Sutter Santa Rosa Medical Center by G9Fnone

VIEWS: 84 PAGES: 293

									                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4710950   CRYO PS                           108.00      108.00 47           BLOOD SERVICES
       4710455   EXCH TRANSFUSION NEWBORN          560.00             47           BLOOD SERVICES
       4710802   FFP PS                            142.00      142.00 47           BLOOD SERVICES
       4710604   IG RHO D MINI 50MCG IJ             70.00             47           BLOOD SERVICES
       4711602   IRRADIATION BLD PROD EA            58.00             47           BLOOD SERVICES
       4711453   LEUK TRANSFUSION                   50.00             47           BLOOD SERVICES
       4710059   MISC LAB PROC                                        47           BLOOD SERVICES
       4712600   PLAS CRYO REDUCED PS               85.00             47           BLOOD SERVICES
       4711701   PLTRP PS                          743.00             47           BLOOD SERVICES
       4710851   POOLING BLD PROD                  121.00             47           BLOOD SERVICES
       4700555   RBC DG PS                         535.00             47           BLOOD SERVICES
       4710257   RBC DG PS                         491.00             47           BLOOD SERVICES
       4710356   RBC L/D PS                        270.00             47           BLOOD SERVICES
       4710158   RBC PS                            270.00      270.00 47           BLOOD SERVICES
       4711107   RBC PS                            315.00             47           BLOOD SERVICES
       4711750   S STRL LEUKOTRAP FILTER            41.50             47           BLOOD SERVICES
       4711354   S STRL RECIPIENT SET                8.00             47           BLOOD SERVICES
       4710703   SPLIT BLD PROD EA UNIT            250.00             47           BLOOD SERVICES
       4710752   SPLIT BLD PROD EA UNIT            121.00             47           BLOOD SERVICES
       4710901   THAWING PROD PER UNIT              69.00             47           BLOOD SERVICES
       4710307   WASHED RBC PS                     352.00             47           BLOOD SERVICES
       4710109   WB PS                             352.00             47           BLOOD SERVICES
       3620507   CARDIAC STRESS TEST               618.00             36           CARDIOLOGY SERVICES
       3620556   CARDIAC STRESS TEST               618.00             36           CARDIOLOGY SERVICES
       3620606   CARDIAC STRESS TEST               618.00             36           CARDIOLOGY SERVICES
       3621109   CARDIAC STRESS TEST               618.00             36           CARDIOLOGY SERVICES
       3621158   CARDIAC STRESS TEST               618.00             36           CARDIOLOGY SERVICES
       3620200   EKG 12 LEAD TRACING               189.00             36           CARDIOLOGY SERVICES
       3620051   EKG 3 LEAD TRACING                 93.00             36           CARDIOLOGY SERVICES
       3620853   EKG W SCAN 24HR RCRD              433.00             36           CARDIOLOGY SERVICES
       3632668   S STRL EX FIX COUPLING          1,424.50             36           CARDIOLOGY SERVICES
       3311503   BRONCHOSCOPY INTERVENTN         2,137.00    2,137.00 33           CATH LAB
       3327350   BRONCHOSCOPY INTERVENTN         2,137.00    2,137.00 33           CATH LAB



9/17/2012                                                                                                   1
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3312857   CA INJ IMA CONDUIT                    392.00      392.00   33         CATH LAB
       3328903   CAC CATH ABD LOW 2ND                2,505.00    2,505.00   33         CATH LAB
       3328150   CAC INTRO CATH IVC /SVC               178.00      178.00   33         CATH LAB
       3327855   COLONOSCOPY                         1,903.00    1,903.00   33         CATH LAB
       3311842   COLONOSCOPY INTERVENTN              2,257.00               33         CATH LAB
       3327905   COLONOSCOPY INTERVENTN              2,257.00    2,257.00   33         CATH LAB
       3327954   COLONOSCOPY INTERVENTN              2,257.00    2,257.00   33         CATH LAB
       3328002   COLONOSCOPY INTERVENTN              2,257.00    2,257.00   33         CATH LAB
       3311958   EGD                                 1,839.00    1,839.00   33         CATH LAB
       3311651   EGD INTERVENTN                      1,974.00    1,974.00   33         CATH LAB
       3312105   EGD INTERVENTN                      1,974.00    1,974.00   33         CATH LAB
       3312204   EGD INTERVENTN                      1,974.00    1,974.00   33         CATH LAB
       3312253   EGD INTERVENTN                      1,974.00    1,974.00   33         CATH LAB
       3312303   EGD INTERVENTN                      1,974.00    1,974.00   33         CATH LAB
       3312501   EGD INTERVENTN                      1,974.00    1,974.00   33         CATH LAB
       3329455   EGD INTERVENTN                      1,974.00    1,974.00   33         CATH LAB
       3329505   EGD INTERVENTN                      1,974.00    1,974.00   33         CATH LAB
       3327400   ERCP                                1,605.00    1,605.00   33         CATH LAB
       3327459   ERCP INTERVENTN                     4,031.00    4,031.00   33         CATH LAB
       3327509   ERCP INTERVENTN                     4,031.00    4,031.00   33         CATH LAB
       3327558   ERCP INTERVENTN                     4,031.00    4,031.00   33         CATH LAB
       3327608   ERCP INTERVENTN                     4,031.00    4,031.00   33         CATH LAB
       3327657   ERCP INTERVENTN                     4,031.00    4,031.00   33         CATH LAB
       3327707   ERCP INTERVENTN                     4,031.00    4,031.00   33         CATH LAB
       3327756   ERCP INTERVENTN                     4,031.00    4,031.00   33         CATH LAB
       3327806   ERCP INTERVENTN                     4,031.00    4,031.00   33         CATH LAB
       3310380   IR ARTHRO SI JNT                      510.00               33         CATH LAB
       3310398   IR BX TRANSCATHETER                 2,661.00               33         CATH LAB
       3313103   IR CARDIOVERT ELCTVE EXT            1,421.00    1,421.00   33         CATH LAB
       3311867   IR ENDO BILI DUCT                     761.00               33         CATH LAB
       3319902   IR EPIDUROGRAM                        519.00               33         CATH LAB
       3311826   IR ERCP BILI PANC DUCT                775.00               33         CATH LAB
       3311834   IR ERCP PANC DUCT                     431.00               33         CATH LAB



9/17/2012                                                                                                       2
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3310406   IR FALLOPN TUBE TRANSCERV          334.00      334.00 33           CATH LAB
       3319878   IR FLUOR CVC PLC/RMV/RPR           323.00             33           CATH LAB
       3311305   IR FLUORO 1HR OR LES               305.00      305.00 33           CATH LAB
       3320629   IR FLUORO 1HR OR LES               305.00             33           CATH LAB
       3310414   IR FLUORO GUIDE SPINE INJ          328.00             33           CATH LAB
       3311107   IR FLUORO NDL PLACE                332.00      332.00 33           CATH LAB
       3311818   IR G TUBE PRC                      766.00             33           CATH LAB
       3310455   IR MYELOGRAM CERV                1,134.00    1,134.00 33           CATH LAB
       3311123   IR NDL PLACE                       683.00             33           CATH LAB
       3320314   IR NDL PLACE                       683.00      683.00 33           CATH LAB
       3319894   IR US VASC ACCESS ADD ON           108.00             33           CATH LAB
       3310349   IRC ABSCSS DRN RENL              1,322.00             33           CATH LAB
       3310281   IRC ABSCSS DRN RETROPE           4,419.00             33           CATH LAB
       3310364   IRC ASP RENL CYST                  144.00             33           CATH LAB
       3310273   IRC BILI CATH CHNG               3,398.00             33           CATH LAB
       3327301   IRC BRONCH W BX                  1,275.00    1,275.00 33           CATH LAB
       3311404   IRC BRONCHOSCOPY DX              1,273.00    1,273.00 33           CATH LAB
       3311453   IRC BRONCHOSCOPY W BX            1,309.00    1,309.00 33           CATH LAB
       3310323   IRC BX ABD RETROPE                 698.00             33           CATH LAB
       3310000   IRC BX BM NDL/TROCAR               604.00             33           CATH LAB
       3310083   IRC BX BONE DEEP                 1,134.00             33           CATH LAB
       3310075   IRC BX BONE SUPER                1,026.00             33           CATH LAB
       3310232   IRC BX LIVER                       848.00             33           CATH LAB
       3310174   IRC BX LUNG MEDIASTNM              546.00             33           CATH LAB
       3310166   IRC BX PLEURA                      392.00             33           CATH LAB
       3310224   IRC BX TRANSCATHETER               337.00             33           CATH LAB
       3310430   IRC BX VERT OPN LUMB/CERV          830.00             33           CATH LAB
       3320165   IRC CATH PORTAL VEIN PRC         1,291.00    1,291.00 33           CATH LAB
       3312055   IRC CHNG GT TUBE                   548.00      548.00 33           CATH LAB
       3319001   IRC DESTRUCT NRV L/S             1,747.00             33           CATH LAB
       3319068   IRC DESTRUCT NRV L/S ADD           667.00             33           CATH LAB
       3319035   IRC DESTRUCT NRV PERIPH            941.00             33           CATH LAB
       3310067   IRC FNA W IMAG GUIDANCE            573.00             33           CATH LAB



9/17/2012                                                                                                    3
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3310737   IRC IMP RVSN SPINAL CATH               887.00             33           CATH LAB
       3310422   IRC IMP/RPLC DEV SUBC RES              535.00             33           CATH LAB
       3310331   IRC INJ AIR CON PERITNL                613.00             33           CATH LAB
       3319605   IRC INJ BLOOD PATCH                    617.00             33           CATH LAB
       3318979   IRC INJ CELIAC PLEX BLK              1,002.00             33           CATH LAB
       3319639   IRC INJ CELIAC PLEX LYTIC            1,511.00             33           CATH LAB
       3310240   IRC INJ CHOL TRANSHEPAT                144.00             33           CATH LAB
       3310265   IRC INJ CHOL VIA CATH                   56.00             33           CATH LAB
       3310851   IRC INJ DISKOGRAM LUMB               1,606.00    1,606.00 33           CATH LAB
       3319662   IRC INJ EPID CERV THOR                 998.00             33           CATH LAB
       3319696   IRC INJ EPID L/S                       960.00             33           CATH LAB
       3320264   IRC INJ EXT VENOGRAM                 1,722.00    1,722.00 33           CATH LAB
       3319720   IRC INJ FACET C/T 1 LVL              1,628.00             33           CATH LAB
       3319092   IRC INJ FACET C/T ADD LVL              525.00             33           CATH LAB
       3319126   IRC INJ FACET L/S 1 LVL              1,549.00             33           CATH LAB
       3319159   IRC INJ FACET L/S ADD LVL              478.00             33           CATH LAB
       3319241   IRC INJ LP                             674.00             33           CATH LAB
       3319183   IRC INJ MAJOR JNT BURSA                213.00             33           CATH LAB
       3319274   IRC INJ NRV BLK C SPINE                728.00             33           CATH LAB
       3319787   IRC INJ NRV BLK C/T 1 LVL            1,686.00             33           CATH LAB
       3319308   IRC INJ NRV BLK C/T ADD                556.00             33           CATH LAB
       3319332   IRC INJ NRV BLK L/S 1 LVL            1,776.00             33           CATH LAB
       3319365   IRC INJ NRV BLK L/S ADD                739.00             33           CATH LAB
       3310018   IRC INJ NRV BLK LUMB THOR            1,156.00             33           CATH LAB
       3319399   IRC INJ NRV BLK PERIPH                 937.00             33           CATH LAB
       3319423   IRC INJ NRV ILIOINGUINAL               511.00             33           CATH LAB
       3319456   IRC INJ NRV INTCOSTL MULT            1,753.00             33           CATH LAB
       3319480   IRC INJ NRV INTCOSTL SNGL              465.00             33           CATH LAB
       3319514   IRC INJ NRV OCCIPITAL                  504.00             33           CATH LAB
       3319548   IRC INJ NRV TRIGEMINAL                 378.00             33           CATH LAB
       3319928   IRC INJ SI JNT ANES/STRD             2,448.00             33           CATH LAB
       3319910   IRC INJ SI JNT ARTHROGRAM            1,444.00             33           CATH LAB
       3310091   IRC INJ SINOGRAM                       656.00             33           CATH LAB



9/17/2012                                                                                                        4
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3319811   IRC INJ SPINE W CATH C/T        1,289.00               33         CATH LAB
       3319571   IRC INJ SPINE W CATH L/S        1,121.00               33         CATH LAB
       3319845   IRC INJ TND SHEATH/LG             159.00               33         CATH LAB
       3310026   IRC INJ TRG PT 1 OR 2 MCL         162.00               33         CATH LAB
       3310034   IRC INJ TRIG PT GT 2 MCL          184.00               33         CATH LAB
       3319753   IRC INJ/ASP INT JNT/BURSA         171.00               33         CATH LAB
       3319217   IRC INJ/ASP JNT/BURSA             146.00               33         CATH LAB
       3319860   IRC INS PICC W/O PORT 5+        1,653.00               33         CATH LAB
       3320215   IRC INS PICC W/O PORT 5+        1,653.00    1,653.00   33         CATH LAB
       3320116   IRC INTRO CATH AORTA            1,091.00    1,091.00   33         CATH LAB
       3310356   IRC INTRO CATH FALLOPN            485.00      485.00   33         CATH LAB
       3310257   IRC INTRO G TUBE LONG              36.00       36.00   33         CATH LAB
       3319886   IRC LP THRP                       813.00               33         CATH LAB
       3310372   IRC NEPHROSTOMY TUBE CHNG       1,235.00               33         CATH LAB
       3310299   IRC PARACENT ABD INI              896.00               33         CATH LAB
       3310315   IRC PARACENT ABD SUBSQ            582.00               33         CATH LAB
       3310216   IRC REMV TUNN CV CATH W/O         505.00               33         CATH LAB
       3310190   IRC REPS PREV PLC CV CATH         541.00               33         CATH LAB
       3329901   IRC THORACENTESIS               1,974.00    1,974.00   33         CATH LAB
       3316155   IRC VEN ANAST PORT OPN          2,360.00    2,360.00   33         CATH LAB
       3310133   IRC VERTEPLASTY ADD PRC           377.00               33         CATH LAB
       3310125   IRC VERTEPLASTY LUMB PRC        1,745.00               33         CATH LAB
       3310117   IRC VERTEPLASTY THOR PRC        1,996.00               33         CATH LAB
       3320512   S CATH GUIDING                    257.00     257.00    33         CATH LAB
       3330206   S CATH GUIDING Z2 7FR             239.00               33         CATH LAB
       3321452   S FILTER VENA CAVA              2,682.00    2,682.00   33         CATH LAB
       3320025   S IMP MAMMOTOME GELMKER           340.00               33         CATH LAB
       3330602   S IMP MAMMOTOME MIC MARK          363.00               33         CATH LAB
       3330024   S IMP MIBB CLIP                   363.00               33         CATH LAB
       3320462   S INTRO NOINTRACARD LSR           252.50      252.50   33         CATH LAB
       3320652   S STNT NOCOAT WDEL SYS          4,377.00    2,800.50   33         CATH LAB
       3350006   S STNT NOCOAT WDEL SYS          3,811.00               33         CATH LAB
       3350055   S STNT NOCOAT WDEL SYS          3,811.00               33         CATH LAB



9/17/2012                                                                                                   5
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3350105   S STNT NOCOAT WDEL SYS           3,811.00               33         CATH LAB
       3350154   S STNT NOCOAT WDEL SYS           3,811.00               33         CATH LAB
       3326105   S STRL 480 GUIDE WIRE              205.50     205.50    33         CATH LAB
       3327251   S STRL 480CM GLIDE WIRE            271.00               33         CATH LAB
       3320819   S STRL ACCUSTICK INTRODUC          345.50      345.50   33         CATH LAB
       3324258   S STRL AMPLATZ DUAL GUIDE          138.00      118.50   33         CATH LAB
       3322351   S STRL AMPLATZ NEEDLE               68.50       59.00   33         CATH LAB
       3324209   S STRL AMPLATZ STIFF WIRE          108.50       93.50   33         CATH LAB
       3321064   S STRL ANCHOR SET PERCUT           232.00      232.00   33         CATH LAB
       3324654   S STRL ARTHROGRAM TRAY             110.00       94.50   33         CATH LAB
       3321650   S STRL ATHRECTOMY CATHETH        1,595.00    1,477.50   33         CATH LAB
       3321700   S STRL ATHRECTOMY MOTOR            228.00      211.00   33         CATH LAB
       3320256   S STRL BICAP PROBE                 606.00      606.00   33         CATH LAB
       3326204   S STRL BILIARY STINT               332.50      308.00   33         CATH LAB
       3320108   S STRL BIOPSY FORCEP               290.50      144.00   33         CATH LAB
       3320207   S STRL BIOPSY FORCEP               162.50      144.00   33         CATH LAB
       3324803   S STRL BIOPSY GUIDE                 82.50       71.50   33         CATH LAB
       3325453   S STRL BRONCH BIOPSY NDL           117.00      100.50   33         CATH LAB
       3312154   S STRL BUTTON REPLACEMEN           410.00      379.50   33         CATH LAB
       3331154   S STRL CANNULA SPHINCTER         1,004.50               33         CATH LAB
       3329885   S STRL CATHETER                    123.00               33         CATH LAB
       3330040   S STRL CEASAR GSPFCEP 160          428.00               33         CATH LAB
       3330065   S STRL CEASAR GSPFCEP 240          428.00               33         CATH LAB
       3322401   S STRL CHIBA NEEDLE                 60.50      52.00    33         CATH LAB
       3320918   S STRL COAXIAL BIOPSY GU            61.50      61.50    33         CATH LAB
       3320926   S STRL COAXIAL BX INSTRMT          221.50               33         CATH LAB
       3320934   S STRL COAXIAL GUIDE NDL            70.00               33         CATH LAB
       3326758   S STRL CONON DIL BALOON            618.50               33         CATH LAB
       3322203   S STRL COOK NEEDLE                  55.50      47.00    33         CATH LAB
       3325156   S STRL CRAGG FX WIRES              382.50     355.00    33         CATH LAB
       3321213   S STRL CRAIG MCNAMARA CAT          375.00     375.00    33         CATH LAB
       3330958   S STRL DILATOR SHORT 4F             25.00               33         CATH LAB
       3331006   S STRL DILATOR SHORT 5F             25.00               33         CATH LAB



9/17/2012                                                                                                    6
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3331055   S STRL DILATOR SHORT 6F            25.00              33          CATH LAB
       3320611   S STRL DRAINAGE                   370.00     370.00   33          CATH LAB
       3326501   S STRL EGD BALLON DLTTN         1,119.50              33          CATH LAB
       3321304   S STRL EMBOL TRACKER SYST         979.00     803.50   33          CATH LAB
       3321205   S STRL EMBOLIZATION COILS          44.50      36.50   33          CATH LAB
       3320660   S STRL ENC 0.035 JAG GUID         475.00     475.00   33          CATH LAB
       3326550   S STRL ENDOSCOPY BANDS #          452.50              33          CATH LAB
       3326600   S STRL ENDOSCOPY BANDS #          511.00              33          CATH LAB
       3326659   S STRL ENDOSCOPY BANDS #          562.00              33          CATH LAB
       3330057   S STRL EPIDURAL TRAY               94.00              33          CATH LAB
       3327004   S STRL ERCP DILITATION BA       1,003.00              33          CATH LAB
       3326808   S STRL ERCP PROTECTOR WIR         444.50              33          CATH LAB
       3326154   S STRL ERCP STONE BASKET          919.50     919.50   33          CATH LAB
       3320710   S STRL ERCPCANULA                 217.00     217.00   33          CATH LAB
       3325800   S STRL GASTROSTOMY BUTTO          366.00     366.00   33          CATH LAB
       3330750   S STRL GRASP FRCP CESAR           430.00              33          CATH LAB
       3330552   S STRL GRASPER RAT TOOTH          227.00              33          CATH LAB
       3330503   S STRL GRSP FORCEP 4PRNG          227.00              33          CATH LAB
       3330859   S STRL HOOD PROTECTOR              80.50              33          CATH LAB
       3321254   S STRL INGENOR PVA EMBOLZ         173.00     141.50   33          CATH LAB
       3323607   S STRL INTRACARDIAC ECHO          560.50     560.50   33          CATH LAB
       3331204   S STRL JACKSON PRATT              102.00              33          CATH LAB
       3323508   S STRL MALECOT CATHETER            87.00      74.50   33          CATH LAB
       3325206   S STRL MEWISSIN CATHETER          155.00     143.50   33          CATH LAB
       3321361   S STRL MONOPTY BIOPSY NE          148.50     148.50   33          CATH LAB
       3321015   S STRL MONOTHERM PROBE            176.00     176.00   33          CATH LAB
       3324605   S STRL MYELOGRAM TRAY             109.00     109.00   33          CATH LAB
       3325958   S STRL NASAL BILIARY TUB          500.00     247.00   33          CATH LAB
       3326352   S STRL NASAL CANNULA               31.50      31.50   33          CATH LAB
       3330354   S STRL NEEDLE SCLRTX 25G          118.50              33          CATH LAB
       3324001   S STRL NEPHROSTOMY CATHET         311.50     267.50   33          CATH LAB
       3323102   S STRL NEPHROSTOMY SET            354.00     354.00   33          CATH LAB
       3330909   S STRL PEELAWAY                   204.00              33          CATH LAB



9/17/2012                                                                                                   7
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3326709   S STRL PEG J TUBE                 305.00               33         CATH LAB
       3325750   S STRL PERC GASTROSTOMY           567.00     567.00    33         CATH LAB
       3327178   S STRL PICC 4 FR OTW              329.00               33         CATH LAB
       3330651   S STRL PICC 4F                    329.00               33         CATH LAB
       3330255   S STRL PICC 5F                    329.00               33         CATH LAB
       3330305   S STRL PICC 6F                    417.00               33         CATH LAB
       3327186   S STRL PICC DBL LUMEN OTW         405.00               33         CATH LAB
       3325859   S STRL POLYPECTOMY SNARE          114.00      55.00    33         CATH LAB
       3327152   S STRL PTA BALLON CATHETE       1,931.00               33         CATH LAB
       3330404   S STRL RETRVL BASK 30X10          227.00               33         CATH LAB
       3330453   S STRL RETRVL BASK 45X15          227.00               33         CATH LAB
       3325404   S STRL SCLEROSING NEEDLE          294.00     252.00    33         CATH LAB
       3322625   S STRL SELIS ASPIR NEEDLE          50.00               33         CATH LAB
       3324506   S STRL SHOLK BALLOON HYST         152.50     130.50    33         CATH LAB
       3320785   S STRL TRANSUDCER COVER            82.50               33         CATH LAB
       3327103   S STRL TUHOUY NEEDLE               48.00               33         CATH LAB
       3320751   S STRL VAN ANDEL DILATOR           79.50      65.50    33         CATH LAB
       3320876   S STRL VAN SONNENBERG NE          170.00     170.00    33         CATH LAB
       3331105   S STRL VESSEL DILATOR              25.00               33         CATH LAB
       3321502   S STRL WALL STENT - LONG        3,921.00    3,361.00   33         CATH LAB
       3330800   S STRL WEB BASKET                 482.00               33         CATH LAB
       3320801   S STRL WIRE GUIDE                 130.50     130.50    33         CATH LAB
       3320967   S STRL WIRE GUIDE                 443.00     443.00    33         CATH LAB
       3321262   S STRL WIRE GUIDE                 255.50     255.50    33         CATH LAB
       3321312   S STRL WIRE GUIDE                 240.50     240.50    33         CATH LAB
       3322617   S STRL YUEH CENTESIS NEDL          79.50               33         CATH LAB
       3330701   S STRL YUEH NEEDLE                 79.50               33         CATH LAB
       3320850   S WIRE GUIDE                      150.50      150.50   33         CATH LAB
       3315900   SIGMOIDOSCOPY                     978.00      978.00   33         CATH LAB
       3318052   XR ANGIO EXT UNI                3,118.00    3,118.00   33         CATH LAB
       3316759   XR BREAST MAMMOGRAPHY LOC         500.00      357.00   33         CATH LAB
       3319852   XRC INJ HIP W ANESTHESIA        1,374.00               33         CATH LAB
       0671909   CA CARDIAC DPPLER LTD             257.00     257.00    06         DIAG IMAGING PROCEDURES



9/17/2012                                                                                                    8
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0671750   CA ECHO 2D CMPL                   900.00      900.00   06         DIAG IMAGING PROCEDURES
       0671701   CA ECHO 2D LTD                    473.00      473.00   06         DIAG IMAGING PROCEDURES
       0672006   CA ECHO 2D W STRES                515.00      515.00   06         DIAG IMAGING PROCEDURES
       0671859   CA ECHO DPPLER CMPL               409.00      409.00   06         DIAG IMAGING PROCEDURES
       0671958   CA ECHO DPPLER COLOR FLOW         625.00      625.00   06         DIAG IMAGING PROCEDURES
       0671800   CA ECHO TRANSESOPHAGEAL         1,008.00    1,008.00   06         DIAG IMAGING PROCEDURES
       0658054   CON GAD-BASE MR 1ML IJ             10.08               06         DIAG IMAGING PROCEDURES
       0628628   CON HOCM <=149MG/ML 1ML             0.20               06         DIAG IMAGING PROCEDURES
       0669754   CON HOCM 250-299MG/ML 1ML           0.40               06         DIAG IMAGING PROCEDURES
       0628594   CON HOCM 250-299MG/ML 1ML           0.40               06         DIAG IMAGING PROCEDURES
       0628578   CON LOCM 200-249S I 1ML             4.68               06         DIAG IMAGING PROCEDURES
       0648402   CON LOCM 300-349S I 1ML             0.84               06         DIAG IMAGING PROCEDURES
       0648451   CON LOCM 300-349S I 1ML             0.76               06         DIAG IMAGING PROCEDURES
       0648501   CON LOCM 300-349S I 1ML             3.32               06         DIAG IMAGING PROCEDURES
       0628560   CON LOCM 300-349S I 1ML             0.76               06         DIAG IMAGING PROCEDURES
       0628586   CON LOCM 300-349S I 1ML             6.04               06         DIAG IMAGING PROCEDURES
       0658088   CON MULTIHANCE 1ML IJ              11.56               06         DIAG IMAGING PROCEDURES
       0648352   CT 3D RENDER W/POSTPROCES       1,917.00               06         DIAG IMAGING PROCEDURES
       0641704   CT ABD W/CON                    1,677.00               06         DIAG IMAGING PROCEDURES
       0641654   CT ABD W/O CON                  1,398.00    1,398.00   06         DIAG IMAGING PROCEDURES
       0641753   CT ABD W-W/O CON                1,877.00               06         DIAG IMAGING PROCEDURES
       0640151   CT BRAIN W CON                  1,393.00    1,393.00   06         DIAG IMAGING PROCEDURES
       0640102   CT BRAIN W/O CON                1,154.00    1,154.00   06         DIAG IMAGING PROCEDURES
       0640201   CT BRAIN W-W/O CON              1,730.00    1,730.00   06         DIAG IMAGING PROCEDURES
       0647503   CT CONSULT FOREIGN FLM            119.00               06         DIAG IMAGING PROCEDURES
       0646224   CT DRN W CATH PLACE PRC           818.00     818.00    06         DIAG IMAGING PROCEDURES
       0642504   CT EXT LOW W CON                1,453.00               06         DIAG IMAGING PROCEDURES
       0642454   CT EXT LOW W/O CON              1,228.00               06         DIAG IMAGING PROCEDURES
       0642553   CT EXT LOW W-W/O CON            1,806.00    1,806.00   06         DIAG IMAGING PROCEDURES
       0642355   CT EXT UPP W CON                1,453.00    1,453.00   06         DIAG IMAGING PROCEDURES
       0642306   CT EXT UPP W/O CON              1,228.00    1,228.00   06         DIAG IMAGING PROCEDURES
       0642405   CT EXT UPP W-W/O CON            1,806.00    1,806.00   06         DIAG IMAGING PROCEDURES
       0642652   CT GUIDE NDL PLACEMENT          1,995.00    1,995.00   06         DIAG IMAGING PROCEDURES



9/17/2012                                                                                                    9
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0642751   CT LTD OR FU STDY                 882.00      882.00 06           DIAG IMAGING PROCEDURES
       0648055   CT LTD OR FU STDY                 882.00      882.00 06           DIAG IMAGING PROCEDURES
       0648105   CT LTD OR FU STDY                 882.00      882.00 06           DIAG IMAGING PROCEDURES
       0648154   CT LTD OR FU STDY                 882.00             06           DIAG IMAGING PROCEDURES
       0640656   CT MAXILLOFACIAL W CON          1,407.00    1,407.00 06           DIAG IMAGING PROCEDURES
       0640607   CT MAXILLOFACIAL W/O CON        1,175.00    1,175.00 06           DIAG IMAGING PROCEDURES
       0640706   CT MAXILLOFACIAL W-W/O          1,739.00    1,739.00 06           DIAG IMAGING PROCEDURES
       0641001   CT NEC W CON                    1,412.00    1,412.00 06           DIAG IMAGING PROCEDURES
       0640953   CT NEC W/O CON                  1,186.00    1,186.00 06           DIAG IMAGING PROCEDURES
       0641050   CT NEC W-W/O CON                1,741.00    1,741.00 06           DIAG IMAGING PROCEDURES
       0640854   CT ORBIT SELLA FOSA W-W/O       1,744.00    1,744.00 06           DIAG IMAGING PROCEDURES
       0640805   CT ORBIT SELLA FOSSA W          1,412.00    1,412.00 06           DIAG IMAGING PROCEDURES
       0640722   CT ORBIT/SELLA/FOSSA W/O        1,186.00    1,186.00 06           DIAG IMAGING PROCEDURES
       0641902   CT PELV W CON                   1,668.00             06           DIAG IMAGING PROCEDURES
       0641852   CT PELV W/O CON                 1,449.00             06           DIAG IMAGING PROCEDURES
       0641969   CT PELV W-W/O CON               1,924.00             06           DIAG IMAGING PROCEDURES
       0641159   CT SPINE CERV W CON             1,725.00    1,725.00 06           DIAG IMAGING PROCEDURES
       0641100   CT SPINE CERV W/O CON           1,453.00    1,453.00 06           DIAG IMAGING PROCEDURES
       0641209   CT SPINE CERV W-W/O CON         2,142.00             06           DIAG IMAGING PROCEDURES
       0642108   CT SPINE LUMB W CON             1,725.00             06           DIAG IMAGING PROCEDURES
       0642058   CT SPINE LUMB W/O CON           1,453.00    1,453.00 06           DIAG IMAGING PROCEDURES
       0642157   CT SPINE LUMB W-W/O CON         2,142.00    2,142.00 06           DIAG IMAGING PROCEDURES
       0641308   CT SPINE THOR W CON             1,725.00    1,725.00 06           DIAG IMAGING PROCEDURES
       0641258   CT SPINE THOR W/O CON           1,453.00    1,453.00 06           DIAG IMAGING PROCEDURES
       0641357   CT SPINE THOR W-W/O             2,142.00    2,142.00 06           DIAG IMAGING PROCEDURES
       0646216   CT STEREOTACTIC LOC             1,999.00             06           DIAG IMAGING PROCEDURES
       0641456   CT THORAX W CON                 1,727.00    1,727.00 06           DIAG IMAGING PROCEDURES
       0641407   CT THORAX W/O CON               1,453.00    1,453.00 06           DIAG IMAGING PROCEDURES
       0641506   CT THORAX W-W/O                 2,149.00    2,149.00 06           DIAG IMAGING PROCEDURES
       0647453   CTA ABD W RUNOFF W-W/O          3,858.00             06           DIAG IMAGING PROCEDURES
       0646760   CTA ABD W-W/O CON               2,921.00             06           DIAG IMAGING PROCEDURES
       0647404   CTA ABD W-W/O CON               2,921.00             06           DIAG IMAGING PROCEDURES
       0647206   CTA CHST NOCORO W-W/O CON       3,006.00             06           DIAG IMAGING PROCEDURES



9/17/2012                                                                                                    10
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0647354   CTA EXT LOW W-W/O CON                2,674.00               06         DIAG IMAGING PROCEDURES
       0647305   CTA EXT UPP W-W/O CON                2,667.00               06         DIAG IMAGING PROCEDURES
       0647107   CTA HEAD W-W/O CON                   2,580.00               06         DIAG IMAGING PROCEDURES
       0646778   CTA NEC W-W/O CON                    2,580.00               06         DIAG IMAGING PROCEDURES
       0647156   CTA NEC W-W/O CON                    2,580.00               06         DIAG IMAGING PROCEDURES
       0647255   CTA PELV W-W/O CON                   2,916.00               06         DIAG IMAGING PROCEDURES
       0647057   CTC ASP RENL CYST                      147.00               06         DIAG IMAGING PROCEDURES
       0647008   CTC BX ABD RETROPE                     716.00               06         DIAG IMAGING PROCEDURES
       0646950   CTC BX LIVER                           870.00               06         DIAG IMAGING PROCEDURES
       0646901   CTC BX LUNG MEDIASTNM                  560.00               06         DIAG IMAGING PROCEDURES
       0647065   CTC BX RENL                            297.00               06         DIAG IMAGING PROCEDURES
       0648303   CTC COMP ASST VOLUMETRIC               406.00               06         DIAG IMAGING PROCEDURES
       0648253   CTC DRAIN PELV HIP JT ABS            1,438.00               06         DIAG IMAGING PROCEDURES
       0647909   CTC DRN ABD ABSCSS OPN               2,352.00               06         DIAG IMAGING PROCEDURES
       0647800   CTC DRN LIVER LESION                 1,937.00               06         DIAG IMAGING PROCEDURES
       0648006   CTC DRN RENL ABSCSS                  1,787.00               06         DIAG IMAGING PROCEDURES
       0647958   CTC DRN RETROPE ABSCSS               1,714.00               06         DIAG IMAGING PROCEDURES
       0647859   CTC INC GALLBLADDER                  1,285.00               06         DIAG IMAGING PROCEDURES
       0646802   CTC THORACENTESIS                    2,025.00               06         DIAG IMAGING PROCEDURES
       0646851   CTC THORACENTESIS W TUBE               742.00               06         DIAG IMAGING PROCEDURES
       0647750   CTC TUBE THORACOSTOMY                1,468.00               06         DIAG IMAGING PROCEDURES
       0661173   D5 0.45 NACL 1000ML                      6.50               06         DIAG IMAGING PROCEDURES
       0669200   IR ANGIO FU EXISTING CATH              359.00      359.00   06         DIAG IMAGING PROCEDURES
       0662056   IR BILI DRN PRC                      1,325.00    1,325.00   06         DIAG IMAGING PROCEDURES
       0624387   IR BILI DUCT DILATE PRC                546.00      546.00   06         DIAG IMAGING PROCEDURES
       0660423   IR CS SAME MD ADD 15M                   72.00               06         DIAG IMAGING PROCEDURES
       0660415   IR CS SAME MD GT5YR 0-30M              350.00               06         DIAG IMAGING PROCEDURES
       0660407   IR CS SAME MD LT5YR 0-30M              213.00               06         DIAG IMAGING PROCEDURES
       0662452   IR DISKOGRAM CERV THOR               1,967.00    1,967.00   06         DIAG IMAGING PROCEDURES
       0662502   IR DISKOGRAM LUMB                    1,830.00    1,830.00   06         DIAG IMAGING PROCEDURES
       0661108   IR DRN W CATH PLACE PRC                797.00      797.00   06         DIAG IMAGING PROCEDURES
       0662551   IR EMBOL TX                          5,531.00    5,531.00   06         DIAG IMAGING PROCEDURES
       0662130   IR FLUORO NDL PLACE                    332.00      332.00   06         DIAG IMAGING PROCEDURES



9/17/2012                                                                                                         11
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0625566   IR GI TUBE INSERT LONG             631.00      631.00 06           DIAG IMAGING PROCEDURES
       0669713   IR IMP NEUROELECTRODE              714.00             06           DIAG IMAGING PROCEDURES
       0660126   IR INFUSION W/MED 0-60MN         1,236.00             06           DIAG IMAGING PROCEDURES
       0661207   IR INJECTION IM/SQ EA              196.00             06           DIAG IMAGING PROCEDURES
       0661132   IR INJECTION IV EA                 138.00             06           DIAG IMAGING PROCEDURES
       0669051   IR PORTOGRAM W HEM EVAL          2,944.00    2,944.00 06           DIAG IMAGING PROCEDURES
       0668558   IR RENL CYST STDY                  321.00      321.00 06           DIAG IMAGING PROCEDURES
       0669150   IR TRANSCATHETER TX IV           4,828.00    4,828.00 06           DIAG IMAGING PROCEDURES
       0662353   IR TUBE CATH CHNG                  492.00      492.00 06           DIAG IMAGING PROCEDURES
       0669101   IR URETERAL STENT PRC              957.00      957.00 06           DIAG IMAGING PROCEDURES
       0669408   IR VENOGRAM EXT BIL                411.00      411.00 06           DIAG IMAGING PROCEDURES
       0669457   IR VENOGRAM EXT UNI                265.00      265.00 06           DIAG IMAGING PROCEDURES
       0669309   IR VENOGRAM IVC                  2,921.00    2,921.00 06           DIAG IMAGING PROCEDURES
       0669507   IR VENOGRAM RENL BIL             2,948.00    2,948.00 06           DIAG IMAGING PROCEDURES
       0669358   IR VENOGRAM SVC                  2,921.00    2,921.00 06           DIAG IMAGING PROCEDURES
       0660233   IRC ASP BLADDER SP CATH          1,262.00             06           DIAG IMAGING PROCEDURES
       0663906   IRC BILI STENT PLACE             1,143.00    1,143.00 06           DIAG IMAGING PROCEDURES
       0664003   IRC BILI STONE EXTRACT           1,098.00    1,098.00 06           DIAG IMAGING PROCEDURES
       0660266   IRC DEST NRV C/T 1 LVL           1,752.00             06           DIAG IMAGING PROCEDURES
       0660258   IRC DEST NRV C/T ADDL LVL        1,019.00             06           DIAG IMAGING PROCEDURES
       0669705   IRC INJ DISKOGRAM CERV           1,336.00             06           DIAG IMAGING PROCEDURES
       0665703   IRC INJ LP                         674.00      674.00 06           DIAG IMAGING PROCEDURES
       0665851   IRC INJ NEPHROGRAM                 604.00             06           DIAG IMAGING PROCEDURES
       0669556   IRC INS PICC W/O PORT LT5        1,695.00             06           DIAG IMAGING PROCEDURES
       0661199   IRC INSERT CATH TMP SMPL           469.00             06           DIAG IMAGING PROCEDURES
       0666453   IRC INTRO CATH BILI DRN          1,127.00    1,127.00 06           DIAG IMAGING PROCEDURES
       0666651   IRC INTRO G TUBE                   494.00      494.00 06           DIAG IMAGING PROCEDURES
       0666909   IRC INTRO NEPHROSTOMY            3,185.65    3,185.65 06           DIAG IMAGING PROCEDURES
       0660340   IRC REM TUNN CVA DEV W PT          470.00             06           DIAG IMAGING PROCEDURES
       0660241   IRC RMVL SQ PUMP/RESERVOR          806.00             06           DIAG IMAGING PROCEDURES
       0660118   IRC THORACENTESIS                1,974.00             06           DIAG IMAGING PROCEDURES
       0623488   IRC THORACENTESIS W TUBE           723.00      723.00 06           DIAG IMAGING PROCEDURES
       0661157   LACTATED RINGERS 1000                6.50             06           DIAG IMAGING PROCEDURES



9/17/2012                                                                                                     12
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0657254   MR 3D RENDER W/O POSTPROS          755.00               06         DIAG IMAGING PROCEDURES
       0656603   MR ABD W CON                     3,032.00               06         DIAG IMAGING PROCEDURES
       0651109   MR ABD W/O CON                   2,527.00    2,527.00   06         DIAG IMAGING PROCEDURES
       0654350   MR ABD W-W/O CON                 5,543.00               06         DIAG IMAGING PROCEDURES
       0651406   MR BONE MARROW                   2,337.00    2,337.00   06         DIAG IMAGING PROCEDURES
       0650101   MR BRAIN W STEM W CON            3,036.00    3,036.00   06         DIAG IMAGING PROCEDURES
       0650051   MR BRAIN W STEM W/O CON          2,529.00    2,529.00   06         DIAG IMAGING PROCEDURES
       0650150   MR BRAIN W STEM W-W/O CON        5,552.00    5,552.00   06         DIAG IMAGING PROCEDURES
       0657007   MR BREAST BIL W-W/O CON          2,535.00               06         DIAG IMAGING PROCEDURES
       0656959   MR BREAST UNI W-W/O CON          2,063.00               06         DIAG IMAGING PROCEDURES
       0656751   MR CARDIAC FNCTN CMPL            2,361.00               06         DIAG IMAGING PROCEDURES
       0656801   MR CARDIAC FNCTN LTD             2,361.00               06         DIAG IMAGING PROCEDURES
       0654277   MR CARDIAC VELOCITY FLOW         1,134.00               06         DIAG IMAGING PROCEDURES
       0654244   MR CARDIAC W CON                 2,563.00               06         DIAG IMAGING PROCEDURES
       0651307   MR CARDIAC W/O CON               2,538.00    2,538.00   06         DIAG IMAGING PROCEDURES
       0655902   MR CHEST W CON                   3,032.00               06         DIAG IMAGING PROCEDURES
       0651208   MR CHEST W/O CON                 2,527.00    2,527.00   06         DIAG IMAGING PROCEDURES
       0655951   MR CHEST W-W/O CON               5,543.00               06         DIAG IMAGING PROCEDURES
       0650309   MR DENTAL PARTIAL EXAM           2,529.00    2,529.00   06         DIAG IMAGING PROCEDURES
       0657106   MR DUPLICATION FLM EA                                   06         DIAG IMAGING PROCEDURES
       0656504   MR EXT LOW JNT W CON             3,023.00               06         DIAG IMAGING PROCEDURES
       0656553   MR EXT LOW JNT W-W/O CON         5,537.00               06         DIAG IMAGING PROCEDURES
       0651604   MR EXT LOW JT W/O CON            2,518.00    2,518.00   06         DIAG IMAGING PROCEDURES
       0654434   MR EXT LOW NO JNT W CON          3,023.00               06         DIAG IMAGING PROCEDURES
       0654426   MR EXT LOW W/O CON               2,518.00               06         DIAG IMAGING PROCEDURES
       0651653   MR EXT LOW W-W/O CON             5,535.00    5,535.00   06         DIAG IMAGING PROCEDURES
       0656405   MR EXT UPP JNT W CON             3,023.00               06         DIAG IMAGING PROCEDURES
       0651505   MR EXT UPP JNT W/O CON           2,518.00    2,518.00   06         DIAG IMAGING PROCEDURES
       0656454   MR EXT UPP JNT W-W/O CON         5,537.00               06         DIAG IMAGING PROCEDURES
       0656306   MR EXT UPP NO JNT W/CON          3,025.00               06         DIAG IMAGING PROCEDURES
       0656256   MR EXT UPP NO JNT W/O CON        2,518.00               06         DIAG IMAGING PROCEDURES
       0656355   MR EXT UPP NO JNT W-W/O          5,537.00               06         DIAG IMAGING PROCEDURES
       0655555   MR ORBIT FACE NEC W CON          3,023.00               06         DIAG IMAGING PROCEDURES



9/17/2012                                                                                                     13
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0650259   MR ORBIT FACE NEC W/O CON        2,518.00    2,518.00 06           DIAG IMAGING PROCEDURES
       0655605   MR ORBIT FACE NEC W-W/O          5,537.00             06           DIAG IMAGING PROCEDURES
       0651000   MR PELV W CON                    3,032.00    3,032.00 06           DIAG IMAGING PROCEDURES
       0656108   MR PELV W/O CON                  2,527.00             06           DIAG IMAGING PROCEDURES
       0656157   MR PELV W-W/O CON                5,543.00             06           DIAG IMAGING PROCEDURES
       0650606   MR SPINE CERV W CON              3,047.00    3,047.00 06           DIAG IMAGING PROCEDURES
       0650457   MR SPINE CERV W/O CON            2,538.00             06           DIAG IMAGING PROCEDURES
       0650556   MR SPINE CERV W-W/O CON          5,567.00    5,567.00 06           DIAG IMAGING PROCEDURES
       0650903   MR SPINE LUMB W CON              3,038.00    3,038.00 06           DIAG IMAGING PROCEDURES
       0650853   MR SPINE LUMB W/O CON            2,799.00    2,799.00 06           DIAG IMAGING PROCEDURES
       0656009   MR SPINE LUMB W-W/O              5,552.00             06           DIAG IMAGING PROCEDURES
       0650705   MR SPINE THOR W CON              3,045.00    3,045.00 06           DIAG IMAGING PROCEDURES
       0650655   MR SPINE THOR W/O CON            2,807.00    2,807.00 06           DIAG IMAGING PROCEDURES
       0650754   MR SPINE THOR W-W/O              5,565.00    5,565.00 06           DIAG IMAGING PROCEDURES
       0656900   MRA ABD W-W/O CON                1,800.00             06           DIAG IMAGING PROCEDURES
       0654368   MRA CHEST W-W/O CON              1,787.00             06           DIAG IMAGING PROCEDURES
       0657205   MRA EXT LOW W-W/O CON            2,225.00             06           DIAG IMAGING PROCEDURES
       0657213   MRA EXT UPP W-W/O CON            2,527.00             06           DIAG IMAGING PROCEDURES
       0655654   MRA HEAD W CON                   2,507.00             06           DIAG IMAGING PROCEDURES
       0650358   MRA HEAD W/O CON                 2,509.00    2,509.00 06           DIAG IMAGING PROCEDURES
       0655803   MRA NEC W CON                    2,507.00             06           DIAG IMAGING PROCEDURES
       0655753   MRA NEC W/O CON                  2,507.00             06           DIAG IMAGING PROCEDURES
       0655852   MRA NEC W-W/O CON                4,976.00             06           DIAG IMAGING PROCEDURES
       0654160   MRA PELV W CON                   3,409.00             06           DIAG IMAGING PROCEDURES
       0657155   MRA PELV W/O CON                 2,352.00             06           DIAG IMAGING PROCEDURES
       0654236   MRA PELV W-W/O CON               2,420.00             06           DIAG IMAGING PROCEDURES
       0656207   MRA PELV W-W/O CON               2,420.00             06           DIAG IMAGING PROCEDURES
       0656058   MRA SPNAL CANAL W-W/O CON        2,796.00             06           DIAG IMAGING PROCEDURES
       0661165   NA CL 0.9% 1000ML                    6.50             06           DIAG IMAGING PROCEDURES
       0647669   NA CL 10ML PREFILLED SYR             6.50             06           DIAG IMAGING PROCEDURES
       0678508   NA CL 10ML PREFILLED SYR             6.50             06           DIAG IMAGING PROCEDURES
       0654079   NA CL 10ML PREFILLED SYR             6.50             06           DIAG IMAGING PROCEDURES
       0636951   NA CL 10ML PREFILLED SYR             6.50             06           DIAG IMAGING PROCEDURES



9/17/2012                                                                                                     14
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0661140   NA CL 10ML PREFILLED SYR                 6.50               06         DIAG IMAGING PROCEDURES
       0620096   NA CL 10ML PREFILLED SYR                 6.50               06         DIAG IMAGING PROCEDURES
       0677294   NI AORTA IVC IL CMPL                   980.00     980.00    06         DIAG IMAGING PROCEDURES
       0677336   NI AORTA IVC IL LTD                    698.00     698.00    06         DIAG IMAGING PROCEDURES
       0677419   NI DIAL ACCES                          868.00     868.00    06         DIAG IMAGING PROCEDURES
       0678706   NI DPPLER EXT VEINS BIL                607.00               06         DIAG IMAGING PROCEDURES
       0677096   NI DUPLEX ABD PELV CMPL              1,659.00    1,659.00   06         DIAG IMAGING PROCEDURES
       0677138   NI DUPLEX ABD PELV LTD                 941.00      941.00   06         DIAG IMAGING PROCEDURES
       0670455   NI DUPLEX EXT LOW BIL                1,475.00    1,475.00   06         DIAG IMAGING PROCEDURES
       0677054   NI DUPLEX EXT LOW UNI                  881.00      881.00   06         DIAG IMAGING PROCEDURES
       0672808   NI DUPLEX EXT UPP BIL                1,165.00    1,165.00   06         DIAG IMAGING PROCEDURES
       0677211   NI DUPLEX EXT UPP UNI                  757.00      757.00   06         DIAG IMAGING PROCEDURES
       0673053   NI DUPLEX EXT VEINS BIL              1,141.00    1,141.00   06         DIAG IMAGING PROCEDURES
       0677252   NI DUPLEX EXT VEINS UNI                781.00      781.00   06         DIAG IMAGING PROCEDURES
       0670307   NI DUPLEX EXTRACRAN BIL              1,208.00    1,208.00   06         DIAG IMAGING PROCEDURES
       0670356   NI DUPLEX EXTRACRAN UNI                761.00      761.00   06         DIAG IMAGING PROCEDURES
       0678425   NI ECHO CNGNITL ANOM CMPL              865.00               06         DIAG IMAGING PROCEDURES
       0678417   NI ECHO CNGNITL ANOM LTD               444.00               06         DIAG IMAGING PROCEDURES
       0676650   NI EXT ART 1 LVL BIL                   583.00               06         DIAG IMAGING PROCEDURES
       0670406   NI INTRACRAN CMPL                    1,466.00    1,466.00   06         DIAG IMAGING PROCEDURES
       0678862   NI US VASC ACCESS ADD ON               104.00               06         DIAG IMAGING PROCEDURES
       0678870   NIC CON DEFNITY 1ML                    304.00               06         DIAG IMAGING PROCEDURES
       0633206   NM ABSCSS LOC LTD                      811.00      811.00   06         DIAG IMAGING PROCEDURES
       0633305   NM ABSCSS LOC WB                     1,494.00    1,494.00   06         DIAG IMAGING PROCEDURES
       0634204   NM AUTO DATA GEN LT 30                 295.00      295.00   06         DIAG IMAGING PROCEDURES
       0631101   NM BONE SCAN LTD                       598.00      598.00   06         DIAG IMAGING PROCEDURES
       0631150   NM BONE SCAN MULTI AREAS               875.00      875.00   06         DIAG IMAGING PROCEDURES
       0631234   NM BONE SCAN W SPECT                 1,394.00               06         DIAG IMAGING PROCEDURES
       0639203   NM BONE SCAN W SPECT                 1,394.00    1,394.00   06         DIAG IMAGING PROCEDURES
       0631200   NM BONE SCAN WB                      1,013.00    1,013.00   06         DIAG IMAGING PROCEDURES
       0639153   NM BONE THREE PHASE                  1,137.00    1,137.00   06         DIAG IMAGING PROCEDURES
       0631051   NM BOWEL (MECKELS)                     729.00               06         DIAG IMAGING PROCEDURES
       0632554   NM BRAIN CISTERNOGRAM                1,170.00    1,170.00   06         DIAG IMAGING PROCEDURES



9/17/2012                                                                                                         15
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0632455   NM BRAIN CMPL STATIC               796.00               06         DIAG IMAGING PROCEDURES
       0632505   NM BRAIN CMPL W FLOW               907.00     907.00    06         DIAG IMAGING PROCEDURES
       0636910   NM BRAIN CMPL W SPECT            1,551.00               06         DIAG IMAGING PROCEDURES
       0632604   NM BRAIN CSF SHUNT EVAL            805.00     805.00    06         DIAG IMAGING PROCEDURES
       0632356   NM BRAIN LTD                       605.00     605.00    06         DIAG IMAGING PROCEDURES
       0636936   NM BRAIN LTD W FLOW                793.00               06         DIAG IMAGING PROCEDURES
       0633008   NM CYSTOGRAM VOIDING               514.00     514.00    06         DIAG IMAGING PROCEDURES
       0630905   NM GASTRIC EMPTYING                975.00               06         DIAG IMAGING PROCEDURES
       0630137   NM GASTROESOPH REFLUX              995.00               06         DIAG IMAGING PROCEDURES
       0630954   NM GI BLEEDING SCAN              1,155.00    1,155.00   06         DIAG IMAGING PROCEDURES
       0631408   NM HEART GATED SNGL              1,301.00    1,301.00   06         DIAG IMAGING PROCEDURES
       0631358   NM HEART MI PLANAR                 571.00               06         DIAG IMAGING PROCEDURES
       0636928   NM HEART MI W SPECT              1,230.00               06         DIAG IMAGING PROCEDURES
       0631606   NM HEART MP MULTI W SPECT        2,735.00    2,735.00   06         DIAG IMAGING PROCEDURES
       0636860   NM HEART MP SNGL W SPEC          1,656.00    1,656.00   06         DIAG IMAGING PROCEDURES
       0639054   NM HEART MP W EF                   395.00               06         DIAG IMAGING PROCEDURES
       0639005   NM HEART MP WALL MOTION            397.00               06         DIAG IMAGING PROCEDURES
       0630707   NM HEPATOBILIARY DUCTAL            875.00      875.00   06         DIAG IMAGING PROCEDURES
       0633255   NM INFLAM LOCAL W SPECT          1,543.00    1,543.00   06         DIAG IMAGING PROCEDURES
       0639104   NM K FLOW/FUNCT MULTIPLE         1,097.00    1,097.00   06         DIAG IMAGING PROCEDURES
       0630194   NM K FLOW/FUNCT W/DRUG           1,084.00               06         DIAG IMAGING PROCEDURES
       0630186   NM K FLOW/FUNCT W/O DRG          1,064.00               06         DIAG IMAGING PROCEDURES
       0632752   NM KIDNEY IMAGING MORPHOL          711.00               06         DIAG IMAGING PROCEDURES
       0636902   NM LIVER SPECT W FLOW            1,387.00               06         DIAG IMAGING PROCEDURES
       0630558   NM LIVER SPLEEN STATIC             689.00     689.00    06         DIAG IMAGING PROCEDURES
       0630517   NM LIVER W SPECT                 1,368.00               06         DIAG IMAGING PROCEDURES
       0639252   NM LIVER W SPECT                 1,368.00    1,368.00   06         DIAG IMAGING PROCEDURES
       0632109   NM LUNG PERF                       818.00      818.00   06         DIAG IMAGING PROCEDURES
       0630160   NM LUNG PERF VENT                  791.00               06         DIAG IMAGING PROCEDURES
       0630178   NM LUNG QUAN DIFF FNCTN          1,665.00               06         DIAG IMAGING PROCEDURES
       0630145   NM LUNG VENT MULTI                 660.00               06         DIAG IMAGING PROCEDURES
       0632257   NM LUNG VENT W GAS                 571.00     571.00    06         DIAG IMAGING PROCEDURES
       0634436   NM LUNG VENT W GAS MULTI         1,146.00               06         DIAG IMAGING PROCEDURES



9/17/2012                                                                                                     16
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0639559   NM LYMPHATIC PATHWAY               995.00               06         DIAG IMAGING PROCEDURES
       0639302   NM PARATHYROID                   1,011.00    1,011.00   06         DIAG IMAGING PROCEDURES
       0633057   NM TESTICULR IMGNG W FLOW          765.00      765.00   06         DIAG IMAGING PROCEDURES
       0630111   NM THYROID IMAG ONLY               434.00               06         DIAG IMAGING PROCEDURES
       0630152   NM THYROID IMAG UPT MULTI          610.00     610.00    06         DIAG IMAGING PROCEDURES
       0630202   NM THYROID IMAG UPT SNGL           565.00     565.00    06         DIAG IMAGING PROCEDURES
       0630251   NM THYROID METS LTD                623.00     623.00    06         DIAG IMAGING PROCEDURES
       0630129   NM THYROID METS UPT                337.00               06         DIAG IMAGING PROCEDURES
       0630301   NM THYROID METS WB               1,272.00    1,272.00   06         DIAG IMAGING PROCEDURES
       0633107   NM TUMOR LOC LTD W RP              805.00               06         DIAG IMAGING PROCEDURES
       0638957   NM TUMOR LOC SPECT W RP          1,540.00    1,540.00   06         DIAG IMAGING PROCEDURES
       0638908   NM TUMOR LOC WB SNGL DAY         1,294.00    1,294.00   06         DIAG IMAGING PROCEDURES
       0633800   NM TX RADIOPHARM ORAL ADM          716.00      716.00   06         DIAG IMAGING PROCEDURES
       0633859   NM TX RADIOPHARM ORAL ADM          716.00      716.00   06         DIAG IMAGING PROCEDURES
       0633909   NM TX RADIOPHARM ORAL ADM          716.00      716.00   06         DIAG IMAGING PROCEDURES
       0633958   NM TX RADIOPHARM ORAL ADM          716.00      716.00   06         DIAG IMAGING PROCEDURES
       0636464   NM WHOLE BODY 2+ DAYS            2,540.00               06         DIAG IMAGING PROCEDURES
       0636944   NMC INSERT CATH TMP SMPL           463.00               06         DIAG IMAGING PROCEDURES
       0630319   NMC NODE IDENTIFICATION             98.00               06         DIAG IMAGING PROCEDURES
       0633156   RP GALLIUM GA-67 DX 1 MCI          559.00     495.00    06         DIAG IMAGING PROCEDURES
       0630400   RP I123 CAP DX 100UCI              164.00     164.00    06         DIAG IMAGING PROCEDURES
       0633354   RP IN111 CITRATE/VL                524.00               06         DIAG IMAGING PROCEDURES
       0632703   RP IN111 DTPA/0.5MCI               880.00     880.00    06         DIAG IMAGING PROCEDURES
       0636894   RP IN111 OCTREOSC DX 1MCI        5,015.00               06         DIAG IMAGING PROCEDURES
       0630756   RP TC99M DISFNIN DX 15MCI          180.00     162.00    06         DIAG IMAGING PROCEDURES
       0632208   RP TC99M MAA DX 10MCI              203.00     180.00    06         DIAG IMAGING PROCEDURES
       0631259   RP TC99M MDP 1-30MCI               203.00     180.00    06         DIAG IMAGING PROCEDURES
       0639450   RP TC99M MERTIAT DX 15MCI          736.00               06         DIAG IMAGING PROCEDURES
       0632653   RP TC99M PENTETA DX 25MCI          244.00     216.00    06         DIAG IMAGING PROCEDURES
       0636985   RP TC99M PENTETA DX 25MCI           74.00               06         DIAG IMAGING PROCEDURES
       0633503   RP TC99M PERTEC DX EA MCI          180.00     154.00    06         DIAG IMAGING PROCEDURES
       0631002   RP TC99M PYROPHO DX 25MCI          244.00     216.00    06         DIAG IMAGING PROCEDURES
       0639351   RP TC99M RBC/TAG DX 30MCI          270.00               06         DIAG IMAGING PROCEDURES



9/17/2012                                                                                                     17
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0639401   RP TC99M RBC/TAG DX 30MCI         862.00              06          DIAG IMAGING PROCEDURES
       0631903   RP TC99M SESTMBI DX 40MCI         188.00     174.00   06          DIAG IMAGING PROCEDURES
       0630608   RP TC99M SULFR/C DX 20MCI         208.00     184.00   06          DIAG IMAGING PROCEDURES
       0636969   RP TC99M SULFR/C DX 20MCI          54.00              06          DIAG IMAGING PROCEDURES
       0631853   RP TL-201 DX PER MCI              460.00     408.00   06          DIAG IMAGING PROCEDURES
       0632307   RP XE133 DX 10MCI                 394.00     350.00   06          DIAG IMAGING PROCEDURES
       0677112   S IMP MAMMOTOME GELMARKER         340.00              06          DIAG IMAGING PROCEDURES
       0629022   S IMP MIBB CLIP                   502.00              06          DIAG IMAGING PROCEDURES
       0621037   S IMP SHOLK BALLOON HYS           152.50              06          DIAG IMAGING PROCEDURES
       0669739   S LD NEUROSTIMULATOR            4,780.00              06          DIAG IMAGING PROCEDURES
       0636977   S NSTRL AEROVENT DEVICE           155.50              06          DIAG IMAGING PROCEDURES
       0647081   S NSTRL CT AUTO REGIST H          199.50              06          DIAG IMAGING PROCEDURES
       0642801   S NSTRL DUPLICATE FILMS                               06          DIAG IMAGING PROCEDURES
       0629204   S NSTRL MAMMOTOME MULTIP        1,048.00              06          DIAG IMAGING PROCEDURES
       0629196   S NSTRL PROBE GUIDE 14GA           69.50              06          DIAG IMAGING PROCEDURES
       0672154   S STRL AMNIOCENTESIS TRA           72.00      59.50   06          DIAG IMAGING PROCEDURES
       0627000   S STRL B E PREP KIT                48.50      41.00   06          DIAG IMAGING PROCEDURES
       0672204   S STRL BIOPSY GUIDE                66.50      54.00   06          DIAG IMAGING PROCEDURES
       0673210   S STRL BIOPSY GUIDE                82.50              06          DIAG IMAGING PROCEDURES
       0674002   S STRL CHIBA NEEDLE                60.50              06          DIAG IMAGING PROCEDURES
       0660290   S STRL CRVD DISP RF CANLA          96.00              06          DIAG IMAGING PROCEDURES
       0660282   S STRL CRVD TIP NDL BLUNT          49.50              06          DIAG IMAGING PROCEDURES
       0660332   S STRL CURVED QUINCKE NDL          43.00              06          DIAG IMAGING PROCEDURES
       0620104   S STRL F MILLER TUBE WIRE          59.50              06          DIAG IMAGING PROCEDURES
       0620112   S STRL FMILLER FDING TUBE         169.00              06          DIAG IMAGING PROCEDURES
       0661215   S STRL GROUNDING PAD               73.50              06          DIAG IMAGING PROCEDURES
       0661124   S STRL IRC 5FR LUMEN PWRP         451.50              06          DIAG IMAGING PROCEDURES
       0661116   S STRL IRC 6FR DBL LUMEN          485.00              06          DIAG IMAGING PROCEDURES
       0660043   S STRL IRC BIOPSY TRAY             86.50              06          DIAG IMAGING PROCEDURES
       0660050   S STRL IRC CENTESIS TRAY           80.00              06          DIAG IMAGING PROCEDURES
       0660084   S STRL IRC DISKOGRAPHY N           67.00              06          DIAG IMAGING PROCEDURES
       0660076   S STRL IRC FASCIAL DILAT           84.00              06          DIAG IMAGING PROCEDURES
       0660100   S STRL IRC MARKED GUIDEW          205.00              06          DIAG IMAGING PROCEDURES



9/17/2012                                                                                                    18
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0660035   S STRL IRC PERC CATH FAS            45.50              06          DIAG IMAGING PROCEDURES
       0660027   S STRL IRC PIGTAIL CENTE           205.00              06          DIAG IMAGING PROCEDURES
       0660092   S STRL IRC SPINAL NEEDLE            45.50              06          DIAG IMAGING PROCEDURES
       0660019   S STRL IRC VINYL CONNECT            39.00              06          DIAG IMAGING PROCEDURES
       0648014   S STRL IV ANGIO CATH INST           21.50              06          DIAG IMAGING PROCEDURES
       0678557   S STRL IV ANGIO CATH INST           21.50              06          DIAG IMAGING PROCEDURES
       0658005   S STRL IV ANGIO CATH INST           21.50              06          DIAG IMAGING PROCEDURES
       0637173   S STRL IV ANGIO CATH INST           21.50              06          DIAG IMAGING PROCEDURES
       0660324   S STRL IV ANGIO CATH INST           21.50              06          DIAG IMAGING PROCEDURES
       0628420   S STRL IV ANGIO CATH INST           21.50              06          DIAG IMAGING PROCEDURES
       0628800   S STRL MAMMOTOME GUIDE 1            58.50              06          DIAG IMAGING PROCEDURES
       0677104   S STRL MAMMOTOME GUIDE 11           58.50              06          DIAG IMAGING PROCEDURES
       0629030   S STRL MAMMOTOME MLTI 14G          795.00              06          DIAG IMAGING PROCEDURES
       0628784   S STRL MAMMOTOME PROBE 1           792.50              06          DIAG IMAGING PROCEDURES
       0628792   S STRL MAMMOTOME PROBE G            58.50              06          DIAG IMAGING PROCEDURES
       0669721   S STRL NEUROSTIM ACCESSO           975.00              06          DIAG IMAGING PROCEDURES
       0629014   S STRL PROBE GUIDE 11GA             69.50              06          DIAG IMAGING PROCEDURES
       0629220   S STRL RESERVOIR CANISTE            34.50              06          DIAG IMAGING PROCEDURES
       0660316   S STRL RF POLE NEEDLE              110.00              06          DIAG IMAGING PROCEDURES
       0660308   S STRL STRGHT DISP RF CAN           86.50              06          DIAG IMAGING PROCEDURES
       0678854   S STRL USC BIOPSY NEEDLE           209.50              06          DIAG IMAGING PROCEDURES
       0677955   S STRL USC BIOPSY TRAY              86.50              06          DIAG IMAGING PROCEDURES
       0678144   S STRL USC CENTESIS TRAY            80.00              06          DIAG IMAGING PROCEDURES
       0678805   S STRL USC SPINAL NEEDLE            45.50              06          DIAG IMAGING PROCEDURES
       0622191   S STRL XRC ARTHROGRAM TR           110.00              06          DIAG IMAGING PROCEDURES
       0620211   S STRL XRC MYELOGRAM TRA           109.00              06          DIAG IMAGING PROCEDURES
       0678409   STATISTICAL TRACKING                                   06          DIAG IMAGING PROCEDURES
       0670653   US ABD CMPL                        521.00     521.00   06          DIAG IMAGING PROCEDURES
       0671255   US AMNIOCENTESIS                   384.00     384.00   06          DIAG IMAGING PROCEDURES
       0671354   US BIO PROFILE W NONSTRES          449.00     449.00   06          DIAG IMAGING PROCEDURES
       0676601   US BIO PROFILE WO NOSTRES          444.00              06          DIAG IMAGING PROCEDURES
       0672402   US BREAST UNI OR BIL               285.00              06          DIAG IMAGING PROCEDURES
       0670604   US CHEST                           345.00     345.00   06          DIAG IMAGING PROCEDURES



9/17/2012                                                                                                     19
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0673756   US DPPLER ECHO FETAL               447.00     447.00   06          DIAG IMAGING PROCEDURES
       0672758   US DPPLER ECHO FETAL FU            265.00     265.00   06          DIAG IMAGING PROCEDURES
       0673301   US DRN W CATH PLACE PRC            822.00     822.00   06          DIAG IMAGING PROCEDURES
       0670802   US ECHO ABD LTD                    373.00     373.00   06          DIAG IMAGING PROCEDURES
       0672600   US ECHO FETAL                      598.00              06          DIAG IMAGING PROCEDURES
       0674184   US ECHO FETAL FU REPEAT            199.00     199.00   06          DIAG IMAGING PROCEDURES
       0677575   US ECHO INF HIPS                   408.00     408.00   06          DIAG IMAGING PROCEDURES
       0671057   US ECHO RETROPE LTD                373.00     373.00   06          DIAG IMAGING PROCEDURES
       0670059   US ENCEPHALOGRAM                   384.00     384.00   06          DIAG IMAGING PROCEDURES
       0672253   US EXT NONVASCULAR                 373.00     373.00   06          DIAG IMAGING PROCEDURES
       0670927   US GUIDE ART PSEUDOANEUR         1,614.00              06          DIAG IMAGING PROCEDURES
       0670158   US HEAD & NEC SFT TISSUE           371.00     371.00   06          DIAG IMAGING PROCEDURES
       0673400   US IN OR                           702.00     702.00   06          DIAG IMAGING PROCEDURES
       0672733   US NDL PLACE                       704.00     704.00   06          DIAG IMAGING PROCEDURES
       0676353   US OB 1ST TRI 1 GEST               567.00              06          DIAG IMAGING PROCEDURES
       0676403   US OB 1ST TRI EA GEST              310.00              06          DIAG IMAGING PROCEDURES
       0671107   US OB AFTR 1ST TRI 1 GEST          583.00              06          DIAG IMAGING PROCEDURES
       0671206   US OB AFTR 1ST TRI EA GES          617.00     617.00   06          DIAG IMAGING PROCEDURES
       0676452   US OB DTLD FTL EXAM 1 GES          984.00              06          DIAG IMAGING PROCEDURES
       0676502   US OB DTLD FTL EXM EA GES          396.00              06          DIAG IMAGING PROCEDURES
       0671156   US OB FU/REEVAL EA FETUS           346.00     346.00   06          DIAG IMAGING PROCEDURES
       0671305   US OB LTD 1/MORE FETUSES           562.00              06          DIAG IMAGING PROCEDURES
       0676551   US OB TRANSVAGINAL                 412.00              06          DIAG IMAGING PROCEDURES
       0678656   US OB UMBILLICAL ARTERY            417.00              06          DIAG IMAGING PROCEDURES
       0671453   US PELV CMPL NONOB                 405.00     405.00   06          DIAG IMAGING PROCEDURES
       0671552   US PELV LTD FU NONOB               269.00     269.00   06          DIAG IMAGING PROCEDURES
       0677450   US PERICARDIOCENT                  410.00     410.00   06          DIAG IMAGING PROCEDURES
       0670901   US RENL TRANSPLANT                 514.00     514.00   06          DIAG IMAGING PROCEDURES
       0670851   US RETROPE CMPL                    514.00     514.00   06          DIAG IMAGING PROCEDURES
       0678391   US SAL INFN SONOHYSTERGHY          410.00              06          DIAG IMAGING PROCEDURES
       0677179   US SPINAL CANAL                    408.00     408.00   06          DIAG IMAGING PROCEDURES
       0671602   US TESTICULAR SCROTUM              401.00     401.00   06          DIAG IMAGING PROCEDURES
       0672451   US TRANSRECTAL                     521.00     521.00   06          DIAG IMAGING PROCEDURES



9/17/2012                                                                                                     20
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0671503   US TRANSVAGINAL                       416.00     416.00    06         DIAG IMAGING PROCEDURES
       0678334   USC AMNIOCENTESIS DX                  899.00     899.00    06         DIAG IMAGING PROCEDURES
       0677773   USC ASP BREAST ADD                    756.00     756.00    06         DIAG IMAGING PROCEDURES
       0677732   USC ASP BREAST CYST                   649.77     649.77    06         DIAG IMAGING PROCEDURES
       0678219   USC ASP RENL CYST                     148.00     148.00    06         DIAG IMAGING PROCEDURES
       0678094   USC BX ABD RETROPE                    720.00     720.00    06         DIAG IMAGING PROCEDURES
       0677815   USC BX BREAST W IMAG                  889.00     889.00    06         DIAG IMAGING PROCEDURES
       0677930   USC BX LIVER                          875.00     875.00    06         DIAG IMAGING PROCEDURES
       0678383   USC BX LYMPH NODE SUPER               477.00               06         DIAG IMAGING PROCEDURES
       0677849   USC BX PANCREAS                     1,846.00               06         DIAG IMAGING PROCEDURES
       0678177   USC BX RENL                           924.00     924.00    06         DIAG IMAGING PROCEDURES
       0678375   USC BX THYROID                        324.00     324.00    06         DIAG IMAGING PROCEDURES
       0678243   USC INJ MAJOR JNT BURSA               100.00               06         DIAG IMAGING PROCEDURES
       0677690   USC INTRO CATH RENL PELV            2,366.00    2,366.00   06         DIAG IMAGING PROCEDURES
       0678011   USC PARACENT ABD INI                  924.00      924.00   06         DIAG IMAGING PROCEDURES
       0678052   USC PARACENT ABD SUBSQ                600.00      600.00   06         DIAG IMAGING PROCEDURES
       0678755   USC PSEUDOANEURYSM INJ                665.00               06         DIAG IMAGING PROCEDURES
       0676304   USC THORACENTESIS                   2,036.00               06         DIAG IMAGING PROCEDURES
       0677856   USC THORACENTESIS                   2,036.00    2,036.00   06         DIAG IMAGING PROCEDURES
       0678607   USC THORACENTESIS                   2,036.00               06         DIAG IMAGING PROCEDURES
       0677898   USC THORACENTESIS W TUBE              746.00     746.00    06         DIAG IMAGING PROCEDURES
       0626051   XR ABD 1V AP                          139.00     139.00    06         DIAG IMAGING PROCEDURES
       0626200   XR ABD CMPL DECUB ERECT               170.00     170.00    06         DIAG IMAGING PROCEDURES
       0626259   XR ABD CMPL W 1V CHEST                199.00     199.00    06         DIAG IMAGING PROCEDURES
       0626150   XR ABD W OBLIQUES CONE                156.00     156.00    06         DIAG IMAGING PROCEDURES
       0628552   XR ABSCSS FIST SIN TRACT              294.00     294.00    06         DIAG IMAGING PROCEDURES
       0624403   XR AC JNT                             177.00     177.00    06         DIAG IMAGING PROCEDURES
       0625756   XR ANKLE 2V                           129.00     129.00    06         DIAG IMAGING PROCEDURES
       0625806   XR ANKLE 3V OR MORE                   141.00     141.00    06         DIAG IMAGING PROCEDURES
       0622126   XR ARTHRO ELBOW                       550.00     550.00    06         DIAG IMAGING PROCEDURES
       0625251   XR ARTHRO HIP                         548.00     548.00    06         DIAG IMAGING PROCEDURES
       0625657   XR ARTHRO KNEE                        670.00     670.00    06         DIAG IMAGING PROCEDURES
       0624353   XR ARTHRO SHOULDER                    548.00     548.00    06         DIAG IMAGING PROCEDURES



9/17/2012                                                                                                        21
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0622225   XR ARTHRO WRIST                   421.00     421.00   06          DIAG IMAGING PROCEDURES
       0626952   XR BE                             462.00     462.00   06          DIAG IMAGING PROCEDURES
       0627208   XR BE THRP                        773.00     773.00   06          DIAG IMAGING PROCEDURES
       0627109   XR BE W AIR CON                   613.00     613.00   06          DIAG IMAGING PROCEDURES
       0620302   XR BONE AGE STDY                  139.00     139.00   06          DIAG IMAGING PROCEDURES
       0620351   XR BONE LENGTH STDY               208.00     208.00   06          DIAG IMAGING PROCEDURES
       0620450   XR BONE SURVEY CMPL               388.00     388.00   06          DIAG IMAGING PROCEDURES
       0620500   XR BONE SURVEY INF                230.00     230.00   06          DIAG IMAGING PROCEDURES
       0620401   XR BONE SURVEY LTD                275.00     275.00   06          DIAG IMAGING PROCEDURES
       0625954   XR CALCANEOUS 2V OR MORE          124.00     124.00   06          DIAG IMAGING PROCEDURES
       0623272   XR CHEST 1V                       114.00     114.00   06          DIAG IMAGING PROCEDURES
       0622100   XR CHEST 2V                       165.00     165.00   06          DIAG IMAGING PROCEDURES
       0622159   XR CHEST 2V W AP LORDOTIC         196.00     196.00   06          DIAG IMAGING PROCEDURES
       0622456   XR CHEST 2V W FLUORO              218.00     218.00   06          DIAG IMAGING PROCEDURES
       0622407   XR CHEST 2V W OBLIQUES            199.00     199.00   06          DIAG IMAGING PROCEDURES
       0628198   XR CHEST 4V CMPL                  211.00              06          DIAG IMAGING PROCEDURES
       0623421   XR CHEST 4V MORE W FLUORO         383.00     383.00   06          DIAG IMAGING PROCEDURES
       0628214   XR CHEST SPECIAL V EA             139.00              06          DIAG IMAGING PROCEDURES
       0627455   XR CHOL EXISTING CATH             220.00     220.00   06          DIAG IMAGING PROCEDURES
       0627406   XR CHOL IN OR                     239.00     239.00   06          DIAG IMAGING PROCEDURES
       0628321   XR CHOL IN OR ADD SET             139.00              06          DIAG IMAGING PROCEDURES
       0624155   XR CLAVICLE CMPL                  136.00     136.00   06          DIAG IMAGING PROCEDURES
       0628933   XR CS SAME MD ADD 15M              77.00              06          DIAG IMAGING PROCEDURES
       0628925   XR CS SAME MD GT5YR 0-30M         191.00              06          DIAG IMAGING PROCEDURES
       0628917   XR CS SAME MD LT5YR 0-30M         227.00              06          DIAG IMAGING PROCEDURES
       0629626   XR CYSTOGRAM 3V OR MORE           275.00              06          DIAG IMAGING PROCEDURES
       0601302   XR DRN W CATH PLACE PRC           706.00              06          DIAG IMAGING PROCEDURES
       0623983   XR DUODENOGRAM HYPOTONIC          328.00     328.00   06          DIAG IMAGING PROCEDURES
       0628396   XR DUPLICATION FLM EA                                 06          DIAG IMAGING PROCEDURES
       0624502   XR ELBOW 2V                       136.00     136.00   06          DIAG IMAGING PROCEDURES
       0624551   XR ELBOW 3V OR MORE               151.00     151.00   06          DIAG IMAGING PROCEDURES
       0624361   XR ENDO BILI DUCT                 811.00              06          DIAG IMAGING PROCEDURES
       0626853   XR ENTEROCLYSIS TUBE PRC          689.00     689.00   06          DIAG IMAGING PROCEDURES



9/17/2012                                                                                                    22
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0624379   XR ERCP BILI PANC DUCT                 826.00              06          DIAG IMAGING PROCEDURES
       0627935   XR ERCP PANC DUCT                      459.00              06          DIAG IMAGING PROCEDURES
       0626457   XR ESOPH                               321.00     321.00   06          DIAG IMAGING PROCEDURES
       0628248   XR EXT INF LOW LES 1YR                 129.00              06          DIAG IMAGING PROCEDURES
       0624700   XR EXT INF UPP LES 1YR                 129.00     129.00   06          DIAG IMAGING PROCEDURES
       0620559   XR EYE FOR FB                          115.00     115.00   06          DIAG IMAGING PROCEDURES
       0620906   XR FACIAL BONE 3V OR MORE              206.00     206.00   06          DIAG IMAGING PROCEDURES
       0620856   XR FACIAL BONE LES 3V                  163.00     163.00   06          DIAG IMAGING PROCEDURES
       0626101   XR FB LOC CHLD                         139.00     139.00   06          DIAG IMAGING PROCEDURES
       0628271   XR FB RMVL ESOPH                       650.00              06          DIAG IMAGING PROCEDURES
       0625400   XR FEMUR 2V                            151.00     151.00   06          DIAG IMAGING PROCEDURES
       0625053   XR FINGER(S) 2V OR MORE                110.00     110.00   06          DIAG IMAGING PROCEDURES
       0625269   XR FLUORO 1-2 HRS                      950.00     950.00   06          DIAG IMAGING PROCEDURES
       0621672   XR FLUORO 1-2 HRS                      950.00              06          DIAG IMAGING PROCEDURES
       0628347   XR FLUORO 1-2 HRS                      950.00              06          DIAG IMAGING PROCEDURES
       0620252   XR FLUORO 1HR OR LES                   325.00     325.00   06          DIAG IMAGING PROCEDURES
       0628362   XR FLUORO GUIDE SPINE INJ              349.00              06          DIAG IMAGING PROCEDURES
       0625293   XR FLUORO NDL PLACE                    354.00              06          DIAG IMAGING PROCEDURES
       0625855   XR FOOT 2V                             129.00     129.00   06          DIAG IMAGING PROCEDURES
       0625905   XR FOOT 3V OR MORE                     141.00     141.00   06          DIAG IMAGING PROCEDURES
       0624650   XR FOREARM 2V                          136.00     136.00   06          DIAG IMAGING PROCEDURES
       0621805   XR GALACTOGRAM 1 DUCT                  658.00     658.00   06          DIAG IMAGING PROCEDURES
       0624908   XR HAND 2V                             129.00     129.00   06          DIAG IMAGING PROCEDURES
       0625004   XR HAND 3V OR MORE                     141.00     141.00   06          DIAG IMAGING PROCEDURES
       0625723   XR HIP OR                              148.00     148.00   06          DIAG IMAGING PROCEDURES
       0625103   XR HIP UNI 1V                          127.00     127.00   06          DIAG IMAGING PROCEDURES
       0625152   XR HIP UNI 2V OR MORE                  153.00     153.00   06          DIAG IMAGING PROCEDURES
       0625202   XR HIPS BIL 2V W PELV                  182.00     182.00   06          DIAG IMAGING PROCEDURES
       0624452   XR HUMERUS 2V OR MORE                  151.00     151.00   06          DIAG IMAGING PROCEDURES
       0626309   XR HYSTEROSALPINGOGRAM                 345.00     345.00   06          DIAG IMAGING PROCEDURES
       0627752   XR IVP W DRIP + OR BOLUS               507.00     507.00   06          DIAG IMAGING PROCEDURES
       0628339   XR IVP W NEPHROTOMOGRAM                548.00              06          DIAG IMAGING PROCEDURES
       0627851   XR IVP W-W/O TOMOGRAM                             440.00   06          DIAG IMAGING PROCEDURES



9/17/2012                                                                                                         23
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0626937   XR KNEE 1 OR 2V                   139.00      139.00 06           DIAG IMAGING PROCEDURES
       0625509   XR KNEE 3V                        151.00             06           DIAG IMAGING PROCEDURES
       0625558   XR KNEE 4V OR MORE                165.00      165.00 06           DIAG IMAGING PROCEDURES
       0625608   XR KNEES STANDING AP              132.00      132.00 06           DIAG IMAGING PROCEDURES
       0621458   XR LARYNGOGRAM W CON              384.00      384.00 06           DIAG IMAGING PROCEDURES
       0621656   XR MAMMO BIL                      380.00      380.00 06           DIAG IMAGING PROCEDURES
       0621607   XR MAMMO UNI                      306.00      306.00 06           DIAG IMAGING PROCEDURES
       0628370   XR MAN APP STRS ANY JNT            36.00             06           DIAG IMAGING PROCEDURES
       0620658   XR MANDIBLE 4V OR MORE            168.00      168.00 06           DIAG IMAGING PROCEDURES
       0620609   XR MANDIBLE LES 4V                139.00      139.00 06           DIAG IMAGING PROCEDURES
       0620138   XR MYELOGRAM CERV               1,208.00             06           DIAG IMAGING PROCEDURES
       0627349   XR MYELOGRAM LUMB               1,036.00    1,036.00 06           DIAG IMAGING PROCEDURES
       0627364   XR MYELOGRAM THOR               1,103.00    1,103.00 06           DIAG IMAGING PROCEDURES
       0627323   XR MYELOGRM 1 OR MORE REG       1,565.00    1,565.00 06           DIAG IMAGING PROCEDURES
       0621003   XR NASAL BONES 3V OR MORE         139.00      139.00 06           DIAG IMAGING PROCEDURES
       0621409   XR NEC SOFT TISSUE                115.00      115.00 06           DIAG IMAGING PROCEDURES
       0620021   XR OR MOBILE                                         06           DIAG IMAGING PROCEDURES
       0628164   XR ORBITS 4V OR MORE              208.00             06           DIAG IMAGING PROCEDURES
       0627620   XR PACEMAKER INSERT               452.00      452.00 06           DIAG IMAGING PROCEDURES
       0627778   XR PELV 1 OR 2V                   139.00      139.00 06           DIAG IMAGING PROCEDURES
       0623959   XR PELV 3V OR MORE                177.00      177.00 06           DIAG IMAGING PROCEDURES
       0628230   XR PELV HIP 2V INF CHLD           153.00             06           DIAG IMAGING PROCEDURES
       0628388   XR PHARYNGEAL SPEECH EVAL         572.00             06           DIAG IMAGING PROCEDURES
       0624445   XR PHARYNX OR ESOPH CERV          313.00      313.00 06           DIAG IMAGING PROCEDURES
       0628172   XR PHARYNXLARYNX W FLUORO         337.00             06           DIAG IMAGING PROCEDURES
       0622803   XR RIBS BIL 3V                    208.00      208.00 06           DIAG IMAGING PROCEDURES
       0622852   XR RIBS BIL W PA CXR              237.00      237.00 06           DIAG IMAGING PROCEDURES
       0622753   XR RIBS UNI & PA CHEST            182.00      182.00 06           DIAG IMAGING PROCEDURES
       0622704   XR RIBS UNI 2V                    153.00      153.00 06           DIAG IMAGING PROCEDURES
       0624106   XR SACRUM COCCYX 2 V MORE         151.00             06           DIAG IMAGING PROCEDURES
       0624205   XR SCAPULA CMPL                   139.00      139.00 06           DIAG IMAGING PROCEDURES
       0621771   XR SCRN MAMMO                     349.00      349.00 06           DIAG IMAGING PROCEDURES
       0628974   XR SHOULDER 1V                    124.00      124.00 06           DIAG IMAGING PROCEDURES



9/17/2012                                                                                                    24
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0624304   XR SHOULDER 2V OR MORE                 151.00      151.00 06           DIAG IMAGING PROCEDURES
       0601203   XR SHUNTOGRAM NONVASC                  185.00             06           DIAG IMAGING PROCEDURES
       0624056   XR SI JNT 3V OR MORE                   163.00      163.00 06           DIAG IMAGING PROCEDURES
       0621557   XR SIALOGRAM                           457.00      457.00 06           DIAG IMAGING PROCEDURES
       0621151   XR SIN PARA 3V OR MORE                 206.00      206.00 06           DIAG IMAGING PROCEDURES
       0621102   XR SIN PARA LES 3V                     163.00      163.00 06           DIAG IMAGING PROCEDURES
       0621300   XR SKULL 4V OR MORE                    239.00      239.00 06           DIAG IMAGING PROCEDURES
       0621250   XR SKULL LES 4V                        168.00      168.00 06           DIAG IMAGING PROCEDURES
       0628313   XR SM BOWEL ENTEROCLYSIS               369.00             06           DIAG IMAGING PROCEDURES
       0626804   XR SM BOWEL SERIES                     349.00      349.00 06           DIAG IMAGING PROCEDURES
       0621755   XR SPECIMEN SURGICAL                   112.00      112.00 06           DIAG IMAGING PROCEDURES
       0623405   XR SPINE C 4V & FLEX/EXT               299.00      299.00 06           DIAG IMAGING PROCEDURES
       0623306   XR SPINE CERV 2-3V                     160.00      160.00 06           DIAG IMAGING PROCEDURES
       0623553   XR SPINE CERV 4V OR MORE               237.00      237.00 06           DIAG IMAGING PROCEDURES
       0629253   XR SPINE LUMB 2-3V                     177.00      177.00 06           DIAG IMAGING PROCEDURES
       0623652   XR SPINE LUMB 4V OR MORE               242.00      242.00 06           DIAG IMAGING PROCEDURES
       0623702   XR SPINE LUMB 4V W BEND                313.00      313.00 06           DIAG IMAGING PROCEDURES
       0623751   XR SPINE LUMB BEND ONLY                230.00      230.00 06           DIAG IMAGING PROCEDURES
       0623561   XR SPINE SCOLIOSIS STNDNG              136.00      136.00 06           DIAG IMAGING PROCEDURES
       0623256   XR SPINE SNGL V CERV                   112.00      112.00 06           DIAG IMAGING PROCEDURES
       0620237   XR SPINE SNGL V LUMB                   112.00             06           DIAG IMAGING PROCEDURES
       0620245   XR SPINE SNGL V THOR                   112.00             06           DIAG IMAGING PROCEDURES
       0623207   XR SPINE SURVEY ENTIRE                 280.00      280.00 06           DIAG IMAGING PROCEDURES
       0623454   XR SPINE THOR 3V                       191.00      191.00 06           DIAG IMAGING PROCEDURES
       0628222   XR SPINE THOR 4V OR MORE               235.00             06           DIAG IMAGING PROCEDURES
       0623504   XR SPINE THOR LUMB 2V                  177.00      177.00 06           DIAG IMAGING PROCEDURES
       0628768   XR STEREO LOC                        1,843.00    1,843.00 06           DIAG IMAGING PROCEDURES
       0622951   XR STERNOCLAVIC 3V MORE                187.00      187.00 06           DIAG IMAGING PROCEDURES
       0622902   XR STERNUM 2V OR MORE                  172.00      172.00 06           DIAG IMAGING PROCEDURES
       0623157   XR SUBTRACTION SERIES                  199.00      199.00 06           DIAG IMAGING PROCEDURES
       0626507   XR SWALLOWING FNCTN                    354.00             06           DIAG IMAGING PROCEDURES
       0625707   XR TIBIA FIBULA 2V                     139.00      139.00 06           DIAG IMAGING PROCEDURES
       0621359   XR TMJ BIL                             220.00      220.00 06           DIAG IMAGING PROCEDURES



9/17/2012                                                                                                         25
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0626002   XR TOE(S) 2V OR MORE               110.00     110.00    06         DIAG IMAGING PROCEDURES
       0629741   XR TOMOGRAM                        345.00     345.00    06         DIAG IMAGING PROCEDURES
       0626705   XR UGI W AIR CON                   447.00     447.00    06         DIAG IMAGING PROCEDURES
       0626754   XR UGI W AIR CON KUB               457.00     457.00    06         DIAG IMAGING PROCEDURES
       0628297   XR UGI W AIR CON SM BOWEL          689.00               06         DIAG IMAGING PROCEDURES
       0626606   XR UGI W KUB                       412.00     412.00    06         DIAG IMAGING PROCEDURES
       0626655   XR UGI W SM BOWEL                  644.00     644.00    06         DIAG IMAGING PROCEDURES
       0626556   XR UGI W/O KUB                     404.00     404.00    06         DIAG IMAGING PROCEDURES
       0628255   XR URETHROCYSTOGRAM                376.00     376.00    06         DIAG IMAGING PROCEDURES
       0628156   XR URETHROCYSTOGRAM VOID           404.00     404.00    06         DIAG IMAGING PROCEDURES
       0628008   XR UROGRAM RETRO                   658.00     658.00    06         DIAG IMAGING PROCEDURES
       0620039   XR VENOGRAM EXT BIL                438.00               06         DIAG IMAGING PROCEDURES
       0620070   XR VENOGRAM EXT UNI                282.00               06         DIAG IMAGING PROCEDURES
       0624759   XR WRIST 2V                        129.00     129.00    06         DIAG IMAGING PROCEDURES
       0624809   XR WRIST 3V OR MORE                141.00     141.00    06         DIAG IMAGING PROCEDURES
       0628610   XRC BREAST NDL WIRE                684.00     684.00    06         DIAG IMAGING PROCEDURES
       0628024   XRC BREAST NDL WIRE ADD            290.00               06         DIAG IMAGING PROCEDURES
       0677740   XRC BX BREAST VAC ASSIST         2,757.00               06         DIAG IMAGING PROCEDURES
       0628016   XRC BX BREAST W IMAG               919.00               06         DIAG IMAGING PROCEDURES
       0628032   XRC IMAG LOC CLIP W BX             646.00               06         DIAG IMAGING PROCEDURES
       0628065   XRC INJ ARTHRO ELBOW               871.00               06         DIAG IMAGING PROCEDURES
       0628081   XRC INJ ARTHRO HIP               1,070.00               06         DIAG IMAGING PROCEDURES
       0628099   XRC INJ ARTHRO KNEE                893.00               06         DIAG IMAGING PROCEDURES
       0628040   XRC INJ ARTHRO SHOULDER            830.00               06         DIAG IMAGING PROCEDURES
       0628073   XRC INJ ARTHRO WRIST               826.00               06         DIAG IMAGING PROCEDURES
       0601104   XRC INJ ASP SHUNT                  242.00               06         DIAG IMAGING PROCEDURES
       0621045   XRC INJ C1 C2 MYELOGRAM            340.00     340.00    06         DIAG IMAGING PROCEDURES
       0628149   XRC INJ CYSTO VCUG               1,211.00               06         DIAG IMAGING PROCEDURES
       0626127   XRC INJ DISKOGRAM LUMB           1,711.00    1,711.00   06         DIAG IMAGING PROCEDURES
       0620047   XRC INJ HIP W ANESTHESIA         2,309.00               06         DIAG IMAGING PROCEDURES
       0626242   XRC INJ LP                         718.00      718.00   06         DIAG IMAGING PROCEDURES
       0620203   XRC INJ MYELOGRAM                1,189.00    1,189.00   06         DIAG IMAGING PROCEDURES
       0626366   XRC INJ SIALOGRAM                  771.00               06         DIAG IMAGING PROCEDURES



9/17/2012                                                                                                     26
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0628131   XRC INTRO G TUBE LONG                   88.00               06         DIAG IMAGING PROCEDURES
       0626358   XRC SAL INFN SONOHYSTER                759.00               06         DIAG IMAGING PROCEDURES
       0629568   XRC THORACENTESIS                    2,103.00    2,103.00   06         DIAG IMAGING PROCEDURES
       0628115   XRC THORACENTESIS W TUBE               771.00               06         DIAG IMAGING PROCEDURES
       0601401   XRC TUBE THORACOSTOMY                1,268.00               06         DIAG IMAGING PROCEDURES
       5010152   ABORTED DIALYSIS TRTMNT                                     50         DIALYSIS SERVICES
       5020011   APHERESIS PLASMA                     5,581.00               50         DIALYSIS SERVICES
       5010012   DIALYS HEMO IP                       1,454.00               50         DIALYSIS SERVICES
       5010103   DIALYS HEMOPERFUSION IP              3,313.00               50         DIALYSIS SERVICES
       5010053   DIALYS PRITNEAL NOCAPD IP              383.00               50         DIALYSIS SERVICES
       3810108   EEG AWAKE AND ASLEEP                   679.00               38         EEG
       3810959   EEG CEREBRAL DEATH EVAL                611.00               38         EEG
       3811106   EEG DURING SURGERY                     776.00               38         EEG
       3810850   EEG GT 1 HR                            697.00               38         EEG
       3811056   EEG MONITOR AMB EA 24HR                499.00               38         EEG
       3810900   EEG SLEEP                              889.00               38         EEG
       3810801   EEG UP TO 1HR                          188.00               38         EEG
       3811007   VISUAL EVOKED POTENT TEST              549.00               38         EEG
       5517651   ADMIN IMMUN EA ADD VACC                 68.00               55         EMERGENCY DEPARTMENT
       5517602   ADMIN IMMUN SGL VACC                    65.00               55         EMERGENCY DEPARTMENT
       5541255   ADMIN IMMUN SGL VACC                    65.00               55         EMERGENCY DEPARTMENT
       5511951   AEROSOL BREATHING TX                   101.00     101.00    55         EMERGENCY DEPARTMENT
       5512009   ALCOHOL (ETHANOL)                       98.00      98.00    55         EMERGENCY DEPARTMENT
       5513460   ARTERIAL PUNCTURE                       95.00               55         EMERGENCY DEPARTMENT
       5541354   BLOOD TRANSFUSN 2-4 HR               1,164.00               55         EMERGENCY DEPARTMENT
       5517354   BLOOD TRANSFUSN GT 6HR               2,251.00               55         EMERGENCY DEPARTMENT
       5541404   BLOOD TRANSFUSN LT 2 HR                666.00               55         EMERGENCY DEPARTMENT
       5541453   BLOOD TRANSFUSN LT 2 HR                666.00               55         EMERGENCY DEPARTMENT
       5512207   CARDIOVERT ELECTIVE EXT              1,226.00    1,226.00   55         EMERGENCY DEPARTMENT
       5512157   CPR                                    246.00      246.00   55         EMERGENCY DEPARTMENT
       5516661   CS SAME MD ADD 15M                     150.00               55         EMERGENCY DEPARTMENT
       5516653   CS SAME MD GT5YR 0-30M                 350.00               55         EMERGENCY DEPARTMENT
       5516679   CS SAME MD LT5YR 0-30M                 350.00               55         EMERGENCY DEPARTMENT



9/17/2012                                                                                                         27
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       5516802   ED CC 1ST 30-74 MN                   1,801.00               55         EMERGENCY DEPARTMENT
       5516703   ED CC EA ADD 30 MN                     598.00               55         EMERGENCY DEPARTMENT
       5511506   ED LEVEL 1                             317.00      317.00   55         EMERGENCY DEPARTMENT
       5511555   ED LEVEL 2                             489.00      489.00   55         EMERGENCY DEPARTMENT
       5511605   ED LEVEL 3                             815.00      815.00   55         EMERGENCY DEPARTMENT
       5511654   ED LEVEL 4                           1,248.00    1,248.00   55         EMERGENCY DEPARTMENT
       5511704   ED LEVEL 5                           1,495.00    1,495.00   55         EMERGENCY DEPARTMENT
       5517800   ED PROC MAJOR                          704.00               55         EMERGENCY DEPARTMENT
       5517156   ED PROC MINOR                          293.00               55         EMERGENCY DEPARTMENT
       5515606   EKG 12 LEAD TRACING ONLY               162.00               55         EMERGENCY DEPARTMENT
       5512405   GASTRIC LAVAGE                         429.00     429.00    55         EMERGENCY DEPARTMENT
       5512355   GLUCOSE FINGERSTICK                     21.00      21.00    55         EMERGENCY DEPARTMENT
       5517503   HYDRATION INFSN 0-60MN                 383.00               55         EMERGENCY DEPARTMENT
       5517453   INFSN W/MED ADD HR 8 MX                267.00               55         EMERGENCY DEPARTMENT
       5517461   INFSN W/MED ADD SQ 0-60MN              250.00               55         EMERGENCY DEPARTMENT
       5517404   INFUSION W/MED 0-60MN                  383.00               55         EMERGENCY DEPARTMENT
       5517552   INFUSN W/VASOACT EA AD                 259.00               55         EMERGENCY DEPARTMENT
       5517479   INJ IVP ADDL SEQ NEW DRG               100.00               55         EMERGENCY DEPARTMENT
       5515051   INJ IVP SNGL/INIT DRG                  134.00               55         EMERGENCY DEPARTMENT
       5515002   INJECTION IM/SQ EA                     169.00               55         EMERGENCY DEPARTMENT
       5517958   INJECTION IM/SQ EA                     169.00               55         EMERGENCY DEPARTMENT
       5517750   IPECAC ADMINISTRATION                  113.00               55         EMERGENCY DEPARTMENT
       5518006   MEDICAL SCREENING                       89.00               55         EMERGENCY DEPARTMENT
       5512454   OCCLT BLD STL QL MULT SPC               30.00      30.00    55         EMERGENCY DEPARTMENT
       5517206   OPHTHALMOLOGY EXAM                      69.00               55         EMERGENCY DEPARTMENT
       5517255   PT LEFT AFTER TRIAGE                                        55         EMERGENCY DEPARTMENT
       5540950   PULSE OXIMETRY - SINGLE                 59.00      59.00    55         EMERGENCY DEPARTMENT
       5541214   PULSE OXIMETRY MULTIPLE                175.00               55         EMERGENCY DEPARTMENT
       5517859   REGIONAL BLOCK FINGERS                 111.00               55         EMERGENCY DEPARTMENT
       5517909   REGIONAL BLOCK TOES                     89.00               55         EMERGENCY DEPARTMENT
       5512959   S NSTRL SPLINT FBR LNGARM              197.00     197.00    55         EMERGENCY DEPARTMENT
       5512900   S NSTRL SPLINT FBR SHORT               170.50     170.50    55         EMERGENCY DEPARTMENT
       5513007   S NSTRL SPLINT FBR SHORT               223.50     223.50    55         EMERGENCY DEPARTMENT



9/17/2012                                                                                                        28
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       5513056   S NSTRL SPLINT FBRGL LONG          249.50     249.50    55         EMERGENCY DEPARTMENT
       5513155   S NSTRL SPLINT PLST L ARM          154.00     154.00    55         EMERGENCY DEPARTMENT
       5513106   S NSTRL SPLINT PLST S ARM          123.00     123.00    55         EMERGENCY DEPARTMENT
       5513205   S NSTRL SPLINT PLST SHLEG          166.50     166.50    55         EMERGENCY DEPARTMENT
       5513254   S NSTRL SPLINT PLSTR LLEG          207.50     207.50    55         EMERGENCY DEPARTMENT
       5512801   S O2 ER                             79.00      79.00    55         EMERGENCY DEPARTMENT
       5541057   S STRL ER SUTURE                    79.00      66.00    55         EMERGENCY DEPARTMENT
       5541156   S STRL LVL 1 FLUID INFUS           294.50               55         EMERGENCY DEPARTMENT
       5512553   SART EXAM                                               55         EMERGENCY DEPARTMENT
       5517305   SEEN NO CHARGE                                          55         EMERGENCY DEPARTMENT
       5516554   TEMP TRANSCUTANEOUS PACE           388.00               55         EMERGENCY DEPARTMENT
       5512603   THROMBOLYSIS CORO IV             1,563.00    1,563.00   55         EMERGENCY DEPARTMENT
       5512256   URNALYSIS MAN W/O MICRO             23.00       23.00   55         EMERGENCY DEPARTMENT
       5512652   VENIPUNCTURE                        19.00               55         EMERGENCY DEPARTMENT
       5514559   VX BCG LIVE TB PERC                 58.00               55         EMERGENCY DEPARTMENT
       5514807   VX DT DIP/TETTOX LT 7YRS            58.00               55         EMERGENCY DEPARTMENT
       5514856   VX DT DIP/TETTOX LT 7YRS            58.00               55         EMERGENCY DEPARTMENT
       5514955   VX HEP B ADULT IM                   58.00               55         EMERGENCY DEPARTMENT
       5514906   VX HEP B PED/ADOL 3 DOSE            58.00               55         EMERGENCY DEPARTMENT
       5514757   VX RABIES INTRAMUSCULAR            258.00               55         EMERGENCY DEPARTMENT
       1530054   DIET INSTRUCTION 60                100.00               15         HEALTH & NUTRITION SERVIC
       1530104   DIET INSTRUCTION 60                150.00               15         HEALTH & NUTRITION SERVIC
       1530153   DIET INSTRUCTION 60                 50.00               15         HEALTH & NUTRITION SERVIC
       1530203   MED NUTR TX EA 15                   57.00               15         HEALTH & NUTRITION SERVIC
       1530252   MED NUTR TX EA 15                   57.00               15         HEALTH & NUTRITION SERVIC
       1530302   MED NUTR TX EA 15                   57.00               15         HEALTH & NUTRITION SERVIC
       3418027   CA ANGIO ADD VESSEL EA           2,807.00               34         HEART CATH
       3419702   CA ANGIO AVS SHUNT                 429.00     429.00    34         HEART CATH
       3412152   CA ANGIO CAROTD CERE BIL         2,902.00               34         HEART CATH
       3418951   CA ANGIO CAROTD CERE BIL         2,902.00    2,902.00   34         HEART CATH
       3417722   CA ANGIO CAROTD CERE UNI         2,878.00               34         HEART CATH
       3417664   CA ANGIO CAROTD CERV BIL         2,902.00               34         HEART CATH
       3417680   CA ANGIO CAROTD CERV UNI         2,878.00               34         HEART CATH



9/17/2012                                                                                                       29
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3416013   CA ANGIO CAROTD XTL BIL         2,911.00               34         HEART CATH
       3416021   CA ANGIO CAROTD XTL UNI         2,878.00               34         HEART CATH
       3417748   CA ANGIO CERVICOCEREBRAL        2,889.00               34         HEART CATH
       3412160   CA ANGIO EXT BIL                2,875.00               34         HEART CATH
       3417565   CA ANGIO EXT BIL                2,875.00               34         HEART CATH
       3418969   CA ANGIO EXT UNI                2,867.00               34         HEART CATH
       3417060   CA ANGIO FU EXISTING CATH         352.00               34         HEART CATH
       3417235   CA ANGIO PELV SELECT            2,530.00    2,530.00   34         HEART CATH
       3417359   CA ANGIO PULM BIL SELECT        2,900.00    2,900.00   34         HEART CATH
       3412459   CA ANGIO PULM NONSELECT         2,530.00               34         HEART CATH
       3418191   CA ANGIO PULM UNI SELECT        2,875.00    2,875.00   34         HEART CATH
       3419355   CA ANGIO RENL BIL               2,904.00    2,904.00   34         HEART CATH
       3417987   CA ANGIO RENL UNI               2,869.00               34         HEART CATH
       3417581   CA ANGIO SPINAL SELECT          2,941.00               34         HEART CATH
       3418241   CA ANGIO VERTEBRAL              2,875.00               34         HEART CATH
       3418365   CA ANGIO VISC                   2,862.00               34         HEART CATH
       3412129   CA AORTOGRAM ABD BIL EXT        3,032.00               34         HEART CATH
       3419405   CA AORTOGRAM ABD BIL EXT        3,032.00    3,032.00   34         HEART CATH
       3418258   CA AORTOGRAM ABD W SER          2,864.00    2,864.00   34         HEART CATH
       3417458   CA AORTOGRAM THOR W SER         2,869.00    2,869.00   34         HEART CATH
       3417557   CA AORTOGRAM THOR W/O SER       2,823.00    2,823.00   34         HEART CATH
       3416724   CA ATHERECTOMY PERIPH ADD         872.00               34         HEART CATH
       3416716   CA ATHERECTOMY PERIPH INI       3,516.00               34         HEART CATH
       3412178   CA BILE STONE EXTRACTION          440.00               34         HEART CATH
       3412343   CA BILI DRN PRC                 1,335.00               34         HEART CATH
       3414802   CA BIOPSY ENDOMYOCARDIAL          807.00     807.00    34         HEART CATH
       3413614   CA BX TRANSCATHETER S&I         2,607.00               34         HEART CATH
       3413051   CA CARDIOVERT ELCTVE EXT        1,393.00    1,393.00   34         HEART CATH
       3417946   CA CATH RENL PELV PRC             937.00               34         HEART CATH
       3412251   CA CHOL EXISTING CATH             376.00               34         HEART CATH
       3419967   CA CHOL TRANSHEPAT PRC            735.00               34         HEART CATH
       3416856   CA CORO/GRFT/IMA WO LHC         3,241.00               34         HEART CATH
       3415809   CA CPR                            280.00               34         HEART CATH



9/17/2012                                                                                                   30
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3411519   CA CS SAME MD ADD 15M                  150.00               34         HEART CATH
       3411501   CA CS SAME MD GT5YR 0-30M              350.00               34         HEART CATH
       3414513   CA CV CATH MECH CLEAR                  280.00               34         HEART CATH
       3412350   CA DILATE NEPHROSTOMY                  733.00               34         HEART CATH
       3416500   CA DPPLR W STRESS ADD VSL              576.00               34         HEART CATH
       3416559   CA DPPLR W STRESS INI                1,155.00               34         HEART CATH
       3412400   CA DRN W CATH PLACE PRC                781.00               34         HEART CATH
       3410222   CA EKG 12 LEAD TRACING                 184.00               34         HEART CATH
       3412061   CA ELEC ANALYS ILR                      44.00               34         HEART CATH
       3412327   CA EMBOL TX                          5,419.00               34         HEART CATH
       3417789   CA EMBOL TX                          5,419.00               34         HEART CATH
       3416757   CA ERGONOVINE PROV TEST                345.00               34         HEART CATH
       3419751   CA EXCHNGE INTRAVAS CATH             1,580.00    1,580.00   34         HEART CATH
       3411451   CA FLUOR CVC PLC/RMV/RPR               317.00               34         HEART CATH
       3417821   CA FLUORO 1HR OR LES                   299.00               34         HEART CATH
       3414000   CA HEART CATH LEFT                   8,633.00    8,633.00   34         HEART CATH
       3414208   CA HEART CATH RIGHT                  3,982.00    3,982.00   34         HEART CATH
       3415759   CA INJ AORTOGRAPHY                     224.00      224.00   34         HEART CATH
       3414406   CA INJ CORO ANGIO                    1,011.00    1,011.00   34         HEART CATH
       3416609   CA INJ GRAFT ANGIO                     782.00               34         HEART CATH
       3417250   CA INJ IMA CONDUIT                     392.00     392.00    34         HEART CATH
       3412103   CA INJ IVP SNGL/INIT DRG               153.00               34         HEART CATH
       3414505   CA INJ L VENT/ATR ANGIO                342.00     342.00    34         HEART CATH
       3417185   CA INJ PULM ANGIO                      198.00               34         HEART CATH
       3413903   CA INJ R VENT/ATR ANGIO                197.00               34         HEART CATH
       3416658   CA INSERT SWAN GANZ                  1,687.00               34         HEART CATH
       3417888   CA IVC FILTER PLACE                  2,820.00               34         HEART CATH
       3416054   CA IVUS CORO ADD VSL                   629.00               34         HEART CATH
       3416005   CA IVUS CORO INI VSL                 1,162.00               34         HEART CATH
       3416096   CA IVUS NONCO ADD                      524.00               34         HEART CATH
       3416088   CA IVUS NONCO INI                                           34         HEART CATH
       3418126   CA NDL PLACE                           669.00               34         HEART CATH
       3419819   CA PERICARDIOCENT                      389.00               34         HEART CATH



9/17/2012                                                                                                        31
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3412145   CA PLACE DRG EL STNT ADDL       5,498.00           34             HEART CATH
       3412137   CA PLACE DRG EL STNT SNGL       9,283.00           34             HEART CATH
       3411055   CA PLACE RAD DEL DEVICE         5,348.00           34             HEART CATH
       3412301   CA PM INSERT                      416.00           34             HEART CATH
       3417508   CA PORTOGRAM W HEM EVAL         2,548.00 2,548.00 34              HEART CATH
       3412095   CA PTA PERIPH ART               3,513.00           34             HEART CATH
       3412210   CA PTA PERIPH ART               3,513.00           34             HEART CATH
       3417755   CA PTA PERIPH ART               3,513.00 3,513.00 34              HEART CATH
       3417854   CA PTA PERIPH ART ADD           1,877.00 1,877.00 34              HEART CATH
       3417953   CA PTA RENL VISC                3,575.00           34             HEART CATH
       3418159   CA PTA VEN                      3,513.00           34             HEART CATH
       3418050   CA PTA VISC ADD                 1,879.00 1,879.00 34              HEART CATH
       3416351   CA PTC ATHERCTMY ADD VSL          279.00           34             HEART CATH
       3416807   CA PTC ATHERCTMY ADD VSL          279.00           34             HEART CATH
       3416302   CA PTC ATHERCTMY SNGL VSL       1,093.00           34             HEART CATH
       3416708   CA PTC ATHERCTMY SNGL VSL       1,093.00           34             HEART CATH
       3416252   CA PTCA ADD VSL                   255.00           34             HEART CATH
       3416203   CA PTCA SNGL VSL                  999.00           34             HEART CATH
       3417847   CA RETRIEVAL VASCULAR FB        2,622.00           34             HEART CATH
       3414059   CA RHC/LHC RETRO               11,275.00 11,275.00 34             HEART CATH
       3414521   CA RMVL CVA DEV OBSTRCTN          323.00           34             HEART CATH
       3418530   CA RMVL CVA DEV OBSTRCTN          323.00           34             HEART CATH
       3416906   CA S/I ANGIO PULM/AO/CORO       2,253.00           34             HEART CATH
       3416401   CA S/I ANGIO VENTRCLR/ATR       1,454.00           34             HEART CATH
       3417151   CA SHUNTOGRAM NONVASC             181.00    181.00 34             HEART CATH
       3417409   CA SPLENOPORTOGRAM              2,528.00 2,528.00 34              HEART CATH
       3416104   CA STENT IC SNGL VSL PRC       11,851.00           34             HEART CATH
       3411352   CA STENT NOCORO/CAR/VERT        3,348.00           34             HEART CATH
       3418043   CA STENT NOCORO/CAR/VERT        3,348.00           34             HEART CATH
       3416153   CA STNT IC ADD VSL PRC            359.00           34             HEART CATH
       3417441   CA THROMBECTOMY CORO PRC        2,178.00           34             HEART CATH
       3415908   CA THROMBLYSIS CORO INFSN         620.00           34             HEART CATH
       3415957   CA THROMBOLYSIS CORO IV         1,775.00           34             HEART CATH



9/17/2012                                                                                                   32
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3417003   CA TMP TRNSCUTANEOUS PACE         441.00               34         HEART CATH
       3419207   CA TRANSCATHETER TX IV          4,730.00    4,730.00   34         HEART CATH
       3417920   CA TUBE CATH CHNG                 482.00               34         HEART CATH
       3419975   CA URETERAL STENT PRC             937.00               34         HEART CATH
       3418084   CA UROGRAM ANTEGRADE              315.00               34         HEART CATH
       3412319   CA VALVULOPLSTY AORTC PRC       2,609.00               34         HEART CATH
       3411063   CA VEN SAMPLING                 2,820.00               34         HEART CATH
       3417904   CA VENOGRAM EXT BIL               403.00      403.00   34         HEART CATH
       3417276   CA VENOGRAM EXT UNI               260.00      260.00   34         HEART CATH
       3417607   CA VENOGRAM HEP W EVAL          2,528.00    2,528.00   34         HEART CATH
       3412087   CA VENOGRAM IVC                 2,862.00               34         HEART CATH
       3418183   CA VENOGRAM IVC                 2,862.00               34         HEART CATH
       3412079   CA VENOGRAM SVC                 2,862.00               34         HEART CATH
       3418225   CA VENOGRAM SVC                 2,862.00               34         HEART CATH
       3417367   CAC AVS DIAL SHUNT              1,371.00               34         HEART CATH
       3412186   CAC BILI STONE EXTRACT          1,076.00               34         HEART CATH
       3413606   CAC BX TRANSCATHETER            1,606.00               34         HEART CATH
       3417045   CAC CATH ABD LOW 1ST              866.00               34         HEART CATH
       3411253   CAC CATH ABD LOW 2ND            2,505.00               34         HEART CATH
       3418019   CAC CATH ABD LOW 2ND            2,505.00    2,505.00   34         HEART CATH
       3418092   CAC CATH ABD LOW 3RD            3,364.00    3,364.00   34         HEART CATH
       3413507   CAC CATH ABD LOW ADD               79.00               34         HEART CATH
       3417094   CAC CATH PORTAL VEIN PRC        1,117.00    1,117.00   34         HEART CATH
       3417029   CAC CATH THOR 1ST ART             357.00               34         HEART CATH
       3417862   CAC CATH THOR 2ND ART             398.00     398.00    34         HEART CATH
       3417938   CAC CATH THOR 3RD ART             210.00     210.00    34         HEART CATH
       3413457   CAC CATH THOR ADD ART             991.00               34         HEART CATH
       3417086   CAC EMBOL OCC NONHEAD NEC       1,302.00               34         HEART CATH
       3412707   CAC EP INSRT TMP LDS DUAL       3,000.00               34         HEART CATH
       3412905   CAC EP REPAIR SNGL LEAD           948.00               34         HEART CATH
       3416039   CAC EXTCRAN CV STENT ADD        1,067.00               34         HEART CATH
       3416047   CAC EXTCRAN CV STENT INIT       2,134.00               34         HEART CATH
       3412038   CAC IMPLANT CARD EVNT RCD       3,022.00               34         HEART CATH



9/17/2012                                                                                                   33
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3417136   CAC INJ EXT VENOGRAM            1,687.00    1,687.00 34           HEART CATH
       3417227   CAC INJ NEPHROGRAM                592.00             34           HEART CATH
       3417110   CAC INS NON-TUN CV CATH5+       1,241.00    1,241.00 34           HEART CATH
       3417243   CAC INS TUNN CV DEV 5+          6,527.00             34           HEART CATH
       3416955   CAC INSERT IABP PRC               407.00             34           HEART CATH
       3412608   CAC INSERT PACER DUAL LDS       8,978.00             34           HEART CATH
       3412806   CAC INSERT PACER GEN DUAL       6,026.00             34           HEART CATH
       3412756   CAC INSERT PACER GEN SNGL       5,104.00             34           HEART CATH
       3412657   CAC INSERT PACER TMP SNGL       2,456.00             34           HEART CATH
       3412558   CAC INSERT PACER/ELEC VNT       7,730.00             34           HEART CATH
       3412509   CAC INSERT PACER/ELECATR        9,082.00             34           HEART CATH
       3418704   CAC INTRO CAROTD VERT ART         248.00      248.00 34           HEART CATH
       3417078   CAC INTRO CATH AORTA            1,336.00    1,336.00 34           HEART CATH
       3418357   CAC INTRO CATH AORTA            1,336.00    1,336.00 34           HEART CATH
       3413754   CAC INTRO CATH BILI DRN         1,104.00             34           HEART CATH
       3411204   CAC INTRO CATH IVC /SVC           178.00             34           HEART CATH
       3417326   CAC INTRO CATH IVC /SVC           178.00             34           HEART CATH
       3417284   CAC INTRO CATH PULM             1,153.00             34           HEART CATH
       3417342   CAC INTRO CATH RENL PELV        2,248.00             34           HEART CATH
       3417383   CAC INTRO EXT ART                 145.00             34           HEART CATH
       3411303   CAC INTRO IVC FILTER            6,166.00             34           HEART CATH
       3419959   CAC INTRO IVC FILTER            6,166.00    6,166.00 34           HEART CATH
       3413853   CAC INTRO NEPHROSTOMY           1,233.00             34           HEART CATH
       3413804   CAC INTRO STENT CATH URET       2,098.00             34           HEART CATH
       3417128   CAC IVCH RETRIEVE FB              571.00             34           HEART CATH
       3413705   CAC IVUS NONCO ADD                300.00             34           HEART CATH
       3413655   CAC IVUS NONCO INI                600.00             34           HEART CATH
       3414547   CAC MECH REMOVE INTRACATH         700.00             34           HEART CATH
       3414539   CAC MECH REMOVE PERICATH        3,806.00             34           HEART CATH
       3418522   CAC MECH REMOVE PERICATH        3,806.00             34           HEART CATH
       3411154   CAC NEPHROSTOMY PERC            3,176.00             34           HEART CATH
       3417425   CAC NEPHROSTOMY TUBE CHNG         338.00             34           HEART CATH
       3410404   CAC PERC VERT AUG ADD VRT       2,207.00             34           HEART CATH



9/17/2012                                                                                                   34
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3412012   CAC PERICARDIOCEN SUBQ             178.00               34         HEART CATH
       3415700   CAC PERICARDIOCENT INI           6,199.00    6,199.00   34         HEART CATH
       3410412   CAC PRC VRT AUG LUMB 1VRT        4,413.00               34         HEART CATH
       3410420   CAC PRC VRT AUG THOR 1VRT        4,413.00               34         HEART CATH
       3418274   CAC PRM ART MTHROM               3,552.00               34         HEART CATH
       3418209   CAC PTA AORTIC                     732.00      732.00   34         HEART CATH
       3418506   CAC PTA BRACHIOCEPH EA           1,987.00    1,987.00   34         HEART CATH
       3418407   CAC PTA FEMPOP                     651.00      651.00   34         HEART CATH
       3418308   CAC PTA IL                       2,169.00               34         HEART CATH
       3412194   CAC PTA RENL VISC                1,005.00               34         HEART CATH
       3418100   CAC PTA RENL VISC                1,005.00    1,005.00   34         HEART CATH
       3417524   CAC PTA TIBEOPERONEAL EA         2,082.00               34         HEART CATH
       3410248   CAC PTATHER AORTIC               3,000.00               34         HEART CATH
       3410271   CAC PTATHER BRACH                4,000.00               34         HEART CATH
       3410214   CAC PTATHER FEM                  3,400.00               34         HEART CATH
       3412236   CAC PTATHER FEM                  3,400.00               34         HEART CATH
       3410263   CAC PTATHER IL                   3,000.00               34         HEART CATH
       3410230   CAC PTATHER RENL                 4,200.00               34         HEART CATH
       3412228   CAC PTATHER TIBIA                  968.00               34         HEART CATH
       3417813   CAC PULM ART L/R                 1,213.00    1,213.00   34         HEART CATH
       3413408   CAC PULM ART SEG SUB             4,612.00               34         HEART CATH
       3410305   CAC REMOVAL OF VEIN CLOT         1,388.00               34         HEART CATH
       3410354   CAC REMV RNL TUBE W/FLUOR          279.00               34         HEART CATH
       3411402   CAC REMV TUNN CV CATH W/O          495.00               34         HEART CATH
       3417540   CAC REMV TUNN CV CATH W/O          495.00               34         HEART CATH
       3412020   CAC REPO LD/PRIOR PACER            702.00               34         HEART CATH
       3413002   CAC REPR ELECT DUAL              8,500.00               34         HEART CATH
       3413556   CAC REPS PREV PLC CV CATH          780.00               34         HEART CATH
       3413309   CAC RMVL CARD EVNT RCDR            779.00               34         HEART CATH
       3413150   CAC RMVL PERM PACER GEN          5,153.00               34         HEART CATH
       3413259   CAC RMVL TV PACR ELC DUAL        1,503.00               34         HEART CATH
       3413200   CAC RMVL TV PACR ELC SNGL        1,082.00               34         HEART CATH
       3412053   CAC RPLC COMP TUN CV CATH          998.00               34         HEART CATH



9/17/2012                                                                                                    35
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3413101   CAC RVSN/REL POCKET/PACER        2,676.00             34           HEART CATH
       3411410   CAC SEC ART MTHROM ADD-ON        1,776.00             34           HEART CATH
       3413358   CAC SELECT CATH 1ST VEN            233.00             34           HEART CATH
       3417771   CAC SELECT CATH 2ND VEN            260.00      260.00 34           HEART CATH
       3418282   CAC STENT NOCORO/CAR/VERT        9,632.00             34           HEART CATH
       3418324   CAC STENT PLCE NONCOR ADD        3,244.00             34           HEART CATH
       3412202   CAC THORACENTESIS                2,000.00             34           HEART CATH
       3412004   CAC THORACENTESIS W TUBE         2,000.00             34           HEART CATH
       3418340   CAC THROMBECTOMY AVS FIST       11,699.00             34           HEART CATH
       3417144   CAC THROMBOLYSIS IV NONCO          561.00             34           HEART CATH
       3416062   CAC TRNCTH STNT CCA W/PRO        7,251.00             34           HEART CATH
       3416070   CAC TRNCTH STNT CCA WO/PR        6,985.00             34           HEART CATH
       3412855   CAC UPGRD PACE SNGL DUAL         8,257.00             34           HEART CATH
       3417706   CAC VEN ANAST PORT OPN           4,150.00    4,150.00 34           HEART CATH
       3411071   CAC VEN CATH BLOOD SAMPLE          301.00             34           HEART CATH
       3434453   CON GAD-BASE MR 1ML IJ              10.08             34           HEART CATH
       3434404   CON HOCM 250-299MG/ML 1ML            0.40             34           HEART CATH
       3434503   CON LOCM 200-249S I 1ML              0.76             34           HEART CATH
       3434354   CON LOCM 300-349S I 1ML              0.84             34           HEART CATH
       3434552   CON LOCM 300-349S I 1ML              3.32             34           HEART CATH
       3418175   IR EXCHNGE INTRAVAS CATH           314.00      314.00 34           HEART CATH
       3412285   IR VERTPLASTY EA FLUORO            851.00             34           HEART CATH
       3410107   IRC BX BONE DEEP                 1,134.00             34           HEART CATH
       3418514   IRC INSERT DIAL VEIN/VEIN          406.00             34           HEART CATH
       3417466   IRC PTA VEN                        666.00             34           HEART CATH
       3412277   IRC VERTEPLASTY ADD PRC            377.00             34           HEART CATH
       3412269   IRC VERTEPLASTY LUMB PRC         1,745.00             34           HEART CATH
       3412293   IRC VERTEPLASTY THOR PRC         1,996.00             34           HEART CATH
       3411006   RO BRACHY HI INT 1-4CATH         4,460.00             34           HEART CATH
       3411105   RO SIMULATION SMPL                 789.00             34           HEART CATH
       3417193   S CATH GUIDING                     257.00             34           HEART CATH
       3431509   S CATH GUIDING                     448.50             34           HEART CATH
       3431525   S CATH GUIDING                   1,719.00             34           HEART CATH



9/17/2012                                                                                                    36
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3434305   S CATH GUIDING                        287.00           34             HEART CATH
       3431491   S CATH GUIDING IV ANGIO                21.50           34             HEART CATH
       3431558   S CATH GUIDING ROTA BURR            4,047.50           34             HEART CATH
       3433554   S CATH HD/PERTNL LNG TRM            1,108.50           34             HEART CATH
       3431632   S CATH INFSN NO HD                    737.50           34             HEART CATH
       3434255   S CATH INFSN NO HD                    368.00           34             HEART CATH
       3431459   S CATH INTRAVASCULAR US             2,218.00           34             HEART CATH
       3431566   S CATH INTRAVASCULAR US                                34             HEART CATH
       3433307   S CATH OCCLUSION                      814.00           34             HEART CATH
       3470051   S CATH OCCLUSION                    1,144.50           34             HEART CATH
       3433257   S CATH THROMB/EMBOLCTMY               810.00           34             HEART CATH
       3433950   S CATH THROMB/EMBOLCTMY             1,470.00           34             HEART CATH
       3480100   S CATH THROMB/EMBOLCTMY               906.50           34             HEART CATH
       3434750   S CATH THROMB/EMBOLCTMY             1,911.00           34             HEART CATH
       3434800   S CATH THROMB/EMBOLCTMY             1,089.00           34             HEART CATH
       3431517   S CATH TRNSLML ATHR DIR             3,594.00           34             HEART CATH
       3433455   S CATH TRNSLML ATHR DIR             3,343.00           34             HEART CATH
       3433505   S CATH TRNSLML ATHR DIR             5,629.50           34             HEART CATH
       3441003   S CATH TRNSLML ATHR DIR             2,588.26           34             HEART CATH
       3431608   S CATH TRNSLML ATHR ROT             3,607.50           34             HEART CATH
       3431533   S CATH TRNSLMNL ANG LSR             4,282.50           34             HEART CATH
       3431541   S CATH TRNSLMNL ANG LSR             5,616.00           34             HEART CATH
       3434149   S CATH TRNSLMNL ANG LSR             4,307.00           34             HEART CATH
       3431202   S CATH TRNSML ANG NOLSR             2,771.50           34             HEART CATH
       3431251   S CATH TRNSML ANG NOLSR             1,090.50           34             HEART CATH
       3432564   S CATH TRNSML ANG NOLSR             1,239.50           34             HEART CATH
       3433000   S CATH TRNSML ANG NOLSR             1,007.50           34             HEART CATH
       3433059   S CATH TRNSML ANG NOLSR               927.00           34             HEART CATH
       3433109   S CATH TRNSML ANG NOLSR             1,496.50           34             HEART CATH
       3433158   S CATH TRNSML ANG NOLSR             1,068.50           34             HEART CATH
       3433208   S CATH TRNSML ANG NOLSR             1,153.00           34             HEART CATH
       3433356   S CATH TRNSML ANG NOLSR             2,113.00           34             HEART CATH
       3433653   S CATH TRNSML ANG NOLSR             4,313.00           34             HEART CATH



9/17/2012                                                                                                       37
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3434008   S CATH TRNSML ANG NOLSR              5,628.00             34           HEART CATH
       3480050   S CATH TRNSML ANG NOLSR              3,118.00             34           HEART CATH
       3431053   S DEVICE CLOSURE VASC                  814.50             34           HEART CATH
       3432705   S DEVICE CLOSURE VASC                  675.50             34           HEART CATH
       3433901   S DEVICE RETRIEVAL SNARE             1,108.50             34           HEART CATH
       3459260   S EVENT RECORDER CARDIAC             4,530.00             34           HEART CATH
       3432309   S FILTER VENA CAVA                   3,633.50             34           HEART CATH
       3432358   S FILTER VENA CAVA                   3,897.50             34           HEART CATH
       3432408   S FILTER VENA CAVA                   4,153.50             34           HEART CATH
       3432457   S FILTER VENA CAVA                   3,900.50             34           HEART CATH
       3451002   S FILTER VENA CAVA                   5,871.50             34           HEART CATH
       3460201   S FILTER VENA CAVA                   5,438.00             34           HEART CATH
       3433703   S GRAFT VASCULAR                     2,556.00             34           HEART CATH
       3411022   S INTR NOINTRACRD NOLSR                 25.00             34           HEART CATH
       3417177   S INTR NOINTRACRD NOLSR                252.50             34           HEART CATH
       3433406   S INTR NOINTRACRD NOLSR              1,128.50             34           HEART CATH
       3434602   S INTR NOINTRACRD NOLSR                368.00             34           HEART CATH
       3434651   S INTR NOINTRACRD NOLSR                525.00             34           HEART CATH
       3434701   S INTR NOINTRACRD NOLSR                144.00             34           HEART CATH
       3460300   S INTR NOINTRACRD NOLSR                312.00             34           HEART CATH
       3480159   S INTRO GDE FXD CRV NOPL               277.50             34           HEART CATH
       3432754   S INTRO GDE STRBLE NOPEEL              328.00             34           HEART CATH
       3432804   S INTRO GDE STRBLE NOPEEL              171.50             34           HEART CATH
       3432853   S INTRO GDE STRBLE NOPEEL              174.00             34           HEART CATH
       3410255   S PORT INDWELLING                    1,166.50             34           HEART CATH
       3434107   S SCRW HV-R BONE CEMENT                642.50             34           HEART CATH
       3433802   S STNT COATD WO DEL SYS              4,031.00             34           HEART CATH
       3470101   S STNT COATD WO DEL SYS              3,000.00             34           HEART CATH
       3470259   S STNT COATD WO DEL SYS                                   34           HEART CATH
       3431103   S STNT COATED WDEL SYS               4,710.50             34           HEART CATH
       3470309   S STNT COATED WDEL SYS               5,700.00             34           HEART CATH
       3417268   S STNT NOCOAT WDEL SYS               4,377.00    2,800.50 34           HEART CATH
       3431707   S STNT NOCOAT WDEL SYS               3,759.00             34           HEART CATH



9/17/2012                                                                                                        38
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3431756   S STNT NOCOAT WDEL SYS           4,039.00             34           HEART CATH
       3431806   S STNT NOCOAT WDEL SYS           4,070.50             34           HEART CATH
       3431855   S STNT NOCOAT WDEL SYS           4,330.50             34           HEART CATH
       3431905   S STNT NOCOAT WDEL SYS           2,874.00             34           HEART CATH
       3432002   S STNT NOCOAT WDEL SYS           4,157.00             34           HEART CATH
       3432051   S STNT NOCOAT WDEL SYS           4,832.50             34           HEART CATH
       3432101   S STNT NOCOAT WDEL SYS           5,178.50             34           HEART CATH
       3432150   S STNT NOCOAT WDEL SYS           4,486.00             34           HEART CATH
       3432200   S STNT NOCOAT WDEL SYS           4,815.50             34           HEART CATH
       3432259   S STNT NOCOAT WDEL SYS           5,335.00             34           HEART CATH
       3434222   S STNT NOCOAT WDEL SYS           4,990.00             34           HEART CATH
       3470150   S STNT NOCOAT WO DEL SYS         4,157.00             34           HEART CATH
       3470200   S STNT NOCOAT WO DEL SYS         3,811.00             34           HEART CATH
       3434065   S STRL BONE BIOPSY DEVICE          499.00             34           HEART CATH
       3434024   S STRL BONE FILLER DEVICE          422.50             34           HEART CATH
       3433851   S STRL CARDIAC BIOPSY FCP          800.50             34           HEART CATH
       3432606   S STRL CATHETER ANGIO              101.00             34           HEART CATH
       3432655   S STRL CATHETER CORONARY            50.00             34           HEART CATH
       3432556   S STRL CATHETER PERIPH             304.50             34           HEART CATH
       3432507   S STRL CATHETER VSLSIZING          155.00             34           HEART CATH
       3434040   S STRL CURETTE T-TIP               716.00             34           HEART CATH
       3434081   S STRL CURETTE WEDGE TIP           716.00             34           HEART CATH
       3433604   S STRL GALILEO CENT CATH         3,849.16             34           HEART CATH
       3417169   S STRL INTRA-AO BAL CATH         1,642.00    1,456.50 34           HEART CATH
       3434123   S STRL KYPHOPAK EXPANDER         4,107.60             34           HEART CATH
       3434164   S STRL KYPHOPAK EXPANDER         4,107.60             34           HEART CATH
       3434180   S STRL KYPHOPAK EXPR TRA         4,107.60             34           HEART CATH
       3431152   S SYS EMBLZTN PROTCTIVE          5,821.50             34           HEART CATH
       3434206   S SYS EMBLZTN PROTCTIVE          4,661.00             34           HEART CATH
       3434248   S WIRE GUIDE                     1,375.00             34           HEART CATH
       3460250   S WIRE GUIDE                       329.00             34           HEART CATH
       3432903   S WIRE GUIDE - PCI                 403.50             34           HEART CATH
       3411030   S WIRE GUIDE AMPLATZ SUPR          150.00             34           HEART CATH



9/17/2012                                                                                                    39
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3433752   S WIRE GUIDE ASAHI 300CM           636.00           34             HEART CATH
       3418266   S WIRE GUIDE DBLEND                103.50           34             HEART CATH
       3432952   S WIRE GUIDE DIAGNOSTIC             73.00           34             HEART CATH
       3417292   S WIRE GUIDE GLIDE WIRE            150.50           34             HEART CATH
       3460151   S WIRE GUIDE HCC AMPLATZ           443.00           34             HEART CATH
       3460102   S WIRE GUIDE HCC EXCHANGE          443.00           34             HEART CATH
       3431350   S WIRE GUIDE PRESSURE            1,829.50           34             HEART CATH
       3431301   S WIRE GUIDE PTCA                  424.50           34             HEART CATH
       3431657   S WIRE GUIDE ROTA                  640.00           34             HEART CATH
       3460052   S WIRE GUIDE TRANSEND            1,322.50           34             HEART CATH
       3416880   XR CS SAME MD ADD 15M               77.00           34             HEART CATH
       3416872   XR CS SAME MD GT5YR 0-30M          191.00           34             HEART CATH
       3416898   XR CS SAME MD LT5YR 0-30M          227.00           34             HEART CATH
       3512308   CA CARDIOVERSION INTERNAL        1,338.00           35             HEART INSTITUTE SERVICES
       3511078   CA CARDIOVERT ELCTVE EXT         1,393.00           35             HEART INSTITUTE SERVICES
       3514015   CA CS SAME MD ADD 15M               70.00           35             HEART INSTITUTE SERVICES
       3514007   CA CS SAME MD GT5YR 0-30M          176.00           35             HEART INSTITUTE SERVICES
       3512027   CA ELEC ANALYS ILR                  44.00           35             HEART INSTITUTE SERVICES
       3511201   CA EP 3D MAPPING                   609.00           35             HEART INSTITUTE SERVICES
       3511557   CA EP ABLTN AV NDE/CNDCTN       11,088.00           35             HEART INSTITUTE SERVICES
       3511607   CA EP ABLTN OF SVT              12,864.00           35             HEART INSTITUTE SERVICES
       3511656   CA EP ABLTN OF VT               11,505.00           35             HEART INSTITUTE SERVICES
       3511250   CA EP EVAL COMP W INDUCT         4,013.00           35             HEART INSTITUTE SERVICES
       3511243   CA EP EVAL COMP WO INDUCT        2,400.00           35             HEART INSTITUTE SERVICES
       3511458   CA EP EVAL ICD LEADS             1,881.00           35             HEART INSTITUTE SERVICES
       3511508   CA EP EVAL ICD LEADS/GEN         2,092.00           35             HEART INSTITUTE SERVICES
       3511516   CA EP EVAL PACING ICD            2,070.00           35             HEART INSTITUTE SERVICES
       3511300   CA EP EVAL W L ATR PACING        7,855.00           35             HEART INSTITUTE SERVICES
       3511359   CA EP EVAL W L VENT PACNG        5,540.00           35             HEART INSTITUTE SERVICES
       3511417   CA EP FOLLOW UP STUDY              922.00           35             HEART INSTITUTE SERVICES
       3511102   CA EP HIS BUNDLE RECORD            614.00           35             HEART INSTITUTE SERVICES
       3511755   CA EP IC ECHO W INTRVNTN         2,999.00           35             HEART INSTITUTE SERVICES
       3512167   CA EP ICD ANLYS DUAL               249.00           35             HEART INSTITUTE SERVICES



9/17/2012                                                                                                      40
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3512266   CA EP ICD ANLYS DUAL               249.00           35             HEART INSTITUTE SERVICES
       3512126   CA EP ICD ANLYS SNGL               190.00           35             HEART INSTITUTE SERVICES
       3512209   CA EP ICD ANLYS SNGL               190.00           35             HEART INSTITUTE SERVICES
       3512001   CA EP IND/TRM ARRHYTH PPM        1,145.00           35             HEART INSTITUTE SERVICES
       3513108   CA EP IND/TRM ARRHYTH PPM        1,145.00           35             HEART INSTITUTE SERVICES
       3512902   CA EP INDUCT ARR BY PACNG        1,241.00           35             HEART INSTITUTE SERVICES
       3511177   CA EP INTRA ATR PACING             552.00           35             HEART INSTITUTE SERVICES
       3512951   CA EP INTRA ATR RECORD             425.00           35             HEART INSTITUTE SERVICES
       3511193   CA EP INTRA VENT PACING            609.00           35             HEART INSTITUTE SERVICES
       3511151   CA EP MAP VENT/ATR TACHY         1,032.00           35             HEART INSTITUTE SERVICES
       3511409   CA EP PRG PCNG POST RX             955.00           35             HEART INSTITUTE SERVICES
       3512852   CA EP R VENT RECORD              2,602.00           35             HEART INSTITUTE SERVICES
       3511706   CA EP TILT TABLE TEST            1,336.00           35             HEART INSTITUTE SERVICES
       3512183   CA ICD DUAL W/REPROGRAM            249.00           35             HEART INSTITUTE SERVICES
       3512241   CA ICD DUAL W/REPROGRAM            249.00           35             HEART INSTITUTE SERVICES
       3512142   CA ICD SNGL W/REPROGRAM            227.00           35             HEART INSTITUTE SERVICES
       3512225   CA ICD SNGL W/REPROGRAM            227.00           35             HEART INSTITUTE SERVICES
       3512068   CA PACER ANLYS DL W/RPRG           189.00           35             HEART INSTITUTE SERVICES
       3512043   CA PACER ANLYS DUAL                145.00           35             HEART INSTITUTE SERVICES
       3512100   CA PACER ANLYS SGL W/RPRG          158.00           35             HEART INSTITUTE SERVICES
       3512084   CA PACER ANLYS SNGL                110.00           35             HEART INSTITUTE SERVICES
       3511037   CA PM INSERT                       416.00           35             HEART INSTITUTE SERVICES
       3511094   CA RHC/TS LHC INTCT SEP         11,101.00           35             HEART INSTITUTE SERVICES
       3511052   CA VENOGRAM EXT UNI                260.00           35             HEART INSTITUTE SERVICES
       3511003   CAC EP ARTERIAL CATH               564.00           35             HEART INSTITUTE SERVICES
       3510237   CAC EP INSRT TMP LDS DUAL        3,000.00           35             HEART INSTITUTE SERVICES
       3510500   CAC EP REPAIR SNGL LEAD            948.00           35             HEART INSTITUTE SERVICES
       3510971   CAC IMPLANT CARD EVNT RCD        3,022.00           35             HEART INSTITUTE SERVICES
       3511011   CAC INJ EXT VENOGRAM             1,687.00           35             HEART INSTITUTE SERVICES
       3510450   CAC INSERT ELECT DUAL            5,220.76           35             HEART INSTITUTE SERVICES
       3510401   CAC INSERT ELECT SNGL            2,979.66           35             HEART INSTITUTE SERVICES
       3510708   CAC INSERT LD PRIOR PACER          882.00           35             HEART INSTITUTE SERVICES
       3511854   CAC INSERT PAC GEN DUAL          9,688.00           35             HEART INSTITUTE SERVICES



9/17/2012                                                                                                      41
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3511805   CAC INSERT PAC GEN SNGL          9,022.00           35             HEART INSTITUTE SERVICES
       3510203   CAC INSERT PACER DUAL LDS        8,978.00           35             HEART INSTITUTE SERVICES
       3510302   CAC INSERT PACER GEN DUAL        6,026.00           35             HEART INSTITUTE SERVICES
       3510252   CAC INSERT PACER GEN SNGL        5,104.00           35             HEART INSTITUTE SERVICES
       3510229   CAC INSERT PACER TMP SNGL        2,456.00           35             HEART INSTITUTE SERVICES
       3510757   CAC INSERT PACER W 3RD LD        2,800.00           35             HEART INSTITUTE SERVICES
       3510153   CAC INSERT PACER/ELEC VNT        7,730.00           35             HEART INSTITUTE SERVICES
       3510104   CAC INSERT PACER/ELECATR         9,082.00           35             HEART INSTITUTE SERVICES
       3511953   CAC INSERT/REPO ELEC DUAL       19,027.00           35             HEART INSTITUTE SERVICES
       3511904   CAC INSERT/REPO ELEC SNGL       10,000.00           35             HEART INSTITUTE SERVICES
       3510351   CAC REPO LD/PRIOR PACER            702.00           35             HEART INSTITUTE SERVICES
       3510807   CAC REPO PRIOR LV LEAD             843.00           35             HEART INSTITUTE SERVICES
       3510559   CAC REPR ELECT DUAL              8,500.00           35             HEART INSTITUTE SERVICES
       3510955   CAC RMV ICD ELEC TV EXTRC        1,962.00           35             HEART INSTITUTE SERVICES
       3510906   CAC RMV ICD PACING GEN SQ        4,531.00           35             HEART INSTITUTE SERVICES
       3510997   CAC RMVL CARD EVNT RCDR            779.00           35             HEART INSTITUTE SERVICES
       3510856   CAC RMVL PERM PACER GEN          5,153.00           35             HEART INSTITUTE SERVICES
       3512282   CAC RMVL PERM PACER GEN          5,153.00           35             HEART INSTITUTE SERVICES
       3510872   CAC RMVL TV PACR ELC DUAL        1,503.00           35             HEART INSTITUTE SERVICES
       3510864   CAC RMVL TV PACR ELC SNGL        1,082.00           35             HEART INSTITUTE SERVICES
       3510658   CAC RVSN PCKT PACING ICD         3,420.00           35             HEART INSTITUTE SERVICES
       3510609   CAC RVSN/REL POCKET/PACER        2,676.00           35             HEART INSTITUTE SERVICES
       3510328   CAC UPGRD PACE SNGL DUAL         8,257.00           35             HEART INSTITUTE SERVICES
       3536208   CON LOCM 300-349S I 1ML              0.84           35             HEART INSTITUTE SERVICES
       3532306   S CATH EP ABLTN 3D VCT MP        1,604.00           35             HEART INSTITUTE SERVICES
       3532314   S CATH EP ABLTN 3D VCT MP        1,120.00           35             HEART INSTITUTE SERVICES
       3533205   S CATH EP ABLTN 3D VCT MP        5,000.00           35             HEART INSTITUTE SERVICES
       3533213   S CATH EP ABLTN 3D VCT MP        5,990.00           35             HEART INSTITUTE SERVICES
       3533007   S CATH EP ABLTN NOCOOL           4,474.50           35             HEART INSTITUTE SERVICES
       3533015   S CATH EP ABLTN NOCOOL           3,207.50           35             HEART INSTITUTE SERVICES
       3533304   S CATH EP ABLTN NOCOOL           2,405.50           35             HEART INSTITUTE SERVICES
       3533312   S CATH EP ABLTN NOCOOL           2,999.00           35             HEART INSTITUTE SERVICES
       3533320   S CATH EP ABLTN NOCOOL           3,849.00           35             HEART INSTITUTE SERVICES



9/17/2012                                                                                                      42
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3532009   S CATH EP DX NO3D LT20                 877.00           35             HEART INSTITUTE SERVICES
       3532017   S CATH EP DX NO3D LT20               2,005.00           35             HEART INSTITUTE SERVICES
       3532108   S CATH EP DX NO3D LT20               2,085.00           35             HEART INSTITUTE SERVICES
       3532207   S CATH EP DX NO3D LT20               2,566.00           35             HEART INSTITUTE SERVICES
       3532223   S CATH EP DX NO3D LT20               1,399.50           35             HEART INSTITUTE SERVICES
       3532215   S CATH EP DX NO3D MP GT19            4,201.50           35             HEART INSTITUTE SERVICES
       3533106   S CATH EP DXABLTN COOL TP            3,528.50           35             HEART INSTITUTE SERVICES
       3531076   S CATH GUIDING                         793.50           35             HEART INSTITUTE SERVICES
       3531068   S CATH OCCLUSION                     1,224.50           35             HEART INSTITUTE SERVICES
       3535150   S CATH OCCLUSION LASER               4,300.00           35             HEART INSTITUTE SERVICES
       3535101   S DEVICE RETRIEVAL LASER             1,287.50           35             HEART INSTITUTE SERVICES
       3551082   S EVENT RECORDER CARDIAC             7,550.00           35             HEART INSTITUTE SERVICES
       3550225   S ICD DUAL CHAMBER                  29,047.70           35             HEART INSTITUTE SERVICES
       3550258   S ICD DUAL CHAMBER                  24,750.00           35             HEART INSTITUTE SERVICES
       3550316   S ICD DUAL CHAMBER                  28,497.70           35             HEART INSTITUTE SERVICES
       3550324   S ICD DUAL CHAMBER                  25,110.00           35             HEART INSTITUTE SERVICES
       3550613   S ICD OTHR THAN SNGL/DL             29,782.50           35             HEART INSTITUTE SERVICES
       3550621   S ICD OTHR THAN SNGL/DL             34,353.00           35             HEART INSTITUTE SERVICES
       3550233   S ICD SNGL CHAMBER                  24,484.53           35             HEART INSTITUTE SERVICES
       3550415   S ICD SNGL CHAMBER                  28,494.70           35             HEART INSTITUTE SERVICES
       3550423   S ICD SNGL CHAMBER                  18,832.00           35             HEART INSTITUTE SERVICES
       3550217   S IMP GEN DL CH ICD+1 GUI           28,785.17           35             HEART INSTITUTE SERVICES
       3551009   S IMP LEAD ARRAY                     5,400.00           35             HEART INSTITUTE SERVICES
       3534518   S INTR NOINTRACRD NOLSR                 53.00           35             HEART INSTITUTE SERVICES
       3534500   S INTRO GDE FXD CRV NOPL               654.50           35             HEART INSTITUTE SERVICES
       3531043   S INTRO GDE FXD CRV PLAWY              702.00           35             HEART INSTITUTE SERVICES
       3531050   S INTRO GDE FXD CRV PLAWY            3,191.50           35             HEART INSTITUTE SERVICES
       3551041   S LD ICD ENDOCRD 2 COIL              8,400.00           35             HEART INSTITUTE SERVICES
       3551025   S LD PCR NO TV SNGL PAS              1,856.25           35             HEART INSTITUTE SERVICES
       3551074   S LD PCR TV VDD 1 PASS                 378.00           35             HEART INSTITUTE SERVICES
       3551033   S LD PCR/ICD COMBO                   5,116.00           35             HEART INSTITUTE SERVICES
       3551058   S LD VENT CORO VEN SYS LT            7,980.00           35             HEART INSTITUTE SERVICES
       3551066   S LD VENT CORO VEN SYS LT            7,980.00           35             HEART INSTITUTE SERVICES



9/17/2012                                                                                                          43
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3534559   S ORTHO EPC SHLDR IMMOBLZ           52.00           35             HEART INSTITUTE SERVICES
       3550118   S PCR 1 CHMBR NRR                8,298.00           35             HEART INSTITUTE SERVICES
       3550126   S PCR 1 CHMBR NRR                6,474.00           35             HEART INSTITUTE SERVICES
       3550019   S PCR 2 CHMBR NRR                9,438.00           35             HEART INSTITUTE SERVICES
       3550027   S PCR 2 CHMBR NRR                8,274.00           35             HEART INSTITUTE SERVICES
       3550514   S PCR NOT 1 OR 2 CHMBR          13,090.00           35             HEART INSTITUTE SERVICES
       3550522   S PCR NOT 1 OR 2 CHMBR          11,825.00           35             HEART INSTITUTE SERVICES
       3536059   S STRL EPC GEN TORQ WREN           123.00           35             HEART INSTITUTE SERVICES
       3536158   S STRL EPC LEAD PLACE SHE          330.50           35             HEART INSTITUTE SERVICES
       3536109   S STRL EPC LEAD TEST CABL          205.00           35             HEART INSTITUTE SERVICES
       3535002   S STRL EPC RAD PAD                 173.00           35             HEART INSTITUTE SERVICES
       3534005   S STRL EPC STL SLEEVE120"           70.00           35             HEART INSTITUTE SERVICES
       3535051   S STRL IV ANGIO CATH INST           21.50           35             HEART INSTITUTE SERVICES
       3535259   S STRL LASER LEAD ACCESS           389.00           35             HEART INSTITUTE SERVICES
       3535200   S STRL LEAD CUTTER                 551.00           35             HEART INSTITUTE SERVICES
       3552056   S STRL MICROPUNCTURE SET           277.50           35             HEART INSTITUTE SERVICES
       3531019   S STRL TUNNELING TOOL            1,604.00           35             HEART INSTITUTE SERVICES
       3552007   S WIRE GUIDE EPC                   150.50           35             HEART INSTITUTE SERVICES
       3536000   S WIRE GUIDE PTCA                  424.50           35             HEART INSTITUTE SERVICES
       3512811   XR CS SAME MD ADD 15M               77.00           35             HEART INSTITUTE SERVICES
       3512803   XR CS SAME MD GT5YR 0-30M          191.00           35             HEART INSTITUTE SERVICES
       3512829   XR CS SAME MD LT5YR 0-30M          227.00           35             HEART INSTITUTE SERVICES
       9553603   BLOOD TRANSFUSN 2-4 HR             731.00           95             INFUSION SERVICES
       9553652   BLOOD TRANSFUSN 4-6 HR           1,149.00           95             INFUSION SERVICES
       9553702   BLOOD TRANSFUSN GT 6HR           1,414.00           95             INFUSION SERVICES
       9553009   BLOOD TRANSFUSN LT 2 HR            418.00           95             INFUSION SERVICES
       9552621   CHEM HORMON ANTINEO SQ/IM          146.00           95             INFUSION SERVICES
       9552639   CHEM IVP EA ADDL DRG               108.00           95             INFUSION SERVICES
       9552654   CHEM IVP SNGL/INIT DRG             162.00           95             INFUSION SERVICES
       9552605   CHEM NO-HORM ANTNEO SQ/IM          146.00           95             INFUSION SERVICES
       9554007   DECLOT VASC DEVICE                 260.00           95             INFUSION SERVICES
       9552019   HYDRATION INFSN 0-60MN             378.00           95             INFUSION SERVICES
       9552027   HYDRATN INFSN ADD HR 8MX           210.00           95             INFUSION SERVICES



9/17/2012                                                                                                      44
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       9552555   INFSN W/MED ADD HR 8 MX                210.00           95             INFUSION SERVICES
       9552035   INFSN W/MED ADD SEQ 0-60M                               95             INFUSION SERVICES
       9552001   INFUSION W/MED 0-60MN                  378.00           95             INFUSION SERVICES
       9552803   INFUSN CHEMO 0-60 MN                   359.00           95             INFUSION SERVICES
       9571001   INFUSN CHEMO 0-60 MN                   359.00           95             INFUSION SERVICES
       9552811   INFUSN CHEMO EA ADD HR                 211.00           95             INFUSION SERVICES
       9571209   INFUSN CHEMO EA ADD HR                 211.00           95             INFUSION SERVICES
       9552043   INJ IVP ADDL SEQ NEW DRG                                95             INFUSION SERVICES
       9552852   INJ IVP SNGL/INIT DRG                   84.00           95             INFUSION SERVICES
       9553751   INJECTION IM/SQ EA                     106.00           95             INFUSION SERVICES
       9553900   INS PICC W/O PORT 5+ YR                895.00           95             INFUSION SERVICES
       9553850   INS PICC W/O PORT LT 5 YR              918.00           95             INFUSION SERVICES
       9550609   LEVEL 1 EST PATIENT                    132.00           95             INFUSION SERVICES
       9552704   LEVEL 2 EST PATIENT                    347.00           95             INFUSION SERVICES
       9552753   LEVEL 3 EST PATIENT                    382.00           95             INFUSION SERVICES
       9557802   LEVEL 4 EST PATIENT                    417.00           95             INFUSION SERVICES
       9553959   NI US VASC ACCESS ADD ON               104.00           95             INFUSION SERVICES
       9553967   NI US VASC ACCESS ADD ON               104.00           95             INFUSION SERVICES
       9553801   PHLEBOTOMY THERAPEUTIC                 258.00           95             INFUSION SERVICES
       9554056   REMV TUNN CV CATH W/O PT               274.00           95             INFUSION SERVICES
       9530056   S STRL ANGIO CATHETER #2                10.50           95             INFUSION SERVICES
       9530106   S STRL ANGIO CATHETER #2                10.50           95             INFUSION SERVICES
       9530155   S STRL ANGIO CATHETER #2                10.50           95             INFUSION SERVICES
       9530304   S STRL BLOOD TUBING                     14.50           95             INFUSION SERVICES
       9530858   S STRL GROSHONG REPAIR K               214.50           95             INFUSION SERVICES
       9531104   S STRL LIFEPORT/PORTACAT                43.00           95             INFUSION SERVICES
       9531153   S STRL LIFEPORT/PORTACAT                43.00           95             INFUSION SERVICES
       9531005   S STRL PICC LANDMARK CAT               121.00           95             INFUSION SERVICES
       9531054   S STRL PICC PER Q CATH                 234.50           95             INFUSION SERVICES
       9550559   VENIPUNCTURE                             9.00           95             INFUSION SERVICES
       4061966                                                           40             LAB
       4095139   11 DEOXYCORTICOSTERONE                  55.00           40             LAB
       4093985   11 DEOXYCORTISOL                        36.00           40             LAB



9/17/2012                                                                                                        45
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4080065   17 OH CORTICOSTERIODS              20.00              40          LAB
       4093613   17 OH CORTICOSTERIODS              33.50              40          LAB
       4094983   17 OH PREGNENOLONE                 31.30              40          LAB
       4080057   17 OH PROGESTRONE                 199.00              40          LAB
       4091104   17 OH PROGESTRONE                  20.35              40          LAB
       4096384   17 OH PROGESTRONE                  24.75              40          LAB
       4080222   18-HYDROXYCORTICOSTERONE           55.00              40          LAB
       4081303   21-HYDROXYLASE ANTIBODY            96.30              40          LAB
       4096947   5 HIAA UR                          24.00              40          LAB
       4099404   5 HIAA UR                          13.50              40          LAB
       4099412   5 NUCLEOTIDASE                     52.61              40          LAB
       4016192   AB ELUTION                        126.00              40          LAB
       4016358   AB ID                             222.00     222.00   40          LAB
       4016093   AB SCRN                           126.00     126.00   40          LAB
       4016234   AB SCRN                           126.00     126.00   40          LAB
       4016333   AB TTR                             55.00      55.00   40          LAB
       4016176   ABO TYP                            33.00      33.00   40          LAB
       4017018   ACE (ANGIOTN CONVR ENZ)            29.00              40          LAB
       4091286   ACE (ANGIOTN CONVR ENZ)            15.50              40          LAB
       4099420   ACE (ANGIOTN CONVR ENZ)            15.00              40          LAB
       4011292   ACETAMINOPHEN                     214.00     214.00   40          LAB
       4011318   ACETAMINOPHEN                     214.00     214.00   40          LAB
       4095055   ACETYLCHOLINE BLK AB               46.16              40          LAB
       4098869   ACETYLCHOLINE MODULE AB            59.69              40          LAB
       4094231   ACETYLCHOLINE RECEPT AB            46.16              40          LAB
       4013454   ACID PHOS PROSTATIC               116.00     116.00   40          LAB
       4099438   ACID PHOS PROSTATIC                12.00              40          LAB
       4016853   ACTH                              204.00     204.00   40          LAB
       4091088   ACTH                               25.00              40          LAB
       4010591   ACTIVATED CLOTTING TIME            44.00      44.00   40          LAB
       4080651   ACYLCARNITINES QN EA              130.00              40          LAB
       4098588   ACYLCARNITINES QN EA               86.00              40          LAB
       4099453   ADENO ENTERIC 40/41 EIA            25.96              40          LAB



9/17/2012                                                                                                   46
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4093159   ADENOVIRUS AB                          24.00              40          LAB
       4093316   ADENOVIRUS DFA                         28.00              40          LAB
       4094264   ADH (VASOPRESSIN)                      63.00              40          LAB
       4094363   ADRENAL AB SCRN                        33.50              40          LAB
       4012233   AFB CULT                              115.00     115.00   40          LAB
       4081121   AFB CULT                               75.00              40          LAB
       4081204   AFB CULT                               75.00              40          LAB
       4091385   AFB CULT                               37.00              40          LAB
       4091971   AFB CULT                               37.00              40          LAB
       4097853   AFB CULT                               48.50              40          LAB
       4012159   AFB CULT                              115.00     115.00   40          LAB
       4097895   AFB CULT BLD                           48.50              40          LAB
       4090064   AFP AMNIOTIC FLD                       40.00              40          LAB
       4016895   AFP MATERNAL                                              40          LAB
       4016879   AFP TUMOR MARKER                      178.00              40          LAB
       4096327   AFP TUMOR MARKER                       71.00              40          LAB
       4099461   AFP TUMOR MARKER                       14.80              40          LAB
       4017257   AG DETECT EIA MULT STEP               126.00     126.00   40          LAB
       4017273   AG DETECT EIA MULT STEP               126.00     126.00   40          LAB
       4093670   AG DETECT EIA MULT STEP                35.00              40          LAB
       4080149   AG DETECT NOS DNA AMP                  95.00              40          LAB
       4080206   AG DETECT NOS DNA AMP                 115.00              40          LAB
       4080313   AG DETECT NOS DNA AMP                 292.50              40          LAB
       4080867   AG DETECT NOS DNA AMP                 250.00              40          LAB
       4081543   AG DETECT NOS DNA AMP                 194.00              40          LAB
       4093522   AG DETECT NOS DNA AMP                 292.50              40          LAB
       4097671   AG DETECT NOS DNA AMP                 165.00              40          LAB
       4099479   AG DETECT NOS DNA AMP                 170.50              40          LAB
       4099487   AG DETECT NOS DNA AMP                 130.00              40          LAB
       4099495   AG DETECT NOS DNA AMP                  85.00              40          LAB
       4010484   AG SCRN PER UNIT PT SPEC               40.00              40          LAB
       4010526   AG SCRN PER UNIT RGNT                  40.00              40          LAB
       4016291   AG TYP PT RBC EA                       41.00      41.00   40          LAB



9/17/2012                                                                                                       47
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4016390   AG TYP PT RBC EA                       41.00      41.00 40            LAB
       4012977   ALBUMIN                                52.00      52.00 40            LAB
       4096913   ALBUMIN                                 6.61            40            LAB
       4096921   ALBUMIN FLD                            24.00            40            LAB
       4097184   ALBUMIN FLD                            55.00            40            LAB
       4010716   ALCOHOL (ETHANOL)                     115.00     115.00 40            LAB
       4010732   ALCOHOL (ETHANOL)                     115.00     115.00 40            LAB
       4099180   ALCOHOL (ETHANOL)                      26.50            40            LAB
       4010187   ALCOHOL (ETHANOL) UR                  115.00            40            LAB
       4099131   ALCOHOL (ETHANOL) UR                   23.50            40            LAB
       4097713   ALDOLASE                               10.50            40            LAB
       4016911   ALDOSTERONE                            29.00      29.00 40            LAB
       4096335   ALDOSTERONE UR 24HR                    55.70            40            LAB
       4096434   ALK PHOS ISOENZYMES                    20.00            40            LAB
       4013439   ALK PHOSPHATASE                        55.00      55.00 40            LAB
       4096954   ALK PHOSPHATASE                        24.00            40            LAB
       4080669   ALLERGEN SPECIFIC IGE QN               14.00            40            LAB
       4092953   ALLERGEN SPECIFIC IGE QN               20.00            40            LAB
       4094652   ALLERGEN SPECIFIC IGE QN                8.00            40            LAB
       4094991   ALLERGEN SPECIFIC IGE QN               35.00            40            LAB
       4097804   ALLERGEN SPECIFIC IGG QN               24.00            40            LAB
       4016903   ALPHA 1 ANTITRYPSIN                    31.00      31.00 40            LAB
       4090890   ALPHA 1 ANTITRYPSIN                    57.00            40            LAB
       4091120   ALPHA 1 ANTITRYPSIN                    13.25            40            LAB
       4080560   ALPHA 2 ANTIPLASMIN                    50.50            40            LAB
       4013538   ALT (SGPT)                             55.00      55.00 40            LAB
       4091310   ALT (SGPT)                             22.00            40            LAB
       4081972   ALUMINIUM                              47.00            40            LAB
       4016952   ALUMINUM                               18.50            40            LAB
       4093092   AMEBIC AB                              23.00            40            LAB
       4016978   AMIKACIN                               16.00            40            LAB
       4090866   AMIKACIN PK                            15.00            40            LAB
       4090858   AMIKACIN TR                            15.00            40            LAB



9/17/2012                                                                                                       48
                                          69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4099172   AMINO ACID BLD QNT 2-5               75.50              40          LAB
       4082103   AMINO ACIDS CSF >5 QN               171.00              40          LAB
       4093134   AMINO ACIDS MULT QL                  23.50              40          LAB
       4091161   AMINO ACIDS PLAS >5 QN              104.00              40          LAB
       4090569   AMINO ACIDS SGL QN                   77.00              40          LAB
       4094611   AMINO ACIDS UR >5 QN                149.00              40          LAB
       4093597   AMIODARONE                           33.50              40          LAB
       4017836   AMITRIPTYLINE                        25.00      25.00   40          LAB
       4012993   AMMONIA                             154.00     154.00   40          LAB
       4098406   AMMONIA                              13.00              40          LAB
       4017752   AMPHETAMINE QN                       97.50              40          LAB
       4081154   AMPHETAMINE QN                       31.00              40          LAB
       4011037   AMPHETAMINE SCRN                    109.00     109.00   40          LAB
       4011078   AMPHETAMINE SCRN                    109.00     109.00   40          LAB
       4095964   AMPHETAMINE SCRN                     69.00              40          LAB
       4099214   AMPHETAMINE SCRN                      5.00              40          LAB
       4013017   AMYLASE                             193.00     193.00   40          LAB
       4080172   AMYLASE                               8.00              40          LAB
       4097960   AMYLASE FLD                         199.00              40          LAB
       4014031   AMYLASE UR 2HR                      151.00     151.00   40          LAB
       4013033   AMYLASE UR RAN                      107.00     107.00   40          LAB
       4010229   AMYLASE UR TIM                      120.00              40          LAB
       4016994   ANA (ANTI NUCLEAR AB)                64.50              40          LAB
       4091245   ANA (ANTI NUCLEAR AB)                 8.00              40          LAB
       4096780   ANA (ANTI NUCLEAR AB)                79.00              40          LAB
       4099503   ANA (ANTI NUCLEAR AB)                42.00              40          LAB
       4098711   ANA TTR                              47.00              40          LAB
       4099040   ANA TTR                              10.00              40          LAB
       4019428   ANCA NEUT CYTO AB SCRN              112.50              40          LAB
       4094942   ANDROSTENEDIONE                      29.75              40          LAB
       4082004   ANGIOTENSION II                      95.00              40          LAB
       4018016   ANTI DNA DBL STRAND                  35.00      69.00   40          LAB
       4091328   ANTI DNA DBL STRAND                  18.50              40          LAB



9/17/2012                                                                                                     49
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4017034   ANTI DNA SINGL STRAND                  69.50            40            LAB
       4096483   ANTI PARIETAL CELLS AB                 26.00            40            LAB
       4098000   ANTI RNP AB                            18.00            40            LAB
       4091146   ANTINEUTROPHILIC AB                    37.00            40            LAB
       4091401   ANTINEUTROPHILIC AB                    17.50            40            LAB
       4098075   ANTIRETICULIN AB W/RFX                 15.00            40            LAB
       4091278   APOLIPOPROTEIN A1                      54.00            40            LAB
       4092938   APOLIPOPROTEIN A1                      18.00            40            LAB
       4093431   APOLIPOPROTEIN A1                      30.00            40            LAB
       4092995   APOLIPOPROTEIN B                       21.50            40            LAB
       4091682   ARSENIC BLD                            19.00            40            LAB
       4093738   ARSENIC UR                             10.00            40            LAB
       4094033   ARSENIC UR                              8.00            40            LAB
       4099511   ARSENIC UR                             10.00            40            LAB
       4094058   ASCORBIC ACID                          51.00            40            LAB
       4096798   ASO SCRN                               24.00            40            LAB
       4015830   ASO TTR                                77.00      77.00 40            LAB
       4091724   ASO TTR                                 9.44            40            LAB
       4018693   ASPERGILLUS AB                        108.00      61.00 40            LAB
       4096491   ASPERGILLUS AB                          6.17            40            LAB
       4013496   AST (SGOT)                             55.00      55.00 40            LAB
       4010666   AT PS                                 137.00            40            LAB
       4091435   AT3 ACTIVITY                           73.00            40            LAB
       4091484   AT3 ACTIVITY                           19.00            40            LAB
       4091526   AT3 AG IMMUNOLOGIC                     26.00            40            LAB
       4090619   B CELLS TOTAL CNT                      37.00            40            LAB
       4097093   B PERTUSSIS/PARAPERT DFA               18.00            40            LAB
       4097606   BABESIA AB 1GG                         30.00            40            LAB
       4097614   BABESIA AB IGM                         30.00            40            LAB
       4011573   BACTERIAL AG EA AG                    107.00            40            LAB
       4090874   BACTERIAL AG EA AG                     42.00            40            LAB
       4097481   BACTERIAL AG EA AG                     97.00            40            LAB
       4099529   BACTERIAL AG EA AG                      8.00            40            LAB



9/17/2012                                                                                                       50
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4099537   BACTERIAL AG EA AG                      30.21              40          LAB
       4081071   BARBITURATES QN                         30.00              40          LAB
       4011136   BARBITURATES SCRN                       38.00      38.00   40          LAB
       4099222   BARBITURATES SCRN                        5.00              40          LAB
       4092201   BARTONELLA AB                            6.02              40          LAB
       4019238   BASIC METABOLIC PNL                     90.00      90.00   40          LAB
       4011151   BENZODIAZEPINE SCRN                     38.00      38.00   40          LAB
       4098836   BENZODIAZEPINE SCRN                     72.00              40          LAB
       4092367   BENZODIAZEPINES                         40.30              40          LAB
       4099545   BENZODIAZEPINES                         16.50              40          LAB
       4099552   BENZODIAZEPINES                         48.22              40          LAB
       4099560   BENZODIAZEPINES                         69.30              40          LAB
       4099271   BENZOYLECGONINE SCRN                     5.00              40          LAB
       4090916   BETA 2 GLYCOPROTN I AB EA               27.25              40          LAB
       4098745   BETA 2 GLYCOPROTN I AB EA               77.00              40          LAB
       4099578   BETA 2 GLYCOPROTN I AB EA               27.25              40          LAB
       4016713   BETA HCG QL                             80.00      80.00   40          LAB
       4016770   BETA HCG QN                            159.00     159.00   40          LAB
       4091039   BETA HCG QN                             39.00              40          LAB
       4092797   BETA HCG QN                             14.30              40          LAB
       4017059   BETA2 MICROGLOBULIN                     33.00              40          LAB
       4091807   BETA2 MICROGLOBULIN                     19.95              40          LAB
       4091336   B-HEXOSAMINIDASE EA ASSAY               90.56              40          LAB
       4019964   BILE ACIDS TOTAL                        38.50              40          LAB
       4013173   BILIRUBIN DIRECT                        52.00      52.00   40          LAB
       4013181   BILIRUBIN NEONATAL                      52.00      52.00   40          LAB
       4091294   BILIRUBIN TOTAL                         19.35              40          LAB
       4098059   BILIRUBIN TOTAL                         52.00              40          LAB
       4080883   BIOTINIDASE ASSAY                       54.00              40          LAB
       4091450   BIOTINIDASE ASSAY                       18.83              40          LAB
       4092987   BLASTOMYCES AB                          21.00              40          LAB
       4090338   BLD CNT RBC AUTO                         2.00              40          LAB
       4093050   BLD FATTY ACIDS                         22.50              40          LAB



9/17/2012                                                                                                        51
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4015012   BLD GAS CORD ART                       206.00     206.00 40            LAB
       4010294   BLD SMR EXAM W MAN DIFF                 36.00      36.00 40            LAB
       4010146   BLD SMR EXAM WO MAN DIFF                36.00            40            LAB
       4010674   BLEEDING TIME TEST                      47.00      47.00 40            LAB
       4081139   BORDETELLA AB                           45.00            40            LAB
       4081378   BORDETELLA AB                           60.00            40            LAB
       4097077   BORDETELLA AB                           29.50            40            LAB
       4081063   BORELLIA BURG AMP PRB                  150.00            40            LAB
       4097879   BORELLIA BURG AMP PRB                  125.00            40            LAB
       4091765   BORRELIA BURGD CONF                     23.00            40            LAB
       4094520   BORRELIA BURGD CONF                     44.00            40            LAB
       4099586   BORRELIA BURGD CONF                     68.00            40            LAB
       4097994   BRUCELLA AB                             13.00            40            LAB
       4096426   B-TYP NATRIURETIC PEPTIDE              171.00            40            LAB
       4013058   BUN                                     41.00            40            LAB
       4093944   BUPROPION                               46.00            40            LAB
       4018255   C DIF TOX BY TISSUE CULT               208.00     208.00 40            LAB
       4080925   C DIFFICILE TOXIN EIA                   18.00            40            LAB
       4019360   C PEPTIDE                              102.00            40            LAB
       4092565   C PEPTIDE                               21.00            40            LAB
       4019162   C REACTIVE PROTEIN                      32.00            40            LAB
       4092607   C REACTIVE PROTEIN                      11.00            40            LAB
       4096806   C REACTIVE PROTEIN                      22.00            40            LAB
       4091989   C1 EST INHIB PROTEIN QNT                17.00            40            LAB
       4096467   C1 ESTERASE INHIBITOR                   17.00            40            LAB
       4019345   CA 125                                 110.50            40            LAB
       4091963   CA 125                                  12.00            40            LAB
       4096848   CA 125                                  87.00            40            LAB
       4019378   CA 15 3 (27.29)                         38.00            40            LAB
       4092045   CA 15 3 (27.29)                         28.90            40            LAB
       4092854   CA 15 3 (27.29)                         15.10            40            LAB
       4092003   CA 19 9                                 15.30            40            LAB
       4091153   CADMIUM                                 51.00            40            LAB



9/17/2012                                                                                                        52
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4091468   CADMIUM                             12.80              40          LAB
       4093555   CADMIUM                             30.00              40          LAB
       4094157   CADMIUM                             10.00              40          LAB
       4099123   CAFFEINE                            37.80              40          LAB
       4080545   CALC ANALYSIS INFARED               25.00              40          LAB
       4093415   CALCITONIN                          27.50              40          LAB
       4013215   CALCIUM                             55.00      55.00   40          LAB
       4090106   CALCIUM                              4.00              40          LAB
       4091476   CALCIUM                             10.00              40          LAB
       4010401   CALCIUM FLD                         55.00              40          LAB
       4015392   CALCIUM IONIZED                    145.00     145.00   40          LAB
       4096699   CALCIUM IONIZED                     15.00              40          LAB
       4013876   CALCIUM UR 24HR                     63.00      63.00   40          LAB
       4092615   CALCIUM UR 24HR                      4.00              40          LAB
       4010021   CALCIUM UR RAN                      63.00              40          LAB
       4097721   CALCIUM UR RAN                      24.00              40          LAB
       4098653   CAMPLYOBACTER AB                    63.00              40          LAB
       4097523   CANDIDA AB                          15.00              40          LAB
       4017794   CANNABINOID SCRN                    45.00      45.00   40          LAB
       4080370   CANNABINOID SCRN                     5.00              40          LAB
       4096897   CANNABINOID SCRN                    35.05              40          LAB
       4091237   CAPILLARY PUNCTURE                  11.00              40          LAB
       4010260   CAPILLARY PUNCTURE                  11.00              40          LAB
       4098489   CARBAMAZEPINE FREE                  45.50              40          LAB
       4010245   CARBAMAZEPINE TOTAL                154.00              40          LAB
       4011235   CARBAMAZEPINE TOTAL                 17.50      17.50   40          LAB
       4080875   CARBO DEF TRANSFERRIN              120.00              40          LAB
       4015095   CARBON MONOXIDE                    132.00     132.00   40          LAB
       4099206   CARBON MONOXIDE                     56.50              40          LAB
       4017133   CARDIOLIPIN AB                      78.00      78.00   40          LAB
       4092128   CARDIOLIPIN AB                      30.00              40          LAB
       4092011   CARDIOLIPIN IGA AB                  17.50              40          LAB
       4092029   CARDIOLIPIN IGG AB                  17.50              40          LAB



9/17/2012                                                                                                    53
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4092037   CARDIOLIPIN IGM AB                      17.50              40          LAB
       4080644   CARNITINE FREE & TOTAL                 125.00              40          LAB
       4092169   CARNITINE FREE & TOTAL                  33.00              40          LAB
       4093191   CAROTENE                                26.00              40          LAB
       4019709   CATECHOL FRAC PLAS                      36.00              40          LAB
       4093902   CATECHOL FRAC PLAS                      44.50              40          LAB
       4097739   CATECHOL FRAC UR                        27.50              40          LAB
       4090502   CATECHOLAMINES TOTAL UR                 27.06              40          LAB
       4010443   CBC AUTO                               105.00      30.00   40          LAB
       4010450   CBC AUTO                                69.00      69.00   40          LAB
       4010419   CBC AUTO W AUTO DIFF WBC                98.00      98.00   40          LAB
       4099594   CCP AB IGG                              45.00              40          LAB
       4017158   CEA                                     39.50      39.50   40          LAB
       4092243   CEA                                     10.63              40          LAB
       4096277   CEA                                     79.00              40          LAB
       4099602   CEA                                     41.00              40          LAB
       4010112   CELL CNT FLD W/ DIFF                    58.00      58.00   40          LAB
       4081709   CELL MARKR INTERPRET 16+                20.00              40          LAB
       4095428   CELL MARKR INTERPRET 2-8                85.00              40          LAB
       4092052   CELL MARKR INTERPRET 2-8                96.00              40          LAB
       4095469   CELL MARKR INTERPRET 9-15               41.00              40          LAB
       4081725   CELL MARKR TECH EA ADDL                  9.00              40          LAB
       4095410   CELL MARKR TECH EA ADDL                 29.22              40          LAB
       4095451   CELL MARKR TECH EA ADDL                 13.00              40          LAB
       4081261   CELL MARKR TECH ONLY 1ST                49.00              40          LAB
       4081717   CELL MARKR TECH ONLY 1ST                15.00              40          LAB
       4095436   CELL MARKR TECH ONLY 1ST                70.00              40          LAB
       4019113   CELL MARKR TECH ONLY 1ST                25.50              40          LAB
       4091492   CELL MARKR TECH ONLY 1ST                75.00              40          LAB
       4095402   CELL MARKR TECH ONLY 1ST                60.17              40          LAB
       4098901   CENTROMERE SCREEN                       20.77              40          LAB
       4092284   CERULOPLASMIN                           11.55              40          LAB
       4097747   CERULOPLASMIN                           45.00              40          LAB



9/17/2012                                                                                                        54
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4018651   CHEMILUMINESCENT ASSAY                171.00              40          LAB
       4080131   CHEMILUMINESCENT ASSAY                 95.00              40          LAB
       4099339   CHLAM TRACH/GC DNA PROBE               17.59              40          LAB
       4094181   CHLAMYD PNEUMO AMP PRB                135.00              40          LAB
       4092326   CHLAMYDIA AB                           17.50              40          LAB
       4095683   CHLAMYDIA AB IGA                        6.00              40          LAB
       4099628   CHLAMYDIA AB IGA                        8.50              40          LAB
       4095766   CHLAMYDIA AB IGG                        6.00              40          LAB
       4096509   CHLAMYDIA AB IGG                        8.50              40          LAB
       4095808   CHLAMYDIA AB IGM                        6.00              40          LAB
       4096517   CHLAMYDIA AB IGM                        8.33              40          LAB
       4094892   CHLAMYDIA AG DFA                       15.00              40          LAB
       4018230   CHLAMYDIA CULT                        208.00     208.00   40          LAB
       4097630   CHLAMYDIA CULT                         35.88              40          LAB
       4099636   CHLAMYDIA CULT                         16.10              40          LAB
       4094579   CHLAMYDIA PNEUMO AB                     6.00              40          LAB
       4094728   CHLAMYDIA PNEUMO AB                     6.00              40          LAB
       4097085   CHLAMYDIA PNEUMO AB                    20.00              40          LAB
       4094801   CHLAMYDIA TRACH AB                      6.00              40          LAB
       4094959   CHLAMYDIA TRACH AB                      6.00              40          LAB
       4018776   CHLAMYDIA TRACH AMP PRB                39.00      39.00   40          LAB
       4018792   CHLAMYDIA TRACH AMP PRB               373.00     373.00   40          LAB
       4019337   CHLAMYDIA TRACH DIR PRB               107.50              40          LAB
       4094694   CHLAMYDIA TRACH DIR PRB                13.85              40          LAB
       4096657   CHLAMYDIA TRACH DIR PRB                84.00              40          LAB
       4014957   CHLORIDE                               49.00      49.00   40          LAB
       4015715   CHLORIDE FLD                           52.00      52.00   40          LAB
       4090668   CHLORIDE OTHER SOURCE                   8.00              40          LAB
       4090676   CHLORIDE OTHER SOURCE                   1.76              40          LAB
       4014973   CHLORIDE UR                            52.00      52.00   40          LAB
       4080768   CHLORIDE UR                             5.50              40          LAB
       4019907   CHLORIDE UR 24HR                       52.00      52.00   40          LAB
       4094819   CHLORIDE UR 24HR                       22.50              40          LAB



9/17/2012                                                                                                       55
                                           69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4013231   CHOLESTEROL                           47.00      47.00 40            LAB
       4097200   CHOLINESTERASE RBC                    10.00            40            LAB
       4097192   CHOLINESTERASE SER                    13.50            40            LAB
       4099388   CHONDROITIN B SULF QNT               130.00            40            LAB
       4099669   CHONDROITIN B SULF QNT                82.00            40            LAB
       4090056   CHRMOSOM ADD KARY EA                  30.00            40            LAB
       4091500   CHRMOSOM ADD KARY EA                  50.00            40            LAB
       4099651   CHRMOSOM ANALYZE 20-25               127.30            40            LAB
       4096368   CHRMOSOM CNT 45/KARY X2              160.00            40            LAB
       4090023   CHRMOSOM CNT/KARY                    208.00            40            LAB
       4090387   CHRMOSOM CNT/KARY                    170.00            40            LAB
       4091518   CHRMOSOM CNT/KARY                     97.00            40            LAB
       4098604   CHRMOSOM HI RESD BND                 120.00            40            LAB
       4081535   CHROMAT QN EA ANALTE                  70.00            40            LAB
       4090791   CHROMAT QN EA ANALTE                  25.00            40            LAB
       4094108   CHROMAT QN EA ANALTE                  60.00            40            LAB
       4098372   CHROMAT QN EA ANALTE                  39.00            40            LAB
       4098018   CHROMAT QN MULT ANALTE                92.00            40            LAB
       4099644   CHROMIUM                              22.25            40            LAB
       4081659   CITRATE UR 24 HR                      40.00            40            LAB
       4094868   CITRATE UR 24HR                       25.55            40            LAB
       4091021   CITRATE UR RNDM                       17.53            40            LAB
       4013298   CK MB FRACTION                       123.00     123.00 40            LAB
       4013256   CK TOTAL                              69.00      69.00 40            LAB
       4096905   CLOZAPINE                             30.00            40            LAB
       4017216   CMV AB                                15.00            40            LAB
       4092789   CMV AB IGM                            14.00            40            LAB
       4097663   CMV AMP PRB                          127.50            40            LAB
       4094587   CMV DNA QN                           110.00            40            LAB
       4014858   CO2 (BICARBONATE)                     52.00      52.00 40            LAB
       4017810   COCAINE QN                            43.50            40            LAB
       4011094   COCAINE SCRN                          38.00      38.00 40            LAB
       4099263   COCAINE SCRN                           5.00            40            LAB



9/17/2012                                                                                                      56
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4018438   COCCI AB COMP FIX                  49.00              40          LAB
       4080255   COCCI AB COMP FIX                  40.00              40          LAB
       4080503   COCCI AB COMP FIX                  33.00              40          LAB
       4080263   COCCI IMMUNO DIFFUSION             34.00              40          LAB
       4080511   COCCI IMMUNO DIFFUSION             27.00              40          LAB
       4080271   COCCIDIOIDES AB                    43.50              40          LAB
       4082046   COCCIDIOIDES AB                    62.00              40          LAB
       4092870   COCCIDIOIDES AB                    22.00              40          LAB
       4080909   COL CHROM/MASS SPEC QNT           165.00              40          LAB
       4090551   COL CHROM/MASS SPEC QNT            73.50              40          LAB
       4099347   COL CHROM/MASS SPEC QNT            60.00              40          LAB
       4099354   COL CHROM/MASS SPEC QNT           245.00              40          LAB
       4014650   COLD AGGLUTININ SCRN               71.00      71.00   40          LAB
       4015855   COLD AGGLUTININ TTR                85.00      85.00   40          LAB
       4091427   COLD AGGLUTININ TTR                25.00              40          LAB
       4098356   COLD AGGLUTININ TTR                34.00              40          LAB
       4098679   COLUMN CHROM ISOTOPE QNT          150.00              40          LAB
       4016218   COMPATIBILITY TEST AHG            159.00     159.00   40          LAB
       4016259   COMPATIBILITY TEST AHG            159.00     159.00   40          LAB
       4010542   COMPATIBILITY TEST IS             177.00              40          LAB
       4092656   COMPLEMENT C1                      20.77              40          LAB
       4091997   COMPLEMENT C1 Q                     7.00              40          LAB
       4017075   COMPLEMENT C2                      27.00              40          LAB
       4017091   COMPLEMENT C3                      25.00              40          LAB
       4091849   COMPLEMENT C3                       7.00              40          LAB
       4096830   COMPLEMENT C3                      50.00              40          LAB
       4017117   COMPLEMENT C4                      15.00      15.00   40          LAB
       4091922   COMPLEMENT C4                       7.00              40          LAB
       4096822   COMPLEMENT C4                      50.00              40          LAB
       4092375   COMPLEMENT C5                      33.00              40          LAB
       4093399   COMPLEMENT C5                      29.50              40          LAB
       4092383   COMPLEMENT C6                      33.00              40          LAB
       4092391   COMPLEMENT C7                      44.00              40          LAB



9/17/2012                                                                                                   57
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4092417   COMPLEMENT C8                       48.00              40          LAB
       4092425   COMPLEMENT C9                       60.00              40          LAB
       4017190   COMPLEMENT TOT (CH50)               55.00              40          LAB
       4092409   COMPLEMENT TOT (CH50)               12.00              40          LAB
       4019253   COMPR MET PNL                      201.00     201.00   40          LAB
       4010344   COOMBS DIRECT C3                    23.00              40          LAB
       4016317   COOMBS DIRECT IG                    58.00      58.00   40          LAB
       4010369   COOMBS DIRECT POLY                  23.00              40          LAB
       4092441   COPPER                              16.54              40          LAB
       4095022   COPPER                              38.00              40          LAB
       4093266   COPPER UR 24HR                      27.50              40          LAB
       4090429   CORTISOL (AM DRAW)                  68.00              40          LAB
       4090437   CORTISOL (PM DRAW)                  68.00              40          LAB
       4091393   CORTISOL FREE SER                   41.00              40          LAB
       4091534   CORTISOL FREE SER                   41.00              40          LAB
       4091542   CORTISOL FREE UR                    91.80              40          LAB
       4092482   CORTISOL FREE UR                    21.25              40          LAB
       4014577   CORTISOL TOTAL                     173.00     173.00   40          LAB
       4090445   CORTISOL TOTAL                      68.00              40          LAB
       4091419   CORTISOL TOTAL                      30.00              40          LAB
       4091559   CORTISOL TOTAL                      30.00              40          LAB
       4092524   CORTISOL TOTAL                      11.14              40          LAB
       4098984   COXSACKIE AB TYP A                  10.00              40          LAB
       4096871   COXSACKIE AB TYP B                   8.00              40          LAB
       4096814   C-REACTIVE PROTEIN HS               12.11              40          LAB
       4097911   C-REACTIVE PROTEIN HS              137.00              40          LAB
       4098562   CREATINE SERUM                      39.00              40          LAB
       4098414   CREATINE UR 24HR                    34.46              40          LAB
       4013314   CREATININE                          55.00      55.00   40          LAB
       4092359   CREATININE                          26.10              40          LAB
       4097218   CREATININE                           9.00              40          LAB
       4013819   CREATININE CLEARANCE                99.00      99.00   40          LAB
       4018917   CREATININE FLD                      55.00              40          LAB



9/17/2012                                                                                                    58
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4019527   CREATININE UR 24HR                  55.00              40          LAB
       4098091   CREATININE UR 24HR                   8.00              40          LAB
       4098109   CREATININE UR 24HR                  24.00              40          LAB
       4013850   CREATININE UR RAN                   55.00      55.00   40          LAB
       4080156   CREATININE UR RAN                   15.00              40          LAB
       4098083   CREATININE UR RAN                    8.02              40          LAB
       4092649   CRYOGLOB QL OR SEMI QL               7.25              40          LAB
       4019154   CRYOGLOBULIN QN                     32.50              40          LAB
       4097648   CRYPTO AG DFA                       30.00              40          LAB
       4098877   CRYPTO NEOFORMANS EIA               23.00              40          LAB
       4010062   CRYPTOCOCCAL AG AGGL                50.00              40          LAB
       4010088   CRYPTOCOCCAL AG AGGL               107.00              40          LAB
       4097812   CRYPTOCOCCAL AG TTR AGGL            48.00              40          LAB
       4093142   CRYPTOCOCCUS AB                     24.00              40          LAB
       4093365   CRYPTOSPORIDIUM                     23.00              40          LAB
       4013751   CRYSTAL ID TISS/FLD NO UR          121.00     121.00   40          LAB
       4099446   CULT ADENOVIRUS                     30.00              40          LAB
       4010500   CULT BACT AEROBIC ID                85.00              40          LAB
       4081352   CULT BACT AEROBIC ID                31.50              40          LAB
       4012258   CULT BACT ANAEROBIC                101.00     101.00   40          LAB
       4011631   CULT BACT ANAEROBIC ID              85.00      85.00   40          LAB
       4012480   CULT BETA STREP A ONLY              71.00      71.00   40          LAB
       4011979   CULT BLD BACTERIA                  110.00     110.00   40          LAB
       4012712   CULT CATHETER TIP                   90.00      90.00   40          LAB
       4017232   CULT CMV                            38.00      38.00   40          LAB
       4011854   CULT CSF                            90.00      90.00   40          LAB
       4012399   CULT EAR                            90.00      90.00   40          LAB
       4012415   CULT ENVIRONMENT                    90.00      90.00   40          LAB
       4012431   CULT EYE                            90.00      90.00   40          LAB
       4012316   CULT FLUID                          90.00      90.00   40          LAB
       4011813   CULT FUNGUS BLD                     96.00      96.00   40          LAB
       4092698   CULT FUNGUS BLD                     11.50              40          LAB
       4012035   CULT FUNGUS OTHER SOURCE            88.00      88.00   40          LAB



9/17/2012                                                                                                    59
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4092086   CULT FUNGUS OTHER SOURCE           11.50              40          LAB
       4012779   CULT FUNGUS YEAST ID              110.00     110.00   40          LAB
       4012191   CULT GC SCRN                       71.00      71.00   40          LAB
       4012514   CULT GENITAL                       90.00      90.00   40          LAB
       4012837   CULT GRP B STREP SCRN              71.00      71.00   40          LAB
       4012811   CULT H20                           46.00              40          LAB
       4017430   CULT HERPES                        64.50      64.50   40          LAB
       4099677   CULT HSV                           21.40              40          LAB
       4097036   CULT LEGIONELLA                    60.50              40          LAB
       4098950   CULT MISC                          36.00              40          LAB
       4099685   CULT MISC                          22.00              40          LAB
       4019402   CULT MRSA SCRN                     71.00      71.00   40          LAB
       4012571   CULT PLACENTA                      90.00      90.00   40          LAB
       4011698   CULT QN AEROBIC                    99.00      99.00   40          LAB
       4094371   CULT RSV                           72.50              40          LAB
       4012332   CULT SCRN B PERTUSSUS              71.00      71.00   40          LAB
       4095097   CULT SCRN B PERTUSSUS              30.00              40          LAB
       4012613   CULT SPUTUM                        90.00      90.00   40          LAB
       4018909   CULT STL E COLI EA PLATE           99.00              40          LAB
       4012076   CULT STL SALM & SHIG               99.00      99.00   40          LAB
       4093233   CULT STL YERSINIA EA PLT           15.00              40          LAB
       4012639   CULT SURFACE WOUND                101.00     101.00   40          LAB
       4012670   CULT THROAT                        90.00      90.00   40          LAB
       4098968   CULT THROAT                        36.00              40          LAB
       4012753   CULT TISSUE (ANAEROBIC)           101.00     101.00   40          LAB
       4011730   CULT TYP (SHIGELLA)                55.00      55.00   40          LAB
       4090577   CULT TYP (SHIGELLA)                19.00              40          LAB
       4090825   CULT TYP FLUORESCENT               22.50              40          LAB
       4098190   CULT TYP FLUORESCENT               25.00              40          LAB
       4099693   CULT TYP FLUORESCENT               15.37              40          LAB
       4099701   CULT TYP FLUORESCENT               60.50              40          LAB
       4011714   CULT TYP SALMONELLA                55.00      55.00   40          LAB
       4012134   CULT UR COLONY CT ONLY             85.00      85.00   40          LAB



9/17/2012                                                                                                   60
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4092433   CULT UR COLONY CT ONLY             34.00              40          LAB
       4019550   CULT UR ID EACH ISOLATE            85.00      85.00   40          LAB
       4092458   CULT UR ID EACH ISOLATE            34.00              40          LAB
       4099156   CULT V ZOSTER                      17.50              40          LAB
       4019451   CULT VRE SCRN                      71.00      71.00   40          LAB
       4012217   CULT WND/ABSCESS ANAEROBE         101.00     101.00   40          LAB
       4018214   CULTVIRAL                          65.00      65.00   40          LAB
       4095915   CULTVIRAL                          59.50              40          LAB
       4099719   CULTVIRAL                          37.00              40          LAB
       4090080   CYCLIC AMP                         27.50              40          LAB
       4099727   CYCLIC AMP                         27.50              40          LAB
       4092722   CYCLOSPORINE                       34.50              40          LAB
       4092763   CYCLOSPORINE                       41.00              40          LAB
       4096673   CYCLOSPORINE                       76.00              40          LAB
       4094116   CYSTICERCUS AB                     54.50              40          LAB
       4094272   CYSTINE UR QN                      49.00              40          LAB
       4081808   CYTGNTC INTERP/RPRT                86.00              40          LAB
       4082087   CYTGNTC INTERP/RPRT                45.00              40          LAB
       4090031   CYTGNTC INTERP/RPRT                75.00              40          LAB
       4091625   CYTGNTC INTERP/RPRT                20.00              40          LAB
       4091633   CYTGNTC INTERP/RPRT                65.00              40          LAB
       4091658   CYTGNTC INTERP/RPRT                35.00              40          LAB
       4092466   CYTGNTC INTERP/RPRT                16.00              40          LAB
       4099735   CYTGNTC INTERP/RPRT                18.00              40          LAB
       4020707   CYTO CL BLK 5 CNT/1 KARY          119.00              40          LAB
       4030102   CYTO CL BLK 5 CNT/1 KARY          119.00              40          LAB
       4030052   CYTOLOGY CONCENTRATION            156.00              40          LAB
       4021655   CYTOLOGY EXTENDED STUDY            38.00              40          LAB
       4021507   CYTOLOGY FLD                      233.00              40          LAB
       4021705   CYTOLOGY PREP & INTERP            176.00              40          LAB
       4019444   CYTOMEGALOVIRUS AG EIA             50.00              40          LAB
       4015376   D DIMER SEMI QN/QL                 77.00      77.00   40          LAB
       4010161   DARK FIELD WO COLLECTION           55.00              40          LAB



9/17/2012                                                                                                   61
                                          69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4081394   D-DIMER QN                           95.00            40            LAB
       4020202   DECALCIFICATION                      74.00            40            LAB
       4093811   DELTA ALA                            40.00            40            LAB
       4094975   DELTA ALA                            33.50            40            LAB
       4094256   DEOXYPYRIDINOLINE                    61.00            40            LAB
       4095170   DEOXYPYRIDINOLINE                    61.00            40            LAB
       4095014   DEOXYRIBNUCLEASE AB                  16.00            40            LAB
       4093332   DESIPRAMINE                          28.00            40            LAB
       4098620   DEXAMETHASONE                        76.00            40            LAB
       4080750   DHEA                                 95.00            40            LAB
       4093993   DHEA                                 47.50            40            LAB
       4092888   DHEA SULFATE                         15.68            40            LAB
       4097226   DIBUCAINE NUMBER                     10.00            40            LAB
       4098844   DIGITOXIN                            57.00            40            LAB
       4011250   DIGOXIN                             140.00     140.00 40            LAB
       4092060   DIHYDROCODEINONE                     36.00            40            LAB
       4092474   DIHYDROCODEINONE                    108.00            40            LAB
       4098992   DIHYDROTESTOSTERONE                  46.26            40            LAB
       4097531   DIPTHERIA AB                         33.98            40            LAB
       4092813   DISOPYRAMIDE                         14.75            40            LAB
       4021580   DNA ANALYSIS                        283.50            40            LAB
       4099305   DNA DBL STRAND AB SCRN               13.00            40            LAB
       4081782   DNA PRB CYTGNTC >100                130.00            40            LAB
       4081790   DNA PRB CYTGNTC >100                180.00            40            LAB
       4092490   DNA PRB CYTGNTC >100                146.00            40            LAB
       4097887   DNA PRB CYTGNTC >100                 82.50            40            LAB
       4091666   DNA PRB CYTGNTC 10 30               155.00            40            LAB
       4091674   DNA PRB CYTGNTC 10 30                40.00            40            LAB
       4097697   DNA PRB CYTGNTC 10 30               100.00            40            LAB
       4099743   DNA PRB CYTGNTC 10 30               140.00            40            LAB
       4099750   DNA PRB CYTGNTC 10 30               140.00            40            LAB
       4098471   DNA PRB CYTGNTC 25-99                35.00            40            LAB
       4081816   DNA PRB CYTGNTC EA                   70.00            40            LAB



9/17/2012                                                                                                     62
                                          69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4082079   DNA PRB CYTGNTC EA                   45.00            40            LAB
       4091690   DNA PRB CYTGNTC EA                  102.00            40            LAB
       4097689   DNA PRB CYTGNTC EA                   80.00            40            LAB
       4099768   DNA PRB CYTGNTC EA                   92.50            40            LAB
       4099776   DNA PRB CYTGNTC EA                   92.50            40            LAB
       4099784   DNA PRB CYTGNTC EA                   42.25            40            LAB
       4099792   DNA PRB CYTGNTC EA                   25.00            40            LAB
       4099800   DNA PRB CYTGNTC EA                   20.00            40            LAB
       4093472   DOXEPIN                              30.50            40            LAB
       4017893   DRG CONF                             64.00            40            LAB
       4081279   DRG CONF                            125.00            40            LAB
       4081287   DRG CONF                             53.00            40            LAB
       4017513   DRG SCRN BLD VOLATILES               79.50      79.50 40            LAB
       4011052   DRG SCRN QL CHROM EA                154.00            40            LAB
       4017935   DRG SCRN QL CHROM EA                 74.50            40            LAB
       4018354   DRG SCRN QL CHROM EA                 17.00            40            LAB
       4018511   DRG SCRN QL CHROM EA                 36.00            40            LAB
       4081162   DRG SCRN UR SGL 1ST                  11.00            40            LAB
       4097929   DRG SCRN UR SGL 1ST                  62.50            40            LAB
       4099818   DRG SCRN UR SGL 1ST                  90.00            40            LAB
       4099891   DRG SCRN UR SGL 1ST                  19.00            40            LAB
       4091708   E HISTOLYTICA GRP EIA                44.50            40            LAB
       4017299   EBV AB EARLY AG                      36.00            40            LAB
       4093860   EBV AB EBNA                          10.00            40            LAB
       4098240   EBV DNA QNT PCR                     129.00            40            LAB
       4092920   EBV VCA AB IGG                       10.00            40            LAB
       4096533   EBV VCA AB IGM                       10.00            40            LAB
       4098935   ECHINOCOCCUS AB                      67.50            40            LAB
       4099859   ECHO TYPE 11 AB                       9.00            40            LAB
       4099867   ECHO TYPE 30 AB                       9.00            40            LAB
       4099826   ECHO TYPE 4 AB                        9.00            40            LAB
       4099834   ECHO TYPE 7 AB                        9.00            40            LAB
       4099842   ECHO TYPE 9 AB                        9.00            40            LAB



9/17/2012                                                                                                     63
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4097549   EHRLICHIA AB IGG                       32.00              40          LAB
       4098687   EHRLICHIA AB IGM                       43.00              40          LAB
       4098885   EHRLICHIA AB IGM                       32.00              40          LAB
       4014916   ELECTROLYTE PNL FLD                    74.00      74.00   40          LAB
       4021556   ELECTRON MICROSCOPY                   486.00              40          LAB
       4095360   ENA AB                                 27.00              40          LAB
       4098158   ENCEPHALITIS CALIF                     11.50              40          LAB
       4098166   ENCEPHALITIS EAST EQUINE               11.50              40          LAB
       4098174   ENCEPHALITIS ST LOUIS                  11.50              40          LAB
       4098182   ENCEPHALITIS WEST EQUINE               11.50              40          LAB
       4098729   ENDOMYSIAL AB SCRN                     43.00              40          LAB
       4098760   ENTEROVIRUS AB                         12.00              40          LAB
       4099875   ENZYME CELL ACT NON-RAD               235.00              40          LAB
       4080743   EOSINOPHILIC CATIONIC PR              108.00              40          LAB
       4010336   EOSINPHILS SMR NASAL                   49.00      49.00   40          LAB
       4094298   EPINEPHRINE                            64.50              40          LAB
       4017992   ERYTHROPOIETIN                         95.50      95.50   40          LAB
       4093001   ERYTHROPOIETIN                         18.00              40          LAB
       4019295   ESTRADIOL (E2)                        148.50     148.50   40          LAB
       4093043   ESTRADIOL (E2)                         19.55              40          LAB
       4096707   ESTRADIOL (E2)                        117.00              40          LAB
       4093977   ESTRIOL                                47.00              40          LAB
       4093548   ESTROGEN TOTAL                         29.97              40          LAB
       4099883   ESTROGEN TOTAL                         34.00              40          LAB
       4093852   ESTRONE                                40.50              40          LAB
       4093027   ETHOSUXIMIDE                           20.50              40          LAB
       4093084   ETHOSUXIMIDE                           20.50              40          LAB
       4097234   ETHYLENE GLYCOL                        24.92              40          LAB
       4018131   FAT STL QL                             55.00      55.00   40          LAB
       4097242   FAT STL QL                             22.50              40          LAB
       4018115   FAT STL QN                            123.00              40          LAB
       4094330   FAT STL QN                             45.00              40          LAB
       4092508   FATTY ACIDS MULT ANALY                197.00              40          LAB



9/17/2012                                                                                                       64
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4098794   FATTY ACIDS MULT ANALY                170.00            40            LAB
       4094462   FCTR II                                85.50            40            LAB
       4095279   FCTR INHIBITOR TEST                   119.00            40            LAB
       4096764   FCTR INHIBITOR TEST                   195.00            40            LAB
       4099909   FCTR INHIBITOR TEST                    32.00            40            LAB
       4095220   FCTR IX                                73.00            40            LAB
       4094389   FCTR V                                 73.00            40            LAB
       4094397   FCTR VII                               73.00            40            LAB
       4081766   FCTR VIII                              45.00            40            LAB
       4094348   FCTR VIII                              58.00            40            LAB
       4097655   FCTR VIII                             130.00            40            LAB
       4095261   FCTR VIII VW                           60.00            40            LAB
       4094306   FCTR VIII VW AG                        59.00            40            LAB
       4081741   FCTR VIII VW MULTIMER                 188.00            40            LAB
       4081758   FCTR VIII VW MULTIMER                  69.00            40            LAB
       4094512   FCTR VIII VW MULTIMER                  85.61            40            LAB
       4094413   FCTR X                                 73.00            40            LAB
       4094421   FCTR XII                               73.00            40            LAB
       4096970   FCTR XIII SCRN                         58.50            40            LAB
       4080107   FENTANYL METABOLITE SCRN               42.00            40            LAB
       4014395   FERRITIN                              145.00            40            LAB
       4093209   FERRITIN                                6.35            40            LAB
       4096251   FERRITIN                               58.00            40            LAB
       4019469   FETAL FIBRONECTIN                     683.00            40            LAB
       4015954   FETAL RBC SMR (K B)                    82.00      82.00 40            LAB
       4010302   FETAL SCRN ROSETTE                     71.00            40            LAB
       4010179   FIBRIN DEGRAD PROD                     74.00      74.00 40            LAB
       4080727   FIBRIN MONOMERS                        40.50            40            LAB
       4010617   FIBRINOGEN                             90.00      90.00 40            LAB
       4099917   FIBRINOGEN                             22.18            40            LAB
       4094736   FLECAINIDE                             16.50            40            LAB
       4081410   FLUOR AB SCRN EA AB SCRN               44.00            40            LAB
       4090353   FLUOR AB SCRN EA AB SCRN               14.00            40            LAB



9/17/2012                                                                                                       65
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4081436   FLUOR AB SCRN EA AB TTR            45.00            40            LAB
       4099925   FLUOR AB SCRN EA AB TTR            12.50            40            LAB
       4093035   FLUOXETINE                         22.00            40            LAB
       4093787   FLUPHENAZINE                       69.76            40            LAB
       4021051   FNA INTERP & RPT                  111.00            40            LAB
       4014510   FOLATE                            156.00            40            LAB
       4090411   FOLATE                             62.00            40            LAB
       4093241   FOLATE                              6.00            40            LAB
       4096343   FOLATE RBC                         19.90            40            LAB
       4093308   FRANCISELLA TULARENSIS AB          28.00            40            LAB
       4018339   FREE T4                            96.00            40            LAB
       4080933   FREE T4                             8.30            40            LAB
       4098398   FREE T4                            23.01            40            LAB
       4018495   FRUCTOSAMINE                       18.50      18.50 40            LAB
       4010286   FSH                               197.00            40            LAB
       4014551   FSH                                16.00      16.00 40            LAB
       4096731   FSH                                78.00            40            LAB
       4018198   FTA ABS (TPPA)                     38.50      38.50 40            LAB
       4092078   FTA ABS (TPPA)                     65.00            40            LAB
       4099933   FTA ABS (TPPA)                      8.85            40            LAB
       4091112   FUNGUS NOT SPECIFIED               30.00            40            LAB
       4091138   FUNGUS NOT SPECIFIED               30.00            40            LAB
       4097556   FUNGUS NOT SPECIFIED               60.00            40            LAB
       4017331   G6PD QN                            18.50            40            LAB
       4091096   G6PD SCRN                           6.77            40            LAB
       4093829   GABAPENTIN                         40.00            40            LAB
       4092516   GALI-1-P URIDYL TRANS QNT          72.00            40            LAB
       4080685   GAMMA HYDROXYBUTYRAT ACID         107.00            40            LAB
       4080792   GANGLIOSIDE AB IGG GQ1B            72.29            40            LAB
       4018750   GANGLIOSIDE GMI AUTO AB           137.00            40            LAB
       4080784   GANGLIOSIDE GMI AUTO AB            50.67            40            LAB
       4090247   GANGLIOSIDE GMI AUTO AB            34.50            40            LAB
       4098380   GASTRIC PARIETAL CELL AB           12.00            40            LAB



9/17/2012                                                                                                   66
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4092821   GASTRIN                                15.00              40          LAB
       4093936   GBM AB                                 45.50              40          LAB
       4018834   GC AMP PRB                             63.00      63.00   40          LAB
       4018859   GC AMP PRB                             63.00      63.00   40          LAB
       4099941   GC AMP PRB                             36.00              40          LAB
       4094660   GC DIR PRB                             10.05              40          LAB
       4096665   GC DIR PRB                             84.00              40          LAB
       4019212   GENERAL HEALTH PNL                    313.00     313.00   40          LAB
       4011359   GENTAMICIN                            173.00     173.00   40          LAB
       4097135   GENTAMICIN PK                         173.00              40          LAB
       4097143   GENTAMICIN TR                         173.00              40          LAB
       4015319   GGT                                    77.00      77.00   40          LAB
       4091302   GGT                                    25.80              40          LAB
       4081824   GIARDIA AB                             30.25              40          LAB
       4094793   GIARDIA AG EIA                         23.00              40          LAB
       4099057   GIARDIA AG EIA                         39.00              40          LAB
       4090072   GLIADIN AB                             16.70              40          LAB
       4019188   GLUCOSE                                41.00      41.00   40          LAB
       4012878   GLUCOSE 1HR PP                         49.00      49.00   40          LAB
       4012894   GLUCOSE 2HR PP                         49.00      49.00   40          LAB
       4014593   GLUCOSE 2HR PP                         49.00      49.00   40          LAB
       4015673   GLUCOSE CSF                            41.00      41.00   40          LAB
       4013355   GLUCOSE FLD                            41.00      41.00   40          LAB
       4098257   GLUCOSE FLD                            17.50              40          LAB
       4013777   GLUCOSE UR QN                          41.00      41.00   40          LAB
       4092094   GLUT ACID DECARB AUTO AB               86.33              40          LAB
       4093324   GLUT ACID DECARB AUTO AB               69.00              40          LAB
       4017398   GROWTH HORMONE                         27.50              40          LAB
       4092706   GROWTH HORMONE                         11.50              40          LAB
       4096715   GROWTH HORMONE                         60.35              40          LAB
       4012910   GTT 2HR 1ST 3 SPEC                    137.00     137.00   40          LAB
       4012951   GTT 3HR 1ST 3 SPEC                    137.00     137.00   40          LAB
       4012936   GTT 4HR 1ST 3 SPEC                    137.00     137.00   40          LAB



9/17/2012                                                                                                       67
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4015459   GTT ADDED SAMPLE                    41.00      41.00 40            LAB
       4018479   H PYLORI AB IGA                     14.00            40            LAB
       4082061   H PYLORI AB IGG                     10.00            40            LAB
       4093407   H PYLORI AB IGG                     20.00            40            LAB
       4097564   H PYLORI AB IGM                     20.00            40            LAB
       4096582   H PYLORI STL EIA                    65.00            40            LAB
       4093449   HALOPERIDOL                         38.50            40            LAB
       4099099   HANTAVIRUS AB                       26.00            40            LAB
       4014098   HAPTOGLOBIN QN                     134.00     134.00 40            LAB
       4091260   HAPTOGLOBIN QN                      45.15            40            LAB
       4097259   HAPTOGLOBIN QN                      13.50            40            LAB
       4097788   HAPTOGLOBIN QN                      53.00            40            LAB
       4013694   HAV AB IGM                         118.00     118.00 40            LAB
       4090148   HAV AB IGM                          47.00            40            LAB
       4097838   HAV AB IGM                          14.00            40            LAB
       4013637   HAV AB TOTAL                       132.00     132.00 40            LAB
       4090155   HAV AB TOTAL                        52.00            40            LAB
       4098331   HAV AB TOTAL                         8.75            40            LAB
       4013710   HB CORE AB IGM                      60.00      60.00 40            LAB
       4090163   HB CORE AB IGM                      49.00            40            LAB
       4097820   HB CORE AB IGM                      11.25            40            LAB
       4013611   HB CORE AB TOTAL                   129.00     129.00 40            LAB
       4090171   HB CORE AB TOTAL                    51.00            40            LAB
       4093647   HBE AB                              14.99            40            LAB
       4093688   HBE AG                              11.00            40            LAB
       4013652   HBS AB                             112.00     112.00 40            LAB
       4090189   HBS AB                              45.00            40            LAB
       4097598   HBS AB                               7.60            40            LAB
       4013702   HBS AG                              99.00      99.00 40            LAB
       4090130   HBS AG                              39.00            40            LAB
       4097861   HBS AG                               8.25            40            LAB
       4092904   HBS AG NEUTRALIZATION               18.50            40            LAB
       4098455   HBS AG NEUTRALIZATION               43.00            40            LAB



9/17/2012                                                                                                    68
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4015418   HCV AB                             11.00      11.00 40            LAB
       4018370   HCV AB                            151.00            40            LAB
       4090197   HCV AB                             60.00            40            LAB
       4093720   HCV AB CONF                        15.00            40            LAB
       4014411   HDL CHOLESTEROL                    88.00      88.00 40            LAB
       4092102   HDV (DELTA) AB                     71.00            40            LAB
       4093423   HDV (DELTA) AB                     30.00            40            LAB
       4017851   HEAVY METAL SCRN UR               157.00            40            LAB
       4081089   HEAVY METALS BLD QN EA             81.00            40            LAB
       4081097   HEAVY METALS BLD QN EA             39.00            40            LAB
       4092342   HEAVY METALS BLD QN EA             63.00            40            LAB
       4098778   HEAVY METALS BLD QN EA             54.50            40            LAB
       4081337   HEAVY METALS UR QN EA              10.00            40            LAB
       4081964   HEAVY METALS UR QN EA              81.00            40            LAB
       4090486   HEAVY METALS UR QN EA              10.00            40            LAB
       4090494   HEAVY METALS UR QN EA              10.00            40            LAB
       4080198   HELMINTH AB                        90.00            40            LAB
       4099958   HELMINTH AB                        46.75            40            LAB
       4010278   HEMATOCRIT                         25.00      25.00 40            LAB
       4090312   HEMATOCRIT                          2.00            40            LAB
       4010237   HEMOGLOBIN                         25.00      25.00 40            LAB
       4090320   HEMOGLOBIN                          2.00            40            LAB
       4014114   HEMOGLOBIN F (APT)                 63.00      63.00 40            LAB
       4090221   HEMOGLOBIN FRACTION QN             15.00            40            LAB
       4091229   HEMOGLOBIN FRACTION QN             20.35            40            LAB
       4096889   HEMOGLOBIN FRACTION QN             20.19            40            LAB
       4017372   HEMOGLOBIN GLYCOSYLTD A1C          52.00      52.00 40            LAB
       4093563   HEMOGLOBIN GLYCOSYLTD A1C           7.55            40            LAB
       4096376   HEMOGLOBIN GLYCOSYLTD A1C          40.00            40            LAB
       4092730   HEMOGLOBIN PLAS                    13.00            40            LAB
       4093373   HEMOLYSIN ACID (HAM'S)             29.00            40            LAB
       4098810   HEMOSIDERIN QL                     12.00            40            LAB
       4092110   HEP B VIRUS AMP PRB                95.00            40            LAB



9/17/2012                                                                                                   69
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4094637   HEP B VIRUS BDNA QN                   165.00              40          LAB
       4096608   HEP C VIRAL RNA GENOTYPE              146.00              40          LAB
       4090932   HEP C VIRUS AMP PRB                    87.25              40          LAB
       4094504   HEP C VIRUS AMP PRB                   106.50              40          LAB
       4094546   HEP C VIRUS BDNA QN                   115.00              40          LAB
       4099966   HEP C VIRUS BDNA QN                   295.00              40          LAB
       4018974   HEP C VIRUS PCR QN                    515.00              40          LAB
       4093480   HEP C VIRUS PCR QN                     93.00              40          LAB
       4093605   HEP C VIRUS PCR QN                    150.00              40          LAB
       4099974   HEP C VIRUS PCR QN                    209.95              40          LAB
       4090395   HEPARIN ASSAY                          76.50              40          LAB
       4019220   HEPATIC FUNCTION PNL                   88.00      88.00   40          LAB
       4098513   HEPATITIS DELTA AGENT                  42.50              40          LAB
       4013595   HEPATITIS PNL ACUTE                   535.00     535.00   40          LAB
       4090122   HEPATITIS PNL ACUTE                   212.00              40          LAB
       4015871   HETEROPHILE AB SCRN                    55.00      55.00   40          LAB
       4080636   HEXAGONAL PHASE                        50.00              40          LAB
       4014312   HGB ELECTRO                            25.00              40          LAB
       4095212   HISTAMINE                              72.00              40          LAB
       4099065   HISTO CAPSULATUM AG EIA                72.00              40          LAB
       4093498   HISTOPLAS AB                           31.50              40          LAB
       4099982   HISTOPLAS AB                           13.21              40          LAB
       4017414   HIV 1 AB                              117.50      64.50   40          LAB
       4017422   HIV 1 AB                               93.00              40          LAB
       4099081   HIV 1 AMP PRB                          86.26              40          LAB
       4081857   HIV 1 GENOTYPE                        400.00              40          LAB
       4081873   HIV 1 GENOTYPE                        247.00              40          LAB
       4096590   HIV 1 GENOTYPE                        400.00              40          LAB
       4098851   HIV 1 PHENO 1ST 10 DRGS             1,365.00              40          LAB
       4098661   HIV 1 PHENO EA ADDL DRG                27.00              40          LAB
       4081881   HIV 1 PHENO LST 10 DRGS               415.00              40          LAB
       4095295   HIV 1 QN BDNA                         105.00              40          LAB
       4093803   HIV 1 QN PCR                           81.00              40          LAB



9/17/2012                                                                                                       70
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4094629   HIV 1 QN PCR                           76.30            40            LAB
       4021457   HIV 1 QN PCR ULTRA                    451.00            40            LAB
       4093845   HIV 1 QN PCR ULTRA                     81.50            40            LAB
       4095238   HIV 1 RNA VIRAL LOAD PCR               81.50            40            LAB
       4096640   HIV 1/HIV 2 AB                         58.00            40            LAB
       4097572   HIV 1/HIV 2 AB                         11.75            40            LAB
       4097580   HIV 1/HIV 2 AB                        145.00            40            LAB
       4094785   HIV AB CONF WESTERN BLOT               20.75            40            LAB
       4095105   HIV AB CONF WESTERN BLOT               66.36            40            LAB
       4096541   HIV AB CONF WESTERN BLOT               63.00            40            LAB
       4098612   HIV-2 AB                               61.50            40            LAB
       4080412   HLA B27                               145.00            40            LAB
       4093886   HLA B27                                25.80            40            LAB
       4080776   HLA TYP A B OR C MULT                 208.80            40            LAB
       4019139   HOMOCYSTINE                            63.00            40            LAB
       4093928   HOMOCYSTINE                            29.50            40            LAB
       4096723   HOMOCYSTINE                            71.00            40            LAB
       4096939   HOMOVANILLIC ACID (HVA)                18.00            40            LAB
       4099990   HOMOVANILLIC ACID (HVA)                18.00            40            LAB
       4081733   HPV AMP PRB                             7.90            40            LAB
       4093761   HSV 1 AB IGG                           20.15            40            LAB
       4096012   HSV 1 AB IGG                           14.25            40            LAB
       4096616   HSV 1 AB IGM                           12.00            40            LAB
       4096020   HSV 2 AB IGG                           14.25            40            LAB
       4096632   HSV 2 AB IGG                           20.15            40            LAB
       4096624   HSV 2 AB IGM                           12.00            40            LAB
       4093969   HSV AB                                 26.00            40            LAB
       4094496   HSV AMP PRB                           110.00            40            LAB
       4095113   HYDROXYPROLINE FREE                    52.00            40            LAB
       4094132   HYDROXYPROLINE TOTAL                   55.00            40            LAB
       4014197   IGA                                    99.00      99.00 40            LAB
       4094041   IGA                                     7.00            40            LAB
       4096038   IGA                                    11.33            40            LAB



9/17/2012                                                                                                       71
                                           69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4097770   IGA                                   39.00            40            LAB
       4095188   IGD                                   63.50            40            LAB
       4094082   IGE                                    8.00            40            LAB
       4080974   IGFBP 2                               54.40            40            LAB
       4093571   IGFBP 3                               33.00            40            LAB
       4014213   IGG                                   99.00      99.00 40            LAB
       4094165   IGG                                    7.00            40            LAB
       4096053   IGG                                   11.33            40            LAB
       4097762   IGG                                   39.00            40            LAB
       4096350   IGG SUBCLASSES                        26.00            40            LAB
       4014239   IGM                                   99.00      99.00 40            LAB
       4094207   IGM                                    7.00            40            LAB
       4096061   IGM                                   11.33            40            LAB
       4097754   IGM                                   39.00            40            LAB
       4096095   IMIPRAMINE                            23.10            40            LAB
       4081105   IMMUNE COMPLEX CD3 CIRC               30.00            40            LAB
       4096079   IMMUNE COMPLEX CD3 CIRC               45.75            40            LAB
       4081113   IMMUNE COMPLEX CIQ BIND               23.00            40            LAB
       4093753   IMMUNE COMPLEX CIQ BIND               37.50            40            LAB
       4090809   IMMUNOASSAY ANALYTE QN               234.00            40            LAB
       4092136   IMMUNOASSAY ANALYTE QN                86.33            40            LAB
       4096103   IMMUNOASSAY ANALYTE QN                46.00            40            LAB
       4096111   IMMUNOASSAY ANALYTE QN               120.00            40            LAB
       4098265   IMMUNOASSAY ANALYTE QN               113.00            40            LAB
       4090924   IMMUNOASSAY NONINFECT                 14.25            40            LAB
       4091070   IMMUNOASSAY NONINFECT                 12.89            40            LAB
       4093381   IMMUNOASSAY NONINFECT                192.00            40            LAB
       4093696   IMMUNOASSAY NONINFECT                 16.00            40            LAB
       4096137   IMMUNOASSAY NONINFECT                 28.40            40            LAB
       4096145   IMMUNOASSAY NONINFECT                 16.70            40            LAB
       4080016   IMMUNOASSAY NOT SPEC                  15.00            40            LAB
       4080800   IMMUNOASSAY NOT SPEC                  77.69            40            LAB
       4080818   IMMUNOASSAY NOT SPEC                  70.26            40            LAB



9/17/2012                                                                                                      72
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4080826   IMMUNOASSAY NOT SPEC                72.29            40            LAB
       4080834   IMMUNOASSAY NOT SPEC                50.67            40            LAB
       4081956   IMMUNOASSAY NOT SPEC                93.00            40            LAB
       4082012   IMMUNOASSAY NOT SPEC                42.00            40            LAB
       4090627   IMMUNOASSAY NOT SPEC                12.00            40            LAB
       4095196   IMMUNOASSAY NOT SPEC                50.00            40            LAB
       4096152   IMMUNOASSAY NOT SPEC               151.75            40            LAB
       4096178   IMMUNOASSAY NOT SPEC               125.00            40            LAB
       4096186   IMMUNOASSAY NOT SPEC                90.95            40            LAB
       4098125   IMMUNOASSAY NOT SPEC                86.00            40            LAB
       4080230   IMMUNOASSAY TUM AG EA               93.75            40            LAB
       4093654   IMMUNOASSAY TUM AG EA               34.50            40            LAB
       4099073   IMMUNODIFFUSION                    110.00            40            LAB
       4080552   IMMUNODIFFUSION GEL                 30.00            40            LAB
       4080420   IMMUNODIFFUSION GEL QUAL            13.00            40            LAB
       4092144   IMMUNODIFFUSION GEL QUAL             8.00            40            LAB
       4090593   IMMUNOFIX CSF                       96.00            40            LAB
       4094249   IMMUNOFIX SER                       48.00            40            LAB
       4094280   IMMUNOFIX UR                        34.50            40            LAB
       4091005   IMMUNOFIXATION OTHER FLDS          183.00            40            LAB
       4021853   IMMUNOFL STDY DRCT EA AN           156.60            40            LAB
       4021903   IMMUNOFL STDY DRCT EA AN           156.60            40            LAB
       4021598   IMMUNOHISTOCHEMISTRY               262.50            40            LAB
       4012738   INDIA INK PREP CSF                  44.00      44.00 40            LAB
       4080115   INF AGENT DET NUC ACID QN          295.00            40            LAB
       4091716   INF AGENT DET NUC ACID QN          224.40            40            LAB
       4098539   INF AGENT DET NUC ACID QN          194.50            40            LAB
       4092755   INFECT AGENT DETECT DFA             15.00            40            LAB
       4092847   INFECT AGENT DETECT DFA             32.00            40            LAB
       4093639   INFECT AGENT DETECT DFA             34.00            40            LAB
       4093100   INFLUENZA A AB                      23.00            40            LAB
       4093118   INFLUENZA A AB                      23.00            40            LAB
       4080982   INFLUENZA A DFA                     12.50            40            LAB



9/17/2012                                                                                                    73
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4010120   INFLUENZA AG A OR B EACH           126.00              40          LAB
       4098927   INFLUENZA B AB                      25.96              40          LAB
       4080990   INFLUENZA B DFA                     12.50              40          LAB
       4098521   INHIBIN A                           81.00              40          LAB
       4080289   INSITU HYBRIDIZATION MAN           101.25              40          LAB
       4019386   INSULIN                             21.50              40          LAB
       4093704   INSULIN                             19.00              40          LAB
       4094322   INSULIN                             12.00              40          LAB
       4090585   INSULIN ANTIBODIES                  27.00              40          LAB
       4092151   INSULIN ANTIBODIES                  86.33              40          LAB
       4092177   INSULIN ANTIBODIES                  75.00              40          LAB
       4094454   INSULIN FREE                        29.00              40          LAB
       4095154   INSULIN GROWTH FCTR                 85.00              40          LAB
       4080719   INTERLEUKIN 6                       99.00              40          LAB
       4010013   INTERP BLD SMR                      49.00      49.00   40          LAB
       4020509   INTERP BM SMR                      526.00              40          LAB
       4021804   INTRAOP CYTOPATH CON ADDL          120.00              40          LAB
       4021754   INTRAOP CYTOPATH CON INIT          180.00              40          LAB
       4093019   INTRINSIC FCTR AB                   20.40              40          LAB
       4014478   IRON                                69.00      69.00   40          LAB
       4091732   IRON                                69.37              40          LAB
       4014494   IRON BINDING CAPACITY               93.00      93.00   40          LAB
       4096194   ISLET CL AB                         31.15              40          LAB
       4014379   ISOENZYMES CPK                     143.00     143.00   40          LAB
       4098976   ISOPROPANOL BLD                     28.00              40          LAB
       4093340   JO 1 AB                             28.50              40          LAB
       4014056   KETONES QL                          47.00      47.00   40          LAB
       4091740   KETONES QN                         114.00              40          LAB
       4092979   KETOSTEROIDS 17 TOTAL               20.00              40          LAB
       4096210   KETOSTEROIDS 17-FRACT              125.00              40          LAB
       4012530   KOH PREP SKIN HAIR NAIL             44.00      44.00   40          LAB
       4017877   L/S RATIO                          105.00     105.00   40          LAB
       4014130   LACTIC ACID                        112.00     112.00   40          LAB



9/17/2012                                                                                                    74
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4092631   LACTOFERRIN FECAL QL               62.00              40          LAB
       4099115   LAMBERT-EATON MYASTH SYND          95.00              40          LAB
       4093506   LAMOTRIGINE                        31.50              40          LAB
       4013371   LDH                                63.00      63.00   40          LAB
       4019477   LDH CSF                            27.00              40          LAB
       4096392   LDH ISOENZYMES                      5.95              40          LAB
       4019972   LDL BY DIRECT MEASURE             101.00              40          LAB
       4096749   LDL BY DIRECT MEASURE              19.09              40          LAB
       4017455   LEAD BLD                          145.00     145.00   40          LAB
       4094405   LEAD BLD                            9.20              40          LAB
       4094850   LEAD UR                            27.00              40          LAB
       4096228   LEAD UR                            25.00              40          LAB
       4097267   LEAD UR 24HR                       16.99              40          LAB
       4092714   LEGIONELLA AB                      11.50              40          LAB
       4093779   LEGIONELLA AB                      38.00              40          LAB
       4094447   LEGIONELLA PNEUMO DFA              41.50              40          LAB
       4092896   LEPTOSPIRA AN                      16.99              40          LAB
       4093183   LEUCINE AMINOPEOTIDASE             25.50              40          LAB
       4093175   LEUK ALK PHOS                      15.00              40          LAB
       4017471   LH                                 43.50              40          LAB
       4094488   LH                                 23.67              40          LAB
       4096269   LH                                 78.00              40          LAB
       4010914   LIDOCAINE                         156.00     156.00   40          LAB
       4096236   LIDOCAINE                          19.25              40          LAB
       4013413   LIPASE                             74.00      74.00   40          LAB
       4092623   LIPASE                              6.50              40          LAB
       4013157   LIPID PNL                         125.00     125.00   40          LAB
       4095493   LIPOPROTEIN (A)                    14.25              40          LAB
       4090841   LIPROPROT BLD HI FRAC/QNT          33.25              40          LAB
       4095501   LIPROPROT BLD HI FRAC/QNT          15.20              40          LAB
       4081527   LISTERIA MONOCYTOGENES A           53.00              40          LAB
       4014817   LITHIUM                            71.00      71.00   40          LAB
       4080495   LONG CHAIN FATTY ACIDS            101.00              40          LAB



9/17/2012                                                                                                   75
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4098133   LSD SCRN SERUM                          74.00            40            LAB
       4017950   LYME DISEASE AB                         71.00      43.50 40            LAB
       4098737   LYME DISEASE AB CSF                    214.00            40            LAB
       4097515   LYME DISEASE AB IGG                     17.00            40            LAB
       4098323   LYME DISEASE AB IGM                     32.00            40            LAB
       4095519   LYMPH CHORIOMENINGITIS AB               18.25            40            LAB
       4098638   LYMPH CHORIOMENINGITIS AB               54.00            40            LAB
       4092532   M TB AMP PRB                            51.00            40            LAB
       4098232   M TB AMP PRB                            99.00            40            LAB
       4081055   MACRO EXAM ARTHROPOD                    25.00            40            LAB
       4099024   MACRO EXAM PARASITE                     21.00            40            LAB
       4094470   MAG AB                                  50.00            40            LAB
       4014338   MAGNESIUM                               71.00      71.00 40            LAB
       4090643   MAGNESIUM                               72.50            40            LAB
       4098802   MAGNESIUM RBC                           30.00            40            LAB
       4097275   MAGNESIUM UR                            71.00            40            LAB
       4097291   MAGNESIUM UR                            11.70            40            LAB
       4097283   MAGNESIUM UR TIM                        71.00            40            LAB
       4097309   MAGNESIUM UR TIM                        11.70            40            LAB
       4081170   MALARIA AB                              48.50            40            LAB
       4095535   MANGANESE SERUM                         37.50            40            LAB
       4095543   MANGANESE SERUM                         37.50            40            LAB
       4095550   MANGANESE SERUM                         40.00            40            LAB
       4095576   MANGANESE SERUM                         45.00            40            LAB
       4093514   MAPROTILINE                             31.50            40            LAB
       4081444   MASS SPECT/TANDEM QN NES               125.00            40            LAB
       4081451   MASS SPECT/TANDEM QN NES               143.00            40            LAB
       4091757   MASS SPECT/TANDEM QN NES               100.00            40            LAB
       4092185   MASS SPECT/TANDEM QN NES                20.35            40            LAB
       4095584   MASS SPECT/TANDEM QN NES                59.51            40            LAB
       4098547   MASS SPECT/TANDEM QN NES               170.00            40            LAB
       4081550   MASS SPECTROMETRY QUAL                  90.00            40            LAB
       4091773   MASS SPECTROMETRY QUAL                  20.17            40            LAB



9/17/2012                                                                                                        76
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4095592   MEPROBAMATE                         32.85              40          LAB
       4017497   MERCURY                             54.00              40          LAB
       4081329   MERCURY                             10.00              40          LAB
       4094561   MERCURY                             25.50              40          LAB
       4094934   MERCURY                             30.50              40          LAB
       4095618   MERCURY                             23.70              40          LAB
       4081469   METANEPHRINES BLOOD                120.00              40          LAB
       4092862   METANEPHRINES BLOOD                150.00              40          LAB
       4096400   METANEPHRINES UR                    36.57              40          LAB
       4019808   METANEPHRINES UR 24HR               29.50              40          LAB
       4098026   METHADONE                           61.10              40          LAB
       4099008   METHADONE CONF                      56.00              40          LAB
       4099016   METHADONE SCRN                      40.00              40          LAB
       4097432   METHANOL BLD                        72.50              40          LAB
       4099255   METHAQUALONE SCRN                    5.00              40          LAB
       4015137   METHEMOGLOBIN                       77.00      77.00   40          LAB
       4094603   METHYLMALONIC ACID QN               31.49              40          LAB
       4080164   METHYLMALONIC ACID UR               45.00              40          LAB
       4094090   MEXILETINE                          31.63              40          LAB
       4016598   MICRO EXAM UR                       33.00      33.00   40          LAB
       4018891   MICROALBUMIN UR 24HR                17.50      17.50   40          LAB
       4090213   MICROALBUMIN UR 24HR                24.00              40          LAB
       4092672   MICROALBUMIN UR 24HR                11.00              40          LAB
       4097952   MICROALBUMIN UR 24HR                24.00              40          LAB
       4094645   MICROALBUMIN UR RAN                 17.50              40          LAB
       4096285   MICROALBUMIN UR RAN                 24.00              40          LAB
       4017539   MICROSOMAL AB                      154.00     154.00   40          LAB
       4019394   MICROSOMAL AB                       65.50              40          LAB
       4090908   MICROSOMAL AB                      121.00              40          LAB
       4091609   MICROSOMAL AB                       30.00              40          LAB
       4092193   MICROSPORA AB                        9.00              40          LAB
       4095626   MISC CHEM                                              40          LAB
       4016010   MISC CHEM TEST                                         40          LAB



9/17/2012                                                                                                    77
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4080180   MISC CHEM TEST                          25.00           40             LAB
       4092540   MISC CHEM TEST                          56.00           40             LAB
       4015996   MISC TS PROC                                            40             LAB
       4091369   MITOCHONDRIAL AB SCRN                   13.25           40             LAB
       4098554   MITOCHONDRIAL AB TTR                    12.00           40             LAB
       4080602   MOL DX AMP NA MLTIP EA SQ                7.00           40             LAB
       4081238   MOL DX AMP NA MLTIP EA SQ               33.00           40             LAB
       4090296   MOL DX AMP NA MLTIP EA SQ               50.00           40             LAB
       4092219   MOL DX AMP NA MLTIP EA SQ               80.00           40             LAB
       4095634   MOL DX AMP NA MLTIP EA SQ                1.94           40             LAB
       4081022   MOL DX AMP PT N ACD EA S                20.00           40             LAB
       4018578   MOL DX AMP PT N ACD EA SQ              203.00           40             LAB
       4019030   MOL DX AMP PT N ACD EA SQ              203.00           40             LAB
       4080586   MOL DX AMP PT N ACD EA SQ                7.00           40             LAB
       4081220   MOL DX AMP PT N ACD EA SQ               33.00           40             LAB
       4081253   MOL DX AMP PT N ACD EA SQ               26.50           40             LAB
       4090288   MOL DX AMP PT N ACD EA SQ               75.50           40             LAB
       4091864   MOL DX AMP PT N ACD EA SQ               50.00           40             LAB
       4090262   MOL DX DOT/SLOT BLOT                    18.50           40             LAB
       4095659   MOL DX DOT/SLOT BLOT                    15.00           40             LAB
       4081030   MOL DX ENZ DIGESTION                     5.50           40             LAB
       4090254   MOL DX ENZ DIGESTION                    18.50           40             LAB
       4092227   MOL DX ENZ DIGESTION                    30.00           40             LAB
       4092557   MOL DX ENZ DIGESTION                    16.00           40             LAB
       4018552   MOL DX EXTRACTION                      410.50           40             LAB
       4018990   MOL DX EXTRACTION                       40.00           40             LAB
       4080578   MOL DX EXTRACTION HI PUR                 5.00           40             LAB
       4090650   MOL DX EXTRACTION HI PUR                30.00           40             LAB
       4090981   MOL DX EXTRACTION HI PUR                 7.75           40             LAB
       4091781   MOL DX EXTRACTION HI PUR                14.00           40             LAB
       4092805   MOL DX EXTRACTION HI PUR               170.00           40             LAB
       4093126   MOL DX EXTRACTION HI PUR               395.00           40             LAB
       4093167   MOL DX EXTRACTION HI PUR                50.00           40             LAB



9/17/2012                                                                                                        78
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4094686   MOL DX EXTRACTION HI PUR              322.00            40            LAB
       4095568   MOL DX EXTRACTION HI PUR              122.00            40            LAB
       4095667   MOL DX EXTRACTION HI PUR               20.00            40            LAB
       4081311   MOL DX EXTRACTION HI PUR               20.00            40            LAB
       4018818   MOL DX GEL ELECTRO SEP                 48.00      48.00 40            LAB
       4018875   MOL DX GEL ELECTRO SEP                 28.00      20.50 40            LAB
       4080610   MOL DX GEL ELECTRO SEP                  3.00            40            LAB
       4081899   MOL DX GEL ELECTRO SEP                  7.00            40            LAB
       4090270   MOL DX GEL ELECTRO SEP                 18.50            40            LAB
       4090999   MOL DX GEL ELECTRO SEP                 14.54            40            LAB
       4092235   MOL DX GEL ELECTRO SEP                 30.00            40            LAB
       4019055   MOL DX INTERP & RPT                    14.50            40            LAB
       4080628   MOL DX INTERP & RPT                     7.00            40            LAB
       4091062   MOL DX INTERP & RPT                     1.84            40            LAB
       4091799   MOL DX INTERP & RPT                    35.00            40            LAB
       4091815   MOL DX INTERP & RPT                    23.00            40            LAB
       4091823   MOL DX INTERP & RPT                    85.00            40            LAB
       4092573   MOL DX ISOLATE & EXTRACT               16.00            40            LAB
       4018594   MOL DX NUC ACID PRB                    11.00            40            LAB
       4018610   MOL DX NUC ACID PRB                    49.50            40            LAB
       4019014   MOL DX NUC ACID PRB                     8.50            40            LAB
       4081931   MOL DX NUC ACID PRB                    14.00            40            LAB
       4092581   MOL DX NUC ACID PRB                    10.00            40            LAB
       4095675   MOL DX NUC ACID PRB                     3.00            40            LAB
       4098505   MOL DX NUC ACID TRANSFER                8.00            40            LAB
       4080354   MOL DX REV TRANSCRIPT                  65.00            40            LAB
       4098042   MOL DX REV TRANSCRIPT                  31.00            40            LAB
       4080123   MOL NUCLEIC AMPLI 2 SEQ               135.00            40            LAB
       4080388   MOL NUCLEIC AMPLI 2 SEQ                 5.00            40            LAB
       4080594   MOL NUCLEIC AMPLI 2 SEQ                26.50            40            LAB
       4080693   MOL NUCLEIC AMPLI 2 SEQ               174.87            40            LAB
       4080941   MOL NUCLEIC AMPLI 2 SEQ                73.26            40            LAB
       4081212   MOL NUCLEIC AMPLI 2 SEQ                63.00            40            LAB



9/17/2012                                                                                                       79
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4081519   MOL NUCLEIC AMPLI 2 SEQ                108.00            40            LAB
       4080040   MONO TEST SCRN                          22.00            40            LAB
       4097978   MUCIN SYNOVIAL FLUID                    27.00            40            LAB
       4091013   MUCOPOLYSACCH ACID QNT                  90.00            40            LAB
       4099396   MUCOPOLYSACCH ACID SCRN                 74.00            40            LAB
       4094678   MUMPS AB IGG                            12.00            40            LAB
       4094835   MUMPS AB IGM                            17.25            40            LAB
       4093910   MURAMIDASE                              18.00            40            LAB
       4093951   MURAMIDASE                              46.00            40            LAB
       4080347   MUTATION ID BY SEQ EA SEG               77.00            40            LAB
       4091831   MUTATION ID BY SEQ EA SEG               46.00            40            LAB
       4099107   MUTATION ID BY SEQ EA SEG               22.00            40            LAB
       4080966   MUTATION ID OLA/SBCE/ASP                35.64            40            LAB
       4081576   MUTATION ID OLA/SBCE/ASP                12.00            40            LAB
       4080396   MUTATION ID OLA/SBCE/ASPE                3.00            40            LAB
       4081907   MUTATION ID OLA/SBCE/ASPE               45.00            40            LAB
       4081923   MUTATION ID OLA/SBCE/ASPE               58.00            40            LAB
       4096558   MYCOPLAS AB IGG                         30.50            40            LAB
       4096566   MYCOPLAS AB IGM                         23.00            40            LAB
       4093217   MYCOPLAS CULT                           26.00            40            LAB
       4093456   MYCOPLAS CULT                           30.00            40            LAB
       4081295   MYCOPLASMA AMPLIF NA PRB               291.00            40            LAB
       4093258   MYELIN BASIC PROTEIN CSF                19.00            40            LAB
       4095691   MYELOPEROXIDASE AB                      16.00            40            LAB
       4097010   MYELOPEROXIDASE AB                      68.00            40            LAB
       4095709   MYOCARDIAL AB SCRN                      20.00            40            LAB
       4015350   MYOGLOBIN                              137.00     137.00 40            LAB
       4018172   MYOGLOBIN                              137.00            40            LAB
       4016671   MYOGLOBIN SCRN UR                      137.00     137.00 40            LAB
       4096418   MYOGLOBIN UR                            23.45            40            LAB
       4011177   NAPA ONLY                               55.00      55.00 40            LAB
       4097705   NATRIURETIC PEPTIDE                     70.00            40            LAB
       4090601   NATURAL KILLER CELLS                    42.50            40            LAB



9/17/2012                                                                                                        80
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4091195   NB GENETIC SCR GALACT                   20.35              40          LAB
       4080362   NEISSERIA MENINGITIDIS AB               13.00              40          LAB
       4081691   NEOPTERIN RIA TECHNIQ                   60.65              40          LAB
       4081980   NEOPTERIN RIA TECHNIQ                   61.00              40          LAB
       4081618   NEURONAL AB (HU AB) SCRN                66.00              40          LAB
       4099321   NEURONAL AB (HU AB) SCRN                75.00              40          LAB
       4099198   NEUTRALIZATION TEST                    580.50              40          LAB
       4098141   NIACIN                                  53.00              40          LAB
       4090940   NICOTINE & METABOLITE                   70.20              40          LAB
       4099164   NICOTINE & METABOLITE                   27.50              40          LAB
       4094769   NORTRIPTYLINE                           24.50              40          LAB
       4095071   NTELOPEPTIDE UR                         45.50              40          LAB
       4080404   NUCLEIC ACID HI RESOLUTE                 3.00              40          LAB
       4080701   NUCLEIC ACID HI RESOLUTE                87.44              40          LAB
       4080958   NUCLEIC ACID HI RESOLUTE                35.64              40          LAB
       4081048   NUCLEIC ACID HI RESOLUTE                20.00              40          LAB
       4081584   NUCLEIC ACID HI RESOLUTE                12.00              40          LAB
       4082095   NUCLEIC ACID HI RESOLUTE                67.00              40          LAB
       4081592   NUCLEIC ACID SIGNAL AMPL                40.00              40          LAB
       4081600   NUCLEIC ACID SIGNAL AMPL                55.00              40          LAB
       4010203   O2 SAT ART                              93.00              40          LAB
       4013793   O2 SAT ART                              93.00              40          LAB
       4015178   O2 SAT VEN                              93.00      93.00   40          LAB
       4015194   O2 SAT VEN                              93.00      93.00   40          LAB
       4016739   OCCLT BLD STL QL MULT SPC               36.00      36.00   40          LAB
       4019519   OCCULT BLD GASTRIC QL                   36.00              40          LAB
       4094751   OLIGOCLONAL BANDS CSF                   18.45              40          LAB
       4080321   OPIATES                                 63.00              40          LAB
       4081188   OPIATES                                 65.00              40          LAB
       4090759   OPIATES                                 40.00              40          LAB
       4018537   OPIATES CONF                           128.00              40          LAB
       4097127   OPIATES CONF                            47.70              40          LAB
       4011110   OPIATES SCRN                            37.00      37.00   40          LAB



9/17/2012                                                                                                        81
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4099230   OPIATES SCRN                            5.00              40          LAB
       4094595   ORGANIC ACIDS QN TOTAL                145.00              40          LAB
       4080891   OROTIC ACID URINE                      96.00              40          LAB
       4015053   OSMOLALITY SER                         71.00      71.00   40          LAB
       4091856   OSMOLALITY SER                         10.00              40          LAB
       4015079   OSMOLALITY UR                          71.00      71.00   40          LAB
       4098273   OSMOLALITY UR                           9.20              40          LAB
       4095030   OSTEOCALCIN                            36.34              40          LAB
       4016796   OVA & PARASITES W CONC                  8.00              40          LAB
       4081667   OXALATE UR                             20.00              40          LAB
       4092748   OXALATE UR                             12.50              40          LAB
       4095717   PANCREAS POLYPEPTIDE                   52.00              40          LAB
       4080248   PANCREATIC ELASTASE                   138.00              40          LAB
       4030151   PAP DX TBS SCRN                        51.00              40          LAB
       4090098   PARAINFLUENZA AB                       21.00              40          LAB
       4097101   PARAINFLUENZA DFA                      21.25              40          LAB
       4094843   PARVOVIRUS B19 AB                      23.00              40          LAB
       4097028   PARVOVIRUS B19 AB IGG                  15.00              40          LAB
       4094710   PARVOVIRUS B19 AB IGM                  15.00              40          LAB
       4020350   PATH CONSULT INTRAOP                   60.00              40          LAB
       4020400   PATH FRZN SECTION 1 BLK               153.00              40          LAB
       4021606   PATH FRZN SECTION ADD                  82.00              40          LAB
       4090205   PCP SCRN                               44.40              40          LAB
       4014999   PH BLD                                 90.00      90.00   40          LAB
       4010393   PH FLD                                 38.00      38.00   40          LAB
       4019980   PH FLD                                 38.00              40          LAB
       4090775   PH FLD                                 20.00              40          LAB
       4098497   PH FLD                                 22.50              40          LAB
       4080487   PHENCYCLIDINE GCMS URINE               65.00              40          LAB
       4010799   PHENOBARBITAL                         121.00     121.00   40          LAB
       4097150   PHENOBARBITAL                          18.88              40          LAB
       4080297   PHENOTHIAZINE                          45.00              40          LAB
       4093746   PHENOTHIAZINE                          37.00              40          LAB



9/17/2012                                                                                                       82
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4093795   PHENOTHIAZINE                       39.00              40          LAB
       4093837   PHENOTHIAZINE                       22.50              40          LAB
       4094017   PHENOTHIAZINE                       29.00              40          LAB
       4012092   PHENYLALANINE BLOOD                 58.00      58.00   40          LAB
       4012852   PHENYLALANINE BLOOD                 26.00              40          LAB
       4091179   PHENYLALANINE BLOOD                 15.40              40          LAB
       4090783   PHENYTOIN FREE                      24.26              40          LAB
       4011276   PHENYTOIN TOTAL                    140.00     140.00   40          LAB
       4014635   PHOSPHATIDYL GLYC (PG)             175.00     175.00   40          LAB
       4093282   PHOSPHATIDYL GLYC (PG)             150.00              40          LAB
       4098695   PHOSPHOLIPID AB                     38.83              40          LAB
       4081345   PHOSPHOLIPID NEUTRALIZATN           41.50              40          LAB
       4010047   PHOSPHOROUS UR RAN                  55.00              40          LAB
       4013470   PHOSPHORUS (PO4)                    49.00              40          LAB
       4081634   PHOSPHORUS UR 24 HR                  8.00              40          LAB
       4013934   PHOSPHORUS UR 24HR                  55.00      55.00   40          LAB
       4097317   PHOSPHORUS UR 24HR                  20.02              40          LAB
       4016838   PINWORM CELLOPHANE TAPE             44.00      44.00   40          LAB
       4080446   PLSMG                               24.00              40          LAB
       4080461   PLSMG ACTIVATOR INHIBITOR           82.00              40          LAB
       4080479   PLSMG ACTIVATOR INHIBITOR           55.00              40          LAB
       4080453   PLSMG AG ASSAY                      75.00              40          LAB
       4094884   PLT AB DIR IGG                      58.50              40          LAB
       4081501   PLT AB DRG INDUCED                  95.00              40          LAB
       4096459   PLT AB DRG INDUCED                  60.00              40          LAB
       4094926   PLT AB INDIRECT                     76.50              40          LAB
       4010534   PLT CNT AUTO                        47.00      47.00   40          LAB
       4098703   PLT NEUTRALIZATION                  30.00              40          LAB
       4099289   PNEUMOCOCCAL AB                     10.00              40          LAB
       4097051   PNEUMOCYSTIS CARINII DFA            44.50              40          LAB
       4099297   POLIO AB                            95.50              40          LAB
       4094702   PORPHOBILINOGEN QN                  15.50              40          LAB
       4094777   PORPHOBILINOGEN QN                  22.00              40          LAB



9/17/2012                                                                                                    83
                                       69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4094025   PORPHYRINS UR QN&FX               30.00              40          LAB
       4014932   POTASSIUM                         49.00      49.00   40          LAB
       4090684   POTASSIUM                          8.00              40          LAB
       4090692   POTASSIUM                          1.76              40          LAB
       4090452   POTASSIUM FECES                   10.00              40          LAB
       4019584   POTASSIUM FLD                     49.00              40          LAB
       4014015   POTASSIUM UR 24 HR                47.00      47.00   40          LAB
       4081626   POTASSIUM UR 24 HR                 7.00              40          LAB
       4098422   POTASSIUM UR 24HR                 19.50              40          LAB
       4013991   POTASSIUM UR RAN                  47.00      47.00   40          LAB
       4019436   PREALBUMIN                        48.50              40          LAB
       4094967   PREALBUMIN                        10.00              40          LAB
       4016754   PREGNANCY SCRN UR                 66.00      66.00   40          LAB
       4095147   PREGNANEDIOL                      55.50              40          LAB
       4081196   PREGNANETRIOL                    106.00              40          LAB
       4093621   PREGNENOLONE                      33.50              40          LAB
       4080438   PREKALLIKREIN ASSAY              104.00              40          LAB
       4019204   PRENATAL PNL                     226.50      61.00   40          LAB
       4019857   PRIMIDONE                         16.00              40          LAB
       4011193   PROCAINAMIDE & NAPA               19.50      19.50   40          LAB
       4019485   PROCAINAMIDE & NAPA              178.00              40          LAB
       4018057   PROGESTERONE                     110.50     110.50   40          LAB
       4095006   PROGESTERONE                      14.00              40          LAB
       4098943   PROGESTERONE                      88.00              40          LAB
       4094223   PROINSULIN                        40.00              40          LAB
       4017570   PROLACTIN                        103.00     103.00   40          LAB
       4095048   PROLACTIN                         14.15              40          LAB
       4096293   PROLACTIN                         81.00              40          LAB
       4091872   PROPOXYPHENE SCRN                 37.00              40          LAB
       4099248   PROPOXYPHENE SCRN                  5.00              40          LAB
       4093068   PROPRANOLOL                       23.00              40          LAB
       4095758   PROTEIMASE 3                      16.00              40          LAB
       4097002   PROTEIMASE 3                      68.00              40          LAB



9/17/2012                                                                                                  84
                                       69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4095303   PROTEIN C ACTIVATED               48.50              40          LAB
       4095089   PROTEIN C ACTIVITY                29.00              40          LAB
       4094900   PROTEIN C AG                      35.00              40          LAB
       4018156   PROTEIN ELECTRO CSF               27.00              40          LAB
       4092599   PROTEIN ELECTRO SER               17.00              40          LAB
       4092961   PROTEIN ELECTRO SER               11.00              40          LAB
       4013736   PROTEIN ELECTRO UR                50.00      50.00   40          LAB
       4093464   PROTEIN ELECTRO UR                30.50              40          LAB
       4095923   PROTEIN ELECTRO UR                38.00              40          LAB
       4096442   PROTEIN ELECTRO UR                28.10              40          LAB
       4081006   PROTEIN NEPHELOMET                60.00              40          LAB
       4081014   PROTEIN NEPHELOMET                60.00              40          LAB
       4081477   PROTEIN NEPHELOMET               115.00              40          LAB
       4091252   PROTEIN NEPHELOMET                50.00              40          LAB
       4093589   PROTEIN NEPHELOMET                33.00              40          LAB
       4095311   PROTEIN NEPHELOMET                13.00              40          LAB
       4095733   PROTEIN NEPHELOMET                54.00              40          LAB
       4095741   PROTEIN NEPHELOMET                12.00              40          LAB
       4082038   PROTEIN S ACTIVITY                66.00              40          LAB
       4095121   PROTEIN S ACTIVITY                38.00              40          LAB
       4082020   PROTEIN S AG TOTAL                61.00              40          LAB
       4093712   PROTEIN S AG TOTAL                36.00              40          LAB
       4092250   PROTEIN S FREE                    91.00              40          LAB
       4013553   PROTEIN TOTAL BLOOD               38.00      38.00   40          LAB
       4097325   PROTEIN TOTAL BLOOD                8.50              40          LAB
       4015699   PROTEIN TOTAL CSF                  9.15       9.15   40          LAB
       4019493   PROTEIN TOTAL CSF                 38.00              40          LAB
       4014155   PROTEIN TOTAL FLD                 38.00      38.00   40          LAB
       4099032   PROTEIN TOTAL FLD                 20.00              40          LAB
       4013892   PROTEIN UR QN 24 HR               38.00      38.00   40          LAB
       4097333   PROTEIN UR QN 24 HR                9.00              40          LAB
       4097341   PROTEIN UR QN RAN                 38.00              40          LAB
       4097358   PROTEIN UR QN RAN                  7.08              40          LAB



9/17/2012                                                                                                  85
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4081428   PROTEIN WESTERN BLOT               44.00              40          LAB
       4098752   PROTEIN WESTERN BLOT              209.75              40          LAB
       4099313   PROTEIN WESTERN BLOT               75.00              40          LAB
       4010633   PROTHROMBIN TIME                   41.00      41.00   40          LAB
       4080842   PROTHROMBIN TIME                    8.00              40          LAB
       4018933   PROTOPORPHYRIN RBC                 77.00      77.00   40          LAB
       4018958   PROTOPORPHYRIN RBC                 77.00      77.00   40          LAB
       4098828   PROTOPORPHYRIN RBC                 15.00              40          LAB
       4094553   PSA FREE                           81.00              40          LAB
       4095204   PSA FREE                           10.00              40          LAB
       4096301   PSA TOTAL                          77.00              40          LAB
       4017596   PSA TOTAL DIAG                     97.50      97.50   40          LAB
       4095162   PSA TOTAL DIAG                     23.50              40          LAB
       4095246   PTH C TERMINAL                     30.00              40          LAB
       4081774   PTH INTACT                        325.00              40          LAB
       4090833   PTH INTACT                         87.00              40          LAB
       4091898   PTH INTACT                         20.20              40          LAB
       4096756   PTH INTACT                         15.00              40          LAB
       4095287   PTH RELATED PROTEIN                61.00              40          LAB
       4010559   PTT PLAS OR WB                     63.00      63.00   40          LAB
       4080305   PTT PLAS OR WB                     30.00              40          LAB
       4080859   PTT PLAS OR WB                      7.00              40          LAB
       4081386   PTT PLAS OR WB                     55.00              40          LAB
       4096996   PTT PLAS OR WB                     18.00              40          LAB
       4010658   PTT SUBSTITUTION EA                69.00      69.00   40          LAB
       4097440   PTT SUBSTITUTION EA                10.00              40          LAB
       4081402   PURKINJE CL AB                     60.00              40          LAB
       4090304   PYRUVATE BLD                       15.00              40          LAB
       4096525   Q FEVER AB                          5.21              40          LAB
       4080081   QN DRG MISC                        77.00              40          LAB
       4080099   QN DRG MISC                        88.00              40          LAB
       4080677   QN DRG MISC                       131.00              40          LAB
       4080735   QN DRG MISC                       104.00              40          LAB



9/17/2012                                                                                                   86
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4081147   QN DRG MISC                            60.00              40          LAB
       4081949   QN DRG MISC                           120.00              40          LAB
       4090882   QN DRG MISC                            76.00              40          LAB
       4091880   QN DRG MISC                           110.40              40          LAB
       4092268   QN DRG MISC                           135.00              40          LAB
       4095063   QN DRG MISC                            40.00              40          LAB
       4095337   QN DRG MISC                           165.00              40          LAB
       4095345   QN DRG MISC                            88.00              40          LAB
       4095352   QN DRG MISC                            55.00              40          LAB
       4095378   QN DRG MISC                            61.00              40          LAB
       4095386   QN DRG MISC                            57.00              40          LAB
       4095774   QN DRG MISC                           124.50              40          LAB
       4095782   QN DRG MISC                            74.50              40          LAB
       4095790   QN DRG MISC                            30.00              40          LAB
       4095816   QN DRG MISC                            30.00              40          LAB
       4095824   QN DRG MISC                            68.00              40          LAB
       4095832   QN DRG MISC                            85.00              40          LAB
       4019535   QUINIDINE                             154.00              40          LAB
       4019949   QUINIDINE                              15.00      15.00   40          LAB
       4090817   RAPID HSV CX W/REFLEX                  21.00              40          LAB
       4019956   RBC FRZ/DEGLYC/WASHED PS              189.00              40          LAB
       4080339   RBC OSMOTIC FRAG UNINCUB               24.07              40          LAB
       4098596   RECEPT ASSAY ENDOCRINE                 85.95              40          LAB
       4021564   RECEPT ASSAY ESTROGEN                 340.00              40          LAB
       4021572   RECEPT ASSAY PROGEST                  343.00              40          LAB
       4030359   RENAL FUNCTION PNL                     93.00      93.00   40          LAB
       4097366   RENIN                                  20.00              40          LAB
       4098364   RETICULIN AB TTR                       33.50              40          LAB
       4010492   RETICULOCYTE MAN                       47.00      47.00   40          LAB
       4016150   RH TYP                                 63.00      63.00   40          LAB
       4015632   RHEUMATOID FCTR QL                     60.00      60.00   40          LAB
       4095394   RHEUMATOID FCTR QL                     35.00              40          LAB
       4096855   RHEUMATOID FCTR QL                     24.00              40          LAB



9/17/2012                                                                                                       87
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4015657   RHEUMATOID FCTR QN                     60.00      60.00 40            LAB
       4095477   RHEUMATOID FCTR QN                     34.00            40            LAB
       4096863   RHEUMATOID FCTR QN                     24.00            40            LAB
       4098315   RHEUMATOID FCTR QN                      7.50            40            LAB
       4094355   RIBOFLAVIN                             55.00            40            LAB
       4090239   RIBOSOMAL P AB                         33.00            40            LAB
       4090510   RMSF AB SCRN IGG                       12.04            40            LAB
       4090528   RMSF AB SCRN IGM                       12.04            40            LAB
       4095329   RO(SS A) AB                            15.00            40            LAB
       4018271   ROTAVIRUS AB                           33.00      33.00 40            LAB
       4015772   RPR QL                                 44.00      44.00 40            LAB
       4092276   RPR QL                                  5.00            40            LAB
       4098349   RPR QL                                 17.00            40            LAB
       4098786   RPR QL                                 10.00            40            LAB
       4017976   RPR TTR                                47.00      47.00 40            LAB
       4080073   RPR TTR                                83.00            40            LAB
       4092292   RPR TTR                                20.00            40            LAB
       4010328   RSV AG EIA                            126.00            40            LAB
       4015897   RUBELLA AB                            154.00     154.00 40            LAB
       4080214   RUBELLA AB                             61.00            40            LAB
       4092664   RUBELLA AB IGG                          9.99            40            LAB
       4094827   RUBELLA AB IGM                          8.50            40            LAB
       4018297   RUBEOLA AB                             29.50            40            LAB
       4092771   RUBEOLA AB IGG                         10.00            40            LAB
       4097622   RUBEOLA AB IGM                         10.00            40            LAB
       4096988   RUSSELL VIPER VENOM DILU               43.00            40            LAB
       4011334   SALICYLATE                             74.00      74.00 40            LAB
       4011375   SALICYLATE                             74.00      74.00 40            LAB
       4093894   SALMONELLA AB                           7.25            40            LAB
       4081998   SCHISTOSOMA AB                         42.00            40            LAB
       4093357   SCLERODERMA AB                         28.50            40            LAB
       4095857   SCLERODERMA AB                         39.00            40            LAB
       4010575   SEDIMENTATION RATE AUTO                27.00      27.00 40            LAB



9/17/2012                                                                                                       88
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4097374   SELENIUM                               25.50              40          LAB
       4010138   SEMEN ANALYSIS COMPLETE               129.00     129.00   40          LAB
       4010195   SEMEN PRESENCE/MOT POST                93.00      93.00   40          LAB
       4010385   SER PRETRTMT ABSORB                    40.00              40          LAB
       4094314   SEROTONIN BLD                          69.00              40          LAB
       4094439   SEROTONIN BLD                          78.50              40          LAB
       4081493   SEROTONIN RELEASE ASSAY               200.00              40          LAB
       4098299   SEX HORMONE BIND GLOB                  22.18              40          LAB
       4093290   SIALIC ACID                            18.50              40          LAB
       4010070   SICKLE CL SCRN                         58.00      58.00   40          LAB
       4091054   SICKLE CL SCRN                          9.75              40          LAB
       4095865   SICKLE CL SCRN                          5.66              40          LAB
       4095253   SIROLIMUS                              92.00              40          LAB
       4090346   SJOGRENS AB                            15.00              40          LAB
       4094876   SMITH AB                               18.00              40          LAB
       4012019   SMR AFB STAIN                          58.00      58.00   40          LAB
       4097903   SMR AFB STAIN                          10.50              40          LAB
       4082053   SMR CMPLX STAIN OVA PARA                8.00              40          LAB
       4012357   SMR CRYPTOSPORIDIUM                    58.00      58.00   40          LAB
       4011896   SMR FLUOR + OR ACID FAST               26.00      26.00   40          LAB
       4019568   SMR FLUOR + OR ACID FAST               58.00              40          LAB
       4091344   SMR FLUOR + OR ACID FAST               51.00              40          LAB
       4098224   SMR FLUOR + OR ACID FAST               10.00              40          LAB
       4012050   SMR GRAM STAIN                         44.00      44.00   40          LAB
       4097044   SMR INCL BODIES PARASITE               18.75              40          LAB
       4010310   SMR MALARIA                           107.00     107.00   40          LAB
       4090114   SMR MALARIA                             9.50              40          LAB
       4092912   SMR MALARIA                            18.50              40          LAB
       4010351   SMR TZANCK                             64.00      51.00   40          LAB
       4011672   SMR WET MOUNT                          44.00      44.00   40          LAB
       4014890   SODIUM                                 52.00      52.00   40          LAB
       4097986   SODIUM FLD                             52.00              40          LAB
       4090700   SODIUM OTHER SOURCE                     1.76              40          LAB



9/17/2012                                                                                                       89
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4099362   SODIUM OTHER SOURCE                 8.00              40          LAB
       4080529   SODIUM UR 24 HR                     6.00              40          LAB
       4013959   SODIUM UR 24HR                     52.00      52.00   40          LAB
       4098430   SODIUM UR 24HR                     21.50              40          LAB
       4097382   SODIUM UR RAN                      52.00              40          LAB
       4080537   SOL TRANSFERRIN                    55.00              40          LAB
       4094124   SOMATOMEDIN C                      28.90              40          LAB
       4091351   SPEC CONCENTRATION                 18.50              40          LAB
       4091377   SPEC CONCENTRATION                  5.00              40          LAB
       4092680   SPEC CONCENTRATION                 15.00              40          LAB
       4019998   SPEC GRAVITY FLD                   27.00              40          LAB
       4011490   SPEC HANDL COURIER                                    40          LAB
       4011524   SPEC HANDL COURIER                                    40          LAB
       4012654   SPEC HANDL COURIER                                    40          LAB
       4020251   SPEC STAIN GRP I MICROORG          55.00              40          LAB
       4011839   SPEC STAIN GRP I MICROORG          55.00      55.00   40          LAB
       4021101   SPEC STAIN GRP II                  58.00              40          LAB
       4097069   SPEC STAIN GRP II                   8.00              40          LAB
       4016499   SPECIFIC GRAVITY UR                27.00      27.00   40          LAB
       4098463   SPECIFIC GRAVITY UR                12.00              40          LAB
       4090742   SPECTROPH ADENO DEAMINASE         140.00              40          LAB
       4095873   SPECTROPH ADENO DEAMINASE         140.00              40          LAB
       4081840   SPECTROPHOTMETRY                   55.00              40          LAB
       4081485   SPECTROPHOTOMETRY                  60.00              40          LAB
       4090478   SPECTROPHOTOMETRY                  29.00              40          LAB
       4098281   SPECTROPHOTOMETRY                  15.00              40          LAB
       4097119   SPERM AB TEST                      17.00              40          LAB
       4010377   STL FOR WBC'S                      44.00      44.00   40          LAB
       4018941   STREP GRP A AG EIA                126.00              40          LAB
       4081568   STREP PNEUM AB 1 SEROTYP           18.00              40          LAB
       4097507   STREP PNEUM AB 1 SEROTYPE          12.25              40          LAB
       4012456   STREPT A BY IA W/OPTIC            126.00     126.00   40          LAB
       4092300   STRIATED MUSCLE AB SCRN            21.00              40          LAB



9/17/2012                                                                                                   90
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4096475   STRIATED MUSCLE AB SCRN            25.04            40            LAB
       4092318   STRIATED MUSCLE AB TTR             28.00            40            LAB
       4098570   STRIATED MUSCLE AB TTR             27.50            40            LAB
       4099370   SUGARS CHROM TLC PAPER            150.00            40            LAB
       4010468   SUGARS QL EA SPEC                  58.00            40            LAB
       4090460   SUGARS QL EA SPEC                  64.00            40            LAB
       4095899   SULFAMETHOXAZOLE                   61.20            40            LAB
       4081675   SULFATE UR                          8.00            40            LAB
       4098448   SULFATE UR 24HR                    21.50            40            LAB
       4020103   SURG PATH LVL I                    61.50            40            LAB
       4020152   SURG PATH LVL II                  141.00            40            LAB
       4020657   SURG PATH LVL III                 181.00            40            LAB
       4020756   SURG PATH LVL V                   433.00            40            LAB
       4020806   SURG PATH LVL VI                  603.00            40            LAB
       4011797   SUSCEPT BY E TEST                  49.00      49.00 40            LAB
       4011771   SUSCEPT BY MIC                     90.00      90.00 40            LAB
       4081360   SUSCEPT BY MIC                     69.00            40            LAB
       4091047   SUSCEPT BY MIC                     36.00            40            LAB
       4091906   SUSCEPT BY MIC                     44.20            40            LAB
       4091914   SUSCEPT BY MIC                    184.00            40            LAB
       4098919   SUSCEPT BY MIC                     39.00            40            LAB
       4011755   SUSCEPT KB DISK <=12               74.00      74.00 40            LAB
       4098216   SUSCEPT MYCOBACT PROPORT           17.80            40            LAB
       4098208   SUSPECT BY MACROBROTH DIL          30.00            40            LAB
       4097473   T LYMPH CD4 (HELPER) CNT           29.45            40            LAB
       4097465   T LYMPH CD4/8 CNT&RATIO            70.00            40            LAB
       4097457   T LYMPH TOT CNT                   170.50            40            LAB
       4018313   T3 FREE                            59.00            40            LAB
       4090957   T3 FREE                            22.00            40            LAB
       4095444   T3 FREE                            35.00            40            LAB
       4094074   T3 REVERSE                         29.00            40            LAB
       4095485   T3 TOTAL                            9.75            40            LAB
       4096772   T3 TOTAL                           60.00            40            LAB



9/17/2012                                                                                                   91
                                           69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4014692   T3 UPTAKE                             69.00      69.00 40            LAB
       4096004   T3 UPTAKE                              6.38            40            LAB
       4095527   TACROLIMUS (FK506)                    50.00            40            LAB
       4096681   TACROLIMUS (FK506)                    58.00            40            LAB
       4097390   TESTOSTERONE FREE                      9.05            40            LAB
       4017653   TESTOSTERONE TOTAL                    49.00            40            LAB
       4095600   TESTOSTERONE TOTAL                    12.95            40            LAB
       4095642   TESTOSTERONE TOTAL                    12.95            40            LAB
       4096319   TESTOSTERONE TOTAL                   109.00            40            LAB
       4094918   TETANUS AB                            30.00            40            LAB
       4014171   THEOPHYLLINE                         151.00     151.00 40            LAB
       4080032   THEOPHYLLINE                          60.00            40            LAB
       4098307   THIOCYANATE                           70.00            40            LAB
       4010039   THROMBIN TIME                         60.00      60.00 40            LAB
       4092334   THROMBIN TIME                         15.00            40            LAB
       4093225   THYR BINDING GLOB (TBG)               27.00            40            LAB
       4095881   THYR STIM IG                          72.00            40            LAB
       4019410   THYROGLOBULIN                         10.50            40            LAB
       4019147   THYROGLOBULIN AB                      85.00            40            LAB
       4019600   THYROGLOBULIN AB                      36.00            40            LAB
       4090965   THYROGLOBULIN AB                      54.00            40            LAB
       4091567   THYROGLOBULIN AB                      10.00            40            LAB
       4090973   THYROID PEROXIDASE AB                 90.00            40            LAB
       4091641   THYROID PEROXIDASE AB                 11.00            40            LAB
       4014718   THYROXINE (T4)                        74.00      74.00 40            LAB
       4096244   THYROXINE (T4)                         8.12            40            LAB
       4090049   TISSUE CULT AMNIO/CVS                100.00            40            LAB
       4090379   TISSUE CULT BM/BLD                   127.30            40            LAB
       4090361   TISSUE CULT LYMPH                    100.00            40            LAB
       4091930   TISSUE CULT LYMPH                    170.00            40            LAB
       4091948   TISSUE CULT LYMPH                    115.00            40            LAB
       4095907   TISSUE CULT LYMPH                    130.00            40            LAB
       4090015   TISSUE CULT SKIN                     150.00            40            LAB



9/17/2012                                                                                                      92
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4021952   TMR IMMUNOHIST W/COM ASS              208.80              40          LAB
       4010757   TOBRAMYCIN                            170.00     170.00   40          LAB
       4097937   TOBRAMYCIN PK                         170.00              40          LAB
       4097945   TOBRAMYCIN TR                         170.00              40          LAB
       4094066   TOPIRAMATE                             35.00              40          LAB
       4097846   TOXOPLAS AB                            47.00              40          LAB
       4018719   TOXOPLAS AB IGG                        13.50              40          LAB
       4095725   TOXOPLAS AB IGG                        40.00              40          LAB
       4017695   TOXOPLAS AB IGM                        13.50              40          LAB
       4095840   TRANSFERRIN                            12.50              40          LAB
       4097796   TRANSFERRIN                            53.00              40          LAB
       4093662   TRAZODONE (DESYREL)                    34.50              40          LAB
       4010955   TRICYCLIC SCRN                         38.00      38.00   40          LAB
       4014452   TRIGLYCERIDE                           60.00      60.00   40          LAB
       4091955   TRIGLYCERIDE                            3.80              40          LAB
       4019543   TRIGLYCERIDE BDY FLD                   60.00              40          LAB
       4019279   TROPONIN I QN                         104.00     104.00   40          LAB
       4090767   TRYPANOSOMA CRUZI AB                   31.25              40          LAB
       4098117   TRYPSIN                                35.00              40          LAB
       4094173   TRYPTASE                               57.00              40          LAB
       4014676   TSH                                   107.00     107.00   40          LAB
       4091211   TSH                                    20.35              40          LAB
       4081832   TULAREMIA                              53.00              40          LAB
       4090536   TYPHUS FEVER AB SC IGG                 15.75              40          LAB
       4090544   TYPHUS FEVER AB SC IGM                 15.75              40          LAB
       4091187   TYROSINE                               15.40              40          LAB
       4093878   TYROSINE                               43.00              40          LAB
       4018412   UNLISTED MICRO PROC                    36.00      36.00   40          LAB
       4010427   UR NITROGEN FLD                        58.00              40          LAB
       4013074   UR NITROGEN UR 24HR                    49.00      49.00   40          LAB
       4097408   UR NITROGEN UR 24HR                     9.00              40          LAB
       4013090   UR NITROGEN UR RAN                     49.00      49.00   40          LAB
       4097416   UREA CLEARANCE                         71.00              40          LAB



9/17/2012                                                                                                       93
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4013579   URIC ACID                               47.00      47.00 40            LAB
       4010104   URIC ACID FLD                           49.00            40            LAB
       4019576   URIC ACID UR 24 HR                      49.00            40            LAB
       4081642   URIC ACID UR 24 HR                       7.00            40            LAB
       4097424   URIC ACID UR 24 HR                      20.02            40            LAB
       4016614   URNALYSIS AUTO W/ MICRO                 33.00      33.00 40            LAB
       4016473   URNALYSIS AUTO W/O MICRO                25.00      25.00 40            LAB
       4016515   URNALYSIS AUTO W/O MICRO                25.00      25.00 40            LAB
       4016531   URNALYSIS AUTO W/O MICRO                25.00      25.00 40            LAB
       4016556   URNALYSIS AUTO W/O MICRO                25.00      25.00 40            LAB
       4016572   URNALYSIS AUTO W/O MICRO                25.00      25.00 40            LAB
       4016432   URNALYSIS MAN W/ MICRO                  33.00      33.00 40            LAB
       4016457   URNALYSIS MAN W/ MICRO                  33.00      33.00 40            LAB
       4098893   URNALYSIS PH                             6.65            40            LAB
       4098067   URNALYSIS QL OR SEMI QL                 22.00            40            LAB
       4015434   URNALYSIS VOL MEASURE                   33.00      33.00 40            LAB
       4010773   VALPROIC ACID                          143.00     143.00 40            LAB
       4092946   VALPROIC ACID                           18.07            40            LAB
       4019923   VANCOMYCIN                             165.00     165.00 40            LAB
       4097168   VANCOMYCIN PK                          165.00            40            LAB
       4097176   VANCOMYCIN TR                          165.00            40            LAB
       4094199   VASOACT INTEST PEPT (VIP)               59.50            40            LAB
       4097499   VDRL CSF QL                              9.25            40            LAB
       4010856   VENIPUNCTURE                            22.00      22.00 40            LAB
       4010898   VENIPUNCTURE                            22.00      22.00 40            LAB
       4010930   VENIPUNCTURE                            22.00      22.00 40            LAB
       4011532   VENIPUNCTURE                            22.00      22.00 40            LAB
       4090718   VIRUS AB NOT SPEC                       47.00            40            LAB
       4090726   VIRUS AB NOT SPEC                       52.37            40            LAB
       4090734   VIRUS AB NOT SPEC                       44.25            40            LAB
       4093530   VIRUS AB NOT SPEC                       32.50            40            LAB
       4095931   VIRUS AB NOT SPEC                       40.00            40            LAB
       4095949   VIRUS AB NOT SPEC                       18.00            40            LAB



9/17/2012                                                                                                        94
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4081865   VIRUS CULT ID                          238.00            40            LAB
       4099149   VIRUS CULT ID                           17.50            40            LAB
       4090635   VIRUS CULT SHELL VIAL                   35.00            40            LAB
       4091203   VIRUS CULT SHELL VIAL                   65.00            40            LAB
       4094009   VIRUS CULT SHELL VIAL                   23.00            40            LAB
       4095956   VIRUS CULT SHELL VIAL                   50.75            40            LAB
       4098034   VISCOSITY                               20.30            40            LAB
       4096129   VITAMIN A                               15.77            40            LAB
       4094215   VITAMIN B1 (THIAMINE)                   38.00            40            LAB
       4095972   VITAMIN B1 (THIAMINE)                   25.00            40            LAB
       4014536   VITAMIN B12                            159.00            40            LAB
       4090403   VITAMIN B12                             63.00            40            LAB
       4096160   VITAMIN B12                              6.00            40            LAB
       4096046   VITAMIN B12 BINDING CAP                 24.50            40            LAB
       4098646   VITAMIN B5                              51.00            40            LAB
       4094140   VITAMIN B6                              55.00            40            LAB
       4096087   VITAMIN D (125 DI HYDROX)               35.00            40            LAB
       4081246   VITAMIN D 25HYDROXY                     78.40            40            LAB
       4096202   VITAMIN D 25HYDROXY                     25.00            40            LAB
       4093274   VITAMIN E                               15.75            40            LAB
       4094538   VITAMIN K                              105.00            40            LAB
       4096962   VMA UR                                  33.04            40            LAB
       4019758   VMA UR 24HR                             27.00            40            LAB
       4081915   VORICONAZOLE                           115.00            40            LAB
       4080024   VW FACTOR COLL BIND ASSAY                6.00            40            LAB
       4017711   VZV AB                                  12.00            40            LAB
       4081683   VZV AB                                  25.00            40            LAB
       4093076   VZV AB IGG                              12.00            40            LAB
       4095980   VZV AB IGM                              12.50            40            LAB
       4096574   VZV DFA                                 23.00            40            LAB
       4010153   WBC CNT AUTO                            27.00      27.00 40            LAB
       4095998   WEST NILE CSF                           30.00            40            LAB
       4091575   WEST NILE SEROLOGY                      30.00            40            LAB



9/17/2012                                                                                                        95
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       4091583   XYLOSE 1HR BLD                          15.00           40             LAB
       4091591   XYLOSE 2HR BLD                          15.00           40             LAB
       4091617   YERSINIA AB                              9.00           40             LAB
       4080917   ZINC                                    28.00           40             LAB
       4092839   ZINC                                    15.00           40             LAB
       4094744   ZINC                                    19.00           40             LAB
       4091443   ZONISAMIDE (ZONEGRAN[TM])               49.50           40             LAB
       0146662   CERT DIABETIC INST LTD                                  01             MISCELLANEOUS
       0103291   OBSERVATION PER HOUR                    91.00           01             MISCELLANEOUS
       0103747   OBSERVATION PER HOUR                    91.00           01             MISCELLANEOUS
       0103754   OBSERVATION PER HOUR                    91.00           01             MISCELLANEOUS
       0103713   OBSERVATION PER HOUR                    91.00           01             MISCELLANEOUS
       0103358   OBSERVATION PER HOUR                    91.00           01             MISCELLANEOUS
       0104406   OBSERVATION PER HOUR                    91.00           01             MISCELLANEOUS
       0103994   OBSERVATION PER HOUR                    91.00           01             MISCELLANEOUS
       0105775   OBSERVATION PER HOUR                    91.00           01             MISCELLANEOUS
       0111856   ROOM MED/SURG/GYN PVT                1,855.00           01             MISCELLANEOUS
       6230007   ABR SCREEN INIT IP                      43.00           62             NEONATAL/NEWBORN SERVICES
       6210306   ABR SCREEN INIT IP                      43.00           62             NEONATAL/NEWBORN SERVICES
       6230015   CIRCUMCISION                           151.00           62             NEONATAL/NEWBORN SERVICES
       6210652   CONFERENCE MSW                                          62             NEONATAL/NEWBORN SERVICES
       6210157   CONFERENCE RN                                           62             NEONATAL/NEWBORN SERVICES
       6210108   COORDINATOR FEE                                         62             NEONATAL/NEWBORN SERVICES
       6121958   AMNIOCENTESIS DX                       385.00           61             OB/GYN SERVICES - IP
       6120455   AMNIOINFUSION                          249.00           61             OB/GYN SERVICES - IP
       6122006   CERCLAGE, VAGINAL                      854.00           61             OB/GYN SERVICES - IP
       6123459   CIRCUMCISION                           151.00           61             OB/GYN SERVICES - IP
       6123152   CPLX GENRL ANES ADD 15M                300.00           61             OB/GYN SERVICES - IP
       6123103   CPLX GENRL ANES FIRST 30M              793.00           61             OB/GYN SERVICES - IP
       6121602   CST (NIPPLE STIM TEST)                 337.00           61             OB/GYN SERVICES - IP
       6121859   DELIVERY VAGINAL LEVEL 1             2,140.00           61             OB/GYN SERVICES - IP
       6121750   DELIVERY VAGINAL LEVEL 2             2,446.00           61             OB/GYN SERVICES - IP
       6122055   EXTERNAL VERSION                       630.00           61             OB/GYN SERVICES - IP



9/17/2012                                                                                                           96
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       6120778   FETAL MON INTERN W/REPORT          256.00            61            OB/GYN SERVICES - IP
       6122154   GLUCOSE FINGERSTICK                 11.00            61            OB/GYN SERVICES - IP
       6122758   IG RHO D MINI 50MCG IJ             328.00            61            OB/GYN SERVICES - IP
       6122105   INJ BLOOD PATCH                    273.00            61            OB/GYN SERVICES - IP
       6121701   LABOR LEVEL 1 / HR-IP              284.00            61            OB/GYN SERVICES - IP
       6121651   LABOR LEVEL 2 / HR-IP              355.00            61            OB/GYN SERVICES - IP
       6122451   LEVEL 1 EST PATIENT                234.00            61            OB/GYN SERVICES - IP
       6122204   LEVEL 1 NEW PATIENT                234.00            61            OB/GYN SERVICES - IP
       6122501   LEVEL 2 EST PATIENT                299.00            61            OB/GYN SERVICES - IP
       6122253   LEVEL 2 NEW PATIENT                299.00            61            OB/GYN SERVICES - IP
       6122550   LEVEL 3 EST PATIENT                314.00            61            OB/GYN SERVICES - IP
       6122303   LEVEL 3 NEW PATIENT                314.00            61            OB/GYN SERVICES - IP
       6122600   LEVEL 4 EST PATIENT                416.00            61            OB/GYN SERVICES - IP
       6122352   LEVEL 4 NEW PATIENT                416.00            61            OB/GYN SERVICES - IP
       6122659   LEVEL 5 EST PATIENT                544.00            61            OB/GYN SERVICES - IP
       6122402   LEVEL 5 NEW PATIENT                544.00            61            OB/GYN SERVICES - IP
       6121909   LIGATE OVIDUCT(S) ADD-ON           299.00            61            OB/GYN SERVICES - IP
       6123566   N NSTRL BAIR BLANKET                29.00            61            OB/GYN SERVICES - IP
       6120133   NST (NON-STRESS TEST)              218.00     218.00 61            OB/GYN SERVICES - IP
       6121099   OB OBSERVATION / HR-OP             324.00            61            OB/GYN SERVICES - IP
       6110027   OB REGIONAL ANESTHESIA             454.00            61            OB/GYN SERVICES - IP
       6123517   S IMP FILSHIE CLIPS                242.10            61            OB/GYN SERVICES - IP
       6123616   S STRL BAKRI TAMP BALLOON          665.00            61            OB/GYN SERVICES - IP
       6123558   S STRL CHROMIC SUTURE                7.50            61            OB/GYN SERVICES - IP
       6123756   S STRL MAXON SUTURE                 25.00            61            OB/GYN SERVICES - IP
       6121420   S STRL OR-CHROMIC SUTURE            35.00            61            OB/GYN SERVICES - IP
       6121438   S STRL OR-PLAIN SUTURE              26.50            61            OB/GYN SERVICES - IP
       6121453   S STRL OR-PLASTIC SKIN S           176.50            61            OB/GYN SERVICES - IP
       6121461   S STRL OR-SUCTION LINER             28.50            61            OB/GYN SERVICES - IP
       6121479   S STRL OR-VICRYL SUTURE             33.50            61            OB/GYN SERVICES - IP
       6123657   S STRL PLAINGUT                      7.50            61            OB/GYN SERVICES - IP
       6123509   S STRL POLY SUTURE                   7.50            61            OB/GYN SERVICES - IP
       6121495   S STRL RR-CARDIOSCOPE               74.00            61            OB/GYN SERVICES - IP



9/17/2012                                                                                                    97
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       6123707   S STRL SOFSILK                           7.50           61             OB/GYN SERVICES - IP
       6123608   S STRL SURGIGUT                          7.50           61             OB/GYN SERVICES - IP
       6123053   STND GENRL ANES ADD 15M                146.00           61             OB/GYN SERVICES - IP
       6123004   STND GENRL ANES FIRST 30M              287.00           61             OB/GYN SERVICES - IP
       6123251   STND PACU LVL 1 ADD 15M                230.00           61             OB/GYN SERVICES - IP
       6123202   STND PACU LVL 1 FIRST 30M              326.00           61             OB/GYN SERVICES - IP
       6123350   STND PACU LVL 2 ADD 15M                240.00           61             OB/GYN SERVICES - IP
       6123301   STND PACU LVL 2 FIRST 30M              431.00           61             OB/GYN SERVICES - IP
       6122907   SURG LVL 1 ADD 15M                     254.00           61             OB/GYN SERVICES - IP
       6122808   SURG LVL 1 FIRST 30M                   987.00           61             OB/GYN SERVICES - IP
       6122956   SURG LVL 2 ADD 15M                     319.00           61             OB/GYN SERVICES - IP
       6122857   SURG LVL 2 FIRST 30M                 1,092.00           61             OB/GYN SERVICES - IP
       6121404   SURG LVL 3 ADD 15M                     370.00           61             OB/GYN SERVICES - IP
       6121388   SURG LVL 3 FIRST 30M                 1,702.00           61             OB/GYN SERVICES - IP
       6122717   URINE DIPSTICK                          11.00           61             OB/GYN SERVICES - IP
       6123400   URNALYSIS AUTO W/O MICRO                11.00           61             OB/GYN SERVICES - IP
       6121628   URNALYSIS MAN W/O MICRO                 12.00           61             OB/GYN SERVICES - IP
       6121610   US BIO PROFILE W NONSTRES              192.00           61             OB/GYN SERVICES - IP
       6120059   US OB LTD 1/MORE FETUSES               562.00           61             OB/GYN SERVICES - IP
       6122709   VENIPUNCTURE                            10.00           61             OB/GYN SERVICES - IP
       6011407   ABR RESCREEN                            44.00           60             OB/GYN SERVICES - OP
       6011357   ABR SCREEN INIT OP                      67.00           60             OB/GYN SERVICES - OP
       6021703   BIO PROFILE W NONSTRES                 172.00           60             OB/GYN SERVICES - OP
       6010805   GLUCOSE FINGERSTICK                     10.00           60             OB/GYN SERVICES - OP
       6024020   LEVEL 1 CONSULT MINOR                   40.00           60             OB/GYN SERVICES - OP
       6010904   LEVEL 1 EST PATIENT                    132.00           60             OB/GYN SERVICES - OP
       6020804   LEVEL 1 EST PATIENT                    132.00           60             OB/GYN SERVICES - OP
       6022313   LEVEL 1 EST PATIENT                    132.00           60             OB/GYN SERVICES - OP
       6022321   LEVEL 1 EST PATIENT                    132.00           60             OB/GYN SERVICES - OP
       6022412   LEVEL 1 EST PATIENT                    132.00           60             OB/GYN SERVICES - OP
       6022420   LEVEL 1 EST PATIENT                    132.00           60             OB/GYN SERVICES - OP
       6022503   LEVEL 1 EST PATIENT                    132.00           60             OB/GYN SERVICES - OP
       6022529   LEVEL 1 EST PATIENT                    132.00           60             OB/GYN SERVICES - OP



9/17/2012                                                                                                        98
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       6022537   LEVEL 1 EST PATIENT                   132.00           60             OB/GYN SERVICES - OP
       6022545   LEVEL 1 EST PATIENT                   132.00           60             OB/GYN SERVICES - OP
       6022602   LEVEL 1 EST PATIENT                   116.00           60             OB/GYN SERVICES - OP
       6022610   LEVEL 1 EST PATIENT                   116.00           60             OB/GYN SERVICES - OP
       6022628   LEVEL 1 EST PATIENT                   116.00           60             OB/GYN SERVICES - OP
       6010854   LEVEL 1 NEW PATIENT                   132.00           60             OB/GYN SERVICES - OP
       6020705   LEVEL 1 NEW PATIENT                   132.00           60             OB/GYN SERVICES - OP
       6024012   LEVEL 2 CONSULT LOW                    50.00           60             OB/GYN SERVICES - OP
       6011001   LEVEL 2 EST PATIENT                   153.00           60             OB/GYN SERVICES - OP
       6021000   LEVEL 2 EST PATIENT                   153.00           60             OB/GYN SERVICES - OP
       6010953   LEVEL 2 NEW PATIENT                   153.00           60             OB/GYN SERVICES - OP
       6020903   LEVEL 2 NEW PATIENT                   153.00           60             OB/GYN SERVICES - OP
       6022305   LEVEL 2 NEW PATIENT                   153.00           60             OB/GYN SERVICES - OP
       6022404   LEVEL 2 NEW PATIENT                   153.00           60             OB/GYN SERVICES - OP
       6022511   LEVEL 2 NEW PATIENT                   153.00           60             OB/GYN SERVICES - OP
       6024046   LEVEL 3 CONSULT MODERATE               75.00           60             OB/GYN SERVICES - OP
       6011100   LEVEL 3 EST PATIENT                   175.00           60             OB/GYN SERVICES - OP
       6021208   LEVEL 3 EST PATIENT                   175.00           60             OB/GYN SERVICES - OP
       6011050   LEVEL 3 NEW PATIENT                   175.00           60             OB/GYN SERVICES - OP
       6021109   LEVEL 3 NEW PATIENT                   175.00           60             OB/GYN SERVICES - OP
       6024038   LEVEL 4 CONSULT MOD/HIGH              100.00           60             OB/GYN SERVICES - OP
       6011209   LEVEL 4 EST PATIENT                   290.00           60             OB/GYN SERVICES - OP
       6021406   LEVEL 4 EST PATIENT                   290.00           60             OB/GYN SERVICES - OP
       6011159   LEVEL 4 NEW PATIENT                   290.00           60             OB/GYN SERVICES - OP
       6021307   LEVEL 4 NEW PATIENT                   290.00           60             OB/GYN SERVICES - OP
       6024053   LEVEL 5 CONSULT HIGH                  150.00           60             OB/GYN SERVICES - OP
       6011308   LEVEL 5 EST PATIENT                   312.00           60             OB/GYN SERVICES - OP
       6021604   LEVEL 5 EST PATIENT                   312.00           60             OB/GYN SERVICES - OP
       6011258   LEVEL 5 NEW PATIENT                   312.00           60             OB/GYN SERVICES - OP
       6021505   LEVEL 5 NEW PATIENT                   312.00           60             OB/GYN SERVICES - OP
       6022008   LEVEL 5 NEW PATIENT                   312.00           60             OB/GYN SERVICES - OP
       6010102   NST (NON-STRESS TEST)                 218.00           60             OB/GYN SERVICES - OP
       6010607   NST (NON-STRESS TEST)                 218.00           60             OB/GYN SERVICES - OP



9/17/2012                                                                                                       99
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       6021802   PF HEALTH RISK ASSESSMENT               66.00           60             OB/GYN SERVICES - OP
       6021901   PF HEALTH RISK ASSESSMENT               66.00           60             OB/GYN SERVICES - OP
       6026009   PRENATAL CLASS SESSION                 100.00           60             OB/GYN SERVICES - OP
       6010706   URNALYSIS MAN W/O MICRO                 11.00           60             OB/GYN SERVICES - OP
       6010656   US OB LTD 1/MORE FETUSES               241.00           60             OB/GYN SERVICES - OP
       6010755   VENIPUNCTURE                             9.00           60             OB/GYN SERVICES - OP
       2416600   NORMOSOL M/D5W 1000ML                    6.68           24             OPEN HEART PROCEDURES
       2415735   S CATH THROMB/EMBOLCTMY                226.80           24             OPEN HEART PROCEDURES
       2414506   S IMP OPTIFORM MITRAL 2              8,096.00           24             OPEN HEART PROCEDURES
       2417954   S IMP ANASTAFO INTRA SHNT              643.50           24             OPEN HEART PROCEDURES
       2418028   S IMP ANASTAFO SHNT 1.5MM              454.00           24             OPEN HEART PROCEDURES
       2418093   S IMP ANASTAFO SHNT 2.5MM              514.50           24             OPEN HEART PROCEDURES
       2418077   S IMP ANASTAFO SHNT 3.0MM              858.00           24             OPEN HEART PROCEDURES
       2418465   S IMP ANNULOPLAS BAND                7,945.00           24             OPEN HEART PROCEDURES
       2418473   S IMP ANNULOPLAS RING                6,094.50           24             OPEN HEART PROCEDURES
       2418440   S IMP BIOGLUE 10                     1,587.50           24             OPEN HEART PROCEDURES
       2418663   S IMP BIOGLUE 2                        860.50           24             OPEN HEART PROCEDURES
       2418432   S IMP BIOGLUE 5                      1,214.50           24             OPEN HEART PROCEDURES
       2418200   S IMP CAN DLP FEM VEN                  446.50           24             OPEN HEART PROCEDURES
       2418218   S IMP CAN EXTEND ART                   256.50           24             OPEN HEART PROCEDURES
       2418226   S IMP CAN SING STG VEN                  88.50           24             OPEN HEART PROCEDURES
       2418572   S IMP CANN T SHP GFT                 3,650.00           24             OPEN HEART PROCEDURES
       2415370   S IMP CANNULA VEIN GRAFT                58.50           24             OPEN HEART PROCEDURES
       2418424   S IMP CARBO AOR VLV RR              11,547.50           24             OPEN HEART PROCEDURES
       2418416   S IMP CARBO AOR VLV TH               8,436.00           24             OPEN HEART PROCEDURES
       2411809   S IMP COSGROVE DURFLO RI             7,634.00           24             OPEN HEART PROCEDURES
       2411957   S IMP COSGROVE DURFLO RI             7,634.00           24             OPEN HEART PROCEDURES
       2412104   S IMP COSGROVE DURFLO RI             7,634.00           24             OPEN HEART PROCEDURES
       2412252   S IMP COSGROVE DURFLO RI             7,634.00           24             OPEN HEART PROCEDURES
       2412401   S IMP COSGROVE DURFLO RI             7,634.00           24             OPEN HEART PROCEDURES
       2412559   S IMP COSGROVE DURFLO RI             7,634.00           24             OPEN HEART PROCEDURES
       2418549   S IMP DURAN RING                     5,500.00           24             OPEN HEART PROCEDURES
       2410900   S IMP ED PORC MITRAL25MM            14,844.00           24             OPEN HEART PROCEDURES



9/17/2012                                                                                                        100
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2411056   S IMP ED PORC MITRAL27MM           14,844.00           24             OPEN HEART PROCEDURES
       2411205   S IMP ED PORC MITRAL29MM           14,844.00           24             OPEN HEART PROCEDURES
       2410603   S IMP EDUARDS PERIMOUNT            13,068.00           24             OPEN HEART PROCEDURES
       2410751   S IMP EDUARDS PERIMOUNT            13,068.00           24             OPEN HEART PROCEDURES
       2410157   S IMP EDWARDS PERIMOUNT            13,068.00           24             OPEN HEART PROCEDURES
       2410306   S IMP EDWARDS PERIMOUNT            13,068.00           24             OPEN HEART PROCEDURES
       2410454   S IMP EDWARDS PERIMOUNT            13,068.00           24             OPEN HEART PROCEDURES
       2417806   S IMP EDWARDS PERIMOUNT            13,068.00           24             OPEN HEART PROCEDURES
       2418267   S IMP ENCL ANAST DEVICE             1,444.00           24             OPEN HEART PROCEDURES
       2418275   S IMP ETH 0 D-8224                     27.00           24             OPEN HEART PROCEDURES
       2418283   S IMP ETH 2-0 10X42                   231.00           24             OPEN HEART PROCEDURES
       2418291   S IMP ETH 2-0 10X82                   128.00           24             OPEN HEART PROCEDURES
       2418309   S IMP ETH 2-0 PX514                    43.00           24             OPEN HEART PROCEDURES
       2418317   S IMP ETH 2-0 PXX41                   148.96           24             OPEN HEART PROCEDURES
       2418325   S IMP ETH 2-0 PXX86                   187.53           24             OPEN HEART PROCEDURES
       2418333   S IMP ETH 2-0 SXX54                   442.50           24             OPEN HEART PROCEDURES
       2418341   S IMP ETH 4-0 X551H                    30.00           24             OPEN HEART PROCEDURES
       2418127   S IMP ETHIBOND 2-0 PXX4               372.50           24             OPEN HEART PROCEDURES
       2418507   S IMP HEMA BIF GFT                  2,337.50           24             OPEN HEART PROCEDURES
       2418564   S IMP HEMA BIFUR GFT                2,138.00           24             OPEN HEART PROCEDURES
       2418499   S IMP HEMA GFT                      1,933.50           24             OPEN HEART PROCEDURES
       2418580   S IMP HEMA TUBE GFT                 1,645.00           24             OPEN HEART PROCEDURES
       2418556   S IMP HEMA WVN DBL GFT              1,718.75           24             OPEN HEART PROCEDURES
       2418523   S IMP MECH AOR VLV                  8,690.00           24             OPEN HEART PROCEDURES
       2418531   S IMP MECH MITR VLV                 7,694.00           24             OPEN HEART PROCEDURES
       2418408   S IMP NOVARE ASST DEV               1,444.00           24             OPEN HEART PROCEDURES
       2414209   S IMP OPTIFORM MITRAL 23            8,096.00           24             OPEN HEART PROCEDURES
       2414357   S IMP OPTIFORM MITRAL 25            8,096.00           24             OPEN HEART PROCEDURES
       2414654   S IMP OPTIFORM MITRAL 29            8,096.00           24             OPEN HEART PROCEDURES
       2414803   S IMP OPTIFORM MITRAL 31            8,096.00           24             OPEN HEART PROCEDURES
       2414951   S IMP OPTIFORM MITRAL 33            8,096.00           24             OPEN HEART PROCEDURES
       2418481   S IMP PERICARD ALLOGFT              1,260.00           24             OPEN HEART PROCEDURES
       2418457   S IMP PERICARD AOR VLV             15,075.50           24             OPEN HEART PROCEDURES



9/17/2012                                                                                                       101
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2411353   S IMP PORCINE MTRL VLV              14,844.00           24             OPEN HEART PROCEDURES
       2411502   S IMP PORCINE MTRL VLV              14,844.00           24             OPEN HEART PROCEDURES
       2411650   S IMP PORCINE MTRL VLV              14,844.00           24             OPEN HEART PROCEDURES
       2418390   S IMP PRO 3-0 MH                        32.50           24             OPEN HEART PROCEDURES
       2412708   S IMP REDUCED AORTIC VAL             8,096.00           24             OPEN HEART PROCEDURES
       2412856   S IMP REDUCED AORTIC VAL             8,096.00           24             OPEN HEART PROCEDURES
       2413003   S IMP REDUCED AORTIC VAL             8,096.00           24             OPEN HEART PROCEDURES
       2413151   S IMP REDUCED AORTIC VAL             8,096.00           24             OPEN HEART PROCEDURES
       2413300   S IMP REDUCED AORTIC VAL             8,096.00           24             OPEN HEART PROCEDURES
       2413458   S IMP REDUCED AORTIC VAL             8,096.00           24             OPEN HEART PROCEDURES
       2418515   S IMP ST JUDE AOR VLV                6,501.60           24             OPEN HEART PROCEDURES
       2418952   S IMP STAND AOR VLV                  7,694.00           24             OPEN HEART PROCEDURES
       2470201   S IMP STENT CHROM COBALT             3,528.50           24             OPEN HEART PROCEDURES
       2418614   S IMP SUT ETHIBOND SXX54               254.50           24             OPEN HEART PROCEDURES
       2418630   S IMP SUT PROLENE M8557                 65.04           24             OPEN HEART PROCEDURES
       2418606   S IMP SUT PROLENE M8701                117.60           24             OPEN HEART PROCEDURES
       2418598   S IMP SUT PROLENE M8725                 82.91           24             OPEN HEART PROCEDURES
       2417111   S IMP SUTURE ETHIBOND X                 58.00           24             OPEN HEART PROCEDURES
       2417178   S IMP SUTURE ETHIBOND X                485.00           24             OPEN HEART PROCEDURES
       2417202   S IMP SUTURE GORTEX 4-0                 83.50           24             OPEN HEART PROCEDURES
       2417236   S IMP SUTURE GORTEX 5-0                 96.00           24             OPEN HEART PROCEDURES
       2417269   S IMP SUTURE GORTEX 6-0                 74.64           24             OPEN HEART PROCEDURES
       2417327   S IMP SUTURE GORTEX 7-0                 68.44           24             OPEN HEART PROCEDURES
       2417350   S IMP SUTURE PROLENE 4-                155.00           24             OPEN HEART PROCEDURES
       2417384   S IMP SUTURE PROLENE 5-                217.50           24             OPEN HEART PROCEDURES
       2417418   S IMP SUTURE PROLENE 6-                217.50           24             OPEN HEART PROCEDURES
       2417442   S IMP SUTURE PROLENE 7-                230.00           24             OPEN HEART PROCEDURES
       2413607   S IMP TOP HAT AORTIC 19M            15,671.00           24             OPEN HEART PROCEDURES
       2413755   S IMP TOP HAT AORTIC 21M            15,671.00           24             OPEN HEART PROCEDURES
       2413904   S IMP TOP HAT AORTIC 23M            15,671.00           24             OPEN HEART PROCEDURES
       2414050   S IMP TOP HAT AORTIC 25M            15,671.00           24             OPEN HEART PROCEDURES
       2418762   S IMP VALVE AORTIC MAGNA             6,720.00           24             OPEN HEART PROCEDURES
       2418754   S IMP VALVE MOSAIC MITRAL            7,400.00           24             OPEN HEART PROCEDURES



9/17/2012                                                                                                        102
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2402352   S NSTRL CAUTERY GROUNDIN            66.00            24            OPEN HEART PROCEDURES
       2418689   S STRL ADHESIVE FLO-SEAL           544.00            24            OPEN HEART PROCEDURES
       2415131   S STRL ATRIAL PACING WIR            61.50            24            OPEN HEART PROCEDURES
       2410108   S STRL BAG PLEUREVAC                83.41            24            OPEN HEART PROCEDURES
       2402055   S STRL BIOSPY FORCEP               330.00     163.50 24            OPEN HEART PROCEDURES
       2402303   S STRL BLN DILATE NONVSC           702.00            24            OPEN HEART PROCEDURES
       2402600   S STRL BLN DILATE NONVSC         1,270.50            24            OPEN HEART PROCEDURES
       2402857   S STRL BUTTON REPL GASTR           396.50            24            OPEN HEART PROCEDURES
       2415222   S STRL CABLE TRANSDUCER/           438.50            24            OPEN HEART PROCEDURES
       2415404   S STRL CANNULA 20FR                169.00            24            OPEN HEART PROCEDURES
       2415438   S STRL CANNULA 22FR                169.00            24            OPEN HEART PROCEDURES
       2415461   S STRL CANNULA 24RT ANGL           116.50            24            OPEN HEART PROCEDURES
       2415529   S STRL CANNULA 29/29 2 S           129.50            24            OPEN HEART PROCEDURES
       2415552   S STRL CANNULA 29/37FR 2            77.18            24            OPEN HEART PROCEDURES
       2415586   S STRL CANNULA 32FR VENO            99.50            24            OPEN HEART PROCEDURES
       2415610   S STRL CANNULA 34FR VENO            99.50            24            OPEN HEART PROCEDURES
       2415677   S STRL CANNULA 36/46FR 2           117.80            24            OPEN HEART PROCEDURES
       2415644   S STRL CANNULA 36FR VENO            99.50            24            OPEN HEART PROCEDURES
       2415255   S STRL CANNULA ARTERIAL            620.74            24            OPEN HEART PROCEDURES
       2415289   S STRL CANNULA ARTERIAL            338.50            24            OPEN HEART PROCEDURES
       2410355   S STRL CANNULA CORONARY             94.50            24            OPEN HEART PROCEDURES
       2417871   S STRL CANNULA EXT AORTIC          129.50            24            OPEN HEART PROCEDURES
       2415313   S STRL CANNULA FEMORAL 2           560.00            24            OPEN HEART PROCEDURES
       2415347   S STRL CANNULA IMA                  47.50            24            OPEN HEART PROCEDURES
       2418242   S STRL CATH FEN FLX ART            127.00            24            OPEN HEART PROCEDURES
       2418259   S STRL CATH LFT HRT VENT            97.50            24            OPEN HEART PROCEDURES
       2410405   S STRL CATHETER CORONARY            77.00            24            OPEN HEART PROCEDURES
       2418234   S STRL CATHETER,ARROW CVP           48.30            24            OPEN HEART PROCEDURES
       2415792   S STRL CHEST DRAIN/AUTO(           256.50            24            OPEN HEART PROCEDURES
       2415883   S STRL CHEST TUBE 28F TH            23.12            24            OPEN HEART PROCEDURES
       2415826   S STRL CHEST TUBE 28F TH            28.00            24            OPEN HEART PROCEDURES
       2415917   S STRL CHEST TUBE 36F TH            28.00            24            OPEN HEART PROCEDURES
       2415941   S STRL CHEST TUBE 36F TH            60.00            24            OPEN HEART PROCEDURES



9/17/2012                                                                                                    103
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2418655   S STRL CLIP FOGARTY 6MM             40.50            24            OPEN HEART PROCEDURES
       2418705   S STRL COSEAL SEALANT              569.00            24            OPEN HEART PROCEDURES
       2418648   S STRL DEFIB PAD                   157.00            24            OPEN HEART PROCEDURES
       2418853   S STRL ELECT BIPOLAR HDPC        5,200.00            24            OPEN HEART PROCEDURES
       2402709   S STRL ENDOSC BANDS # 5            580.50            24            OPEN HEART PROCEDURES
       2402659   S STRL ENDOSC BANDS #3             513.50            24            OPEN HEART PROCEDURES
       2402758   S STRL ENDOSC BANDS #8             638.50            24            OPEN HEART PROCEDURES
       2418622   S STRL FOGARTY INSERT SET           84.00            24            OPEN HEART PROCEDURES
       2402501   S STRL GASTROSTOMY BUTTO           416.00            24            OPEN HEART PROCEDURES
       2417913   S STRL GEZYME IMMOBILIZER        3,415.50            24            OPEN HEART PROCEDURES
       2402550   S STRL GI TUBE                     240.00            24            OPEN HEART PROCEDURES
       2416337   S STRL HANCOCK AORTIC PU           114.00            24            OPEN HEART PROCEDURES
       2416360   S STRL HANCOCK AORTIC PU           176.00            24            OPEN HEART PROCEDURES
       2416394   S STRL HANCOCK AORTIC PU           176.00            24            OPEN HEART PROCEDURES
       2416667   S STRL HEART-LUNG PACK           2,014.50            24            OPEN HEART PROCEDURES
       2416428   S STRL HEMOCONCENTRATOR            326.99            24            OPEN HEART PROCEDURES
       2418358   S STRL IABP BAL 10FR             1,746.25            24            OPEN HEART PROCEDURES
       2418366   S STRL IABP BAL 8FR              1,911.25            24            OPEN HEART PROCEDURES
       2415164   S STRL INTRACARDIAC ECHO           353.00            24            OPEN HEART PROCEDURES
       2415198   S STRL INTRACARDIAC ECHO           353.00            24            OPEN HEART PROCEDURES
       2415768   S STRL IV 14GAX2 ABBOCT              6.00            24            OPEN HEART PROCEDURES
       2418374   S STRL KIT ARR MILTI LUM            54.60            24            OPEN HEART PROCEDURES
       2418382   S STRL KIT RTRO CATH CVP            64.50            24            OPEN HEART PROCEDURES
       2416519   S STRL MYOTHERN DELIVERY            47.80            24            OPEN HEART PROCEDURES
       2416576   S STRL NDLE 3/8 CIRC CT             21.50            24            OPEN HEART PROCEDURES
       2416543   S STRL NEEDLE 1 WALL 18G            14.00            24            OPEN HEART PROCEDURES
       2416691   S STRL OPEN HEART                  987.33            24            OPEN HEART PROCEDURES
       2416634   S STRL PACK BRAT                   629.00            24            OPEN HEART PROCEDURES
       2402808   S STRL PEG J TUBE                  346.50            24            OPEN HEART PROCEDURES
       2402451   S STRL PERC GASTROSTOMY            644.00            24            OPEN HEART PROCEDURES
       2416758   S STRL PERICARDIAL SUMP             69.51            24            OPEN HEART PROCEDURES
       2419000   S STRL PLEUREVAC                   137.87            24            OPEN HEART PROCEDURES
       2402253   S STRL POLYPECTOMY SNARE           129.00      62.00 24            OPEN HEART PROCEDURES



9/17/2012                                                                                                    104
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2416782   S STRL PRO PADS-STERILE            224.00            24            OPEN HEART PROCEDURES
       2418903   S STRL PUNCH ENCLOSE 4MM         1,306.25            24            OPEN HEART PROCEDURES
       2416931   S STRL REDUCER 3/8 X 1/4            26.00            24            OPEN HEART PROCEDURES
       2416998   S STRL RETRACTOR OCTOPUS         4,135.50            24            OPEN HEART PROCEDURES
       2416964   S STRL RETRACT-O-TAPE 18            80.50            24            OPEN HEART PROCEDURES
       2402204   S STRL SCLEROSING NEEDLE           333.50     286.00 24            OPEN HEART PROCEDURES
       2418671   S STRL SHEATH STERILE KIT          205.00            24            OPEN HEART PROCEDURES
       2418804   S STRL SHUNT PUMP 7.5              214.00            24            OPEN HEART PROCEDURES
       2417020   S STRL STRYKER SAW BLADE           115.50            24            OPEN HEART PROCEDURES
       2416451   S STRL TRNSLML ANGIO LSR         3,180.50            24            OPEN HEART PROCEDURES
       2417533   S STRL TUBING 1/2 X 3/32             6.50            24            OPEN HEART PROCEDURES
       2417566   S STRL TUBING 1/4 X 1/16            61.00            24            OPEN HEART PROCEDURES
       2417657   S STRL VENT L HEART 16FR            57.47            24            OPEN HEART PROCEDURES
       2417681   S STRL VENTRICULAR PACIN            35.88            24            OPEN HEART PROCEDURES
       2417715   S STRL VESSEL CANNULA RI            24.50            24            OPEN HEART PROCEDURES
       2215259   HEPARIN 1KUNIT/500 ML               86.00            22            PERFUSION SERVICES
       2211001   NA CL 0.9% 250ML                     2.50            22            PERFUSION SERVICES
       2212454   S NSTRL LMA CLASSIC # 1.         1,299.00            22            PERFUSION SERVICES
       2214807   S NSTRL MONITOR SENSOR B           117.00            22            PERFUSION SERVICES
       2212009   S NSTRL UPPER BODY BLANK            80.50            22            PERFUSION SERVICES
       2214559   S STRL 2 LUMEN CATH KIT-           359.50            22            PERFUSION SERVICES
       2214351   S STRL BLOOD Y SET WITH             11.50            22            PERFUSION SERVICES
       2200855   S STRL BRAT COLLECTN RES           402.00            22            PERFUSION SERVICES
       2200905   S STRL BRAT PAK 007-214-           514.50            22            PERFUSION SERVICES
       2214104   S STRL BRONCHOCATH                 280.00            22            PERFUSION SERVICES
       2213809   S STRL CANNULA(MAC SAFC)            18.50            22            PERFUSION SERVICES
       2215101   S STRL CATH MAC ACCESS             291.50            22            PERFUSION SERVICES
       2211035   S STRL CATHETER TRAY 18G           122.50            22            PERFUSION SERVICES
       2215408   S STRL CATHETER,ARROW CVP          179.34            22            PERFUSION SERVICES
       2211704   S STRL EPIDURAL CONTI BR            70.00            22            PERFUSION SERVICES
       2211209   S STRL ET TUBE UNIVENT             527.00            22            PERFUSION SERVICES
       2211019   S STRL FEMORAL ARTERY CAT           45.00            22            PERFUSION SERVICES
       2200103   S STRL HEART-LUNG PACK           2,191.50            22            PERFUSION SERVICES



9/17/2012                                                                                                    105
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2212603   S STRL INFUSOR BAG 3000C               282.00           22             PERFUSION SERVICES
       2211282   S STRL IV WARMING SET                   55.00           22             PERFUSION SERVICES
       2211050   S STRL NDL SPROTTE                      46.50           22             PERFUSION SERVICES
       2215051   S STRL NDL STIMEX                       25.80           22             PERFUSION SERVICES
       2215150   S STRL NDL STIMUPLEX                    46.00           22             PERFUSION SERVICES
       2215457   S STRL NDL TOUHY                        60.00           22             PERFUSION SERVICES
       2212306   S STRL NEEDLE WHITACRE 2                17.96           22             PERFUSION SERVICES
       2200954   S STRL OPEN HEART PACK E             2,280.00           22             PERFUSION SERVICES
       2201309   S STRL PERFUSION PACK 92             1,320.00           22             PERFUSION SERVICES
       2221000   S STRL PROBE LITHOCLAST              1,844.50           22             PERFUSION SERVICES
       2214757   S STRL PROVE V-PACING TR               815.50           22             PERFUSION SERVICES
       2211027   S STRL PUMP KIT                        845.00           22             PERFUSION SERVICES
       2211100   S STRL SENSOR TEMP FOLEY                70.00           22             PERFUSION SERVICES
       2215358   S STRL SENSOR TEMP FOLEY                70.00           22             PERFUSION SERVICES
       2214609   S STRL SENSOR TEMPE FOLE                70.00           22             PERFUSION SERVICES
       2215309   S STRL SPROTTE SPINAL ND                35.00           22             PERFUSION SERVICES
       2214500   S STRL SV02 PA LINE CONT               861.25           22             PERFUSION SERVICES
       2211852   S STRL TRAY SPINAL 24GA                 49.88           22             PERFUSION SERVICES
       2201259   S STRL TUBING PACK VAD OB            1,856.50           22             PERFUSION SERVICES
       2201002   S STRL VAVD PACK IJ30R(M                70.00           22             PERFUSION SERVICES
       8391054   ABATACEPT 10MG IJ                       49.31           83             PHARMACY - INJECTIBLES
       8300048   ABCIXIMAB 10MG IJ                    1,313.30           83             PHARMACY - INJECTIBLES
       8300071   ACETAZOLAMIDE 500MG INJ                 98.92           83             PHARMACY - INJECTIBLES
       8300097   ACETYLCYSTEINE                         378.46           83             PHARMACY - INJECTIBLES
       8300147   ACYCLOVIR 500MG INJ                    117.36           83             PHARMACY - INJECTIBLES
       8300220   ADENOSINE                              403.62           83             PHARMACY - INJECTIBLES
       8300246   ADENOSINE 100MCG/10ML IN               192.00           83             PHARMACY - INJECTIBLES
       8300212   ADENOSINE 6MG IJ                       126.02           83             PHARMACY - INJECTIBLES
       8300238   ADENOSINE 90MG/30ML INJ                556.70           83             PHARMACY - INJECTIBLES
       8300360   ALBUMIN                                270.50           83             PHARMACY - INJECTIBLES
       8300295   ALBUMIN 25% 100ML                      569.60           83             PHARMACY - INJECTIBLES
       8300287   ALBUMIN 25%/50ML                       330.86           83             PHARMACY - INJECTIBLES
       8300352   ALBUMIN 5%/250ML                       270.32           83             PHARMACY - INJECTIBLES



9/17/2012                                                                                                        106
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8380040   ALDESLEUKIN/SGL DOSE IJ          2,260.56           83             PHARMACY - INJECTIBLES
       8320046   ALFENTANIL 1MG/2ML INJ              96.50           83             PHARMACY - INJECTIBLES
       8300568   ALPROSTADIL 500MCG INJ             303.92           83             PHARMACY - INJECTIBLES
       8390015   ALTEPLASE 1MG IJ                   176.00           83             PHARMACY - INJECTIBLES
       8300634   AMIKACIN 500MG INJ                 124.10           83             PHARMACY - INJECTIBLES
       8300709   AMINOCAPROIC ACID 5GM IJ           110.24           83             PHARMACY - INJECTIBLES
       8300774   AMINOPHYLLINE 500MG INJ            108.65           83             PHARMACY - INJECTIBLES
       8300840   AMIODARONE 150MG INJ               120.22           83             PHARMACY - INJECTIBLES
       8320087   AMOBARBITAL SOD 500MG INJ           67.50           83             PHARMACY - INJECTIBLES
       8300980   AMPHO B LIPID 100MGIJ              587.84           83             PHARMACY - INJECTIBLES
       8300915   AMPHO B LPD CMPLX 10MG IJ          148.74           83             PHARMACY - INJECTIBLES
       8301129   AMPICILLIN 1GM INJ                 125.12           83             PHARMACY - INJECTIBLES
       8301194   AMPICILLIN 2GM INJ                 141.34           83             PHARMACY - INJECTIBLES
       8301053   AMPICILLIN 500MG INJ               116.66           83             PHARMACY - INJECTIBLES
       8310104   AMRINONE 100MG INJ                 287.50           83             PHARMACY - INJECTIBLES
       8305088   ANTIVENIN                        2,668.84           83             PHARMACY - INJECTIBLES
       8301400   ANTIVENIN (R.SNAKE) 10ML         2,819.00           83             PHARMACY - INJECTIBLES
       8301426   APROTININ KIU IJ                   663.06           83             PHARMACY - INJECTIBLES
       8380081   ASPARAGINASE 10000U IJ             603.62           83             PHARMACY - INJECTIBLES
       8330128   ATRACURIUM 100MG INJ                60.00           83             PHARMACY - INJECTIBLES
       8301475   ATROPINE SO4 1MG INJ                54.90           83             PHARMACY - INJECTIBLES
       8301541   ATROPINE SO4 1MG SYG                61.08           83             PHARMACY - INJECTIBLES
       8330243   ATROPINE.4MG/ML20MLIJ               54.22           83             PHARMACY - INJECTIBLES
       8330367   AUROTHIOGLUCOSE 500MG INJ          813.00           83             PHARMACY - INJECTIBLES
       8301558   AZITHROMYCIN 500MG INJ             172.83           83             PHARMACY - INJECTIBLES
       8301616   AZTREONAM 1GM INJ                  163.42           83             PHARMACY - INJECTIBLES
       8390437   AZTREONAM 500MG IJ                  29.55           83             PHARMACY - INJECTIBLES
       8301681   BACITRACIN 50 KUNITS INJ           133.00           83             PHARMACY - INJECTIBLES
       8331449   BACTRIM 10ML INJML INJ             125.26           83             PHARMACY - INJECTIBLES
       8331563   BACTRIM 30ML INJML INJ             146.82           83             PHARMACY - INJECTIBLES
       8301897   BENZTROPINE MESYL 2MG INJ           76.94           83             PHARMACY - INJECTIBLES
       8330482   BETAMETHASONE SUSP 6MG IN           78.96           83             PHARMACY - INJECTIBLES
       8301962   BETHANECHOL 5MG INJ                 65.16           83             PHARMACY - INJECTIBLES



9/17/2012                                                                                                    107
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8302010   BIVALIRUDIN                           111.49           83             PHARMACY - INJECTIBLES
       8380123   BLEOMYCIN 15U IJ                      836.50           83             PHARMACY - INJECTIBLES
       8310112   BOTULINUM TOX A/U IJ                1,269.12           83             PHARMACY - INJECTIBLES
       8390411   BOTULINUM TOX A/U IJ                   12.69           83             PHARMACY - INJECTIBLES
       8302036   BRETYLIUM TOSYL 500MG IJ               98.80           83             PHARMACY - INJECTIBLES
       8302101   BUMETANIDE 0.5MG INJ                   57.42           83             PHARMACY - INJECTIBLES
       8302176   BUMETANIDE 2.5MG INJ                  123.20           83             PHARMACY - INJECTIBLES
       8330847   BUPIV/EPI 0.25% MDV% MDV               78.90           83             PHARMACY - INJECTIBLES
       8302457   BUPIV/EPI 0.25% SDV% SDV               59.42           83             PHARMACY - INJECTIBLES
       8330961   BUPIV/EPI 0.5% MDV% MDV                80.64           83             PHARMACY - INJECTIBLES
       8302523   BUPIV/EPI 0.5% SDV% SDV                57.88           83             PHARMACY - INJECTIBLES
       8330607   BUPIVACAINE 0.25% MDV                  74.30           83             PHARMACY - INJECTIBLES
       8302242   BUPIVACAINE 0.25% SDV                  58.54           83             PHARMACY - INJECTIBLES
       8330722   BUPIVACAINE 0.5% MDV                   76.58           83             PHARMACY - INJECTIBLES
       8302317   BUPIVACAINE 0.5% SDV                   58.12           83             PHARMACY - INJECTIBLES
       8302382   BUPIVACAINE 0.75% SDV                 121.10           83             PHARMACY - INJECTIBLES
       8302598   BUPIVACAINE 0.75%/8.25%                63.20           83             PHARMACY - INJECTIBLES
       8320129   BUPRENORPHINE 0.3MG INJ                88.88           83             PHARMACY - INJECTIBLES
       8302663   BUTORPHANOL 2MG INJ                    65.18           83             PHARMACY - INJECTIBLES
       8302879   CA CL 1GM INJIDE 1GM INJ              109.42           83             PHARMACY - INJECTIBLES
       8302945   CA CL 1GM SYGIDE 1GM SYG               61.22           83             PHARMACY - INJECTIBLES
       8303018   CA GLUCONATE 1GM INJ                   55.70           83             PHARMACY - INJECTIBLES
       8303083   CA GLUCONATE 5GM INJ                  317.12           83             PHARMACY - INJECTIBLES
       8302689   CAFF CIT/1ML IJ                       144.30           83             PHARMACY - INJECTIBLES
       8302739   CALCITONIN 400 UNITS INJ              144.82           83             PHARMACY - INJECTIBLES
       8302804   CALCITRIOL 1MCG INJ                    84.54           83             PHARMACY - INJECTIBLES
       8331084   CANDIDA SKN TST INJ-DIAG               69.42           83             PHARMACY - INJECTIBLES
       8380206   CARBOPLATIN 150MG INJ               1,495.72           83             PHARMACY - INJECTIBLES
       8380164   CARBOPLATIN 50MG IJ                   813.12           83             PHARMACY - INJECTIBLES
       8303224   CARBOPROST 250MCG INJ                 186.10           83             PHARMACY - INJECTIBLES
       8303257   CASPOFUNGIN                           931.52           83             PHARMACY - INJECTIBLES
       8303265   CASPOFUNGIN                         1,168.94           83             PHARMACY - INJECTIBLES
       8303364   CEFAZOLIN 1GM INJ                     113.84           83             PHARMACY - INJECTIBLES



9/17/2012                                                                                                       108
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8303331   CEFEPIME                           150.46           83             PHARMACY - INJECTIBLES
       8303570   CEFOTAXIME 1GM INJ                 127.86           83             PHARMACY - INJECTIBLES
       8303646   CEFOTAXIME 2GM INJ                 149.82           83             PHARMACY - INJECTIBLES
       8303711   CEFOXITIN 1GM INJ                  131.80           83             PHARMACY - INJECTIBLES
       8303786   CEFOXITIN 2GM INJ                  155.59           83             PHARMACY - INJECTIBLES
       8303851   CEFTAZIDIME 1GM INJ                136.29           83             PHARMACY - INJECTIBLES
       8303927   CEFTAZIDIME 2GM INJ                164.75           83             PHARMACY - INJECTIBLES
       8304065   CEFTRIAXONE 1GM INJ                156.14           83             PHARMACY - INJECTIBLES
       8303992   CEFTRIAXONE 250MG INJ              140.80           83             PHARMACY - INJECTIBLES
       8304131   CEFTRIAXONE 2GM INJ                310.97           83             PHARMACY - INJECTIBLES
       8304271   CEFUROXIME 1.5GM INJ               134.76           83             PHARMACY - INJECTIBLES
       8304206   CEFUROXIME 750MG INJ               121.37           83             PHARMACY - INJECTIBLES
       8304347   CHLORAMPHENICOL 1GM INJ            153.34           83             PHARMACY - INJECTIBLES
       8320160   CHLORDIAZEPOXD 100MG INJ           186.50           83             PHARMACY - INJECTIBLES
       8304412   CHLOROPROCAINE 2% INJ               83.18           83             PHARMACY - INJECTIBLES
       8304487   CHLOROPROCAINE 3% INJ               85.42           83             PHARMACY - INJECTIBLES
       8304503   CHLOROTHIAZIDE 500MG INJ            84.82           83             PHARMACY - INJECTIBLES
       8304552   CHLORPROMAZINE 50MG INJ             63.20           83             PHARMACY - INJECTIBLES
       8304628   CIDOFOVIR 375MG INJ              1,883.84           83             PHARMACY - INJECTIBLES
       8304693   CIPRO 200MG INJ00MG INJ            136.66           83             PHARMACY - INJECTIBLES
       8304719   CISATRACURIUM                       95.44           83             PHARMACY - INJECTIBLES
       8390346   CISPLATIN 10MG IJ                  129.30           83             PHARMACY - INJECTIBLES
       8380248   CISPLATIN 50MG INJ                 642.50           83             PHARMACY - INJECTIBLES
       8304909   CLINDAMYCIN 900MG INJ              131.92           83             PHARMACY - INJECTIBLES
       8304925   CLONIDINE HCL 1MG EPIDINJ          269.16           83             PHARMACY - INJECTIBLES
       8331324   COCCI SKIN TEST 1:100 IJ-           60.92           83             PHARMACY - INJECTIBLES
       8320202   CODEINE 60MG INJG INJ               82.76           83             PHARMACY - INJECTIBLES
       8304974   COLCHICINE 1MG INJ                  69.42           83             PHARMACY - INJECTIBLES
       8305047   COSYNTROPIN 0.25MG INJ             231.58           83             PHARMACY - INJECTIBLES
       8305112   CYANOCOBALAMIN 1MG INJ              55.20           83             PHARMACY - INJECTIBLES
       8380321   CYCLOPHOSPHAMID 1GM INJ            570.56           83             PHARMACY - INJECTIBLES
       8380289   CYCLOPHOSPHAMID 500MG INJ          521.18           83             PHARMACY - INJECTIBLES
       8305187   CYSTEINE 500MG INJ                 114.10           83             PHARMACY - INJECTIBLES



9/17/2012                                                                                                    109
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8380362   CYTARABINE 100MG INJ                36.00           83             PHARMACY - INJECTIBLES
       8305682   D10W 5ML INJ                        57.24           83             PHARMACY - INJECTIBLES
       8305609   D25W 10ML2.5GM/10ML SYG             63.92           83             PHARMACY - INJECTIBLES
       8305674   D50W 50 ML5GM/50ML SYG              63.38           83             PHARMACY - INJECTIBLES
       8380404   DACARBAZINE 200MG INJ              519.05           83             PHARMACY - INJECTIBLES
       8305252   DANTROLENE 20MG INJ                304.84           83             PHARMACY - INJECTIBLES
       8390338   DAPTOMYCIN 1MG IJ                    0.98           83             PHARMACY - INJECTIBLES
       8380446   DAUNORUBICIN 20 MG INJ           1,356.18           83             PHARMACY - INJECTIBLES
       8305328   DEFEROXAMINE 500MG INJ             153.84           83             PHARMACY - INJECTIBLES
       8305393   DESMOPRESSIN ACET 4MCG             136.88           83             PHARMACY - INJECTIBLES
       8305534   DEXAMETHASONE 10MG INJ              58.60           83             PHARMACY - INJECTIBLES
       8305468   DEXAMETHASONE 4MG INJ               56.10           83             PHARMACY - INJECTIBLES
       8320244   DIAZEPAM 10MG INJ                   82.24           83             PHARMACY - INJECTIBLES
       8320285   DIAZEPAM 10MG PARAMED SYG           36.00           83             PHARMACY - INJECTIBLES
       8305740   DIAZOXIDE 300MG INJ                312.76           83             PHARMACY - INJECTIBLES
       8305815   DICYCLOMINE 20MG INJ                97.38           83             PHARMACY - INJECTIBLES
       8390429   DIDANOSINE 25MG PO                   1.53           83             PHARMACY - INJECTIBLES
       8305880   DIGOXIN 0.1MG INJ                   68.32           83             PHARMACY - INJECTIBLES
       8305955   DIGOXIN 0.5MG INJ                   57.68           83             PHARMACY - INJECTIBLES
       8306029   DIGOXIN IMM FAB VIAL IJ          1,570.40           83             PHARMACY - INJECTIBLES
       8306094   DIHYDROERGOT 1MG INJ               156.00           83             PHARMACY - INJECTIBLES
       8306169   DILTIAZEM 25MG INJ                  63.92           83             PHARMACY - INJECTIBLES
       8306235   DIMERCAPROL 300MG INJ              225.86           83             PHARMACY - INJECTIBLES
       8331803   DIPHENHYDRAMINE 50MG INJ            55.92           83             PHARMACY - INJECTIBLES
       8306300   DIPYRIDAMOLE/10MG IJ                76.42           83             PHARMACY - INJECTIBLES
       8306375   DOBUTAMINE 250MG INJ               131.84           83             PHARMACY - INJECTIBLES
       8381741   DOCETAXEL 20MG IJ                1,263.42           83             PHARMACY - INJECTIBLES
       8306391   DOLASETRON                         205.34           83             PHARMACY - INJECTIBLES
       8306383   DOLASETRON 12.5MG INJ               91.32           83             PHARMACY - INJECTIBLES
       8306441   DOPAMINE 400MG INJ                 180.38           83             PHARMACY - INJECTIBLES
       8331928   DOXAPRAM 400MG INJ                 302.60           83             PHARMACY - INJECTIBLES
       8380487   DOXORUBICIN 10MG IJ                494.30           83             PHARMACY - INJECTIBLES
       8380560   DOXORUBICIN 50MG INJ               574.30           83             PHARMACY - INJECTIBLES



9/17/2012                                                                                                    110
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8380529   DOXORUBICN LIPO 20MG INJ             2,315.06           83             PHARMACY - INJECTIBLES
       8306581   DOXYCYCLINE 100MG INJ                  137.34           83             PHARMACY - INJECTIBLES
       8306656   DROPERIDOL 5MG INJ                      36.00           83             PHARMACY - INJECTIBLES
       8306607   DROTRECOGIN                            703.96           83             PHARMACY - INJECTIBLES
       8306615   DROTRECOGIN                          2,492.34           83             PHARMACY - INJECTIBLES
       8332405   EDROPHONIUM 10MG/ML 10ML                75.42           83             PHARMACY - INJECTIBLES
       8306862   EDTA 1GM INJISOD 1GM INJ               204.54           83             PHARMACY - INJECTIBLES
       8306946   ENALAPRILAT                             68.92           83             PHARMACY - INJECTIBLES
       8306938   ENALAPRILAT 1.25MG INJ                  61.42           83             PHARMACY - INJECTIBLES
       8307050   ENOXAPARIN                             232.60           83             PHARMACY - INJECTIBLES
       8307035   ENOXAPARIN 100MG SYG                   202.78           83             PHARMACY - INJECTIBLES
       8307068   ENOXAPARIN 150MG SYG                   277.24           83             PHARMACY - INJECTIBLES
       8307001   ENOXAPARIN 30MG SYG                     98.52           83             PHARMACY - INJECTIBLES
       8307019   ENOXAPARIN 40MG SYG                    113.40           83             PHARMACY - INJECTIBLES
       8307043   ENOXAPARIN 60MG SYG                    143.22           83             PHARMACY - INJECTIBLES
       8307027   ENOXAPARIN 80MG SYG                    173.00           83             PHARMACY - INJECTIBLES
       8307076   EPHEDRINE 50MG INJ                      55.94           83             PHARMACY - INJECTIBLES
       8307217   EPINEPHRINE 1MG INJ                     55.02           83             PHARMACY - INJECTIBLES
       8307282   EPINEPHRINE 1MG SYG                     58.98           83             PHARMACY - INJECTIBLES
       8332520   EPINEPHRINE 30MG INJ                    72.42           83             PHARMACY - INJECTIBLES
       8307357   EPOETIN ALFA 10KUNIT INJ               358.18           83             PHARMACY - INJECTIBLES
       8307423   EPOETIN ALFA 2KUNIT INJ                105.54           83             PHARMACY - INJECTIBLES
       8307498   EPOETIN ALFA 3KUNIT INJ                145.20           83             PHARMACY - INJECTIBLES
       8307373   EPOETIN ALFA 40KUNIT INJ             1,270.92           83             PHARMACY - INJECTIBLES
       8307563   EPOETIN ALFA 4KUNIT INJ                175.62           83             PHARMACY - INJECTIBLES
       8390031   EPOETIN NON-ESRD/1000U IJ               81.50           83             PHARMACY - INJECTIBLES
       8307605   EPTIFIBATIDE 20MG INJ                  225.12           83             PHARMACY - INJECTIBLES
       8390049   EPTIFIBATIDE 5MG IJ                     87.00           83             PHARMACY - INJECTIBLES
       8307639   ERGOCALCIFEROL 500 KU IJ               147.50           83             PHARMACY - INJECTIBLES
       8307704   ERGONOVINE MAL 0.2MG INJ                39.50           83             PHARMACY - INJECTIBLES
       8307779   ERYTHROMYCIN 500MG INJ                 115.24           83             PHARMACY - INJECTIBLES
       8307985   ESMOLOL 100MG/10ML INJ                  99.90           83             PHARMACY - INJECTIBLES
       8307910   ESMOLOL 2.5GM/10ML INJ                 367.24           83             PHARMACY - INJECTIBLES



9/17/2012                                                                                                        111
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8332645   ESTRADIOL CYP 50MG INJ                121.52           83             PHARMACY - INJECTIBLES
       8321689   ESTRADIOL CYP-ESTRA INJ               151.62           83             PHARMACY - INJECTIBLES
       8332769   ESTRADIOL VAL 20MG INJ                 97.70           83             PHARMACY - INJECTIBLES
       8308058   ESTROGENS CONJ 25MG INJ               195.04           83             PHARMACY - INJECTIBLES
       8308066   ETHANOLOMINE 100MG IJ                 308.24           83             PHARMACY - INJECTIBLES
       8300428   ETOH 5ML INJLUTE 5ML INJ               91.04           83             PHARMACY - INJECTIBLES
       8308124   ETOMIDATE 40MG INJ                     77.32           83             PHARMACY - INJECTIBLES
       8380602   ETOPOSIDE 100MG INJ                   509.30           83             PHARMACY - INJECTIBLES
       8308132   FACTOR 7A RECOM 1MCG IJ             2,405.60           83             PHARMACY - INJECTIBLES
       8308140   FACTOR 9 CMPLX                          1.94           83             PHARMACY - INJECTIBLES
       8308199   FAMOTIDINE 20MG INJ                    61.42           83             PHARMACY - INJECTIBLES
       8332884   FAMOTIDINE 40MG INJ                   122.84           83             PHARMACY - INJECTIBLES
       8308223   FENOLDOPAM                          1,114.98           83             PHARMACY - INJECTIBLES
       8322000   FENTANYL                              101.50           83             PHARMACY - INJECTIBLES
       8322034   FENTANYL                              101.50           83             PHARMACY - INJECTIBLES
       8320327   FENTANYL 0.1MG/2ML INJ                 82.68           83             PHARMACY - INJECTIBLES
       8320368   FENTANYL 0.25MG/5ML INJ                83.40           83             PHARMACY - INJECTIBLES
       8320376   FENTANYL 1MG/20ML INJ                 139.40           83             PHARMACY - INJECTIBLES
       8308264   FILGRASTIM 300MCG INJ                 529.92           83             PHARMACY - INJECTIBLES
       8308330   FILGRASTIM 480MCG INJ                 812.30           83             PHARMACY - INJECTIBLES
       8333007   FLUMAZENIL 0.5MG/5ML INJ              261.08           83             PHARMACY - INJECTIBLES
       8333122   FLUORESCEIN 500MG INJ                  68.50           83             PHARMACY - INJECTIBLES
       8380644   FLUOROURACIL 500MG INJ                 34.46           83             PHARMACY - INJECTIBLES
       8333163   FLUPHENAZINE 25MG INJ                 192.50           83             PHARMACY - INJECTIBLES
       8308405   FLUPHENAZINE DECANO 25MG               23.08           83             PHARMACY - INJECTIBLES
       8333247   FOLIC ACID 1MG INJ                     58.37           83             PHARMACY - INJECTIBLES
       8333254   FOMEPIZOLE 15MG IJ                  2,875.84           83             PHARMACY - INJECTIBLES
       8390056   FOMEPIZOLE 15MG IJ                     78.50           83             PHARMACY - INJECTIBLES
       8308470   FOSPHENYTOIN 100MG INJ                105.72           83             PHARMACY - INJECTIBLES
       8308488   FOSPHENYTOIN 500MG INJ                209.30           83             PHARMACY - INJECTIBLES
       8390064   FOSPHENYTOIN 50MG IJ                  117.00           83             PHARMACY - INJECTIBLES
       8308686   FUROSEMIDE 100MG INJ                   58.50           83             PHARMACY - INJECTIBLES
       8308546   FUROSEMIDE 20MG INJ                    55.70           83             PHARMACY - INJECTIBLES



9/17/2012                                                                                                       112
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8308611   FUROSEMIDE 40MG INJ                 56.80           83             PHARMACY - INJECTIBLES
       8390072   GANCICLOVIR 4.5MG IMPLNT            36.00           83             PHARMACY - INJECTIBLES
       8308751   GANCICLOVIR 500MG INJ              205.85           83             PHARMACY - INJECTIBLES
       8381923   GEMCITABINE 200MG IJ               757.10           83             PHARMACY - INJECTIBLES
       8308827   GENTAMICIN 20MG INJ                110.20           83             PHARMACY - INJECTIBLES
       8333361   GENTAMICIN 800MG INJ               132.72           83             PHARMACY - INJECTIBLES
       8308892   GENTAMICIN 80MG INJ                 55.60           83             PHARMACY - INJECTIBLES
       8308967   GLUCAGON 1 MG INJ                  216.42           83             PHARMACY - INJECTIBLES
       8309031   GLYCOPYRROLATE 0.4MG INJ            60.20           83             PHARMACY - INJECTIBLES
       8333379   GOLD SODIUM 500MG                  337.38           83             PHARMACY - INJECTIBLES
       8331209   GONADOTROPIN GON 10 K IJ            63.96           83             PHARMACY - INJECTIBLES
       8309312   HALOPERIDOL 100MG INJ              152.92           83             PHARMACY - INJECTIBLES
       8309171   HALOPERIDOL 5MG INJ                 68.90           83             PHARMACY - INJECTIBLES
       8309247   HALOPERIDOL DEC 50MG INJ            73.92           83             PHARMACY - INJECTIBLES
       8333726   HEPARIN 1 KUNITS INJ                29.12           83             PHARMACY - INJECTIBLES
       8333841   HEPARIN 1 KUNITS/ML 30ML            33.96           83             PHARMACY - INJECTIBLES
       8333965   HEPARIN 10 KUNITS KUNITS            44.50           83             PHARMACY - INJECTIBLES
       8309452   HEPARIN 10 KUNITS/1ML INJ           30.34           83             PHARMACY - INJECTIBLES
       8333601   HEPARIN LOC 100 U/ML 30ML           28.16           83             PHARMACY - INJECTIBLES
       8333486   HEPARIN LOCK PF 10 UNITS            47.29           83             PHARMACY - INJECTIBLES
       8334567   HISTOPLASMIN INJ-DIAG               36.00           83             PHARMACY - INJECTIBLES
       8309668   HYALURONIDASE 150 U INJ            103.92           83             PHARMACY - INJECTIBLES
       8309734   HYDRALAZINE 20MG INJ                91.42           83             PHARMACY - INJECTIBLES
       8334807   HYDROCORT NA SUCC 100MG             59.00           83             PHARMACY - INJECTIBLES
       8334922   HYDROCORT NA SUCC 250MG             62.88           83             PHARMACY - INJECTIBLES
       8320491   HYDROMORPH 60MG/60ML PCA            88.72           83             PHARMACY - INJECTIBLES
       8320442   HYDROMORPHONE 2MG INJ               83.54           83             PHARMACY - INJECTIBLES
       8320400   HYDROMORPHONE 40MG/20ML            156.06           83             PHARMACY - INJECTIBLES
       8350902   HYDROMORPHONE 4MG IJ               184.40           83             PHARMACY - INJECTIBLES
       8390395   HYDROMORPHONE 4MG IJ                73.76           83             PHARMACY - INJECTIBLES
       8320483   HYDROMORPHONE 4MG INJ               83.26           83             PHARMACY - INJECTIBLES
       8320533   HYDROMORPHONE 500MG/50ML           552.26           83             PHARMACY - INJECTIBLES
       8320525   HYDROMORPHONE 50MG/5ML             143.36           83             PHARMACY - INJECTIBLES



9/17/2012                                                                                                    113
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8309809   HYDROXYZINE HCL 100MG IJ                56.50           83             PHARMACY - INJECTIBLES
       8309825   IBUTILIDE 1MG ING                      697.48           83             PHARMACY - INJECTIBLES
       8380685   IFOSFAMIDE 1GM INJ                     616.92           83             PHARMACY - INJECTIBLES
       8309585   IG HEPATITIS B HUMAN IM                211.42           83             PHARMACY - INJECTIBLES
       8309593   IG HEPATITIS B HUMAN IM                314.72           83             PHARMACY - INJECTIBLES
       8310088   IG IMMUNE GLOB 1CC IJ                2,769.60           83             PHARMACY - INJECTIBLES
       8335044   IG IMMUNE GLOB 1CC IJ                  141.98           83             PHARMACY - INJECTIBLES
       8309940   IG IMMUNE GLOB 1CC IJ                  594.60           83             PHARMACY - INJECTIBLES
       8310013   IG IMMUNE GLOB 1CC IJ                1,519.60           83             PHARMACY - INJECTIBLES
       8390080   IG IVIG LYOPHILIZD 500MG               161.00           83             PHARMACY - INJECTIBLES
       8390148   IG IVIG NONLYOPHLZD 500MG              161.00           83             PHARMACY - INJECTIBLES
       8316523   IG RABIES IM/SUBCU                     413.30           83             PHARMACY - INJECTIBLES
       8316598   IG RABIES IM/SUBCU                   2,035.00           83             PHARMACY - INJECTIBLES
       8316739   IG RESP SYNC VIRUS 50MG              1,536.50           83             PHARMACY - INJECTIBLES
       8316747   IG RESP SYNC VIRUS 50MG              2,177.20           83             PHARMACY - INJECTIBLES
       8390114   IG RESP SYNC VIRUS 50MG                101.50           83             PHARMACY - INJECTIBLES
       8317927   IG TETANUS 250 IU IJ                    54.97           83             PHARMACY - INJECTIBLES
       8319188   IG VARICELLA-ZOSTER IM                 303.92           83             PHARMACY - INJECTIBLES
       8319196   IG VARICELLA-ZOSTER IM               1,433.92           83             PHARMACY - INJECTIBLES
       8309882   IMIPENEM/CILAST                        182.66           83             PHARMACY - INJECTIBLES
       8309874   IMIPENEM/CILAST 500MG                  159.50           83             PHARMACY - INJECTIBLES
       8310153   INDIGO CARMINE 0.8% INJ                 70.62           83             PHARMACY - INJECTIBLES
       8310229   INDOMETHACIN 1MG INJ                   198.57           83             PHARMACY - INJECTIBLES
       8310245   INFLIXIMAB 100MG INJ                 1,511.05           83             PHARMACY - INJECTIBLES
       8390007   INFLIXIMAB/10MG IJ                     160.00           83             PHARMACY - INJECTIBLES
       8390403   INSULIN 5 UNITS IJ                      66.01           83             PHARMACY - INJECTIBLES
       8335309   INSULIN ASPART                          70.09           83             PHARMACY - INJECTIBLES
       8335903   INSULIN GLARGIN                         68.96           83             PHARMACY - INJECTIBLES
       8335408   INSULIN LENTE U100                      60.33           83             PHARMACY - INJECTIBLES
       8335291   INSULIN LIS/NPH                         70.09           83             PHARMACY - INJECTIBLES
       8335523   INSULIN LISPRO U100                     70.09           83             PHARMACY - INJECTIBLES
       8335648   INSULIN NPH HUM U100                    60.84           83             PHARMACY - INJECTIBLES
       8335762   INSULIN REG HUM U100                    60.84           83             PHARMACY - INJECTIBLES



9/17/2012                                                                                                        114
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8335283   INSULIN REG/NPH U100                    60.84           83             PHARMACY - INJECTIBLES
       8335887   INSULIN ULTRA U100AL U100               60.84           83             PHARMACY - INJECTIBLES
       8310302   INTERFERON A-2B                        721.98           83             PHARMACY - INJECTIBLES
       8310369   IRON DEXTRAN 100MG INJ                 133.00           83             PHARMACY - INJECTIBLES
       8310377   IRON SUCROSE 1MG IJ                     12.26           83             PHARMACY - INJECTIBLES
       8310435   ISOPROTERENOL 1MG INJ                  115.50           83             PHARMACY - INJECTIBLES
       8310427   ISOSULFAN BLUE 1% ML INJ               125.92           83             PHARMACY - INJECTIBLES
       8310450   ITRACONAZOLE                           552.44           83             PHARMACY - INJECTIBLES
       8315475   K ACET 40MEQ INJ0MEQ INJ                28.22           83             PHARMACY - INJECTIBLES
       8315624   K CL                                    27.03           83             PHARMACY - INJECTIBLES
       8315541   K CL 40MEQ INJR 40MEQ INJ               27.86           83             PHARMACY - INJECTIBLES
       8315616   K PHOS 66MEQ INJ6MEQ INJ                29.54           83             PHARMACY - INJECTIBLES
       8310500   KANAMYCIN 1GM INJ                      121.70           83             PHARMACY - INJECTIBLES
       8320566   KETAMINE 500MG INJ                      92.12           83             PHARMACY - INJECTIBLES
       8320574   KETAMINE 500MG INJ                     127.50           83             PHARMACY - INJECTIBLES
       8310575   KETOROLAC 30MG/1ML INJ                  57.82           83             PHARMACY - INJECTIBLES
       8310641   KETOROLAC 60MG/2ML INJ                  58.12           83             PHARMACY - INJECTIBLES
       8310716   LABETALOL 100MG INJ                     63.92           83             PHARMACY - INJECTIBLES
       8310781   LEUCOVORIN 100MG INJ                   483.05           83             PHARMACY - INJECTIBLES
       8390098   LEUCOVORIN/50MG IJ                      36.00           83             PHARMACY - INJECTIBLES
       8380727   LEUPROLIDE/3.75MG IJ                 1,282.10           83             PHARMACY - INJECTIBLES
       8380768   LEUPROLIDE/3.75MG IJ                 1,531.42           83             PHARMACY - INJECTIBLES
       8310823   LEVOFLOXACIN 500MG INJ                 199.14           83             PHARMACY - INJECTIBLES
       8320608   LEVORPHANAL 2MG INJ                     37.50           83             PHARMACY - INJECTIBLES
       8310856   LEVOTHYROXINE 200MCG INJ                68.92           83             PHARMACY - INJECTIBLES
       8311482   LIDO/DEXTROSE 5% AMP                    59.32           83             PHARMACY - INJECTIBLES
       8336364   LIDO/EPI 0.5% MDV.5% MDV                66.28           83             PHARMACY - INJECTIBLES
       8336489   LIDO/EPI 1% MDV 1% MDV                  56.92           83             PHARMACY - INJECTIBLES
       8311276   LIDO/EPI 1% SDV 1% SDV                  70.57           83             PHARMACY - INJECTIBLES
       8311342   LIDO/EPI 1.5% SDV.5% SDV                72.25           83             PHARMACY - INJECTIBLES
       8336604   LIDO/EPI 2% MDV 2% MDV                  58.28           83             PHARMACY - INJECTIBLES
       8311417   LIDO/EPI 2% SDV 2% SDV                  85.72           83             PHARMACY - INJECTIBLES
       8311144   LIDOCAINE                               69.20           83             PHARMACY - INJECTIBLES



9/17/2012                                                                                                        115
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8336000   LIDOCAINE 0.5% MDV                 58.74           83             PHARMACY - INJECTIBLES
       8310922   LIDOCAINE 0.5% SDV                 58.78           83             PHARMACY - INJECTIBLES
       8336125   LIDOCAINE 1% MDV                   55.08           83             PHARMACY - INJECTIBLES
       8310997   LIDOCAINE 1% SDV                   55.22           83             PHARMACY - INJECTIBLES
       8311060   LIDOCAINE 1.5% SDV                 77.22           83             PHARMACY - INJECTIBLES
       8311201   LIDOCAINE 100MG SYG                61.22           83             PHARMACY - INJECTIBLES
       8336240   LIDOCAINE 2% MDV                   55.18           83             PHARMACY - INJECTIBLES
       8311136   LIDOCAINE 2% SDV                   59.64           83             PHARMACY - INJECTIBLES
       8336729   LIDOCAINE-BUFFERED 1% MDV         109.52           83             PHARMACY - INJECTIBLES
       8311490   LINEZOLID/200MG IJ                 81.49           83             PHARMACY - INJECTIBLES
       8390106   LINEZOLID/200MG IJ                165.00           83             PHARMACY - INJECTIBLES
       8320681   LORAZEPAM 20MG INJ                254.12           83             PHARMACY - INJECTIBLES
       8320640   LORAZEPAM 2MG INJ                  94.28           83             PHARMACY - INJECTIBLES
       8311557   MAG SO4 5GM INJ                    29.62           83             PHARMACY - INJECTIBLES
       8311540   MAG SO4UM                          56.04           83             PHARMACY - INJECTIBLES
       8311763   MANNITOL 25% INJ                   56.34           83             PHARMACY - INJECTIBLES
       8336968   MEDROXYPROGEST AC 150MG I         185.00           83             PHARMACY - INJECTIBLES
       8336844   MEDROXYPROGEST ACET 1GM I         321.50           83             PHARMACY - INJECTIBLES
       8320814   MEPERIDINE 100MG AMP               27.96           83             PHARMACY - INJECTIBLES
       8320806   MEPERIDINE 100MG SYG               28.58           83             PHARMACY - INJECTIBLES
       8320889   MEPERIDINE 2000MG/20ML            147.94           83             PHARMACY - INJECTIBLES
       8320830   MEPERIDINE 300MG/30ML PCA          52.00           83             PHARMACY - INJECTIBLES
       8320723   MEPERIDINE 50MG SYG                28.52           83             PHARMACY - INJECTIBLES
       8320848   MEPERIDINE 600MG/60ML PCA         104.48           83             PHARMACY - INJECTIBLES
       8320764   MEPERIDINE 75MG SYG                29.18           83             PHARMACY - INJECTIBLES
       8337081   MEPIVACAINE HCL 1% MDV             86.48           83             PHARMACY - INJECTIBLES
       8311979   MEPIVACAINE HCL 1% SDV             70.42           83             PHARMACY - INJECTIBLES
       8337206   MEPIVACAINE HCL 2% MDV             77.74           83             PHARMACY - INJECTIBLES
       8312118   MEROPENEM 1GM INJ                 189.00           83             PHARMACY - INJECTIBLES
       8312043   MEROPENEM 500MG INJ               144.50           83             PHARMACY - INJECTIBLES
       8337321   MESNA 1000MG INJ                  736.68           83             PHARMACY - INJECTIBLES
       8390288   MESNA 200MG IJ                    147.32           83             PHARMACY - INJECTIBLES
       8312183   MESORIDAZINE 25MG INJ              47.00           83             PHARMACY - INJECTIBLES



9/17/2012                                                                                                   116
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8312241   METARAMINOL 100GM INJ                  134.56           83             PHARMACY - INJECTIBLES
       8320921   METHADONE 10MG INJ                      36.00           83             PHARMACY - INJECTIBLES
       8320962   METHADONE 200MG/20ML INJ               166.58           83             PHARMACY - INJECTIBLES
       8321002   METHOHEXITAL 500MG INJ                 177.34           83             PHARMACY - INJECTIBLES
       8380883   METHOTREXATE 1000MG INJ                114.46           83             PHARMACY - INJECTIBLES
       8380800   METHOTREXATE 250MG INJ                  66.28           83             PHARMACY - INJECTIBLES
       8380842   METHOTREXATE 250MG PF INJ               50.72           83             PHARMACY - INJECTIBLES
       8312258   METHYLDOPATE 250MG INJ                  78.92           83             PHARMACY - INJECTIBLES
       8312324   METHYLENE BLUE 10ML INJ                 74.28           83             PHARMACY - INJECTIBLES
       8312399   METHYLERGONOVIN 0.2MG INJ               64.28           83             PHARMACY - INJECTIBLES
       8337560   METHYLPRED 125MG INJG INJ               62.20           83             PHARMACY - INJECTIBLES
       8337685   METHYLPRED 1GM INJM INJ                148.26           83             PHARMACY - INJECTIBLES
       8337446   METHYLPRED 40MG INJG INJ                59.06           83             PHARMACY - INJECTIBLES
       8312464   METHYLPRED ACET 80MG INJ                83.54           83             PHARMACY - INJECTIBLES
       8312530   METOCLOPRAMIDE 10MG INJ                 56.60           83             PHARMACY - INJECTIBLES
       8312605   METOPROLOL 5MG INJ                      58.72           83             PHARMACY - INJECTIBLES
       8321069   MIDAZOLAM                              155.88           83             PHARMACY - INJECTIBLES
       8321085   MIDAZOLAM 10MG INJ                      88.94           83             PHARMACY - INJECTIBLES
       8321051   MIDAZOLAM 1MG/ML 10ML INJ               87.00           83             PHARMACY - INJECTIBLES
       8321044   MIDAZOLAM 2MG INJ                       82.26           83             PHARMACY - INJECTIBLES
       8311862   MILRINONE 100MG INJ                    400.62           83             PHARMACY - INJECTIBLES
       8380966   MITOMYCIN 20MG INJ                     945.00           83             PHARMACY - INJECTIBLES
       8380925   MITOMYCIN 5MG INJ                      166.96           83             PHARMACY - INJECTIBLES
       8311888   MIVACURIUM 20MG INJ                     92.30           83             PHARMACY - INJECTIBLES
       8321473   MORPHINE                               131.68           83             PHARMACY - INJECTIBLES
       8321218   MORPHINE 10MG INJ AMP                   79.50           83             PHARMACY - INJECTIBLES
       8321242   MORPHINE 10MG/10ML PARA                 96.16           83             PHARMACY - INJECTIBLES
       8321465   MORPHINE PF 200MG                      764.00           83             PHARMACY - INJECTIBLES
       8321168   MORPHINE PF/10 MG IJ                   144.42           83             PHARMACY - INJECTIBLES
       8321283   MORPHINE SO4 10MG SYG                   83.38           83             PHARMACY - INJECTIBLES
       8321374   MORPHINE SO4 150MG/30ML P              106.00           83             PHARMACY - INJECTIBLES
       8321325   MORPHINE SO4 15MG SYG                   83.18           83             PHARMACY - INJECTIBLES
       8321457   MORPHINE SO4 2000MG/40/ML              177.82           83             PHARMACY - INJECTIBLES



9/17/2012                                                                                                        117
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8321127   MORPHINE SO4 2MG SYG                    29.12           83             PHARMACY - INJECTIBLES
       8321408   MORPHINE SO4 300MG MDV                 141.68           83             PHARMACY - INJECTIBLES
       8321366   MORPHINE SO4 60MG/60ML                  62.50           83             PHARMACY - INJECTIBLES
       8321135   MORPHINE SULFATE 4MG SYS                82.64           83             PHARMACY - INJECTIBLES
       8337925   MUMPS SKIN TEST                         82.50           83             PHARMACY - INJECTIBLES
       8319667   MVI 5ML/INJLT 5ML/INJ                   49.50           83             PHARMACY - INJECTIBLES
       8319741   MVI PEDI PEDI INJI INJ                 134.72           83             PHARMACY - INJECTIBLES
       8319675   MVI-12 10ML INJ0ML INJ                 127.20           83             PHARMACY - INJECTIBLES
       8316945   NA ACET 40MEQ INJMEQ INJ                31.74           83             PHARMACY - INJECTIBLES
       8317174   NA BICARB                               27.00           83             PHARMACY - INJECTIBLES
       8317083   NA BICARB 50MEQ INJ                     28.34           83             PHARMACY - INJECTIBLES
       8317158   NA BICARB 50MEQ SYG                     60.20           83             PHARMACY - INJECTIBLES
       8317018   NA BICARB 5MEQ SYG                      60.18           83             PHARMACY - INJECTIBLES
       8317430   NA BIPHOSPHATE 60MEQ INJ                39.04           83             PHARMACY - INJECTIBLES
       8317216   NA CL                                   28.44           83             PHARMACY - INJECTIBLES
       8317380   NA CL                                   26.99           83             PHARMACY - INJECTIBLES
       8317224   NA CL 0.9% 10ML INJ                      0.68           83             PHARMACY - INJECTIBLES
       8317232   NA CL 0.9% LOCK SYG                     30.00           83             PHARMACY - INJECTIBLES
       8317364   NA CL CONC 120MEQ INJ INJ               29.84           83             PHARMACY - INJECTIBLES
       8312951   NAFCILLIN 10GM INJ                      83.50           83             PHARMACY - INJECTIBLES
       8312811   NAFCILLIN 1GM INJ                      125.12           83             PHARMACY - INJECTIBLES
       8312886   NAFCILLIN 2GM INJ                      141.34           83             PHARMACY - INJECTIBLES
       8312746   NAFCILLIN 500MG INJ                     36.00           83             PHARMACY - INJECTIBLES
       8313025   NALBUPHINE 10MG INJ                     55.14           83             PHARMACY - INJECTIBLES
       8313090   NALMEFENE 2MG INJ                       72.48           83             PHARMACY - INJECTIBLES
       8313165   NALOXONE 0.4MG INJ                      56.22           83             PHARMACY - INJECTIBLES
       8338162   NALOXONE 4MG/10ML MDV INJ              195.84           83             PHARMACY - INJECTIBLES
       8338048   NALOXONE 5MG INJ                       118.32           83             PHARMACY - INJECTIBLES
       8321481   NANDROLONE DEC 200MG INJ                87.92           83             PHARMACY - INJECTIBLES
       8313231   NEOSTIGMINE 10MG INJ                    62.42           83             PHARMACY - INJECTIBLES
       8313249   NESIRITIDE                             814.41           83             PHARMACY - INJECTIBLES
       8313264   NICARDIPINE                            270.34           83             PHARMACY - INJECTIBLES
       8313314   NITROGLYCERIN 100MCG/ML                122.62           83             PHARMACY - INJECTIBLES



9/17/2012                                                                                                        118
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8313371   NITROPRUSSIDE 50MG INJ             122.72           83             PHARMACY - INJECTIBLES
       8313447   NOREPINEPHRINE 4MG INJ             121.12           83             PHARMACY - INJECTIBLES
       8313306   NTG 50MG INJN 50MG INJ             135.96           83             PHARMACY - INJECTIBLES
       8338287   OCTREOTIDE AC 1000MCG/1ML          596.36           83             PHARMACY - INJECTIBLES
       8313512   OCTREOTIDE ACET 0.1MG INJ           92.62           83             PHARMACY - INJECTIBLES
       8313546   OLANZAPINE                         102.68           83             PHARMACY - INJECTIBLES
       8390197   OMALIZUMAB PER 5MG IJ               41.37           83             PHARMACY - INJECTIBLES
       8338527   ONDANSETRON 40MG INJ               642.02           83             PHARMACY - INJECTIBLES
       8338402   ONDANSETRON 4MG INJ                107.34           83             PHARMACY - INJECTIBLES
       8338410   OPRELVEKIN 5MG INJ                 665.92           83             PHARMACY - INJECTIBLES
       8338642   ORPHENADRINE 300MG INJ              98.92           83             PHARMACY - INJECTIBLES
       8313587   OXYTOCIN 10 UNITS INJ              117.22           83             PHARMACY - INJECTIBLES
       8380990   PACLITAXEL 30MG IJ                 817.24           83             PHARMACY - INJECTIBLES
       8381006   PACLITAXEL 30MG INJ              2,929.50           83             PHARMACY - INJECTIBLES
       8313595   PALIVIZUMAB 100MG INJ            1,668.14           83             PHARMACY - INJECTIBLES
       8313652   PAMIDRONATE 30MG INJ               667.56           83             PHARMACY - INJECTIBLES
       8338766   PANCURONIUM BROM 10MG INJ          142.04           83             PHARMACY - INJECTIBLES
       8313678   PANTOPRAZOLE 40MG INJ              113.92           83             PHARMACY - INJECTIBLES
       8313728   PAPAVERINE 60MG IJ                  60.92           83             PHARMACY - INJECTIBLES
       8313793   PCN G BENZ 1.2 MUNITS              147.28           83             PHARMACY - INJECTIBLES
       8313868   PCN G BENZ CR 1.2 MUNIT            128.32           83             PHARMACY - INJECTIBLES
       8314288   PCN G K 20 MUNIT INJ               129.22           83             PHARMACY - INJECTIBLES
       8314213   PCN G K 5 MUNIT INJIT INJ          114.73           83             PHARMACY - INJECTIBLES
       8314007   PCN G PROC 1.2 MUNITS               97.54           83             PHARMACY - INJECTIBLES
       8313934   PCN G PROC 600 KUNITS               80.12           83             PHARMACY - INJECTIBLES
       8314353   PENTAMIDINE 300MG INJ              202.24           83             PHARMACY - INJECTIBLES
       8321523   PENTOBARBITAL 100MG INJ            110.23           83             PHARMACY - INJECTIBLES
       8321564   PHENOBARBITAL 130MG INJ             89.00           83             PHARMACY - INJECTIBLES
       8314429   PHENOL 6% IN GLYCERIN INJ          146.00           83             PHARMACY - INJECTIBLES
       8314494   PHENOL 6% IN ST H20 INJ            103.00           83             PHARMACY - INJECTIBLES
       8314569   PHENOL15%/DIATRIZOATE 30%          103.00           83             PHARMACY - INJECTIBLES
       8314635   PHENTOLAMINE 5MG INJ               123.92           83             PHARMACY - INJECTIBLES
       8314700   PHENYLEPHRINE 10MG INJ             114.10           83             PHARMACY - INJECTIBLES



9/17/2012                                                                                                    119
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8314775   PHENYTOIN 100MG INJ                     61.82           83             PHARMACY - INJECTIBLES
       8314841   PHENYTOIN 250MG INJ                     63.30           83             PHARMACY - INJECTIBLES
       8314916   PHYSOSTIGMINE 2MG INJ                   63.64           83             PHARMACY - INJECTIBLES
       8315053   PHYTONADIONE 10MG INJ                   66.90           83             PHARMACY - INJECTIBLES
       8314981   PHYTONADIONE 1MG INJ                    60.70           83             PHARMACY - INJECTIBLES
       8381048   PLICAMYCIN 2500MCG INJ                 510.50           83             PHARMACY - INJECTIBLES
       8315400   POLYMYXIN B 500 KUNIT IJ               136.60           83             PHARMACY - INJECTIBLES
       8315756   PRALIDOXIME 1GM INJ                    270.67           83             PHARMACY - INJECTIBLES
       8338881   PROCAINAMIDE 1GM/10ML INJ              113.26           83             PHARMACY - INJECTIBLES
       8315822   PROCAINAMIDE 1GM/2ML INJ                56.00           83             PHARMACY - INJECTIBLES
       8315897   PROCAINE 10% INJ                        58.74           83             PHARMACY - INJECTIBLES
       8339004   PROCHLORPERAZIN 10MG INJ                73.04           83             PHARMACY - INJECTIBLES
       8339129   PROGESTERONE 500MG INJ                 206.50           83             PHARMACY - INJECTIBLES
       8315962   PROMETHAZINE 25MG INJ                   58.70           83             PHARMACY - INJECTIBLES
       8316036   PROMETHAZINE 50MG INJ                   59.92           83             PHARMACY - INJECTIBLES
       8316101   PROPOFOL 200MG/20ML INJ                 84.32           83             PHARMACY - INJECTIBLES
       8316176   PROPRANOLOL 1MG INJ                     91.04           83             PHARMACY - INJECTIBLES
       8316242   PROTAMINE SO4 50MG INJ                  93.90           83             PHARMACY - INJECTIBLES
       8300493   PROTEINASE INHB 10MG IJ                108.54           83             PHARMACY - INJECTIBLES
       8390023   PROTEINASE INHB 10MG IJ                  6.27           83             PHARMACY - INJECTIBLES
       8316317   PROTIRELIN 0.5MG INJ                   264.00           83             PHARMACY - INJECTIBLES
       8316382   PYRIDOSTIGMINE 10MG INJ                 99.28           83             PHARMACY - INJECTIBLES
       8339244   PYRIDOXINE 3000MG INJ                   65.02           83             PHARMACY - INJECTIBLES
       8316457   QUINIDINE GLUC 800MG INJ                98.84           83             PHARMACY - INJECTIBLES
       8321580   REMIFENTANIL                           364.06           83             PHARMACY - INJECTIBLES
       8316671   RIFAMPIN 600MG INJ                     262.84           83             PHARMACY - INJECTIBLES
       8316705   RISPERIDONE                          1,220.52           83             PHARMACY - INJECTIBLES
       8316713   RISPERIDONE                            928.92           83             PHARMACY - INJECTIBLES
       8382889   RITUXIMAB 100MG IJ                   1,607.78           83             PHARMACY - INJECTIBLES
       8339368   ROCURONIUM 50MG INJ                     87.20           83             PHARMACY - INJECTIBLES
       8318248   ROPIVACAINE 1MG IJ                       4.18           83             PHARMACY - INJECTIBLES
       8316812   SARGRAMOSTIM 250MCG                    366.02           83             PHARMACY - INJECTIBLES
       8390122   SARGRAMOSTIM 50MCG IJ                  156.50           83             PHARMACY - INJECTIBLES



9/17/2012                                                                                                        120
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8316879   SCOPOLAMINE 1MG INJ                     65.18           83             PHARMACY - INJECTIBLES
       8316895   SELENIUM 400MCG/10ML INJ               113.42           83             PHARMACY - INJECTIBLES
       8316887   SINCALIDE 5MCG INJ                     183.02           83             PHARMACY - INJECTIBLES
       8317570   STREPTOKINASE 750 KUNITSJ              670.34           83             PHARMACY - INJECTIBLES
       8390130   STREPTOKINASE/250KIU IJ              1,485.00           83             PHARMACY - INJECTIBLES
       8317646   STREPTOMYCIN 1GM INJ                   126.04           83             PHARMACY - INJECTIBLES
       8339483   SUCCINYLCHOLINE CL 200MG                59.72           83             PHARMACY - INJECTIBLES
       8321606   SUFENTANIL 50MCG INJ                    94.28           83             PHARMACY - INJECTIBLES
       8317786   SUMATRIPTAN 6MG INJ                    192.94           83             PHARMACY - INJECTIBLES
       8317802   TENECTEPLASE                         5,915.84           83             PHARMACY - INJECTIBLES
       8317851   TERBUTALINE 1MG INJ                    118.88           83             PHARMACY - INJECTIBLES
       8321648   TESTOSTERONE CYP 2000MG I              105.44           83             PHARMACY - INJECTIBLES
       8321721   TESTOSTERONE ENA 2GM IJ                242.90           83             PHARMACY - INJECTIBLES
       8318065   TETRACAINE 1% 2ML INJ                   65.62           83             PHARMACY - INJECTIBLES
       8318131   TETRADECYL NA SOD INJ                  141.50           83             PHARMACY - INJECTIBLES
       8318206   THIAMINE 100MG INJ                      55.92           83             PHARMACY - INJECTIBLES
       8318271   THIETHYLPERAZN 10MG INJ                 43.50           83             PHARMACY - INJECTIBLES
       8321804   THIOPENTAL NA 500MG KIT                135.04           83             PHARMACY - INJECTIBLES
       8321838   THIOPENTAL NA 500MG SYG                 36.00           83             PHARMACY - INJECTIBLES
       8340085   TIGAN 200MG INJ200MG INJ                68.72           83             PHARMACY - INJECTIBLES
       8339848   TOBRAMYCIN 1.2GM MDV INJ               326.36           83             PHARMACY - INJECTIBLES
       8318404   TOBRAMYCIN 20MG INJ                    115.14           83             PHARMACY - INJECTIBLES
       8318412   TOBRAMYCIN 80MG INJ                     66.40           83             PHARMACY - INJECTIBLES
       8318487   TOLAZOLINE 250MG INJ                   100.50           83             PHARMACY - INJECTIBLES
       8383044   TOPOTECAN 4MG IJ                     2,063.44           83             PHARMACY - INJECTIBLES
       8318552   TRACE ELEM 4 INJNJ                     118.46           83             PHARMACY - INJECTIBLES
       8318560   TRACE ELEM PEDI INJ                    140.16           83             PHARMACY - INJECTIBLES
       8390320   TRASTUZUMAB 10MG IJ                    445.20           83             PHARMACY - INJECTIBLES
       8394991   TRIAMCINOLONE                           17.07           83             PHARMACY - INJECTIBLES
       8335333   TRIAMCINOLONE 40MG IJ                   68.30           83             PHARMACY - INJECTIBLES
       8318628   TRIAMCINOLONE ACET 40MG I               68.30           83             PHARMACY - INJECTIBLES
       8339962   TRIFLUOPERAZINE 20MG INJ               189.50           83             PHARMACY - INJECTIBLES
       8381097   TRIMETREXATE                           380.06           83             PHARMACY - INJECTIBLES



9/17/2012                                                                                                        121
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8381089   TRIMETREXATE 25MG INJ                  317.00           83             PHARMACY - INJECTIBLES
       8318693   TUBERCULN SKIN TEST INTRA               36.00           83             PHARMACY - INJECTIBLES
       8340200   TUBERCULN SKIN TEST INTRA               60.53           83             PHARMACY - INJECTIBLES
       8340325   TUBERCULN SKIN TEST INTRA               46.50           83             PHARMACY - INJECTIBLES
       8340440   TUBOCURARINE 30MG INJ                   61.68           83             PHARMACY - INJECTIBLES
       8318834   UROKINASE 250K IU IJ                 1,269.50           83             PHARMACY - INJECTIBLES
       8318768   UROKINASE 5 KUNITS INJ                 303.50           83             PHARMACY - INJECTIBLES
       8318776   VALPROATE NA 500MG INJ                 140.14           83             PHARMACY - INJECTIBLES
       8318974   VANCOMYCIN 1000MG INJ                  260.67           83             PHARMACY - INJECTIBLES
       8319048   VANCOMYCIN 5000MG INJ                  175.00           83             PHARMACY - INJECTIBLES
       8318909   VANCOMYCIN 500MG INJ                   115.72           83             PHARMACY - INJECTIBLES
       8319253   VASOPRESSIN 20 U INJ                   119.84           83             PHARMACY - INJECTIBLES
       8319329   VECURONIUM 10MG INJ                     55.23           83             PHARMACY - INJECTIBLES
       8319394   VERAPAMIL 5MG INJ                      109.00           83             PHARMACY - INJECTIBLES
       8381121   VINBLASTINE 10MG INJ                   478.43           83             PHARMACY - INJECTIBLES
       8381162   VINBLASTINE 1MG INJ                     46.96           83             PHARMACY - INJECTIBLES
       8383168   VINORELBINE/10MG IJ                    292.98           83             PHARMACY - INJECTIBLES
       8319600   VIT A 100 KUNITS INJ INJ               109.26           83             PHARMACY - INJECTIBLES
       8319717   VORICONAZOLE                           109.05           83             PHARMACY - INJECTIBLES
       8306797   VX DT DIP/TETTOX LT 7YRS                64.62           83             PHARMACY - INJECTIBLES
       8302044   VX DTAP DIP/TETTOX/APERTU              105.20           83             PHARMACY - INJECTIBLES
       8332298   VX DTAP-HEPB-IPV                       228.84           83             PHARMACY - INJECTIBLES
       8332041   VX DTAP-HIB DTAP-HEMOPH B              105.20           83             PHARMACY - INJECTIBLES
       8332165   VX DTP DIP/TETTOX /PERTUS              113.50           83             PHARMACY - INJECTIBLES
       8332280   VX DTP-HIB DTP-HEMOPH B                188.00           83             PHARMACY - INJECTIBLES
       8335168   VX FLU SPLIT 6-35MOS IM                 71.42           83             PHARMACY - INJECTIBLES
       8309106   VX HEMOPH FLU B PRP-T                  108.00           83             PHARMACY - INJECTIBLES
       8309528   VX HEP A ADULT IM                      193.98           83             PHARMACY - INJECTIBLES
       8309544   VX HEP A ADULT IM                      261.00           83             PHARMACY - INJECTIBLES
       8334088   VX HEP B ADULT IM                      211.00           83             PHARMACY - INJECTIBLES
       8334203   VX HEP B PED/ADOL 3 DOSE               146.00           83             PHARMACY - INJECTIBLES
       8334328   VX HEP B PED/ADOL 3 DOSE               111.94           83             PHARMACY - INJECTIBLES
       8334443   VX HEP B PED/ADOL 3 DOSE               201.28           83             PHARMACY - INJECTIBLES



9/17/2012                                                                                                        122
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8309627   VX HIB CONJUGATE HEP B            160.56           83             PHARMACY - INJECTIBLES
       8311516   VX LYME DISEASE IM                319.50           83             PHARMACY - INJECTIBLES
       8311839   VX MEASLES SUBCU                   86.00           83             PHARMACY - INJECTIBLES
       8311847   VX MENINGOCOCCAL POLYSACC         269.18           83             PHARMACY - INJECTIBLES
       8311904   VX MMR                            153.73           83             PHARMACY - INJECTIBLES
       8312670   VX MUMPS                           99.38           83             PHARMACY - INJECTIBLES
       8315269   VX PNMOCOCCL PLYSAC GT 2Y         120.44           83             PHARMACY - INJECTIBLES
       8315277   VX PNMOCOCCL PLYSAC GT 2Y         226.68           83             PHARMACY - INJECTIBLES
       8315335   VX POLIOVIRUS INACTIV INJ         116.90           83             PHARMACY - INJECTIBLES
       8316663   VX RABIES INTRAMUSCULAR           398.50           83             PHARMACY - INJECTIBLES
       8316804   VX RUBELLA                         95.02           83             PHARMACY - INJECTIBLES
       8306722   VX TET DIPHTH TX GT 7Y IM          64.62           83             PHARMACY - INJECTIBLES
       8317992   VX TETANUS TOXOID                  64.10           83             PHARMACY - INJECTIBLES
       8339608   VX TETANUS TOXOID                  54.69           83             PHARMACY - INJECTIBLES
       8339723   VX TETANUS TOXOID                  60.00           83             PHARMACY - INJECTIBLES
       8319113   VX VARICELLA VIRUS LIVE           220.60           83             PHARMACY - INJECTIBLES
       8319691   WARFARIN 5MG INJ                  100.39           83             PHARMACY - INJECTIBLES
       8319881   WATERSTERILE 100ML INJ              3.36           83             PHARMACY - INJECTIBLES
       8319816   WATERSTERILE 10ML INJ              27.00           83             PHARMACY - INJECTIBLES
       8319956   ZIDOVUDINE 200MG INJ              156.60           83             PHARMACY - INJECTIBLES
       8319972   ZINC CHLORIDE 10MG/10ML I          29.36           83             PHARMACY - INJECTIBLES
       8319998   ZIPRASIDONE                        78.42           83             PHARMACY - INJECTIBLES
       8315186   ZOSYN/TAZO 3.375GM INM IN         145.12           83             PHARMACY - INJECTIBLES
       8315194   ZOSYN/TAZO 4.5GM IJ               148.91           83             PHARMACY - INJECTIBLES
       8100034   ABACAVIR 300MG                     29.03           81             PHARMACY - ORAL
       8100042   ACARBOSE 50MG                      15.30           81             PHARMACY - ORAL
       8100083   ACEBUTOLOL 200MG                   15.49           81             PHARMACY - ORAL
       8100133   ACETAZOLAMIDE                      19.68           81             PHARMACY - ORAL
       8100125   ACETAZOLAMIDE 250MG                14.35           81             PHARMACY - ORAL
       8154874   ACETYLCYSTEINE                     40.08           81             PHARMACY - ORAL
       8150047   ACETYLCYSTEINE 20% SOL             38.82           81             PHARMACY - ORAL
       8100166   ACYCLOVIR 200MG                    15.72           81             PHARMACY - ORAL
       8150088   ACYCLOVIR 200MG/5ML SUSP           96.86           81             PHARMACY - ORAL



9/17/2012                                                                                                   123
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8100208   ACYCLOVIR 800MG                     21.91           81             PHARMACY - ORAL
       8100216   ALBENDAZOLE 200MG                   16.77           81             PHARMACY - ORAL
       8100240   ALBUTEROL 2MG                       14.12           81             PHARMACY - ORAL
       8150120   ALBUTEROL 2MG/5ML ORALSYR           42.58           81             PHARMACY - ORAL
       8100273   ALENDRONATE                         53.66           81             PHARMACY - ORAL
       8100257   ALENDRONATE 10MG                    19.22           81             PHARMACY - ORAL
       8100281   ALLOPURINOL 100MG                   13.93           81             PHARMACY - ORAL
       8100323   ALLOPURINOL 300MG                   14.70           81             PHARMACY - ORAL
       8150203   ALOH 600MG/5ML SUSP                 27.00           81             PHARMACY - ORAL
       8170045   ALPRAZOLAM 0.25MG                   28.23           81             PHARMACY - ORAL
       8170086   ALPRAZOLAM 0.5MG                    28.68           81             PHARMACY - ORAL
       8100364   AMANTADINE 100MG                    14.68           81             PHARMACY - ORAL
       8150286   AMANTADINE 50MG/5ML SYR             52.79           81             PHARMACY - ORAL
       8100406   AMILORIDE HCL 5MG                   14.43           81             PHARMACY - ORAL
       8100448   AMINOCAPROIC ACID 500MG             16.96           81             PHARMACY - ORAL
       8150328   AMINOPHYLLINE 105MG/5MLLQ           29.50           81             PHARMACY - ORAL
       8100489   AMINOPHYLLINE 200MG                  7.00           81             PHARMACY - ORAL
       8100521   AMIODARONE 200MG                    20.54           81             PHARMACY - ORAL
       8100562   AMITRIPTYLINE 10MG                  13.84           81             PHARMACY - ORAL
       8100604   AMITRIPTYLINE 25MG                  14.21           81             PHARMACY - ORAL
       8100646   AMITRIPTYLINE 50MG                  14.78           81             PHARMACY - ORAL
       8100687   AMITRIPTYLINE 75MG                  15.27           81             PHARMACY - ORAL
       8100729   AMLODIPINE 5MG                      17.06           81             PHARMACY - ORAL
       8100885   AMOXICILLIN 250MG                   14.00           81             PHARMACY - ORAL
       8150369   AMOXICILLIN 250MG/5ML SUS           37.80           81             PHARMACY - ORAL
       8100927   AMOXICILLIN 500MG                   14.46           81             PHARMACY - ORAL
       8150443   AMPHO B 100MG/ML SUSPUSP           159.50           81             PHARMACY - ORAL
       8101149   AMPRENAVIR 150MG                    16.70           81             PHARMACY - ORAL
       8150575   APAP                                 2.43           81             PHARMACY - ORAL
       8101198   APAP                                 1.52           81             PHARMACY - ORAL
       8150526   APAP 100MG/ML ORAL DRP               3.85           81             PHARMACY - ORAL
       8150567   APAP 160MG/5ML ORAL LIQ              6.15           81             PHARMACY - ORAL
       8101206   APAP 325MG                           1.46           81             PHARMACY - ORAL



9/17/2012                                                                                                    124
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8101164   APAP 80MG                            1.50           81             PHARMACY - ORAL
       8102204   APAP/BUT/CAFF 50MG                  14.75           81             PHARMACY - ORAL
       8180051   APAP/COD 120/12MG/5ML BUL           27.94           81             PHARMACY - ORAL
       8170169   APAP/COD 325MG/15MG                 27.57           81             PHARMACY - ORAL
       8170201   APAP/COD 325MG/30MG                 27.40           81             PHARMACY - ORAL
       8170243   APAP/COD 325MG/60MG                 28.16           81             PHARMACY - ORAL
       8180044   APAP/COD 360MG/36MG/15ML            28.16           81             PHARMACY - ORAL
       8171886   APAP/OXYCOD 5/325MG                 29.76           81             PHARMACY - ORAL
       8172207   APAP/PROPOX NAP 100MG               28.08           81             PHARMACY - ORAL
       8101214   ARIPIPRAZOLE                        37.54           81             PHARMACY - ORAL
       8101222   ARIPIPRAZOLE                        37.54           81             PHARMACY - ORAL
       8101362   ASA 325MG                            1.44           81             PHARMACY - ORAL
       8101404   ASA 325MG                            1.49           81             PHARMACY - ORAL
       8101321   ASA 81MG EC                          1.37           81             PHARMACY - ORAL
       8101289   ASA BUFFERED 325MG                   1.43           81             PHARMACY - ORAL
       8101313   ASA DOSE                             1.54           81             PHARMACY - ORAL
       8170409   ASA/BUT/CAFF 50MGFF 50MG            28.37           81             PHARMACY - ORAL
       8170326   ASA/COD 325MG/30MG30MG              27.30           81             PHARMACY - ORAL
       8170367   ASA/COD 325MG/60MG60MG              27.49           81             PHARMACY - ORAL
       8105538   ASA/DIPYR SR200A SR200              18.26           81             PHARMACY - ORAL
       8171928   ASA/OXYCOD 5/325MG                  29.37           81             PHARMACY - ORAL
       8101248   ASCORBIC ACID 500MG                 13.61           81             PHARMACY - ORAL
       8101438   ATENOLOL                            15.08           81             PHARMACY - ORAL
       8101446   ATENOLOL 50MG                       15.26           81             PHARMACY - ORAL
       8101453   ATORVASTATIN 10MG                   19.55           81             PHARMACY - ORAL
       8101461   ATORVASTATIN 20MG                   22.14           81             PHARMACY - ORAL
       8101479   ATORVASTATIN 40 MG TAB              21.72           81             PHARMACY - ORAL
       8150609   ATOVAQUONE 750MG/5ML SUSP          413.27           81             PHARMACY - ORAL
       8100968   AUGMENTIN 250MG                     20.48           81             PHARMACY - ORAL
       8150401   AUGMENTIN 250MG/5MLG/5ML           123.48           81             PHARMACY - ORAL
       8101008   AUGMENTIN 500MG                     23.78           81             PHARMACY - ORAL
       8101040   AUGMENTIN 875MG                     27.22           81             PHARMACY - ORAL
       8101529   AZATHIOPRINE 50MG                   16.36           81             PHARMACY - ORAL



9/17/2012                                                                                                    125
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8150617   AZITHROMYCIN 200MG/5ML SU              104.54           81             PHARMACY - ORAL
       8101560   AZITHROMYCIN 250MG                      31.80           81             PHARMACY - ORAL
       8101602   BACLOFEN SCRN KIT 1AMP                  14.30           81             PHARMACY - ORAL
       8151524   BACTRIM                                 52.22           81             PHARMACY - ORAL
       8104127   BACTRIM 160MG                           15.76           81             PHARMACY - ORAL
       8104085   BACTRIM 80MG                            14.50           81             PHARMACY - ORAL
       8101735   BENAZEPRIL                              15.82           81             PHARMACY - ORAL
       8101727   BENAZEPRIL 10MG                         15.82           81             PHARMACY - ORAL
       8101685   BENAZEPRIL 5MG                          15.82           81             PHARMACY - ORAL
       8110447   BENZOCAINE                              27.25           81             PHARMACY - ORAL
       8101768   BENZONATATE 100MG                       15.01           81             PHARMACY - ORAL
       8101800   BENZTROPINE MESYLATE 1MG                14.24           81             PHARMACY - ORAL
       8101842   BENZTROPINE MESYLATE 2MG                14.30           81             PHARMACY - ORAL
       8101883   BETHANECHOL 10MG                        16.47           81             PHARMACY - ORAL
       8101925   BETHANECHOL 25MG                        17.47           81             PHARMACY - ORAL
       8101966   BISACODYL 5MG                           13.58           81             PHARMACY - ORAL
       8102006   BROMOCRIPTINE 2.5MG                     19.50           81             PHARMACY - ORAL
       8102048   BROMPHENIRAMINE 12/75MG                  7.00           81             PHARMACY - ORAL
       8102089   BUMETANIDE 1MG                          14.30           81             PHARMACY - ORAL
       8102105   BUPROPION 100MG                         15.42           81             PHARMACY - ORAL
       8102097   BUPROPION 75MG                          14.94           81             PHARMACY - ORAL
       8102139   BUPROPION SR 100MG                      18.35           81             PHARMACY - ORAL
       8102147   BUPROPION SR 150 MG                     18.70           81             PHARMACY - ORAL
       8102162   BUSPIRONE 10MG                          16.17           81             PHARMACY - ORAL
       8102121   BUSPIRONE 5MG                           15.02           81             PHARMACY - ORAL
       8140048   BUSULFAN 2MG                            18.42           81             PHARMACY - ORAL
       8102329   CA ACET 667MG                           13.96           81             PHARMACY - ORAL
       8102444   CA CARB 1250MG                          13.70           81             PHARMACY - ORAL
       8102360   CA CARB 500MG                           13.56           81             PHARMACY - ORAL
       8102402   CA CARB 648MG                           13.51           81             PHARMACY - ORAL
       8150807   CA CARB SUSP/SIMETH SUSP                27.01           81             PHARMACY - ORAL
       8102451   CA CIT 1.5GM/2                          13.68           81             PHARMACY - ORAL
       8150849   CA GLUBIONATE 1.8GM/5ML                 36.97           81             PHARMACY - ORAL



9/17/2012                                                                                                        126
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8106247   CAFERGOT 1MGART/CAFF 1MG            16.18           81             PHARMACY - ORAL
       8102246   CAFFEINE 200MG                      13.77           81             PHARMACY - ORAL
       8150765   CAFFEINE CIT 20MG/ML SOL           124.62           81             PHARMACY - ORAL
       8102287   CALCITRIOL 0.25MCG                  16.32           81             PHARMACY - ORAL
       8140063   CAPECITABINE                        43.76           81             PHARMACY - ORAL
       8140055   CAPECITABINE 150MG PO               22.57           81             PHARMACY - ORAL
       8102527   CAPTOPRIL 12.5MG                    14.94           81             PHARMACY - ORAL
       8102568   CAPTOPRIL 25MG                      15.04           81             PHARMACY - ORAL
       8102600   CAPTOPRIL 50MG                      16.34           81             PHARMACY - ORAL
       8150898   CARBAMAZEPINE                       17.98           81             PHARMACY - ORAL
       8102642   CARBAMAZEPINE 100MG                 14.32           81             PHARMACY - ORAL
       8150880   CARBAMAZEPINE 100MG/5ML             51.42           81             PHARMACY - ORAL
       8102683   CARBAMAZEPINE 200MG                 15.00           81             PHARMACY - ORAL
       8150872   CARBAMAZEPINE 200MG/10ML            14.50           81             PHARMACY - ORAL
       8102725   CARBIDOPA/LEVODOPA 10/100           14.97           81             PHARMACY - ORAL
       8102766   CARBIDOPA/LEVODOPA 25/100           15.68           81             PHARMACY - ORAL
       8102808   CARBIDOPA/LEVODOPA 25/100           16.14           81             PHARMACY - ORAL
       8102840   CARBIDOPA/LEVODOPA 25/250           15.44           81             PHARMACY - ORAL
       8102881   CARISOPRODOL 350MG                  14.68           81             PHARMACY - ORAL
       8102915   CARVEDILOL                          18.32           81             PHARMACY - ORAL
       8102873   CARVEDILOL                          17.49           81             PHARMACY - ORAL
       8102899   CARVEDILOL 6.25MG                   17.49           81             PHARMACY - ORAL
       8150922   CASCARA ORAL LIQ                    38.00           81             PHARMACY - ORAL
       8150963   CASTOR OIL ORAL                     31.26           81             PHARMACY - ORAL
       8102931   CEFIXIME 400MG                      32.00           81             PHARMACY - ORAL
       8151003   CEFUROXIME 125MG/5ML SUSP           99.88           81             PHARMACY - ORAL
       8102923   CEFUROXIME 250MG                    24.78           81             PHARMACY - ORAL
       8102907   CELECOXIB                           17.73           81             PHARMACY - ORAL
       8110488   CEPACOL ORALOAT ORAL                27.15           81             PHARMACY - ORAL
       8102964   CEPHALEXIN 250MG                    15.16           81             PHARMACY - ORAL
       8151045   CEPHALEXIN 250MG/5ML SUSP           64.76           81             PHARMACY - ORAL
       8103004   CEPHALEXIN 500MG                    16.94           81             PHARMACY - ORAL
       8151128   CHARCOAL 50GM LIQ0GM LIQ            27.12           81             PHARMACY - ORAL



9/17/2012                                                                                                    127
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8151086   CHARCOAL AQ 50GM LIQM LIQ           27.12           81             PHARMACY - ORAL
       8180127   CHLORAL HYDRATE 500MG/5ML           28.58           81             PHARMACY - ORAL
       8140089   CHLORAMBUCIL 2MG                    18.16           81             PHARMACY - ORAL
       8170524   CHLORDIAZEPOXD 10MG                 27.40           81             PHARMACY - ORAL
       8170565   CHLORDIAZEPOXD 25MG                 27.42           81             PHARMACY - ORAL
       8170482   CHLORDIAZEPOXD 5MGMG                27.52           81             PHARMACY - ORAL
       8151169   CHLORHEX GLUC ORAL RIN              27.01           81             PHARMACY - ORAL
       8103087   CHLOROQUINE 500MG                   26.05           81             PHARMACY - ORAL
       8151201   CHLOROTHIAZIDE 250MG/5ML            39.38           81             PHARMACY - ORAL
       8151243   CHLORPHENIRAMIN 2MG/5ML             33.50           81             PHARMACY - ORAL
       8103129   CHLORPHENIRAMIN 4MG                 13.57           81             PHARMACY - ORAL
       8151292   CHLORPROMAZINE                      49.54           81             PHARMACY - ORAL
       8103244   CHLORPROMAZINE 100MG                14.29           81             PHARMACY - ORAL
       8103285   CHLORPROMAZINE 200MG                15.58           81             PHARMACY - ORAL
       8103160   CHLORPROMAZINE 25MG                 14.05           81             PHARMACY - ORAL
       8151284   CHLORPROMAZINE 30MG/ML SY           41.00           81             PHARMACY - ORAL
       8103202   CHLORPROMAZINE 50MG                 14.07           81             PHARMACY - ORAL
       8103368   CHLORZOXAZONE 500MG                 14.47           81             PHARMACY - ORAL
       8151326   CHOLESTYRAMINE 4GM ORAL             16.02           81             PHARMACY - ORAL
       8119133   CILOSTAZOL                          17.94           81             PHARMACY - ORAL
       8103400   CIPRO 500MG                         26.32           81             PHARMACY - ORAL
       8151334   CIPRO 500MG/5ML00MG/5ML S          289.94           81             PHARMACY - ORAL
       8103442   CIPRO 750MG                         26.95           81             PHARMACY - ORAL
       8103392   CIPROFLOXACIN 250MG                 24.48           81             PHARMACY - ORAL
       8103509   CITALOPRAM                          19.75           81             PHARMACY - ORAL
       8154205   CITRIC ACID ORAL SOLL SOL           14.70           81             PHARMACY - ORAL
       8151409   CLARITHROMYCIN 250MG/5ML           192.56           81             PHARMACY - ORAL
       8103525   CLARITHROMYCIN 500MG                24.09           81             PHARMACY - ORAL
       8103566   CLINDAMYCIN 150MG                   15.78           81             PHARMACY - ORAL
       8151441   CLINDAMYCIN75MG/5MLSU               88.18           81             PHARMACY - ORAL
       8103608   CLOFAZIMINE 50MG                     7.00           81             PHARMACY - ORAL
       8103640   CLOFIBRATE 500MG                     7.00           81             PHARMACY - ORAL
       8103681   CLOMIPRAMINE 25MG                   15.15           81             PHARMACY - ORAL



9/17/2012                                                                                                    128
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8103723   CLOMIPRAMINE 50MG                    8.00           81             PHARMACY - ORAL
       8170607   CLONAZEPAM 0.5MG                    28.56           81             PHARMACY - ORAL
       8170649   CLONAZEPAM 1MG                      28.77           81             PHARMACY - ORAL
       8170680   CLONAZEPAM 2MG                      15.96           81             PHARMACY - ORAL
       8103764   CLONIDINE 0.1MG                     13.95           81             PHARMACY - ORAL
       8103806   CLONIDINE 0.2MG                     14.13           81             PHARMACY - ORAL
       8103814   CLOPIDOGREL 75MG                    22.84           81             PHARMACY - ORAL
       8170722   CLORAZEPATE 3.75MG                  29.84           81             PHARMACY - ORAL
       8103848   CLOTRIMAZOLE 10MG TROCHE            17.53           81             PHARMACY - ORAL
       8103921   CLOZAPINE 100MG                     20.34           81             PHARMACY - ORAL
       8103889   CLOZAPINE 25MG                      16.13           81             PHARMACY - ORAL
       8170763   CODEINE 15MG                        27.83           81             PHARMACY - ORAL
       8170805   CODEINE 30MG                        27.99           81             PHARMACY - ORAL
       8103962   COLCHICINE 0.5MG                     7.00           81             PHARMACY - ORAL
       8104002   COLCHICINE 0.6MG                    14.15           81             PHARMACY - ORAL
       8151482   COLESTIPOL 5GM ORAL                 17.93           81             PHARMACY - ORAL
       8153249   COLYTE 4L SOLN                      26.97           81             PHARMACY - ORAL
       8100059   COMBIVIR                            54.12           81             PHARMACY - ORAL
       8109704   COMBIVIR 150/300MG                  38.57           81             PHARMACY - ORAL
       8104044   CORTISONE ACET 5MG                   7.00           81             PHARMACY - ORAL
       8112807   COTAZYMLIPASE                       14.01           81             PHARMACY - ORAL
       8104143   CYANOCOBALAMIN 1MG                  13.60           81             PHARMACY - ORAL
       8104168   CYCLOBENZAPRINE                     15.42           81             PHARMACY - ORAL
       8140121   CYCLOPHOSPHAMID 25MGG               18.00           81             PHARMACY - ORAL
       8151565   CYCLOSPORINE 100MG/1ML OR          692.62           81             PHARMACY - ORAL
       8151540   CYCLOSPORINE 25MG                   16.95           81             PHARMACY - ORAL
       8151532   CYCLOSPORINE ME 25MG                16.54           81             PHARMACY - ORAL
       8104200   CYPROHEPTADINE 4MG                  14.43           81             PHARMACY - ORAL
       8104242   DANAZOL 100MG                       19.21           81             PHARMACY - ORAL
       8104283   DANTROLENE 25MG                     15.52           81             PHARMACY - ORAL
       8104366   DAPSONE 100MG                       13.91           81             PHARMACY - ORAL
       8104325   DAPSONE 25MG                        13.89           81             PHARMACY - ORAL
       8104333   DELAVIRDINE 100MG                   15.24           81             PHARMACY - ORAL



9/17/2012                                                                                                    129
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8104408   DEMECLOCYCLINE 150MG               36.99           81             PHARMACY - ORAL
       8104440   DESIPRAMINE 10MG                   14.28           81             PHARMACY - ORAL
       8104481   DESIPRAMINE 25MG                   14.44           81             PHARMACY - ORAL
       8104523   DESIPRAMINE 50MG                   15.28           81             PHARMACY - ORAL
       8104531   DESMOPRESSIN ACETATE 0.1M          20.19           81             PHARMACY - ORAL
       8104564   DEXAMETHASONE 0.5MG                13.97           81             PHARMACY - ORAL
       8104648   DEXAMETHASONE 1.5MG                14.26           81             PHARMACY - ORAL
       8104606   DEXAMETHASONE 1MG                  14.17           81             PHARMACY - ORAL
       8151607   DEXAMETHASONE 1MG/1ML OR           65.06           81             PHARMACY - ORAL
       8104689   DEXAMETHASONE 2MG                  14.78           81             PHARMACY - ORAL
       8104721   DEXAMETHASONE 4MG                  14.72           81             PHARMACY - ORAL
       8170847   DEXEDRINE 5MG                      27.48           81             PHARMACY - ORAL
       8151649   DEXTROMETH7.5MG/5MLSYLSYR          36.92           81             PHARMACY - ORAL
       8170961   DIAZEPAM 10MG                      14.33           81             PHARMACY - ORAL
       8170888   DIAZEPAM 2MG                       27.44           81             PHARMACY - ORAL
       8170920   DIAZEPAM 5MG                       27.60           81             PHARMACY - ORAL
       8150658   DIAZOXIDE                         362.47           81             PHARMACY - ORAL
       8104762   DICLOFENAC 50MG                    15.50           81             PHARMACY - ORAL
       8104804   DICLOFENAC 75MG                    16.30           81             PHARMACY - ORAL
       8104846   DICLOXACILLIN 250MG                14.80           81             PHARMACY - ORAL
       8151722   DICLOXACILLIN 62.5MG/5ML           39.50           81             PHARMACY - ORAL
       8104887   DICYCLOMINE 10MG                   14.01           81             PHARMACY - ORAL
       8105009   DIDANOSINE 100MG                   18.59           81             PHARMACY - ORAL
       8104929   DIDANOSINE 25MG                    14.76           81             PHARMACY - ORAL
       8105017   DIDANOSINE 25MG PO                 15.24           81             PHARMACY - ORAL
       8105025   DIDANOSINE 25MG PO                 12.27           81             PHARMACY - ORAL
       8104960   DIDANOSINE 50MG                    16.04           81             PHARMACY - ORAL
       8151748   DIGOXIN                            16.16           81             PHARMACY - ORAL
       8151763   DIGOXIN 0.05MG/ML ELXIR            55.00           81             PHARMACY - ORAL
       8105082   DIGOXIN 0.125MG                    14.22           81             PHARMACY - ORAL
       8105124   DIGOXIN 0.25MG                     14.22           81             PHARMACY - ORAL
       8105165   DILTIAZEM 30MG                     14.38           81             PHARMACY - ORAL
       8105207   DILTIAZEM 60MG                     14.89           81             PHARMACY - ORAL



9/17/2012                                                                                                   130
                                       69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8105249   DILTIAZEM CD 120MG                16.23           81             PHARMACY - ORAL
       8105280   DILTIAZEM CD 180MG                16.49           81             PHARMACY - ORAL
       8105322   DILTIAZEM CD 240MG                17.75           81             PHARMACY - ORAL
       8105363   DILTIAZEM CD 300MG                19.01           81             PHARMACY - ORAL
       8150724   DIMETAPP DM ELX/PPA ELX           37.47           81             PHARMACY - ORAL
       8105405   DIPHEN/LIDOVIS/MGOH/ALOH          64.32           81             PHARMACY - ORAL
       8151813   DIPHENHYDRAMINE                   14.36           81             PHARMACY - ORAL
       8151805   DIPHENHYDRAMINE 12.5MG/5M         30.54           81             PHARMACY - ORAL
       8105447   DIPHENHYDRAMINE 25MG              13.70           81             PHARMACY - ORAL
       8105488   DIPHENHYDRAMINE 50MG              13.75           81             PHARMACY - ORAL
       8105520   DIPYRIDAMOLE/10MG IJ              14.02           81             PHARMACY - ORAL
       8105561   DIPYRIDAMOLE/10MG IJ              14.08           81             PHARMACY - ORAL
       8105603   DISOPYRAMIDE 100MG                14.87           81             PHARMACY - ORAL
       8105645   DISOPYRAMIDE 150MG                15.12           81             PHARMACY - ORAL
       8105686   DISULFIRAM 250MG                  14.73           81             PHARMACY - ORAL
       8118283   DIVALPROEX EC 250MG               16.43           81             PHARMACY - ORAL
       8118291   DIVALPROEX EC 500MG               18.89           81             PHARMACY - ORAL
       8118275   DIVALPROEX SPRINKL125M            15.01           81             PHARMACY - ORAL
       8151854   DOCUSATE                          14.56           81             PHARMACY - ORAL
       8105728   DOCUSATE NA 100MG                 13.71           81             PHARMACY - ORAL
       8151847   DOCUSATE NA 10MG/ML SOLL          34.04           81             PHARMACY - ORAL
       8105769   DOCUSATE NA 250MG                 13.66           81             PHARMACY - ORAL
       8105819   DOCUSATE/CASAN                    14.22           81             PHARMACY - ORAL
       8105801   DOCUSATE/CASANASANTHRANOL         13.00           81             PHARMACY - ORAL
       8105785   DOFETILIDE 125MCG                 18.18           81             PHARMACY - ORAL
       8105793   DOFETILIDE 250MCG                 18.18           81             PHARMACY - ORAL
       8105827   DOLASETRON                       128.53           81             PHARMACY - ORAL
       8105777   DONEPEZIL 5MG                     24.32           81             PHARMACY - ORAL
       8101644   DONNATAL ALKALOIDS/PB             13.83           81             PHARMACY - ORAL
       8150641   DONNATAL ELXLK/PB ELX             34.63           81             PHARMACY - ORAL
       8105843   DOXAZOSIN 2MG                     15.33           81             PHARMACY - ORAL
       8105884   DOXEPIN 10MG                      14.13           81             PHARMACY - ORAL
       8105926   DOXEPIN 25MG                      14.34           81             PHARMACY - ORAL



9/17/2012                                                                                                  131
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8105967   DOXEPIN 50MG                        14.00           81             PHARMACY - ORAL
       8106049   DOXYCYCLINE 100MG                   15.72           81             PHARMACY - ORAL
       8171043   DRONABINOL 2.5MG                    37.98           81             PHARMACY - ORAL
       8171050   DRONABINOL 5MG                      49.90           81             PHARMACY - ORAL
       8106130   DULOXETINE                          20.24           81             PHARMACY - ORAL
       8106148   DULOXETINE                          21.07           81             PHARMACY - ORAL
       8117764   DYAZIDE 37.5/25MG7.5/25MG           14.97           81             PHARMACY - ORAL
       8152001   EES/SULFISOX ERYTH SUSP             50.86           81             PHARMACY - ORAL
       8106064   EFAVIRENZ                           24.58           81             PHARMACY - ORAL
       8114308   EMTRICITABINE                       38.55           81             PHARMACY - ORAL
       8106080   ENALAPRIL MALEATE 5MG               15.52           81             PHARMACY - ORAL
       8108433   ENTCAPONE                           19.21           81             PHARMACY - ORAL
       8106106   EPHEDRINE 25MG                      14.09           81             PHARMACY - ORAL
       8106122   ERGOCALCIFEROL 50 KUNITS            13.66           81             PHARMACY - ORAL
       8151888   ERGOCALCIFEROL 8K/ML DRP           183.04           81             PHARMACY - ORAL
       8106163   ERGOLOID MESYLS 1MG                 15.42           81             PHARMACY - ORAL
       8106205   ERGOTAMINE TART 2MG SL              24.83           81             PHARMACY - ORAL
       8106288   ERYTHROMYCIN BASE EC 250M            7.00           81             PHARMACY - ORAL
       8106320   ERYTHROMYCIN BASE EC 500M           14.38           81             PHARMACY - ORAL
       8106361   ERYTHROMYCIN ES 400MG                7.00           81             PHARMACY - ORAL
       8151961   ERYTHROMYCIN ES 400MG/5ML           44.94           81             PHARMACY - ORAL
       8151920   ERYTHROMYCIN EST 250MG/5M           44.00           81             PHARMACY - ORAL
       8106387   ESCITALOPRAM                        18.68           81             PHARMACY - ORAL
       8106403   ESTRADIOL 1MG                       14.17           81             PHARMACY - ORAL
       8106643   ESTRADIOL ESTRADIOL 0.02M            7.00           81             PHARMACY - ORAL
       8106445   ESTROGENS CONJ 0.3MG                15.91           81             PHARMACY - ORAL
       8106486   ESTROGENS CONJ 0.625MG              15.70           81             PHARMACY - ORAL
       8106528   ESTROGENS CONJ 1.25MG               16.15           81             PHARMACY - ORAL
       8106569   ETHAMBUTOL 100MG                    14.83           81             PHARMACY - ORAL
       8106601   ETHAMBUTOL 400MG                    18.01           81             PHARMACY - ORAL
       8106684   ETHOSUXIMIDE 250MG                  16.03           81             PHARMACY - ORAL
       8106726   ETHOTOIN 250MG                       7.00           81             PHARMACY - ORAL
       8106767   ETIDRONATE/300MG IJ                 20.75           81             PHARMACY - ORAL



9/17/2012                                                                                                    132
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8140105   ETOPOSIDE 50MG PO                      108.76           81             PHARMACY - ORAL
       8106817   EZETIMIBE                               19.49           81             PHARMACY - ORAL
       8106783   FAMCICLOVIR                             22.04           81             PHARMACY - ORAL
       8106791   FAMCICLOVIR                             32.16           81             PHARMACY - ORAL
       8106809   FAMOTIDINE 20MG                         16.96           81             PHARMACY - ORAL
       8152043   FAMOTIDINE 20MG/2.5ML SUS              242.38           81             PHARMACY - ORAL
       8106841   FE GLUCONATE 300MG                      13.67           81             PHARMACY - ORAL
       8152118   FE SO4                                  14.30           81             PHARMACY - ORAL
       8152084   FE SO4 125MG/ML DRPL DRP                38.22           81             PHARMACY - ORAL
       8152126   FE SO4 220MG/5ML ELXL ELX               26.98           81             PHARMACY - ORAL
       8106924   FE SO4 300MG                            13.82           81             PHARMACY - ORAL
       8106882   FE SO4 SR 250MG                         13.87           81             PHARMACY - ORAL
       8106833   FENOFIBRATE                             20.79           81             PHARMACY - ORAL
       8106932   FEXOFENADINE                            16.88           81             PHARMACY - ORAL
       8106940   FEXOFENADINE                            19.38           81             PHARMACY - ORAL
       8107005   FINASTERIDE 5MG                         19.87           81             PHARMACY - ORAL
       8107047   FLAVOXATE 100MG                         17.14           81             PHARMACY - ORAL
       8107088   FLECAINIDE 100MG                        20.31           81             PHARMACY - ORAL
       8153447   FLEET ORAL SOLORAL SOL                  30.27           81             PHARMACY - ORAL
       8107120   FLUCONAZOLE 100MG                       34.02           81             PHARMACY - ORAL
       8152134   FLUCONAZOLE 40MG/ML SUS                332.06           81             PHARMACY - ORAL
       8107161   FLUCYTOSINE 250MG                       23.27           81             PHARMACY - ORAL
       8107203   FLUCYTOSINE 500MG                       26.00           81             PHARMACY - ORAL
       8107245   FLUDROCORTISONE 0.1MG                   15.50           81             PHARMACY - ORAL
       8152167   FLUORIDE NA 0.5MG/ML DRPP               40.96           81             PHARMACY - ORAL
       8107286   FLUORIDE NA 2.2MG                       13.61           81             PHARMACY - ORAL
       8152175   FLUOXETINE                              25.18           81             PHARMACY - ORAL
       8107328   FLUOXETINE 10MG                         18.94           81             PHARMACY - ORAL
       8107369   FLUOXETINE 20MG                         19.08           81             PHARMACY - ORAL
       8152183   FLUOXETINE 4MG/ML ORAL LQ              454.78           81             PHARMACY - ORAL
       8171084   FLUOXYMESTERONE 10MG                    19.82           81             PHARMACY - ORAL
       8107526   FLUPHENAZINE 10MG                       16.89           81             PHARMACY - ORAL
       8107401   FLUPHENAZINE 1MG                        14.74           81             PHARMACY - ORAL



9/17/2012                                                                                                        133
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8107443   FLUPHENAZINE 2.5MG                  15.15           81             PHARMACY - ORAL
       8107484   FLUPHENAZINE 5MG                    16.18           81             PHARMACY - ORAL
       8152209   FLUPHENAZINE 5MG/ML LIQ            181.11           81             PHARMACY - ORAL
       8171126   FLURAZEPAM 15MG                     27.60           81             PHARMACY - ORAL
       8140162   FLUTAMIDE 125MG                     18.93           81             PHARMACY - ORAL
       8107617   FLUVOXAMINE 100MG                   18.50           81             PHARMACY - ORAL
       8107609   FLUVOXAMINE 50MG                    18.63           81             PHARMACY - ORAL
       8107641   FOLIC ACID 1MG                      13.93           81             PHARMACY - ORAL
       8118721   FOLIC ACID FPCTAL FPC                7.00           81             PHARMACY - ORAL
       8152241   FURAZOLIDONE 16.7MG/5ML             98.50           81             PHARMACY - ORAL
       8152290   FUROSEMIDE                          28.68           81             PHARMACY - ORAL
       8152282   FUROSEMIDE 10MG/ML 60ML             47.76           81             PHARMACY - ORAL
       8107682   FUROSEMIDE 20MG                     13.82           81             PHARMACY - ORAL
       8107724   FUROSEMIDE 40MG                     13.87           81             PHARMACY - ORAL
       8107765   FUROSEMIDE 80MG                     14.53           81             PHARMACY - ORAL
       8107757   GABAPENTIN 100MG                    15.01           81             PHARMACY - ORAL
       8107773   GABAPENTIN 300MG                    17.08           81             PHARMACY - ORAL
       8107781   GABAPENTIN 400 MG                   17.66           81             PHARMACY - ORAL
       8107807   GANCICLOVIR 250MG                   23.50           81             PHARMACY - ORAL
       8150245   GAVISCON SUSPB/AA SUSP              26.99           81             PHARMACY - ORAL
       8107849   GEMFIBROZIL 600MG                   15.67           81             PHARMACY - ORAL
       8107864   GLIMEPIRIDE 2MG                     14.85           81             PHARMACY - ORAL
       8107880   GLIPIZIDE 5MG                       14.21           81             PHARMACY - ORAL
       8151680   GLUCOSE 40% GELL                    19.98           81             PHARMACY - ORAL
       8107922   GLYBURIDE 2.5MG                     14.09           81             PHARMACY - ORAL
       8107963   GLYBURIDE 5MG                       14.53           81             PHARMACY - ORAL
       8152357   GUAIF/COD                           27.64           81             PHARMACY - ORAL
       8180218   GUAIF/COD                           27.95           81             PHARMACY - ORAL
       8180200   GUAIF/COD SYR                       36.48           81             PHARMACY - ORAL
       8152365   GUAIF/DM SYRYR                      28.50           81             PHARMACY - ORAL
       8180283   GUAIF/HYDROCOD 100MG/5MLL           27.88           81             PHARMACY - ORAL
       8152324   GUAIFENESIN 100MG/5ML SYR           30.50           81             PHARMACY - ORAL
       8152332   GUAIFENESIN 100MG/5ML5ML            36.92           81             PHARMACY - ORAL



9/17/2012                                                                                                    134
                                       69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8152340   GUAIFENESIN 200MG/10ML UD         14.38           81             PHARMACY - ORAL
       8108003   GUAIFENESIN SR 600MG              14.06           81             PHARMACY - ORAL
       8107971   GUANFACINE 1MG                    15.22           81             PHARMACY - ORAL
       8108045   HALOPERIDOL 0.5MG                 14.07           81             PHARMACY - ORAL
       8108201   HALOPERIDOL 10MG                  16.76           81             PHARMACY - ORAL
       8108086   HALOPERIDOL 1MG                   14.39           81             PHARMACY - ORAL
       8108128   HALOPERIDOL 2MG                   14.68           81             PHARMACY - ORAL
       8154346   HALOPERIDOL 2MG/ML 4Q             32.94           81             PHARMACY - ORAL
       8152407   HALOPERIDOL 2MG/ML LIQ            89.00           81             PHARMACY - ORAL
       8108169   HALOPERIDOL 5MG                   15.43           81             PHARMACY - ORAL
       8108359   HCTZ                              14.33           81             PHARMACY - ORAL
       8108367   HCTZ 25MG                         13.78           81             PHARMACY - ORAL
       8108409   HCTZ 50MG                         13.83           81             PHARMACY - ORAL
       8180325   HYCODAN SYR/HOMATROP SYR          28.42           81             PHARMACY - ORAL
       8108243   HYDRALAZINE 10MG                  13.92           81             PHARMACY - ORAL
       8108284   HYDRALAZINE 25MG                  14.19           81             PHARMACY - ORAL
       8108326   HYDRALAZINE 50MG                  14.36           81             PHARMACY - ORAL
       8170300   HYDROCOD/APAP                     28.03           81             PHARMACY - ORAL
       8172538   HYDROCOD/APAP                     29.16           81             PHARMACY - ORAL
       8180093   HYDROCOD/APAP                     19.68           81             PHARMACY - ORAL
       8170284   HYDROCOD/APAP 500MG/5MG           27.74           81             PHARMACY - ORAL
       8180085   HYDROCOD/APAP334/5MG/10ML         29.42           81             PHARMACY - ORAL
       8180242   HYDROCOD/CHLORP SR SUS            42.24           81             PHARMACY - ORAL
       8108441   HYDROCORT 10MG                    13.98           81             PHARMACY - ORAL
       8152449   HYDROCORT 10MG/5ML SUSP          160.00           81             PHARMACY - ORAL
       8108482   HYDROCORT 20MG                    14.74           81             PHARMACY - ORAL
       8171175   HYDROMORPHONE                     29.26           81             PHARMACY - ORAL
       8180341   HYDROMORPHONE 1MG/MLSYRUP         29.73           81             PHARMACY - ORAL
       8171167   HYDROMORPHONE 2MG                 28.47           81             PHARMACY - ORAL
       8140204   HYDROXYUREA 500MG                 16.13           81             PHARMACY - ORAL
       8108565   HYDROXYZINE HCL 10MG              14.73           81             PHARMACY - ORAL
       8152480   HYDROXYZINE HCL 10MG/5ML          39.71           81             PHARMACY - ORAL
       8108607   HYDROXYZINE HCL 25MG              15.31           81             PHARMACY - ORAL



9/17/2012                                                                                                  135
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8108649   HYDROXYZINE HCL 50MG                   13.80           81             PHARMACY - ORAL
       8152506   HYOSCYAMNE                            110.88           81             PHARMACY - ORAL
       8108680   HYOSCYAMNE SO4 .125MG SL               14.06           81             PHARMACY - ORAL
       8152530   IBUPROFEN                              18.38           81             PHARMACY - ORAL
       8152514   IBUPROFEN 100MG/5ML                    14.00           81             PHARMACY - ORAL
       8152522   IBUPROFEN 100MG/5ML SUSP               43.62           81             PHARMACY - ORAL
       8108722   IBUPROFEN 200MG                        13.64           81             PHARMACY - ORAL
       8108763   IBUPROFEN 400MG                        13.91           81             PHARMACY - ORAL
       8108805   IBUPROFEN 600MG                        14.09           81             PHARMACY - ORAL
       8108847   IBUPROFEN 800MG                        14.28           81             PHARMACY - ORAL
       8108888   IMIPRAMINE 10MG                        14.34           81             PHARMACY - ORAL
       8108920   IMIPRAMINE 25MG                        14.92           81             PHARMACY - ORAL
       8108961   IMIPRAMINE 50MG                        15.50           81             PHARMACY - ORAL
       8109001   INDAPAMIDE 2.5MG                       15.14           81             PHARMACY - ORAL
       8109043   INDINAVIR 400MG                        19.82           81             PHARMACY - ORAL
       8109084   INDOMETHACIN 25MG                      14.58           81             PHARMACY - ORAL
       8109126   INDOMETHACIN 50MG                      14.50           81             PHARMACY - ORAL
       8109167   INDOMETHACIN SR 75MG                   17.75           81             PHARMACY - ORAL
       8109209   IODOQUINOL 650MG                       15.67           81             PHARMACY - ORAL
       8152605   IPECAC 30ML ORAL SYR                   16.58           81             PHARMACY - ORAL
       8154841   ISONIAZID                              80.28           81             PHARMACY - ORAL
       8109282   ISONIAZID 100MG                        13.71           81             PHARMACY - ORAL
       8109324   ISONIAZID 300MG                        13.78           81             PHARMACY - ORAL
       8109407   ISOSORBIDE 10MG                        13.84           81             PHARMACY - ORAL
       8109365   ISOSORBIDE 5MG SL                      13.89           81             PHARMACY - ORAL
       8109373   ISOSORBIDE CR 60MG                     16.21           81             PHARMACY - ORAL
       8109449   ISOSORBIDE SR 40MG                     15.00           81             PHARMACY - ORAL
       8109480   ITRACONAZOLE 100MG                     34.10           81             PHARMACY - ORAL
       8153645   K CL 20MEQ/15ML LIQ                    14.58           81             PHARMACY - ORAL
       8153686   K CL 40MEQ/30ML LIQ                    14.62           81             PHARMACY - ORAL
       8113763   K CL SR 10MEQOR SR 10MEQ               14.19           81             PHARMACY - ORAL
       8113722   K CL SR 8MEQLOR SR 8MEQ                13.92           81             PHARMACY - ORAL
       8153728   K IODIDE 1GM/ML SOL                    51.16           81             PHARMACY - ORAL



9/17/2012                                                                                                       136
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8110223   KALETRA 133.3/33.3                      22.33           81             PHARMACY - ORAL
       8109522   KANAMYCIN 500MG                          8.00           81             PHARMACY - ORAL
       8152647   KAOLIN-PECTIN/PECTIN ORAL               26.98           81             PHARMACY - ORAL
       8109563   KETOCONAZOLE 200MG                      19.80           81             PHARMACY - ORAL
       8109605   LABETALOL 100MG                         14.44           81             PHARMACY - ORAL
       8109647   LABETALOL 200MG                         14.84           81             PHARMACY - ORAL
       8109662   LACTASE 3000 UNITS                      13.59           81             PHARMACY - ORAL
       8109746   LACTOBACILLUS                           21.45           81             PHARMACY - ORAL
       8109688   LACTOBACILLUS ACIDOPHILUS               13.57           81             PHARMACY - ORAL
       8152696   LACTULOSE                               14.68           81             PHARMACY - ORAL
       8152688   LACTULOSE 10GM/15ML SYR                 27.07           81             PHARMACY - ORAL
       8150534   LAMIVUDINE                             119.52           81             PHARMACY - ORAL
       8109720   LAMIVUDINE 150MG                        25.05           81             PHARMACY - ORAL
       8109753   LAMOTRIGINE                             21.92           81             PHARMACY - ORAL
       8152704   LEUCOVORIN                              31.50           81             PHARMACY - ORAL
       8109761   LEUCOVORIN 5MG                           7.00           81             PHARMACY - ORAL
       8109779   LEVOCARNITINE 250MG                     14.75           81             PHARMACY - ORAL
       8109803   LEVODOPA 250MG                           7.00           81             PHARMACY - ORAL
       8109811   LEVOFLOXACIN 500MG                      37.04           81             PHARMACY - ORAL
       8109852   LEVONORGESTREL                          42.36           81             PHARMACY - ORAL
       8171209   LEVORPHANAL 2MG                          9.00           81             PHARMACY - ORAL
       8109845   LEVOTHYROXINE 0.05MG                    13.96           81             PHARMACY - ORAL
       8109860   LEVOTHYROXINE 0.088MG                   14.03           81             PHARMACY - ORAL
       8109928   LEVOTHYROXINE 0.112MG                   14.08           81             PHARMACY - ORAL
       8109969   LEVOTHYROXINE 0.125MG                   14.12           81             PHARMACY - ORAL
       8110009   LEVOTHYROXINE 0.15MG                    14.14           81             PHARMACY - ORAL
       8109886   LEVOTHYROXINE 0.1MG                     14.03           81             PHARMACY - ORAL
       8103046   LIBRAX 5MG                              13.89           81             PHARMACY - ORAL
       8152720   LIDOCAINE 2% VISC 100ML                 55.36           81             PHARMACY - ORAL
       8152761   LIDOCAINE 2% VISCOUS                    16.00           81             PHARMACY - ORAL
       8109910   LINEZOLID/200MG IJ                     155.52           81             PHARMACY - ORAL
       8110041   LIOTHYRONINE 25MCG                      15.33           81             PHARMACY - ORAL
       8112880   LIPRAM EC MTE EC MT                     15.84           81             PHARMACY - ORAL



9/17/2012                                                                                                        137
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8112849   LIPRAM ECPASE EC                    14.27           81             PHARMACY - ORAL
       8110082   LITHIUM CARB 150MG                  13.76           81             PHARMACY - ORAL
       8110124   LITHIUM CARB 300MG                  13.90           81             PHARMACY - ORAL
       8110165   LITHIUM CARB SR 300MG               14.86           81             PHARMACY - ORAL
       8152803   LITHIUM CIT 8MEQ/5ML SYR            60.51           81             PHARMACY - ORAL
       8180176   LOMOTIL                             28.00           81             PHARMACY - ORAL
       8171001   LOMOTIL 2.5MG/ATROP 2.5MG           14.44           81             PHARMACY - ORAL
       8180168   LOMOTIL ORAL LIQRAL LIQ             43.30           81             PHARMACY - ORAL
       8152845   LOPERAMIDE 1MG/5ML LIQ              38.16           81             PHARMACY - ORAL
       8110207   LOPERAMIDE 2MG                      14.89           81             PHARMACY - ORAL
       8110249   LORATADINE 10MG                     20.00           81             PHARMACY - ORAL
       8171241   LORAZEPAM 0.5MG                     28.35           81             PHARMACY - ORAL
       8171282   LORAZEPAM 1MG                       28.72           81             PHARMACY - ORAL
       8171324   LORAZEPAM 2MG                       29.60           81             PHARMACY - ORAL
       8180408   LORAZEPAM 2MG/ML SOLN              120.22           81             PHARMACY - ORAL
       8109902   LOSARTAN                            17.16           81             PHARMACY - ORAL
       8109894   LOSARTAN 25MG                       17.16           81             PHARMACY - ORAL
       8110413   LOXAPINE                            18.62           81             PHARMACY - ORAL
       8110363   LOXAPINE 10MG                       16.02           81             PHARMACY - ORAL
       8110405   LOXAPINE 25MG                       17.33           81             PHARMACY - ORAL
       8110322   LOXAPINE 5MG                        15.47           81             PHARMACY - ORAL
       8152563   LUGOLS STRONG ORAL SOL              30.06           81             PHARMACY - ORAL
       8152977   MAG ALOH SIMETH                     15.58           81             PHARMACY - ORAL
       8152985   MAG ALOH SIMETH                     13.50           81             PHARMACY - ORAL
       8152969   MAG ALOH SIMETH DS SUSPSP           26.99           81             PHARMACY - ORAL
       8152886   MAG CIT ORAL LIQ LIQ                13.49           81             PHARMACY - ORAL
       8110520   MAG CL SR (64MG MG)                 13.72           81             PHARMACY - ORAL
       8110561   MAG OXIDE 400MG                     13.92           81             PHARMACY - ORAL
       8152936   MAG/AL HYD/LIDO/BELLA SUS           54.28           81             PHARMACY - ORAL
       8152944   MAG/AL HYD/LIDO/DIPHEN SU           27.08           81             PHARMACY - ORAL
       8110645   MEBENDAZOLE 100MG                   24.12           81             PHARMACY - ORAL
       8110686   MECLIZINE 25MG                      13.83           81             PHARMACY - ORAL
       8110769   MEDROXYPROGEST 10MG                 14.42           81             PHARMACY - ORAL



9/17/2012                                                                                                    138
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8110728   MEDROXYPROGEST 2.5MG                14.08           81             PHARMACY - ORAL
       8150237   MEGESTROL                           56.42           81             PHARMACY - ORAL
       8140246   MEGESTROL AC 40MG/ML SUSP          112.50           81             PHARMACY - ORAL
       8140287   MEGESTROL ACET 40MG0MG              16.22           81             PHARMACY - ORAL
       8171365   MEPERIDINE 50MG                     29.02           81             PHARMACY - ORAL
       8180440   MEPERIDINE 50MG/5ML SYR             28.79           81             PHARMACY - ORAL
       8171407   MEPHOBARBITAL 32MG                   9.00           81             PHARMACY - ORAL
       8171449   MEPHOBARBITAL 50MG                  28.75           81             PHARMACY - ORAL
       8171480   MEPROBAMATE 400MG                    9.00           81             PHARMACY - ORAL
       8110850   MESALAMINE                          14.95           81             PHARMACY - ORAL
       8110868   MESALAMINE                          15.68           81             PHARMACY - ORAL
       8171498   MESALAMINE SR 250MG                  7.00           81             PHARMACY - ORAL
       8171506   MESALAMINE SR 400MG                  7.00           81             PHARMACY - ORAL
       8110801   MESORIDAZINE 10MG                   15.29           81             PHARMACY - ORAL
       8110843   MESORIDAZINE 25MG                   15.91           81             PHARMACY - ORAL
       8153009   MESORIDAZINE 25MG/ML ORA           351.50           81             PHARMACY - ORAL
       8110884   METAPROTERENOL 10MG                 14.16           81             PHARMACY - ORAL
       8153041   METAPROTERENOL 10MG/5ML             42.90           81             PHARMACY - ORAL
       8110926   METFORMIN 500MG                     14.89           81             PHARMACY - ORAL
       8110967   METFORMIN 850MG                     15.87           81             PHARMACY - ORAL
       8171563   METHADONE 10MG                      27.83           81             PHARMACY - ORAL
       8180481   METHADONE 1MG/ML ORAL SOL           27.11           81             PHARMACY - ORAL
       8171522   METHADONE 5MG                       27.73           81             PHARMACY - ORAL
       8111007   METHIMAZOLE 10MG                    15.87           81             PHARMACY - ORAL
       8111049   METHOCARBAMOL 500MG                 14.23           81             PHARMACY - ORAL
       8140329   METHOTREXATE 2.5MG                  21.34           81             PHARMACY - ORAL
       8111080   METHYLDOPA 250MG                    14.22           81             PHARMACY - ORAL
       8111122   METHYLERGONOVIN 0.2MG               14.96           81             PHARMACY - ORAL
       8171647   METHYLPHENIDATE 10MG                27.91           81             PHARMACY - ORAL
       8171605   METHYLPHENIDATE 5MG                 27.46           81             PHARMACY - ORAL
       8111205   METHYLPRED 16MG                     19.16           81             PHARMACY - ORAL
       8111163   METHYLPRED 4MG                      14.56           81             PHARMACY - ORAL
       8152415   METOCLOPRAMIDE                      28.74           81             PHARMACY - ORAL



9/17/2012                                                                                                    139
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8111247   METOCLOPRAMIDE 10MG                 14.11           81             PHARMACY - ORAL
       8153082   METOCLOPRAMIDE 5MG/5ML SY           31.00           81             PHARMACY - ORAL
       8111288   METOLAZONE 5MG                      17.61           81             PHARMACY - ORAL
       8111320   METOPROLOL 50MG                     14.62           81             PHARMACY - ORAL
       8111346   METOPROLOL SR 50MG                  15.36           81             PHARMACY - ORAL
       8111361   METRONIDAZOLE 250MG                 14.73           81             PHARMACY - ORAL
       8111403   METRONIDAZOLE 500MG                 15.76           81             PHARMACY - ORAL
       8180416   MIDAZOLAM 2MG/ML SOLN               29.12           81             PHARMACY - ORAL
       8106338   MIDODRINE                           15.88           81             PHARMACY - ORAL
       8171191   MIGRATINE                           14.75           81             PHARMACY - ORAL
       8109241   MIGRATINE/DICHLORALP/APAP            7.00           81             PHARMACY - ORAL
       8153124   MINERAL OIL 30ML ORAL               14.64           81             PHARMACY - ORAL
       8111486   MINOXIDIL 10MG                      16.06           81             PHARMACY - ORAL
       8111445   MINOXIDIL 2.5MG                     14.66           81             PHARMACY - ORAL
       8153256   MIRALAX                             17.70           81             PHARMACY - ORAL
       8111502   MIRTAZAPINE 15MT                    19.79           81             PHARMACY - ORAL
       8100000   MISC OTHER DRUG                                     81             PHARMACY - ORAL
       8111528   MISOPROSTOL 100MCG                  15.82           81             PHARMACY - ORAL
       8111569   MOLINDONE 5MG                       16.41           81             PHARMACY - ORAL
       8152928   MOM UD SUSPDE UD SUSP               14.32           81             PHARMACY - ORAL
       8111585   MONTELUKAST 5MG                     20.36           81             PHARMACY - ORAL
       8180531   MORPHINE                            30.82           81             PHARMACY - ORAL
       8180523   MORPHINE 20MG/ML ORAL SOL           28.20           81             PHARMACY - ORAL
       8171738   MORPHINE SO4 SR 100MG               37.37           81             PHARMACY - ORAL
       8171688   MORPHINE SO4 SR 15MG                28.62           81             PHARMACY - ORAL
       8171720   MORPHINE SO4 SR 30MG                30.27           81             PHARMACY - ORAL
       8111619   MOXIFLOXACIN                        36.86           81             PHARMACY - ORAL
       8154684   MVI DRPS-MULTIPLE DRP               36.16           81             PHARMACY - ORAL
       8154726   MVI ORAL LIQT ORAL LIQ              38.55           81             PHARMACY - ORAL
       8118606   MVI PRENATALT W/MIN & FOL           14.03           81             PHARMACY - ORAL
       8111593   MYCOPHENOLATE 250MG PO              19.95           81             PHARMACY - ORAL
       8115966   NA BICARB 650MG                     13.51           81             PHARMACY - ORAL
       8116006   NA CL 1GM                           13.61           81             PHARMACY - ORAL



9/17/2012                                                                                                    140
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8111601   NADOLOL 40MG                            15.64           81             PHARMACY - ORAL
       8111643   NAPROXEN 250MG                          15.08           81             PHARMACY - ORAL
       8111684   NAPROXEN 375MG                          15.67           81             PHARMACY - ORAL
       8111726   NEFAZODONE 100MG                        17.07           81             PHARMACY - ORAL
       8111734   NELFINAVIR 250MG                        18.52           81             PHARMACY - ORAL
       8111767   NEOMYCIN 500MG                          17.43           81             PHARMACY - ORAL
       8153488   NEUTRA-PHOS 1.25GM                      14.57           81             PHARMACY - ORAL
       8153405   NEUTRA-PHOS-K 1.45GM                    14.79           81             PHARMACY - ORAL
       8153140   NEVIRAPINE 10MG/ML SUSP                122.77           81             PHARMACY - ORAL
       8111809   NEVIRAPINE 200MG                        26.43           81             PHARMACY - ORAL
       8111924   NIACIN 500MG SR                         13.60           81             PHARMACY - ORAL
       8111882   NIACIN 50MG                             13.53           81             PHARMACY - ORAL
       8111841   NICOTINE 2MG ORAL GUM                   14.63           81             PHARMACY - ORAL
       8111965   NIFEDIPINE 10MG                         14.00           81             PHARMACY - ORAL
       8112005   NIFEDIPINE 30MG SR                      16.74           81             PHARMACY - ORAL
       8112047   NIMODIPINE 30MG                         31.94           81             PHARMACY - ORAL
       8112120   NITROFURANTOIN 100MG                    18.57           81             PHARMACY - ORAL
       8112088   NITROFURANTOIN 50MG                     15.68           81             PHARMACY - ORAL
       8112443   NORTRIPTYLINE 10MG                      14.37           81             PHARMACY - ORAL
       8112484   NORTRIPTYLINE 25MG                      15.09           81             PHARMACY - ORAL
       8112211   NTG .3MG SL 1TAB                        31.00           81             PHARMACY - ORAL
       8112252   NTG .4MG SL 1TAB                        13.50           81             PHARMACY - ORAL
       8112294   NTG .6MG SL 1TAB                        13.00           81             PHARMACY - ORAL
       8112203   NTG 0.3MG SL                            27.13           81             PHARMACY - ORAL
       8112245   NTG 0.4MG SL                            27.32           81             PHARMACY - ORAL
       8112286   NTG 0.6MG SL                            27.13           81             PHARMACY - ORAL
       8112153   NTG SL 1 SPRAY                          94.52           81             PHARMACY - ORAL
       8112161   NTG SPRAYERIN SL SPRAY                  92.54           81             PHARMACY - ORAL
       8112328   NTG SR 2.5MG                            13.78           81             PHARMACY - ORAL
       8112369   NTG SR 6.5MG                             7.00           81             PHARMACY - ORAL
       8153173   NYSTATIN                                57.26           81             PHARMACY - ORAL
       8153165   NYSTATIN 100 KUNIT/ML SUS               60.84           81             PHARMACY - ORAL
       8112567   OLANZAPINE 10MG                         36.48           81             PHARMACY - ORAL



9/17/2012                                                                                                        141
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8112575   OLANZAPINE 10MG QTAB                    38.93           81             PHARMACY - ORAL
       8112518   OLANZAPINE 2.5MG                        26.42           81             PHARMACY - ORAL
       8112526   OLANZAPINE 5MG                          28.76           81             PHARMACY - ORAL
       8112534   OLANZAPINE 5MG QTAB                     31.21           81             PHARMACY - ORAL
       8112609   OLSALAZINE 250MG                        16.93           81             PHARMACY - ORAL
       8112641   OMEPRAZOLE 20MG                         15.00           81             PHARMACY - ORAL
       8112682   ONDANSETRON 4MG                         63.97           81             PHARMACY - ORAL
       8180564   OPIUM DILUTE TNC 0.4%                  340.90           81             PHARMACY - ORAL
       8180606   OPIUM TINCTURE 10% ORAL                 31.90           81             PHARMACY - ORAL
       8112724   ORPHENADRINE 100MG                      17.83           81             PHARMACY - ORAL
       8112401   OVRAL NORGES/ETH .5MG                  116.80           81             PHARMACY - ORAL
       8171746   OXANDROLONE 2.5MG                       38.11           81             PHARMACY - ORAL
       8171761   OXAZEPAM 10MG                           28.70           81             PHARMACY - ORAL
       8171803   OXAZEPAM 15MG                           29.14           81             PHARMACY - ORAL
       8112732   OXCARBAZEPINE                           16.21           81             PHARMACY - ORAL
       8112740   OXCARBAZEPINE                           18.46           81             PHARMACY - ORAL
       8112765   OXYBUTYNIN 5MG                          14.72           81             PHARMACY - ORAL
       8153207   OXYBUTYNIN 5MG/5ML SYR                  60.61           81             PHARMACY - ORAL
       8171878   OXYCODONE                               39.00           81             PHARMACY - ORAL
       8180671   OXYCODONE                               31.50           81             PHARMACY - ORAL
       8180663   OXYCODONE 20MG/ML ORAL                  30.01           81             PHARMACY - ORAL
       8171845   OXYCODONE HCL 5MG                       28.34           81             PHARMACY - ORAL
       8171852   OXYCODONE SR 10MG                       30.51           81             PHARMACY - ORAL
       8112906   PANTOPRAZOLE 40MG                       21.66           81             PHARMACY - ORAL
       8180648   PAREGORIC TNCATED TNC                   29.98           81             PHARMACY - ORAL
       8112898   PAROMOMYCIN 250MG                       20.93           81             PHARMACY - ORAL
       8112930   PAROXETINE                              19.90           81             PHARMACY - ORAL
       8112922   PAROXETINE 20MG                         20.32           81             PHARMACY - ORAL
       8153223   PAROXETINE 2MG/ML ORAL                  28.30           81             PHARMACY - ORAL
       8113003   PCN V K 250MG 250MG                     13.95           81             PHARMACY - ORAL
       8153280   PCN V K 250MG/5ML SUSPUSP               32.52           81             PHARMACY - ORAL
       8113045   PCN V K 500MG 500MG                     14.28           81             PHARMACY - ORAL
       8112963   PENICILLAMINE 250MG                     15.80           81             PHARMACY - ORAL



9/17/2012                                                                                                        142
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8171969   PENTOBARBITAL 100MG                  9.00           81             PHARMACY - ORAL
       8113086   PENTOXIFYLLINE 400MG                14.50           81             PHARMACY - ORAL
       8113243   PERPHENAZINE 16MG                   16.55           81             PHARMACY - ORAL
       8153322   PERPHENAZINE 16MG/ML ORAL          147.36           81             PHARMACY - ORAL
       8113128   PERPHENAZINE 2MG                    15.03           81             PHARMACY - ORAL
       8113169   PERPHENAZINE 4MG                    15.60           81             PHARMACY - ORAL
       8113201   PERPHENAZINE 8MG                    15.50           81             PHARMACY - ORAL
       8113284   PHENAZOPYRIDINE 100MG               14.44           81             PHARMACY - ORAL
       8113326   PHENAZOPYRIDINE 200MG               15.16           81             PHARMACY - ORAL
       8113367   PHENELZINE 15MG                     14.56           81             PHARMACY - ORAL
       8172124   PHENOBARBITAL 100MG                 27.13           81             PHARMACY - ORAL
       8172009   PHENOBARBITAL 15MG                  27.05           81             PHARMACY - ORAL
       8172041   PHENOBARBITAL 30MG                  27.11           81             PHARMACY - ORAL
       8180721   PHENOBARBITAL 30MG/7.5ML            28.22           81             PHARMACY - ORAL
       8172082   PHENOBARBITAL 60MG                  27.09           81             PHARMACY - ORAL
       8113441   PHENOXYBENZAMIN 10MG                26.73           81             PHARMACY - ORAL
       8153371   PHENYTOIN                           27.24           81             PHARMACY - ORAL
       8113524   PHENYTOIN 100MG                     14.29           81             PHARMACY - ORAL
       8153363   PHENYTOIN 100MG/4ML SUSP            17.34           81             PHARMACY - ORAL
       8113482   PHENYTOIN 50MG                      14.42           81             PHARMACY - ORAL
       8153520   PHOS CARBO LIQARB LIQ               39.90           81             PHARMACY - ORAL
       8113565   PHYTONADIONE 5MG                    14.79           81             PHARMACY - ORAL
       8150682   PINK BISMUTH ORAL LIQIQ             26.98           81             PHARMACY - ORAL
       8113581   PIOGLITAZONE 15 MG                  21.31           81             PHARMACY - ORAL
       8108524   PLAQUENIL 200MG                     15.94           81             PHARMACY - ORAL
       8153603   POLYSTYRENE 15GM SUSM SUS           30.78           81             PHARMACY - ORAL
       8113789   PRAMIPEXOLE 0.125MG                 16.61           81             PHARMACY - ORAL
       8113797   PRAMIPEXOLE 1MG                     18.49           81             PHARMACY - ORAL
       8113771   PRAVASTATIN 20MG                    20.46           81             PHARMACY - ORAL
       8113805   PRAZIQUANTEL 600MG                  38.28           81             PHARMACY - ORAL
       8153769   PREDNISOLONE 5MG/5ML SOL            48.40           81             PHARMACY - ORAL
       8153819   PREDNISONE                          15.50           81             PHARMACY - ORAL
       8113920   PREDNISONE 10MG                     13.75           81             PHARMACY - ORAL



9/17/2012                                                                                                    143
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8113847   PREDNISONE 1MG                      13.95           81             PHARMACY - ORAL
       8113961   PREDNISONE 20MG                     13.83           81             PHARMACY - ORAL
       8113888   PREDNISONE 5MG                      13.72           81             PHARMACY - ORAL
       8153801   PREDNISONE 5MG/5ML SOL              66.57           81             PHARMACY - ORAL
       8172488   PREGABALIN                          85.05           81             PHARMACY - ORAL
       8172496   PREGABALIN                          85.00           81             PHARMACY - ORAL
       8172504   PREGABALIN                          85.06           81             PHARMACY - ORAL
       8109837   PREVEN EC .25MG/.05                116.50           81             PHARMACY - ORAL
       8114001   PRIMAQUINE PHOS 15MG                15.64           81             PHARMACY - ORAL
       8114084   PRIMIDONE 250MG                     15.47           81             PHARMACY - ORAL
       8153843   PRIMIDONE 250MG/5ML SUSP           203.00           81             PHARMACY - ORAL
       8114043   PRIMIDONE 50MG                      14.51           81             PHARMACY - ORAL
       8114126   PROBENECID 500MG                    17.86           81             PHARMACY - ORAL
       8114167   PROCAINAMIDE 250MG                  15.14           81             PHARMACY - ORAL
       8114290   PROCAINAMIDE SR12 1000MG             7.00           81             PHARMACY - ORAL
       8114258   PROCAINAMIDE SR12 500MG             15.89           81             PHARMACY - ORAL
       8140360   PROCARBAZINE 50MG                  124.84           81             PHARMACY - ORAL
       8114365   PROCHLORPERAZIN 10MG                15.69           81             PHARMACY - ORAL
       8114324   PROCHLORPERAZIN 5MG                 14.97           81             PHARMACY - ORAL
       8153884   PROCHLORPERAZIN 5MG/5ML S          134.00           81             PHARMACY - ORAL
       8180770   PROMETH/COD                         28.96           81             PHARMACY - ORAL
       8180762   PROMETH/COD SYRD SYR                45.37           81             PHARMACY - ORAL
       8114407   PROMETHAZINE 25MG                   14.66           81             PHARMACY - ORAL
       8153926   PROMETHAZINE 6.25MG/5ML S           41.91           81             PHARMACY - ORAL
       8114449   PROPAFENONE 150MG                   19.80           81             PHARMACY - ORAL
       8114480   PROPANTHELINE BR 15MG               14.89           81             PHARMACY - ORAL
       8172165   PROPOXYPHENE HCL 65MG               28.38           81             PHARMACY - ORAL
       8114522   PROPRANOLOL 10MG                    13.93           81             PHARMACY - ORAL
       8114563   PROPRANOLOL 20MG                    14.13           81             PHARMACY - ORAL
       8153942   PROPRANOLOL 20MG/5ML SYR            46.24           81             PHARMACY - ORAL
       8114647   PROPRANOLOL SR 120MG                17.61           81             PHARMACY - ORAL
       8114605   PROPRANOLOL SR 80MG                 16.00           81             PHARMACY - ORAL
       8114688   PROPYLTHIOURACL 50MG                13.79           81             PHARMACY - ORAL



9/17/2012                                                                                                    144
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8154007   PSEUD/TRIP SYRIPROL SYR            34.14           81             PHARMACY - ORAL
       8114886   PSEUD/TRIPD/TRIPROL                13.57           81             PHARMACY - ORAL
       8114845   PSEUDO/CHLOR SR SRHEN SR            7.00           81             PHARMACY - ORAL
       8114720   PSEUDOEPHEDRINE 30MG               13.62           81             PHARMACY - ORAL
       8153967   PSEUDOEPHEDRINE 30MG/5ML           31.54           81             PHARMACY - ORAL
       8114761   PSEUDOEPHEDRINE 60MG               13.65           81             PHARMACY - ORAL
       8114803   PSEUDOEPHEDRINE SR 120MG           14.16           81             PHARMACY - ORAL
       8154049   PSYLLIUM SF 6GM ORAL PWD           14.02           81             PHARMACY - ORAL
       8154080   PYRANTEL 250MG/5ML SUSP            42.36           81             PHARMACY - ORAL
       8114928   PYRAZINAMIDE 500MG                 15.75           81             PHARMACY - ORAL
       8114969   PYRIDOSTIGMINE 60MG                15.17           81             PHARMACY - ORAL
       8115008   PYRIDOXINE 50MG                    13.51           81             PHARMACY - ORAL
       8115040   PYRIMETHAMINE 25MG                 14.69           81             PHARMACY - ORAL
       8115065   QUETIAPINE 100MG                   20.38           81             PHARMACY - ORAL
       8115073   QUETIAPINE 200MG                   26.49           81             PHARMACY - ORAL
       8115057   QUETIAPINE 25MG                    17.42           81             PHARMACY - ORAL
       8115123   QUINIDINE SO4 200MG                13.88           81             PHARMACY - ORAL
       8115206   QUINIDINE SO4 300MG                14.00           81             PHARMACY - ORAL
       8115164   QUINIDINE SO4 SR 300MG             15.24           81             PHARMACY - ORAL
       8115081   QUINIDINE SR 324MG                 16.22           81             PHARMACY - ORAL
       8115248   QUININE SO4 CAP 200MG              14.59           81             PHARMACY - ORAL
       8115289   QUININE SO4 CAP 325MG              15.03           81             PHARMACY - ORAL
       8115297   RALOXIFENE                         20.20           81             PHARMACY - ORAL
       8115305   REPAGLINIDE                        16.06           81             PHARMACY - ORAL
       8115313   REPAGLINIDE                        16.06           81             PHARMACY - ORAL
       8115321   RESERPINE 0.1MG                    14.12           81             PHARMACY - ORAL
       8115362   RESERPINE 0.25MG                   14.38           81             PHARMACY - ORAL
       8115404   RIFABUTIN 150MG                    29.33           81             PHARMACY - ORAL
       8115446   RIFAMPIN 150MG                     17.01           81             PHARMACY - ORAL
       8115487   RIFAMPIN 300MG                     17.43           81             PHARMACY - ORAL
       8115503   RISPERIDONE 0.25MG                 20.37           81             PHARMACY - ORAL
       8115529   RISPERIDONE 1MG                    21.51           81             PHARMACY - ORAL
       8154098   RISPERIDONE 1MG/ML SOLN           296.32           81             PHARMACY - ORAL



9/17/2012                                                                                                   145
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8115560   RISPERIDONE 2MG                         26.31           81             PHARMACY - ORAL
       8115602   RISPERIDONE 3MG                         28.55           81             PHARMACY - ORAL
       8115610   RISPERIDONE 4MG                         33.71           81             PHARMACY - ORAL
       8110231   RITONAVIR                               26.51           81             PHARMACY - ORAL
       8115644   RITONAVIR 100MG                         34.91           81             PHARMACY - ORAL
       8154114   RITONAVIR 80MG/ML ORAL               1,827.21           81             PHARMACY - ORAL
       8115628   ROFECOXIB                               19.50           81             PHARMACY - ORAL
       8115594   ROFECOXIB 12.5 MG                       19.50           81             PHARMACY - ORAL
       8115636   ROSIGLITAZONE 2MG                       18.30           81             PHARMACY - ORAL
       8115651   ROSIGLITAZONE 4MG                       20.36           81             PHARMACY - ORAL
       8154320   S NSTRL SYRUP CHERRY                    31.54           81             PHARMACY - ORAL
       8154288   S NSTRL SYRUP SIMPLE                    31.68           81             PHARMACY - ORAL
       8154270   S NSTRL SYRUP SUSP VEH OR               34.76           81             PHARMACY - ORAL
       8154122   SALIVA SUBSTITEC                        36.60           81             PHARMACY - ORAL
       8115685   SALSALATE 750MG                         14.17           81             PHARMACY - ORAL
       8115727   SAQUINAVIR 200MG                        16.41           81             PHARMACY - ORAL
       8172249   SECOBARBITAL 100MG                       9.00           81             PHARMACY - ORAL
       8115768   SELEGILINE 5MG                          18.09           81             PHARMACY - ORAL
       8115800   SENNA 187MG                             13.97           81             PHARMACY - ORAL
       8115883   SERTRALINE 100MG                        19.51           81             PHARMACY - ORAL
       8115842   SERTRALINE 50MG                         19.51           81             PHARMACY - ORAL
       8115867   SEVELAMER 403MG                         15.03           81             PHARMACY - ORAL
       8115875   SEVELAMER 800 MG                        16.57           81             PHARMACY - ORAL
       8154163   SIMETHICONE 67MG/ML DRP                 34.14           81             PHARMACY - ORAL
       8115925   SIMETHICONE 80MG                        13.84           81             PHARMACY - ORAL
       8154254   SORBITOL                                16.07           81             PHARMACY - ORAL
       8154247   SORBITOL 70% ORAL SOL                   26.98           81             PHARMACY - ORAL
       8116048   SOTALOL 80MG                            18.61           81             PHARMACY - ORAL
       8116097   SPIRONOLACTONE                          16.43           81             PHARMACY - ORAL
       8116089   SPIRONOLACTONE 25MG                     14.34           81             PHARMACY - ORAL
       8116121   STAVUDINE 15MG                          24.91           81             PHARMACY - ORAL
       8116162   STAVUDINE 20MG                          25.37           81             PHARMACY - ORAL
       8116170   STAVUDINE 30MG                          26.11           81             PHARMACY - ORAL



9/17/2012                                                                                                        146
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8116204   SUCRALFATE 1GM                         15.02           81             PHARMACY - ORAL
       8116246   SULFADIAZINE 500MG                     16.09           81             PHARMACY - ORAL
       8116287   SULFASALAZINE 500MG                    13.99           81             PHARMACY - ORAL
       8116329   SULFINPYRAZONE 100MG                   15.48           81             PHARMACY - ORAL
       8116360   SULINDAC 150MG                         15.50           81             PHARMACY - ORAL
       8116402   SULINDAC 200MG                         15.96           81             PHARMACY - ORAL
       8116444   SUMATRIPTAN 50MG                       52.66           81             PHARMACY - ORAL
       8116477   TACROLIMUS/1MG PO                      21.76           81             PHARMACY - ORAL
       8140402   TAMOXIFEN 10MG                         17.95           81             PHARMACY - ORAL
       8116451   TAMSULOSIN SR O.4MG                    18.41           81             PHARMACY - ORAL
       8172322   TEMAZEPAM 15MG                         28.39           81             PHARMACY - ORAL
       8172363   TEMAZEPAM 30MG                         15.15           81             PHARMACY - ORAL
       8172280   TEMAZEPAM 7.5MG                        33.56           81             PHARMACY - ORAL
       8116469   TENOFOVIR                              48.21           81             PHARMACY - ORAL
       8116485   TERAZOSIN 1MG                          16.69           81             PHARMACY - ORAL
       8116527   TERAZOSIN 5MG                          16.69           81             PHARMACY - ORAL
       8116568   TERBUTALINE 2.5MG                      14.53           81             PHARMACY - ORAL
       8116600   TERBUTALINE 5MG                        14.99           81             PHARMACY - ORAL
       8116642   TETRACYCLINE 250MG                     13.64           81             PHARMACY - ORAL
       8116808   THEOPHYLLINE SR 200MG                  14.21           81             PHARMACY - ORAL
       8116881   THEOPHYLLINE SR 300MG                  14.98           81             PHARMACY - ORAL
       8116923   THIABENDAZOLE 500MG                    16.00           81             PHARMACY - ORAL
       8116964   THIAMINE 100MG                         13.62           81             PHARMACY - ORAL
       8117004   THIETHYLPERAZN 10MG                    14.70           81             PHARMACY - ORAL
       8117160   THIORIDAZINE 100MG                     14.85           81             PHARMACY - ORAL
       8117046   THIORIDAZINE 10MG                      14.16           81             PHARMACY - ORAL
       8117202   THIORIDAZINE 200MG                      7.00           81             PHARMACY - ORAL
       8117087   THIORIDAZINE 25MG                      14.44           81             PHARMACY - ORAL
       8154403   THIORIDAZINE 30MG/ML LIQ              121.62           81             PHARMACY - ORAL
       8117129   THIORIDAZINE 50MG                      14.68           81             PHARMACY - ORAL
       8117368   THIOTHIXENE 10MG                       14.82           81             PHARMACY - ORAL
       8117244   THIOTHIXENE 1MG                        13.95           81             PHARMACY - ORAL
       8117400   THIOTHIXENE 20MG                       18.28           81             PHARMACY - ORAL



9/17/2012                                                                                                       147
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8117285   THIOTHIXENE 2MG                        14.11           81             PHARMACY - ORAL
       8117327   THIOTHIXENE 5MG                        14.43           81             PHARMACY - ORAL
       8154445   THIOTHIXENE 5MG/ML OR LQ              130.80           81             PHARMACY - ORAL
       8117442   THYROID 15MG                           13.73           81             PHARMACY - ORAL
       8117483   THYROID 30MG                           13.99           81             PHARMACY - ORAL
       8117525   THYROID 60MG                           14.02           81             PHARMACY - ORAL
       8117566   TICLOPIDINE 250MG                      17.21           81             PHARMACY - ORAL
       8118044   TIGAN 100MGZAMIDE 100MG                 7.00           81             PHARMACY - ORAL
       8118051   TIGAN 250MG PO                         16.34           81             PHARMACY - ORAL
       8118085   TIGAN 250MGZAMIDE 250MG                14.00           81             PHARMACY - ORAL
       8117608   TOCAINIDE 400MG                        15.65           81             PHARMACY - ORAL
       8117640   TOCAINIDE 600MG                        16.24           81             PHARMACY - ORAL
       8117699   TOLTERODINE                            20.66           81             PHARMACY - ORAL
       8117665   TOPIRAMATE                             24.27           81             PHARMACY - ORAL
       8117657   TOPIRAMATE 25MG                        17.44           81             PHARMACY - ORAL
       8117673   TRAMADOL 50MG                          16.13           81             PHARMACY - ORAL
       8117723   TRAZODONE 100MG                        14.95           81             PHARMACY - ORAL
       8117681   TRAZODONE 50MG                         14.33           81             PHARMACY - ORAL
       8117806   TRIAMTERENE 100MG                      17.35           81             PHARMACY - ORAL
       8172405   TRIAZOLAM 0.125MG                      28.24           81             PHARMACY - ORAL
       8172447   TRIAZOLAM 0.25MG                       28.30           81             PHARMACY - ORAL
       8117921   TRIFLUOPERAZINE 10MG                   16.84           81             PHARMACY - ORAL
       8117848   TRIFLUOPERAZINE 2MG                    15.25           81             PHARMACY - ORAL
       8117889   TRIFLUOPERAZINE 5MG                    15.71           81             PHARMACY - ORAL
       8117962   TRIHEXYPHENIDYL 2MG                    13.85           81             PHARMACY - ORAL
       8154486   TRIHEXYPHENIDYL 2MG/5ML                42.56           81             PHARMACY - ORAL
       8118002   TRIHEXYPHENIDYL 5MG                    14.21           81             PHARMACY - ORAL
       8118127   TRIMETHOPRIM 100MG                     14.85           81             PHARMACY - ORAL
       8118168   TROLEANDOMYCIN 250MG                    7.00           81             PHARMACY - ORAL
       8118200   URISEDY ANTISEPTIC                     14.44           81             PHARMACY - ORAL
       8118242   URSODIOL 300MG                         22.58           81             PHARMACY - ORAL
       8101487   VALACYCLOVIR 500MG                     25.11           81             PHARMACY - ORAL
       8108029   VALPROIC ACID                          16.43           81             PHARMACY - ORAL



9/17/2012                                                                                                       148
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8154528   VALPROIC ACID 250MG/5ML                63.75           81             PHARMACY - ORAL
       8154536   VALPROIC ACID 250MG/5ML                17.36           81             PHARMACY - ORAL
       8154569   VANCO 250MG/5ML ORAL SOL              117.00           81             PHARMACY - ORAL
       8118325   VENLAFAXINE 37.5MG                     17.25           81             PHARMACY - ORAL
       8118366   VENLAFAXINE 50MG                       17.20           81             PHARMACY - ORAL
       8118382   VENLAFAXINE XR                         19.82           81             PHARMACY - ORAL
       8118390   VENLAFAXINE XR                         20.58           81             PHARMACY - ORAL
       8118408   VERAPAMIL 80MG                         14.36           81             PHARMACY - ORAL
       8118440   VERAPAMIL SR 120MG                     15.35           81             PHARMACY - ORAL
       8118481   VERAPAMIL SR 180MG                     16.44           81             PHARMACY - ORAL
       8118523   VIT A 10 KUNITSNITS                    13.54           81             PHARMACY - ORAL
       8118564   VIT E 400 UNITSNITS                    13.61           81             PHARMACY - ORAL
       8154643   VIT E 50 U/ML DRP DRP                  88.66           81             PHARMACY - ORAL
       8154767   VITAMINS-PREMIE-E DRP                  42.00           81             PHARMACY - ORAL
       8118739   VORICONAZOLE                           90.84           81             PHARMACY - ORAL
       8153561   VX POLIOVIRUS LIVE ORAL                76.00           81             PHARMACY - ORAL
       8118762   WARFARIN 1MG                           15.12           81             PHARMACY - ORAL
       8118846   WARFARIN 2.5MG                         15.24           81             PHARMACY - ORAL
       8118804   WARFARIN 2MG                           15.19           81             PHARMACY - ORAL
       8118853   WARFARIN 3MG                           15.25           81             PHARMACY - ORAL
       8118887   WARFARIN 5MG                           15.32           81             PHARMACY - ORAL
       8118929   WARFARIN 7.5MG                         15.93           81             PHARMACY - ORAL
       8118937   ZAFIRLUKAST 20MG                       16.39           81             PHARMACY - ORAL
       8118960   ZALCITABINE 0.375MG                    18.02           81             PHARMACY - ORAL
       8119000   ZIDOVUDINE 100MG                       17.99           81             PHARMACY - ORAL
       8154809   ZIDOVUDINE 50MG/5ML SYR                81.04           81             PHARMACY - ORAL
       8119042   ZINC SO4 220MG                         13.71           81             PHARMACY - ORAL
       8119141   ZIPRASIDONE                            26.06           81             PHARMACY - ORAL
       8119117   ZIPRASIDONE 20MG                       24.42           81             PHARMACY - ORAL
       8119109   ZIPRASIDONE 40MG                       24.42           81             PHARMACY - ORAL
       8172470   ZOLPIDEM 5MG                           34.17           81             PHARMACY - ORAL
       8212128   AA 3%/ELECTRO-TPN 1000ML               80.99           82             PHARMACY - OTHER
       8250045   ACETASOL ACID OTIC SOL                106.96           82             PHARMACY - OTHER



9/17/2012                                                                                                       149
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8250128   ACETASOL HC                            80.52           82             PHARMACY - OTHER
       8250086   ACETIC AC/AL ACET                      41.72           82             PHARMACY - OTHER
       8240046   ACETIC ACID 0.25% IRRSOL               27.00           82             PHARMACY - OTHER
       8250144   ACETYLCHOLINE                         115.78           82             PHARMACY - OTHER
       8240129   ACYCLOVIR 5% TOP ONT                  224.96           82             PHARMACY - OTHER
       8280919   ADVAIR DISKUS                          32.19           82             PHARMACY - OTHER
       8281032   ADVAIR DISKUS                          34.01           82             PHARMACY - OTHER
       8281040   ADVAIR DISKUS                          35.66           82             PHARMACY - OTHER
       8281057   ADVAIR DISKUS                          39.26           82             PHARMACY - OTHER
       8240848   AL SO4 SOL 2.4GM TOPP                  28.11           82             PHARMACY - OTHER
       8280091   ALBUTEROL                              14.28           82             PHARMACY - OTHER
       8280083   ALBUTEROL 0.083%UD INSOL               15.90           82             PHARMACY - OTHER
       8280042   ALBUTEROL 0.5% INH SLOL                59.96           82             PHARMACY - OTHER
       8280125   ALBUTEROL INHLR                        69.78           82             PHARMACY - OTHER
       8220022   ALTEPLASE TPA 2MG                     331.48           82             PHARMACY - OTHER
       8220030   ALTEPLASE TPA 50MG                  3,512.62           82             PHARMACY - OTHER
       8220162   AMINO ACIDS 10% 500ML                 898.93           82             PHARMACY - OTHER
       8220089   AMINO ACIDS 6% 500ML                   81.21           82             PHARMACY - OTHER
       8280166   AMMONIA 0.33ML INHL AMP                20.20           82             PHARMACY - OTHER
       8280208   AMYL NITRITE 0.3ML INHL                18.02           82             PHARMACY - OTHER
       8240285   ANALGESIC BALM ONT                     30.50           82             PHARMACY - OTHER
       8270563   ANUSOL SUPAL SUP                       13.97           82             PHARMACY - OTHER
       8242687   ANUSOL TOP ONTOP ONT                   34.20           82             PHARMACY - OTHER
       8270043   APAP 120MG RECTAL SUP                   2.40           82             PHARMACY - OTHER
       8270084   APAP 300MG RECTAL SUP                   2.56           82             PHARMACY - OTHER
       8270126   APAP 600MG RECTAL SUP                   2.67           82             PHARMACY - OTHER
       8270209   ASA 300MG RECTAL SUP SUP                2.32           82             PHARMACY - OTHER
       8270241   ASA 600MG RECTAL SUP SUP                2.34           82             PHARMACY - OTHER
       8250243   ATROPINE SO4 1% OPTH ONT               31.80           82             PHARMACY - OTHER
       8250284   ATROPINE SO4 1% OPTH SOL               32.84           82             PHARMACY - OTHER
       8250169   AURALGAN OTIC SOL                      34.94           82             PHARMACY - OTHER
       8212672   AZTREONAM                             171.32           82             PHARMACY - OTHER
       8212680   AZTREONAM 500MG IJ                    118.22           82             PHARMACY - OTHER



9/17/2012                                                                                                       150
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8270282   B&O 16.2/30MG SUP30MG SUP          33.77           82             PHARMACY - OTHER
       8270324   B&O 16.2/60MG SUP60MG SUP          34.07           82             PHARMACY - OTHER
       8244881   BACI/POLYMIX 15GM TOP ON           45.16           82             PHARMACY - OTHER
       8251928   BACI/POLYMIX OPTH ONT              78.36           82             PHARMACY - OTHER
       8240327   BACITRACIN 0.9GM TOP ONT           13.88           82             PHARMACY - OTHER
       8240368   BACITRACIN 30GM TOP ONT            35.93           82             PHARMACY - OTHER
       8250326   BACITRACIN OPTH ONT                36.46           82             PHARMACY - OTHER
       8240426   BECAPLERMIN 0.01%               1,247.36           82             PHARMACY - OTHER
       8200057   BECLOMETHASONE 84 NASA            216.96           82             PHARMACY - OTHER
       8280240   BECLOMETHASONE INHLR              383.40           82             PHARMACY - OTHER
       8240459   BENZOCAINE                         40.21           82             PHARMACY - OTHER
       8240483   BENZOCAINE                         27.13           82             PHARMACY - OTHER
       8240442   BENZOCAINE 20% TOP SPR             84.94           82             PHARMACY - OTHER
       8245763   BENZOCAINE GELBENZOCAINE           35.30           82             PHARMACY - OTHER
       8240566   BENZOIN TINCURE COMPOUND           36.04           82             PHARMACY - OTHER
       8280281   BERACTANT 200MG INHL            1,504.50           82             PHARMACY - OTHER
       8240608   BETAMETHASONE DIP .05% C           41.96           82             PHARMACY - OTHER
       8240640   BETAMETHASONE DIP .05% LO          87.94           82             PHARMACY - OTHER
       8240681   BETAMETHASONE DIP .05% ON          41.96           82             PHARMACY - OTHER
       8240723   BETAMETHASONE VAL .1% CR           36.86           82             PHARMACY - OTHER
       8240764   BETAMETHASONE VAL .1% LT           53.22           82             PHARMACY - OTHER
       8250334   BETAXOLOL HCL 0.25% OPTH          120.72           82             PHARMACY - OTHER
       8270365   BISACODYL 10MG RECTAL SUP          13.74           82             PHARMACY - OTHER
       8250342   BRIMONIDINE                       119.38           82             PHARMACY - OTHER
       8250359   BRIMONIDINE 4MG                    99.52           82             PHARMACY - OTHER
       8251456   BSS                                41.00           82             PHARMACY - OTHER
       8251472   BSS                               323.50           82             PHARMACY - OTHER
       8251449   BSS IRRIG SOL 18ML                 39.88           82             PHARMACY - OTHER
       8280992   BUDESONIDE .25MG INHL AMP          23.86           82             PHARMACY - OTHER
       8240939   CADEXOMR IODINE                   146.50           82             PHARMACY - OTHER
       8240947   CADEXOMR IODINE                    60.18           82             PHARMACY - OTHER
       8270449   CAFERGOT RSUPRT/CAFF RSUP          28.36           82             PHARMACY - OTHER
       8240921   CALAMINE TOP LOT                   29.54           82             PHARMACY - OTHER



9/17/2012                                                                                                   151
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8200081   CALCITONIN NASAL SPRAY            105.12           82             PHARMACY - OTHER
       8280307   CALFACTANT 210MG INHL           1,477.72           82             PHARMACY - OTHER
       8240962   CAPSAICIN 0.075% CRM               80.86           82             PHARMACY - OTHER
       8250391   CARBACHOL                          88.22           82             PHARMACY - OTHER
       8250409   CARBAMIDE PEROX 6.5% OTIC          32.94           82             PHARMACY - OTHER
       8210056   CARDIOPLGIC SOL SOL 1000M         449.56           82             PHARMACY - OTHER
       8210072   CEFAZOLIN                         117.84           82             PHARMACY - OTHER
       8210080   CEFAZOLIN 1GM IVPB                121.84           82             PHARMACY - OTHER
       8210130   CEFOTAXIME                        133.36           82             PHARMACY - OTHER
       8210114   CEFOXITIN                         111.48           82             PHARMACY - OTHER
       8210098   CEFTRIAXONE 1GM IVPB              161.24           82             PHARMACY - OTHER
       8210106   CEFTRIAXONE W NA D2.4W            222.02           82             PHARMACY - OTHER
       8210163   CEFUROXIME 1.5GM IVPB             113.20           82             PHARMACY - OTHER
       8210122   CEFUROXIME 750MG IVPB              99.80           82             PHARMACY - OTHER
       8240491   CETACAINE SPRTRACAINE SPR         143.96           82             PHARMACY - OTHER
       8252363   CETAPRED 10/0.25 OPT ONT          119.54           82             PHARMACY - OTHER
       8290041   CHEMOTHERAPY SERVICE                               82             PHARMACY - OTHER
       8270407   CHLORAL HYDRATE 325MG              32.96           82             PHARMACY - OTHER
       8270415   CHLORAL HYDRATE 648MG              35.14           82             PHARMACY - OTHER
       8250482   CHLORAMPHENICOL .5% OPT           128.00           82             PHARMACY - OTHER
       8250441   CHLORAMPHENICOL 1% OPT            119.50           82             PHARMACY - OTHER
       8245524   CHLORASEPTIC SPRAY TOP             26.99           82             PHARMACY - OTHER
       8250524   CIPRO 0.3% OP SOL% OP SOL         137.72           82             PHARMACY - OTHER
       8210197   CIPRO 200MG IVPB0MG IVPB          112.10           82             PHARMACY - OTHER
       8210205   CIPRO 400MG IVPB0MG IVPB           81.18           82             PHARMACY - OTHER
       8245409   CLEANSERS SUBSTITUTE LOT           59.50           82             PHARMACY - OTHER
       8201055   CLINDAMYCIN                        36.25           82             PHARMACY - OTHER
       8210213   CLINDAMYCIN 600MG D5W IVP         105.48           82             PHARMACY - OTHER
       8210221   CLINDAMYCIN 900MG D5W IVP         110.94           82             PHARMACY - OTHER
       8241002   CLONIDINE .1MG TP PC               48.21           82             PHARMACY - OTHER
       8241044   CLONIDINE .2MG TP PC               71.95           82             PHARMACY - OTHER
       8241085   CLONIDINE .3MG TP PC               94.60           82             PHARMACY - OTHER
       8241200   CLOTRI/BETAMETH CRMTH CRM          72.70           82             PHARMACY - OTHER



9/17/2012                                                                                                   152
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8241127   CLOTRIMAZOLE 1% CRM                    61.60           82             PHARMACY - OTHER
       8241168   CLOTRIMAZOLE 1% TOP SOL                58.00           82             PHARMACY - OTHER
       8200123   CLOTRIMAZOLE 1% VAG CRM                50.96           82             PHARMACY - OTHER
       8200164   CLOTRIMAZOLE 500MG VTAB                32.96           82             PHARMACY - OTHER
       8241366   COAL TAR 0.5% SHPP                     27.07           82             PHARMACY - OTHER
       8241283   COAL TAR TOP GEL                       62.40           82             PHARMACY - OTHER
       8241325   COAL TAR TOPICAL OIL                  105.00           82             PHARMACY - OTHER
       8241440   COCAINE HCL 10% TOP SOL               112.98           82             PHARMACY - OTHER
       8241481   COCAINE HCL 4% TOP SOL                 77.32           82             PHARMACY - OTHER
       8241408   COCAINE HCL POWDER                     31.07           82             PHARMACY - OTHER
       8241887   COD LIVER OIL ONT                      33.16           82             PHARMACY - OTHER
       8243800   COLLAGEN HEMOST                       243.62           82             PHARMACY - OTHER
       8243842   COLLAGEN HEMOST                       299.88           82             PHARMACY - OTHER
       8280570   COMBIVENTUM/ALBUTERAL                 201.14           82             PHARMACY - OTHER
       8290082   COMPOUNDING SERVICE                                    82             PHARMACY - OTHER
       8252082   CORTISPORIN OPTH SUS                  159.34           82             PHARMACY - OTHER
       8244840   CORTISPORIN TOP ONT                   148.62           82             PHARMACY - OTHER
       8280323   CROMOLYN 20MG INHL AMP                 15.14           82             PHARMACY - OTHER
       8250623   CROMOLYN NA 4%                        101.46           82             PHARMACY - OTHER
       8280364   CROMOLYN NA INHLR                     172.72           82             PHARMACY - OTHER
       8200206   CROMOLYN NA NASAL SOL                  56.54           82             PHARMACY - OTHER
       8241648   CROTAMITON 10% CRM                     53.68           82             PHARMACY - OTHER
       8241523   CUSHING'S TOP ONT                       9.00           82             PHARMACY - OTHER
       8200248   CYANIDE KIT INJE KIT INJ              603.04           82             PHARMACY - OTHER
       8250649   CYCLOMYDRIL OPTH SOL                   57.96           82             PHARMACY - OTHER
       8250565   CYCLOPENTOLATE .5% OPTSL              111.72           82             PHARMACY - OTHER
       8250607   CYCLOPENTOLATE 1% OPTSL                56.58           82             PHARMACY - OTHER
       8210767   D10W 1000ML LVP                        80.88           82             PHARMACY - OTHER
       8210809   D10W 500ML LVP                         80.89           82             PHARMACY - OTHER
       8210437   D51/2NS 1000ML/KCL 10                  80.89           82             PHARMACY - OTHER
       8210445   D51/2NS 1000ML/KCL 20                  80.88           82             PHARMACY - OTHER
       8210486   D51/2NS 1000ML/KCL 30                  80.89           82             PHARMACY - OTHER
       8210528   D51/2NS 1000ML/KCL 40                  80.89           82             PHARMACY - OTHER



9/17/2012                                                                                                       153
                                       69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8210643   D51/2NS 1000MLL LVP               80.88           82             PHARMACY - OTHER
       8210403   D51/4NS 1000ML/KCL 20             80.89           82             PHARMACY - OTHER
       8210601   D51/4NS 1000MLL LVP               80.88           82             PHARMACY - OTHER
       8210361   D5LR 1000ML LVP                   80.88           82             PHARMACY - OTHER
       8210726   D5NS 1000ML LVP                   80.88           82             PHARMACY - OTHER
       8210460   D5NS 1000ML/KCL 20                80.89           82             PHARMACY - OTHER
       8211088   D5W 1000ML LVP                    80.90           82             PHARMACY - OTHER
       8210965   D5W 100ML IVPB                    31.24           82             PHARMACY - OTHER
       8211039   D5W 150ML                          0.07           82             PHARMACY - OTHER
       8211062   D5W 250ML GLASS LVP                0.04           82             PHARMACY - OTHER
       8211005   D5W 250ML IVPB                    26.97           82             PHARMACY - OTHER
       8210916   D5W 25ML IVPB                     31.66           82             PHARMACY - OTHER
       8211054   D5W 500ML GLASS LVP               80.90           82             PHARMACY - OTHER
       8211047   D5W 500ML LVP                     80.89           82             PHARMACY - OTHER
       8210924   D5W 50ML IVPB                     31.24           82             PHARMACY - OTHER
       8210049   D5W/ETOH 1000ML                   80.90           82             PHARMACY - OTHER
       8210841   D70W 500ML LVP                     0.02           82             PHARMACY - OTHER
       8241689   DAKINS 1/2 STR IRR SOL            26.99           82             PHARMACY - OTHER
       8241721   DAKINS 1/4 STR IRR SOL            26.98           82             PHARMACY - OTHER
       8241762   DAKINS 1/8 STR IRR SOL            99.00           82             PHARMACY - OTHER
       8241804   DAKINS FULL STR IRR SOL           99.00           82             PHARMACY - OTHER
       8240525   DERMAPLAST TOP AEROSOROSO         34.20           82             PHARMACY - OTHER
       8200289   DESMOPRESSIN 0.01% NASAL         375.36           82             PHARMACY - OTHER
       8250680   DEXAMETHASONE .1% OPT S           61.58           82             PHARMACY - OTHER
       8251407   DEXAMETHASONE OPTH SOL           114.00           82             PHARMACY - OTHER
       8241820   DEXAMETHASONE.4%ULTRAGEL         440.76           82             PHARMACY - OTHER
       8210288   DEXTRAN 40/D5W 500MLW LVP         80.99           82             PHARMACY - OTHER
       8210320   DEXTRAN 40/NS 500MLS LVP          80.99           82             PHARMACY - OTHER
       8210247   DEXTRAN 70 6% IN NS LVP           80.94           82             PHARMACY - OTHER
       8200321   DEXTRAN 70 70% STERILE            80.08           82             PHARMACY - OTHER
       8201329   DIALYSATE                          0.01           82             PHARMACY - OTHER
       8201360   DIALYSATE                      1,123.61           82             PHARMACY - OTHER
       8201402   DIALYSATE                      1,123.61           82             PHARMACY - OTHER



9/17/2012                                                                                                  154
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8201444   DIALYSATE                        1,123.61           82             PHARMACY - OTHER
       8241929   DIBUCAINE 1% TOP ONT                33.94           82             PHARMACY - OTHER
       8250474   DICLOFENAC                          94.61           82             PHARMACY - OTHER
       8210346   DILTIAZEM                          108.67           82             PHARMACY - OTHER
       8200495   DINOPROSTONE                       487.86           82             PHARMACY - OTHER
       8200487   DINOPROSTONE 0.5MG CV GEL          903.00           82             PHARMACY - OTHER
       8200560   DINOPROSTONE 20MG VAG SUP          984.66           82             PHARMACY - OTHER
       8200529   DINOPROSTONE 3MG VAG GEL           643.00           82             PHARMACY - OTHER
       8250805   DIPIVEFRIN 0.1% OPTH SOL            81.36           82             PHARMACY - OTHER
       8200461   DMSO BLAD IROXIDE BLAD IR          146.96           82             PHARMACY - OTHER
       8211112   DOBUTAMINE                          81.04           82             PHARMACY - OTHER
       8211104   DOBUTAMINE 500/D5W250L              81.00           82             PHARMACY - OTHER
       8211120   DOPAMINE 400MG/D5W 250ML            81.11           82             PHARMACY - OTHER
       8211138   DOPAMINE 800MG/D5W 250ML            81.05           82             PHARMACY - OTHER
       8280406   DORNASE ALFA 2.5MG INHSOL          126.70           82             PHARMACY - OTHER
       8250847   DORZOLAMIDE 2% OPTH SOL             87.72           82             PHARMACY - OTHER
       8280588   DUONEB                              36.00           82             PHARMACY - OTHER
       8250888   ECHOTHIP IODIDE .06% SL            176.50           82             PHARMACY - OTHER
       8250920   ECHOTHIP IODIDE .125% SL           196.50           82             PHARMACY - OTHER
       8250961   ECHOTHIP IODIDE .25% SL            220.00           82             PHARMACY - OTHER
       8243412   EMLA                                45.00           82             PHARMACY - OTHER
       8243404   EMLA CRME/PRILOCAINE CRM            23.50           82             PHARMACY - OTHER
       8243529   EMOLLIENTS                          27.00           82             PHARMACY - OTHER
       8243560   EMOLLIENTS 195ML                    27.00           82             PHARMACY - OTHER
       8244642   EMOLLIENTS FOR DRY SKIN             35.28           82             PHARMACY - OTHER
       8230195   EMPTY-STRL BAXABAG 2000ML                           82             PHARMACY - OTHER
       8230229   EMPTY-STRL BAXABAG 3000ML                           82             PHARMACY - OTHER
       8230252   EMPTY-STRL BAXABAG 4000ML                           82             PHARMACY - OTHER
       8211732   EPTIFIBATIDE 75MG INJJ             589.68           82             PHARMACY - OTHER
       8251043   ERYTHROMYCIN OPTH ONT               38.42           82             PHARMACY - OTHER
       8251050   ERYTHROMYCIN U/D OPTH ONT           30.23           82             PHARMACY - OTHER
       8242000   ESTRADIOL 0.05MG TOP PTC            33.76           82             PHARMACY - OTHER
       8200602   ESTROGENS CONJ VAG CRM             183.96           82             PHARMACY - OTHER



9/17/2012                                                                                                    155
                                       69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8251480   EYE IRRIG 120ML                   34.54           82             PHARMACY - OTHER
       8251522   EYE LUBE LUBRICANT ONT            34.72           82             PHARMACY - OTHER
       8250201   EYE LUBE OPTH SOL                 31.86           82             PHARMACY - OTHER
       8211302   FAMOTIDINE 20MG IVPB              94.50           82             PHARMACY - OTHER
       8242059   FENTANYL                         120.78           82             PHARMACY - OTHER
       8242125   FENTANYL 100MCG/HR PTC           151.47           82             PHARMACY - OTHER
       8242042   FENTANYL 25MCG/HR PTC             60.60           82             PHARMACY - OTHER
       8242083   FENTANYL 50MCG/HR PTC             88.46           82             PHARMACY - OTHER
       8211526   FLUCONAZOL 200MG/100ML NS        323.64           82             PHARMACY - OTHER
       8211567   FLUCONAZOL 400MG/200ML NS         82.65           82             PHARMACY - OTHER
       8200644   FLUNISOLIDE .025% NSL IN         119.94           82             PHARMACY - OTHER
       8280489   FLUNISOLIDE INHLR                198.26           82             PHARMACY - OTHER
       8242281   FLUOCINOLONE 0.01% CRM            36.42           82             PHARMACY - OTHER
       8242240   FLUOCINOLONE 0.025% CRM           41.36           82             PHARMACY - OTHER
       8242323   FLUOCINONIDE 0.05% CRM            54.76           82             PHARMACY - OTHER
       8242364   FLUOCINONIDE 0.05% E CRM         117.08           82             PHARMACY - OTHER
       8251084   FLUORESCEIN NA OPTH STPP          27.48           82             PHARMACY - OTHER
       8242406   FLUOROURACIL 5% TOP CRM          258.82           82             PHARMACY - OTHER
       8250631   FLURBIPROFEN                      61.08           82             PHARMACY - OTHER
       8251126   FLUROMETHOLONE 0.1% SUSPP         57.02           82             PHARMACY - OTHER
       8200651   FLUTICASONE .05% NASAL AE        194.22           82             PHARMACY - OTHER
       8280497   FLUTICASONE 110MCG INHALE        218.18           82             PHARMACY - OTHER
       8280505   FLUTICASONE 220MCG INHALR        324.02           82             PHARMACY - OTHER
       8280513   FLUTICASONE 44MCG INHLR          169.78           82             PHARMACY - OTHER
       8211609   FOSCARNET 6000MG/250ML            81.59           82             PHARMACY - OTHER
       8242489   GELATIN SPONGE 100 TOP           117.95           82             PHARMACY - OTHER
       8242521   GELATIN SPONGE 12-7MM TOP         45.73           82             PHARMACY - OTHER
       8242448   GELFOAM POWDER 1GM TOPPWD        192.36           82             PHARMACY - OTHER
       8242562   GENTAMICIN 0.1% TOP ONT           26.96           82             PHARMACY - OTHER
       8251209   GENTAMICIN 0.3% OPT SOL           46.04           82             PHARMACY - OTHER
       8251167   GENTAMICIN 0.3% OPTH ONT          66.30           82             PHARMACY - OTHER
       8242604   GENTIAN VIOLET 1% TOP SOL         34.12           82             PHARMACY - OTHER
       8270480   GLYCERIN ADULT RECTAL SUP         13.99           82             PHARMACY - OTHER



9/17/2012                                                                                                  156
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8270530   GLYCERIN LIQUID CHILD SUP          15.64           82             PHARMACY - OTHER
       8270522   GLYCERIN RECTAL SUPAL SUP          13.89           82             PHARMACY - OTHER
       8242646   GLYCERIN TOP LIQ                   28.82           82             PHARMACY - OTHER
       8251340   GONIOSOL                           49.34           82             PHARMACY - OTHER
       8211641   HEPARIN 1 KUNIT/500ML NS           80.90           82             PHARMACY - OTHER
       8211658   HEPARIN 2 KUNIT/1000ML NS          80.89           82             PHARMACY - OTHER
       8211682   HEPARIN 25,000 U/250ML             80.92           82             PHARMACY - OTHER
       8211724   HETASTARCH 500ML                   81.00           82             PHARMACY - OTHER
       8242760   HEXACHLOROPHENE 3% UD LIQ          27.23           82             PHARMACY - OTHER
       8251241   HOMATROPINE 2% OPTH SOL            72.96           82             PHARMACY - OTHER
       8251282   HOMATROPINE 5% OPTH SOL            53.42           82             PHARMACY - OTHER
       8242802   HYDROCORT 0.5% CRM% CRM            32.94           82             PHARMACY - OTHER
       8242844   HYDROCORT 1% TOP CRM               33.31           82             PHARMACY - OTHER
       8242927   HYDROCORT 1% TOP ONT               31.56           82             PHARMACY - OTHER
       8270647   HYDROCORT 100MG ENEMA              37.78           82             PHARMACY - OTHER
       8242885   HYDROCORT 2.5% CRM                 48.96           82             PHARMACY - OTHER
       8242729   HYDROCORT 2.5% CRM5% CRM           76.84           82             PHARMACY - OTHER
       8242893   HYDROCORT 2.5% OINT                36.88           82             PHARMACY - OTHER
       8270605   HYDROCORT 25MG SUPMG SUP           15.36           82             PHARMACY - OTHER
       8242968   HYDROCORT POWDER USP               69.16           82             PHARMACY - OTHER
       8270688   HYDROCORT/PRAMOXINE RCRM          124.02           82             PHARMACY - OTHER
       8243008   HYDROGEN PEROX 3% SOL              26.96           82             PHARMACY - OTHER
       8270704   HYDROMORPHONE 3MG RSUP             35.26           82             PHARMACY - OTHER
       8270720   INDOMETHACIN 50MG RSUP              7.00           82             PHARMACY - OTHER
       8251142   IODIXANOL                         114.41           82             PHARMACY - OTHER
       8211765   IONOSOL MD/D5W1000                 72.00           82             PHARMACY - OTHER
       8211807   IONOSOL-T/D5W 500 MLL LVP          72.00           82             PHARMACY - OTHER
       8280521   IPRATROPIUM 0.02% UD SOL           16.12           82             PHARMACY - OTHER
       8280562   IPRATROPIUM BROMIDE INHLR         176.85           82             PHARMACY - OTHER
       8240202   ISOPROPYL ETOH 70% 480MLL          26.50           82             PHARMACY - OTHER
       8240244   ISOPROPYL ETOH 99% 3.8LL           26.97           82             PHARMACY - OTHER
       8212466   K CL                               80.91           82             PHARMACY - OTHER
       8212292   K CL 0.9+JCK 20MEQ                 80.89           82             PHARMACY - OTHER



9/17/2012                                                                                                   157
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8212086   K CL 10MEQ IVPBMEQ IVPB             59.54           82             PHARMACY - OTHER
       8212102   K CL 10MEQ/50MLIVQ/50MLIV          108.00           82             PHARMACY - OTHER
       8212094   K CL 20MEQ IVPBMEQ IVPB             59.70           82             PHARMACY - OTHER
       8212110   K CL 40MEQ/1OOML                   108.00           82             PHARMACY - OTHER
       8245326   K NITRATE TOP APLP APL              13.70           82             PHARMACY - OTHER
       8243057   KETOCONAZOLE                        83.81           82             PHARMACY - OTHER
       8243040   KETOCONAZOLE 2% TOP CRM             59.88           82             PHARMACY - OTHER
       8211849   LACTATED RINGERS 1000               80.88           82             PHARMACY - OTHER
       8290124   LAMINAR FLOW HOOD                                   82             PHARMACY - OTHER
       8251308   LATANOPROST OPTH SOLH SOL          155.66           82             PHARMACY - OTHER
       8200768   LAXITIVE OF CHOICE                                  82             PHARMACY - OTHER
       8211823   LEVOFLOX 250MG/50ML D5W            126.54           82             PHARMACY - OTHER
       8211815   LEVOFLOX 500MG/100ML D5W           172.18           82             PHARMACY - OTHER
       8211831   LEVOFLOX 750MG/150ML D5W           108.65           82             PHARMACY - OTHER
       8243123   LIDO/EPI/TETRACAINE TOP             67.18           82             PHARMACY - OTHER
       8243115   LIDOCAINE                           45.04           82             PHARMACY - OTHER
       8243156   LIDOCAINE                           49.86           82             PHARMACY - OTHER
       8243164   LIDOCAINE 2% TOP GEL                68.22           82             PHARMACY - OTHER
       8243172   LIDOCAINE 2% UROJET GEL             42.98           82             PHARMACY - OTHER
       8243248   LIDOCAINE 2GM/10ML PINTOP           55.50           82             PHARMACY - OTHER
       8211880   LIDOCAINE 2GM/250ML D5W             80.94           82             PHARMACY - OTHER
       8243289   LIDOCAINE 4% TOP SOL                45.28           82             PHARMACY - OTHER
       8243206   LIDOCAINE 5% TOP ONT                57.34           82             PHARMACY - OTHER
       8243446   LINDANE 1% TOP LOT                  40.50           82             PHARMACY - OTHER
       8243487   LINDANE 1% TOP SHP                  42.00           82             PHARMACY - OTHER
       8211393   LIPID EMULSION                     116.42           82             PHARMACY - OTHER
       8211369   LIPID EMULSION 10% LVP              80.93           82             PHARMACY - OTHER
       8211443   LIPID EMULSION 20% LVP              80.97           82             PHARMACY - OTHER
       8211377   LIPID EMULSION 30% LVP              81.01           82             PHARMACY - OTHER
       8243602   LUBRICANTS 128GM TOP GEL            21.50           82             PHARMACY - OTHER
       8243644   LUBRICANTS 5GM TOP GEL              21.50           82             PHARMACY - OTHER
       8243651   MAFENIDE ACET 8.5 TOP CR           117.66           82             PHARMACY - OTHER
       8212714   MAG SO4                              2.31           82             PHARMACY - OTHER



9/17/2012                                                                                                    158
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8211922   MAG SO4 1GM/D5W100W IVPB                94.64           82             PHARMACY - OTHER
       8211963   MAG SO4 40GM/1000ML00ML W               80.90           82             PHARMACY - OTHER
       8243685   MAG SO4 TOP CRY CRY                     29.32           82             PHARMACY - OTHER
       8211948   MAG SO4/DEXTROSE 5%                     84.12           82             PHARMACY - OTHER
       8212003   MANNITOL 20% 500ML LVP                  81.16           82             PHARMACY - OTHER
       8250722   MAXITROL OPTH ONT                       42.96           82             PHARMACY - OTHER
       8250763   MAXITROL OPTH SUS                       42.96           82             PHARMACY - OTHER
       8270811   MESALAMINE                              34.91           82             PHARMACY - OTHER
       8270761   MESALAMINE 4GM RECTAL                   50.46           82             PHARMACY - OTHER
       8270803   MESALAMINE 500MG RSUP                   24.31           82             PHARMACY - OTHER
       8280604   METAPROTERENOL .4% IN SL                36.00           82             PHARMACY - OTHER
       8280646   METAPROTERENOL .6% IN SL                15.50           82             PHARMACY - OTHER
       8280687   METAPROTERENOL 5% INH SL                59.70           82             PHARMACY - OTHER
       8280729   METAPROTERENOL INHLR                   100.82           82             PHARMACY - OTHER
       8280844   METHACHOLINE 100MG INHL S              122.84           82             PHARMACY - OTHER
       8240293   METHYL SALICYLA                         36.67           82             PHARMACY - OTHER
       8200800   METRONIDAZOLE 0.75% VGEL               190.58           82             PHARMACY - OTHER
       8212045   METRONIDAZOLE 500MG IVPB                85.78           82             PHARMACY - OTHER
       8243727   MICONAZOLE 2% TOP CRM                   33.73           82             PHARMACY - OTHER
       8243768   MICONAZOLE 2% TOP PWD                   37.21           82             PHARMACY - OTHER
       8200842   MICONAZOLE 2% VAG CRM                   46.54           82             PHARMACY - OTHER
       8200883   MICONAZOLE 200MG VAG SUP                56.83           82             PHARMACY - OTHER
       8243883   MINERAL OIL LIGHT TOP                   26.98           82             PHARMACY - OTHER
       8243925   MINERAL OIL-STER 10ML TOP               25.00           82             PHARMACY - OTHER
       8270845   MORPHINE SO4 10MG RSUP                  29.74           82             PHARMACY - OTHER
       8243966   MORPHINE SO4 PWDR                       27.60           82             PHARMACY - OTHER
       8252934   MOXIFLOXACIN                           139.84           82             PHARMACY - OTHER
       8211930   MOXIFLOXACIN                            81.23           82             PHARMACY - OTHER
       8244014   MUPIROCIN                               13.48           82             PHARMACY - OTHER
       8244006   MUPIROCIN 2% TOP ONT                   128.50           82             PHARMACY - OTHER
       8212441   NA CL 0.45% 1000ML                      80.88           82             PHARMACY - OTHER
       8212391   NA CL 0.45% 250ML                       88.02           82             PHARMACY - OTHER
       8201246   NA CL 0.65% NASAL SPRAYY                31.16           82             PHARMACY - OTHER



9/17/2012                                                                                                        159
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8212482   NA CL 0.9% 1000ML LVP               80.90           82             PHARMACY - OTHER
       8212326   NA CL 0.9% 100ML IVPB                4.28           82             PHARMACY - OTHER
       8245441   NA CL 0.9% 1L IRR SOL SOL           26.96           82             PHARMACY - OTHER
       8212367   NA CL 0.9% 250ML IVPB               26.97           82             PHARMACY - OTHER
       8212409   NA CL 0.9% 500ML LVP                80.92           82             PHARMACY - OTHER
       8212284   NA CL 0.9% 50ML IVPB                 4.28           82             PHARMACY - OTHER
       8212201   NA CL 3% 500ML00ML LVP              80.92           82             PHARMACY - OTHER
       8212243   NA CL 5% 500ML00ML LVP              72.00           82             PHARMACY - OTHER
       8201253   NA CL NASAL RINSE                   27.30           82             PHARMACY - OTHER
       8212276   NA CL O.9% 25ML IVPB                85.46           82             PHARMACY - OTHER
       8251266   NA HYALURONATE HEALON5             366.42           82             PHARMACY - OTHER
       8212037   NAFCILLIN 2MG IVPB                 144.82           82             PHARMACY - OTHER
       8251324   NAPHAZOLONE 0.1% OPTH SL            38.26           82             PHARMACY - OTHER
       8251365   NAPHCON-A OPTH SOLPTH SOL           42.72           82             PHARMACY - OTHER
       8252009   NEO/POLY/GRAM OPTH SOLL             87.02           82             PHARMACY - OTHER
       8252041   NEO/POLY/HC OTIC SOL                88.56           82             PHARMACY - OTHER
       8252124   NEO/POLY/HC OTIC SUS                88.56           82             PHARMACY - OTHER
       8251886   NEOMYCIN/HC OPTH ONT                59.62           82             PHARMACY - OTHER
       8244923   NEOSPORIN 0.9GM ONT                 27.49           82             PHARMACY - OTHER
       8244964   NEOSPORIN 30GM ONT                  38.98           82             PHARMACY - OTHER
       8201204   NEOSPORIN GU 1ML IRRIGG             60.36           82             PHARMACY - OTHER
       8251969   NEOSPORIN OPTH ONT                  58.50           82             PHARMACY - OTHER
       8244089   NICOTINE 14MG TOP PTC               18.52           82             PHARMACY - OTHER
       8244121   NICOTINE 21MG TOP PTC               18.52           82             PHARMACY - OTHER
       8244048   NICOTINE 7MG TOP PTC                18.52           82             PHARMACY - OTHER
       8211856   NORMOSOL R 500MLE 1L LVP            72.00           82             PHARMACY - OTHER
       8244170   NTG                                 14.50           82             PHARMACY - OTHER
       8244204   NTG .1MG/H 2.5MG PC PATCH           16.64           82             PHARMACY - OTHER
       8244246   NTG .2MG/H5MGPCMG PATCH             16.71           82             PHARMACY - OTHER
       8244287   NTG .3MG/H 7.5MG PC PATCH           19.31           82             PHARMACY - OTHER
       8244329   NTG 0.4MG/H 10MG PCPATCH            17.17           82             PHARMACY - OTHER
       8244360   NTG 0.6MG/H 15MG PCPATCH            17.55           82             PHARMACY - OTHER
       8212078   NTG 100MG/D5W 250ML 250ML           80.95           82             PHARMACY - OTHER



9/17/2012                                                                                                    160
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8244162   NTG 2% TOP ONT2% TOP ONT           47.90           82             PHARMACY - OTHER
       8244402   NYSTATIN 1.5 MUNITS PWD            81.88           82             PHARMACY - OTHER
       8244444   NYSTATIN 100 KUNITS CRM            41.20           82             PHARMACY - OTHER
       8244485   NYSTATIN 100 KUNITS ONT            41.20           82             PHARMACY - OTHER
       8200925   NYSTATIN 100 KUNITS VTAB           31.27           82             PHARMACY - OTHER
       8244527   NYSTATIN/TRIAMC CRMRM              40.16           82             PHARMACY - OTHER
       8244568   OATMEAL COLL TOP BAR               30.76           82             PHARMACY - OTHER
       8244600   OATMEAL COLL TOPL TOP              28.23           82             PHARMACY - OTHER
       8251415   OFLOXACIN 0.3% OP SOL             129.12           82             PHARMACY - OTHER
       8245847   ORBASE B PSTT/BENZOCAINE           34.96           82             PHARMACY - OTHER
       8201006   OXYMETAZOLINE NAS SPR              37.00           82             PHARMACY - OTHER
       8212151   OXYTOCIN                           53.95           82             PHARMACY - OTHER
       8212177   OXYTOCIN                           54.02           82             PHARMACY - OTHER
       8244709   PANAFIL                           202.96           82             PHARMACY - OTHER
       8244683   PANAFIL TOP ONTP TOP ONT          186.86           82             PHARMACY - OTHER
       8244733   PAPAIN/UREA                        60.94           82             PHARMACY - OTHER
       8244691   PAPAIN/UREA                       136.06           82             PHARMACY - OTHER
       8212144   PCN G K                           108.94           82             PHARMACY - OTHER
       8280760   PENTAMIDINE 300MG INHL            224.46           82             PHARMACY - OTHER
       8270886   PENTOBARBITAL 200MG SUPP           24.00           82             PHARMACY - OTHER
       8270860   PENTOBARBITAL 60MG SUPP            17.50           82             PHARMACY - OTHER
       8244766   PERMETHRIN 1% TOP LIQ              45.36           82             PHARMACY - OTHER
       8244725   PERMETHRIN 5% CRM                  85.26           82             PHARMACY - OTHER
       8246407   PETROLATUM 30GM ONTGM ONT          29.71           82             PHARMACY - OTHER
       8246365   PETROLATUM 5GM ONTGM ONT           28.56           82             PHARMACY - OTHER
       8201121   PHENYLEPHRINE .25% NASL            33.94           82             PHARMACY - OTHER
       8201162   PHENYLEPHRINE .5% NAS SP           33.94           82             PHARMACY - OTHER
       8201048   PHENYLEPHRINE .5% NASL D           33.94           82             PHARMACY - OTHER
       8201089   PHENYLEPHRINE 1% NSL DRP           34.86           82             PHARMACY - OTHER
       8251563   PHENYLEPHRINE 10% OPT SL           40.36           82             PHARMACY - OTHER
       8251605   PHENYLEPHRINE 2.5% OPT S           35.24           82             PHARMACY - OTHER
       8251647   PILOCARPINE 0.5% OPTH SOL          40.20           82             PHARMACY - OTHER
       8251688   PILOCARPINE 1% OPTH SOL            45.38           82             PHARMACY - OTHER



9/17/2012                                                                                                   161
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8251720   PILOCARPINE 2% OPTH SOL             50.54           82             PHARMACY - OTHER
       8251761   PILOCARPINE 3% OPTH SOL             48.32           82             PHARMACY - OTHER
       8251803   PILOCARPINE 4% OPTH SOL             49.26           82             PHARMACY - OTHER
       8251845   PILOCARPINE 6% OPTH SOL             53.06           82             PHARMACY - OTHER
       8212029   PIPERACILLIN/TAZA 2.25MG           105.36           82             PHARMACY - OTHER
       8212052   PIPERACILLIN/TAZO 3.375GM          117.60           82             PHARMACY - OTHER
       8212060   PIPERACILLIN/TAZO 4.5GM I          127.40           82             PHARMACY - OTHER
       8280802   PIRBUTEROL INHLRINHLR              228.58           82             PHARMACY - OTHER
       8244808   PODOPHYLLUM 25% TOP LIQ            155.36           82             PHARMACY - OTHER
       8270928   POLYSTYRENE 30GM ENM                52.82           82             PHARMACY - OTHER
       8201105   POVIDONE IODINE 0.3% SOL            27.01           82             PHARMACY - OTHER
       8245003   POVIDONE IODINE 10% ONT             30.20           82             PHARMACY - OTHER
       8245045   POVIDONE IODINE 10% UD ON           27.17           82             PHARMACY - OTHER
       8252405   PRED/SULFACET 10/.5 ONT             47.50           82             PHARMACY - OTHER
       8252165   PREDNISOLONE ACET 1% OPTH           52.16           82             PHARMACY - OTHER
       8270969   PROCHLORPERAZIN 25MG RSP            21.16           82             PHARMACY - OTHER
       8270951   PROCHLORPERAZIN 5MAG RSP            19.69           82             PHARMACY - OTHER
       8271009   PROMETHAZINE 12.5MG RSUP            22.23           82             PHARMACY - OTHER
       8271041   PROMETHAZINE 25MG RSUP              23.51           82             PHARMACY - OTHER
       8271082   PROMETHAZINE 50MG RSUP              23.55           82             PHARMACY - OTHER
       8252207   PROPARACINE 0.5% OPTH SL            49.46           82             PHARMACY - OTHER
       8212169   PROPOFOL 1000 MG/100ML IN          205.84           82             PHARMACY - OTHER
       8245169   PYRITHIONE 1% SHP1% SHP             26.99           82             PHARMACY - OTHER
       8280455   RACEPINEPHRINE                      18.04           82             PHARMACY - OTHER
       8280448   RACEPINEPHRINE 2.25% SL            108.00           82             PHARMACY - OTHER
       8220253   RETEPLASE 10 UNIT INJ            5,147.50           82             PHARMACY - OTHER
       8280885   RIBAVIRIN 6GM INHL VIL           3,174.56           82             PHARMACY - OTHER
       8241242   S NSTRL CLOVE OIL TOP               33.08           82             PHARMACY - OTHER
       8211153   S STRL EMPTY STERILE 250             9.50           82             PHARMACY - OTHER
       8211203   S STRL EMPTY-STERILE 300            45.00           82             PHARMACY - OTHER
       8211161   S STRL EMPTY-STERILE 500            20.42           82             PHARMACY - OTHER
       8211328   S STRL EVAC 1000ML LVP              40.08           82             PHARMACY - OTHER
       8211245   S STRL EVAC 250ML IVPB              38.38           82             PHARMACY - OTHER



9/17/2012                                                                                                    162
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8211286   S STRL EVAC 500ML LVP               39.46           82             PHARMACY - OTHER
       8230047   S STRL FILTER 0.22 MICRO            31.56           82             PHARMACY - OTHER
       8230161   S STRL IV-SET-LONG                 110.00           82             PHARMACY - OTHER
       8245086   SALICYLIC ACID 40% PLS              29.00           82             PHARMACY - OTHER
       8280927   SALMETEROL INHLR                   234.50           82             PHARMACY - OTHER
       8245128   SCOPOLAMINE 1.5MG TOP PTC           28.24           82             PHARMACY - OTHER
       8252249   SCOPOLAMINE HBR .25% SL             73.08           82             PHARMACY - OTHER
       8245201   SELENIUM SULFID 2.5% SHPP           50.15           82             PHARMACY - OTHER
       8245284   SILV SULFADIAZN 1% 400GM            97.10           82             PHARMACY - OTHER
       8245243   SILV SULFADIAZN 1% 50GM             45.32           82             PHARMACY - OTHER
       8252280   SULFACETAMIDE 10% OPT ON            43.16           82             PHARMACY - OTHER
       8252322   SULFACETAMIDE 10% OPT SL            37.12           82             PHARMACY - OTHER
       8201287   SULFACETAMIDE VAG CRM               36.50           82             PHARMACY - OTHER
       8245458   TALC-STERILE 5GM TOP PWD           928.92           82             PHARMACY - OTHER
       8252520   TETRACAINE 0.5% OPTH SOL            33.28           82             PHARMACY - OTHER
       8245482   TETRACAINE 2% TOP SOL              126.92           82             PHARMACY - OTHER
       8252561   TETRAHYDROZOLIN .05% SL             30.76           82             PHARMACY - OTHER
       8245565   THROMBIN 5 KUNITS TOP VIL          188.16           82             PHARMACY - OTHER
       8271124   TIGAN 100MG RSUP00MG RSUP           14.70           82             PHARMACY - OTHER
       8271165   TIGAN 200MG RSUP00MG RSUP           16.17           82             PHARMACY - OTHER
       8252603   TIMOLOL 0.25% OPTH SLL              56.96           82             PHARMACY - OTHER
       8252645   TIMOLOL 0.5% OPTH SOL               60.96           82             PHARMACY - OTHER
       8280935   TIOTROPIUM                          38.34           82             PHARMACY - OTHER
       8252777   TOBRA/DEXAMETH .3/0.1%OPO          176.08           82             PHARMACY - OTHER
       8252769   TOBRA/DEXAMETH .3/0.1%OPS          159.34           82             PHARMACY - OTHER
       8252686   TOBRAMYCIN 0.3% OPTH ONT           146.22           82             PHARMACY - OTHER
       8252728   TOBRAMYCIN 0.3% OPTH SOL            56.96           82             PHARMACY - OTHER
       8245607   TOBRAMYCIN 1.2GM PWD VIL           769.82           82             PHARMACY - OTHER
       8245649   TOLNAFTATE 1% TOP CRM               58.72           82             PHARMACY - OTHER
       8245680   TOLNAFTATE 1% TOP PWD               34.34           82             PHARMACY - OTHER
       8245722   TOLNAFTATE 1% TOP SOL               32.96           82             PHARMACY - OTHER
       8246126   TRIAMCINOLONE .1% PST               58.46           82             PHARMACY - OTHER
       8245888   TRIAMCINOLONE 0.025% CRM            37.46           82             PHARMACY - OTHER



9/17/2012                                                                                                    163
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       8246001   TRIAMCINOLONE 0.025% ONT                37.46            82            PHARMACY - OTHER
       8245920   TRIAMCINOLONE 0.1% CRM                  38.46            82            PHARMACY - OTHER
       8246043   TRIAMCINOLONE 0.1% ONT                  39.46            82            PHARMACY - OTHER
       8245961   TRIAMCINOLONE 0.5% CRM                  37.24            82            PHARMACY - OTHER
       8246084   TRIAMCINOLONE 0.5% ONT                  38.56            82            PHARMACY - OTHER
       8280968   TRIAMCINOLONE ACET INHLR               219.84            82            PHARMACY - OTHER
       8252801   TRIETHANOLAMINE 10% OTICP              119.56            82            PHARMACY - OTHER
       8252843   TRIFLURIDINE 1% OPTH SOL               258.36            82            PHARMACY - OTHER
       8212524   TROMETHAMINE 3.6% LVP                   81.70            82            PHARMACY - OTHER
       8252884   TROPICAMIDE 1% OPTH SOL                 60.96            82            PHARMACY - OTHER
       8246209   UREA 10% TOP LOT                        27.02            82            PHARMACY - OTHER
       8212540   VANCOMYCIN                              81.24            82            PHARMACY - OTHER
       8252447   VASOCIDIN                               74.94            82            PHARMACY - OTHER
       8252488   VASOCIDIN                               47.50            82            PHARMACY - OTHER
       8252892   VIDARABINE 3% OPTH OINT                135.50            82            PHARMACY - OTHER
       8250466   VISCOAT                                398.92            82            PHARMACY - OTHER
       8246241   VIT A&D TOP ONT ONT                     28.88            82            PHARMACY - OTHER
       8246282   VIT E TOP OIL OIL                       40.88            82            PHARMACY - OTHER
       8212607   WATER IJ 1000ML000ML LVP                                 82            PHARMACY - OTHER
       8212615   WATER IJ 250ML                       1,066.00            82            PHARMACY - OTHER
       8212565   WATER IJ 250ML250ML IVPB                27.00            82            PHARMACY - OTHER
       8246324   WATER IRRIG 1000MLRR SOL                26.96            82            PHARMACY - OTHER
       8246142   XENADERM                               165.64            82            PHARMACY - OTHER
       8240509   ZINC                                    30.66            82            PHARMACY - OTHER
       8246449   ZINC OX 30GM TOP ONT                    31.96            82            PHARMACY - OTHER
       8246522   ZINC OX 454GM TOP ONT                   47.96            82            PHARMACY - OTHER
       8246480   ZINC OX PASTE                           21.50            82            PHARMACY - OTHER
       8246563   ZINC OX/BENZETHONIUM ONT                55.42            82            PHARMACY - OTHER
       8246605   ZINC OX/CALAMINE BND                    69.22            82            PHARMACY - OTHER
       3012259   AEROSOL TX SUBSQ                       115.00            30            PULMONARY SERVICES
       3027000   AEROSOL TX SUBSQ                       110.00     110.00 30            PULMONARY SERVICES
       3011053   AIRWAY RESISTANCE                      123.00     123.00 30            PULMONARY SERVICES
       3010105   ARTERIAL PUNCTURE                      108.00     108.00 30            PULMONARY SERVICES



9/17/2012                                                                                                        164
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3020955   ARTERIAL PUNCTURE                      108.00              30          PULMONARY SERVICES
       3025459   BD CONTINUOUS SUBSQ DAY                115.00              30          PULMONARY SERVICES
       3027257   BIPAP INITIAL DAY                    1,023.00              30          PULMONARY SERVICES
       3027307   BIPAP SUBSEQUENT DAY                 1,023.00              30          PULMONARY SERVICES
       3012408   BRONCHIAL PROVOCATION                  654.00              30          PULMONARY SERVICES
       3010402   CO DIFFUSING CAPACITY                  240.00     240.00   30          PULMONARY SERVICES
       3010758   CO DIFFUSING CAPACITY                  240.00     240.00   30          PULMONARY SERVICES
       3023603   CPAP INITIAL DAY                       893.00              30          PULMONARY SERVICES
       3027158   CPAP INITIAL DAY                       893.00              30          PULMONARY SERVICES
       3027208   CPAP SUBSEQUENT DAY                    893.00              30          PULMONARY SERVICES
       3026952   CPR                                    280.00              30          PULMONARY SERVICES
       3023009   CPT INITIAL                            195.00              30          PULMONARY SERVICES
       3023058   CPT SUBSEQUENT                         111.00              30          PULMONARY SERVICES
       3022050   ETCO2 INIT DAY                         377.00              30          PULMONARY SERVICES
       3027455   ETCO2 INIT DAY                         377.00              30          PULMONARY SERVICES
       3011103   FUNCTIONAL RES CAP/VOL                 198.00     198.00   30          PULMONARY SERVICES
       3010451   HAST                                   389.00     389.00   30          PULMONARY SERVICES
       3010469   HAST WITH O2 TIRATE                    399.00              30          PULMONARY SERVICES
       3022209   INHALATION TX                                              30          PULMONARY SERVICES
       3011004   INHALATION TX PENTAMIDINE              171.00     171.00   30          PULMONARY SERVICES
       3023157   IPPB DEMO/EVAL                         247.00              30          PULMONARY SERVICES
       3023207   IPPB TX SUBSEQUENT                     115.00              30          PULMONARY SERVICES
       3012309   MDI/NEB DEMO/EVAL                      247.00              30          PULMONARY SERVICES
       3025301   MDI/NEB DEMO/EVAL                      237.00              30          PULMONARY SERVICES
       3030350   PULSE OXIMETRY MULTIPLE                175.00              30          PULMONARY SERVICES
       3012457   PULSE OXIMETRY MULTIPLE                175.00              30          PULMONARY SERVICES
       3024155   PULSE OXIMETRY MULTIPLE                175.00              30          PULMONARY SERVICES
       3010550   PULSE OXIMETRY SINGLE                   67.00      67.00   30          PULMONARY SERVICES
       3024106   PULSE OXIMETRY SINGLE                   67.00              30          PULMONARY SERVICES
       3010808   PULSE OX-OVERNIGHT CONT                241.00     241.00   30          PULMONARY SERVICES
       3012358   PULSE OX-OVERNIGHT CONT                241.00              30          PULMONARY SERVICES
       3027406   PULSE OX-OVERNIGHT CONT                241.00     241.00   30          PULMONARY SERVICES
       3010303   RESP FLOW VOLUME LOOP                  263.00     263.00   30          PULMONARY SERVICES



9/17/2012                                                                                                        165
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3010857   RESP FLOW VOLUME LOOP                  263.00     263.00 30            PULMONARY SERVICES
       3024205   RESP FLOW VOLUME LOOP                  263.00            30            PULMONARY SERVICES
       3027554   RESP FLOW VOLUME LOOP                  263.00     263.00 30            PULMONARY SERVICES
       3010154   S NSTRL ABT SUPPLY KIT P                45.00      45.00 30            PULMONARY SERVICES
       3020351   S NSTRL ABT SUPPLY KIT R               109.50            30            PULMONARY SERVICES
       3024304   S NSTRL AEROSOL MASK, AD                32.50            30            PULMONARY SERVICES
       3024353   S NSTRL AEROSOL MASK, PE                37.50            30            PULMONARY SERVICES
       3020609   S NSTRL AEROSOL NEBULIZE                51.00            30            PULMONARY SERVICES
       3025400   S NSTRL CONTIN NEBULIZER                70.50            30            PULMONARY SERVICES
       3022654   S NSTRL DRAIN BAG                       26.50            30            PULMONARY SERVICES
       3021250   S NSTRL FILTER BACTERIA/                61.50            30            PULMONARY SERVICES
       3021854   S NSTRL HME NOSE                        51.00            30            PULMONARY SERVICES
       3021805   S NSTRL HUMIDIFIER                      51.00            30            PULMONARY SERVICES
       3022258   S NSTRL INCENTIVE SPIROM                48.50            30            PULMONARY SERVICES
       3023553   S NSTRL INFANT CPAP RESUS              296.50            30            PULMONARY SERVICES
       3030053   S NSTRL INSPIRA MUSCLE T                87.00      87.00 30            PULMONARY SERVICES
       3020450   S NSTRL IPPB CIRCUIT                    60.50            30            PULMONARY SERVICES
       3020559   S NSTRL LRG VOL NEBULIZER               32.50            30            PULMONARY SERVICES
       3025350   S NSTRL METERED DOSE INH                72.00            30            PULMONARY SERVICES
       3020757   S NSTRL MIST TENT                      193.00            30            PULMONARY SERVICES
       3021557   S NSTRL NASAL CANNULA, 2                34.50            30            PULMONARY SERVICES
       3021409   S NSTRL NASAL CANNULA, A                32.50            30            PULMONARY SERVICES
       3021458   S NSTRL NASAL CANNULA, N                32.50            30            PULMONARY SERVICES
       3021508   S NSTRL NASAL CANNULA, P                32.50            30            PULMONARY SERVICES
       3022506   S NSTRL NON-REBREATHER M                32.50            30            PULMONARY SERVICES
       3022407   S NSTRL O2 MASK ADULT                   37.50            30            PULMONARY SERVICES
       3022605   S NSTRL OXYGEN MASK, PED                37.50            30            PULMONARY SERVICES
       3011509   S NSTRL PEAK FLOW METER                 47.00      47.00 30            PULMONARY SERVICES
       3022308   S NSTRL PEAK FLOW METER                 66.00            30            PULMONARY SERVICES
       3022159   S NSTRL PRESSURE VENT CI               149.00            30            PULMONARY SERVICES
       3021151   S NSTRL PULSE OXI SENSOR               109.50            30            PULMONARY SERVICES
       3021755   S NSTRL SMALL BORE TUBIN                26.50            30            PULMONARY SERVICES
       3021003   S NSTRL VOL VENT CIRCUIT               171.50            30            PULMONARY SERVICES



9/17/2012                                                                                                        166
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3021052   S NSTRL VOL VENT SUCTION            81.00              30          PULMONARY SERVICES
       3022753   S O2 OXYGEN PER HOUR                28.50              30          PULMONARY SERVICES
       3022704   S O2 OXYGEN, RECV ROO              151.50              30          PULMONARY SERVICES
       3020203   S STRL DISP RESUS BAG              206.50              30          PULMONARY SERVICES
       3010204   S STRL NASAL CANNULA SUP            41.50      41.50   30          PULMONARY SERVICES
       3012002   SLEEP STUDY UNATTENDED             435.00     435.00   30          PULMONARY SERVICES
       3010907   SPIROMETRY PRE/POST BD             555.00     555.00   30          PULMONARY SERVICES
       3010501   SPUTUM INDCTN VIA AEROSOL          346.00     346.00   30          PULMONARY SERVICES
       3021359   SPUTUM INDCTN VIA AEROSOL          346.00              30          PULMONARY SERVICES
       3022803   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3027505   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3029501   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3029519   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3029527   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3029535   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3029543   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3029550   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3029568   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3029576   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3029584   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3029592   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3029600   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3029618   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3029626   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3029634   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3029642   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3029659   STATISTICAL TRACKING                                   30          PULMONARY SERVICES
       3030400   THER PROC RESP FNCTN 15M           101.89              30          PULMONARY SERVICES
       3030202   THER PROC RESP FNCTN GRP            94.00      94.00   30          PULMONARY SERVICES
       3012507   THERAPIST TIME 15 MIN                                  30          PULMONARY SERVICES
       3010709   THORACIC GAS VOLUME                486.00     486.00   30          PULMONARY SERVICES
       3023801   VENT MGMNT INIT NEO/PEDS         1,890.00              30          PULMONARY SERVICES
       3024403   VENT MGMNT INITIAL               1,573.00              30          PULMONARY SERVICES



9/17/2012                                                                                                    167
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3027059   VENT MGMNT SUBSEQUENT                1,283.00              30          PULMONARY SERVICES
       3027109   VENT MGMNT SUBSQ NEO/PEDS            1,758.00              30          PULMONARY SERVICES
       3022357   VITAL CAPACITY                         115.00              30          PULMONARY SERVICES
       2810109   CPLX PACU ADD 15M                    1,094.00              28          RECOVERY SERVICES
       2810158   CPLX PACU FIRST 30M                  2,204.00              28          RECOVERY SERVICES
       2810356   S NSTRL AEROSOL MASK, AD                32.50              28          RECOVERY SERVICES
       2830057   S NSTRL BAIR BLANKET                    31.50              28          RECOVERY SERVICES
       2810307   S NSTRL LRG VOL NEBULIZER               32.50              28          RECOVERY SERVICES
       2830107   S NSTRL NASAL CANNULA A                 32.50              28          RECOVERY SERVICES
       2830115   S NSTRL NON-REBREATHER M                32.50              28          RECOVERY SERVICES
       2830131   S NSTRL O2 MASK ADULT                   37.50              28          RECOVERY SERVICES
       2830123   S NSTRL OXYGEN MASK, PED                37.50              28          RECOVERY SERVICES
       2810257   S O2 OXYGEN PACU                       151.50              28          RECOVERY SERVICES
       2810034   STND PACU LVL 1 ADD 15M                337.00              28          RECOVERY SERVICES
       2810059   STND PACU LVL 1 FIRST 30M              685.00              28          RECOVERY SERVICES
       2810208   STND PACU LVL 1 FIRST 30M              685.00              28          RECOVERY SERVICES
       3238680                                                              32          REHAB SERVICES
       3230158   HOT CLD PCK PER TX OR VST                                  32          REHAB SERVICES
       3239506   NS NSTRL EDEMA GLOVE                    16.00              32          REHAB SERVICES
       3211257   OT ADL TRAIN EA 15                     104.00     104.00   32          REHAB SERVICES
       3217700   OT APP SPLNT FINGER DYN                149.00              32          REHAB SERVICES
       3217718   OT APP SPLNT FINGER STA                143.00              32          REHAB SERVICES
       3217726   OT APP SPLNT LONG ARM                  144.00              32          REHAB SERVICES
       3217734   OT APP SPLNT SHRT ARM DYN              567.00              32          REHAB SERVICES
       3217742   OT APP SPLNT SHRT ARM STA              137.00              32          REHAB SERVICES
       3216900   OT ASSISTED PROC EA 15                                     32          REHAB SERVICES
       3214368   OT CASE CONSULT AND REP                332.00     332.00   32          REHAB SERVICES
       3214392   OT COGN RETRAIN EA 15                   81.00      81.00   32          REHAB SERVICES
       3210101   OT COMBO MODAL INIT 30                 274.00     274.00   32          REHAB SERVICES
       3216496   OT CONTRAST BATH INIT 30               202.00     202.00   32          REHAB SERVICES
       3214202   OT CONTRAST BATHS EA 15                111.00     111.00   32          REHAB SERVICES
       3214426   OT DEBRIDE/DRESS INIT 30               244.00     244.00   32          REHAB SERVICES
       3214459   OT DYSPHAGIA TRT ADD 15                101.00     101.00   32          REHAB SERVICES



9/17/2012                                                                                                        168
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3214483   OT DYSPHAGIA TRT INIT 30              200.00     200.00   32          REHAB SERVICES
       3216520   OT E-STIM MANUAL INIT 30              149.00     149.00   32          REHAB SERVICES
       3214517   OT E-STIM SUP INIT 30                 113.00     113.00   32          REHAB SERVICES
       3212453   OT E-STIM SUPERVISED 15                75.00      75.00   32          REHAB SERVICES
       3214335   OT E-STIM SUPERVISED 30               220.00     220.00   32          REHAB SERVICES
       3214541   OT EVAL 105                           802.00     802.00   32          REHAB SERVICES
       3214574   OT EVAL 120                           916.00     916.00   32          REHAB SERVICES
       3214608   OT EVAL 15                            116.00     116.00   32          REHAB SERVICES
       3212107   OT EVAL 30                            231.00     231.00   32          REHAB SERVICES
       3214632   OT EVAL 45                            310.00     310.00   32          REHAB SERVICES
       3211752   OT EVAL 60                            404.00     404.00   32          REHAB SERVICES
       3214665   OT EVAL 75                            498.00     498.00   32          REHAB SERVICES
       3214699   OT EVAL 90                            712.00     712.00   32          REHAB SERVICES
       3212156   OT EVAL ADD 15                        112.00     112.00   32          REHAB SERVICES
       3210168   OT EVAL FNX SWALL 105                 727.00              32          REHAB SERVICES
       3210184   OT EVAL FNX SWALL 120                 831.00              32          REHAB SERVICES
       3210028   OT EVAL FNX SWALL 15                  239.00              32          REHAB SERVICES
       3210044   OT EVAL FNX SWALL 30                  283.00              32          REHAB SERVICES
       3210069   OT EVAL FNX SWALL 45                  380.00              32          REHAB SERVICES
       3210085   OT EVAL FNX SWALL 60                  460.00              32          REHAB SERVICES
       3210127   OT EVAL FNX SWALL 75                  511.00              32          REHAB SERVICES
       3210143   OT EVAL FNX SWALL 90                  643.00              32          REHAB SERVICES
       3214723   OT EVAL INIT 30                       229.00     229.00   32          REHAB SERVICES
       3216041   OT FNX ACT ADD 15                      86.00      86.00   32          REHAB SERVICES
       3216074   OT FNX ACT INIT 30                    182.00     182.00   32          REHAB SERVICES
       3233905   OT HUBBARD TANK EA 15                 143.00     143.00   32          REHAB SERVICES
       3214756   OT HYDRO SUP INIT 30                  204.00     204.00   32          REHAB SERVICES
       3214780   OT IONTOPHORESIS ADD 15               131.00     131.00   32          REHAB SERVICES
       3216553   OT IONTOPHORESIS ADD 15               131.00     131.00   32          REHAB SERVICES
       3211729   OT IONTOPHORESIS EA 15                132.00     132.00   32          REHAB SERVICES
       3214814   OT IONTOPHORESIS INIT 30              227.00     227.00   32          REHAB SERVICES
       3216587   OT IONTOPHORESIS INIT 30              227.00     227.00   32          REHAB SERVICES
       3214848   OT JOINT MOB EA VISIT                 106.00     106.00   32          REHAB SERVICES



9/17/2012                                                                                                       169
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3214871   OT JOINT/SPINAL ADD 15                  97.00      97.00   32          REHAB SERVICES
       3214905   OT JOINT/SPINAL INIT 30                200.00     200.00   32          REHAB SERVICES
       3212602   OT MANUAL THER EA 15                    94.00      94.00   32          REHAB SERVICES
       3214939   OT MYOFASCIAL REL INIT 30              200.00     200.00   32          REHAB SERVICES
       3216611   OT NEUROMUSC REED INIT 30              171.00     171.00   32          REHAB SERVICES
       3214962   OT ORTHOTIC FAB INIT 30                232.00     232.00   32          REHAB SERVICES
       3210325   OT ORTHOTIC TRAIN ADD 15                87.00              32          REHAB SERVICES
       3214996   OT ORTHOTIC TRAIN ADD 15                87.00      87.00   32          REHAB SERVICES
       3216645   OT ORTHOTIC TRAIN ADD 15                87.00      87.00   32          REHAB SERVICES
       3215027   OT ORTHOTIC TRAIN INIT 30              197.00     197.00   32          REHAB SERVICES
       3216678   OT ORTHOTIC TRAIN INIT 30              197.00     197.00   32          REHAB SERVICES
       3215050   OT PARAFFIN BATH 15                     70.00      70.00   32          REHAB SERVICES
       3215084   OT PARAFFIN BATH 30                     91.00      91.00   32          REHAB SERVICES
       3212354   OT PARAFFIN BATH ADD 15                 55.00      55.00   32          REHAB SERVICES
       3210655   OT PARAFFIN BATH INIT 30               156.00     156.00   32          REHAB SERVICES
       3215118   OT PHONOPHORESIS ADD 15                 96.00      96.00   32          REHAB SERVICES
       3215142   OT PHONOPHORESIS INIT 30               195.00     195.00   32          REHAB SERVICES
       3215175   OT PROSTH TRAIN ADD 15                  96.00      96.00   32          REHAB SERVICES
       3216702   OT PROSTH TRAIN ADD 15                  96.00      96.00   32          REHAB SERVICES
       3215209   OT PROSTH TRAIN EA 15                  119.00     119.00   32          REHAB SERVICES
       3215233   OT PROSTH TRAIN INIT 30                213.00     213.00   32          REHAB SERVICES
       3216736   OT PROSTH TRAIN INIT 30                213.00     213.00   32          REHAB SERVICES
       3211554   OT PROSTHETIC FU EA 15M                 86.00      86.00   32          REHAB SERVICES
       3215266   OT RE-EVAL 105                         727.00     727.00   32          REHAB SERVICES
       3215290   OT RE-EVAL 120                         831.00     831.00   32          REHAB SERVICES
       3215324   OT RE-EVAL 15                          125.00     125.00   32          REHAB SERVICES
       3215357   OT RE-EVAL 30                          246.00     246.00   32          REHAB SERVICES
       3215381   OT RE-EVAL 45                          340.00     340.00   32          REHAB SERVICES
       3215415   OT RE-EVAL 60                          421.00     421.00   32          REHAB SERVICES
       3215449   OT RE-EVAL 75                          417.00     417.00   32          REHAB SERVICES
       3215472   OT RE-EVAL 90                          478.00     478.00   32          REHAB SERVICES
       3215506   OT RE-EVAL ADD 15                      115.00     115.00   32          REHAB SERVICES
       3215530   OT RE-EVAL COMPREHENSIVE               152.00     152.00   32          REHAB SERVICES



9/17/2012                                                                                                        170
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3215563   OT RE-EVAL EXTENDED                    495.00     495.00   32          REHAB SERVICES
       3215597   OT RE-EVAL INIT 30                     198.00     198.00   32          REHAB SERVICES
       3215621   OT RE-EVAL INTERMEDIATE                221.00     221.00   32          REHAB SERVICES
       3215654   OT RE-EVAL LTD                         202.00     202.00   32          REHAB SERVICES
       3215712   OT ROM BODY WO HAND 45                 209.00     209.00   32          REHAB SERVICES
       3215746   OT ROM BODY WO HAND 60                 279.00     279.00   32          REHAB SERVICES
       3210507   OT ROM HAND 15                          99.00      99.00   32          REHAB SERVICES
       3215779   OT ROM HAND 30                         107.00     107.00   32          REHAB SERVICES
       3215803   OT ROM HAND 45                         171.00     171.00   32          REHAB SERVICES
       3215837   OT ROM HAND 60                         114.00     114.00   32          REHAB SERVICES
       3214152   OT SENS INTEGRATION EA 15              113.00     113.00   32          REHAB SERVICES
       3217809   OT STRAP ANKLE/FOOT                     79.00              32          REHAB SERVICES
       3217817   OT STRAP ELBOW/WRIST                    65.00              32          REHAB SERVICES
       3217825   OT STRAP HAND/FINGERS                   79.00              32          REHAB SERVICES
       3217833   OT STRAP HIP                            65.00              32          REHAB SERVICES
       3217841   OT STRAP KNEE                           65.00              32          REHAB SERVICES
       3217858   OT STRAP LOW BACK                       79.00              32          REHAB SERVICES
       3217866   OT STRAP SHOULDER                       65.00              32          REHAB SERVICES
       3217874   OT STRAP TOES                           65.00              32          REHAB SERVICES
       3215860   OT TENS ADD 15                         106.00     106.00   32          REHAB SERVICES
       3215894   OT TENS INIT 30                        209.00     209.00   32          REHAB SERVICES
       3215928   OT THER ACT ADD 15                     108.00     108.00   32          REHAB SERVICES
       3210952   OT THER ACT EA 15                       94.00      94.00   32          REHAB SERVICES
       3215951   OT THER ACT INIT 30                    165.00     165.00   32          REHAB SERVICES
       3215985   OT THER EX ADD 15                      103.00     103.00   32          REHAB SERVICES
       3216769   OT THER EX ADD 15                      103.00     103.00   32          REHAB SERVICES
       3230505   OT THER EX EA 15                        93.00      93.00   32          REHAB SERVICES
       3216017   OT THER EX INIT 30                     188.00     188.00   32          REHAB SERVICES
       3216793   OT THER EX INIT 30                     188.00     188.00   32          REHAB SERVICES
       3216108   OT THER MASSAGE ADD 15                 126.00     126.00   32          REHAB SERVICES
       3212552   OT THER MASSAGE EA 15                   68.00      68.00   32          REHAB SERVICES
       3216132   OT THER MASSAGE INIT 30                147.00     147.00   32          REHAB SERVICES
       3216165   OT TREAT ADD 15                         99.00      99.00   32          REHAB SERVICES



9/17/2012                                                                                                        171
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3216199   OT TREAT INIT 30                   196.00     196.00   32          REHAB SERVICES
       3216223   OT TX SWALL/ORAL FNX 105           368.00     368.00   32          REHAB SERVICES
       3216256   OT TX SWALL/ORAL FNX 120           748.00     748.00   32          REHAB SERVICES
       3216280   OT TX SWALL/ORAL FNX 15            129.00     129.00   32          REHAB SERVICES
       3216686   OT TX SWALL/ORAL FNX 30            243.00     243.00   32          REHAB SERVICES
       3220258   OT TX SWALL/ORAL FNX 30            243.00     243.00   32          REHAB SERVICES
       3216314   OT TX SWALL/ORAL FNX 45            371.00     371.00   32          REHAB SERVICES
       3216348   OT TX SWALL/ORAL FNX 60            420.00     420.00   32          REHAB SERVICES
       3216371   OT TX SWALL/ORAL FNX 75            468.00     468.00   32          REHAB SERVICES
       3216405   OT TX SWALL/ORAL FNX 90            561.00     561.00   32          REHAB SERVICES
       3216439   OT ULTRASOUND ADD 15               102.00     102.00   32          REHAB SERVICES
       3216827   OT ULTRASOUND ADD 15               102.00     102.00   32          REHAB SERVICES
       3210853   OT ULTRASOUND EA 15                102.00     102.00   32          REHAB SERVICES
       3216462   OT ULTRASOUND INIT 30              166.00     166.00   32          REHAB SERVICES
       3216850   OT ULTRASOUND INIT 30              166.00     166.00   32          REHAB SERVICES
       3210200   OT UNLISTED PHYS MED PROC          107.00     107.00   32          REHAB SERVICES
       3211158   OT UNLISTED PROC EA 15              69.00      69.00   32          REHAB SERVICES
       3214103   OT WHLCHR MNG/TRAIN EA 15          119.00     119.00   32          REHAB SERVICES
       3232105   PT ADL TRAIN ADD 15                 80.00      80.00   32          REHAB SERVICES
       3234333   PT ADL TRAIN EA 15                 104.00     104.00   32          REHAB SERVICES
       3232055   PT ADL TRAIN INIT 30               234.00     234.00   32          REHAB SERVICES
       3234366   PT APP LONG LEG SPLNT              238.00              32          REHAB SERVICES
       3233608   PT APP SPLNT FINGER DYN            193.00              32          REHAB SERVICES
       3233616   PT APP SPLNT FINGER STA            103.00              32          REHAB SERVICES
       3233624   PT APP SPLNT LONG ARM              479.00              32          REHAB SERVICES
       3233640   PT APP SPLNT SHRT ARM DY           230.00              32          REHAB SERVICES
       3233632   PT APP SPLNT SHRT ARM STA          420.00              32          REHAB SERVICES
       3233509   PT BURN DSG / DEBRIDE LG           154.00     154.00   32          REHAB SERVICES
       3233459   PT BURN DSG / DEBRIDE MED          128.00     128.00   32          REHAB SERVICES
       3233400   PT BURN DSG / DEBRIDE SM           115.00     115.00   32          REHAB SERVICES
       3234572   PT CASE CONSULT AND REP            268.00     268.00   32          REHAB SERVICES
       3231602   PT CONTRAST BATH ADD 15            146.00     146.00   32          REHAB SERVICES
       3237005   PT CONTRAST BATH ADD 15            146.00     146.00   32          REHAB SERVICES



9/17/2012                                                                                                    172
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3234606   PT CONTRAST BATH INIT 30               293.00     293.00    32         REHAB SERVICES
       3237039   PT CONTRAST BATH INIT 30               293.00     293.00    32         REHAB SERVICES
       3234630   PT CONTRAST BATHS EA 15                111.00     111.00    32         REHAB SERVICES
       3234390   PT DEBRID SEL<=20CM 105MN              807.00     807.00    32         REHAB SERVICES
       3234424   PT DEBRID SEL<=20CM 120MN              904.00     904.00    32         REHAB SERVICES
       3234408   PT DEBRID SEL>20CM 105MN               541.00               32         REHAB SERVICES
       3234432   PT DEBRID SEL>20CM 120MN               922.00               32         REHAB SERVICES
       3234663   PT DEBRIDE NON-SELECT 15               115.00     115.00    32         REHAB SERVICES
       3234697   PT DEBRIDE NON-SELECT 30               208.00     208.00    32         REHAB SERVICES
       3234721   PT DEBRIDE NON-SELECT 45               387.00     387.00    32         REHAB SERVICES
       3234754   PT DEBRIDE SEL<=20CM 15MN              118.00     118.00    32         REHAB SERVICES
       3233350   PT DEBRIDE SEL<=20CM 30MN              240.00     240.00    32         REHAB SERVICES
       3234200   PT DEBRIDE SEL<=20CM 45MN              330.00     330.00    32         REHAB SERVICES
       3234788   PT DEBRIDE SEL<=20CM 60MN              426.00     426.00    32         REHAB SERVICES
       3230224   PT DEBRIDE SEL<=20CM 75MN              493.00     493.00    32         REHAB SERVICES
       3230240   PT DEBRIDE SEL<=20CM 90MN              547.00     547.00    32         REHAB SERVICES
       3234762   PT DEBRIDE SEL>20CM 15MN               139.00               32         REHAB SERVICES
       3233368   PT DEBRIDE SEL>20CM 30MN               271.00               32         REHAB SERVICES
       3234218   PT DEBRIDE SEL>20CM 45MN               363.00               32         REHAB SERVICES
       3234796   PT DEBRIDE SEL>20CM 60MN               477.00               32         REHAB SERVICES
       3230232   PT DEBRIDE SEL>20CM 75MN               502.00               32         REHAB SERVICES
       3230273   PT DEBRIDE SEL>20CM 90MN               636.00               32         REHAB SERVICES
       3234812   PT DEBRIDE/DRESS ADD 15                154.00      154.00   32         REHAB SERVICES
       3234846   PT DEBRIDE/DRESS INIT 30               309.00      309.00   32         REHAB SERVICES
       3231354   PT E-STIM EA 15                         77.00       77.00   32         REHAB SERVICES
       3234879   PT E-STIM MANUAL ADD 15                135.00      135.00   32         REHAB SERVICES
       3237062   PT E-STIM MANUAL ADD 15                135.00      135.00   32         REHAB SERVICES
       3230257   PT E-STIM MANUAL INIT 30               198.00      198.00   32         REHAB SERVICES
       3237096   PT E-STIM MANUAL INIT 30               198.00      198.00   32         REHAB SERVICES
       3234903   PT E-STIM SUP INIT 30                  144.00      144.00   32         REHAB SERVICES
       3234937   PT EVAL 105                            830.00      830.00   32         REHAB SERVICES
       3234960   PT EVAL 120                          1,026.00    1,026.00   32         REHAB SERVICES
       3234994   PT EVAL 15                             110.00      110.00   32         REHAB SERVICES



9/17/2012                                                                                                        173
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3235025   PT EVAL 30                            218.00      218.00   32         REHAB SERVICES
       3235058   PT EVAL 45                            349.00      349.00   32         REHAB SERVICES
       3232451   PT EVAL 60                            454.00      454.00   32         REHAB SERVICES
       3235082   PT EVAL 75                            788.00      788.00   32         REHAB SERVICES
       3235116   PT EVAL 90                            958.00      958.00   32         REHAB SERVICES
       3235140   PT EVAL ADD 15                        121.00      121.00   32         REHAB SERVICES
       3235173   PT EVAL FNX CAPACITY 120              393.00      393.00   32         REHAB SERVICES
       3235207   PT EVAL FNX CAPACITY 240              819.00      819.00   32         REHAB SERVICES
       3235231   PT EVAL FNX CAPACITY 360            1,245.00    1,245.00   32         REHAB SERVICES
       3235264   PT EVAL FNX CAPACITY 480            1,671.00    1,671.00   32         REHAB SERVICES
       3233053   PT EVAL INIT 30                       242.00      242.00   32         REHAB SERVICES
       3232006   PT FNX ACT ADD 15                     109.00      109.00   32         REHAB SERVICES
       3237120   PT FNX ACT ADD 15                     109.00      109.00   32         REHAB SERVICES
       3235298   PT FNX ACT INIT 30                    214.00      214.00   32         REHAB SERVICES
       3237153   PT FNX ACT INIT 30                    214.00      214.00   32         REHAB SERVICES
       3231305   PT GAIT TRAIN ADD 15                  116.00      116.00   32         REHAB SERVICES
       3237187   PT GAIT TRAIN ADD 15                  116.00      116.00   32         REHAB SERVICES
       3235322   PT GAIT TRAIN EA 15                   111.00      111.00   32         REHAB SERVICES
       3235355   PT GAIT TRAIN INIT 30                 235.00      235.00   32         REHAB SERVICES
       3237211   PT GAIT TRAIN INIT 30                 235.00      235.00   32         REHAB SERVICES
       3235389   PT IONTOPHORESIS ADD 15               120.00      120.00   32         REHAB SERVICES
       3237245   PT IONTOPHORESIS ADD 15               120.00      120.00   32         REHAB SERVICES
       3231404   PT IONTOPHORESIS EA 15                132.00      132.00   32         REHAB SERVICES
       3235413   PT IONTOPHORESIS INIT 30              220.00      220.00   32         REHAB SERVICES
       3237278   PT IONTOPHORESIS INIT 30              220.00      220.00   32         REHAB SERVICES
       3235447   PT JOB SITE ASSESS 120                361.00      361.00   32         REHAB SERVICES
       3235470   PT JOB SITE ASSESS 180                700.00      700.00   32         REHAB SERVICES
       3235504   PT JOB SITE ASSESS 240                653.00      653.00   32         REHAB SERVICES
       3235538   PT JOB SITE ASSESS 300              1,465.00    1,465.00   32         REHAB SERVICES
       3235561   PT JOB SITE ASSESS 60                 350.00      350.00   32         REHAB SERVICES
       3235595   PT JOINT MOB ADD 15                   118.00      118.00   32         REHAB SERVICES
       3235629   PT JOINT MOB EA VISIT                 227.00      227.00   32         REHAB SERVICES
       3235652   PT JOINT MOB INIT 30                  236.00      236.00   32         REHAB SERVICES



9/17/2012                                                                                                       174
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3235660   PT MANUAL LYMPH DRAIN 15               119.00              32          REHAB SERVICES
       3235678   PT MANUAL LYMPH DRAIN 30               237.00              32          REHAB SERVICES
       3231800   PT MANUAL THER EA 15                   109.00     109.00   32          REHAB SERVICES
       3235686   PT MANUAL TRACT ADD 15                 154.00     154.00   32          REHAB SERVICES
       3231453   PT MANUAL TRACT INIT 30                198.00     198.00   32          REHAB SERVICES
       3230208   PT MECH TRACT 15                       103.00     103.00   32          REHAB SERVICES
       3235710   PT MECH TRACT 30                       171.00     171.00   32          REHAB SERVICES
       3235744   PT MYOFAC/SOFT MOB 15                  119.00     119.00   32          REHAB SERVICES
       3235777   PT MYOFAC/SOFT MOB 30                  203.00     203.00   32          REHAB SERVICES
       3231206   PT NEUROMUSC REED ADD 15               116.00     116.00   32          REHAB SERVICES
       3237302   PT NEUROMUSC REED ADD 15               116.00     116.00   32          REHAB SERVICES
       3235801   PT NEUROMUSC REED EA 15                118.00     118.00   32          REHAB SERVICES
       3235835   PT NEUROMUSC REED INIT 30              213.00     213.00   32          REHAB SERVICES
       3237336   PT NEUROMUSC REED INIT 30              213.00     213.00   32          REHAB SERVICES
       3236973   PT NO SHOW                                                 32          REHAB SERVICES
       3238086   PT NP WND TX <=50CM ADD15              105.00      63.00   32          REHAB SERVICES
       3239340   PT NP WND TX <=50CM ADD15              105.00      63.00   32          REHAB SERVICES
       3238078   PT NP WND TX <=50CM INT30              210.00     126.00   32          REHAB SERVICES
       3239308   PT NP WND TX <=50CM INT30              210.00     126.00   32          REHAB SERVICES
       3238102   PT NP WND TX >50CM ADD 15              105.00      63.00   32          REHAB SERVICES
       3239381   PT NP WND TX >50CM ADD 15              105.00      63.00   32          REHAB SERVICES
       3238094   PT NP WND TX >50CM INT 30              210.00     126.00   32          REHAB SERVICES
       3239365   PT NP WND TX >50CM INT 30              210.00     126.00   32          REHAB SERVICES
       3234481   PT NP WOUND TX <=50 CM 30              191.00     191.00   32          REHAB SERVICES
       3238011   PT NP WOUND TX <=50 CM 30              191.00     191.00   32          REHAB SERVICES
       3234549   PT NP WOUND TX <=50 CM 45              351.00     351.00   32          REHAB SERVICES
       3238037   PT NP WOUND TX <=50 CM 45              351.00     351.00   32          REHAB SERVICES
       3238052   PT NP WOUND TX <=50 CM 60              452.00     452.00   32          REHAB SERVICES
       3238383   PT NP WOUND TX <=50 CM 60              452.00     452.00   32          REHAB SERVICES
       3234515   PT NP WOUND TX >50 CM 30               227.00     227.00   32          REHAB SERVICES
       3238029   PT NP WOUND TX >50 CM 30               227.00     227.00   32          REHAB SERVICES
       3238045   PT NP WOUND TX >50 CM 45               388.00     388.00   32          REHAB SERVICES
       3238367   PT NP WOUND TX >50 CM 45               388.00     388.00   32          REHAB SERVICES



9/17/2012                                                                                                        175
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3238060   PT NP WOUND TX >50 CM 60               496.00     496.00   32          REHAB SERVICES
       3238409   PT NP WOUND TX >50 CM 60               496.00     496.00   32          REHAB SERVICES
       3235868   PT ORT/PRO/ADL CK ADD 15               120.00     120.00   32          REHAB SERVICES
       3235892   PT ORT/PRO/ADL CK INIT 30              336.00     336.00   32          REHAB SERVICES
       3235926   PT ORTHOTIC FAB INIT 30                191.00     191.00   32          REHAB SERVICES
       3233202   PT ORTHOTIC TRAIN ADD 15               147.00     147.00   32          REHAB SERVICES
       3237369   PT ORTHOTIC TRAIN ADD 15               147.00     147.00   32          REHAB SERVICES
       3237393   PT ORTHOTIC TRAIN ADD 15               147.00     147.00   32          REHAB SERVICES
       3235959   PT ORTHOTIC TRAIN EA 15                101.00     101.00   32          REHAB SERVICES
       3235983   PT ORTHOTIC TRAIN INIT 30              178.00     178.00   32          REHAB SERVICES
       3237427   PT ORTHOTIC TRAIN INIT 30              178.00     178.00   32          REHAB SERVICES
       3236015   PT PARAFFIN BATH 15                     70.00      70.00   32          REHAB SERVICES
       3236049   PT PARAFFIN BATH 30                     91.00      91.00   32          REHAB SERVICES
       3236072   PT PARAFFIN BATH ADD 15                 92.00      92.00   32          REHAB SERVICES
       3236106   PT PARAFFIN BATH INIT 30               175.00     175.00   32          REHAB SERVICES
       3236130   PT PHONOPHORESIS ADD 15                218.00     218.00   32          REHAB SERVICES
       3236163   PT PHONOPHORESIS INIT 30               224.00     224.00   32          REHAB SERVICES
       3232501   PT PHYS PERFRM TEST EA 15              139.00     139.00   32          REHAB SERVICES
       3236197   PT PROSTH TRAIN ADD 15                 116.00     116.00   32          REHAB SERVICES
       3237450   PT PROSTH TRAIN ADD 15                 116.00     116.00   32          REHAB SERVICES
       3231909   PT PROSTH TRAIN EA 15                  119.00     119.00   32          REHAB SERVICES
       3236221   PT PROSTH TRAIN INIT 30                230.00     230.00   32          REHAB SERVICES
       3237484   PT PROSTH TRAIN INIT 30                230.00     230.00   32          REHAB SERVICES
       3230703   PT PROSTHETIC FU EA 15M                 86.00      86.00   32          REHAB SERVICES
       3236254   PT RE-EVAL 105                         794.00     794.00   32          REHAB SERVICES
       3236288   PT RE-EVAL 120                         907.00     907.00   32          REHAB SERVICES
       3236312   PT RE-EVAL 15                          130.00     130.00   32          REHAB SERVICES
       3233756   PT RE-EVAL 30                          289.00     289.00   32          REHAB SERVICES
       3236346   PT RE-EVAL 45                          314.00     314.00   32          REHAB SERVICES
       3236379   PT RE-EVAL 60                          440.00     440.00   32          REHAB SERVICES
       3236403   PT RE-EVAL 75                          441.00     441.00   32          REHAB SERVICES
       3236437   PT RE-EVAL 90                          510.00     510.00   32          REHAB SERVICES
       3236460   PT RE-EVAL ADD 15                      102.00     102.00   32          REHAB SERVICES



9/17/2012                                                                                                        176
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3236494   PT RE-EVAL INIT 30                     208.00     208.00   32          REHAB SERVICES
       3236528   PT SINGLE MODAL ADD 15                 122.00     122.00   32          REHAB SERVICES
       3236551   PT SINGLE MODAL INIT 30                238.00     238.00   32          REHAB SERVICES
       3210309   PT SINGLE PROC ADD 15                  143.00     143.00   32          REHAB SERVICES
       3236585   PT SINGLE PROC INIT 30                 292.00     292.00   32          REHAB SERVICES
       3236619   PT SOFT TISSUE MOB INIT30              184.00     184.00   32          REHAB SERVICES
       3237799   PT STRAP ANKLE/FOOT                     79.00              32          REHAB SERVICES
       3237716   PT STRAP ELBOW/WRIST                    61.00              32          REHAB SERVICES
       3237724   PT STRAP HAND/FINGERS                   61.00              32          REHAB SERVICES
       3237732   PT STRAP HIP                            61.00              32          REHAB SERVICES
       3237740   PT STRAP KNEE                           61.00              32          REHAB SERVICES
       3237781   PT STRAP LOW BACK                       79.00              32          REHAB SERVICES
       3237765   PT STRAP SHOULDER                       61.00              32          REHAB SERVICES
       3237773   PT STRAP TOES                           61.00              32          REHAB SERVICES
       3234457   PT STRAP UNNA BOOT                     254.00     254.00   32          REHAB SERVICES
       3236643   PT TENS ADD 15                          98.00      98.00   32          REHAB SERVICES
       3236676   PT TENS INIT 30                        131.00     131.00   32          REHAB SERVICES
       3236700   PT THER ACT ADD 15                      83.00      83.00   32          REHAB SERVICES
       3236734   PT THER ACT EA 15                      136.00     136.00   32          REHAB SERVICES
       3233103   PT THER ACT INIT 30                    189.00     189.00   32          REHAB SERVICES
       3236767   PT THER EX ADD 15                      118.00     118.00   32          REHAB SERVICES
       3231156   PT THER EX EA 15                       120.00     120.00   32          REHAB SERVICES
       3236791   PT THER EX INIT 30                     189.00     189.00   32          REHAB SERVICES
       3231552   PT THER MASSAGE ADD 15                 125.00     125.00   32          REHAB SERVICES
       3237518   PT THER MASSAGE ADD 15                 125.00     125.00   32          REHAB SERVICES
       3236825   PT THER MASSAGE EA 15                   96.00      96.00   32          REHAB SERVICES
       3236858   PT THER MASSAGE INIT 30                229.00     229.00   32          REHAB SERVICES
       3237542   PT THER MASSAGE INIT 30                229.00     229.00   32          REHAB SERVICES
       3230406   PT TREAT COMBO ADD 15                  129.00     129.00   32          REHAB SERVICES
       3231255   PT TREAT COMBO INIT 30                 252.00     252.00   32          REHAB SERVICES
       3231651   PT ULTRASOUND ADD 15                   128.00     128.00   32          REHAB SERVICES
       3237575   PT ULTRASOUND ADD 15                   128.00     128.00   32          REHAB SERVICES
       3236882   PT ULTRASOUND EA 15                    102.00     102.00   32          REHAB SERVICES



9/17/2012                                                                                                        177
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3236916   PT ULTRASOUND INIT 30                  206.00     206.00 32            REHAB SERVICES
       3237609   PT ULTRASOUND INIT 30                  206.00     206.00 32            REHAB SERVICES
       3230281   PT VASOPNEUMATIC 15                     62.00            32            REHAB SERVICES
       3230265   PT VASOPNEUMATIC 30                     98.00            32            REHAB SERVICES
       3231750   PT WHIRLPOOL 15                         96.00      96.00 32            REHAB SERVICES
       3233152   PT WHIRLPOOL 30                        202.00     202.00 32            REHAB SERVICES
       3236940   PT WHLCHR MNG/TRAIN EA 15              119.00     119.00 32            REHAB SERVICES
       3238425   S OT EO EL W/MTL JT PF                 106.00            32            REHAB SERVICES
       3238417   S OT EO W/O JOINTS CF                  215.00            32            REHAB SERVICES
       3238441   S OT EWHFO W/JOINT(S) CF             1,013.00            32            REHAB SERVICES
       3238433   S OT EWHO RIG WO JNTS CF               956.00            32            REHAB SERVICES
       3238672   S OT FO FINGER K/B                      48.00            32            REHAB SERVICES
       3238623   S OT HFO FGR EXTN C/S                   59.00            32            REHAB SERVICES
       3238615   S OT HFO K/B 2 SEG FLX                 100.00            32            REHAB SERVICES
       3238664   S OT HFO RVS K/B OTRG                  101.00            32            REHAB SERVICES
       3238607   S OT HFO W/JOINT(S) CF                 240.00            32            REHAB SERVICES
       3238565   S OT HFO WO JOINTS CF                  202.00            32            REHAB SERVICES
       3238599   S OT HO WO JOINTS CF                   202.00            32            REHAB SERVICES
       3238581   S OT METACARPL FX PREFAB                79.00            32            REHAB SERVICES
       3238557   S OT PF HFO ELASTIC                     18.00            32            REHAB SERVICES
       3238656   S OT WHF DORSAL WRIST PF                91.00            32            REHAB SERVICES
       3238490   S OT WHF DYN HNG W/F CBL             1,498.00            32            REHAB SERVICES
       3238482   S OT WHF DYN HNG WRST/FG             1,217.00            32            REHAB SERVICES
       3238631   S OT WHF FGR EXTN W/WRST                56.00            32            REHAB SERVICES
       3238466   S OT WHF LONG OPPN CUST                320.00            32            REHAB SERVICES
       3238649   S OT WHF PALMER PREFAB                  82.00            32            REHAB SERVICES
       3238458   S OT WHF SHORT OPPN CUST               205.00            32            REHAB SERVICES
       3238474   S OT WHF W/O JT PREFAB                 187.00            32            REHAB SERVICES
       3238573   S OT WHF WRST EXTN W/OTR               120.00            32            REHAB SERVICES
       3238524   S OT WHF WRST GNT THB SP               520.00            32            REHAB SERVICES
       3238532   S OT WHO COCK-UP NON MOL                61.00            32            REHAB SERVICES
       3238508   S OT WHO NONTRSN JNT(S C               740.00            32            REHAB SERVICES
       3238516   S OT WHO WO JNT CUST                   405.00            32            REHAB SERVICES



9/17/2012                                                                                                        178
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3238540   S OT WO EL PREFAB                       11.00               32         REHAB SERVICES
       3239555   S STRL SILICONE GEL SHEET               40.00               32         REHAB SERVICES
       3236908   SP ASSISTED PROC EA 15                                      32         REHAB SERVICES
       3221033   SP EVAL FNX SWALL 15                   239.00      239.00   32         REHAB SERVICES
       3221066   SP EVAL FNX SWALL 30                   283.00      283.00   32         REHAB SERVICES
       3221090   SP EVAL FNX SWALL 45                   380.00      380.00   32         REHAB SERVICES
       3220209   SP EVAL FNX SWALL 60                   460.00      460.00   32         REHAB SERVICES
       3220217   SP EVAL FNX SWALL 75                   643.00      643.00   32         REHAB SERVICES
       3220225   SP EVAL FNX SWALL 90                   653.00      653.00   32         REHAB SERVICES
       3220308   SP EVAL MTN FLUOR SWAL 15              135.00      135.00   32         REHAB SERVICES
       3221181   SP EVAL SP/LNG/COM/AUD 15              153.00      153.00   32         REHAB SERVICES
       3221215   SP EVAL SP/LNG/COM/AUD 30              296.00      296.00   32         REHAB SERVICES
       3221249   SP EVAL SP/LNG/COM/AUD 45              426.00      426.00   32         REHAB SERVICES
       3220100   SP EVAL SP/LNG/COM/AUD 60              582.00      582.00   32         REHAB SERVICES
       3221272   SP EVAL SP/LNG/COM/AUD 75              637.00      637.00   32         REHAB SERVICES
       3221306   SP EVAL SP/LNG/COM/AUD 90              862.00      862.00   32         REHAB SERVICES
       3221124   SP EVL SP/LNG/COM/AUD 105            1,004.00    1,004.00   32         REHAB SERVICES
       3221157   SP EVL SP/LNG/COM/AUD 120            1,145.00    1,145.00   32         REHAB SERVICES
       3221330   SP TX SP/LANG/COM IND 105              568.00      568.00   32         REHAB SERVICES
       3221363   SP TX SP/LANG/COM IND 120              877.00      877.00   32         REHAB SERVICES
       3221397   SP TX SP/LANG/COM IND 15               141.00      141.00   32         REHAB SERVICES
       3220159   SP TX SP/LANG/COM IND 30               216.00      216.00   32         REHAB SERVICES
       3221421   SP TX SP/LANG/COM IND 45               362.00      362.00   32         REHAB SERVICES
       3221454   SP TX SP/LANG/COM IND 60               467.00      467.00   32         REHAB SERVICES
       3221488   SP TX SP/LANG/COM IND 75               677.00      677.00   32         REHAB SERVICES
       3221512   SP TX SP/LANG/COM IND 90               802.00      802.00   32         REHAB SERVICES
       3221546   SP TX SWALL/ORAL FNX 105               843.00      843.00   32         REHAB SERVICES
       3221579   SP TX SWALL/ORAL FNX 120               961.00      961.00   32         REHAB SERVICES
       3221603   SP TX SWALL/ORAL FNX 15                129.00      129.00   32         REHAB SERVICES
       3221637   SP TX SWALL/ORAL FNX 30                243.00      243.00   32         REHAB SERVICES
       3221660   SP TX SWALL/ORAL FNX 45                371.00      371.00   32         REHAB SERVICES
       3221694   SP TX SWALL/ORAL FNX 60                420.00      420.00   32         REHAB SERVICES
       3221728   SP TX SWALL/ORAL FNX 75                608.00      608.00   32         REHAB SERVICES



9/17/2012                                                                                                        179
                                           69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       3221751   SP TX SWALL/ORAL FNX 90              725.00     725.00 32            REHAB SERVICES
       3210259   STATISTICAL TRACKING                                   32            REHAB SERVICES
       3231107   STATISTICAL TRACKING                                   32            REHAB SERVICES
       0095307   NEWBORN LEVEL I                      660.00            00            ROOM & BED
       0090704   NEWBORN LEVEL I                      660.00            00            ROOM & BED
       0085308   NEWBORN LEVEL II                   2,072.00            00            ROOM & BED
       0080705   NEWBORN LEVEL II                   2,072.00            00            ROOM & BED
       0075309   NEWBORN LEVEL III                  2,704.00            00            ROOM & BED
       0072900   NEWBORN LEVEL III                  2,704.00            00            ROOM & BED
       0070706   NEWBORN LEVEL III                  2,704.00            00            ROOM & BED
       0065300   NEWBORN LEVEL IV                   3,921.00            00            ROOM & BED
       0062901   NEWBORN LEVEL IV                   3,921.00            00            ROOM & BED
       0060707   NEWBORN LEVEL IV                   3,921.00            00            ROOM & BED
       0023408   ROOM BEHAVIORAL HEALTH             1,908.00            00            ROOM & BED
       0071746   ROOM ICU                           4,173.00            00            ROOM & BED
       0071720   ROOM ICU                           4,173.00            00            ROOM & BED
       0070102   ROOM ICU                           4,173.00            00            ROOM & BED
       0071712   ROOM ICU                           4,173.00            00            ROOM & BED
       0076505   ROOM ICU                           4,173.00            00            ROOM & BED
       0070201   ROOM ICU                           4,173.00            00            ROOM & BED
       0070185   ROOM ICU PEDIATRICS                3,904.00            00            ROOM & BED
       0070508   ROOM ICU PEDIATRICS                3,904.00            00            ROOM & BED
       0021741   ROOM MED/SURG/GYN                  1,787.00            00            ROOM & BED
       0031740   ROOM MED/SURG/GYN                  1,787.00            00            ROOM & BED
       0021550   ROOM MED/SURG/GYN                  1,787.00            00            ROOM & BED
       0031559   ROOM MED/SURG/GYN                  1,787.00            00            ROOM & BED
       0021717   ROOM MED/SURG/GYN                  1,787.00            00            ROOM & BED
       0021725   ROOM MED/SURG/GYN                  1,787.00            00            ROOM & BED
       0031716   ROOM MED/SURG/GYN                  1,787.00            00            ROOM & BED
       0031724   ROOM MED/SURG/GYN                  1,787.00            00            ROOM & BED
       0070169   ROOM MED/SURG/GYN                  1,787.00            00            ROOM & BED
       0020107   ROOM MED/SURG/GYN                  1,787.00            00            ROOM & BED
       0026500   ROOM MED/SURG/GYN                  1,787.00            00            ROOM & BED



9/17/2012                                                                                                      180
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0030106   ROOM MED/SURG/GYN               1,787.00           00             ROOM & BED
       0021774   ROOM MED/SURG/GYN               1,787.00           00             ROOM & BED
       0031773   ROOM MED/SURG/GYN               1,787.00           00             ROOM & BED
       0021766   ROOM MED/SURG/GYN               1,787.00           00             ROOM & BED
       0031765   ROOM MED/SURG/GYN               1,787.00           00             ROOM & BED
       0021808   ROOM MED/SURG/GYN               1,787.00           00             ROOM & BED
       0031807   ROOM MED/SURG/GYN               1,787.00           00             ROOM & BED
       0020206   ROOM MED/SURG/GYN               1,787.00           00             ROOM & BED
       0030205   ROOM MED/SURG/GYN               1,787.00           00             ROOM & BED
       0011726   ROOM MED/SURG/GYN PVT           1,855.00           00             ROOM & BED
       0011742   ROOM MED/SURG/GYN PVT           1,855.00           00             ROOM & BED
       0011551   ROOM MED/SURG/GYN PVT           1,855.00           00             ROOM & BED
       0011718   ROOM MED/SURG/GYN PVT           1,855.00           00             ROOM & BED
       0070151   ROOM MED/SURG/GYN PVT           1,855.00           00             ROOM & BED
       0010108   ROOM MED/SURG/GYN PVT           1,855.00           00             ROOM & BED
       0016501   ROOM MED/SURG/GYN PVT           1,855.00           00             ROOM & BED
       0011775   ROOM MED/SURG/GYN PVT           1,855.00           00             ROOM & BED
       0011767   ROOM MED/SURG/GYN PVT           1,855.00           00             ROOM & BED
       0011809   ROOM MED/SURG/GYN PVT           1,855.00           00             ROOM & BED
       0010207   ROOM MED/SURG/GYN PVT           1,855.00           00             ROOM & BED
       0023804   ROOM OB/MATERNAL                1,669.00           00             ROOM & BED
       0024000   ROOM OB/MATERNAL                1,669.00           00             ROOM & BED
       0033803   ROOM OB/MATERNAL                1,669.00           00             ROOM & BED
       0013805   ROOM OB/MATERNAL PVT            2,064.00           00             ROOM & BED
       0022905   ROOM PEDIATRIC                  2,385.00           00             ROOM & BED
       0032904   ROOM PEDIATRIC                  2,385.00           00             ROOM & BED
       0020503   ROOM PEDIATRIC                  2,208.28           00             ROOM & BED
       0030502   ROOM PEDIATRIC                  2,385.00           00             ROOM & BED
       0012906   ROOM PEDIATRIC PVT              1,985.00           00             ROOM & BED
       0010504   ROOM PEDIATRIC PVT              1,838.00           00             ROOM & BED
       0025809   ROOM SNF M/S DSNCT              1,386.00           00             ROOM & BED
       0051748   ROOM TELEMETRY/SPEC CARE        1,940.00           00             ROOM & BED
       1866516   GLUCOSE FINGERSTICK                10.00           18             SPECIALTY CLINICS



9/17/2012                                                                                                   181
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       1868769   LEVEL 1 CONSULT MINOR                                  18             SPECIALTY CLINICS
       1868678   LEVEL 1 EST PATIENT                                    18             SPECIALTY CLINICS
       1868660   LEVEL 1 NEW PATIENT                                    18             SPECIALTY CLINICS
       1868629   LEVEL 2 CONSULT LOW                                    18             SPECIALTY CLINICS
       1868777   LEVEL 2 CONSULT LOW                                    18             SPECIALTY CLINICS
       1868546   LEVEL 2 EST PATIENT                   153.00           18             SPECIALTY CLINICS
       1868694   LEVEL 2 EST PATIENT                   153.00           18             SPECIALTY CLINICS
       1868538   LEVEL 2 NEW PATIENT                   153.00           18             SPECIALTY CLINICS
       1868686   LEVEL 2 NEW PATIENT                                    18             SPECIALTY CLINICS
       1868637   LEVEL 3 CONSULT MODERATE              305.00           18             SPECIALTY CLINICS
       1868785   LEVEL 3 CONSULT MODERATE                               18             SPECIALTY CLINICS
       1868561   LEVEL 3 EST PATIENT                   175.00           18             SPECIALTY CLINICS
       1868710   LEVEL 3 EST PATIENT                   175.00           18             SPECIALTY CLINICS
       1868553   LEVEL 3 NEW PATIENT                   175.00           18             SPECIALTY CLINICS
       1868702   LEVEL 3 NEW PATIENT                   175.00           18             SPECIALTY CLINICS
       1867456   LEVEL 4 CONSULT MOD/HIGH              264.00           18             SPECIALTY CLINICS
       1868645   LEVEL 4 CONSULT MOD/HIGH              264.00           18             SPECIALTY CLINICS
       1868793   LEVEL 4 CONSULT MOD/HIGH              264.00           18             SPECIALTY CLINICS
       1868587   LEVEL 4 EST PATIENT                   290.00           18             SPECIALTY CLINICS
       1868736   LEVEL 4 EST PATIENT                   290.00           18             SPECIALTY CLINICS
       1868579   LEVEL 4 NEW PATIENT                   290.00           18             SPECIALTY CLINICS
       1868728   LEVEL 4 NEW PATIENT                   290.00           18             SPECIALTY CLINICS
       1868652   LEVEL 5 CONSULT HIGH                  605.00           18             SPECIALTY CLINICS
       1868801   LEVEL 5 CONSULT HIGH                  605.00           18             SPECIALTY CLINICS
       1868751   LEVEL 5 EST PATIENT                   312.00           18             SPECIALTY CLINICS
       1866615   LEVEL 5 NEW PATIENT                   312.00           18             SPECIALTY CLINICS
       1868744   LEVEL 5 NEW PATIENT                   312.00           18             SPECIALTY CLINICS
       1860469   NI AORTA IVC IL CMPL                  980.00           18             SPECIALTY CLINICS
       1860477   NI AORTA IVC IL LTD                   698.00           18             SPECIALTY CLINICS
       1860485   NI DIAL ACCES                         868.00           18             SPECIALTY CLINICS
       1860626   NI DIAL ACCES                         868.00           18             SPECIALTY CLINICS
       1860576   NI DPPLER EXT VEINS BIL               607.00           18             SPECIALTY CLINICS
       1860444   NI DUPLEX ABD PELV CMPL             1,659.00           18             SPECIALTY CLINICS



9/17/2012                                                                                                       182
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       1860451   NI DUPLEX ABD PELV LTD            941.00           18             SPECIALTY CLINICS
       1860386   NI DUPLEX EXT LOW BIL           1,475.00           18             SPECIALTY CLINICS
       1860394   NI DUPLEX EXT LOW UNI             881.00           18             SPECIALTY CLINICS
       1860402   NI DUPLEX EXT UPP BIL           1,165.00           18             SPECIALTY CLINICS
       1860410   NI DUPLEX EXT UPP UNI             757.00           18             SPECIALTY CLINICS
       1860428   NI DUPLEX EXT VEINS BIL         1,141.00           18             SPECIALTY CLINICS
       1860436   NI DUPLEX EXT VEINS UNI           781.00           18             SPECIALTY CLINICS
       1860345   NI DUPLEX EXTRACRAN BIL         1,208.00           18             SPECIALTY CLINICS
       1860352   NI DUPLEX EXTRACRAN UNI           761.00           18             SPECIALTY CLINICS
       1860717   NI EXT ART 1 LVL BIL              583.00           18             SPECIALTY CLINICS
       1860360   NI EXT ART MULTI BIL              876.00           18             SPECIALTY CLINICS
       1860378   NI EXT LOW W STRES              1,041.00           18             SPECIALTY CLINICS
       1867803   PF HEALTH RISK ASSESSMENT          66.00           18             SPECIALTY CLINICS
       1863315   S STRL ATEC HANDPIECE 12          878.00           18             SPECIALTY CLINICS
       1863307   S STRL ATEC HANDPIECE 20          878.00           18             SPECIALTY CLINICS
       1863406   S STRL BIOPSY SITE IDENTI         284.00           18             SPECIALTY CLINICS
       1863125   S STRL BIOSPY SITE IDNTFR         314.50           18             SPECIALTY CLINICS
       1863109   S STRL BREAST BIOPSY NDL          855.50           18             SPECIALTY CLINICS
       1863513   S STRL COAXIAL INTRODUCER         130.00           18             SPECIALTY CLINICS
       1863414   S STRL CORE BIOPSY NEEDLE          56.00           18             SPECIALTY CLINICS
       1863158   S STRL MAMMO GELMARKER            314.50           18             SPECIALTY CLINICS
       1863133   S STRL MAMMOTOMEPROBE 11G         789.50           18             SPECIALTY CLINICS
       1863117   S STRL MAMMOTOMEPROBE 8G          895.50           18             SPECIALTY CLINICS
       1863141   S STRL MAMMOTOMEPROBE 8G          789.50           18             SPECIALTY CLINICS
       1860568   S STRL VABB NEEDLE                819.00           18             SPECIALTY CLINICS
       1864008   URNALYSIS MAN W/O MICRO            11.00           18             SPECIALTY CLINICS
       1860246   US ABD CMPL                       521.00           18             SPECIALTY CLINICS
       1860733   US BIO PROFILE WO NOSTRES         444.00           18             SPECIALTY CLINICS
       1860220   US BREAST UNI OR BIL              300.00           18             SPECIALTY CLINICS
       1860238   US BREAST UNI OR BIL              300.00           18             SPECIALTY CLINICS
       1869007   US BREAST UNI OR BIL              300.00           18             SPECIALTY CLINICS
       1860212   US CHEST                          345.00           18             SPECIALTY CLINICS
       1860642   US DRN W CATH PLACE PRC           822.00           18             SPECIALTY CLINICS



9/17/2012                                                                                                   183
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       1860253   US ECHO ABD LTD                    373.00           18             SPECIALTY CLINICS
       1860279   US ECHO RETROPE LTD                373.00           18             SPECIALTY CLINICS
       1860329   US EXT NONVASCULAR                 373.00           18             SPECIALTY CLINICS
       1860618   US FU STDY                         273.00           18             SPECIALTY CLINICS
       1860204   US HEAD & NEC SFT TISSUE           371.00           18             SPECIALTY CLINICS
       1860337   US NDL PLACE                       704.00           18             SPECIALTY CLINICS
       1860709   US OB 1ST TRI 1 GEST               567.00           18             SPECIALTY CLINICS
       1860741   US OB 1ST TRI EA GEST              310.00           18             SPECIALTY CLINICS
       1860659   US OB AFTR 1ST TRI 1 GEST          583.00           18             SPECIALTY CLINICS
       1860675   US OB AFTR 1ST TRI EA GES          617.00           18             SPECIALTY CLINICS
       1860683   US OB DTLD FTL EXAM 1 GES          984.00           18             SPECIALTY CLINICS
       1860691   US OB DTLD FTL EXM EA GES          396.00           18             SPECIALTY CLINICS
       1860667   US OB FU/REEVAL EA FETUS           346.00           18             SPECIALTY CLINICS
       1860766   US OB LTD 1/MORE FETUSES           562.00           18             SPECIALTY CLINICS
       1863000   US OB LTD 1/MORE FETUSES           241.00           18             SPECIALTY CLINICS
       1860758   US OB TRANSVAGINAL                 412.00           18             SPECIALTY CLINICS
       1860725   US OB UMBILLICAL ARTERY            417.00           18             SPECIALTY CLINICS
       1860303   US PELV CMPL NONOB                 405.00           18             SPECIALTY CLINICS
       1860311   US PELV LTD FU NONOB               269.00           18             SPECIALTY CLINICS
       1860634   US RENL TRANSPLANT                 514.00           18             SPECIALTY CLINICS
       1860261   US RETROPE CMPL                    514.00           18             SPECIALTY CLINICS
       1860295   US SAL INFN SONOHYSTERGHY          410.00           18             SPECIALTY CLINICS
       1860774   US TESTICULAR SCROTUM              401.00           18             SPECIALTY CLINICS
       1860287   US TRANSVAGINAL                    416.00           18             SPECIALTY CLINICS
       1860030   USC ASP BREAST ADD                 396.25           18             SPECIALTY CLINICS
       1860022   USC ASP BREAST CYST                461.00           18             SPECIALTY CLINICS
       1860121   USC ASP THYROID CYST               327.00           18             SPECIALTY CLINICS
       1860071   USC BREAST NDL WIRE                662.00           18             SPECIALTY CLINICS
       1860089   USC BREAST NDL WIRE ADD            416.00           18             SPECIALTY CLINICS
       1860055   USC BX BREAST W IMAG               889.00           18             SPECIALTY CLINICS
       1860584   USC BX LYMPH NODE SUPER            477.00           18             SPECIALTY CLINICS
       1860105   USC BX MUSCLE                      754.00           18             SPECIALTY CLINICS
       1860592   USC BX MUSCLE                      754.00           18             SPECIALTY CLINICS



9/17/2012                                                                                                    184
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       1860139   USC BX THYROID                    324.00           18             SPECIALTY CLINICS
       1860014   USC FNA W IMAG GUIDANCE           591.00           18             SPECIALTY CLINICS
       1860543   USC PARACENT ABD INI              924.00           18             SPECIALTY CLINICS
       1860600   USC PUNCTURE DRN LESION           174.00           18             SPECIALTY CLINICS
       1860113   USC SAL INFN SONOHYSTER           734.00           18             SPECIALTY CLINICS
       1864503   VENIPUNCTURE                        9.00           18             SPECIALTY CLINICS
       1860170   XR BREAST MAMMOGRAPHY LOC         500.00           18             SPECIALTY CLINICS
       1860550   XR CAD SCRN MAMMO DIG              35.00           18             SPECIALTY CLINICS
       1869858   XR DEXA APPEN                     199.00           18             SPECIALTY CLINICS
       1869809   XR DEXA AXIAL SKELETON            350.00           18             SPECIALTY CLINICS
       1860501   XR DIAG MAMMO DIG BILAT           350.00           18             SPECIALTY CLINICS
       1860519   XR DIAG MAMMO DIG UNILAT          297.00           18             SPECIALTY CLINICS
       1860527   XR DIAG MAMMO DIG W COMP           35.00           18             SPECIALTY CLINICS
       1860147   XR GALACTOGRAM 1 DUCT             658.00           18             SPECIALTY CLINICS
       1868827   XR GALACTOGRAM MULTI              914.00           18             SPECIALTY CLINICS
       1869254   XR MAMMO BIL                      380.00           18             SPECIALTY CLINICS
       1869759   XR MAMMO UNI                      306.00           18             SPECIALTY CLINICS
       1869502   XR SCRN MAMMO                     349.00           18             SPECIALTY CLINICS
       1860493   XR SCRN MAMMO DIG BILAT           237.50           18             SPECIALTY CLINICS
       1860196   XR SIALOGRAM                      457.00           18             SPECIALTY CLINICS
       1860188   XR SPECIMEN SURGICAL              112.00           18             SPECIALTY CLINICS
       1860162   XR STEREO LOC                   1,843.00           18             SPECIALTY CLINICS
       1869908   XRC BREAST NDL WIRE               684.00           18             SPECIALTY CLINICS
       1869957   XRC BREAST NDL WIRE ADD           290.00           18             SPECIALTY CLINICS
       1860063   XRC BX BREAST VAC ASSIST        2,757.00           18             SPECIALTY CLINICS
       1860097   XRC IMAG LOC CLIP W BX            646.00           18             SPECIALTY CLINICS
       1860048   XRC INJ DUCT GALACTOGRAM          687.00           18             SPECIALTY CLINICS
       0474353   ACETIC ACID .255                   36.00           04             SUPPLIES - CS
       0457424   AMINO ACIDS 3.5% 1000ML            43.00           04             SUPPLIES - CS
       0472555   D10W 500ML LVP                     85.50           04             SUPPLIES - CS
       0472605   D51/2NS 1000ML LVP                 85.50           04             SUPPLIES - CS
       0472654   D51/4NS 1000ML LVP                 85.50           04             SUPPLIES - CS
       0472704   D5LR 1000ML LVP                    85.50           04             SUPPLIES - CS



9/17/2012                                                                                                   185
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0472753   D5NS 1000ML LVP                        85.50           04             SUPPLIES - CS
       0472803   D5W 1000ML LVP                         85.50           04             SUPPLIES - CS
       0472852   D5W 100ML IVPB                         85.50           04             SUPPLIES - CS
       0473405   D5W 100ML IVPB                         85.50           04             SUPPLIES - CS
       0474304   D5W 100ML IVPB                         85.50           04             SUPPLIES - CS
       0472902   D5W 250ML IVPB                         85.50           04             SUPPLIES - CS
       0474254   D5W 25ML IVPB                          85.50           04             SUPPLIES - CS
       0472951   D5W 500ML LVP                          85.50           04             SUPPLIES - CS
       0474205   D5W 50ML IVPB                          85.50           04             SUPPLIES - CS
       0460741   EYE IRRIG 2000CC                       52.00           04             SUPPLIES - CS
       0460782   EYE IRRIG 2000CC 1.5%GLY               28.00           04             SUPPLIES - CS
       0401133   FLEET ENEMA                             2.50           04             SUPPLIES - CS
       0406249   HEPARIN 1000 ML                       116.50           04             SUPPLIES - CS
       0406231   HEPARIN 1MU/NS500                     116.50           04             SUPPLIES - CS
       0403816   LACTATED RINGERS 1000CC                47.00           04             SUPPLIES - CS
       0473009   LACTATED RINGERS 1000LV                85.50           04             SUPPLIES - CS
       0406199   LACTATED RINGERS 500                   85.00           04             SUPPLIES - CS
       0473058   NA CL 0.9% 1000ML LVP                  85.50           04             SUPPLIES - CS
       0473108   NA CL 0.9% 250ML IVPB                  85.50           04             SUPPLIES - CS
       0474452   NA CL 0.9% 25ML IVPB                   85.50           04             SUPPLIES - CS
       0473157   NA CL 0.9% 500ML LVP                   85.50           04             SUPPLIES - CS
       0474403   NA CL 0.9% 50ML IVPB                   85.50           04             SUPPLIES - CS
       0403634   NA CL 500                              47.00           04             SUPPLIES - CS
       0403964   NA CL IRRIG 1000ML INJ                 34.00           04             SUPPLIES - CS
       0475202   NA CL IRRIG 3000ML                     26.50           04             SUPPLIES - CS
       0404954   S NSTRL ARM SUPPORT                    58.00           04             SUPPLIES - CS
       0400176   S NSTRL AUTO LANCET                    55.00           04             SUPPLIES - CS
       0400333   S NSTRL BAG, OSTOMY                    20.50           04             SUPPLIES - CS
       0402305   S NSTRL BANDAGE COHESIVE               18.00           04             SUPPLIES - CS
       0400507   S NSTRL BODY LOTION                     5.50           04             SUPPLIES - CS
       0404970   S NSTRL BUDDY STRAP                    13.00           04             SUPPLIES - CS
       0400291   S NSTRL CARAKLENZ                      72.50           04             SUPPLIES - CS
       0405340   S NSTRL CAST BRACE HINGE              704.00           04             SUPPLIES - CS



9/17/2012                                                                                                       186
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0405472   S NSTRL CAST FBR CYLINDER              566.50            04            SUPPLIES - CS
       0405449   S NSTRL CAST FBR LONG ARM              496.50            04            SUPPLIES - CS
       0405464   S NSTRL CAST FBR LONG LEG              620.50            04            SUPPLIES - CS
       0405431   S NSTRL CAST FBR SHRT ARM              372.00            04            SUPPLIES - CS
       0405456   S NSTRL CAST FBR SHRT LEG              496.50            04            SUPPLIES - CS
       0405423   S NSTRL CAST FBR THUMB SP              372.00            04            SUPPLIES - CS
       0473801   S NSTRL CAST LENG LEG PED              202.00            04            SUPPLIES - CS
       0473652   S NSTRL CAST LNG ARM ADLT              227.00            04            SUPPLIES - CS
       0473702   S NSTRL CAST LNG ARM PED               185.00            04            SUPPLIES - CS
       0405258   S NSTRL CAST LONG ARM A                317.50            04            SUPPLIES - CS
       0473751   S NSTRL CAST LONG ARM PED              278.50            04            SUPPLIES - CS
       0405274   S NSTRL CAST LONG LEG A                446.50            04            SUPPLIES - CS
       0403824   S NSTRL CAST SHOE                       18.48            04            SUPPLIES - CS
       0405266   S NSTRL CAST SHORT LEG A               344.50            04            SUPPLIES - CS
       0473850   S NSTRL CAST SHT ARM ADLT              175.00            04            SUPPLIES - CS
       0473900   S NSTRL CAST SHT ARM PED               134.00            04            SUPPLIES - CS
       0473959   S NSTRL CAST SHT LEG ADLT              216.00            04            SUPPLIES - CS
       0474007   S NSTRL CAST SHT LEG PED               150.00            04            SUPPLIES - CS
       0474155   S NSTRL CASTING 3IN FIBE                58.00            04            SUPPLIES - CS
       0474106   S NSTRL CASTING 4 IN FIB                80.00            04            SUPPLIES - CS
       0400598   S NSTRL CATHETER CONDOM                 13.00            04            SUPPLIES - CS
       0400663   S NSTRL CATHETER RECTAL                197.00            04            SUPPLIES - CS
       0405811   S NSTRL CENTRAL SERVICE                                  04            SUPPLIES - CS
       0400127   S NSTRL COMPRESSION SOCK               395.50            04            SUPPLIES - CS
       0400788   S NSTRL DRAINS PENROSE                   8.00            04            SUPPLIES - CS
       0404731   S NSTRL FEATHER LITE REA               111.00            04            SUPPLIES - CS
       0404905   S NSTRL FINGER EXT. ASSI                85.50            04            SUPPLIES - CS
       0400267   S NSTRL FLANGE 2PC CUSTO                21.00            04            SUPPLIES - CS
       0471953   S NSTRL FLANGE CONVEX CU                52.50      52.50 04            SUPPLIES - CS
       0400622   S NSTRL FOLEY CATH PLUG                  7.50            04            SUPPLIES - CS
       0400275   S NSTRL GEL, WOUND CARE                 62.50            04            SUPPLIES - CS
       0404871   S NSTRL GLOVE HYPOALLERG                43.00            04            SUPPLIES - CS
       0404806   S NSTRL HAND EXERCISER                  51.00            04            SUPPLIES - CS



9/17/2012                                                                                                        187
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0445668   S NSTRL HYPERGEL                    29.50            04            SUPPLIES - CS
       0403337   S NSTRL HYPOTHERM BLANKET          265.50            04            SUPPLIES - CS
       0404491   S NSTRL INFANT RESTRAINT           134.00            04            SUPPLIES - CS
       0404236   S NSTRL ISOLATION BAG               11.50            04            SUPPLIES - CS
       0403311   S NSTRL K-PAD BLANKET               63.00            04            SUPPLIES - CS
       0402420   S NSTRL LAMBS WOOL                  13.50            04            SUPPLIES - CS
       0400184   S NSTRL LANCETS ADULT               55.00            04            SUPPLIES - CS
       0457051   S NSTRL MICROK ANTIS WOUN          137.50            04            SUPPLIES - CS
       0404566   S NSTRL NASAL PACKING               81.50            04            SUPPLIES - CS
       0400341   S NSTRL OSTOMY BAG CLAMP            19.00            04            SUPPLIES - CS
       0402602   S NSTRL PACK PNEUMO ICN             52.50            04            SUPPLIES - CS
       0401588   S NSTRL PACKING IODOFORM            36.50            04            SUPPLIES - CS
       0404848   S NSTRL PEAK FLOW METER             92.00            04            SUPPLIES - CS
       0402032   S NSTRL PEDI DIABETES IN            56.50            04            SUPPLIES - CS
       0400382   S NSTRL PONCH POST OP DR            41.50            04            SUPPLIES - CS
       0400234   S NSTRL POUCH DRAINABLE             33.50            04            SUPPLIES - CS
       0472001   S NSTRL POUCH DRAINABLE             28.00      28.00 04            SUPPLIES - CS
       0402412   S NSTRL POUCH UROSTOMY D            53.00            04            SUPPLIES - CS
       0405548   S NSTRL PR HEEL PROTECTOR          168.00            04            SUPPLIES - CS
       0404855   S NSTRL PUTTY                       36.00            04            SUPPLIES - CS
       0405076   S NSTRL REACHER XL                 159.00            04            SUPPLIES - CS
       0401661   S NSTRL REFILL KIT RIBAV           122.00            04            SUPPLIES - CS
       0474551   S NSTRL SHEATH REMOVAL B           435.00            04            SUPPLIES - CS
       0400325   S NSTRL SKIN BOND CEMENT           152.50            04            SUPPLIES - CS
       0405381   S NSTRL SPLINT FBR LNGARM          218.50            04            SUPPLIES - CS
       0405407   S NSTRL SPLINT FBR LNGLEG          276.50            04            SUPPLIES - CS
       0405399   S NSTRL SPLINT FBR SHT LG          247.50            04            SUPPLIES - CS
       0405373   S NSTRL SPLINT FBR SHTARM          189.50            04            SUPPLIES - CS
       0403782   S NSTRL TRAY SCRUB                  57.00            04            SUPPLIES - CS
       0463380   S NSTRL TRIPLE CARE CLEA            28.00            04            SUPPLIES - CS
       0463422   S NSTRL TRIPLE CARE CREAM           43.00            04            SUPPLIES - CS
       0402487   S NSTRL WIRE CUTTER                 37.50            04            SUPPLIES - CS
       0401539   S O2 CO2 DETECTOR                  152.50            04            SUPPLIES - CS



9/17/2012                                                                                                    188
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0404673   S ORTHO AIR/WALKER                271.00           04             SUPPLIES - CS
       0404384   S ORTHO AIRGEL ANKLE BRA          123.00           04             SUPPLIES - CS
       0457549   S ORTHO ALUM SPL 1X18 18           25.00           04             SUPPLIES - CS
       0401687   S ORTHO BELT RIB                   73.50           04             SUPPLIES - CS
       0402354   S ORTHO BIO-BOOT & LINER          146.50           04             SUPPLIES - CS
       0403865   S ORTHO CLAVICLE BRACE M           44.50           04             SUPPLIES - CS
       0403840   S ORTHO CLIPPER BLADE              40.50           04             SUPPLIES - CS
       0403873   S ORTHO COLLAR STOFF NEC           89.00           04             SUPPLIES - CS
       0403857   S ORTHO COLLAR, CERVICAL           48.00           04             SUPPLIES - CS
       0473306   S ORTHO CORSET LUMBAR FE          268.50           04             SUPPLIES - CS
       0473256   S ORTHO CORSET LUMBAR MA          256.50           04             SUPPLIES - CS
       0404269   S ORTHO CUSTOM BRACE/PRO                           04             SUPPLIES - CS
       0404780   S ORTHO DORSIFLEX SPLINT          242.50           04             SUPPLIES - CS
       0404798   S ORTHO HANDSPLINT                136.50           04             SUPPLIES - CS
       0405654   S ORTHO HANDSPLINT                136.50           04             SUPPLIES - CS
       0445585   S ORTHO HINGED KNEE BRAC          439.00           04             SUPPLIES - CS
       0405522   S ORTHO HIPSPICA ONE&HALF       1,153.00           04             SUPPLIES - CS
       0401372   S ORTHO HOSE TED KNEE HI           79.50           04             SUPPLIES - CS
       0401380   S ORTHO HOSE TED THIGH H           97.00           04             SUPPLIES - CS
       0405415   S ORTHO KNEE BRACE HINGE          293.00           04             SUPPLIES - CS
       0404830   S ORTHO MOLDED HAND SPLI          170.50           04             SUPPLIES - CS
       0401760   S ORTHO POST OP SHOES              92.00           04             SUPPLIES - CS
       0403923   S ORTHO SHOULDER IMMOBLZR          80.00           04             SUPPLIES - CS
       0401786   S ORTHO SLING, UNIVERSAL           42.50           04             SUPPLIES - CS
       0401810   S ORTHO SPLINT ALUM FING           52.00           04             SUPPLIES - CS
       0403915   S ORTHO SPLINT COCKUP              42.50           04             SUPPLIES - CS
       0401828   S ORTHO SPLINT CUTTER              26.00           04             SUPPLIES - CS
       0405084   S ORTHO SPLINT STRAP               43.50           04             SUPPLIES - CS
       0401851   S ORTHO SPLINT, COLLES             68.50           04             SUPPLIES - CS
       0403899   S ORTHO SPLINT, UNIVERSAL         439.00           04             SUPPLIES - CS
       0401836   S ORTHO SPLINTS FROG               56.00           04             SUPPLIES - CS
       0401844   S ORTHO SPLINTS NOSE               56.00           04             SUPPLIES - CS
       0402545   S ORTHO SUPPORT-SAC-LUMB          122.00           04             SUPPLIES - CS



9/17/2012                                                                                                   189
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0403907   S ORTHO URETH SOUNDS                    51.00           04             SUPPLIES - CS
       0400366   S PR OSTOMY BELT                        32.50           04             SUPPLIES - CS
       0463869   S SRG DRS XERPFORM GAUZE                 9.00           04             SUPPLIES - CS
       0474858   S STRL 1A BP CATH 10F 50             2,526.50           04             SUPPLIES - CS
       0474601   S STRL ADAPTOR POSITIVE                 29.00           04             SUPPLIES - CS
       0404657   S STRL AIRWAY EXCHG CATH               189.00           04             SUPPLIES - CS
       0405977   S STRL ALLEVYN HYDRO 4X4                25.00           04             SUPPLIES - CS
       0406181   S STRL ALVN SACRUM 7 X 7                50.00           04             SUPPLIES - CS
       0405134   S STRL ANGIO 12 G                       62.50           04             SUPPLIES - CS
       0401505   S STRL ARTERIAL MONITOR                188.00           04             SUPPLIES - CS
       0406355   S STRL BAG CPAP INF                    296.50           04             SUPPLIES - CS
       0404186   S STRL BIFUSE INFUSION S                45.50           04             SUPPLIES - CS
       0401299   S STRL BIOPSY FORCEP                   192.00           04             SUPPLIES - CS
       0402313   S STRL BIOPSY INSTRUMENT               208.50           04             SUPPLIES - CS
       0405704   S STRL BIOPSY SYSTEM                   227.50           04             SUPPLIES - CS
       0405993   S STRL BLN DILATE NONVSC             2,303.50           04             SUPPLIES - CS
       0406173   S STRL BNDG PROFORE LITE                53.50           04             SUPPLIES - CS
       0406165   S STRL BNDG VISCOPASTE                  50.00           04             SUPPLIES - CS
       0404202   S STRL BOLT ADAPTER                    221.50           04             SUPPLIES - CS
       0402834   S STRL BONE MARROW BIOPS               317.50           04             SUPPLIES - CS
       0406454   S STRL BOWEL CATH KIT                1,166.50           04             SUPPLIES - CS
       0406462   S STRL BOWEL COL BAG                    46.50           04             SUPPLIES - CS
       0406157   S STRL BROVIAC REPAIR KIT              408.00           04             SUPPLIES - CS
       0445627   S STRL BUCKS TRACTION SP               102.50           04             SUPPLIES - CS
       0403428   S STRL BUTTERFLY H-L                    12.00           04             SUPPLIES - CS
       0406314   S STRL CAN NASAL 7IN                    32.50           04             SUPPLIES - CS
       0406330   S STRL CAN NASAL NEONTL                 32.50           04             SUPPLIES - CS
       0406322   S STRL CAN NASAL PEDI                   32.50           04             SUPPLIES - CS
       0464222   S STRL CARDIAC PACING TR               246.00           04             SUPPLIES - CS
       0404608   S STRL CATH & G SUC KIT                 13.00           04             SUPPLIES - CS
       0404483   S STRL CATH & SLEEVE SGL                 9.50           04             SUPPLIES - CS
       0403493   S STRL CATH ANGIO                       21.00           04             SUPPLIES - CS
       0401950   S STRL CATH ARGYLE                      13.00           04             SUPPLIES - CS



9/17/2012                                                                                                        190
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0401968   S STRL CATH ARGYLE PK/10                55.00           04             SUPPLIES - CS
       0406140   S STRL CATH BROVIAC 2.7                385.50           04             SUPPLIES - CS
       0406132   S STRL CATH BROVIAC 4.2                539.50           04             SUPPLIES - CS
       0471706   S STRL CATH GROSHONG 18G               553.00           04             SUPPLIES - CS
       0471755   S STRL CATH GROSHONG 20G               560.50           04             SUPPLIES - CS
       0471656   S STRL CATH GROSHONG DUA               720.50           04             SUPPLIES - CS
       0406215   S STRL CATH MAC MULT ACCS              321.50           04             SUPPLIES - CS
       0400630   S STRL CATH MALECOTT                    69.50           04             SUPPLIES - CS
       0400697   S STRL CATH N SLEEVE - 6                78.00           04             SUPPLIES - CS
       0400705   S STRL CATH N SLEEVE - B               429.50           04             SUPPLIES - CS
       0400580   S STRL CATH PERIDIAL                   122.00           04             SUPPLIES - CS
       0400671   S STRL CATH RECT BALLOON               137.00           04             SUPPLIES - CS
       0470757   S STRL CATH TRAY DUAL LU               489.00           04             SUPPLIES - CS
       0406223   S STRL CATH UMB DLMN5-3.5              155.00           04             SUPPLIES - CS
       0403055   S STRL CATH, PERICARDIAL               121.50           04             SUPPLIES - CS
       0402552   S STRL CATH, THERMODILUT               468.00           04             SUPPLIES - CS
       0402156   S STRL CATH, UMBILICAL 3                82.00           04             SUPPLIES - CS
       0402149   S STRL CATH, UMBILICAL 5                68.50           04             SUPPLIES - CS
       0400655   S STRL CATH, WORD                      110.00           04             SUPPLIES - CS
       0459107   S STRL CATH,URETH BALLOO               265.00           04             SUPPLIES - CS
       0400689   S STRL CATHETER SILASTIC                78.50           04             SUPPLIES - CS
       0459065   S STRL CATHETER TUBE HOL                44.50           04             SUPPLIES - CS
       0475350   S STRL CATHETER URINARY                 60.50           04             SUPPLIES - CS
       0475400   S STRL CATHETER URINE 3.5               60.50           04             SUPPLIES - CS
       0474056   S STRL CAUTERY BOVIE                    80.00           04             SUPPLIES - CS
       0405019   S STRL CAVITY DRAINING K               539.50           04             SUPPLIES - CS
       0404160   S STRL CHEST TUBE SET                  349.00           04             SUPPLIES - CS
       0400168   S STRL CLEFT PALATE NURS                76.00           04             SUPPLIES - CS
       0403832   S STRL CLICK LOCK                       51.00           04             SUPPLIES - CS
       0459180   S STRL COMFEEL 4X4                      28.00           04             SUPPLIES - CS
       0459222   S STRL COMFEEL 6X6                      53.50           04             SUPPLIES - CS
       0459263   S STRL COMFEEL 8X8                      81.50           04             SUPPLIES - CS
       0406405   S STRL CONN O2 SUPPLY                   38.00           04             SUPPLIES - CS



9/17/2012                                                                                                        191
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0404301   S STRL COUDE FOLEY                 124.50            04            SUPPLIES - CS
       0405142   S STRL CPM SET                     116.50            04            SUPPLIES - CS
       0456921   S STRL CRANIAL ACCESS KI         1,036.50            04            SUPPLIES - CS
       0476002   S STRL CRICOTHYROTOMY CA           202.50            04            SUPPLIES - CS
       0405803   S STRL CRITCORE FOLEY              157.00            04            SUPPLIES - CS
       0402735   S STRL CVP CATH KIT                190.00            04            SUPPLIES - CS
       0464727   S STRL CYSTO SET                    30.00            04            SUPPLIES - CS
       0402560   S STRL DEFIB PAD                    66.50            04            SUPPLIES - CS
       0457002   S STRL DERMABOND ADHESIV            87.50            04            SUPPLIES - CS
       0401026   S STRL DIALYSIS CATHETER           450.00            04            SUPPLIES - CS
       0471805   S STRL DISP RESUS BAG              206.50            04            SUPPLIES - CS
       0404111   S STRL DISP. BIOPSY FORC           425.00            04            SUPPLIES - CS
       0404418   S STRL DISPOSABLE PAD              122.00            04            SUPPLIES - CS
       0400648   S STRL DRAINAGE                    122.00            04            SUPPLIES - CS
       0402537   S STRL DRAINAGE                    178.00            04            SUPPLIES - CS
       0406090   S STRL DRESG WND OAS 7X20          553.50            04            SUPPLIES - CS
       0404541   S STRL DRESSING NV-GEL              50.00            04            SUPPLIES - CS
       0472068   S STRL DRESSING PR PRISMA           38.48            04            SUPPLIES - CS
       0470856   S STRL DRESSING ROUND 6             65.00      65.00 04            SUPPLIES - CS
       0471201   S STRL DRESSING THIN 4X4            76.00      76.00 04            SUPPLIES - CS
       0470906   S STRL DRESSING TRIAD 6O            76.00      76.00 04            SUPPLIES - CS
       0406447   S STRL DRESSING X CELL              46.50            04            SUPPLIES - CS
       0400853   S STRL DRESSING XEROFORM            14.00            04            SUPPLIES - CS
       0400861   S STRL DRESSING XEROFORM            14.00            04            SUPPLIES - CS
       0406116   S STRL DRSG ACTICOAT 4X5            25.00            04            SUPPLIES - CS
       0406421   S STRL DRSG AQUACEL AG              48.00            04            SUPPLIES - CS
       0405886   S STRL DRSG BIOPATCH                25.00            04            SUPPLIES - CS
       0405852   S STRL DRSG CALCIUM ROPE            25.00            04            SUPPLIES - CS
       0405985   S STRL DRSG COURSITE 4X4             7.50            04            SUPPLIES - CS
       0406082   S STRL DRSG COURSITE 6X6             7.50            04            SUPPLIES - CS
       0472050   S STRL DRSG LYOFOAM POLUR           35.50            04            SUPPLIES - CS
       0405951   S STRL DRSG MEPILEX 4X4             25.00            04            SUPPLIES - CS
       0405969   S STRL DRSG MEPTEL 3X4              25.00            04            SUPPLIES - CS



9/17/2012                                                                                                    192
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0406108   S STRL DRSG SFT - FOAM              50.00           04             SUPPLIES - CS
       0405894   S STRL DRSG TEGASORB 3X3            25.00           04             SUPPLIES - CS
       0405845   S STRL DRSG TEGASORB 4X6            50.00           04             SUPPLIES - CS
       0406124   S STRL DRSG WND OASI 7X20          553.50           04             SUPPLIES - CS
       0406074   S STRL DRSG WND OASIS 3X7          184.00           04             SUPPLIES - CS
       0406207   S STRL DRSG WND OASIS7X20          553.50           04             SUPPLIES - CS
       0400820   S STRL DRSNG VASELINE 1/            23.00           04             SUPPLIES - CS
       0400838   S STRL DRSNG VASELINE 1X            14.50           04             SUPPLIES - CS
       0400846   S STRL DRSNG VASELINE 3X            15.50           04             SUPPLIES - CS
       0405159   S STRL DUAL BRST PUMP KT           160.00           04             SUPPLIES - CS
       0404095   S STRL DUAL LUMEN IUPC             213.50           04             SUPPLIES - CS
       0445635   S STRL DUAL LUMEN PICC L           482.00           04             SUPPLIES - CS
       0400978   S STRL DUODERM                      36.50           04             SUPPLIES - CS
       0401984   S STRL ELECTRODE, SPINAL            47.00           04             SUPPLIES - CS
       0471854   S STRL ENDO TRACH TUBE              87.50           04             SUPPLIES - CS
       0401125   S STRL ENEMA OIL RETENT              2.50           04             SUPPLIES - CS
       0475608   S STRL EPIDURAL KIT - FL           140.50           04             SUPPLIES - CS
       0403154   S STRL EXCHANGE TRANSFUS           200.00           04             SUPPLIES - CS
       0405597   S STRL FEMALE CATH KIT              30.00           04             SUPPLIES - CS
       0404988   S STRL FEMORAL ART LINE            179.50           04             SUPPLIES - CS
       0405191   S STRL FEMOSTOP                    409.50           04             SUPPLIES - CS
       0405670   S STRL FEMOSTOP                    409.50           04             SUPPLIES - CS
       0402826   S STRL FETAL SAMPLING KI            97.00           04             SUPPLIES - CS
       0405118   S STRL FLEXI SENSOR                 15.00           04             SUPPLIES - CS
       0404640   S STRL FLEXILIGHT                  160.00           04             SUPPLIES - CS
       0475103   S STRL FLOW DIR PACING C           475.50           04             SUPPLIES - CS
       0400077   S STRL FLUID DRAPE                  79.00           04             SUPPLIES - CS
       0460188   S STRL FORCEPS, DISPOSAB            94.00           04             SUPPLIES - CS
       0406009   S STRL GASTMY REPL BUTTON          685.50           04             SUPPLIES - CS
       0401414   S STRL GASTRIC LAVAGE KI           225.00           04             SUPPLIES - CS
       0402578   S STRL GASTRIC LAVAGE TU           116.50           04             SUPPLIES - CS
       0404277   S STRL GASTROSTOMY KIT           1,212.00           04             SUPPLIES - CS
       0403352   S STRL GROSHONG REPAIR K           234.50           04             SUPPLIES - CS



9/17/2012                                                                                                    193
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0402669   S STRL HAND DRILL                  298.50           04             SUPPLIES - CS
       0404996   S STRL HD/PRITNL SHRT TRM          256.00           04             SUPPLIES - CS
       0402677   S STRL HEIMLICH VALVE               78.00           04             SUPPLIES - CS
       0402685   S STRL HEIMLICH VALVE CO            47.00           04             SUPPLIES - CS
       0404178   S STRL HOHN CATH                   216.00           04             SUPPLIES - CS
       0401398   S STRL HOT ICE BLANKET             298.00           04             SUPPLIES - CS
       0404442   S STRL HYDRO GEL DRESSIN            26.00           04             SUPPLIES - CS
       0403329   S STRL HYPOTHERMIA PROBE            62.50           04             SUPPLIES - CS
       0403360   S STRL ICP MONITOR KIT           1,757.00           04             SUPPLIES - CS
       0456939   S STRL INCENTIVE SPIROME            72.00           04             SUPPLIES - CS
       0402644   S STRL INFANT NURSING PA            14.50           04             SUPPLIES - CS
       0400143   S STRL INFSN NOHEMODIALYS          155.00           04             SUPPLIES - CS
       0403444   S STRL INTRACATH                    13.00           04             SUPPLIES - CS
       0405936   S STRL INTRD MIC PUNC 5FR          120.00           04             SUPPLIES - CS
       0402461   S STRL INTRODUCER                   97.00           04             SUPPLIES - CS
       0402743   S STRL INTRODUCER KIT              377.50           04             SUPPLIES - CS
       0404624   S STRL INTUBATION AIRWAY             9.50           04             SUPPLIES - CS
       0404152   S STRL IUPC                        176.50           04             SUPPLIES - CS
       0403436   S STRL IV BUTTERFLY                  7.50           04             SUPPLIES - CS
       0460980   S STRL IV PF 100ML MACL             58.00           04             SUPPLIES - CS
       0460949   S STRL IV PF100CC W/5%DE            58.00           04             SUPPLIES - CS
       0403394   S STRL IV SET                       29.00           04             SUPPLIES - CS
       0403378   S STRL IV SET BLOOD                 17.50           04             SUPPLIES - CS
       0404632   S STRL LARYNGEAL MASK AI           329.00           04             SUPPLIES - CS
       0404574   S STRL LEAD WIRE SET                28.50           04             SUPPLIES - CS
       0404533   S STRL LEG BAG - EXT TUB            38.00           04             SUPPLIES - CS
       0400408   S STRL LEG URINE BAG                68.00           04             SUPPLIES - CS
       0405746   S STRL LEVEL 1 BLOOD FIL           114.00           04             SUPPLIES - CS
       0405787   S STRL LEVEL 1 PREFILTER            55.00           04             SUPPLIES - CS
       0401521   S STRL MANIFOLD KIT                171.50           04             SUPPLIES - CS
       0403196   S STRL MANOMETER TRAY               43.50           04             SUPPLIES - CS
       0406413   S STRL MASK NONREBRWVENT            32.50           04             SUPPLIES - CS
       0406389   S STRL MASK O2 #1                   37.50           04             SUPPLIES - CS



9/17/2012                                                                                                    194
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0406371   S STRL MASK O2 #2                      37.50           04             SUPPLIES - CS
       0406348   S STRL MASK O2 DISP                    36.50           04             SUPPLIES - CS
       0406397   S STRL MASK O2 PEDI                    37.50           04             SUPPLIES - CS
       0400721   S STRL MASK POCKET                     62.50           04             SUPPLIES - CS
       0402867   S STRL MECONIUM ASPIRATO               20.50           04             SUPPLIES - CS
       0406439   S STRL MICRINTRD KIT                  142.00           04             SUPPLIES - CS
       0404335   S STRL MICRO BURET SET                 60.00           04             SUPPLIES - CS
       0404319   S STRL MICRO CASSETTE                 143.50           04             SUPPLIES - CS
       0404525   S STRL MULTI FLOW ADAPTE               21.50           04             SUPPLIES - CS
       0401513   S STRL NASOSTAT                       214.50           04             SUPPLIES - CS
       0403253   S STRL NEEDLE                          68.00           04             SUPPLIES - CS
       0402453   S STRL NEEDLE ANESTHESIA               81.50           04             SUPPLIES - CS
       0401471   S STRL NEEDLE JAM SHIDI                97.00           04             SUPPLIES - CS
       0402446   S STRL NEEDLE, COOK                    84.00           04             SUPPLIES - CS
       0403261   S STRL NEEDLE, INTRODUCE               73.00           04             SUPPLIES - CS
       0401869   S STRL NEEDLE, SPINAL                  45.50           04             SUPPLIES - CS
       0402321   S STRL NEEDLE, TRUCUT                 149.00           04             SUPPLIES - CS
       0401778   S STRL NORMAL SALINE IRR               18.00           04             SUPPLIES - CS
       0404285   S STRL NP TUBE PEDI                    59.00           04             SUPPLIES - CS
       0457101   S STRL NSL AN PK/CAU UNI              279.00           04             SUPPLIES - CS
       0402636   S STRL NURSING KIT, INFA               95.50           04             SUPPLIES - CS
       0406363   S STRL OXISNSR NEONATAL               109.50           04             SUPPLIES - CS
       0404244   S STRL PACING ELECTRODE               268.50           04             SUPPLIES - CS
       0402438   S STRL PACING PAD                     241.50           04             SUPPLIES - CS
       0404558   S STRL PACKING GAUZE 2 I               61.50           04             SUPPLIES - CS
       0404467   S STRL PACKING STRIP GEL               51.50           04             SUPPLIES - CS
       0403014   S STRL PARACENTESIS TRAY               79.50           04             SUPPLIES - CS
       0446708   S STRL PEDI CVP CATH KIT              166.50           04             SUPPLIES - CS
       0442608   S STRL PEDI MULTI LUMEN               261.50           04             SUPPLIES - CS
       0442657   S STRL PEDI TWO LUMEN CA              194.00           04             SUPPLIES - CS
       0405167   S STRL PERICARDIO SET                 215.50           04             SUPPLIES - CS
       0404210   S STRL PERMA CATH                     522.50           04             SUPPLIES - CS
       0404434   S STRL PERMACATH INTRODU              304.50           04             SUPPLIES - CS



9/17/2012                                                                                                       195
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0475152   S STRL PIGTL URET STENT                584.50           04             SUPPLIES - CS
       0402594   S STRL PLEUR E VAC                     628.50           04             SUPPLIES - CS
       0400739   S STRL PORT-A-CATH                      42.00           04             SUPPLIES - CS
       0405209   S STRL POWER PICC 5 FR SL              808.00           04             SUPPLIES - CS
       0405514   S STRL POWER PICC 5 FR TL              808.00           04             SUPPLIES - CS
       0405217   S STRL POWER PICC 6 FR DL              808.00           04             SUPPLIES - CS
       0406272   S STRL PRISMA ADAPTOR                   25.00           04             SUPPLIES - CS
       0406280   S STRL PRISMA BAG                       25.00           04             SUPPLIES - CS
       0406306   S STRL PRISMA BGK 2/0                  101.00           04             SUPPLIES - CS
       0406298   S STRL PRISMA BK 03.5                  101.00           04             SUPPLIES - CS
       0406264   S STRL PRISMA DILUTIONSET              728.00           04             SUPPLIES - CS
       0404459   S STRL PUMP TUBING - BLO                72.50           04             SUPPLIES - CS
       0403477   S STRL RADIAL ARTERY CAT                64.50           04             SUPPLIES - CS
       0405761   S STRL REPAIR KIT PICC                  59.00           04             SUPPLIES - CS
       0404616   S STRL RETROGRADE INTUB                305.00           04             SUPPLIES - CS
       0405035   S STRL SCLERO NEEDLE                   500.50           04             SUPPLIES - CS
       0475954   S STRL SEASORB 4 X 4 DRE                26.50           04             SUPPLIES - CS
       0475053   S STRL SEASORB FILLER                   26.50           04             SUPPLIES - CS
       0400317   S STRL SET IRRIGATION OS               161.00           04             SUPPLIES - CS
       0403030   S STRL SET PERIDIAL                     23.00           04             SUPPLIES - CS
       0402610   S STRL SET PNEUMO ER                   591.00           04             SUPPLIES - CS
       0402131   S STRL SET URINARY DRAIN                74.00           04             SUPPLIES - CS
       0403519   S STRL SET, BLOOD DONOR                 16.50           04             SUPPLIES - CS
       0400416   S STRL SET, BLOOD PUMP                 103.50           04             SUPPLIES - CS
       0405241   S STRL SHORT ARM CAST A                255.00           04             SUPPLIES - CS
       0452227   S STRL SIGMOIDOSCOPE, DI                28.00           04             SUPPLIES - CS
       0405530   S STRL SITE GUIDE PWR PIC               43.00           04             SUPPLIES - CS
       0401901   S STRL SKIN CLOSURE                     21.50           04             SUPPLIES - CS
       0404376   S STRL SKIN STAPLER                     56.00           04             SUPPLIES - CS
       0404509   S STRL SPROTTE SPINAL NE               121.00           04             SUPPLIES - CS
       0406017   S STRL SRSG ALLEVYN 8X8                 63.00           04             SUPPLIES - CS
       0406025   S STRL SRSG CLC ALGIN 4X4               25.00           04             SUPPLIES - CS
       0403600   S STRL STOPCOCK K 73                    21.00           04             SUPPLIES - CS



9/17/2012                                                                                                        196
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0402511   S STRL SUCTION LINER                67.50           04             SUPPLIES - CS
       0402529   S STRL SUMP DRAIN FILTER            47.00           04             SUPPLIES - CS
       0403972   S STRL SURGICEL VIAL 2X3           111.00           04             SUPPLIES - CS
       0403980   S STRL SURGICEL VIAL 4X8           194.00           04             SUPPLIES - CS
       0401364   S STRL SURGIGATOR TIP               79.00           04             SUPPLIES - CS
       0404004   S STRL SUTURE, SILK                 42.00           04             SUPPLIES - CS
       0475756   S STRL SWAN GANZ SVO2 PA           877.00           04             SUPPLIES - CS
       0464545   S STRL SWAN-GANZ INSERTI         1,713.00           04             SUPPLIES - CS
       0405902   S STRL TEGASORB HYDRO SAC           50.00           04             SUPPLIES - CS
       0402065   S STRL THERAPEUTIC LENS            159.00           04             SUPPLIES - CS
       0406256   S STRL TL 7F 20CM IMPREG           453.50           04             SUPPLIES - CS
       0404822   S STRL T-MOUNT                     132.00           04             SUPPLIES - CS
       0405910   S STRL TRACH INTRD TRAY          1,064.50           04             SUPPLIES - CS
       0404350   S STRL TRACH TUBE NEO              186.50           04             SUPPLIES - CS
       0404681   S STRL TRANS BRONCHIAL A           280.50           04             SUPPLIES - CS
       0402917   S STRL TRAY ADULT CUTDOW           204.00           04             SUPPLIES - CS
       0402107   S STRL TRAY CATH WITH FO           124.50           04             SUPPLIES - CS
       0402883   S STRL TRAY CRYCOTHYROTO            87.00           04             SUPPLIES - CS
       0402941   S STRL TRAY EPISTAXIS              238.50           04             SUPPLIES - CS
       0404061   S STRL TRAY GROSHONG CAT         1,186.50           04             SUPPLIES - CS
       0403162   S STRL TRAY LUMBAR PUNCT           158.00           04             SUPPLIES - CS
       0402859   S STRL TRAY MYRINGOTOMY             59.00           04             SUPPLIES - CS
       0402842   S STRL TRAY NASAL FX               109.00           04             SUPPLIES - CS
       0403188   S STRL TRAY PARA BLOCK              97.50           04             SUPPLIES - CS
       0405928   S STRL TRAY PERICARDIOCEN          564.00           04             SUPPLIES - CS
       0403048   S STRL TRAY PER-Q-CATH             318.00           04             SUPPLIES - CS
       0401976   S STRL TRAY SPINAL ANEST            74.50           04             SUPPLIES - CS
       0403063   S STRL TRAY THORACENTESI           298.50           04             SUPPLIES - CS
       0474700   S STRL TRAY UMBILICAL DI           242.00           04             SUPPLIES - CS
       0463208   S STRL TRCH INTRD TRAY           1,068.50           04             SUPPLIES - CS
       0401018   S STRL TRIPLE LUMEN CATH           181.50           04             SUPPLIES - CS
       0405878   S STRL TRNSLML ANGI NOLSR          453.50           04             SUPPLIES - CS
       0401182   S STRL TUBE FEEDING 6 PA            25.00           04             SUPPLIES - CS



9/17/2012                                                                                                    197
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0401190   S STRL TUBE FEEDING 6 PA               25.00           04             SUPPLIES - CS
       0401174   S STRL TUBE FEEDING SING                7.50           04             SUPPLIES - CS
       0406066   S STRL TUBE GASTMY MOSS               749.50           04             SUPPLIES - CS
       0402206   S STRL TUBE KEO-FEED                  104.00           04             SUPPLIES - CS
       0402990   S STRL TUBE MINNESOTA                 700.50           04             SUPPLIES - CS
       0402081   S STRL TUBE RECT- HARRIS               38.50           04             SUPPLIES - CS
       0403089   S STRL TUBE TRACHEOSTOMY              112.00           04             SUPPLIES - CS
       0402875   S STRL TUBE, BLAKEMORE                460.00           04             SUPPLIES - CS
       0402214   S STRL TUBE, CANTOR                   104.00           04             SUPPLIES - CS
       0400762   S STRL TUBE, CHEST                    194.50           04             SUPPLIES - CS
       0400754   S STRL TUBE, CHEST TROCA              117.00           04             SUPPLIES - CS
       0402222   S STRL TUBE, SALEM SUMP                42.00           04             SUPPLIES - CS
       0400515   S STRL URETERAL                       141.50           04             SUPPLIES - CS
       0400523   S STRL URETERAL                       221.00           04             SUPPLIES - CS
       0400549   S STRL URETERAL                       141.50           04             SUPPLIES - CS
       0400556   S STRL URETERAL                        69.50           04             SUPPLIES - CS
       0400564   S STRL URETERAL                       119.50           04             SUPPLIES - CS
       0400572   S STRL URETERAL                        50.00           04             SUPPLIES - CS
       0400606   S STRL URETERAL                       114.00           04             SUPPLIES - CS
       0400614   S STRL URETERAL                         7.50           04             SUPPLIES - CS
       0402123   S STRL URIMETER                        68.00           04             SUPPLIES - CS
       0402115   S STRL URIMETER W/FOLEY               210.00           04             SUPPLIES - CS
       0405860   S STRL URINE BAG PEDI                 103.50           04             SUPPLIES - CS
       0402818   S STRL VACUUM EXTRACTOR               125.50           04             SUPPLIES - CS
       0403451   S STRL VENT DRAIN BAG                  61.00           04             SUPPLIES - CS
       0403469   S STRL VENT DRAIN SET                 382.00           04             SUPPLIES - CS
       0403204   S STRL VESSEL DILATOR                  54.00           04             SUPPLIES - CS
       0404939   S STRL VRE KIT                         49.50           04             SUPPLIES - CS
       0405100   S STRL WARMING BLANKET                141.50           04             SUPPLIES - CS
       0402479   S STRL WIRE GUIDE                     119.50           04             SUPPLIES - CS
       0406058   S STRL WND CLNSR DERMAL                50.00           04             SUPPLIES - CS
       0400242   S STRL WOULD DRAINAGE CO               78.50           04             SUPPLIES - CS
       0405944   S STRL WOUND VAC SPONGE               163.50           04             SUPPLIES - CS



9/17/2012                                                                                                       198
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       0475301   S STRL WOUND VACUM CANIS               147.50           04             SUPPLIES - CS
       0475251   WATER IRRIG 3000ML                      26.50           04             SUPPLIES - CS
       0401034   WATER IRRIGATING                        18.00           04             SUPPLIES - CS
       2621266   CS SAME MD ADD 15M                     150.00           26             SURGICAL SERVICES - OP
       2621258   CS SAME MD GT5YR 0-30M                 350.00           26             SURGICAL SERVICES - OP
       2621274   CS SAME MD LT5YR 0-30M                 350.00           26             SURGICAL SERVICES - OP
       2630101   CYST/URETSCP/PYLSCP LITHO            3,897.00           26             SURGICAL SERVICES - OP
       2621316   DESTRUCT NRV C/T 1 LVL               1,993.00           26             SURGICAL SERVICES - OP
       2621324   DESTRUCT NRV C/T ADDL LV             1,160.00           26             SURGICAL SERVICES - OP
       2621100   DESTRUCT NRV L/S                     1,948.00           26             SURGICAL SERVICES - OP
       2621159   DESTRUCT NRV L/S ADDL LVL            1,779.00           26             SURGICAL SERVICES - OP
       2622256   DESTRUCT NRV PERIPH                  1,993.00           26             SURGICAL SERVICES - OP
       2621209   IMPLANT/REV CATH MED ADM               351.00           26             SURGICAL SERVICES - OP
       2620102   INJ BLOOD/CLOT PATCH                   244.00           26             SURGICAL SERVICES - OP
       2620250   INJ BRACHIAL PLEX SNGL                 331.00           26             SURGICAL SERVICES - OP
       2621001   INJ DISKOGRAM LUMB                     844.00           26             SURGICAL SERVICES - OP
       2620151   INJ EPID CERV THOR                     395.00           26             SURGICAL SERVICES - OP
       2620201   INJ EPIDL L/S                          380.00           26             SURGICAL SERVICES - OP
       2620607   INJ FACET C/T 1 LVL                  1,816.00           26             SURGICAL SERVICES - OP
       2620656   INJ FACET C/T ADDL LVL                 586.00           26             SURGICAL SERVICES - OP
       2620409   INJ FACET L/S 1 LVL                    613.00           26             SURGICAL SERVICES - OP
       2620458   INJ FACET L/S ADDL LVL                 533.00           26             SURGICAL SERVICES - OP
       2621050   INJ MAJOR JNT BURSA                     84.00           26             SURGICAL SERVICES - OP
       2620300   INJ NRV AXILLARY                       324.00           26             SURGICAL SERVICES - OP
       2620706   INJ NRV BLK C SPINE                    812.00           26             SURGICAL SERVICES - OP
       2620508   INJ NRV BLK L/S 1 LVL                1,981.00           26             SURGICAL SERVICES - OP
       2620557   INJ NRV BLK L/S ADDL LVL               824.00           26             SURGICAL SERVICES - OP
       2620755   INJ NRV BLK LUMB THOR                1,290.00           26             SURGICAL SERVICES - OP
       2620359   INJ NRV BLK PERIPH                     418.00           26             SURGICAL SERVICES - OP
       2620805   INJ SI JNT ANES/STRD                 2,730.00           26             SURGICAL SERVICES - OP
       2620854   INJ TRIGGER PT 1 OR 2 MCL               75.00           26             SURGICAL SERVICES - OP
       2620904   INJ TRIGGER PT GT 2 MCL                 75.00           26             SURGICAL SERVICES - OP
       2622157   IR ANALYZE NEUROSTIM CPLX            1,190.00           26             SURGICAL SERVICES - OP



9/17/2012                                                                                                        199
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2622306   IR FLOURO 1HR OR LESS                  589.50           26             SURGICAL SERVICES - OP
       2622058   IR IMP NEUROELECTRODE                7,200.00           26             SURGICAL SERVICES - OP
       2620953   IRC INJ DISKOGRAM CERV               1,336.00           26             SURGICAL SERVICES - OP
       2621514   LACTATED RINGERS 500                    72.50           26             SURGICAL SERVICES - OP
       2621506   LACTATED RINGERS 500 ML                 78.50           26             SURGICAL SERVICES - OP
       2630150   LITHO ESWL BILAT                    16,832.00           26             SURGICAL SERVICES - OP
       2630051   LITHO ESWL UNILAT                   13,414.00           26             SURGICAL SERVICES - OP
       2620367   N BLOCK INJ CERVICAL PLEX              475.00           26             SURGICAL SERVICES - OP
       2621407   NA CL 10ML PREFILLED SYR                 6.50           26             SURGICAL SERVICES - OP
       2622108   S LD NEUROSTIMULATOR                 7,000.00           26             SURGICAL SERVICES - OP
       2621522   S O2 OXYGEN                            151.50           26             SURGICAL SERVICES - OP
       2621852   S STRL CRVD DISP RF CANLA               96.00           26             SURGICAL SERVICES - OP
       2621803   S STRL CRVD TIP NDL BLUNT               49.50           26             SURGICAL SERVICES - OP
       2621555   S STRL EPIDURAL TRAY                    94.00           26             SURGICAL SERVICES - OP
       2621654   S STRL IRC DISKOGRAPHY N                67.00           26             SURGICAL SERVICES - OP
       2621605   S STRL IRC SPINAL NEEDLE                45.50           26             SURGICAL SERVICES - OP
       2621357   S STRL IV ANDIO CATH INST               21.50           26             SURGICAL SERVICES - OP
       2621753   S STRL MONOTHERM PROBE                 176.00           26             SURGICAL SERVICES - OP
       2621456   S STRL NASAL CANNULA                    31.50           26             SURGICAL SERVICES - OP
       2621951   S STRL RF POLE NEEDLE                  110.00           26             SURGICAL SERVICES - OP
       2622207   S STRL SNAP LID CABLE                  975.00           26             SURGICAL SERVICES - OP
       2621902   S STRL STRGHT DISP RF CAN               86.50           26             SURGICAL SERVICES - OP
       2621704   S STRL TOUHEY NEEDLE                    48.00           26             SURGICAL SERVICES - OP
       2621019   XR DISKOGRAM LUMB                    1,950.00           26             SURGICAL SERVICES - OP
       2363372                                                           23             SURGICAL SUPPLIES
       2364453                                                           23             SURGICAL SUPPLIES
       2381655   BSS 500 ML                              42.00           23             SURGICAL SUPPLIES
       2381606   BSS PLUS                               213.00           23             SURGICAL SUPPLIES
       2381358   D5W 1000ML                              78.50           23             SURGICAL SUPPLIES
       2381259   D5W 100ML                               78.50           23             SURGICAL SUPPLIES
       2381309   D5W 250ML                               78.50           23             SURGICAL SUPPLIES
       2322345   DRML SUB NO-MET ACT EA C             2,854.50           23             SURGICAL SUPPLIES
       2322360   DRML SUB NO-MET ACT EA C             2,079.00           23             SURGICAL SUPPLIES



9/17/2012                                                                                                        200
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2322378   DRML SUB NO-MET ACT EA C              518.00           23             SURGICAL SUPPLIES
       2322386   DRML SUB NO-MET ACT EA C              647.50           23             SURGICAL SUPPLIES
       2322394   DRML SUB NO-MET ACT EA C              647.50           23             SURGICAL SUPPLIES
       2322410   DRML SUB NO-MET ACT EA C            1,190.75           23             SURGICAL SUPPLIES
       2322428   DRML SUB NO-MET ACT EA C            1,355.75           23             SURGICAL SUPPLIES
       2322436   DRML SUB NO-MET ACT EA C            2,227.50           23             SURGICAL SUPPLIES
       2322444   DRML SUB NO-MET ACT EA C            1,864.50           23             SURGICAL SUPPLIES
       2322469   DRML SUB NO-MET ACT EA C              887.25           23             SURGICAL SUPPLIES
       2322477   DRML SUB NO-MET ACT EA C            1,402.50           23             SURGICAL SUPPLIES
       2322485   DRML SUB NO-MET ACT EA C            2,106.50           23             SURGICAL SUPPLIES
       2322493   DRML SUB NO-MET ACT EA C            2,307.25           23             SURGICAL SUPPLIES
       2322519   DRML SUB NO-MET ACT EA C            2,040.50           23             SURGICAL SUPPLIES
       2322527   DRML SUB NO-MET ACT EA C            2,824.25           23             SURGICAL SUPPLIES
       2322535   DRML SUB NO-MET ACT EA C            3,874.75           23             SURGICAL SUPPLIES
       2322543   DRML SUB NO-MET ACT EA C            3,921.50           23             SURGICAL SUPPLIES
       2322568   DRML SUB NO-MET ACT EA C            4,642.00           23             SURGICAL SUPPLIES
       2322576   DRML SUB NO-MET ACT EA C            5,021.50           23             SURGICAL SUPPLIES
       2322584   DRML SUB NO-MET ACT EA C            3,927.00           23             SURGICAL SUPPLIES
       2322592   DRML SUB NO-MET ACT EA C            4,471.50           23             SURGICAL SUPPLIES
       2322618   DRML SUB NO-MET ACT EA C            1,105.00           23             SURGICAL SUPPLIES
       2322626   DRML SUB NO-MET ACT EA C            1,702.25           23             SURGICAL SUPPLIES
       2322634   DRML SUB NO-MET ACT EA C            2,365.00           23             SURGICAL SUPPLIES
       2322642   DRML SUB NO-MET ACT EA C            2,026.75           23             SURGICAL SUPPLIES
       2322667   DRML SUB NO-MET ACT EA C            1,457.50           23             SURGICAL SUPPLIES
       2322675   DRML SUB NO-MET ACT EA C            2,288.00           23             SURGICAL SUPPLIES
       2322683   DRML SUB NO-MET ACT EA C            4,215.75           23             SURGICAL SUPPLIES
       2322691   DRML SUB NO-MET ACT EA C            4,053.50           23             SURGICAL SUPPLIES
       2322717   DRML SUB NO-MET ACT EA C            4,202.00           23             SURGICAL SUPPLIES
       2322725   DRML SUB NO-MET ACT EA C            4,216.00           23             SURGICAL SUPPLIES
       2322733   DRML SUB NO-MET ACT EA C            4,586.00           23             SURGICAL SUPPLIES
       2322741   DRML SUB NO-MET ACT EA C            5,412.00           23             SURGICAL SUPPLIES
       2322766   DRML SUB NO-MET ACT EA C            4,088.00           23             SURGICAL SUPPLIES
       2322790   DRML SUB NO-MET ACT EA C            5,976.00           23             SURGICAL SUPPLIES



9/17/2012                                                                                                       201
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2322832   DRML SUB NO-MET ACT EA C             6,428.00              23          SURGICAL SUPPLIES
       2322337   DRML SUB NO-MET ACT EA C               802.75              23          SURGICAL SUPPLIES
       2321271   GEN NRSTIM RECHG BAT SY             17,875.00              23          SURGICAL SUPPLIES
       2321339   GEN NRSTIM RECHG BAT SY             15,004.00              23          SURGICAL SUPPLIES
       2324770   GEN NRSTIM RECHG BAT SY             20,295.00              23          SURGICAL SUPPLIES
       2310670   GLYCINE 1.5% 3000                       24.50      24.50   23          SURGICAL SUPPLIES
       2321768   ILIAC EXTENDER FLARED                6,500.00              23          SURGICAL SUPPLIES
       2381457   LACTATED RINGERS 1000                    3.00              23          SURGICAL SUPPLIES
       2313831   LACTATED RINGERS 1000CC                 52.50      52.50   23          SURGICAL SUPPLIES
       2381051   LACTATED RINGERS 1000D5                 78.50              23          SURGICAL SUPPLIES
       2313435   LACTATED RINGERS 3000                   20.50      20.50   23          SURGICAL SUPPLIES
       2381408   LACTATED RINGERS 500                    78.50              23          SURGICAL SUPPLIES
       2381200   NA CL 0.45% 1000ML                      78.50              23          SURGICAL SUPPLIES
       2381150   NA CL 0.45% 500ML                       78.50              23          SURGICAL SUPPLIES
       2381101   NA CL 0.9% 1000ML D50                   78.50              23          SURGICAL SUPPLIES
       2381002   NA CL 100                               78.50              23          SURGICAL SUPPLIES
       2313351   NA CL 1000                             168.50     168.50   23          SURGICAL SUPPLIES
       2381556   NA CL 1000                               2.44              23          SURGICAL SUPPLIES
       2381507   NA CL 500                                2.16              23          SURGICAL SUPPLIES
       2313377   NA CL IRRIG 1000/1500                    5.50       5.50   23          SURGICAL SUPPLIES
       2311371   NA CL IRRIG 3000ML                      17.50      17.50   23          SURGICAL SUPPLIES
       2320745   S ADAP/EXT PCE/NEURSTM LD            1,911.25              23          SURGICAL SUPPLIES
       2320760   S ADAP/EXT PCE/NEURSTM LD              647.50              23          SURGICAL SUPPLIES
       2320778   S ADAP/EXT PCE/NEURSTM LD              942.50              23          SURGICAL SUPPLIES
       2320786   S ADAP/EXT PCE/NEURSTM LD            2,186.25              23          SURGICAL SUPPLIES
       2321297   S ADAP/EXT PCE/NEURSTM LD            1,911.25              23          SURGICAL SUPPLIES
       2328425   S ADAP/EXT PCE/NEURSTM LD            4,372.00              23          SURGICAL SUPPLIES
       2321347   S ANCHR                              4,386.25              23          SURGICAL SUPPLIES
       2329605   S ANCHR CURVTEC LG                   1,571.50              23          SURGICAL SUPPLIES
       2329704   S ANCHR CURVTEC MD                   1,498.00              23          SURGICAL SUPPLIES
       2329910   S ANCHR DART                           369.50              23          SURGICAL SUPPLIES
       2328011   S ANCHR GII ANCHOR 21031               886.40              23          SURGICAL SUPPLIES
       2328029   S ANCHR GII ANCHOR 21039               603.50              23          SURGICAL SUPPLIES



9/17/2012                                                                                                        202
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2328037   S ANCHR GII ANCHOR 21239           818.00            23            SURGICAL SUPPLIES
       2329282   S ANCHR GII QUICK                  870.40            23            SURGICAL SUPPLIES
       2321131   S ANCHR KNOTLESS                   881.50            23            SURGICAL SUPPLIES
       2328151   S ANCHR MITEK GILANCHORS           892.80            23            SURGICAL SUPPLIES
       2324663   S ANCHR PARASORB                   958.74            23            SURGICAL SUPPLIES
       2320794   S ANCHR PUSHLOC                  1,105.00            23            SURGICAL SUPPLIES
       2322139   S ANCHR RAPIDLOC                   686.00            23            SURGICAL SUPPLIES
       2321024   S ANCHR SUT LASSO                  490.00            23            SURGICAL SUPPLIES
       2323848   S ANCHR SUT SWVL                 1,153.75            23            SURGICAL SUPPLIES
       2329308   S ANCHR TAG ROD 3.7MM              576.00            23            SURGICAL SUPPLIES
       2329555   S ANCHR TAG ROD II                 350.00            23            SURGICAL SUPPLIES
       2323947   S ANCHR VERSALOK ORTHO           1,105.00            23            SURGICAL SUPPLIES
       2313021   S CATH ABLTN NOCARD ENDVS        1,993.75            23            SURGICAL SUPPLIES
       2330124   S CATH EP DX NO3D LT20           1,677.50            23            SURGICAL SUPPLIES
       2330918   S CATH GUIDING                     975.00            23            SURGICAL SUPPLIES
       2330116   S CATH GUIDING ATTAIN            1,375.00            23            SURGICAL SUPPLIES
       2313104   S CATH INTRASPINAL               1,636.25            23            SURGICAL SUPPLIES
       2313120   S CATH INTRASPINAL               1,553.75            23            SURGICAL SUPPLIES
       2312262   S CATH OCCLUSION                   880.75            23            SURGICAL SUPPLIES
       2311215   S CATH THROMB/EMBOLCTMY            115.95     115.95 23            SURGICAL SUPPLIES
       2312569   S CATH THROMB/EMBOLCTMY            227.50            23            SURGICAL SUPPLIES
       2312882   S CATH THROMB/EMBOLCTMY                              23            SURGICAL SUPPLIES
       2312221   S CATH TRNSML ANG NOLSR            992.32            23            SURGICAL SUPPLIES
       2312445   S CATH URETERAL                     87.50            23            SURGICAL SUPPLIES
       2310696   S CATH URETERAL CATH                32.72      32.72 23            SURGICAL SUPPLIES
       2312627   S CATH URETERAL WHISTLE             29.00            23            SURGICAL SUPPLIES
       2320927   S DEVICE JNT                     3,927.00            23            SURGICAL SUPPLIES
       2320935   S DEVICE JNT                     4,386.25            23            SURGICAL SUPPLIES
       2311785   S DVC RPR URN INC NOSLG            258.13            23            SURGICAL SUPPLIES
       2324697   S DVC RPR URN INCN SLNG          2,736.25            23            SURGICAL SUPPLIES
       2320430   S DVC RPR URN INCN SLNG          2,064.00            23            SURGICAL SUPPLIES
       2329167   S DVC RPR URN INCN SLNG          2,357.00            23            SURGICAL SUPPLIES
       2320141   S GEN NEUROSTIM NONRECHG         9,354.00            23            SURGICAL SUPPLIES



9/17/2012                                                                                                    203
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2320612   S GEN NEUROSTIM NONRECHG        12,314.50             23           SURGICAL SUPPLIES
       2321263   S GEN NEUROSTIM NONRECHG        13,524.50             23           SURGICAL SUPPLIES
       2321313   S GRAFT VASCULAR                 1,474.00             23           SURGICAL SUPPLIES
       2325157   S GRAFT VASCULAR                   686.00      686.00 23           SURGICAL SUPPLIES
       2326114   S GRAFT VASCULAR 10X15           1,398.50             23           SURGICAL SUPPLIES
       2321818   S GRAFT VASCULAR 50X70           2,323.75             23           SURGICAL SUPPLIES
       2321834   S GRAFT VASCULAR 5X7.5             903.50             23           SURGICAL SUPPLIES
       2324564   S GRAFT VASCULAR ADV             2,126.43             23           SURGICAL SUPPLIES
       2324572   S GRAFT VASCULAR ADV VXT         2,569.88             23           SURGICAL SUPPLIES
       2321305   S GRAFT VASCULAR BIF             2,200.00    2,200.00 23           SURGICAL SUPPLIES
       2329381   S GRAFT VASCULAR GORTEX          1,482.25             23           SURGICAL SUPPLIES
       2321826   S GRAFT VASCULAR PATCH             822.85             23           SURGICAL SUPPLIES
       2326023   S GRAFT VASCULAR RRT08030        2,612.50             23           SURGICAL SUPPLIES
       2327930   S GRAFT VASCULAR RRT70L          2,307.25             23           SURGICAL SUPPLIES
       2321842   S GRAFT VASCULAR STP             1,196.25             23           SURGICAL SUPPLIES
       2324580   S GRAFT VASCULAR ULTRA S         1,256.61             23           SURGICAL SUPPLIES
       2323210   S GRAFT VASCULAR ULTRAMA         1,522.92             23           SURGICAL SUPPLIES
       2327914   S GRAFT VASCULAR V06070L         1,476.75             23           SURGICAL SUPPLIES
       2328102   S GRAFT VASCULAR V47040L         1,100.00             23           SURGICAL SUPPLIES
       2330579   S ICD DUAL CHAMBER              27,000.00             23           SURGICAL SUPPLIES
       2329423   S IMP                            2,640.00             23           SURGICAL SUPPLIES
       2320919   S IMP ACCESSORY KIT                525.00             23           SURGICAL SUPPLIES
       2320182   S IMP DYNAGRAFT 10ML             2,846.25             23           SURGICAL SUPPLIES
       2320166   S IMP DYNAGRAFT 2.5ML              990.00             23           SURGICAL SUPPLIES
       2320174   S IMP DYNAGRAFT 5ML              1,361.25             23           SURGICAL SUPPLIES
       2323939   S IMP EX FIX HALF PIN              437.50             23           SURGICAL SUPPLIES
       2323921   S IMP EX FIX KWIRE                 437.50             23           SURGICAL SUPPLIES
       2323491   S IMP PATELLA                    1,476.78             23           SURGICAL SUPPLIES
       2321685   S IMP PUTTY 5CC                  1,988.25             23           SURGICAL SUPPLIES
       2327864   S IMP 45GIA RELOADS                681.00             23           SURGICAL SUPPLIES
       2323087   S IMP ACETABULER SHELL           3,096.28             23           SURGICAL SUPPLIES
       2323194   S IMP ACHILLES TEND FRZ          2,992.00             23           SURGICAL SUPPLIES
       2326163   S IMP ACTIVENT VENT TUBE            69.00             23           SURGICAL SUPPLIES



9/17/2012                                                                                                    204
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2323483   S IMP ADAPTER SLEEVE               914.07               23         SURGICAL SUPPLIES
       2328094   S IMP ADCON L                    1,930.50               23         SURGICAL SUPPLIES
       2328839   S IMP ALLERGAN 10L                 541.00     541.00    23         SURGICAL SUPPLIES
       2323590   S IMP APEX HOLE ELIM               598.50               23         SURGICAL SUPPLIES
       2323962   S IMP APLIGRAF                   3,743.44               23         SURGICAL SUPPLIES
       2329258   S IMP ARMSTRONG MYRIN TUB           83.20               23         SURGICAL SUPPLIES
       2323780   S IMP ART SURFACE CR             2,351.25               23         SURGICAL SUPPLIES
       2329001   S IMP ARTHROTECH ARROW           1,497.50               23         SURGICAL SUPPLIES
       2322915   S IMP ARTICULEZE HEAD            2,776.13               23         SURGICAL SUPPLIES
       2322402   S IMP ASIF PLATES-MINI             183.75     183.75    23         SURGICAL SUPPLIES
       2322303   S IMP ASIF PLATES-REG              437.50     437.50    23         SURGICAL SUPPLIES
       2323467   S IMP ASR ACET CUP               7,945.50               23         SURGICAL SUPPLIES
       2323475   S IMP ASR UNI FEMORAL            4,358.06               23         SURGICAL SUPPLIES
       2320877   S IMP BIFUR TRUNK                8,544.00               23         SURGICAL SUPPLIES
       2324036   S IMP BIOIMPLANT 4X5             4,990.00               23         SURGICAL SUPPLIES
       2324085   S IMP BIOIMPLANT 5X15            5,590.00               23         SURGICAL SUPPLIES
       2322212   S IMP BIOPLATE PLATE 2H            128.80               23         SURGICAL SUPPLIES
       2322220   S IMP BIOPLATE PLATE 4H            238.00               23         SURGICAL SUPPLIES
       2322238   S IMP BIOPLATE PLATE XY            416.50               23         SURGICAL SUPPLIES
       2323798   S IMP BIPOLAR CUP                1,281.69               23         SURGICAL SUPPLIES
       2324598   S IMP BLADE HELICAL              1,405.25               23         SURGICAL SUPPLIES
       2324713   S IMP BOLT LOCKING                 651.00               23         SURGICAL SUPPLIES
       2324952   S IMP BONE BLOCK                 2,818.75    2,818.75   23         SURGICAL SUPPLIES
       2320299   S IMP BONE CEMENT                  428.40               23         SURGICAL SUPPLIES
       2320521   S IMP BONE CEMENT                  295.20               23         SURGICAL SUPPLIES
       2320539   S IMP BONE CEMENT                1,008.00               23         SURGICAL SUPPLIES
       2320547   S IMP BONE CEMENT                1,361.25               23         SURGICAL SUPPLIES
       2321354   S IMP BONE CEMENT                  391.30     391.30    23         SURGICAL SUPPLIES
       2321677   S IMP BONE CEMENT                  612.50               23         SURGICAL SUPPLIES
       2323228   S IMP BONE CEMENT                1,235.00               23         SURGICAL SUPPLIES
       2326056   S IMP BONE CEMENT                3,135.00    3,135.00   23         SURGICAL SUPPLIES
       2327625   S IMP BONE CEMENT                1,293.50               23         SURGICAL SUPPLIES
       2327856   S IMP BONE CEMENT                1,875.00               23         SURGICAL SUPPLIES



9/17/2012                                                                                                    205
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2329720   S IMP BONE CEMENT                      333.72               23         SURGICAL SUPPLIES
       2321776   S IMP BONE CEMENT                      612.50               23         SURGICAL SUPPLIES
       2327617   S IMP BONE CEMENT KYPHON               350.00               23         SURGICAL SUPPLIES
       2323244   S IMP BONE CEMENT MATRIX               926.26               23         SURGICAL SUPPLIES
       2327641   S IMP BONE CEMENT PALACO             1,283.85               23         SURGICAL SUPPLIES
       2327633   S IMP BONE CEMENT SIMPLEX            1,157.06               23         SURGICAL SUPPLIES
       2322121   S IMP BONE CEMENT SMARTS               799.50               23         SURGICAL SUPPLIES
       2326551   S IMP BONE CHIPS-30                  1,212.75               23         SURGICAL SUPPLIES
       2326205   S IMP BONE CHIPS-60CC                2,475.00    2,475.00   23         SURGICAL SUPPLIES
       2323319   S IMP BONE GEL 5CC                   1,773.75               23         SURGICAL SUPPLIES
       2323376   S IMP BONE MATRIX                    2,915.00               23         SURGICAL SUPPLIES
       2329324   S IMP BONE PUTTY 3CC                 1,120.00               23         SURGICAL SUPPLIES
       2323145   S IMP BONE STIMULATOR                6,576.00               23         SURGICAL SUPPLIES
       2322246   S IMP BURR HOLE COVER                  525.00               23         SURGICAL SUPPLIES
       2322873   S IMP BURR HOLE COVER                  644.00               23         SURGICAL SUPPLIES
       2330033   S IMP CAP TERMINAL                     157.50               23         SURGICAL SUPPLIES
       2322816   S IMP CATH GROSHONG SNGL               844.80               23         SURGICAL SUPPLIES
       2324838   S IMP CATH PERITONEAL                  503.00               23         SURGICAL SUPPLIES
       2320414   S IMP CATHETER GROSHONG              1,152.00               23         SURGICAL SUPPLIES
       2329266   S IMP CBLEGRP 8 HOLE PLTE            2,065.00               23         SURGICAL SUPPLIES
       2325355   S IMP CEEA UNIT                        812.50     812.50    23         SURGICAL SUPPLIES
       2322840   S IMP CERV SPACER                    6,930.00               23         SURGICAL SUPPLIES
       2323509   S IMP CHROMIC SUTURES                   26.00      26.00    23         SURGICAL SUPPLIES
       2321206   S IMP CLIP HEMA                         19.00      19.00    23         SURGICAL SUPPLIES
       2320323   S IMP CLIP HEMOCLIP                     37.87               23         SURGICAL SUPPLIES
       2329340   S IMP COLLAGRAFT STRIP               2,020.50               23         SURGICAL SUPPLIES
       2323335   S IMP CONNEXUS PUTTY 10C             4,083.75               23         SURGICAL SUPPLIES
       2323327   S IMP CONNEXUS PUTTY 1CC               893.72               23         SURGICAL SUPPLIES
       2327955   S IMP CORAL BLACK 12                 3,194.00               23         SURGICAL SUPPLIES
       2327963   S IMP CORAL BLOCK 10                 3,596.00               23         SURGICAL SUPPLIES
       2321107   S IMP CSF SHUNT                      2,200.00    2,200.00   23         SURGICAL SUPPLIES
       2319226   S IMP CUT RELOAD 2.5MM                 787.00               23         SURGICAL SUPPLIES
       2319200   S IMP CUT RELOAD ARTIC                 654.67               23         SURGICAL SUPPLIES



9/17/2012                                                                                                        206
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2322956   S IMP DACRON PATCH GRAFT               315.50      315.50 23           SURGICAL SUPPLIES
       2320455   S IMP DCP PLATE                      1,140.00    1,140.00 23           SURGICAL SUPPLIES
       2322253   S IMP DISP TA55-3.5                    381.00      381.00 23           SURGICAL SUPPLIES
       2323863   S IMP DP FEM STEM                    6,559.50             23           SURGICAL SUPPLIES
       2324762   S IMP DP PEG                           262.50             23           SURGICAL SUPPLIES
       2324176   S IMP DP ROM SLEEVE                  4,382.82             23           SURGICAL SUPPLIES
       2324069   S IMP DP SCREW CANN                    861.25             23           SURGICAL SUPPLIES
       2324168   S IMP DP ULTAMET INSERT              4,919.06             23           SURGICAL SUPPLIES
       2321255   S IMP DRS SURGICEL 4X8                 189.84       32.50 23           SURGICAL SUPPLIES
       2321180   S IMP DURAL GFT MATRX 1X3            1,072.50             23           SURGICAL SUPPLIES
       2321149   S IMP DURAL GRFT MATRX3X3            1,729.75             23           SURGICAL SUPPLIES
       2324747   S IMP DURASEAL SEALANT               1,512.50             23           SURGICAL SUPPLIES
       2326502   S IMP EAS STAPLER                    1,183.50             23           SURGICAL SUPPLIES
       2360709   S IMP EBI EXT FIXATOR                6,120.50             23           SURGICAL SUPPLIES
       2360758   S IMP EBI EXT WRIST FIX              3,849.00             23           SURGICAL SUPPLIES
       2321503   S IMP EEA-25                           816.00      816.00 23           SURGICAL SUPPLIES
       2323384   S IMP END CAP                          655.06             23           SURGICAL SUPPLIES
       2324689   S IMP END CAP                          452.45             23           SURGICAL SUPPLIES
       2320588   S IMP ENDER NAIL                       984.75             23           SURGICAL SUPPLIES
       2326130   S IMP ENDO CLIP 5MM                    490.00             23           SURGICAL SUPPLIES
       2326148   S IMP ENDO CLIP ER320                  753.00             23           SURGICAL SUPPLIES
       2319903   S IMP ENDO GIA 12MM                    429.50             23           SURGICAL SUPPLIES
       2328458   S IMP ENDO GIA 30 CARTR                915.00             23           SURGICAL SUPPLIES
       2319911   S IMP ENDO GIA ROTICULA                613.00             23           SURGICAL SUPPLIES
       2319432   S IMP ENDO STCH SILK                    95.00             23           SURGICAL SUPPLIES
       2319937   S IMP ENDO STPLR GIA 30                709.00             23           SURGICAL SUPPLIES
       2318707   S IMP ENDO SURGITIE                     55.00             23           SURGICAL SUPPLIES
       2319382   S IMP ENDOCLIP                         310.66             23           SURGICAL SUPPLIES
       2328409   S IMP ENDOHERNIA STAPLE                758.50             23           SURGICAL SUPPLIES
       2328359   S IMP ENDOSTITCH                       393.50             23           SURGICAL SUPPLIES
       2323608   S IMP ETHIBOND SUTURES                  22.50       22.50 23           SURGICAL SUPPLIES
       2323541   S IMP EX FIX HALF PIN                  280.00             23           SURGICAL SUPPLIES
       2361301   S IMP EXT FIX EBI DIMENS             6,669.50             23           SURGICAL SUPPLIES



9/17/2012                                                                                                        207
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2361350   S IMP EXT FIX EBI DYNAFI            6,127.00               23         SURGICAL SUPPLIES
       2320893   S IMP EXTENDER DEVICE               4,518.00               23         SURGICAL SUPPLIES
       2327559   S IMP EZ35B RELOAD                    345.00               23         SURGICAL SUPPLIES
       2327609   S IMP EZ35W RELOAD                    377.00               23         SURGICAL SUPPLIES
       2320604   S IMP FALOPE RING                     155.00     155.00    23         SURGICAL SUPPLIES
       2328516   S IMP FASCIA LATA SLING             1,557.00               23         SURGICAL SUPPLIES
       2322170   S IMP FEM COMP                      5,670.00               23         SURGICAL SUPPLIES
       2324721   S IMP FEM COMP NXGN                 8,884.80               23         SURGICAL SUPPLIES
       2322857   S IMP FEM CONDY PLATE               1,914.00    1,914.00   23         SURGICAL SUPPLIES
       2323913   S IMP FEM HEAD                      2,279.58               23         SURGICAL SUPPLIES
       2323186   S IMP FEM POST AUG                  2,363.63               23         SURGICAL SUPPLIES
       2322931   S IMP FEM STEM                      9,174.00               23         SURGICAL SUPPLIES
       2326254   S IMP FEM. CROSS SECTION              723.50     723.50    23         SURGICAL SUPPLIES
       2323517   S IMP FEMORAL COMP                  8,676.10               23         SURGICAL SUPPLIES
       2323111   S IMP FEMORAL HEAD                  1,475.29               23         SURGICAL SUPPLIES
       2326601   S IMP FIBULA STRUT                  1,074.00               23         SURGICAL SUPPLIES
       2329043   S IMP FILSHIE CLIPS                   242.10               23         SURGICAL SUPPLIES
       2320026   S IMP FIXATION POST ACL               315.50               23         SURGICAL SUPPLIES
       2328060   S IMP FRA SPACER                   10,881.50               23         SURGICAL SUPPLIES
       2329449   S IMP GFT SLNG FASCIA 6X            3,913.50               23         SURGICAL SUPPLIES
       2323137   S IMP GIA LOAD UNIT SNGL              166.74               23         SURGICAL SUPPLIES
       2325454   S IMP GIA LOADING UNIT                330.88     330.88    23         SURGICAL SUPPLIES
       2329233   S IMP GIA LOADING UNIT                492.86               23         SURGICAL SUPPLIES
       2326098   S IMP GIA RELOAD                      161.00               23         SURGICAL SUPPLIES
       2329217   S IMP GIA RELOAD                      280.04               23         SURGICAL SUPPLIES
       2323764   S IMP GLENOID                       4,207.50               23         SURGICAL SUPPLIES
       2320901   S IMP GOLD MAX. FACE PLA              682.50     682.50    23         SURGICAL SUPPLIES
       2321701   S IMP GORTEX GFT-CM                    35.00      35.00    23         SURGICAL SUPPLIES
       2324556   S IMP GORTEX SUTURE                    73.00      73.00    23         SURGICAL SUPPLIES
       2320075   S IMP GRAFT ATRIUM 6 X 6              233.50               23         SURGICAL SUPPLIES
       2320497   S IMP GRAFT DURAGUARD               1,080.00               23         SURGICAL SUPPLIES
       2320513   S IMP GRAFT DURAGUARD                 880.00               23         SURGICAL SUPPLIES
       2321669   S IMP GRAFT VASCULAR BIF            9,360.00               23         SURGICAL SUPPLIES



9/17/2012                                                                                                       208
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2324044   S IMP GRAFTON GEL 10CC              2,893.00             23           SURGICAL SUPPLIES
       2320364   S IMP GRAFTON GEL 1CC                 612.50             23           SURGICAL SUPPLIES
       2327989   S IMP GRAFTON PUTTY 10CC            3,299.50             23           SURGICAL SUPPLIES
       2327971   S IMP GRAFTON PUTTY 5CC             2,130.00             23           SURGICAL SUPPLIES
       2320315   S IMP HAKIM VALVE PROG              7,324.00             23           SURGICAL SUPPLIES
       2321628   S IMP HEAD BIPOLAR                  2,289.38             23           SURGICAL SUPPLIES
       2329472   S IMP HEMASHIELD PATCH                431.80             23           SURGICAL SUPPLIES
       2329480   S IMP HEMASHIELD PATCH                513.40             23           SURGICAL SUPPLIES
       2325611   S IMP HEMOLOK 15                      483.50             23           SURGICAL SUPPLIES
       2325637   S IMP HEMOLOK 6 ML                     89.56             23           SURGICAL SUPPLIES
       2325629   S IMP HEMOLOK 6 MLX                    58.73             23           SURGICAL SUPPLIES
       2325645   S IMP HEMOLOK 6 XL                    118.32             23           SURGICAL SUPPLIES
       2324135   S IMP HM ENDO HEAD                  1,300.00             23           SURGICAL SUPPLIES
       2324127   S IMP HM SPACER CMTD                  428.40             23           SURGICAL SUPPLIES
       2324119   S IMP HM STEM CMTD                  6,040.00             23           SURGICAL SUPPLIES
       2324143   S IMP HM TAPER SLEEVE                 590.80             23           SURGICAL SUPPLIES
       2323749   S IMP HUMERAL HEAD                  4,853.75             23           SURGICAL SUPPLIES
       2323988   S IMP HUMERAL HEAD                  3,859.87             23           SURGICAL SUPPLIES
       2328763   S IMP HUMERAL SHAFT                   959.00             23           SURGICAL SUPPLIES
       2324010   S IMP HUMERAL STEM                  5,059.52             23           SURGICAL SUPPLIES
       2321636   S IMP ILIAC EXT CUFF                4,650.00             23           SURGICAL SUPPLIES
       2321644   S IMP ILIAC EXT CUFF                4,450.00             23           SURGICAL SUPPLIES
       2322881   S IMP ILIAC LONG                    4,850.00             23           SURGICAL SUPPLIES
       2323392   S IMP IM NAIL                       3,106.54             23           SURGICAL SUPPLIES
       2325108   S IMP IM ROD - TIBIAL -             2,659.00    2,659.00 23           SURGICAL SUPPLIES
       2325959   S IMP IM ROD TIBIAL REAM            1,001.50             23           SURGICAL SUPPLIES
       2327906   S IMP IMPLANTS MISC                                      23           SURGICAL SUPPLIES
       2317568   S IMP IN FAST SLING KIT             2,326.50             23           SURGICAL SUPPLIES
       2319812   S IMP INFAST KIT WO SLIN            1,990.00             23           SURGICAL SUPPLIES
       2325603   S IMP INTERCEED                       633.50      633.50 23           SURGICAL SUPPLIES
       2322758   S IMP KIRSCHNER WIRE                   39.00       39.00 23           SURGICAL SUPPLIES
       2321610   S IMP KIT BIOTENODESIS                577.50             23           SURGICAL SUPPLIES
       2320869   S IMP KIT REVISION                    975.00             23           SURGICAL SUPPLIES



9/17/2012                                                                                                       209
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2322808   S IMP KNOWLES PINS                 114.00     114.00 23            SURGICAL SUPPLIES
       2322774   S IMP KWIRE                          9.50            23            SURGICAL SUPPLIES
       2323715   S IMP LAP BAND SYS               6,390.00            23            SURGICAL SUPPLIES
       2327880   S IMP LC-45GIA CUTTER            1,479.00            23            SURGICAL SUPPLIES
       2319184   S IMP LIN CUT ARTIC 45MM         1,430.27            23            SURGICAL SUPPLIES
       2327310   S IMP LIN CUT BLUE 55            1,033.50            23            SURGICAL SUPPLIES
       2319838   S IMP LIN CUT RELOAD               841.50            23            SURGICAL SUPPLIES
       2326536   S IMP LIN CUT RELOAD               684.65            23            SURGICAL SUPPLIES
       2327344   S IMP LIN CUT RELOAD               459.00            23            SURGICAL SUPPLIES
       2319044   S IMP LIN CUT VASC 45MM          1,351.00            23            SURGICAL SUPPLIES
       2319820   S IMP LINEAR CUTTER                831.74            23            SURGICAL SUPPLIES
       2327252   S IMP LINEAR CUTTER TLC            716.00            23            SURGICAL SUPPLIES
       2327302   S IMP LINEAR CUTTER TLC            996.50            23            SURGICAL SUPPLIES
       2319853   S IMP LINEAR STAP RELD             391.00            23            SURGICAL SUPPLIES
       2319846   S IMP LINEAR STAPLER               738.00            23            SURGICAL SUPPLIES
       2319861   S IMP LINEAR STAPLER               723.50            23            SURGICAL SUPPLIES
       2327203   S IMP LINEAR STAPLER AX            868.50            23            SURGICAL SUPPLIES
       2327153   S IMP LINEAR STAPLER ZX            868.50            23            SURGICAL SUPPLIES
       2323079   S IMP LINER                      3,110.03            23            SURGICAL SUPPLIES
       2323814   S IMP LINER                        936.03            23            SURGICAL SUPPLIES
       2323632   S IMP LINER LONGEVITY            3,888.14            23            SURGICAL SUPPLIES
       2322923   S IMP LNR ATB                    3,970.32            23            SURGICAL SUPPLIES
       2323806   S IMP MAXON SUTURE                  32.00      32.00 23            SURGICAL SUPPLIES
       2320224   S IMP MEDPOR SHEET                 832.00            23            SURGICAL SUPPLIES
       2317428   S IMP MENTOR POLYTET PAS           919.50            23            SURGICAL SUPPLIES
       2323954   S IMP MERSILENE SUTURE             126.50     126.50 23            SURGICAL SUPPLIES
       2324002   S IMP MERSILENE SUTURE              87.00      87.00 23            SURGICAL SUPPLIES
       2320828   S IMP MESH POUCH                   297.50            23            SURGICAL SUPPLIES
       2322006   S IMP MISC SUTURE                   11.50      11.50 23            SURGICAL SUPPLIES
       2326007   S IMP MITEK SNAP PK                296.50     296.50 23            SURGICAL SUPPLIES
       2320232   S IMP MYRINGOTOMY DURAVEN          104.13            23            SURGICAL SUPPLIES
       2320240   S IMP MYRINGOTOMY TINY TI          195.12            23            SURGICAL SUPPLIES
       2324358   S IMP N. ANEUR CL 940/1            547.50     547.50 23            SURGICAL SUPPLIES



9/17/2012                                                                                                    210
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2324309   S IMP N. ANEUR CL 940/2               335.00     335.00 23            SURGICAL SUPPLIES
       2324812   S IMP NAIL TROCH                    3,410.00            23            SURGICAL SUPPLIES
       2323160   S IMP NAIL TROCH 10MM               4,178.96            23            SURGICAL SUPPLIES
       2311975   S IMP NOCOR WDEL SYS TMP              644.00     644.00 23            SURGICAL SUPPLIES
       2319440   S IMP NUROLON SUT                      51.00            23            SURGICAL SUPPLIES
       2323681   S IMP NXGN LCCK FEM                 8,696.06            23            SURGICAL SUPPLIES
       2324077   S IMP NXGN ART SURF FLX             3,712.06            23            SURGICAL SUPPLIES
       2323426   S IMP NXGN ART SURFACE              2,212.95            23            SURGICAL SUPPLIES
       2323434   S IMP NXGN FEM COMP                 5,486.28            23            SURGICAL SUPPLIES
       2323970   S IMP NXGN KNEE LPS FEM             1,258.26            23            SURGICAL SUPPLIES
       2323699   S IMP NXGN LCCK ART SURF            3,866.72            23            SURGICAL SUPPLIES
       2323996   S IMP NXGN PROLONG SURF             3,807.23            23            SURGICAL SUPPLIES
       2323640   S IMP NXGN STEM EXT                 2,367.61            23            SURGICAL SUPPLIES
       2323665   S IMP NXGN STEM OFST                3,093.37            23            SURGICAL SUPPLIES
       2323442   S IMP NXGN TIB                      2,581.78            23            SURGICAL SUPPLIES
       2323897   S IMP NXGN TIBIAL PLATE             3,596.03            23            SURGICAL SUPPLIES
       2323657   S IMP NYLON SUTURE                     18.50      18.50 23            SURGICAL SUPPLIES
       2321032   S IMP OPUS COBRAID                    587.50            23            SURGICAL SUPPLIES
       2320281   S IMP OPUS MAGNUM                     425.00            23            SURGICAL SUPPLIES
       2321040   S IMP OPUS MAGNUM                   1,134.00            23            SURGICAL SUPPLIES
       2325801   S IMP ORTHO SORB                      583.31     583.31 23            SURGICAL SUPPLIES
       2328045   S IMP ORTHOBLAST 10CC               3,355.00            23            SURGICAL SUPPLIES
       2328078   S IMP ORTHOBLAST-5CC                1,911.25            23            SURGICAL SUPPLIES
       2322824   S IMP ORTHOSORB 2.0                   595.00            23            SURGICAL SUPPLIES
       2320018   S IMP ORTHOSORB KIT                 1,940.50            23            SURGICAL SUPPLIES
       2322188   S IMP PATELLA                       1,876.88            23            SURGICAL SUPPLIES
       2323293   S IMP PATELLA TENDON                3,753.75            23            SURGICAL SUPPLIES
       2319879   S IMP PDS SUTURE                       21.50            23            SURGICAL SUPPLIES
       2319887   S IMP PDS SUTURE                       62.50            23            SURGICAL SUPPLIES
       2323905   S IMP PDS SUTURE                       41.00      41.00 23            SURGICAL SUPPLIES
       2322865   S IMP PINNACLE ACET CUP             4,646.81            23            SURGICAL SUPPLIES
       2323418   S IMP PINNACLE ACET LNR             4,129.13            23            SURGICAL SUPPLIES
       2323707   S IMP PLAIN SUTURE                     19.50      19.50 23            SURGICAL SUPPLIES



9/17/2012                                                                                                       211
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2323012   S IMP PLATE 1SEG ANT CERV            4,070.00            23            SURGICAL SUPPLIES
       2323020   S IMP PLATE 2SEG ANT CERV            4,496.25            23            SURGICAL SUPPLIES
       2322972   S IMP PLATE 2SEG SLIMLINE            3,657.50            23            SURGICAL SUPPLIES
       2322980   S IMP PLATE 3SEG SLIMLINE            3,905.00            23            SURGICAL SUPPLIES
       2322998   S IMP PLATE 4SEG SLIMLINE            4,152.50            23            SURGICAL SUPPLIES
       2322279   S IMP PLATE BOXCAR 4H                  521.50            23            SURGICAL SUPPLIES
       2322287   S IMP PLATE BOXCAR 6H                  682.50            23            SURGICAL SUPPLIES
       2322295   S IMP PLATE BOXCAR 8H                  731.25            23            SURGICAL SUPPLIES
       2323129   S IMP PLATE CALCANEAL                1,113.75            23            SURGICAL SUPPLIES
       2321578   S IMP PLATE LCP                      2,953.50            23            SURGICAL SUPPLIES
       2321586   S IMP PLATE LCP                      3,775.75            23            SURGICAL SUPPLIES
       2323582   S IMP PLATE MAXLOCK 1SLT             2,722.50            23            SURGICAL SUPPLIES
       2323574   S IMP PLATE MAXLOCK SLTLS            2,585.00            23            SURGICAL SUPPLIES
       2322097   S IMP PLATE PERI R 10-12H            1,929.51            23            SURGICAL SUPPLIES
       2322113   S IMP PLATE PERI R 14-16H            2,000.18            23            SURGICAL SUPPLIES
       2322089   S IMP PLATE PERI R 2-8H              1,855.87            23            SURGICAL SUPPLIES
       2320398   S IMP PLATE SEG SLIMLINE             3,404.50            23            SURGICAL SUPPLIES
       2321594   S IMP PLATE SEMITUBULAR                269.50            23            SURGICAL SUPPLIES
       2322329   S IMP PLATE STRAIGHT 16H               975.00            23            SURGICAL SUPPLIES
       2322311   S IMP PLATE STRAIGHT 2H                150.50            23            SURGICAL SUPPLIES
       2328052   S IMP PLIF SPACER                    4,550.00            23            SURGICAL SUPPLIES
       2321859   S IMP POLYETHYLENE TUBE                 98.50      98.50 23            SURGICAL SUPPLIES
       2323525   S IMP POROUS FEMORAL                 5,130.00            23            SURGICAL SUPPLIES
       2323756   S IMP PROLENE SUTURE                    24.50      24.50 23            SURGICAL SUPPLIES
       2329464   S IMP PROTRACK STPLR 5MM               854.50            23            SURGICAL SUPPLIES
       2325405   S IMP PURSESTRING                      215.00     182.50 23            SURGICAL SUPPLIES
       2321784   S IMP PUTTY 5CC                      2,147.75            23            SURGICAL SUPPLIES
       2320810   S IMP REFILL KIT SYNCHROM               98.00            23            SURGICAL SUPPLIES
       2327351   S IMP RELOAD LINEAR CUT                593.00            23            SURGICAL SUPPLIES
       2319416   S IMP RET PERFLURON                  1,463.00            23            SURGICAL SUPPLIES
       2326031   S IMP RETINA ASYM TIRE                  69.50            23            SURGICAL SUPPLIES
       2326049   S IMP RETINA CIRC BAND                  49.00            23            SURGICAL SUPPLIES
       2326189   S IMP RETINA MED CVD                    84.00            23            SURGICAL SUPPLIES



9/17/2012                                                                                                        212
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2326015   S IMP RETINA SIL SLV                   27.50              23          SURGICAL SUPPLIES
       2326064   S IMP RETINA SIL STRP                  53.00              23          SURGICAL SUPPLIES
       2326080   S IMP RETINAL PLUG                     95.00              23          SURGICAL SUPPLIES
       2329241   S IMP REVEAL                       11,210.50              23          SURGICAL SUPPLIES
       2324655   S IMP ROTICULATOR                     685.03     685.03   23          SURGICAL SUPPLIES
       2321404   S IMP RUSH PIN                        126.50     126.50   23          SURGICAL SUPPLIES
       2323095   S IMP SCREW CAPTURED                  653.25              23          SURGICAL SUPPLIES
       2320422   S IMP SEPRAFILM                       569.00              23          SURGICAL SUPPLIES
       2323277   S IMP SIGMA FEM TC3                 8,370.00              23          SURGICAL SUPPLIES
       2324739   S IMP SIGMA TIB INS                 5,363.32              23          SURGICAL SUPPLIES
       2323616   S IMP SIGMA TRAY REV                6,615.00              23          SURGICAL SUPPLIES
       2329845   S IMP SILICONE SHEET                   63.00              23          SURGICAL SUPPLIES
       2323855   S IMP SILK SUTURE                      22.50      22.50   23          SURGICAL SUPPLIES
       2327005   S IMP SOFTWIRE CABLE                  411.00              23          SURGICAL SUPPLIES
       2323772   S IMP SPACER X-STOP                 6,600.00              23          SURGICAL SUPPLIES
       2326809   S IMP SPINE SET PLATE               2,515.50              23          SURGICAL SUPPLIES
       2320307   S IMP STAPLE LDS-15                   496.02     496.02   23          SURGICAL SUPPLIES
       2320208   S IMP STAPLE TA-55-4.8                645.00     645.00   23          SURGICAL SUPPLIES
       2319754   S IMP STAPLER TA30                    338.00              23          SURGICAL SUPPLIES
       2319747   S IMP STAPLER TA30 RELOA              173.00              23          SURGICAL SUPPLIES
       2319739   S IMP STAPLER TA60                    307.47              23          SURGICAL SUPPLIES
       2320257   S IMP STAPLER TA90                    307.97     307.97   23          SURGICAL SUPPLIES
       2319721   S IMP STAPLER TA90 RELOA              161.25              23          SURGICAL SUPPLIES
       2328201   S IMP STATAK REG/MIN                  561.50              23          SURGICAL SUPPLIES
       2322782   S IMP STEINMAN PIN                     17.50              23          SURGICAL SUPPLIES
       2323673   S IMP STEINMAN PIN/DRILL              747.50              23          SURGICAL SUPPLIES
       2322907   S IMP STEINMAN PINS                    74.50      74.50   23          SURGICAL SUPPLIES
       2322899   S IMP STENT BIFUR                   9,060.00              23          SURGICAL SUPPLIES
       2320885   S IMP STENT CONTRALATERA            6,738.00              23          SURGICAL SUPPLIES
       2321016   S IMP STENT GRAFT                  12,100.00              23          SURGICAL SUPPLIES
       2321693   S IMP STENT ILIAC LIMB 1            5,650.00              23          SURGICAL SUPPLIES
       2321719   S IMP STENT ILIAC LIMB 1            6,200.00              23          SURGICAL SUPPLIES
       2321743   S IMP STENT ILIAC LIMB 1            6,900.00              23          SURGICAL SUPPLIES



9/17/2012                                                                                                       213
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2321727   S IMP STENT ILIAC LIMB 8            5,550.00              23          SURGICAL SUPPLIES
       2321735   S IMP STENT ILIAC LIMB 8            5,350.00              23          SURGICAL SUPPLIES
       2321198   S IMP STENT TRUNK                   8,757.60              23          SURGICAL SUPPLIES
       2322147   S IMP SUPRAFOIL                       123.59              23          SURGICAL SUPPLIES
       2326700   S IMP SURGICEL                         93.50      82.00   23          SURGICAL SUPPLIES
       2326957   S IMP SURGICEL                        125.50              23          SURGICAL SUPPLIES
       2321552   S IMP SURGICLIP 9.5/11                190.00     190.00   23          SURGICAL SUPPLIES
       2319952   S IMP SUT BIOSYN                       21.50              23          SURGICAL SUPPLIES
       2319994   S IMP SUT CHROMIC                      47.50              23          SURGICAL SUPPLIES
       2311066   S IMP SUT ETHIBOND CS46D               55.00              23          SURGICAL SUPPLIES
       2311041   S IMP SUT ETHIBOND CX45D               82.50              23          SURGICAL SUPPLIES
       2320331   S IMP SUT ETHIBOND MB47G              145.99              23          SURGICAL SUPPLIES
       2310068   S IMP SUT ETHIBOND MX76                50.96              23          SURGICAL SUPPLIES
       2310100   S IMP SUT ETHILON 10-0                 65.00              23          SURGICAL SUPPLIES
       2361053   S IMP SUT FIBERWIRE #2                 67.50              23          SURGICAL SUPPLIES
       2361004   S IMP SUT FIBERWIRE #5                110.50              23          SURGICAL SUPPLIES
       2310142   S IMP SUT PLAIN                        49.50              23          SURGICAL SUPPLIES
       2319978   S IMP SUT PROLENE                      36.00              23          SURGICAL SUPPLIES
       2310241   S IMP SUT PROLENE 2795G               109.00              23          SURGICAL SUPPLIES
       2310266   S IMP SUT PROLENE 6-0                  90.50              23          SURGICAL SUPPLIES
       2311025   S IMP SUT PROLENE 8702H                71.00              23          SURGICAL SUPPLIES
       2310282   S IMP SUT PROLENE 9091G                87.00              23          SURGICAL SUPPLIES
       2310225   S IMP SUT PROLENE M8702               128.06              23          SURGICAL SUPPLIES
       2310183   S IMP SUT PROLENE M8735               336.50              23          SURGICAL SUPPLIES
       2310209   S IMP SUT PROLENE M8736               178.00              23          SURGICAL SUPPLIES
       2310308   S IMP SUT SILK                         42.00              23          SURGICAL SUPPLIES
       2310340   S IMP SUT VICRYL                       73.50              23          SURGICAL SUPPLIES
       2310167   S IMP SUT WIRE #6                     108.00              23          SURGICAL SUPPLIES
       2320158   S IMP SUTURE PG1A                     964.00     964.00   23          SURGICAL SUPPLIES
       2320109   S IMP SUTURE WIRE                      24.50      24.50   23          SURGICAL SUPPLIES
       2320448   S IMP TAPE OB KIT                   2,887.50              23          SURGICAL SUPPLIES
       2321800   S IMP TEFLON FELT                     118.50     118.50   23          SURGICAL SUPPLIES
       2323533   S IMP TIB BEARING INSERT            3,250.50              23          SURGICAL SUPPLIES



9/17/2012                                                                                                       214
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2322196   S IMP TIBIAL INSERT                  3,825.94             23           SURGICAL SUPPLIES
       2323178   S IMP TIBIAL INSERT                  3,948.95             23           SURGICAL SUPPLIES
       2322162   S IMP TIBIAL TRAY                    4,965.00             23           SURGICAL SUPPLIES
       2324051   S IMP TICRON SUTURE                     24.50       24.50 23           SURGICAL SUPPLIES
       2328813   S IMP TISSELL-2CC                      567.60             23           SURGICAL SUPPLIES
       2328524   S IMP TISSELL-5CC                    1,267.75             23           SURGICAL SUPPLIES
       2312916   S IMP TITANIUM CONNECTOR             1,235.00    1,235.00 23           SURGICAL SUPPLIES
       2322154   S IMP TOE IMPLANTS                   2,268.75             23           SURGICAL SUPPLIES
       2323285   S IMP TRICORT WEDGE                  2,079.00             23           SURGICAL SUPPLIES
       2328532   S IMP TRICORTICAL BLOCK              2,417.50             23           SURGICAL SUPPLIES
       2329969   S IMP UNICLIP                        1,283.00             23           SURGICAL SUPPLIES
       2320216   S IMP UNICLIP INTEGRA                1,283.00             23           SURGICAL SUPPLIES
       2324754   S IMP UNIVERSAL IM NAIL              2,172.12    2,172.12 23           SURGICAL SUPPLIES
       2323624   S IMP VERSYS FEM STEM                7,325.56             23           SURGICAL SUPPLIES
       2328789   S IMP WASHERS                           60.00             23           SURGICAL SUPPLIES
       2311967   S INTR NOINTRACRD NOLSR                192.50             23           SURGICAL SUPPLIES
       2330926   S INTR NOINTRACRD NOSLR                350.00             23           SURGICAL SUPPLIES
       2330801   S INTRO GDE FXD CRV PLAWY              297.50             23           SURGICAL SUPPLIES
       2330850   S INTRO GDE FXD CRV PLAWY              175.00             23           SURGICAL SUPPLIES
       2328441   S IOL IMPLANT                          521.50             23           SURGICAL SUPPLIES
       2331023   S LD ICD ENDOCRD 2 COIL              8,400.00             23           SURGICAL SUPPLIES
       2320646   S LD NEUROSTIMULATOR                 4,125.00             23           SURGICAL SUPPLIES
       2320661   S LD NEUROSTIMULATOR                 3,822.50             23           SURGICAL SUPPLIES
       2320679   S LD NEUROSTIMULATOR                 4,620.00             23           SURGICAL SUPPLIES
       2320687   S LD NEUROSTIMULATOR                 5,225.00             23           SURGICAL SUPPLIES
       2320695   S LD NEUROSTIMULATOR                 5,360.00             23           SURGICAL SUPPLIES
       2320711   S LD NEUROSTIMULATOR                 4,780.00             23           SURGICAL SUPPLIES
       2320729   S LD NEUROSTIMULATOR                 7,000.00             23           SURGICAL SUPPLIES
       2320737   S LD NEUROSTIMULATOR                 3,822.50             23           SURGICAL SUPPLIES
       2321289   S LD NEUROSTIMULATOR                 7,000.00             23           SURGICAL SUPPLIES
       2324788   S LD NEUROSTIMULATOR                 4,780.00             23           SURGICAL SUPPLIES
       2330074   S LD PCR NO TV SNGL PAS              2,612.50             23           SURGICAL SUPPLIES
       2330090   S LD PCR NO TV SNGL PAS              3,437.50             23           SURGICAL SUPPLIES



9/17/2012                                                                                                        215
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2330959   S LD PCR NO TV SNGL PASCA        1,856.25            23            SURGICAL SUPPLIES
       2331007   S LD PCR NO TV SNGL PASGU        2,062.50            23            SURGICAL SUPPLIES
       2330082   S LD VENT CORO VEN SYS L         4,800.00            23            SURGICAL SUPPLIES
       2321560   S MESH IMPLANT                   4,665.20            23            SURGICAL SUPPLIES
       2329084   S MESH IMPLANT                   2,967.25            23            SURGICAL SUPPLIES
       2326510   S MESH IMPLANT - DUALMESH        3,283.50            23            SURGICAL SUPPLIES
       2326528   S MESH IMPLANT - SURGIPRO          431.50            23            SURGICAL SUPPLIES
       2329027   S MESH IMPLANT BARD PLUG         1,354.50            23            SURGICAL SUPPLIES
       2324457   S MESH IMPLANT DEXON               698.81     698.81 23            SURGICAL SUPPLIES
       2320190   S MESH IMPLANT DUALMESH          4,994.00            23            SURGICAL SUPPLIES
       2320273   S MESH IMPLANT DUALMESH          2,409.00            23            SURGICAL SUPPLIES
       2321164   S MESH IMPLANT DUALMESH          4,518.00            23            SURGICAL SUPPLIES
       2321172   S MESH IMPLANT DUALMESH          3,701.00            23            SURGICAL SUPPLIES
       2324671   S MESH IMPLANT DUALMESH          1,204.50            23            SURGICAL SUPPLIES
       2329076   S MESH IMPLANT KUGEL 6X8         2,417.25            23            SURGICAL SUPPLIES
       2320380   S MESH IMPLANT KUGEL 7X9         3,203.00            23            SURGICAL SUPPLIES
       2329092   S MESH IMPLANT KUGEL 8X10        4,116.75            23            SURGICAL SUPPLIES
       2329951   S MESH IMPLANT KUGEL 8X12          804.25            23            SURGICAL SUPPLIES
       2320265   S MESH IMPLANT KUGEL COMP        1,146.75            23            SURGICAL SUPPLIES
       2329712   S MESH IMPLANT KUGEL COMP        1,585.38            23            SURGICAL SUPPLIES
       2329928   S MESH IMPLANT KUGEL COMP        2,340.25            23            SURGICAL SUPPLIES
       2329209   S MESH IMPLANT KUGEL COMP        5,043.00            23            SURGICAL SUPPLIES
       2329225   S MESH IMPLANT KUGEL COMP        6,415.00            23            SURGICAL SUPPLIES
       2329902   S MESH IMPLANT KUGEL PATC          999.00            23            SURGICAL SUPPLIES
       2329936   S MESH IMPLANT KUGEL PATC          985.00            23            SURGICAL SUPPLIES
       2329126   S MESH IMPLANT KUGEL SM          1,707.50            23            SURGICAL SUPPLIES
       2329183   S MESH IMPLANT KUGEL18X23        4,017.75            23            SURGICAL SUPPLIES
       2329100   S MESH IMPLANT KUGEN MED         2,523.00            23            SURGICAL SUPPLIES
       2329118   S MESH IMPLANT KUGL 10X13        5,423.00            23            SURGICAL SUPPLIES
       2320059   S MESH IMPLANT MARLEX              760.50     821.50 23            SURGICAL SUPPLIES
       2321115   S MESH IMPLANT MARLEX 1X4          300.50            23            SURGICAL SUPPLIES
       2329886   S MESH IMPLANT MARLEX 6X6          519.00            23            SURGICAL SUPPLIES
       2327013   S MESH IMPLANT MERSILENE           953.81            23            SURGICAL SUPPLIES



9/17/2012                                                                                                    216
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2320471   S MESH IMPLANT PATCH CRU         1,262.25            23            SURGICAL SUPPLIES
       2320489   S MESH IMPLANT PATCH CRU         1,014.00            23            SURGICAL SUPPLIES
       2320562   S MESH IMPLANT PLUG                708.80            23            SURGICAL SUPPLIES
       2329142   S MESH IMPLANT POLYPROPYL          331.00            23            SURGICAL SUPPLIES
       2321065   S MESH IMPLANT PRMESH 6X6          326.50            23            SURGICAL SUPPLIES
       2323822   S MESH IMPLANT PROCEED           1,417.63            23            SURGICAL SUPPLIES
       2323830   S MESH IMPLANT PROCEED           4,150.27            23            SURGICAL SUPPLIES
       2320596   S MESH IMPLANT PROLENE             665.21            23            SURGICAL SUPPLIES
       2326353   S MESH IMPLANT PROLENE             114.50            23            SURGICAL SUPPLIES
       2321214   S MESH IMPLANT PROLITE              98.42            23            SURGICAL SUPPLIES
       2321222   S MESH IMPLANT PROLITE             190.00            23            SURGICAL SUPPLIES
       2321123   S MESH IMPLANT SLING 4X7         1,134.00            23            SURGICAL SUPPLIES
       2325553   S MESH IMPLANT TITANIUM            634.50     634.50 23            SURGICAL SUPPLIES
       2321230   S MESH IMPLANT VENTRALX          1,211.38            23            SURGICAL SUPPLIES
       2321248   S MESH IMPLANT VENTRALX          1,147.88            23            SURGICAL SUPPLIES
       2329035   S MESH PROCEED                   1,443.31            23            SURGICAL SUPPLIES
       2322071   S MESH TIMESH COMP 4X6             731.25            23            SURGICAL SUPPLIES
       2322063   S MESH TIMESH COMP 8X6           1,375.00            23            SURGICAL SUPPLIES
       2311884   S MORCELLATOR                    1,443.20            23            SURGICAL SUPPLIES
       2324796   S NEUROSTIM PATIENT PRGR         3,272.50            23            SURGICAL SUPPLIES
       2320620   S NEUROSTIM PATIENT PRGRM        2,736.25            23            SURGICAL SUPPLIES
       2320638   S NEUROSTIM PATIENT PRGRM        3,272.50            23            SURGICAL SUPPLIES
       2321321   S NEUROSTIM PATIENT PRGRM        3,272.50            23            SURGICAL SUPPLIES
       2311165   S NSTRL BAIR BLANKET                29.00            23            SURGICAL SUPPLIES
       2310407   S NSTRL COMPRESSION SOCK            78.00            23            SURGICAL SUPPLIES
       2319960   S NSTRL COMPRESSION SOCK           127.75            23            SURGICAL SUPPLIES
       2318376   S NSTRL ELMED GROUND PAD            16.50            23            SURGICAL SUPPLIES
       2312031   S NSTRL GROUNDING PADS              11.00      11.00 23            SURGICAL SUPPLIES
       2319598   S NSTRL IMOB ABD ANTICLT           302.00            23            SURGICAL SUPPLIES
       2319606   S NSTRL IMOBL ULTRA SLNG           189.00            23            SURGICAL SUPPLIES
       2311769   S NSTRL K-PAD BLANKET               15.96            23            SURGICAL SUPPLIES
       2312049   S NSTRL SOMNO GROUND PAD            43.00            23            SURGICAL SUPPLIES
       2361160   S ORTHO IMMOB BRACE UNIV           348.50            23            SURGICAL SUPPLIES



9/17/2012                                                                                                    217
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2361806   S ORTHO IMMOB BRACE UNIV           437.50             23           SURGICAL SUPPLIES
       2361251   S ORTHO IMMOB SHOU ABD             201.00             23           SURGICAL SUPPLIES
       2361202   S ORTHO IMMOB SUPR SLNG             31.50             23           SURGICAL SUPPLIES
       2330454   S PCR PACEMAKER                                       23           SURGICAL SUPPLIES
       2330041   S PCR 1 CHMBR                    7,500.00             23           SURGICAL SUPPLIES
       2330066   S PCR 1 CHMBR                    6,600.00             23           SURGICAL SUPPLIES
       2330702   S PCR 1 CHMBR RR                 6,474.00             23           SURGICAL SUPPLIES
       2330751   S PCR 1 CHMBR RR                 6,114.00             23           SURGICAL SUPPLIES
       2330553   S PCR 2 CHMBR RR                 8,154.00             23           SURGICAL SUPPLIES
       2330603   S PCR 2 CHMBR RR                 6,840.00             23           SURGICAL SUPPLIES
       2330652   S PCR 2 CHMBR RR                 7,674.00             23           SURGICAL SUPPLIES
       2331056   S PCR 2 CHMBR RR                 8,700.00             23           SURGICAL SUPPLIES
       2331106   S PCR 2 CHMBR RR                 7,914.00             23           SURGICAL SUPPLIES
       2331155   S PCR 2 CHMBR RR                 8,274.00             23           SURGICAL SUPPLIES
       2330900   S PCR NOT 1 OR 2 CHMBR          11,825.00             23           SURGICAL SUPPLIES
       2313427   S PORT INDWELLING                1,859.55             23           SURGICAL SUPPLIES
       2320703   S PORT INDWELLING                1,210.00    1,210.00 23           SURGICAL SUPPLIES
       2323251   S PORT INDWELLINGH               1,381.50    1,381.50 23           SURGICAL SUPPLIES
       2317147   S PR CATH IND FOLEY 3 WAY           63.00             23           SURGICAL SUPPLIES
       2312007   S PROBE CRYOABLATION 2.4         1,168.00             23           SURGICAL SUPPLIES
       2312148   S PROBE CRYOABLATION TEMP          103.00             23           SURGICAL SUPPLIES
       2320349   S PUMP INFSN PROGRAMABLE        12,320.00             23           SURGICAL SUPPLIES
       2323871   S SCRW BONE ANCHOR               2,786.25             23           SURGICAL SUPPLIES
       2323731   S SCRW EX FIX SCHANZ 4             444.50             23           SURGICAL SUPPLIES
       2323723   S SCRW EX FIX SCHANZ 5             504.00             23           SURGICAL SUPPLIES
       2323368   S SCRW FIXATION                  1,001.00             23           SURGICAL SUPPLIES
       2324093   S SCRW LOCKING                     602.00             23           SURGICAL SUPPLIES
       2320570   S SCRW RESCUE                      958.75             23           SURGICAL SUPPLIES
       2323343   S SCRW STAPLE MENISCAL             702.00             23           SURGICAL SUPPLIES
       2320372   S SCRW WIDE ROOT                   958.75             23           SURGICAL SUPPLIES
       2320844   S SCRW 2.0                         165.38             23           SURGICAL SUPPLIES
       2323269   S SCRW ACL MILAGRO                 942.50             23           SURGICAL SUPPLIES
       2322451   S SCRW ASIF SCREWS-MINI             62.13       62.13 23           SURGICAL SUPPLIES



9/17/2012                                                                                                    218
                                          69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2322352   S SCRW   ASIF SCREWS-REG             72.62      72.62 23            SURGICAL SUPPLIES
       2328557   S SCRW   BIO SCREWS                 938.00            23            SURGICAL SUPPLIES
       2328540   S SCRW   BIO SCREW-TAPER          1,129.50            23            SURGICAL SUPPLIES
       2328771   S SCRW   BIO-CORKSCREW-AR19         796.25            23            SURGICAL SUPPLIES
       2321073   S SCRW   BIOINTER SCREW TIB         495.50            23            SURGICAL SUPPLIES
       2323038   S SCRW   BONE ANCHOR LG           1,121.25            23            SURGICAL SUPPLIES
       2323046   S SCRW   BONE ANCHOR SM             926.25            23            SURGICAL SUPPLIES
       2321396   S SCRW   BONE VOID FILL 10        2,062.00            23            SURGICAL SUPPLIES
       2321412   S SCRW   BONE VOID FILL 15        2,846.25            23            SURGICAL SUPPLIES
       2321438   S SCRW   BONE VOID FILL 25        4,138.75            23            SURGICAL SUPPLIES
       2321420   S SCRW   BONE VOID FILL 30        4,221.25            23            SURGICAL SUPPLIES
       2321388   S SCRW   BONE VOID FILL 5C        1,235.00            23            SURGICAL SUPPLIES
       2321446   S SCRW   BONE VOID FILL XL        6,070.00            23            SURGICAL SUPPLIES
       2320463   S SCRW   CANCELLOUS LF              157.50            23            SURGICAL SUPPLIES
       2320133   S SCRW   CANCELLOUS T                85.50            23            SURGICAL SUPPLIES
       2329985   S SCRW   CANNULATED SCR THD         367.00            23            SURGICAL SUPPLIES
       2320083   S SCRW   CANNULATED SCREW           689.00            23            SURGICAL SUPPLIES
       2325058   S SCRW   CANNULATED SCREWS          549.95     549.95 23            SURGICAL SUPPLIES
       2325900   S SCRW   CANNULATED SCREWS          437.04     437.04 23            SURGICAL SUPPLIES
       2323152   S SCRW   COMPRESSION SCREW           74.00      51.50 23            SURGICAL SUPPLIES
       2329753   S SCRW   CORKSCREW W FIBRWR         796.25            23            SURGICAL SUPPLIES
       2320836   S SCRW   CORT TI                    105.00            23            SURGICAL SUPPLIES
       2320992   S SCRW   CORTEX                     105.77            23            SURGICAL SUPPLIES
       2322949   S SCRW   CORTEX                     157.85            23            SURGICAL SUPPLIES
       2323889   S SCRW   CORTEX SLF TAP             147.88            23            SURGICAL SUPPLIES
       2326866   S SCRW   CORTICAL ACUMED            210.00            23            SURGICAL SUPPLIES
       2329977   S SCRW   CORTICAL SCREW             471.80            23            SURGICAL SUPPLIES
       2323236   S SCRW   CROSSPIN 2.7MM             955.50            23            SURGICAL SUPPLIES
       2326155   S SCRW   DISTRACTOR SCREWS          133.00     133.00 23            SURGICAL SUPPLIES
       2321529   S SCRW   FOAM CUP 52MM            5,610.00            23            SURGICAL SUPPLIES
       2321537   S SCRW   FOAM CUP 56MM            6,520.00            23            SURGICAL SUPPLIES
       2321545   S SCRW   FOAM DISC 72MM           4,570.00            23            SURGICAL SUPPLIES
       2321511   S SCRW   FOAM HALF MOON 16        5,120.00            23            SURGICAL SUPPLIES



9/17/2012                                                                                                     219
                                          69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2321487   S SCRW   FOAM STRIP 25X100        5,720.00            23            SURGICAL SUPPLIES
       2321479   S SCRW   FOAM STRIP 25X50X        2,763.75            23            SURGICAL SUPPLIES
       2321495   S SCRW   FOAM STRIP 75X100        6,410.00            23            SURGICAL SUPPLIES
       2321461   S SCRW   FOAM STRIP THIN          2,983.75            23            SURGICAL SUPPLIES
       2324622   S SCRW   FUSION DEV                 923.00            23            SURGICAL SUPPLIES
       2321008   S SCRW   GOLD MAX. FACE SCR         209.50     209.50 23            SURGICAL SUPPLIES
       2329894   S SCRW   INFAST SCREW BONE          898.50            23            SURGICAL SUPPLIES
       2321081   S SCRW   INTER SCREW ACL            666.40            23            SURGICAL SUPPLIES
       2321099   S SCRW   INTER SCREW DELTA          679.50            23            SURGICAL SUPPLIES
       2325751   S SCRW   INTERFERENCE SCREW         369.50     369.50 23            SURGICAL SUPPLIES
       2320034   S SCRW   INTRFRNCE SCRW ACL         698.00            23            SURGICAL SUPPLIES
       2320042   S SCRW   INTRFRNCE SCRW ACL         422.50            23            SURGICAL SUPPLIES
       2320067   S SCRW   INTRFRNCE SCRW ACL         777.50            23            SURGICAL SUPPLIES
       2321370   S SCRW   KIT AC TIGHTROPE         1,718.25            23            SURGICAL SUPPLIES
       2329803   S SCRW   LACTOSCREW                 822.00            23            SURGICAL SUPPLIES
       2324028   S SCRW   LAG 12.7                   662.58            23            SURGICAL SUPPLIES
       2321867   S SCRW   LAG SCREW                  557.50            23            SURGICAL SUPPLIES
       2321875   S SCRW   LAG SCREW                  557.50            23            SURGICAL SUPPLIES
       2321883   S SCRW   LAG SCREW                  557.50            23            SURGICAL SUPPLIES
       2321891   S SCRW   LAG SCREW                  557.50            23            SURGICAL SUPPLIES
       2321917   S SCRW   LAG SCREW                  557.50            23            SURGICAL SUPPLIES
       2321925   S SCRW   LAG SCREW                  510.50            23            SURGICAL SUPPLIES
       2321933   S SCRW   LAG SCREW                  461.50            23            SURGICAL SUPPLIES
       2321941   S SCRW   LAG SCREW                  461.50            23            SURGICAL SUPPLIES
       2321966   S SCRW   LAG SCREW                  461.50            23            SURGICAL SUPPLIES
       2321974   S SCRW   LAG SCREW                  461.50            23            SURGICAL SUPPLIES
       2321982   S SCRW   LAG SCREW                  461.50            23            SURGICAL SUPPLIES
       2321990   S SCRW   LAG SCREW                  474.00            23            SURGICAL SUPPLIES
       2322014   S SCRW   LAG SCREW                  474.50            23            SURGICAL SUPPLIES
       2322022   S SCRW   LAG SCREW                  474.50            23            SURGICAL SUPPLIES
       2322030   S SCRW   LAG SCREW                  474.50            23            SURGICAL SUPPLIES
       2322048   S SCRW   LAG SCREW                  474.50            23            SURGICAL SUPPLIES
       2324614   S SCRW   LOCKING                    574.00            23            SURGICAL SUPPLIES



9/17/2012                                                                                                     220
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2320117   S SCRW LOCKING SCREW               338.52              23          SURGICAL SUPPLIES
       2324515   S SCRW LOCKING SCREW               419.90              23          SURGICAL SUPPLIES
       2326908   S SCRW LOCKING SCREW               227.00              23          SURGICAL SUPPLIES
       2325918   S SCRW MALLEOLAR                    74.97              23          SURGICAL SUPPLIES
       2323566   S SCRW MAXLOCK                     577.50              23          SURGICAL SUPPLIES
       2324648   S SCRW MENISCAL                  1,122.00              23          SURGICAL SUPPLIES
       2329654   S SCRW OST LAG SCR 2.4X16          470.50              23          SURGICAL SUPPLIES
       2320125   S SCRW OSTEOMED                    185.50              23          SURGICAL SUPPLIES
       2324630   S SCRW PEG                         262.50              23          SURGICAL SUPPLIES
       2321792   S SCRW PERIARTICULAR                84.00              23          SURGICAL SUPPLIES
       2321362   S SCRW REPOSE GAHM                 893.75              23          SURGICAL SUPPLIES
       2322964   S SCRW SELF DRILL                1,023.75              23          SURGICAL SUPPLIES
       2323061   S SCRW SELF TAP                    309.79              23          SURGICAL SUPPLIES
       2327997   S SCRW SOFT SILK SCREWS            437.50              23          SURGICAL SUPPLIES
       2326858   S SCRW SPINE SET SCREW             664.00              23          SURGICAL SUPPLIES
       2327054   S SCRW TIMESH SCREWS               157.50              23          SURGICAL SUPPLIES
       2320091   S SCRW WASHER LG SYNTHES            78.00              23          SURGICAL SUPPLIES
       2360675   S SRL EX FIX PIN CAP                56.95              23          SURGICAL SUPPLIES
       2311819   S STNT NOCOR WDEL SYS TMP          209.50     209.50   23          SURGICAL SUPPLIES
       2328417   S STNT NOCOR WO DEL TMP            580.00              23          SURGICAL SUPPLIES
       2312809   S STRL ACCESS KIT LAP BA         1,636.25              23          SURGICAL SUPPLIES
       2317360   S STRL ACCESSORY KIT / E         1,935.00              23          SURGICAL SUPPLIES
       2314474   S STRL ACETABULAR CEMENT           134.50     134.50   23          SURGICAL SUPPLIES
       2319762   S STRL ACL DRILL PIN KIT           277.00              23          SURGICAL SUPPLIES
       2312858   S STRL ACUFEX CANNULA               56.50      61.00   23          SURGICAL SUPPLIES
       2310654   S STRL ACUFEX SUTURE RET           103.50     103.50   23          SURGICAL SUPPLIES
       2310662   S STRL ACUFUSER 100                551.00              23          SURGICAL SUPPLIES
       2310647   S STRL ACUFUSER 275                933.00              23          SURGICAL SUPPLIES
       2310621   S STRL ACUFUSER 275D               726.00              23          SURGICAL SUPPLIES
       2310688   S STRL ACUFUSER 550                967.50              23          SURGICAL SUPPLIES
       2310704   S STRL ACUFUSER 550D             1,007.50              23          SURGICAL SUPPLIES
       2360329   S STRL ALVARDO KNEE KIT            101.50              23          SURGICAL SUPPLIES
       2319648   S STRL ANCHOR CURVTEC ND            30.00              23          SURGICAL SUPPLIES



9/17/2012                                                                                                    221
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2310043   S STRL ANCHOR DART CANN                 94.50              23          SURGICAL SUPPLIES
       2316016   S STRL ANGIOCATH                        45.50              23          SURGICAL SUPPLIES
       2314599   S STRL ANGLED ELECTRODE                135.50     135.50   23          SURGICAL SUPPLIES
       2310860   S STRL ANSPACH NEURO DRI               277.20              23          SURGICAL SUPPLIES
       2310886   S STRL ANSPACH NEURO DRI               237.60              23          SURGICAL SUPPLIES
       2313716   S STRL ANSPACH NEURO DRI               360.00     360.00   23          SURGICAL SUPPLIES
       2315026   S STRL ANTENNA PATIENT P               525.00              23          SURGICAL SUPPLIES
       2311116   S STRL ARCH BARS                        33.00      33.00   23          SURGICAL SUPPLIES
       2316032   S STRL ARROW CVA SET                   482.00              23          SURGICAL SUPPLIES
       2364487   S STRL ARTHREX ACL KIT             926,325.00              23          SURGICAL SUPPLIES
       2317824   S STRL ARTHRO SPINE WAND             3,127.00              23          SURGICAL SUPPLIES
       2360386   S STRL ARTHROWAND A1330-               539.50              23          SURGICAL SUPPLIES
       2360410   S STRL ARTHROWAND A1345-               598.50              23          SURGICAL SUPPLIES
       2360394   S STRL ARTHROWAND A1630-               561.00              23          SURGICAL SUPPLIES
       2360402   S STRL ARTHROWAND A2430-               561.00              23          SURGICAL SUPPLIES
       2360352   S STRL ARTHROWAND A2823-               561.00              23          SURGICAL SUPPLIES
       2360360   S STRL ARTHROWAND AS1335               668.50              23          SURGICAL SUPPLIES
       2360378   S STRL ARTHROWAND AS2530               647.00              23          SURGICAL SUPPLIES
       2360345   S STRL ARTHROWAND X1003-             1,150.50              23          SURGICAL SUPPLIES
       2361103   S STRL ARTHROWND AS5500                709.00              23          SURGICAL SUPPLIES
       2310761   S STRL AUTO TRANSFUSION              2,323.67              23          SURGICAL SUPPLIES
       2312502   S STRL AUTOLOGUS PLAT SY             1,237.50              23          SURGICAL SUPPLIES
       2311249   S STRL BAIR BLANKET CARD               109.97              23          SURGICAL SUPPLIES
       2316933   S STRL BALLOON RETRACTOR               539.50              23          SURGICAL SUPPLIES
       2311009   S STRL BARIATRIC PACK                  704.98              23          SURGICAL SUPPLIES
       2315349   S STRL BASKET STONE STAMI              492.00              23          SURGICAL SUPPLIES
       2315323   S STRL BASKT STONE EXPAND              624.00              23          SURGICAL SUPPLIES
       2310753   S STRL BILE BAG                         39.00      39.00   23          SURGICAL SUPPLIES
       2310795   S STRL BILIARY IRRIG CAT               331.00     331.00   23          SURGICAL SUPPLIES
       2310811   S STRL BILIARY PROBE                   116.09     116.09   23          SURGICAL SUPPLIES
       2323053   S STRL BIO PLUG CEMENT R               399.50     399.50   23          SURGICAL SUPPLIES
       2313658   S STRL BIOPSY NEEDLE                   139.00     139.00   23          SURGICAL SUPPLIES
       2362705   S STRL BIOTENODESIS KIT                525.00              23          SURGICAL SUPPLIES



9/17/2012                                                                                                        222
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2318285   S STRL BIPLR CUT FCP 5MM        1,079.00              23          SURGICAL SUPPLIES
       2362200   S STRL BLADE DISP ARTHROS         282.96              23          SURGICAL SUPPLIES
       2362556   S STRL BLADE KOMET                 35.00              23          SURGICAL SUPPLIES
       2319895   S STRL BLADE KOMET                 23.00              23          SURGICAL SUPPLIES
       2362457   S STRL BLADE LINVATEC OSC         210.00              23          SURGICAL SUPPLIES
       2360139   S STRL BLADE LINVATEC SAG         171.50              23          SURGICAL SUPPLIES
       2362069   S STRL BLADE OSC/RECEP            107.73              23          SURGICAL SUPPLIES
       2362234   S STRL BLADE PATELLA              557.48              23          SURGICAL SUPPLIES
       2362085   S STRL BLADE SAGITAL              234.00              23          SURGICAL SUPPLIES
       2316115   S STRL BLOOD Y                     51.00              23          SURGICAL SUPPLIES
       2360220   S STRL BONE BIOPSY DEV            455.00              23          SURGICAL SUPPLIES
       2362952   S STRL BONE BIOPSY KIT          4,273.50              23          SURGICAL SUPPLIES
       2324606   S STRL BONE DOWEL                 610.50     610.50   23          SURGICAL SUPPLIES
       2360212   S STRL BONE FILL DEV              402.50              23          SURGICAL SUPPLIES
       2322550   S STRL BONE STAPLES               121.00      42.00   23          SURGICAL SUPPLIES
       2310571   S STRL BOVIE                       57.00      57.00   23          SURGICAL SUPPLIES
       2311876   S STRL BOVIE HAND CONTRO           13.00      13.00   23          SURGICAL SUPPLIES
       2311033   S STRL BROWN DERMATONE            249.00     249.00   23          SURGICAL SUPPLIES
       2362028   S STRL BUCKS CMENT RESTRT         429.50              23          SURGICAL SUPPLIES
       2360147   S STRL BUR LINVATEC OVAL          126.00              23          SURGICAL SUPPLIES
       2362143   S STRL BURR                        63.80              23          SURGICAL SUPPLIES
       2315067   S STRL BURR DIAMOND               402.50              23          SURGICAL SUPPLIES
       2315042   S STRL BURR RND                   210.00              23          SURGICAL SUPPLIES
       2324200   S STRL CANAL RESTRICTOR           122.00     122.00   23          SURGICAL SUPPLIES
       2360857   S STRL CANN SHLDR 5.75            112.00              23          SURGICAL SUPPLIES
       2310449   S STRL CANNULA QUICK DRAW       1,144.00              23          SURGICAL SUPPLIES
       2319713   S STRL CANNULA RETROGRADE         357.50              23          SURGICAL SUPPLIES
       2312403   S STRL CAPIO DEVICE               808.44              23          SURGICAL SUPPLIES
       2312940   S STRL CAROTID SHUNT              807.95              23          SURGICAL SUPPLIES
       2322659   S STRL CAST MISC                  210.00     210.00   23          SURGICAL SUPPLIES
       2318640   S STRL CATH BLN URN OCCLD         614.50              23          SURGICAL SUPPLIES
       2311389   S STRL CATH CODA BALLOON        1,176.50              23          SURGICAL SUPPLIES
       2311751   S STRL CATH DRAINAGE              194.50     194.50   23          SURGICAL SUPPLIES



9/17/2012                                                                                                   223
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2317188   S STRL CATH EPISTAT SIL            190.00               23         SURGICAL SUPPLIES
       2315000   S STRL CATH PASSER                 343.00               23         SURGICAL SUPPLIES
       2311520   S STRL CATH TORQUE 5FR             308.00               23         SURGICAL SUPPLIES
       2312247   S STRL CATHETER ANGIODYNA           75.00               23         SURGICAL SUPPLIES
       2312288   S STRL CATHETER ANGIOGRAP          395.50               23         SURGICAL SUPPLIES
       2311983   S STRL CATHETER BALLOON          1,369.50               23         SURGICAL SUPPLIES
       2311942   S STRL CATHETER STENT BL         1,223.75               23         SURGICAL SUPPLIES
       2313476   S STRL CATHETER TRAY               142.00     142.00    23         SURGICAL SUPPLIES
       2310472   S STRL CAUTERY DISP                142.50     142.50    23         SURGICAL SUPPLIES
       2310910   S STRL CELL SAVER SUCTIO            83.00      83.00    23         SURGICAL SUPPLIES
       2313070   S STRL CEMENT INJECT CAR           167.09     167.09    23         SURGICAL SUPPLIES
       2363000   S STRL CEMENT INSERT KIT           437.50               23         SURGICAL SUPPLIES
       2361608   S STRL CEMENT NOZZLE               122.00               23         SURGICAL SUPPLIES
       2318327   S STRL CHEST DRAIN THORA           164.68               23         SURGICAL SUPPLIES
       2341006   S STRL CHEST TUBE 32F               15.52               23         SURGICAL SUPPLIES
       2310852   S STRL CHOLANGIO CATH              284.00     284.00    23         SURGICAL SUPPLIES
       2319697   S STRL CHRON SULFATE               237.50               23         SURGICAL SUPPLIES
       2315695   S STRL CIRCON EHL PROBE            607.00               23         SURGICAL SUPPLIES
       2311132   S STRL CLIP LEROY RANEY             74.50      74.50    23         SURGICAL SUPPLIES
       2312387   S STRL CLOSESURE                   385.00               23         SURGICAL SUPPLIES
       2318756   S STRL COBLAT EVAC T&A             663.00               23         SURGICAL SUPPLIES
       2314268   S STRL CONCEPTUS ESSURE          3,162.50               23         SURGICAL SUPPLIES
       2318343   S STRL CONSTAVAC W TROCA           120.00               23         SURGICAL SUPPLIES
       2311678   S STRL COOK LEAD                   130.50     130.50    23         SURGICAL SUPPLIES
       2312932   S STRL CORDIS LUMBAR DRA           635.50     635.50    23         SURGICAL SUPPLIES
       2362168   S STRL CORING REAMER               656.00               23         SURGICAL SUPPLIES
       2318855   S STRL CORNEA PUN 8.5              243.50               23         SURGICAL SUPPLIES
       2318905   S STRL CORNEA PUN VAC8.25          272.00               23         SURGICAL SUPPLIES
       2315711   S STRL CORSON/STRYKER              159.60               23         SURGICAL SUPPLIES
       2320851   S STRL CRANIOPLASTY KIT          2,271.50    2,271.50   23         SURGICAL SUPPLIES
       2317220   S STRL CSYTOFLO II URINA            17.50               23         SURGICAL SUPPLIES
       2312023   S STRL CURETTE LATITUDE            682.50               23         SURGICAL SUPPLIES
       2314995   S STRL CUSA DISPOSABLE             783.25     783.25    23         SURGICAL SUPPLIES



9/17/2012                                                                                                    224
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2310480   S STRL CUTTER ECHELON 60M        1,214.56               23         SURGICAL SUPPLIES
       2311744   S STRL DERMABOND ADHESIVE           66.15               23         SURGICAL SUPPLIES
       2323558   S STRL DEXON SUTURE                 27.50      27.50    23         SURGICAL SUPPLIES
       2362507   S STRL DISP ARTHROSCOPY            213.00               23         SURGICAL SUPPLIES
       2312577   S STRL DISP BURBS                  133.00     133.00    23         SURGICAL SUPPLIES
       2311546   S STRL DISP RESUS BAG               32.16               23         SURGICAL SUPPLIES
       2317048   S STRL DISSECTING HOOK             441.50               23         SURGICAL SUPPLIES
       2317022   S STRL DISSECTOR 5MM               150.50               23         SURGICAL SUPPLIES
       2310506   S STRL DRAIN PEZZER                 25.80               23         SURGICAL SUPPLIES
       2313492   S STRL DRAINAGE BAG                 34.50      34.50    23         SURGICAL SUPPLIES
       2360014   S STRL DRILL BIT                   217.00               23         SURGICAL SUPPLIES
       2362804   S STRL DRILL BIT                   350.00               23         SURGICAL SUPPLIES
       2360030   S STRL DRILL BIT 1.1MM             192.50               23         SURGICAL SUPPLIES
       2360048   S STRL DRILL BIT 1.5MM             206.50               23         SURGICAL SUPPLIES
       2360022   S STRL DRILL BIT 1.8MM             413.00               23         SURGICAL SUPPLIES
       2360063   S STRL DRILL BIT 2.0MM             218.75               23         SURGICAL SUPPLIES
       2363265   S STRL DRILL BIT 2.4MM             487.50               23         SURGICAL SUPPLIES
       2363208   S STRL DRILL BIT 2.5               698.75               23         SURGICAL SUPPLIES
       2360071   S STRL DRILL BIT 2.7MM             239.75               23         SURGICAL SUPPLIES
       2360097   S STRL DRILL BIT 4.0MM             434.00               23         SURGICAL SUPPLIES
       2360121   S STRL DRILL BIT CALIBRA           560.00               23         SURGICAL SUPPLIES
       2360089   S STRL DRILL BIT QUICK C           486.50               23         SURGICAL SUPPLIES
       2360113   S STRL DRILL BIT SYNTHES           374.50               23         SURGICAL SUPPLIES
       2319945   S STRL DRILL PIN GFT PAS           532.50               23         SURGICAL SUPPLIES
       2362101   S STRL DRILL WIRE PASS              63.80               23         SURGICAL SUPPLIES
       2313179   S STRL DRS XEROFORM                 13.00      13.00    23         SURGICAL SUPPLIES
       2315257   S STRL DURA HOOKS                   40.64               23         SURGICAL SUPPLIES
       2324408   S STRL DURA REPLACEMENT          1,201.50    1,201.50   23         SURGICAL SUPPLIES
       2314011   S STRL DYONICS BURS                344.50      344.50   23         SURGICAL SUPPLIES
       2360907   S STRL EBI EXT WRIST FIX         4,080.00               23         SURGICAL SUPPLIES
       2318426   S STRL ELEC 3.5 90DEG              622.50               23         SURGICAL SUPPLIES
       2360956   S STRL ELEC COBL II ULTRA          634.50               23         SURGICAL SUPPLIES
       2319705   S STRL ELEC EYE CORD                27.50               23         SURGICAL SUPPLIES



9/17/2012                                                                                                    225
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2329506   S STRL ELEC RAZOR VAC              682.00            23            SURGICAL SUPPLIES
       2310746   S STRL ELEC RSCT CLD KNFE          561.00            23            SURGICAL SUPPLIES
       2318582   S STRL ELEC SABER 30               622.50            23            SURGICAL SUPPLIES
       2319564   S STRL ELEC STIM PRB PASS          328.50            23            SURGICAL SUPPLIES
       2319572   S STRL ELEC SUBDERMAL              277.00            23            SURGICAL SUPPLIES
       2318434   S STRL ELECTROD MICRO NDL          164.00            23            SURGICAL SUPPLIES
       2310787   S STRL ELECTRODE DAC                81.36            23            SURGICAL SUPPLIES
       2311140   S STRL ELECTRODE ELLMED            197.00            23            SURGICAL SUPPLIES
       2311629   S STRL ELECTRODE SOMNO ND        1,080.00            23            SURGICAL SUPPLIES
       2310902   S STRL ELECTRODE STARION           506.60            23            SURGICAL SUPPLIES
       2326452   S STRL EMS STAPLER                 985.50            23            SURGICAL SUPPLIES
       2319242   S STRL ENDO BABCK 5MM              626.00            23            SURGICAL SUPPLIES
       2328383   S STRL ENDO BABCOCK 10MM           332.00            23            SURGICAL SUPPLIES
       2314912   S STRL ENDO BAGS                   366.00     366.00 23            SURGICAL SUPPLIES
       2315018   S STRL ENDO CHERRY                 947.00     947.00 23            SURGICAL SUPPLIES
       2317840   S STRL ENDO CINCH II               337.00            23            SURGICAL SUPPLIES
       2318442   S STRL ENDO CLOSE                  113.50            23            SURGICAL SUPPLIES
       2315653   S STRL ENDO GRASPER/CAUT           317.00            23            SURGICAL SUPPLIES
       2318624   S STRL ENDO KITTNER                 79.50            23            SURGICAL SUPPLIES
       2319556   S STRL ENDO KNOT 5MM               330.50            23            SURGICAL SUPPLIES
       2312585   S STRL ENDO KNOT VICRYL            166.64            23            SURGICAL SUPPLIES
       2319267   S STRL ENDO KNT PUSH 4MM           515.50            23            SURGICAL SUPPLIES
       2310944   S STRL ENDO NEEDLE                 356.40            23            SURGICAL SUPPLIES
       2319283   S STRL ENDO PEANUT 5MM              80.40            23            SURGICAL SUPPLIES
       2315612   S STRL ENDO RETRACT                491.00            23            SURGICAL SUPPLIES
       2315679   S STRL ENDO SCISSOR/CAUT           377.50            23            SURGICAL SUPPLIES
       2319689   S STRL ENDO SCRUB                  125.00            23            SURGICAL SUPPLIES
       2318483   S STRL ENDO SHEERS 5MM           1,155.00            23            SURGICAL SUPPLIES
       2318467   S STRL ENDO SLIDE PUSHER            49.50            23            SURGICAL SUPPLIES
       2310829   S STRL ENDO SUT GRASPER             95.00            23            SURGICAL SUPPLIES
       2310803   S STRL ENDO TORCAR BLUNT           380.00            23            SURGICAL SUPPLIES
       2312544   S STRL ENDO TROCAR 18MM            294.17            23            SURGICAL SUPPLIES
       2328003   S STRL ENDOBUTTON/LOOP             879.50            23            SURGICAL SUPPLIES



9/17/2012                                                                                                    226
                                            69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2311728   S STRL ENDOCATCH                      373.87            23            SURGICAL SUPPLIES
       2319127   S STRL ENDOCATCH                      284.00            23            SURGICAL SUPPLIES
       2319101   S STRL ENDOCLOSE                      108.00            23            SURGICAL SUPPLIES
       2319085   S STRL ENDOCUT SCISS                  199.50            23            SURGICAL SUPPLIES
       2319143   S STRL ENDOGRASPER 5MM                216.76            23            SURGICAL SUPPLIES
       2327807   S STRL ENDOLOOP                        91.20            23            SURGICAL SUPPLIES
       2310613   S STRL ENDOPORT                       355.00     355.00 23            SURGICAL SUPPLIES
       2316214   S STRL EPIDURAL MINI PAC               79.50            23            SURGICAL SUPPLIES
       2316230   S STRL EPIDURAL TRAY                  175.50            23            SURGICAL SUPPLIES
       2325652   S STRL EPIGARD                         69.50      69.50 23            SURGICAL SUPPLIES
       2327401   S STRL ER 320 CLIP APPLI              589.00            23            SURGICAL SUPPLIES
       2361400   S STRL ESMARK 4                        12.50            23            SURGICAL SUPPLIES
       2361459   S STRL ESMARK 6                        18.50            23            SURGICAL SUPPLIES
       2316255   S STRL ESOPH STETHOSCOPE               54.50            23            SURGICAL SUPPLIES
       2315919   S STRL EVERSHEAR                      307.50            23            SURGICAL SUPPLIES
       2315893   S STRL EVERSHEAR SCISSOR              397.50            23            SURGICAL SUPPLIES
       2363489   S STRL EX FIX RING 150              2,200.00            23            SURGICAL SUPPLIES
       2363497   S STRL EX FIX RING 150                975.00            23            SURGICAL SUPPLIES
       2363430   S STRL EX FIX BAR THD                 350.00            23            SURGICAL SUPPLIES
       2363331   S STRL EX FIX CLAMP                 1,804.00            23            SURGICAL SUPPLIES
       2363455   S STRL EX FIX CLAMP SNGL            1,127.50            23            SURGICAL SUPPLIES
       2363315   S STRL EX FIX CONN ROD              1,581.25            23            SURGICAL SUPPLIES
       2362580   S STRL EX FIX COUPLING              1,424.50            23            SURGICAL SUPPLIES
       2360592   S STRL EX FIX CUBE RANCH              630.00            23            SURGICAL SUPPLIES
       2360626   S STRL EX FIX CUBE RANCH              656.50            23            SURGICAL SUPPLIES
       2360634   S STRL EX FIX CUBE RANCH              767.00            23            SURGICAL SUPPLIES
       2360618   S STRL EX FIX DRILL HEX             1,001.00            23            SURGICAL SUPPLIES
       2363471   S STRL EX FIX FOOT RING             2,750.00            23            SURGICAL SUPPLIES
       2360576   S STRL EX FIX HALF PIN                728.00            23            SURGICAL SUPPLIES
       2360287   S STRL EX FIX HALF RING             2,098.25            23            SURGICAL SUPPLIES
       2363349   S STRL EX FIX HII CLAMP             2,530.00            23            SURGICAL SUPPLIES
       2363463   S STRL EX FIX K-WIRE CLA              560.00            23            SURGICAL SUPPLIES
       2360584   S STRL EX FIX NUT                     324.28            23            SURGICAL SUPPLIES



9/17/2012                                                                                                       227
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2363414   S STRL EX FIX NUTS WASHE           262.50              23          SURGICAL SUPPLIES
       2363448   S STRL EX FIX PIN 2H               542.50              23          SURGICAL SUPPLIES
       2363364   S STRL EX FIX PIN CVR              120.00              23          SURGICAL SUPPLIES
       2363323   S STRL EX FIX POST                 364.00              23          SURGICAL SUPPLIES
       2363398   S STRL EX FIX POST                 367.50              23          SURGICAL SUPPLIES
       2363422   S STRL EX FIX RING CONN            175.00              23          SURGICAL SUPPLIES
       2360691   S STRL EX FIX ROD                  754.00              23          SURGICAL SUPPLIES
       2360642   S STRL EX FIX ROG LG             5,403.75              23          SURGICAL SUPPLIES
       2360667   S STRL EX FIX ROG SM             3,753.75              23          SURGICAL SUPPLIES
       2363380   S STRL EX FIX SCRW HOLDE           828.75              23          SURGICAL SUPPLIES
       2362226   S STRL EX FIX SLEEVE               385.00              23          SURGICAL SUPPLIES
       2363406   S STRL EX FIX SLIDER 3 H           910.00              23          SURGICAL SUPPLIES
       2360279   S STRL EX FIX WASHER                66.85              23          SURGICAL SUPPLIES
       2360261   S STRL EX FIX WIRE BAY             378.01              23          SURGICAL SUPPLIES
       2313286   S STRL EXP ACCESS KIT              795.00              23          SURGICAL SUPPLIES
       2317402   S STRL EXPAND LE MAITRE          1,012.50              23          SURGICAL SUPPLIES
       2312528   S STRL EXT RECHARGER             5,980.00              23          SURGICAL SUPPLIES
       2313054   S STRL EXT RECHARGER             4,780.00              23          SURGICAL SUPPLIES
       2311827   S STRL EXTERNAL TISS EXPA          402.50              23          SURGICAL SUPPLIES
       2311397   S STRL EXTRA ET TUBE                14.50      14.50   23          SURGICAL SUPPLIES
       2314235   S STRL EXTRA MIXING BOWL           186.50     186.50   23          SURGICAL SUPPLIES
       2311637   S STRL EYE CAUTERY                  45.50      45.50   23          SURGICAL SUPPLIES
       2311611   S STRL EYE KNIFE REGULAR            13.50      13.50   23          SURGICAL SUPPLIES
       2362044   S STRL FEMORAL BONE BRUSH           65.50              23          SURGICAL SUPPLIES
       2315232   S STRL FLEX CURETTE                101.46              23          SURGICAL SUPPLIES
       2318665   S STRL FLEX IRIS RETRACT            36.40              23          SURGICAL SUPPLIES
       2314136   S STRL FLUID URO TUBE IR           298.00     298.00   23          SURGICAL SUPPLIES
       2311199   S STRL FOGARTY ARTERIAL            175.00     175.00   23          SURGICAL SUPPLIES
       2310548   S STRL FOGARTY IRRIGATING           82.60              23          SURGICAL SUPPLIES
       2313518   S STRL FOLEY                       136.00     136.00   23          SURGICAL SUPPLIES
       2315356   S STRL FOLEY                        50.05              23          SURGICAL SUPPLIES
       2312429   S STRL GASTRIC TUBE                 37.20              23          SURGICAL SUPPLIES
       2311090   S STRL GASTROSTOMY TUBE             38.00      38.00   23          SURGICAL SUPPLIES



9/17/2012                                                                                                    228
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2310928   S STRL GELPORT                   1,317.25               23         SURGICAL SUPPLIES
       2329407   S STRL GIA 30 3.5 RELOAD           364.00               23         SURGICAL SUPPLIES
       2313856   S STRL GIGI SAW BLADE               70.50      70.50    23         SURGICAL SUPPLIES
       2311991   S STRL GILL BIOPSY BRUSH           120.50     120.50    23         SURGICAL SUPPLIES
       2315778   S STRL GLIDE WIRE                  160.00               23         SURGICAL SUPPLIES
       2361707   S STRL GRAFT KNIFE MITEK           222.50               23         SURGICAL SUPPLIES
       2310993   S STRL GRAFT KNIFE STORZ            31.00      31.00    23         SURGICAL SUPPLIES
       2317006   S STRL GRASPER ST 5MM              596.50               23         SURGICAL SUPPLIES
       2314490   S STRL GRASPERS/SHEARS           1,153.00    1,153.00   23         SURGICAL SUPPLIES
       2324804   S STRL GROSHONG CATH               646.00      672.00   23         SURGICAL SUPPLIES
       2362903   S STRL GUIDE PIN                    98.00               23         SURGICAL SUPPLIES
       2314730   S STRL GUIDING                     252.50     252.50    23         SURGICAL SUPPLIES
       2316917   S STRL GUIDING                     197.00               23         SURGICAL SUPPLIES
       2317279   S STRL GUIDING                   1,747.00               23         SURGICAL SUPPLIES
       2317600   S STRL GUIDING                   2,955.00               23         SURGICAL SUPPLIES
       2311603   S STRL GYRUS CUT FCP 15CM        1,199.25               23         SURGICAL SUPPLIES
       2317949   S STRL GYRUS CUT FCP 5MM           963.50               23         SURGICAL SUPPLIES
       2311223   S STRL GYRUS KNIFE                 578.00               23         SURGICAL SUPPLIES
       2317964   S STRL GYRUS NEEDLE ELEC           682.50               23         SURGICAL SUPPLIES
       2311124   S STRL GYRUS OPEN FORCEP           682.50               23         SURGICAL SUPPLIES
       2317980   S STRL GYRUS SCISSOR               542.50               23         SURGICAL SUPPLIES
       2310720   S STRL HAND ACCESS               1,394.66               23         SURGICAL SUPPLIES
       2313013   S STRL HARRIS UTER INJEC            78.00      78.00    23         SURGICAL SUPPLIES
       2316818   S STRL HD/PERITNL LNG TRM          692.50               23         SURGICAL SUPPLIES
       2316909   S STRL HD/PERITNL LNG TRM        1,004.50               23         SURGICAL SUPPLIES
       2320653   S STRL HD/PERITNL SHT              549.00     549.00    23         SURGICAL SUPPLIES
       2312817   S STRL HD/PRITNL SHRT TRM          625.00     625.00    23         SURGICAL SUPPLIES
       2317469   S STRL HD/PRITNL SHRT TRM          389.00               23         SURGICAL SUPPLIES
       2362754   S STRL HEMOERASER 23G              126.00               23         SURGICAL SUPPLIES
       2360311   S STRL HEWSON SUTURE RETR          217.00               23         SURGICAL SUPPLIES
       2323400   S STRL HICKMAN CATH DOUB           683.00     683.00    23         SURGICAL SUPPLIES
       2323350   S STRL HICKMAN CATH SING           329.00     329.00    23         SURGICAL SUPPLIES
       2312460   S STRL HOOK DERMA                   50.12               23         SURGICAL SUPPLIES



9/17/2012                                                                                                    229
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2312122   S STRL HOOK STAY LG               154.00              23          SURGICAL SUPPLIES
       2313039   S STRL HUM UTER MANIPULA          111.65      97.50   23          SURGICAL SUPPLIES
       2310522   S STRL HYDRO THERMABLATOR       2,062.50              23          SURGICAL SUPPLIES
       2311504   S STRL INDEFLATOR 20/20           157.50              23          SURGICAL SUPPLIES
       2311660   S STRL INDRODUCER 12FR CO         121.26              23          SURGICAL SUPPLIES
       2311405   S STRL INFLATION DEVICE           248.50              23          SURGICAL SUPPLIES
       2312601   S STRL INJECTOR                   194.00              23          SURGICAL SUPPLIES
       2312163   S STRL INSERT TRACT 33MM           70.00              23          SURGICAL SUPPLIES
       2360683   S STRL INTEGRA CUSA TIP         1,010.75              23          SURGICAL SUPPLIES
       2312841   S STRL INTEGRA CUSA WREN          171.50              23          SURGICAL SUPPLIES
       2312866   S STRL INTEGRA TBG MANIF          656.50              23          SURGICAL SUPPLIES
       2314615   S STRL INTESTINAL BAG              68.00      68.00   23          SURGICAL SUPPLIES
       2316354   S STRL INTRACATH                  145.50              23          SURGICAL SUPPLIES
       2312676   S STRL INTRAMEDLLRY BRUSH          93.50      93.50   23          SURGICAL SUPPLIES
       2314672   S STRL INTRO GDE FXD CRVP         278.50     278.50   23          SURGICAL SUPPLIES
       2312304   S STRL INTRO SHTH CORDIS           33.48              23          SURGICAL SUPPLIES
       2312189   S STRL INTRODUCER 11F              68.25              23          SURGICAL SUPPLIES
       2311561   S STRL INTRODUCER COAXIAL         171.00              23          SURGICAL SUPPLIES
       2311348   S STRL INTRODUCER FAST CA          80.50              23          SURGICAL SUPPLIES
       2313047   S STRL INTRODUCER SET              87.33              23          SURGICAL SUPPLIES
       2311306   S STRL INTRODUCER SHEATH          430.50              23          SURGICAL SUPPLIES
       2311322   S STRL INTRODUCER SHEATH          269.50              23          SURGICAL SUPPLIES
       2316982   S STRL IRRIGATION EPT03           142.00              23          SURGICAL SUPPLIES
       2311553   S STRL JACKSON PRATT RES           93.50      93.50   23          SURGICAL SUPPLIES
       2310878   S STRL JEJUNOSTOMY CATH           639.20     639.20   23          SURGICAL SUPPLIES
       2311587   S STRL KIT ARTERIAL SNG            31.20              23          SURGICAL SUPPLIES
       2311900   S STRL KIT CELL SVR BOWL          204.68              23          SURGICAL SUPPLIES
       2362655   S STRL KWIRE                       70.00              23          SURGICAL SUPPLIES
       2312064   S STRL KYPHOPAK TRAY            6,908.00              23          SURGICAL SUPPLIES
       2315075   S STRL LAP CHOLE KITS             740.00              23          SURGICAL SUPPLIES
       2319028   S STRL LAP COAG SHRS 5MM        1,194.00              23          SURGICAL SUPPLIES
       2318541   S STRL LAP HOOK ELECTROD          214.50              23          SURGICAL SUPPLIES
       2319168   S STRL LAP SHEARS 5MM           1,254.00              23          SURGICAL SUPPLIES



9/17/2012                                                                                                   230
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2316453   S STRL LASER ET TUBE                   258.00               23         SURGICAL SUPPLIES
       2312700   S STRL LASER FIBER                   2,475.00               23         SURGICAL SUPPLIES
       2313062   S STRL LASER FIBER                     884.00               23         SURGICAL SUPPLIES
       2315083   S STRL LASER FIBER                   2,956.25               23         SURGICAL SUPPLIES
       2318004   S STRL LEEP ELECTRODE                   65.50               23         SURGICAL SUPPLIES
       2317329   S STRL LENS GLIDE                       31.50               23         SURGICAL SUPPLIES
       2324259   S STRL LEVEEN SHUNT                  1,911.00    1,911.00   23         SURGICAL SUPPLIES
       2390706   S STRL LEVEL I INFUSOR                 358.00      358.00   23         SURGICAL SUPPLIES
       2317030   S STRL LG ORGAN RETRACTO               764.00               23         SURGICAL SUPPLIES
       2311082   S STRL LIGASURE                        563.50               23         SURGICAL SUPPLIES
       2311108   S STRL LIGASURE ATLAS                  975.00               23         SURGICAL SUPPLIES
       2310589   S STRL LIGASURE DIVIDER              1,280.00               23         SURGICAL SUPPLIES
       2310845   S STRL LIGASURE PRECISE                581.50               23         SURGICAL SUPPLIES
       2318319   S STRL LIN CIRC LOAD UNIT            1,113.75               23         SURGICAL SUPPLIES
       2318335   S STRL LIN CUT LOAD UNIT             2,376.00               23         SURGICAL SUPPLIES
       2318368   S STRL LINEAR STAPLER RAL            1,175.63               23         SURGICAL SUPPLIES
       2318350   S STRL LINEAR STPLR RALC3              978.99               23         SURGICAL SUPPLIES
       2360568   S STRL LINVATEC ARTH BLAD              178.60               23         SURGICAL SUPPLIES
       2362408   S STRL LINVATEC CANNULA                 98.80               23         SURGICAL SUPPLIES
       2360295   S STRL LINVATEC SUTUR RET              193.00               23         SURGICAL SUPPLIES
       2312080   S STRL LONE STAR RETRACT               154.00               23         SURGICAL SUPPLIES
       2316479   S STRL LONGDWELL                        32.00               23         SURGICAL SUPPLIES
       2363059   S STRL LOOP DISP ARTH                  122.50               23         SURGICAL SUPPLIES
       2316495   S STRL LTA KIT                          53.50               23         SURGICAL SUPPLIES
       2317154   S STRL LUKENS ASPIRATING                26.00               23         SURGICAL SUPPLIES
       2314094   S STRL LUMBAR DRAIN KIT                412.50     412.50    23         SURGICAL SUPPLIES
       2317162   S STRL MALCOTT                         103.00               23         SURGICAL SUPPLIES
       2390805   S STRL MARK III HELMET S               304.00               23         SURGICAL SUPPLIES
       2311736   S STRL MEDTRON PERCU IND                65.00      65.00    23         SURGICAL SUPPLIES
       2364503   S STRL MENISCAL APPLIER                381.50               23         SURGICAL SUPPLIES
       2311058   S STRL MESHGRAFT SPREADE                93.00      93.00    23         SURGICAL SUPPLIES
       2310019   S STRL MISC SURGERY SUPP                                    23         SURGICAL SUPPLIES
       2364495   S STRL MITEK ACL KIT                 1,137.50               23         SURGICAL SUPPLIES



9/17/2012                                                                                                        231
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2364511   S STRL MITEK SUTURE NDL                437.50              23          SURGICAL SUPPLIES
       2360238   S STRL MIXING BOWL                     357.00              23          SURGICAL SUPPLIES
       2311454   S STRL MIXING BOWLS                    262.50     262.50   23          SURGICAL SUPPLIES
       2317261   S STRL MULTI-LUMEN CV CA             1,175.50              23          SURGICAL SUPPLIES
       2313534   S STRL NASO GASTRIC TUBE                33.50      33.50   23          SURGICAL SUPPLIES
       2311363   S STRL NEEDLE ENTRY 18G                 10.60              23          SURGICAL SUPPLIES
       2312825   S STRL NEEDLE LAP BAND                  40.00              23          SURGICAL SUPPLIES
       2310498   S STRL NERVE LOCATOR DIS                33.00      33.00   23          SURGICAL SUPPLIES
       2311298   S STRL NERVE STIMULATOR                 19.50      19.50   23          SURGICAL SUPPLIES
       2314375   S STRL NEURO BURS/BLADES               532.80     532.80   23          SURGICAL SUPPLIES
       2313864   S STRL NOVASURE NS 2000              2,612.50              23          SURGICAL SUPPLIES
       2319580   S STRL NRV STIM VARI-STIM              176.50              23          SURGICAL SUPPLIES
       2317295   S STRL NYLON BLOCK KATENA              156.50              23          SURGICAL SUPPLIES
       2316537   S STRL O2 NASAL CANNULA                 14.00              23          SURGICAL SUPPLIES
       2312726   S STRL OCCLUDER RUMI                   169.15              23          SURGICAL SUPPLIES
       2319481   S STRL OCCUCOAT                        199.50              23          SURGICAL SUPPLIES
       2314755   S STRL OLYMPUS BALL-BAR-               231.50     231.50   23          SURGICAL SUPPLIES
       2325504   S STRL OMMYA CSF RESERVO               606.00     606.00   23          SURGICAL SUPPLIES
       2319069   S STRL ONE SEAL CAP                     41.00              23          SURGICAL SUPPLIES
       2319614   S STRL ON-Q SOAKER 100ML               551.00              23          SURGICAL SUPPLIES
       2319622   S STRL ON-Q SOAKER 270ML               846.50              23          SURGICAL SUPPLIES
       2318780   S STRL ON-Q SOAKER 400ML             1,215.00              23          SURGICAL SUPPLIES
       2318772   S STRL ON-Q SOAKER 65ML                551.00              23          SURGICAL SUPPLIES
       2316958   S STRL OPTIVIEW 12MM                   489.00              23          SURGICAL SUPPLIES
       2319663   S STRL OPUS M CONN                     459.00              23          SURGICAL SUPPLIES
       2319655   S STRL OPUS SUT CART                   560.00              23          SURGICAL SUPPLIES
       2317659   S STRL ORATE C INTOR NEE               198.50              23          SURGICAL SUPPLIES
       2315737   S STRL ORIGIN PDB2 TROCA               531.08              23          SURGICAL SUPPLIES
       2327708   S STRL ORIGIN T-10 SB                  453.50              23          SURGICAL SUPPLIES
       2327658   S STRL ORIGIN TACKER                   720.00              23          SURGICAL SUPPLIES
       2318020   S STRL ORTEC SPINE CATH              3,484.00              23          SURGICAL SUPPLIES
       2360303   S STRL ORTHO MISC                                          23          SURGICAL SUPPLIES
       2360659   S STRL OSTEOMED CANNULAT               869.50              23          SURGICAL SUPPLIES



9/17/2012                                                                                                        232
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2363307   S STRL OSTEOTOME                       497.00            23            SURGICAL SUPPLIES
       2317121   S STRL OVAL BALLON OMS-X               673.00            23            SURGICAL SUPPLIES
       2330025   S STRL PACING CABLE                    105.00            23            SURGICAL SUPPLIES
       2319630   S STRL PAIN BUSTER                     422.50            23            SURGICAL SUPPLIES
       2326759   S STRL PAS PORT CATH                 2,841.00            23            SURGICAL SUPPLIES
       2360816   S STRL PASSER STR SHOT8.5              268.50            23            SURGICAL SUPPLIES
       2360246   S STRL PEG DRIVER                      101.50            23            SURGICAL SUPPLIES
       2310290   S STRL PENROSE DRAIN                     8.00       8.00 23            SURGICAL SUPPLIES
       2312668   S STRL PERC TRACT KIT                2,123.50            23            SURGICAL SUPPLIES
       2313088   S STRL PERS THER MANGR               5,486.25            23            SURGICAL SUPPLIES
       2311777   S STRL PFISTER SCHWARTZ                319.00     319.00 23            SURGICAL SUPPLIES
       2363257   S STRL PILOT DRILL                     556.50            23            SURGICAL SUPPLIES
       2316966   S STRL PISTOL GRIP PROBE               563.00            23            SURGICAL SUPPLIES
       2319770   S STRL PLUG ACL BONE TUNN               76.00            23            SURGICAL SUPPLIES
       2319929   S STRL PLUG ACL GOLD                    73.00            23            SURGICAL SUPPLIES
       2318384   S STRL PLUME-AWAY                       78.75            23            SURGICAL SUPPLIES
       2312106   S STRL POUCH SURG TISSUE               156.17            23            SURGICAL SUPPLIES
       2326122   S STRL PRB LITHO E9F                   595.00            23            SURGICAL SUPPLIES
       2319366   S STRL PROBE LITHO E3F                 731.25            23            SURGICAL SUPPLIES
       2319325   S STRL PROBE LITHO E5F                 558.50            23            SURGICAL SUPPLIES
       2311447   S STRL PROGLIDE 6FR                    647.50            23            SURGICAL SUPPLIES
       2312965   S STRL PROXIMATE PPH                 1,264.25            23            SURGICAL SUPPLIES
       2312510   S STRL PRUITT INAHARA ST               971.75     971.75 23            SURGICAL SUPPLIES
       2316651   S STRL RAE ET TUBE                      53.50            23            SURGICAL SUPPLIES
       2311264   S STRL RELOAD ECHELON 60M              662.51            23            SURGICAL SUPPLIES
       2319515   S STRL RESECT BLD CUT                  351.00            23            SURGICAL SUPPLIES
       2319507   S STRL RESECT COAG LOOP                295.50            23            SURGICAL SUPPLIES
       2319523   S STRL RESECT ROLL BALL                420.00            23            SURGICAL SUPPLIES
       2318681   S STRL RESECTOSCP VAPOR                588.00            23            SURGICAL SUPPLIES
       2311868   S STRL RESERV CELLSAV                   95.55            23            SURGICAL SUPPLIES
       2326072   S STRL RET ADAP INFUS                  252.00            23            SURGICAL SUPPLIES
       2319465   S STRL RET FILTER                        9.50            23            SURGICAL SUPPLIES
       2319499   S STRL RET FRAG PK                     255.50            23            SURGICAL SUPPLIES



9/17/2012                                                                                                        233
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2319424   S STRL RET INFUS CANN                  103.00              23          SURGICAL SUPPLIES
       2319457   S STRL RET NEED 20GA                    65.50              23          SURGICAL SUPPLIES
       2319473   S STRL RET PRB LSR END                 595.00              23          SURGICAL SUPPLIES
       2318608   S STRL RETENTION BRIDGE                 40.50              23          SURGICAL SUPPLIES
       2319788   S STRL RETINA PROBE                    164.00              23          SURGICAL SUPPLIES
       2316719   S STRL ROBT SHAW ET TUBE               315.50              23          SURGICAL SUPPLIES
       2313575   S STRL SALEM PUMP                       18.00      18.00   23          SURGICAL SUPPLIES
       2317287   S STRL SALIVARY BYPASS T             1,083.00              23          SURGICAL SUPPLIES
       2364479   S STRL SCORPION NEEDLE                 490.00              23          SURGICAL SUPPLIES
       2311645   S STRL SEAL SELF 7FR                    56.00              23          SURGICAL SUPPLIES
       2360501   S STRL S-EGG BUR                       226.80              23          SURGICAL SUPPLIES
       2315331   S STRL SEQURA STONE BASK               730.50              23          SURGICAL SUPPLIES
       2312890   S STRL SHILEY TRACH TUBE               108.50     108.50   23          SURGICAL SUPPLIES
       2311207   S STRL SHUNT PASSER                    295.78              23          SURGICAL SUPPLIES
       2317170   S STRL SILASTC FOLEY CATH               45.00              23          SURGICAL SUPPLIES
       2360436   S STRL S-INTRA OVAL BLAD               409.36              23          SURGICAL SUPPLIES
       2314250   S STRL SKIN STAPLER - PL                74.06      74.06   23          SURGICAL SUPPLIES
       2314334   S STRL SKIN STAPLER - RE                23.32      23.32   23          SURGICAL SUPPLIES
       2313401   S STRL SKIN STPLER RELOAD               48.62              23          SURGICAL SUPPLIES
       2360493   S STRL S-LINDEMAND DRILL               226.80              23          SURGICAL SUPPLIES
       2362606   S STRL SMARTSET CARTRIDG               478.96              23          SURGICAL SUPPLIES
       2325306   S STRL SOFT CELL/VAS CAT               321.00              23          SURGICAL SUPPLIES
       2314276   S STRL SOFT TISSUE MINI                277.00     277.00   23          SURGICAL SUPPLIES
       2319804   S STRL SOMNO DOUBLE                  1,080.00              23          SURGICAL SUPPLIES
       2319796   S STRL SOMNO SINGLE                  1,150.00              23          SURGICAL SUPPLIES
       2318418   S STRL SOMNO TURBINATE                 569.00              23          SURGICAL SUPPLIES
       2318400   S STRL SOMNO TURBINATE                 569.00              23          SURGICAL SUPPLIES
       2360519   S STRL S-OVAL BUR                      178.00              23          SURGICAL SUPPLIES
       2323459   S STRL SP/CYSTOSCOPIC                  345.50     345.50   23          SURGICAL SUPPLIES
       2316990   S STRL SPATULA 5MM                     304.50              23          SURGICAL SUPPLIES
       2316735   S STRL SPINAL NEEDLE                    12.00              23          SURGICAL SUPPLIES
       2316750   S STRL SPINAL TRAY                     175.50              23          SURGICAL SUPPLIES
       2360451   S STRL S-RASP-113                      445.50              23          SURGICAL SUPPLIES



9/17/2012                                                                                                        234
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2360469   S STRL S-RASP-114                  445.50              23          SURGICAL SUPPLIES
       2360444   S STRL S-RECIP BLADE               282.24              23          SURGICAL SUPPLIES
       2360527   S STRL S-ROUND BUR                 160.50              23          SURGICAL SUPPLIES
       2360485   S STRL S-SERRATED DRILL            257.50              23          SURGICAL SUPPLIES
       2319531   S STRL ST SHOT 4MM                 504.00              23          SURGICAL SUPPLIES
       2311462   S STRL STENT GUIDE                  63.00              23          SURGICAL SUPPLIES
       2312908   S STRL STR SHOT SKIMMER            998.82              23          SURGICAL SUPPLIES
       2360808   S STRL STRAITSHOT RAD 55           749.00              23          SURGICAL SUPPLIES
       2360428   S STRL STRYKER 'A' BLADE           254.50              23          SURGICAL SUPPLIES
       2317212   S STRL STRYKER CONSTAVAC           447.00              23          SURGICAL SUPPLIES
       2317378   S STRL STRYKER SUCT IRRGT          391.00              23          SURGICAL SUPPLIES
       2360543   S STRL STYKER SAW BLADE            140.98              23          SURGICAL SUPPLIES
       2316776   S STRL SUB CLAVIAN CATH            236.00              23          SURGICAL SUPPLIES
       2312312   S STRL SUCTION CAUTERY              35.98      35.98   23          SURGICAL SUPPLIES
       2312734   S STRL SUNDT CAROTID SHU           327.60     327.60   23          SURGICAL SUPPLIES
       2317337   S STRL SUPERBLADE                   55.00              23          SURGICAL SUPPLIES
       2314359   S STRL SURGIGRIP                    22.50      56.00   23          SURGICAL SUPPLIES
       2310084   S STRL SUT ETHILON                  26.00              23          SURGICAL SUPPLIES
       2320943   S STRL SUT FIBERWIRE #2             91.00              23          SURGICAL SUPPLIES
       2310126   S STRL SUT MONOCRYL                 17.50              23          SURGICAL SUPPLIES
       2312981   S STRL SUT SAVER KIT               122.50              23          SURGICAL SUPPLIES
       2310365   S STRL SUT VICRYL                   39.00              23          SURGICAL SUPPLIES
       2310381   S STRL SUT VICRYL                   58.50              23          SURGICAL SUPPLIES
       2311801   S STRL SUTURE CHROMIC               12.00              23          SURGICAL SUPPLIES
       2311686   S STRL SUTURE ETHILON               12.00              23          SURGICAL SUPPLIES
       2364461   S STRL SUTURE FIBERCHAIN           157.50              23          SURGICAL SUPPLIES
       2310605   S STRL SUTURE MAXBRAID              81.00              23          SURGICAL SUPPLIES
       2322105   S STRL SUTURE NEEDLES               16.50      16.50   23          SURGICAL SUPPLIES
       2311843   S STRL SUTURE POLYPROPLYE           86.03              23          SURGICAL SUPPLIES
       2313443   S STRL SUTURE PROLENE               41.20              23          SURGICAL SUPPLIES
       2311702   S STRL SUTURE VICRYL                12.00              23          SURGICAL SUPPLIES
       2360535   S STRL S-WIRE PASS DRILL           241.92              23          SURGICAL SUPPLIES
       2312213   S STRL SWIVEL ADAPTOR PO            41.50      41.50   23          SURGICAL SUPPLIES



9/17/2012                                                                                                    235
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2310738   S STRL T TUBE                       31.00      31.00 23            SURGICAL SUPPLIES
       2329829   S STRL TA 60 MULTIFIRE             435.00            23            SURGICAL SUPPLIES
       2329860   S STRL TA 60 RELOAD                181.00            23            SURGICAL SUPPLIES
       2311579   S STRL TAUT CHOLANGIO CA            54.00      54.00 23            SURGICAL SUPPLIES
       2324903   S STRL TENCKHOFF CURL CA           393.00     393.00 23            SURGICAL SUPPLIES
       2315430   S STRL TIMESH DRILL BIT            319.50            23            SURGICAL SUPPLIES
       2310969   S STRL TISSEEL SPRAY SET           152.00            23            SURGICAL SUPPLIES
       2312924   S STRL TISSUE PREP SYS             173.25            23            SURGICAL SUPPLIES
       2312379   S STRL TLS DRAIN                   130.00     130.00 23            SURGICAL SUPPLIES
       2311421   S STRL TORQUE DEVICE               132.05            23            SURGICAL SUPPLIES
       2319002   S STRL TRCAR ENDPTH 10/11          438.00            23            SURGICAL SUPPLIES
       2318954   S STRL TRCAR ENDPTH 10/12          438.00            23            SURGICAL SUPPLIES
       2312643   S STRL TRCAR ENDPTH HAS            605.00            23            SURGICAL SUPPLIES
       2317303   S STRL TREPHINE KATENA             295.00            23            SURGICAL SUPPLIES
       2312650   S STRL TRIP LUM SUMP DRA            93.50      93.50 23            SURGICAL SUPPLIES
       2315869   S STRL TROCAR 11                   388.18            23            SURGICAL SUPPLIES
       2315844   S STRL TROCAR 11.5                  69.50            23            SURGICAL SUPPLIES
       2315828   S STRL TROCAR 12                   424.23            23            SURGICAL SUPPLIES
       2316974   S STRL TROCAR 20MM                 323.50            23            SURGICAL SUPPLIES
       2317014   S STRL TROCAR 20MM FPK03           620.50            23            SURGICAL SUPPLIES
       2319671   S STRL TROCAR 5-8MM                170.00            23            SURGICAL SUPPLIES
       2311488   S STRL TROCAR BLDLESS              314.65            23            SURGICAL SUPPLIES
       2318392   S STRL TROCAR BLUNTPORT P          233.50            23            SURGICAL SUPPLIES
       2315836   S STRL TROCAR SHORT                 87.50            23            SURGICAL SUPPLIES
       2315851   S STRL TROCAR W/CANNULA            126.00            23            SURGICAL SUPPLIES
       2316941   S STRL T-TROCAR 1-2MM              175.50            23            SURGICAL SUPPLIES
       2315273   S STRL T-TUBE                       31.60            23            SURGICAL SUPPLIES
       2310563   S STRL TUBE LAVACUATOR             190.00            23            SURGICAL SUPPLIES
       2312783   S STRL TUBING LAP BAND             437.50            23            SURGICAL SUPPLIES
       2310951   S STRL TUR BALL                     76.50      76.50 23            SURGICAL SUPPLIES
       2310977   S STRL TUR KNIFE                    47.00      47.00 23            SURGICAL SUPPLIES
       2311496   S STRL TUR LOOPS                   466.50     466.50 23            SURGICAL SUPPLIES
       2362002   S STRL TWIST DRILL                  33.50            23            SURGICAL SUPPLIES



9/17/2012                                                                                                    236
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2314979   S STRL ULTRACISION HAND                362.00      362.00 23           SURGICAL SUPPLIES
       2314953   S STRL ULTRACISION HOOK/             1,069.00    1,069.00 23           SURGICAL SUPPLIES
       2310324   S STRL UMBILICAL TAPE                    8.50             23           SURGICAL SUPPLIES
       2321453   S STRL UNI SHUNT                       850.50      850.50 23           SURGICAL SUPPLIES
       2313559   S STRL URETERAL                          8.00        8.00 23           SURGICAL SUPPLIES
       2313591   S STRL URETERAL                        140.50      140.50 23           SURGICAL SUPPLIES
       2315299   S STRL URETERAL                         10.50             23           SURGICAL SUPPLIES
       2317204   S STRL URETERAL                         72.00             23           SURGICAL SUPPLIES
       2313617   S STRL URIMETER W/FOLEY                 78.40       78.40 23           SURGICAL SUPPLIES
       2317253   S STRL URO-GUIDED URETER               475.00             23           SURGICAL SUPPLIES
       2317311   S STRL VACUUM TREPHINE                 463.00             23           SURGICAL SUPPLIES
       2319549   S STRL VAR A PULSE                     317.08             23           SURGICAL SUPPLIES
       2318806   S STRL VARAPULS BR TIP                  65.50             23           SURGICAL SUPPLIES
       2314797   S STRL VAS-CATH REPAIR K               355.50      355.50 23           SURGICAL SUPPLIES
       2314771   S STRL VAS-SPLIT KIT                   106.50      106.50 23           SURGICAL SUPPLIES
       2310027   S STRL VEIN HARVEST KIT              2,612.50             23           SURGICAL SUPPLIES
       2311173   S STRL VEIN STRIPPER                   125.50      125.50 23           SURGICAL SUPPLIES
       2314078   S STRL VERES NEEDLE                     78.50       78.50 23           SURGICAL SUPPLIES
       2318046   S STRL VERSA 11MM                      384.00             23           SURGICAL SUPPLIES
       2318186   S STRL VERSA ACC NDL                    92.50             23           SURGICAL SUPPLIES
       2318061   S STRL VERSA D/C 11MM                  234.82             23           SURGICAL SUPPLIES
       2318087   S STRL VERSA D/C 12MM                  317.50             23           SURGICAL SUPPLIES
       2318129   S STRL VERSA D/C 5MM                   213.00             23           SURGICAL SUPPLIES
       2318145   S STRL VERSA DAD SLV                   278.50             23           SURGICAL SUPPLIES
       2318160   S STRL VERSA INS/ACS NDL                78.64             23           SURGICAL SUPPLIES
       2318202   S STRL VERSA LG D/C 5MM                262.50             23           SURGICAL SUPPLIES
       2318228   S STRL VERSA LG EXP SLV                316.00             23           SURGICAL SUPPLIES
       2318244   S STRL VERSA LG EXP SLV                220.50             23           SURGICAL SUPPLIES
       2318103   S STRL VERSA NDLE 14GA                 146.00             23           SURGICAL SUPPLIES
       2318269   S STRL VERSA RAD EXP SLV               210.00             23           SURGICAL SUPPLIES
       2316727   S STRL VERSAPORT SEAL                   90.50             23           SURGICAL SUPPLIES
       2316743   S STRL VERSAPORT SEAL PLS              107.50             23           SURGICAL SUPPLIES
       2311280   S STRL VESSEL DILATOR                   15.20             23           SURGICAL SUPPLIES



9/17/2012                                                                                                        237
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2324101   S STRL VICRYL SUTURE                24.50      24.50 23            SURGICAL SUPPLIES
       2319408   S STRL VISC INJ PACK               259.50            23            SURGICAL SUPPLIES
       2312478   S STRL VISCERAL RETRACTO            72.00      72.00 23            SURGICAL SUPPLIES
       2318566   S STRL VITRECT HANDLE              929.50            23            SURGICAL SUPPLIES
       2317139   S STRL VIVA JEJUNOST KIT         1,159.00            23            SURGICAL SUPPLIES
       2312767   S STRL VTI ASPIRATOR STR           595.00            23            SURGICAL SUPPLIES
       2312742   S STRL VTI HEADSET                 357.00            23            SURGICAL SUPPLIES
       2363158   S STRL WEDGE FEM PRESS             164.50            23            SURGICAL SUPPLIES
       2319341   S STRL WIRE GUID SNE .035          186.50            23            SURGICAL SUPPLIES
       2319309   S STRL WIRE GUID ZEB ANG           213.00            23            SURGICAL SUPPLIES
       2360105   S STRL WIRE GUIDE                  105.00     105.00 23            SURGICAL SUPPLIES
       2360154   S STRL WIRE GUIDE                  183.50     183.50 23            SURGICAL SUPPLIES
       2360204   S STRL WIRE GUIDE                  147.00     147.00 23            SURGICAL SUPPLIES
       2360253   S STRL WIRE GUIDE                  271.39     271.39 23            SURGICAL SUPPLIES
       2362853   S STRL WIRE GUIDE                   70.00            23            SURGICAL SUPPLIES
       2370104   S STRL WIRE GUIDE                  490.00            23            SURGICAL SUPPLIES
       2370153   S STRL WIRE GUIDE                  392.00            23            SURGICAL SUPPLIES
       2360550   S STRL WIRE GUIDE                   85.50            23            SURGICAL SUPPLIES
       2360600   S STRL WIRE GUIDE                   53.50            23            SURGICAL SUPPLIES
       2361509   S STRL WIRE GUIDE 2.8MM            132.50            23            SURGICAL SUPPLIES
       2362127   S STRL WIRE PASS                    63.80            23            SURGICAL SUPPLIES
       2315471   S STRL WIZARD CUTTER               324.00            23            SURGICAL SUPPLIES
       2315455   S STRL WIZARD TUBING                58.00            23            SURGICAL SUPPLIES
       2310464   S STRL WOUND VAC SPONGE            981.50            23            SURGICAL SUPPLIES
       2330017   S STRL WRENCH KIT                  122.50            23            SURGICAL SUPPLIES
       2361152   S STRL ZIM HIP ABD IMMOB           120.00            23            SURGICAL SUPPLIES
       2312205   S STRLXPANDER INFLAT             3,022.25            23            SURGICAL SUPPLIES
       2328847   S TISSUE CONNCTV NOHUMAN         2,887.50            23            SURGICAL SUPPLIES
       2312320   S WIRE GUIDE                        22.00            23            SURGICAL SUPPLIES
       2312361   S WIRE GUIDE                       280.00            23            SURGICAL SUPPLIES
       2362218   S WIRE GUIDE ACUTRAK                36.00            23            SURGICAL SUPPLIES
       2363356   S WIRE GUIDE PIN                   229.50            23            SURGICAL SUPPLIES
       2363109   S WIRE GUIDE THD                   315.35            23            SURGICAL SUPPLIES



9/17/2012                                                                                                    238
                                       69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2314193   SORBITOL 3000                     24.50       24.50 23           SURGICAL SUPPLIES
       2313393   WATER 1000                         3.00        3.00 23           SURGICAL SUPPLIES
       2313419   WATER 1000/1500                    5.50        5.50 23           SURGICAL SUPPLIES
       2311181   WATER IRRIG 3000ML                24.50             23           SURGICAL SUPPLIES
       2044543   ANOSCOPY INTERVENTN            1,808.00             20           SURGICAL SVCS IP PROCEDUR
       2042208   BRONCHOSCOPY                   1,820.00             20           SURGICAL SVCS IP PROCEDUR
       2042307   BRONCHOSCOPY INTERVENTN        2,137.00    2,137.00 20           SURGICAL SVCS IP PROCEDUR
       2042406   BRONCHOSCOPY INTERVENTN        2,137.00             20           SURGICAL SVCS IP PROCEDUR
       2042505   BRONCHOSCOPY INTERVENTN        2,137.00             20           SURGICAL SVCS IP PROCEDUR
       2042604   BRONCHOSCOPY INTERVENTN        2,137.00             20           SURGICAL SVCS IP PROCEDUR
       2044402   BRONCHOSCOPY INTERVENTN        2,137.00             20           SURGICAL SVCS IP PROCEDUR
       2045755   BRONCHOSCOPY INTERVENTN        2,137.00             20           SURGICAL SVCS IP PROCEDUR
       2070001   CA ECHO TRANSESOPHAGEAL        1,180.00             20           SURGICAL SVCS IP PROCEDUR
       2070100   CA TEE PLACE PROBE               894.00             20           SURGICAL SVCS IP PROCEDUR
       2038255   CELL SAVER SERVICE             2,554.00             20           SURGICAL SVCS IP PROCEDUR
       2012003   CELL SAVER SERVICE             2,554.00             20           SURGICAL SVCS IP PROCEDUR
       2012011   CELL SAVER SERVICE             2,554.00             20           SURGICAL SVCS IP PROCEDUR
       2041457   COLONOSCOPY                    1,903.00             20           SURGICAL SVCS IP PROCEDUR
       2041515   COLONOSCOPY                    1,903.00             20           SURGICAL SVCS IP PROCEDUR
       2041507   COLONOSCOPY INTERVENTN         2,257.00    2,257.00 20           SURGICAL SVCS IP PROCEDUR
       2041523   COLONOSCOPY INTERVENTN         2,257.00             20           SURGICAL SVCS IP PROCEDUR
       2041531   COLONOSCOPY INTERVENTN         2,257.00             20           SURGICAL SVCS IP PROCEDUR
       2041549   COLONOSCOPY INTERVENTN         2,257.00             20           SURGICAL SVCS IP PROCEDUR
       2041556   COLONOSCOPY INTERVENTN         2,257.00             20           SURGICAL SVCS IP PROCEDUR
       2041564   COLONOSCOPY INTERVENTN         2,257.00             20           SURGICAL SVCS IP PROCEDUR
       2041572   COLONOSCOPY INTERVENTN         2,257.00             20           SURGICAL SVCS IP PROCEDUR
       2041580   COLONOSCOPY INTERVENTN         2,257.00             20           SURGICAL SVCS IP PROCEDUR
       2041598   COLONOSCOPY INTERVENTN         2,257.00             20           SURGICAL SVCS IP PROCEDUR
       2041655   COLONOSCOPY INTERVENTN         2,257.00             20           SURGICAL SVCS IP PROCEDUR
       2041705   COLONOSCOPY INTERVENTN         2,257.00             20           SURGICAL SVCS IP PROCEDUR
       2041754   COLONOSCOPY INTERVENTN         2,257.00             20           SURGICAL SVCS IP PROCEDUR
       2044550   COLONOSCOPY INTERVENTN         2,257.00             20           SURGICAL SVCS IP PROCEDUR
       2045706   COLONOSCOPY INTERVENTN         2,257.00             20           SURGICAL SVCS IP PROCEDUR



9/17/2012                                                                                                     239
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2023158   CPLX GENRL ANES ADD 15M                287.00             20           SURGICAL SVCS IP PROCEDUR
       2023208   CPLX GENRL ANES FIRST 30M              537.00             20           SURGICAL SVCS IP PROCEDUR
       2023513   CS SAME MD ADD 15M                     150.00             20           SURGICAL SVCS IP PROCEDUR
       2044667   CS SAME MD ADD 15M                     150.00             20           SURGICAL SVCS IP PROCEDUR
       2023505   CS SAME MD GT5YR 0-30M                 350.00             20           SURGICAL SVCS IP PROCEDUR
       2044659   CS SAME MD GT5YR 0-30M                 350.00             20           SURGICAL SVCS IP PROCEDUR
       2023521   CS SAME MD LT5YR 0-30M                 350.00             20           SURGICAL SVCS IP PROCEDUR
       2044675   CS SAME MD LT5YR 0-30M                 350.00             20           SURGICAL SVCS IP PROCEDUR
       2010775   CX CASE OR                             916.00             20           SURGICAL SVCS IP PROCEDUR
       2045482   D5 0.45 NACL 1000ML                      6.00             20           SURGICAL SVCS IP PROCEDUR
       2042802   EGD                                  1,839.00             20           SURGICAL SVCS IP PROCEDUR
       2042083   EGD INTERVENTN                       1,974.00             20           SURGICAL SVCS IP PROCEDUR
       2042752   EGD INTERVENTN                       1,974.00    1,974.00 20           SURGICAL SVCS IP PROCEDUR
       2043008   EGD INTERVENTN                       1,974.00             20           SURGICAL SVCS IP PROCEDUR
       2043057   EGD INTERVENTN                       1,974.00             20           SURGICAL SVCS IP PROCEDUR
       2043107   EGD INTERVENTN                       1,974.00             20           SURGICAL SVCS IP PROCEDUR
       2043156   EGD INTERVENTN                       1,974.00             20           SURGICAL SVCS IP PROCEDUR
       2043206   EGD INTERVENTN                       1,974.00             20           SURGICAL SVCS IP PROCEDUR
       2043305   EGD INTERVENTN                       1,974.00             20           SURGICAL SVCS IP PROCEDUR
       2043354   EGD INTERVENTN                       1,974.00             20           SURGICAL SVCS IP PROCEDUR
       2043602   EGD INTERVENTN                       1,974.00             20           SURGICAL SVCS IP PROCEDUR
       2045656   EGD INTERVENTN                       1,974.00             20           SURGICAL SVCS IP PROCEDUR
       2040004   ENC PORTABLE TRACKING                                     20           SURGICAL SVCS IP PROCEDUR
       2044519   ENDO BILI DUCT                         873.00             20           SURGICAL SVCS IP PROCEDUR
       2042836   ENDO UPPER GI TUBE CHNG              2,532.00             20           SURGICAL SVCS IP PROCEDUR
       2041903   ENTEROSCOPY                          2,249.00             20           SURGICAL SVCS IP PROCEDUR
       2042018   ENTEROSCOPY                          2,249.00             20           SURGICAL SVCS IP PROCEDUR
       2041911   ENTEROSCOPY INTERVENTN               2,736.00             20           SURGICAL SVCS IP PROCEDUR
       2041929   ENTEROSCOPY INTERVENTN               2,736.00             20           SURGICAL SVCS IP PROCEDUR
       2041937   ENTEROSCOPY INTERVENTN               2,736.00             20           SURGICAL SVCS IP PROCEDUR
       2041945   ENTEROSCOPY INTERVENTN               2,736.00             20           SURGICAL SVCS IP PROCEDUR
       2041952   ENTEROSCOPY INTERVENTN               2,736.00             20           SURGICAL SVCS IP PROCEDUR
       2041960   ENTEROSCOPY INTERVENTN               2,736.00             20           SURGICAL SVCS IP PROCEDUR



9/17/2012                                                                                                           240
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2041978   ENTEROSCOPY INTERVENTN          2,736.00             20           SURGICAL SVCS IP PROCEDUR
       2041986   ENTEROSCOPY INTERVENTN          2,736.00             20           SURGICAL SVCS IP PROCEDUR
       2041994   ENTEROSCOPY INTERVENTN          2,736.00             20           SURGICAL SVCS IP PROCEDUR
       2042026   ENTEROSCOPY INTERVENTN          2,736.00             20           SURGICAL SVCS IP PROCEDUR
       2042034   ENTEROSCOPY INTERVENTN          2,736.00             20           SURGICAL SVCS IP PROCEDUR
       2042042   ENTEROSCOPY INTERVENTN          2,736.00             20           SURGICAL SVCS IP PROCEDUR
       2044428   ERCP                            2,609.00             20           SURGICAL SVCS IP PROCEDUR
       2044535   ERCP BILI PANC DUCT               889.00             20           SURGICAL SVCS IP PROCEDUR
       2044436   ERCP INTERVENTN                 4,031.00             20           SURGICAL SVCS IP PROCEDUR
       2044444   ERCP INTERVENTN                 4,031.00             20           SURGICAL SVCS IP PROCEDUR
       2044451   ERCP INTERVENTN                 4,031.00             20           SURGICAL SVCS IP PROCEDUR
       2044469   ERCP INTERVENTN                 4,031.00             20           SURGICAL SVCS IP PROCEDUR
       2044477   ERCP INTERVENTN                 4,031.00             20           SURGICAL SVCS IP PROCEDUR
       2044485   ERCP INTERVENTN                 4,031.00             20           SURGICAL SVCS IP PROCEDUR
       2044493   ERCP INTERVENTN                 4,031.00             20           SURGICAL SVCS IP PROCEDUR
       2044501   ERCP INTERVENTN                 4,031.00             20           SURGICAL SVCS IP PROCEDUR
       2044808   ERCP INTERVENTN                 4,031.00             20           SURGICAL SVCS IP PROCEDUR
       2044527   ERCP PANC DUCT                    495.00             20           SURGICAL SVCS IP PROCEDUR
       2044006   ESOPHAGOSCOPY INTERVENTN        4,130.00             20           SURGICAL SVCS IP PROCEDUR
       2044204   GASTROSCOPY                     1,788.00             20           SURGICAL SVCS IP PROCEDUR
       2042851   GASTROSCOPY INTERVENTN          2,319.00    2,319.00 20           SURGICAL SVCS IP PROCEDUR
       2042059   ILEOSCOPY                         933.00             20           SURGICAL SVCS IP PROCEDUR
       2042067   ILEOSCOPY INTERVENTN            2,176.00             20           SURGICAL SVCS IP PROCEDUR
       2042075   ILEOSCOPY INTERVENTN            2,176.00             20           SURGICAL SVCS IP PROCEDUR
       2023257   INJ BLOOD PATCH                   616.00             20           SURGICAL SVCS IP PROCEDUR
       2023307   INJ EPIDL L/S                   1,038.00             20           SURGICAL SVCS IP PROCEDUR
       2045383   IR FB RMVL ESOPH                1,630.00             20           SURGICAL SVCS IP PROCEDUR
       2045375   IR FLUORO NDL PLACE               332.00             20           SURGICAL SVCS IP PROCEDUR
       2045110   IR G TUBE PRC                     766.00             20           SURGICAL SVCS IP PROCEDUR
       2020352   MAC/REG ADD 15M                   219.00             20           SURGICAL SVCS IP PROCEDUR
       2023109   MAC/REG ADD 15M                   219.00             20           SURGICAL SVCS IP PROCEDUR
       2023356   MAC/REG ADD 15M NONOR             220.00             20           SURGICAL SVCS IP PROCEDUR
       2023406   MAC/REG FIRST 30M                 452.00             20           SURGICAL SVCS IP PROCEDUR



9/17/2012                                                                                                      241
                                             69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2023455   MAC/REG FIRST 30M NONOR                444.00            20            SURGICAL SVCS IP PROCEDUR
       2045474   NA CL 0.9% 1000ML                        6.00            20            SURGICAL SVCS IP PROCEDUR
       2045409   NA CL 10ML PREFILLED SYR                 6.00            20            SURGICAL SVCS IP PROCEDUR
       2031052   PERFUSION SERVICE                    3,718.00            20            SURGICAL SVCS IP PROCEDUR
       2045342   S CATH GUIDING                         148.00            20            SURGICAL SVCS IP PROCEDUR
       2045359   S CATH GUIDING                         302.00            20            SURGICAL SVCS IP PROCEDUR
       2045177   S IMP ENC WALL STENT                 3,850.00            20            SURGICAL SVCS IP PROCEDUR
       2045185   S IMP ENC WALL STENT COV             4,400.00            20            SURGICAL SVCS IP PROCEDUR
       2011161   S IMP FIBRILLAR                        212.00            20            SURGICAL SVCS IP PROCEDUR
       2045516   S O2 ENDOSCOPY                         151.50            20            SURGICAL SVCS IP PROCEDUR
       2045607   S STNT COATED WDEL SYS               3,460.00            20            SURGICAL SVCS IP PROCEDUR
       2045417   S STNT NOCOAT WDEL SYS               4,881.00            20            SURGICAL SVCS IP PROCEDUR
       2045615   S STNT NOCOAT WDEL SYS               8,732.50            20            SURGICAL SVCS IP PROCEDUR
       2045391   S STNT NOCOAT WO DEL SYS               418.00            20            SURGICAL SVCS IP PROCEDUR
       2044352   S STRL 480 GUIDE WIRE                  190.50            20            SURGICAL SVCS IP PROCEDUR
       2020956   S STRL ARROW CVA SET                   323.50            20            SURGICAL SVCS IP PROCEDUR
       2042109   S STRL BICAP PROBE                     578.00     512.00 20            SURGICAL SVCS IP PROCEDUR
       2044253   S STRL BICAP PROBE                     436.50            20            SURGICAL SVCS IP PROCEDUR
       2044287   S STRL BILIARY STENT                   308.00            20            SURGICAL SVCS IP PROCEDUR
       2045508   S STRL BIOPSY FORCEP                   269.00            20            SURGICAL SVCS IP PROCEDUR
       2021053   S STRL BLITT CVP CATHETER              124.00            20            SURGICAL SVCS IP PROCEDUR
       2044238   S STRL BUTTON REPLACEMEN               379.50            20            SURGICAL SVCS IP PROCEDUR
       2044212   S STRL COLON DIL BALLOON               572.50            20            SURGICAL SVCS IP PROCEDUR
       2045458   S STRL CONTRAST RAPID REF               80.00            20            SURGICAL SVCS IP PROCEDUR
       2045466   S STRL CYTOLOGY BRUSH                  277.00            20            SURGICAL SVCS IP PROCEDUR
       2044329   S STRL EGD BALLON DLTTN              1,036.50            20            SURGICAL SVCS IP PROCEDUR
       2045334   S STRL ENC 0.025 JAG GUI               508.00            20            SURGICAL SVCS IP PROCEDUR
       2045276   S STRL ENC APC CATHETER                678.00            20            SURGICAL SVCS IP PROCEDUR
       2045243   S STRL ENC APC MEMBRANE                 40.00            20            SURGICAL SVCS IP PROCEDUR
       2045318   S STRL ENC BICAP PROBE W               677.00            20            SURGICAL SVCS IP PROCEDUR
       2045219   S STRL ENC DILATION SYRI                78.00            20            SURGICAL SVCS IP PROCEDUR
       2045136   S STRL ENC EGD BANDING E               476.00            20            SURGICAL SVCS IP PROCEDUR
       2045284   S STRL ENC ENTERYX KIT               4,661.00            20            SURGICAL SVCS IP PROCEDUR



9/17/2012                                                                                                           242
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2045292   S STRL ENC ENTERYX NEEDL           391.00           20             SURGICAL SVCS IP PROCEDUR
       2045201   S STRL ENC ERCP ULTRA TA           411.00           20             SURGICAL SVCS IP PROCEDUR
       2045268   S STRL ENC ESOPHAGEAL OV           425.00           20             SURGICAL SVCS IP PROCEDUR
       2045169   S STRL ENC EXTRACTOR BAL           507.00           20             SURGICAL SVCS IP PROCEDUR
       2045144   S STRL ENC FOREIGN BODY            270.00           20             SURGICAL SVCS IP PROCEDUR
       2045433   S STRL ENC HEMOCLIP                212.00           20             SURGICAL SVCS IP PROCEDUR
       2045326   S STRL ENC HYRDA JAGWIRE           675.00           20             SURGICAL SVCS IP PROCEDUR
       2045193   S STRL ENC INFLATION DEV           318.00           20             SURGICAL SVCS IP PROCEDUR
       2045300   S STRL ENC INJECTION NEE           122.00           20             SURGICAL SVCS IP PROCEDUR
       2045250   S STRL ENC LITHOTRIPSY B           957.00           20             SURGICAL SVCS IP PROCEDUR
       2045151   S STRL ENC P0LYP SNARE R            80.00           20             SURGICAL SVCS IP PROCEDUR
       2045235   S STRL ENC SPEEDBAND 7             957.00           20             SURGICAL SVCS IP PROCEDUR
       2045128   S STRL ENC SPHINCTERTOME           677.00           20             SURGICAL SVCS IP PROCEDUR
       2045227   S STRL ENC SPHINCTERTOME           893.00           20             SURGICAL SVCS IP PROCEDUR
       2044295   S STRL ENDOSCOPY BANDS #           520.50           20             SURGICAL SVCS IP PROCEDUR
       2044311   S STRL ENDOSCOPY BANDS #           419.00           20             SURGICAL SVCS IP PROCEDUR
       2044378   S STRL ENDOSCOPY BANDS #           473.00           20             SURGICAL SVCS IP PROCEDUR
       2021350   S STRL EPIDURAL MINI PACK           90.50           20             SURGICAL SVCS IP PROCEDUR
       2021400   S STRL EPIDURAL TRAY               201.00           20             SURGICAL SVCS IP PROCEDUR
       2044279   S STRL ERCP DILITATION B           925.00           20             SURGICAL SVCS IP PROCEDUR
       2044394   S STRL ERCP PROTECTOR WI           411.50           20             SURGICAL SVCS IP PROCEDUR
       2044303   S STRL ERCP STONE BASKET           105.00           20             SURGICAL SVCS IP PROCEDUR
       2044337   S STRL GASTROSTOMY BUTTO           339.00           20             SURGICAL SVCS IP PROCEDUR
       2045557   S STRL GROUNDING PAD                20.00           20             SURGICAL SVCS IP PROCEDUR
       2021657   S STRL INT JUGULAR SET             162.50           20             SURGICAL SVCS IP PROCEDUR
       2044220   S STRL INTRACARDIAC ECHO           519.00           20             SURGICAL SVCS IP PROCEDUR
       2045425   S STRL IV ANGIO CATH INST           20.00           20             SURGICAL SVCS IP PROCEDUR
       2044246   S STRL JAG WIRE                  1,004.00           20             SURGICAL SVCS IP PROCEDUR
       2021855   S STRL KAPLAN CVP CATH             363.50           20             SURGICAL SVCS IP PROCEDUR
       2045102   S STRL NASAL CANNULA                31.50           20             SURGICAL SVCS IP PROCEDUR
       2045490   S STRL NEEDLE KNIFE                510.00           20             SURGICAL SVCS IP PROCEDUR
       2044345   S STRL PEG J TUBE                  315.00           20             SURGICAL SVCS IP PROCEDUR
       2044360   S STRL PERC GASTROSTOMY            525.00           20             SURGICAL SVCS IP PROCEDUR



9/17/2012                                                                                                       243
                                         69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2044261   S STRL POLYPECTOMY SNARE           105.50               20         SURGICAL SVCS IP PROCEDUR
       2022200   S STRL PRESSURE INFUSORS           163.50               20         SURGICAL SVCS IP PROCEDUR
       2022358   S STRL RADIAL ARTERY SET            38.00               20         SURGICAL SVCS IP PROCEDUR
       2044386   S STRL SCLEROSING NEEDLE           272.00               20         SURGICAL SVCS IP PROCEDUR
       2022606   S STRL SPINAL NEEDLE                13.50               20         SURGICAL SVCS IP PROCEDUR
       2022655   S STRL SPINAL TRAY                 201.00               20         SURGICAL SVCS IP PROCEDUR
       2022705   S STRL SUB CLAVIAN CATH            269.00               20         SURGICAL SVCS IP PROCEDUR
       2022804   S STRL SWAN-GANZ THERMO            177.50               20         SURGICAL SVCS IP PROCEDUR
       2022903   S STRL VENOUS PRESS TRAY            66.50               20         SURGICAL SVCS IP PROCEDUR
       2045441   S WIRE GUIDE                       469.00               20         SURGICAL SVCS IP PROCEDUR
       2043404   SIGMOIDOSCOPY                      978.00               20         SURGICAL SVCS IP PROCEDUR
       2043412   SIGMOIDOSCOPY INTERVENTN         1,936.00               20         SURGICAL SVCS IP PROCEDUR
       2044154   SIGMOIDOSCOPY INTERVENTN         1,936.00               20         SURGICAL SVCS IP PROCEDUR
       2044568   SIGMOIDOSCOPY INTERVENTN         1,936.00               20         SURGICAL SVCS IP PROCEDUR
       2044576   SIGMOIDOSCOPY INTERVENTN         1,936.00               20         SURGICAL SVCS IP PROCEDUR
       2044584   SIGMOIDOSCOPY INTERVENTN         1,936.00               20         SURGICAL SVCS IP PROCEDUR
       2044592   SIGMOIDOSCOPY INTERVENTN         1,936.00               20         SURGICAL SVCS IP PROCEDUR
       2044600   SIGMOIDOSCOPY INTERVENTN         1,936.00               20         SURGICAL SVCS IP PROCEDUR
       2044618   SIGMOIDOSCOPY INTERVENTN         1,936.00               20         SURGICAL SVCS IP PROCEDUR
       2044626   SIGMOIDOSCOPY INTERVENTN         1,936.00               20         SURGICAL SVCS IP PROCEDUR
       2044634   SIGMOIDOSCOPY INTERVENTN         1,936.00               20         SURGICAL SVCS IP PROCEDUR
       2044642   SIGMOIDOSCOPY INTERVENTN         1,936.00               20         SURGICAL SVCS IP PROCEDUR
       2023653   STND ANES ADD 15M NONOR            224.00               20         SURGICAL SVCS IP PROCEDUR
       2023703   STND ANES FIRST 30M NONOR          441.00               20         SURGICAL SVCS IP PROCEDUR
       2020055   STND GENRL ANES ADD 15M            232.00               20         SURGICAL SVCS IP PROCEDUR
       2023752   STND GENRL ANES FIRST 30M          467.00               20         SURGICAL SVCS IP PROCEDUR
       2010353   SURG LVL 1 ADD 15M                 720.00     720.00    20         SURGICAL SVCS IP PROCEDUR
       2013001   SURG LVL 1 FIRST 30M             1,686.00               20         SURGICAL SVCS IP PROCEDUR
       2010452   SURG LVL 2 ADD 15M                 853.00     853.00    20         SURGICAL SVCS IP PROCEDUR
       2013050   SURG LVL 2 FIRST 30M             2,124.00               20         SURGICAL SVCS IP PROCEDUR
       2010551   SURG LVL 3 ADD 15M                 966.00     966.00    20         SURGICAL SVCS IP PROCEDUR
       2013100   SURG LVL 3 FIRST 30M             2,575.00               20         SURGICAL SVCS IP PROCEDUR
       2010650   SURG LVL 4 ADD 15M               1,025.00    1,025.00   20         SURGICAL SVCS IP PROCEDUR



9/17/2012                                                                                                       244
                                        69aa2a1d-d717-4617-b5c9-48317ebaae22.xls


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



       2013159   SURG LVL 4 FIRST 30M            3,019.00             20           SURGICAL SVCS IP PROCEDUR
       2010759   SURG LVL 5 ADD 15M              1,283.00    1,283.00 20           SURGICAL SVCS IP PROCEDUR
       2013308   SURG LVL 5 FIRST 30M            3,155.00             20           SURGICAL SVCS IP PROCEDUR




9/17/2012                                                                                                      245
                                                                Santa Rosa
                                                                 Pharmacy
                                                               Charge Master
label_name                         charge_num   Calculated Price
           A5D5 IV SOLUTION          8210049        $108.94
          ABACAVIR 300MG TAB         8100034         $31.44
   ABACAVIR/LAMIV/ZIDOVUDINE TAB     8100059         $59.33
     ABATACEPT/MALTOSE 250MG         8391054       $1,238.23
          ABCIXIMAB 10MG INJ         8300048       $1,431.92
          ACARBOSE 50MG TAB          8100042         $16.27
        ACEBUTOLOL 200MG CAP         8100083         $16.16
      ACETAZOLAMIDE 250MG TAB        8100125         $15.02
    ACETAZOLAMIDE 500 MG CAP SA      8100133         $20.21
      ACETAZOLAMIDE 500MG INJ        8300071        $109.12
       ACETIC ACID 0.25% IRRSOL      8240046         $38.66
       ACETIC ACID 2% OTIC SOL       8250045        $108.31
      ACETIC ACID/BUROWS OTIC        8250086         $43.07
       ACETIC ACID/HC OTIC SOL       8250128         $81.87
   ACETYLCHOLINE CL 1% OPTH KIT      8250144        $124.17
    ACETYLCYSTEINE 20% SOL 30ML      8150047         $43.29
    ACETYLCYSTEINE 20% VIAL 4ML      8154874         $41.43
    ACETYLCYSTEINE 200MG/ML INJ      8300097        $421.05
         ACYCLOVIR 200MG CAP         8100166         $16.39
     ACYCLOVIR 200MG/5ML SUSP        8150088         $98.21
        ACYCLOVIR 5% TOP ONT         8240129        $294.47
         ACYCLOVIR 500MG INJ         8300147        $122.75
         ACYCLOVIR 800MG TAB         8100208         $22.58
        ADENOSINE 6MG/2ML INJ