORAL
8130452   TIGAN 200MG IJ                        70            81             PHARMACY SERVICES-ORAL
8130478   TIGAN 250MG PO                        15            81             PHARMACY SERVICES-ORAL
8141285   TIMOLOL .25% OPH GTTS                 12            81             PHARMACY SERVICES-ORAL
8141277   TIMOLOL .5%5MLOPH GTT                 14            81             PHARMACY SERVICES-ORAL
8117194   TIZANIDINE HCL 4MG TAB                 1            81             PHARMACY SERVICES-ORAL
8117202   TOCAINIDE 400MG TAB UD 24             16            81             PHARMACY SERVICES-ORAL
8117210   TOLAZAMIDE 100MG TABLET                             81             PHARMACY SERVICES-ORAL
8130445   TOLAZAMIDE 100MG UD                   16            81             PHARMACY SERVICES-ORAL
8117236   TOLAZAMIDE 250MG TABLET                             81             PHARMACY SERVICES-ORAL
8117228   TOLAZAMIDE 250MG TABLET                             81             PHARMACY SERVICES-ORAL
8117244   TOLAZAMIDE 250MG TABLET U             16            81             PHARMACY SERVICES-ORAL
8117251   TOLBUTAMIDE 500MG TABLET                            81             PHARMACY SERVICES-ORAL
8117269   TOLCAPONE 100MG TABLET                  2           81             PHARMACY SERVICES-ORAL
8123994   TOLTERODINE 2MG CAP SA                              81             PHARMACY SERVICES-ORAL
8117277   TOLTERODINE 2MG TAB                   19            81             PHARMACY SERVICES-ORAL
8117285   TOLTERODINE 2MG TABLET                 1            81             PHARMACY SERVICES-ORAL
8117293   TOPIRAMATE 100MG TABLET                3            81             PHARMACY SERVICES-ORAL
8117319   TOPIRAMATE 25MG TABLET                 1            81             PHARMACY SERVICES-ORAL
8130585   TOPIRAMATE 25MG UD 24H                18            81             PHARMACY SERVICES-ORAL
8117335   TORSEMIDE 10MG TAB                    17            81             PHARMACY SERVICES-ORAL
8117343   TORSEMIDE 20MG TABLET                  1            81             PHARMACY SERVICES-ORAL
8117350   TRAMADOL 50MG TABLET                   1            81             PHARMACY SERVICES-ORAL
8117368   TRANYLCYPROMINE 10MG TAB                            81             PHARMACY SERVICES-ORAL
8117376   TRAZODONE 100MG TABLET                  1           81             PHARMACY SERVICES-ORAL
8117384   TRAZODONE 50MG TABLET                               81             PHARMACY SERVICES-ORAL
8117392   TRAZODONE 50MG TABLET T                             81             PHARMACY SERVICES-ORAL
8117400   TRAZODONE 50MG TABLET UD              15            81             PHARMACY SERVICES-ORAL




                                                 Page 146
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8118655   TRIAMTERENE 100MG CAPSUL                            81             PHARMACY SERVICES-ORAL
8119729   TRIAMTERENE 50MG CAPSULE              16            81             PHARMACY SERVICES-ORAL
8118648   TRIAMTERENE 50MG CAPSULE                            81             PHARMACY SERVICES-ORAL
8130262   TRIAZOLAM 0.125MG TABLET                            81             PHARMACY SERVICES-ORAL
8130270   TRIAZOLAM 0.25MG TABLET                             81             PHARMACY SERVICES-ORAL
8122111   TRIETHANOLAMINE OTIC GTT                7           81             PHARMACY SERVICES-ORAL
8117418   TRIFLUOPERAZINE 10MG TAB                            81             PHARMACY SERVICES-ORAL
8117434   TRIFLUOPERAZINE 2MG TAB                             81             PHARMACY SERVICES-ORAL
8117426   TRIFLUOPERAZINE 2MG TAB                             81             PHARMACY SERVICES-ORAL
8117442   TRIFLUOPERAZINE 5MG TAB                             81             PHARMACY SERVICES-ORAL
8117459   TRIHEXYPHENIDYL 2MG TAB                             81             PHARMACY SERVICES-ORAL
8117467   TRIHEXYPHENIDYL 5MG TAB                             81             PHARMACY SERVICES-ORAL
8117475   TRIMETHOPRIM 100MG TAB                              81             PHARMACY SERVICES-ORAL
8130460   TRIMETHOPRIM 100MG TAB 24             13            81             PHARMACY SERVICES-ORAL
8117491   TRIMETHOPRIM 100MG TAB 24             15            81             PHARMACY SERVICES-ORAL
8117483   TRIMETHOPRIM 100MG TAB D                            81             PHARMACY SERVICES-ORAL
8130635   TRIMETHOPRIM/POLYMIXIN B             125            81             PHARMACY SERVICES-ORAL
8124737   TRUVADA                                             81             PHARMACY SERVICES-ORAL
8123200   URSODIOL 250MG TABLET                               81             PHARMACY SERVICES-ORAL
8123721   URSODIOL 300MG CAP                    24            81             PHARMACY SERVICES-ORAL
8121659   VALACYCLOVIR 500MG CAP                25            81             PHARMACY SERVICES-ORAL
8117509   VALGANCICLOVIR 450MG TAB              88            81             PHARMACY SERVICES-ORAL
8181208   VALPROATE 50MG/ML SYRUP               19            81             PHARMACY SERVICES-ORAL
8131559   VALPROATE ER 500MG TABLET              3            81             PHARMACY SERVICES-ORAL
8141723   VALPROIC ACID                                       81             PHARMACY SERVICES-ORAL
8118663   VALPROIC ACID 250MG CAP                             81             PHARMACY SERVICES-ORAL
8121873   VALPROIC ACID 250MG CAP                             81             PHARMACY SERVICES-ORAL
8181273   VALPROIC ACID 50MG/ML LI                            81             PHARMACY SERVICES-ORAL
8119893   VALSARTAN 80MG CAPSULE                17            81             PHARMACY SERVICES-ORAL
8181661   VANCOMYCIN                                          81             PHARMACY SERVICES-ORAL
8119778   VANCOMYCIN 125MG CAPSULE              33            81             PHARMACY SERVICES-ORAL
8118671   VANCOMYCIN 125MG CAPSULE               5            81             PHARMACY SERVICES-ORAL
8141566   VANCOMYCIN 1GM SOLN                                 81             PHARMACY SERVICES-ORAL
8118689   VANCOMYCIN 250MG CAPSULE              11            81             PHARMACY SERVICES-ORAL
8130544   VENLAFAXINE                           26            81             PHARMACY SERVICES-ORAL
8117525   VENLAFAXINE 100MG TABLET               1            81             PHARMACY SERVICES-ORAL
8117541   VENLAFAXINE 25MG TABLET                1            81             PHARMACY SERVICES-ORAL
8117533   VENLAFAXINE 25MG TABLET                1            81             PHARMACY SERVICES-ORAL
8117566   VENLAFAXINE 75MG TABLET               12            81             PHARMACY SERVICES-ORAL
8117558   VENLAFAXINE 75MG TABLET               12            81             PHARMACY SERVICES-ORAL
8117582   VENLAFAXINE HCL 50MG TAB               1            81             PHARMACY SERVICES-ORAL
8118952   VENLAFAXINE XR 37.5MG CAP              3            81             PHARMACY SERVICES-ORAL
8118960   VENLAFAXINE XR 75MG CAP                3            81             PHARMACY SERVICES-ORAL
8117590   VERAPAMIL 120MG TABLET                              81             PHARMACY SERVICES-ORAL
8117608   VERAPAMIL 180MG SR TAB UD             18            81             PHARMACY SERVICES-ORAL
8117616   VERAPAMIL 180MG SR TABLET              1            81             PHARMACY SERVICES-ORAL
8117624   VERAPAMIL 40MG TABLET                               81             PHARMACY SERVICES-ORAL
8117632   VERAPAMIL 40MG TABLET UD              15            81             PHARMACY SERVICES-ORAL
8117640   VERAPAMIL 80MG TABLET                               81             PHARMACY SERVICES-ORAL
8117657   VERAPAMIL SR 120MG TAB                16            81             PHARMACY SERVICES-ORAL
8117665   VERAPAMIL SR 180MG TAB                 1            81             PHARMACY SERVICES-ORAL
8117673   VERAPAMIL SR 240MG TAB                 1            81             PHARMACY SERVICES-ORAL
8117681   VERAPAMIL SR 240MG TAB D               1            81             PHARMACY SERVICES-ORAL
8118697   VIT A 10000U CAP                                    81             PHARMACY SERVICES-ORAL
8119737   VIT A 10IU CAP                          1           81             PHARMACY SERVICES-ORAL




                                                 Page 147
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8118705   VIT A 50000U CAP                                    81             PHARMACY SERVICES-ORAL
8141236   VIT A&D OINT 1.5OZ                      1           81             PHARMACY SERVICES-ORAL
8114522   VIT B CMPLX                             2           81             PHARMACY SERVICES-ORAL
8117707   VIT B&C TABLET                                      81             PHARMACY SERVICES-ORAL
8119745   VIT E 200IU CAP                         1           81             PHARMACY SERVICES-ORAL
8118721   VIT E 200U CAP                                      81             PHARMACY SERVICES-ORAL
8118739   VIT E 400UNIT CAP                                   81             PHARMACY SERVICES-ORAL
8181554   VIT E 50IU/12ML DROPS                               81             PHARMACY SERVICES-ORAL
8117699   VORICONAZOLE 200MG TAB               191            81             PHARMACY SERVICES-ORAL
8117731   WARFARIN 10MG TABLET                                81             PHARMACY SERVICES-ORAL
8117723   WARFARIN 1MG TAB UD                   16            81             PHARMACY SERVICES-ORAL
8117756   WARFARIN 1MG TABLET                                 81             PHARMACY SERVICES-ORAL
8117764   WARFARIN 1MG TABLET UD                 1            81             PHARMACY SERVICES-ORAL
8117749   WARFARIN 1OMG TABLET UD               17            81             PHARMACY SERVICES-ORAL
8117772   WARFARIN 2.5MG TAB UD                 16            81             PHARMACY SERVICES-ORAL
8117780   WARFARIN 2.5MG TABLET                               81             PHARMACY SERVICES-ORAL
8117798   WARFARIN 2MG TABLET                                 81             PHARMACY SERVICES-ORAL
8117806   WARFARIN 2MG TABLET D                               81             PHARMACY SERVICES-ORAL
8117822   WARFARIN 2MG TABLET UD                16            81             PHARMACY SERVICES-ORAL
8122830   WARFARIN 3MG TABLET                    1            81             PHARMACY SERVICES-ORAL
8122822   WARFARIN 4MG TABLET                    1            81             PHARMACY SERVICES-ORAL
8117830   WARFARIN 5MG TAB UD                   16            81             PHARMACY SERVICES-ORAL
8117848   WARFARIN 5MG TABLET                                 81             PHARMACY SERVICES-ORAL
8117855   WARFARIN 5MG TABLET D                               81             PHARMACY SERVICES-ORAL
8117871   WARFARIN 7.5MG TABLET                               81             PHARMACY SERVICES-ORAL
8117889   WARFARIN 7.5MG TABLET D                             81             PHARMACY SERVICES-ORAL
8123671   ZALCITABINE 0.375MG PO                              81             PHARMACY SERVICES-ORAL
8123093   ZALEPLON 10MG CAPSULE                               81             PHARMACY SERVICES-ORAL
8181653   ZIDOVUDINE 100MG PO                                 81             PHARMACY SERVICES-ORAL
8124950   ZIDOVUDINE 100MG PO                                 81             PHARMACY SERVICES-ORAL
8119752   ZIDOVUDINE 100MG PO                   19            81             PHARMACY SERVICES-ORAL
8118762   ZINC SO4 220MG CAP                                  81             PHARMACY SERVICES-ORAL
8119760   ZINC SULFATE 220MG CAPSUL             15            81             PHARMACY SERVICES-ORAL
8190076   ZIOX 30GM OINTMENT                   206            81             PHARMACY SERVICES-ORAL
8122673   ZIPRASIDONE 20MG CAP                  25            81             PHARMACY SERVICES-ORAL
8118945   ZIPRASIDONE 40MG CAPSULE               4            81             PHARMACY SERVICES-ORAL
8119364   ZIPRASIDONE 80MG CAPSULE               4            81             PHARMACY SERVICES-ORAL
8126005   ZOLPIDEM                                            81             PHARMACY SERVICES-ORAL
8117897   ZOLPIDEM 10MG TABLET                    2           81             PHARMACY SERVICES-ORAL
8117913   ZOLPIDEM 5MG TABLET                     2           81             PHARMACY SERVICES-ORAL
8117939   ZOLPIDEM 5MG TABLET UD                 35           81             PHARMACY SERVICES-ORAL
8126286   ZONISAMIDE                           0.01           81             PHARMACY SERVICES-ORAL
8124182   ZONISAMIDE 100MG CAP                   20           81             PHARMACY SERVICES-ORAL
8221624   AA 4.25%/D25W 1000ML                  224           82             PHARMACY SERVICES-OTHER
8241507   ACCUZYME OINT 30GM                    150           82             PHARMACY SERVICES-OTHER
8241861   ACCUZYME OINTMENT                     249           82             PHARMACY SERVICES-OTHER
8290058   ACCUZYME OINTMENT                     249           82             PHARMACY SERVICES-OTHER
8220139   ACETIC ACID CH3COOH IRR S             120           82             PHARMACY SERVICES-OTHER
8240533   ACETIC ACID GLACIAL                                 82             PHARMACY SERVICES-OTHER
8230005   ACETIC ACID XEROF GZE 5X9              1            82             PHARMACY SERVICES-OTHER
8250052   ACETYLCHOLINE OPHTH 2ML               21            82             PHARMACY SERVICES-OTHER
8222127   ACETYLCHOLINE OPHTH 2ML               21            82             PHARMACY SERVICES-OTHER
8250060   ACETYLCHOLINE OPHTH KIT              119            82             PHARMACY SERVICES-OTHER
8280000   ACETYLCYSTEINE 10%INH SOL             28            82             PHARMACY SERVICES-OTHER
8280331   ACETYLCYSTEINE 20% 4ML                 7            82             PHARMACY SERVICES-OTHER




                                                 Page 148
                                  c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION               SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                     AMOUNT AMOUNT CODE

8280349   ACETYLCYSTEINE20%INH SOL3            124            82             PHARMACY SERVICES-OTHER
8222655   ACYCLOVIR                                           82             PHARMACY SERVICES-OTHER
8240004   ACYCLOVIR 5% OINT 15GM                24            82             PHARMACY SERVICES-OTHER
8240012   ACYCLOVIR 5% OINT 15GM N             229            82             PHARMACY SERVICES-OTHER
8280158   ADVAIR DISKUS 100/50MG IN            316            82             PHARMACY SERVICES-OTHER
8280141   ADVAIR DISKUS 250/50MG IN            392            82             PHARMACY SERVICES-OTHER
8280133   ADVAIR DISKUS 500/50MG IN            530            82             PHARMACY SERVICES-OTHER
8240566   AL SO4 PACKET                                       82             PHARMACY SERVICES-OTHER
8281339   ALBUTEROL                                           82             PHARMACY SERVICES-OTHER
8281370   ALBUTEROL                            0.01           82             PHARMACY SERVICES-OTHER
8281362   ALBUTEROL                            0.01           82             PHARMACY SERVICES-OTHER
8281313   ALBUTEROL                                           82             PHARMACY SERVICES-OTHER
8280083   ALBUTEROL 0.5% INH SOL                55            82             PHARMACY SERVICES-OTHER
8291098   ALBUTEROL 0.5% INH SOL               106            82             PHARMACY SERVICES-OTHER
8280075   ALBUTEROL 17GM INHALER               113            82             PHARMACY SERVICES-OTHER
8291080   ALBUTEROL 17GM INHALER               195            82             PHARMACY SERVICES-OTHER
8280687   ALBUTEROL 5MG/ML 0.5ML                 1            82             PHARMACY SERVICES-OTHER
8280018   ALBUTEROL INH SL5MG/M                 12            82             PHARMACY SERVICES-OTHER
8280026   ALBUTEROL INHALER 17 GM               14            82             PHARMACY SERVICES-OTHER
8280034   ALBUTEROL INHALER 17GM                24            82             PHARMACY SERVICES-OTHER
8280356   ALBUTEROL SL2.5MG/3ML                  1            82             PHARMACY SERVICES-OTHER
8280844   ALBUTEROL SL2.5MG/3ML                  1            82             PHARMACY SERVICES-OTHER
8280372   ALBUTEROL.083%SOL 3ML                 17            82             PHARMACY SERVICES-OTHER
8290793   ALUM CL                                             82             PHARMACY SERVICES-OTHER
8221749   ALUM CL POWDER                        58            82             PHARMACY SERVICES-OTHER
8242117   ALUM HYDROXIDE                                      82             PHARMACY SERVICES-OTHER
8221715   AMINO ACIDS 10% 1000ML               130            82             PHARMACY SERVICES-OTHER
8220618   AMINO ACIDS 10% 1000ML                26            82             PHARMACY SERVICES-OTHER
8220626   AMINO ACIDS 10% 500ML                110            82             PHARMACY SERVICES-OTHER
8220642   AMINO ACIDS 3.5% 1000ML                             82             PHARMACY SERVICES-OTHER
8220634   AMINO ACIDS 8.5% 1000ML              137            82             PHARMACY SERVICES-OTHER
8221632   AMINOSYN 4.25% 1000ML                               82             PHARMACY SERVICES-OTHER
8290728   AMIODARONE 200MG TAB UD                23           82             PHARMACY SERVICES-OTHER
8290751   AMITRIPTYLINE 10MG TAB UD              12           82             PHARMACY SERVICES-OTHER
8290777   AMITRIPTYLINE 25MG TAB UD              13           82             PHARMACY SERVICES-OTHER
8242794   AMLACTIN XL LOTION                   0.01           82             PHARMACY SERVICES-OTHER
8290827   AMLODIPINE 5MG TABLET UD               16           82             PHARMACY SERVICES-OTHER
8290009   AMMONIA INHALANTS 12/BX                15           82             PHARMACY SERVICES-OTHER
8290868   AMMONIA INHALANTS 12/BX                13           82             PHARMACY SERVICES-OTHER
8290926   AMOXICILLIN 250MG CAP UD               12           82             PHARMACY SERVICES-OTHER
8241531   AMOXICILLIN SUSP 250MG/5M              85           82             PHARMACY SERVICES-OTHER
8291346   AMYL NITRITE 0.3ML AMP                              82             PHARMACY SERVICES-OTHER
8240574   ANALGESIC BALM 1.25 OZ                 2            82             PHARMACY SERVICES-OTHER
8240590   ANALGESIC BALM OINT 30GM               5            82             PHARMACY SERVICES-OTHER
8280729   ANALGESIC BALM OINT 30GM              72            82             PHARMACY SERVICES-OTHER
8291049   ANTIVENIN BLACK WIDOW INJ            175            82             PHARMACY SERVICES-OTHER
8290975   ANTIVENIN RATTLESNAKE INJ            705            82             PHARMACY SERVICES-OTHER
8240608   ANUSOL OINT 1OZ                        3            82             PHARMACY SERVICES-OTHER
8240616   ANUSOL OINTMENT 30 GM                  9            82             PHARMACY SERVICES-OTHER
8291072   ANUSOL OINTMENT 30 GM                 79            82             PHARMACY SERVICES-OTHER
8270142   ANUSOL SUPP                           15            82             PHARMACY SERVICES-OTHER
8291031   ANUSOL SUPP                           12            82             PHARMACY SERVICES-OTHER
8270159   APAP 120MG SUPP                       15            82             PHARMACY SERVICES-OTHER
8270167   APAP 325MG SUPP                        2            82             PHARMACY SERVICES-OTHER
8270175   APAP 650MG SUPP                        2            82             PHARMACY SERVICES-OTHER




                                                 Page 149
                                c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION             SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                   AMOUNT AMOUNT CODE

8270183   APAP SUPP 600MG                                   82             PHARMACY SERVICES-OTHER
8250144   APRACLONIDINE 0.5% OPH 5M          190            82             PHARMACY SERVICES-OTHER
8250151   APRACLONIDINE HCL 0.25ML            14            82             PHARMACY SERVICES-OTHER
8291007   ARIPIPRAZOLE 15MG TAB               12            82             PHARMACY SERVICES-OTHER
8270712   ASA                                               82             PHARMACY SERVICES-OTHER
8270209   ASA 300MG SUPPO                      2            82             PHARMACY SERVICES-OTHER
8291106   ASA 300MG SUPPO                     12            82             PHARMACY SERVICES-OTHER
8270233   ASA 600MG SUPPOSITRY 12/             2            82             PHARMACY SERVICES-OTHER
8290918   ASA CHEW 81MG TAB UD                12            82             PHARMACY SERVICES-OTHER
8290900   ASA EC 325MG TAB UD                 12            82             PHARMACY SERVICES-OTHER
8270217   ASA SUPP 300MG                                    82             PHARMACY SERVICES-OTHER
8270225   ASA SUPP 600MG                                    82             PHARMACY SERVICES-OTHER
8291163   ATENOLOL 50MG TABLET UD              14           82             PHARMACY SERVICES-OTHER
8222010   ATORVASTATIN 40MG TABLET              4           82             PHARMACY SERVICES-OTHER
8251563   ATROPINE                           0.01           82             PHARMACY SERVICES-OTHER
8251506   ATROPINE                                          82             PHARMACY SERVICES-OTHER
8250177   ATROPINE 1%15ML OPHSL                8            82             PHARMACY SERVICES-OTHER
8290991   ATROPINE 1%15ML OPHSL D              8            82             PHARMACY SERVICES-OTHER
8250193   ATROPINE 1%OPT SOL 5ML              34            82             PHARMACY SERVICES-OTHER
8290694   ATROPINE 1%OPT SOL 5ML              77            82             PHARMACY SERVICES-OTHER
8251084   AUGMENTIN 250MG/5ML SUSP           196            82             PHARMACY SERVICES-OTHER
8250201   AURALGAN OTIC SOLN 10ML             37            82             PHARMACY SERVICES-OTHER
8250219   AURALGAN OTIC SOLN 15ML              6            82             PHARMACY SERVICES-OTHER
8222101   AURALGAN OTIC SOLN 15ML              6            82             PHARMACY SERVICES-OTHER
8240632   AZELASTINE 137MCG NASAL S          167            82             PHARMACY SERVICES-OTHER
8290017   AZITHROMYCIN                                      82             PHARMACY SERVICES-OTHER
8270241   B&O SUPP 60MG                        1            82             PHARMACY SERVICES-OTHER
8270258   B&O SUPPOSITORY                     36            82             PHARMACY SERVICES-OTHER
8241747   BACI/POLYMIX OINT 15GM              15            82             PHARMACY SERVICES-OTHER
8242125   BACI/POLYMIX 1GM PACKTS O                         82             PHARMACY SERVICES-OTHER
8240640   BACI/POLYMIX OINT 1OZ                 4           82             PHARMACY SERVICES-OTHER
8250227   BACI/POLYMIX OPH OINT                 9           82             PHARMACY SERVICES-OTHER
8241515   BACI/POLYMIX OPH OINT                 9           82             PHARMACY SERVICES-OTHER
8240665   BACI/POLYMIX PKT                                  82             PHARMACY SERVICES-OTHER
8280810   BACITRACIN 50,000U IJ              106            82             PHARMACY SERVICES-OTHER
8240681   BACITRACIN OINTMENT 15GM             8            82             PHARMACY SERVICES-OTHER
8280828   BACITRACIN OINTMENT 15GM            72            82             PHARMACY SERVICES-OTHER
8250235   BACITRACIN OPH OINT                  1            82             PHARMACY SERVICES-OTHER
8250250   BACITRACIN OPTH OINT                38            82             PHARMACY SERVICES-OTHER
8240699   BACITRACIN TOP OINT 1OZ              1            82             PHARMACY SERVICES-OTHER
8240673   BACITRACIN ZINC OINT 1/32            2            82             PHARMACY SERVICES-OTHER
8280836   BACLOFEN 10MG TAB N                 13            82             PHARMACY SERVICES-OTHER
8221756   BARIUM ENEMA KIT                     1            82             PHARMACY SERVICES-OTHER
8242042   BECAPLERMIN .01% 15GM GEL                         82             PHARMACY SERVICES-OTHER
8280943   BECLOMETHASONE 40MCG NASA                         82             PHARMACY SERVICES-OTHER
8281164   BECLOMETHASONE 7.3G INH 4          155            82             PHARMACY SERVICES-OTHER
8281057   BECLOMETHASONE AQ .042% N                         82             PHARMACY SERVICES-OTHER
8280380   BECLOMETHASONE INH 16.8G            19            82             PHARMACY SERVICES-OTHER
8280406   BECLOMETHASONE INH 17GM             19            82             PHARMACY SERVICES-OTHER
8242562   BENZOCAINE                                        82             PHARMACY SERVICES-OTHER
8242703   BENZOCAINE                         0.01           82             PHARMACY SERVICES-OTHER
8241994   BENZOCAINE 20% GEL                    9           82             PHARMACY SERVICES-OTHER
8240715   BENZOCAINE 20% SPRAY 2 OZ            11           82             PHARMACY SERVICES-OTHER
8270266   BENZOCAINE HEMORRHOID SUP                         82             PHARMACY SERVICES-OTHER
8280786   BENZOIN CMPD TIN LQ60ML             75            82             PHARMACY SERVICES-OTHER




                                               Page 150
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8280752   BENZTROPINE 1MG TABLET UD            12            82             PHARMACY SERVICES-OTHER
8242232   BETAMETHASONE                                      82             PHARMACY SERVICES-OTHER
8242224   BETAMETHASONE                                      82             PHARMACY SERVICES-OTHER
8242216   BETAMETHASONE                                      82             PHARMACY SERVICES-OTHER
8242208   BETAMETHASONE                                      82             PHARMACY SERVICES-OTHER
8242190   BETAMETHASONE                                      82             PHARMACY SERVICES-OTHER
8242182   BETAMETHASONE                                      82             PHARMACY SERVICES-OTHER
8240731   BETAMETHASONE DIP 0.05% C             4            82             PHARMACY SERVICES-OTHER
8240723   BETAMETHASONE DIP 0.05% C             9            82             PHARMACY SERVICES-OTHER
8240749   BETAMETHASONE VAL 0.1% CR            46            82             PHARMACY SERVICES-OTHER
8280711   BETAMETHASONE VAL 0.1% CR            77            82             PHARMACY SERVICES-OTHER
8240756   BETAMETHASONE VAL 0.1% OI             3            82             PHARMACY SERVICES-OTHER
8250268   BETAXOLOL 0.25% OPTH                 12            82             PHARMACY SERVICES-OTHER
8251076   BETAXOLOL 0.25% OPTH                 12            82             PHARMACY SERVICES-OTHER
8251217   BETAXOLOL 0.5% EYE SOL                             82             PHARMACY SERVICES-OTHER
8251209   BIMATOPROST 0.03% OPH SOL            69            82             PHARMACY SERVICES-OTHER
8270274   BISACODYL 10MG SUPP UD                2            82             PHARMACY SERVICES-OTHER
8280778   BISACODYL 10MG SUPP UD               12            82             PHARMACY SERVICES-OTHER
8280794   BISACODYL EC 5MG TAB UD              12            82             PHARMACY SERVICES-OTHER
8270282   BISACODYL SUPP 10MG                                82             PHARMACY SERVICES-OTHER
8222630   BIVALIRUDIN 1MG IJ                                 82             PHARMACY SERVICES-OTHER
8221954   BIVALIRUDIN 1MG IJ                  445            82             PHARMACY SERVICES-OTHER
8250276   BLEPHAMIDE .2% OPHTH SUSP           125            82             PHARMACY SERVICES-OTHER
8240194   BLISTEX                               2            82             PHARMACY SERVICES-OTHER
8250003   BRIMONIDINE .2% EYE DROPS            25            82             PHARMACY SERVICES-OTHER
8250029   BRIMONIDINE 0.15% OPTH SO           125            82             PHARMACY SERVICES-OTHER
8250011   BRIMONIDINE 0.2% 5ML OP S            62            82             PHARMACY SERVICES-OTHER
8250037   BRINZOLAMIDE 1%OPTDRP10ML            48            82             PHARMACY SERVICES-OTHER
8250078   BSS                                  42            82             PHARMACY SERVICES-OTHER
8240764   BSS OPHTHALMIC SOLN 15ML             42            82             PHARMACY SERVICES-OTHER
8240772   BSS OPHTHALMIC SOLN 500ML            81            82             PHARMACY SERVICES-OTHER
8240780   BSS SOLN 15ML                         6            82             PHARMACY SERVICES-OTHER
8290025   BUDESONIDE 200MCG NASAL I           378            82             PHARMACY SERVICES-OTHER
8281180   BUDESONIDE PULMICORT 0.5M                          82             PHARMACY SERVICES-OTHER
8280414   BUDESONIDE PULMICORT 0.5M             6            82             PHARMACY SERVICES-OTHER
8291239   BUPIV/EPI 0.5% 10ML                  83            82             PHARMACY SERVICES-OTHER
8291247   BUPIV/EPI 0.5% IJ 50ML              110            82             PHARMACY SERVICES-OTHER
8210080   BUPROPION SR 150MG PO                 4            82             PHARMACY SERVICES-OTHER
8210098   CA ACET 667MG TAB                                  82             PHARMACY SERVICES-OTHER
8270001   CAFERGOT SUPPOSITORY                 28            82             PHARMACY SERVICES-OTHER
8240038   CALAMINE LOTION 120ML                 5            82             PHARMACY SERVICES-OTHER
8240020   CALAMINE LOTION 4OZ                   1            82             PHARMACY SERVICES-OTHER
8290033   CALCITONIN IP # 33174828             36            82             PHARMACY SERVICES-OTHER
8241945   CALMOSEPTINE OINTMENT                13            82             PHARMACY SERVICES-OTHER
8241879   CALMOSEPTINE OINTMENT                84            82             PHARMACY SERVICES-OTHER
8242489   CAMPHOR MENTHOL LOTION                             82             PHARMACY SERVICES-OTHER
8242364   CAPSAICIN 0.025% 60GM CRE                          82             PHARMACY SERVICES-OTHER
8240046   CAPSAICIN CREAM 30ML                 29            82             PHARMACY SERVICES-OTHER
8250284   CARBACHOL 0.01% 1.5ML                26            82             PHARMACY SERVICES-OTHER
8250292   CARBACHOL 0.01% 1.5ML OPT            91            82             PHARMACY SERVICES-OTHER
8250300   CARBACHOL 3% 15ML                    13            82             PHARMACY SERVICES-OTHER
8250318   CARBACHOL 3% 15ML OPHT SO           119            82             PHARMACY SERVICES-OTHER
8250326   CARBAMIDE PEROX OTIC GTTS             4            82             PHARMACY SERVICES-OTHER
8250342   CARBAMIDE PEROXIDE 6.5% 1            34            82             PHARMACY SERVICES-OTHER
8250359   CARBAMIDE PEROXIDE OTIC              77            82             PHARMACY SERVICES-OTHER




                                                Page 151
                                c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION             SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                   AMOUNT AMOUNT CODE

8291262   CELLULOSE SURGIFOAM POWDE            93           82             PHARMACY SERVICES-OTHER
8240053   CEPACOL MOUTHWASH 120ML *            72           82             PHARMACY SERVICES-OTHER
8242687   CETACAINE                          0.01           82             PHARMACY SERVICES-OTHER
8240202   CETACAINE SPRAY                     159           82             PHARMACY SERVICES-OTHER
8250367   CETAPRED .25% OPHTH OINT            153           82             PHARMACY SERVICES-OTHER
8242588   CHLORAHEXIDEN                                     82             PHARMACY SERVICES-OTHER
8240814   CHLORAHEXIDEN BETASEPT 4%           13            82             PHARMACY SERVICES-OTHER
8240822   CHLORHEX GLUC .012% RINSE           13            82             PHARMACY SERVICES-OTHER
8220006   CHLORHEX GLUC HIBICLENS 4            3            82             PHARMACY SERVICES-OTHER
8242372   CICLOPIROX 0.77% TOP SUSP                         82             PHARMACY SERVICES-OTHER
8250045   CIPRO                               67            82             PHARMACY SERVICES-OTHER
8251100   CIPRO FLOXACIN HC OTIC SO          226            82             PHARMACY SERVICES-OTHER
8222366   CIPRO OPTH 3.5G                    143            82             PHARMACY SERVICES-OTHER
8250375   CIPROFLOXACIN 0.3% OP SOL           49            82             PHARMACY SERVICES-OTHER
8242554   CLOBETASOL                                        82             PHARMACY SERVICES-OTHER
8242430   CLOBETASOL 0.05% CREAM 30            32           82             PHARMACY SERVICES-OTHER
8250383   CLONIDINE TTS-1 PATCH                48           82             PHARMACY SERVICES-OTHER
8240061   CLONIDINE TTS-1 PATCH                 4           82             PHARMACY SERVICES-OTHER
8240079   CLONIDINE TTS-2 PATCH                 7           82             PHARMACY SERVICES-OTHER
8240103   CLONIDINE-TTS-3 PATCH                41           82             PHARMACY SERVICES-OTHER
8242745   CLOTRIMAZOLE                       0.01           82             PHARMACY SERVICES-OTHER
8240830   CLOTRIMAZOLE 1% CRM 15GM             42           82             PHARMACY SERVICES-OTHER
8240129   CLOTRIMAZOLE 1% CRM 30GM             13           82             PHARMACY SERVICES-OTHER
8240137   CLOTRIMAZOLE 1% CRM15GM               7           82             PHARMACY SERVICES-OTHER
8240848   CLOTRIMAZOLE 1% SOLN 30M             15           82             PHARMACY SERVICES-OTHER
8240111   CLOTRIMAZOLE VAGINAL CRM             12           82             PHARMACY SERVICES-OTHER
8270019   CLOTRIMAZOLE VAGINAL SUP              2           82             PHARMACY SERVICES-OTHER
8240855   COLLAGEN HEMOST AVITENE 1           270           82             PHARMACY SERVICES-OTHER
8251068   COLLAGEN HEMOST AVITENE 1           527           82             PHARMACY SERVICES-OTHER
8240863   COLLAGEN HEMOST AVITENE S            87           82             PHARMACY SERVICES-OTHER
8240871   COLLAGEN HEMOSTAVITENE 70           338           82             PHARMACY SERVICES-OTHER
8251050   COLLAGEN HEMOSTAVITENE 70           527           82             PHARMACY SERVICES-OTHER
8240889   COLLODION FLEXIBLE 120ML             58           82             PHARMACY SERVICES-OTHER
8240897   COLLODION FLEXIBLE 4OZ                3           82             PHARMACY SERVICES-OTHER
8280091   COMBIVENT INHALER                    55           82             PHARMACY SERVICES-OTHER
8291148   COMBIVENT INHALER                    55           82             PHARMACY SERVICES-OTHER
8280109   COMBIVENT INHALER 14GM              174           82             PHARMACY SERVICES-OTHER
8240160   CORTISPORIN OINTMENT 15GM           124           82             PHARMACY SERVICES-OTHER
8240152   CORTISPORIN OPH OINT                  9           82             PHARMACY SERVICES-OTHER
8250391   CORTISPORIN OPH SUSP 7.5             11           82             PHARMACY SERVICES-OTHER
8251464   COSOPT                                            82             PHARMACY SERVICES-OTHER
8251357   COSOPT EYE DROPS 5ML                              82             PHARMACY SERVICES-OTHER
8220089   CUSTOM HYPERALIMENTATION           630            82             PHARMACY SERVICES-OTHER
8222614   CUSTOM TPN                                        82             PHARMACY SERVICES-OTHER
8250417   CYCLOPENTOLATE 1% 2ML                4            82             PHARMACY SERVICES-OTHER
8250433   CYCLOPENTOLATE 1% OPH SOL           29            82             PHARMACY SERVICES-OTHER
8250441   CYCLOPENTOLATE 2% 2ML                6            82             PHARMACY SERVICES-OTHER
8280463   CYCLOPHOSPHAMID 100MG IJ           553            82             PHARMACY SERVICES-OTHER
8280455   CYCLOPHOSPHAMID 100MG IJ           509            82             PHARMACY SERVICES-OTHER
8280448   CYCLOPHOSPHAMID 100MG IJ             7            82             PHARMACY SERVICES-OTHER
8280430   CYCLOPHOSPHAMID 100MG IJ                          82             PHARMACY SERVICES-OTHER
8280422   CYCLOPHOSPHAMID 100MG IJ            27            82             PHARMACY SERVICES-OTHER
8280497   CYTARABINE 100MG IJ                               82             PHARMACY SERVICES-OTHER
8280489   CYTARABINE 100MG IJ                503            82             PHARMACY SERVICES-OTHER
8280471   CYTARABINE 100MG IJ                124            82             PHARMACY SERVICES-OTHER




                                               Page 152
                                      c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION                   SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                         AMOUNT AMOUNT CODE

8280992   CYTARABINE 100MG IJ                                     82             PHARMACY SERVICES-OTHER
8281354   CYTARABINE 100MG IJ                                     82             PHARMACY SERVICES-OTHER
8281347   CYTARABINE 100MG IJ                                     82             PHARMACY SERVICES-OTHER
8281289   CYTARABINE 100MG IJ                                     82             PHARMACY SERVICES-OTHER
8220956   D10W 1000ML                               90            82             PHARMACY SERVICES-OTHER
8220949   D10W 1000ML                              133            82             PHARMACY SERVICES-OTHER
8220931   D10W 1000ML                               26            82             PHARMACY SERVICES-OTHER
8220659   D10W 500ML PF 1 L                         26            82             PHARMACY SERVICES-OTHER
8220667   D10W 5ML                                   2            82             PHARMACY SERVICES-OTHER
8222598   D20W 500ML                                              82             PHARMACY SERVICES-OTHER
8220691   D25W 10ML                                 91            82             PHARMACY SERVICES-OTHER
8220675   D25W 10ML                                 13            82             PHARMACY SERVICES-OTHER
8221103   D50W 1000ML                               50            82             PHARMACY SERVICES-OTHER
8221111   D50W 2000ML                                             82             PHARMACY SERVICES-OTHER
8220733   D50W 50 ML                                66            82             PHARMACY SERVICES-OTHER
8220725   D50W 50 ML                                              82             PHARMACY SERVICES-OTHER
8220717   D50W 50 ML D                                2           82             PHARMACY SERVICES-OTHER
8220741   D50W 500ML                                              82             PHARMACY SERVICES-OTHER
8220147   D51/2NS 1000ML                            26            82             PHARMACY SERVICES-OTHER
8220154   D51/2NS 1000ML .45%                       89            82             PHARMACY SERVICES-OTHER
8222390   D51/2NS 1000ML IV                                       82             PHARMACY SERVICES-OTHER
8220170   D51/2NS 1000ML/KCL 20                     90            82             PHARMACY SERVICES-OTHER
8220162   D51/2NS 1000ML/KCL 20                     26            82             PHARMACY SERVICES-OTHER
8220188   D51/2NS 1000ML/KCL 30                     26            82             PHARMACY SERVICES-OTHER
8220709   D51/2NS 500ML                             25            82             PHARMACY SERVICES-OTHER
8220196   D51/4NS 1000ML                            26            82             PHARMACY SERVICES-OTHER
8220204   D51/4NS 1000ML 0.225% NAC                 89            82             PHARMACY SERVICES-OTHER
8222416   D51/4NS 1000ML IV SOL                                   82             PHARMACY SERVICES-OTHER
8220212   D51/4NS 1000ML/KCL 20                     26            82             PHARMACY SERVICES-OTHER
8220220   D51/4NS 1000ML/KCL 40                     26            82             PHARMACY SERVICES-OTHER
8220238   D51/4NS 500ML                             26            82             PHARMACY SERVICES-OTHER
8220253   D5LR 1000ML                               89            82             PHARMACY SERVICES-OTHER
8220246   D5LR 1000ML                               26            82             PHARMACY SERVICES-OTHER
8222432   D5LR 1000ML IV SOLUTION                                 82             PHARMACY SERVICES-OTHER
8210114   D5LR/KCL 20MEQ 1000ML                    100            82             PHARMACY SERVICES-OTHER
8220261   D5NS 1000ML                               26            82             PHARMACY SERVICES-OTHER
8220279   D5NS 1000ML 0.9%                          89            82             PHARMACY SERVICES-OTHER
8222440   D5NS 1000ML IV SOLUTION                                 82             PHARMACY SERVICES-OTHER
8220287   D5NS 1000ML/KCL 20                        50            82             PHARMACY SERVICES-OTHER
8220295   D5NS 500ML                                26            82             PHARMACY SERVICES-OTHER
8221061   D5W 1000ML                                89            82             PHARMACY SERVICES-OTHER
8221053   D5W 1000ML                                89            82             PHARMACY SERVICES-OTHER
8221046   D5W 1000ML                                26            82             PHARMACY SERVICES-OTHER
8222523   D5W 1000ML IV SOLUTION                                  82             PHARMACY SERVICES-OTHER
8220303   D5W 1000ML/KCL 20                         26            82             PHARMACY SERVICES-OTHER
8221707   D5W 100ML                                  2            82             PHARMACY SERVICES-OTHER
8220998   D5W 100ML                                133            82             PHARMACY SERVICES-OTHER
8220980   D5W 100ML                                 26            82             PHARMACY SERVICES-OTHER
8221129   D5W 150ML                                 26            82             PHARMACY SERVICES-OTHER
8221558   D5W 250ML                                 66            82             PHARMACY SERVICES-OTHER
8220774   D5W 250ML                                  3            82             PHARMACY SERVICES-OTHER
8220758   D5W 250ML                                 26            82             PHARMACY SERVICES-OTHER
8220766   D5W 250ML GLASS D                         26            82             PHARMACY SERVICES-OTHER
8222507   D5W 250ML IV SOLUTION                                   82             PHARMACY SERVICES-OTHER
8221038   D5W 500ML                                 97            82             PHARMACY SERVICES-OTHER




                                                     Page 153
                                c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION             SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                   AMOUNT AMOUNT CODE

8221020   D5W 500ML                           88            82             PHARMACY SERVICES-OTHER
8221004   D5W 500ML                           88            82             PHARMACY SERVICES-OTHER
8221012   D5W 500ML GLASS D                   13            82             PHARMACY SERVICES-OTHER
8220972   D5W 50ML                            26            82             PHARMACY SERVICES-OTHER
8220964   D5W 50ML D                          26            82             PHARMACY SERVICES-OTHER
8220790   D70W 1000ML                        107            82             PHARMACY SERVICES-OTHER
8220782   D70W 1000ML                         50            82             PHARMACY SERVICES-OTHER
8221137   D70W 100ML                                        82             PHARMACY SERVICES-OTHER
8281297   DACARBAZINE 100MG IJ                              82             PHARMACY SERVICES-OTHER
8281222   DACARBAZINE 100MG IJ                              82             PHARMACY SERVICES-OTHER
8281214   DACARBAZINE 100MG IJ               274            82             PHARMACY SERVICES-OTHER
8280505   DACARBAZINE 100MG IJ                20            82             PHARMACY SERVICES-OTHER
8221319   DAKINS FULL STRENGTH 1L             14            82             PHARMACY SERVICES-OTHER
8221301   DAKINS SOLN 1/2STRNGHT 1L           14            82             PHARMACY SERVICES-OTHER
8221772   DAKINS SOLN 1/4 STRE 1L             14            82             PHARMACY SERVICES-OTHER
8220014   DAKINS SOLN 1L                      40            82             PHARMACY SERVICES-OTHER
8240210   DERMAPLAST 20% SPRAY 3 OZ            4            82             PHARMACY SERVICES-OTHER
8280174   DESFLURANE INHALATION SOL          349            82             PHARMACY SERVICES-OTHER
8240178   DESITIN OINT 1OZ                     2            82             PHARMACY SERVICES-OTHER
8240186   DESITIN OINTMENT 120GM               8            82             PHARMACY SERVICES-OTHER
8280125   DESMOPRESSIN NASAL SP 5ML          415            82             PHARMACY SERVICES-OTHER
8242273   DEXAMETHASONE 3.5GM OINT                          82             PHARMACY SERVICES-OTHER
8251282   DEXAMETHASONE 5ML DROPS                           82             PHARMACY SERVICES-OTHER
8222374   DEXTROSE 5% WATER ADD 50M             4           82             PHARMACY SERVICES-OTHER
8222671   DIANEAL/DEXT                                      82             PHARMACY SERVICES-OTHER
8221780   DIANEAL/DEXT 1.5% SOLN 2L           35            82             PHARMACY SERVICES-OTHER
8221806   DIANEAL/DEXT2.5% SOLN 2L            36            82             PHARMACY SERVICES-OTHER
8270308   DINOPROSTONE 10MG INSERT           251            82             PHARMACY SERVICES-OTHER
8270316   DINOPROSTONE SUPP 20MG              39            82             PHARMACY SERVICES-OTHER
8242380   DIPHENHYDRAMINE 1% CREAM                          82             PHARMACY SERVICES-OTHER
8250466   DIPIVEFRIN 0.1% 5ML                  9            82             PHARMACY SERVICES-OTHER
8250474   DIPIVEFRIN 0.1% 5ML OPHT            58            82             PHARMACY SERVICES-OTHER
8220329   DOBUTAMINE 500/D5W250             2499            82             PHARMACY SERVICES-OTHER
8220311   DOBUTAMINE 500/D5W250               56            82             PHARMACY SERVICES-OTHER
8200008   DOME PASTE BAND                     11            82             PHARMACY SERVICES-OTHER
8220816   DOPAMINE 400MG/D5W 250ML           153            82             PHARMACY SERVICES-OTHER
8220808   DOPAMINE 400MG/D5W 250ML            20            82             PHARMACY SERVICES-OTHER
8280935   DORNASE ALFA 1MG/ML SOL I           42            82             PHARMACY SERVICES-OTHER
8250482   DORZOLAMIDE 2% OPH SOLN 5           84            82             PHARMACY SERVICES-OTHER
8250490   DORZOLAMIDE OPTH 2% 5ML             26            82             PHARMACY SERVICES-OTHER
8281271   DOXORUBICIN 10MG IJ                               82             PHARMACY SERVICES-OTHER
8281230   DOXORUBICIN 10MG IJ                               82             PHARMACY SERVICES-OTHER
8280513   DUONEB 2.5-0.5MG/3ML SOL              2           82             PHARMACY SERVICES-OTHER
8280539   DUONEB INHALATION SOLUTIO            33           82             PHARMACY SERVICES-OTHER
8242760   ECONAZOLE                          0.01           82             PHARMACY SERVICES-OTHER
8280547   EDTA CA DISODUM 1000MG IJ           164           82             PHARMACY SERVICES-OTHER
8240905   ELASE OINTMENT 10GM                 121           82             PHARMACY SERVICES-OTHER
8242786   EMLA                               0.01           82             PHARMACY SERVICES-OTHER
8240913   EMLA CREAM                            7           82             PHARMACY SERVICES-OTHER
8240921   EMLA CREAM W/TEGADERM 5GM            48           82             PHARMACY SERVICES-OTHER
8240988   EMOLLIENTS        EU                 16           82             PHARMACY SERVICES-OTHER
8240939   EMOLLIENTS CRM 16 OZ                  8           82             PHARMACY SERVICES-OTHER
8240947   EMOLLIENTS CRM 4 OZ                   4           82             PHARMACY SERVICES-OTHER
8222580   EMT TOOTHSAVER                                    82             PHARMACY SERVICES-OTHER
8280554   ENFLURANE 125ML                     88            82             PHARMACY SERVICES-OTHER




                                               Page 154
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8280562   ENFLURANE 250ML                     131            82             PHARMACY SERVICES-OTHER
8250508   EPINEPHRINE 1:1000 OPH GT             2            82             PHARMACY SERVICES-OTHER
8280588   EPINEPHRINE SOLN/INH 7.5M             6            82             PHARMACY SERVICES-OTHER
8240954   EPINEPHRINE TOPICAL 30ML              6            82             PHARMACY SERVICES-OTHER
8251514   ERYTHROMYCIN                                       82             PHARMACY SERVICES-OTHER
8242398   ERYTHROMYCIN 2% GEL                                82             PHARMACY SERVICES-OTHER
8250516   ERYTHROMYCIN OPH OINT                38            82             PHARMACY SERVICES-OTHER
8221822   ESOPHAGEAL COCKTAIL SUSP             38            82             PHARMACY SERVICES-OTHER
8221830   ESOPHAGEAL SUSP LI/MY/DON           117            82             PHARMACY SERVICES-OTHER
8242505   ESTRADIOL                                          82             PHARMACY SERVICES-OTHER
8290066   ESTRADIOL 8MG PATCH                   2            82             PHARMACY SERVICES-OTHER
8270324   ESTROGENS VAG CRM                    16            82             PHARMACY SERVICES-OTHER
8240970   ETHYL CL SPRAY                        5            82             PHARMACY SERVICES-OTHER
8250540   EYE IRRIG                            56            82             PHARMACY SERVICES-OTHER
8250524   EYE IRRIG 1 OZ                        6            82             PHARMACY SERVICES-OTHER
8241911   EYE LUBE                             12            82             PHARMACY SERVICES-OTHER
8250169   EYE LUBE     ARTIFICIAL               9            82             PHARMACY SERVICES-OTHER
8251092   EYE LUBE LACRI.7GM OPHT O            18            82             PHARMACY SERVICES-OTHER
8250532   EYE LUBE OPH OINT                     5            82             PHARMACY SERVICES-OTHER
8242109   FACILITY SPEC DESCRIPTION                          82             PHARMACY SERVICES-OTHER
8242752   FENTANYL                            0.01           82             PHARMACY SERVICES-OTHER
8240996   FENTANYL PATCH 100MCG                147           82             PHARMACY SERVICES-OTHER
8241002   FENTANYL PATCH 100MCG/HR              25           82             PHARMACY SERVICES-OTHER
8241010   FENTANYL PATCH 25MCG/HR                9           82             PHARMACY SERVICES-OTHER
8241036   FENTANYL PATCH 50MCG/HR               14           82             PHARMACY SERVICES-OTHER
8241044   FENTANYL PATCH 75MCG/HR               21           82             PHARMACY SERVICES-OTHER
8270027   FLEET                                  1           82             PHARMACY SERVICES-OTHER
8270332   FLEET BARIUM PREP KIT NO               9           82             PHARMACY SERVICES-OTHER
8220824   FLUCONAZOL 200MG/100ML NS            314           82             PHARMACY SERVICES-OTHER
8220840   FLUCONAZOL 400MG/200ML NS            406           82             PHARMACY SERVICES-OTHER
8220832   FLUCONAZOL 400MG/200ML NS            148           82             PHARMACY SERVICES-OTHER
8280596   FLUNISOLIDE INHALER 7GM               20           82             PHARMACY SERVICES-OTHER
8241077   FLUOCINONIDE .05% CRM30GM             17           82             PHARMACY SERVICES-OTHER
8241069   FLUOCINONIDE .05% CRM30GM             17           82             PHARMACY SERVICES-OTHER
8241085   FLUOCINONIDE .05%OIN 15GM             12           82             PHARMACY SERVICES-OTHER
8250557   FLUORESCEIN 9MG OPHTH STR             27           82             PHARMACY SERVICES-OTHER
8260093   FLUORESCEIN STRIPS #300               33           82             PHARMACY SERVICES-OTHER
8251407   FLUOROMETHOLONE                                    82             PHARMACY SERVICES-OTHER
8250565   FLURBIPROFEN .03% OPH SOL            46            82             PHARMACY SERVICES-OTHER
8250573   FLURBIPROFEN .03% OPH SUS            17            82             PHARMACY SERVICES-OTHER
8280612   FLUTICASONE 110MCG INHALE           143            82             PHARMACY SERVICES-OTHER
8280620   FLUTICASONE 220MCG INHLR             56            82             PHARMACY SERVICES-OTHER
8280638   FLUTICASONE 50MCG NASAL S           188            82             PHARMACY SERVICES-OTHER
8221970   GATIFLOX 200MG/100ML D5W             21            82             PHARMACY SERVICES-OTHER
8220865   GATIFLOX 200MG/100ML D5W            255            82             PHARMACY SERVICES-OTHER
8221921   GATIFLOX 400MG/200ML D5W             45            82             PHARMACY SERVICES-OTHER
8220881   GATIFLOX 400MG/200ML D5W            487            82             PHARMACY SERVICES-OTHER
8251472   GATIFLOXACIN                                       82             PHARMACY SERVICES-OTHER
8221913   GATIFLOXACIN 200MG TABLET             8            82             PHARMACY SERVICES-OTHER
8222119   GATIFLOXACIN 400MG TABLET             9            82             PHARMACY SERVICES-OTHER
8222077   GATIFLOXACIN 400MG TABLET             9            82             PHARMACY SERVICES-OTHER
8241093   GELATIN SPONGE 100MM                 17            82             PHARMACY SERVICES-OTHER
8241101   GELATIN SPONGE 12-7                   3            82             PHARMACY SERVICES-OTHER
8241119   GELATIN SPONGE SIZE 100             124            82             PHARMACY SERVICES-OTHER
8241127   GELATIN SPONGE SIZE 12-7M            48            82             PHARMACY SERVICES-OTHER




                                                Page 155
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8242349   GELFOAM POWDER                                     82             PHARMACY SERVICES-OTHER
8241135   GENTAMICIN 0.1% 15GM OINT            37            82             PHARMACY SERVICES-OTHER
8242281   GENTAMICIN 3.5GM OINT                              82             PHARMACY SERVICES-OTHER
8220899   GENTAMICIN 80MG/100ML NS               7           82             PHARMACY SERVICES-OTHER
8250581   GENTAMICIN OPH GTTS 5ML                5           82             PHARMACY SERVICES-OTHER
8241143   GENTIAN VIOLET 1% 30ML                 1           82             PHARMACY SERVICES-OTHER
8241150   GLYCERIN 2OZ                           1           82             PHARMACY SERVICES-OTHER
8270340   GLYCERIN ADULT SUPPOSITOR              2           82             PHARMACY SERVICES-OTHER
8270357   GLYCERIN PEDIATRIC SUPP                2           82             PHARMACY SERVICES-OTHER
8270365   GLYCERIN SUPP ADULT                                82             PHARMACY SERVICES-OTHER
8270373   GLYCERIN SUPP INFANT                               82             PHARMACY SERVICES-OTHER
8250599   GONIOSOL 2.5% OPTH SOL               51            82             PHARMACY SERVICES-OTHER
8210049   GUAIF/DM 100-10MG/5ML SYR             2            82             PHARMACY SERVICES-OTHER
8222085   GUAIFENESIN SA 600MG TAB                           82             PHARMACY SERVICES-OTHER
8241176   HALOTHANE 125ML                      32            82             PHARMACY SERVICES-OTHER
8222663   HEPARIN 1MU/NS500                                  82             PHARMACY SERVICES-OTHER
8220352   HEPARIN 25KU/D5W500                  98            82             PHARMACY SERVICES-OTHER
8220337   HEPARIN 25KU/D5W500                  20            82             PHARMACY SERVICES-OTHER
8220345   HEPARIN 25KU/D5W500 D                29            82             PHARMACY SERVICES-OTHER
8220360   HETASTARCH 500ML                     67            82             PHARMACY SERVICES-OTHER
8222622   HETASTARCH 500ML 6% LR              180            82             PHARMACY SERVICES-OTHER
8220378   HETASTARCH 500ML 6%NS               149            82             PHARMACY SERVICES-OTHER
8220022   HEXACHLOROPHENE 3% 15                70            82             PHARMACY SERVICES-OTHER
8251316   HOMATROPINE 2% 5ML                                 82             PHARMACY SERVICES-OTHER
8200016   HOMATROPINE 5% 5ML                    9            82             PHARMACY SERVICES-OTHER
8291130   HYDROCOD/APAP 10/325MG                1            82             PHARMACY SERVICES-OTHER
8222192   HYDROCORT                           102            82             PHARMACY SERVICES-OTHER
8241184   HYDROCORT 0.5% CRM 30G                1            82             PHARMACY SERVICES-OTHER
8241192   HYDROCORT 1% CRM 30G                  2            82             PHARMACY SERVICES-OTHER
8241218   HYDROCORT 1% LOT 4                    7            82             PHARMACY SERVICES-OTHER
8241226   HYDROCORT 1% OINT 30G                 2            82             PHARMACY SERVICES-OTHER
8241234   HYDROCORT 10MG/ML 1 OZ               14            82             PHARMACY SERVICES-OTHER
8241242   HYDROCORT CRM 1 OZ                   14            82             PHARMACY SERVICES-OTHER
8241259   HYDROCORT CRM 1OZ                    12            82             PHARMACY SERVICES-OTHER
8241267   HYDROCORT CRM 2.5% 30G                4            82             PHARMACY SERVICES-OTHER
8241556   HYDROCORT OTIC SOLN                  12            82             PHARMACY SERVICES-OTHER
8270381   HYDROCORT SUPP                        1            82             PHARMACY SERVICES-OTHER
8242034   HYDROCORT/PRAM 1% 30GM CR                          82             PHARMACY SERVICES-OTHER
8241275   HYDROCORTISON 0.5% 30GM C             6            82             PHARMACY SERVICES-OTHER
8241283   HYDROCORTISON 10% CRM 2O             28            82             PHARMACY SERVICES-OTHER
8241291   HYDROCORTISON 2.5% 30GM C            84            82             PHARMACY SERVICES-OTHER
8241309   HYDROCORTISONE 1% 30GM CR             8            82             PHARMACY SERVICES-OTHER
8270407   HYDROCORTISONE 25MG SUPP             16            82             PHARMACY SERVICES-OTHER
8221194   HYDROGEN PEROX 3%120ML SO            28            82             PHARMACY SERVICES-OTHER
8241317   HYDROGEN PEROX 8 OZ                   1            82             PHARMACY SERVICES-OTHER
8270415   HYDROMORPHONE SUPP 3MG                2            82             PHARMACY SERVICES-OTHER
8251449   HYOSCYAMNE                                         82             PHARMACY SERVICES-OTHER
8281081   IFOSFAMIDE/1GM IJ                                  82             PHARMACY SERVICES-OTHER
8281305   IFOSFAMIDE/1GM IJ                                  82             PHARMACY SERVICES-OTHER
8270571   INDOMETHACIN 50MG SUPP                17           82             PHARMACY SERVICES-OTHER
8270431   INDOMETHACIN SUPP 50MG                 1           82             PHARMACY SERVICES-OTHER
8221848   IODINE       BUNNE                    14           82             PHARMACY SERVICES-OTHER
8241440   IODINE TC 2%                          54           82             PHARMACY SERVICES-OTHER
8241457   IODINE TINCTURE 480ML                101           82             PHARMACY SERVICES-OTHER
8281388   IPRATROPIUM                         0.01           82             PHARMACY SERVICES-OTHER




                                                Page 156
                                c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION             SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                   AMOUNT AMOUNT CODE

8280646   IPRATROPIUM .02% 2.5ML IN           18            82             PHARMACY SERVICES-OTHER
8280695   IPRATROPIUM INHALAT SOLN             2            82             PHARMACY SERVICES-OTHER
8280869   IPRATROPIUM INHALER 14GM           118            82             PHARMACY SERVICES-OTHER
8210106   ISOPROPYL ETOH 70% 3840ML                         82             PHARMACY SERVICES-OTHER
8250870   ISOPTO TEARS 15ML                    6            82             PHARMACY SERVICES-OTHER
8220923   K CL 10MEQ/WATER 100ML              91            82             PHARMACY SERVICES-OTHER
8221087   K CL 20MEQ/WATER 100ML              17            82             PHARMACY SERVICES-OTHER
8221079   K CL 20MEQ/WATER 100ML 1                          82             PHARMACY SERVICES-OTHER
8221160   K CL 30MEQ/WATER 100ML              17            82             PHARMACY SERVICES-OTHER
8242513   KETOCONAZOLE                                      82             PHARMACY SERVICES-OTHER
8290074   KETOCONAZOLE 2% CREAM               15            82             PHARMACY SERVICES-OTHER
8242133   KETOCONAZOLE 2%CREAM 15GM                         82             PHARMACY SERVICES-OTHER
8251498   KETOROLAC                                         82             PHARMACY SERVICES-OTHER
8251241   KETOROLAC 0.5% EYE DROPS            45            82             PHARMACY SERVICES-OTHER
8251118   KETOROLAC 5% OPTH SOLUTIO          117            82             PHARMACY SERVICES-OTHER
8222341   KETOROLAC 5% OPTH SOLUTIO          179            82             PHARMACY SERVICES-OTHER
8241424   LACHYDRIN 12%LT 240ML               75            82             PHARMACY SERVICES-OTHER
8290884   LACHYDRIN 12%LT 240ML              101            82             PHARMACY SERVICES-OTHER
8242299   LACHYDRIN CREAM 12% 280GM                         82             PHARMACY SERVICES-OTHER
8220386   LACTATED RINGERS 1000               26            82             PHARMACY SERVICES-OTHER
8220394   LACTATED RINGERS 1000ML-N           88            82             PHARMACY SERVICES-OTHER
8290082   LANOLIN 30GM                         1            82             PHARMACY SERVICES-OTHER
8251233   LANOLIN LACRI-LUBE OINT 3           47            82             PHARMACY SERVICES-OTHER
8251480   LATANOPROST                                       82             PHARMACY SERVICES-OTHER
8251043   LATANOPROST 0.005% 2.5ML           252            82             PHARMACY SERVICES-OTHER
8251001   LATANOPROST 0.005%,2.5ML            44            82             PHARMACY SERVICES-OTHER
8250862   LATANOPROST 0.005%,2.5ML            44            82             PHARMACY SERVICES-OTHER
8281321   LEVALBUTEROL                                      82             PHARMACY SERVICES-OTHER
8281248   LEVALBUTEROL 0.63MG/3ML                           82             PHARMACY SERVICES-OTHER
8250896   LEVOBUNOLOL OPH 0.5% 5ML            13            82             PHARMACY SERVICES-OTHER
8220907   LEVOFLOX 500MG/100ML D5W            95            82             PHARMACY SERVICES-OTHER
8222358   LEVOFLOXACIN 0.5% SOLUTI            45            82             PHARMACY SERVICES-OTHER
8291189   LEVOFLOXACIN 250MG TAB               9            82             PHARMACY SERVICES-OTHER
8220410   LIDO/DEXTROSE 2GM 250ML             19            82             PHARMACY SERVICES-OTHER
8241960   LIDO/EPI/TETRA 5ML                  16            82             PHARMACY SERVICES-OTHER
8242570   LIDOCAINE                                         82             PHARMACY SERVICES-OTHER
8241432   LIDOCAINE 2% 30ML JELLY             32            82             PHARMACY SERVICES-OTHER
8290090   LIDOCAINE 2% JELLY 30GM              8            82             PHARMACY SERVICES-OTHER
8221095   LIDOCAINE 2GM/D5W250               104            82             PHARMACY SERVICES-OTHER
8241374   LIDOCAINE 4% 50ML TOP SOL           33            82             PHARMACY SERVICES-OTHER
8290108   LIDOCAINE 4% CREAM 5GM              11            82             PHARMACY SERVICES-OTHER
8241465   LIDOCAINE 4% TOPICAL SOL             5            82             PHARMACY SERVICES-OTHER
8241598   LIDOCAINE 5% 35GM TOP OIN           62            82             PHARMACY SERVICES-OTHER
8290116   LIDOCAINE 5% OINT 30GM               2            82             PHARMACY SERVICES-OTHER
8290124   LIDOCAINE 5% PATCH                   5            82             PHARMACY SERVICES-OTHER
8290132   LINDANE LOTION 2 OZ                  2            82             PHARMACY SERVICES-OTHER
8290140   LINDANE SHAMPOO 2 OZ                 2            82             PHARMACY SERVICES-OTHER
8220428   LIPID EMULSION 20% 500ML            84            82             PHARMACY SERVICES-OTHER
8290157   LUBRICANTS 2OZ TUBE                  1            82             PHARMACY SERVICES-OTHER
8290165   LUBRICANTS 3GM                       5            82             PHARMACY SERVICES-OTHER
8290173   LUBRICANTS 5GM TUBE                               82             PHARMACY SERVICES-OTHER
8241382   LUGOLS SOLN 30ML BOTTLE              1            82             PHARMACY SERVICES-OTHER
8222168   MAG ALOH HYD                        12            82             PHARMACY SERVICES-OTHER
8241390   MAG HYDROXIDE CONC 10ML                           82             PHARMACY SERVICES-OTHER
8241986   MAG SO4 1816 GM GRNS ORAL             2           82             PHARMACY SERVICES-OTHER




                                               Page 157
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8220444   MAG SO4 1GM/D5W100                    5            82             PHARMACY SERVICES-OTHER
8241952   MAG SO4 454GM CRYSTALS                1            82             PHARMACY SERVICES-OTHER
8241895   MAGIC MOUTHWASH SUSPENS              76            82             PHARMACY SERVICES-OTHER
8220030   MAGNESIUM SO4 500MG IJ               21            82             PHARMACY SERVICES-OTHER
8251019   MAXITROL .1% 5ML OPHTH SU            42            82             PHARMACY SERVICES-OTHER
8241606   MAXITROL 3.5GM OPHTH OINT            44            82             PHARMACY SERVICES-OTHER
8222309   MAXITROL OP SOL                      63            82             PHARMACY SERVICES-OTHER
8290181   MAXITROL OPH OINT                    12            82             PHARMACY SERVICES-OTHER
8250888   MAXITROL SUSP 5ML                    12            82             PHARMACY SERVICES-OTHER
8251126   MEDRYSONE 1% OPH SUSP 5M              8            82             PHARMACY SERVICES-OTHER
8270621   MESALAMINE 500MG SUPP 24H            23            82             PHARMACY SERVICES-OTHER
8270662   MESALAMINE 500MG SUPPOS               5            82             PHARMACY SERVICES-OTHER
8221855   METAPROTERENOL                        1            82             PHARMACY SERVICES-OTHER
8280919   METAPROTERENOL .6%INH SL              1            82             PHARMACY SERVICES-OTHER
8280653   METAPROTERENOL INH 15ML              14            82             PHARMACY SERVICES-OTHER
8251423   METIPRANOLOL                                       82             PHARMACY SERVICES-OTHER
8242422   METRONIDAZOLE 0.75% GEL                            82             PHARMACY SERVICES-OTHER
8241614   MICONAZOLE 2% 45GM VAG CR             49           82             PHARMACY SERVICES-OTHER
8290199   MICONAZOLE 2% CRM                      9           82             PHARMACY SERVICES-OTHER
8290207   MICONAZOLE 2% CRM 15GM                 8           82             PHARMACY SERVICES-OTHER
8290215   MICONAZOLE 2% VAGINAL CR              16           82             PHARMACY SERVICES-OTHER
8290223   MICONAZOLE CLOTRIMAZOLE 1              1           82             PHARMACY SERVICES-OTHER
8270449   MICONAZOLE VAGINAL SUPP                2           82             PHARMACY SERVICES-OTHER
8222606   MIRALAX GENERIC 17GM                   2           82             PHARMACY SERVICES-OTHER
8221277   MISC ORAL LIQUID CHRYSYRP              2           82             PHARMACY SERVICES-OTHER
8251548   MOXIFLOXACIN                        0.01           82             PHARMACY SERVICES-OTHER
8242307   MUPIROCIN 2% CREAM 15GM                            82             PHARMACY SERVICES-OTHER
8290231   MUPIROCIN 2% NASAL OINTME              6           82             PHARMACY SERVICES-OTHER
8242315   MUPIROCIN 2% OINT 22GM                             82             PHARMACY SERVICES-OTHER
8241622   MUPIROCIN 2% OINTMENT 15G            77            82             PHARMACY SERVICES-OTHER
8222465   NA CHLORIDE 0.9% IV 50ML                           82             PHARMACY SERVICES-OTHER
8251431   NA CL                                              82             PHARMACY SERVICES-OTHER
8280679   NA CL .9% 3ML INH                    68            82             PHARMACY SERVICES-OTHER
8222291   NA CL .9% 3ML INH SOL                29            82             PHARMACY SERVICES-OTHER
8220113   NA CL 0.45% 1000ML                   88            82             PHARMACY SERVICES-OTHER
8221681   NA CL 0.9% 100ML                      3            82             PHARMACY SERVICES-OTHER
8221657   NA CL 0.9% 100ML                      5            82             PHARMACY SERVICES-OTHER
8220600   NA CL 0.9% 100ML                     26            82             PHARMACY SERVICES-OTHER
8210163   NA CL 0.9% 100ML                                   82             PHARMACY SERVICES-OTHER
8220055   NA CL 0.9% 100ML VIAL                 2            82             PHARMACY SERVICES-OTHER
8220493   NA CL 0.9% 150ML                     26            82             PHARMACY SERVICES-OTHER
8220048   NA CL 0.9% 1L                        26            82             PHARMACY SERVICES-OTHER
8220519   NA CL 0.9% 250ML                      3            82             PHARMACY SERVICES-OTHER
8220501   NA CL 0.9% 250ML                     26            82             PHARMACY SERVICES-OTHER
8222473   NA CL 0.9% 250ML SOLUTION                          82             PHARMACY SERVICES-OTHER
8220550   NA CL 0.9% 500ML                     88            82             PHARMACY SERVICES-OTHER
8220543   NA CL 0.9% 500ML                     88            82             PHARMACY SERVICES-OTHER
8220535   NA CL 0.9% 500ML                     26            82             PHARMACY SERVICES-OTHER
8220527   NA CL 0.9% 500ML 0.45 U              26            82             PHARMACY SERVICES-OTHER
8210148   NA CL 0.9% 500ML NON-PVC                           82             PHARMACY SERVICES-OTHER
8222382   NA CL 0.9% 50ML                      72            82             PHARMACY SERVICES-OTHER
8220568   NA CL 0.9% 50ML                      88            82             PHARMACY SERVICES-OTHER
8220576   NA CL 0.9% 50ML D                    26            82             PHARMACY SERVICES-OTHER
8281198   NA CL 0.9% 5ML INH SOL                             82             PHARMACY SERVICES-OTHER
8220469   NA CL 0.9% IR SLN 3L                 50            82             PHARMACY SERVICES-OTHER




                                                Page 158
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8210056   NA CL 1000ML/KCL 20                 104            82             PHARMACY SERVICES-OTHER
8210064   NA CL 1000ML/KCL 40                 104            82             PHARMACY SERVICES-OTHER
8220063   NA CL 1L IRRIG                        4            82             PHARMACY SERVICES-OTHER
8281206   NA CL 3% 15ML INH SOL                              82             PHARMACY SERVICES-OTHER
8220915   NA CL 3% 500ML                       26            82             PHARMACY SERVICES-OTHER
8222549   NA CL IRRIG 2000ML                  128            82             PHARMACY SERVICES-OTHER
8251308   NA HYALURON/CHRON DUOVISC                          82             PHARMACY SERVICES-OTHER
8251290   NA HYALURONATE HEALON5                             82             PHARMACY SERVICES-OTHER
8242141   NA HYPOCHLORITE 1000ML FU                          82             PHARMACY SERVICES-OTHER
8242158   NA HYPOCHLORITE 1000ML HA                          82             PHARMACY SERVICES-OTHER
8242166   NA HYPOCHLORITE 1000ML QU                          82             PHARMACY SERVICES-OTHER
8251555   NAPHAZOLINE                         0.01           82             PHARMACY SERVICES-OTHER
8251530   NAPHAZOLONE                         0.01           82             PHARMACY SERVICES-OTHER
8250706   NAPHAZOLONE                           38           82             PHARMACY SERVICES-OTHER
8250409   NEO/POLY/HC                           88           82             PHARMACY SERVICES-OTHER
8290249   NEO/POLY/HC OTIC SOLN                 12           82             PHARMACY SERVICES-OTHER
8242679   NEOSPORIN                           0.01           82             PHARMACY SERVICES-OTHER
8241630   NEOSPORIN .9GM TOP OINT U              2           82             PHARMACY SERVICES-OTHER
8222275   NEOSPORIN 10ML OPHTH SOLN             90           82             PHARMACY SERVICES-OTHER
8250680   NEOSPORIN 10ML OPHTH SOLN                          82             PHARMACY SERVICES-OTHER
8241655   NEOSPORIN 15GM TOP OINTME           0.01           82             PHARMACY SERVICES-OTHER
8241648   NEOSPORIN 3.5GM OPHTH OIN             48           82             PHARMACY SERVICES-OTHER
8240244   NEOSPORIN GU IRRIG                   175           82             PHARMACY SERVICES-OTHER
8240228   NEOSPORIN GU IRRIG                     1           82             PHARMACY SERVICES-OTHER
8290256   NEOSPORIN OINT 30G                     1           82             PHARMACY SERVICES-OTHER
8290264   NEOSPORIN OPH OIN                      1           82             PHARMACY SERVICES-OTHER
8250698   NEOSPORIN OPH SOLN 10ML              163           82             PHARMACY SERVICES-OTHER
8242539   NICOTINE                                           82             PHARMACY SERVICES-OTHER
8290272   NICOTINE PATCHES OTC                  4            82             PHARMACY SERVICES-OTHER
8241853   NICOTINE PATCHES OTC                  3            82             PHARMACY SERVICES-OTHER
8241663   NICOTINE PATCHES OTC                  3            82             PHARMACY SERVICES-OTHER
8241580   NITROFURAZONE DRESSNG 28G            61            82             PHARMACY SERVICES-OTHER
8242521   NTG                                                82             PHARMACY SERVICES-OTHER
8241671   NTG 0.1MG/HR PATCH                   18            82             PHARMACY SERVICES-OTHER
8241689   NTG 0.2MG/HR PATCH                   18            82             PHARMACY SERVICES-OTHER
8241697   NTG 0.3MG/HR PATCH                   19            82             PHARMACY SERVICES-OTHER
8241705   NTG 0.4MG/HR PATCH                   18            82             PHARMACY SERVICES-OTHER
8241713   NTG 2% 30MG OINT                     44            82             PHARMACY SERVICES-OTHER
8290306   NTG 2% OIN 30GM                      44            82             PHARMACY SERVICES-OTHER
8290314   NTG 2% OINT                           3            82             PHARMACY SERVICES-OTHER
8220584   NTG 50MG/D5W 250ML                   80            82             PHARMACY SERVICES-OTHER
8220592   NTG 50MG/D5W 250ML                  271            82             PHARMACY SERVICES-OTHER
8210072   NTG 50MG/D5W 250ML                    7            82             PHARMACY SERVICES-OTHER
8290322   NTG PTCH .1MG/H                       1            82             PHARMACY SERVICES-OTHER
8290330   NTG PTCH .2MG/H                       1            82             PHARMACY SERVICES-OTHER
8290348   NTG PTCH .3MG/H                       1            82             PHARMACY SERVICES-OTHER
8290355   NTG PTCH .4MG/H                       1            82             PHARMACY SERVICES-OTHER
8290363   NTG PTCH .6MG/H                       1            82             PHARMACY SERVICES-OTHER
8241721   NYSTATIN 15GM CREAM                  35            82             PHARMACY SERVICES-OTHER
8290371   NYSTATIN CRM 15GM                     2            82             PHARMACY SERVICES-OTHER
8290389   NYSTATIN OINT 15GM                    2            82             PHARMACY SERVICES-OTHER
8222176   NYSTATIN POWDER 15GM                114            82             PHARMACY SERVICES-OTHER
8270456   NYSTATIN VAGINAL SUPP                              82             PHARMACY SERVICES-OTHER
8242257   NYSTATIN/TRIAMC 30GM OINT                          82             PHARMACY SERVICES-OTHER
8290397   NYSTATIN/TRIAMC CRM 15GM               2           82             PHARMACY SERVICES-OTHER




                                                Page 159
                                 c516fb76-d4e1-482c-a7cd-a465595042ac.xls




CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8290405   NYSTATIN/TRIAMC CRM 30GM              5            82             PHARMACY SERVICES-OTHER
8290413   NYSTATIN/TRIAMC OINT 15GM             2            82             PHARMACY SERVICES-OTHER
8240624   OATMEAL COLL         A               16            82             PHARMACY SERVICES-OTHER
8222135   OATMEAL COLL 16OZ                     5            82             PHARMACY SERVICES-OTHER
8222051   OLANZAPINE ZYDIS 10MG TAB            12            82             PHARMACY SERVICES-OTHER
8251399   OLOPATADINE                                        82             PHARMACY SERVICES-OTHER
8241903   OMEPRAZOLE PEG SUSPENSION             14           82             PHARMACY SERVICES-OTHER
8290421   ORBASE B 5GM OINT                      2           82             PHARMACY SERVICES-OTHER
8210122   OXYTOCIN 1OU IJ                       22           82             PHARMACY SERVICES-OTHER
8210171   OXYTOCIN 1OU IJ                     0.01           82             PHARMACY SERVICES-OTHER
8222028   PANTOPRAZOLE 40MG TABLET               4           82             PHARMACY SERVICES-OTHER
8290439   PAPAIN/UREA OINT 1OZ                  32           82             PHARMACY SERVICES-OTHER
8222044   PEGFILGRASTIM 6MG IJ               5710            82             PHARMACY SERVICES-OTHER
8291197   PERGOLIDE 1 MG TAB                     4           82             PHARMACY SERVICES-OTHER
8242661   PERMETHRIN                          0.01           82             PHARMACY SERVICES-OTHER
8290454   PERMETHRIN 5% CRM 60GM                17           82             PHARMACY SERVICES-OTHER
8242547   PETROLATUM                                         82             PHARMACY SERVICES-OTHER
8241473   PETROLATUM 30GM                       1            82             PHARMACY SERVICES-OTHER
8241481   PETROLATUM PKTS                       8            82             PHARMACY SERVICES-OTHER
8241812   PETROLATUM WHITE 30GM OIN             4            82             PHARMACY SERVICES-OTHER
8241820   PETROLATUM WHITE GEL 5GM              2            82             PHARMACY SERVICES-OTHER
8281065   PHENYLEPHRINE                        29            82             PHARMACY SERVICES-OTHER
8242323   PHENYLEPHRINE                                      82             PHARMACY SERVICES-OTHER
8251134   PHENYLEPHRINE 0.12% OPH G              6           82             PHARMACY SERVICES-OTHER
8251142   PHENYLEPHRINE 0.25% SPRAY              3           82             PHARMACY SERVICES-OTHER
8281156   PHENYLEPHRINE 0.5% DRPS15                          82             PHARMACY SERVICES-OTHER
8251159   PHENYLEPHRINE 1% GTT                  3            82             PHARMACY SERVICES-OTHER
8251027   PHENYLEPHRINE 10% 1ML OPH            36            82             PHARMACY SERVICES-OTHER
8251175   PHENYLEPHRINE 10% OPH GTT             2            82             PHARMACY SERVICES-OTHER
8251035   PHENYLEPHRINE 2.5% 5ML OP           156            82             PHARMACY SERVICES-OTHER
8242240   PHENYTOIN 100MG/4ML SUS S            18            82             PHARMACY SERVICES-OTHER
8241739   PHENYTOIN 125MG SUSP                 19            82             PHARMACY SERVICES-OTHER
8250912   PILOCARPINE 0.25% 15ML                8            82             PHARMACY SERVICES-OTHER
8250920   PILOCARPINE 0.5% 15ML                 7            82             PHARMACY SERVICES-OTHER
8250938   PILOCARPINE 1% 15ML                   8            82             PHARMACY SERVICES-OTHER
8251266   PILOCARPINE 15ML DROPS                             82             PHARMACY SERVICES-OTHER
8250946   PILOCARPINE 2% 15ML                   8            82             PHARMACY SERVICES-OTHER
8250953   PILOCARPINE 2% 1ML                    4            82             PHARMACY SERVICES-OTHER
8250961   PILOCARPINE 4% 15ML                   9            82             PHARMACY SERVICES-OTHER
8241523   PILOCARPINE 4% 15ML T                 9            82             PHARMACY SERVICES-OTHER
8250730   PILOCARPINE 4% 15ML OP SL            48            82             PHARMACY SERVICES-OTHER
8250979   PILOCARPINE 6% 15ML                   8            82             PHARMACY SERVICES-OTHER
8242406   PIMECROLIMUS 1% CREAM                              82             PHARMACY SERVICES-OTHER
8222093   PIOGLITAZONE 15MG TABLET               3           82             PHARMACY SERVICES-OTHER
8222002   PIOGLITAZONE 45MG TABLET               5           82             PHARMACY SERVICES-OTHER
8210130   PLASMAPROT FRAC 5% 250ML                           82             PHARMACY SERVICES-OTHER
8251258   POLYMYX/TRIMETH EYE DROP             19            82             PHARMACY SERVICES-OTHER
8241564   POLYMYXIN B 0.5 MIL UNIT              6            82             PHARMACY SERVICES-OTHER
8222143   POLYSTYRENE                          46            82             PHARMACY SERVICES-OTHER
8291254   POLYSTYRENE 60M                      70            82             PHARMACY SERVICES-OTHER
8230013   POVIDONE IODINE                       5            82             PHARMACY SERVICES-OTHER
8241754   POVIDONE IODINE 10% OINT             72            82             PHARMACY SERVICES-OTHER
8222325   POVIDONE IODINE 5% SOL               44            82             PHARMACY SERVICES-OTHER
8290462   POVIDONE IODINE OIN 0.9GM                          82             PHARMACY SERVICES-OTHER
8290470   POVIDONE IODINE OINT 1OZ               1           82             PHARMACY SERVICES-OTHER




                                                Page 160
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CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE

8251225   POVIDONE IODINE OPH SOL              13            82             PHARMACY SERVICES-OTHER
8290488   POVIDONE IODINE SCRB 16OZ             2            82             PHARMACY SERVICES-OTHER
8290496   POVIDONE IODINE SCRB 32               4            82             PHARMACY SERVICES-OTHER
8241499   POVIDONE IODINE SL 16 OZ              2            82             PHARMACY SERVICES-OTHER
8230021   POVIDONE IODINE SOAP                 36            82             PHARMACY SERVICES-OTHER
8221863   POVIDONE IODINE SOLN 32               3            82             PHARMACY SERVICES-OTHER
8221871   POVIDONE IODINE SOLN 8                1            82             PHARMACY SERVICES-OTHER
8242414   PRAMOXINE 1% LOTION                                82             PHARMACY SERVICES-OTHER
8222184   PREDNISOLONE 1% OPHT SUSP            55            82             PHARMACY SERVICES-OTHER
8251274   PREDNISOLONE 5ML DROPS SU                          82             PHARMACY SERVICES-OTHER
8270589   PREPARATION H SUPPOSITORY             2            82             PHARMACY SERVICES-OTHER
8270597   PROCHLORPERAZIN                      21