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106311000-CDM_2005xls - Office of Statewide Health Planning and

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106311000-CDM_2005xls - Office of Statewide Health Planning and Powered By Docstoc
					a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9709874 9708652 9701582 9700972 9701590 9708678 9709957 9700477 9701970 9701988 9701921 9701913 9701939 9701962 9701244 9701285 9708975 9707167 9708983 9709973 9700899 9708967 9708942 9701616 9706268 9709866 9709569 9708694 9708629 9708587 9708561 9708538 9708488 9708603 9700444 9708611 9700642 9799990 9799917 9708579 9701434 9709916 9708660 9701400 9701467 9701475 9702390 9704008 9701608 9700709 9701442 9708645 9707225

ADJ - ACCT CONSOLIDATION ADJ - INTEREST CHARGE ADJ. INSURED SERVICES REC ADJUSTMENT - MSIC CONV ADJUSTMENT - SUTTER HOSPI ALLOWANCE - C.O.B. ALLOWANCE - INSURANCE C/A ALLOWANCE-ADMINISTRATIVE CHARITY CARE-CATASTROPHIC CHARITY CARE-CATASTROPHIC CHARITY CARE-FULL CHARITY CHARITY CARE-FULL CHARITY CHARITY CARE-PARTIAL CHAR CHARITY CARE-PARTIAL CHAR DENIAL - CHARGES W/O DENIAL - DAYS W/O DENIAL - NON-AUTH W/O EMPLOYEE PHYSICALS ERROR - CBO W/O ERROR - CM/UR W/O ERROR - IT W/O ERROR - MEDICAL REC W/O ERROR - REGISTRATION W/O ERROR-VENDOR ESCHEAT TO STATE ESCHEATMENT-INSURANCE W/O ESCHEATMENT-PRIVATE PAY W MESSAGE - APPEAL SENT REFUND - INSURANCE REFUND - PATIENT RETURNED CHECK - INSURANC RETURNED CHECK - PATIENT TRANSFER - BABY CHARGES TRANSFER - INS PAYMENT TRANSFER - INTER HOSPTIAL TRANSFER - PRIVATE PMT TRANSFER - SUTTER ENTITY TRANSFER FROM AR TO BD TRANSFER FROM BD TO AR TRANSFER-ACCOUNT BALANCE W/O - ANCILLARY DEPTMENT W/O - BAD DEBT W/O - INSURANCE INTEREST W/O - LATE CHARGES W/O - MEDICARE SECONDARY W/O - SUB ACUTE MISC CON W/O - SUTTER SNF W/O - VARIANCE W/O ARBITRATION VARIANCE W/O DISCOUNT-EMPLOYEE ALL W/O DISCOUNT-NEGOTIATED I W/O DISCOUNT-PRIVATE PAY W/O DISCOUNT-SPECIAL PACK

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97

AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS

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a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9707522 9701483 9704842 9700683 9701277 9708926 9707209 9701293 9704107 9704222 9704180 9704206 9704123 9704149 9704164 9980012 9971110 9970013 9999988 9999558 9970039 9970021 9960014 9960642 9967373 9967365 9966201 9967381 9980020 9973025 9970070 9915018 9977018 9971003 9977026 9980178 9980038 9971102 9950023 9980137 9971201 9977034 9970062 9971300 9977042 9970641 9973009 9960022 9964123 9971540 9970732 9966052 9966086

W/O EMPLOYEE INJURY W/O KAISER VARIANCE W/O OVER 360 CRITERIA W/O SMALL BALANCE W/O UNBILLABLE CHARGES W/O UNCOMPENSATED CARE W/O-DISCOUNT-EXPERIMENTAL W/O-OVERLAPPING STAY W/O-SPECIAL CIRCUMSTANCES W/O-TRANSPLANT DONOR-HEAR W/O-TRANSPLANT DONOR-KIDN W/O-TRANSPLANT DONOR-LIVE W/O-TRANSPLANT GLOBAL RAT W/O-TRANSPLANT GLOBAL RAT W/O-TRANSPLANT GLOBAL RAT AARP ACCORDIA BENEFIT SERVICES ADMAR PPO ADMINISTRATION CONVERSION ADMINISTRATIVE DUMMY ACCO AENTA PPO AETNA EPO MANAGED CHOICE AETNA HMO AETNA HMO GOULD AETNA HMO SIP IPA AETNA HMO SMG IPA AETNA HMO SMG IPA AETNA HMO SWMG IPA AETNA INDEMNITY AETNA NAP PPO AETNA SELECT PPO AETNA SENIOR CHOICE MEDIC AETNA WORKERS COMP PPO AFFORDABLE FIRST HEALTH P AFFORDABLE FIRST HEALTH W ALLSTATE ALTA REGIONAL AMERICAN HEALTH NETWORK A ASSOCIATED CLAIMS WORKERS AUTO INSURANCE MISC PAY BEECH STREET PPO BEECH STREET WORKERS COMP BENEFIT PANEL SERVICE EPO BENEFIT PANEL SERVICES PP BENEFIT RISK MNGMENT W/C BLUE CORSS OUT OF STATE BLUE CROSS CAL PERS PYMNT BLUE CROSS CALIF CARE HMO BLUE CROSS CALIFORNIA CAR BLUE CROSS DELTA BENE SCH BLUE CROSS FEDERAL PPO BLUE CROSS HILL HMO IPA BLUE CROSS HMO MDCL

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99

AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR ADJUSTMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS

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a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9966755 9966011 9966029 9966045 9966037 9966060 9971557 9971599 9971573 9977315 9970633 9980053 9970096 9970849 9921040 9970138 9964115 9964131 9960030 9966136 9966169 9966763 9966094 9966102 9960501 9966110 9960659 9966144 9960527 9960576 9970625 9970716 9970146 9970104 9960683 9970112 9980046 9932187 9970153 9931098 9970161 9931106 9970187 9971409 9977059 9923046 9923988 9923996 9923038 9900234 9923020 9923012 9923061

BLUE CROSS HMO OTHER IPA BLUE CROSS HMO SIP IPA BLUE CROSS HMO SMG IPA BLUE CROSS HMO SNMG IPA BLUE CROSS HMO SWMG IPA BLUE CROSS HMO UCDMG IPA BLUE CROSS INTERPLN CEMNT BLUE CROSS MCS NETWORK BLUE CROSS OF CA CARPENTE BLUE CROSS OTHER W/C PPO BLUE CROSS OUT OF STATE BLUE CROSS OUT OF STATE BLUE CROSS PBP BLUE CROSS PERS CARE BLUE CROSS SAC COUNTY GMC BLUE CROSS STANDARD BLUE SHIELD CAP BLUE SHIELD HLTHY FAMILIE BLUE SHIELD HMO BLUE SHIELD HMO HILL IPA BLUE SHIELD HMO MDCL BLUE SHIELD HMO OTHER IPA BLUE SHIELD HMO SIP IPA BLUE SHIELD HMO SMG IPA BLUE SHIELD HMO ST JOSEPH BLUE SHIELD HMO SWMG IPA BLUE SHIELD HMO UCD BLUE SHIELD HMO UCDMG IPA BLUE SHIELD IFP HMO BLUE SHIELD MERCY BLUE SHIELD OUT OF STATE BLUE SHIELD OUT OF STATE BLUE SHIELD PERF SR PLAN BLUE SHIELD PERS PPO BLUE SHIELD PERSCHOICE PY BLUE SHIELD PPO BLUE SHILED OUT OF STATE CA FORENSIC GROUP CFMG CALIF YOUTH AUTHORITY CANCER STUDIES CAPPCARE BEECH ST PPO CARDIAC REHAB CCN GLOBAL PPO CCN PPO CCN WORKERS COMP PPO CCS BUTTE COUNTY CCS CONVERSION CCS OTHER COUNTIES CCS PLACER COUNTY CCS REFERRED CCS REGIONAL CCS SACRAMENTO COUNTY CCS SAN JOAQUIN COUNTY

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99

AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS

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a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9923053 9971581 9930025 9930983 9930058 9930017 9960592 9927039 9980202 9960048 9966854 9980095 9910035 9970237 9932021 9977141 9977075 9927013 9927021 9927989 9977083 9980426 9900267 9932195 9931015 9980152 9990011 9932096 9931270 9999228 9999053 9900317 9900994 9931189 9960428 9980434 9933029 9964057 9960188 9966656 9960394 9960410 9966607 9966805 9966615 9966623 9966649 9966631 9960386 9966664 9900101 9971011 9960477

CCS SOLANO COUNTY CEMENT MASONS/HLTH/WELFAR CHAMP VA CHAMPUS CONVERSION CHAMPUS MTF ACTIVE DUTY CHAMPUS TRICARE CHARTER BEHAV HEALTH OF N CHDP CIGNA CONNECTICUT GENERAL CIGNA HMO CIGNA HMO UCDMG IPA CIGNA INDEMNITY CIGNA NG CIGNA PPO CITY OF ROSEVILLE CITY OF SACRAMENTO W/C PP CLAIMS MANAGEMENT W/C PPO CMISP SAC CO MIA CMSP CMSP CONVERSION COMPRO PHN W/C PPO CORRECTIONAL HEALTH SERVI COSMETIC SURGERY COUNTY OF SACRAMENTO COWELL CSAA DEPT OF REHAB DEPT OF SOCIAL SERVICES DONORS FAMILY RELATED EMPLOYEE PAYROLL DEDUCTIO EMPLOYEE PHYSICALS ENTITLEMENT EQUIFAX EVALUATION KIDNEY EXCEL MED GROUP FAMILY STATIONS INC FEDERAL GOVERNMENT MISC FHP TAKECARE CAPITATION FHP TAKECARE HMO FHP TAKECARE HMO HILL IPA FHP TAKECARE HMO LODI MEM FHP TAKECARE HMO MARSHALL FHP TAKECARE HMO MODESTO FHP TAKECARE HMO OTHER IP FHP TAKECARE HMO SIP IPA FHP TAKECARE HMO SMG IPA FHP TAKECARE HMO SNMG IPA FHP TAKECARE HMO SWMG IPA FHP TAKECARE HMO UCD FHP TAKECARE HMO UCDMG IP FINANCIAL AGREEMENT FIRST HEALTH PPO FOUNDATION HEALTH 65 PLUS

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99

AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS

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a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9960055 9960105 9960139 9977091 9971037 9980004 9950007 9923079 9990128 9933987 9931981 9971722 9971912 9990250 9970294 9970286 9900184 9921131 9966599 9964149 9960063 9960402 9966300 9966334 9960246 9966268 9966276 9966284 9960253 9966318 9970831 9960626 9960287 9970864 9970856 9967399 9967407 9914011 9916560 9916578 9916545 9915208 9916511 9916040 9916503 9915190 9916057 9915067 9915166 9916214 9915042 9916529 9915216

FOUNDATION HEALTH HMO FOUNDATION HEALTH MERCY FOUNDATION HEALTH UCD FOUNDATION HEALTH W/C PPO GEHA GOV EMP HEALTH ASSOC GENERIC INSURANCE GENERIC WORKERS COMPENSAT GHPP GOLDEN STATE DONOR SERVIC GOVERNMENT OTHER CONVERSI GRANTS/APPROVED RESEARCH GREAT WEST LIFE GREAT WEST LIFE OHP HEALTH CARE LEGAL SERVICE HEALTHCARE FOUND OF SUP C HEALTHCARE FOUND OF SUP C HEALTHCASH HEALTHNET GMC/EHS HEALTHNET GOULD IPA HEALTHNET HLTHY FAMILIES HEALTHNET HMO HEALTHNET HMO GOULD HEALTHNET HMO HILL IPA HEALTHNET HMO MEDCLINIC I HEALTHNET HMO MERCY HEALTHNET HMO SIP IPA HEALTHNET HMO SMG IPA HEALTHNET HMO SWMG IPA HEALTHNET HMO UCD HEALTHNET HMO UCDMG IPA HEALTHNET OPTIONS PPO HEALTHNET OTHER HOSPITAL HEALTHNET SELECT HMO HEALTHNET SELECT PPO HEALTHNET SELECT PPO POS HEALTHNET SELECT SIP HEALTHNET SELECT SMG HEALTHNET SR CAP HEALTHNET SR DELTA IPA HEALTHNET SR EL DORADO IP HEALTHNET SR GOLDEN ST IP HEALTHNET SR GOULD HEALTHNET SR GOULD IPA HEALTHNET SR HILL IPA HEALTHNET SR LODI PRI IPA HEALTHNET SR LODI PRIMARY HEALTHNET SR MEDCLINIC IP HEALTHNET SR MEDICARE HMO HEALTHNET SR OTHER HOSP HEALTHNET SR OTHER IPA HEALTHNET SR PLUS MERCY H HEALTHNET SR SIERRA NV IP HEALTHNET SR SIERRA NV ME

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99

AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS

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a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9916537 9916024 9916016 9916032 9915059 9916495 9916552 9977109 9933078 9960543 9960550 9933086 9960568 9933094 9933128 9967415 9970971 9960972 9999202 9966987 9964982 9960980 9967985 9960006 9977158 9970310 9971508 9977117 9970385 9960071 9921057 9915026 9915182 9960519 9970930 9900119 9960089 9970948 9960113 9966342 9966359 9917048 9990078 9960121 9920018 9924986 9922055 9922980 9922022 9922097 9922048 9922030 9922014

HEALTHNET SR SIERRA V IPA HEALTHNET SR SIP IPA HEALTHNET SR SMG IPA HEALTHNET SR SWNG IPA HEALTHNET SR UCD HMO HEALTHNET SR UCD IPA HEALTHNET SR WOODLAND IPA HEALTHNET WORKERS COMP PP HEALTHY FAMILIES BC PMT HEALTHY FAMILIES BLUE CRO HEALTHY FAMILIES BLUE SHI HEALTHY FAMILIES BS PMT HEALTHY FAMILIES HEALTHNE HEALTHY FAMILIES HN PMT HEALTHY FAMILIES MISC PMT HELATHNET SELECT SWMG HIGH DOLLAR HIGH DOLLAR HIGH DOLLAR PROJECT HMO CAPITATION CONVERSION HMO CAPITATION HOSPITAL C HMO CONVERSION HMO CPAITATION IPA CONVER HMO NON CONTRACTING OTHER INDUSTRIAL INDEMNITY/IND INTEGRATED HEALTHCARE ADM INTERPLAN PPO INTERPLAN WORKERS COMP PP IPM HEALTH AND WELFARE ST KAISER HMO KAISER SACRAMENTO COUNTY KAISER SR ADVANTAGE KAISER SR ADVANTAGE PSYCH KASIER NEONATAL TRANSPORT LABORERS HEALTH & WELFARE LEGAL LIFEGUARD HMO MAILHANDLERS BENEFIT TRUS MAXICARE HMO MAXICARE HMO SIP IPA MAXICARE HMO SMG IPA MCARE HMO CARD/SIP/SMG/SW MED FIN MEDCLINIC BEHAVORAL HMO MEDI-CAL MEDI-CAL CAPITATION CONV MEDI-CAL CCS BUTTE COUNTY MEDI-CAL CCS CONVERSION MEDI-CAL CCS GMC MEDI-CAL CCS OTHER COUNTI MEDI-CAL CCS PLACER COUNT MEDI-CAL CCS REGIONAL MEDI-CAL CCS SACRAMENTO C

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99

AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS

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a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9922063 9970393 9920984 9922089 9921982 9925983 9925017 9920083 9925058 9920075 9900093 9914987 9910985 9910076 9915984 9915141 9917022 9917030 9917014 9916982 9910019 9910068 9910050 9910027 9910084 9980186 9977406 9960436 9960469 9926981 9926015 9900044 9900085 9900051 9900036 9900077 9900069 9926023 9921107 9925033 9980343 9931023 9971052 9970906 9900143 9960147 9999285 9999137 9999269 9970427 9999046 9980988 9970450

MEDI-CAL CCS SOLANO COUNT MEDICAL CONTROL INC PPO MEDI-CAL CONVERSION MEDI-CAL GHPP MEDI-CAL GMC CONVERSION MEDI-CAL HMO CONVERSION MEDI-CAL HMO OTHER MEDI-CAL I/P CROSSOVER MEDI-CAL OMNI HMO MEDI-CAL OUT OF STATE MEDI-CAL REFERRED MEDICARE CAPITATION CONVE MEDICARE CONVERSION MEDICARE DRG ADJUSTMENT MEDICARE HMO CONVERSION MEDICARE HMO OTHER MEDICARE HMO REHAB/SIP MEDICARE HMO REHAB/SMG MEDICARE HMO REHAB/SWMG MEDICARE HMO/IPA CONVERSI MEDICARE PART A & B MEDICARE PART A ONLY MEDICARE PART B ONLY MEDICARE PHYSICIAN MEDICARE SECONDARY PAYOR MEDI-PLUS HEALTH MEDRISK, INC MERCY RECIPROCOL HEALTH C METRAHEALTH HMO MIA CONVERSION MIA PLACER COUNTY MIA REFERRED BUTTE CO MIA REFERRED OTHER COUNTI MIA REFERRED PLACER CO MIA REFERRED SACRAMENTO C MIA REFERRED SAN JOARUIN MIA REFERRED SOLANO CO MIA YOLO COUNTY MOLINA GMC MOLINA PCCM OUT OF COUNTY MUTUAL OF OMAHA NAT MARROW DONOE PROG NATIONAL ACCS LTR CAR NON NATIONAL ASSOC LETTER CAR NATIONAL BUSINESS FACTORS NATIONAL MED HMO NCO RESEARCHING NCO TPL MEDICARE NHR SPECIAL PROJECT NN INVESTORS LIFE PPO AIC NO PATIENT CHARGE NON CONTRACT PAYERS CONVE NORTHERN CALIF BUTCHERS P

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99

AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS

Page 7

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9932112 9966730 9966748 9966813 9966698 9966706 9966722 9966714 9960279 9970666 9970484 9932989 9971607 9970492 9960535 9964040 9960295 9960162 9960360 9966425 9966482 9960352 9966516 9960337 9966433 9966789 9966441 9966458 9966474 9966466 9960345 9966490 9960634 9967464 9970500 9970542 9925025 9999020 9900127 9900242 9970518 9970575 9999194 9970534 9932054 9932047 9932039 9921115 9932013 9932062 9970559 9971987 9977984

OFFICE OF FAMILY PLANNING ONE HEALTH HMO HILL IPA ONE HEALTH HMO MDCL IPA ONE HEALTH HMO OTHER IPA ONE HEALTH HMO SIP IPA ONE HEALTH HMO SMG IPA ONE HEALTH HMO SNMG IPA ONE HEALTH HMO SWMG IPA ONE HEALTH PLAN HMO ONE HEALTH PLAN PPO OPERATING ENG LOCAL #3 PP OTHER CO SPONS AGENCIES C OUCH PPO PACIFIC HEALTH ALLIANCE P PACIFICARE BEHABIORAL HEA PACIFICARE CAPITATION PACIFICARE CHOICE PACIFICARE HMO PACIFICARE HMO GOULD PACIFICARE HMO GOULD IPA PACIFICARE HMO HILL IPA PACIFICARE HMO LODI MEMOR PACIFICARE HMO MDCL PACIFICARE HMO MERCY PACIFICARE HMO MODESTO IP PACIFICARE HMO OTHER IPA PACIFICARE HMO SIP IPA PACIFICARE HMO SMG IPA PACIFICARE HMO SNMG IPA PACIFICARE HMO SWMG IPA PACIFICARE HMO UCD PACIFICARE HMO UCDMG IPA PACIFICARE OTHER HOSP CAP PACIFICARE OTHER IPA CAPP PACIFICARE PPO PARCELSUS HEALTHCARE PPO PARTNERSHIP HEALTH PLAN PATIENT INCIDENT AT HOSPI PENDING LIABILITY INFO PENDING MEDI-CAL OTSD VND PENSIONED OPERATING ENG P PERFERRED HEALTH NETWORK PHYSICIAN STUDY PMT PILOT LIFE INS CO BPS PPO PLACER CO BLOOD ALCOHOL PLACER CO DISTRICT ATTORN PLACER CO MENTAL HEALTH PLACER COUNTY MANAGED CAR PLACER COUNTY PRE BOOKING PLCAER CO S.A.R.T. PPO ALLIANCE PPO CONVERSION PPO/WORK COMP CONVERSION

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99

AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS

Page 8

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9977299 9970583 9971706 9900010 9900986 9900002 9900150 9960170 9966565 9966581 9966797 9966524 9966532 9966540 9915133 9916248 9916198 9916180 9916206 9966557 9967357 9980384 9970617 9999244 9990151 9990094 9900135 9921016 9921081 9921099 9931031 9932070 9990144 9932104 9980996 9930991 9970997 9966995 9960998 9964990 9971995 9914029 9915232 9916651 9916669 9916677 9915224 9916644 9916099 9916107 9915075 9915091 9916222

PREF HEALTH NETWORK WORK PREFERRED HEALTH NETWORK PRIVATE HEALTHCARE SYS LT PRIVATE PAY PRIVATE PAY CONVERSION PRIVATE PAY DEFAULT PRIVATE PAY FACILITY BILL PRUCARE HMO PRUCARE HMO HILL IPA PRUCARE HMO MDCL IPA PRUCARE HMO OTHER IPA PRUCARE HMO SIP IPA PRUCARE HMO SMG IPA PRUCARE HMO SWMG IPA PRUCARE SENIOR HMO PRUCARE SENIOR OTHER IPA PRUCARE SENIOR SIP IPA PRUCARE SENIOR SMG IPA PRUCARE SENIOR SWMG IPA PRUCARE SNMG IPA PRUCARE UCDMG PRUDENTIAL PRUDENTIAL PRU NET PPO RADIOLOGICAL ASSOC RADIOLOGICAL ASSOCIATE MR RADIOLOGICAL ASSOCIATES RETURN MAIL RIVER CITY HEALTHNET RIVER CITY MAXICARE GMC RIVER CITY MCAL GROUP GMC ROBODOC ROSEVILLE POLICE DEPT RUSSIAN NATIONAL PROGRAM SACRAMENTO CO DISTRICT AT SECONDARY SAME AS PRIMARY SECONDARY SAME AS PRIMARY SECONDARY SAME AS PRIMARY SECONDARY SAME AS PRIMARY SECONDARY SAME AS PRIMARY SECONDARY SAME AS PRIMARY SECONDARY SAME AS PRIMARY SECURE HORIZONS CAP SECURE HORIZONS DELTA SECURE HORIZONS DELTA IPA SECURE HORIZONS EL DOR IP SECURE HORIZONS GLDN S IP SECURE HORIZONS GOULD SECURE HORIZONS GOULD IPA SECURE HORIZONS HILLS IPA SECURE HORIZONS MDCL IPA SECURE HORIZONS MEDICARE SECURE HORIZONS MERCY HMO SECURE HORIZONS OTHER IPA

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99

AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS

Page 9

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9916073 9916065 9916081 9915109 9916636 9900978 9932179 9931080 9966821 9966839 9900309 9999236 9900192 9960196 9977257 9980392 9977067 9932211 9977273 9977174 9990086 9931122 9925041 9915034 9967308 9960378 9999996 9971748 9971755 9999103 9910043 9980145 9960238 9977133 9970898 9921065 9970922 9900028 9980335 9980400 9970674 9960485 9977190 9971086 9960204 9977166 9950031 9970955 9933011 9960212 9932088 9990169 9999210

SECURE HORIZONS SIP IPA SECURE HORIZONS SMG IPA SECURE HORIZONS SWMG IPA SECURE HORIZONS UCD HMO SECURE HORIZONS WDLND IPA SELF PAY ADMIN REVIEW PMT SHORT DOYLE - CLINIC SIMR SIP PT/OT CONSORTIUM SMG PT/OT CONSORTIUM SNF PRIVATE PAY SPECIAL PROJECT SPIRIT PROJECT ST JOSEPH'S HMO STATE COMP SCIF BX STATE FARM AUTO STATE FUNG W/C PPO STATE PERINATAL AFP PROGR STATE+B715 COMP STATE EMP SUTTER EMPLOYEE W/C PPO SUTTER HOSPICE SUTTER MED FOUNDATION CLA SUTTER SENIOR CARE HMO SUTTER SENIOR MEDICARE HM SWMG PT/OT CONSORTIUM TAKECARE HMO MERCY TEST CARRIER FOR HDX THE GUARDIAN THE NEW ENGLAND PPO THIRD PARTY AUDIT IN PROG TRANS AMERICA NG TRAVELERS TRAVELERS HMO TRAVELERS WORKERS COMP PP TRI COUNTY SCHOOLS PPO UCD WESTERN HEALTH ADVANT UFCW NO CA H&W UNCOMPENSATED CARE UNICARE UNITED AMERCIAN UNITED HEALTH CARE PPO UNITED HEALTHCARE HMO UNITED HEALTHCARE W/C UNIVERSAL HEALTH NETWORK US BEHAVIORAL HEALTH US COMP SERVICES AHN W/C US DEPARTMENT OF LABOR W/ USA HEALTHNET PPO VA NORTHERN CA HEALTH CAR VALUE OPTIONS VICTIM WITNESS VINCE AQUISTO REFERRAL VIP PROGRAM

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99

AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS

Page 10

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9999038 9977398 9970690 9960675 9960865 9970799 9915257 9915273 9915265 9915281 9960881 9915240 9950981 9823022 9800079 9809955 9800038 9800061 9810052 9800053 9800012 9810029 9810037 9800046 9800020 9810060 9823030 9823055 9823063 9823105 9823139 9823865 9800087 9800095 9808924 9823147 9823162 9823154 9823170 9823196 9823188 9823204 9823931 9823949 9823238 9823253 9823261 9823279 9806266 9800400 9809864 9823311 9823915

VISITOR INJURY AT HOSPITA W/C CACHE CREEK WEIMAR INSTITUE PPO WESTERN HEALTH ADV/HMO/UC WESTERN HEALTH ADV/MERCY WESTERN HEALTH NETWORK PP WESTERN HLTH ADV SR GLDN WESTERN HLTH ADV SR HILLS WESTERN HLTH ADV SR MED WESTERN HLTH ADV SR UCD WESTERN HLTH ADV/NON CONT WESTERNHLTH ADV SR GLD ST WORKERS COMP NON CONTRACT AUDIT REVIEW INCOME BAD DEBT ADMIN W/O BAD DEBT C/A BAD DEBT CONVERSION ADJ BAD DEBT INS REFUND BAD DEBT NSF BAD DEBT PATIENT REFUND BAD DEBT PURGE W/O BAD DEBT REC DIRECT CASH BAD DEBT RECOVERY AGENCY BAD DEBT SMALL BAL W/O BAD DEBT W/O BAD DEBT-INSURANCE PAYMNT BADGE REVENUE CAFETERIA SALES CANCER CLINICAL CAP-RAS CASH OVER/SHORT CENTRAL INFUSION THRPY 19 CHARITY-BILLED BD W/O CHARITY-UNBILLED BD W/O CHARITY-UNBILLED W/O BD CHIPS CMSP- PT CLAIMS WITHHOLD CMSP-COST RPT SETTLEMENT COLLECTION AGENCY FEE COPY REVENUE-XRAYS COPY REV-MED REC&SUBPEONA DONATION EAP CASH EAP RENT EDUC - DIETARY EDUC - IN SERVICE EDUC-MISC COMMUNITY ED ENVIR SVC-HSK REVENUE ESCHEAT TO STATE-BD FINANCE CHARGE ADJUSTMENT INSURANCE ESCHEATMENT BD INTEREST INCOME LACTATION OP-OTHER OP REV

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

99 99 99 99 99 99 99 99 99 99 99 99 99 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98

AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS AR PAYMENTS BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH

Page 11

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9823907 9823386 9823394 9823402 9823824 9823428 9823436 9823410 9823444 9823451 9823360 9823352 9800525 9823014 9823519 9823493 9823501 9823527 9823543 9809567 9823576 9823584 9823592 9815069 9823899 9823600 9823618 9823626 9823634 9823642 9823659 9823972 9823956 9823964 9823667 9823758 9823378 4740163 4740171 4740155 4740197 4740213 4740031 4740007 4740114 4740122 4740064 4710034 4710281 4710042 4740080 4740098 4710240

LACTATION OP-RETAIL SALES MCAL COST REPORT SETTLEMN MCAL PATIENT CLAIMS WITHH MCARE COST REPORT SETTLEM MCARE PASS THRU - BAD DEB MCARE PASS THRU-KIDNEY AC MCARE PASS THRU-RETURN ON MCARE PA-THRU-GME/DME/IME MCARE PATIENT CLAIMS W/H MCARE TOPPS MED STAFF DUES/FEES 13100 MED STAFF SRV 118710-5578 MEDICARE (MEDICAL BD) MISC CASH RECEIPTS PHARMACY - OP MOB PHARMACY-LTC MCARE ENTRA1 PHARMACY-OP HOSPITAL PHYSICAL THERAPY-CLASSES PHYSICAL THERAPY-MASSAGE PRIVATE PAY ESCH W/O BD RADIOLOGICAL ASSOC (RAS) REBATES-MEDICAL SUPPLIES REBATES-PHAMACY RECOVERY RESOURCES PAYMNT REFUND-PRO FEES PHY,TRAUM RENT RECEIPTS 131000=1069 SCRAP & WASTE SALES SENIOR SVC/SR PARTNER REV SPA LAB CAP SUPPLIES SOLD-NON PATIENT TELEPHONE REVENUE TPA REVENUE UNCOMPENSATED CARE REFUND URGENT CARE CAP REFUNDS VENDING MACHINE COMMISSIO YOLO PERINATAL CLINIC 10 AB ID AB ID 2 AB SCRN ABO TYP AG SCRN PER UNIT PT SPEC AG SCRN PER UNIT RGNT AG SCRN PER UNIT RGNT APHERESIS PLASMA APHERESIS PLATELET CMV AB CRYO PS FFP DR PS FFP PS HLA TYP A B OR C MULT HLA TYP DR/DQ MULT IG RHO D MINI

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 185.50 79.50 53.00 21.20 42.40 53.00 291.50 0.00 0.00 37.10 85.85 96.45 85.85 424.00 318.00 164.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47

BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BD PYMTS/ADJ & MISC CASH BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES

Page 12

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4740056 4710315 4710323 4740148 4710190 4710182 4710166 4710133 4740130 4710059 4710026 4710232 4710000 4710018 4710273 4740106 4740254 4710299 4710364 4710083 4710356 4710414 4710075 4710307 4710380 4710372 4710398 4710216 4710091 4710422 4710349 4710224 4710406 4710331 4710265 4740221 4710109 4740205 4740189 4740239 4740247 4710117 4710125 1640002 1610005 1621028 1621036 1621044 1621051 1621069 1621077 1621085 1621093

IRRADIATION BLD PROD EA MISC TS PROC MISC TS PROC MISC TS PROC MISC TS PROC MISC TS PROC MISC TS PROC MISC TS PROC MISC TS PROC MISC TS PROC MISC TS PROC MISC TS PROC MISC TS PROC MISC TS PROC MISC TS PROC MISC TS PROC MISC TS PROC MISC TS PROC PHER IRRADIATED PS PHER L/D HLA MATCHED PS PHER L/D IRRADIATED PS PHER L/D IRRADIATED PS PHER PS PLAS CRYO REDUCED PS PLTC IRRADIATED PS PLTC L/D IRRADIATED PS PLTC L/D PS PLTC PS RBC DG PS RBC FRZ/DEGLYC/WASHED PS RBC IRRADIATED PS RBC L/D CMV NEG PS RBC L/D IRRADIATED PS RBC L/D IRRADIATED PS RBC L/D PS RBC PRETRTMT DENSITY GRAD RBC PS RH PHENOTYP COMPLETE RH TYP SER PRETRTMT INC/INHIB SPEC HANDL FEE WASHED RBC PS WB PS CT EMERGENCY CALL BACK HC SERVICE AFTER HOURS IC MD CANCELLED RAD IC NO SHOW RAD IC PT CANCELLED RAD IC PT LEFT AMA RAD IC PT REFUSED RAD IC REQ LOC CANCELLED RAD IC RESCHEDULED RAD IC TECHNICAL CANCEL RAD

58.30 132.50 323.30 106.00 822.55 0.00 884.05 290.45 79.50 42.40 296.80 1127.85 330.00 530.00 164.30 53.00 40.00 884.05 727.15 1076.95 727.15 727.15 668.85 100.70 101.75 101.75 85.85 85.85 393.25 451.55 281.95 95.40 315.90 300.00 257.60 212.00 211.00 79.50 21.20 84.80 106.00 324.35 249.10 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 47 16 16 16 16 16 16 16 16 16 16

BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BLOOD SERVICES BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC

Page 13

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

1621135 1621119 1621101 1621127 1621143 1621150 1621168 1621176 1621184 1621192 1621200 1621218 1621226 1621234 1621242 1621259 1621267 221523 223529 1925536 1660000 1652957 1675750 1630003 1632850 1630052 1620004 1670025 1670017 1973502 1973551 1972439 1973510 1973569 1977024 1670033 1670009 1972066 1972058 1973106 1972017 1972025 1621705 1621788 1621804 1621861 1621929 1621903 1622182 1622208 1622323 1622307 1622349

IC USED RESIDENCE RAD IC WRONG DATE RAD IC WRONG PATIENT RAD IC WRONG PROCEDURE RAD ICC COMPLAINT NURSING RAD ICC COMPLAINT PHYSICIAN R ICC COMPLAINT RADIOLOGIST ICC COMPLAINT RN RAD ICC COMPLAINT SECTION RAD ICC DELAY OF PATIENT RAD ICC INFO MISS H&P RAD ICC NO RADIOLOGIST AVAIL ICC NO RN AVAIL RAD ICC PATIENT COMPLAINTS RA ICC PATIENT INFO ERROR RA ICC PREP INCORRECT RAD ICC SATISFACTION SURVEY R IR CON N/C 100S 10ML IR CON N/C 300S 10ML IR GALACTOGRAM 1 DUCT IR SERVICE AFTER HOURS MR CARDIAC VELOCITY FLOW NI DUPLEX EXT UPP BIL NM EMERGENCY CALL BACK NM GASTRIC EMPTYING NO CHARGE PROCEDURE NMED RAD EMERGENCY CALL BACK US 1/2 HOUR ROOM TIME` US BEDSIDE US BREAST UNI OR BIL US BREAST UNI OR BIL US NC BIOPSY CORE MRS US NC BREAST BILAT MRS US NC BREAST UNILAT MRS US NDL PLACE US OB LTD 1/MORE FETUSES US SERVICE AFTER HOURS USC ASP BREAST ADD USC ASP BREAST CYST USC ASP BREAST CYST USC BREAST NDL WIRE ADD USC NC ASPIRATN BRST MRS XR ABD 1V AP XR ABD CMPL W 1V CHEST XR ABD W OBLIQUES CONE XR AC JNT XR ANKLE 2V XR ANKLE 3V OR MORE XR ARTHRO SHOULDER XR ARTHRO TMJ XR BE XR BE THRP XR BE W AIR CON

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 592.00 0.00 1278.00 0.00 0.00 0.00 0.00 384.00 384.00 0.00 0.00 0.00 952.00 616.00 0.00 226.00 380.00 391.00 0.00 0.00 538.00 1208.00 1009.00 829.00 494.00 662.00 1072.00 1230.00 1974.00 1005.00 1978.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1120.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 541.00 0.00 0.00 0.00 0.00 0.00 0.00 130.00 338.00 151.00 294.00 121.00 163.00 0.00 402.00 368.00 881.00 0.00

16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 2 2 19 16 16 16 16 16 16 16 16 16 19 19 19 19 19 19 16 16 19 19 19 19 19 16 16 16 16 16 16 16 16 16 16 16

BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC

Page 14

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

1622802 1622844 1622869 1622901 1623008 1923002 1623461 1623305 1623388 1623404 1623362 1623560 1623537 1623545 1623586 1623602 1623685 1925510 1925502 1925528 1622687 1622828 1927110 1927102 1927144 1927151 1923010 1929496 1927128 1929504 1623024 1923028 1622364 1622000 1622380 1622406 1623040 1926021 1923044 1623081 1926039 1923085 1623149 1622505 1622521 1922418 1922533 1622620 1622612 1622638 1622653 1622679 1622422

XR BONE AGE STDY XR BONE LENGTH STDY XR BONE SURVEY INF XR BONE SURVEY LTD XR BREAST MAMMOGRAPHY LOC XR BREAST MAMMOGRAPHY LOC XR CHEST 1V XR CHEST 2V XR CHEST 2V W AP LORDOTIC XR CHEST 2V W OBLIQUES XR CHEST SPECIAL V EA XR CHOL EXISTING CATH XR CHOL IN OR XR CHOL IN OR ADD SET XR CHOL TRANSHEPAT PRC XR CHOLECYSTOGRAM ORAL XR CINE/VIDEO COMPLEMENT XR GALACTOGRAM 1 DUCT XR GALACTOGRAM MULTI XR GALACTOGRAM MULTI XR GI TUBE INSERT LONG XR JNT SURVEY 1V XR MAMMO BIL XR MAMMO BIL XR MAMMO UNI XR MAMMO UNI XR NC BRST/NDL LC/STE/MRS XR NC SPECIMEN MRS XR SCRN MAMMO XR SPECIMEN SURGICAL XR STEREO LOC XR STEREO LOC XR SWALLOWING FNCTN XRC ASP BREAST CYST XRC BILI CATH CHNG XRC BILI STONE EXTRACT XRC BREAST NDL WIRE XRC BREAST NDL WIRE XRC BREAST NDL WIRE XRC BREAST NDL WIRE ADD XRC BREAST NDL WIRE ADD XRC BREAST NDL WIRE ADD XRC BRONCHOGRAM W-W/O CON XRC BX BONE DEEP XRC BX BONE SUPER XRC BX BREAST VAC ASSIST XRC BX BREAST W IMAG XRC BX MUSCLE XRC BX NASOPHARNYX XRC BX PANCREAS XRC BX PLEURA XRC BX RENL XRC EXCSN BREAST W LOC

656.00 656.00 227.00 730.00 490.00 445.00 391.00 638.00 666.00 719.00 638.00 1582.00 1582.00 852.00 1582.00 537.00 314.00 669.00 920.00 0.00 1690.00 656.00 479.00 371.00 388.00 388.00 0.00 0.00 198.00 118.00 1927.00 1752.00 821.00 418.00 709.00 1328.00 1009.00 917.00 917.00 440.00 400.00 400.00 447.00 3181.00 1084.00 2391.00 0.00 876.00 983.00 2880.00 1242.00 905.00 1812.00

577.00 577.00 0.00 640.00 462.00 0.00 106.00 162.00 267.00 0.00 0.00 801.00 801.00 480.00 801.00 473.00 273.00 0.00 0.00 0.00 1483.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 720.00 394.00 0.00 0.00 952.00 0.00 0.00 416.00 0.00 0.00 392.00 952.00 354.00 0.00 0.00 283.00 0.00 938.00 406.00 793.00 1593.00

16 16 16 16 16 19 16 16 16 16 16 16 16 16 16 16 16 19 19 19 16 16 19 19 19 19 19 19 19 19 16 19 16 16 16 16 16 19 19 16 19 19 16 16 16 19 19 16 16 16 16 16 16

BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC

Page 15

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

1922434 1923036 1922020 1610708 1623487 3415858 3415809 3414802 3413051 3412103 3412152 3414257 3413507 3416401 3414000 3414158 3414208 3414356 3414406 3413309 3414307 3413705 3414505 3414554 3414604 3415882 3412806 3417185 3410107 3412905 3412954 3413259 3413200 3414216 3415650 3414109 3414059 3414265 3415601 3414224 3414240 3415940 3415924 3415965 3415908 3416005 3416203 3416252 3413606 3415106 3416609 3416625 3416641

XRC EXCSN BREAST W LOC XRC IMAG LOC CLIP W BX XRC NC ASPIRA/BREAST MRS XRC PERICARDIOCENT INI XRC THORACENTESIS W TUBE CA ANGIO ADD VESSEL EA CA ANGIO PULM NONSELECT CA BIOPSY ENDOMYOCARDIAL CA CARDIOVERT ELCTVE EXT CA EP ABLTN AV NDE/CNDCTN CA EP ABLTN OF SVT CA EP HIS BUNDLE RECORD CA EP INTRA ATR RECORD CA EP TILT TABLE TEST CA HEART CATH LEFT CA HEART CATH LEFT CA HEART CATH RIGHT CA INJ AORTOGRAPHY CA INJ CORO ANGIO CA INJ CORO ANGIO CA INJ GRAFT ANGIO CA INJ GRAFT ANGIO CA INJ L VENT/ATR ANGIO CA INJ PULM ANGIO CA INJ R VENT/ATR ANGIO CA INSERT SWAN GANZ CA INSERT SWAN GANZ CA PLACE OCC DEV VEIN ART CA PTC ATHERCTMY ADD VSL CA PTC ATHERCTMY ADD VSL CA PTC ATHERCTMY SNGL VSL CA PTCA ADD VSL CA PTCA SNGL VSL CA RHC CNGNITL ANMLES CA RHC/LHC CNGNITL ANMLES CA RHC/LHC RETRO CA RHC/LHC RETRO CA RHC/LHC THRU OPN SEPTM CA RHC/LHC THRU OPN SEPTM CA RHC/TS LHC INTCT SEP CA RHC/TS LHC OPN SEP CNG CA S/I ANGIO PULM/AO/CORO CA S/I ANGIO PULM/AO/CORO CA S/I ANGIO VENTRCLR/ATR CA S/I ANGIO VENTRCLR/ATR CA SEPTOSTMY ATR TV METHD CA STENT IC SNGL VSL PRC CA STNT IC ADD VSL PRC CA THROMBLYSIS CORO INFSN CA TMP TRNSCUTANEOUS PACE CA VALVULOPLSTY AORTC PRC CA VALVULOPLSTY MITRL PRC CA VALVULOPLSTY PULM PRC

1648.00 537.00 0.00 3731.00 718.00 0.00 953.00 421.00 647.00 4548.00 6929.00 3772.00 1317.00 0.00 5631.00 7726.00 3534.00 837.00 1820.00 7726.00 2513.00 7726.00 1879.00 143.00 143.00 3533.00 955.00 429.00 4314.00 1414.00 5189.00 4314.00 4738.00 3534.00 0.00 7153.00 10099.00 9828.00 0.00 9828.00 10099.00 2055.00 2055.00 60.00 607.00 0.00 6336.00 1794.00 2598.00 183.00 6689.00 6891.00 5321.00

0.00 0.00 0.00 3275.00 631.00 0.00 838.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 840.00 347.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 161.00 0.00 0.00 0.00

19 19 19 16 16 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34

BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC BREAST CLINIC CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH

Page 16

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

3416500 3414703 3415205 3415254 3415353 3415304 3415551 3415700 3412608 3412509 3415049 3415403 3412558 3415007 3415056 3474731 3474749 3491404 3491115 3480753 3452406 3452307 3450590 3452208 3452109 3433307 3440302 3452414 3481959 3485448 3450582 3490752 3490901 3461001 3462215 3460516 3491438 3480555 3480019 3480076 3431715 3435435 3435427 3485638 3435658 3460524 3491446 3469202 3469251 3469301 3469350 3441086 3469657

CAC EMBOL OCC NONHEAD NEC CAC INSERT IABP PRC CAC INSERT PACER DUAL LDS CAC INSERT PACER GEN SNGL CAC INSERT PACER GEN SNGL CAC INSERT PACER TMP SNGL CAC INSERT PACER/ELEC VNT CAC PERICARDIOCENT INI CAC RMV ICD PACING GEN SQ CAC RMV ICD PACING GEN SQ CAC RMVL PERM PACER GEN CAC RMVL TV PACR ELC SNGL CAC RMVL TV PACR ELC SNGL CAC UPGRD PACE SNGL DUAL CAC UPGRD PACE SNGL DUAL S IMP HCG PTCA COATED STE S IMP HCG PTCA NON-COATED S NSTRL HC COVER SNAP S NSTRL HC DEFIB PADS S NSTRL HC DEFIBRILLATOR S NSTRL HC IABP INSERTION S PCR HC PACEMAKER DUAL S PCR HC PACEMAKER LEAD S PCR HC PACEMAKER SINGL S PCR HC PACEMAKER TRANS S STRL ELECT, I-STAT (EYE S STRL HC BALLOON PACING S STRL HC IABP CATHETER S STRL HC INDEFLATOR PACK S STRL HC MICROPUNCTURE S S STRL HC PACEMAKER CABLE S STRL HC PADS GROUNDING S STRL HC PRESSURE TUBING S STRL HC SLEEVER STERILE S STRL HC TORQUE DEVICE S STRL HC TOUHY BORST S STRL HC TRANSDUCER DISP S STRL HC TRAY HEART CATH S STRL HC TRAY PACEMAKER S STRL HC TRAY PERICARDIO S STRL HCG BALLOON PTCA S STRL HCG CATH CORONARY S STRL HCG CATH MICROCATH S STRL HCG CATH SNARE S STRL HCG CATH THERMODIL S STRL HCG DILATORS ALL S STRL HCG DISC COMPRESSO S STRL HCG GUIDEWIRE S STRL HCG GUIDEWIRE HYDR S STRL HCG GUIDEWIRE INFU S STRL HCG GUIDEWIRE MICR S STRL HCG INDEFLATOR S STRL HCG INTRODUCER PEE

5673.00 2111.00 3584.00 2265.00 3519.00 2126.00 3476.00 3731.00 2780.00 1496.00 3757.00 1171.00 1496.00 105.00 74.00 4585.00 4062.00 26.00 92.00 183.00 433.00 15394.00 2542.00 13809.00 669.00 53.00 590.00 2791.00 262.00 157.00 131.00 26.00 13.00 53.00 39.00 118.00 53.00 315.00 249.00 629.00 1284.00 53.00 1297.00 1061.00 262.00 26.00 26.00 79.00 236.00 891.00 787.00 262.00 262.00

0.00 0.00 3144.00 1989.00 3089.00 1867.00 0.00 0.00 2441.00 0.00 0.00 1029.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34 34

CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH

Page 17

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

3481652 3481108 3440203 3444056 3469608 3469558 3469509 3440252 3487006 3620127 3610250 3610037 3610011 3610045 3620069 3620143 3620051 3620093 3620077 3310240 3310018 3310307 3310315 3310158 225102 223800 223404 232520 231480 231464 231449 231407 231506 232645 231563 232686 232728 232769 232801 232843 232884 232165 231662 233247 232140 233585 233569 233551 231522 232009 232124 231647 231621

S STRL HCG MANIFOLD S STRL HCG NEEDLE VASCULA S STRL HCG PACING WIRE S STRL HCG PTCA GUIDE S STRL HCG SHEATH FIXED C S STRL HCG SHEATH LONG S STRL HCG SHEATH REGULAR S STRL HGG CATH BERMAN S STRL HGG VASCULAR CLOSE CA TILT TABLE TEST CARD REHAB ED GROUP CARD REHAB EXIT EVAL CARD REHAB NEW EVAL CARDIAC REHAB W EKG CARDIAC STRESS TEST CARDIAC STRESS TEST EKG 12 LEAD TRACING EKG SIGNAL AVERAGED INVOICED SERVICE CA ANGIO INT MAMMARY CA INJ AORTOGRAPHY CA STENT IC SNGL VSL PRC CA STNT IC ADD VSL PRC CA TMP TRNSCUTANEOUS PACE CON IONIC 300ML CON NI 300S 150ML CON NI 300S 50ML S CATH INFSN NO HD S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR

53.00 13.00 472.00 289.00 315.00 183.00 53.00 222.00 983.00 1412.00 0.00 0.00 0.00 148.00 649.00 119.00 284.00 488.00 556.00 1213.00 837.00 7398.00 1619.00 2556.00 62.00 527.00 326.00 1822.00 1202.00 1113.00 1128.00 1202.00 1128.00 1080.00 1125.00 1148.00 1080.00 1148.00 1148.00 1080.00 1148.00 1837.00 1081.00 1080.00 1837.00 1534.00 1392.00 1534.00 1202.00 1383.00 1837.00 1128.00 1047.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

34 34 34 34 34 34 34 34 34 36 36 36 36 36 36 36 36 36 36 33 33 33 33 33 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIAC CATH CARDIOLOGY SERVICES CARDIOLOGY SERVICES CARDIOLOGY SERVICES CARDIOLOGY SERVICES CARDIOLOGY SERVICES CARDIOLOGY SERVICES CARDIOLOGY SERVICES CARDIOLOGY SERVICES CARDIOLOGY SERVICES CARDIOLOGY SERVICES CATH LAB CATH LAB CATH LAB CATH LAB CATH LAB CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES

Page 18

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

231605 231589 231381 231548 232025 233445 232108 233163 233288 233346 233361 233080 233429 233049 233460 233486 233502 233528 233536 233544 232926 231068 232066 231126 231365 231340 231324 233122 231142 233403 232041 231084 231100 231043 232967 233007 231308 233320 243188 243204 243220 243246 243105 243121 243147 246009 252304 252403 252106 252205 252502 276006 276022

S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S CATH TRNSML ANG NOLSR S IMP EMBO COIL SPRING 2. S IMP EMBO COIL SPRING 4. S IMP EMBOLI COIL SPRING S IMP IR EMBOLI COI SPRIN S IMP IR EMBOLI COIL 2X20 S IMP IR EMBOLI COIL 2X40 S IMP IR EMBOLI COIL 3X60 S IMP IR G01 VENA CAVA FI S IMP IR NEURO GDC COIL 2 S IMP IR NEURO GDC COIL 3 S IMP IR NEURO GDC COIL S S IMP IR NEURO GDC COIL S S IMP IR NEURO GDC COIL U S IMP IR STENT BILIARY 20 S IMP IR STENT BILIARY 80

1128.00 984.00 1128.00 1202.00 1726.00 129.00 1837.00 1080.00 1148.00 1148.00 1253.00 1080.00 1148.00 1148.00 1148.00 1154.00 1148.00 1154.00 1148.00 1392.00 1080.00 902.00 1837.00 1203.00 1127.00 1643.00 1128.00 1148.00 902.00 1253.00 1837.00 1203.00 1203.00 1203.00 1149.00 1078.00 1207.00 1080.00 121.00 278.00 121.00 209.00 362.00 398.00 398.00 2529.00 2122.00 3537.00 2542.00 2673.00 2909.00 4563.00 4563.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES

Page 19

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

276485 276568 276501 276584 276600 276527 276543 276626 276642 276667 276683 276105 276121 276162 276147 276188 276204 276220 276303 276246 276329 276261 276287 276345 276469 276360 276402 276048 276063 274563 274522 274548 274845 274829 274803 274860 274886 274902 276089 243055 243071 274738 274753 274704 274407 251389 251603 251405 251629 251421 251447 251660 251462

S IMP IR STENT SMART 10X2 S IMP IR STENT SMART 10X2 S IMP IR STENT SMART 10X4 S IMP IR STENT SMART 10X4 S IMP IR STENT SMART 10X6 S IMP IR STENT SMART 10X6 S IMP IR STENT SMART 10X8 S IMP IR STENT SMART 12X4 S IMP IR STENT SMART 12X6 S IMP IR STENT SMART 14X4 S IMP IR STENT SMART 14X6 S IMP IR STENT SMART 7X20 S IMP IR STENT SMART 7X40 S IMP IR STENT SMART 7X40 S IMP IR STENT SMART 7X60 S IMP IR STENT SMART 7X60 S IMP IR STENT SMART 7X80 S IMP IR STENT SMART 8X20 S IMP IR STENT SMART 8X40 S IMP IR STENT SMART 8X40 S IMP IR STENT SMART 8X60 S IMP IR STENT SMART 8X60 S IMP IR STENT SMART 8X80 S IMP IR STENT SMART 9X20 S IMP IR STENT SMART 9X40 S IMP IR STENT SMART 9X40 S IMP IR STENT SMART 9X60 S IMP IR STENT UNISTEP 60 S IMP IR STENT UNISTEP LL S IMP IR STENT URETERAL 8 S IMP IR STENT URETERAL 8 S IMP IR STENT URETERAL 8 S IMP IR STENT VASCULAR 1 S IMP IR STENT VASCULAR 1 S IMP IR STENT VASCULAR 1 S IMP IR STENT VASCULAR 2 S IMP IR STENT VASCULAR 3 S IMP IR STENT VASCULAR 6 S IMP IR STENT WALL 7X40 S IMP IRG EMOBILIZATION C S IMP IRG EMOBILIZATION C S IMP IRG STENT MOUNTED S IMP IRG STENT SELF-EXPA S IMP IRG STENT UN-MOUNTE S IMP IRG URETERAL STENT S IMP NR GDC 10MM X 30CM S IMP NR GDC 10MM X30CM 2 S IMP NR GDC 12MM X 30CM S IMP NR GDC 12MMX30CM 2D S IMP NR GDC 14MM X 30CM S IMP NR GDC 16MM X 30CM S IMP NR GDC 16MMX30CM 2D S IMP NR GDC 18MM X 30CM

3558.00 3558.00 5434.00 3558.00 3558.00 4448.00 3558.00 2844.00 3917.00 3917.00 3917.00 4147.00 4147.00 4147.00 4147.00 4147.00 4147.00 3521.00 4147.00 4147.00 4147.00 4147.00 4147.00 4147.00 3558.00 4147.00 3558.00 4685.00 3521.00 529.00 445.00 552.00 4264.00 3544.00 4264.00 3733.00 2955.00 4108.00 3521.00 275.00 419.00 4192.00 3944.00 3275.00 694.00 2084.00 2147.00 2084.00 2147.00 2084.00 2230.00 2147.00 2230.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES

Page 20

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

251686 251488 251728 251025 251744 251769 251041 251785 251066 251082 251124 251108 251223 251504 251140 251520 251264 251181 251207 251546 251280 251306 251561 251322 251587 251363 251165 235713 246108 252320 252122 252361 252346 252163 252148 252049 234047 234070 234088 234963 234187 234120 234245 234708 234823 234906 235002 235028 235101 235127 235085 283101 231209

S IMP NR GDC 18MMX30CM 2D S IMP NR GDC 20MM X 30CM S IMP NR GDC 2MM X 2CM SO S IMP NR GDC 2MM X 4CM SO S IMP NR GDC 2MMX3CM SOFT S IMP NR GDC 2MMX6CM SOFT S IMP NR GDC 2MMX8CM SOFT S IMP NR GDC 3MMX3CM SOFT S IMP NR GDC 3MMX4CM SOFT S IMP NR GDC 3MMX8CM SOFT S IMP NR GDC 4MMX10CM SOF S IMP NR GDC 4MMX6CM SOFT S IMP NR GDC 5MMX15CM COI S IMP NR GDC 5MMX20CM 2D S IMP NR GDC 5MMX8CM SOFT S IMP NR GDC 6MM X 20CM 2 S IMP NR GDC 6MM X 20CM C S IMP NR GDC 6MMX10CM SOF S IMP NR GDC 6MMX15CM SOF S IMP NR GDC 7MM X 30CM 2 S IMP NR GDC 7MM X 30CM C S IMP NR GDC 8MM X 20CM C S IMP NR GDC 8MM X 30CM 2 S IMP NR GDC 8MM X 30CM C S IMP NR GDC 9MM X 30CM 2 S IMP NR GDC 9MM X 30CM C S IMP S IMP NR GDC 5MMX12 S IMP STENT,URETERAL,DOUB S IMP VENA CAVA FILTER GF S NSTRL NR STENT/NEURO 3 S NSTRL NR STENT/NEURO 3 S NSTRL NR STENT/NEURO 4 S NSTRL NR STENT/NEURO 4 S NSTRL NR STENT/NEURO 4 S NSTRL NR STENT/NEURO 4 S NSTRL NR WIRE 300 FLOP S STRL CATH AORTIC FLUS S STRL CATH BERENSTINE S STRL CATH BERENSTINE S STRL CATH BERENSTINE 4F S STRL CATH COBRA C2 5F S STRL CATH COBRA WITH S STRL CATH GUIDE 4FRAN S STRL CATH MPA 5FR S STRL CATH PIGTAIL 6FR S STRL CATH SIMMONS I 5 S STRL CATH SIMMONS S2 S STRL CATH SOS OMNI S STRL CATH STRAIGHT 5F S STRL CATH STRAIGHT 5F S STRL CATH STRAIGHT 5F S STRL HI-PRESSURE TUBI S STRL IR BALLOON OCCLU

2293.00 2230.00 2152.00 2152.00 2152.00 2152.00 2152.00 2152.00 2152.00 2152.00 2278.00 2278.00 2278.00 2354.00 2278.00 2480.00 2405.00 2405.00 2405.00 2480.00 2405.00 2405.00 2480.00 2405.00 2480.00 2405.00 2278.00 769.00 4425.00 6789.00 6789.00 6789.00 6789.00 6789.00 6789.00 1443.00 126.00 107.00 109.00 107.00 117.00 100.00 269.00 109.00 72.00 100.00 109.00 111.00 103.00 100.00 102.00 21.00 557.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES

Page 21

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

231159 234427 234005 234260 234526 234443 232546 282756 234401 235309 234583 234625 234344 234765 234690 234542 234955 234328 243048 243022 235200 235226 241091 243303 261420 261008 261024 261040 261065 261081 261206 261222 261289 261305 261321 261347 261362 261388 281907 281808 281956 281857 282053 282004 282152 282103 282509 281774 243386 243287 243329 243345 241067

S STRL IR BALLOONS OCCL S STRL IR CAHT FOGARTY S STRL IR CATH 5FR 65CM S STRL IR CATH BERN GLD S STRL IR CATH COBRAGD S STRL IR CATH COBRAGD S STRL IR CATH DIAL ACC S STRL IR CATH DRAIN PI S STRL IR CATH FAST TRA S STRL IR CATH H1 S STRL IR CATH HOOK VIS S STRL IR CATH JB2 S STRL IR CATH MPC GD 6 S STRL IR CATH PIGTAIL S STRL IR CATH RAPID TR S STRL IR CATH RESSGD 8 S STRL IR CATH SIM1 5FR S STRL IR CATH SIM2 GD S STRL IR CATH TRACKER S STRL IR CATH TRACKER S STRL IR CATH TRACKER S STRL IR CATH VENTURE S STRL IR CATHETER INFU S STRL IR CONTOUR 250-3 S STRL IR DILATOR 10FR S STRL IR DILATOR 11FR S STRL IR DILATOR 12FR S STRL IR DILATOR 13FR S STRL IR DILATOR 14FR S STRL IR DILATOR 16FR S STRL IR DILATOR 20FR S STRL IR DILATOR 22FR S STRL IR DILATOR 4FR S STRL IR DILATOR 5FR S STRL IR DILATOR 6FR S STRL IR DILATOR 7FR S STRL IR DILATOR 8FR S STRL IR DILATOR 9FR S STRL IR DRAIN CAST BI S STRL IR DRAIN CATH AP S STRL IR DRAIN CATH BI S STRL IR DRAIN CATH BI S STRL IR DRAIN CATH NE S STRL IR DRAIN CATH NE S STRL IR DRAIN CATH NE S STRL IR DRAIN CATH NE S STRL IR DRAIN CATH VA S STRL IR DRAINAGE CATH S STRL IR EMBO WIRE TAP S STRL IR EMBOLI CONTOU S STRL IR EMBOLI CONTOU S STRL IR EMBOLI CONTOU S STRL IR FLO-SWITCH

1061.00 129.00 116.00 296.00 529.00 502.00 840.00 260.00 387.00 107.00 70.00 67.00 556.00 51.00 1443.00 529.00 100.00 557.00 1336.00 1292.00 1466.00 1560.00 760.00 418.00 38.00 40.00 40.00 40.00 40.00 40.00 38.00 61.00 39.00 35.00 33.00 33.00 35.00 33.00 384.00 439.00 419.00 419.00 476.00 476.00 371.00 292.00 552.00 105.00 669.00 418.00 418.00 418.00 33.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES

Page 22

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

250209 234195 263301 263004 263020 263327 263046 263368 263343 263285 263061 263160 263087 263103 263145 263129 263202 263228 263186 246504 285445 241109 282558 256107 256206 252809 250605 283309 285056 285155 285403 285759 244004 244020 244061 244046 235143 241125 245506 245605 286203 286302 266007 266106 266148 266163 287201 285007 287003 287144 287102 246157 267203

S STRL IR GELFOAM S STRL IR GLIDE CATH C2 S STRL IR INTRODUCER 4F S STRL IR INTRODUCER 5F S STRL IR INTRODUCER 6F S STRL IR INTRODUCER 7F S STRL IR INTRODUCER 7F S STRL IR INTRODUCER 8F S STRL IR INTRODUCER 8F S STRL IR INTRODUCER 9F S STRL IR INTRODUCER BA S STRL IR INTRODUCER PE S STRL IR INTRODUCER PE S STRL IR INTRODUCER PE S STRL IR INTRODUCER PE S STRL IR INTRODUCER PE S STRL IR INTRODUCER PE S STRL IR INTRODUCER PE S STRL IR INTRODUCER PE S STRL IR IVC FILTER SE S STRL IR MICROPUNCTURE S STRL IR MONITORING TU S STRL IR NEPHROSTOMY K S STRL IR NEURO CEM KIT S STRL IR NEURO CEM KIT S STRL IR NEURO CONNECT S STRL IR NEURO CRANIOP S STRL IR NEURO, BARIUM S STRL IR SET GASTROJEJ S STRL IR SET GROSHONG S STRL IR SET M-R FEEDI S STRL IR SNARE 25MM S STRL IR STONE BASKET S STRL IR STONE BASKET S STRL IR STONE BASKET S STRL IR STONE BASKET S STRL IR STRAIGHT 5FR S STRL IR T-FASTENER BS STRL IR TORQUE DEVICE S STRL IR TRANSDUCER NA S STRL IR TRAY PNEUMOTH S STRL IR TRAY THORACEN S STRL IR TUB GASTRO 18 S STRL IR TUB GASTRO 22 S STRL IR TUBE GJ 16FR S STRL IR TUBE GJ 22FR S STRL IR VASC CLOS VAS S STRL IR VASCULAR ACCE S STRL IR VASCULAR CLOS S STRL IR VASCULAR CLOS S STRL IR VASCULAR CLOS S STRL IR VENA CAVA FILTE S STRL IR WIRE AMPLATZ

39.00 267.00 62.00 112.00 112.00 110.00 356.00 206.00 201.00 206.00 196.00 249.00 280.00 236.00 236.00 276.00 249.00 236.00 236.00 3669.00 144.00 17.00 694.00 1965.00 1572.00 222.00 1139.00 354.00 742.00 1907.00 278.00 1743.00 946.00 1198.00 1085.00 919.00 97.00 260.00 45.00 103.00 194.00 229.00 697.00 697.00 697.00 697.00 987.00 393.00 983.00 329.00 255.00 3263.00 206.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES

Page 23

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

267260 267245 267302 267500 267807 268128 268102 268003 268045 268227 268029 268060 268144 268086 268508 268524 268565 268540 267104 267708 268649 268706 268805 268169 268847 281758 231738 231704 231753 234054 235705 235507 235457 235556 235606 235408 260505 234419 243162 250506 269209 269258 269308 269357 241083 269654 269605 269555 269506 234641 285809 286351 241166

S STRL IR WIRE AMPLATZ S STRL IR WIRE AMPLATZ S STRL IR WIRE BENTSON S STRL IR WIRE COONS BENS S STRL IR WIRE EXCHANGE S STRL IR WIRE GLD 38X1 S STRL IR WIRE GLD ANGL S STRL IR WIRE GLD ANGL S STRL IR WIRE GLD ANGL S STRL IR WIRE GLD GOLD S STRL IR WIRE GLD STRG S STRL IR WIRE GLD STRG S STRL IR WIRE GLDANGLE S STRL IR WIRE GLDSTRGH S STRL IR WIRE HTF 180 S STRL IR WIRE HTF 300 S STRL IR WIRE INFUSION S STRL IR WIRE INFUSION S STRL IR WIRE J MVBL C S STRL IR WIRE MICROPUN S STRL IR WIRE NEWTON L S STRL IR WIRE ROSEN S STRL IR WIRE SEEKER S STRL IR WIRE TRANSEND S STRL IR WIRE WHOLEY S STRL IRG BAG DRAINAGE S STRL IRG BALLOON PTA S STRL IRG BALLOON PTA S STRL IRG BALLOONS S STRL IRG CATH BERGMAN S STRL IRG CATHETER S STRL IRG CATHETER HYD S STRL IRG CATHETER LON S STRL IRG CATHETER MAR S STRL IRG CATHETER MIC S STRL IRG CATHETER SHO S STRL IRG DILATORS S STRL IRG EMBOLECTOMY S STRL IRG EMBOLI COIL S STRL IRG EMOBILIZATIO S STRL IRG GUIDEWIRES S STRL IRG GUIDEWIRES H S STRL IRG GUIDEWIRES I S STRL IRG GUIDEWIRES M S STRL IRG INDEFLATOR S STRL IRG INTRODUCER S S STRL IRG INTRODUCERS S STRL IRG INTRODUCERS S STRL IRG INTRODUCERS S STRL IRG NEEDLE TLA S STRL IRG SET RING TRA S STRL IRG THROMBOLYTIC S STRL IRG TORQUE DEVIC

166.00 255.00 91.00 98.00 87.00 278.00 267.00 190.00 190.00 835.00 190.00 166.00 294.00 166.00 603.00 603.00 334.00 742.00 8.00 93.00 64.00 126.00 718.00 919.00 673.00 39.00 1088.00 1088.00 1088.00 222.00 0.00 301.00 131.00 131.00 1284.00 92.00 26.00 236.00 616.00 930.00 787.00 249.00 891.00 171.00 262.00 262.00 315.00 183.00 53.00 131.00 1821.00 2293.00 39.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES

Page 24

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

286005 240408 285700 285452 284208 284158 284257 252288 252247 253104 253153 253252 253203 253450 253401 285502 264465 264523 264481 264549 234021 285353 266205 675611 675678 675694 675645 675637 675884 629998 644906 646208 646158 646109 641449 640144 641431 641605 641555 641506 648725 648774 646224 642835 642827 642819 642934 642926 642918 641407 640193 646851 643338

S STRL IRG TRAY ANGIO S STRL IRG VASCULAR EMB S STRL IRG VASCULAR SNA S STRL MICRO PUNCTURE 5 S STRL NEEDLE 18GA THIN S STRL NEEDLE SMART LAR S STRL NEEDLE WESTCOTT S STRL NR BATTERIES S STRL NR GDC POWER SUP S STRL NR KYPHOPAK 15/3 S STRL NR KYPHOPAK 15/3 S STRL NR KYPHOPAK 20/3 S STRL NR KYPHOPAK 20/3 S STRL NR KYPHX INFLAT S STRL NR KYPHX TOOL KI S STRL PERCU-FIX SET S STRL RF PROBE 2CMX15CM S STRL RF PROBE 3.5CMX15C S STRL RF PROBE 3CMX15CM S STRL RF PROBE 4CMX15CM S STRL S STRL CATH AORT S STRL SET LIVER BIOPSY S STRL TUBE TRANSGASTRI CA ECHO 2D CMPL CA ECHO 2D LTD CA ECHO 2D W STRES CA ECHO DPPLER CMPL CA ECHO DPPLER COLOR FLOW CA ECHO TRANSESOPHAGEAL CONV. MISC. DIAG RAD CT 3D RECONSTRUCTION CT ABD W/CON CT ABD W/O CON CT ABD W-W/O CON CT BONE DENSITY STDY APPN CT BONE DENSTY STDY AXIAL CT BONE DENSTY STDY AXIAL CT BRAIN W CON CT BRAIN W/O CON CT BRAIN W-W/O CON CT CARDIAC SCORING CT COLONOSCOPY VIRTL SCRN CT DRN W CATH PLACE PRC CT EXT LOW W CON CT EXT LOW W/O CON CT EXT LOW W-W/O CON CT EXT UPP W CON CT EXT UPP W/O CON CT EXT UPP W-W/O CON CT GUIDE NDL PLACEMENT CT GUIDE RAD TX FIELDS CT GUIDE RAD TX FIELDS CT LTD OR FU STDY

171.00 930.00 983.00 143.00 34.00 390.00 65.00 0.00 0.00 10192.00 6932.00 6932.00 10192.00 4006.00 3752.00 82.00 758.00 1152.00 983.00 1348.00 122.00 361.00 987.00 1327.00 778.00 374.00 587.00 611.00 1509.00 0.00 1812.00 2179.00 2044.00 2542.00 390.00 646.00 400.00 2939.00 2636.00 3728.00 479.00 801.00 2124.00 3160.00 2748.00 3639.00 2525.00 1817.00 3261.00 1086.00 1556.00 400.00 1298.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1593.00 956.00 887.00 1041.00 0.00 0.00 0.00 1441.00 1119.00 1535.00 0.00 0.00 1866.00 1456.00 1296.00 1897.00 0.00 1594.00 0.00 1025.00 0.00 0.00 1140.00

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES CENTRAL SUPPLIES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 25

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

648758 643908 643858 644054 644005 643957 644757 644807 644856 644708 644658 644609 641472 641274 646265 641282 646455 646406 646356 646604 646554 646505 646752 646703 646653 646802 643601 643551 643502 646315 646216 643627 642850 642959 641621 644070 644724 642744 642736 647560 647628 647701 647669 647743 647784 647503 642462 642454 667253 642488 648139 642538 642504

CT LUNG SCREENING CT MAXILLOFACIAL W CON CT MAXILLOFACIAL W/O CON CT NEC W CON CT NEC W/O CON CT NEC W-W/O CON CT ORBIT SELLA FOSA W-W/O CT ORBIT SELLA FOSSA W CT ORBIT/SELLA/FOSSA W/O CT PELV W CON CT PELV W/O CON CT PELV W-W/O CON CT PERFUSION W/CON CBF CT SEDATION IV/IM/INH CT SEDATION MONITORING CT SEDATION PO/PR/INASAL CT SPINE CERV W CON CT SPINE CERV W/O CON CT SPINE CERV W-W/O CON CT SPINE LUMB W CON CT SPINE LUMB W/O CON CT SPINE LUMB W-W/O CON CT SPINE THOR W CON CT SPINE THOR W/O CON CT SPINE THOR W-W/O CT STEREOTACTIC LOC CT THORAX W CON CT THORAX W/O CON CT THORAX W-W/O CT VERTEBROPLASTY CTA ABD W-W/O CON CTA CHEST W-W/O CON CTA EXT LOW W-W/O CON CTA EXT UPP W-W/O CON CTA HEAD W-W/O CON CTA NEC W-W/O CON CTA PELV W-W/O CON CTC ABLTN CRYO OPN LIVER CTC ABLTN RENAL RF PRC CTC ABSCSS CYST LIVER PRC CTC ABSCSS DRN PELV PRC CTC ABSCSS DRN PERITNL CTC ABSCSS DRN RENL CTC ABSCSS DRN RETROPE CTC ABSCSS DRN SUBDIAP CTC ABSCSS INC SFT TISSUE CTC ASP BREAST ADD CTC ASP BREAST CYST CTC ASP RENL CYST CTC ASP SPINAL CYST PRC CTC BX ABD RETROPE CTC BX BM NDL/TROCAR CTC BX BONE DEEP

801.00 3116.00 2852.00 3116.00 2794.00 3874.00 3874.00 3116.00 2794.00 2166.00 2069.00 2310.00 5280.00 544.00 0.00 362.00 3116.00 3901.00 4661.00 3180.00 3978.00 4569.00 3116.00 4033.00 4569.00 3160.00 3921.00 3720.00 4123.00 290.00 6088.00 6007.00 1430.00 6087.00 5025.00 6088.00 6088.00 4297.00 4475.00 3921.00 1206.00 2621.00 4367.00 1321.00 1426.00 1057.00 160.00 378.00 338.00 1787.91 661.00 660.00 836.00

0.00 1441.00 1251.00 1441.00 1225.00 1504.00 1504.00 1441.00 1225.00 891.00 807.00 1117.00 0.00 0.00 0.00 0.00 1757.00 1597.00 1916.00 1794.00 1630.00 1916.00 1757.00 1597.00 1916.00 2775.00 1608.00 1519.00 1689.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1059.00 0.00 0.00 1160.00 1252.00 929.00 0.00 0.00 319.00 0.00 623.00 0.00 732.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 26

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

648006 642520 648113 648261 648147 648154 640060 648162 648170 648196 642645 648204 642470 642694 648659 642991 642405 643056 643106 643155 648279 648287 643312 647453 647461 643478 647487 644385 649566 669713 649012 678144 638015 678011 669721 649020 678151 638023 678029 669739 649038 678169 638031 678037 669747 649046 678177 638049 678045 669754 649053 678185 638056

CTC BX BONE DEEP CTC BX BONE SUPER CTC BX BRAIN W BURR HOLE CTC BX EXCSN LYMPH NODE CTC BX LIVER CTC BX LUNG MEDIASTNM CTC BX MUSCLE CTC BX NASOPHARNYX CTC BX PANCREAS CTC BX PLEURA CTC BX PROSTATE CTC BX RENL CTC BX STEREO ASPIR HEAD CTC BX THYROID CTC ENDO SB W JEJ TUB PRC CTC EXCHANGE DRN CATH CTC FNA W IMAG GUIDANCE CTC INJ CON ABSCSS CTC INJ FACET C/T 1 LVL CTC INJ FACET L/S ADD LVL CTC INJ NRV BLK C/T 1 LVL CTC INJ NRV BLK C/T ADD CTC INTRO CATH IVC SVC CTC PARACENT ABD INI CTC PARACENT ABD SUBSQ CTC PNMNSTOMY W DRN PRC CTC PUNCTURE DRN LESION CTC REMV TUNN CV CATH W/O CTC THORACENTESIS IC DUPLICATE ORDER ANGIO IC DUPLICATE ORDER CT IC DUPLICATE ORDER NINV IC DUPLICATE ORDER NMED IC DUPLICATE ORDER US IC MD CANCELLED ANGIO IC MD CANCELLED CT IC MD CANCELLED NINV IC MD CANCELLED NMED IC MD CANCELLED US IC NO SHOW ANGIO IC NO SHOW CT IC NO SHOW NINV IC NO SHOW NMED IC NO SHOW US IC PT CANCELLED ANGIO IC PT CANCELLED CT IC PT CANCELLED NINV IC PT CANCELLED NMED IC PT CANCELLED US IC PT LEFT AMA ANGIO IC PT LEFT AMA CT IC PT LEFT AMA NINV IC PT LEFT AMA NMED

819.00 966.00 3656.00 887.85 675.00 1395.00 758.00 1828.00 1166.00 498.00 774.00 459.00 4044.00 388.00 726.33 280.00 506.00 157.00 765.00 331.00 765.00 1005.00 428.00 725.00 507.00 695.00 230.67 531.57 610.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

718.00 460.00 0.00 0.00 0.00 531.00 0.00 682.00 0.00 0.00 0.00 433.00 0.00 0.00 0.00 0.00 0.00 0.00 671.00 294.00 0.00 0.00 0.00 684.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 27

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

678052 649061 678193 638130 678060 669762 669770 649079 678250 678078 669788 649087 678201 678086 678524 669960 669796 649095 678219 638080 678094 669838 649137 678268 638114 678136 669812 649111 638122 678110 669804 649103 678227 638098 678102 669820 649129 678243 638106 678128 638155 638163 678409 638148 678276 678417 678284 678292 669861 678425 649178 678433 638171

IC PT LEFT AMA US IC PT REFUSED CT IC PT REFUSED NINV IC PT REFUSED NMED IC PT REFUSED US IC REFUSED ANGIO IC REQ LOC CANCELLED ANGI IC REQ LOC CANCELLED CT IC REQ LOC CANCELLED NINV IC REQ LOC CANCELLED US IC RESCHEDULED ANGIO IC RESCHEDULED CT IC RESCHEDULED NINV IC RESCHEDULED US IC SATISFACTION NINV IC SATISFACTION SURVEY AN IC TECHNICAL CANCEL ANGIO IC TECHNICAL CANCEL CT IC TECHNICAL CANCEL NINV IC TECHNICAL CANCEL NMED IC TECHNICAL CANCEL US IC USED RESIDENCE ANGIO IC USED RESIDENCE CT IC USED RESIDENCE NINV IC USED RESIDENCE NMED IC USED RESIDENCE US IC WRONG DATE ANGIO IC WRONG DATE CT IC WRONG DATE NMED IC WRONG DATE US IC WRONG PATIENT ANGIO IC WRONG PATIENT CT IC WRONG PATIENT NINV IC WRONG PATIENT NMED IC WRONG PATIENT US IC WRONG PROCEDURE ANGIO IC WRONG PROCEDURE CT IC WRONG PROCEDURE NINV IC WRONG PROCEDURE NMED IC WRONG PROCEDURE US ICC COMPLAING PHYSICIAN N ICC COMPLAING RADIOLOGIST ICC COMPLAINT NURSING NIN ICC COMPLAINT NURSING NMD ICC COMPLAINT NURSING US ICC COMPLAINT PHYSICIAN N ICC COMPLAINT PHYSICIAN U ICC COMPLAINT RADIOLOGIST ICC COMPLAINT RADIOLOGIST ICC COMPLAINT RADIOLOGIST ICC COMPLAINT RN CT ICC COMPLAINT RN NINV ICC COMPLAINT RN NMED

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 28

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

678300 669887 649186 678441 638189 678318 669895 649194 678458 638197 678326 669903 649202 678466 638205 678334 638213 678342 678474 669911 649210 669929 649228 678482 638221 678359 669937 679233 678490 638239 678367 669945 649244 678508 638247 678375 669952 649251 678516 638254 678383 649269 638262 678391 678235 626648 625103 661140 661157 661207 661256 661306 661355

ICC COMPLAINT RN US ICC COMPLAINT SECTION ANG ICC COMPLAINT SECTION CT ICC COMPLAINT SECTION NIN ICC COMPLAINT SECTION NMD ICC COMPLAINT SECTION US ICC DELAY OF PATIENT ANGI ICC DELAY OF PATIENT CT ICC DELAY OF PATIENT NINV ICC DELAY OF PATIENT NMED ICC DELAY OF PATIENT US ICC INFO MISS H&P ANGIO ICC INFO MISS H&P CT ICC INFO MISS H&P NINV ICC INFO MISS H&P NMED ICC MISS H&P US ICC NO RADIOLOGIST AVAIL ICC NO RADIOLOGIST AVAIL ICC NO RADIOLOGIST AVAIL ICC NO RADIOLOGIST AVAIL ICC NO RADIOLOGIST AVAIL ICC NO RN AVAIL ANGIO ICC NO RN AVAIL CT ICC NO RN AVAIL NINV ICC NO RN AVAIL NMED ICC NO RN AVAIL US ICC PATIENT COMPLAINTS AN ICC PATIENT COMPLAINTS CT ICC PATIENT COMPLAINTS NI ICC PATIENT COMPLAINTS NM ICC PATIENT COMPLAINTS US ICC PATIENT INFO ERROR AN ICC PATIENT INFO ERROR CT ICC PATIENT INFO ERROR NI ICC PATIENT INFO ERROR NM ICC PATIENT INFO ERROR US ICC PREP INCORRECT ANGIO ICC PREP INCORRECT CT ICC PREP INCORRECT NINV ICC PREP INCORRECT NMED ICC PREP INCORRECT US ICC SATISFACTION SURVEY C ICC SATISFACTION SURVEY N ICC SATISFACTION SURVEY U ICC WRONG DATE NINV INTERP OF FOREIGN FILMS IR ABSCSS FIST SIN TRACT IR ABSCSS FIST SIN TRACT IR ANGIO ADD VESSEL EA IR ANGIO ADRENAL BIL IR ANGIO ADRENAL UNI IR ANGIO AVS SHUNT IR ANGIO BRACH

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 847.00 1617.00 1388.00 4418.00 4418.00 1699.00 4418.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3877.00 3877.00 0.00 0.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 29

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

662155 662254 662205 662304 661405 661454 661504 662601 662650 669200 668350 668400 668509 668608 668657 668905 669606 669655 661850 661801 661959 661900 661975 662742 662767 662783 662775 662007 662056 662064 662080 662072 662106 668707 662429 662403 667733 662437 662445 668301 662452 662502 661108 662551 660001 662635 661058 662577 662585 662668 662536 667824 668806

IR ANGIO CAROTD CERE BIL IR ANGIO CAROTD CERE UNI IR ANGIO CAROTD CERV BIL IR ANGIO CAROTD CERV UNI IR ANGIO CAROTD XTL BIL IR ANGIO CAROTD XTL UNI IR ANGIO CERVICOCEREBRAL IR ANGIO EXT BIL IR ANGIO EXT UNI IR ANGIO FU EXISTING CATH IR ANGIO PELV SELECT IR ANGIO PULM NONSELECT IR ANGIO PULM UNI SELECT IR ANGIO RENL BIL IR ANGIO RENL UNI IR ANGIO SPINAL SELECT IR ANGIO VERTEBRAL IR ANGIO VISC IR AORTOGRAM ABD BIL EXT IR AORTOGRAM ABD W SER IR AORTOGRAM THOR W SER IR AORTOGRAM THOR W/O SER IR ARTHRO SI JNT IR ATHERECTOMY PERIPH ADD IR ATHERECTOMY RENL IR ATHERECTOMY VISC ADD IR ATHERECTOMY VISC INI IR BILI DRN INT XTL IR BILI DRN PRC IR BILI DUCT DILATE PRC IR BRONCHOGRAM BIL IR BRONCHOGRAM UNI IR BX TRANSCATHETER IR CATH RENL PELV PRC IR CHOL EXISTING CATH IR CHOL TRANSHEPAT PRC IR CINE/VIDEO COMPLEMENT IR CISTERNOGRAM IR CORPORA CAVERNOSOGRAM IR DILATE NEPHROSTOMY IR DISKOGRAM CERV THOR IR DISKOGRAM LUMB IR DRN W CATH PLACE PRC IR EMBOL TX IR EMERGENCY CALL BACK IR ENDO BILI DUCT IR ENDOVAS REPR ABD AO IR EPIDUROGRAM IR FALLOPN TUBE TRANSCERV IR FLUORO 1HR OR LES IR FLUORO NDL PLACE IR G TUBE PRC IR GALACTOGRAM 1 DUCT

5874.00 4418.00 4418.00 3689.00 4418.00 3689.00 5145.00 7328.00 2345.00 1569.00 4418.00 3689.00 3689.00 5145.00 2345.00 4418.00 5145.00 5145.00 2545.00 3689.00 2294.00 4418.00 284.00 1136.00 2133.00 1136.00 2133.00 3874.00 3874.00 827.00 300.00 197.00 5452.00 2176.00 107.00 1582.00 107.00 184.00 153.00 4908.00 4096.00 1144.00 1933.00 7194.00 0.00 428.00 841.00 294.00 428.00 1213.00 172.00 428.00 354.00

0.00 0.00 0.00 0.00 3877.00 0.00 0.00 0.00 0.00 0.00 3877.00 0.00 0.00 0.00 0.00 3877.00 0.00 0.00 0.00 0.00 0.00 3877.00 0.00 0.00 0.00 0.00 0.00 3400.00 0.00 0.00 0.00 0.00 1777.00 0.00 0.00 801.00 0.00 0.00 0.00 0.00 752.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 30

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

662684 665646 669259 667931 667923 668269 668152 668251 660050 660852 661066 669051 668376 661553 661603 661652 661751 661702 662700 661272 661280 668855 668939 668954 660902 669168 669002 669150 667550 669101 666115 674432 668756 669275 669283 669374 669408 669457 669382 669390 669309 669465 669507 669556 669481 669473 669358 660829 661132 663062 663104 663153 663187

IR HYSTEROSALPINGOGRAM IR INJECTION IM/SQ EA IR IVC FILTER PLACE IR IVUS NONCO ADD IR IVUS NONCO INI IR LYMPHANGIO ABD UNI IR LYMPHANGIO EXT BIL IR LYMPHANGIO PELV BIL IR N/C PROCEDURE IR PLACE OCC DEV VEIN ART IR PLACE PROS REPR AAA IR PORTOGRAM W HEM EVAL IR PORTOGRAM W/O HEM EVAL IR PTA PERIPH ART IR PTA PERIPH ART ADD IR PTA RENL VISC IR PTA VEN IR PTA VISC ADD IR RETRIEVAL VASCULAR FB IR SEDATION IV/IM/INH IR SEDATION PO/PR/INASAL IR SHUNTOGRAM NONVASC IR SIALOGRAM IR SPLENOPORTOGRAM IR STENT NOCORO/CAR/VERT IR STENT NOCORO/CAR/VERT IR SUBTRACTION SERIES IR TRANSCATHETER TX IV IR TUBE CATH CHNG IR URETERAL STENT PRC IR URETHROCYSTOGRAM VOID IR US VASC ACCESS ADD ON IR VEN SAMPLING IR VENOGRAM ADRENAL BIL IR VENOGRAM ADRENAL UNI IR VENOGRAM EPID IR VENOGRAM EXT BIL IR VENOGRAM EXT UNI IR VENOGRAM HEP W EVAL IR VENOGRAM HEP W/O EVAL IR VENOGRAM IVC IR VENOGRAM ORBITAL IR VENOGRAM RENL BIL IR VENOGRAM RENL UNI IR VENOGRAM SAG SINUS IR VENOGRAM SIN JUGULAR IR VENOGRAM SVC IRC ABLTN RENAL RF PRC IRC ABSCSS CYST LIVER PRC IRC ABSCSS DRN PELV PRC IRC ABSCSS DRN PERITNL IRC ABSCSS DRN RENL IRC ABSCSS DRN RETROPE

177.00 58.23 6601.00 311.00 618.00 827.00 3022.00 3322.00 0.00 429.00 307.00 1596.00 1705.00 7162.00 2944.00 5703.00 2773.00 2944.00 4779.00 594.00 395.00 493.00 243.00 6081.00 13723.00 4779.00 361.00 8094.00 2178.00 2973.00 215.00 190.50 1610.00 1705.00 1705.00 1705.00 2440.00 2078.00 1705.00 1705.00 3689.00 129.00 4418.00 2621.00 1705.00 1705.00 3689.00 4475.00 1907.00 593.00 6453.00 4571.00 645.00

0.00 0.00 0.00 0.00 0.00 0.00 988.00 1090.00 0.00 347.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4192.00 0.00 0.00 432.00 0.00 1982.00 0.00 4192.00 0.00 3386.00 1912.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2142.00 0.00 0.00 0.00 0.00 0.00 0.00 2301.00 0.00 0.00 0.00 0.00 882.00 0.00 2102.00 0.00 0.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 31

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

663203 666180 664235 664227 663682 663708 663757 663807 663906 664003 663856 664441 664052 664029 662528 664086 664102 662627 664151 664201 664250 664276 664292 664409 664458 664508 664557 667709 667642 664607 664656 664755 664706 666172 666610 666693 666685 663666 663021 665166 664805 667873 664961 669853 669879 665059 664573 664219 665372 665208 665257 665307 665638

IRC ABSCSS DRN SUBDIAP IRC ASP BLADDER SP CATH IRC ASP BREAST ADD IRC ASP BREAST CYST IRC ASP SPINAL CYST PRC IRC AVS DIAL SHUNT IRC BILI CATH CHNG IRC BILI ENDO W/O STENT IRC BILI STENT PLACE IRC BILI STONE EXTRACT IRC BILI STONE RMVL IRC BRONCH W BX IRC BX ABD RETROPE IRC BX BM NDL/TROCAR IRC BX BONE SUPER IRC BX LIVER IRC BX LIVER W MAJOR IRC BX MUSCLE IRC BX NASOPHARNYX IRC BX PANCREAS IRC BX PLEURA IRC BX PROSTATE IRC BX SALIVARY GLAND NDL IRC BX THYROID IRC CATH ABD LOW 1ST IRC CATH ABD LOW 2ND IRC CATH ABD LOW 3RD IRC CATH ABD LOW ADD IRC CATH PORTAL VEIN PRC IRC CATH THOR 1ST ART IRC CATH THOR 2ND ART IRC CATH THOR 3RD ART IRC CATH THOR ADD ART IRC CHNG GT TUBE IRC CHNG GT TUBE IRC CYSTO TUBE CHNG CMPLX IRC CYSTO TUBE CHNG SMPL IRC DECLOT XTL CAN W BLN IRC DRN ABSCESS COMP/MULT IRC DRN APPNCL ABSCSS OPN IRC EMBOL OCC NONHEAD NEC IRC ENDO SB W JEJ TUB PRC IRC ENDO UPPER GI TUBE IRC ERCP RMVL CALC IRC ERCP W/BIOPSY IRC ESOPH DILATE RETRO IRC EXCHANGE DRN CATH IRC FNA W IMAG GUIDANCE IRC INJ C1 C2 MYELOGRAM IRC INJ CELIAC PLEX BLK IRC INJ CHOL TRANSHEPAT IRC INJ CHOL VIA CATH IRC INJ CON ABSCSS

3389.00 1219.00 160.00 378.00 1787.91 902.00 430.00 1997.00 5204.00 1733.00 2184.00 1217.00 661.00 660.00 783.00 675.00 1216.00 545.00 854.00 2505.00 654.00 774.00 333.00 388.00 1191.00 1490.00 1771.00 284.00 1907.00 509.00 1490.00 1771.00 339.00 362.00 362.00 645.00 440.00 5363.00 256.00 1993.00 4363.00 726.33 801.00 1608.00 1141.00 2531.00 280.00 506.00 466.00 0.00 1410.00 1301.00 157.00

2974.00 0.00 0.00 0.00 0.00 792.00 0.00 1753.00 1696.00 0.00 1915.00 0.00 0.00 0.00 0.00 0.00 1067.00 0.00 750.00 1237.00 573.00 0.00 0.00 366.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5793.00 0.00 0.00 0.00 0.00 825.00 0.00 0.00 0.00 0.00 460.00 424.00 0.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 32

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

666107 665331 665356 665406 665448 665455 669846 665976 664474 665505 665653 665703 665752 665737 665851 665877 665885 665901 665950 665604 665968 665430 665687 665661 665679 666057 666099 664243 666198 667782 667790 666362 666370 666388 666396 667808 667667 667675 667816 666263 666255 666859 666206 666453 666297 666305 666354 666404 666750 666651 666602 666701 666909

IRC INJ CYSTO RETRO IRC INJ DACROCYSTOGRAM IRC INJ DISKOGRAM CERV IRC INJ DISKOGRAM LUMB IRC INJ EPID CERV THOR IRC INJ EPID L/S IRC INJ ERCP IRC INJ EXT VENOGRAM IRC INJ FACET C/T 1 LVL IRC INJ FACET L/S 1 LVL IRC INJ ILEAL CONDUIT IRC INJ LP IRC INJ LYMPHANGIO IRC INJ MYELOGRAM IRC INJ NEPHROGRAM IRC INJ NRV BLK C/T 1 LVL IRC INJ NRV BLK C/T ADD IRC INJ NRV BLK L/S 1 LVL IRC INJ NRV BLK L/S ADD IRC INJ NRV BLK LUMB THOR IRC INJ PANCREAT INTRAOP IRC INJ SPINE W CATH L/S IRC INJ TND SHEATH/LG IRC INJ TRG PT 1 OR 2 MCL IRC INJ TRIG PT GT 2 MCL IRC INJ URETERO PYELOGRAM IRC INJ URETHROCYST CHAIN IRC INJ/ASP GANGLION CYST IRC INS INTRA ART PUMP IRC INS NON-TUN CV CATH<5 IRC INS NON-TUN CV CATH5+ IRC INS PICC W/O PORT 5+ IRC INS PICC W/O PORT LT5 IRC INS PICC W/PORT 5+YRS IRC INS PICC W/PORT LT 5 IRC INS TUN CV NO PRT LT5 IRC INS TUNN CV DEV 5+ IRC INS TUNN CV DEV LT 5 IRC INS TUNN CV NO PORT5+ IRC INTRO AORTA IRC INTRO BRACH ART IRC INTRO CAROTD VERT ART IRC INTRO CATH AORTA IRC INTRO CATH BILI DRN IRC INTRO CATH FALLOPN IRC INTRO CATH IVC /SVC IRC INTRO CATH PULM IRC INTRO CATH RENL PELV IRC INTRO EXT ART IRC INTRO G TUBE IRC INTRO G TUBE LONG IRC INTRO IVC FILTER IRC INTRO NEPHROSTOMY

476.00 2229.00 2773.00 681.00 883.00 765.00 1085.00 1215.00 765.00 722.00 476.00 781.00 575.00 841.00 551.00 765.00 1005.00 765.00 1005.00 0.00 342.00 876.00 194.00 185.00 211.00 355.00 1491.00 188.00 2013.00 3512.00 3512.00 1207.00 1329.00 5363.00 5968.00 3512.00 4602.00 4644.00 3512.00 45.00 1151.00 82.00 1187.00 1855.00 947.00 428.00 788.00 1108.00 693.00 6512.00 354.00 4737.00 1661.00

0.00 0.00 2434.00 0.00 0.00 671.00 0.00 0.00 0.00 671.00 419.00 685.00 0.00 0.00 180.00 0.00 0.00 671.00 881.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1008.00 72.00 0.00 0.00 0.00 404.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 33

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

666958 666156 667006 667055 665109 667378 667360 663534 663518 663575 667105 667113 664953 664763 667840 664854 664987 664979 667832 663252 663302 663351 665984 663450 663500 663559 663609 667477 667485 664797 667568 667519 667154 667204 668723 669598 669580 668517 663542 662726 662734 667691 667683 667717 666164 667303 667352 667402 667451 663773 669564 667469 665158

IRC INTRO STENT CATH URET IRC IVCH RETRIEVE FB IRC NEPHROSTOMY MANOMETRY IRC NEPHROSTOMY TUBE CHNG IRC NONTHROMBOLYSIS IV IRC OPN INTRVAS STENT ADD IRC OPN INTRVS STENT INIT IRC OPN TRANS ANGIO ILIAC IRC OPN TRANS ANGIO RENAL IRC OPN TRANS ANGIO TIBIO IRC PARACENT ABD INI IRC PARACENT ABD SUBSQ IRC PERM EMBOL OCC CNS IRC PNMNSTOMY W DRN OPN IRC PNMNSTOMY W DRN PRC IRC PRM EMBL OCC HEAD NEC IRC PROCTOSIGMOID W/DIL IRC PROCTOSIGMOIDOSCPY DX IRC PSEUDOANEURYSM INJ IRC PTA AORTIC IRC PTA BRACHIOCEPH EA IRC PTA FEMPOP IRC PTA FEMPOP OPN IRC PTA IL IRC PTA RENL VISC IRC PTA TIBEOPERONEAL EA IRC PTA VEN IRC PTATHER AORTIC IRC PTATHER FEMPOP IRC PTATHER IL IRC PTATHER RENL IRC PTATHER TIBIA IRC PULM ART L/R IRC PULM ART SEG SUB IRC REM TUNN CVA DEV W PT IRC REMOVE PERM CAN/CATH IRC REMV TUNN CV CATH W/O IRC RMVL INTHCL/EPID CATH IRC RMVL INTRA ART PUMP IRC RMVL KDY STN PRC GT 2 IRC RMVL KDY STN PRC/LES2 IRC RPLC COMP NON-TUNN CV IRC RPLC COMP TUN CV CATH IRC RPLC COMP TUN CV W/PT IRC RVSN INTRA ART PUMP IRC SELECT CATH 1ST VEN IRC SELECT CATH 2ND VEN IRC STENT NOCORO/CAR/VERT IRC STENT PLACE NONCO ADD IRC TEMP BAL ARTERIAL OCC IRC THORACENTESIS IRC THROMBOLYSIS CEREB IV IRC THROMBOLYSIS IV NONCO

1315.00 1572.00 1052.00 317.00 1778.00 752.00 1560.00 1209.00 1863.00 1674.00 725.00 507.00 6299.00 3226.00 695.00 6299.00 2540.00 245.00 638.00 2156.00 2672.00 2057.00 1449.00 1690.00 4375.00 3819.00 1155.00 2914.00 2972.00 2914.00 2914.00 2914.00 946.00 1105.00 1148.61 1103.88 597.00 1159.00 917.00 4252.00 2980.00 1061.00 739.00 3718.62 1222.00 1278.00 1105.00 5736.00 2866.00 1867.00 610.00 1685.00 2267.00

0.00 0.00 342.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 684.00 0.00 0.00 0.00 0.00 5531.00 0.00 0.00 0.00 1892.00 0.00 0.00 0.00 0.00 3841.00 3353.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1120.00 0.00 0.00 0.00 0.00 0.00 1480.00 0.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 34

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

665000 663005 667600 667501 667634 666149 666131 666123 654905 654913 652107 650515 652727 652719 652735 652800 652750 652701 652859 652909 652958 653055 653006 652255 650572 640748 652503 652453 652651 652602 654962 654988 653105 653204 653303 654947 653501 653451 653600 653709 653659 653758 653907 653857 653808 652776 652404 652552 655506 653352 653402 652693 675702

IRC TUBE PLACE JEJUNUM IRC TUBE THORACOSTOMY IRC URETERAL TUBE CHNG IRC VEN ANAST PORT OPN IRC VEN CATH BLOOD SAMPLE IRC VERTEPLASTY ADD PRC IRC VERTEPLASTY LUMB PRC IRC VERTEPLASTY THOR PRC MR 3D RECONSTRUCTION MR 3D RECONSTRUCTION MR ABD W/O CON MR BONE MARROW MR BRAIN OPN W CON MR BRAIN OPN W/O CON MR BRAIN OPN W-W/O CON MR BRAIN W STEM W CON MR BRAIN W STEM W/O CON MR BRAIN W STEM W-W/O CON MR CARDIAC FNCTN CMPL MR CARDIAC FNCTN LTD MR CARDIAC VELOCITY FLOW MR CARDIAC W CON MR CARDIAC W/O CON MR CHEST W/O CON MR CHEST W/O CON MR DENTAL PARTIAL EXAM MR EXT LOW JT W/O CON MR EXT LOW W-W/O CON MR EXT UPP JNT W/O CON MR EXT UPP NO JNT W-W/O MR GUIDE NDL PLACE MR GUIDE VISCL TISS ABLTN MR ORBIT FACE NEC W/O MR ORBIT FACE NEC W/O MR PELV W CON MR SPECTROSCOPY MR SPINE CERV W CON MR SPINE CERV W/O CON MR SPINE CERV W-W/O CON MR SPINE LUMB W CON MR SPINE LUMB W/O CON MR SPINE LUMB W-W/O MR SPINE THOR W CON MR SPINE THOR W/O CON MR SPINE THOR W-W/O MR VENOGRAM BRAIN MRA CHEST W-W/O CON MRA EXT LOW W-W/O CON MRA HEAD W-W/O CON MRA PELV W-W/O CON MRA SPNAL CANAL W-W/O CON MRC BX STEREO ASPIR HEAD NI AORTA IVC IL CMPL

1457.00 1349.00 303.00 5780.00 589.00 2594.00 3603.00 3603.00 1265.00 1265.00 2031.00 2651.00 555.00 502.00 557.00 3231.00 2633.00 3506.00 4260.00 4260.00 0.00 4260.00 3893.00 2331.00 2380.00 1451.00 3717.00 3717.00 3717.00 3644.00 1514.00 1860.00 2380.00 2331.00 1991.00 2070.00 3717.00 2380.00 3893.00 3644.00 2331.00 3893.00 3644.00 2331.00 3893.00 557.00 2331.00 3644.00 2589.00 2331.00 2589.00 4044.00 1457.00

1280.00 1184.00 268.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2781.00 0.00 0.00 3740.00 3740.00 0.00 3740.00 0.00 2048.00 0.00 0.00 0.00 0.00 0.00 3198.00 0.00 0.00 0.00 2048.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2048.00 3198.00 0.00 2048.00 2272.00 0.00 0.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 35

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

675215 675355 676379 675942 675108 675157 675462 675470 675256 675801 675306 676403 676387 676452 675850 675868 675413 675603 676254 670505 675504 675553 675017 675058 675009 631002 637918 631101 631150 631200 632828 631309 632505 636985 631606 631655 631705 631754 631457 631507 631556 631408 631804 631903 631952 630053 631853 634550 632059 632109 632158 632208 632406

NI AORTA IVC IL LTD NI DIAL ACCES NI DPPLER EXT VEINS BIL NI DPPLER EXTRACRAN BIL NI DUPLEX ABD PELV CMPL NI DUPLEX ABD PELV LTD NI DUPLEX EXT LOW BIL NI DUPLEX EXT LOW UNI NI DUPLEX EXT UPP BIL NI DUPLEX EXT UPP BIL NI DUPLEX EXT UPP UNI NI DUPLEX EXT VEINS BIL NI DUPLEX EXT VEINS UNI NI DUPLEX EXT VEINS UNI NI DUPLEX EXTRACRAN BIL NI DUPLEX EXTRACRAN UNI NI EXT ART 1 LVL BIL NI EXT ART MULTI BIL NI INTRACRAN CMPL NI INTRACRAN LTD NI PENILE VESSELS CMPL NI PENILE VESSELS LTD NINV BEDSIDE NINV EMERGENCY CALL BACK NINV SERVICE AFTER HOURS NM ABSCSS LOC LTD NM ABSCSS LOC LTD NM ABSCSS LOC WB NM ADD V X 1 NM ADD V X 2 NM ADDL IMAGING/FUSION NM ADRENAL NM AUTO DATA GEN GT 30 NM BMA BODY FAT ANALYSIS NM BMA HIP NM BMA SPINE AP NM BMA SPINE LATERAL NM BMA WB NM BONE MARROW LTD NM BONE MARROW MULTI NM BONE MARROW WB NM BONE SCAN LTD NM BONE SCAN MULTI AREAS NM BONE SCAN W SPECT NM BONE SCAN WB NM BONE SCAN WB NM BONE THREE PHASE NM BOWEL (MECKELS) NM BRAIN CISTERNOGRAM NM BRAIN CMPL STATIC NM BRAIN CMPL W FLOW NM BRAIN CMPL W SPECT NM BRAIN CSF SHUNT EVAL

1474.00 1278.00 738.00 339.00 1090.00 869.00 1596.00 1596.00 1596.00 592.00 1596.00 1596.00 0.00 1596.00 1596.00 1117.00 603.00 1596.00 1806.00 1772.00 1457.00 1628.00 0.00 0.00 0.00 611.00 1037.00 2147.00 0.00 0.00 247.00 2371.00 0.00 0.00 0.00 0.00 0.00 0.00 1005.00 1367.00 1731.00 1122.00 1223.00 691.00 1494.00 1494.00 1436.00 1346.00 475.00 1367.00 1457.00 691.00 1278.00

0.00 0.00 163.00 0.00 0.00 0.00 707.00 584.00 707.00 0.00 584.00 682.00 0.00 584.00 682.00 654.00 0.00 960.00 0.00 745.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1348.00 0.00 0.00 0.00 2080.00 0.00 0.00 0.00 0.00 0.00 0.00 881.00 1200.00 1521.00 699.00 743.00 517.00 894.00 894.00 827.00 0.00 0.00 0.00 0.00 0.00 0.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 36

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

632257 632307 632356 633701 637140 632554 636746 636761 632075 632455 632653 632752 632869 632950 633008 633107 633206 633149 633156 633552 633602 633651 633354 638379 636878 636860 636852 633057 633750 633800 631051 634006 634253 634303 634055 634154 634204 634105 634352 634493 634402 634436 634451 634501 635615 637173 634600 634659 634782 634709 634758 634857 635185

NM BRAIN FLOW ONLY NM BRAIN LTD NM BRAIN LTD W FLOW NM CARDIAC SHUNT EVAL NM CARDIAC STRESS NM COMP AUTO DATA SMPL NM CONSULT 1-131 THERAPY NM CONSULT MOAB TX NM CSF FLOW W SPECT NM CSF LEAKAGE DETECT NM CYSTOGRAM VOIDING NM ESOPH MOTILITY NM GASTRIC EMPTYING NM GASTROESOPH REFLUX NM GI BLEEDING SCAN NM HEART 1S PASS SNGL NM HEART GATED MULTIVIEW NM HEART GATED SNGL NM HEART GATED SNGL NM HEART MI PLANAR NM HEART MI W EF NM HEART MI W SPECT NM HEART MP MULTI PLANAR NM HEART MP MULTI W SPECT NM HEART MP SNGL PLANAR NM HEART MP SNGL W SPEC NM HEART MP SNGL W SPEC NM HEART MP W EF NM HEART MP WALL MOTION NM HEPATOBILIARY DUCTAL NM INFLAM LOCAL W SPECT NM LIVER FNCTN STDY NM LIVER SPLEEN STATIC NM LIVER SPLEEN W FLOW NM LIVER STATIC NM LIVER W SPECT NM LIVER W SPECT NM LIVER W VASCULAR FLOW NM LUNG PERF NM LUNG QUAN DIFF FNCTN NM LUNG VENT W GAS NM LUNG VENT W GAS MULTI NM LUNG VENTI1V NM LYMPHATIC PATHWAY NM MONOCLONAL AB IV INFSN NM NM MOBILE NM PARATHYROID NM PLASMA VOLUME MULTI NM PLATELET SURVIVAL STDY NM RED CELL MASS MULTI NM RED CELL SURVIVAL NM RENL FNCTN NONIMAG NM RENL FNCTN W-W/O DRG M

730.00 1278.00 1278.00 1135.00 0.00 0.00 0.00 0.00 778.00 2098.00 984.00 861.00 1165.00 854.00 1373.00 1457.00 2900.00 748.00 2262.00 1210.00 1731.00 691.00 2138.00 3075.00 1136.00 0.00 2960.00 616.00 1120.00 1397.00 2006.00 1731.00 1367.00 1373.00 1112.00 2006.00 2282.00 1278.00 1253.00 931.00 733.00 976.00 1094.00 1731.00 1153.00 0.00 931.00 1373.00 540.00 1202.00 1278.00 931.00 784.00

0.00 0.00 0.00 995.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1296.00 1042.00 0.00 490.00 1877.00 0.00 996.00 0.00 2597.00 0.00 674.00 801.00 0.00 1521.00 1200.00 810.00 976.00 1762.00 1607.00 1120.00 729.00 0.00 0.00 617.00 0.00 1521.00 0.00 0.00 817.00 0.00 0.00 0.00 1120.00 0.00 0.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 37

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

634907 635052 635151 635201 634816 635219 636621 636670 636654 636613 632901 635250 631267 635409 635458 635706 636001 635953 635979 636050 635839 636100 636159 636209 636258 636308 636407 636456 636514 636480 635607 635755 635656 635805 635854 635508 635557 635904 634675 632802 631119 631135 636555 636605 634378 635300 633958 634774 636464 633842 633834 633891 633875

NM RENL STATIC ONLY NM RENL W FLOW NM RENL W SPECT NM RENOGRAM NO FLOW NM RENOGRAM SNGL W DRG NM RENOGRAM SNGL W/O DRG NM RESEARCH IN111-IDEC NM RESEARCH LEUTECH NM RESEARCH LUNAR FACET NM RESEARCH PROSTATE/PERI NM SALIVARY ASP NM SALIVARY GLND W SER NM SEDATION MONITORING NM SPLEEN NM TESTICULAR W FLOW NM THERAPY CATH/LOCAL NM THYROID IMAG ONLY NM THYROID IMAG UPT MULTI NM THYROID IMAG UPT SNGL NM THYROID IMAG W FLOW NM THYROID METS LTD NM THYROID METS WB NM THYROID SUPP STIM NM THYROID UPTAKE MULTI NM THYROID UPTAKE SNGL NM TUMOR LOC LTD W RP NM TUMOR LOC MULTI W RP NM TUMOR LOC SPECT W RP NM TUMOR LOC WB SNGL DAY NM TUMOR LOC WB SNGL DAY NM TX INTRACAVITY NM TX RADIOPHARM IV ADM NM TX RADIOPHARM IV ADM NM TX RADIOPHARM ORAL ADM NM TX RADIOPHARM ORAL ADM NM TX RADIOPHARM ORAL ADM NM TX RADIOPHARM ORAL ADM NM TX RADIOPHARM ORAL ADM NM UREA TEST C14 ANALYSIS NM VASCULAR FLOW NCARDIO NM VEN THROMBOSIS ACUTE NM VEN THROMBOSIS STDY NM VENOGRAM BIL NM VENOGRAM UNI NM VENT/PER REBRTH/WASHOU NM VIT B12 COMBINED NM VP SHUNT PATENCY NM WB VOL DETERMINATION NM WHOLE BODY 2+ DAYS NMC INJ ASP SHUNT NMC INJ VP SHUNT NMC INSERT CATH TMP SMPL NMC NODE IDENTIFICATION

1005.00 1457.00 2188.00 825.00 1154.00 1527.00 0.00 0.00 0.00 0.00 0.00 1367.00 0.00 1112.00 1071.00 0.00 931.00 1036.00 902.00 1112.00 339.00 1391.00 729.00 729.00 379.00 1031.00 1049.00 626.00 1715.00 3601.00 912.00 2400.00 912.00 912.00 912.00 507.00 765.00 912.00 84.00 343.00 873.00 540.00 1731.00 778.00 763.00 1112.00 1278.00 624.00 3975.00 253.00 177.00 100.00 122.00

0.00 0.00 0.00 0.00 924.00 893.00 0.00 0.00 0.00 0.00 0.00 1200.00 0.00 976.00 691.00 0.00 817.00 584.00 567.00 976.00 0.00 0.00 639.00 0.00 0.00 478.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 229.00 0.00 0.00 1521.00 491.00 0.00 976.00 1120.00 0.00 0.00 0.00 0.00 0.00 0.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 38

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

681056 681155 684050 684100 684159 683714 682179 682161 684662 684829 684845 684860 684886 684902 699520 699512 699504 699462 699454 699165 699140 699124 699629 699801 699926 699918 699900 699421 699405 699850 699470 699579 699561 699553 699835 699645 699272 699256 699264 699280 699322 699306 699314 699330 699223 699207 699215 699231 699355 699108 699603 699660 699744

PS BRAIN METBLC EVAL PS BRAIN PERF EVAL PS HEART METBLC EVAL PS HEART PERF MULTI PS HEART PERF SNGL PS TUMOR FULL BODY PS TUMOR FULL BODY PS TUMOR FULL BODY PS TUMOR FULL BODY PS TUMOR LIMITED AREA PS TUMOR SKULL TO THIGH PS TUMOR W/CT LTD PS TUMOR W/CT SKULL THIGH PS TUMOR W/CT WHOLE BODY RO APLY INTRACV RAD CMPLX RO APLY INTRACV RAD INTRM RO APLY INTRACV RAD SMPL RO APLY INTRSTL RAD INTRM RO APLY INTRSTL RAD SMPL RO BRACHY DOSE PLAN CMPLX RO BRACHY DOSE PLAN INTRM RO BRACHY DOSE PLAN SMPL RO CONSULT CONT MED PHYSC RO DOSIMETRY SPECIAL RO DVCS CONSTRUCT CMPLX 4 RO DVCS CONSTRUCT INTRM RO DVCS CONSTRUCT SMPL RO IMRT DLVR EA SESSION RO INFUSE RADIOELMNT SOLN RO INTRSTIT RADIAT CMPLX RO INTRSTIT RADIAT CMPLX RO ISODOSE PLAN CMPLX RO ISODOSE PLAN INTRM RO ISODOSE PLAN SMPL RO LOADING RAD SOURCE RO RAD PORT FILM(S) RO RAD TX 2 AREA 11-19MEV RO RAD TX 2 AREA 1-5MEV RO RAD TX 2 AREA 6-10MEV RO RAD TX 2 AREA GT 19MEV RO RAD TX 3/MORE 11-19MEV RO RAD TX 3/MORE 1-5MEV RO RAD TX 3/MORE 6-10MEV RO RAD TX 3/MORE GT 19MEV RO RAD TX SNGL 11-19MEV RO RAD TX SNGL 1-5MEV RO RAD TX SNGL 6-10MEV RO RAD TX SNGL GT 19MEV RO RAD TX SUPERFICIAL RO RADIAT DOSIMETRY CALC RO RADIATION PHYSICS CNSL RO SIMULATION 3D RO SIMULATION CMPLX

1150.00 1150.00 1150.00 1150.00 1150.00 1150.00 1150.00 1150.00 1150.00 1150.00 1150.00 1150.00 1150.00 1150.00 926.00 745.00 519.00 873.00 451.00 1021.00 717.00 489.00 615.00 105.00 670.00 392.00 278.00 1430.78 275.00 1057.00 1057.00 549.00 482.00 383.00 105.00 124.00 433.00 433.00 433.00 433.00 482.00 482.00 482.00 482.00 366.00 366.00 366.00 366.00 366.00 278.00 615.00 5758.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 39

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

699728 699702 699819 699827 633859 649145 649152 649160 672253 674713 673004 673152 674606 674150 673558 672766 673608 670901 673657 673707 673756 673806 672931 672303 674127 674184 674044 674069 672154 674143 673954 674002 674200 674259 674192 670851 667857 674903 674309 672733 674564 674572 674630 674721 674580 674598 674663 674697 674747 674507 674523 674556 670703

RO SIMULATION INTRM RO SIMULATION SMPL RO SPECIAL PORT PLAN BODY RO SPECIAL TX PROCEDURE RP SUPPLY DX S STRL ICC COMPLAINT NU S STRL ICC COMPLAINT PH S STRL ICC COMPLAINT RA US ABD CMPL US AMNIOCENTESIS US AMNIOCENTESIS US ASP OVA US BIO PROFILE W NONSTRES US BIO PROFILE WO NOSTRES US BREAST UNI OR BIL US BX ENDOMYOCARDIAL US CHEST US CONSULT FOREIGN FLM US CONSULTATION PHYSICIST US CRYOSURGERY US DPPLER ECHO FETAL US DPPLER ECHO FETAL FU US DRN W CATH PLACE PRC US ECHO ABD LTD US ECHO FETAL US ECHO FETAL FU REPEAT US ECHO INF HIPS US ECHO INF HIPS LTD US ECHO RETROPE LTD US ENCEPHALOGRAM US EXT NONVASCULAR US EXT NONVASCULAR US FETAL TRANSFUSION IUT US FU STDY US GUIDE ART PSEUDOANEUR US GUIDE VISCRL TISS ABLN US GUIDE VISCRL TISS ABLN US HEAD & NEC SFT TISSUE US IN OR US NDL PLACE US OB 1ST TRI 1 GEST US OB 1ST TRI EA GEST US OB AFTR 1ST TRI 1 GEST US OB AFTR 1ST TRI EA GES US OB DTLD FTL EXAM 1 GES US OB DTLD FTL EXM EA GES US OB FU/REEVAL EA FETUS US OB LTD 1/MORE FETUSES US OB TRANSVAGINAL US PELV CMPL NONOB US PELV LTD FU NONOB US PERICARDIOCENT US RADIATION FIELD PLACE

0.00 717.00 834.00 772.00 0.00 0.00 0.00 0.00 1293.00 607.00 616.00 1047.00 548.00 214.00 618.00 1047.00 870.00 0.00 0.00 0.00 870.00 870.00 889.00 679.00 890.00 870.00 201.00 187.00 866.00 933.00 1484.00 616.00 201.00 220.00 830.00 221.00 221.00 906.00 510.00 502.00 143.00 100.00 731.00 878.00 483.00 165.00 501.00 1057.00 198.00 1049.00 279.00 870.00 889.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 493.00 551.00 541.00 295.00 0.00 0.00 584.00 371.00 0.00 0.00 0.00 0.00 404.00 127.00 0.00 611.00 763.00 0.00 0.00 0.00 761.00 0.00 0.00 541.00 0.00 193.00 0.00 0.00 0.00 514.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 473.00 411.00 0.00 404.00 0.00 136.00 299.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 40

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

672857 676155 672808 670000 674820 674846 670752 673905 674218 670836 670844 670828 672501 673376 673335 672949 673384 673350 672956 672063 673228 672493 673251 670406 672758 672592 670034 672600 670026 670067 622530 672584 672535 670075 670083 672550 672790 672972 673368 673301 673343 673921 674036 672485 679001 670323 672576 676007 671107 674325 674317 674788 674796

US RENL TRANSPLANT US RENL TRANSPLANT US RETROPE CMPL US SERVICE AFTER HOURS US SPINAL CANAL US TESTICULAR SCROTUM US TRANSRECTAL US TRANSVAGINAL US VILLUS SAMPLING USC ABLTN CRYO OPN LIVER USC ABLTN PROSTATE CRYO USC ABLTN RENAL RF PRC USC ABSCSS CYST LIVER PRC USC ABSCSS DRN PELV PRC USC ABSCSS DRN PERITNL USC ABSCSS DRN RENL USC ABSCSS DRN RETROPE USC ABSCSS DRN SUBDIAP USC AMNIOCENTESIS DX USC ASP BREAST ADD USC ASP RENL CYST USC ASP SPINAL CYST PRC USC ASP THYROID CYST USC BREAST NDL WIRE ADD USC BX ABD RETROPE USC BX BM NDL/TROCAR USC BX BONE DEEP USC BX BONE SUPER USC BX BONE SUPER USC BX BREAST PRC W/O USC BX BREAST W IMAG USC BX LIVER USC BX MUSCLE USC BX PANCREAS USC BX PLEURA USC BX PROSTATE USC BX THYROID USC CORDOCENTESIS IUT USC DRN ABD ABSCSS OPN USC DRN ABSCESS COMP/MULT USC DRN PANC PSEUDOCYST USC ENDO SB W JEJ TUB PRC USC EXCHANGE DRN CATH USC FNA W IMAG GUIDANCE USC INJ CON ABSCSS USC INJ DUCT GALACTOGRAM USC INJ NEC BX USC INJ PENILE CAVERNOUS USC INJ SINOGRAM USC INS PICC W/O PORT 5+ USC INS PICC W/O PORT LT5 USC LAP ABLATION RF LIVER USC LAP ABLTN CRYO LIVER

1319.00 616.00 951.00 0.00 870.00 1049.00 1627.00 521.00 201.00 4297.00 3752.00 4475.00 8396.00 593.00 591.00 588.00 645.00 697.00 1017.00 160.00 338.00 1787.91 323.00 337.00 661.00 660.00 2545.00 783.00 934.00 649.00 1315.00 675.00 405.00 2513.00 1065.00 629.00 388.00 709.00 665.00 256.00 696.00 726.33 280.00 506.00 157.00 210.00 750.00 549.00 494.00 1207.00 1329.00 3652.00 3653.00

0.00 0.00 835.00 0.00 763.00 383.00 0.00 233.00 0.00 0.00 0.00 0.00 3142.00 0.00 0.00 0.00 0.00 0.00 325.00 0.00 0.00 0.00 0.00 123.00 0.00 0.00 936.00 0.00 350.00 233.00 0.00 0.00 356.00 936.00 398.00 551.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 167.00 0.00 481.00 0.00 0.00 0.00 0.00 0.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 41

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

674408 671628 671644 674945 676585 674879 674960 676353 672980 621698 621763 643007 621888 621912 622100 622126 622142 622167 622225 622258 622241 622274 622266 620807 625582 624387 622886 622084 671057 627604 623165 623223 623280 623355 623322 623413 623421 603522 623629 623660 623686 623702 623710 623769 629899 623868 627430 622951 636969 622944 627174 627521 627075

USC NEPHROSTOMY TUBE CHNG USC PARACENT ABD INI USC PARACENT ABD SUBSQ USC PLC NDL PROSTATE INST USC PSEUDOANEURYSM INJ USC THORACENTESIS USC URINE CAPACITY MEASUR USC VASOTOMY FOR VASOGRAM USC VILLUS SAMPLING XR ABD 1V AP XR ABD CMPL DECUB ERECT XR ABSCSS FIST SIN TRACT XR AC JNT XR ANKLE 2V XR ARTHRO ANKLE XR ARTHRO ELBOW XR ARTHRO HIP XR ARTHRO KNEE XR ARTHRO WRIST XR ATHERECTOMY PERIPH ADD XR ATHERECTOMY RENL XR ATHERECTOMY VISC INI XR ATHRECTOMY VISC ADD XR BE W AIR CON XR BILE STONE EXTRACTION XR BILI DUCT DILATE PRC XR BONE SURVEY CMPL XR BONE SURVEY LTD XR BREAST MAMMOGRAPHY LOC XR CALCANEOUS 2V OR MORE XR CEPHALOGRAM ORDO XR CHEST 1V XR CHEST 2V XR CHEST 2V XR CHEST 2V W FLUORO XR CHEST 4V CMPL XR CHEST 4V MORE W FLUORO XR CHOL IN OR XR CHOLECYSTOGRAM ORAL FU XR CINE/VIDEO XR CINE/VIDEO COMPLEMENT XR CISTERNOGRAM XR CISTERNOGRAM XR CLAVICLE CMPL XR CORPORA CAVERNOSOGRAM XR CYSTOGRAM 3V OR MORE XR DACRYOCYSTOGRAPHY XR DEXA APPEN XR DEXA AXIAL SKELETON XR DEXA AXIAL SKELETON XR DIAG MAMMO DIG W COMP XR DILATE NEPHROSTOMY XR DISKOGRAM CERV THOR

1436.00 725.00 507.00 2436.00 638.00 610.00 101.49 1257.00 528.00 551.00 1090.00 847.00 847.00 505.00 1072.00 1072.00 1530.00 1072.00 1072.00 1136.00 2133.00 2133.00 1136.00 2018.00 241.00 538.00 914.00 746.00 613.00 494.00 257.00 341.00 580.00 561.00 638.00 107.00 719.00 1612.00 364.00 314.00 319.00 1416.00 300.00 597.00 153.00 1097.00 129.00 104.00 1861.00 421.00 28.00 788.00 1134.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 1103.00 0.00 133.00 258.00 743.00 744.00 0.00 940.00 940.00 404.00 940.00 940.00 0.00 0.00 0.00 0.00 0.00 0.00 175.00 0.00 654.00 303.00 121.00 83.00 0.00 147.00 0.00 0.00 101.00 633.00 817.00 320.00 0.00 281.00 427.00 0.00 153.00 0.00 0.00 0.00 0.00 1632.00 397.00 0.00 0.00 0.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 42

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

627083 623983 622969 624049 624007 624288 624221 626135 624320 624304 624429 624106 626747 626762 624809 624825 624841 625137 625467 625483 624908 625004 625053 625251 625061 625079 625087 625095 625186 625194 622746 625335 625301 625400 625541 625517 625509 623827 625616 625608 625699 625707 625715 625673 625665 625814 625848 624403 626846 626804 626861 626937 626887

XR DISKOGRAM LUMB XR DUODENOGRAM HYPOTONIC XR DXA BONE DENS VRT FRAC XR ELBOW 2V XR ELBOW 3V OR MORE XR ENDO BILI DUCT XR ENTEROCLYSIS TUBE PRC XR EPIDUROGRAM XR ERCP BILI PANC DUCT XR ERCP PANC DUCT XR ESOPH XR EXAM OF MIDDLE EAR XR EXT INF LOW LES 1YR XR EXT INF UPP LES 1YR XR EYE FOR FB XR FACIAL BONE 3V OR MORE XR FACIAL BONE LES 3V XR FALLOPN TUBE TRANSCERV XR FB LOC CHLD XR FB RMVL ESOPH XR FEMUR 2V XR FINGER(S) 2V OR MORE XR FLUORO 1-2 HRS XR FLUORO 1HR OR LES XR FLUORO 2-3 HRS XR FLUORO 3-4 HRS XR FLUORO 4-5 HRS XR FLUORO 5-6 HRS XR FLUORO CVC PLC/RMV/RPR XR FLUORO GUIDE SPINE INJ XR FLUORO NDL PLACE XR FOOT 2V XR FOOT 3V OR MORE XR FOREARM 2V XR G TUBE PRC XR GALACTOGRAM 1 DUCT XR GALACTOGRAM MULTI XR GI TUBE INSERT LONG XR HAND 2V XR HAND 3V OR MORE XR HIP OR XR HIP UNI 1V XR HIP UNI 1V XR HIP UNI 2V OR MORE XR HIPS BIL 2V W PELV XR HUMERUS 2V OR MORE XR HYSTEROSALPINGOGRAM XR INTRALUMINAL DILATE XR IVP W DRIP + OR BOLUS XR IVP W-W/O TOMOGRAM XR IVP W-W/O TOMOGRAM XR KNEE 1 OR 2V XR KNEE 3V

1063.00 1436.00 537.00 528.00 721.00 1879.00 1690.00 294.00 2098.00 1890.00 917.00 101.00 560.00 475.00 993.00 951.00 835.00 428.00 376.00 866.00 709.00 434.00 616.00 704.00 616.00 616.00 616.00 616.00 180.00 177.00 172.00 474.00 622.00 545.00 6512.00 1365.00 1863.00 1726.00 436.00 696.00 545.00 534.00 545.00 798.00 980.00 599.00 1039.00 428.00 1704.00 1636.00 1855.00 500.00 763.00

0.00 480.00 537.00 133.00 177.00 695.00 1483.00 0.00 779.00 729.00 226.00 0.00 144.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 172.00 106.00 0.00 682.00 0.00 0.00 0.00 0.00 0.00 0.00 163.00 118.00 160.00 134.00 2121.00 446.00 597.00 1513.00 111.00 137.00 134.00 131.00 134.00 294.00 301.00 144.00 0.00 407.00 0.00 404.00 476.00 124.00 186.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 43

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

626903 626960 627000 627109 627117 627158 627141 626879 627208 627224 627240 627265 627307 627349 627380 627364 627323 627406 627448 620054 627547 627562 627588 627620 627752 627703 625749 627794 627687 627695 627844 627869 621821 627901 627984 627950 627943 628123 628180 628206 627125 627182 628164 628289 628958 628263 628107 628008 628198 627646 627661 628909 628941

XR KNEE 4V OR MORE XR KNEES STANDING AP XR LARYNGOGRAM W CON XR MAMMO BIL XR MAMMO BIL XR MAMMO UNI XR MAMMO UNI XR MAN APP STRS ANY JNT XR MANDIBLE 4V OR MORE XR MANDIBLE LES 4V XR MASTOIDS 3V OR MORE XR MASTOIDS LES 3V XR MYELOGRAM CERV XR MYELOGRAM LUMB XR MYELOGRAM POST FOSSA XR MYELOGRAM THOR XR MYELOGRM 1 OR MORE REG XR NASAL BONES 3V OR MORE XR NEC SOFT TISSUE XR NO CHRG TRAUMA SERIES XR OPTIC FORAMINA XR ORBITS 4V OR MORE XR ORTHOPANTOGRAM XR PACEMAKER INSERT XR PELV 1 OR 2V XR PELV 3V OR MORE XR PELV HIP 2V INF CHLD XR PELVIMETRY XR PERINEOGRAM XR PERITONEOGRAM XR PHARYNGEAL SPEECH EVAL XR PHARYNXLARYNX W FLUORO XR RADIO ABSORPTIOMETRY XR RIBS BIL 3V XR RIBS BIL W PA CXR XR RIBS UNI & PA CHEST XR RIBS UNI 2V XR SACRUM COCCYX 2 V MORE XR SALIVARY GLAND CALC XR SCAPULA CMPL XR SCRN MAMMO XR SCRN MAMMO DIG W COMP XR SELLA TURCICA XR SHOULDER 1V XR SHOULDER 1V XR SHOULDER 2V OR MORE XR SI JNT 1 OR 2V XR SI JNT 3V OR MORE XR SIALOGRAM XR SIN PARA 3V OR MORE XR SIN PARA LES 3V XR SKULL 4V OR MORE XR SKULL LES 4V

793.00 251.00 1026.00 617.00 527.00 397.00 536.00 81.00 1094.00 853.00 1094.00 853.00 2079.00 1047.00 1912.00 1912.00 1510.00 729.00 767.00 0.00 682.00 960.00 355.00 1213.00 545.00 1003.00 78.00 144.00 197.00 177.00 1410.00 344.00 104.00 560.00 121.00 838.00 421.00 757.00 354.00 734.00 140.00 28.00 55.00 510.00 521.00 716.00 156.00 192.00 715.00 1115.00 866.00 1484.00 697.00

0.00 0.00 335.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 960.00 749.00 762.00 0.00 861.00 762.00 0.00 181.00 0.00 0.00 176.00 0.00 119.00 1064.00 134.00 300.00 0.00 0.00 0.00 0.00 460.00 0.00 0.00 0.00 0.00 202.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 130.00 133.00 225.00 0.00 167.00 0.00 0.00 0.00 0.00 0.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 44

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

624205 628982 629501 629063 629097 629048 629253 629220 629162 629188 629147 629261 629287 629022 629303 629329 629345 629360 629402 671065 629428 629444 624460 629600 629527 629543 629667 629741 629725 629717 629790 629816 629824 629832 629840 629808 629865 629873 627505 629881 629907 629980 629949 629931 623520 623561 622043 622001 622068 622076 624247 622563 624262

XR SM BOWEL ENTEROCLYSIS XR SM BOWEL SERIES XR SPECIMEN SURGICAL XR SPINE C 4V & FLEX/EXT XR SPINE CERV 2-3V XR SPINE CERV 4V OR MORE XR SPINE LUMB 2-3V XR SPINE LUMB 2-3V XR SPINE LUMB 4V OR MORE XR SPINE LUMB 4V W BEND XR SPINE LUMB BEND ONLY XR SPINE SCOLIOSIS STNDNG XR SPINE SCOLIOSIS SUP ER XR SPINE SNGL V CERV XR SPINE SURVEY ENTIRE XR SPINE THOR 2V XR SPINE THOR 3V XR SPINE THOR 4V OR MORE XR SPINE THOR LUMB 2V XR STEREO LOC XR STERNOCLAVIC 3V MORE XR STERNUM 2V OR MORE XR SWALLOWING FNCTN XR TIBIA FIBULA 2V XR TMJ BIL XR TMJ UNI XR TOE(S) 2V OR MORE XR TOMOGRAM XR TOMOGRAM CMPLX XR TOMOGRAM CMPLX BIL XR UGI W AIR CON XR UGI W AIR CON KUB XR UGI W AIR CON SM BOWEL XR UGI W KUB XR UGI W SM BOWEL XR UGI W/O KUB XR URETHROCYSTOGRAM XR URETHROCYSTOGRAM VOID XR UROGRAM ANTEGRADE XR UROGRAM RETRO XR VASOGRAM VESICULOGRAM XR WRIST 2V XR WRIST 3V OR MORE XR XERORADIOGRAPHY X-RAY TECH 2HRS X-RAY TECH SURGERY XRC ASP BREAST ADD XRC ASP BREAST CYST XRC ASP RENL CYST XRC ASP SPINAL CYST PRC XRC BILI ENDO W/O STENT XRC BILI STENT PLACE XRC BILI STONE RMVL

821.00 1407.00 130.00 1470.00 788.00 1169.00 776.00 807.00 1483.00 1483.00 1278.00 633.00 807.00 646.00 633.00 981.00 1019.00 512.00 807.00 1455.00 254.00 740.00 960.00 575.00 836.00 653.00 434.00 788.00 969.00 1112.00 1122.00 1669.00 772.00 1669.00 1810.00 1052.00 1129.00 1406.00 1383.00 1535.00 548.00 480.00 429.00 55.00 0.00 0.00 160.00 378.00 338.00 1787.91 1997.00 5308.00 2184.00

720.00 343.00 0.00 379.00 388.00 329.00 243.00 236.00 437.00 437.00 272.00 165.00 236.00 171.00 165.00 243.00 236.00 0.00 236.00 0.00 0.00 0.00 726.00 141.00 732.00 572.00 106.00 0.00 314.00 358.00 436.00 0.00 0.00 431.00 445.00 342.00 275.00 374.00 0.00 391.00 480.00 118.00 190.00 0.00 0.00 0.00 151.00 357.00 0.00 1787.91 1753.00 1729.00 1915.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 45

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

626028 623082 622555 622514 622480 622571 622670 622795 622787 622779 622696 621326 629857 625558 626150 624163 624155 624361 624353 624171 624379 624338 624346 624601 624650 623033 625905 625921 625947 625962 625988 626002 626564 626424 626408 626044 626630 626069 626085 626101 626127 625863 626143 624312 626168 626184 626580 626218 626242 626440 626267 626341 626366

XRC BREAST NDL WIRE XRC BREAST NDL WIRE ADD XRC BX ABD RETROPE XRC BX BM NDL/TROCAR XRC BX LIVER XRC BX LIVER W MAJOR XRC BX RENL XRC BX SKIN LESION EA ADD XRC BX SKIN LESION SNGL XRC BX SOFT TISS NEC THOR XRC BX THYROID XRC CHANGE TUBE XRC CYSTOMETROGRAM CMPLX XRC ENDO SB W JEJ TUB PRC XRC ERCP BLN DILATION XRC ERCP INS BIL/PAN TUBE XRC ERCP INS NASO TUBE XRC ERCP RETRO DESTRUCTN XRC ERCP RMVL CALC XRC ERCP RMVL FB/CHNG XRC ERCP W/ABLATION XRC ERCP W/BIOPSY XRC ERCP W/SPHINC/PAPIL XRC ESOPH DILATE BLN <30M XRC ESOPH DILATE BLN >30M XRC IMAG LOC CLIP W BX XRC INJ ARTHRO ANKLE XRC INJ ARTHRO ELBOW XRC INJ ARTHRO HIP XRC INJ ARTHRO KNEE XRC INJ ARTHRO SHOULDER XRC INJ ARTHRO WRIST XRC INJ ASP SHUNT XRC INJ BLOOD PATCH XRC INJ BRONCH W SCOPE XRC INJ C1 C2 MYELOGRAM XRC INJ CYSTO RETRO XRC INJ CYSTO VCUG XRC INJ DACROCYSTOGRAM XRC INJ DISKOGRAM CERV XRC INJ DISKOGRAM LUMB XRC INJ DUCT GALACTOGRAM XRC INJ EPIDL L/S XRC INJ ERCP XRC INJ FACET C/T 1 LVL XRC INJ FACET LS ADDL LVL XRC INJ HIP W ANESTHESIA XRC INJ ILEAL CONDUIT XRC INJ LP XRC INJ MAJOR JNT BURSA XRC INJ MYELOGRAM XRC INJ NRV BLK C/T 1 LVL XRC INJ NRV BLK L/S 1 LVL

716.00 716.00 661.00 660.00 675.00 1216.00 459.00 98.00 271.00 750.00 388.00 362.00 307.00 726.33 1338.00 1351.00 1338.00 1800.00 1608.00 1474.00 1339.00 1141.00 1339.00 3333.00 925.00 591.00 297.00 357.00 429.00 613.00 302.00 380.00 274.00 1047.00 921.00 1279.00 363.00 355.00 561.00 2773.00 2294.00 1927.00 1256.00 1085.00 765.00 1024.00 493.00 2215.00 369.00 247.00 520.00 765.00 1005.00

345.00 0.00 623.00 0.00 0.00 1067.00 0.00 0.00 0.00 707.00 366.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1085.00 811.00 0.00 259.00 314.00 375.00 199.00 267.00 335.00 242.00 648.00 299.00 417.00 0.00 118.00 182.00 0.00 748.00 1818.00 409.00 0.00 671.00 299.00 432.00 0.00 323.00 219.00 0.00 671.00 881.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES

Page 46

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

626507 626283 626374 626473 626481 626523 626549 626622 621524 621532 621656 621649 621672 621664 621540 621615 621607 621557 621417 621409 626671 626655 626689 626697 627026 627802 627828 627893 621334 627877 626200 621391 623884 851113 851105 824300 823351 822700 822551 824102 824151 824250 824029 824003 851204 851303 850131 852103 852806 853259 853507 854158 858100

XRC INJ NRV BLK SCTC SNGL XRC INJ NRV BLK SUBARACH XRC INJ PANCREAT INTRAOP XRC INJ SI JNT ARTHROGRAM XRC INJ SIALOGRAM XRC INJ SINOGRAM XRC INJ TRANSTRACH BRONCH XRC INJ URETHROCYST CHAIN XRC INS NON-TUN CV CATH<5 XRC INS NON-TUN CV CATH5+ XRC INS PICC W/O PORT 5+ XRC INS PICC W/O PORT LT5 XRC INS PICC W/PORT 5+YRS XRC INS PICC W/PORT LT 5 XRC INS TUN CV NO PRT LT5 XRC INS TUNN CV DEV 5+ XRC INS TUNN CV DEV LT 5 XRC INS TUNN CV NO PORT5+ XRC INSERT CATH TMP CMPLX XRC INSERT CATH TMP SMPL XRC INTRO CAROTD VERT ART XRC INTRO CATH BILI DRN XRC INTRO CATH FALLOPN XRC INTRO CATH IVC /SVC XRC LP THRP XRC PARACENT ABD INI XRC PARACENT ABD SUBSQ XRC REMV TUNN CV CATH W/O XRC REPOSITION G TUBE XRC RPLC COMP NON-TUNN CV XRC SAL INFN SONOHYSTER XRC URINE VOIDING PRESSUR XRC UROFLOWMETRY COMPLEX ADENOSINE 30MG IJ ADENOSINE 6MG INJ CON IONIC 50ML CON IONIC 50ML CON NI 200S 100ML CON NI 200S 20ML CON NI 300S 150ML CON NI 300S 150ML CON NI 300S 200ML CON NI 300S 20ML CON NI 300S 50ML HEPARIN 1000U/ML INJ HEPARIN 10U/ML INJ NM HEART MI PLANAR NM RP I-123 200 UCI NM RP I-131 UTAKE CAP NM RP IN-111 MYOSCINT NM RP IN-111 OCTREOSCAN NM RP SR-89 UP TO 4 MCI NM RP TL-201 PER MCI

428.00 765.00 342.00 1404.00 330.00 375.00 315.00 1491.00 3512.00 3512.00 1207.00 1329.00 5363.00 5968.00 3512.00 4602.00 4644.00 3512.00 176.06 110.24 0.00 1855.00 3548.00 428.00 489.00 725.00 507.00 531.57 369.00 1061.00 666.00 184.11 142.00 293.00 105.00 186.00 186.00 1045.00 524.00 0.00 1553.00 2084.00 173.00 524.00 13.00 5.00 1210.00 0.00 0.00 0.00 0.00 0.00 0.00

374.00 671.00 0.00 0.00 288.00 147.00 275.00 0.00 0.00 0.00 0.00 1253.00 0.00 5631.00 0.00 0.00 4382.00 0.00 0.00 110.24 0.00 1628.00 1156.00 0.00 430.00 684.00 478.00 0.00 348.00 0.00 214.00 0.00 0.00 0.00 99.00 174.00 174.00 971.00 487.00 0.00 1445.00 1941.00 0.00 487.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8

DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING PROCEDURES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES

Page 47

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

858209 850123 850172 851485 851519 851493 851501 851527 851543 852509 852525 860007 851709 851659 852020 852608 852467 852475 852657 853200 853523 853002 853309 853408 853630 854018 854026 854059 854109 855056 855452 855601 855502 855700 855759 855908 856104 856328 856427 856500 857300 856609 856658 856674 856708 858258 856757 855007 856807 856906 856955 856914 857003

NM RP XE-133 GAS NM TUMOR LOC LTD W RP NM VASCULAR FLOW NCARDIO RP C14 UREA/TEST RP CO57 COBALT CHLORIDE RP CO57/0.5MCI ORAL RP CO57/CO58 0.5UCI RP CR51 PER 50 MCI RP CR51 PER 50 MCI RP DX I-131 CAP PER MCI RP DX I131 SOD SOL/MCI RP FDG/DOSE 4-40MCI/ML RP GALLIUM GA 67 MCI RP GALLIUM GA 67 MCI RP I123/100UCI RP I-131 BASE CHGE 1-6MCI RP I-131 BEXXAR DX DS RP I-131 BEXXAR TX DS RP I-131 HIPPURAN 300 UCI RP IN111 DTPA/0.5MCI RP IN111 OCTREOSC/3 MCI RP IN111 ONCOSCINT/DS RP IN111 PROSTASCN/DS RP IN111 WBC/0.5MCI RP IN-111 ZEVALIN/DOSE RP P32 CHROMIC/MCI RP P32 SODIUM PHO/MCI RP SM153 QUADR/50MCI RP SR89 PER MCI RP TC99M ACUTECT/VL RP TC99M CEA SCAN/VL RP TC99M CERETEC/DS RP TC99M CERETEWBC/DS RP TC99M CHOLETEC/VL RP TC99M DISOFENIN/VL RP TC99M DTPA/VL RP TC99M GLUCOHEP/VL RP TC99M MAA/1MCI RP TC99M MAGIII/MCI RP TC99M MDP 1-30MCI RP TC99M MERALUMA RP TC99M MYOVIEW/DS RP TC99M NEOTECT/1MCI RP TC99M NEOTECT/1MCI RP TC99M NEUROLITE/DS RP TC99M NEUTROSPEC/DS RP TC99M NEUTROSPEC/DS RP TC99M PERTECH/DS RP TC99M PYP/VL RP TC99M RBC/TAG/MCI RP TC99M RBC/TAG/MCI RP TC99M RBC/TAG/MCI RP TC99M SC

0.00 4903.00 0.00 164.00 547.00 547.00 611.00 589.00 611.00 501.00 415.00 225.00 79.00 217.00 2.00 0.00 4740.00 41082.00 0.00 1965.00 3381.00 5612.00 4585.00 1965.00 3809.00 2620.00 852.00 4585.00 3275.00 2358.00 4878.00 1638.00 2097.00 209.00 209.00 73.00 73.00 14.00 142.00 99.00 524.00 475.00 3171.00 202.00 1703.00 0.00 2022.00 74.00 236.00 21.00 209.00 21.00 99.00

0.00 0.00 0.00 0.00 0.00 0.00 535.00 0.00 535.00 473.00 0.00 0.00 0.00 189.00 0.00 0.00 0.00 0.00 0.00 1854.00 0.00 5295.00 4326.00 1854.00 0.00 0.00 0.00 4326.00 0.00 2225.00 4601.00 1545.00 0.00 0.00 197.00 69.00 69.00 0.00 0.00 0.00 494.00 0.00 0.00 0.00 1607.00 0.00 0.00 70.00 223.00 0.00 197.00 0.00 0.00

8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8

DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES

Page 48

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

857102 855551 855304 858001 852541 852574 858225 857607 850107 851352 5050034 5050075 5050042 5050000 5050018 5060009 5060033 3810025 3810330 3810322 3810157 3810017 3810140 3810355 3810165 3810249 3810348 3810074 3810314 3810066 3810256 3810306 3810272 3810298 3810181 3810264 3810199 3810207 3810116 3810124 3810280 3810231 3810108 3810090 3810215 3810223 3810033 3810173 5521414 5570379 5570387 5570361 5570346

RP TC99M SC/EGG/DS RP TC99M SC/FILTER/DS RP TC99M SESTAMIBI/DS RP TL-201 PER MCI RP TX I-131 CAP PER MCI RP TX I131 SOD SOL/MCI RP XE133/10MCI RP Y-90 IBRITUM/DOSE SINCALIDE THYROTHROPIN 1.1MG VL DIALYS CAPD IP DIALYS CAPD OP DIALYS CCPD IP DIALYS HEMO IP DIALYS PRITNEAL NOCAPD IP S STRL ARTIFICIAL KIDNEY S STRL GUIDE WIRE AD EVAL ABR AD EVAL PEDS <3 VRA AD EVAL PEDS >3 VRA EEG AWAKE AND ASLEEP EEG AWAKE AND DROWSY EEG CEREBRAL DEATH EVAL EEG DIGITAL ANALYSIS EEG DURING SURGERY EEG GT 1 HR EEG INSERT SPHEN ELECTR EEG MONITOR AMB EA 24HR EEG MONITOR W/DRG/ACTIVTN EEG RCRD/INTERP/24HR EEG SLEEP EEG UP TO 1HR EEG W/VIDEO RCRD/24HR ELCTRDE STIM BRAIN 1ST HR ELCTRDE STIM BRAIN EA HR ELECTROCORTICOGRAM SURG H REFLX TEST GSTR/SOL UNI NEUROLOGICAL PROCEDURE SEP LOWER LIMBS BIL SEP LOWER LIMBS BIL SEP LOWER LIMBS UNI SEP TRUNK/HEAD SEP UPPER LIMBS BIL SEP UPPER LIMBS UNI SLEEP STUDY ATTENDED SLEEP STUDY UNATTENDED VISUAL EVOKED POTENT TEST WADA ACTIVATION TEST ALCOHOL (ETHANOL) BREATH APP LONG LEG SPLNT APP LOW LEG SPLNT APP SPLNT FINGER STA APP SPLNT LONG ARM

197.00 505.00 371.00 112.00 54.00 40.00 16.00 32975.00 4486.00 1312.00 258.00 258.00 716.00 2493.00 207.00 201.00 113.00 811.00 812.00 652.00 1230.00 1139.00 1412.00 782.00 1713.00 812.00 545.00 829.00 545.00 1663.00 870.00 782.00 1511.00 782.00 782.00 1713.00 652.00 652.00 1312.00 893.00 545.00 1193.00 893.00 1312.00 812.00 652.00 717.00 1193.00 71.00 574.00 287.00 84.00 383.00

0.00 0.00 371.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1001.00 937.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

8 8 8 8 8 8 8 8 8 8 50 50 50 50 50 50 50 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 55 55 55 55 55

DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIAG IMAGING SUPPLIES DIALYSIS SERVICES DIALYSIS SERVICES DIALYSIS SERVICES DIALYSIS SERVICES DIALYSIS SERVICES DIALYSIS SERVICES DIALYSIS SERVICES EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG EEG ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA

Page 49

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

5570353 5570155 5570163 5570189 5570171 5520200 5520218 5520226 5520192 5510904 5510508 5540422 5540414 5540463 5570569 5570502 5570494 5521406 5510334 5510342 5510011 5510029 5510037 5510045 5510052 5510391 5510383 5520317 5510474 5510466 5510755 5510409 5510417 5510425 5510433 5570593 5570585 5570577 5570072 5510458 5570080 5510441 5570130 5570148 5510557 5570510 5570528 5570536 5570544 5570551 5570007 5550058 5550025

APP SPLNT SHRT ARM STA APPLY LONG ARM CAST APPLY SHORT ARM CAST APPLY SHORT LEG CAST APPY LONG LEG CAST BLOOD TRANSFUSN 2-4 HR BLOOD TRANSFUSN 4-6 HR BLOOD TRANSFUSN GT 6HR BLOOD TRANSFUSN LT 2 HR BLOOD TRANSFUSN LT 2 HR CARDIOVERT ELECTIVE EXT D51/2NS 1000ML/KCL 20 D5NS 1000ML/KCL 20 D5W 100ML DEBRIDE SKIN&SUBCUT TISS DRAIN ABSCESS COMP/MULT DRAIN ABSCESS SMPL/SNGL DRG SCRN EA DRG ED CC 1ST 30-74 MN ED CC EA ADD 30 MN ED LEVEL 1 ED LEVEL 2 ED LEVEL 3 ED LEVEL 4 ED LEVEL 5 ED PROC MAJOR ED PROC MINOR EKG 12 LEAD TRACING ONLY GASTRIC LAVAGE GI INTUB CONT HEM GLUCOSE FINGERSTICK INFSN W-W/O MED 0-60 MN INFSN W-W/O MED EA ADD HR INFUSN W/VASOACT 0-60 MN INFUSN W/VASOACT EA AD INJ MAJOR JNT BURSA INJ/ASP INT JNT/BURSA INJ/ASP JNT/BURSA INJECTION IM/SQ EA INJECTION IM/SQ EA INJECTION IV EA INJECTION IV EA INSERT CATH NONINDWLLNG INSERT CATH TEMP INDWLLNG IPECAC ADMINISTRATION LAC SMPL 2.5CM/LESS LAC SMPL 2.6-7.5CM LAC SMPL 7.6-12.5CM LAC SMPL/F,E,N 2.5CM/LESS LAC SMPL/F,E,N 2.6-5.0CM LEVEL 1 EST PATIENT LEVEL 1 NEW PATIENT LEVEL 1 NEW PATIENT

287.00 417.00 304.00 344.00 456.00 0.00 0.00 0.00 458.00 432.50 596.00 247.00 310.00 120.00 262.00 1179.00 262.00 71.00 3352.00 1206.00 335.00 579.00 1054.00 1406.00 1658.00 1179.00 262.00 284.00 590.00 157.00 0.00 131.00 99.00 262.00 197.00 262.00 262.00 262.00 118.00 111.00 65.00 61.00 262.00 262.00 131.00 262.00 262.00 262.00 262.00 262.00 70.00 0.00 70.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55

ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA

Page 50

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

5570015 5550033 5570023 5550041 5570031 5570049 5540471 5510136 5520184 5510482 5510565 5510078 5520234 5520267 5570486 5570478 5510524 5570197 5521208 5540034 5540356 5540158 5540364 5570395 5570403 5540166 5540182 5540174 5521216 5521224 5540075 5521026 5540257 5570221 5540208 5540216 5521232 5521240 5521257 5540190 5540059 5521034 5521075 5540497 5570312 5540224 5521265 5521273 5521281 5570320 5540232 5570338 5540240

LEVEL 2 EST PATIENT LEVEL 2 NEW PATIENT LEVEL 3 EST PATIENT LEVEL 3 NEW PATIENT LEVEL 4 EST PATIENT LEVEL 5 EST PATIENT NA CL 0.9% 100ML NO TREATMENT OBSERVATION PER-HOUR OPHTHALMOLOGY EXAM PHLEBOTOMY THERAPEUTIC PT LEFT AFTER TRIAGE REGIONAL BLOCK FINGERS REGIONAL BLOCK TOES REMOVAL FB SUBQ TISS COMP REMOVAL FB SUBQ TISS SMPL RHYTHM EKG 3 LEAD TRACING RMV/BIVLVE BOOT/BODYCAST S NSTRL ANKLE STIRRUP S NSTRL CAN NASAL 7FT S NSTRL CASE LOWER EXTREM S NSTRL CAST LONG LOWER S NSTRL CAST UPPER EXTREM S NSTRL CERV COL THERMPLA S NSTRL CERV COL THERMPLA S NSTRL COLLAR ASPEN S NSTRL COLLAR CERV SFT S NSTRL COLLAR PHIL USE S NSTRL COLLAR,HARD OR P S NSTRL COLLAR,SOFT S NSTRL CURETTER EAR DISP S NSTRL CURRETE, EAR DIS S NSTRL DIGITAL SPLINT S NSTRL DIGITAL SPLINT S NSTRL IMBLR LOWER S NSTRL IMMOBILIZER UPPER S NSTRL IMMOBILIZER,KNEE S NSTRL IMMOBILIZER,LOWE S NSTRL IMMOBILIZER,UPPE S NSTRL KNEE IMBLR S NSTRL MASK 02 7' TUBE S NSTRL NOSE CLIP S NSTRL PULSE OX SPOT CH S NSTRL RESUS ADULT S NSTRL SHOE POST OP S NSTRL SHOE POST OP S NSTRL SHOE,POST-OP S NSTRL SLING S NSTRL SLING & SWATH S NSTRL SLING ARM S NSTRL SLING ARM S NSTRL SLING SWATHE S NSTRL SLING SWATHE

119.00 119.00 169.00 169.00 218.00 267.00 120.00 0.00 238.00 393.00 524.00 0.00 262.00 262.00 1179.00 262.00 328.00 169.00 211.00 42.00 846.00 838.00 525.00 1269.00 117.00 1269.00 211.00 117.00 117.00 211.00 76.00 76.00 16.00 16.00 282.00 211.00 211.00 211.00 211.00 207.00 65.00 34.00 47.00 502.00 302.00 302.00 302.00 147.00 272.00 147.00 147.00 272.00 272.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55

ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA

Page 51

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

5570213 5540141 5540307 5521349 5521307 5521323 5570239 5540273 5521315 5521331 5540281 5570247 5540299 5521299 5521356 5521364 5521372 5540265 5521380 5540042 5521000 5570411 5570288 5570270 5570296 5570262 5570304 5570254 5570122 5570106 5570114 5521182 5521190 5521083 5540539 5540117 5540125 5540000 5570056 5540505 5570445 5540554 5521018 5540570 5521109 5540398 5540521 5540513 5521117 5540547 5570452 5521125 5540372

S NSTRL SPIROMTR INCNTV S NSTRL SPLINT ANKLE S NSTRL SPLINT CLAV S NSTRL SPLINT ELBOW/FOR S NSTRL SPLINT LONG ARM S NSTRL SPLINT LONG LEG S NSTRL SPLINT LOWER EXT S NSTRL SPLINT LOWER EXT S NSTRL SPLINT SHORT ARM S NSTRL SPLINT SHORT LEG S NSTRL SPLINT UPPER EXT S NSTRL SPLINT UPPER EXT S NSTRL SPLINT WRIST S NSTRL SPLINT,DIGITAL S NSTRL SPLINT,LOWER EXT S NSTRL SPLINT,UPPER EXT S NSTRL SPLINT,VELCRO WR S NSTRL SPLINT/HARE/TRACT S NSTRL STRAP,CLAVICLE S NSTRL SYRINGE EAR & ULC S NSTRL VAGINAL SPECULUM S OT FM COLLAR CERV FLEX S OT KO ADJ KNEE JT RGD S OT KO IMMOB CNVS LONG S OT NON-PNEUM WALK BOOT S OT SO FIG 8 ABDC REST S OT SO SNGL EL PREFAB S OT WHO WRST EXTN C-UP S PR BAG URN LEG/ABDOMEN S PR CATH INTERMITT URIN S PR CATH W/DRAIN 2WAY LX S STRL .9% NACI IRR SOL 1 S STRL .9% NACI IRR SOL 2 S STRL AEROCHAMBER S STRL CATH BARTHLN GLAND S STRL CATH IN & OUT S STRL CATH INDWELLING S STRL CATH IV ANGIO S STRL CATH IV ANGIO S STRL CATH KIT SUCTION S STRL CATH TROCAR THORA S STRL CATH TROCAR THORA S STRL CATH WARD BARTHOLI S STRL CAUTERY PEN S STRL CAUTERY-HAND HELD S STRL CENTRAL VEIN KIT S STRL DEFIB PADS S STRL DEFIB PD EXT PACE S STRL DERMABOND SKIN ADH S STRL DRAIN CHEST VAC S STRL DRAIN CHEST VAC S STRL DRESSING XEROFORM S STRL KIT ART LINE 20G

167.00 211.00 93.00 197.00 417.00 574.00 361.00 361.00 383.00 287.00 256.00 256.00 102.00 16.00 361.00 256.00 102.00 525.00 100.00 55.00 76.00 211.00 211.00 211.00 135.00 93.00 282.00 102.00 117.00 108.00 400.00 211.00 147.00 162.00 105.00 108.00 400.00 83.00 144.00 40.00 353.00 353.00 105.00 211.00 162.00 772.00 135.00 202.00 196.00 1610.00 1610.00 38.00 484.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55

ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA

Page 52

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

5540083 5521166 5540562 5521067 5521133 5521091 5570601 5570098 5540067 5540109 5521042 5540406 5521174 5521141 5540430 5570429 5540448 5540026 5570064 5540018 5540331 5570437 5540323 5540315 5521158 5540455 5540380 5540349 5540489 5540091 5540588 5540133 5510300 5510912 5520242 5510920 5520259 5520168 5521430 5510532 5510490 5510516 5530118 5530092 5530100 5510888 5510896 5510870 5510854 5510862 5570460 5510573 5520051

S STRL KIT NASOSTAT S STRL LENS MORGAN DISP S STRL LENS MORGAN DISP S STRL NEBULIZER KIT S STRL NUGAUZE-PACKING S STRL PEAKFLOW METER S STRL PIN SKULL STERILE S STRL PROBE OXIMETER DIS S STRL PROBE OXIMETR DISP S STRL RHINO ROCKET S STRL RHINOROCKET-SUPP S STRL SET BLOOD TUBNG S STRL SET THERAPEUTIC DL S STRL SKIN STAPLER DISP S STRL SOL .9NACL WO MEQ S STRL SOL IRR NACL/H20 S STRL SOL IRR NACL/H2O S STRL SOL IV 500CC ALL S STRL SOL IV IL ALL S STRL SOL IV IL ALL S STRL STAPLE SIGNET SKIN S STRL SUTURE CUTICILAR S STRL SUTURE CUTICULAR S STRL SUTURE DERAMOND S STRL SUTURE,SINGLE PKG S STRL TRACH TUBE LWP S STRL TRANSDUCR PRES DSP S STRL TRAY LUMBAR DISP S STRL TRAY THORA DISP S STRL TUBE FEED DOBHOFF S STRL TUBE INFANT FED S STRL URINARY BAG LG DRN SART EXAM SEDATION IV/IM SEDATION IV/IM SEDATION PO/PR/INTRANASAL SEDATION PO/PR/INTRANASAL SEEN NO CHARGE SKIN TEST TB SLIT LAMP PROCEDURE TEMP TRANSCUTANEOUS PACE THROMBOLYSIS CORO IV TRAUMA ACT EVAL LVL 2 TRAUMA ACT FULL LVL 2 TRAUMA ACT PARTL LVL 2 TRAUMA EXT 1ST 30-74MN FF TRAUMA EXT EA ADD 30MN FF TRAUMA HIGH FF TRAUMA LOW FF TRAUMA MEDIUM FF TUBE THORACOSTOMY UC INJECTION IM/SQ EA UC LEVEL 1 EST PATIENT

574.00 388.00 345.00 181.00 154.00 174.00 624.00 120.00 120.00 440.00 440.00 265.00 147.00 290.00 340.00 96.00 96.00 178.00 211.00 211.00 290.00 142.00 142.00 196.00 142.00 978.00 555.00 409.00 588.00 555.00 83.00 117.00 442.00 466.00 494.00 247.00 262.00 0.00 18.00 34.00 364.00 655.00 3180.00 8321.00 7261.00 8034.00 4017.00 6890.00 2120.00 5830.00 1179.00 118.00 112.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55

ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA

Page 53

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

5520069 5520010 5520077 5520028 5520085 5520036 5520093 5520044 5520002 5520309 5520176 5521422 5570205 721704 721761 721886 721860 721928 721902 722843 727602 723247 723288 723387 723403 723528 723767 724047 724005 724823 724849 724906 725002 725200 725325 725309 725408 725614 725606 725705 725671 725663 725812 722827 726919 726901 726968 727404 727446 727560 727743 727701 727909

UC LEVEL 2 EST PATIENT UC LEVEL 2 NEW PATIENT UC LEVEL 3 EST PATIENT UC LEVEL 3 NEW PATIENT UC LEVEL 4 EST PATIENT UC LEVEL 4 NEW PATIENT UC LEVEL 5 EST PATIENT UC LEVEL 5 NEW PATIENT UC LEVEL I NEW PATIENT UC PROC MINOR URG CARE PT SENT TO ER VENIPUNCTURE WINDOWING OF CAST XR ABD 1V AP XR ABD CMPL DECUB ERECT XR AC JNT XR AC JNT XR ANKLE 2V XR ANKLE 3V OR MORE XR BONE LENGTH STDY XR CALCANEOUS 2V OR MORE XR CHEST 1V XR CHEST 2V XR CHEST 2V W AP LORDOTIC XR CHEST 2V W OBLIQUES XR CHOL IN OR XR CLAVICLE CMPL XR ELBOW 2V XR ELBOW 3V OR MORE XR FACIAL BONE 3V OR MORE XR FACIAL BONE LES 3V XR FEMUR 2V XR FINGER(S) 2V OR MORE XR FLUORO 1HR OR LES XR FOOT 2V XR FOOT 3V OR MORE XR FOREARM 2V XR HAND 2V XR HAND 3V OR MORE XR HIP UNI 1V XR HIP UNI 2V OR MORE XR HIPS BIL 2V W PELV XR HUMERUS 2V OR MORE XR JNT SURVEY 1V XR KNEE 1 OR 2V XR KNEE 4V OR MORE XR KNEES STANDING AP XR NASAL BONES 3V OR MORE XR NEC SOFT TISSUE XR ORBITS 4V OR MORE XR PELV 1 OR 2V XR PELV 3V OR MORE XR RIBS BIL 3V

127.00 135.00 135.00 144.00 158.00 167.00 174.00 183.00 119.00 262.00 0.00 16.00 107.00 126.00 247.00 709.00 746.00 458.00 596.00 591.00 117.00 329.00 510.00 599.00 647.00 0.00 147.00 127.00 172.00 864.00 758.00 165.00 101.00 0.00 113.00 154.00 128.00 107.00 133.00 126.00 282.00 291.00 138.00 591.00 118.00 720.00 227.00 174.00 697.00 873.00 127.00 290.00 509.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

55 55 55 55 55 55 55 55 55 55 55 55 55 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7

ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA ER/URGENT CARE/TRAUMA IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB

Page 54

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

727941 728121 728204 728287 728261 728105 728006 728907 728949 729061 729087 729046 729244 729160 729186 729269 729285 729327 729368 729400 729426 729442 729608 729665 729954 729947 9480013 9483165 9483363 9483520 9483173 9480070 9450404 9480104 9482241 9470022 9450024 9450511 9450032 9450016 9450412 9483322 9470048 9480203 9480252 9480260 9480278 9480286 9480294 9450594 9450602 9450628 9450610

XR RIBS UNI 2V XR SACRUM COCCYX 2 V MORE XR SCAPULA CMPL XR SHOULDER 1V XR SHOULDER 2V OR MORE XR SI JNT 1 OR 2V XR SI JNT 3V OR MORE XR SKULL 4V OR MORE XR SKULL LES 4V XR SPINE C 4V & FLEX/EXT XR SPINE CERV 2-3V XR SPINE CERV 4V OR MORE XR SPINE LUMB 2-3V XR SPINE LUMB 4V OR MORE XR SPINE LUMB 4V W BEND XR SPINE SCOLIOSIS STNDNG XR SPINE SCOLIOSIS SUP ER XR SPINE THOR 2V XR SPINE THOR 4V OR MORE XR SPINE THOR LUMB 2V XR STERNOCLAVIC 3V MORE XR STERNUM 2V OR MORE XR TIBIA FIBULA 2V XR TOE(S) 2V OR MORE XR WRIST 2V XR WRIST 3V OR MORE ACYCLOVIR 50MG IV ALBUMIN 25%/50ML ALTEPLASE 1MG IJ ALTEPLASE 1MG IJ AMPHO B LPD CMPLX 10MG IJ AMPICILLIN NA 500MG INJ ASPIRATION BONE MARROW ATROPINE SO4 TO 0.3MG IV AUROTHIOGLUCOSE TO 50MG BLEOMYCIN 15U IJ BLOOD TRANSFUSN 2-4 HR BLOOD TRANSFUSN 4-6 HR BLOOD TRANSFUSN GT 6HR BLOOD TRANSFUSN LT 2 HR BX BONE MARROW CALCIUM GLUCONATE 10ML IJ CARBOPLATIN 50MG IJ CEFAZOLIN 500MG IV CEFOTAXIME PER 1GM IJ CEFOTETAN PER 500MG IV CEFTAZIDIME PER 500MG IV CEFTIZOXIMENA/500MG IV CEFTRIAXONE NA/250MG IV CHEMO CNS W/SPINAL PUNC CHEMO INJ BRAIN/HEART SQ CHEMO IV PMP INFSN GT 8HR CHEMO IV PUSH

383.00 689.00 667.00 125.00 217.00 142.00 161.00 1349.00 634.00 365.00 374.00 316.00 227.00 421.00 421.00 160.00 227.00 234.00 465.00 227.00 231.00 673.00 136.00 101.00 113.00 183.00 $0.00 $0.00 $0.00 $101.25 $0.00 $0.00 $476.41 $16.33 $0.00 $0.00 $857.98 $1,286.30 $1,651.94 $488.32 $512.14 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $1,263.67 $742.00 $668.16 $410.90

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94

IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB IMAGINIG MOB INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY

Page 55

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9450586 9450578 9450065 9480336 9480328 9470063 9480351 9483181 9450396 9480427 9480435 9470089 9470097 9470105 9470113 9410101 9410127 9410184 9410200 9410150 9410028 9410069 9470568 9482548 9483074 9470170 9450446 9480468 9480500 9480518 9480559 9480567 9470188 9480096 9470196 9470204 9480575 9480583 9482951 9480625 9482969 9482985 9482993 9483348 9483009 9483355 9481839 9481821 9483314 9470238 9470246 9480963 9480971

CHEMO PERITNL W/PERITONEO CHEMO PLURAL CAV W/THOR CHEMO SQ/IM CIMETIDINE 300MG IV CIPRO 200MG IV CISPLATIN 10MG IJ CLINDAMYCIN 300MG IV CMV IMM GLOB/SGL DOSE IJ COLLECT BLD VNS ACCES DVC COSYNTROPIN/0.25MG INJ CYANOCOBALAMIN 1000MCG IN CYCLOPHOSPHAMID 100MG IV CYCLOPHOSPHAMID 1GM IV CYCLOPHOSPHAMID 200MG IV CYCLOPHOSPHAMID 2GM IV D51/2NS 1000ML D51/2NS 1000ML/KCL 20 D5LR 1000ML D5LR/KCL 20MEQ 1000ML D5NS 1000ML D5W 1000ML D5W 250ML DACARBAZINE 100MG IJ DACLIZUMAB 25MG IJ DARBEPOETIN 1MCG NON-ESRD DAUNORUBICIN 10MG IJ DECLOT VASC DEVICE DEFEROXAMINE MESYL 500MG DESMOPRESSIN ACET/1MCG DEXAMETHASONE 1MG INJ DIPHENHYDRAMINE TO 50MG DOBUTAMINE 250/D5W250 DOCETAXEL 20MG IJ DOLASETRON 12.5MG DOXORUBICIN 10MG IJ DOXORUBICIN LIPID 10MG IJ DOXYCYCLINE HYCLATE 100MG DROPERIDOL TO 5MG,IV ENOXAPARIN SOC 10MG INJ EPINEPHRINE 1:1000 TO 1ML EPOETIN ESRD EPOETIN NON-ESRD/1000U IJ EPOETIN NON-ESRD/1000U IJ ERTAPENEM 500MG IJ ETOPOSIDE 10MG IV FE GLUCONATE 12.5MG IJ FILGRASTIM 300MCG IJ FILGRASTIM 480MCG IJ FLU VACC >3YRS FLUDARABINE 50MG IJ FLUOROURACIL 500MG IJ FUROSEMIDE 20MG TAB FUROSEMIDE TO 20 MG IV

$1,286.30 $1,263.67 $512.14 $0.00 $0.00 $0.00 $0.00 $0.00 $297.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $75.76 $37.10 $75.88 $89.22 $37.10 $75.90 $3.10 $0.00 $0.00 $0.00 $0.00 $438.29 $0.00 $0.00 $12.69 $50.42 $0.00 $0.00 $39.43 $0.00 $0.00 $0.00 $56.50 $0.00 $49.28 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.00 $24.81

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94

INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY

Page 56

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9483033 9470253 9481102 9483223 9483264 9481136 9481144 9483371 9481193 9480377 9480369 9481276 9481284 9481292 9483199 9482944 9482944 9450123 9450115 9450131 9482118 9450271 9450172 9450073 9450503 9450305 9450198 9450453 9450636 9450651 9481425 9470030 9481441 9483140 9483389 9483306 9410218 9481474 9483207 9450164 9450529 9450461 9450537 9450479 9450545 9450487 9450552 9450495 9450560 9480393 9481557 9450420 9482845

GATIFLOXACIN 200MG IV GEMCITABINE 200MG IJ GENTAMICIN TO 80MG IV GOLD SODIUM THIOMALATE 50 GOSERELIN/3.6MG IP GRANISETRON 100MCG IJV HEP B IMMGLOB/1ML IJ HEP B VACC ADULT 2 DOSE HEPARIN 100U/ML FLUSH HEPARIN LOCK FLUSH PER 10 HEPARIN NA PER 1000U HYDROCORT NA SUCC TO 100 HYDROXYZINE HCL 50MG/1ML IMIPENEM/CILAST 250MG INJ IMMUNE GLOB 10MG IJ IMMUNE GLOBULIN 1GM IMMUNE GLOBULIN 1GM INF CHEM INTRA ART 1-8 HR INF CHEM INTRA ART PROLNG INF CHEM INTRA ART TO 1HR INFLIXIMAB/10MG IJ INFSN W-W/O MED 0-60 MN INFSN W-W/O MED EA ADD HR INFUSN CHEMO 0-60 MN INFUSN CHEMO EA ADD HR INJECTION ANTIBIOTIC IM INJECTION IM/SQ EA INJECTION IV EA INS PICC W/O PORT 5+ YR INSRT NON-TUNN CV CATH<5 INTERFERON B-1B/.25MG IJ IRINOTECAN 20MG IJ IRON DEXTRAN 50MG INJ IRON SUCROSE IV PER 1MG K CL 20 MEQ IJ KETOROLAC TROMETHAMINE 30 LACTATED RINGERS 1000ML LEUCOVORIN 50MG IV LEUPROLIDE 7.5MG IJ LEVEL 1 EST PATIENT LEVEL 1 NEW PATIENT LEVEL 2 EST PATIENT LEVEL 2 NEW PATIENT LEVEL 3 EST PATIENT LEVEL 3 NEW PATIENT LEVEL 4 EST PATIENT LEVEL 4 NEW PATIENT LEVEL 5 EST PATIENT LEVEL 5 NEW PATIENT LIDOCAINE HCL 50CC LORAZEPAM 2MG IV LP DIAGNOSTIC MAG SO4 SL4/500MG INJ

$0.00 $0.00 $0.00 $0.00 $0.00 $43.84 $2,073.35 $0.00 $0.00 $8.05 $12.28 $51.90 $2.65 $0.00 $0.00 $0.00 $0.00 $333.48 $668.16 $668.16 $0.00 $557.40 $262.02 $668.16 $333.48 $178.65 $178.65 $343.01 $2,939.43 $4,130.44 $365.15 $0.00 $0.00 $51.30 $0.00 $0.00 $75.50 $0.00 $0.00 $319.19 $357.30 $571.69 $714.61 $911.13 $911.13 $1,163.62 $1,163.62 $1,458.99 $1,905.63 $48.75 $54.88 $843.24 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94

INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY

Page 57

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9481565 9470360 9481664 9482902 9481649 9481623 9481672 9482035 9483231 9470402 9470402 9482191 9410283 9410291 9481888 9470550 9470428 9481896 9483157 9450255 9481938 9460171 9482019 9482084 9450297 9482308 9470436 9450644 9450669 9431750 9431776 9430083 9430208 9431594 9431628 9431602 9431610 9430273 9430240 9430257 9430265 9430331 9430349 9430786 9430794 9430752 9430760 9430224 9430232 9430745 9430828 9430844 9430836

MEPERIDINE HCL/100MG INJ METHOTREXATE 50MG IV METHYLPRED 125MG METHYLPRED 1GM IV METHYLPRED ACET 40MG IV METHYLPRED ACET 80MG IV METOCLOPRAMIDE HCL TO10MG MIDAZOLAM HCL PER 1MG INJ MILRINONE 5MG IV MITOXANTRONE/5MG IJ MITOXANTRONE/5MG IJ NA CL 0.9% 10ML FTVL NA CL 0.9% 250ML NA CL 0.9% 500ML ONDANSETRON/1MG IV OXALIPLATIN PER 5MG INJ PACLITAXEL 30MG IJ PAMIDRONATE/30MG IJ PEGFILGRASTIM 6MG IJ PHLEBOTOMY THERAPEUTIC PHYTONADIONE/1MG INJ PROCHLORPERAZIN 10MG TAB PROTEINASE INHB 10MG IJ RABIES ANTIGEN VACC REFILL PORTABLE PUMP RETEPLASE (TPA) 2MG/2ML RITUXIMAB 100MG IJ RPLC COMP NON-TUN CV CATH RPLC COMP TUNN PICC W/O S STRL APPL CHL SWABSTICK S STRL BLD Y-TYPE SET N-V S STRL BLOOD SET Y-TYPE S STRL CATH AUTOGURD 22X1 S STRL CATH IV 14GX1/75" S STRL CATH IV PROT 18G S STRL CATH IV PROT 22G S STRL CATH PROT IV 20G S STRL CATH SAF 24GA/3/4 S STRL CATH SAF-T18GA X 1 S STRL CATH SAF-T20GA X 1 S STRL CATH SAF-T-INTIMA S STRL DRESS BIOPATCH 1IN S STRL DRESS BIOPATCH 3/4 S STRL GROSHONG PICC 3FR S STRL GROSHONG PICC 4FR S STRL GRSHNG CATH REP 8 S STRL GRSHNG CATH RP 9.5 S STRL GRSHNG REP CON 8FR S STRL GRSHNG REP CON 9.5 S STRL GRSHNG REP KIT DL S STRL INTRD NDL PICC 3FR S STRL INTRD NDL PICC 4FR S STRL INTRD NDL PICC 5FR

$2.15 $0.00 $0.00 $0.00 $0.00 $21.45 $52.71 $18.37 $0.00 $0.00 $0.00 $31.06 $2.80 $37.10 $25.36 $0.00 $0.00 $0.00 $0.00 $357.30 $5.84 $13.62 $0.00 $0.00 $742.00 $0.00 $0.00 $4,130.44 $2,939.43 $0.00 $62.85 $34.25 $5.10 $11.60 $13.15 $13.15 $13.15 $9.75 $9.75 $9.75 $9.75 $12.50 $12.50 $258.20 $258.20 $350.55 $350.55 $34.05 $34.05 $288.90 $43.85 $43.85 $43.85

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94

INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY

Page 58

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9431065 9431552 9431560 9431578 9431099 9431107 9431115 9431123 9431180 9431198 9431172 9431214 9431206 9431420 9430034 9431545 9431727 9431735 9431743 9430315 9430323 9483272 9482365 9470477 9481755 9482415 9450248 9470485 9470501 9470410 9482530 9483249 9540394 9540402 9530635 9530098 9530296 9530106 9530346 9530080 9550088 9550054 9530171 9500562 9550567 9550070 4093340 4093001 4096988 4093019 4093035 4097002 4096996

S STRL LUMBAR TRAY 20G S STRL MICR INTRD KT 3 FR S STRL MICR INTRD KT 4 FR S STRL MICR INTRD KT 5 FR S STRL MIDLINE CATH 3FR S STRL MIDLINE CATH 4FR S STRL NDL GRIP 20G X 3/4 S STRL NDL GRIP 22G X 3/4 S STRL NDL HUB LP 20G X.5 S STRL NDL HUB LP 22GX.75 S STRL NDL HUBER LP 20GX1 S STRL PICC CONN 4FR S STRL PICC CONN 5FR S STRL SET PHLEBTYM DONAT S STRL SNGLE LUMN CATH KT S STRL THORACENTESIS TRAY S STRL TRAY GRSHNG PIC3FR S STRL TRAY GRSHNG PIC4FR S STRL TRAY GRSHNG PIC5FR S STRL TRAY MAHRKR DL DSP S STRL TRAY MAHRKR DL DSP SECRETIN 0.2MCG INJ TOBRAMYCIN SO4 TO 80MG TOPOTECAN 4MG IJ TRACE ELEM-5 10ML IV VANCOMYCIN 500MG IV VENIPUNCTURE VINBLASTINE 1MG IJ VINCRISTINE SULF 2MG IV VINORELBINE/10MG IJ WINRHO 100IU IJ ZOLEDRONIC ACID 1MG INJ S STRL BLOOD LEUK FTR/100 S STRL BLOOD LEUK FTR/50Y S STRL CATH ARROW CVC TL S STRL GRSHNG PICC-DL LMN S STRL HUBER NEEDLE W/EXT S STRL HUBER NEEDLE W/EXT S STRL INTIMA IV CATHETER S STRL INTRODUCER NDL PIC S STRL PERIPHRL IV INSER S STRL PERIPHRL IV INSRTN S STRL PICC INSERTIN TRAY S STRL PICC INSERTION S STRL PICC INSERTION OP S STRL PORT ACCES INSERTN 11 DEOXYCORTICOSTERONE 11 DEOXYCORTISOL 11 DEOXYCORTISOL 17 OH CORTICOSTERIODS 17 OH PREGNENOLONE 17 OH PREGNENOLONE 17 OH PROGESTRONE

$48.55 $144.95 $144.95 $144.95 $134.85 $134.85 $18.55 $18.55 $18.55 $18.55 $0.00 $0.00 $0.00 $123.25 $59.10 $72.35 $618.90 $618.90 $821.35 $783.70 $784.30 $0.00 $0.00 $0.00 $82.50 $0.00 $59.55 $0.00 $0.00 $0.00 $0.00 $0.00 298.00 201.00 318.00 1239.00 52.00 103.00 22.00 52.00 0.00 0.00 580.00 0.00 275.00 78.00 49.00 36.00 20.00 32.00 33.25 20.00 20.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 94 95 95 95 95 95 95 95 95 95 95 95 95 95 95 40 40 40 40 40 40 40

INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY INFUSION THERAPY IV THERAPY IV THERAPY IV THERAPY IV THERAPY IV THERAPY IV THERAPY IV THERAPY IV THERAPY IV THERAPY IV THERAPY IV THERAPY IV THERAPY IV THERAPY IV THERAPY LAB LAB LAB LAB LAB LAB LAB

Page 59

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4010880 4094793 4095071 4094579 4092060 4040051 4012050 4040028 4092201 4040101 4040093 4012068 4011086 4040077 4011094 4090585 4010054 4095592 4098281 4093043 4090551 4098273 4094082 4081279 4090569 4094090 4095139 4094983 4094173 4094447 4081378 4094645 4090999 4081360 4094520 4050001 4091922 4095998 4040127 4012084 4040119 4012092 4012076 4040010 4010070 4097051 4097069 4010088 4090577 4093050 4095295 4095089 4094801

17 OH PROGESTRONE 5 HIAA UR 5 HIAA UR 5 NUCLEOTIDASE AB ELUTION AB ELUTION AB ELUTION AB ID AB ID AB SCRN AB TTR AB TTR AB TTR 3 ABO TYP ABO TYP ACE (ANGIOTN CONVR ENZ) ACETAMINOPHEN ACETYLCHOLINE MODULE AB ACETYLCHOLINE RECEPT AB ACID PHOS PROSTATIC ACTH ACYLCARNITINES QN EA ADENOVIRUS AB ADENOVIRUS DFA ADH (VASOPRESSIN) ADRENAL AB SCRN ADRENAL AB SCRN ADRENAL AB SCRN ADRENAL AB SCRN ADRENAL AB TTR AFB CULT AFB CULT AFB CULT AFB CULT BLD AFB CULT BLD AFP TUMOR MARKER AG DETECT EIA MULT STEP AG DETECT EIA MULT STEP AG SCRN PER UNIT PT SPEC AG SCRN PER UNIT PT SPEC AG SCRN PER UNIT RGNT AG SCRN PER UNIT RGNT AG TYP PT RBC EA AG TYP PT RBC EA ALBUMIN ALBUMIN ALBUMIN FLD ALCOHOL (ETHANOL) ALDOLASE ALDOSTERONE ALDOSTERONE UR 24HR ALK PHOS ISOENZYMES ALK PHOS ISOENZYMES

142.00 15.60 24.07 17.00 150.00 220.00 220.00 544.00 170.00 301.00 264.00 264.00 37.00 121.00 142.00 12.00 354.00 48.00 45.00 12.00 25.00 116.22 22.00 122.00 25.00 25.00 0.00 371.88 17.00 32.00 235.00 33.45 24.25 235.00 26.00 154.00 27.97 24.00 178.00 178.00 220.00 220.00 110.00 110.00 39.00 8.90 8.90 130.00 8.50 27.00 39.00 20.00 17.00

29.00 0.00 0.00 0.00 0.00 0.00 53.00 0.00 0.00 0.00 71.00 71.00 0.00 17.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 53.00 0.00 71.00 27.00 0.00 21.00 0.00 0.00 51.00 0.00 0.00 0.00 0.00 0.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

Page 60

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4010096 4096020 4096038 4096046 4096012 4096004 4095568 4094785 4095055 4096947 4092250 4011383 4098224 4093076 4093092 4093100 4093118 4093084 4093126 4096681 4010104 4010997 4011102 4016192 4012142 4098091 4010120 4010138 4010146 4012233 4096236 4095394 4096962 4093159 4091039 4094140 4098356 4098240 4098349 4092409 4094108 4095519 4092391 4096616 4092482 4093209 4094041 4095220 4091328 4092433 4095535 4092441 4094199

ALK PHOSPHATASE ALLERGEN SPECIFIC IGE QN ALLERGEN SPECIFIC IGE QN ALLERGEN SPECIFIC IGE QN ALLERGEN SPECIFIC IGE QN ALLERGEN SPECIFIC IGE QN ALPHA 1 ANTITRYP PHENO ALPHA 1 ANTITRYPSIN ALPHA 1 ANTITRYPSIN ALPHA 1 ANTITRYPSIN ALPHA 2 ANTIPLASMIN ALT (SGPT) AMEBIC AB AMIKACIN AMINO ACIDS CSF >5 QN AMINO ACIDS MULT QL AMINO ACIDS UR >5 QN AMINO ACIDS UR MULT QL AMIODARONE AMITRIPTYLINE AMMONIA AMPHETAMINE SCRN AMPHETAMINE SCRN AMPHETAMINE SCRN AMPHETAMINE SCRN AMYLASE AMYLASE AMYLASE FLD AMYLASE UR RAN AMYLASE UR TIM ANA (ANTI NUCLEAR AB) ANA (ANTI NUCLEAR AB) ANDROSTENEDIONE ANDROSTENEDIONE ANTI DNA DBL STRAND ANTI DNA SINGL STRAND ANTI RNP AB ANTI RNP AB ANTI SM AB ANTINEUTROPHILIC AB ANTINEUTROPHILIC AB ANTINEUTROPHILIC AB ANTINEUTROPHILIC AB ANTIRETICULIN AB W/RFX APOLIPOPROTEIN A1 ARSENIC BLD ASCORBIC ACID ASO TTR ASO TTR ASPERGILLUS AB ASPERGILLUS AB ASPERGILLUS AB ASPERGILLUS AB

39.00 5.93 5.93 5.93 5.93 5.93 22.00 13.25 13.75 57.00 50.50 39.00 19.00 22.00 63.00 76.00 76.00 19.00 29.00 23.00 138.00 260.00 38.00 48.00 48.00 14.50 153.00 199.00 243.00 167.00 11.62 7.27 20.00 21.00 12.00 32.00 18.00 26.00 18.00 15.30 37.00 16.62 15.29 13.20 14.25 19.00 14.00 9.75 10.07 6.16 6.17 6.17 26.00

21.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 61.00 0.00 0.00 11.00 39.00 0.00 29.00 0.00 43.00 36.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

Page 61

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4092458 4011375 4090197 4096475 4094553 4020285 4080156 4097028 4098265 4013140 4011821 4013157 4090668 4093746 4092573 4011110 4010377 4093225 4094884 4010195 4010211 4096640 4030383 4030052 4030102 4098018 4092292 4094959 4094207 4010245 4010385 4080362 4095113 4094835 4016176 4050027 4095667 4095402 4094686 4090502 4020244 4094827 4095105 4010260 4013082 4090270 4010013 4012282 4013165 4010278 4094603 4092615 4092599

ASPERGILLUS AB AST (SGOT) AT3 ACTIVITY AT3 AG IMMUNOLOGIC B PERTUSSIS/PARAPERT DFA B PERTUSSIS/PARAPERT DFA BACTERIAL AG EA AG BACTERIAL AG EA AG BACTERIAL AG EA AG BARBITURATES SCRN BASIC METABOLIC PNL BENZODIAZEPINE SCRN BENZODIAZEPINES BENZODIAZEPINES BETA 2 GLYCOPROTN I AB EA BETA HCG QL BETA HCG QN BETA HCG QN BETA2 MICROGLOBULIN BILIRUBIN DIRECT BILIRUBIN NEONATAL BLD CNT RBC AUTO BLD SMR EXAM W MAN DIFF BLEEDING TIME TEST BLEEDING TIME TEST BORRELIA BURGD CONF BORRELIA BURGD CONF BORRELIA BURGD CONF BRUCELLA AB BUN C DIFFICILE TOXIN EIA C DIFFICILE TOXIN EIA C PEPTIDE C PEPTIDE C REACTIVE PROTEIN CA 125 CA 15 3 (27.29) CA 15 3 (27.29) CA 15 3 (27.29) CA 19 9 CALC ANALYSIS CHEM QN CALCITONIN CALCITONIN CALCIUM CALCIUM FLD CALCIUM IONIZED CALCIUM UR 24HR CALCIUM UR RAN CANNABINOID SCRN CARBAMAZEPINE TOTAL CARDIOLIPIN AB CARDIOLIPIN IGA AB CARDIOLIPIN IGG AB

6.17 37.00 19.00 26.00 20.00 125.00 142.00 42.00 8.00 48.00 297.00 48.00 16.50 37.00 23.15 272.00 434.00 11.00 22.50 37.00 39.00 5.04 215.00 197.00 197.00 10.66 20.29 60.10 13.00 37.00 171.00 171.00 21.50 16.00 104.00 164.00 14.00 28.90 15.00 15.30 44.00 27.50 27.50 39.00 135.00 10.00 167.00 138.00 48.00 330.00 19.50 23.14 23.14

0.00 21.00 0.00 0.00 0.00 36.00 56.00 0.00 0.00 11.00 163.00 11.00 0.00 0.00 0.00 56.00 116.00 0.00 0.00 21.00 21.00 0.00 23.00 93.00 0.00 0.00 0.00 0.00 0.00 21.00 65.00 0.00 0.00 0.00 37.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21.00 0.00 0.00 36.00 25.00 11.00 83.00 0.00 0.00 0.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

Page 62

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4092607 4095899 4093233 4095303 4093373 4096798 4090635 4090643 4030193 4030185 4030367 4010286 4050035 4050803 4030136 4030128 4030144 4030110 4098497 4055380 4055372 4098489 4094132 4090296 4094876 4096376 4096541 4096384 4094405 4096392 4098463 4096558 4081089 4090965 4096533 4081410 4095261 4081006 4010351 4013371 4016226 4010369 4093258 4098539 4098521 4096442 4055307 4094942 4010476 4010484 4030151 4091062 4098117

CARDIOLIPIN IGM AB CARDIOLIPIN IGM AB CARNITINE FREE & TOTAL CAROTENE CATECHOL FRAC PLAS CATECHOL FRAC PLAS CATECHOL FRAC UR CATECHOLAMINES TOTAL UR CBC AUTO CBC AUTO W AUTO DIFF WBC CBC AUTO W AUTO DIFF WBC CEA CEA CEA CELL CNT FLD W/ DIFF CELL CNT FLD W/ DIFF CELL CNT FLD W/ DIFF CELL CNT FLD W/O DIFF CELL MARKR TECH EA ADDL CELL MARKR TECH EA ADDL CELL MARKR TECH ONLY 1ST CELL MARKR TECH ONLY 1ST CENTROMERE AB SCRN CERULOPLASMIN CHLAMYDIA AB CHLAMYDIA AB IGA CHLAMYDIA AB IGG CHLAMYDIA AB IGG CHLAMYDIA AB IGM CHLAMYDIA AB IGM CHLAMYDIA AB IGM CHLAMYDIA AB IGM CHLAMYDIA AG DFA CHLAMYDIA CULT CHLAMYDIA PNEUMO AB CHLAMYDIA TRACH AMP PRB CHLAMYDIA TRACH AMP PRB CHLAMYDIA TRACH DIR PRB CHLORIDE CHLORIDE UR CHLORIDE UR TIM CHOLESTEROL CHOLINESTERASE RBC CHOLINESTERASE RBC CHOLINESTERASE SER CHRMOSOM CNT/KARY CHRMOSOM CNT/KARY CITRATE UR 24HR CK MB FRACTION CK TOTAL CLOT RETRACTION CMV AB CMV AB IGG

23.14 26.13 31.00 15.00 25.00 41.09 41.25 27.50 144.00 248.00 124.00 329.00 262.00 329.00 78.00 147.00 78.00 78.00 85.95 35.00 70.00 85.95 19.00 9.75 17.50 20.00 20.00 20.00 23.00 20.00 17.38 20.00 105.00 30.61 20.00 90.00 30.00 99.00 39.00 39.00 0.00 39.00 24.00 9.44 9.44 165.00 334.00 18.00 343.00 130.00 119.00 55.44 16.34

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 23.00 0.00 91.00 0.00 91.00 0.00 34.00 0.00 33.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 40.00 0.00 0.00 39.00 0.00 40.00 21.00 0.00 0.00 21.00 0.00 0.00 0.00 0.00 0.00 0.00 98.00 25.00 0.00 0.00 0.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

Page 63

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4095873 4098125 4095881 4096079 4095980 4010401 4013173 4095147 4094470 4095162 4096368 4094231 4096350 4096095 4055216 4040135 4040069 4096244 4098323 4051041 4051058 4098331 4091088 4011896 4040176 4040044 4092011 4040036 4090304 4020350 4050068 4050076 4093274 4096053 4050050 4050043 4096954 4098513 4098067 4098026 4098034 4098042 4098059 4098075 4016168 4010500 4010492 4016119 4093282 4010518 4012274 4096749 4096517

CMV AB IGG CMV AB IGM CMV AB IGM CMV AMP PRB CMV DNA QN CO2 (BICARBONATE) COCAINE SCRN COCCI AB COMP FIX COCCI IMMUNO DIFFUSION COCCI IMMUNO DIFFUSION COCCIDIOIDES AB COCCIDIOIDES AB COCCIDIOIDES AB COCCIDIOIDES AB CSF COLD AGGLUTININ TTR COMPATIBILITY TEST AHG COMPATIBILITY TEST IS COMPLEMENT C1 COMPLEMENT C3 COMPLEMENT C3 COMPLEMENT C4 COMPLEMENT C4 COMPLEMENT TOT (CH50) COMPR MET PNL COOMBS DIRECT C3 COOMBS DIRECT IG COOMBS DIRECT IG COOMBS DIRECT POLY COPPER COPPER CORTISOL (AM DRAW) CORTISOL (PM DRAW) CORTISOL FREE UR CORTISOL FREE UR CORTISOL TOTAL CORTISOL TOTAL CORTISOL TOTAL CORTISOL TOTAL COXSACKIE AB TYP B COXSACKIE AB TYP B COXSACKIE AB TYP B COXSACKIE AB TYP B COXSACKIE AB TYP B COXSACKIE AB TYP B C-REACTIVE PROTEIN HS CREATININE CREATININE CLEARANCE CREATININE FLD CREATININE FLD CREATININE UR 24HR CREATININE UR RAN CREATININE UR RAN CRYOGLOB QL OR SEMI QL

11.00 16.34 11.00 87.50 109.00 39.00 48.00 34.00 44.00 29.00 43.50 51.00 43.50 43.50 253.00 363.00 299.00 11.62 16.00 67.00 67.00 16.00 11.00 519.00 56.00 153.00 20.00 153.00 15.00 86.00 128.00 128.00 22.00 21.25 128.00 128.00 50.00 11.11 5.81 5.81 5.81 5.81 5.81 5.81 169.00 37.00 376.00 42.00 13.00 357.00 153.00 17.50 7.00

0.00 0.00 0.00 0.00 0.00 21.00 11.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21.00 21.00 0.00 0.00 285.00 30.00 32.00 0.00 32.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 53.00 21.00 72.00 0.00 0.00 65.00 25.00 0.00 0.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

Page 64

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4090205 4091229 4081097 4081345 4094538 4081402 4010641 4081253 4080305 4080214 4080503 4080180 4080016 4081246 4081220 4081048 4081071 4091070 4096830 4081063 4081105 4080024 4081113 4081030 4081022 4081147 4080529 4081139 4080222 4080321 4080230 4081162 4080354 4080040 4090973 4096418 4094546 4096574 4081212 4081170 4080339 4080271 4081188 4080263 4080461 4080479 4080545 4080164 4020103 4080453 4081238 4080537 4081352

CRYOGLOB QL OR SEMI QL CRYOGLOBULIN QN CRYPTO AG DFA CRYPTOCOCCAL AG AGGL CRYPTOSPORIDIUM CRYPTOSPORIDIUM AG EIA CRYSTALS FLD CULT ABCESS CULT BACT AEROBIC ID CULT BACT ANAEROBIC CULT BACT ANAEROBIC ID CULT BETA STREP A ONLY CULT BLD BACTERIA CULT BLD BACTERIA CULT BX CULT CAPD CULT CATHETER TIP CULT CMV CULT CMV CULT CSF CULT EAR CULT ENVIRONMENT CULT EYE CULT FLUID CULT FLUID (ANAEROBIC) CULT FUNGUS BLD CULT FUNGUS MOLD ID CULT FUNGUS OTHER SOURCE CULT FUNGUS OTHER SOURCE CULT FUNGUS YEAST ID CULT GC SCRN CULT GENITAL CULT GRP B STREP SCRN CULT H20 CULT HERPES CULT HSV CULT LEGIONELLA CULT LEGIONELLA CULT LOWER RESPIRATORY CULT MISC CULT MRSA SCRN CULT NOSE/THROAT CULT SCRN B PERTUSSUS CULT SPUTUM/BRONCH WASH CULT STL OTHER EA PLATE CULT STL OTHER EA PLATE CULT STL OTHER EA PLATE CULT STL SALM & SHIG CULT STL SALM & SHIG CULT STL SALM & SHIG CULT TISSUE (ANAEROBIC) CULT TYP AGGL CULT TYP BY NA PRB

6.77 18.00 27.00 122.00 25.00 54.00 211.00 238.00 53.00 312.00 131.00 125.00 295.00 238.00 238.00 238.00 238.00 57.83 20.00 238.00 238.00 12.00 238.00 238.00 271.00 146.00 53.00 146.00 171.00 53.00 115.00 238.00 100.00 47.00 27.73 21.00 56.00 30.00 108.00 238.00 138.00 219.00 238.00 240.00 105.00 105.00 96.00 306.00 25.00 306.00 238.00 131.00 144.00

0.00 0.00 24.00 0.00 0.00 34.00 43.00 49.00 17.00 64.00 0.00 36.00 71.00 49.00 49.00 49.00 49.00 0.00 0.00 49.00 49.00 0.00 49.00 49.00 61.00 46.00 0.00 46.00 50.00 17.00 39.00 49.00 81.00 33.00 0.00 0.00 0.00 0.00 33.00 49.00 109.00 50.00 49.00 49.00 0.00 0.00 0.00 69.00 0.00 0.00 49.00 0.00 0.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

Page 65

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CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4080289 4080313 4080347 4081261 4093308 4096756 4093134 4090676 4094249 4093316 4020160 4020012 4020061 4020384 4020368 4020004 4020020 4020038 4020053 4020079 4092094 4092037 4030003 4030417 4093324 4098455 4090692 4090700 4096970 4090718 4098000 4093357 4010559 4090783 4055414 4096269 4093365 4010112 4011854 4011862 4091344 4096327 4096897 4091351 4091336 4096301 4096491 4096319 4010583 4020343 4095527 4094157 4096624

CULT UR COLONY CT ONLY CULT UR ID ISOLATES CULT VRE SCRN CULT WND/ABSCESS ANAEROBE CYANIDE CYANIDE SCRN CYCLIC AMP CYCLOSPORINE (PROGRAF) CYSTICERCOSIS AB CYSTINE UR QN CYTO CL BLK 5 CNT/1 KARY CYTOLOGY FLD CYTOLOGY OTHER SOURCE CYTOLOGY PREP & INTERP CYTOLOGY SEL CELL ENHANCE CYTOLOGY SMR & FILTER CYTOLOGY SMR & FILTER CYTOLOGY SMR & FILTER CYTOLOGY SMR & FILTER CYTOLOGY UR CYTOTOXIC AB SCRN QUICK CYTOTOXIC AB SCRN STND D DIMER QN D DIMER SEMI QN/QL DELTA ALA DEOXYRIBNUCLEASE AB DESIPRAMINE DHEA DHEA DHEA SULFATE DIGITOXIN DIGITOXIN DIGOXIN DISOPYRAMIDE DNA CL CYCLE DNA DBL STRAND AB SCRN DOXEPIN DRG CONF DRG SCRN QL CHROM EA DRG SCRN QL CHROM EA EBV AB EARLY AG EBV AB EBNA EBV AB EBNA EBV AB EBNA EBV VCA AB IGG EBV VCA AB IGG EBV VCA AB IGM EBV VCA AB IGM ELECTROLYTE PNL FLD ELECTRON MICROSCOPY ENA AB ENA AB ENDOMYSIAL AB SCRN

153.00 50.00 52.00 238.00 28.00 35.99 45.00 32.10 50.00 49.00 188.00 260.00 157.00 118.00 118.00 266.00 125.00 207.00 206.00 211.00 120.00 200.00 197.00 50.00 28.00 33.51 18.25 25.00 20.00 12.00 57.00 22.00 376.00 15.00 170.00 11.62 22.00 135.00 358.00 235.00 28.90 9.69 38.00 38.00 25.49 9.69 12.00 9.69 148.00 649.00 36.00 27.00 43.00

39.00 17.00 40.00 49.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 83.00 0.00 0.00 0.00 0.00 41.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 82.00 0.00 0.00 0.00 0.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

Page 66

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4096459 4098547 4030201 4090338 4051124 4093399 4090734 4093407 4093415 4092623 4094892 4095691 4093423 4051223 4092896 4092631 4092730 4092748 4092763 4092672 4092938 4055356 4092649 4094678 4092904 4055265 4092912 4092656 4055273 4051116 4092664 4092920 4051215 4092862 4055349 4098372 4092870 4055281 4092680 4092946 4055315 4092698 4055364 4092953 4051140 4092961 4092706 4092714 4092979 4050084 4055257 4050811 4051157

ENDOMYSIAL AB SCRN EOSINOPHIL COUNT URINE EOSINPHILS SMR NASAL ERYTHROPOIETIN ESTRADIOL (E2) ESTRIOL ESTROGEN TOTAL ESTRONE ETHOSUXIMIDE EUGLOBULIN LYSIS FAT STL QL FAT STL QL FAT STL QN FCTR II FCTR II FCTR II FCTR INHIBITOR TEST FCTR INHIBITOR TEST FCTR INHIBITOR TEST FCTR IX FCTR IX FCTR IX FCTR V FCTR V FCTR V FCTR V FCTR VII FCTR VII FCTR VII FCTR VIII FCTR VIII FCTR VIII FCTR VIII VW FCTR VIII VW AG FCTR VIII VW AG FCTR VIII VW MULTIMER FCTR VIII VW MULTIMER FCTR X FCTR X FCTR X FCTR XA AB CHROMGN FCTR XI FCTR XI FCTR XI FCTR XII FCTR XII FCTR XII FCTR XIII FCTR XIII SCRN FERRITIN FETAL FIBRONECTIN FETAL FIBRONECTIN FETAL RBC SMR (K B)

43.00 20.75 26.00 20.43 169.00 17.00 26.00 27.00 17.10 41.40 14.63 16.45 44.80 109.00 127.50 78.00 110.00 117.00 114.30 67.50 127.50 96.60 49.00 92.45 127.50 107.00 127.50 59.00 107.00 281.00 45.00 127.50 121.00 59.00 102.46 187.75 69.00 109.00 59.00 127.50 97.40 49.00 96.60 127.50 109.00 127.50 49.00 40.00 50.00 108.00 382.00 7.00 101.00

0.00 0.00 0.00 0.00 37.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 133.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

Page 67

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4050878 4040143 4030169 4096673 4030177 4092722 4094710 4094165 4020392 4020111 4050092 4090361 4090866 4050894 4093449 4050100 4095956 4095063 4094934 4093183 4093597 4090379 4098364 4093175 4095279 4081428 4091013 4081154 4010682 4010674 4010666 4081055 4081394 4010757 4093456 4010690 4010716 4010765 4016150 4096582 4050308 4094702 4012134 4010740 4080057 4081451 4095311 4094397 4090080 4051017 4050985 4051009 4096848

FETAL RBC SMR (K B) FETAL SCRN ROSETTE FIBRIN DEGRAD PROD FIBRINOGEN QN FIBRINOGEN QN FIBRINOGEN QN FLECAINIDE FLUOR AB SCRN EA AB SCRN FNA ADEQUACY EVAL FNA INTERP & RPT FOLATE FOLATE RBC FREE T4 FREE T4 FRUCTOSAMINE FSH FTA ABS (TPPA) G6PD QN G6PD QN GANGLIOSIDE GMI AUTO AB GANGLIOSIDE GMI AUTO AB GASTRIN GBM AB GBM AB GC AMP PRB GC AMP PRB GC DIR PRB GC DIR PRB GENTAMICIN GENTAMICIN GGT GIARDIA AG DFA GIARDIA AG EIA GLUC PRENAT 50 GM SCRN GLUCAGON GLUCOSE GLUCOSE 2HR PP GLUCOSE FLD GLUCOSE UR QN GLUT ACID DECARB AUTO AB GLYCOHEMOGLOBIN GROWTH HORMONE GTT 2HR 1ST 3 SPEC GTT ADDED SAMPLE H PYLORI AB IGA H PYLORI STL EIA HANTAVIRUS AB HANTAVIRUS AB HAPTOGLOBIN QN HAV AB IGM HAV AB TOTAL HB CORE AB IGM HBE AB

73.00 106.00 197.00 15.00 184.00 15.00 20.10 30.00 243.00 38.00 108.00 19.90 19.90 121.00 10.25 135.00 8.85 0.00 14.00 50.00 26.00 15.00 42.00 42.00 30.00 90.00 21.12 93.00 380.00 380.00 138.00 97.00 54.00 37.00 25.00 37.00 46.00 142.00 128.00 69.00 75.00 12.50 63.00 26.00 11.00 110.00 25.00 48.00 10.00 76.00 47.00 96.00 10.00

0.00 0.00 49.00 0.00 37.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 39.00 0.00 35.00 0.00 0.00 25.00 17.00 34.00 0.00 0.00 21.00 0.00 29.00 0.00 0.00 0.00 0.00 51.00 0.00 0.00 110.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

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a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4091146 4091153 4095782 4050977 4050993 4097044 4050845 4094280 4013223 4094298 4093464 4090387 4030250 4096665 4030268 4096657 4096632 4098257 4092243 4093779 4094504 4092466 4092219 4092276 4095600 4095790 4094629 4094918 4092268 4092888 4016184 4011904 4050852 4092755 4090395 4093472 4020400 4093191 4094314 4016127 4016093 4097036 4094751 4096871 4050860 4094637 4055232 4091179 4092151 4092110 4051033 4051132 4092342

HBE AB Hbe AG HBE AG HBS AG HBS AG HBS AG NEUTRALIZATION HCV AB HCV AB CONF HDL CHOLESTEROL HDV (DELTA) AB HEAVY METALS BLD QN EA HEAVY METALS UR QN EA HEMATOCRIT HEMATOCRIT HEMOGLOBIN HEMOGLOBIN HEMOGLOBIN FRACTION QN HEMOGLOBIN FRACTION QN HEMOGLOBIN FRACTION QN HEMOGLOBIN PLAS HEMOLYSIN ACID (HAM'S) HEP B PCR QN HEP B PCR QN HEP B VIRUS BDNA QN HEP C VIRAL RNA GENOTYPE HEP C VIRUS BDNA QN HEP C VIRUS BDNA QN HEP C VIRUS PCR QN HEPARIN ASSAY HEPARIN ASSAY HEPATIC FUNCTION PNL HEPATIC FUNCTION PNL HEPATITIS PNL ACUTE HEXAGONAL PHASE NEUTRALIZ HGB ELECTRO HISTAMINE HISTO STAIN FRZN SECTION HISTONE AB HISTOPLAS AB HIV 1 AB HIV 1 AB HIV 1 QN BDNA HIV 1 QN PCR HIV 1 QN PCR ULTRA HIV 1/HIV 2 AB HIV 1/HIV 2 AB HIV 1/HIV 2 AB HLA B27 HLA TYP A B OR C MULT HLA TYP DR/DQ MULT HOMOCYSTINE HOMOCYSTINE HSV 1 AB IGG

15.10 11.00 10.00 65.00 65.00 43.20 120.00 66.00 36.00 25.00 75.00 30.00 71.00 5.04 71.00 5.04 5.04 30.00 15.40 14.65 42.50 355.00 104.98 81.12 145.35 92.86 135.66 94.35 76.50 82.00 173.00 275.00 143.00 46.73 11.05 67.00 50.00 20.00 40.50 74.00 238.00 113.05 76.30 84.15 74.00 8.75 56.00 25.00 400.00 300.00 124.00 61.00 21.46

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19.00 0.00 0.00 0.00 8.00 0.00 8.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 53.00 144.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 106.00 0.00 0.00 0.00 0.00 0.00 27.00 0.00 0.00 0.00 32.00 0.00 0.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

Page 69

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4091161 4095469 4098141 4095477 4098158 4092359 4092367 4095485 4094306 4098133 4098208 4095584 4091385 4094116 4093480 4091286 4095436 4092318 4093514 4091187 4095444 4091195 4097077 4092326 4097085 4093555 4093605 4092334 4091971 4095451 4091278 4090759 4094215 4098406 4096608 4096590 4098083 4051090 4096061 4091211 4091203 4094595 4094728 4095832 4020277 4020335 4020269 4020210 4080065 4081121 4095725 4094330 4081287

HSV 1 AB IGG HSV 1 AB IGG HSV 1 AB IGM HSV 2 AB IGG HSV 2 AB IGG HSV 2 AB IGG HSV AB HSV AB HSV AB HSV AB IGM HSV AB IGM HSV AMP PRB HTLV 1 AB HTLV II AB HYDROXYPROLINE TOTAL IGA IGA IGA IGD IGE IGG IGG IGG IGG IGG IGG SUBCLASSES IGG SUBCLASSES IGM IGM IGM IGM IMIPRAMINE IMMUNE COMPLEX CIQ BIND IMMUNOASSAY ANALYTE QN IMMUNOASSAY NONINFECT IMMUNOASSAY NONINFECT IMMUNOASSAY NONINFECT IMMUNOASSAY TUM AG EA IMMUNOASSAY TUM AG EA IMMUNOELCTRO IEP SER IMMUNOELCTRO IEP UR IMMUNOFIX SER IMMUNOFIX UR IMMUNOFIX UR IMMUNOFL STUDY DIRECT IMMUNOFL STUDY DIRECT IMMUNOFL STUDY DIRECT IMMUNOHISTOCHEMISTRY INDIA INK PREP CSF INDIA INK PREP CSF INFECT AGENT DETECT DFA INFLUENZA A AB INFLUENZA A DFA

28.50 15.20 16.34 15.20 16.34 21.47 21.47 15.20 41.00 16.34 24.10 109.25 25.00 51.25 109.00 40.00 8.00 7.00 21.00 3.12 8.00 40.00 8.90 7.00 8.90 44.00 33.00 7.00 40.00 8.00 8.00 22.00 16.25 234.00 14.25 14.25 13.00 169.00 29.00 22.00 41.58 89.00 30.25 16.37 306.00 449.00 388.00 110.00 112.00 146.00 19.05 16.00 122.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 48.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21.00 46.00 0.00 0.00 0.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

Page 70

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4081436 4081444 4094348 4081295 4094926 4094355 4020376 4020087 4010849 4010831 4094900 4094363 4096723 4093027 4010062 4080081 4095758 4010872 4010898 4090932 4092490 4090494 4090411 4096566 4096855 4094371 4093647 4098232 4050209 4094975 4016218 4012290 4010914 4010922 4092284 4091302 4095410 4096764 4092300 4092136 4092144 4010948 4016200 4016234 4096467 4093662 4095964 4095659 4096731 4093688 4090775 4095675 4051231

INFLUENZA AG A OR B EACH INFLUENZA AG A OR B EACH INFLUENZA B AB INFLUENZA B DFA INSULIN INSULIN ANTIBODIES INTERP BLD SMR INTERP BM SMR IRON IRON BINDING CAPACITY IRON LIVER TISSUE ISLET CL AB JO 1 AB KETOGENIC STEROIDS FX KETONES QN KOH PREP SKIN HAIR NAIL LA (SS B) AB LACTIC ACID LDH LDH ISOENZYMES LDL BY DIRECT MEASURE LEAD BLD LEGIONELLA AB LEGIONELLA AB LEGIONELLA PNEUMO DFA LEPTOSPIRA AN LEUCINE AMINOPEOTIDASE LEUK ALK PHOS LH LIDOCAINE LIPASE LIPASE LIPID PNL LITHIUM LYME DISEASE AB LYME DISEASE AB LYME DISEASE AB LYME DISEASE AB IGG WB LYME DISEASE AB IGM WB LYMPHOCYTOTOX TTR LYMPHOCYTOTOX TTR MAGNESIUM MAGNESIUM UR MAGNESIUM UR TIM MASS SPECT/TANDEM QN NES MERCURY MERCURY METANEPHRINES BLOOD METANEPHRINES UR METANEPHRINES UR METANEPHRINES UR 24HR METANEPHRINES UR 24HR METHOTREXATE

79.00 79.00 16.00 122.00 10.50 42.00 138.00 219.00 142.00 161.00 82.55 25.00 31.00 31.00 138.00 112.00 11.50 130.00 130.00 14.75 14.00 8.08 35.00 10.50 35.00 32.00 32.00 15.00 145.00 20.30 136.00 153.00 148.00 130.00 25.00 29.62 19.46 25.00 20.29 60.00 60.00 144.00 153.00 149.00 142.50 19.50 18.00 118.40 17.50 37.00 23.68 28.00 393.00

37.00 37.00 0.00 0.00 0.00 0.00 0.00 0.00 25.00 33.00 0.00 0.00 0.00 0.00 17.00 21.00 0.00 24.00 25.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 29.00 61.00 29.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 25.00 0.00 34.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 159.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

Page 71

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4095972 4050407 4050506 4050829 4094769 4098109 4091377 4095048 4013058 4013033 4013025 4013041 4091047 4098448 4096210 4095931 4092532 4096186 4095907 4094843 4096178 4098414 4095923 4092508 4095915 4096194 4098422 4095949 4096228 4092540 4098430 4092524 4092516 4080370 4091237 4094389 4096293 4094512 4091245 4095493 4092375 4095501 4092383 4098505 4080107 4093696 4095774 4090429 4013207 4093217 4095196 4096913 4093704

METHYLMALONIC ACID QN MICROALBUMIN UR 24HR MICROALBUMIN UR RAN MICROALBUMIN UR RAN MICROSOMAL AB MISC CHEM TEST MISC CHEM TEST MISC LAB PROC *1 MISC TS PROC MISC TS PROC MISC TS PROC MISC TS PROC MITOCHONDRIAL AB TTR MOL DX AMP PATIENT NA MOL DX AMP PT NA MULTIPLX MOL DX AMP PT NA MULTIPLX MOL DX AMP PT NA MULTIPLX MOL DX ENZ DIGESTION MOL DX ENZ DIGESTION MOL DX EXTRACTION MOL DX EXTRACTION HI PUR MOL DX EXTRACTION HI PUR MOL DX EXTRACTION HI PUR MOL DX EXTRACTION HI PUR MOL DX GEL ELECTRO SEP MOL DX GEL ELECTRO SEP MOL DX INTERP & RPT MOL DX INTERP & RPT MOL DX INTERP & RPT MOL DX INTERP & RPT MOL DX NUC ACID PRB MOL DX NUC ACID PRB MOL DX NUC ACID PRB MONO TEST SCRN MUMPS AB IGG MUMPS AB IGM MURAMIDASE MURAMIDASE MYCOPLAS AB MYCOPLAS AB IGG MYCOPLAS AB IGG MYCOPLAS AB IGM MYCOPLAS AB IGM MYCOPLAS CULT MYCOPLAS CULT MYELIN BASIC PROTEIN CSF MYOGLOBIN MYOGLOBIN UR NATRIURETIC PEPTIDE NATRIURETIC PEPTIDE NB GENETIC SCR GALACT NEURONAL AB (HU AB) SCRN NEURONTIN

31.49 82.00 82.00 82.00 9.35 14.50 0.00 0.00 138.00 46.00 34.00 138.00 11.00 49.88 28.26 22.00 25.57 28.26 22.00 186.91 28.26 11.97 22.00 23.11 22.00 28.26 13.96 22.00 28.26 23.11 11.97 25.57 25.57 161.00 22.85 17.25 18.00 43.00 52.00 15.00 22.10 15.00 22.10 24.15 47.00 19.00 26.50 15.00 458.00 73.00 15.40 75.00 25.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 40.00 29.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

Page 72

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4090809 4090791 4080388 4080115 4097093 4093720 4013181 4093738 4011011 4011029 4080248 4090437 4096483 4020046 4081303 4081311 4081329 4096822 4095709 4095717 4020095 4020129 4013199 4012035 4092474 4011045 4093761 4095188 4010567 4092581 4094611 4090445 4016143 4016135 4011052 4010021 4080123 4096335 4094660 4095733 4096087 4051199 4051165 4051207 4051173 4051181 4030219 4092771 4095550 4093795 4096525 4093803 4011078

NEWBORN SCRN PANEL NORTRIPTYLINE OCCULT BLD GASTRIC QL OCCULT BLD STL QL DIAG OLIGOCLONAL BANDS CSF OLIGOCLONAL BANDS CSF OPIATES SCRN ORGANIC ACIDS QN TOTAL OSMOLALITY SER OSMOLALITY UR OVA & PARASITES W CONC OXALATE UR OXYCARBAZEPINE PAP SCRN C/V MD INTERP PARAINFLUENZA TYP 1 FA PARAINFLUENZA TYP 2 FA PARAINFLUENZA TYP 3 FA PARVOVIRUS B 19 DNA PCR PARVOVIRUS B19 AB IGG PARVOVIRUS B19 AB IGM PATH CONSULT INTRAOP PATH FRZN SECTION 1 BLK PCP SCRN PH FLD PH FLD PHENOBARBITAL PHENYLALANINE BLOOD PHENYLALANINE BLOOD PHENYTOIN TOTAL PHOSPHOLIPID AB PHOSPHOLIPID AB PHOSPHOROUS UR RAN PHOSPHOROUS UR RAN PHOSPHOROUS UR RAN PHOSPHORUS (PO4) PHOSPHORUS UR 24HR PINWORM CELLOPHANE TAPE PLT AB DIR IGG PLT AB DRG INDUCED PLT AB HEPARIN PLT AB INDIRECT PLT AGGREGATION EA AGENT PLT AGGREGATION EA AGENT PLT AGGREGATION EA AGENT PLT AGGREGATION EA AGENT PLT AGGREGATION EA AGENT PLT CNT AUTO PLT NEUTRALIZATION PNEUMOCYSTIS CARINII DFA PORPHOBILINOGEN QN PORPHYRINS UR QN&FX PORPHYRINS UR QN&FX POTASSIUM

6.00 16.40 16.00 71.00 8.90 17.50 48.00 125.00 138.00 142.00 231.00 12.00 27.00 20.00 122.00 122.00 122.00 85.00 15.00 15.00 57.00 82.00 0.00 13.00 20.00 354.00 37.50 15.40 354.00 23.14 120.36 9.24 36.00 36.00 37.00 167.00 42.00 54.09 70.80 60.00 10.00 67.00 67.00 67.00 67.00 67.00 138.00 27.07 40.50 25.00 5.93 46.50 39.00

0.00 0.00 0.00 15.00 0.00 0.00 11.00 0.00 29.00 29.00 61.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 83.00 0.00 0.00 83.00 0.00 0.00 0.00 0.00 0.00 21.00 36.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 0.00 0.00 0.00 0.00 0.00 21.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

Page 73

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CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4012258 4016242 4093811 4093837 4090817 4011136 4093845 4051025 4093787 4096715 4050951 4092789 4093860 4090940 4095576 4096103 4090312 4095824 4096137 4096129 4050969 4092797 4092805 4096111 4012118 4095808 4011185 4011177 4095816 4012225 4012266 4096905 4092813 4030235 4092821 4055430 4095170 4055422 4050837 4011144 4093753 4090841 4096426 4092839 4030243 4092847 4030409 4093878 4094421 4094413 4095683 4090288 4093431

POTASSIUM UR 24 HR POTASSIUM UR TIM PREALBUMIN PREGNENOLONE PRIMIDONE PROCAINAMIDE & NAPA PROINSULIN PROLACTIN PROPHOBILINOGEN UR QL PROTEIN C ACTIVATED PROTEIN C ACTIVITY PROTEIN C AG PROTEIN ELECTRO CSF PROTEIN ELECTRO SER PROTEIN ELECTRO SER PROTEIN ELECTRO SER PROTEIN ELECTRO UR PROTEIN ELECTRO UR PROTEIN NEPHELOMET PROTEIN NEPHELOMET PROTEIN S ACTIVITY PROTEIN S AG TOTAL PROTEIN S FREE PROTEIN TOTAL BLOOD PROTEIN TOTAL BLOOD PROTEIN TOTAL BLOOD PROTEIN TOTAL CSF PROTEIN TOTAL FLD PROTEIN UR QN 24 HR PROTEIN UR QN 24 HR PROTEIN UR QN RAN PROTEIN WESTERN BLOT PROTHROMBIN TIME PROTHROMBIN TIME PROTHROMBIN TIME SUBT EA PSA FREE PSA FREE PSA TOTAL PSA TOTAL PSA TOTAL DIAG PTH C TERMINAL PTH INTACT PTH RELATED PROTEIN PTT PLAS OR WB PTT PLAS OR WB PTT SUBSTITUTION EA PTT SUBSTITUTION EA PYRUVATE BLD Q FEVER AB Q FEVER AB QN DRG MISC QN DRG MISC QN DRG MISC

167.00 149.00 9.75 36.50 22.85 376.00 126.00 169.00 21.50 45.00 171.00 35.00 71.00 18.00 14.25 5.00 34.00 16.37 5.00 5.00 198.00 35.00 91.00 5.00 133.00 16.37 142.00 39.00 16.37 167.00 142.00 75.00 7.86 165.00 26.10 75.00 20.19 89.00 278.00 262.00 39.00 14.25 55.00 6.77 176.00 20.00 94.75 15.00 30.00 30.00 47.14 100.50 36.00

36.00 34.00 0.00 0.00 0.00 91.00 0.00 37.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 24.00 0.00 29.00 21.00 0.00 36.00 25.00 0.00 0.00 25.00 0.00 0.00 0.00 0.00 77.00 77.00 0.00 0.00 0.00 0.00 32.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

Page 74

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CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4093613 4093654 4093852 4096921 4096939 4096343 4090536 4095204 4011227 4092565 4090031 4090049 4090023 4020228 4020251 4051108 4013116 4095741 4090858 4030284 4090015 4040085 4050704 4098307 4050605 4097010 4098315 4092987 4092854 4095766 4080412 4080396 4080404 4081196 4092177 4051082 4098174 4098166 4091369 4055240 4011342 4094652 4030292 4011474 4011367 4030391 4013009 4090650 4081337 4092045 4020319 4090064 4040168

QN DRG MISC QN DRG MISC QN DRG MISC QN DRG MISC QN DRG MISC QN DRG MISC QN DRG MISC QUINIDINE QUINIDINE RAPAMYCIN (SIROLIMUS) RBC PRETRTMT CHEM/DRG RBC PRETRTMT DENSITY GRAD RBC PRETRTMT ENZYME RECEPT ASSAY ESTROGEN RECEPT ASSAY PROGEST RECEPT ASSAY PROGEST RENAL FUNCTION PNL RENIN RENIN RETICULOCYTE MAN RH PHENOTYP COMPLETE RH TYP RHEUMATOID FCTR QL RHEUMATOID FCTR QN RHEUMATOID FCTR QN RIBOSOMAL P AB RIBOSOMAL P AB RISTOCETIN COFACTOR RISTOCETIN COFACTOR RO(SS A) AB ROTAVIRUS AG EIA RPR QL RSV AG EIA RSV DFA RUBELLA AB RUBELLA AB RUBELLA AB IGG RUBELLA AB IGM RUBEOLA AB RUSSELL VIPER VENOM DILU SALICYLATE SCLERODERMA AB SEDIMENTATION RATE MAN SEM MOT/CNT (NO HUHNER) SEMEN ANALYSIS COMPLETE SEMEN PRESENCE/MOT POST SEMEN PRESENCE/MOT POST SER BACTERICIDAL TTR SER BACTERICIDAL TTR SER PRETRTMT ABSORB SER PRETRTMT ABSORB SER PRETRTMT ABSORB SER PRETRTMT ABSORB

25.00 30.00 31.50 76.00 82.55 124.50 20.50 270.00 354.00 55.00 80.00 125.00 80.00 681.00 524.00 169.00 371.00 18.00 16.50 172.00 15.00 104.00 133.00 11.25 110.00 33.00 11.25 87.00 108.00 11.50 161.00 105.00 161.00 142.00 73.15 84.00 16.34 16.34 20.00 208.00 354.00 9.00 138.00 35.00 94.00 39.00 31.00 42.95 227.00 75.00 179.00 70.00 179.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 83.00 0.00 0.00 0.00 0.00 0.00 0.00 37.00 184.00 0.00 0.00 30.00 0.00 16.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 40.00 0.00 21.00 0.00 0.00 0.00 0.00 83.00 0.00 22.00 0.00 0.00 37.00 27.00 0.00 0.00 0.00 0.00 0.00 0.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

Page 75

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CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4092052 4096889 4093886 4096251 4030300 4030318 4030342 4030326 4030375 4092425 4092417 4091054 4081386 4080446 4030359 4080032 4081014 4080206 4011441 4011433 4096145 4096152 4096160 4012241 4011458 4093894 4080420 4080511 4011466 4010906 4011540 4020194 4020202 4080487 4081204 4098299 4094181 4020186 4020178 4020152 4020327 4020137 4020145 4081469 4080438 4080131 4080149 4055406 4055323 4055398 4055331 4093902 4093910

SER PRETRTMT INCUB/ DRG SEROTONIN BLD SEROTONIN BLD SJOGRENS AB SKIN TEST CANDIDA SKIN TEST COCCI SKIN TEST HISTO SKIN TEST MUMPS SKIN TEST TB SMITH AB SMITH AB SMOOTH MUSCLE AB SCRN SMR AFB STAIN SMR FLUOR + OR ACID FAST SMR GIEMSA SMR GRAM STAIN SMR INCL BODIES PARASITE SMR WET MOUNT SODIUM SODIUM FLD SODIUM OTHER SOURCE SODIUM OTHER SOURCE SODIUM OTHER SOURCE SODIUM UR 24HR SODIUM UR RAN SOMATOMEDIN C SPEC CONCENTRATION SPEC CONCENTRATION SPEC GRAVITY FLD SPEC HANDL LGL BLD ALC SPEC HANDL UR DRG SCRN SPEC STAIN GRP I MICROORG SPEC STAIN GRP II SPEC STAIN GRP II STREP GRP A AG EIA STRIATED MUSCLE AB SCRN STRIATED MUSCLE AB TTR SURG PATH LVL I SURG PATH LVL II SURG PATH LVL III SURG PATH LVL IV SURG PATH LVL V SURG PATH LVL V SUSCEPT BY E TEST SUSCEPT BY ENZYME DETECT SUSCEPT BY MIC SUSCEPT KB DISK <=12 T LMPH TOT CNT T LYMPH CD4 (HELPER) CNT T LYMPH CD4/8 CNT&RATIO T LYMPH CD4/8 CNT&RATIO T3 FREE T3 REVERSE

65.00 50.00 49.00 11.62 113.00 113.00 113.00 113.00 113.00 12.50 12.50 22.50 80.00 79.00 125.00 112.00 63.00 94.00 39.00 37.00 8.00 8.00 8.00 167.00 142.00 25.00 53.00 131.00 37.00 42.00 80.00 40.00 42.00 79.00 88.00 17.00 17.00 46.00 161.00 179.00 197.00 574.00 278.00 10.00 79.00 263.00 156.00 70.00 70.00 70.00 105.00 11.00 29.00

0.00 0.00 0.00 0.00 19.00 19.00 19.00 19.00 19.00 0.00 0.00 0.00 0.00 0.00 17.00 17.00 56.00 15.00 21.00 0.00 0.00 0.00 0.00 36.00 0.00 0.00 0.00 0.00 0.00 33.00 0.00 0.00 0.00 0.00 76.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 49.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

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CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4093928 4011581 4092557 4095006 4051074 4094819 4095097 4051066 4040150 4011508 4030227 4030334 4093936 4096707 4090882 4095543 4096277 4011490 4055299 4096434 4080495 4011524 4091260 4095840 4098182 4098190 4091310 4095857 4093951 4093969 4096509 4011557 4011565 4012191 4098216 4013215 4092235 4092227 4010039 4011599 4090486 4011607 4020293 4010047 4011672 4011656 4011706 4011714 4011649 4011276 4011680 4011664 4012209

T3 TOTAL T3 UPTAKE TACROLIMUS (FK506) TACROLIMUS (FK506) TACROLIMUS (FK506) TESTOSTERONE FREE TESTOSTERONE TOTAL TESTOSTERONE TOTAL THAWING PROD PER UNIT THEOPHYLLINE THROMBIN TIME THROMBIN TIME THYR BINDING GLOB (TBG) THYR STIM IG THYROGLOBULIN AB THYROGLOBULIN AB THYROID PEROXIDASE AB THYROXINE (T4) TISSUE CULT BM/BLD TISSUE CULT LYMPH TISSUE HOMOGENIZATION TOBRAMYCIN TOXOPLAS AB TOXOPLAS AB IGG TOXOPLAS AB IGG TOXOPLAS AB IGM TOXOPLAS AB IGM TOXOPLAS AB IGM TRANSFERRIN TRAZODONE (DESYREL) TRAZODONE (DESYREL) TRICYCLICS SER TRIGLYCERIDE TROPONIN I QN TRYPSIN TSH TSH TYROSINE UR NITROGEN UR 24HR UR NITROGEN UR RAN UR NITROGEN UR RAN URIC ACID URIC ACID FLD URIC ACID UR 24 HR URNALYSIS AUTO W/O MICRO URNALYSIS AUTO W/O MICRO URNALYSIS AUTO W/O MICRO URNALYSIS AUTO W/O MICRO URNALYSIS AUTO W/O MICRO URNALYSIS AUTO W/O MICRO URNALYSIS AUTO W/O MICRO URNALYSIS AUTO W/O MICRO URNALYSIS MAN W/ MICRO

10.00 147.00 49.88 83.25 169.00 21.80 48.00 169.00 37.00 354.00 179.00 179.00 18.25 71.25 19.75 8.00 8.27 139.00 334.00 165.00 53.00 380.00 24.65 8.75 16.34 16.34 3.12 8.75 11.00 32.00 24.00 183.00 39.00 300.00 45.31 14.00 15.40 15.40 167.00 31.00 9.24 138.00 138.00 167.00 13.00 13.00 13.00 37.00 37.00 22.00 35.00 13.00 120.00

0.00 0.00 0.00 0.00 80.00 0.00 0.00 32.00 0.00 89.00 29.00 18.00 0.00 0.00 0.00 0.00 0.00 36.00 0.00 0.00 0.00 89.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21.00 269.00 0.00 0.00 0.00 0.00 36.00 0.00 0.00 25.00 25.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB

Page 77

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CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

4011631 4013363 4013124 4011722 4011730 4093993 4091294 4010435 4098398 4096400 4098380 4090981 4096863 4092193 4094009 4094017 4050019 4094025 4090890 4096780 4090916 4096772 4090908 4094058 4094066 4090924 4094777 4095865 4096699 4096806 4096814 4094074 1103332 1103308 1103324 1103357 1103373 1103316 1103431 1103423 1103407 1103415 6230056 6120117 6120026 6120125 6120083 6120109 6120000 6120091 6120182 6120216 6120208

URNALYSIS MAN W/O MICRO URNALYSIS SGL ASSAY URNALYSIS VOL MEASURE VALPROIC ACID VANCOMYCIN VASOACT INTEST PEPT (VIP) VDRL CSF QL VENIPUNCTURE VIRUS AB NOT SPEC VIRUS AB NOT SPEC VIRUS AB NOT SPEC VIRUS CULT ID VIRUS CULT SHELL VIAL VISCOSITY VITAMIN A VITAMIN B1 (THIAMINE) VITAMIN B12 VITAMIN B12 BINDING CAP VITAMIN B6 VITAMIN D (125 DI HYDROX) VITAMIN D (125 DI HYDROX) VITAMIN D 25HYDROXY VITAMIN D 25HYDROXY VITAMIN E VITAMIN K VMA UR VZV AB VZV AB IGM WBC CNT AUTO WEST NILE VIRUS AB IGG WEST NILE VIRUS AB IGM ZINC S NSTRL CAST CYLINDER S NSTRL CAST LONG ARM S NSTRL CAST LONG LEG S NSTRL CAST PTB S NSTRL CAST SHORT ARM S NSTRL CAST SHORT LEG S NSTRL SPLINT APP LONG L S NSTRL SPLINT APP SHORT S NSTRL SPLINT LONG ARM S NSTRL SPLINT/APP SHORT CIRCUMCISION CERCLAGE, VAGINAL DELIVERY VAGINAL LEVEL 1 DELIVERY VAGINAL LEVEL 2 EXTERNAL VERSION INJ BLOOD PATCH LABOR LEVEL 1 / HR-IP LABOR LEVEL 2 / HR-IP NST (NON-STRESS TEST) NST MULTI GEST NST MULTI GEST

94.00 13.00 0.00 298.00 354.00 49.00 6.00 16.00 37.50 42.56 37.50 30.00 20.00 15.00 15.77 38.00 119.00 15.00 28.00 27.59 35.00 27.60 20.19 15.75 60.00 20.62 24.07 12.50 10.00 28.00 28.00 12.00 270.00 304.00 344.00 363.00 417.00 210.00 574.00 287.00 383.00 287.00 217.00 767.00 2870.00 4305.00 489.00 767.00 91.00 142.00 405.00 810.00 608.00

19.00 0.00 0.00 0.00 90.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 11 11 11 11 11 11 11 11 11 11 62 61 61 61 61 61 61 61 61 61 61

LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB MISC NURSING CHARGES (TRA MISC NURSING CHARGES (TRA MISC NURSING CHARGES (TRA MISC NURSING CHARGES (TRA MISC NURSING CHARGES (TRA MISC NURSING CHARGES (TRA MISC NURSING CHARGES (TRA MISC NURSING CHARGES (TRA MISC NURSING CHARGES (TRA MISC NURSING CHARGES (TRA NEONATAL/NEWBORN SERVICES OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP

Page 78

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CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

6140370 6130132 6130124 6140305 6140214 6140065 6140347 6140032 6140339 6140008 6140206 6140388 6140297 6140073 6140016 6140354 6140172 6140123 6140230 6140248 6140164 6140149 6140131 6140198 6140289 6140255 6140156 6140222 6140081 6140263 6140180 6140099 6140115 6140107 6140271 6140321 6140040 6140313 6140057 6140024 6140362 6130116 6130108 6120059 6130140 6130025 6130017 6130041 6130033 6130066 6130058 6120174 6010086

PULSE OXIMETRY-SINGLE REG ADD 15M REG FIRST 30M S STRL AMNIHOOK S STRL BOVIE PENCIL DISPO S STRL CATH UMBILICAL S STRL ELECTRODE FETAL SP S STRL KIT BREAST PUMP S STRL NEEDLE FERGUSON S STRL NEEDLE SPINAL 25G S STRL NEEDLE SPINAL WHIT S STRL NIPPLE SHIELD S STRL NURSE SYS SUPPLMNT S STRL PAD GROUND PT S STRL STAPLE SKIN 35W S STRL STRAP FETAL MONITO S STRL SUTURE 0 GS21 POLY S STRL SUTURE 0 GS24 POLY S STRL SUTURE 0 POLY TIES S STRL SUTURE 2-0 CHROMIC S STRL SUTURE 2-0 GS21 PO S STRL SUTURE 2-0 GS-24 P S STRL SUTURE 2-0 GS-25 P S STRL SUTURE 2-0 POLYSOR S STRL SUTURE 2-0 V20 POL S STRL SUTURE 3-0 CHROMIC S STRL SUTURE 3-0 GS21 PO S STRL SUTURE 3-0 POLY TI S STRL SUTURE 3-0 POLYSOR S STRL SUTURE 4-0 CHROMIC S STRL SUTURE 4-0 P12 POL S STRL SUTURE 4-0 POLYSOR S STRL SUTURE BIOSYN 0 GS S STRL SUTURE GEN CL TAPE S STRL SUTURE GI SINGLE S STRL TRANDUCER INTERUTE S STRL TRAY EPIDURAL S STRL TRAY PUDENDAL ANES S STRL TRAY SPINAL W/DRUG S STRL VACUUM EXTRACTOR STATISTICAL TRACKING STND GENRL ANES ADD 15M STND GENRL ANES FIRST 30M STND PACU LVL 1 ADD 15M STND PACU LVL 1 FIRST 30M SURG LVL 1 ADD 15M SURG LVL 1 FIRST 30M SURG LVL 2 ADD 15M SURG LVL 2 FIRST 30M SURG LVL 3 ADD 15M SURG LVL 3 FIRST 30M TRANSFUSION SRV FETAL AMNIOCENTESIS DX

110.00 39.00 79.00 65.00 179.00 426.00 34.00 46.06 63.00 167.00 188.00 15.00 525.00 181.00 290.00 12.00 101.00 101.00 102.00 90.00 101.00 101.00 101.00 215.00 90.00 90.00 101.00 102.00 101.00 90.00 257.00 101.00 101.00 101.00 90.00 183.00 416.00 403.00 416.00 291.00 0.00 275.00 551.00 217.00 433.00 767.00 1534.00 1003.00 2006.00 1140.00 2962.00 0.00 1170.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 60

OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - IP OB/GYN SERVICES - OP

Page 79

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CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

6020135 6020143 6020366 6020150 6020010 6020374 6020168 6020176 6020317 6020325 6020184 6020192 6020267 6020218 6020275 6020226 6020283 6020234 6020291 6020242 6020309 6020259 6020382 6020358 6020028 6020390 6010045 6050009 6010037 6020077 6020200 6041008 6040000 1230010 1230127 1230028 1230036 1230044 1230101 1230069 1230051 1230077 1230085 1230002 1230093 1230119 1260033 1260041 1260066 1260017 1260025 1260009 1260074

CERCLAGE, VAGINAL CORDOCENTESIS CST (CONTRAC STRESS TEST) CST (CONTRAC STRESS TEST) CST (CONTRAC STRESS TEST) CST (CONTRAC STRESS TEST) EXTERNAL VERSION GLUCOSE FINGERSTICK INFSN W-W/O MED 0-60 MN INFSN W-W/O MED EA ADD HR INJECTION IM/SQ EA INJECTION IV EA LEVEL 1 EST PATIENT LEVEL 1 NEW PATIENT LEVEL 2 EST PATIENT LEVEL 2 NEW PATIENT LEVEL 3 EST PATIENT LEVEL 3 NEW PATIENT LEVEL 4 EST PATIENT LEVEL 4 NEW PATIENT LEVEL 5 EST PATIENT LEVEL 5 NEW PATIENT NST (NON-STRESS TEST) NST (NON-STRESS TEST) NST (NON-STRESS TEST) NST MULTI GEST OBSERVATION PER HOUR OBSERVATION PER HOUR OBSERVATION PER HOUR OCT (OXYTOCIN CHLNG TEST) PULSE OXIMETRY-SINGLE S STRL RESUS NEONATL DISP S STRL STRAP FETAL MONITO RO CONSULT CONT MED PHYSC RO DOSIMETRY SPECIAL RO IMRT DLVR EA SESSION RO IMRT DLVR EA SESSION RO ISODOSE PLAN SMPL RO RAD PORT FILM(S) RO RAD TX 2 AREA 1-5MEV RO RAD TX 3/MORE 1-5MEV RO RAD TX SNGL 1-5MEV RO RAD TX SUPERFICIAL RO RADIAT DOSIMETRY CALC RO RADIATION PHYSICS CNSL RO SIMULATION SMPL S STRL MAMMOTOME 11 GAUGE S STRL MAMMOTOME 11 PROBE S STRL MAMMTM VAC CAN DSP S STRL NDL BREAST20X2.5IN S STRL NDL BREAST20X3.5 S STRL NDL BREAST2OX1.5IN S STRL TISSUE MARKER

767.00 767.00 461.00 489.00 414.00 461.00 489.00 37.00 131.00 99.00 118.00 65.00 105.00 99.00 116.00 116.00 126.00 119.00 139.00 139.00 154.00 154.00 573.00 382.00 405.00 764.00 96.00 164.00 337.00 626.00 110.00 1029.00 11.00 405.00 498.00 0.00 0.00 717.00 552.00 364.00 426.00 301.00 271.00 1188.00 829.00 649.00 1167.00 1395.00 37.00 94.00 96.00 96.00 540.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12

OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP OB/GYN SERVICES - OP ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES ONCOLOGY SERVICES

Page 80

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9168907 9168923 9197385 9189200 9107426 9107798 9179698 9128281 9128299 9100124 9137001 9179706 9100025 9128307 9100082 9155003 9155011 9155029 9159047 9100132 9100140 9310012 9100157 9170101 9173923 9113358 9173865 9187568 9168162 9100033 9179714 9169012 9305616 9100165 9187519 9174269 9174277 9174285 9112871 9195009 9195017 9132002 9179417 9132184 9100199 9100207 9173014 9103185 9310533 9151093 9107319 9100710 9108754

A & D OINT UD PACKET $0.00 A & D OINTMENT 45GM $0.00 ABACAVIR 300MG TABLET $26.88 ABCIXIMAB 2MG/ML INJ $1,181.80 ACARBOSE 50MG TABLET $14.11 ACEBUTOLOL 200MG CAPSULE $14.73 ACETAMINOPHEN 100MG/ML DROPS 15ML$0.00 ACETAMINOPHEN 120MG SUPP $0.00 ACETAMINOPHEN 325MG SUPP $0.00 ACETAMINOPHEN 325MG TABLET $0.00 ACETAMINOPHEN 325MG/10.15ML CUP $0.00 ACETAMINOPHEN 32MG/ML LIQ 120ML $0.00 ACETAMINOPHEN 500MG TABLET $0.00 ACETAMINOPHEN 650MG SUPP $0.00 ACETAMINOPHEN 80MG CHEW TAB $0.00 ACETAMINOPHEN/CODEINE 300/15MG TAB26.05 $ ACETAMINOPHEN/CODEINE 300/30MG TAB26.09 $ ACETAMINOPHEN/CODEINE 300/60MG TAB26.72 $ ACETAMINOPHEN/CODEINE LIQ 5ML UDCUP $26.36 ACETAZOLAMIDE 125MG TABLET $13.40 ACETAZOLAMIDE 250MG TABLET $13.59 ACETAZOLAMIDE 500MG INJ $95.88 ACETAZOLAMIDE SR 500MG CAPSULE $15.52 ACETIC ACID 0.25% IRRIG. 1000ML $31.60 ACETIC ACID 2% OTIC SOLN 15ML $45.44 ACETOHYDROXAMIC 250MG TAB $14.78 ACETYLCHOLINE 1% OP SOLN 2ML $96.94 ACETYLCYSTEINE 20% SOLN 30ML $55.06 ACID MANTLE CREAM 120GM $45.12 ACYCLOVIR 200MG CAPSULE $14.96 ACYCLOVIR 40MG/ML SUSP 120ML $80.95 ACYCLOVIR 5% OINTMENT 15GM $189.26 ACYCLOVIR 500MG INJ $199.76 ACYCLOVIR 800MG TABLET $21.15 ADENOSINE 6MG/2ML INJ $132.76 ADVAIR 100/50 DISKUS #28 DISKS $183.52 ADVAIR 250/50 DISKUS #28 DISKS $220.52 ADVAIR 500/50 DISKUS #28 DISKS $299.82 ALBENDAZOLE 200MG TABLET $15.59 ALBUMIN (HUMAN) 5% INJ 500ML $686.40 ALBUMIN 25% INJ 50ML $461.90 ALBUTEROL 0.083% 2.5MG/3ML INH $15.14 ALBUTEROL 0.4MG/ML SYRUP 120ML $41.06 ALBUTEROL 2.5MG/0.5ML INH $14.52 ALBUTEROL 2MG TABLET $13.36 ALBUTEROL 4MG TABLET $13.66 ALBUTEROL INHALER 17GM $68.26 ALBUTEROL SR 4MG TABLET $14.90 ALCOHOL (ETHYL) DEHYD. 98% AMPUL $118.02 ALCOHOL 10% /DEXTROSE 5% IV SOLN $123.84 ALENDRONATE 10MG TABLET $17.62 ALENDRONATE 35MG TABLET $47.01 ALENDRONATE 5MG TABLET $17.62

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 93 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 81

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9108762 9163486 9103268 9113325 9100231 9100249 9170200 9155052 9155045 9310004 9193012 9193038 9100256 9178245 9100264 9168964 9189218 9305004 9100272 9147901 9147745 9147752 9147760 9147778 9100280 9310020 9310038 9310541 9100215 9183427 9100298 9100306 9100314 9105040 9174095 9168246 9137324 9100330 9100348 9178021 9305939 9306317 9305012 9306242 9305376 9306267 9100363 9305046 9305384 9100371 9305368 9179656 9306408

ALENDRONATE 70MG TABLET $47.01 ALFENTANIL 1000MCG/2ML INJ $93.82 ALKA-SELTZER GOLD EFF TABLET $0.00 ALLBEE PLUS VIT C TABLET $0.00 ALLOPURINOL 100MG TABLET $13.17 ALLOPURINOL 300MG TABLET $13.94 ALOE VESTA 2-N-1 OINT 56GM $32.70 ALPRAZOLAM 0.25MG TABLET $26.71 ALPRAZOLAM 0.5MG TABLET $26.96 ALPROSTADIL 500MCG/ML INJ $300.88 ALTEPLASE (TPA) 1MG/ML INJ $159.51 ALTEPLASE 50MG VIAL $2,989.26 ALUMINUM HYDROX 400MG CAP $0.00 ALUMINUM HYDROXIDE GEL $0.00 AMANTADINE 100MG CAPSULE $13.92 AMERICAINE OINTMENT 30GM $0.00 AMIFOSTINE 500MG INJ $1,055.39 AMIKACIN 500MG/2ML INJ $170.28 AMILORIDE 5MG (MIDAMOR) TABLET $13.67 AMINO ACIDS - HBC 7% IV SOLN $198.72 AMINO ACIDS 10% IV SOLN $99.12 AMINO ACIDS 7% IV SOLN $96.64 AMINO ACIDS 8% IV SOLN $306.62 AMINO ACIDS-RF 5.2% IV SOLN $115.64 AMINOCAPROIC ACID 500MG TABLET $16.20 AMINOCAPROIC ACID 5GM/20ML INJ $105.12 AMINOPHYLLINE 250MG/10ML INJ $103.38 AMIODARONE 150MG/3ML INJ $313.18 AMIODARONE 200MG TABLET $18.66 AMITRIPTYLINE 100MG/10ML INJ $76.20 AMITRIPTYLINE 10MG TABLET $13.08 AMITRIPTYLINE 25MG TABLET $13.45 AMITRIPTYLINE 50MG TABLET $14.02 AMLODIPINE (NORVASC) 5MG TABLET $15.62 AMMONIA AROMATIC AMPUL $13.34 AMMONIUM LACTATE 12% LOT 400GM $158.78 AMOXICILLIN 200MG/5ML UD SUSP $29.44 AMOXICILLIN 250MG CAPSULE $13.25 AMOXICILLIN 500MG CAPSULE $13.70 AMOXICILLIN 50MG/ML SUSP 150ML $39.60 AMPHOTERICIN B INJ $141.52 AMPHOTERICIN B LIPID CMPLX (ABELCET) INJ $155.62 AMPHOTERICIN B LIPOSOME (AMBISONE) INJ $494.26 AMPICILLIN 125MG INJ $104.92 AMPICILLIN 1GM INJ $105.59 AMPICILLIN 1GM/50ML NS (FBC) $103.76 AMPICILLIN 250 MG CAPSULE $13.19 AMPICILLIN 250MG INJ $103.01 AMPICILLIN 2GM INJ $107.19 AMPICILLIN 500MG CAPSULE $13.52 AMPICILLIN 500MG INJ $105.34 AMPICILLIN 50MG/ML SUSP 100ML $39.52 AMPICILLIN SYRINGE in NS $114.16

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 93 93 93 91 91 91 91 91 91 91 91 91 91 91 91 93 93 93 93 93 93 91 93 93 91 93 91 93

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 82

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9305954 9108598 9168055 9107285 9310780 9186107 9186123 9128018 9168097 9128315 9174301 9173030 9170176 9112871 9178047 9113366 9100389 9310053 9316118 9168428 9128265 9109414 9128273 9100058 9100652 9102468 9113291 9100405 9100397 9187865 9106071 9108580 9179813 9183591 9189481 9173063 9187758 9187022 9100462 9178716 9100447 9178062 9107715 9173709 9100421 9172040 9100470 9174608 9113820 9112871 9178732 9305913 9305020

AMPICILLIN/SULBACTAM 3GM INJ $132.47 ANAGRELIDE 0.5MG CAPSULE $24.07 ANALGESIC BALM OINT 30GM $0.00 ANASTROZOLE 1MG TABLET $27.30 ANTITHROMBIN 3 INJ $257.16 ANTIVENIN(LATRODECTUS) INJ $115.68 ANTIVENIN,CROTALIDAE (SNAKE) INJ $2,200.88 ANUSOL HC 25MG SUPP $14.60 ANUSOL OINTMENT $0.00 ANUSOL SUPPOSITORY $0.00 APRACLONIDINE 0.5% OP SOLN 5ML $150.44 APRACLONIDINE 1% OP SOLN 0.1ML $66.94 AQUAPHOR OINTMENT 60GM $30.06 ARIPIPRAZOLE 5MG TABLET $34.67 ASCORBIC ACID 100MG/ML DROPS 50ML $62.86 ASCORBIC ACID 500MG CHEW TAB $0.00 ASCORBIC ACID 500MG TABLET $0.00 ASCORBIC ACID 500MG/2ML INJ $106.00 ASPARAGINASE 10,000 UNITS INJ $577.02 ASPERCREME 10% 90GM $32.02 ASPIRIN 300MG SUPP $0.00 ASPIRIN 325MG TABLET $0.00 ASPIRIN 600MG SUPP $0.00 ASPIRIN 81MG CHEW TABLET $0.00 ASPIRIN BUFFERED 325MG TABLET $0.00 ASPIRIN EC 325MG TABLET $0.00 ASPIRIN EC 81MG TABLET $0.00 ATENOLOL 25MG TABLET $13.93 ATENOLOL 50MG TABLET $14.50 ATENOLOL 5MG/10ML INJ $67.64 ATORVASTATIN 10MG TABLET $17.34 ATORVASTATIN 20MG TABLET $19.95 ATOVAQUONE 750MG/5ML LIQ 120ML $869.60 ATRACURIUM 100MG/10ML INJ $163.66 ATROPINE 0.4MG/1ML INJ $51.76 ATROPINE 1% OPHTH SOLN 15ML $34.36 ATROPINE 1MG/10ML SYRINGE $56.14 ATROPINE 1MG/1ML INJ $51.86 AUGMENTIN 250MG TABLET $18.58 AUGMENTIN 400MG/5ML SUSP 75ML $129.48 AUGMENTIN 500MG TABLET $21.34 AUGMENTIN 50MG/ML SUSP 150ML $183.88 AUGMENTIN 875MG TABLET $24.22 AURALGAN OTIC SOLN 15ML $31.60 AURANOFIN 3MG CAP $18.40 AVITENE 1GM SHEET $230.20 AZATHIOPRINE 50MG TABLET $15.60 AZELASTINE 137MCG NASAL SPRAY 34ML $144.58 AZITHROMYCIN 250MG TABLET $27.37 AZITHROMYCIN 40MG/ML SUSP 15ML $87.46 AZITHROMYCIN 40MG/ML SUSP 30ML $87.46 AZITHROMYCIN 500MG INJ $153.73 AZTREONAM 1GM INJ $142.94

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

93 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 93 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 93

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 83

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9305038 9112871 9305053 9169855 9173097 9172057 9169947 9100512 9168980 9100686 9112871 9112871 9112871 9112871 9112871 9112871 9112871 9112871 9112871 9168154 9175050 9173121 9173105 9175068 9173113 9174749 9174806 9100538 9100546 9100520 9170440 9173683 9168956 9182114 9170184 9170010 9175076 9100587 9100553 9100561 9189473 9132127 9169079 9168543 9183609 9168972 9169061 9169053 9173089 9100603 9100611 9100595 9187063

AZTREONAM 2GM INJ $183.92 B COMPLEX W/VITAMIN C TABLET $12.85 BACITRACIN 50,000 UNITS INJ $125.52 BACITRACIN OINT 30GM $31.42 BACITRACIN OPHTH OINT 3.5GM $33.34 BACITRACIN/POLYMYXIN B OINT PKT $13.10 BACITRACIN/POLYMYXIN OINT 30GM $33.04 BACLOFEN 10MG TABLET $13.51 BAG BALM OINTMENT 300GM $0.00 BARIUM SULFATE 9.5GM PACKET $25.44 BB UNLISTED DRUG $0.00 BBATROPINE 0.4MG/ML 20ML VIAL $53.88 BBGLYCOPYRROLATE 0.2MG/ML 20ML INJ $86.48 BBINSULIN HUMAN 70/30 $0.00 BBINSULIN HUMAN LENTE $0.00 BBINSULIN HUMAN REGULAR $0.00 BBINSULIN NPH HUMAN $0.00 BBINSULIN, LISPRO $0.00 BBNACL 0.9% 10ML VIAL #25 $0.00 BECAPLERMIN 0.01% GEL 15GM $1,026.66 BECLOMETHASONE 40MCG ORAL INH 7.3GM $120.12 BECLOMETHASONE 42MCG NASAL INHALER $139.64 BECLOMETHASONE 42MCG ORAL INHALER $126.45 BECLOMETHASONE 80MCG ORAL INH 7.3GM $144.70 BECLOMETHASONE AQ 42MCG NASAL SPY $153.56 BECLOMETHASONE AQ 84MCG NASAL SPY $140.88 BECLOMETHASONE DS 84MCG ORAL INHALER $132.10 BENAZEPRIL 10MG TABLET $14.76 BENAZEPRIL 20MG TABLET $14.76 BENAZEPRIL 5MG TABLET $14.76 BENGAY OINTMENT 57GM $32.52 BENOXINATE/FLUORESCEIN OP SOLN 15ML $48.32 BENZALKONIUM CHLOR 1:750 SOL $57.66 BENZOCAINE 10% DENTAL GEL 5.3GM $32.04 BENZOCAINE 20% (DERMOPLAST) SPRAY $0.00 BENZOCAINE 20% (HURRICAINE) GEL $30.40 BENZOCAINE 20% OTIC DROPS 15ML $50.22 BENZONATATE 100MG CAPSULE $14.63 BENZTROPINE 0.5MG TABLET $13.15 BENZTROPINE 1MG TABLET $13.20 BENZTROPINE 2MG/2ML INJ $67.32 BERACTANT INTRATRACHEAL SUSP $1,622.68 BETAMETHASONE DP 0.05% CRM 15GM $40.44 BETAMETHASONE DP 0.05% OINT 15GM $40.44 BETAMETHASONE SOLU 6MG/ML INJ $103.24 BETAMETHASONE VAL 0.1% CRM 15GM $35.34 BETAMETHASONE VAL 0.1% LOT 60ML $50.04 BETAMETHASONE VAL 0.1% OINT 15GM $35.96 BETAXOLOL S 0.25% OPSOL $95.94 BETHANECHOL 10MG TABLET $15.10 BETHANECHOL 25MG TABLET $15.89 BETHANECHOL 5MG TABLET $13.99 BETHANECHOL 5MG/1ML INJ $62.12

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

93 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 84

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9316613 9197104 9306515 9137019 9112871 9113457 9112771 9128323 9100637 9100629 9178534 9103623 9113341 9108440 9316027 9173139 9189507 9310061 9174616 9174251 9100645 9173188 9132085 9174343 9187089 9107020 9183625 9183807 9183526 9183054 9183054 9183567 9112871 9183476 9183476 9183047 9189408 9189663 9187659 9189515 9113853 9101916 9107681 9107699 9100660 9128430 9182023 9310558 9187071 9108606 9168527 9187576 9169871

BEVACIZUMAB 400MG/16ML INJ $5,945.20 BICALUTAMIDE 50MG TABLET $39.73 BICILLIN CR 600,000U/ML INJ $73.28 BICITRA SOLN 30ML UDCUP $26.66 BIMATOPROST 0.03% OP SOL 2.5ML $149.64 BIRTH CONTROL PILL $17.77 BIRTH CONTROL PILLS (PT OWN) $0.00 BISACODYL 10MG SUPP $0.00 BISACODYL EC 5MG TABLET $0.00 BISMUTH SUBSALICYLATE CHEW TABLET $0.00 BISMUTH SUBSALICYLATE SUSP 240ML $0.00 BISOPROLOL 10MG/HCTZ 6.25MG TAB $15.00 BISOPROLOL 2.5MG/HCTZ 6.25MG TAB $15.43 BISOPROLOL 5MG/HCTZ 6.25MG TAB $15.43 BLEOMYCIN 15 UNITS INJ $1,056.76 BLEPHAMIDE 0.2% OP SOLN 5ML $99.86 BOTULINUM TOX TYPE A INJ $1,030.88 BRETYLIUM 500MG/10ML INJ $95.76 BRIMONIDINE 0.15% OP SOLN 5ML $101.62 BRINZOLAMIDE 1% OP SOLN 5ML $84.70 BROMOCRIPTINE 2.5MG TABLET $18.20 BSS OPHTH SOLN 30ML $44.68 BUDESONIDE 0.5MG/2ML RESPULE $21.88 BUDESONIDE 200MCG TURBUHALER $307.22 BUMETANIDE 0.5MG/2ML INJ $54.26 BUMETANIDE 1MG TABLET $13.54 BUMETANIDE 2.5MG/10ML INJ $63.38 BUPIVACAINE 0.25% INJ 10ML $56.30 BUPIVACAINE 0.25% INJ 30ML $62.35 BUPIVACAINE 0.25% W/EPI INJ 30ML $59.36 BUPIVACAINE 0.25% W/EPI INJ 30ML $65.50 BUPIVACAINE 0.5% INJ 30ML $54.82 BUPIVACAINE 0.5% 10ML INJ $57.14 BUPIVACAINE 0.5% W/EPI INJ 30ML $56.92 BUPIVACAINE 0.5% W/EPI INJ 30ML $65.94 BUPIVACAINE 0.75% INJ 30ML $59.56 BUPIVACAINE 0.75% W/EPI INJ 30ML $67.10 BUPIVACAINE PF (FOR EPIDURAL - (MG) $71.44 BUPIVACAINE PF 0.75%/ DEXTROSE INJ $60.16 BUPRENORPHINE 0.3MG/ML INJ $57.00 BUPROPION 100MG TABLET $14.66 BUPROPION 75MG TABLET $14.18 BUPROPION CR 100MG TABLET $16.29 BUPROPION CR 150MG TABLET $16.55 BUSPIRONE 5MG TABLET $14.26 BUTOCONAZOLE 2% VAG CRM 20GM $50.36 BUTORPHANOL 10MG/ML NASAL SPY 2.5ML $220.96 BUTORPHANOL 1MG/ML INJ $92.54 BUTORPHANOL 2MG/ML INJ $92.82 CABERGOLINE 0.5MG TABLET $83.00 CADEXOMER GEL WOUND DRESSING $107.28 CAFF/SOD BENZOATE 500MG VL $88.38 CALAMINE LOTION 120ML $0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

93 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 85

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9187097 9173568 9101973 9187675 9103771 9106626 9113689 9182106 9113630 9104514 9310079 9187766 9113697 9310087 9310087 9101932 9113861 9116351 9168550 9109273 9109711 9168170 9101999 9113895 9113218 9174814 9173766 9102021 9113929 9178476 9107863 9107871 9173261 9168691 9106808 9105859 9106790 9105867 9108549 9316183 9310095 9174954 9105891 9170507 9316019 9174350 9100041 9107491 9109430 9305822 9179466 9102039 9178054

CALCITONIN 200 UNITS/ML INJ $135.10 CALCITONIN 200IU/AC NASAL SPRAY 2ML$98.57 CALCITRIOL 0.25MCG CAPSULE $15.14 CALCITRIOL 1MCG/ML AMPUL $81.50 CALCIUM ACETATE 667MG TABLET $13.01 CALCIUM CARB/VIT D 250MG/125 IU TAB $12.84 CALCIUM CARB/VIT D 500MG/200IU TAB $12.83 CALCIUM CARBONATE 500MG CHEW TAB $0.00 CALCIUM CARBONATE 600MG TABLET $12.84 CALCIUM CARBONATE 650MG TABLET $12.75 CALCIUM CHLORIDE 10% INJ $52.46 CALCIUM CHLORIDE 10% SYRINGE $56.48 CALCIUM CITRATE 200MG TABLET $12.84 CALCIUM GLUCONATE 0.465MEQ/ML INJ $27.22 CALCIUM GLUCONATE 100MG/ML INJ $27.22 CALCIUM GLUCONATE 500MG TABLET $13.17 CALCIUM LACTATE 650MG TABLET $12.78 CALCIUM/MAG 426/246MG TABLET $12.83 CALMOSEPTINE OINTMENT 113GM $36.06 CANDESARTAN 16MG TABLET $15.61 CAPECITABINE 500MG TABLET $34.25 CAPSAICIN 0.025% CREAM 60GM $39.34 CAPTOPRIL 12.5MG TABLET $14.18 CAPTOPRIL 25MG TABLET $15.15 CAPTOPRIL/HCTZ 25/15 TABLET $14.27 CARBACHOL 0.01% OP SOLN 1.5ML $80.44 CARBACHOL 3% OP SOLN 15ML $98.56 CARBAMAZEPINE 100MG CHEW TABLET $13.32 CARBAMAZEPINE 200MG TABLET $13.63 CARBAMAZEPINE 20MG/ML SUSP 120ML $41.29 CARBAMAZEPINE XR 100MG TABLET $13.29 CARBAMAZEPINE XR 200MG TABLET $13.85 CARBAMIDE PEROX 6.5% OTIC SOLN 15ML $29.84 CARBAMIDE PEROXIDE 10% LIQ 15ML $34.60 CARBIDOPA/LEVODOPA CR 50/200 TAB $16.98 CARBIDOPA/LEVODOPA 10/100 TAB $14.16 CARBIDOPA/LEVODOPA 25/100 TAB $14.62 CARBIDOPA/LEVODOPA 25/250 TAB $14.87 CARBIDOPA/LEVODOPA CR 25/100 TAB $14.92 CARBOPLATIN 50MG INJ $731.46 CARBOPROST 250MCG/ML INJ $165.18 CARBOXYMETHYLCELL 1% OP SOL 3ML $27.36 CARISOPRODOL 350MG TABLET $13.92 CARMEX LIP OINTMENT 7.5GM $27.82 CARMUSTINE 100MG INJ $713.12 CARTEOLOL 1% OPHTH SOLN 5ML $64.72 CARVEDILOL 12.5MG TABLET $16.16 CARVEDILOL 3.125MG TABLET $16.16 CARVEDILOL 6.25MG TABLET $16.16 CASPOFUNGIN INJ $201.76 CASTOR OIL 120ML $32.84 CEFACLOR 250MG CAPSULE $16.70 CEFACLOR 50MG/ML SUSP 75ML $83.50

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 93 91 91 91 91 93 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 86

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9116369 9116377 9305574 9306424 9305491 9305491 9306366 9306275 9305475 9305699 9305707 9305525 9305525 9305525 9305418 9306432 9305061 9305061 9305079 9305517 9305533 9178781 9305392 9305400 9306440 9305558 9305558 9306382 9305566 9305426 9305442 9305434 9305459 9305467 9102088 9179474 9113960 9305343 9305343 9306374 9108622 9113374 9113382 9182072 9102062 9102070 9179482 9169095 9170432 9107897 9178559 9178559 9112871

CEFADROXIL 1GM TABLET $33.35 CEFADROXIL 500MG CAPSULE $23.68 CEFAMANDOL 1GM INJ $119.89 CEFAMANDOLE 2GM INJ $138.02 CEFAZOLIN 1GM INJ $114.74 CEFAZOLIN 1GM/10ML SW SYRINGE $115.76 CEFAZOLIN 1GM/20ML SYRINGE $115.76 CEFAZOLIN 1GM/50ML D5W $115.76 CEFAZOLIN 500MG INJ $108.24 CEFEPIME 1GM INJ $135.86 CEFEPIME 2GM INJ $169.44 CEFOTAXIME 1GM INJ $122.96 CEFOTAXIME 1GM/10ML SW SYRINGE $122.96 CEFOTAXIME 1GM/20ML SW SYRINGE $122.96 CEFOTAXIME 2GM INJ $146.24 CEFOTAXIME 500MG INJ $116.26 CEFOTETAN 1000MG INJ $127.04 CEFOTETAN 1GM INJ $127.04 CEFOTETAN 2GM INJ $154.42 CEFOXITIN 1GM VIAL $124.26 CEFOXITIN 2GM VIAL $146.76 CEFPROZIL 50MG/ML SUSP 100ML $171.16 CEFTAZIDIME 1GM INJ $130.21 CEFTAZIDIME 2GM INJ $158.67 CEFTAZIDINE 500MG INJ $115.99 CEFTIZOXIME 1000MG INJ $125.48 CEFTIZOXIME 1GM INJ $125.48 CEFTIZOXIME 1GM/20ML SYRINGE $125.48 CEFTIZOXIME 2GM INJ $145.82 CEFTRIAXONE 1GM INJ $203.98 CEFTRIAXONE 250MG INJ $134.72 CEFTRIAXONE 2GM INJ $304.89 CEFTRIAXONE 500MG INJ $161.50 CEFUROXIME 1.5GM INJ $128.68 CEFUROXIME 250MG TABLET $22.69 CEFUROXIME 25MG/ML SUSP 100ML $107.02 CEFUROXIME 500MG TABLET $30.89 CEFUROXIME 750MG INJ $233.64 CEFUROXIME 750MG/10ML SW SYRINGE $127.56 CEFUROXIME 750MG/20ML SYRINGE $233.64 CELECOXIB 100MG CAPSULE $16.00 CENTRUM SILVER TABLET $0.00 CENTRUM TABLET $0.00 CEPACOL SORE THROAT LOZENGE $0.00 CEPHALEXIN 250MG CAPSULE $14.42 CEPHALEXIN 500MG CAPSULE $16.18 CEPHALEXIN 50MG/ML SUSP $63.24 CETACAINE SPRAY 56GM $129.44 CETAPHIL MOIST LOTION 60ML $27.63 CETIRIZINE 10MG TABLET $16.80 CHARCOAL-AQUA 50GM LIQ 240ML $48.54 CHARCOAL-SORBITOL 50GM LIQ 240ML $51.74 CHERRY SYRUP $0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 93 93 93 93 93 93 93 93 93 93 93 93 93 93 93 93 93 93 93 91 93 93 93 93 93 93 93 93 93 93 93 93 91 91 91 93 93 93 91 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 87

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9158056 9159070 9197047 9168824 9155102 9155110 9155094 9178112 9183450 9102120 9113317 9102146 9310756 9102161 9102203 9102179 9178096 9102195 9189499 9102229 9102237 9109455 9105685 9106360 9106378 9168584 9109752 9114026 9310715 9100009 9174590 9173733 9179722 9306325 9102245 9306309 9305673 9102252 9102260 9175126 9316035 9108523 9316282 9104068 9104076 9178823 9117037 9169103 9102286 9178138 9305103 9305624 9169152

CHLORAL HYDRATE 100MG/ML LIQ $25.50 CHLORAL HYDRATE 500MG/5ML UD CUP $27.05 CHLORAMBUCIL 2MG TABLET $16.68 CHLORASEPTIC THROAT SPRAY 180ML $0.00 CHLORDIAZEPOXIDE 10MG CAPSULE $25.88 CHLORDIAZEPOXIDE 25MG CAPSULE $25.90 CHLORDIAZEPOXIDE 5MG CAPSULE $25.82 CHLORHEXIDINE 0.12% MOUTHWASH $49.08 CHLOROPROCAINE 3% 20ML INJ $101.88 CHLOROQUINE 250MG TABLET $17.70 CHLOROQUINE 500MG TABLET $20.82 CHLOROTHIAZIDE 250MG TABLET $13.02 CHLOROTHIAZIDE 500MG INJ $72.96 CHLORPHENIRAMINE 4MG TABLET $0.00 CHLORPROMAZINE 10MG TABLET $13.42 CHLORPROMAZINE 25MG TABLET $13.29 CHLORPROMAZINE 30MG/ML CONC 120ML $37.34 CHLORPROMAZINE 50MG TABLET $13.31 CHLORPROMAZINE 50MG/2ML INJ $60.14 CHLORPROPAMIDE 250MG TABLET $13.94 CHLORTHALIDONE 25MG TABLET $13.07 CHOLESTYRAMINE LIGHT PACKET $16.04 CHOLESTYRAMINE PACKET $17.46 CHOLINE/MAG SALIC 500MG TABLET $13.64 CHOLINE/MAG SALIC 750MG TABLET $14.18 CICLOPIROX 0.77% CREAM 15GM $69.66 CILOSTAZOL 100MG TABLET $16.16 CIMETIDINE 300MG TABLET $14.77 CIMETIDINE 300MG/2ML INJ $108.52 CIMETIDINE 400MG TABLET $16.06 CIPROFLOXACIN 0.3% OP OINT 3.5GM $117.94 CIPROFLOXACIN 0.3% OP SOLN 5ML $108.06 CIPROFLOXACIN 100MG/ML SUSP 100ML $244.20 CIPROFLOXACIN 200MG/100ML D5W $132.98 CIPROFLOXACIN 250MG TABLET $22.40 CIPROFLOXACIN 400MG/200ML D5W $161.78 CIPROFLOXACIN 400MG/40ML INJ $159.38 CIPROFLOXACIN 500MG TABLET $23.66 CIPROFLOXACIN 750MG TABLET $24.23 CIPROFLOXACIN HC OTIC SUSP 10ML $175.44 CISPLATIN INJ $480.20 CITALOPRAM 20MG TABLET $17.54 CLADRIBINE 1MG/ML VIAL $587.18 CLARITHROMYCIN 250MG TABLET $21.48 CLARITHROMYCIN 500MG TABLET $21.48 CLARITHROMYCIN 50MG/ML SUSP $168.66 CLARITHROMYCIN XL 500MG TABLET $21.90 CLINDAMYCIN 1% LOTION 60ML $114.80 CLINDAMYCIN 150MG CAPSULE $17.48 CLINDAMYCIN 15MG/ML SUSP $73.62 CLINDAMYCIN 600MG/4ML INJ $117.34 CLINDAMYCIN 900MG/6ML INJ $122.18 CLOBETASOL 0.05% CREAM 30GM $92.10

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 93 91 93 93 91 91 91 93 91 93 91 91 91 91 91 91 91 93 93 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 88

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9168592 9170515 9105776 9155128 9155136 9102310 9171000 9171018 9171026 9107608 9155144 9169707 9169111 9169137 9169145 9104738 9169459 9170218 9170390 9159062 9159054 9155169 9163494 9102369 9187113 9109703 9170192 9174293 9112871 9174921 9174202 9173238 9187121 9107905 9107913 9173824 9173816 9132028 9175084 9169186 9170226 9187147 9107921 9102377 9173832 9173246 9175043 9316043 9197054 9103250 9178831 9103243 9189119

CLOBETASOL 0.05% OINT 15GM $71.98 CLOBETASOL 0.05% TOPICAL SOLN 50ML $104.64 CLOFAZIMINE 50MG CAPSULE $13.13 CLONAZEPAM 0.5MG TABLET $27.04 CLONAZEPAM 1MG TABLET $27.25 CLONIDINE 0.1MG TABLET $13.19 CLONIDINE-TTS 1 PATCH $37.05 CLONIDINE-TTS 2 PATCH $53.68 CLONIDINE-TTS 3 PATCH $69.54 CLOPIDOGREL 75MG TABLET $20.61 CLORAZEPATE 3.75MG TABLET $28.32 CLORPACTIN WCS-90 POWDER 2GM $35.34 CLOTRIMAZOLE 1% CREAM 30GM $52.24 CLOTRIMAZOLE 1% LOTION 30ML $87.56 CLOTRIMAZOLE 1% VAG CRM 45GM $39.84 CLOTRIMAZOLE 10MG TROCHE $15.93 CLOTRIMAZOLE/BETAMETHASONE CRM 15GM $71.18 CLOTRIMAZOLE/BETAMETHASONE LOTION 30ML $127.20 COAL TAR SOLUTION 473ML $55.64 COCAINE 10% TOP SOLN 4ML $95.04 COCAINE 4% SOLUTION 4ML $66.18 CODEINE 30MG TABLET $26.33 CODEINE 30MG/2ML INJ $78.18 COLCHICINE 0.6MG TABLET $13.11 COLCHICINE 1MG/2ML INJ $66.38 COLESEVELAM 625MG TABLET $14.36 COLLAGENASE 250UNIT/GM OINT 30GM $155.26 COMBIVENT 14.7GM INHALER $128.20 CORTISONE ACETATE 25MG TABLET $13.64 CORTISPORIN OPHTH OINT 3.5GM $104.42 CORTISPORIN OPHTH SOLN 7.5ML $134.60 CORTISPORIN OTIC SUSP 10ML $87.04 COSYNTROPIN 0.25MG INJ $86.15 CREON 10 CAP DELAYED RELEASE $14.64 CREON 20 CAP DELAYED RELEASE $16.44 CROMOLYN 4% NASAL SPRAY 13ML $40.38 CROMOLYN 800MCG INHALER 8GM $132.62 CROMOLYN NEBULIZER SOL 2ML $14.12 CROMOLYN SOD 4% OPHTH SOL 10ML $99.84 CROTAMITON 10% CREAM 60GM $52.16 CURASOL GEL WOUND DRESSING 30GM $39.94 CYANOCOBALAMIN 1000MCG/ML INJ $52.16 CYANOCOBALAMIN 250MCG TABLET $12.79 CYCLOBENZAPRINE 10MG TABLET $14.66 CYCLOPENTOLATE 0.5% OP SOLN 15ML $96.32 CYCLOPENTOLATE 1% OP SOLN 2ML $50.32 CYCLOPENTOLATE 2% OP SOLN 2ML $58.06 CYCLOPHOSHAMIDE 100MG INJ $457.58 CYCLOPHOSPHAMIDE 25MG TABLET $17.24 CYCLOSPORINE 100MG CAPSULE $26.59 CYCLOSPORINE 100MG/ML LIQ 50ML $698.72 CYCLOSPORINE 25MG CAPSULE $16.19 CYCLOSPORINE 50MG/ML INJ $156.76

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 93

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 89

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9107277 9179839 9107269 9179821 9102401 9316050 9316365 9147331 9147331 9147042 9147042 9147190 9147190 9147034 9147034 9147620 9147786 9147026 9147026 9134016 9147000 9147000 9147018 9147018 9134008 9147513 9147521 9147539 9147448 9147455 9147463 9147471 9147240 9147240 9147232 9147232 9147729 9147729 9147257 9147257 9147265 9147265 9147281 9147299 9147422 9147430 9147315 9147315 9147307 9147307 9147091 9147109 9151093

CYCLOSPORINE MICRO (NEORAL) 100MG$24.93 CAP 0.00 CYCLOSPORINE MICRO (NEORAL) 100MG/ML LIQ 50ML 0.00 $691.10 CYCLOSPORINE MICRO (NEORAL) 25MG CAP $15.78 0.00 CYCLOSPORINE MICRO(GENGRAF)100MG/ML 50ML $648.12 0.00 CYPROHEPTADINE 4MG TABLET $13.58 0.00 CYTARABINE 100MG INJ $452.20 0.00 CYTARABINE LIPOSOME 10MG INJ $1,227.20 0.00 D10NS 1000ML $91.94 0.00 D10NS 1000ML (FLOORSTOCK) $91.94 0.00 D10W 1000ML $79.88 0.00 D10W 1000ML (FLOORSTOCK) $79.88 0.00 D10W 250ML $80.32 0.00 D10W 250ML (FLOORSTOCK) $80.32 0.00 D10W 500ML $80.18 0.00 D10W 500ML (FLOORSTOCK) $80.18 0.00 D20W 500ML $100.64 0.00 D50W 500ML $85.54 0.00 D5W 1000ML $80.22 0.00 D5W 1000ML (FLOORSTOCK) $80.22 0.00 D5W 100ML $4.06 0.00 D5W 250ML $3.00 0.00 D5W 250ML (FLOORSTOCK) $79.32 0.00 D5W 500ML $79.38 0.00 D5W 500ML (FLOORSTOCK) $79.38 0.00 D5W 50ML $4.02 0.00 D5W W/20MEQ KCL $82.38 0.00 D5W W/30MEQ KCL $109.90 0.00 D5W W/40MEQ KCL $82.38 0.00 D5W/0.22%NACL W/10MEQ KCL $82.38 0.00 D5W/0.22%NACL W/20MEQ KCL $82.38 0.00 D5W/0.22%NACL W/30MEQ KCL $82.38 0.00 D5W/0.22%NACL W/40MEQ KCL $82.38 0.00 D5W/0.225% NACL 1000ML $79.82 0.00 D5W/0.225% NACL 1000ML(FLOORSTOCK) 79.82 $ 0.00 D5W/0.225% NACL 500ML $79.92 0.00 D5W/0.225% NACL 500ML (FLOORSTOCK)$79.92 0.00 D5W/0.45% NACL 1000ML $80.06 0.00 D5W/0.45% NACL 1000ML (FLOORSTOCK)$80.06 0.00 D5W/0.45% NACL 250ML $79.94 0.00 D5W/0.45% NACL 250ML (FLOORSTOCK) $79.94 0.00 D5W/0.45% NACL 500ML $79.92 0.00 D5W/0.45% NACL 500ML(FLOORSTOCK) $79.92 0.00 D5W/0.45% NACL W/10MEQ KCL $82.38 0.00 D5W/0.45% NACL W/20MEQ KCL $80.42 0.00 D5W/0.45% NACL W/30MEQ KCL $82.38 0.00 D5W/0.45% NACL W/40MEQ KCL $82.38 0.00 D5W/0.9% NACL 1000ML $79.72 0.00 D5W/0.9% NACL 1000ML(FLOORSTOCK) $79.72 0.00 D5W/0.9% NACL 500ML $79.92 0.00 D5W/0.9% NACL 500ML (FLOORSTOCK) $79.92 0.00 D5W/0.9% NACL W/20MEQ KCL $84.64 0.00 D5W/0.9% NACL W/40MEQ KCL $84.64 0.00 D5W/ALCOHOL 5% $101.76 0.00

91 91 91 91 91 93 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 90

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9147216 9147208 9147117 9147562 9147216 9147208 9147794 9316068 9112863 9316076 9169194 9169202 9187584 9102419 9104696 9316290 9173303 9310400 9102534 9187881 9187162 9102443 9102450 9169897 9187600 9173717 9169004 9168618 9170234 9173279 9178146 9102484 9102492 9187956 9178856 9102518 9102526 9187170 9190018 9147083 9147075 9189457 9187188 9189267 9189259 9147646 9147646 9147653 9147653 9147661 9147661 9112871 9160045

D5W/LACTATED RINGERS 1000ML $80.18 D5W/LACTATED RINGERS 500ML $80.34 D5W/LACTATED RINGERS W/20MEQ KCL $93.54 D5W/LACTATED RINGERS W/40MEQ KCL $93.54 D5W/LR 1000ML (FLOORSTOCK) $80.18 D5W/LR 500ML (FLOORSTOCK) $80.34 D70W 500ML $86.98 DACARBAZINE 100MG INJ $468.82 DACRIOSE OPHTH SOLN 15ML $33.98 DACTINOMYCIN 0.5MG INJ $474.40 DAKIN'S SOLN ( FULL STRENGTH) $33.50 DAKIN'S SOLN ( HALF STRENGTH) $33.50 DANTROLENE 20MG INJ $216.04 DANTROLENE 25MG CAPSULE $14.80 DAPSONE 25MG TABLET $13.10 DAUNORUBICIN INJ $622.08 DDAVP 0.01% NASAL SPRAY 5ML $347.56 DEFEROXAMINE 500MG INJ $134.24 DEMECLOCYLINE 150MG TABLET $23.29 DEPO-MEDROL 40MG/ML INJ $65.58 DEPO-MEDROL 80MG/ML INJ $75.14 DESIPRAMINE 10MG TABLET $13.52 DESIPRAMINE 25MG TABLET $13.68 DESITIN OINTMENT 120GM $31.64 DESMOPRESSIN 4MCG/ML INJ $96.66 DESONIDE 0.05% CREAM 15GM $56.38 DESONIDE 0.05% LOTION 59ML $91.10 DESONIDE 0.05% OINT 15GM $50.34 DESOXIMETASONE 0.25% CRM 15GM $77.16 DEXAMETHASONE 0.1% OP SOLN 5ML $93.20 DEXAMETHASONE 0.1MG/ML LIQ 120ML $52.03 DEXAMETHASONE 0.5MG TABLET $13.05 DEXAMETHASONE 0.75MG TABLET $13.01 DEXAMETHASONE 10MG/1ML INJ $55.54 DEXAMETHASONE 1MG/ML INTENSOL 30ML $60.04 DEXAMETHASONE 2MG TABLET $13.90 DEXAMETHASONE 4MG TABLET $13.96 DEXAMETHASONE 4MG/1ML INJ $53.64 DEXRAZOXANE 250MG INJ $577.72 DEXTRAN 40/NS IV SOLN. $349.68 DEXTRAN 40-DEXTROSE 5% IV SOLN. $348.36 DEXTROSE 10% 5ML INJ $53.66 DEXTROSE 25% SYRINGE 10ML $64.38 DEXTROSE 50% SYRINGE 50ML $60.88 DEXTROSE 50% VIAL 50ML $53.16 DIANEAL W/1.5% DEXTROSE $147.72 DIANEAL W/1.5% DEXTROSE(FLOORSTOCK) $147.72 DIANEAL W/2.5% DEXTROSE $149.62 DIANEAL W/2.5% DEXTROSE(FLOORSTOCK) $149.62 DIANEAL W/4.25% DEXTROSE $151.42 DIANEAL W/4.25% DEXTROSE (FLOORSTOCK) $151.42 DIATRIZOATE 50% 50ML VIAL $64.24 DIAZEPAM 10MG RECTAL GEL $424.86

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 93 91 93 91 91 91 91 91 93 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 91

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9163015 9300450 9155201 9155227 9159104 9310103 9174632 9114216 9114208 9102914 9178872 9102542 9102559 9114232 9102567 9188814 9179847 9168253 9179649 9102583 9106519 9102591 9187204 9189150 9174962 9188145 9310319 9102633 9102633 9102658 9109471 9103938 9103946 9103953 9102690 9102187 9102682 9113655 9113663 9113671 9179854 9178195 9128364 9168626 9168493 9137266 9170242 9102716 9102724 9187774 9179862 9159039 9155276

DIAZEPAM 10MG/2ML INJ $80.04 DIAZEPAM 1MG/ML ORAL SOLN $26.18 DIAZEPAM 2MG TABLET $25.92 DIAZEPAM 5MG TABLET $26.08 DIAZEPAM 5MG/5ML UD CUP $46.98 DIAZOXIDE 300MG/20ML INJ $309.72 DICLOFENAC 0.1% OP SOLN 2.5ML $86.48 DICLOFENAC EC 25MG TABLET $13.65 DICLOFENAC EC 50MG TABLET $14.53 DICLOFENAC EC 75MG TABLET $14.81 DICLOXACILLIN 12.5MG/ML SUSP 100ML $45.60 DICLOXACILLIN 250MG CAPSULE $14.04 DICLOXACILLIN 500MG CAPSULE $15.12 DICYCLOMINE 10MG CAPSULE $13.25 DICYCLOMINE 20MG TABLET $13.42 DICYCLOMINE 20MG/2ML INJ $84.36 DIDANOSINE 10MG/ML LIQ 200ML $190.80 DIFLORASONE 0.05% OINT 60GM $305.74 DIGOXIN 0.05MG/ML ORAL SOLN 60ML $46.24 DIGOXIN 0.125MG TABLET $13.39 DIGOXIN 0.1MG CAPSULE $13.31 DIGOXIN 0.25MG TABLET $13.39 DIGOXIN 0.5MG/2ML INJ $54.64 DIGOXIN IMMUNE FAB $1,618.24 DIHYDROERGOT 4MG/ML NASAL SPY 4ML $250.04 DIHYDROERGOTAMINE 1MG/ML INJ $117.30 DILTIAZEM 25MG/5ML INJ $109.02 DILTIAZEM 30MG TABLET $13.62 DILTIAZEM 60MG TABLET $14.13 DILTIAZEM 90MG TABLET $14.43 DILTIAZEM CD 120MG CAPSULE $15.60 DILTIAZEM CD 180MG CAPSULE $16.18 DILTIAZEM CD 240MG CAPSULE $17.64 DILTIAZEM CD 300MG CAPSULE $19.06 DILTIAZEM SR 120MG CAPSULE $15.04 DILTIAZEM SR 60MG CAPSULE $14.91 DILTIAZEM SR 90MG CAPSULE $14.45 DILTIAZEM XR 120MG CAPSULE $15.64 DILTIAZEM XR 180MG CAPSULE $16.16 DILTIAZEM XR 240MG CAPSULE $16.40 DIMETANE DX COUGH SYRUP 120ML $34.63 DIMETAPP ELIXIR 120ML $33.02 DINOPROSTONE 10MG VAG SUPP $417.56 DINOPROSTONE CERVICAL GEL $396.92 DIPHENHYDRAMINE 1% CRM 28.3GM $32.28 DIPHENHYDRAMINE 12.5MG/5ML LIQ UDCUP $25.92 DIPHENHYDRAMINE 2% CRM 15GM $31.76 DIPHENHYDRAMINE 25MG CAPSULE $0.00 DIPHENHYDRAMINE 50MG CAPSULE $12.99 DIPHENHYDRAMINE 50MG/ML INJ $53.28 DIPHENHYDRAMINE LIQ DF,AF,SF 120ML $34.00 DIPHENOXY/ATROPINE LIQ 5ML UDCUP $27.22 DIPHENOXYLATE/ATROPINE TABLET $26.98

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 92

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9112871 9174129 9102732 9187139 9108796 9102773 9102781 9102740 9102757 9107061 9107079 9107087 9107095 9310111 9151002 9316480 9170457 9114315 9179490 9105123 9102674 9113283 9102666 9108804 9108812 9108820 9113390 9189762 9189093 9174822 9172073 9107509 9178583 9151051 9310368 9174152 9163163 9102872 9102898 9102831 9114364 9170259 9102856 9316084 9305111 9102880 9155243 9187253 9310897 9310905 9132150 9189606 9168105

DIPHTHERIA/TETANUS (PEDIATRIC) $69.90 DIPIVEFRIN 0.1% OP SOLN 5ML $53.64 DIPYRIDAMOLE 25MG TABLET $13.12 DIPYRIDAMOLE 5MG/ML INJ $62.88 DIPYRIDAMOLE SR 200MG/ASPIRIN 25MG$16.37 DISOPYRAMIDE 100MG CAPSULE $14.11 DISOPYRAMIDE 150MG CAPSULE $14.36 DISOPYRAMIDE CR 100MG CAPSULE $14.95 DISOPYRAMIDE CR 150MG CAPSULE $15.34 DIVALPROEX EC 125MG DELAYED RELEASE TAB $13.83 DIVALPROEX EC 250MG DELAYED RELEASE TAB $14.87 DIVALPROEX EC 500MG DELAYED RELEASE TAB $16.65 DIVALPROEX SPRINKLE 125MG CAPSULE$13.84 DOBUTAMINE 250MG/20ML INJ $121.54 DOBUTAMINE 500MG/250ML D5W $185.76 DOCETAXEL 20MG/0.5ML INJ $1,136.48 DOCOSANOL 10% CREAM 2GM $52.80 DOCUSATE CALCIUM 240MG CAPSULE $0.00 DOCUSATE SOD 10MG/ML LIQ 120ML $0.00 DOCUSATE SOD/CASANTHRANOL 100/30 $13.06 CAP DOCUSATE SODIUM 100MG CAPSULE $0.00 DOCUSATE SODIUM 250MG CAPSULE $0.00 DOCUSATE SODIUM 50MG CAPSULE $0.00 DOFETILIDE 0.125MG CAPSULE $16.54 DOFETILIDE 0.25MG CAPSULE $16.54 DOFETILIDE 500MCG CAPSULE $16.54 DOLASETRON 100MG TABLET $165.20 DOLASETRON 100MG/5ML VIAL $397.20 DOLASETRON 12.5MG AMP $88.28 DOMEBORO OTIC SOLN 60ML $40.20 DOMEBORO PACKET $14.18 DONEPEZIL 5MG TABLET $22.18 DONNATAL ELIXIR 120ML $32.82 DOPAMINE 400MG/250ML D5W $114.02 DOPAMINE 400MG/5ML INJ $109.94 DORZOLAMIDE 2% OP SOLN 5ML $79.32 DOXAPRAM 20MG/ML INJ $245.64 DOXAZOSIN 1MG TABLET $14.57 DOXAZOSIN 2MG TABLET $14.57 DOXEPIN 10MG CAPSULE $13.45 DOXEPIN 25MG CAPSULE $13.58 DOXEPIN 5% CREAM 45GM $117.24 DOXEPIN 50MG CAPSULE $13.86 DOXORUBICIN 2MG/ML INJ $467.70 DOXYCYCLINE 100MG INJ $131.26 DOXYCYCLINE 100MG TABLET $13.76 DRONABINOL 2.5MG CAPSULE $34.27 DROPERIDOL 5MG/2ML INJ $59.38 DROTRECOGIN ALFA 20MG INJ $2,117.76 DROTRECOGIN ALFA 5MG INJ $605.76 DUONEB 2.5-0.5MG SOL 3ML $16.72 DUOVISC VISCOELASTIC SYSTEM $370.44 ECONAZOLE 1% CREAM 30GM $89.72

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 93 93 91 91 91 93 93 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 93

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9187964 9170069 9102948 9102955 9188830 9188616 9187030 9188574 9188624 9188665 9109778 9310145 9183658 9187790 9188517 9174970 9132119 9188020 9188731 9151119 9311010 9113408 9102963 9306457 9173311 9305129 9305137 9102997 9114422 9102989 9178625 9113192 9179870 9116385 9310137 9310855 9113051 9116401 9171158 9171174 9171042 9169269 9171158 9171042 9107962 9109505 9103029 9112871 9183773 9183781 9107350 9103037 9114448

EDROPHONIUM 150MG/10ML INJ $72.38 EMLA CREAM 5GM $43.32 ENALAPRIL 10MG TABLET $14.86 ENALAPRIL 5MG TABLET $14.76 ENALAPRILAT 1.25MG/ML INJ $62.64 ENOXAPARIN 100MG /1ML INJ $173.34 ENOXAPARIN 30MG/0.3ML INJ $87.58 ENOXAPARIN 40MG/0.4ML INJ $99.80 ENOXAPARIN 60MG/0.6ML INJ $124.36 ENOXAPARIN 80MG/0.8ML INJ $148.84 ENTACAPONE 200MG TABLET $16.36 EPHEDRINE 50MG/ML INJ $51.88 EPINEPHRINE 1:1000 INJ 30ML $69.38 EPINEPHRINE 1MG/10ML SYRINGE $107.04 EPINEPHRINE 1MG/ML INJ $59.64 EPINEPHRINE 2% OP SOLN 15ML $134.16 EPINEPHRINE INH 2.25% 0.5ML $15.22 EPOETIN ALFA 20,000 UNITS/ML INJ $81.03 EPTIFIBATIDE 20MG/10ML INJ $236.76 EPTIFIBATIDE 75MG/100ML PREMIX $524.26 ER-AMIODARONE 300MG/20ML D5W KIT $528.62 ERGOCALCIFEROL 400IU CAPSULE $12.77 ERGOCALCIFEROL 50,000 UNITS CAP $13.44 ERTAPENEM 1GM INJ $197.14 ERYTHROMYCIN 0.5% OPH OINT 3.5GM $36.68 ERYTHROMYCIN 1GM INJ $117.06 ERYTHROMYCIN 500MG INJ $109.16 ERYTHROMYCIN EC 250MG TABLET $13.22 ERYTHROMYCIN EC 333MG TABLET $13.46 ERYTHROMYCIN EC 500MG TABLET $13.57 ERYTHROMYCIN EST 50MG/ML SUSP $58.81 ERYTHROMYCIN ETH 400MG TABLET $13.23 ERYTHROMYCIN ETH 40MG/ML SUSP $34.96 ESCITALOPRAM 10MG TABLET $17.26 ESMOLOL 100MG/10ML INJ $144.28 ESMOLOL 2500MG/10ML INJ $303.24 ESOMEPRAZOLE 20MG CAP $21.56 ESOMEPRAZOLE 40MG CAP $21.56 ESTRADIOL (CLIMARA) 0.05MG/24HR PTCH28.88 $ ESTRADIOL (CLIMARA) 0.075MG/24HR PTCH $28.88 ESTRADIOL (CLIMARA) 0.1MG/24HR PTCH$28.88 ESTRADIOL 0.01% VAG CRM 42.5GM $134.66 ESTRADIOL 0.05MG PATCH (BI-WEEKLY) $19.93 ESTRADIOL 0.1MG PATCH (BI-WEEKLY) $20.20 ESTRADIOL 0.5MG TABLET $13.23 ESTRADIOL 1MG TABLET $13.41 ESTRADIOL 2MG TABLET $14.59 ESTRADIOL CYPIONATE 25MG/5ML VIAL$101.66 ESTRADIOL VAL 200MG/5ML INJ $317.38 ESTRADIOL VAL 50MG/5ML INJ $164.88 ESTRATEST TABLET $16.14 ESTROGENS,CON 0.3MG TABLET $14.01 ESTROGENS,CON 0.625MG TABLET $14.36

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 93 93 93 91 91 93 91 93 93 91 91 91 91 91 91 91 93 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 94

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9103045 9103052 9188152 9169251 9107970 9105008 9188160 9103086 9103094 9188756 9103110 9107988 9189424 9316167 9197393 9169905 9168261 9106105 9174830 9100736 9196098 9196056 9109281 9103144 9188178 9188178 9151242 9151234 9151267 9151226 9108853 9100074 9109398 9112871 9163056 9161035 9112871 9155854 9166174 9163031 9161001 9155755 9161019 9161027 9178187 9113200 9103177 9179664 9179664 9103193 9114505 9113416 9107590

ESTROGENS,CON 0.9MG TABLET $14.69 ESTROGENS,CON 1.25MG TABLET $14.99 ESTROGENS,CONJ 25MG INJ $170.36 ESTROGENS,CONJ VAG CRM 42.5GM $152.20 ESTROPIPATE 0.75MG TAB (OGEN 0.625) $13.58 ESTROPIPATE 1.5MG TAB (OGEN 1.25) $15.16 ETHACRYNATE SOD 50MG INJ $98.48 ETHAMBUTOL 100MG TABLET $13.91 ETHAMBUTOL 400MG TABLET $16.69 ETHANOLAMINE 5% INJ 2ML $185.84 ETHOSUXIMIDE 250MG CAPSULE $14.75 ETODOLAC 400MG TABLET $15.66 ETOMIDATE 40MG/20ML INJ $112.58 ETOPOSIDE 100MG/5ML INJ $482.70 ETOPOSIDE 50MG CAPSULE $108.00 EUCERIN CREAM 120GM $35.54 EUCERIN LOTION 240ML $0.00 EXCEDRIN MIGRAINE TABLET $0.00 EYE WASH OPHTH SOLN 120ML $33.02 EZETIMIBE 10MG TABLET $17.55 FACTOR 7 (NOVOSEVEN) $5,152.10 FACTOR 8 (HEMOFIL) $500.40 FAMCICLOVIR 500MG TABLET $29.03 FAMOTIDINE 20MG TABLET $16.20 FAMOTIDINE 20MG/20ML SYRINGE $53.86 FAMOTIDINE 20MG/2ML INJ $104.74 FAT EMULSIONS 10% 200ML $104.24 FAT EMULSIONS 10% 500ML $97.80 FAT EMULSIONS 20% 200ML $110.24 FAT EMULSIONS 20% 500ML $136.90 FELODIPINE CR 2.5MG TABLET $15.18 FELODIPINE CR 5MG TABLET $15.18 FENOFIBRATE, MICR 160MG TAB $17.99 FENOLDOPAM 10MG/ML INJ $570.88 FENTANYL 100MCG/2ML INJ $78.02 FENTANYL 100MCG/HR PATCH $118.64 FENTANYL 1250MCG/250ML NS DRIP $156.40 FENTANYL 200MCG LOZENGE $41.11 FENTANYL 200MCG/BUPIVAC 0.1% /100ML NS $209.08 FENTANYL 250MCG/5ML INJ $78.64 FENTANYL 25MCG/HR PATCH $53.44 FENTANYL 400MCG LOZENGE $45.52 FENTANYL 50MCG/HR PATCH $72.13 FENTANYL 75MCG/HR PATCH $99.54 FERROUS 15MG/0.6ML DROPS 50ML $34.48 FERROUS FUMARATE 90MG TABLET $12.77 FERROUS GLUCONATE 325MG TABLET $12.88 FERROUS SULF 300MG/5ML LIQ $13.54 FERROUS SULF 44MG/ML LIQ 120ML $0.00 FERROUS SULFATE 325MG TABLET $0.00 FERROUS SULFATE CR 160MG TAB $0.00 FEXOFENADINE 180MG TABLET $17.42 FEXOFENADINE 60MG TABLET $15.43

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 93 93 91 91 91 93 91 91 91 91 91 91 91 91 91 91 93 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 95

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9113622 9188087 9188095 9100066 9103011 9155284 9116419 9103227 9103219 9109521 9128166 9128158 9316092 9104647 9305848 9178963 9316191 9103276 9187907 9173469 9173519 9169277 9170408 9169285 9168998 9168295 9168683 9112871 9188186 9174434 9170275 9174442 9173683 9170267 9316100 9107996 9114570 9178971 9109539 9106493 9183351 9103292 9173170 9113044 9197062 9173998 9174178 9174186 9174194 9116427 9107459 9107301 9114612

FEXOFENADINE/PSEUD (ALLEGRA-D) 60/120 TAB $15.48 FILGRASTIM 300MCG/ML INJ $465.88 FILGRASTIM 480MCG/1.6ML INJ $712.14 FINASTERIDE 5MG TABLET $18.05 FIORICET TABLET $14.39 FIORINAL/CODEINE #3 CAPSULE $28.94 FISH OIL 1000MG CAPSULE $12.86 FLAVOXATE 100MG TABLET $15.63 FLECAINIDE 100MG TABLET $18.79 FLECAINIDE 50MG TABLET $16.59 FLEET ENEMA 133ML $27.30 FLEET MINERAL OIL ENEMA 133ML $28.66 FLOXURIDINE 500MG INJ $742.70 FLUCONAZOLE 100MG TABLET $29.23 FLUCONAZOLE 2MG/ML NS PREMIX $296.88 FLUCONAZOLE 40MG/ML SUSP 35ML $270.70 FLUDARABINE 50MG INJ $1,132.96 FLUDROCORTISONE 0.1MG TABLET $14.39 FLUMAZENIL 1MG/10ML INJ $250.84 FLUNISOLIDE 0.025% NASAL SPY 25ML $118.42 FLUNISOLIDE INHALER 7GM $167.50 FLUOCINOLONE 0.01% CRM 15GM $29.88 FLUOCINOLONE 0.01% TOP SOLN 60ML $47.44 FLUOCINOLONE 0.025% CRM 15GM $31.54 FLUOCINOLONE 0.025% OINT 60GM $144.70 FLUOCINONIDE 0.05% CRM 15GM $52.54 FLUOCINONIDE 0.05% SOL 60ML $73.74 FLUORESCEIN 0.6MG EYE STRIP $25.69 FLUORESCEIN 10% INJ 5ML $92.00 FLUORESCEIN 9MG STRIP $13.24 FLUORI-METHANE 85/15 SPRAY 103ML $89.20 FLUOROMETHOLONE 0.1% OP SOL 15ML $95.80 FLUOROMETHONLONE 0.25% OP SOL 5ML68.26 $ FLUOROURACIL 5% CRM 25GM $235.82 FLUOROURACIL 500MG/10ML INJ $452.70 FLUOXETINE 10MG CAPSULE $17.92 FLUOXETINE 20MG CAPSULE $18.06 FLUOXETINE 4MG/ML LIQ $261.44 FLUOXYMESTERONE 10MG TABLET $31.78 FLUPHENAZINE 1MG TABLET $13.72 FLUPHENAZINE 25MG/10ML INJ $138.68 FLUPHENAZINE 5MG TABLET $15.37 FLURBIPROFEN 0.03% OP SOL 2.5ML $66.40 FLURBIPROFEN 50MG TABLET $14.30 FLUTAMIDE 125MG CAPSULE $16.90 FLUTICASONE 0.05% NASAL SPY 16GM $155.46 FLUTICASONE 110MCG INH 13GM $179.84 FLUTICASONE 220MCG INH 13GM $304.69 FLUTICASONE 44MCG INH 13GM $162.55 FLUVASTATIN XL 80MG SR TAB $17.04 FLUVOXAMINE 50MG TABLET $19.38 FLUVSTATIN 20MG CAPSULE $16.09 FOLIC ACID 1MG TABLET $13.03

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 93 91 93 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 96

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9310590 9174624 9100090 9187477 9187493 9187824 9178203 9103318 9103326 9187816 9107194 9107186 9107673 9179888 9109786 9112871 9305632 9108861 9305798 9108879 9305889 9306416 9103334 9178211 9169319 9169327 9316415 9103409 9316464 9170135 9169350 9173329 9173337 9305145 9305160 9306101 9137217 9316449 9108002 9109299 9103375 9114620 9108564 9113077 9107343 9188202 9108887 9113705 9112871 9113275 9103359 9103425 9114638

FOLIC ACID 5MG/ML INJ $27.91 FORMOTEROL AEROLIZER 12MCG CAP #12 $69.84 FOSINOPRIL 10MG TABLET $15.19 FOSPHENYTOIN PE 100MG/2ML INJ $92.30 FOSPHENYTOIN PE 500MG/10ML INJ $175.14 FUROSEMIDE 100MG/10ML INJ $55.46 FUROSEMIDE 10MG/ML LIQ 60ML $46.24 FUROSEMIDE 20MG TABLET $13.03 FUROSEMIDE 40MG TABLET $13.07 FUROSEMIDE 40MG/4ML INJ $53.64 GABAPENTIN 100MG CAPSULE $13.95 GABAPENTIN 300MG CAPSULE $15.62 GABAPENTIN 400MG CAPSULE $16.08 GABAPENTIN 50MG/ML SOLN 120ML $76.86 GALANTAMINE 4MG TABLET $17.44 GANCICLOVIR 250MG CAPSULE $22.36 GANCICLOVIR 500MG INJ $522.49 GATIFLOXACIN 200MG TABLET $30.63 GATIFLOXACIN 200MG/100ML D5W $137.76 GATIFLOXACIN 400MG TABLET $30.63 GATIFLOXACIN 400MG/200ML D5W $177.86 GATIFLOXACIN 400MG/40ML VIAL $177.86 GAVISCON FOAMTAB $0.00 GAVISCON SUSP 360ML $0.00 GELATIN POWDER 1GM $181.64 GELFILM OPHTHALMIC DRESSING $88.18 GEMCITABINE 200MG INJ $699.96 GEMFIBROZIL 600MG TABLET $14.91 GEMTUZUMAB 5MG INJ $4,870.20 GENTAMICIN 0.1% CREAM 15GM $32.64 GENTAMICIN 0.1% OINT 15GM $32.64 GENTAMICIN 0.3% OP OINT 3.5GM $64.78 GENTAMICIN 0.3% OP SOLN 5ML $64.94 GENTAMICIN 80MG/2ML INJ $106.92 GENTAMICIN PEDI 20MG/2ML INJ $104.12 GENTAMINCIN PEDI SYRINGE IN NS $102.94 GI COCKTAIL 40ML $31.44 GLATIRAMER 20MG INJ $2,660.58 GLIMEPIRIDE 2MG TABLET $13.72 GLIMEPIRIDE 4MG TABLET $14.62 GLIPIZIDE 10MG TABLET $14.06 GLIPIZIDE 5MG TABLET $13.47 GLIPIZIDE XL 10MG TABLET $14.31 GLIPIZIDE XL 2.5MG TABLET $13.53 GLIPIZIDE XL 5MG TABLET $13.53 GLUCAGON 1MG INJ $199.60 GLUCOSAMINE 500MG CAPSULE $13.12 GLUCOSAMINE/CHONDROIT 500/400 CAP$13.55 GLUCOSE 40% GEL 37.5GM $31.12 GLUTAMINE 10GM PACKET $16.10 GLYBURIDE 2.5MG TABLET $13.33 GLYBURIDE 3MG TABLET $14.20 GLYBURIDE 5MG TABLET $13.77

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 93 91 93 93 91 91 91 91 93 91 93 91 91 91 91 93 93 93 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 97

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9179516 9128026 9128034 9178997 9188210 9103367 9178229 9187246 9306119 9168709 9109844 9100751 9116435 9179896 9137068 9137159 9178252 9106634 9159112 9158130 9113267 9103391 9186099 9103466 9103474 9178260 9103482 9188228 9189523 9183708 9183716 9183823 9188236 9183682 9151069 9151044 9189184 9145046 9145004 9194002 9186198 9147182 9188244 9173352 9170002 9189531 9158148 9158155 9114737 9188277 9103540 9103557 9114711

GLYCERIN 50% ORAL LIQ 220ML $87.94 GLYCERIN ADULT SUPP $12.98 GLYCERIN PEDIATRIC SUPP $12.93 GLYCERIN SOLN 480ML $32.86 GLYCOPYRROLATE 0.2MG/ML INJ $52.66 GLYCOPYRROLATE 1MG TABLET $14.04 GOLYTELY SOLUTION 4000ML $62.32 GOSERELIN 3.6MG IMPLANT SYRN $1,385.18 GRANISETRON 1MG/ML INJ $441.28 GRANULEX SPRAY 56.7ML $53.24 GUAIFED CAP $15.56 GUAIFEN/PHENYL 600/30MG SR TAB $15.54 GUAIFEN/PSEUDO 600/120 SR TAB $14.68 GUAIFENESIN (SF,AF,SF,DF) 100MG/5ML LIQ 118ML $32.94 GUAIFENESIN 200MG/10ML UD CUP $26.28 GUAIFENESIN DM SYRUP 10ML UD CUP $26.18 GUAIFENESIN DM SYRUP 10ML UD CUP $29.40 GUAIFENESIN LA 600MG TABLET $13.30 GUAIFENESIN W/CODEINE 10ML CUP $26.40 GUAIFENESIN W/CODEINE 10ML CUP $25.50 GUAIFENESIN/PSEUDO 300/60 SR CAP $13.63 GUANFACINE 1MG TABLET $14.46 HAEMOPHILUS B CONJUGATE VACCINE$104.96 HALOPERIDOL 0.5MG TABLET $13.29 HALOPERIDOL 1MG TABLET $13.63 HALOPERIDOL 2MG/ML CONC LIQ 120ML $95.66 HALOPERIDOL 5MG TABLET $14.63 HALOPERIDOL 5MG/ML INJ $65.86 HALOPERIDOL DEC 50MG/ML INJ $129.72 HEPARIN 1,000 UNITS/ML 10ML INJ $53.88 HEPARIN 1,000 UNITS/ML 30ML INJ $29.98 HEPARIN 10 UNITS/ML 10ML INJ $26.62 HEPARIN 10,000 UNITS/ML INJ $54.26 HEPARIN 100 UNITS/ML 10ML INJ $52.38 HEPARIN 1,000 UNITS/500ML NS $83.82 HEPARIN 25,000 UNITS/250ML D5W DRIP$88.44 HEPARIN 5,000 UNITS/ML INJ $52.80 HEPARIN PF 10 UNITS/ML INJ $26.68 HEPARIN PF 100 UNITS/ML INJ $26.84 HEPATITIS B IMMUNE GLOBULIN INJ $589.40 HEPATITIS B VACCINE $111.84 HETASTARCH (HESPAN) 6%/NS 500ML $133.92 HISTOPLASMIN SKIN TEST $72.13 HOMATROPINE 5% OP SOLN 5ML $51.90 HURRICAINE 20% AEROSOL 60ML $59.64 HYALURONATE 10MG/ML OP INJ 0.55ML $288.38 HYCODAN SYRUP $25.54 HYCOTUSS SYRUP $25.62 HYDRALAZINE 10MG TABLET $12.84 HYDRALAZINE 20MG/1ML INJ $80.88 HYDRALAZINE 25MG TABLET $13.06 HYDRALAZINE 50MG TABLET $13.15 HYDROCHLOROTHIAZIDE 25MG TABLET $13.02

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 98

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9155540 9155599 9155664 9155839 9155722 9155581 9159013 9155763 9169301 9169392 9169376 9169400 9128414 9170465 9128141 9169418 9168725 9128448 9188285 9188301 9188293 9103599 9169590 9163122 9163320 9163122 9163395 9158361 9155334 9163122 9166125 9128042 9155342 9163130 9166018 9163551 9168311 9103615 9197070 9189416 9103649 9114752 9179680 9108465 9108457 9113713 9102435 9147638 9103664 9178237 9114778 9103680 9189366

HYDROCODONE/APAP (LORCET) 10/650 TAB $28.33 HYDROCODONE/APAP (LORTAB) 7.5/500 TAB $27.33 HYDROCODONE/APAP (NORCO) 10/325 TAB $27.53 HYDROCODONE/APAP (NORCO) 5/325 TAB26.78 $ HYDROCODONE/APAP (VICODIN) 10/500 TAB $27.42 HYDROCODONE/APAP (VICODIN) 5/500 TAB $27.14 HYDROCODONE/APAP LIQ 15ML UDCUP $31.64 HYDROCODONE/IBUPROFEN 7.5/200 TABLET $28.10 HYDROCORTISONE 0.2% CRM 45GM $98.14 HYDROCORTISONE 0.5% CRM 30GM $0.00 HYDROCORTISONE 1% CREAM 30GM $33.70 HYDROCORTISONE 1% OINT 28GM $32.52 HYDROCORTISONE 1% RECTAL CRM 30GM $118.52 HYDROCORTISONE 10% RECTAL FOAM $192.70 15GM HYDROCORTISONE 100MG ENEMA $49.68 HYDROCORTISONE 2.5% CRM 30GM $43.12 HYDROCORTISONE 2.5% OINT 30GM $43.12 HYDROCORTISONE 2.5% RECTAL CRM 30GM $99.70 HYDROCORTISONE SOD SUCC 100MG INJ 55.36 $ HYDROCORTISONE SOD SUCC 250MG INJ 58.80 $ HYDROCORTISONE SOD SUCC 500MG INJ 68.78 $ HYDROCORTONE 10MG TABLET $13.22 HYDROGEN PEROXIDE 3% SOL 120ML $26.90 HYDROMORPHONE 1 - 4MG INJ $86.96 HYDROMORPHONE 10MG/ML INJ $83.40 HYDROMORPHONE 1-2MG INJ $78.98 HYDROMORPHONE 1MG/ML INJ $78.40 HYDROMORPHONE 1MG/ML LIQ $25.89 HYDROMORPHONE 2MG TABLET $26.69 HYDROMORPHONE 2MG/ML INJ $78.98 HYDROMORPHONE 30MG/30ML NS PCA $178.20 HYDROMORPHONE 3MG SUPP $32.63 HYDROMORPHONE 4MG TABLET $27.34 HYDROMORPHONE 4MG/ML INJ $78.60 HYDROMORPHONE 50MG/100ML NS $180.12 HYDROMORPHONE 50MG/5ML INJ $109.90 HYDROPHILIC WOUND CREAM 75GM $54.58 HYDROXYCHLOROQUINE 200MG TABLET$15.18 HYDROXYUREA 500MG CAPSULE $15.37 HYDROXYZINE 100MG/2ML INJ $53.46 HYDROXYZINE HCL 10MG TABLET $13.97 HYDROXYZINE HCL 25MG TABLET $14.55 HYDROXYZINE HCL 2MG/ML LIQ 120ML $38.19 HYDROXYZINE PAMOATE 25MG CAP $13.13 HYDROXYZINE PAMOATE 50MG CAP $13.99 HYOSCYAMINE SL 0.125MG TABLET $14.02 HYOSCYAMINE SR 0.375MG CAPSULE $13.80 HYSKON IRRIG SOLN 100ML $78.56 IBUPROFEN 200MG TABLET $0.00 IBUPROFEN 20MG/ML LIQ 120ML $0.00 IBUPROFEN 400MG TABLET $13.15 IBUPROFEN 600MG TABLET $13.33 IBUTILIDE 1MG/10ML INJ $602.08

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 99

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9316258 9316225 9305178 9103730 9103748 9194044 9194093 9103722 9188327 9197138 9114828 9103821 9189358 9186081 9145020 9145038 9183039 9112871 9183302 9145111 9145095 9183096 9145061 9189549 9179011 9112871 9137076 9132051 9174756 9174764 9173162 9108515 9114844 9316506 9188335 9173436 9182080 9179730 9103847 9169848 9310707 9103862 9103870 9103888 9103854 9116443 9107152 9107160 9108424 9112871 9114877 9103672 9179441

IDARUBICIN INJ $1,427.50 IFOSFAMIDE 1GM INJ $784.88 IMIPENEM/CILASTATIN 500MG INJ $164.63 IMIPRAMINE 10MG TABLET $13.29 IMIPRAMINE 25MG TABLET $14.47 IMMUNE GLOB (HUMAN) 10% INJ $456.90 IMMUNE GLOBULIN, GAMMA (IGG) $314.40 INDAPAMIDE 2.5MG TABLET $14.43 INDIGO CARMINE 0.8% INJ 5ML $67.58 INDINAVIR 400MG CAPSULE $18.79 INDOMETHACIN 25MG CAPSULE $13.52 INDOMETHACIN 50MG CAPSULE $14.08 INFLIXIMAB 10MG INJ $240.08 INFLUENZA VACCINE $68.38 INSULIN HUMAN NPH $50.93 INSULIN HUMAN REGULAR $50.93 INSULIN NPL/LISPRO 75/25 MIX (VIAL) $159.08 INSULIN, ASPART (VIAL) $159.08 INSULIN, GLARGINE (VIAL) $144.86 INSULIN, HUMAN 70/30 MIX $50.93 INSULIN, HUMAN LENTE $50.93 INSULIN, HUMAN ULTRALENTE (VIAL) $104.00 INSULIN, LISPRO $50.99 INTERFERON BETA-1B 0.3MG INJ $211.08 IODINE MILD TINCTURE 480ML $45.98 IOTHALAMATE-43 50ML VIAL $41.82 IPECAC SYRUP 30ML UDCUP $28.24 IPRATROPIUM 0.02% SOL 2.5ML $16.24 IPRATROPIUM 0.03% NASAL SPY 30ML $125.54 IPRATROPIUM 0.06% NASAL SPY 15ML $111.26 IPRATROPIUM INHALER 14GM $123.54 IRBESARTAN 150MG TABLET $15.89 IRBESARTAN 75MG TABLET $15.73 IRINOTECAN 20MG/ML INJ $764.81 IRON DEXTRAN 100MG/2ML INJ $177.16 ISOETHARINE 1% SOLN 10ML $61.94 ISOFLURANE 100ML $100.88 ISONIAZID 10MG/ML LIQ 120ML $35.59 ISONIAZID 300MG TABLET $13.02 ISOPROPYL ALCOHOL 70% SOLN 480ML $27.92 ISOPROTERENOL 1MG/5ML INJ $142.54 ISOSORBIDE DINITRATE 10MG TAB $13.08 ISOSORBIDE DINITRATE 20MG TAB $13.17 ISOSORBIDE DINITRATE 5MG SL TAB $12.83 ISOSORBIDE DINITRATE 5MG TAB $13.04 ISOSORBIDE DN 40MG SR TAB $13.85 ISOSORBIDE MONONITRATE 20MG TAB $14.81 ISOSORBIDE MONONITRATE SR 30MG TAB $16.68 ISOSORBIDE MONONITRATE SR 60MG TAB $15.45 ISOSULFAN BLUE 1% 5ML VIAL $330.88 ISRADIPINE 2.5MG CAPSULE $15.41 ITRACONAZOLE 100MG CAPSULE $29.72 ITRACONAZOLE 10MG/ML LIQ 150ML $270.02

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

93 93 93 91 91 93 93 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 93 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 100

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9306358 9109943 9306234 9179524 9163379 9169582 9170093 9114919 9173444 9103714 9188061 9188038 9114893 9106683 9103987 9183112 9103961 9173378 9147141 9147141 9113259 9103979 9137092 9197211 9108036 9107434 9108044 9199043 9174715 9116450 9188632 9170481 9109984 9101957 9189226 9101940 9316530 9132069 9108945 9173402 9173386 9174707 9174988 9107822 9305814 9104019 9104027 9104035 9114950 9109547 9188343 9103995 9114943

ITRACONAZOLE 250MG INJ $471.50 IVERMECTIN 3MG TABLET $23.60 KANAMYCIN 1GM/3ML INJ $115.62 KAOPECTATE SUSPENSION 240ML $31.90 KETAMINE 500MG/10ML INJ $108.82 KETOCONAZOLE 2% CREAM 15GM $58.36 KETOCONAZOLE 2% SHAMPOO 120ML $77.28 KETOCONAZOLE 200MG TABLET $19.04 KETOROLAC 0.5% OP SOLN 5ML $137.96 KETOROLAC 10MG TABLET $14.58 KETOROLAC 30MG/1ML INJ $58.88 KETOROLAC 60MG/2ML INJ $63.38 K-LYTE/CL EFF 25MEQ TABLET $15.59 KU-ZYME CAPSULE $13.91 LABETALOL 100MG TABLET $13.68 LABETALOL 100MG/20ML INJ $60.88 LABETALOL 200MG TABLET $14.08 LACRI-LUBE OPHTH OINT $38.66 LACTATED RINGERS 1000ML $79.82 LACTATED RINGERS 1L (FLOORSTOCK) $79.82 LACTOBACILLUS ACIDOPH PACKET $13.83 LACTOBACILLUS CHEW TABLET $12.96 LACTULOSE 20GM/30ML UD CUP $31.40 LAMIVUDINE 150MG TABLET $23.25 LAMOTRIGINE 25MG TABLET $18.44 LANSOPRAZOLE 15MG SR CAPSULE $21.46 LANSOPRAZOLE 30MG SR CAPSULE $21.63 LANSOPRAZOLE 3MG/ML SUSP 50ML $101.44 LATANOPROST 0.005% OP SOLN 2.5ML $131.44 LEFLUNOMIDE 10MG TABLET $32.97 LEPIRUDIN 50MG INJ $340.26 LET SOLUTION 5ML $21.02 LETROZOLE 2.5MG TABLET $27.65 LEUCOVORIN 25MG TABLET $40.10 LEUCOVORIN 50MG INJ $109.26 LEUCOVORIN 5MG TABLET $19.22 LEUPROLIDE 2-WK 1MG/0.2ML KIT $934.58 LEVALBUTEROL 0.63MG/3ML INH SOLN $17.40 LEVETIRACETAM 500MG TABLET $16.76 LEVOBUNOLOL 0.25% OP SOLN 5ML $57.08 LEVOBUNOLOL 0.5% OP SOLN 5ML $58.72 LEVOCABASTINE 0.05% OP SOLN 5ML $122.22 LEVOFLOXACIN 0.5% OP SOLN 5ML $99.74 LEVOFLOXACIN 500MG TABLET $31.93 LEVOFLOXACIN 500MG/100ML D5W $187.98 LEVOTHYROXINE 100MCG TAB $13.27 LEVOTHYROXINE 112MCG TAB $13.32 LEVOTHYROXINE 125MCG TAB $13.36 LEVOTHYROXINE 150MCG TAB $13.38 LEVOTHYROXINE 175MCG TAB $13.46 LEVOTHYROXINE 200MCG INJ $120.76 LEVOTHYROXINE 25MCG TABLET $13.37 LEVOTHYROXINE 50MCG TAB $13.20

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

93 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 101

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9104001 9104043 9114984 9183120 9183187 9183138 9183195 9189432 9187857 9183161 9170168 9179789 9137290 9183203 9151390 9188384 9169442 9169434 9171190 9189465 9189614 9188400 9189622 9189630 9112871 9109257 9306291 9104092 9104084 9104118 9104126 9104134 9114992 9103805 9103813 9103797 9113424 9109976 9104175 9115007 9104167 9104159 9179037 9174996 9103763 9137191 9104209 9106824 9106816 9155060 9155078 9163452 9163254

LEVOTHYROXINE 75MCG TAB $13.38 LEVOTHYROXINE 88MCG TAB $13.27 LIBRAX CAP $16.86 LIDOCAINE 0.5% INJ 50ML $55.38 LIDOCAINE 0.5%/EPI 1:200000 INJ 50ML $56.80 LIDOCAINE 1% INJ 20ML $56.04 LIDOCAINE 1%/EPI 1:100000 INJ 20ML $53.64 LIDOCAINE 1.5%/EPI 1:200000 INJ 10ML $65.42 LIDOCAINE 100MG SYRINGE $55.40 LIDOCAINE 2% INJ 20ML $51.66 LIDOCAINE 2% JELLY 30ML $64.18 LIDOCAINE 2% VISCOUS 100ML $30.70 LIDOCAINE 2% VISCOUS 20ML UDCUP $27.96 LIDOCAINE 2%/EPI 1:100000 INJ 20ML $54.10 LIDOCAINE 2GM/250ML D5W PREMIX $97.92 LIDOCAINE 4% INJ 5ML $55.50 LIDOCAINE 4% TOPICAL SOLN 50ML $39.52 LIDOCAINE 5% OINTMENT 35GM $53.06 LIDOCAINE 5% PATCH $74.69 LIDOCAINE 5%-GLUCOSE 7.5% INJ 2ML $56.28 LIDOCAINE MPF 1% INJ 5ML $55.62 LIDOCAINE MPF 1.5% INJ 20ML $75.82 LIDOCAINE MPF 2% 10ML INJ $56.10 LIDOCAINE MPF 2%/EPI 1:200000 10ML $67.84 LINEZOLID 100MG/5ML SUSP 150ML $669.60 LINEZOLID 600MG TABLET $131.99 LINEZOLID 600MG/300ML SW PREMIX $263.14 LIOTHYRONINE 25MCG TABLET $13.98 LIOTHYRONINE 5MCG TABLET $13.77 LIOTRIX 60MG TABLET $14.07 LIOTRIX 120MG TABLET $14.31 LIOTRIX 180MG TABLET $14.66 LIOTRIX 30MG TABLET $13.80 LISINOPRIL 10MG TABLET $14.95 LISINOPRIL 20MG TABLET $14.74 LISINOPRIL 5MG TABLET $14.88 LISINOPRIL/HCTZ 20/12.5 TABLET $15.39 LISINOPRIL/HCTZ 20/25 TABLET $15.42 LITHIUM CARB 150MG CAPSULE $13.06 LITHIUM CARB 300MG CAPSULE $13.14 LITHIUM CARB SR (LITHOBID) 300MG TAB$13.61 LITHIUM CARB SR 450MG TABLET $13.86 LITHIUM CITRATE 60MG/ML LIQ 120ML $34.81 LODOXAMIDE 0.1% OP SOLN 10ML $151.20 LOPERAMIDE 2MG CAPSULE $14.13 LOPERAMIDE 2MG/10ML LIQ UDCUP $27.84 LORATADINE 10MG TABLET $19.18 LORATADINE/PSEUDO SR 12HR TABLET $16.36 LORATADINE/PSEUDO SR 24HR TABLET $20.00 LORAZEPAM 0.5MG TABLET $26.83 LORAZEPAM 1MG TABLET $27.25 LORAZEPAM 20MG/10ML INJ $195.64 LORAZEPAM 2MG/1 ML INJ $93.08

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 102

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9158080 9107327 9175001 9175019 9108093 9104233 9137282 9168329 9199035 9115114 9178120 9104290 9188418 9188418 9151408 9169467 9151010 9310509 9173394 9173410 9112871 9112871 9115171 9316423 9104365 9104373 9187931 9104399 9108101 9104407 9179078 9113481 9109802 9104415 9112871 9163197 9158320 9163155 9163171 9163148 9166133 9163197 9163171 9155359 9163155 9163197 9163171 9183484 9183831 9183237 9106840 9197120 9306283

LORAZEPAM 2MG/ML ORAL SOLN $28.12 LOSARTAN 50MG TABLET $15.75 LOTEPREDNOL 0.2% OP SOLN 5ML $98.52 LOTEPREDNOL 0.5% OP SOLN 5ML $83.00 LOVASTATIN 10MG TABLET $15.41 LOVASTATIN 20MG TABLET $18.09 MAALOX PLUS EX-STR 30ML UD CUP $0.00 MAFENIDE 8.5% CREAM 453.6GM $333.88 MAGIC MOUTHWASH 120ML $43.44 MAGNESIUM CHLORIDE CR 64MG TAB $12.95 MAGNESIUM CITRATE LIQ 300ML $28.64 MAGNESIUM OXIDE 400MG TABLET $13.12 MAGNESIUM SULF 8MEQ/2ML INJ $26.62 MAGNESIUM SULFATE 1GM/2ML INJ $26.62 MAGNESIUM SULFATE 40GM/1000ML SWFI $91.82 MAGNESIUM SULFATE CRYSTALS 454GM$27.80 MANNITOL 20% IV SOLN 500ML $112.88 MANNITOL 25% 50ML VIAL $55.16 MAXITROL OPHTH OINT 3.5GM $131.94 MAXITROL OPHTH SOLN 5ML $123.32 MD-GASTROVIEW 66/10 SOL 240ML $110.30 MEASLES,MUMPS&RUBELLA VACCINE $91.98 MEBENDAZOLE 100MG CHEW TABLET $23.36 MECHLORETHAMINE 10MG INJ $470.48 MECLIZINE 12.5MG TABLET $13.04 MECLIZINE 25MG TABLET $13.07 MEDROXYPROGESTERONE 150MG/ML INJ $163.10 MEDROXYPROGESTERONE 2.5MG TABLET $13.32 MEDROXYPROGESTERONE 5MG TABLET$13.62 MEGESTROL 40MG TABLET $14.86 MEGESTROL 40MG/ML LIQ 240ML $313.34 MELATONIN 3MG TABLET $12.84 MELOXICAM 7.5MG TABLET $17.44 MELPHALAN 2MG TABLET $18.20 MEMANTINE 10MG TABLET $17.37 MEPERIDINE 100MG/1ML INJ $78.98 MEPERIDINE 10MG/ML SYRUP $25.75 MEPERIDINE 25 - 50MG INJ $78.98 MEPERIDINE 25 - 75MG INJ $78.98 MEPERIDINE 25MG/1ML INJ $78.22 MEPERIDINE 300MG/30ML NS PCA $150.80 MEPERIDINE 50 - 100MG INJ $78.98 MEPERIDINE 50 - 75MG INJ $78.98 MEPERIDINE 50MG TABLET $26.68 MEPERIDINE 50MG/1ML INJ $77.68 MEPERIDINE 75 - 100MG INJ $78.98 MEPERIDINE 75MG/ML INJ $78.38 MEPIVACAINE 1% INJ 30ML $66.38 MEPIVACAINE 1.5% INJ 30ML $71.88 MEPIVACAINE 2% INJ 20ML $68.08 MEPROBAMATE 400MG TABLET $26.13 MERCAPTOPURINE 50MG TABLET $20.70 MEROPENEM 1GM INJ $205.44

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 93

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 103

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9107392 9128067 9128216 9104894 9316233 9112871 9132192 9132200 9104423 9174939 9108432 9107467 9107293 9109315 9155375 9158205 9155367 9158015 9113473 9104431 9104449 9104456 9104464 9106501 9104472 9183492 9115239 9104480 9163098 9197088 9316548 9109463 9104522 9104530 9310731 9188426 9104548 9187691 9155409 9104555 9183294 9183260 9187154 9183252 9115270 9174657 9104571 9188434 9179532 9104563 9151424 9104589 9104597

MESALAMINE 250MG CAPSULE $13.92 MESALAMINE 4GM/60ML ENEMA $55.92 MESALAMINE 500MG SUPP $20.91 MESALAMINE EC 400MG TABLET $14.60 MESNA 100MG/ML INJ $185.97 MESSAGE $0.00 METAPROTERENOL 0.4% INH 2.5ML $15.18 METAPROTERENOL 0.6% INH 2.5ML $15.18 METAPROTERENOL 10MG TABLET $13.40 METAPROTERENOL INHALER 14GM $88.94 METAXALONE 400MG TABLET $14.84 METFORMIN 500MG TABLET $14.13 METFORMIN 850MG TABLET $15.11 METFORMIN XR 500MG TABLET $14.25 METHADONE 10MG TABLET $26.22 METHADONE 1MG/ML LIQUID $25.56 METHADONE 5MG TABLET $26.12 METHADONE INTENSOL 10MG/ML LIQ $26.94 METHAZOLAMIDE 25MG TABLET $13.68 METHAZOLAMIDE 50MG TABLET $14.30 METHENAMINE HIPPURATE 1GM TAB $15.50 METHENAMINE MANDELATE 1GM TAB $13.78 METHENAMINE MANDELATE EC 500MG TAB $13.38 METHIMAZOLE 10MG TABLET $14.26 METHIMAZOLE 5MG TABLET $13.61 METHOCARBAMOL 1000MG/10ML INJ $81.98 METHOCARBAMOL 500MG TABLET $13.47 METHOCARBAMOL 750MG TABLET $13.71 METHOHEXITAL 500MG INJ $141.14 METHOTREXATE 2.5MG TABLET $20.16 METHOTREXATE PF 25MG/ML INJ $453.96 METHYLCELLULOSE PACKET $13.27 METHYLDOPA 250MG TABLET $13.46 METHYLDOPA 500MG TABLET $14.07 METHYLDOPATE 250MG/5ML INJ $126.76 METHYLENE BLUE 1% INJ $64.88 METHYLERGONOVINE 0.2MG TABLET $14.20 METHYLERGONOVINE 0.2MG/ML INJ $59.04 METHYLPHENIDATE 5MG TABLET $26.11 METHYLPREDNISOLONE 4MG TABLET $13.69 METHYLPREDNISOLONE SS 125MG INJ $57.66 METHYLPREDNISOLONE SS 1GM INJ $89.44 METHYLPREDNISOLONE SS 40MG INJ $55.09 METHYLPREDNISOLONE SS 500MG INJ $69.96 METHYSERGIDE 2MG TABLET $18.40 METIPRANOLOL 0.3% OP SOLN 5ML $65.30 METOCLOPRAMIDE 10MG TABLET $13.35 METOCLOPRAMIDE 10MG/2ML INJ $106.46 METOCLOPRAMIDE 1MG/ML LIQ 120ML $35.08 METOCLOPRAMIDE 5MG TABLET $13.53 METOCLOPROMIDE 50MG/50ML D5W $182.84 METOLAZONE 2.5MG TABLET $15.19 METOLAZONE 5MG TABLET $15.46

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 93 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 104

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9104605 9188442 9109901 9115296 9168774 9170036 9104639 9104621 9305541 9104498 9168345 9170150 9169491 9128356 9128349 9128422 9163304 9163288 9158221 9163460 9107533 9108408 9310129 9137126 9174780 9112871 9306838 9107004 9104688 9104670 9199019 9116468 9170283 9107566 9112871 9113432 9113440 9104274 9109562 9316134 9316324 9183286 9137100 9168808 9168477 9170317 9174483 9107558 9108952 9163445 9163445 9166141 9163445

METOPROLOL 50MG TABLET $13.86 METOPROLOL 5MG/5ML INJ $57.76 METOPROLOL XL 25MG SR TAB $14.17 METOPROLOL XL 50MG TABLET $14.17 METRONIDAZOLE 0.75% GEL 28.4GM $103.94 METRONIDAZOLE 0.75% VAG GEL 70GM$115.08 METRONIDAZOLE 250MG TABLET $13.30 METRONIDAZOLE 500MG TABLET $14.38 METRONIDAZOLE 5MG/ML PREMIX $106.66 MEXILETINE 150MG CAPSULE $14.10 MICONAZOLE 2% CREAM 15GM $64.72 MICONAZOLE 2% POWDER 45GM $32.94 MICONAZOLE 2% VAG CREAM 45GM $51.92 MICONAZOLE 3 200MG VAG SUPP #3 $85.94 MICONAZOLE 7 100MG VAG SUPP #7 $48.58 MICONAZOLE DUAL PACK $82.92 MIDAZOLAM 2MG/2ML INJ $77.70 MIDAZOLAM 10MG/10ML INJ $85.08 MIDAZOLAM 2MG/ML SYRUP $27.63 MIDAZOLAM 50MG/10ML INJ $103.50 MIDODRINE 2.5MG TABLET $15.22 MIDODRINE 5MG TABLET $17.75 MILRINONE 20MG/20ML INJ $296.76 MINERAL OIL ( ORAL) 30ML UDCUP $26.34 MINERAL OIL LIGHT SOLN 10ML $28.14 MINOCYCLINE 100MG CAPSULE $17.64 MINOCYCLINE 100MG INJ $194.52 MINOCYCLINE PELLETIZED 50MG CAP $17.39 MINOXIDIL 10MG TABLET $15.30 MINOXIDIL 2.5MG TABLET $13.90 MIRACLE MOUTHWASH 120ML $43.44 MIRALAX 17GM PACKET $16.70 MIRALAX POWDER 255GM $65.00 MIRTAZAPINE 15MG TABLET $18.26 MIRTAZAPINE 30MG TABLET $18.43 MIRTAZAPINE SOL 15MG TABLET $17.53 MIRTAZAPINE SOL 30MG TABLET $17.67 MISOPROSTOL 200MCG TABLET $15.54 MISOPROSTOL 25MCG DOSE $15.52 MITOMYCIN 5MG INJ $585.20 MITOXANTRONE 2MG/ML INJ $1,005.60 MIVACURIUM 20MG/10ML INJ $88.14 MOM 30ML UDCUP $0.00 MOMETASONE 0.1% CREAM 15GM $70.30 MOMETASONE 0.1% LOTION 60ML $118.30 MOMETASONE 0.1% OINT 15GM $70.30 MOMETASONE 50MCG NASAL SPY 17GM $160.34 MONTELUKAST 10MG TABLET $18.55 MONTELUKAST 4MG CHEW TAB $18.55 MORPHINE 1 - 10MG INJ $78.72 MORPHINE 1 - 5MG INJ $78.72 MORPHINE 100MG/100ML NS DRIP $154.72 MORPHINE 10MG/ML INJ $78.04

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 93 93 91 91 91 91 91 91 91 91 91 91 93 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 105

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9163478 9163445 9163221 9163445 9112871 9163445 9158023 9163189 9163445 9166158 9163445 9163221 9166166 9163437 9163429 9163544 9163569 9163528 9155391 9155383 9155433 9155300 9183419 9115379 9178427 9310335 9100702 9109570 9174848 9169574 9174673 9106600 9179904 9106667 9108143 9108150 9104746 9305582 9306465 9187709 9108473 9187717 9188475 9106576 9163619 9174665 9173915 9173873 9108481 9104753 9104761 9104779 9104787

MORPHINE 15MG/ML 20ML INJ $101.08 MORPHINE 2 - 10MG INJ $78.72 MORPHINE 2 - 4MG INJ $78.72 MORPHINE 2 - 5MG INJ $78.72 MORPHINE 2 - 6MG INJ $78.72 MORPHINE 2 - 8MG INJ $78.72 MORPHINE 20MG/ML ORAL SOLN $26.68 MORPHINE 2MG/ML INJ $78.52 MORPHINE 3 - 8MG INJ $78.72 MORPHINE 30MG/30ML NS PCA $152.32 MORPHINE 4 - 8MG INJ $78.72 MORPHINE 4MG/ML INJ $78.58 MORPHINE 50MG/100ML DRIP $150.62 MORPHINE 50MG/ML 20ML INJ $254.36 MORPHINE PF 10MG/10ML INJ $94.78 MORPHINE PF 200MG/20ML INJ $388.32 MORPHINE PF 500MG/20ML AMP $638.32 MORPHINE PF 5MG/10ML INJ $93.52 MORPHINE SR 100MG TABLET $36.38 MORPHINE SR 15MG TABLET $27.43 MORPHINE SR 30MG TABLET $29.23 MORPHINE SR 60MG TABLET $32.83 MORRHUATE 50MG/ML INJ $175.88 MOXIFLOXACIN 400MG TABLET $31.57 MULTIVITAMIN LIQ 120ML $36.30 MULTIVITAMIN INJ $44.80 MULTIVITAMIN TABLET $0.00 MULTIVITAMIN,THER W/MIN TABLET $0.00 MUPIROCIN 2% NASAL OINT 1GM $37.22 MUPIROCIN 2% OINTMENT 22GM $116.80 MURO-128 5% OPHT SOL 15ML $54.24 MYCOPHENALATE 250MG CAPSULE $18.59 MYCOPHENOLATE 200MG/ML LIQ 175ML$847.30 NABUMETONE 500MG TABLET $15.72 NABUMETONE 750MG TABLET $16.26 NADOLOL 20MG TABLET $14.57 NADOLOL 40MG TABLET $14.88 NAFCILLIN 1GM INJ $107.42 NAFCILLIN 500MG INJ $106.14 NALBUPHINE 10MG/ML INJ $53.16 NALIDIXIC ACID 1GM TABLET $17.93 NALOXONE 0.4MG/ML INJ $53.68 NALOXONE 2MG/2ML INJ $60.86 NALTREXONE 50MG TABLET $21.27 NANDROLONE DE 200MG/2ML INJ $105.38 NAPHAZOLINE 0.1% OP SOLN 15ML $72.74 NAPHAZOLINE/ANTAZOLINE EYE DROPS $41.70 NAPHAZOLINE/PHENIRAMINE OPSOL $41.20 NAPROXEN 220MG TABLET $12.90 NAPROXEN 250MG TABLET $14.32 NAPROXEN 275MG TABLET $14.41 NAPROXEN 375MG TABLET $14.91 NAPROXEN 500MG TABLET $15.40

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 93 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 106

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9108499 9173980 9103631 9108168 9179136 9104795 9169558 9172024 9173485 9173477 9183310 9107335 9107111 9189648 9106592 9105644 9197377 9170291 9108507 9104837 9104829 9109372 9104837 9104852 9310913 9104845 9109992 9107103 9171067 9171067 9171075 9171075 9182098 9171059 9104860 9104886 9113721 9113739 9115445 9104878 9113754 9113242 9107038 9104902 9130071 9179912 9104910 9108689 9171083 9171091 9182064 9171109 9171117

NAPROXEN 550MG TABLET $15.31 NEDOCROMIL INHALER 16.2GM $110.88 NEFAZODONE 100MG TABLET $15.76 NEFAZODONE 150MG TABLET $15.82 NEOMYCIN 25MG/ML LIQ 120ML $38.69 NEOMYCIN 500MG TABLET $16.67 NEOSPORIN OINT 30GM $30.64 NEOSPORIN OINT PACKET $12.94 NEOSPORIN OPHTH OINT 3.5GM $56.98 NEOSPORIN OPHTH SOLN 10ML $89.70 NEOSTIGMINE 1MG (1:1000) INJ $68.74 NEPHROCAPS CAPSULE $0.00 NEPHRO-VITE TABLET $13.04 NESIRITIDE INJ $405.76 NEUTRA PHOS K PWD (250MG PHOS) $13.76 NEUTRA-PHOS PKT (250MG PHOS) $13.59 NEVIRAPINE 200MG TABLET $24.94 NEW SKIN LIQUID 2.55GM $0.00 NIACIN 100MG TABLET $12.77 NIACIN 500MG TABLET $12.81 NIACIN 50MG TABLET $12.76 NIACIN SR 250MG CAPSULE $12.84 NIACIN SR 500MG TABLET $12.84 NICARDIPINE 20MG CAPSULE $13.51 NICARDIPINE 25MG/10ML INJ $146.50 NICARDIPINE 30MG CAPSULE $13.97 NICARDIPINE SR 30MG CAPSULE $14.54 NICARDIPINE SR 45MG CAPSULE $15.60 NICOTINE 11MG PATCH $18.43 NICOTINE 14MG PATCH $19.46 NICOTINE 21MG PATCH $20.99 NICOTINE 22MG PATCH $18.43 NICOTINE 2MG GUM #12 $35.92 NICOTINE 7MG PATCH $19.46 NIFEDIPINE 10MG CAPSULE $14.05 NIFEDIPINE 20MG CAPSULE $14.74 NIFEDIPINE SR 30MG TABLET $15.67 NIFEDIPINE SR 60MG TABLET $17.98 NIFEDIPINE XL 30MG TABLET $16.10 NIFEDIPINE XL 60MG TABLET $18.57 NIFEDIPINE XL 90MG TABLET $19.47 NIFEREX-150 CAPSULE $13.45 NIFEREX-150 FORTE CAPSULE $13.49 NIMODIPINE 30MG CAPSULE $27.81 NITRAZINE PAPER W/DISPENSER $85.46 NITROFURANTOIN 25MG/5ML LIQ 60ML $57.28 NITROFURANTOIN MACRO 50MG CAP $14.19 NITROFURANTOIN SR (MACROBID) 100MG CAP $16.68 NITROGLYCERIN 0.1MG/HR PATCH $16.90 NITROGLYCERIN 0.2MG/HR PATCH $15.95 NITROGLYCERIN 0.4MG SPRAY 12GM $97.58 NITROGLYCERIN 0.4MG/HR PATCH $16.41 NITROGLYCERIN 0.6MG/HR PATCH $16.79

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 107

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9172016 9310517 9151085 9182015 9182049 9182007 9104928 9104936 9310152 9115460 9310434 9106618 9147489 9147323 9147323 9147489 9104951 9104969 9168444 9178344 9128059 9169616 9168352 9169525 9187626 9188608 9113465 9174699 9113648 9103698 9100728 9112871 9175092 9105206 9102328 9102336 9103441 9188509 9106832 9160003 9112871 9189275 9112871 9105016 9101924 9306473 9306499 9316555 9108986 9104704 9155441 9155458 9109000

NITROGLYCERIN 2% OINT UD PKT $14.00 NITROGLYCERIN 50MG/10ML INJ $129.88 NITROGLYCERIN 50MG/D5W 250ML DRIP$90.24 NITROGLYCERIN SL 0.3MG TABLET $42.18 NITROGLYCERIN SL 0.4MG TAB #25 $34.56 NITROGLYCERIN SL 0.6MG TABLET $42.18 NITROGLYCERIN SR 2.5MG CAPSULE $13.02 NITROGLYCERIN SR 6.5MG CAPSULE $13.07 NITROPRESS 50MG/2ML INJ $105.26 NIZATIDINE 150MG CAPSULE $19.01 NOREPINEPHRINE 4MG/4ML INJ $127.92 NORETHINDRONE 5MG TABLET $15.95 NORMOSOL R/D5W 1000ML $82.62 NORMOSOL-R 1000ML(FLOORSTOCK) $82.46 NORMOSOL-R IV SOLN $82.46 NORMOSOL-R/D5W (FLOORSTOCK) $82.62 NORTRIPTYLINE 10MG CAPSULE $13.61 NORTRIPTYLINE 25MG CAPSULE $14.49 NYSTATIN 100,000 U/GM OINT 15GM $30.94 NYSTATIN 100,000 U/ML SUSP 60ML $58.24 NYSTATIN 100,000 UNITS VAG TAB $16.81 NYSTATIN 100,000U/GM POWDER $80.36 NYSTATIN 100,000UN/GM CRM 30GM $37.44 NYSTATIN/TRIAMCINOLONE CRM 30GM $38.70 OCTREOTIDE 0.05MG/1 ML INJ $69.70 OCTREOTIDE 1000MCG/5ML INJ $427.54 OCUVITE TABLET $12.99 OFLOXACIN 0.3% OPHTH SOLN 5ML $104.54 OFLOXACIN 200MG TABLET $22.20 OLANZAPINE 5MG TABLET $24.97 OLMESARTAN 20MG TABLET $15.35 OLMESARTAN 5MG TABLET $15.35 OLOPATADINE 0.1% OPH SOLN 5ML $159.20 OLSALAZINE 250MG CAPSULE $15.20 OMEPRAZOLE 20MG SR CAPSULE $21.95 OMEPRAZOLE 40MG SR CAPSULE $25.96 ONDANSETRON 4MG TABLET $50.68 ONDANSETRON 4MG/2ML INJ $105.94 ONDANSETRON ODT 4MG TABLET $47.44 OPIUM & BELLADONNA 60MG SUPP $30.76 OPIUM TINCTURE 10MG/ML $26.50 OPRELVEKIN 5MG INJ $642.04 ORAL BALANCE MOUTH MOIST GEL $35.38 ORPHENADRINE CR 100MG TABLET $17.07 OSCAL 500 TAB ( 1.25GM CA CARB) $0.00 OXACILLIN 1GM VIAL $108.46 OXACILLIN 2GM VIAL $114.60 OXALIPLATIN 5MG INJ $644.05 OXANDROLONE 2.5MG TABLET $34.09 OXAPROZIN 600MG TABLET $16.93 OXAZEPAM 10MG CAPSULE $27.16 OXAZEPAM 15MG CAPSULE $27.62 OXCARBAZEPINE 300MG TABLET $16.56

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 93 91 91 91 91 91 91 93 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 93 93 93 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 108

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9178179 9179771 9105032 9109265 9158098 9155557 9155615 9155565 9155771 9155466 9174061 9310475 9316209 9188111 9168519 9105073 9108192 9103565 9183328 9310814 9109018 9168147 9187279 9188657 9113747 9103508 9103516 9113762 9112871 9189598 9189309 9155789 9155797 9168139 9105107 9306523 9305350 9305905 9305194 9305202 9112871 9105115 9115585 9179748 9306507 9305855 9163411 9155730 9163536 9163502 9109810 9106675 9107400

OXCARBAZEPINE 300MG/5ML LIQ 250ML$203.32 OXYBUTYNIN 1MG/ML LIQ 120ML $52.07 OXYBUTYNIN 5MG TABLET $13.61 OXYBUTYNIN XL 5MG TABLET $18.06 OXYCODONE 20MG/ML ORAL SOLN $27.77 OXYCODONE 5MG TABLET $26.26 OXYCODONE SR 10MG TABLET $28.36 OXYCODONE SR 20MG TABLET $31.03 OXYCODONE SR 40MG TABLET $35.36 OXYCODONE/APAP 5/325MG TABLET $27.84 OXYMETAZOLINE 0.05% NASAL SPY 30ML$30.74 OXYTOCIN 10 UNITS/ML INJ $52.94 PACLITAXEL 6MG/ML INJ $790.64 PAMIDRONATE 30MG INJ $661.48 PANAFIL OINTMENT 30GM $201.44 PANCREASE EC CAPSULE $13.62 PANCREASE MT-10 EC CAPSULE $14.71 PANCREASE MT-16 CAPSULE EC $15.91 PANCURONIUM 1MG/ML VIAL $59.64 PANTOPRAZOLE 40MG INJ $151.76 PANTOPRAZOLE SR 40MG TABLET $19.75 PAPAIN/UREA OINTMENT 30GM $123.64 PAPAVERINE 60MG/2ML INJ $57.88 PARICALCITOL 5MCG/ML INJ $108.56 PAROXETINE 10MG TABLET $18.13 PAROXETINE 20MG TABLET $18.48 PAROXETINE 30MG TABLET $18.54 PAROXETINE CR 12.5MG TABLET $18.13 PEDIATRIC MULTIVITAMINS 1ML INJ $30.82 PEGFILGRASTIM INJ $1,428.53 PEGFILGRASTIM INJ $6,345.20 PEMOLINE 18.75MG TABLET $27.75 PEMOLINE 37.5MG TABLET $29.07 PENCICLOVIR 1% CREAM 1.5GM $73.54 PENICILLAMINE 250MG CAP $15.04 PENICILLIN G BENZ 1.2MUN/2ML INJ $106.06 PENICILLIN G BENZ 2.4MUN/4ML INJ $163.94 PENICILLIN G BENZ 600,000 UNITS/ML INJ$82.74 PENICILLIN G POT 1 MUNIT INJ $103.61 PENICILLIN G POT 5MUNIT INJ $108.65 PENICILLIN G SODIUM 5MUNIT INJ $186.12 PENICILLIN VK 250MG TABLET $12.97 PENICILLIN VK 500MG TABLET $12.99 PENICILLIN VK 50MG/ML SUSP 100ML $31.02 PENTAMIDINE 300MG INHALATION $222.94 PENTAMIDINE 300MG INJ $196.16 PENTAZOCINE 30MG/ML INJ $85.08 PENTAZOCINE/NALOLONE TABLET $27.97 PENTOBARBITAL 1000MG/20ML INJ $108.84 PENTOBARBITAL 2500MG/50ML INJ $137.02 PENTOSAN 100MG CAP $16.99 PENTOXIFYLLINE CR 400MG TABLET $14.03 PERGOLIDE 0.05MG TABLET $15.22

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 93 93 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 93 93 91 91 91 91 91 91 91 93 93 93 91 91 91 91 93 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 109

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9107418 9169780 9169798 9105131 9105149 9105164 9105172 9105180 9159005 9102807 9102815 9155508 9163080 9155482 9155490 9155847 9163072 9187287 9174517 9174012 9174541 9173501 9188491 9174863 9187915 9137274 9187923 9179540 9105230 9105222 9105214 9112871 9179557 9187295 9187311 9187303 9115668 9174103 9173527 9173535 9173543 9173550 9113119 9174137 9171182 9105198 9109026 9305228 9305236 9305251 9175035 9106717 9115684

PERGOLIDE 0.25MG TABLET $16.86 PERMETHRIN 1% LIQUID 60ML $38.19 PERMETHRIN 5% CREAM 60GM $81.52 PERPHENAZINE 2MG TABLET $13.80 PERPHENAZINE 4MG TABLET $14.21 PHENAZOPYRIDINE 100MG TABLET $13.62 PHENAZOPYRIDINE 200MG TABLET $14.39 PHENELZINE 15MG TABLET $13.80 PHENOBARB 30MG/7.5ML LIQ UDCUP $26.28 PHENOBARB/BELLADONNA SR TABLET $14.58 PHENOBARB/BELLADONNA TABLET $13.38 PHENOBARBITAL 100MG TABLET $25.61 PHENOBARBITAL 130MG/ML INJ $80.36 PHENOBARBITAL 15MG TABLET $25.52 PHENOBARBITAL 30MG TABLET $25.59 PHENOBARBITAL 60MG TABLET $25.56 PHENOBARBITAL 65MG/ML INJ $79.72 PHENTOLAMINE 5MG INJ $120.88 PHENYLEPHRINE 0.25% NASAL SPY 15ML$32.42 PHENYLEPHRINE 0.5% NASAL SPY 15ML $32.42 PHENYLEPHRINE 1% NASAL SPY 15ML $33.34 PHENYLEPHRINE 10% OP SOLN 5ML $38.84 PHENYLEPHRINE 10MG/ML INJ $108.02 PHENYLEPHRINE 2.5% OP SOLN 5ML $66.06 PHENYTOIN 100MG/2ML INJ $58.78 PHENYTOIN 100MG/4ML UD CUP $26.55 PHENYTOIN 250MG/5ML INJ $60.26 PHENYTOIN 25MG/ML LIQ 120ML $58.74 PHENYTOIN 50MG CHEW TABLET $13.48 PHENYTOIN SR 100MG CAPSULE $13.38 PHENYTOIN SR 30MG CAPSULE $13.24 PHOSPHATE PROTOCOL $0.00 PHOSPHO-SODA SOLUTION 45ML $27.84 PHYSOSTIGMINE 2MG/2ML INJ $60.60 PHYTONADIONE 10MG/1ML INJ $61.24 PHYTONADIONE 1MG/0.5ML INJ $56.30 PHYTONADIONE 5MG TABLET $14.03 PILOCARPINE 0.5% OP SOLN 15ML $38.68 PILOCARPINE 1% OP SOLN 15ML $43.84 PILOCARPINE 2% OP SOLN 15ML $49.04 PILOCARPINE 3% OP SOLN 15ML $46.80 PILOCARPINE 4% OP SOLN 15ML $47.74 PILOCARPINE 5MG TABLET $15.65 PILOCARPINE HS 4% OP GEL 4GM $107.44 PIMECROLIMUS 1% CREAM 15GM $75.48 PIMOZIDE 2MG TABLET $14.79 PIOGLITAZONE 15MG TABLET $19.38 PIPERACILLIN 2GM INJ $131.26 PIPERACILLIN 3GM INJ $146.00 PIPERACILLIN 4GM INJ $160.74 PIRBUTEROL INHALER 14GM $153.00 PIROXICAM 10MG CAPSULE $15.54 PIROXICAM 20MG CAPSULE $18.16

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 93 93 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 110

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9195025 9186008 9170143 9108614 9306341 9174558 9174855 9173584 9310160 9109588 9188996 9310939 9113002 9137142 9105271 9112871 9105289 9105305 9114901 9178377 9183336 9183336 9115643 9168360 9168014 9168501 9107749 9168071 9170333 9106550 9105313 9115700 9105321 9115718 9173899 9137332 9179565 9178526 9106691 9105362 9105354 9179201 9105347 9105370 9115742 9109513 9105396 9128182 9128380 9189556 9117045 9175100 9105404

PLASMA PROTEIN 5% IV SOLN $384.40 PNEUMOCOCCAL VACCINE ADULT INJ $82.14 PODOFILOX 0.5% TOPICAL SOLN 3.5ML $246.50 POLYCARBOPHIL CAL 625MG TABLET $12.99 POLYMYXIN B SULF 50,000 UNITS INJ $68.88 POLYMYXIN B/TMP OP SOLN 10ML $60.28 POLY-PRED OPHTH SOLN 5ML $82.54 POLYSPORIN OPHTH OINT 3.5GM $87.96 POTASSIUM ACETATE 2MEQ/ML INJ $28.64 POTASSIUM BICARB EFF 25MEQ TABLET $13.37 POTASSIUM CHLORIDE 10MEQ/50ML SWFI $107.08 POTASSIUM CHLORIDE 2MEQ/ML INJ $26.52 POTASSIUM CITRATE SR 5 MEQ TAB $13.22 POTASSIUM CL 10% 40MEQ/30ML UDCUP$26.22 POTASSIUM CL 20MEQ PACKET $15.69 POTASSIUM CL 30MEQ/100ML SW $107.02 POTASSIUM CL SR 10MEQ CAPSULE $13.36 POTASSIUM CL SR 20MEQ TABLET $13.85 POTASSIUM CL SR 8MEQ CAPSULE $13.36 POTASSIUM IODIDE 1GM/ML LIQ 30ML $49.64 POTASSIUM PHOS 3MM0L/ML INJ $28.22 POTASSIUM PHOS 4.4MEQ/ML INJ $28.22 POTASSIUM PHOSPHOROUS 250MG TAB $13.02 POVIDONE IODINE 5% SPRAY 88ML $42.14 POVIDONE-IODINE 10% OINT 30GM $28.88 POVIDONE-IODINE 10% SOLN 240ML $29.60 PRAMIPEXOLE 0.125MG TABLET $14.50 PRAMOXINE 1% FOAM 15GM $80.30 PRAMOXINE 1% GEL 118GM $38.62 PRAVASTATIN 20MG TABLET $18.61 PRAZIQUANTEL 600MG TABLET $36.52 PRAZOSIN 1MG CAPSULE $13.31 PRAZOSIN 2MG CAPSULE $13.48 PRAZOSIN 5MG CAPSULE $14.03 PREDNISOLONE 1% OP SOLN 10ML $71.64 PREDNISOLONE 15MG/5ML UD CUP $27.80 PREDNISOLONE 1MG/ML LIQ 120ML $82.48 PREDNISOLONE 3MG/ML LIQ 30ML $39.63 PREDNISOLONE 5MG TABLET $13.00 PREDNISONE 10MG TABLET $12.90 PREDNISONE 1MG TABLET $13.14 PREDNISONE 1MG/ML LIQ 120ML $61.43 PREDNISONE 2.5MG TABLET $12.88 PREDNISONE 20MG TABLET $12.98 PREDNISONE 5MG TABLET $12.86 PREMPRO 0.625/2.5MG TABLET $15.32 PRENATAL VIT/FE/FA TABLET $13.25 PREPARATION H OINT 30GM $0.00 PREPARATION H SUPP $13.68 PRE-PEN 0.25MG INJ $109.58 PRIMAQUINE 26.3MG TABLET $14.53 PRIMATENE MIST INHALER 15GM $49.16 PRIMIDONE 250MG TABLET $15.95

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

93 91 91 91 91 91 91 91 91 91 93 91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 111

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9106709 9105412 9183377 9183344 9105420 9105446 9105453 9105453 9105479 9105487 9105503 9187337 9128075 9128398 9105495 9169624 9179227 9128091 9128083 9105511 9187345 9128109 9187352 9159021 9179235 9179672 9105438 9115833 9173592 9189101 9187444 9187469 9155516 9155524 9105529 9310228 9105537 9108226 9105552 9105586 9187378 9187360 9105602 9105610 9105628 9179250 9105636 9107442 9105651 9310665 9115924 9107582 9107616

PRIMIDONE 50MG TABLET $13.52 PROBENECID 500MG TABLET $14.69 PROCAINAMIDE 1000MG/10ML INJ $53.24 PROCAINAMIDE 1000MG/2ML INJ $54.50 PROCAINAMIDE 250MG CAPSULE $14.38 PROCAINAMIDE 375MG CAPSULE $15.02 PROCAINAMIDE ER 500MG TAB (PROCANBID) $14.65 PROCAINAMIDE SR 500MG TABLET $14.32 PROCAINAMIDE SR 750MG TABLET $14.51 PROCARBAZINE 50MG CAPSULE $14.11 PROCHLORPERAZINE 10MG TABLET $14.56 PROCHLORPERAZINE 10MG/2ML INJ $69.18 PROCHLORPERAZINE 25MG SUPP $18.97 PROCHLORPERAZINE 5MG SUPP $18.63 PROCHLORPERAZINE 5MG TABLET $13.95 PROCTOFOAM-HC FOAM 10GM $114.50 PROMETHAZINE 1.25MG/ML LIQ 120ML $32.46 PROMETHAZINE 12.5MG SUPP $21.10 PROMETHAZINE 25MG SUPP $19.93 PROMETHAZINE 25MG TABLET $13.85 PROMETHAZINE 25MG/1ML INJ $55.64 PROMETHAZINE 50MG SUPP $22.50 PROMETHAZINE 50MG/ML INJ $58.54 PROMETHAZINE W/COD 5ML UDCUP $26.62 PROMETHAZINE W/DM LIQ 120ML $36.30 PROMETHAZINE-PHENYLEPHRINE LIQ 120ML $42.99 PROPAFENONE 150MG TABLET $15.99 PROPANTHELINE 15MG TABLET $14.00 PROPARACAINE 0.5% OP SOLN 15ML $42.76 PROPOFOL 1000MG/100ML INJ $184.32 PROPOFOL 200MG/20ML INJ $77.56 PROPOFOL 500MG/50ML INJ $117.60 PROPOXYPHENE 65MG CAPSULE $26.67 PROPOXYPHENE-N/APAP 100/650 TAB $26.56 PROPRANOLOL 10MG TABLET $13.13 PROPRANOLOL 1MG/1ML INJ $88.00 PROPRANOLOL 20MG TABLET $13.26 PROPRANOLOL LA 60MG CAPSULE $15.13 PROPRANOLOL LA 80MG CAPSULE $15.54 PROPYLTHIOURACIL 50MG TABLET $13.03 PROTAMINE SULF 250MG/25ML INJ $75.86 PROTAMINE SULF 50MG/5ML INJ $59.20 PSEUDOEPHEDRINE 30MG TABLET $0.00 PSYLLIUM PACKET $0.00 PYRAZINAMIDE 500MG TABLET $14.92 PYRIDOSTIGMINE 12MG/ML LIQ 120ML $51.84 PYRIDOSTIGMINE 60MG TABLET $13.97 PYRIDOSTIGMINE SR 180MG TABLET $14.82 PYRIDOXINE 100MG TABLET $12.80 PYRIDOXINE 100MG/ML INJ $57.48 PYRIMETHAMINE 25MG TABLET $13.83 QUETIAPINE 100MG TABLET $18.53 QUETIAPINE 25MG TABLET $15.91

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 112

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9104340 9104324 9104332 9183393 9105701 9115940 9105727 9105693 9105735 9105669 9105743 9109042 9194069 9186164 9108234 9108242 9107129 9105750 9179268 9310442 9107723 9115957 9193020 9117029 9105792 9108267 9105784 9187238 9106766 9174871 9113614 9109224 9107202 9179755 9316498 9109638 9179920 9183211 9109067 9109075 9113010 9113028 9109083 9109091 9117151 9112871 9194036 9186073 9178294 9175118 9173204 9106774 9310921

QUINAPRIL 10MG TABLET $15.02 QUINAPRIL 20MG TABLET $15.02 QUINAPRIL 5MG TABLET $15.02 QUINIDINE GLUC 80MG/ML INJ $91.94 QUINIDINE GLUC SR 324MG TABLET $13.92 QUINIDINE SULF 200MG TABLET $13.12 QUINIDINE SULF 300MG TABLET $13.49 QUINIDINE SULF SR 300MG TABLET $14.48 QUININE 200MG CAPSULE $13.18 QUININE 260MG TABLET $13.14 QUININE 325MG CAPSULE $13.35 RABEPRAZOLE 20MG TABLET $21.27 RABIES IMMUNE GLOBULIN INJ $573.90 RABIES VACCINE INJ $362.68 RALOXIFENE 60MG TABLET $17.63 RAMIPRIL 1.25MG CAPSULE $14.75 RAMIPRIL 2.5 MG CAPSULE $15.17 RANITIDINE 150MG TABLET $16.89 RANITIDINE 15MG/ML LIQ 120ML $133.68 RANITIDINE 50MG/2ML INJ $109.74 REPAGLINIDE 2MG TABLET $14.58 RESERPINE 0.1MG TABLET $13.36 RETEPLASE 10 UNITS (18.1MG) KIT $2,851.76 RIBOFLAVIN 25MG TABLET $12.76 RIFABUTIN (MYCOBUTIN) 150MG CAP $25.30 RIFAMPIN 150MG CAPSULE $15.88 RIFAMPIN 300MG CAPSULE $16.67 RIFAMPIN 600MG INJ $256.76 RIMANTADINE 100MG TABLET $16.38 RIMEXOLONE 1% OP SOLN 5ML $81.20 RISEDRONATE (ACTONEL) 35MG TAB $45.30 RISEDRONATE (ACTONEL) 5MG TAB $17.37 RISPERIDONE 1MG TABLET $18.84 RISPERIDONE 1MG/ML LIQ 30ML $250.96 RITUXIMAB 10MG/ML INJ $1,445.22 RIVASTIGMINE 1.5MG CAPSULE $17.56 RIVASTIGMINE 2MG/ML LIQ 120ML $560.02 ROCURONIUM 100MG/10ML INJ $114.78 ROFECOXIB 12.5MG TABLET $18.22 ROFECOXIB 25MG TABLET $18.22 ROPINIROLE 0.25MG TABLET $15.23 ROPINIROLE 1MG TABLET $15.23 ROSIGLITAZONE 2MG TABLET $16.72 ROSIGLITAZONE 4MG TABLET $18.27 ROSUVASTATIN 20MG TAB $17.97 ROSUVASTATIN 5MG TABLET $17.97 RSV IMMUNOGLOBULIN INJ $289.24 RUBELLA VACCINE $67.77 SALIVA SUBSTITUTE LIQ 120ML $35.08 SALMETEROL 50MCG DISKUS #28 $133.94 SALMETEROL INHALER 13GM $193.10 SALSALATE 500MG TABLET $13.39 SARGRAMOSTIM 500MCG/ML INJ $713.58

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 93 91 91 93 91 91 91 91 93 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 93

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 113

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9168485 9173600 9187402 9171133 9105800 9105818 9112871 9178567 9113333 9105677 9109109 9112871 9112871 9169640 9178385 9105842 9112871 9106659 9113499 9108846 9187725 9310970 9310384 9105875 9310376 9310251 9310251 9147711 9147349 9147356 9147414 9147570 9147505 9147414 9147570 9147166 9174020 9132218 9145079 9147711 9147166 9147364 9134032 9310269 9147364 9147349 9132143 9147356 9134024 9134024 9106857 9147679 9310954

SARNA ANTI-ITCH LOTION 222ML $40.46 SCOPOLAMINE 0.25% OP SOLN 5ML $64.20 SCOPOLAMINE 0.4MG/ML INJ $54.84 SCOPOLAMINE 1.5MG PATCH $23.13 SELEGILINE 5MG CAPSULE $17.58 SENNA/DSS TABLET $13.57 SENNOSIDES 15MG CHEW TAB $13.20 SENNOSIDES ORAL LIQ 74ML $37.58 SENNOSIDES TABLET $0.00 SERTRALINE 50MG TABLET $17.76 SEVELAMER 403MG CAPSULE $14.00 SEVELAMER 800MG TABLET $15.18 SILDENAFIL 50MG TABLET $33.98 SILVER SULFADIAZINE 1% CRM 50GM $37.84 SIMETHICONE 40MG/0.6ML DROPS $32.62 SIMETHICONE 80MG CHEW TABLET $0.00 SIMPLE SYRUP $0.00 SIMVASTATIN 20MG TABLET $21.54 SIMVASTATIN 40MG TABLET $21.54 SIMVASTATIN 5MG TABLET $16.49 SINCALIDE 5MCG INJ $120.08 SODIUM ACETATE 2MEQ/ML INJ $30.22 SODIUM BICARB 4.2% SYRINGE $61.74 SODIUM BICARB 650MG TABLET $12.75 SODIUM BICARB 8.4% SYRINGE 10ML $56.66 SODIUM BICARB 8.4% SYRINGE 50ML $57.70 SODIUM BICARB 8.4% VIAL 50ML $30.04 SODIUM CHL 0.45% 1000ML(FLOORSTOCK) $79.08 SODIUM CHL 0.9% 250ML (FLOORSTOCK) $2.80 SODIUM CHL 0.9% 500ML(FLOORSTOCK) $78.88 SODIUM CHL 0.9% FOR IRRG 1L (FLOORSTOCK) $33.96 SODIUM CHL 0.9% FOR IRRIG 250ML(FLOORSTOCK) $28.92 SODIUM CHL 0.9% IRRIG 3000ML $42.60 SODIUM CHL 0.9% IRRIG. 1000ML $33.96 SODIUM CHL 0.9% IRRIG. 250ML $28.92 SODIUM CHL O.45% 500ML (FLOORSTOCK) $79.08 SODIUM CHLOR 0.65% NASAL SPY 45ML $29.64 SODIUM CHLOR 10% PILLOW 15ML $14.32 SODIUM CHLORIDE 0.9% FLUSH $26.80 SODIUM CHLORIDE 0.45% 1000ML $79.08 SODIUM CHLORIDE 0.45% 500ML $79.08 SODIUM CHLORIDE 0.9% 1000ML $79.94 SODIUM CHLORIDE 0.9% 100ML $4.06 SODIUM CHLORIDE 0.9% 10ML VIAL $26.40 SODIUM CHLORIDE 0.9% 1L (FLOORSTOCK) $79.94 SODIUM CHLORIDE 0.9% 250ML $2.80 SODIUM CHLORIDE 0.9% 3ML PILLOW $13.00 SODIUM CHLORIDE 0.9% 500ML $78.88 SODIUM CHLORIDE 0.9% 50ML $4.06 SODIUM CHLORIDE 0.9% 50ML VIAL $2.38 SODIUM CHLORIDE 1GM TABLET $12.85 SODIUM CHLORIDE 3% IV SOLN $226.07 SODIUM CHLORIDE 4MEQ/ML INJ $29.04

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 114

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9147554 9147547 9310947 9310947 9128406 9179623 9137308 9179573 9104712 9105909 9107541 9179938 9197237 9310996 9187527 9189564 9189572 9147398 9147398 9306259 9306259 9183401 9179581 9105933 9182122 9163510 9168634 9168642 9173626 9173618 9106873 9105826 9305921 9179599 9105958 9100694 9113507 9105974 9105982 9182031 9107368 9187667 9310962 9108572 9103524 9189283 9170341 9154014 9105990 9107525 9170358 9112871 9173048

SODIUM CHLORIDE W/20MEQ KCL $93.54 SODIUM CHLORIDE W/40MEQ KCL $93.54 SODIUM PHOSPHATE 3MMOL/ML INJ $28.30 SODIUM PHOSPHATE 4MEQ/ML INJ $28.30 SODIUM POLYSTYRENE ENEMA 30GM/120ML $64.78 SODIUM POLYSTYRENE SUSP 30GM/120 ML $48.41 SORBITOL 70% LIQUID 30ML CUP $27.44 SORBITOL 70% LIQUID 30ML CUP $29.22 SOTALOL 80MG TABLET $18.74 SPIRONOLACTONE 25MG TABLET $13.58 SPIRONOLACTONE/HCTZ 25/25 TABLET $14.07 STAVUDINE 1MG/ML LIQ 200ML $154.46 STAVUDINE 40MG CAPSULE $24.30 STERILE WATER FOR INJ $80.82 STERILE WATER FOR INJ 10ML $0.00 STERILE WATER FOR INJ 20ML $1.80 STERILE WATER FOR INJ 50ML $3.50 STERILE WATER FOR IRR.1000ML(FLOORSTOCK) $29.20 STERILE WATER FOR IRRIG. 1000ML $29.20 STREPTOMYCIN 1GM INJ $114.66 STREPTOZOCIN 1GM INJ $733.00 SUCCINYLCHOLINE 200MG/10ML INJ $52.98 SUCRALFATE 0.1GM/ML LIQ 120ML $48.19 SUCRALFATE 1GM TABLET $14.26 SUCRETS LOZENGE $30.28 SUFENTANIL 50MCG/ML INJ $98.74 SULCONAZOLE 1% CREAM 30GM $69.64 SULCONAZOLE 1% LIQUID 30ML $79.54 SULFACETAMIDE 10% OP OINT 3.5GM $41.64 SULFACETAMIDE 10% OP SOLN 15ML $35.60 SULFADIAZINE 500MG TABLET $15.33 SULFAMETHOXAZOLE/TMP DS TABLET $15.00 SULFAMETHOXAZOLE/TMP INJ $103.04 SULFAMETHOXAZOLE/TMP SUSP 100ML $50.70 SULFASALAZINE 500MG TABLET $13.23 SULFASALAZINE EC 500MG TABLET $13.49 SULFINPYRAZONE 100MG TABLET $14.63 SULINDAC 150MG TABLET $14.74 SULINDAC 200MG TABLET $15.20 SUMATRIPTAN 20MG NASAL SPRAY $75.14 SUMATRIPTAN 25MG TABLET $50.95 SUMATRIPTAN 6MG/0.5ML INJ $166.98 SYNERCID 500MG INJ $323.06 TACRINE 10MG CAPSULE $15.64 TACROLIMUS 1MG CAPSULE $19.35 TACROLIMUS 5MG/ML INJ $351.86 TALC POWDER 70.9GM $30.88 TALC POWDER-STERILE 5GM $102.03 TAMOXIFEN 10MG TABLET $16.77 TAMSULOSIN CR 0.4MG CAPSULE $16.52 TAZAROTENE 0.1% GEL 30GM $181.84 TAZOROTENE 0.1% CREAM 30GM $181.84 TEARS, ARTIFICIAL OP SOLN 15ML $30.34

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 93 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 93 91 91 93 91 93 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 115

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9112871 9112871 9109646 9155532 9155623 9113515 9197401 9197419 9193004 9105834 9108317 9168865 9104100 9187428 9116039 9106006 9169483 9170416 9128372 9155813 9163346 9193996 9186065 9186032 9173634 9189077 9106014 9179763 9174046 9113234 9116054 9151200 9179607 9113234 9116054 9106048 9106063 9113226 9106055 9106030 9170325 9106097 9187436 9108648 9106089 9197112 9163312 9106113 9116096 9179797 9106121 9316175 9106154

TEGASEROD 2MG TABLET $17.85 TEGASEROD 6MG TABLET $17.85 TELMISARTAN 40MG TABLET $15.73 TEMAZEPAM 15MG CAPSULE $26.87 TEMAZEPAM 7.5MG CAPSULE $28.58 TEMOZOLOMIDE 100MG CAPSULE $314.33 TEMOZOLOMIDE 20MG CAPSULE $73.04 TEMOZOLOMIDE 5MG CAPSULE $27.80 TENECTEPLASE 50MG INJ $5,601.76 TERAZOSIN 1MG CAPSULE $15.93 TERAZOSIN 5MG CAPSULE $15.93 TERBINAFINE 1% CREAM 12GM $42.42 TERBINAFINE 250MG TABLET $30.81 TERBUTALINE 1MG/ML INJ $110.28 TERBUTALINE 2.5MG TABLET $13.68 TERBUTALINE 5MG TABLET $14.11 TERCONAZOLE 0.4% VAG CRM 45GM $99.34 TERCONAZOLE 0.8% VAG CRM 20GM $99.34 TERCONAZOLE 3 80MG SUPP $99.34 TESTOLACTONE 50MG TABLET $29.62 TESTOSTERONE 200MG/ML INJ $110.52 TETANUS IMM GLOB 250 UNIT/ML INJ $504.40 TETANUS TOXOID 0.5ML INJ $68.40 TETANUS/DIPHTHERIA (ADULT) INJ $69.90 TETRACAINE 0.5% OP SOLN 2ML $35.94 TETRACAINE 1% 20MG/2ML INJ $62.58 TETRACYCLINE 250MG CAPSULE $12.88 TETRACYCLINE 25MG/ML LIQ 120ML $60.37 TETRAHYDROZOLINE 0.05% OP SOLN 15ML $31.06 THEOPHYLLINE 200MG SR CAP $13.33 THEOPHYLLINE 300MG SR CAP $13.76 THEOPHYLLINE 400MG/250ML D5W $88.54 THEOPHYLLINE 80MG/15ML LIQ 120ML $28.95 THEOPHYLLINE SR (THEO-24) 200MG CAP14.06 $ THEOPHYLLINE SR (THEO-24) 300MG CAP $14.29 THEOPHYLLINE SR (THEODUR) 200MG TAB $13.22 THEOPHYLLINE SR (THEODUR) 300MG TAB $13.34 THEOPHYLLINE SR (THEODUR) 450MG TAB $13.76 THEOPHYLLINE SR (UNIPHYL) 400MG TAB $14.88 THEOPHYLLINE SR(THEODUR)100MG TAB $13.13 THERA-GESIC ANALGESIC CRM 150GM $0.00 THIAMINE 100MG TABLET $0.00 THIAMINE 200MG/2ML INJ $55.64 THIAMINE 50MG TABLET $0.00 THIETHYLPERAZINE 10MG TABLET $13.83 THIOGUANINE 40MG TABLET $22.36 THIOPENTAL 500MG INJ $84.24 THIORIDAZINE 10MG TABLET $13.40 THIORIDAZINE 25MG TABLET $13.68 THIORIDAZINE 30MG/ML LIQ 120ML $56.00 THIORIDAZINE 50MG TABLET $13.92 THIOTEPA 15MG INJ $691.46 THIOTHIXENE 1MG CAPSULE $13.66

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 116

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9300401 9169822 9106188 9106196 9113523 9108325 9305608 9105719 9306333 9173659 9173642 9174244 9106246 9174681 9174228 9169772 9151416 9107707 9173964 9173956 9183005 9305277 9174731 9305269 9173790 9173808 9116161 9106253 9106261 9108697 9169988 9169962 9108531 9113531 9113549 9113556 9109125 9316274 9310301 9116203 9113564 9113572 9106287 9316472 9175027 9106303 9106295 9170424 9170366 9169657 9168873 9169673 9169756

THIOTHIXENE 5MG CAPSULE $13.67 THROMBIN 5,000 UNITS POWDER VIAL $114.52 THYROID 30MG TABLET $12.99 THYROID 60MG TABLET $13.22 TIAGABINE 2MG TABLET $15.56 TIAGABINE 4MG TABLET $15.56 TICARCILLIN 3GM INJ $125.70 TICLOPIDINE 250MG TABLET $16.64 TIMENTIN 3.1GM INJ $133.16 TIMOLOL 0.5% OPHTH SOLN 5ML $59.44 TIMOLOL 0.25% OPHTH SOLN 5ML $55.44 TIMOLOL 0.5%/DORZOLAMIDE 2% OPSOL117.42 $ TIMOLOL 10MG TABLET $13.49 TIMOLOL XE 0.25% OPHTH GEL 5ML $77.38 TIMOLOL-XE 0.5% OPHT SOL 2.5ML $64.14 TIOCONAZOLE 6.5% OINT 4.6GM $54.22 TIROFIBAN INJ $562.80 TIZANIDINE 4MG TABLET $15.98 TOBRAMYCIN 0.3% OP OINT 3.5GGM $116.70 TOBRAMYCIN 0.3% OP SOLN 5ML $55.44 TOBRAMYCIN 1.2GM POWDER VIAL $690.84 TOBRAMYCIN 20MG/2ML INJ $109.06 TOBRAMYCIN 300MG/5ML INHAL SOLN $115.62 TOBRAMYCIN 80MG/2ML INJ $128.04 TOBRAMYCIN/DEXAMETH OP OINT 3.5GM $132.94 TOBRAMYCIN/DEXAMETH OP SOLN 2.5ML $75.06 TOCAINIDE 400MG TABLET $14.80 TOLAZAMIDE 100MG TABLET $13.65 TOLAZAMIDE 250MG TABLET $13.62 TOLCAPONE 100MG TABLET $17.78 TOLNAFTATE 1% AEROSOL 120ML $35.44 TOLNAFTATE 1% CREAM 15GM $30.90 TOLTERODINE 2MG TABLET $16.17 TOLTERODINE LA 2MG CAPSULE $18.50 TOPIRAMATE 200MG TABLET $21.07 TOPIRAMATE 25MG SPRINKLE CAPSULE $16.20 TOPIRAMATE 25MG TABLET $15.76 TOPOTECAN 4MG INJ $2,045.56 TRACE ELEMENTS INJ $27.93 TRAMADOL 50MG TABLET $14.77 TRAMADOL/APAP (ULTRACET) 37.5/325 TAB $14.77 TRANDOLAPRIL 2MG TABLET $14.64 TRANYLCYPROMINE 10MG TABLET $14.09 TRASTUZUMAB INJ $560.88 TRAVOPROST 0.004% OP SOLN 2.5ML $129.44 TRAZODONE 100MG TABLET $14.19 TRAZODONE 50MG TABLET $13.57 TRETINOIN 0.01% GEL 45GM $189.48 TRETINOIN 0.025% CREAM 45GM $146.92 TRIAMCINOLONE 0.025% CRM 15GM $29.08 TRIAMCINOLONE 0.1% CREAM 80GM $35.64 TRIAMCINOLONE 0.1% CRM 15GM $30.84 TRIAMCINOLONE 0.1% LOTION 60ML $45.88

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 93 91 93 91 91 91 91 91 91 91 91 91 91 91 91 93 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 117

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9169764 9170374 9168899 9168949 9187451 9174566 9175142 9174160 9106311 9104357 9102930 9109489 9109554 9155573 9174897 9106345 9106329 9106337 9173667 9106352 9116229 9128117 9128125 9187485 9106386 9106923 9113580 9108721 9106931 9170473 9100181 9113598 9108895 9151333 9174905 9174913 9187998 9189580 9158288 9186206 9170382 9168782 9170499 9168790 9113606 9105925 9100116 9112871 9178609 9189028 9106956 9107814 9108911

TRIAMCINOLONE 0.1% OINT 15GM $30.84 TRIAMCINOLONE 0.1% PASTE 5GM $45.24 TRIAMCINOLONE 0.5% CRM 15GM $34.66 TRIAMCINOLONE 0.5% OINT 15GM $35.42 TRIAMCINOLONE 40MG/ML INJ $63.80 TRIAMCINOLONE 55MCG NASAL INH 10GM $136.80 TRIAMCINOLONE AQ 55MCG NASAL 16.5GM $148.62 TRIAMCINOLONE ORAL INHALER 20GM $162.60 TRIAMTERENE 50MG CAPSULE $14.69 TRIAMTERENE/HCTZ (MAXZIDE) 37.5/25 TAB $13.98 TRIAMTERENE/HCTZ 37.5/25 CAPSULE $13.86 TRIAMTERENE/HCTZ 50/25 CAPSULE $13.28 TRIAMTERENE/HCTZ 75/50 TABLET $15.20 TRIAZOLAM 0.125MG TABLET $26.72 TRIETHANOLAMINE 10% OTIC SOLN 12ML $114.38 TRIFLUOPERAZINE 10MG TABLET $16.08 TRIFLUOPERAZINE 2MG TABLET $14.49 TRIFLUOPERAZINE 5MG TABLET $14.95 TRIFLURIDINE 1% OP SOLN 7.5ML $223.46 TRIHEXYPHENIDYL 2MG TABLET $13.09 TRIHEXYPHENIDYL 5MG TABLET $13.45 TRIMETHOBENZAMIDE 100MG SUPP $13.91 TRIMETHOBENZAMIDE 200MG SUPP $14.00 TRIMETHOBENZAMIDE 200MG/2ML INJ $61.84 TRIMETHOBENZAMIDE 250MG CAPSULE $14.27 TRIMETHOPRIM 100MG TABLET $14.09 TRIMIPRAMINE 25MG CAPSULE $14.53 TRIMIPRAMINE 50MG CAPSULE $15.68 TRINSICON CAPSULE $0.00 TRIPLE ANTIBIOTIC SOLN 120ML $92.64 TRIPROLIDINE/PSEUDO TABLET $12.81 TRIZIVIR TABLET $49.72 TROLEANDOMYCIN 250MG CAPSULE $15.37 TROMETHAMINE IV SOLN 500ML $455.62 TROPICAMIDE 0.5% OP SOLN 15ML $90.06 TROPICAMIDE 1% OP SOLN 15ML $103.56 TUBERCULIN 5 TUNIT INJ $54.49 TUBOCURARINE 30MG/10ML INJ $62.88 TUSSIONEX PENNKINETIC SUSP $26.18 TYPHOID 25MCG/0.5ML VACCINE INJ $146.26 UREA 10% CREAM 90GM $43.24 UREA 10% LOTION 480ML $57.04 UREA 40 CREAM 28.35GM $76.00 UREACIN-20 CREAM 120GM $44.44 URISED TABLET $13.80 URSODIOL 300MG CAPSULE $18.37 VALACYCLOVIR 500MG TABLET $20.96 VALGANCICLOVIR 450MG TABLET $72.67 VALPROATE 50MG/ML LIQ 120ML $57.15 VALPROATE 500MG/5ML INJ $126.58 VALPROIC ACID 250MG CAPSULE $13.28 VALSARTAN 80MG TABLET $15.65 VANCOMYCIN 125MG CAPSULE $26.85

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 118

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9305301 9102625 9179615 9305293 9174889 9310483 9310426 9108358 9107244 9107236 9107632 9107640 9106972 9113150 9113168 9113176 9106949 9310491 9106964 9108556 9106998 9106980 9109729 9107376 9173675 9316316 9316142 9316332 9105065 9189655 9109679 9100488 9106410 9106428 9109307 9305830 9113093 9173931 9106436 9106444 9116252 9108366 9106451 9106469 9112871 9112871 9112871 9107483 9197195 9197203 9169996 9310343 9106477

VANCOMYCIN 1GM INJ $113.89 VANCOMYCIN 250MG CAPSULE $40.97 VANCOMYCIN 25MG/ML LIQ 40ML $179.68 VANCOMYCIN 500MG INJ $107.82 VASOCIDIN 0.25% OP SOLN 10ML $79.36 VASOPRESSIN 20 UNITS/1ML INJ $65.38 VECURONIUM 10MG INJ $66.38 VENLAFAXINE 25MG TABLET $15.73 VENLAFAXINE 37.5MG TABLET $15.82 VENLAFAXINE 50MG TABLET $15.91 VENLAFAXINE XR 37.5MG CAPSULE $17.55 VENLAFAXINE XR 75MG CAPSULE $18.13 VERAPAMIL 120MG TABLET $13.51 VERAPAMIL 24H SR 120MG CAPSULE $16.68 VERAPAMIL 24H SR 180MG CAPSULE $16.87 VERAPAMIL 24H SR 240MG CAPSULE $17.40 VERAPAMIL 40MG TABLET $13.27 VERAPAMIL 5MG/2ML INJ $55.76 VERAPAMIL 80MG TABLET $13.86 VERAPAMIL SR 120MG TABLET $14.59 VERAPAMIL SR 180MG TABLET $15.12 VERAPAMIL SR 240MG TABLET $15.83 VICON FORTE CAPSULE $0.00 VICON-C CAPSULE $0.00 VIDARABINE 3% OP OINT 3.5GM $79.54 VINBLASTINE INJ $451.83 VINCRISTINE INJ $508.70 VINORELBINE 10MG/ML INJ $673.96 VIOKASE TAB $13.53 VISCOAT SYRINGE 0.5ML $313.38 VITAMIN A 10000IU CAP $12.78 VITAMIN B COMPLEX CAPSULE $12.81 VITAMIN E 200IU CAPSULE $12.82 VITAMIN E 400IU CAPSULE $12.85 VI-ZAC CAP $13.40 VORICONAZOLE 200MG INJ $314.26 VORICONAZOLE 200MG TABLET $75.22 VOSOL HC OTIC SOLN 10ML $79.00 WARFARIN 1MG TABLET $14.15 WARFARIN 2.5MG TABLET $14.26 WARFARIN 2MG TABLET $14.21 WARFARIN 3MG TABLET $14.27 WARFARIN 5MG TABLET $14.33 WARFARIN 7.5MG TABLET $14.97 WARFARIN PER PROTOCOL $0.00 WINRHO (IMM GLOB)RHO(D) 5000UNITS2,417.40 $ XENADERM OINTMENT $124.64 ZAFIRLUKAST 20MG TABLET $15.24 ZALCITABINE 0.375MG TABLET $17.26 ZIDOVUDINE 100MG CAPSULE $16.82 ZINC OXIDE OINTMENT 30GM $28.64 ZINC SULFATE 1MG/ML INJ $25.94 ZINC SULFATE 220MG CAPSULE $12.96

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

93 91 91 93 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 93 93 93 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91 91 91 93 91 91 91 91 91 91 91

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY

Page 119

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

9109174 9310988 9108739 9155821 9109141 9305319 9305327 9305327 9305863 3020211 3020302 3021375 3021417 3021425 3021409 3021458 3021391 3021441 3021433 3021219 3021607 3020971 3020989 3021235 3010485 3021037 3021383 3021722 3020872 3020880 3020278 3020260 3010444 3021177 3021201 3021185 3021193 3021169 3010493 3010097 3010519 3010469 3021888 3021334 3010188 3020757 3021664 3020013 3021730 3020807 3021847 3020815 3021854

ZIPRASIDONE 40MG CAPSULE ZOLEDRONIC 4MG INJ ZOLMITRIPTAN 2.5MG TABLET ZOLPIDEM 5MG TABLET ZONISAMIDE 100MG CAPSULE ZOSYN 2.25GM INJ ZOSYN 3.375GM INJ ZOSYN 3.375GM/20ML SYRINGE ZOSYN 4.5GM INJ *TECH TIME-STANDARD *TECH TIME-TRAUMA ABG--CALIBRATION ABG-CHANGE MEMBRANES ABG-CHANGE TUBES ABG--DEPRTOTINIZE ABG--MONTHLY QC REPORT ABG--QC--AM ABG--QC--NOC ABG--QC--PM AEROSOL EQUIPMENT CHANGE AEROSOL SYSTEM INITIATION AEROSOL TX DEMO/EVAL AEROSOL TX SUBSQ AIRWAY CHANGE AIRWAY RESISTANCE AIRWAY SUCTION AS PART OF DAILY MAINT/QC ASTHMA PATIENT EDUCATION BD CONTINUOUS INITIAL DAY BD CONTINUOUS SUBSQ DAY BIPAP INITIAL DAY BIPAP SUBSEQUENT DAY BLD GASES W/02 SAT BLOOD GAS -- ARTERIAL PUN BLOOD GAS --OBSERVATION BLOOD GAS--ARTERIAL LINE BLOOD GAS--CORD BODY PLETHYSMOGRAPHY BRONCHIAL PROVOCATION BRONCHOSCOPY CALCIUM IONIZED CARDIOVERT ELECTIVE EXT CATH LAB STANDBY - 15 MIN CATH LAB STANDBY-30 MINU CO DIFFUSING CAPACITY COMPREHEN PT. ASSESSMENT CONT PULSE OX SYSTM CHECK CONTINUOUS VENT SET-UP COPD PATIENT EDUCATION CPR CPT INITIAL CPT INITIAL CPT SUBSEQUENT

$21.29 $1,958.10 $44.60 $29.80 $16.70 $123.38 $134.18 $134.18 $142.83 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 125.00 119.00 0.00 236.00 0.00 0.00 0.00 174.00 174.00 2620.00 2620.00 341.00 0.00 0.00 0.00 0.00 0.00 507.00 1583.00 136.00 0.00 0.00 0.00 236.00 0.00 0.00 0.00 0.00 571.00 248.00 192.00 248.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

91 91 91 91 91 93 93 93 93 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30

PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PHARMACY PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES

Page 120

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

3020823 3021870 3021318 3021268 3021276 3021284 3020203 3021250 3021599 3021581 3020724 3021052 3010477 3020856 3020864 3021698 3021243 3030202 3020104 3020096 3020831 3020849 3021862 3021292 3010527 3020740 3030160 3021227 3021714 3020138 3021821 3020229 3021839 3021326 3021896 3021342 3021904 3021359 3021086 3021078 3010204 3021573 3021367 3021060 3021748 3010253 3010451 3021128 3021136 3021144 3021813 3021102 3021110

CPT SUBSEQUENT CT SCAN STANDBY - 15 MIN CT SCAN STANDBY - 30 MIN DISCHARGE PLANNING-HOME 2 DISCHARGE PLANNING-PULMOA DOCTOR WAITING TIME EKG-RT ET TUBE CARE ETC02 PT/SYS CHECK ETC02 SYSTEM INITIATION ETCO2 INIT DAY EXTUBATION FUNCTIONAL RES CAP/VOL INCENTIVE SPIROM, INITIAL INCENTIVE SPIROM, SUBSEQT INHALATION TX PENTAMIDINE INTUBATION ASSIST INTUBATION EMERGENCY IPPB DEMO/EVAL IPPB TX SUBSEQUENT IPV DEMO/EVAL IPV SUBSEQUENT L & D STBY - 15 MINUTES L&D STBY - 30 MINUTES LACTIC ACID LIMITED PT. ASSESSMENT LUNG REC MAN 20 MIN MANUAL VENTILATION MDI SELF MEDICATION MDI/NEB DEMO/EVAL MDI/NEB DEMO/EVAL MDI/NEB SUBSQ MDI/NEB SUBSQ MRI STANDBY-30 MINUTES NUC MED STANDBY - 15 MIN NUC MED STANDBY-30 MINUTE OR STANDBY - 15 MINUTES OR STANDBY-30 MINUTES OXYGEN EQUIPMENT CHANGE OXYGEN PT/SYS CHECK OXYGEN UPTAKE SIMPLE PAPR UNIT PASSY-MUIR EVAL PATIENT TRANSPORT-INTERNA PEAK FLOW MEASUREMENT PH BLD PH FLD PRE-OP EKG -- DR.JAMMAL PRE-OP EKG -- DR.PETERS PRE-OP EKG -- DR.WAMPOLD PRE-OP EKG DR YADLAPALLI PRE-OP EKG DR.EBENEZER PRE-OP EKG--DR.FEHRENBACH

192.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1405.00 0.00 236.00 0.00 0.00 361.00 0.00 420.00 113.00 119.00 146.00 146.00 0.00 0.00 133.00 0.00 0.00 0.00 0.00 128.00 125.00 121.00 126.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 391.00 0.00 0.00 0.00 0.00 46.00 46.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30

PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES

Page 121

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

3010261 3030095 3010345 3010287 3030038 3010196 3020377 3021656 3030046 3010295 3021672 3033818 3021680 3021797 3021771 3021789 3021706 3020708 3020369 3020328 3020310 3020393 3020955 3020344 3020401 3020443 3020419 3020963 3020930 3020948 3030186 3030178 3030194 3020567 3010279 3020922 3021029 3030145 3030152 3030129 3030137 3021805 3030111 3010428 3010303 3010378 3021045 3021300 3020617 3010386 3020765 3021755 3020781

PUL FUNCT DIFF. CAP PULMONARY REHAB EVAL INIT PULMONARY STRESS COMPLEX PULMONARY STRESS SIMPLE PULSE OXIMETRY MULTIPLE PULSE OXIMETRY MULTIPLE PULSE OXIMETRY SINGLE PULSE OX-OVERNIGHT CONT REHAB PULSE OX PER CHECK RESP FLOW VOLUME LOOP S N OXIDE INIT DAY S N OXIDE PER HOUR S N OXIDE SUBSQ DAY S NSTRL HFOV BELLOWS TRA S NSTRL HFOV CIRCUIT S NSTRL HFOV DISPHRAGM S NSTRL PENTAMIDINE NEBU S O2 BRONCHSCOPY S O2 CATH LAB S O2 CONT AEROSOL INIT DA S O2 CONT AEROSOL SUBSQ D S O2 ER S O2 INITIAL DAY S O2 OB S O2 PACU 2HOURS S O2 SPA 2 HOURS S O2 SPA. S O2 SUBSEQUENT DAY S O2 TENT HUMID INIT DAY S O2 TENT HUMID SUBS DAY SMIKING CESSATION - SUBSQ SMOKING CESSATION - INIT SMOKING CESSATION - INIT SPIROMETRY SPIROMETRY PRE/POST BD SPUTUM INDCTN VIA AEROSOL SUCTION NASOTRACHEAL TCM INITIAL DAY TCM SUBSEQUENT DAY THER PROC RESP FNCTN 15M THER PROC RESP FNCTN GRP THER PROC RESP FNCTN GRP THER PROC STRNTH/ENDR 15M THORACENTESIS INIT/SUBSQ THORACIC GAS VOLUME TILT TABLE-PF TRACH TUBE CARE TRAUMA CALL TRAUMA VENT SET-UP TREADMILL-PF VENT MGMNT INITIAL VENT MGMNT INITIAL HF VENT MGMNT INITIAL TRAUMA

0.00 0.00 555.00 501.00 247.00 148.00 45.00 288.00 0.00 170.00 19770.00 420.00 11791.00 496.00 783.00 207.00 173.00 145.00 145.00 318.00 318.00 145.00 754.00 145.00 145.00 145.00 145.00 754.00 318.00 318.00 0.00 146.00 124.00 170.00 201.00 225.00 61.00 1879.00 1876.00 70.00 67.00 0.00 70.00 528.00 471.00 0.00 0.00 0.00 0.00 0.00 2375.00 3401.00 2362.00

0.00 0.00 520.00 0.00 0.00 146.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 188.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 441.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30

PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES

Page 122

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

3020773 3021763 3020799 3021094 3020252 2810182 2810174 2810166 2810158 2810208 2810190 3212651 3211224 3212644 3213428 3210317 3210309 3212768 3212776 3212784 3212792 3213261 3213287 3213303 3213329 3213279 3213295 3213311 3213337 3212693 3212800 3210903 3211679 3212511 3212610 3212222 3212230 3212453 3212461 3212578 3212180 3212701 3212156 3212560 3212164 3212172 3212735 3212727 3213378 3213360 3212743 3212677 3212669

VENT MGMNT SUBSEQUENT VENT MGMNT SUBSEQUENT HF VENT MGMNT SUBSQ TRAUMA VENT SYSTEM CALIBRATION VITAL CAPACITY CPLX PACU ADD 15M CPLX PACU FIRST 30M STND PACU LVL 1 ADD 15M STND PACU LVL 1 FIRST 30M STND PACU LVL 2 ADD 15M STND PACU LVL 2 FIRST 30M OT ADL TRAIN ADD 15 OT ADL TRAIN EA 15 OT ADL TRAIN INIT 30 OT COMPU ASSIST TRAIN >30 OT CONTRAST BATH INIT 30 OT CONTRAST BATHS EA 15 OT DEBRIDE NON-SELECT 15 OT DEBRIDE NON-SELECT 30 OT DEBRIDE NON-SELECT 45 OT DEBRIDE NON-SELECT 60 OT DEBRIDE SEL<=20CM 15MN OT DEBRIDE SEL<=20CM 30MN OT DEBRIDE SEL<=20CM 45MN OT DEBRIDE SEL<=20CM 60MN OT DEBRIDE SEL>20CM 15MN OT DEBRIDE SEL>20CM 30MN OT DEBRIDE SEL>20CM 45MN OT DEBRIDE SEL>20CM 60MN OT DEBRIDE SKIN FULL OT DEBRIDE SKIN/TISSUE OT E-STIM EA 15 OT E-STIM MANUAL INIT 30 OT E-STIM SUPERVISED 15 OT E-STIM SUPERVISED 30 OT EVAL 15 OT EVAL 30 OT EVAL 45 OT EVAL 60 OT EVAL ADD 15 OT EVAL BRIEF OT EVAL COMPREHENSIVE OT EVAL EXTENDED OT EVAL INIT 30 OT EVAL INTERMEDIATE OT EVAL LTD OT EXER GP ADD 15 OT EXER GP INIT 30 OT EXTREMITY TEST ADD 15 OT EXTREMITY TEST INT 30 OT IONTOPHORESIS EA 15 OT IONTOPHORESIS INIT 30 OT JOINT MOB EA VISIT

2228.00 3401.00 2362.00 0.00 15.00 298.00 719.00 147.00 590.00 99.00 393.00 60.00 157.00 125.00 80.00 42.00 42.00 191.00 243.00 296.00 348.00 160.00 193.60 234.26 283.45 176.00 212.96 257.68 311.79 393.00 470.00 47.00 47.00 60.00 105.00 210.00 262.00 315.00 366.00 65.00 73.00 383.00 322.00 262.00 290.00 145.00 60.00 99.00 65.00 130.00 48.00 100.00 139.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 58.00 75.00 0.00 0.00 0.00 125.00 165.00 205.00 245.00 80.00 96.80 117.13 141.72 88.00 106.48 128.84 155.90 275.00 230.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

30 30 30 30 30 28 28 28 28 28 28 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32

PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES PULMONARY SERVICES RECOVERY SERVICES RECOVERY SERVICES RECOVERY SERVICES RECOVERY SERVICES RECOVERY SERVICES RECOVERY SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES

Page 123

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

3212552 3212636 3211604 3211653 3213352 3213345 3210614 3210580 3211174 3210572 3211711 3210499 3210606 3210564 3212685 3212487 3211596 3212198 3212206 3212214 3212628 3211257 3211422 3211281 3210481 3212602 3211646 3212594 3212586 3213386 3213394 3213402 3213410 3210960 3210978 3211364 3212719 3211695 3233129 3233103 3233483 3231370 3231362 3234093 3234119 3234101 3234127 3233566 3232220 3233574 3233582 3233970 3233996

OT MANUAL THER EA 15 OT MYOFAC/SOFT MOB 30 OT NEUROMUSC REED EA 15 OT NEUROMUSC REED INIT 30 OT ORT/PRO/ADL CK ADD 15 OT ORT/PRO/ADL CK INIT 30 OT ORTHOTIC FAB INIT 30 OT ORTHOTIC TRAIN ADD 15 OT ORTHOTIC TRAIN EA 15 OT ORTHOTIC TRAIN INIT 30 OT PARAFFIN BATH 15 OT PROC/MOD ADD 15 OT PROSTH TRAIN ADD 15 OT PROSTH TRAIN EA 15 OT PROSTH TRAIN INIT 30 OT RE-EVAL 15 OT RE-EVAL 30 OT RE-EVAL EXTENDED OT RE-EVAL INTERMEDIATE OT RE-EVAL LTD OT SOFT TISSUE MOB INT30 OT THER ACT EA 15 OT THER ACT INIT 30 OT THER EX EA 15 OT THER EX INIT 30 OT THER MASSAGE EA 15 OT THER MASSAGE INIT 30 OT TREAT ADD 15 OT TREAT INIT 30 OT TRN BIOFD ANY MODAL 15 OT TRN BIOFD ANY MODAL 30 OT TRN BIOFD ANY MODAL 45 OT TRN BIOFD ANY MODAL 60 OT ULTRASOUND EA 15 OT ULTRASOUND INIT 30 OT WHEELCHAIR TRAIN EA 15 OT WHIRLPOOL 15 OT WHIRLPOOL 30 PT ADL TRAIN EA 15 PT ADL TRAIN INIT 30 PT AQUATC THER EA 15 PT AQUATC THER EX ADD 15 PT AQUATC THER EX INIT 30 PT DEBRID SEL<=20CM 105MN PT DEBRID SEL<=20CM 120MN PT DEBRID SEL>20CM 105MN PT DEBRID SEL>20CM 120MN PT DEBRIDE NON-SELECT 15 PT DEBRIDE NON-SELECT 30 PT DEBRIDE NON-SELECT 45 PT DEBRIDE NON-SELECT 60 PT DEBRIDE SEL<=20CM 15MN PT DEBRIDE SEL<=20CM 30MN

112.00 192.00 165.00 138.00 65.00 130.00 146.00 71.00 173.00 142.00 39.00 69.00 71.00 73.00 142.00 164.00 291.00 322.00 290.00 145.00 144.00 179.00 146.00 166.00 139.00 73.00 110.00 60.00 144.00 70.00 80.00 90.00 100.00 39.00 78.00 122.00 73.00 97.00 180.00 146.00 78.00 78.00 154.00 502.15 607.60 552.36 668.36 99.00 145.00 191.00 243.00 160.00 193.60

0.00 0.00 53.00 0.00 0.00 0.00 0.00 0.00 53.00 0.00 0.00 0.00 0.00 0.00 0.00 85.00 114.00 0.00 0.00 0.00 0.00 58.00 0.00 54.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 40.00 25.00 34.00 58.00 0.00 0.00 0.00 0.00 251.07 303.80 276.18 334.18 65.00 95.00 125.00 155.00 80.00 96.80

32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32

REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES

Page 124

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

3234010 3234036 3234051 3234077 3233988 3234002 3234028 3234044 3234069 3234085 3233830 3233848 3233855 3232915 3231891 3232725 3233558 3233954 3233962 3233624 3233319 3233640 3233657 3233871 3230091 3231206 3231214 3233863 3231222 3231230 3232170 3231487 3233061 3232451 3231396 3231909 3231917 3231537 3232477 3231412 3232709 3233665 3231511 3232402 3231347 3234135 3234150 3234176 3234192 3234218 3234234 3234259 3234242

PT DEBRIDE SEL<=20CM 45MN PT DEBRIDE SEL<=20CM 60MN PT DEBRIDE SEL<=20CM 75MN PT DEBRIDE SEL<=20CM 90MN PT DEBRIDE SEL>20CM 15MN PT DEBRIDE SEL>20CM 30MN PT DEBRIDE SEL>20CM 45MN PT DEBRIDE SEL>20CM 60MN PT DEBRIDE SEL>20CM 75MN PT DEBRIDE SEL>20CM 90MN PT DEBRIDE SKIN FULL PT DEBRIDE SKIN PARTIAL PT DEBRIDE SKIN/TISSUE PT E-STIM EA 15 PT E-STIM MANUAL INIT 30 PT E-STIM SUPERVISED 15 PT E-STIM SUPERVISED 30 PT E-STIM WOUND CARE 15 PT E-STIM WOUND CARE 15 PT EVAL 15 PT EVAL 30 PT EVAL 45 PT EVAL 60 PT EVAL ADD 15 PT EVAL BRIEF PT EVAL COMPREHENSIVE PT EVAL EXTENDED PT EVAL INIT 30 PT EVAL INTERMEDIATE PT EVAL LTD PT EXER GP ADD 15 PT EXER GP INIT 30 PT FNX ACT INIT 30 PT GAIT TRAIN EA 15 PT GAIT TRAIN INIT 30 PT IONTOPHORESIS EA 15 PT IONTOPHORESIS INIT 30 PT JOINT MOB EA VISIT PT MANUAL THER EA 15 PT MANUAL TRACT INIT 30 PT MECH TRACT 15 PT MECH TRACT 30 PT MYOFAC/SOFT MOB 30 PT NEUROMUSC REED EA 15 PT NEUROMUSC REED INIT 30 PT NP WOUND TX <=50 CM 15 PT NP WOUND TX <=50 CM 30 PT NP WOUND TX <=50 CM 45 PT NP WOUND TX <=50 CM 60 PT NP WOUND TX <=50 CM 90 PT NP WOUND TX <=50CM 105 PT NP WOUND TX <=50CM 120 PT NP WOUND TX >50 CM 105

234.26 283.45 342.97 415.00 176.00 212.96 257.68 311.79 377.27 456.50 403.00 240.00 516.00 113.00 139.00 115.00 138.00 97.00 97.00 210.00 584.00 315.00 366.00 131.00 83.00 383.00 322.00 290.00 290.00 143.00 56.00 96.00 139.00 138.00 121.00 115.00 100.00 139.00 144.00 126.00 118.00 197.00 196.00 165.00 138.00 100.00 130.00 169.00 220.00 286.00 371.00 483.00 376.00

117.13 141.72 171.49 207.50 88.00 106.48 128.84 155.90 188.64 228.25 0.00 0.00 230.00 46.00 0.00 37.00 55.00 37.00 37.00 0.00 224.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 47.00 0.00 37.00 0.00 0.00 49.00 0.00 0.00 0.00 0.00 53.00 0.00 80.00 96.00 115.00 138.00 166.00 199.00 239.00 204.00

32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32

REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES

Page 125

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

3234267 3234143 3234168 3234184 3234200 3234226 3232196 3232964 3231735 3233699 3233194 3233707 3230190 3233715 3231321 3233723 3233434 3231586 3233301 3233749 3233756 3233764 3231263 3230992 3231008 3233897 3233889 3233145 3233038 3233772 3232378 3231313 3232493 3231438 3233913 3233905 3234275 3234283 3234291 3234309 3233368 3231958 3232014 3232675 3232808 3233806 3240025 3240009 3240017 3240033 3212024 3212057 3211992

PT NP WOUND TX >50 CM 120 PT NP WOUND TX >50 CM 15 PT NP WOUND TX >50 CM 30 PT NP WOUND TX >50 CM 45 PT NP WOUND TX >50 CM 60 PT NP WOUND TX >50 CM 90 PT ORT/PRO/ADL CK INIT 30 PT ORTHOTIC TRAIN EA 15 PT PARAFFIN BATH 15 PT PROC THER GP 15 PT PROC THER GP 30 PT PROC THER GP 45 PT PROC THER GP 60 PT PROC THER GP 60 PT PROC/MOD ADD 15 PT PROSTH TRAIN ADD 15 PT PROSTH TRAIN EA 15 PT PROSTH TRAIN INIT 30 PT RE-EVAL 15 PT RE-EVAL 30 PT RE-EVAL 45 PT RE-EVAL 60 PT RE-EVAL EXTENDED PT RE-EVAL INTERMEDIATE PT RE-EVAL LTD PT SINGLE PROC ADD 15 PT SINGLE PROC INIT 30 PT SOFT TISSUE MOB INIT30 PT THER ACT EA 15 PT THER ACT INIT 30 PT THER EX EA 15 PT THER EX INIT 30 PT THER MASSAGE EA 15 PT THER MASSAGE INIT 30 PT TREAT COMBO ADD 15 PT TREAT COMBO INIT 30 PT TRN BIOFD ANY MODAL 15 PT TRN BIOFD ANY MODAL 30 PT TRN BIOFD ANY MODAL 45 PT TRN BIOFD ANY MODAL 60 PT ULTRASOUND EA 15 PT ULTRASOUND INIT 30 PT UNLISTED PHYS MED PROC PT WHEELCHAIR TRAIN EA 15 PT WHIRLPOOL 15 PT WHIRLPOOL 30 S NSTRL E-STIM ELECTRODES S NSTRL E-STIM ELECTRODES S NSTRL IONTOPHORESIS ELE S NSTRL IONTOPHORESIS PAT S NSTRL SPLINT MCP MOB S NSTRL SPLINT MISC S NSTRL SPLINT THOMAS

488.00 105.00 135.00 174.00 225.00 291.00 108.00 172.00 85.00 25.00 44.00 71.00 101.00 97.00 69.00 53.00 73.00 144.00 164.00 217.00 270.00 321.00 322.00 290.00 145.00 60.00 144.00 146.00 152.00 146.00 149.00 139.00 133.00 110.00 60.00 144.00 80.00 80.00 90.00 100.00 37.00 78.00 66.00 122.00 99.00 183.00 10.00 8.00 17.00 21.00 92.00 0.00 83.00

244.00 85.00 101.00 120.00 142.00 171.00 0.00 55.00 30.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 95.00 135.00 175.00 0.00 0.00 0.00 0.00 25.00 90.00 0.00 57.00 0.00 54.00 0.00 43.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 40.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32

REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES

Page 126

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

3212925 3212065 3212909 3212917 3213238 3212016 3213188 3213220 3213170 3213097 3213139 3213113 3213121 3213212 3212032 3213246 3213147 3212073 3212958 3213030 3213048 3213196 3213204 3213063 3213055 3212115 3212966 3211950 3212982 3212974 3212990 3213154 3213253 3212131 3212081 3211943 3213006 3213014 3213162 3212941 3212933 3211984 3213071 3213022 3211976 3211968 3213105 3213089 3220738 3220787 3220795 3220803 3220456

S OT EO DBL F/A EXT/FLEX S OT EO EL PF W/STAYS S OT EO EL PREFAB S OT EO EL W/MTL JT PF S OT FO FINGER K/B S OT FO SAF PIN MODIFIED S OT FO SAF PIN SPNG WIRE S OT HFO COMPOSITE EL S OT HFO FGR EXTN C/S S OT HFO FLEX GLV EL FGR S OT HFO K/B 2 SEG FLX S OT HFO K/B BNDR PREFAB S OT HFO K/B BNDR W/OTRG S OT HFO RVS K/B OTRG S OT HFO RVS K/B PREFAB S OT HFO SPREADING HAND S OT HFO W/O JT PREFAB S OT SO ACRO/CLAV CNVS PF S OT WHF 2ND MP ABDC AST S OT WHF ADJ MP FLEX CTRL S OT WHF ADJ MP FLEX/IP S OT WHF DORSAL WRIST PF S OT WHF DORSAL WRST OTRG S OT WHF DYN HNG W/F CBL S OT WHF DYN HNG WRST/FGR S OT WHF FGR EXTN W/WRST S OT WHF IP EXTN W/MP SP S OT WHF LONG OPPN CUST S OT WHF MP EXTENSION AST S OT WHF MP EXTENSION SP S OT WHF MP SPNG EXTN AST S OT WHF OPHR PREFAB S OT WHF OPHR W/KNCK S OT WHF OPHR W/RVS S OT WHF PALMER PREFAB S OT WHF SHORT OPPN CUST S OT WHF SPNG SWIVL THUMB S OT WHF THB IP EXTN W/MP S OT WHF THOMAS SPN S OT WHF THUMB ABDC BAR S OT WHF W/O JT PREFAB S OT WHF WRST EXTN W/OTRG S OT WHF WRST GNT THB SPC S OT WHO CAN WRST W/DSFLX S OT WHO COCK-UP NON MOLD S OT WHO GAUNTLET CUST S OT WHO WRST EXTN C-UP S OT WO EL PREFAB SP COGN RETRAIN EA 15 SP EVAL 30 SP EVAL 45 SP EVAL 60 SP EVAL FNX SWALL 15

1093.00 83.00 52.00 126.00 60.00 54.00 48.00 105.00 69.00 115.00 118.00 94.00 118.00 118.00 90.00 100.00 44.00 793.00 58.00 142.00 162.00 107.00 106.00 1775.00 1443.00 65.00 115.00 380.00 94.00 60.00 99.00 119.00 181.00 180.00 96.00 243.00 57.00 97.00 98.00 75.00 219.00 142.00 617.00 106.00 72.00 480.00 100.00 61.00 131.00 164.00 197.00 230.00 197.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 75.00 100.00 125.00 150.00 125.00

32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32

REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES

Page 127

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

3220464 3220472 3220480 3220753 3220761 3220779 3220498 3220506 3220514 3220522 3220530 3220548 3220555 3220563 3220571 3220589 3220597 3220233 3220860 3220852 3220811 3220829 3220837 3220845 3220605 3220613 3220621 3220639 3220647 3220654 3220662 3220670 3220688 3220225 3220696 3220704 3220878 3212503 3233822 3233814 3212495 3220712 3220720 95307 92908 85308 75309 9019 3012 1511 1560 1743 2014

SP EVAL FNX SWALL 30 SP EVAL FNX SWALL 45 SP EVAL FNX SWALL 60 SP EVAL LANG 30 SP EVAL LANG 45 SP EVAL LANG 60 SP EVAL MTN FLUOR SWA 120 SP EVAL MTN FLUOR SWAL 15 SP EVAL MTN FLUOR SWAL 30 SP EVAL MTN FLUOR SWAL 45 SP EVAL MTN FLUOR SWAL 60 SP EVAL MTN FLUOR SWAL 75 SP EVAL MTN FLUOR SWAL 90 SP EVAL SP/LANG/COM 15 SP EVAL SP/LANG/COM 30 SP EVAL SP/LANG/COM 45 SP EVAL SP/LANG/COM 60 SP EXAM NEUROBEHAVIOR HR SP SP/LANG THER EA 30 SP THER SP/LANG EA 60 SP THER SP/LANG GRP 15 SP THER SP/LANG GRP 30 SP THER SP/LANG GRP 45 SP THER SP/LANG GRP 60 SP TX SP/LANG/COM 15 SP TX SP/LANG/COM 30 SP TX SP/LANG/COM 45 SP TX SP/LANG/COM 60 SP TX SP/LANG/COM GP 15 SP TX SP/LANG/COM GP 30 SP TX SP/LANG/COM GP 45 SP TX SP/LANG/COM GP 60 SP TX SWALL/ORAL FNX 15 SP TX SWALL/ORAL FNX 30 SP TX SWALL/ORAL FNX 45 SP TX SWALL/ORAL FNX 60 SP UNLISTED SERVICE/PROC TECH ASSIST TECH ASSIST TECH ASSIST TECH ASSIST TECH ASSIST TECH ASSIST NEWBORN LEVEL I NEWBORN LEVEL II NEWBORN LEVEL II NEWBORN LEVEL III OBSERVATION PER HOUR OBSERVATION PER HOUR OBSERVATION PER HOUR OBSERVATION PER HOUR OBSERVATION PER HOUR OBSERVATION PER HOUR

262.00 328.00 393.00 164.00 197.00 230.00 760.00 164.00 249.00 335.00 419.00 505.00 590.00 197.00 262.00 328.00 393.00 492.00 197.00 328.00 53.00 105.00 157.00 210.00 131.00 197.00 262.00 310.00 53.00 105.00 157.00 210.00 131.00 197.00 262.00 328.00 419.00 0.00 0.00 0.00 0.00 0.00 0.00 1223.00 2446.00 2446.00 3672.00 112.00 112.00 112.00 112.00 112.00 112.00

150.00 200.00 250.00 100.00 125.00 150.00 0.00 85.00 130.00 175.00 220.00 265.00 310.00 125.00 175.00 225.00 275.00 287.00 115.00 195.00 20.00 40.00 60.00 80.00 75.00 115.00 155.00 195.00 20.00 40.00 60.00 80.00 75.00 115.00 155.00 195.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 0 0 0 0 0 0 0 0 0 0

REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES REHAB SERVICES ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED

Page 128

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2022 2915 315 4010 5314 8011 70300 74005 73502 70409 23507 31732 42903 20404 49007 31500 20305 21733 22004 24000 33001 23002 62901 29009 22905 28001 51730 54007 53504 21501 51508 50401 50302 80309 84004 80408 83501 82909 33506 30304 34009 81737 89003 82008 30403 83006 93500 94003 90407 90308 64006 63503 60400

OBSERVATION PER HOUR OBSERVATION PER HOUR OBSERVATION PER HOUR OBSERVATION PER HOUR OBSERVATION PER HOUR OBSERVATION PER HOUR ROOM CCU ROOM ICU ROOM ICU ROOM ICU ROOM MED/SURG/GYN ROOM MED/SURG/GYN ROOM MED/SURG/GYN ROOM MED/SURG/GYN ROOM MED/SURG/GYN ROOM MED/SURG/GYN ROOM MED/SURG/GYN ROOM MED/SURG/GYN ROOM MED/SURG/GYN ROOM MED/SURG/GYN ROOM MED/SURG/GYN ROOM MED/SURG/GYN ROOM MED/SURG/GYN ROOM OB/MATERNAL ROOM OB/MATERNAL ROOM OB/MATERNAL ROOM TELEMETRY/SPEC CARE ROOM TELEMETRY/SPEC CARE ROOM TELEMETRY/SPEC CARE ROOM TELEMETRY/SPEC CARE ROOM TELEMETRY/SPEC CARE ROOM TELEMETRY/SPEC CARE ROOM TELEMETRY/SPEC CARE ROOM TRAUMA CCU ROOM TRAUMA ICU ROOM TRAUMA ICU ROOM TRAUMA ICU ROOM TRAUMA ICU PEDIATRIC ROOM TRAUMA MED/SURG/GYN ROOM TRAUMA MED/SURG/GYN ROOM TRAUMA MED/SURG/GYN ROOM TRAUMA MED/SURG/GYN ROOM TRAUMA MED/SURG/GYN ROOM TRAUMA MED/SURG/GYN ROOM TRAUMA MED/SURG/GYN ROOM TRAUMA MED/SURG/GYN ROOM TRAUMA PEDIATRIC ROOM TRAUMA PEDIATRIC ROOM TRAUMA PEDIATRIC ROOM TRAUMA PEDIATRIC ROOM TRAUMA TELEMETRY ROOM TRAUMA TELEMETRY ROOM TRAUMA TELEMETRY

112.00 112.00 112.00 106.00 112.00 112.00 4433.00 4433.00 4182.00 4182.00 2175.00 2175.00 2175.00 2175.00 2175.00 2175.00 2175.00 2175.00 2175.00 2175.00 2175.00 2175.00 2175.00 2865.00 2175.00 2175.00 2882.00 2882.00 2882.00 2306.00 2882.00 2882.00 2882.00 5542.00 5542.00 5542.00 5542.00 2882.00 2719.00 2719.00 2719.00 2719.00 2719.00 2719.00 2719.00 2719.00 2882.00 2882.00 2882.00 2882.00 3603.00 3603.00 3603.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED ROOM & BED

Page 129

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

60301 81505 404103 404368 403956 404293 404285 404525 404509 403998 404319 404301 404327 404012 404186 403972 404004 404335 404277 404129 404152 404244 404020 404137 404079 404442 404251 404343 404160 404517 404053 404434 404095 404178 404236 409839 412981 404392 404459 404467 404202 404350 404228 404210 467381 467399 467357 467365 467373 406561 411298 408146 465567

ROOM TRAUMA TELEMETRY ROOM TRAUMA TELEMETRY D10W 1000ML D10W 250ML D10W 500ML D51/2NS 1000ML D51/2NS 1000ML/KCL 10 D51/2NS 1000ML/KCL 20 D51/2NS 1000ML/KCL 30 D51/2NS 1000ML/KCL 40 D51/2NS 250ML D51/2NS 500ML D51/4NS 1000ML D51/4NS 1000ML/KCL 10 D51/4NS 1000ML/KCL 20 D51/4NS 1000ML/KCL 30 D51/4NS 1000ML/KCL 40 D51/4NS 500ML D5LR 1000ML D5LR/KCL 20MEQ 1000ML D5LR/KCL 40MEQ 1000ML D5NS 1000ML D5NS 1000ML/KCL 20 D5NS 1000ML/KCL 40 D5NS 1000ML/KCL 40 D5NS 500ML D5NS 500ML D5W 1000ML D5W 1000ML/KCL 20 D5W 1000ML/KCL 40 D5W 250ML D5W 500ML D5W 500ML HEPARIN 25KU/1/2NS250 LACTATED RINGERS 1000 LIDO/DEXTROSE MANNITOL NA CL 0.45% 1000ML NA CL 0.45% 500ML NA CL 0.9% 1000ML NA CL 0.9% 250ML NA CL 0.9% 500ML NORMOSOL R 1000ML NORMOSOL R/D5W 1000ML S BRACH SOURCE GOLD 198 S BRACH SOURCE HI IRID192 S BRACH SOURCE NHDR IR192 S BRACH SOURCE PALLADM103 S BRACH SOURCE YTTRIUM 90 S IMP KNEE DURACON TIBIA S IMP PROSTHESIS IMPLANT S NSTRL ADPTR TRACH TEE S NSTRL AFO AHOC ANKL

3603.00 3603.00 181.00 192.00 181.00 162.00 247.00 247.00 247.00 247.00 169.00 169.00 162.00 247.00 247.00 247.00 247.00 169.00 198.00 321.00 321.00 162.00 310.00 324.00 310.00 169.00 169.00 186.00 247.00 247.00 162.00 158.00 158.00 320.00 181.00 72.00 587.00 186.00 165.00 167.00 153.00 153.00 320.00 282.00 0.00 0.00 0.00 0.00 0.00 6078.00 0.00 31.00 1284.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0 0 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

ROOM & BED ROOM & BED SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS

Page 130

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

465476 465492 465534 465518 465484 465609 465559 415612 408096 403733 411314 466474 401422 416032 416040 416057 416073 416065 416081 416099 416024 407999 400820 408088 401364 401372 409698 401349 465187 465336 465328 408195 408187 415604 401455 409987 401539 401554 401521 409847 467068 465179 465138 466599 409730 409862 401299 465385 465351 465393 465369 400978 465302

S NSTRL AFO ANKLE SPLNT S NSTRL AFO CSTM FIT S NSTRL AFO DBL UPRT S NSTRL AFO MOLDED RIGD S NSTRL AFO SNGL BR ADJ S NSTRL AFO SOFT INNRFC S NSTRL AFO TIB FX RGD S NSTRL ASPEN COLLAR S NSTRL BAG BREATHING S NSTRL BINDER, ABDOMINAL S NSTRL BLANKET WARMER S NSTRL BODY SOCK S NSTRL BOOT BUCK TRCTN S NSTRL BRCE WRIST LH L S NSTRL BRCE WRIST LH M S NSTRL BRCE WRIST LH S S NSTRL BRCE WRIST RH L S NSTRL BRCE WRIST RH L S NSTRL BRCE WRIST RH M S NSTRL BRCE WRIST RH S S NSTRL BRCE WRST LH XL S NSTRL CAN NASAL 7FT S NSTRL CAN NASAL ADLT S NSTRL CAN NASAL PED S NSTRL CAST FBGL 2"/3 S NSTRL CAST FBGL 4"/5 S NSTRL CAST LONG LOWER S NSTRL CAST SHOE S NSTRL CERV CL SPN EX S NSTRL CERV HULO VEST S NSTRL CHRBCK LSO BRCE S NSTRL CIRC VENT IPPB S NSTRL CIRCUIT VENT S NSTRL COLLAR ASPEN S NSTRL COLLAR CERV SFT S NSTRL COLLAR PHIL USE S NSTRL COLOSTOMY POUCH S NSTRL COLSTMY IRR BAG S NSTRL COLSTMY IRR SLE S NSTRL DIGITAL SPLINT S NSTRL DRSG SILCON 4X7 S NSTRL FG 8 SPLNT SHLD S NSTRL HALO MRI SYS S NSTRL HO ADB CNTRL S NSTRL IMBLR LOWER S NSTRL IMMOBILIZER UPPER S NSTRL KIT CPM TRCTN S NSTRL KNEE IMBLR S NSTRL KO ADJ-KNEE FIT S NSTRL KO CUSTM MLDD S NSTRL KO ELSTC CNDYL S NSTRL LEAD TEMP S NSTRL LS BDY JCKT

2302.00 2248.00 3507.00 4318.00 2588.00 1078.00 5097.00 202.00 65.00 212.00 400.00 711.00 542.00 146.00 146.00 146.00 146.00 146.00 146.00 146.00 146.00 42.00 76.00 63.00 175.00 257.00 838.00 230.00 3752.00 14402.00 3130.00 101.00 270.00 1269.00 211.00 117.00 101.00 547.00 144.00 16.00 194.00 734.00 6484.00 6473.00 282.00 211.00 793.00 211.00 4263.00 8438.00 1000.00 1191.00 6716.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS

Page 131

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

465310 408047 408062 408179 408211 408120 408237 408112 412254 409029 467076 406066 410381 410357 408245 401406 411900 413021 401398 401448 408138 415828 465245 410043 410050 401273 401240 409599 415521 401018 414177 467266 408161 465286 465294 465260 408021 465591 467142 414854 414847 402560 403501 413757 415620 406850 403857 400788 404756 404624 415034 404657 402693

S NSTRL LSO CORSET FIT S NSTRL MASK 02 7' TUBE S NSTRL MASK AEROSOL S NSTRL MASK IPPB S NSTRL MASK O2 VENTI S NSTRL MASK TRACH S NSTRL NEBULIZER HAND S NSTRL NEBULIZER KIT S NSTRL PAD HEAT THERP S NSTRL PAD HEAT THERP S NSTRL PAD HEAT THPY S NSTRL PROBE TEMP S NSTRL RESUS ADULT S NSTRL RESUS NEWBORN S NSTRL SENSOR TEMP S NSTRL SHOE POST OP S NSTRL SHOULDER IMBLR S NSTRL SLEEVE SEQUENT CO S NSTRL SLING ARM S NSTRL SLING SWATHE S NSTRL SPIROMTR INCNTV S NSTRL SPLINT ANKLE S NSTRL SPLINT COCK-UP S NSTRL SPLINT LOWER EXTR S NSTRL SPLINT UPPER EXTR S NSTRL SPLINT WRIST S NSTRL SPLINT, CLAV S NSTRL SPLINT/HARE/TRACT S NSTRL SPLNT GURD FNGR S NSTRL STCKNG ANTI EMB S NSTRL STCKNG EMBL TH S NSTRL STRAP FETAL MONIT S NSTRL TENT CANOPY S NSTRL TLSO BDY JCKT S NSTRL TLSO BDY JCKT S NSTRL TLSO JEWTT HYEX S NSTRL TUBE LRG BORE S NSTRL VARS/VALGS STRP S STRL ADPT TUOHY-BORST S STRL AEROVENT S STRL AQUAPAK 1000CC S STRL BAG AUTOTRANS S STRL BAG BILE S STRL BAG RESUS DISP S STRL BARRIER SKIN GUA S STRL BONE WAX S STRL BOTTLE EVAC 1L S STRL CAN NASAL 8' S STRL CATH 7F FEMORAL S STRL CATH ANGIO QUCK S STRL CATH BARTHLN GLAND S STRL CATH BILIARY DRAIN S STRL CATH EXTERNAL MALE

1325.00 65.00 46.00 31.00 73.00 65.00 74.00 181.00 262.00 243.00 631.00 227.00 502.00 554.00 31.00 302.00 282.00 506.00 147.00 272.00 167.00 211.00 733.00 361.00 256.00 102.00 93.00 525.00 36.00 171.00 251.00 12.00 262.00 8507.00 10711.00 3191.00 31.00 672.00 81.00 162.00 91.00 976.00 183.00 501.00 108.00 155.00 291.00 46.00 1734.00 94.00 105.00 531.00 87.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS

Page 132

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

404582 402750 402636 412700 402594 402669 465047 402602 467928 410084 401059 467258 413344 404608 404558 404574 404632 400622 404731 402610 404673 404616 403600 412239 404822 404830 404764 404780 415422 414110 402537 407858 415380 403816 409854 403147 411447 406033 406074 467779 402529 400358 400374 409680 400432 466839 466847 466854 466870 466888 466912 466946 466961

S STRL CATH FEMORAL ARTRY S STRL CATH FOLEY S STRL CATH FOLEY 3CC S STRL CATH FOLEY 3CC/5CC S STRL CATH FOLEY 3-WAY S STRL CATH FOLEY COUDE S STRL CATH FOLEY COUNCIL S STRL CATH FOLLWR PHIL S STRL CATH HEMO DL GAMBR S STRL CATH IN & OUT S STRL CATH INTRDUCR S STRL CATH IUP INTRN DIS S STRL CATH IV ALL S STRL CATH IV ANGIO S STRL CATH IV ANGIO S STRL CATH IV ANGIO S STRL CATH IV PERIPHERAL S STRL CATH KIT SUCTION S STRL CATH LUMN CTR VN S STRL CATH MALECOT S STRL CATH NEPHROSTOMY S STRL CATH PERIP 2-LUMEN S STRL CATH RECTAL ROBIN S STRL CATH ROB NEL S STRL CATH THERMO 7F S STRL CATH THERMO HEPARN S STRL CATH UMBILCL ARTRY S STRL CATH UMBLCL STPCCK S STRL CATH V 4.0FR S STRL CATH, INDWELLING S STRL CATH, TROCAR THORA S STRL CATHETER, COHEN UR S STRL CATH-V 3.0 MIDLINE S STRL CAUTERY STRL S STRL CLAMP DISP 10MM S STRL CURETTER EAR DISP S STRL CUSTOM ORTHO S STRL DEFIB PADS S STRL DEFIB PD EXT PACE S STRL DERMABOND S STRL DRAIN CHEST VAC S STRL DRES DUDRM 4X4 S STRL DRES DUDRM 4X5 S STRL DRES GUZE IODO/PLN S STRL DRESS VASELINE GZE S STRL DRS SIL MEPITL 2X3 S STRL DRS SIL MEPITL 3X4 S STRL DRS SIL MEPITL 4X8 S STRL DRSG AQUACEL 2X2 S STRL DRSG AQUACEL 4X4 S STRL DRSG CARBOFLEX 3X6 S STRL DRSG CLR COMFL 2X2 S STRL DRSG CLR COMFL 3X5

322.00 198.00 272.00 198.00 290.00 340.00 290.00 283.00 536.00 108.00 496.00 183.00 93.00 131.00 144.00 51.00 101.00 40.00 690.00 299.00 549.00 74.00 103.00 52.00 1854.00 1143.00 257.00 426.00 711.00 400.00 353.00 833.00 711.00 237.00 1327.00 76.00 0.00 135.00 202.00 292.00 1610.00 120.00 219.00 154.00 74.00 60.00 74.00 115.00 40.00 40.00 233.00 39.00 51.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS

Page 133

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

466953 466979 466987 466995 466706 466722 466862 466821 466748 467027 467001 467019 467290 467159 402347 408013 467134 415406 415372 415398 415810 400986 406611 414821 414813 400671 409706 413476 402891 466276 403923 404798 402768 403519 401034 415927 415935 415919 466359 403782 401117 402867 466128 416156 406413 403238 407866 467647 407940 404533 404541 412114 414839

S STRL DRSG CLR COMFL 4X4 S STRL DRSG CLR COMFL 6X6 S STRL DRSG COMFL 24"SQ S STRL DRSG COMFL 42"SQ S STRL DRSG CURASOL GEL S STRL DRSG IMPREG MESALT S STRL DRSG KALTOSTAT 3X4 S STRL DRSG MEPILEX S STRL DRSG RIBBN MESALT S STRL DRSG XEROFLO 1X8 S STRL DRSG XEROFLO 2X2 S STRL DRSG XEROFLO 5X9 S STRL ELECT FETAL SCALP S STRL ESOPH/RCTL TMP DSP S STRL EXTRACTR VACUM CUP S STRL FILTER BACTERIA S STRL FLOWMETER PEAK S STRL GROSHONG 3FR PICC S STRL GROSHONG 4FR PICC S STRL GROSHONG DUL 5PICC S STRL GUIDEWIRE S STRL GUIDEWIRE DUAL S STRL GUIDEWIRE, AMPLATZ S STRL HEATER COLUMN S STRL HEATER RESERVOIR S STRL HUMIDIFIER 325ML S STRL INTRAOSEOUS NEEDLE S STRL IV REFLUX VALVE S STRL KIT AMNIO PRES S STRL KIT ANES ART-LINE S STRL KIT ANESTH LTA II S STRL KIT ART LINE 20G S STRL KIT CATH SMALL S STRL KIT GASTRIC LAVAGE S STRL KIT INLNE TEMP INJ S STRL KIT MICRO SAFE 3FR S STRL KIT MICRO SAFE 4FR S STRL KIT MICRO SAFE 5FR S STRL KIT MLT LUMEN 9 FR S STRL KIT NASOSTAT S STRL KIT PERCT SHTH S STRL KIT PUMP BREAST S STRL KIT SEED RECOVERY S STRL KT TRANSDUCER BIFU S STRL LACTATED RINGERS S STRL LENS THRP EYE DISP S STRL LOOP, CUTTING/ELEC S STRL MASTISOL S STRL NASAL PCK MED DISP S STRL NDL IV BTRFLY S STRL NDL IV BTRFLY 12" S STRL NDO DISECTOR S STRL NEBULIZER ADAPTOR

40.00 65.00 61.00 83.00 55.00 25.00 63.00 65.00 25.00 39.00 18.00 39.00 34.00 178.00 291.00 16.00 174.00 1871.00 2401.00 2401.00 584.00 270.00 865.00 322.00 120.00 70.00 380.00 63.00 662.00 690.00 147.00 484.00 94.00 314.00 567.00 106.00 106.00 106.00 1173.00 574.00 772.00 416.00 316.00 546.00 275.00 388.00 1854.00 12.00 93.00 90.00 90.00 499.00 119.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS

Page 134

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

401232 466102 467282 405241 404665 401224 407742 406132 467274 466581 466615 406017 466136 466524 403550 409631 409037 401968 401836 400440 466110 401109 402131 400556 400531 400515 400499 400523 413799 404400 404145 404194 404483 404269 408765 408880 404087 404475 401760 405100 401471 412825 413245 413260 465039 413211 413203 413187 413195 413179 413161 406918 406892

S STRL NEEDLE BIOPSY S STRL NEEDLE BRACHYTHRPY S STRL NEEDLE FURGESON S STRL NEEDLE PERCUTAN 18 S STRL NEEDLE PERCUTANEUS S STRL NEEDLE SPINAL DISP S STRL NEEDLE SPNE WHITKR S STRL PAD, PATIENT GROUN S STRL PK C-SECTION CUS S STRL PROBE O2 INFNT DSP S STRL PROBE O2 PED DISP S STRL PROBE OXIMETR DISP S STRL RADIONUCLIDE SEEDS S STRL RADIONUCLIDE SEEDS S STRL RESUS NEONATL DISP S STRL RHINO ROCKET S STRL SENSOR O2 PROB DIS S STRL SET BLOOD NV Y-TYP S STRL SET BLOOD TUBNG S STRL SET IRR TUR 'Y S STRL SET PROSTATE DISP S STRL SHEATH, INTRODUCER S STRL SLV CATH GURD 80CM S STRL SOL IRR NACL/H20 S STRL SOL IRR NACL/H20 S STRL SOL IRR NACL/H20 S STRL SOL IRR NACL/H20 S STRL SOL IRR SORB/MANN S STRL SOL IRR, NACL/H20 S STRL SOL IV 1L STOCK SO S STRL SOL, .9NACL WO MEQ S STRL SOL, D5.9NACL 250 S STRL SOL, D5W PARTIAL F S STRL SOL, DR LACT RINGE S STRL SOL, IV 1L, ALL S STRL SOL, IV 500CC, ALL S STRL SOL, LMD 10% & NAC S STRL SOL, NACL .9%PARTI S STRL SOLUSET S STRL STAPLE EXTRC SKIN S STRL STAPLE SIGNET SKIN S STRL STERILE SUPPLIES S STRL SUTURE CARDIOVAS S STRL SUTURE CUTICULAR S STRL SUTURE DERMABOND S STRL SUTURE GI POP OFF S STRL SUTURE GI SINGLE S STRL SUTURE GORTEX CV S STRL SUTURE MAXON S STRL SUTURE ORTHO S STRL SUTURE PLASTIC-ALL S STRL SUTURE, GC MULTI P S STRL SUTURE, GEN. TAPER

555.00 136.00 63.00 453.00 1018.00 167.00 188.00 181.00 1163.00 351.00 271.00 120.00 181.00 181.00 1029.00 440.00 409.00 230.00 265.00 237.00 1156.00 547.00 182.00 96.00 61.00 63.00 90.00 237.00 344.00 245.00 321.00 169.00 229.00 189.00 211.00 178.00 1420.00 229.00 79.00 119.00 290.00 0.00 209.00 142.00 196.00 290.00 90.00 366.00 472.00 106.00 257.00 215.00 101.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS

Page 135

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

406900 406868 410019 414722 402511 400697 408450 413898 467241 403915 403097 402719 465104 403881 402842 403113 404806 404723 403899 403105 409102 402727 402586 400895 400929 400846 415232 400747 407726 402651 402685 414151 402578 402701 402834 465088 465096 404699 466896 467936 467910 2610145 2610798 2610780 2610616 2610608 2610566 2610574 2630176 2610699 2610707 2610731 2610749

S STRL SUTURE, PLASTIC S STRL SUTURE, SUPRAMID S STRL SYRINGE EAR & ULCE S STRL SYS SPPLMNTL NUTR S STRL TRACH SUCTN CLSD S STRL TRACH TUBE LWP S STRL TRANSDUCER 3T S STRL TRANSDUCR PRES DSP S STRL TRAY ANES PUDENTL S STRL TRAY ANESTH DISP S STRL TRAY BIOPSY DISP S STRL TRAY CATH FOLEY S STRL TRAY EPIDURAL S STRL TRAY EPIDURAL DISP S STRL TRAY FOLEY W/BAG S STRL TRAY LUMBAR DISP S STRL TRAY MAHURKR DL L S STRL TRAY MYELOGRM DISP S STRL TRAY SPINAL DISP S STRL TRAY THORA DISP S STRL TRAY THORC VNT DIS S STRL TRAY URETHRAL S STRL TRAY URNE MTR FOLY S STRL TUBE FEED DOBHOFF S STRL TUBE FEED KEOFEED S STRL TUBE INFANT FED S STRL TUBE JEJUNAL FEED S STRL TUBE TRACH IN CAN S STRL TUBE, BRONCHO-ENDO S STRL URINARY BAG S STRL URINARY BAG LEG S STRL URINARY BAG LG DRN S STRL URINARY DRAIN UNIT S STRL URINE METER W/BAG S STRL UROSTOMY BAG S STRL VALVE SPEAK (VENT) S STRL VALVE SPEAK(TRACH) S STRL VESSEL DILATOR S STRL WOUND CLEANSER S STRL WOUND VAC CANNISTR S STRL WOUND VAC DRSG CANDELA LITHOTRIPSER BILA CPLX GENRL ANES ADD 15M CPLX GENRL ANES FIRST 30M CPLX PACU ADD 15M CPLX PACU FIRST 30M CX CASE OR CX CASE PREOP CYST/URETSCP/PYLSCP LITHO INJ EPID CERV THOR INJ EPIDL L/S INJ FACET L/S 1 LVL INJ NRV BLK C SPINE

257.00 93.00 55.00 525.00 433.00 978.00 546.00 555.00 403.00 484.00 406.00 115.00 314.00 631.00 287.00 409.00 1551.00 1321.00 416.00 588.00 3407.00 122.00 400.00 555.00 344.00 93.00 888.00 120.00 1537.00 156.00 117.00 117.00 291.00 275.00 110.00 709.00 709.00 171.00 103.00 140.00 149.00 0.00 247.00 792.00 147.00 590.00 590.00 0.00 2375.00 1029.00 1029.00 122.00 122.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 26 26 26 26 26 26 26 26 26 26 26 26

SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SUPPLIES - CS SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP

Page 136

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2610756 2610723 2610715 2651768 2651750 2610814 2610806 2651016 2650349 2610822 2610830 2610848 2610855 2610863 2610772 2610764 2610590 2610582 2610632 2610624 2610491 2610517 2610509 2610533 2610525 2610558 2610541 2610871 2610129 2375145 2369601 2375152 2375210 2375202 2375244 2375236 2375178 2375194 2375186 2375103 2367472 2367498 2367407 2367399 2367456 2367480 2375228 2375160 2375020 2375004 2375012 2375038 2355659

INJ NRV BLK LUMB THOR INJ NRV INTCOSTL MULT INJ NRV INTCOSTL SNGL LITHO ESWL BILAT LITHO ESWL UNILAT MAC/REG ADD 15M MAC/REG FIRST 30M S STRL DRESSING GAUZE IMP S STRL TRAP SPEC BRONCH SEDATION < 2 HRS SEDATION 2 HRS - 4 HRS SEDATION 4 HRS - 6 HRS SEDATION 6 HRS - 8 HRS SEDATION 8 HRS - 10 HRS STND GENRL ANES ADD 15M STND GENRL ANES FIRST 30M STND PACU LVL 1 ADD 15M STND PACU LVL 1 FIRST 30M STND PACU LVL 2 ADD 15M STND PACU LVL 2 FIRST 30M SURG LVL 3 ADD 15M SURG LVL 4 ADD 15M SURG LVL 4 FIRST 30M SURG LVL 5 ADD 15M SURG LVL 5 FIRST 30M SURG LVL COSM ADD 15M SURG LVL COSM FIRST 30M US NDL PLACE YAG LASER ROOM, EACH 1/4 AD EVAL ABR CHNG GT TUBE EEG DURING SURGERY ELCTRDE STIM BRAIN 1ST HR EMG FOUR LIMBS EMG HEAD OR NECK BIL EMG HEAD OR NECK UNI EMG ONE LIMB EMG THREE LIMBS EMG TWO LIMBS H REFLX TEST GSTR/SOL UNI LACTATED RINGERS 1000 LACTATED RINGERS 3000 NA CL IRRIG 1000ML NA CL IRRIG 1500ML NA CL IRRIG 3000ML NA CL IRRIG 500ML NEURMSC JUNCTION TEST EA NRV MOTOR CONDUCT STDY EA NRV TEST IOP EA HOUR NRV TEST IOP EA HOUR NRV TEST IOP EA HOUR NRV TEST IOP EA HOUR S BRACH SOURCE IODINE 125

122.00 122.00 122.00 17209.00 9178.00 111.00 439.00 0.00 12.00 660.00 660.00 660.00 660.00 660.00 165.00 528.00 298.00 719.00 99.00 393.00 394.00 1816.00 6057.00 1843.00 6149.00 747.00 2388.00 736.00 0.00 834.00 143.00 2263.00 1012.00 1310.00 1787.00 1787.00 864.00 1162.00 1131.00 893.00 47.00 16.00 16.00 17.00 46.00 13.00 893.00 893.00 5240.00 1667.00 2858.00 7623.00 145.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SERVICES - OP SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 137

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2352664 2354322 2391159 2391167 2320794 2391175 2391183 2320802 2391191 2320810 2391209 2391217 2391225 2391233 2391241 2391266 2391258 2320828 2391274 2391282 2391290 2391308 2320836 2391316 2320844 2391324 2391332 2391340 2391357 2320851 2320869 2391365 2391373 2391381 2391399 2320877 2391415 2391407 2391423 2320885 2391431 2391449 2320893 2391456 2391464 2391472 2391480 2391498 2391506 2320901 2320919 2391142 2391514

S IMP SCREW, CANNTED WIT S IMP SCREW, MALLEOLAR S IMP #13 HIP STEM S IMP #13 IMAL SLEEVE S IMP #14 PROX SLEEVE S IMP #3 FEMORAL S IMP #3 FEMORAL S IMP #3 TIBIAL INSERT S IMP #3 TIBIAL INSERT S IMP #4 FEM COMP RT S IMP #4 FEMORAL S IMP #4 FEMORAL S IMP #4 FEMORAL S IMP #4 HIP STEM S IMP #4 TIBIAL INSERT S IMP #5 FEMORAL S IMP #5 FEMORAL S IMP #5 HIP STEM S IMP #5 PATELLAR S IMP #7 FEMORAL S IMP #7 PATELLA DOME S IMP #8 HIP STEM S IMP 10 TIBIAL INSERT S IMP 10MM TIB INSERT S IMP 11 DISTAL CENT S IMP 12MM ACET INSERT S IMP 13MM CENTRAL S IMP 13MM TIBIAL INSERT S IMP 16MM ORBITAL S IMP 2 HOLE SIDEPLATE S IMP 26 FEM HEAD S IMP 28MM C-TAPER S IMP 28MM FEM HEAD S IMP 28MM FEM HEAD S IMP 3 HOLE BARREL S IMP 32 FEM HEAD S IMP 32MM FEM HEAD S IMP 32MM FEM HEAD S IMP 32MM HEAD V40 S IMP 36 FEM HEAD S IMP 36MM FEM HEAD S IMP 4 HOLE SIDE 145 S IMP 4 SLEEVE S IMP 47MM HEAD S IMP 48MM HUM HEAD S IMP 5.5 CROSSLINK S IMP 50MM ACET SHELL S IMP 54MM ACET SHELL S IMP 54MM HEAD S IMP 56 ACETAB SHELL S IMP 63 FEM COMP RT S IMP 80MM LAG S IMP 8MM TIB INSERT

589.00 230.00 11099.00 6585.00 6585.00 6462.00 8899.00 2831.00 2585.00 5825.00 7307.00 6563.00 8899.00 4996.00 3446.00 7162.00 8899.00 9173.00 2575.00 7163.00 2575.00 5133.00 2463.00 3446.00 633.00 5420.00 954.00 3354.00 3060.00 1370.00 2503.00 3673.00 2388.00 3149.00 1345.00 3148.00 2867.00 3855.00 3002.00 4389.00 4374.00 1317.00 962.00 1681.00 6047.00 4328.00 5283.00 5952.00 3582.00 5952.00 6563.00 1156.00 3287.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 138

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2320927 2350965 2350981 2350973 2351013 2370559 2374767 2340008 2374296 2370922 2391076 2360857 2348316 2348308 2348217 2348183 2348191 2348209 2348241 2348225 2343150 2348258 2348282 2348266 2348274 2349439 2348290 2347912 2349421 2348324 2352169 2348340 2348373 2348233 2348332 2347763 2347771 2347805 2347789 2347797 2343135 2343143 2360865 2358604 2358786 2358661 2358679 2344398 2370393 2371847 2391654 2391522 2390748

S IMP 9 TIBIAL INSERT S IMP ACUMED, POLARIUS RO S IMP ACUMED, SCREW CANC S IMP ACUMED, SCREW CANC S IMP ACUMED, SCREW CORT S IMP ALLGRAFT ALL SIZES S IMP ALLOGRAFT DBX PUTTY S IMP ALLOGRAFT IMPL S IMP ALLOGRAFT PUTTY DBX S IMP ALTA CAP LOCKING S IMP ANCHOR 6.5MM S IMP ANCHOR TRANSVAGINAL S IMP ANCHOR, AME 3.5 90S IMP ANCHOR, AME 4.5 90S IMP ANCHOR, CORKSCREW 3 S IMP ANCHOR, CORKSCREW 5 S IMP ANCHOR, CORKSCREW 5 S IMP ANCHOR, CORKSCREW 6 S IMP ANCHOR, FASTAK AR-1 S IMP ANCHOR, FASTAK AR-1 S IMP ANCHOR, INSERTER IN S IMP ANCHOR, MAINSTAY 2. S IMP ANCHOR, MAINSTAY 3. S IMP ANCHOR, MAINSTAY 4. S IMP ANCHOR, MAINSTAY 4. S IMP ANCHOR, OGDEN ANCHO S IMP ANCHOR, PANALOCK 3. S IMP ANCHOR, QUICK ANCHO S IMP ANCHOR, QUICK ANCHO S IMP ANCHOR, QUICK ANCHO S IMP ANCHOR, SUPER QUICK S IMP ANCHOR, SURETAC II S IMP ANCHOR, SURETAC II S IMP ANCHOR, SUTURE FAST S IMP ANCHOR, SUTURE STAT S IMP ANCHOR, SUTURE, ART S IMP ANCHOR, SUTURE, SRG S IMP ANCHOR, TISSUE TAK S IMP ANCHOR, TISSUE TAK S IMP ANCHOR, TISSUE TAK S IMP ANCHOR, TRANSVAGINA S IMP ANCHOR, TRANSVAGINA S IMP ANCHOR,PANALOCK #2 S IMP ANCHOR,QUICK ANC S IMP ANCHOR,QUICKANCH S IMP ANCHOR,SNAP-PAK S IMP ANCHOR,SNAP-PAK S IMP AQUAFLOW DEVICE S IMP ASNIS NAIL/CREWS S IMP BAR TRANSVERSE 6.0S IMP BLADE 105MM S IMP BLADE 95MM S IMP BOLT 100MM

3712.00 1883.00 447.00 447.00 447.00 3967.00 4525.00 1174.00 2969.00 1553.00 1406.00 1253.00 761.00 761.00 843.00 1187.00 843.00 919.00 457.00 919.00 670.00 579.00 579.00 608.00 494.00 761.00 658.00 940.00 914.00 964.00 773.00 967.00 490.00 634.00 566.00 894.00 967.00 860.00 1105.00 1371.00 1189.00 912.00 978.00 775.00 853.00 752.00 742.00 1590.00 1626.00 969.00 2124.00 2124.00 2124.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 139

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2390755 2351203 2351195 2351187 2349017 2348555 2391530 2349298 2370310 2373025 2373249 2391084 2374536 2391563 2391548 2391555 2391589 2391571 2372704 2376572 2374239 2375848 2367209 2367217 2370351 2371102 2391605 2373553 2379923 2371342 2371672 2390110 2320356 2373306 2372167 2340834 2391597 2377158 2371003 2370989 2369031 2369049 2342392 2342400 2342418 2367654 2353704 2353720 2353712 2343440 2343085 2390334 2391639

S IMP BOLT 110MM S IMP BOLT, LOCKING 3.9 X S IMP BOLT, LOCKING 3.9 X S IMP BOLT, LOCKING 3.9 X S IMP BONE GRAFT, ILIA S IMP BONE MATRIX, GRAFTO S IMP BONE PLUG S IMP BONE PLUGS SM-7MM:M S IMP CABLE & SLEEVE DAEL S IMP CABLE 1.0 W/CRIMP S S IMP CABLE 1M W/CRIMP DO S IMP CAGE EXPAND S IMP CALCIUM BONE FILLER S IMP CAP END 0MM S IMP CAP END 1500 S IMP CAP END 15MM NAILS S IMP CAP FIXATOR 5.0MM S IMP CAP FIXATOR 6MM S IMP CAP LOCK CLIC X 3-D S IMP CATH CODMAN NEURO V S IMP CATH INTRATHECAL ME S IMP CATH VENTRICULAR SH S IMP CATH, PERMCATH 36CM S IMP CATH, PERMCATH 40CM S IMP CEMENT SYSTEM S IMP CEMENT SYSTEM KNEE S IMP CHAN NEUROSTIM S IMP CLAMP TITA W/POST N S IMP CLAMP UNIVERSAL S IMP CLIP ANEURISM S IMP COLLAR 6.0/TRAN-CON S IMP COMPONENT TIBIAL TR S IMP CONNE ANGLED S IMP CONNECTOR PARALLEL S IMP COVER, BURR HOLE 12 S IMP DISC, SHAH DISC 8.5 S IMP DOU CAB W/CRIMP S IMP DRAIN POUCH DRAINAB S IMP DURACON FEMORAL COM S IMP DURACON TIBIAL BASE S IMP ELE PICES COMPACT L S IMP ELE PICES QUAD LEAD S IMP ELECT, MED. SINGLE S IMP ELECT, MED. SYNERGY S IMP ELECT, PLUG SYNERGY S IMP ENDO DISSECT, 5MM W S IMP EXPANDER, TISSUE SI S IMP EXPANDER, TISSUE, C S IMP EXPANDER, TISSUE, M S IMP EYE PROSTHESIS S IMP FALOPE-RING, TUBAL S IMP FEMORAL COMPONENT C S IMP FEMORAL HEAD V40

2124.00 369.00 369.00 369.00 1287.00 613.00 835.00 143.00 3534.00 1490.00 1887.00 20950.00 3515.00 708.00 922.00 816.00 40.00 40.00 1381.00 1992.00 2809.00 628.00 1126.00 901.00 6266.00 8279.00 38412.00 3108.00 2395.00 1001.00 625.00 6219.00 322.00 2042.00 1108.00 226.00 1861.00 47.00 16390.00 13936.00 3108.00 3108.00 2025.00 23187.00 381.00 628.00 2058.00 2151.00 2362.00 210.00 164.00 8899.00 2388.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 140

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2391613 2391621 2357325 2379238 2373884 2341089 2320711 2391100 2320729 2320786 2391118 2320737 2320745 2374338 2320752 2379733 2320778 2320760 2391126 2391134 2376549 2377133 2357333 2357341 2357358 2357366 2357382 2357291 2357374 2357309 2357283 2357259 2357242 2357234 2357317 2377125 2374874 2379808 2343093 2340875 2352078 2352052 2352037 2352045 2348175 2354561 2352003 2347896 2351070 2352011 2343069 2343077 2343101

S IMP FEMORAL MED S IMP FEMORAL MED/LG S IMP FILTER GREENFIELD S IMP FLO SEAL S IMP GEL, IMP 350CC S IMP GRADT, SCLERA, EYE S IMP GRAFT 10 BONE S IMP GRAFT 10 X 20 S IMP GRAFT 11 FRA S IMP GRAFT 13 SPACER S IMP GRAFT 14 X 30CM S IMP GRAFT 14 X 7 VASC S IMP GRAFT 16 X 8 VASC S IMP GRAFT 18 X 9MM HEMA S IMP GRAFT 6 SPACER S IMP GRAFT 6MM X 40CM GO S IMP GRAFT 8 SPACER S IMP GRAFT 8 X 50 VASC S IMP GRAFT CERVICAL 8L S IMP GRAFT DURAL 1 X 3 S IMP GRAFT DURAL MATRIX S IMP GRAFT DURAL MATRIX S IMP GRAFT GORTEX S IMP GRAFT GORTEX S IMP GRAFT GORTEX S IMP GRAFT GORTEX S IMP GRAFT GORTEX S IMP GRAFT GORTEX S IMP GRAFT GORTEX S IMP GRAFT GORTEX S IMP GRAFT GORTEX S IMP GRAFT GORTEX S IMP GRAFT GORTEX S IMP GRAFT GORTEX S IMP GRAFT GORTEX S IMP GRAFT INFUSE BONE G S IMP GRAFT INVASIVE INJE S IMP GRAFT MASTERGRAFT 1 S IMP GRAFT, ACELLULAR AL S IMP GRAFT, ACELLULAR TI S IMP GRAFT, ALLODERM ACE S IMP GRAFT, ALLOGRAFT 11 S IMP GRAFT, ALLOGRAFT 13 S IMP GRAFT, ALLOGRAFT 14 S IMP GRAFT, ALLOGRAFT AT S IMP GRAFT, APLIGRAF SKI S IMP GRAFT, AUTOLOGOUS C S IMP GRAFT, BONE S IMP GRAFT, CANCELLOUS B S IMP GRAFT, COLLOGRAFT S S IMP GRAFT, DURADERM 2 X S IMP GRAFT, DURADERM 2 X S IMP GRAFT, FASCIA LATA

6901.00 8387.00 2211.00 1072.00 4328.00 1636.00 5056.00 6144.00 9825.00 9825.00 2371.00 3196.00 3078.00 3079.00 4243.00 1816.00 4243.00 3551.00 4425.00 1416.00 1699.00 2795.00 1472.00 518.00 1437.00 1472.00 860.00 817.00 542.00 1126.00 1304.00 1406.00 1534.00 101.00 745.00 15674.00 5117.00 2265.00 1902.00 1790.00 670.00 1917.00 1917.00 1960.00 3743.00 1785.00 23383.00 3647.00 745.00 1699.00 954.00 954.00 1534.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 141

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2357424 2357416 2357432 2357457 2357465 2357440 2352128 2352110 2352136 2340099 2355022 2355030 2340107 2340917 2341071 2356939 2357408 2357390 2356806 2356814 2374833 2370377 2375806 2370385 2370898 2373462 2370914 2371037 2370906 2391662 2371045 2373132 2373173 2373140 2373199 2373181 2372597 2391712 2376762 2340081 2342681 2347755 2341097 2341105 2341113 2354520 2345403 2345411 2341121 2354033 2353936 2354009 2353779

S IMP GRAFT, GORTEX S IMP GRAFT, GORTEX S IMP GRAFT, GORTEX S IMP GRAFT, GORTEX S IMP GRAFT, GORTEX S IMP GRAFT, GORTEX S IMP GRAFT, INTERPORE 5B S IMP GRAFT, INTERPORE-GR S IMP GRAFT, INTERPORE-SM S IMP GRAFT, PUTTY 10CC 7 S IMP GRAFT, PUTTY ALLOMA S IMP GRAFT, PUTTY ALLOMA S IMP GRAFT, PUTTY DYNAGR S IMP GRAFT, SCLERA, EYE S IMP GRAFT, SCLERA, EYE S IMP GRAFT,ACELLULAR COL S IMP GRAFT,ARTEGRAFT COL S IMP GRAFT,ARTEGRAFT COL S IMP GRAFT,REPLIFORM 2X1 S IMP GRAFT,REPLIFORM 2X7 S IMP GREENFIELD VCF SYST S IMP GUIDE PINS S IMP GUIDEWIRE MEDIUM $ S IMP HAGIE PINS S IMP HEAD COMPONENT FEMO S IMP HEAD FOR CLICK X SC S IMP HIP BIPOLAR CENTRAX S IMP HIP DISTAL CENTRALI S IMP HIP FIXATION SYSTEM S IMP HIP STEM #7 S IMP HIP TOTAL S IMP HOOK TITA LAMI THOR S IMP HOOK TITA PEDICLE L S IMP HOOK TITA PEDICLE R S IMP HOOK TITA TRANSV PR S IMP HOOK TITA TRANSV PR S IMP HOOK, DERMA HOOK S IMP IMAL SLEEVE S IMP IMPANT INSERT TIBIA S IMP IMPL BONESOURCE 419 S IMP IMPL, ADCON L ADHES S IMP IMPL, BONE GROWTH S S IMP IMPL, CHIN LG. ANAT S IMP IMPL, CHIN MED. ANA S IMP IMPL, CHIN SM ANATO S IMP IMPL, DOW CORNING S S IMP IMPL, EYE EAGLE PLU S IMP IMPL, EYE GOLD EYEL S IMP IMPL, MALAR SHELL T S IMP IMPL, MAMM 27-16344 S IMP IMPL, MAMM 350-1450 S IMP IMPL, MAMM 350-1460 S IMP IMPL, MAMM 350-1470

599.00 1345.00 2438.00 1660.00 2133.00 2284.00 957.00 1275.00 954.00 1299.00 940.00 1113.00 1673.00 496.00 338.00 1352.00 1517.00 1364.00 1113.00 1739.00 4810.00 358.00 396.00 425.00 4842.00 2621.00 7353.00 1008.00 7285.00 8356.00 19050.00 1752.00 1822.00 1752.00 1822.00 1822.00 545.00 6585.00 3477.00 1655.00 2025.00 8025.00 422.00 639.00 639.00 990.00 110.00 757.00 919.00 1496.00 1403.00 1029.00 1403.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 142

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2353993 2353910 2353928 2353688 2353738 2353894 2353746 2353761 2353837 2353753 2353969 2353803 2353795 2353811 2353951 2353845 2353852 2353886 2353860 2353829 2353878 2353787 2353944 2354025 2354017 2353977 2353985 2353654 2353647 2353639 2353902 2341139 2341147 2354652 2341170 2345429 2345437 2341055 2341238 2354660 2342806 2342814 2354876 2354959 2354942 2354694 2354678 2354686 2354595 2354603 2354579 2354587 2354777

S IMP IMPL, MAMM 350-1480 S IMP IMPL, MAMM 350-1640 S IMP IMPL, MAMM 350-1660 S IMP IMPL, MAMM 350-1670 S IMP IMPL, MAMM 350-7200 S IMP IMPL, MAMM 350-7350 S IMP IMPL, MAMM 350-7450 S IMP IMPL, MAMM 354-1757 S IMP IMPL, MAMM 354-2007 S IMP IMPL, MAMM 354-2507 S IMP IMPL, MAMM 354-2514 S IMP IMPL, MAMM 354-2625 S IMP IMPL, MAMM 354-2670 S IMP IMPL, MAMM 354-2757 S IMP IMPL, MAMM 354-3007 S IMP IMPL, MAMM 354-4325 S IMP IMPL, MAMM 354-4350 S IMP IMPL, MAMM 354-4507 S IMP IMPL, MAMM 354-5000 S IMP IMPL, MAMM 354-5007 S IMP IMPL, MAMM 354-6000 S IMP IMPL, MAMM 354-6007 S IMP IMPL, MAMM 354-7000 S IMP IMPL, MAMM 354-7007 S IMP IMPL, MAMM 357-4507 S IMP IMPL, MAMM CONTOUR S IMP IMPL, MAMM CONTOUR S IMP IMPL, MAMM EXPANDER S IMP IMPL, MAMM EXPANDER S IMP IMPL, MAMM EXPANDER S IMP IMPL, MAMM, STYLE 6 S IMP IMPL, MAND LAT LT S IMP IMPL, MAND LAT RT S IMP IMPL, METATARSAL LA S IMP IMPL, MOON-LIPPY N0 S IMP IMPL, OCULAR 20MM S S IMP IMPL, OCULAR 22MM S S IMP IMPL, OSSICULAR AUS S IMP IMPL, OSSICULAR WIE S IMP IMPL, PHANLAGEAL, S S IMP IMPL, PROCEED S IMP IMPL, TISSELL 2ML S IMP IMPL, TOE STA-PEG A S IMP IMPL, TOE SWANSON F S IMP IMPL, TOE SWANSON F S IMP IMPL, TOE, SGARLATO S IMP IMPL, TOE, SGARLATO S IMP IMPL, TOE, SGARLATO S IMP IMPL, TOE, SM METAT S IMP IMPL, TOE, SM PHALA S IMP IMPL, TOE, SUTTER H S IMP IMPL, TOE, SUTTER H S IMP IMPL, TOE, SUTTER H

1029.00 1287.00 1029.00 1287.00 1496.00 1496.00 1496.00 1590.00 1636.00 1590.00 2223.00 1090.00 1124.00 1636.00 1754.00 1573.00 1573.00 1590.00 3401.00 1636.00 3401.00 1590.00 4458.00 1590.00 1496.00 1520.00 2151.00 2058.00 3743.00 3743.00 1287.00 533.00 533.00 2775.00 552.00 173.00 173.00 776.00 1780.00 2379.00 483.00 752.00 1207.00 1780.00 1688.00 1279.00 1279.00 1279.00 2775.00 2775.00 1412.00 1412.00 1456.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 143

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2354611 2354793 2354645 2354637 2352094 2343127 2356996 2356830 2356822 2357002 2356780 2356798 2356988 2356863 2356954 2356772 2356764 2356921 2356947 2356962 2356848 2356855 2355055 2341154 2390219 2390284 2390268 2390326 2379089 2378677 2374866 2375293 2374718 2378636 2378214 2378297 2378305 2374577 2374379 2374395 2374304 2374288 2379931 2376457 2375970 2374601 2379717 2379774 2374387 2374908 2374650 2374569 2379279

S IMP IMPL, TOE, SUTTER H S IMP IMPL, TOE, SUTTER H S IMP IMPL, TOE, SUTTER S S IMP IMPL, TOE, SUTTER S S IMP IMPL, TRANSFIX S IMP IMPL, TVT DEVICE 81 S IMP IMPL,CONTIGEN BARD S IMP IMPL,CUFF S.T. AMS S IMP IMPL,CUFF S.T.AMS 7 S IMP IMPL,DURASPHERE 030 S IMP IMPL,ENRO PROSTECES S IMP IMPL,PENILE 15CM WI S IMP IMPL,PENILE ALPHA 1 S IMP IMPL,PENILE ALPHA 1 S IMP IMPL,PENILE AMS 21C S IMP IMPL,PENILE AMS DYN S IMP IMPL,PENILE AMS MAL S IMP IMPL,PENILE RESERVO S IMP IMPL,PENILE RESERVO S IMP IMPL,PENILE RESERVO S IMP IMPL,PRESS REG BALL S IMP IMPL,PUMP SPHINCTER S IMP IMPL,TOE,PRO OSTEON S IMP IMPL. MORETZ PEG-TO S IMP IMPLANT #11 FEMORAL S IMP IMPLANT #2 HIP STEM S IMP IMPLANT #3 HIP STEM S IMP IMPLANT #4 FEMORAL S IMP IMPLANT 0MM UNIVERS S IMP IMPLANT 10MM DISTAL S IMP IMPLANT 10MM HIP ST S IMP IMPLANT 10MM TIBIAL S IMP IMPLANT 11 X 360MM S IMP IMPLANT 12MM DISTAL S IMP IMPLANT 12MM DISTAL S IMP IMPLANT 13MM DISTAL S IMP IMPLANT 13MM HIP CE S IMP IMPLANT 26MM UNIVER S IMP IMPLANT 28MM ACETAB S IMP IMPLANT 28MM ACETAB S IMP IMPLANT 28MM C-TAPE S IMP IMPLANT 28MM FEMORA S IMP IMPLANT 28MM V40 HE S IMP IMPLANT 3.5 TI ROD S IMP IMPLANT 3.5 TI ROD S IMP IMPLANT 32MM C-TAPE S IMP IMPLANT 38MM HEAD U S IMP IMPLANT 40MM HEAD C S IMP IMPLANT 46MM ACETAB S IMP IMPLANT 46MM ACETAB S IMP IMPLANT 47MM UNIVER S IMP IMPLANT 48MM UNIVER S IMP IMPLANT 4MM SLEEVE

1412.00 1412.00 1510.00 1510.00 558.00 1249.00 1642.00 3231.00 2244.00 729.00 3928.00 7248.00 7137.00 6865.00 7248.00 4320.00 3760.00 2319.00 1440.00 2319.00 2381.00 3401.00 2383.00 879.00 7163.00 8357.00 7481.00 8899.00 908.00 707.00 4996.00 5764.00 4015.00 681.00 554.00 601.00 601.00 3583.00 3258.00 3258.00 3002.00 2869.00 2402.00 1412.00 678.00 3674.00 1682.00 2099.00 3258.00 5284.00 3935.00 3583.00 1106.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 144

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2374882 2378792 2379659 2379220 2374916 2374486 2374775 2374361 2390136 2390078 2376895 2374791 2376754 2390128 2390094 2374890 2390144 2390086 2377000 2374940 2375871 2378669 2375913 2375756 2376648 2376655 2379899 2378651 2378255 2375921 2378289 2376556 2376028 2378800 2378537 2374221 2390151 2390201 2390300 2390169 2390177 2390193 2390235 2377026 2390250 2376986 2390292 2390185 2377075 2377067 2390243 2378206 2374320

S IMP IMPLANT 52MM ACETAB S IMP IMPLANT 5MM END CAP S IMP IMPLANT 6 HOLE PLAT S IMP IMPLANT 6.0 X 75MM S IMP IMPLANT 67 45 TIBIA S IMP IMPLANT 8MM TIBIAL S IMP IMPLANT ACETABULAR S IMP IMPLANT ACETABULAR S IMP IMPLANT ACETABULAR S IMP IMPLANT ACETABULAR S IMP IMPLANT ACETABULAR S IMP IMPLANT ACETABULAR S IMP IMPLANT ACETABULAR S IMP IMPLANT ACETABULAR S IMP IMPLANT ACETABULAR S IMP IMPLANT ACETABULAR S IMP IMPLANT ACETABULAR S IMP IMPLANT ACETABULAR S IMP IMPLANT ALUMINA INS S IMP IMPLANT BASEPLATE T S IMP IMPLANT BONE PLUG M S IMP IMPLANT CEMENT SPAC S IMP IMPLANT COLLAR S IMP IMPLANT COMPRESSION S IMP IMPLANT C-TAPER HEA S IMP IMPLANT C-TAPER HEA S IMP IMPLANT C-TAPER HEA S IMP IMPLANT DISTAL CENT S IMP IMPLANT DISTAL CENT S IMP IMPLANT DISTAL CENT S IMP IMPLANT DISTAL STEM S IMP IMPLANT EAR FLEX H/ S IMP IMPLANT END CAP $ S IMP IMPLANT END CAP T2 S IMP IMPLANT END CAP T2 S IMP IMPLANT EXTERNAL FI S IMP IMPLANT FEMORAL #5 S IMP IMPLANT FEMORAL COM S IMP IMPLANT FEMORAL COM S IMP IMPLANT FEMORAL COM S IMP IMPLANT FEMORAL COM S IMP IMPLANT FEMORAL COM S IMP IMPLANT FEMORAL COM S IMP IMPLANT FEMORAL COM S IMP IMPLANT FEMORAL COM S IMP IMPLANT FEMORAL COM S IMP IMPLANT FEMORAL COM S IMP IMPLANT FEMORAL COM S IMP IMPLANT FEMORAL COM S IMP IMPLANT FEMORAL COM S IMP IMPLANT FEMORAL COM S IMP IMPLANT FEMORAL END S IMP IMPLANT FEMORAL HEA

5284.00 704.00 1507.00 1062.00 5360.00 3446.00 4538.00 3258.00 5612.00 5952.00 5284.00 4369.00 3258.00 5612.00 5952.00 5284.00 7294.00 5952.00 6760.00 5518.00 627.00 707.00 675.00 248.00 2388.00 2388.00 2389.00 681.00 629.00 680.00 601.00 1846.00 704.00 704.00 667.00 2791.00 6563.00 7163.00 8387.00 6642.00 6901.00 7163.00 7307.00 6900.00 7307.00 6563.00 8387.00 6953.00 8386.00 8386.00 7307.00 546.00 3002.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 145

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2376689 2374346 2374353 2374841 2376671 2374270 2379949 2376663 2379907 2374742 2376853 2374635 2390318 2377091 2379915 2376887 2374858 2377059 2376903 2377117 2376911 2377042 2376994 2377109 2374684 2376879 2390359 2377034 2390342 2379451 2374924 2390276 2375335 2374809 2376564 2379758 2379766 2376176 2376846 2374189 2374197 2390102 2374817 2374734 2374593 2374700 2376838 2375798 2376481 2390227 2379956 2376713 2376697

S IMP IMPLANT FEMORAL HEA S IMP IMPLANT FEMORAL HEA S IMP IMPLANT FEMORAL HEA S IMP IMPLANT FEMORAL HEA S IMP IMPLANT FEMORAL HEA S IMP IMPLANT FEMORAL HEA S IMP IMPLANT FEMORAL HEA S IMP IMPLANT FEMORAL HEA S IMP IMPLANT FEMORAL HEA S IMP IMPLANT FEMORAL NAI S IMP IMPLANT FEMORAL NAI S IMP IMPLANT FEMORAL NAI S IMP IMPLANT FEMORAL RIG S IMP IMPLANT FEMORAL STE S IMP IMPLANT HEAD V40 28 S IMP IMPLANT HEAD V40 32 S IMP IMPLANT HIP STEM #1 S IMP IMPLANT HIP STEM #1 S IMP IMPLANT HIP STEM #2 S IMP IMPLANT HIP STEM #3 S IMP IMPLANT HIP STEM #3 S IMP IMPLANT HIP STEM #4 S IMP IMPLANT HIP STEM #4 S IMP IMPLANT HIP STEM #4 S IMP IMPLANT HIP STEM #5 S IMP IMPLANT HIP STEM 13 S IMP IMPLANT HIP STEM 6X S IMP IMPLANT HIP STEM CE S IMP IMPLANT HIP STEM HO S IMP IMPLANT HOLE ELIMAN S IMP IMPLANT HUMERAL HEA S IMP IMPLANT HUMERAL STE S IMP IMPLANT INSERT 28MM S IMP IMPLANT INSERT 32MM S IMP IMPLANT LAG SCREW 9 S IMP IMPLANT LAMINA HOOK S IMP IMPLANT LAMINA HOOK S IMP IMPLANT LEIBINGER B S IMP IMPLANT LOW PROFILE S IMP IMPLANT MAMMARY 350 S IMP IMPLANT MAMMARY 350 S IMP IMPLANT NAIL 11 X 3 S IMP IMPLANT NAIL 12 X 3 S IMP IMPLANT NAIL 13 X 3 S IMP IMPLANT NAIL TIBIAL S IMP IMPLANT NAIL TIBIAL S IMP IMPLANT NAIL TIBIAL S IMP IMPLANT NUT 11MM S IMP IMPLANT OMEGA KEYLE S IMP IMPLANT ORTHOBIOLOG S IMP IMPLANT PATELLA S IMP IMPLANT PATELLA 11M S IMP IMPLANT PATELLA 3-P

2388.00 3105.00 3105.00 4854.00 2388.00 2869.00 2440.00 2388.00 2389.00 4015.00 4215.00 3833.00 8538.00 11098.00 2389.00 5132.00 4996.00 8357.00 5332.00 12008.00 5332.00 8357.00 6707.00 12008.00 3938.00 5132.00 12123.00 8357.00 12009.00 1224.00 5440.00 8214.00 5845.00 4435.00 1883.00 1944.00 1944.00 901.00 4056.00 2605.00 2605.00 5987.00 4551.00 4015.00 3651.00 4015.00 4015.00 345.00 1385.00 7291.00 2571.00 2835.00 2570.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 146

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2374254 2374171 2390045 2379964 2376721 2379980 2376705 2378222 2378164 2376184 2376473 2377018 2376739 2376978 2379832 2375947 2379600 2376440 2378644 2376432 2376424 2378529 2378511 2369114 2369130 2390367 2376820 2376531 2376523 2374932 2376937 2374957 2376952 2376929 2376945 2374585 2376770 2374494 2374403 2374510 2374502 2374437 2390052 2374726 2374478 2374692 2374981 2374999 2377083 2374973 2390060 2374965 2376960

S IMP IMPLANT PATELLA 9MM S IMP IMPLANT PATELLA ALL S IMP IMPLANT PATELLA DOM S IMP IMPLANT PATELLA DOM S IMP IMPLANT PATELLA S 1 S IMP IMPLANT PATELLA STA S IMP IMPLANT PATELLAR CO S IMP IMPLANT PIN SCHANZ S IMP IMPLANT PIN SCHANZ S IMP IMPLANT PLATE LEIBI S IMP IMPLANT PLATE OMEGA S IMP IMPLANT PLIF SPACER S IMP IMPLANT PRESS FIT S S IMP IMPLANT PROXIMAL SL S IMP IMPLANT RADIANCE IN S IMP IMPLANT ROD 50MM $ S IMP IMPLANT SHEET MEDPO S IMP IMPLANT SIDEPLATE 1 S IMP IMPLANT SPACER CEME S IMP IMPLANT STD BARREL S IMP IMPLANT STD SIDEPLA S IMP IMPLANT STEM CENTRA S IMP IMPLANT STEM CENTRA S IMP IMPLANT SUBTALAR 8M S IMP IMPLANT SUBTALAR M S IMP IMPLANT SYNCHROMED S IMP IMPLANT T2 TIBIAL N S IMP IMPLANT TI TRANSCON S IMP IMPLANT TI TRANSCON S IMP IMPLANT TIBIAL BASE S IMP IMPLANT TIBIAL BASE S IMP IMPLANT TIBIAL BASE S IMP IMPLANT TIBIAL BASE S IMP IMPLANT TIBIAL BASE S IMP IMPLANT TIBIAL BASE S IMP IMPLANT TIBIAL BEAR S IMP IMPLANT TIBIAL INSE S IMP IMPLANT TIBIAL INSE S IMP IMPLANT TIBIAL INSE S IMP IMPLANT TIBIAL INSE S IMP IMPLANT TIBIAL INSE S IMP IMPLANT TIBIAL INSE S IMP IMPLANT TIBIAL KEEL S IMP IMPLANT TIBIAL NAIL S IMP IMPLANT TIBIAL NAIL S IMP IMPLANT TIBIAL NAIL S IMP IMPLANT TIBIAL TRAY S IMP IMPLANT TIBIAL TRAY S IMP IMPLANT TIBIAL TRAY S IMP IMPLANT TIBIAL TRAY S IMP IMPLANT TIBIAL TRAY S IMP IMPLANT TIBIAL TRAY S IMP IMPLANT TIBIAL TRAY

2836.00 2590.00 2576.00 2571.00 2835.00 2576.00 2575.00 556.00 479.00 901.00 1385.00 6851.00 3072.00 6586.00 2376.00 703.00 1365.00 1395.00 681.00 1395.00 1395.00 661.00 661.00 2078.00 2078.00 30009.00 4015.00 1694.00 1694.00 5518.00 5517.00 5518.00 5517.00 5517.00 5517.00 3630.00 3477.00 3478.00 3287.00 3478.00 3478.00 3330.00 5865.00 4015.00 3425.00 4015.00 5524.00 5524.00 8596.00 5524.00 5865.00 5524.00 5523.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 147

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2374619 2375962 2374544 2374676 2376804 2374668 2374551 2376796 2376788 2375954 2374312 2378263 2378545 2379691 2379816 2369247 2373868 2373850 2373819 2373835 2373827 2369213 2373454 2371011 2379188 2343457 2320943 2391761 2351732 2356905 2356913 2370997 2358646 2358653 2391779 2391787 2391795 2391092 2375376 2391670 2342699 2342756 2342749 2342707 2340891 2340883 2340909 2340867 2340859 2320935 2369205 2351047 2351062

S IMP IMPLANT TRANSCONNEC S IMP IMPLANT UNIVERSAL D S IMP IMPLANT UNIVERSAL H S IMP IMPLANT UNIVERSAL H S IMP IMPLANT UNIVERSAL H S IMP IMPLANT UNIVERSAL H S IMP IMPLANT UNIVERSAL H S IMP IMPLANT UNIVERSAL H S IMP IMPLANT UNIVERSAL H S IMP IMPLANT UNIVERSAL S S IMP IMPLANT V40 L FIT H S IMP IMPLANT WASHER SPIK S IMP IMPLANT WASHER THRE S IMP IMPLANT ZIMMER BIPO S IMP IMPLANT ZIMMER BIPO S IMP IMPLANT, BONE PRO O S IMP IMPLANT, CMF HEX-FI S IMP IMPLANT, CMF HEX-FI S IMP IMPLANT, CMF SQU-FI S IMP IMPLANT, CMF SQU-FI S IMP IMPLANT, CMF SQU-FI S IMP IMPLANT, MAMMARY S IMP IMPLANT, TOE LTIP30 S IMP INSERT ACETABULAR S IMP IOL ALCON MA60AC 24 S IMP JARDON 22MM S IMP KIT CRANIOPLASTY S IMP KIT RESOR BEAD S IMP KIT, BONE MULCH S IMP KIT,ACESSORY FOR S IMP KIT,ASSEMBLY PEN S IMP KNEE DRACON TIBIAL S IMP KUGEL HERNIA PATCH S IMP KUGEL HERNIA PATCH S IMP K-WIRE 1.25 X 150MM S IMP K-WIRE 1.25MM S IMP K-WIRE 1.5 X 5MM S IMP LEAD PISCES QUAD S IMP LEIBINGER CROSS FIT S IMP LG NAIL 11X320X135 S IMP MARLEX MESH S IMP MARLEX MESH, 1" X 4 S IMP MARLEX MESH, 10" X S IMP MARLEX MESH, 2" X 1 S IMP MCGEE LOOP PISTON, S IMP MCGEE LOOP PISTON, S IMP MCGEE LOOP PISTON, S IMP MCGEE LOOP PISTON, S IMP MCGEE LOOP PISTON, S IMP MED FEM COMP RT S IMP MENISCAL DART ARTHR S IMP MENISCAL, DART A S IMP MENISCAL, DART A

3765.00 706.00 3583.00 3935.00 3934.00 3935.00 3583.00 3934.00 3934.00 706.00 3002.00 638.00 673.00 1588.00 2546.00 1885.00 4220.00 4220.00 3879.00 3879.00 3879.00 1855.00 2546.00 5125.00 1007.00 138.00 2656.00 2540.00 1636.00 1842.00 1145.00 6078.00 815.00 979.00 78.00 92.00 765.00 2809.00 67.00 4829.00 94.00 388.00 940.00 518.00 258.00 258.00 258.00 258.00 330.00 7355.00 1269.00 1021.00 1021.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 148

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2351054 2351039 2351716 2351690 2351708 2351724 2377851 2391803 2320976 2391811 2369197 2391829 2320984 2376861 2342962 2342830 2342723 2342715 2343044 2343051 2342764 2342848 2342855 2342863 2342871 2342889 2342772 2342905 2342939 2342921 2342913 2369171 2342731 2342970 2343002 2342988 2342954 2342996 2343010 2342780 2342798 2342897 2369189 2343028 2343036 2374429 2374445 2391837 2374627 2391647 2391845 2391852 2374460

S IMP MENISCAL, DART A S IMP MENISCAL, DART C S IMP MENISCUS ARROW, S IMP MENISCUS ARROW, S IMP MENISCUS ARROW, S IMP MENISCUS ARROW, S IMP MESH 3 X 6 PROLENE S IMP MESH 6 X 6.010 S IMP MESH 60 X 60 X 1 S IMP MESH 8 X 12CM SM S IMP MESH MARLES PERFIX S IMP MESH MED OVAL S IMP MESH PATCH LG S IMP MESH SURGISIS GOLD S IMP MESH, A SOR A LE SE S IMP MESH, ATRIUM 3 X 7. S IMP MESH, BARD 1 X 4 01 S IMP MESH, BARD 10 X 14 S IMP MESH, BARD 2 X 4 01 S IMP MESH, BARD 3 X 6 01 S IMP MESH, BARD 3 X 6 01 S IMP MESH, BARD 3DMAX, L S IMP MESH, BARD 3DMAX, R S IMP MESH, BARD 4 X 8 01 S IMP MESH, BARD 6 X 6 01 S IMP MESH, BARD 6 X 8 01 S IMP MESH, COMPOSIX 8 X S IMP MESH, DUALMESH ANTI S IMP MESH, DUALMESH ANTI S IMP MESH, DUALMESH ANTI S IMP MESH, DUALMESH ANTI S IMP MESH, DUALMESH ANTI S IMP MESH, MARLEX 2 X 12 S IMP MESH, MARLEX KEYHOL S IMP MESH, MARLEX PERFIX S IMP MESH, MARLEX PERFIX S IMP MESH, MARLEX PERFIX S IMP MESH, MARLEX PERFIX S IMP MESH, ORIGIN 3 X 6/ S IMP MESH, PROLENE 6" X S IMP MESH, PROLENE MED. S IMP MESH, SCREEN, 1.3, S IMP MESH, SURGIPRO S IMP MESH, SURGIPRO 14"X S IMP MESH, SURGIPRO 3*5" S IMP NAIL 10 X 32CM TIBI S IMP NAIL 10 X 34CM TIBI S IMP NAIL 10 X 380MM FEM S IMP NAIL 10 X 420MM T2 S IMP NAIL 10MM X 130 S IMP NAIL 11 X 330MM TIB S IMP NAIL 11 X 340MM FEM S IMP NAIL 11 X 34MM TIBI

1021.00 211.00 562.00 562.00 562.00 562.00 314.00 1462.00 1905.00 2672.00 660.00 3824.00 4399.00 4449.00 639.00 436.00 204.00 781.00 476.00 505.00 1066.00 569.00 569.00 1492.00 337.00 1269.00 1871.00 1560.00 1282.00 1937.00 2918.00 1560.00 345.00 553.00 678.00 660.00 660.00 660.00 356.00 272.00 812.00 2505.00 382.00 382.00 211.00 3328.00 3425.00 4215.00 3833.00 5137.00 3651.00 4215.00 3425.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 149

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2391860 2374247 2391886 2391878 2391894 2320992 2374411 2321008 2374759 2391902 2391910 2391928 2392124 2392132 2391936 2391944 2391951 2391969 2374825 2392140 2392157 2391977 2391985 2373892 2373900 2373918 2376812 2392173 2392181 2374452 2392199 2392165 2391993 2392009 2392017 2392025 2392033 2392041 2392058 2392066 2392074 2392082 2392090 2392108 2392116 2391688 2340131 2340156 2370500 2379972 2392272 2377778 2392207

S IMP NAIL 11 X 380MM FEM S IMP NAIL 11 X 38CM FEMO S IMP NAIL 11 X 400MM S IMP NAIL 11 X 400MM FEM S IMP NAIL 11 X 420MM FEM S IMP NAIL 12 X 380 FEM S IMP NAIL 12 X 38CM FEMO S IMP NAIL 12 X 40 FEM S IMP NAIL 12 X 400MM FEM S IMP NAIL 12 X 420MM FEM S IMP NAIL 13 X 400MM FEM S IMP NAIL 13 X 42CM FEM S IMP NAIL 7.5MMX225MM S IMP NAIL 7.5MMX240MM S IMP NAIL 9 X 315MM TIB S IMP NAIL 9 X 330MM TIB S IMP NAIL 9 X 345MM TIB S IMP NAIL 9 X 34CM TIB S IMP NAIL 9 X 380MM FEMO S IMP NAIL 9MMX240MM S IMP NAIL 9MMX255MM S IMP NAIL FEM 10X340MM S IMP NAIL FEM 10X380MM S IMP NAIL RETRO 9MMX14CM S IMP NAIL RETRO 9MMX16CM S IMP NAIL RETRO 9MMX18CM S IMP NAIL T2 TIBIAL 9 X S IMP NAIL TIB 11X345MM S IMP NAIL TIB 11X360MM S IMP NAIL TIBIAL NAIL 9 S IMP NAIL TROC S IMP NAIL TROC S IMP NAIL TROC 10X235MM S IMP NAIL TROC 10X300MM S IMP NAIL TROC 10X320MM S IMP NAIL TROC 10X400MM S IMP NAIL TROC 10X420MM S IMP NAIL TROC 11X340MM S IMP NAIL TROC 11X360MM S IMP NAIL TROC 12X360MM S IMP NAIL TROC 12X380MM S IMP NAIL TROC 12X400MM S IMP NAIL TROC 12X420MM S IMP NAIL TROC 12X440MM S IMP NAIL TROC 12X460MM S IMP NAIL TROCH S IMP PALTE, LEIB 54-0515 S IMP PALTE, LEIB 54-0628 S IMP PATELLA COMP PLASTI S IMP PATELLA OVAL DOME 3 S IMP PIN 1.8X18MM S IMP PIN 2.8 X 230MM THR S IMP PIN 2.8 X 450MM

4015.00 2809.00 5987.00 3833.00 4215.00 4579.00 3293.00 3293.00 4216.00 4773.00 4773.00 3200.00 6710.00 8755.00 4551.00 3651.00 4551.00 3328.00 4773.00 6439.00 6439.00 3736.00 3736.00 4400.00 4400.00 4400.00 4015.00 3840.00 3840.00 3425.00 5137.00 5137.00 4426.00 5274.00 5274.00 5274.00 5274.00 5274.00 5274.00 5274.00 5274.00 5274.00 5274.00 5274.00 5274.00 4310.00 400.00 415.00 5633.00 2571.00 356.00 260.00 425.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 150

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2321024 2392215 2392223 2392249 2392231 2392256 2392280 2392264 2392298 2370401 2392306 2375822 2377208 2392322 2392314 2370419 2392330 2392348 2392355 2392363 2375731 2390763 2351237 2351252 2370609 2340842 2343465 2343473 2370971 2393411 2393155 2393536 2392371 2393163 2393171 2392405 2392397 2392413 2392389 2371649 2371573 2371581 2371631 2371599 2378909 2378917 2371607 2371615 2371623 2321032 2378958 2392694 2392439

S IMP PIN 4 X 120 S IMP PIN 4.5MMX180MM S IMP PIN 5 X 120MM S IMP PIN 5 X 150MM S IMP PIN 5 X 150MM S IMP PIN 5 X 180MM S IMP PIN 5 X 225MM S IMP PIN 5 X 250MM S IMP PIN DISTRA 14MM S IMP PIN K WIRES S IMP PIN K-WIRE 1.6MM S IMP PIN K-WIRE 1.6MM $ S IMP PIN K-WIRE 2.0 X 15 S IMP PIN STEIN 4.5MM S IMP PIN STEIN 5.0MM S IMP PIN STEINMAN S IMP PIN STNMN 4.5MM S IMP PIN STNMN 5MM S IMP PIN STNMN 5MM S IMP PIN STNMN 5MM S IMP PIN THREADED TIP GU S IMP PIN TO ROD CONN S IMP PIN, ORTHOSORB A S IMP PIN, ORTHO-SORB, S IMP PIN/SCREW ORTHO FIX S IMP PISTON, MCGEE, MOD S IMP P-K FLAT HEADED PED S IMP P-K THREADED SLEVE S IMP PLASTE COMPRESSION S IMP PLATE S IMP PLATE 1.0MM 6-H S IMP PLATE 1.3MM 3X4-H S IMP PLATE 1.5MM CONDO S IMP PLATE 1.5MM LFT S IMP PLATE 1.5MM RT S IMP PLATE 1/3 TUB 3-H S IMP PLATE 1/3 TUB 3-H S IMP PLATE 1/3 TUB 4-H S IMP PLATE 1/3 TUB 9-H S IMP PLATE 1/3 TUBULAR 1 S IMP PLATE 1/3 TUBULAR 2 S IMP PLATE 1/3 TUBULAR 3 S IMP PLATE 1/3 TUBULAR 4 S IMP PLATE 1/3 TUBULAR 5 S IMP PLATE 1/3 TUBULAR 5 S IMP PLATE 1/3 TUBULAR 6 S IMP PLATE 1/3 TUBULAR 6 S IMP PLATE 1/3 TUBULAR 7 S IMP PLATE 1/3 TUBULAR 8 S IMP PLATE 10 HOLE S IMP PLATE 10 HOLE 3.5 L S IMP PLATE 10-H S IMP PLATE 10-H MED

558.00 631.00 565.00 574.00 625.00 625.00 631.00 717.00 601.00 156.00 78.00 591.00 78.00 631.00 631.00 146.00 631.00 631.00 631.00 631.00 232.00 2411.00 537.00 476.00 1403.00 258.00 173.00 417.00 3267.00 2528.00 903.00 922.00 1260.00 1030.00 1030.00 327.00 716.00 778.00 834.00 442.00 202.00 255.00 140.00 274.00 778.00 778.00 193.00 420.00 420.00 4336.00 835.00 1900.00 4334.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 151

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2392447 2392421 2392470 2392462 2392496 2392488 2392454 2379626 2379048 2392702 2321040 2392504 2392512 2393114 2393106 2393098 2393122 2391720 2392520 2392538 2392546 2393130 2393148 2392728 2392710 2392744 2392736 2379790 2379527 2392553 2392579 2393031 2392587 2393189 2392603 2392595 2321057 2379501 2392611 2393668 2393676 2393684 2393692 2393437 2393445 2393452 2393544 2392645 2392660 2392678 2392652 2321123 2321073

S IMP PLATE 10-H TIB S IMP PLATE 10-H TIB S IMP PLATE 12 H S IMP PLATE 12 H S IMP PLATE 12 H S IMP PLATE 12 H S IMP PLATE 12 HOLE S IMP PLATE 12 HOLE 3.5 L S IMP PLATE 12 HOLE NARRO S IMP PLATE 12-H S IMP PLATE 12MM MESH S IMP PLATE 13 H S IMP PLATE 13 H S IMP PLATE 135 DEG 2-H S IMP PLATE 135 DEG 2-H S IMP PLATE 135 DEG 2-H S IMP PLATE 135 DEG 3-H S IMP PLATE 135/3 HOLE S IMP PLATE 14 H S IMP PLATE 14 H S IMP PLATE 14 H S IMP PLATE 140 4-H S IMP PLATE 145 DEG 6-H S IMP PLATE 14-H S IMP PLATE 14-H S IMP PLATE 16-H S IMP PLATE 16-H S IMP PLATE 2 HOLE PLATE S IMP PLATE 2 HOLE SIDEPL S IMP PLATE 2 X 2 H S IMP PLATE 2.0MM Y S IMP PLATE 20 HOLE S IMP PLATE 24 H S IMP PLATE 2MM 2X3-H S IMP PLATE 3 H "T" S IMP PLATE 3 H T S IMP PLATE 3 HOLE S IMP PLATE 3 HOLE "T" PL S IMP PLATE 3 X 2 H L S IMP PLATE 3.5MM 10-H S IMP PLATE 3.5MM 11-H S IMP PLATE 3.5MM 12-H S IMP PLATE 3.5MM 9-H S IMP PLATE 3.5X137 10-H S IMP PLATE 3.5X150 11-H S IMP PLATE 3.5X98 7-H S IMP PLATE 3X3-H LFT S IMP PLATE 4 H S IMP PLATE 4 H S IMP PLATE 4 H S IMP PLATE 4 H T S IMP PLATE 4 HOLE S IMP PLATE 4 HOLE

3258.00 4443.00 4409.00 1074.00 4264.00 4492.00 866.00 1473.00 885.00 4648.00 2402.00 4749.00 4749.00 1740.00 1739.00 1739.00 1740.00 1694.00 4543.00 4947.00 4482.00 1739.00 1739.00 4307.00 4307.00 2655.00 3102.00 2245.00 1395.00 758.00 1125.00 1405.00 4204.00 935.00 1521.00 1345.00 1410.00 1346.00 798.00 2036.00 2138.00 2216.00 2011.00 1331.00 1385.00 1409.00 922.00 6032.00 1193.00 344.00 1454.00 809.00 1163.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 152

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2321115 2321107 2321099 2321065 2321081 2374213 2392629 2392637 2379493 2379519 2392686 2392751 2392769 2392785 2392777 2393320 2393247 2393254 2393338 2393262 2393270 2393346 2393288 2393353 2393296 2393361 2393304 2393312 2393379 2393072 2393213 2393221 2393700 2392819 2393080 2393387 2392827 2379592 2392793 2392801 2379139 2392850 2392843 2392876 2392835 2392868 2392561 2321131 2321149 2379576 2379725 2379212 2374205

S IMP PLATE 4 HOLE S IMP PLATE 4 HOLE S IMP PLATE 4 HOLE S IMP PLATE 4 HOLE S IMP PLATE 4 HOLE S IMP PLATE 4 HOLE S IMP PLATE 4 HOLE S IMP PLATE 4 HOLE S IMP PLATE 4 HOLE MAXILL S IMP PLATE 4 HOLE MODULA S IMP PLATE 4 X 2 H SQ S IMP PLATE 4.5MM 6-H S IMP PLATE 4.5MM 6-H S IMP PLATE 4.5MM 9-H S IMP PLATE 4.5MM 9-H S IMP PLATE 4.5MMX10-H S IMP PLATE 4.5MMX10-H S IMP PLATE 4.5MMX11-H S IMP PLATE 4.5MMX11-H S IMP PLATE 4.5MMX12-H S IMP PLATE 4.5MMX14-H S IMP PLATE 4.5MMX5-H S IMP PLATE 4.5MMX6-H S IMP PLATE 4.5MMX6-H S IMP PLATE 4.5MMX7-H S IMP PLATE 4.5MMX7-H S IMP PLATE 4.5MMX8-H S IMP PLATE 4.5MMX9-H S IMP PLATE 4.5MMX9-H S IMP PLATE 4H 2.0MM S IMP PLATE 4-H LFT TIB S IMP PLATE 4-H RT TIB S IMP PLATE 4-HHEAD 3-H S IMP PLATE 5 H S IMP PLATE 5 H 94MM S IMP PLATE 5 H X 156MM S IMP PLATE 5 HOLE S IMP PLATE 5 HOLE 135 DE S IMP PLATE 5 HOLE 3.5 S IMP PLATE 5 HOLE 3.5 S IMP PLATE 5 X 4 HOLES L S IMP PLATE 6 H S IMP PLATE 6 H S IMP PLATE 6 H S IMP PLATE 6 H S IMP PLATE 6 H "Y" S IMP PLATE 6 HO S IMP PLATE 6 HOLE S IMP PLATE 6 HOLE S IMP PLATE 6 HOLE 2.4MM S IMP PLATE 6 HOLE LCP S IMP PLATE 6 HOLE MINI S IMP PLATE 6 HOLE PERIAR

809.00 809.00 809.00 809.00 809.00 2687.00 1810.00 1009.00 1322.00 1352.00 1329.00 1482.00 1381.00 1754.00 2070.00 884.00 1125.00 1149.00 884.00 1118.00 1118.00 638.00 903.00 723.00 903.00 723.00 1125.00 1125.00 723.00 1030.00 1304.00 1304.00 1345.00 4498.00 1739.00 3942.00 358.00 1317.00 1628.00 1270.00 940.00 4346.00 1458.00 4252.00 853.00 855.00 1351.00 942.00 1079.00 1515.00 1803.00 1030.00 2673.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 153

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2392892 2392900 2393056 2392884 2378933 2392975 2392983 2392959 2392942 2392934 2392926 2392918 2392967 2378941 2379550 2379204 2392991 2393064 2393007 2393023 2393015 2379584 2379303 2393619 2393429 2393049 2371094 2393197 2393205 2371326 2370286 2375830 2376242 2393403 2393395 2376259 2393460 2393478 2321156 2370468 2393601 2375988 2375996 2375939 2376747 2393551 2393569 2393577 2393585 2393593 2376325 2393239 2371664

S IMP PLATE 7 H S IMP PLATE 7 HOLE S IMP PLATE 7 HOLE S IMP PLATE 7 HOLE S IMP PLATE 7 HOLE 1/3 TU S IMP PLATE 8 H S IMP PLATE 8 H S IMP PLATE 8 H S IMP PLATE 8 H S IMP PLATE 8 H S IMP PLATE 8 HOLE S IMP PLATE 8 HOLE S IMP PLATE 8 HOLE S IMP PLATE 8 HOLE 1/3 L S IMP PLATE 8 HOLE 3.5 LC S IMP PLATE 8 HOLE MODULA S IMP PLATE 8 HOLES S IMP PLATE 8-HS S IMP PLATE 9 HOLE S IMP PLATE 9 HOLE S IMP PLATE 9 HOLE S IMP PLATE 9 HOLE 3.5 LC S IMP PLATE 9 HOLE MODULA S IMP PLATE ADLT 85MM S IMP PLATE CAL S IMP PLATE CAL S IMP PLATE DHS S IMP PLATE L 2MM 3X4-H S IMP PLATE L 2MM 4X6-H S IMP PLATE LARGE ASIF S IMP PLATE LARGE ASIF BU S IMP PLATE LEIBINGER 2 H S IMP PLATE LEIBINGER I-S S IMP PLATE L-MINI OBL S IMP PLATE L-MINI OBL S IMP PLATE L-SHAPE BAR 1 S IMP PLATE L-SM OBL S IMP PLATE L-SM OBL S IMP PLATE MESH 100X100 S IMP PLATE MIN ASIF S IMP PLATE ORBI 9H S IMP PLATE OSTEOMED 15MM S IMP PLATE OSTEOMED 22MM S IMP PLATE OSTEOMED DOUB S IMP PLATE PROXIMAL TIBI S IMP PLATE RT 3-H S IMP PLATE RT 4-H S IMP PLATE RT 5-H S IMP PLATE RT 7-H S IMP PLATE RT 8-H S IMP PLATE SKULL FLAP 6 S IMP PLATE SM 14HOL S IMP PLATE STR 2 HOLE 1.

1654.00 1125.00 1211.00 1976.00 835.00 4488.00 1320.00 3473.00 2058.00 1320.00 703.00 1739.00 4789.00 835.00 1480.00 1030.00 4789.00 1381.00 3942.00 3942.00 3942.00 1538.00 1125.00 1978.00 2528.00 1730.00 3043.00 985.00 1093.00 1476.00 1922.00 607.00 940.00 319.00 319.00 947.00 319.00 319.00 5833.00 370.00 922.00 678.00 678.00 689.00 3132.00 1531.00 1356.00 1405.00 1526.00 1603.00 1000.00 1415.00 624.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 154

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2371656 2393726 2379782 2393759 2393767 2393742 2393783 2393775 2393791 2393809 2393817 2393825 2393833 2393841 2393858 2393866 2393874 2393882 2393890 2393908 2393916 2393924 2393932 2393940 2393494 2393502 2393973 2393981 2393627 2393957 2393999 2394005 2393510 2393528 2393965 2393486 2394021 2394013 2394039 2394047 2394054 2393635 2393643 2393650 2393734 2394062 2394070 2394088 2394096 2394104 2394112 2394120 2372076

S IMP PLATE STR 4 HOLE 1. S IMP PLATE STUB 6H S IMP PLATE SYNTH 14 HOLE S IMP PLATE T 1.5MM 3-H S IMP PLATE T 1.5MM 4-H S IMP PLATE T 3X4-H S IMP PLATE T 4 SHAFT S IMP PLATE T 4H 84 S IMP PLATE T 5 SHAFT S IMP PLATE T 6 SHAFT S IMP PLATE T 7 SHAFT S IMP PLATE T 8 SHAFT S IMP PLATE T RT 3-H4-H S IMP PLATE T RT 3-H5-H S IMP PLATE T RT 3-H6-H S IMP PLATE T RT 3-H7-H S IMP PLATE T RT 3-H8-H S IMP PLATE T RT 4-H5-H S IMP PLATE T RT 4-H7-H S IMP PLATE T RT 4-H8-H S IMP PLATE T TIB 6-H S IMP PLATE T TIB 8-H S IMP PLATE TI 2.4 STR S IMP PLATE TI 2.4 STR S IMP PLATE TIB 10-H LFT S IMP PLATE TIB 12-H LFT S IMP PLATE TIB 13-H LFT S IMP PLATE TIB 13-H RT S IMP PLATE TIB 4.5MM 4 S IMP PLATE TIB 4-H S IMP PLATE TIB 5-H LFT S IMP PLATE TIB 5-H RT S IMP PLATE TIB 6-H LFT S IMP PLATE TIB 6-H RT S IMP PLATE TIB 8-H S IMP PLATE TIB 8HOLE RT S IMP PLATE TIB 9 H S IMP PLATE TIBIAL S IMP PLATE T-MIN 2-H S IMP PLATE T-SM 3-H S IMP PLATE TUB 3-H 23M S IMP PLATE TUB 4H 33MM S IMP PLATE TUB 5H 41MM S IMP PLATE TUB 6H 49MM S IMP PLATE TUB 7H S IMP PLATE TUB 7-H 55M S IMP PLATE TUB 8-H 63MM S IMP PLATE WRIST FUSION S IMP PLATE X 1.0MM TI 5S IMP PLATE X 2.0MM TI 4S IMP PLATE Y 1.3MM TI 1X S IMP PLATE Y 1.5MM S IMP PLATE, "X" 1.5MMX4

466.00 363.00 2178.00 985.00 1030.00 922.00 1356.00 1055.00 1405.00 1458.00 1526.00 1603.00 1398.00 1537.00 1507.00 1875.00 2167.00 1537.00 1875.00 2167.00 1147.00 1342.00 1124.00 1158.00 4653.00 4699.00 4749.00 4749.00 4465.00 4465.00 4749.00 4749.00 4563.00 4563.00 4570.00 2026.00 4749.00 4757.00 319.00 319.00 340.00 365.00 387.00 427.00 391.00 447.00 478.00 3037.00 866.00 903.00 872.00 985.00 1025.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 155

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2352243 2352250 2352268 2373215 2373058 2372605 2373165 2352342 2373595 2373603 2373686 2373694 2373512 2373504 2373090 2373280 2352276 2352284 2352300 2373363 2373272 2373447 2373314 2373157 2351286 2373934 2373652 2373660 2373959 2373579 2373942 2373520 2373926 2373561 2373975 2373678 2373967 2373629 2373983 2373587 2373991 2373546 2373538 2373611 2373744 2374031 2374023 2373793 2374015 2373769 2373637 2373751 2374007

S IMP PLATE, 1/3 TUB 4H S IMP PLATE, 1/3 TUB 5H S IMP PLATE, 1/3 TUB 6H S IMP PLATE, ADAPTION 100 S IMP PLATE, ADAPTION 193 S IMP PLATE, ADAPTION 90X S IMP PLATE, ADAPTION 95X S IMP PLATE, AN SM 3H 245 S IMP PLATE, ANG 4X11HO 2 S IMP PLATE, ANG 4X11HO 2 S IMP PLATE, ANG 4X14HO 2 S IMP PLATE, ANG 4X14HO 2 S IMP PLATE, ANG 4X8HO 2. S IMP PLATE, ANG 4X8HO 2. S IMP PLATE, ANGLED 6HO 2 S IMP PLATE, ANGLED 6HO 2 S IMP PLATE, AO, 3 HOLE S IMP PLATE, AO, 4 HOLE S IMP PLATE, BONE 7-HOLE, S IMP PLATE, BUTTR 158M, S IMP PLATE, BUTTR 158M, S IMP PLATE, BUTTR 190M, S IMP PLATE, BUTTR 190M, S IMP PLATE, C SYMPHSIS 4 S IMP PLATE, CALCANEAL 70 S IMP PLATE, CERVI TITA 2 S IMP PLATE, CERVI TITA 2 S IMP PLATE, CERVI TITA 2 S IMP PLATE, CERVI TITA 2 S IMP PLATE, CERVI TITA 2 S IMP PLATE, CERVI TITA 2 S IMP PLATE, CERVI TITA 2 S IMP PLATE, CERVI TITA 2 S IMP PLATE, CERVI TITA 2 S IMP PLATE, CERVI TITA 3 S IMP PLATE, CERVI TITA 3 S IMP PLATE, CERVI TITA 3 S IMP PLATE, CERVI TITA 3 S IMP PLATE, CERVI TITA 3 S IMP PLATE, CERVI TITA 3 S IMP PLATE, CERVI TITA 3 S IMP PLATE, CERVI TITA 3 S IMP PLATE, CERVI TITA 3 S IMP PLATE, CERVI TITA 3 S IMP PLATE, CERVI TITA 4 S IMP PLATE, CERVI TITA 4 S IMP PLATE, CERVI TITA 4 S IMP PLATE, CERVI TITA 4 S IMP PLATE, CERVI TITA 4 S IMP PLATE, CERVI TITA 4 S IMP PLATE, CERVI TITA 4 S IMP PLATE, CERVI TITA 4 S IMP PLATE, CERVI TITA 4

153.00 171.00 158.00 1849.00 1538.00 1297.00 1817.00 293.00 3153.00 3153.00 3279.00 3279.00 2910.00 2910.00 1701.00 1998.00 263.00 330.00 349.00 2202.00 1993.00 2482.00 2063.00 1817.00 1010.00 4627.00 3247.00 3261.00 4627.00 3121.00 4627.00 3098.00 4627.00 3121.00 4627.00 3270.00 4627.00 3243.00 4627.00 3121.00 4545.00 3098.00 3098.00 3243.00 3402.00 4545.00 4545.00 3566.00 4545.00 3414.00 3243.00 3402.00 4545.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 156

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2373736 2374072 2374064 2374056 2373702 2374049 2373710 2373728 2373785 2373645 2374114 2374080 2374098 2373777 2374106 2374122 2374148 2374130 2372134 2372290 2373470 2372878 2373108 2350189 2371912 2373496 2373488 2371862 2371920 2352102 2371946 2371979 2371938 2371805 2373439 2373397 2373405 2373413 2373421 2371896 2371888 2372118 2372126 2372142 2372159 2371789 2371771 2352318 2349835 2352326 2340149 2350635 2350643

S IMP PLATE, CERVI TITA 5 S IMP PLATE, CERVI TITA 5 S IMP PLATE, CERVI TITA 5 S IMP PLATE, CERVI TITA 5 S IMP PLATE, CERVI TITA 5 S IMP PLATE, CERVI TITA 5 S IMP PLATE, CERVI TITA 5 S IMP PLATE, CERVI TITA 5 S IMP PLATE, CERVI TITA 5 S IMP PLATE, CERVI TITA 5 S IMP PLATE, CERVI TITA 6 S IMP PLATE, CERVI TITA 6 S IMP PLATE, CERVI TITA 6 S IMP PLATE, CERVI TITA 6 S IMP PLATE, CERVI TITA 6 S IMP PLATE, CERVI TITA 7 S IMP PLATE, CERVI TITA 7 S IMP PLATE, CERVI TITA 7 S IMP PLATE, CERVICAL 25, S IMP PLATE, CERVICAL 41, S IMP PLATE, CRANI CROSSS IMP PLATE, CURVED 4HO 2 S IMP PLATE, CURVED 6HO 2 S IMP PLATE, DCS 6 HOLE S IMP PLATE, DOU Y 1HO AR S IMP PLATE, DOU Y 6HO 2M S IMP PLATE, DOU Y 6HO 2M S IMP PLATE, H 5HO SIDEX1 S IMP PLATE, H 5HO SIDEX1 S IMP PLATE, INTERMEDICS S IMP PLATE, L 2 BASX3HO S IMP PLATE, L 2 BASX3HO S IMP PLATE, L 2HO BASX3 S IMP PLATE, L 2HO BASX3 S IMP PLATE, L 2X2HO 2.0 S IMP PLATE, L 2X2HO 2.0 S IMP PLATE, L 2X2HO 2.0 S IMP PLATE, L 2X2HO 2.0 S IMP PLATE, L 2X2HO 2.0 S IMP PLATE, L 3HO BASX4 S IMP PLATE, L 3HO BASX4 S IMP PLATE, L 3HOBASX4HO S IMP PLATE, L 3HOBASX4HO S IMP PLATE, L 4HO BASX6S IMP PLATE, L 4HO BASX6S IMP PLATE, L 4X5HO SHAF S IMP PLATE, L 4X5HO SHAF S IMP PLATE, LARGE FRAG 4 S IMP PLATE, LATERAL FIBU S IMP PLATE, LEIB 54-0510 S IMP PLATE, LEIB 54-0517 S IMP PLATE, LG ASIF BD/D S IMP PLATE, LG BUTT 4HOL

3363.00 4948.00 4948.00 4545.00 3363.00 4545.00 3363.00 3363.00 3552.00 3243.00 4948.00 4948.00 4948.00 3538.00 4948.00 4948.00 4948.00 4948.00 1073.00 1164.00 2653.00 1509.00 1701.00 1585.00 990.00 1654.00 1654.00 976.00 990.00 1685.00 990.00 1003.00 990.00 942.00 1308.00 1308.00 1308.00 1308.00 1308.00 983.00 983.00 1053.00 1053.00 1094.00 1094.00 934.00 934.00 112.00 1437.00 273.00 564.00 449.00 431.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 157

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2349744 2350536 2350650 2350668 2350676 2371722 2372365 2371730 2373371 2372092 2371904 2351302 2351310 2369254 2351328 2351278 2350551 2350569 2350627 2350544 2350577 2350585 2350593 2351336 2350619 2351294 2351344 2350601 2372431 2372886 2372845 2373355 2373322 2372373 2373074 2372860 2372852 2372324 2372894 2372589 2372902 2372175 2372308 2373017 2373116 2373223 2373041 2373033 2371714 2371698 2371763 2372951 2373298

S IMP PLATE, LT DORSA RAD S IMP PLATE, MINI ASIF QU S IMP PLATE, MINI ASIF QU S IMP PLATE, MINI ASIF ST S IMP PLATE, MINI ASIF ST S IMP PLATE, ORBI 4HO 1.7 S IMP PLATE, ORBIT RIM 49 S IMP PLATE, ORBITA 6HOLE S IMP PLATE, ORBITAL MED. S IMP PLATE, ORBITAL RIM S IMP PLATE, ORBITAL RIM S IMP PLATE, OSTEOMED L 2 S IMP PLATE, OSTEOMED L 2 S IMP PLATE, RECON 3.5 HL S IMP PLATE, RECON 3.5M 7 S IMP PLATE, SHORT BEND W S IMP PLATE, SM FRAG ASIF S IMP PLATE, SM FRAG ASIF S IMP PLATE, SM FRAG ASIF S IMP PLATE, SM FRAG ASIF S IMP PLATE, SM FRAG ASIF S IMP PLATE, SM FRAG ASIF S IMP PLATE, SM FRAG ASIF S IMP PLATE, SM FRAG ASIF S IMP PLATE, SM FRAG ASIF S IMP PLATE, SM FRAG L SH S IMP PLATE, SM FRAG T 3 S IMP PLATE, SM PERIARTIC S IMP PLATE, SQU 3X2HOLE S IMP PLATE, SQU 4X2 HO 1 S IMP PLATE, SQUARE 2X2HO S IMP PLATE, STR 14HOLE 2 S IMP PLATE, STR 16 HO 2. S IMP PLATE, STR 16HOLE 1 S IMP PLATE, STR 24HOLE 1 S IMP PLATE, STR 4HO 2.0 S IMP PLATE, STR 4HO 2.0 S IMP PLATE, STR 4HO 2.3S S IMP PLATE, STR 4HOLE 2. S IMP PLATE, STR 4HOLE 2. S IMP PLATE, STR 4HOLE 2. S IMP PLATE, STR 4HOLE 35 S IMP PLATE, STR 4HOLE 40 S IMP PLATE, STR 6 HOLE 2 S IMP PLATE, STR 6HO 2.3M S IMP PLATE, STR 6HO 2.3M S IMP PLATE, STR 6HOLE 2. S IMP PLATE, STR 6HOLE 50 S IMP PLATE, STR 8 HOLE 1 S IMP PLATE, STR 8 HOLE 1 S IMP PLATE, STR 8HOLE 1. S IMP PLATE, STR 8HOLE 60 S IMP PLATE, STR BRI MX 1

1636.00 103.00 126.00 134.00 206.00 716.00 1175.00 735.00 2317.00 1038.00 983.00 394.00 394.00 710.00 573.00 1684.00 152.00 152.00 292.00 488.00 152.00 145.00 233.00 121.00 330.00 99.00 194.00 400.00 1213.00 1516.00 1409.00 2185.00 1106.00 1179.00 1556.00 689.00 683.00 1238.00 1516.00 1284.00 742.00 1117.00 1225.00 778.00 1717.00 1857.00 1515.00 1505.00 657.00 651.00 766.00 1571.00 2019.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 158

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2373389 2373348 2373256 2373231 2372985 2373066 2373124 2355063 2351625 2352292 2371813 2371953 2349967 2372084 2371854 2371961 2371821 2371839 2373082 2371797 2371870 2372100 2347102 2391696 2391704 2378495 2375889 2357275 2378487 2390821 2375251 2341196 2354546 2356897 2356889 2357101 2357028 2357051 2357044 2357010 2357085 2370518 2369163 2394138 2355667 2394146 2321198 2379485 2379618 2321206 2372720 2372712 2372738

S IMP PLATE, STR BRI MX 1 S IMP PLATE, STR BRI MX 1 S IMP PLATE, STR BRI MX 8 S IMP PLATE, STRA 16HO 12 S IMP PLATE, STRAIGHT 8HO S IMP PLATE, STRUT 30X16H S IMP PLATE, STRUT 42MX22 S IMP PLATE, SYNTHES S IMP PLATE, SYNTHES COND S IMP PLATE, SYNTHES, 241 S IMP PLATE, T 5HOX5HO SH S IMP PLATE, T 5HOX7HO SH S IMP PLATE, T, 5 HOLE S IMP PLATE, Y 1HO ARMX3H S IMP PLATE, Y 1HO ARMX3H S IMP PLATE, Y 2 ARMX4HO S IMP PLATE, Y 2X5HOLES S S IMP PLATE, Y 3X7HOLES S S IMP PLATE, Y 87MM S IMP PLATE, ZYGOMATIC 22 S IMP PLATE, ZYGOMATIC 27 S IMP PLATE, ZYGOMATIC 32 S IMP PLATE,LIEB.ORIBITAL S IMP PLIF SPACER 13MM S IMP PLIF SPACER 15MM S IMP PLUG BONE SMALL S IMP PLUG LARGE BONE $ S IMP PORTACATH,PERITONEA S IMP POUCH MESH SYNCHROM S IMP PROGR SYNERGY S IMP PROSTHESIS IMPLANT S IMP PROSTHESIS, EAR WEH S IMP PROSTHESIS, SGARLET S IMP PROSTHESIS,PENILE S IMP PROSTHESIS,PENILE S IMP PROSTHESIS,PENILE, S IMP PROSTHESIS,PENILE, S IMP PROSTHESIS,PENILE, S IMP PROSTHESIS,PENILE, S IMP PROSTHESIS,PENILE, S IMP PROSTHESIS,SPHINCT S IMP PROXIMAL SPACER S IMP PUMP SYCHROMED S IMP PUTTY 1CC DBX S IMP RADIONUCLIDE,SEEDS S IMP RING LOKG AXIS S IMP ROD 6.0 X 350 TI S IMP ROD 6.0 X 400MM HAR S IMP ROD 8 X 8MM ROD TO S IMP ROD 8.0 X 220 S IMP ROD CURV SOF TITA 6 S IMP ROD CURV SOF TITA 6 S IMP ROD CURV SOFTTITA 6

2383.00 2122.00 1925.00 1879.00 1634.00 1544.00 1731.00 1773.00 533.00 521.00 942.00 990.00 339.00 1025.00 969.00 997.00 962.00 962.00 1689.00 934.00 976.00 1046.00 1727.00 6852.00 6852.00 627.00 627.00 1865.00 618.00 4629.00 0.00 1330.00 1084.00 3799.00 4174.00 8044.00 3590.00 1391.00 7365.00 4310.00 4807.00 952.00 20842.00 1033.00 145.00 689.00 1299.00 1299.00 1385.00 796.00 1381.00 1381.00 1381.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 159

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2379477 2372357 2372340 2372282 2372548 2372449 2370963 2372456 2372464 2371755 2371680 2371748 2371706 2340818 2377190 2377885 2394161 2377844 2394179 2394187 2394195 2394203 2394211 2394229 2394237 2394245 2377877 2394252 2375772 2321214 2378230 2379436 2321222 2394260 2394278 2377943 2377968 2394302 2394294 2394310 2394328 2394336 2377950 2394344 2394351 2394286 2394369 2394377 2394385 2321230 2321248 2394393 2394401

S IMP ROD HARD TITA 6.0 X S IMP ROD HARD TITA 6.0MM S IMP ROD HARD TITA 6.0MM S IMP ROD HARD TITA 6.0MM S IMP ROD HARD TITA 6.0MM S IMP ROD HARD TITA 6.0MM S IMP ROD INTERMEDULLARY S IMP ROD SOFT TITA 6.0MM S IMP ROD SOFT TITA 6.0MM S IMP ROD SOFT TITA 6.0X1 S IMP ROD SOFT TITA 6.0X5 S IMP ROD SOFT TITA 6.0X5 S IMP ROD SOFT TITA 6.0X5 S IMP SCLERAL GRAFT S IMP SCREW 1.2 X 4MM CRO S IMP SCREW 1.5 X 10MM S IMP SCREW 1.5 X 11MM S IMP SCREW 1.5 X 12MM CO S IMP SCREW 1.5 X 13MM S IMP SCREW 1.5 X 14MM S IMP SCREW 1.5 X 16MM S IMP SCREW 1.5 X 18MM S IMP SCREW 1.5 X 20MM S IMP SCREW 1.5 X 22M S IMP SCREW 1.5 X 24MM S IMP SCREW 1.5 X 8MM S IMP SCREW 1.5 X 8MM S IMP SCREW 1.5 X 9MM S IMP SCREW 1.6 X 6MM OST S IMP SCREW 1.8 S IMP SCREW 100/30 ORTHOF S IMP SCREW 110MM LAG STA S IMP SCREW 115 LAG S IMP SCREW 120MM LAG S IMP SCREW 14MM S IMP SCREW 2 X 16MM CORT S IMP SCREW 2 X 22MM CORT S IMP SCREW 2.0 X 10MM S IMP SCREW 2.0 X 11MM S IMP SCREW 2.0 X 12MM S IMP SCREW 2.0 X 13MM S IMP SCREW 2.0 X 14MM S IMP SCREW 2.0 X 18MM CO S IMP SCREW 2.0 X 20MM S IMP SCREW 2.0 X 24MM S IMP SCREW 2.0 X 26MM S IMP SCREW 2.0 X 28MM S IMP SCREW 2.0 X 30MM S IMP SCREW 2.0 X 32MM S IMP SCREW 2.0 X 4 S IMP SCREW 2.0 X 6 S IMP SCREW 2.0 X 6MM S IMP SCREW 2.0 X 7MM

1299.00 1239.00 1239.00 1157.00 1228.00 1213.00 6118.00 1213.00 1213.00 749.00 633.00 735.00 657.00 538.00 67.00 319.00 311.00 311.00 311.00 311.00 319.00 319.00 331.00 331.00 319.00 331.00 319.00 331.00 286.00 1419.00 616.00 1193.00 1109.00 1109.00 696.00 352.00 352.00 366.00 366.00 366.00 405.00 352.00 352.00 352.00 366.00 352.00 352.00 352.00 352.00 339.00 339.00 352.00 352.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 160

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2321255 2394419 2394427 2394435 2394443 2378057 2394450 2378099 2378073 2378081 2378065 2378107 2321263 2394468 2394476 2394484 2394492 2378040 2321271 2394500 2377448 2394518 2377901 2377893 2377810 2394526 2377802 2394534 2394542 2394559 2394567 2394575 2394583 2394591 2377273 2394609 2394617 2394625 2394633 2379642 2379634 2379162 2321289 2379121 2379113 2379105 2394641 2394658 2394666 2377455 2378131 2375467 2377422

S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW

2.0 X 8 2.0 X 8MM 2.0 X 9MM 2.4 X 10MM 2.4 X 12MM 2.4 X 14MM CO 2.4 X 16MM 2.4 X 18MM CO 2.4 X 20MM 2.4 X 22MM CO 2.4 X 24MM 2.4 X 28MM 2.4 X 6 2.4 X 8MM 2.4 X 9MM 2.4X13MM 2.4X16MM 2.5 X 12MM MF 2.7 X 10 2.7 X 14MM 2.7 X 14MM CO 2.7 X 16MM 2.7 X 16MM CO 2.7 X 18MM CO 2.7 X 22MM CO 2.7 X 26MM 2.7 X 26MM CO 2.7 X 28MM 2.7 X 30MM 2.7 X 32MM 2.7 X 34MM 2.7 X 36MM 2.7 X 38MM 2.7 X 40MM 2.7 X 40MM 2.7 X 45MM 2.7 X 50MM 2.7 X 55MM 2.7X24MM 24MM MINI FIX 26MM MINI FIX 3.0 X 16MM CA 3.0 X 18 3.0 X 30MM CA 3.0 X 32MM CA 3.0 X 38MM CA 3.2 X 22MM 3.5 X 10MM 3.5 X 12MM 3.5 X 12MM CO 3.5 X 12MM CO 3.5 X 14MM CO 3.5 X 14MM CO

339.00 352.00 352.00 465.00 465.00 447.00 436.00 447.00 447.00 447.00 447.00 447.00 364.00 465.00 465.00 465.00 465.00 447.00 128.00 345.00 157.00 163.00 333.00 333.00 280.00 157.00 280.00 151.00 157.00 130.00 163.00 151.00 151.00 163.00 118.00 151.00 163.00 163.00 157.00 1482.00 1482.00 955.00 954.00 921.00 921.00 921.00 435.00 628.00 585.00 157.00 448.00 118.00 157.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 161

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2378149 2378321 2378156 2375475 2378339 2377430 2378115 2378347 2394674 2377240 2375525 2378354 2394682 2378362 2394716 2394690 2394708 2378123 2377265 2378370 2377364 2394732 2394724 2377232 2378388 2394740 2377257 2378396 2377299 2377653 2378404 2377372 2377612 2378412 2394757 2375590 2378420 2394765 2378438 2394781 2394773 2378446 2377646 2378453 2321297 2375632 2378461 2394799 2394807 2394815 2377604 2394823 2378479

S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW

3.5 X 14MM CO 3.5 X 14MM LO 3.5 X 16MM CO 3.5 X 16MM CO 3.5 X 16MM LO 3.5 X 18MM CO 3.5 X 18MM CO 3.5 X 18MM LO 3.5 X 20MM 3.5 X 20MM CO 3.5 X 20MM CO 3.5 X 20MM LO 3.5 X 22MM 3.5 X 22MM LO 3.5 X 24MM 3.5 X 24MM 3.5 X 24MM 3.5 X 25MM CO 3.5 X 26MM CO 3.5 X 26MM LO 3.5 X 26MM SH 3.5 X 28MM 3.5 X 28MM 3.5 X 28MM CO 3.5 X 28MM LO 3.5 X 30MM 3.5 X 30MM CO 3.5 X 30MM LO 3.5 X 32 CORT 3.5 X 32MM CO 3.5 X 32MM LO 3.5 X 32MM SH 3.5 X 34MM CO 3.5 X 34MM LO 3.5 X 35MM 3.5 X 36MM CO 3.5 X 36MM LO 3.5 X 38MM 3.5 X 38MM LO 3.5 X 40MM 3.5 X 40MM 3.5 X 40MM LO 3.5 X 42MM CO 3.5 X 45MM LO 3.5 X 46 3.5 X 50MM CO 3.5 X 50MM LO 3.5 X 55MM 3.5 X 55MM 3.5 X 55MM 3.5 X 55MM CO 3.5 X 60MM 3.5 X 60MM LO

448.00 605.00 448.00 118.00 605.00 157.00 448.00 605.00 594.00 118.00 151.00 605.00 118.00 605.00 628.00 128.00 594.00 448.00 118.00 605.00 143.00 594.00 1072.00 118.00 605.00 126.00 118.00 605.00 124.00 197.00 605.00 143.00 197.00 605.00 133.00 151.00 605.00 594.00 605.00 594.00 118.00 605.00 197.00 605.00 278.00 151.00 605.00 128.00 180.00 634.00 197.00 180.00 605.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 162

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2394831 2377463 2377620 2377414 2394849 2394856 2377638 2394864 2394872 2321396 2321305 2321313 2394880 2394898 2394914 2394906 2394930 2394922 2394948 2394955 2394963 2377935 2377927 2377307 2377315 2377331 2378628 2377323 2378610 2377349 2379071 2379063 2375491 2378974 2377281 2378883 2377356 2378768 2379535 2375459 2375442 2377224 2375434 2375426 2377547 2321321 2377471 2377505 2377679 2377513 2377687 2377539 2379147

S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW

3.5 X 65MM 3.5 X 65MM CO 3.5 X 70MM CO 3.5 X 70MM CO 3.5 X 75MM 3.5 X 80MM 3.5 X 80MM CO 3.5 X 85MM 3.5 X 90MM 3MM 4 X 13 4 X 14 4.0 12MM 4.0 14MM 4.0 16MM 4.0 16MM 4.0 18MM 4.0 18MM 4.0 20MM 4.0 22MM 4.0 24MM 4.0 X 16MM CA 4.0 X 18MM CA 4.0 X 18MM CA 4.0 X 22MM CA 4.0 X 26MM CA 4.0 X 26MM LO 4.0 X 30MM CA 4.0 X 34MM LO 4.0 X 40MM CA 4.0 X 40MM CA 4.0 X 44MM CA 4.0 X 45MM PA 4.0 X 48MM CA 4.0 X 50MM CA 4.0 X 55MM CA 4.0 X 60MM CA 4.0 X 80MM EX 4.35 X 14MM C 4.5 X 14MM CO 4.5 X 14MM CO 4.5 X 14MM CO 4.5 X 18MM CO 4.5 X 22MM CO 4.5 X 28MM CO 4.5 X 30 4.5 X 30MM CO 4.5 X 32MM CO 4.5 X 34MM CO 4.5 X 34MM CO 4.5 X 36MM CO 4.5 X 40MM CO 4.5 X 42MM CA

128.00 157.00 197.00 152.00 151.00 151.00 197.00 180.00 163.00 1036.00 1691.00 1691.00 929.00 929.00 929.00 929.00 929.00 929.00 929.00 929.00 929.00 351.00 351.00 134.00 134.00 134.00 675.00 134.00 675.00 134.00 908.00 908.00 128.00 862.00 124.00 767.00 134.00 683.00 1405.00 113.00 113.00 113.00 113.00 113.00 160.00 5036.00 160.00 160.00 187.00 160.00 187.00 160.00 955.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 163

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2377497 2379154 2377695 2377380 2377554 2377521 2377489 2321339 2377570 2321347 2377398 2377588 2377406 2377703 2376150 2321354 2378719 2378818 2378727 2379014 2378735 2379022 2378990 2378925 2379006 2379030 2379253 2379402 2379246 2321362 2379840 2379857 2379865 2379055 2374155 2374163 2378685 2378693 2378701 2378552 2378859 2378503 2378560 2378867 2378578 2378594 2378875 2377729 2377737 2377760 2379873 2379881 2379410

S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW

4.5 X 44MM CO 4.5 X 46MM CA 4.5 X 46MM CO 4.5 X 46MM CO 4.5 X 48MM CO 4.5 X 50MM CO 4.5 X 54MM CO 4.5 X 56 4.5 X 56MM CO 4.5 X 58 4.5 X 58MM CO 4.5 X 64MM CO 4.5 X 70MM CO 4.5 X 72MM CO 4.9 X 40MM LO 5.0 X 30 5.0 X 30MM LO 5.0 X 35MM LO 5.0 X 36MM LO 5.0 X 40MM LO 5.0 X 40MM LO 5.0 X 65MM CA 5.0 X 70MM CA 5.0 X 70MM CA 5.0 X 75MM CA 5.0 X 80MM LO 5.5 X 105MM 5.5 X 110MM C 5.5 X 95MM 6.0 X 30 6.0 X 35MM SI 6.0 X 40MM SI 6.0 X 60MM SI 6.0 X 85MM LO 6.2 X 55MM PE 6.2 X 60MM PE 6.28 X 40MM C 6.28 X 45MM C 6.28 X 50MM C 6.5 X 16MM BO 6.5 X 20MM CA 6.5 X 20MM CA 6.5 X 20MM CA 6.5 X 25MM CA 6.5 X 30MM CA 6.5 X 35MM BO 6.5 X 35MM CA 6.5 X 75MM CA 6.5 X 80MM CA 6.5 X 85MM CA 7.0 X 55MM SI 7.0 X 60MM SI 7.3 X 115MM C

160.00 955.00 187.00 148.00 160.00 160.00 160.00 122.00 160.00 122.00 148.00 160.00 148.00 220.00 796.00 940.00 710.00 704.00 710.00 875.00 710.00 875.00 875.00 797.00 875.00 875.00 1085.00 1172.00 1085.00 2378.00 2378.00 2378.00 2378.00 905.00 2583.00 2583.00 707.00 707.00 707.00 675.00 757.00 643.00 675.00 757.00 675.00 675.00 757.00 227.00 227.00 252.00 2378.00 2378.00 1188.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 164

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2379428 2379444 2379345 2379352 2379394 2370294 2370427 2378602 2378586 2375509 2377711 2370534 2375277 2375780 2378784 2376036 2371060 2376317 2376309 2375574 2375517 2375624 2375640 2375558 2375541 2375616 2375582 2375608 2375483 2375533 2375566 2375723 2375665 2375657 2375681 2375699 2375707 2375715 2376010 2371078 2371086 2379543 2370930 2321370 2376465 2376390 2376275 2370955 2376069 2376077 2376093 2378826 2376051

S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW S IMP SCREW

7.3 X 120MM C 7.3 X 75MM LO 7.3 X 85MM CA 7.3 X 90MM CA 9 X 35MM DELT ACET OSTEO ALL BONE 6.5 X 24 BONE HOWMEDIC CANCELLOUS 4. CANCELLOUS TH CANNULATED CANNULATED BI COMPRESSION 3 COMPRESSION T COMPRESSION T CORTEX CORTEX TITANI CORTEX TITANI CORTICAL 3.5 CORTICAL 3.5 CORTICAL 3.5 CORTICAL 3.5 CORTICAL 3.5 CORTICAL 3.5 CORTICAL 3.5 CORTICAL 3.5 CORTICAL 3.5 CORTICAL 3.5 CORTICAL 3.5 CORTICAL 3.5 CORTICAL 4.5 CORTICAL 4.5 CORTICAL 4.5 CORTICAL OMEG CORTICAL OMEG CORTICAL OMEG CORTICAL OMEG CROSS 6.28 X DHS LAG DHS/DCS COMPR GAMMA LAG 12 INTERMEDULLAR LAG 70MM LAG GAMMA 100 LAG SCREW 100 LAG SCREW 105 LBG COMPRESS LOCKING 5 X 4 LOCKING 5 X 5 LOCKING 5 X 6 LOCKING 5.0 X LOCKING 5X40M

1188.00 1218.00 1138.00 1138.00 1163.00 992.00 338.00 675.00 675.00 130.00 227.00 1254.00 1163.00 310.00 704.00 704.00 219.00 992.00 992.00 151.00 151.00 151.00 151.00 151.00 151.00 151.00 151.00 151.00 118.00 151.00 151.00 186.00 153.00 153.00 186.00 186.00 186.00 186.00 704.00 2021.00 299.00 1448.00 1544.00 1312.00 1448.00 1327.00 961.00 1870.00 704.00 704.00 704.00 704.00 704.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 165

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2376101 2375749 2375673 2370948 2377562 2376002 2376606 2376598 2376614 2379261 2379287 2376366 2376374 2376267 2376358 2376168 2376044 2376085 2376127 2376119 2376416 2397396 2397586 2397594 2397602 2397610 2397628 2396844 2396851 2396901 2397263 2397271 2397289 2397297 2397255 2396919 2396927 2397404 2397412 2397420 2397438 2397446 2397453 2397461 2397479 2397487 2397495 2397503 2397511 2397529 2397537 2397545 2397552

S IMP SCREW LOCKING T2 65 S IMP SCREW LOCKING TITAN S IMP SCREW OMEGA PLUS CO S IMP SCREW REG BONE S IMP SCREW SELF TAPPING S IMP SCREW SET SCREW 27M S IMP SCREW SIDE OPENING S IMP SCREW SIDE OPENING S IMP SCREW SIDE OPENING S IMP SCREW STANDARD LAG S IMP SCREW STANDARD LAG S IMP SCREW STANDARD LAG S IMP SCREW STANDARD LAG S IMP SCREW STANDARD LAG S IMP SCREW SUPER LAG SCR S IMP SCREW SYNTHES TI LO S IMP SCREW T2 30MM HOWME S IMP SCREW T2 55MM HOWME S IMP SCREW T2 75MM LOCKI S IMP SCREW T2 LOCKING 70 S IMP SCREW TITANIUM 4.5 S IMP SCREW, 3MMX15MM S IMP SCREW, 3MMX20MM S IMP SCREW, 3MMX22MM S IMP SCREW, 3MMX26MM S IMP SCREW, 4MMX10MM S IMP SCREW, 4MMX30MM S IMP SCREW, 60MM S IMP SCREW, 65MM S IMP SCREW, 2.0MMX4MM S IMP SCREW, 4.0MMX28MM S IMP SCREW, 4.0MMX50MM S IMP SCREW, 4.0MMX55MM S IMP SCREW, 4.0MMX60MM S IMP SCREW, 4.0X30MM S IMP SCREW, 4.5 X 18MM S IMP SCREW, 4.5 X 60MM S IMP SCREW, 4.5MMX20MM S IMP SCREW, 4.5MMX22MM S IMP SCREW, 4.5MMX24MM S IMP SCREW, 4.5MMX26MM S IMP SCREW, 4.5MMX28MM S IMP SCREW, 4.5MMX30MM S IMP SCREW, 4.5MMX32MM S IMP SCREW, 4.5MMX34MM S IMP SCREW, 4.5MMX36MM S IMP SCREW, 4.5MMX38MM S IMP SCREW, 4.5MMX40MM S IMP SCREW, 4.5MMX44MM S IMP SCREW, 4.5MMX48MM S IMP SCREW, 4.5MMX50MM S IMP SCREW, 4.5MMX52MM S IMP SCREW, 4.5MMX54MM

704.00 243.00 186.00 243.00 160.00 704.00 2402.00 2402.00 2402.00 1106.00 1109.00 1196.00 1196.00 961.00 1196.00 822.00 704.00 704.00 704.00 704.00 1351.00 955.00 955.00 954.00 955.00 929.00 929.00 227.00 227.00 352.00 133.00 133.00 133.00 133.00 135.00 160.00 160.00 954.00 954.00 954.00 954.00 954.00 954.00 954.00 954.00 954.00 954.00 954.00 954.00 954.00 954.00 954.00 954.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 166

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2397875 2397883 2397891 2397560 2396935 2397578 2396836 2397636 2397644 2397222 2397230 2397248 2397651 2396869 2396877 2396885 2396893 2398105 2397974 2397982 2398113 2398121 2398139 2398147 2398154 2398162 2398170 2398188 2398196 2398204 2398212 2398220 2398238 2398246 2398253 2398261 2398279 2398287 2398295 2398303 2397909 2397917 2397925 2398311 2398329 2398337 2398345 2398352 2398360 2320091 2398378 2398386 2397990

S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW,

4.5MMX56MM 4.5MMX60MM 4.5MMX64MM 4.5MMX68MM 4.5X22MM 4.5X72MM 50MM 6.5MMX110M 6.5MMX55MM 6.5X25MM 6.5X30MM 6.5X35MM 7.0MMX70MM 70MM 75MM 80MM 85MM 1.0X6MM 1.3X3MM 1.3X6MM 1.5MMX11MM 1.5MMX12MM 1.5MMX14MM 1.5MMX6MM 1.5MMX7MM 1.5MMX9MM 1.5X10MM 1.5X16MM 1.5X8MM 2.0MMX10MM 2.0MMX16MM 2.0MMX8MM 2.0X20MM 2.0X6MM 2.4 X 6MM 2.4MMX11MM 2.7MMX32MM 2.7MMX44MM 2.7X6MM 2.7X8MM 3.0 X 40MM 3.0MMX29MM 3.0X38MM 3.5MMX34MM 3.5MMX36MM 3.5MMX42MM 3.5MMX44MM 3.5MMX46MM 3.5MMX48MM 3.5MMX50MM 3.5MMX50MM 3.5X45MM 3.5X60MM

954.00 954.00 954.00 954.00 160.00 954.00 227.00 251.00 227.00 240.00 240.00 240.00 1142.00 227.00 227.00 251.00 251.00 443.00 417.00 417.00 155.00 155.00 155.00 155.00 155.00 155.00 155.00 155.00 155.00 157.00 157.00 157.00 157.00 157.00 447.00 447.00 157.00 157.00 157.00 157.00 954.00 954.00 954.00 122.00 122.00 157.00 157.00 157.00 157.00 776.00 122.00 122.00 189.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 167

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2398006 2398014 2398022 2396968 2396950 2396976 2396984 2397305 2397313 2396992 2397008 2397321 2397016 2397024 2397339 2397032 2397040 2397057 2397065 2397073 2398394 2398402 2398410 2398428 2398436 2398444 2397081 2397099 2397107 2320299 2397115 2397123 2397131 2397156 2397149 2397164 2397172 2397669 2397677 2397685 2397180 2397693 2396943 2397701 2397719 2397727 2397735 2397198 2397743 2397206 2397214 2397750 2397933

S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW, S IMP SCREW,

4.0MMX12MM 4.0MMX14MM 4.0MMX16MM 4.0X10MM 4.0X10MM 4.0X12MM 4.0X12MM 4.0X12MM 4.0X14MM 4.0X14MM 4.0X16MM 4.0X16MM 4.0X18MM 4.0X20MM 4.0X20MM 4.0X24MM 4.0X26MM 4.0X28MM 4.0X32MM 4.0X45MM 4.5 4.5MMX66MM 4.5MMX76MM 4.5MMX80MM 4.5MMX85MM 4.5MMX90MM 4.5X12MM SD 4.5X14MM SD 4.5X16MM SD 5.0 X 150M 6.5 45X16MM 6.5 45X32MM 6.5 65X16MM 6.5MM 6.5MM 6.5MMX100MM 6.5MMX105MM 6.5MMX105MM 6.5MMX110MM 6.5MMX25MM 6.5MMX30MM 6.5MMX30MM 6.5MMX35MM 6.5MMX40MM 6.5MMX40MM 6.5MMX50MM 6.5MMX55MM 6.5MMX60MM 6.5MMX85MM 6.5MMX90MM 6.5MMX95MM 6.5MMX95MM 7.3MM X 135

1531.00 1531.00 1531.00 133.00 133.00 133.00 133.00 1531.00 1531.00 133.00 133.00 1531.00 133.00 133.00 929.00 133.00 133.00 133.00 133.00 133.00 118.00 160.00 242.00 242.00 242.00 242.00 1467.00 1467.00 1467.00 730.00 227.00 227.00 227.00 227.00 227.00 251.00 251.00 251.00 251.00 227.00 227.00 227.00 227.00 227.00 227.00 227.00 227.00 227.00 251.00 251.00 251.00 251.00 1142.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 168

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2397941 2397768 2397776 2397784 2397792 2397800 2397818 2397826 2397834 2397842 2397859 2397867 2397347 2397354 2397362 2397370 2398519 2398527 2398535 2398543 2398550 2398568 2398576 2398584 2398592 2398600 2398618 2398626 2398634 2398642 2398659 2398667 2398030 2398048 2398055 2398063 2398071 2398089 2398097 2398675 2398683 2398709 2398691 2394971 2394989 2394997 2395002 2395028 2395010 2395036 2395044 2395051 2395069

S IMP SCREW, 7.3MM X 140 S IMP SCREW, 7.3MMX100MM S IMP SCREW, 7.3MMX105MM S IMP SCREW, 7.3MMX110MM S IMP SCREW, 7.3MMX115MM S IMP SCREW, 7.3MMX120MM S IMP SCREW, 7.3MMX125MM S IMP SCREW, 7.3MMX130MM S IMP SCREW, 7.3MMX55MM S IMP SCREW, 7.3MMX60MM S IMP SCREW, 7.3MMX75MM S IMP SCREW, 7.3MMX80MM S IMP SCREW, 7.3X32X135M S IMP SCREW, 7.3X32X140M S IMP SCREW, 7.3X32X145M S IMP SCREW, 7.3X32X150M S IMP SCREW, LRG 4.5MMX7 S IMP SCREW, TAP 2.0X54M S IMP SCREW, TAP 4.5 125 S IMP SCREW, TI 1.0X2MM S IMP SCREW, TI 1.0X3MM S IMP SCREW, TI 1.0X4MM S IMP SCREW, TI 1.5MM X S IMP SCREW, TI 1.5X6MM S IMP SCREW, TI 2.4MM X S IMP SCREW, TI 2.4X14MM S IMP SCREW, TI 2.4X26MM S IMP SCREW, TI 2.4X30MM S IMP SCREW, TI 2.4X32MM S IMP SCREW, TI 2.4X34MM S IMP SCREW, TI 2.4X8MM S IMP SCREW, TI 3.5 X 18 S IMP SCREW, TI 4.5X44MM S IMP SCREW, TI 4.5X46MM S IMP SCREW, TI 4.5X48MM S IMP SCREW, TI 4.5X50MM S IMP SCREW, TI 4.5X52MM S IMP SCREW, TI 4.5X54MM S IMP SCREW, TI 4.5X56MM S IMP SCREW, TITAN 2.7 X S IMP SCREW, TITAN 3.5MM S IMP SCREW, TITAN 3.5MM S IMP SCREW, TITAN 3.5MM S IMP SCREW, 4.0 24MM S IMP SCREW, 4.0 26MM S IMP SCREW, 4.0 28MM S IMP SCREW, 4.0 32MM S IMP SCREW, 4.0 34MM S IMP SCREW, 4.0 34MM S IMP SCREW, 4.0 36MM S IMP SCREW, 4.0 38MM S IMP SCREW, 4.0 40MM S IMP SCREW, 4.0 42MM

1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 193.00 587.00 645.00 443.00 443.00 443.00 319.00 319.00 447.00 447.00 447.00 447.00 447.00 447.00 447.00 122.00 193.00 193.00 193.00 193.00 193.00 193.00 193.00 319.00 122.00 122.00 122.00 929.00 929.00 929.00 929.00 929.00 929.00 929.00 929.00 929.00 929.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 169

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2395077 2395085 2395093 2395101 2395119 2395127 2395135 2395143 2395150 2395168 2395176 2395184 2395192 2395200 2395218 2395226 2395234 2395242 2395259 2395267 2395275 2395283 2395291 2395309 2395317 2395325 2395333 2395341 2395358 2395366 2395374 2395382 2395390 2395408 2395416 2395424 2351666 2395432 2395440 2395457 2395465 2395473 2395481 2395507 2395499 2320307 2395523 2395531 2395549 2395556 2395564 2395572 2395580

S IMP SCREW, 4.0 44MM S IMP SCREW, 4.0 50MM S IMP SCREW, 4.0 X 12MM S IMP SCREW, 4.0 X 16 MM S IMP SCREW, 4.0 X 16MM S IMP SCREW, 4.0 X 17MM S IMP SCREW, 4.0 X 20MM S IMP SCREW, 4.0 X 22 MM S IMP SCREW, 4.0 X 22MM S IMP SCREW, 4.0 X 26 S IMP SCREW, 4.0 X 26MM S IMP SCREW, 4.0 X 28MM S IMP SCREW, 4.0 X 30MM S IMP SCREW, 4.0 X 30MM S IMP SCREW, 4.0 X 30MM S IMP SCREW, 4.0 X 30MM S IMP SCREW, 4.0 X 32MM S IMP SCREW, 4.0 X 36MM S IMP SCREW, 4.0 X 38MM S IMP SCREW, 4.0 X 40MM S IMP SCREW, 4.0 X 42MM S IMP SCREW, 4.0 X 42MM S IMP SCREW, 4.0 X 46MM S IMP SCREW, 4.0 X 46MM S IMP SCREW, 4.0 X 46MM S IMP SCREW, 4.0 X 48MM S IMP SCREW, 4.0 X 50MM S IMP SCREW, 4.2 X 30MM S IMP SCREW, 4.35 S IMP SCREW, 4.35 X 12MM S IMP SCREW, 4.35 X 16MM S IMP SCREW, 4.5 LG 24MM S IMP SCREW, 4.5 LG 26MM S IMP SCREW, 4.5 LG 28MM S IMP SCREW, 4.5 LG 36MM S IMP SCREW, 4.5 LG 42MM S IMP SCREW, 4.5 TITANIU S IMP SCREW, 4.5 X 12MM S IMP SCREW, 4.5 X 14MM S IMP SCREW, 4.5 X 14MM S IMP SCREW, 4.5 X 20MM S IMP SCREW, 4.5 X 24MM S IMP SCREW, 4.5 X 26MM S IMP SCREW, 4.5 X 32MM S IMP SCREW, 4.5 X 32MM S IMP SCREW, 4.5 X 36MM S IMP SCREW, 4.5 X 38MM S IMP SCREW, 4.5 X 40MM S IMP SCREW, 4.5 X 42MM S IMP SCREW, 4.5 X 46MM S IMP SCREW, 4.5 X 50MM S IMP SCREW, 4.5 X 62MM S IMP SCREW, 4.5 X 68MM

929.00 929.00 1117.00 678.00 1537.00 1537.00 122.00 678.00 966.00 699.00 966.00 966.00 699.00 133.00 931.00 678.00 931.00 966.00 678.00 138.00 908.00 674.00 908.00 966.00 674.00 966.00 966.00 2472.00 1211.00 1299.00 1461.00 118.00 118.00 118.00 118.00 118.00 53.00 1299.00 1403.00 211.00 166.00 151.00 151.00 156.00 133.00 156.00 156.00 133.00 147.00 122.00 225.00 160.00 993.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 170

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2395598 2395606 2395614 2395622 2395630 2395648 2395655 2395663 2395671 2395689 2395697 2395705 2395713 2395721 2395739 2395770 2395762 2395754 2395747 2395812 2395804 2395796 2395788 2395820 2395838 2395846 2395853 2395887 2395879 2395861 2395903 2395895 2395911 2395929 2395986 2395978 2395994 2396000 2396018 2396034 2396026 2396042 2396059 2396067 2396075 2396083 2396091 2396109 2396117 2396125 2396141 2396133 2396166

S IMP SCREW, 5 X 65MM S IMP SCREW, 5 X 75MM S IMP SCREW, 5 X 85MM S IMP SCREW, 5.0 X 200MM S IMP SCREW, 5.0 X 150MM S IMP SCREW, 5.0 X 18MM S IMP SCREW, 5.0 X 200MM S IMP SCREW, 5.0 X 26MM S IMP SCREW, 5.0 X 32MM S IMP SCREW, 5.0 X 34MM S IMP SCREW, 5.0 X 35MM S IMP SCREW, 5.0 X 38MM S IMP SCREW, 5.0 X 40MM S IMP SCREW, 5.0 X 45MM S IMP SCREW, 5.0 X 46MM S IMP SCREW, 5.0 X 50MM S IMP SCREW, 5.0 X 50MM S IMP SCREW, 5.0 X 50MM S IMP SCREW, 5.0 X 50MM S IMP SCREW, 5.0 X 55MM S IMP SCREW, 5.0 X 55MM S IMP SCREW, 5.0 X 55MM S IMP SCREW, 5.0 X 55MM S IMP SCREW, 5.0 X 60MM S IMP SCREW, 5.0 X 65MM S IMP SCREW, 5.0 X 75MM S IMP SCREW, 5.0 X 80MM S IMP SCREW, 5.0 X 85MM S IMP SCREW, 5.0 X 85MM S IMP SCREW, 5.0 X 85MM S IMP SCREW, 5.0 X 90MM S IMP SCREW, 5.0 X 90MM S IMP SCREW, 5.0X28MM S IMP SCREW, 5.0X42MM S IMP SCREW, 6.5 100MM/ S IMP SCREW, 6.5 100MM/ S IMP SCREW, 6.5 105MM/ S IMP SCREW, 6.5 105MM/ S IMP SCREW, 6.5 110MM/ S IMP SCREW, 6.5 115MM/ S IMP SCREW, 6.5 115MM/ S IMP SCREW, 6.5 120MM/ S IMP SCREW, 6.5 120MM/ S IMP SCREW, 6.5 125MM/ S IMP SCREW, 6.5 125MM/ S IMP SCREW, 6.5 130MM/ S IMP SCREW, 6.5 130MM/ S IMP SCREW, 6.5 135MM/ S IMP SCREW, 6.5 140MM/ S IMP SCREW, 6.5 140MM/ S IMP SCREW, 6.5 145MM/ S IMP SCREW, 6.5 145MM/ S IMP SCREW, 6.5 150MM/

829.00 829.00 829.00 730.00 901.00 881.00 579.00 881.00 320.00 1492.00 940.00 691.00 881.00 940.00 1492.00 954.00 709.00 940.00 940.00 881.00 709.00 703.00 874.00 940.00 881.00 881.00 709.00 881.00 667.00 874.00 875.00 709.00 691.00 691.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 171

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2396158 2396174 2395945 2396182 2396190 2396208 2395952 2396224 2396216 2396232 2396240 2396257 2396265 2396273 2396281 2396299 2396307 2395960 2396323 2396315 2396331 2396349 2396356 2396364 2396372 2395937 2396380 2396398 2396406 2396414 2396422 2396430 2396448 2396455 2396463 2396471 2396489 2396497 2396505 2396513 2396521 2396539 2396547 2396554 2396612 2396562 2396620 2396570 2396638 2396588 2396646 2396653 2396596

S IMP SCREW, 6.5 150MM/ S IMP SCREW, 6.5 30MM/ S IMP SCREW, 6.5 35MM S IMP SCREW, 6.5 35MM/ S IMP SCREW, 6.5 40MM/ S IMP SCREW, 6.5 45MM/ S IMP SCREW, 6.5 50MM S IMP SCREW, 6.5 50MM/ S IMP SCREW, 6.5 50MM/ S IMP SCREW, 6.5 55MM/ S IMP SCREW, 6.5 55MM/ S IMP SCREW, 6.5 60MM/ S IMP SCREW, 6.5 60MM/ S IMP SCREW, 6.5 65MM/ S IMP SCREW, 6.5 70MM/ S IMP SCREW, 6.5 75MM/ S IMP SCREW, 6.5 75MM/ S IMP SCREW, 6.5 80MM S IMP SCREW, 6.5 80MM/ S IMP SCREW, 6.5 80MM/ S IMP SCREW, 6.5 85MM/ S IMP SCREW, 6.5 90MM/ S IMP SCREW, 6.5 90MM/ S IMP SCREW, 6.5 95MM/ S IMP SCREW, 6.5 95MM/ S IMP SCREW, 6.5 110MM S IMP SCREW, 6.5 X 110MM S IMP SCREW, 6.5 X 12MM S IMP SCREW, 6.5 X 30MM S IMP SCREW, 6.5 X 35MM S IMP SCREW, 6.5 X 45MM S IMP SCREW, 6.5 X 45MM S IMP SCREW, 6.5 X 60MM S IMP SCREW, 6.5 X 65MM S IMP SCREW, 6.5 X 70MM S IMP SCREW, 6.5 X 70MM S IMP SCREW, 6.5 X 70MM S IMP SCREW, 6.5 X 75MM S IMP SCREW, 6.5 X 85MM S IMP SCREW, 6.5 X 90MM S IMP SCREW, 6X1.3MM S IMP SCREW, 7.0 X 32MM S IMP SCREW, 7.0 X 40MM S IMP SCREW, 7.0 X 50MM S IMP SCREW, 7.3 100MM S IMP SCREW, 7.3 100MM S IMP SCREW, 7.3 105MM S IMP SCREW, 7.3 110MM S IMP SCREW, 7.3 150MM S IMP SCREW, 7.3 50MM S IMP SCREW, 7.3 80MM S IMP SCREW, 7.3 90MM S IMP SCREW, 7.3 90MM

1142.00 1142.00 227.00 1142.00 1142.00 1142.00 227.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 227.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 251.00 1188.00 643.00 790.00 790.00 790.00 1188.00 227.00 1142.00 209.00 227.00 1142.00 227.00 1142.00 251.00 417.00 888.00 2402.00 2308.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 172

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2396661 2396604 2396679 2396687 2396695 2396703 2396711 2396729 2396737 2396745 2396752 2396760 2396786 2396778 2396794 2396802 2396810 2396828 2351351 2352508 2352516 2351591 2351609 2350023 2350031 2350049 2350056 2350064 2350072 2351534 2351526 2353332 2351518 2353522 2353464 2353472 2353480 2353498 2353456 2353530 2353506 2353514 2350510 2350353 2350361 2350502 2349892 2349942 2352987 2353233 2352490 2354298 2352912

S IMP SCREW, 7.3 95MM S IMP SCREW, 7.3 95MM S IMP SCREW, 7.3 X 115MM S IMP SCREW, 7.3 X 120MM S IMP SCREW, 7.3 X 125MM S IMP SCREW, 7.3 X 35MM S IMP SCREW, 7.3 X 40MM S IMP SCREW, 7.3 X 50MM S IMP SCREW, 7.3 X 55MM S IMP SCREW, 7.3 X 65MM S IMP SCREW, 7.3 X 70MM S IMP SCREW, 7.3 X 75MM S IMP SCREW, 7.3 X 85MM S IMP SCREW, 7.3 X 85MM S IMP SCREW, 7.3 X 90MM S IMP SCREW, 7.3MM 105MM S IMP SCREW, 7.3MM 145X1 S IMP SCREW, 7.3MM 45X32 S IMP SCREW, ACUTRAK FIX S IMP SCREW, ARTHREX 7 X S IMP SCREW, ARTHREX ORT S IMP SCREW, ARTHROTEK 2 S IMP SCREW, ARTHROTEK 4 S IMP SCREW, ASNIS CANNT S IMP SCREW, ASNIS CANNT S IMP SCREW, ASNIS CANNT S IMP SCREW, ASNIS CANNT S IMP SCREW, ASNIS CANNT S IMP SCREW, ASNIS CANNT S IMP SCREW, BIOMET 4.5 S IMP SCREW, BIOMET 4.5M S IMP SCREW, BOLD 1110-1 S IMP SCREW, BONE, ACUTR S IMP SCREW, CANC P/T 4. S IMP SCREW, CANC P/T 4. S IMP SCREW, CANC P/T 4. S IMP SCREW, CANC P/T 4. S IMP SCREW, CANC P/T 4. S IMP SCREW, CANC P/T 4. S IMP SCREW, CANC P/T 4. S IMP SCREW, CANC P/T 4. S IMP SCREW, CANC P/T 4. S IMP SCREW, CANC, 6.5MM S IMP SCREW, CANC, 6.5MM S IMP SCREW, CANC, 6.5MM S IMP SCREW, CANC, 6.5MM S IMP SCREW, CANCELLOUS S IMP SCREW, CANCELLOUS S IMP SCREW, CANCELLOUS S IMP SCREW, CANCELLOUS S IMP SCREW, CANCELLOUS S IMP SCREW, CANCELLOUS S IMP SCREW, CANCELLOUS

1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1302.00 1302.00 1142.00 1157.00 1218.00 1218.00 1142.00 1142.00 1140.00 1199.00 1431.00 946.00 594.00 447.00 508.00 573.00 573.00 520.00 682.00 682.00 414.00 414.00 592.00 1472.00 46.00 46.00 46.00 46.00 46.00 46.00 46.00 46.00 46.00 87.00 46.00 83.00 83.00 160.00 99.00 93.00 447.00 348.00 112.00 112.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 173

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2354504 2354488 2354462 2354447 2354496 2354454 2352938 2352946 2354470 2352953 2352920 2350221 2350239 2350205 2350213 2350247 2352961 2352979 2352896 2352839 2352797 2352805 2352813 2352821 2352847 2352854 2352730 2352714 2352698 2352672 2352656 2352649 2353001 2352722 2352904 2352706 2352888 2352870 2352995 2352615 2352581 2352599 2352623 2352862 2352573 2352680 2352607 2352763 2352771 2352789 2352755 2352631 2352748

S IMP SCREW, CANCELLOUS, S IMP SCREW, CANCELLOUS, S IMP SCREW, CANCELLOUS, S IMP SCREW, CANCELLOUS, S IMP SCREW, CANCELLOUS, S IMP SCREW, CANCELLOUS, S IMP SCREW, CANCELLOUS, S IMP SCREW, CANCELLOUS, S IMP SCREW, CANCELLOUS, S IMP SCREW, CANCELLOUS, S IMP SCREW, CANCELLOUS, S IMP SCREW, CANC-FULL T S IMP SCREW, CANC-FULL T S IMP SCREW, CANC-FULL T S IMP SCREW, CANC-FULL T S IMP SCREW, CANC-SHRT T S IMP SCREW, CANNTED 2.3 S IMP SCREW, CANNTED 2.3 S IMP SCREW, CANNTED 3.5 S IMP SCREW, CANNTED BIO S IMP SCREW, CANNTED BIO S IMP SCREW, CANNTED BIO S IMP SCREW, CANNTED BIO S IMP SCREW, CANNTED BIO S IMP SCREW, CANNTED BIO S IMP SCREW, CANNTED BIO S IMP SCREW, CANNTED INT S IMP SCREW, CANNTED INT S IMP SCREW, CANNTED INT S IMP SCREW, CANNTED INT S IMP SCREW, CANNTED INT S IMP SCREW, CANNTED INT S IMP SCREW, CANNTED INT S IMP SCREW, CANNTED INT S IMP SCREW, CANNTED INT S IMP SCREW, CANNTED INT S IMP SCREW, CANNTED INT S IMP SCREW, CANNTED INT S IMP SCREW, CANNTED MAG S IMP SCREW, CANNTED MAG S IMP SCREW, CANNTED MAG S IMP SCREW, CANNTED MAG S IMP SCREW, CANNTED MAG S IMP SCREW, CANNTED MAG S IMP SCREW, CANNTED MAG S IMP SCREW, CANNTED MAG S IMP SCREW, CANNTED MAG S IMP SCREW, CANNTED WIT S IMP SCREW, CANNTED WIT S IMP SCREW, CANNTED WIT S IMP SCREW, CANNTED WIT S IMP SCREW, CANNTED WIT S IMP SCREW, CANNTED WIT

112.00 112.00 112.00 112.00 112.00 112.00 46.00 46.00 112.00 46.00 112.00 83.00 83.00 46.00 434.00 83.00 615.00 615.00 397.00 691.00 691.00 691.00 691.00 691.00 691.00 757.00 534.00 534.00 534.00 534.00 534.00 534.00 534.00 534.00 515.00 534.00 515.00 515.00 539.00 431.00 539.00 539.00 442.00 539.00 539.00 539.00 348.00 589.00 589.00 471.00 589.00 589.00 589.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 174

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2353134 2350908 2350916 2350890 2350932 2350924 2350882 2398717 2350445 2350296 2354306 2372316 2372415 2372423 2372407 2372209 2372191 2372977 2372969 2372993 2373009 2350270 2350262 2354272 2351385 2351393 2350288 2354280 2351427 2351435 2351443 2351492 2351500 2351419 2351401 2350320 2350338 2350304 2350346 2351484 2351476 2351468 2351450 2350452 2350486 2350460 2350437 2350429 2350411 2350403 2350395 2350387 2350478

S IMP SCREW, CANNTED WIT S IMP SCREW, CANU 3.5 FU S IMP SCREW, CANU 3.5 FU S IMP SCREW, CANU 3.5 FU S IMP SCREW, CANU 3.5 FU S IMP SCREW, CANU 3.5 FU S IMP SCREW, CANU 3.5 TH S IMP SCREW, CORT FIXATIO S IMP SCREW, CORTES, 4.5 S IMP SCREW, CORTEX 2.0M S IMP SCREW, CORTEX OR C S IMP SCREW, CORTEX TITA S IMP SCREW, CORTEX TITA S IMP SCREW, CORTEX TITA S IMP SCREW, CORTEX TITA S IMP SCREW, CORTEX TITA1 S IMP SCREW, CORTEX TITA1 S IMP SCREW, CORTEX TITA1 S IMP SCREW, CORTEX TITA1 S IMP SCREW, CORTEX TITA1 S IMP SCREW, CORTEX TITA1 S IMP SCREW, CORTEX, 1.5 S IMP SCREW, CORTEX, 1.5 S IMP SCREW, CORTEX, 1.5 S IMP SCREW, CORTEX, 1.5 S IMP SCREW, CORTEX, 1.5 S IMP SCREW, CORTEX, 2.0 S IMP SCREW, CORTEX, 2.0 S IMP SCREW, CORTEX, 2.0 S IMP SCREW, CORTEX, 2.0 S IMP SCREW, CORTEX, 2.0 S IMP SCREW, CORTEX, 2.0 S IMP SCREW, CORTEX, 2.0 S IMP SCREW, CORTEX, 2.0 S IMP SCREW, CORTEX, 2.0 S IMP SCREW, CORTEX, 2.7 S IMP SCREW, CORTEX, 2.7 S IMP SCREW, CORTEX, 2.7 S IMP SCREW, CORTEX, 2.7 S IMP SCREW, CORTEX, 2.7 S IMP SCREW, CORTEX, 2.7 S IMP SCREW, CORTEX, 2.7 S IMP SCREW, CORTEX, 2.7 S IMP SCREW, CORTEX, 4.5 S IMP SCREW, CORTEX, 4.5 S IMP SCREW, CORTEX, 4.5 S IMP SCREW, CORTEX, 4.5 S IMP SCREW, CORTEX, 4.5 S IMP SCREW, CORTEX, 4.5 S IMP SCREW, CORTEX, 4.5 S IMP SCREW, CORTEX, 4.5 S IMP SCREW, CORTEX, 4.5 S IMP SCREW, CORTEX, 4.5

589.00 46.00 46.00 46.00 348.00 397.00 128.00 822.00 293.00 55.00 428.00 562.00 583.00 583.00 583.00 527.00 527.00 763.00 763.00 751.00 764.00 43.00 37.00 155.00 56.00 63.00 55.00 54.00 52.00 54.00 55.00 43.00 43.00 54.00 55.00 90.00 53.00 35.00 53.00 52.00 52.00 52.00 51.00 51.00 112.00 37.00 90.00 112.00 44.00 44.00 44.00 44.00 293.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 175

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2350379 2354215 2350007 2350528 2350163 2350015 2349991 2349959 2349983 2350122 2349975 2354199 2354181 2354207 2354512 2349843 2349868 2349876 2349884 2349850 2353431 2353019 2353027 2352532 2352540 2353340 2353357 2353365 2353373 2353381 2353449 2353407 2353118 2353415 2353423 2353217 2353399 2351617 2350783 2350775 2350791 2353084 2353035 2353050 2353068 2353076 2353092 2352524 2353043 2353100 2351542 2353225 2352565

S IMP SCREW, CORTEX, 4.5 S IMP SCREW, CORTEX, 4.5 S IMP SCREW, CORTEX-FN 3 S IMP SCREW, CORTEX-FN 3 S IMP SCREW, CORTEX-FN 3 S IMP SCREW, CORTEX-FN 3 S IMP SCREW, CORTEX-FN 3 S IMP SCREW, CORTEX-FN 3 S IMP SCREW, CORTEX-FN 3 S IMP SCREW, CORTEX-FN 3 S IMP SCREW, CORTEX-FN 3 S IMP SCREW, CORTEX-FN 3 S IMP SCREW, CORTEX-FN 3 S IMP SCREW, CORTEX-FN 3 S IMP SCREW, CORTEX-FN 3 S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 3. S IMP SCREW, CORTICAL 30 S IMP SCREW, CORTICAL 4. S IMP SCREW, CORTICAL 4. S IMP SCREW, CORTICAL 4. S IMP SCREW, CORTICAL 4. S IMP SCREW, CORTICAL 4. S IMP SCREW, CORTICAL 4. S IMP SCREW, CORTICAL 4. S IMP SCREW, CORTICAL 4. S IMP SCREW, CORTICAL 4. S IMP SCREW, CORTICAL 4. S IMP SCREW, CORTICAL 4. S IMP SCREW, CORTICAL 4. S IMP SCREW, CORTICAL 50 S IMP SCREW, CORTICAL PO S IMP SCREW, CORTICAL RE

112.00 112.00 55.00 48.00 55.00 112.00 55.00 53.00 48.00 48.00 48.00 55.00 55.00 55.00 55.00 116.00 116.00 116.00 116.00 116.00 35.00 263.00 263.00 263.00 263.00 263.00 263.00 263.00 35.00 263.00 35.00 211.00 263.00 35.00 35.00 263.00 263.00 224.00 143.00 47.00 115.00 263.00 174.00 263.00 263.00 263.00 263.00 263.00 263.00 263.00 411.00 447.00 663.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 176

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2352557 2350833 2350809 2350817 2350825 2398725 2398733 2372555 2372563 2372571 2398741 2399921 2372910 2372928 2372936 2372944 2372332 2372217 2372753 2372761 2372746 2398758 2372399 2372381 2398766 2398774 2398782 2398808 2398790 2398816 2398832 2398857 2398824 2398840 2398865 2398915 2398907 2398899 2398881 2398873 2398956 2398998 2398972 2398949 2398964 2398980 2398931 2398923 2399020 2399046 2399012 2399038 2399004

S IMP SCREW, CORTICAL RE S IMP SCREW, CORTICAL, 4 S IMP SCREW, CORTICAL, 4 S IMP SCREW, CORTICAL, 4 S IMP SCREW, CORTICAL, 4 S IMP SCREW, CRANIAL 4X1. S IMP SCREW, CRANIAL 5X1. S IMP SCREW, CROSS-PIN 1. S IMP SCREW, CROSS-PIN 1. S IMP SCREW, CROSS-PIN 1. S IMP SCREW, CTRSINK 4.5M S IMP SCREW, ED 3.0X30MM S IMP SCREW, EMER 1.4X3MM S IMP SCREW, EMER 1.4X5MM S IMP SCREW, EMER 1.4X7MM S IMP SCREW, EMER 1.4X9MM S IMP SCREW, EMER 1.9X4MM S IMP SCREW, EMER 1.9X5MM S IMP SCREW, EMER HE FIT S IMP SCREW, EMER HEXFIT S IMP SCREW, EMER HEXFIT S IMP SCREW, EMER MF 1.7X S IMP SCREW, EMER SQU 2.3 S IMP SCREW, EMER SQU 2.3 S IMP SCREW, EMER T1 2.4X S IMP SCREW, EMER TI 1.2X S IMP SCREW, EMER TI 1.2X S IMP SCREW, EMER TI 1.2X S IMP SCREW, EMER TI 1.2X S IMP SCREW, EMER TI 1.2X S IMP SCREW, EMER TI 1.7X S IMP SCREW, EMER TI 1.7X S IMP SCREW, EMER TI 1.7X S IMP SCREW, EMER TI 1.7X S IMP SCREW, EMER TI 1.7X S IMP SCREW, EMER TI 2.0X S IMP SCREW, EMER TI 2.0X S IMP SCREW, EMER TI 2.0X S IMP SCREW, EMER TI 2.0X S IMP SCREW, EMER TI 2.0X S IMP SCREW, EMER TI 2.4X S IMP SCREW, EMER TI 2.4X S IMP SCREW, EMER TI 2.4X S IMP SCREW, EMER TI 2.4X S IMP SCREW, EMER TI 2.4X S IMP SCREW, EMER TI 2.4X S IMP SCREW, EMER TI 2.4X S IMP SCREW, EMER TI 2.4X S IMP SCREW, EMER TI 2.7X S IMP SCREW, EMER TI 2.7X S IMP SCREW, EMER TI 2.7X S IMP SCREW, EMER TI 2.7X S IMP SCREW, EMER TI 2.7X

663.00 115.00 115.00 142.00 115.00 417.00 417.00 610.00 610.00 610.00 998.00 954.00 751.00 751.00 751.00 751.00 564.00 528.00 669.00 669.00 669.00 437.00 579.00 579.00 336.00 458.00 458.00 458.00 458.00 458.00 437.00 437.00 437.00 437.00 437.00 339.00 339.00 339.00 339.00 339.00 336.00 336.00 336.00 336.00 336.00 336.00 336.00 336.00 482.00 481.00 482.00 482.00 482.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 177

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2341204 2372787 2372779 2372795 2372803 2372811 2372829 2372837 2372613 2372621 2372647 2372696 2372654 2372662 2372670 2372688 2372639 2372506 2372530 2372514 2372498 2372480 2372472 2372522 2399095 2399087 2399079 2399053 2399061 2399103 2399111 2399129 2340164 2340172 2340180 2352433 2340206 2340198 2340214 2353175 2353167 2353142 2353159 2353183 2399137 2399236 2399244 2399251 2399269 2399277 2399285 2399293 2399301

S IMP SCREW, ENDOBROW BI S IMP SCREW, FACIAL 1.2X1 S IMP SCREW, FACIAL 1.2X1 S IMP SCREW, FACIAL 1.2X3 S IMP SCREW, FACIAL 1.2X4 S IMP SCREW, FACIAL 1.2X5 S IMP SCREW, FACIAL 1.2X6 S IMP SCREW, FACIAL 1.2X8 S IMP SCREW, HEX FIT 2.7X S IMP SCREW, HEX FIT 2.7X S IMP SCREW, HEX FIT 2.7X S IMP SCREW, HEX FIT 2.7X S IMP SCREW, HEX FIT 2.7X S IMP SCREW, HEX FIT 2.7X S IMP SCREW, HEX FIT 2.7X S IMP SCREW, HEX FIT 2.7X S IMP SCREW, HEX FIT 2.7X S IMP SCREW, HEX-FIT 2.3X S IMP SCREW, HEX-FIT 2.3X S IMP SCREW, HEX-FIT 2.3X S IMP SCREW, HEX-FIT 2.3X S IMP SCREW, HEX-FIT 2.3X S IMP SCREW, HEX-FIT 2.3X S IMP SCREW, HEX-FIT 2.3X S IMP SCREW, LAG 12.7MM X S IMP SCREW, LAG 12.7MM X S IMP SCREW, LAG 12.7MM X S IMP SCREW, LAG 12.7MM X S IMP SCREW, LAG 12.7MM X S IMP SCREW, LAG 12.7MMX1 S IMP SCREW, LAG 12.7MMX1 S IMP SCREW, LAG 14MMX110 S IMP SCREW, LEIB 1.2 3 S IMP SCREW, LEIB 1.7 X S IMP SCREW, LEIB 1.7 X S IMP SCREW, LEIB 1.7 X S IMP SCREW, LEIB 2.0 X S IMP SCREW, LEIB 2.0 X S IMP SCREW, LEIB 2.0 X S IMP SCREW, LOCKING 4.5 S IMP SCREW, LOCKING 4.5 S IMP SCREW, LOCKING 4.5 S IMP SCREW, LOCKING 4.5 S IMP SCREW, LOCKING 5.0 S IMP SCREW, LOCKINT TI S S IMP SCREW, LOKG 3.5MM/ S IMP SCREW, LOKG 3.5X90 S IMP SCREW, LOKG 5MM/14 S IMP SCREW, LOKG 5MM/16 S IMP SCREW, LOKG 5MM/18 S IMP SCREW, LOKG 5MM/20 S IMP SCREW, LOKG 5MM/22 S IMP SCREW, LOKG 5MM/24

298.00 674.00 674.00 674.00 674.00 674.00 674.00 674.00 652.00 652.00 652.00 652.00 652.00 652.00 652.00 652.00 652.00 590.00 590.00 590.00 590.00 590.00 590.00 590.00 1363.00 1363.00 1363.00 1363.00 1363.00 1363.00 1363.00 1462.00 175.00 160.00 160.00 175.00 154.00 147.00 154.00 238.00 238.00 238.00 238.00 453.00 821.00 709.00 709.00 709.00 709.00 709.00 709.00 709.00 709.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 178

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2399319 2399327 2399145 2399152 2399160 2399178 2399186 2399194 2399202 2399210 2399228 2399335 2399376 2399384 2399368 2399350 2399343 2398451 2398469 2398477 2398485 2398493 2398501 2399459 2399418 2399400 2399392 2399426 2399434 2399442 2399467 2350494 2350171 2353209 2353191 2399475 2399483 2399509 2399491 2399517 2399533 2399558 2399525 2399541 2399608 2399590 2399582 2399574 2399566 2350197 2351369 2351377 2351559

S IMP SCREW, LOKG 5MM/26 S IMP SCREW, LOKG 5MM/44 S IMP SCREW, LOKG 3.5 S IMP SCREW, LOKG 3.5 S IMP SCREW, LOKG 3.5 S IMP SCREW, LOKG 3.5 36M S IMP SCREW, LOKG 4MM/18M S IMP SCREW, LOKG 4MM/22M S IMP SCREW, LOKG 4MMX14M S IMP SCREW, LOKG 4MMX50 S IMP SCREW, LOKG 80MM X S IMP SCREW, LOKG SLF-TAP S IMP SCREW, LOKG TI 5MMX S IMP SCREW, LOKG TI 5MMX S IMP SCREW, LOKG TI 5MMX S IMP SCREW, LOKG TI 5MMX S IMP SCREW, LOKG TI 5MMX S IMP SCREW, LRG 4.5MMX24 S IMP SCREW, LRG 4.5MMX28 S IMP SCREW, LRG 4.5MMX30 S IMP SCREW, LRG 4.5MMX42 S IMP SCREW, LRG 4.5MMX42 S IMP SCREW, LRG 4.5MMX60 S IMP SCREW, MALLEOLAR 4. S IMP SCREW, MALLEOLAR 4. S IMP SCREW, MALLEOLAR 4. S IMP SCREW, MALLEOLAR 4. S IMP SCREW, MALLEOLAR 4. S IMP SCREW, MALLEOLAR 4. S IMP SCREW, MALLEOLAR 4. S IMP SCREW, MALLEOLAR 4. S IMP SCREW, MALLEOLAR/4 S IMP SCREW, MALLEOLAR/5 S IMP SCREW, MENISCUS AR S IMP SCREW, MENISCUS AR S IMP SCREW, MF 2.0X6MM S IMP SCREW, MINI 1.5MMX S IMP SCREW, MINI 2.7MMX S IMP SCREW, MINI 2.7MMX S IMP SCREW, MINI 2.7MMX S IMP SCREW, ORTHO S CAN S IMP SCREW, ORTHO S CAN S IMP SCREW, ORTHO S CAN S IMP SCREW, ORTHO S CAN S IMP SCREW, ORTHO S CAN S IMP SCREW, ORTHO S CAN S IMP SCREW, ORTHO S CAN S IMP SCREW, ORTHO S CAN S IMP SCREW, ORTHO S CAN S IMP SCREW, ORTHOFIX, C S IMP SCREW, ORTHOFIX, C S IMP SCREW, ORTHOFIX, C S IMP SCREW, OSTEOMED 2

709.00 709.00 594.00 594.00 594.00 594.00 672.00 672.00 672.00 696.00 1252.00 594.00 847.00 847.00 847.00 847.00 847.00 133.00 133.00 133.00 193.00 821.00 193.00 216.00 216.00 216.00 216.00 216.00 216.00 216.00 216.00 92.00 92.00 562.00 562.00 352.00 306.00 319.00 319.00 319.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 1142.00 342.00 342.00 342.00 171.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 179

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2399632 2399624 2399616 2399665 2399657 2399640 2399673 2399681 2399715 2399699 2399707 2399723 2353282 2353274 2353266 2353258 2353241 2399731 2399749 2399772 2399756 2399764 2399780 2399806 2399848 2399814 2399822 2399798 2399830 2399855 2373264 2373207 2373330 2399863 2399871 2399889 2372225 2372027 2371987 2372019 2372001 2371995 2372035 2372043 2372050 2372068 2372233 2372241 2372258 2372266 2372274 2353589 2353597

S IMP SCREW, PEDICLE TI 6 S IMP SCREW, PEDICLE TI 6 S IMP SCREW, PEDICLE TI 6 S IMP SCREW, PEDICLE TI 7 S IMP SCREW, PEDICLE TI 7 S IMP SCREW, PEDICLE TI 7 S IMP SCREW, PEDICLE TI 7 S IMP SCREW, PEDICLE TI 8 S IMP SCREW, PEDICLE TI 8 S IMP SCREW, PEDICLE TI 8 S IMP SCREW, PEDICLE TI 8 S IMP SCREW, SCHANZ TITAN S IMP SCREW, SELF TAPPIN S IMP SCREW, SELF TAPPIN S IMP SCREW, SELF TAPPIN S IMP SCREW, SELF TAPPIN S IMP SCREW, SELF TAPPIN S IMP SCREW, SELF TAPPING S IMP SCREW, SHAFT 3.5 X S IMP SCREW, SHAFT 3.5MM S IMP SCREW, SHAFT 3.5MM S IMP SCREW, SHAFT 3.5MM S IMP SCREW, SHAFT 3.5MM S IMP SCREW, SHAFT 3.5MMX S IMP SCREW, SHAFT 3.5MMX S IMP SCREW, SHAFT 3.5MMX S IMP SCREW, SHAFT 3.5MMX S IMP SCREW, SHAFT 3.5MMX S IMP SCREW, SHAFT 3.5MMX S IMP SCREW, SHZ 4MM/2.5M S IMP SCREW, SIDE OPEN 5. S IMP SCREW, SIDE OPEN 5X S IMP SCREW, SIDE OPEN 5X S IMP SCREW, SIDE-OPEN TI S IMP SCREW, SPNL TI SHZ S IMP SCREW, SPNL TI SO 7 S IMP SCREW, SQUARE 1.7X1 S IMP SCREW, SQUARE 2.0X1 S IMP SCREW, SQUARE 2.0X1 S IMP SCREW, SQUARE 2.0X1 S IMP SCREW, SQUARE 2.0X1 S IMP SCREW, SQUARE 2.0X1 S IMP SCREW, SQUARE 2.0X4 S IMP SCREW, SQUARE 2.0X5 S IMP SCREW, SQUARE 2.0X6 S IMP SCREW, SQUARE 2.0X8 S IMP SCREW, SQUARE FIT 1 S IMP SCREW, SQUARE FIT 1 S IMP SCREW, SQUARE FIT 1 S IMP SCREW, SQUARE FIT 1 S IMP SCREW, SQUARE FIT 1 S IMP SCREW, STAY FUSE M S IMP SCREW, STAY FUSE M

2582.00 2582.00 2582.00 2582.00 2582.00 2582.00 2582.00 2582.00 2582.00 2582.00 2582.00 866.00 199.00 199.00 156.00 156.00 156.00 156.00 143.00 143.00 143.00 143.00 143.00 143.00 143.00 143.00 143.00 143.00 143.00 675.00 1983.00 1828.00 2122.00 2378.00 1217.00 2378.00 528.00 462.00 462.00 462.00 462.00 462.00 462.00 462.00 462.00 462.00 528.00 528.00 528.00 528.00 528.00 465.00 465.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 180

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2353571 2353308 2353316 2353290 2399905 2399897 2399913 2351575 2351567 2399939 2399947 2399954 2399962 2399970 2399996 2399988 2320059 2320042 2320067 2320034 2320026 2351583 2320083 2320075 2353324 2397958 2397388 2397966 2355097 2355147 2355121 2355113 2355071 2355139 2355105 2355089 2355170 2355188 2355162 2355154 2355212 2355196 2355204 2370302 2374783 2378891 2320109 2371029 2369148 2371268 2376515 2374643 2378834

S IMP SCREW, STAY FUSE P S IMP SCREW, SYNTHES 12, S IMP SCREW, SYNTHES 16, S IMP SCREW, SYNTHES, 1. S IMP SCREW, TAP EXPAN HE S IMP SCREW, TAP EXPAN HE S IMP SCREW, TEMPO FIX 3. S IMP SCREW, TENSIONING S IMP SCREW, TENSIONING S IMP SCREW, TI 1.3X5MM S IMP SCREW, TI 1.3X8MM S IMP SCREW, TI 2.4X12MM S IMP SCREW, TI 6.2X40MM S IMP SCREW, TI 6.2X50MM S IMP SCREW, TI SELF TAP S IMP SCREW, TI SELF TAP S IMP SCREW, TI SELF TAP S IMP SCREW, TI SELF TAP S IMP SCREW, TI SELF TAP S IMP SCREW, TI SELF TAP S IMP SCREW, TI SELF TAP S IMP SCREW, TICANNTED 4 S IMP SCREW, TNSN TI 4MMX S IMP SCREW, TNSN TI 4MMX S IMP SCREW, TRANS-FIX I S IMP SCREW,5MM/25MM S IMP SCREW,7.3MM/70MM S IMP SCREW,7.3MMX60MM S IMP SCREW,CANCELLOUS 4 S IMP SCREW,CANCELLOUS 4 S IMP SCREW,CANCELLOUS 4 S IMP SCREW,CANCELLOUS 4 S IMP SCREW,CANCELLOUS 4 S IMP SCREW,CANCELLOUS 4 S IMP SCREW,CANCELLOUS 4 S IMP SCREW,CANCELLOUS 4 S IMP SCREW,CANCELLOUS 6 S IMP SCREW,CANCELLOUS 6 S IMP SCREW,CANCELLOUS 6 S IMP SCREW,CANCELLOUS 6 S IMP SCREW,CORTICAL 4.0 S IMP SCREW,CORTICAL 4.0 S IMP SCREW,CORTICAL 4.0 S IMP SCREWS DISTRACTION S IMP SET GUNTHER TULIP V S IMP SET SCREW VERTEX S IMP SET, 1.6MM BEADED C S IMP SHELL ACETABULAR S IMP SHIP TOE IMPLANT S IMP SHUNT CATH VALVES S IMP SHUNT FLUSHING VALV S IMP SHUNT MULTIPURPOSE S IMP SHUNT PERITONEAL CA

465.00 217.00 80.00 280.00 1345.00 1345.00 435.00 409.00 409.00 417.00 417.00 447.00 2582.00 2582.00 319.00 319.00 352.00 352.00 352.00 352.00 319.00 474.00 860.00 860.00 1508.00 903.00 1124.00 1252.00 112.00 46.00 112.00 112.00 112.00 46.00 112.00 112.00 76.00 99.00 107.00 275.00 263.00 263.00 263.00 1138.00 4298.00 770.00 1836.00 9646.00 854.00 4428.00 1516.00 3840.00 730.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 181

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2320125 2376580 2340925 2341212 2370567 2317154 2312775 2377794 2376143 2357168 2357119 2357135 2357218 2357150 2357176 2357184 2357192 2357200 2357127 2357143 2356558 2356566 2356608 2356541 2356533 2356525 2356517 2356509 2356574 2356590 2356582 2356632 2356616 2356624 2356657 2356681 2356673 2356699 2356665 2356640 2354538 2320133 2320141 2320158 2320166 2320174 2391738 2375285 2356756 2356871 2391746 2340826 2373801

S IMP SHUNT, FLUSHING VAL S IMP SLEEVE CABLE GRIP 1 S IMP STAPES, MCGEE SS PI S IMP STAPES, STORZ ROBIN S IMP STAPLES BONE ALL S IMP STENT BILIARY COTTO S IMP STENT BILIARY COTTO S IMP STENT COTTON LEUNG S IMP STENT GEENEN PANCRE S IMP STENT URETERAL S IMP STENT URETERAL S IMP STENT URETERAL S IMP STENT URETERAL S IMP STENT URETERAL S IMP STENT URETERAL S IMP STENT URETERAL S IMP STENT URETERAL S IMP STENT URETERAL S IMP STENT URETERAL S IMP STENT URETERAL S IMP STENT, URETERAL S IMP STENT, URETERAL S IMP STENT, URETERAL S IMP STENT, URETERAL S IMP STENT, URETERAL S IMP STENT, URETERAL S IMP STENT, URETERAL S IMP STENT, URETERAL S IMP STENT, URETERAL S IMP STENT, URETERAL S IMP STENT, URETERAL S IMP STENT, URETERAL S IMP STENT,INFUSUR INJEC S IMP STENT,INFUSUR INJEC S IMP STENT,URETERAL S IMP STENT,URETERAL S IMP STENT,URETERAL S IMP STENT,URETERAL S IMP STENT,URETERAL S IMP STENT,URETERAL S IMP SUTTER IMPL, LTIP S IMP SWVR CRUCIFORM 1.5M S IMP SWVR CRUCIFORM SLV S IMP SWVR CRUCIFORM W/SL S IMP SWVR EXPAN HEAD 4.0 S IMP SWVR HEXAGONAL 3.9M S IMP SYNC PUMP S IMP T2 25MM LOCKING $ S IMP TESTICULAR PROSTHE S IMP TESTICULAR PROSTHE S IMP TIS EXPA S IMP TORP, TOTAL OSSICUL S IMP TRANCONN/6.0 ROD 24

1512.00 2186.00 80.00 81.00 1033.00 0.00 277.00 278.00 763.00 552.00 443.00 537.00 515.00 456.00 644.00 537.00 537.00 537.00 2107.00 894.00 443.00 443.00 443.00 443.00 443.00 443.00 443.00 293.00 443.00 443.00 443.00 716.00 728.00 728.00 575.00 537.00 537.00 537.00 537.00 716.00 1084.00 2390.00 1497.00 3403.00 1438.00 1176.00 30009.00 667.00 895.00 9833.00 4955.00 1238.00 3840.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 182

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2373876 2373843 2372183 2320182 2353662 2357226 2369023 2354108 2391753 2320190 2320208 2351641 2351658 2350254 2320216 2320224 2320232 2370252 2375855 2320240 2320257 2320265 2320273 2320281 2350312 2346518 2347243 2347227 2347250 2347219 2347201 2347235 2347193 2347185 2347268 2347292 2347284 2347300 2347318 2347326 2347342 2347276 2347359 2347334 2344406 2344588 2344620 2344612 2344604 2344596 2344497 2344463 2344471

S IMP TRANCONN/6.0 ROD 31 S IMP TRANCONN/6.0 ROD 35 S IMP TRANS CONN CLAMP BO S IMP TROCHANTERIC FIXATI S IMP UNOKM NANN 350-1690 S IMP VESSICA,SUTURE A S IMP VNS GENERATOR S IMP VNS LEAD S IMP WASHER 7MM S IMP WASHER, 10MM S IMP WASHER, 6.5MM S IMP WASHER, ARTHROTE S IMP WASHER, ASNIS S IMP WASHER, CANC SCR S IMP WASHER, LG SCREW 13 S IMP WASHER, SPIKED 13.5 S IMP WASHER, SPIKED 8.0X S IMP WASHERS S IMP WIRE K-WIRE 450MM $ S IMP WIRE, 2.0MMN S IMP WIRE, KIRSCHNER 1.6 S IMP WIRE, KIRSCHNER 2.0 S IMP WIRE, KIRSCHNER SPA S IMP, CAP EXTFIX 11MM TU S IMPSCREW, CORTEX, 2.7 S IOL IOL, ALCON MC60CM 9 S IOL IOL, ALCON SA60AT 1 S IOL IOL, ALCON SA60AT 1 S IOL IOL, ALCON SA60AT 1 S IOL IOL, ALCON SA60AT 1 S IOL IOL, ALCON SA60AT 1 S IOL IOL, ALCON SA60AT 1 S IOL IOL, ALCON SA60AT 1 S IOL IOL, ALCON SA60AT 1 S IOL IOL, ALCON SA60AT 1 S IOL IOL, ALCON SA60AT 2 S IOL IOL, ALCON SA60AT 2 S IOL IOL, ALCON SA60AT 2 S IOL IOL, ALCON SA60AT 2 S IOL IOL, ALCON SA60AT 2 S IOL IOL, ALCON SA60AT 2 S IOL IOL, ALCON SA60AT 2 S IOL IOL, ALCON SA60AT 2 S IOL IOL, ALCON SA60AT 2 S IOL IOL, ALLERGAN AR4 S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40,

4299.00 4135.00 1143.00 5137.00 1287.00 2301.00 19801.00 8775.00 173.00 196.00 164.00 1291.00 185.00 44.00 179.00 637.00 642.00 234.00 618.00 229.00 89.00 816.00 251.00 118.00 90.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 183

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2344489 2344448 2344430 2344422 2344455 2344414 2344505 2344513 2344521 2344539 2344547 2344554 2344562 2344570 2347086 2347094 2347078 2347151 2347169 2347177 2347128 2347110 2347367 2347482 2347508 2347631 2347623 2347615 2347607 2347599 2347581 2347573 2347565 2347557 2347540 2347532 2347466 2347516 2347490 2347474 2347458 2347441 2347433 2347425 2347417 2347409 2347391 2347383 2347375 2347524 2344638 2346419 2345460

S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN AR40, S IOL IOL, ALLERGAN OC11N S IOL IOL, ALLERGAN PC11N S IOL IOL, ALLERGAN PC11N S IOL IOL, ALLERGAN SA40N S IOL IOL, ALLERGAN SA40N S IOL IOL, ALLERGAN SA40N S IOL IOL, ALLERGAN, A140 S IOL IOL, ALLERGAN, S130 S IOL IOL, ALLERGAN, SI30 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, ALLERGAN, SI40 S IOL IOL, CHIRON C11UB 2 S IOL IOL, CILCO MA60AC, S IOL IOL, CILCO LX10BD 1

1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 184

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2345684 2345445 2345692 2345452 2345676 2345650 2345635 2345619 2345593 2345577 2345510 2345551 2345536 2345478 2345528 2345486 2345494 2345502 2345767 2345775 2345783 2345700 2345817 2345734 2345825 2345833 2345841 2345858 2345791 2345544 2345759 2345585 2345742 2345601 2345718 2345726 2345569 2345627 2345643 2345668 2346450 2346468 2346476 2346484 2346492 2346500 2346179 2345148 2345221 2345296 2345288 2345270 2345262

S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 1 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 2 S IOL IOL, CILCO LX10BD 3 S IOL IOL, CILCO LX10BD 9 S IOL IOL, CILCO LX10BD 9 S IOL IOL, CILCO MA60BM 1 S IOL IOL, CILCO MA60BM 1 S IOL IOL, CILCO MA60BM 1 S IOL IOL, CILCO MA60BM 2 S IOL IOL, CILCO MA60BM 2 S IOL IOL, CILCO MA60BM 2 S IOL IOL, CILCO, CA30BA, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO,

1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 185

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2345239 2345205 2345197 2345189 2345171 2345213 2345155 2345023 2345130 2345122 2345114 2345106 2345098 2345080 2345072 2345064 2345056 2345049 2345163 2345247 2345320 2345312 2345338 2345346 2345353 2345361 2345379 2345387 2345395 2345304 2346138 2345882 2346096 2346047 2346054 2346062 2346070 2346088 2346104 2346112 2346120 2346039 2346153 2346005 2346146 2345908 2345866 2346021 2345890 2346013 2345916 2345924 2345932

S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CR5BUO, S IOL IOL, CILCO, CZ70BD, S IOL IOL, CILCO, CZ70BD, S IOL IOL, CILCO, CZ70BD, S IOL IOL, CILCO, CZ70BD, S IOL IOL, CILCO, CZ70BD, S IOL IOL, CILCO, CZ70BD, S IOL IOL, CILCO, CZ70BD, S IOL IOL, CILCO, CZ70BD, S IOL IOL, CILCO, CZ70BD, S IOL IOL, CILCO, CZ70BD, S IOL IOL, CILCO, LK90BD, S IOL IOL, CILCO, LX90BD S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD,

1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 456.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 186

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2345957 2345965 2345973 2345981 2345999 2345940 2345874 2346393 2346310 2346328 2346336 2346344 2346351 2346369 2346377 2346385 2346401 2346187 2346302 2346161 2346286 2346278 2346260 2346252 2346245 2346237 2346229 2346211 2346195 2346203 2346294 2346435 2346443 2346427 2346740 2346807 2346583 2346799 2346815 2346781 2346773 2346765 2346757 2346724 2346708 2346690 2346682 2346666 2346641 2346609 2346567 2346732 2346625

S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, LX90BD, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA30BA, S IOL IOL, CILCO, MA60BD S IOL IOL, CILCO, MA60BD, S IOL IOL, CILCO, MA60BD, S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 1

1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 187

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2346716 2346658 2346856 2346823 2346849 2346831 2346534 2346559 2346575 2346591 2346617 2346633 2346674 2346526 2346542 2346864 2346906 2346914 2346898 2346880 2346872 2346922 2346997 2346930 2346948 2346955 2346963 2346989 2347003 2347029 2347052 2347011 2346971 2347045 2347037 2347060 2347144 2347136 2345254 2345031 2345809 2344216 2344323 2343549 2343721 2343739 2343747 2343754 2343762 2343770 2343788 2343481 2343713

S IOL IOL, CILCO, MT4U, 1 S IOL IOL, CILCO, MT4U, 2 S IOL IOL, CILCO, MT4U, 2 S IOL IOL, CILCO, MT4U, 2 S IOL IOL, CILCO, MT4U, 2 S IOL IOL, CILCO, MT4U, 2 S IOL IOL, CILCO, MT4U, 2 S IOL IOL, CILCO, MT4U, 2 S IOL IOL, CILCO, MT4U, 2 S IOL IOL, CILCO, MT4U, 2 S IOL IOL, CILCO, MT4U, 2 S IOL IOL, CILCO, MT4U, 2 S IOL IOL, CILCO, MT4U, 3 S IOL IOL, CILCO, MT4U, 8 S IOL IOL, CILCO, MT4U, 9 S IOL IOL, CILCO, MTA3UO, S IOL IOL, CILCO, MTA4UO, S IOL IOL, CILCO, MTA4UO, S IOL IOL, CILCO, MTA4UO, S IOL IOL, CILCO, MTA4UO, S IOL IOL, CILCO, MTA4UO, S IOL IOL, CILCO, MZ60BD S IOL IOL, CILCO, MZ60BD, S IOL IOL, CILCO, MZ60BD, S IOL IOL, CILCO, MZ60BD, S IOL IOL, CILCO, MZ60BD, S IOL IOL, CILCO, MZ60BD, S IOL IOL, CILCO, MZ60BD, S IOL IOL, CILCO, MZ60BD, S IOL IOL, CILCO, MZ60BD, S IOL IOL, CILCO, MZ60BD, S IOL IOL, CILCO, MZ60BD, S IOL IOL, CILCO, MZ60BD, S IOL IOL, CILCO, MZ60BD, S IOL IOL, CILCO, MZ60BD, S IOL IOL, CILCO, MZ60CD, S IOL IOL, CILCO, SA30AL S IOL IOL, CILCO, SA30AL S IOL IOL, CILCO. CR5BUO, S IOL IOL, CILDO, CR5BUO, S IOL IOL, COLCI LX10BD 2 S IOL IOL, SATRR AQ2010 1 S IOL IOL, STAAR AQ2010 S IOL IOL, STAAR, AA4203 S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203,

1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 188

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2343804 2343796 2343663 2343689 2343697 2343705 2343671 2343655 2343648 2343630 2343622 2343614 2343606 2343598 2343580 2343515 2343572 2343507 2343499 2343523 2343531 2343556 2343564 2343812 2344158 2343887 2343937 2343903 2343853 2343861 2343945 2343895 2343846 2343929 2343838 2343879 2343911 2344117 2343952 2343960 2344034 2344091 2344083 2344075 2344125 2344109 2343978 2344018 2344026 2343994 2344059 2343986 2344067

S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4203, S IOL IOL, STAAR, AA4207 S IOL IOL, STAAR, AQ1016 S IOL IOL, STARR AA4207 1 S IOL IOL, STARR AA4207 1 S IOL IOL, STARR AA4207 1 S IOL IOL, STARR AA4207 1 S IOL IOL, STARR AA4207 1 S IOL IOL, STARR AA4207 1 S IOL IOL, STARR AA4207 1 S IOL IOL, STARR AA4207 1 S IOL IOL, STARR AA4207 1 S IOL IOL, STARR AA4207 1 S IOL IOL, STARR AA4207 1 S IOL IOL, STARR AA4207 1 S IOL IOL, STARR AA4207 2 S IOL IOL, STARR AA4207 2 S IOL IOL, STARR AA4207 2 S IOL IOL, STARR AA4207 2 S IOL IOL, STARR AA4207 2 S IOL IOL, STARR AA4207 2 S IOL IOL, STARR AA4207 2 S IOL IOL, STARR AA4207 2 S IOL IOL, STARR AA4207 2 S IOL IOL, STARR AA4207 2 S IOL IOL, STARR AA4207 2 S IOL IOL, STARR AA4207 2 S IOL IOL, STARR AA4207 2 S IOL IOL, STARR AA4207 2 S IOL IOL, STARR AA4207 2 S IOL IOL, STARR AA4207 2

1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 189

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2344042 2344000 2343820 2344133 2344331 2344356 2344349 2344380 2344174 2344208 2344166 2344257 2344182 2344646 2344653 2344661 2344679 2344687 2344695 2344711 2344737 2344703 2344729 2344810 2344828 2344794 2344869 2344851 2344836 2344802 2344752 2344745 2344844 2344992 2344984 2344877 2345007 2344935 2345015 2344976 2344968 2344950 2344943 2344927 2344919 2344901 2344885 2344778 2344760 2344893 2344786 2344141 2344299

S IOL IOL, STARR AA4207 2 S IOL IOL, STARR AA4207 2 S IOL IOL, STARR AA4207 3 S IOL IOL, STARR AQ1016, S IOL IOL, STARR AQ2010 S IOL IOL, STARR AQ2010 S IOL IOL, STARR AQ2010 S IOL IOL, STARR AQ2010 S IOL IOL, STARR AQ2010 1 S IOL IOL, STARR AQ2010 1 S IOL IOL, STARR AQ2010 2 S IOL IOL, STARR AQ2010, S IOL IOL, STARR AQ2010, S IOL IOL, STARR CC4203 2 S IOL IOL, STARR CC4203 2 S IOL IOL, STARR CC4203 2 S IOL IOL, STARR CC4203 2 S IOL IOL, STARR CC4203 2 S IOL IOL, STARR CC4203 2 S IOL IOL, STARR CC4203 2 S IOL IOL, STARR CC4203 2 S IOL IOL, STARR CC4203 2 S IOL IOL, STARR CC4203 3 S IOL IOL, STARR CC4204 1 S IOL IOL, STARR CC4204 1 S IOL IOL, STARR CC4204 1 S IOL IOL, STARR CC4204 1 S IOL IOL, STARR CC4204 1 S IOL IOL, STARR CC4204 1 S IOL IOL, STARR CC4204 1 S IOL IOL, STARR CC4204 1 S IOL IOL, STARR CC4204 1 S IOL IOL, STARR CC4204 1 S IOL IOL, STARR CC4204 2 S IOL IOL, STARR CC4204 2 S IOL IOL, STARR CC4204 2 S IOL IOL, STARR CC4204 2 S IOL IOL, STARR CC4204 2 S IOL IOL, STARR CC4204 2 S IOL IOL, STARR CC4204 2 S IOL IOL, STARR CC4204 2 S IOL IOL, STARR CC4204 2 S IOL IOL, STARR CC4204 2 S IOL IOL, STARR CC4204 2 S IOL IOL, STARR CC4204 2 S IOL IOL, STARR CC4204 2 S IOL IOL, STARR CC4204 2 S IOL IOL, STARR CC4204 2 S IOL IOL, STARR CC4204 2 S IOL IOL, STARR CC4204 2 S IOL IOL, STARR CC4204 3 S IOL IOL, STARR, AQ1016, S IOL IOL, STARR, AQ201

1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 190

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2344372 2344364 2344315 2344307 2344281 2344240 2344273 2344190 2344224 2344232 2344265 2390375 2320968 2321016 2348985 2371136 2342004 2341998 2377166 2370443 2370435 2348670 2348712 2349702 2349694 2349686 2348688 2348696 2348738 2348746 2370781 2390631 2370799 2371227 2370625 2370617 2377786 2330025 2330033 2330041 2330058 2330009 2330066 2340628 2341410 2348977 2370195 2320018 2320000 2349108 2348563 2349116 2349124

S IOL IOL, STARR, AQ201 S IOL IOL, STARR, AQ201 S IOL IOL, STARR, AQ201 S IOL IOL, STARR, AQ201 S IOL IOL, STARR, AQ201 S IOL IOL, STARR, AQ2010 S IOL IOL, STARR, AQ2010 S IOL IOL, STARR, AQ2010 S IOL IOL, STARR, AQ2010 S IOL IOL, STARR, AQ2010 S IOL IOL, STARR, AQ2010 S IOL LENS S LD PCR LEAD BIPOLAR S LD PCR PACING CABLES S NSTRL ARTHREX, FOAM IN S NSTRL BAG PRESSURE S NSTRL BAIR HUGGER BLANE S NSTRL BAIR HUGGER, BLA S NSTRL CAP PROTECTIVE S NSTRL CAST LOWER EXTREM S NSTRL CAST UPPER EXTREM S NSTRL CAST, LONG ARM C S NSTRL CAST, LONG LEG A S NSTRL CAST, SHOE, LARG S NSTRL CAST, SHOE, MEDI S NSTRL CAST, SHOE, SM S NSTRL CAST, SHORT ARM S NSTRL CAST, SHORT ARM S NSTRL CAST, SHORT LEG S NSTRL CAST, SHORT LEG S NSTRL CILLAR PHILIADEL S NSTRL COLLAR ASPEN S NSTRL COLLAR CERVICAL H S NSTRL COLLAR CERVICAL H S NSTRL COLOSTOMY CLAMP S NSTRL COLOSTOMY POUCH S NSTRL CONTAINER KCI VAC S NSTRL CRY/CUF, ANKLE W S NSTRL CRY/CUF, ELB W/C S NSTRL CRY/CUF,HND/WRST S NSTRL CRY/CUF,KNEE LG S NSTRL CRY/CUF,KNEE MED S NSTRL CRY/CUF,SHLD W/C S NSTRL EAR PROTECTOR, E S NSTRL FILTER, BACTERIA S NSTRL FILTER, VERSA LI S NSTRL HELMET SYSTEM S NSTRL HSE, SEQ COMP, T S NSTRL HSO, TED THIGH L S NSTRL IMMO, KNEE, LARG S NSTRL IMMOB, DON JOY 1 S NSTRL IMMOB, KNEE, MED S NSTRL IMMOB, KNEE, SM

1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 1025.00 3173.00 231.00 211.00 217.00 145.00 117.00 40.00 769.00 478.00 272.00 272.00 54.00 51.00 48.00 196.00 138.00 196.00 138.00 510.00 31.00 611.00 611.00 92.00 100.00 272.00 448.00 448.00 448.00 448.00 448.00 505.00 85.00 11.00 767.00 52.00 317.00 56.00 92.00 555.00 91.00 88.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 191

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2349132 2347953 2347979 2347961 2347672 2354421 2349348 2354983 2354991 2340669 2340677 2341303 2354157 2370773 2349736 2349728 2349710 2349678 2340560 2343275 2354330 2354371 2354355 2354363 2354348 2354389 2354397 2349355 2370526 2370583 2370344 2349454 2370336 2347656 2347680 2348092 2348100 2347664 2349496 2349504 2349488 2349462 2349447 2349629 2354405 2340776 2340784 2340792 2349587 2349595 2349579 2349611 2349546

S NSTRL IMMOB, KNEE, X-L S NSTRL IMMOB, SHOULDER, S NSTRL IMMOB, SHOULDER, S NSTRL IMMOB, SHOULDER, S NSTRL IMMOB, SHOULDER, S NSTRL KIT, EDINTRAK NE S NSTRL KIT, SHOULDER SU S NSTRL K-WIRE .045, UNS S NSTRL K-WIRE .062, UNS S NSTRL LASER, ANGLED DE S NSTRL LASER, FIBER BAR S NSTRL PAD, K-THERMIA 2 S NSTRL POST-OP SHOE (ZI S NSTRL RESUSCITATOR/AMBU S NSTRL ROLL, PLASTER FS NSTRL ROLL, PLASTER FS NSTRL ROLL, PLASTER FS NSTRL ROLL, PLASTER FS NSTRL S NSTRL BAND, UN S NSTRL SHIELD, EYE, MET S NSTRL SHOE, CAST, MEDI S NSTRL SHOE, POST-OP WO S NSTRL SHOE, POST-OP, M S NSTRL SHOE, POST-OP, M S NSTRL SHOE, POST-OP, M S NSTRL SHOE, POST-OP, W S NSTRL SHOE, POST-OP, W S NSTRL SKIN-TRAC, MEDIU S NSTRL SPLINT ARM/LEG S NSTRL SPLINT FIBERGLASS S NSTRL SPLINT KNEE UNIVE S NSTRL SPLINT ROLL, PLA S NSTRL SPLINT WRIST S NSTRL SPLINT, ALUMAFOA S NSTRL SPLINT, FINGER S NSTRL SPLINT, FINGER 3 S NSTRL SPLINT, FINGER 4 S NSTRL SPLINT, KNEE S NSTRL SPLINT, ORTHO-GL S NSTRL SPLINT, ORTHO-GL S NSTRL SPLINT, ORTHO-GL S NSTRL SPLINT, SHORT AR S NSTRL SPLINT, WRIST S NSTRL SPLNT ORTHO-GLAS S NSTRL SPLNT, "PRO-MOTI S NSTRL SPLNT, NAS, BYRO S NSTRL SPLNT, NAS, BYRO S NSTRL SPLNT, NAS, BYRO S NSTRL SPLNT, OCL SUPER S NSTRL SPLNT, OCL SUPER S NSTRL SPLNT, OCL SUPER S NSTRL SPLNT, ORTHO-GLA S NSTRL SPLNT, PLASTER F

93.00 66.00 69.00 69.00 62.00 499.00 280.00 36.00 35.00 1124.00 817.00 108.00 47.00 493.00 166.00 127.00 88.00 71.00 79.00 8.00 51.00 65.00 65.00 65.00 65.00 65.00 65.00 39.00 854.00 1310.00 467.00 88.00 238.00 2620.00 30.00 28.00 28.00 299.00 3.00 5.00 3.00 158.00 165.00 194.00 1115.00 81.00 99.00 81.00 429.00 528.00 381.00 170.00 79.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 192

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2349538 2349561 2349553 2349520 2349512 2349603 2348076 2348035 2348068 2348050 2348043 2348084 2340347 2349413 2349652 2349660 2349645 2349637 2370575 2348993 2349009 2355469 2370872 2370880 2390490 2312825 2390508 2368066 2368074 2368082 2351005 2350999 2311009 2341931 2341949 2371144 2355881 2340552 2368991 2348829 2368777 2368785 2369262 2341956 2349090 2312684 2312700 2371169 2341378 2356749 2355915 2355923 2312668

S NSTRL SPLNT, PLASTER F S NSTRL SPLNT, PLASTER F S NSTRL SPLNT, PLASTER F S NSTRL SPLNT, PLASTER F S NSTRL SPLNT, SHORT LEG S NSTRL SPLNT, SHORT LEG S NSTRL SPLNT, WRIST, CO S NSTRL SPLNT, WRIST, CO S NSTRL SPLNT, WRIST, CO S NSTRL SPLNT, WRIST, CO S NSTRL SPLNT, WRIST, CO S NSTRL SPLNT, WRIST, CO S NSTRL STACKHOUSE REDUCE S NSTRL SUCTION, PUDDLE S NSTRL TAPE, FIBERGLASS S NSTRL TAPE, FIBERGLASS S NSTRL TAPE, FIBERGLASS S NSTRL TAPE, FIBERGLASS S NSTRL TRACTION SKIN FAS S NSTRL TRAP, FINGER ART S NSTRL TRAP, FINGER LIN S NSTRL VISE,TORQUE 730S STRL 10/11 M NON BLADED S STRL 10/11 M STABILITY S STRL 14.5 X 23CM HEMO S STRL 20 FR G-TUBE S STRL 5FR KUMPE ANGL S STRL ABC HANDPIECE LAP S STRL ABC HANDPIECE LAP S STRL ABC HANDPIECE LAP S STRL ACUMED, DRILL BIT S STRL ACUMED, GUIDE WIR S STRL ADAPTER, S STRL ADAPTER, BETA-CAP S STRL ADAPTER, BETA-CAP S STRL ADAPTOR STRAIGHT C S STRL ADAPTOR,UROLOCK M S STRL AIRWAY SPLNT, DOY S STRL ANCHOR BIOKNOTLESS S STRL ANCHOR, DRILL BIT S STRL ANESTHESIA GENERAL S STRL ANESTHESIA REGIONA S STRL ARCH BARS S STRL ARTERIAL LINE SU S STRL ARTHREX, HAND PAD S STRL AUTOTOME CANN 20MM S STRL AUTOTOME CANNU 30M S STRL BAG BLOOD TRANSFER S STRL BAG, IRRIGATION P S STRL BAG,URIMETER S STRL BAG,URINARY DRNAG S STRL BAG,URINARY,LEG,M S STRL BALL DILA FW CRE 1

8.00 183.00 131.00 5.00 201.00 170.00 83.00 83.00 83.00 83.00 83.00 83.00 18.00 145.00 47.00 26.00 42.00 24.00 76.00 145.00 76.00 43.00 657.00 512.00 1442.00 667.00 161.00 581.00 561.00 581.00 212.00 243.00 44.00 21.00 31.00 198.00 113.00 27.00 846.00 354.00 1039.00 698.00 147.00 64.00 121.00 1644.00 1644.00 227.00 73.00 74.00 35.00 27.00 1297.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 193

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2312718 2312767 2312759 2312742 2312734 2312726 2312791 2390417 2390425 2390391 2390409 2390441 2390433 2390458 2390466 2312643 2390383 2369544 2379683 2311199 2311207 2356061 2356079 2356053 2356046 2356087 2356095 2360881 2311215 2355584 2370542 2370328 2371243 2370492 2378248 2370484 2366466 2365781 2365773 2348506 2340578 2366045 2348464 2348431 2348456 2348449 2348472 2348480 2348514 2348522 2348530 2348548 2365807

S STRL BALL DILA WG CRE 1 S STRL BALL DILA WG CRE 1 S STRL BALL DILA WG CRE 1 S STRL BALL DILA WG CRE 1 S STRL BALL DILA WG CRE 1 S STRL BALL DILA WG CRE 1 S STRL BALL ESO/PLY/COL S STRL BALL HELI 11X85MM S STRL BALL HELI 11X95MM S STRL BALL HELICAL 11MMX S STRL BALL HELICAL 11MMX S STRL BALL SAW 15 X 7MM S STRL BALL SAW GIGLI S STRL BALL SAW STE 35MM S STRL BALL SPRL TI 75MM S STRL BALL TRIPLE-LUMEN S STRL BALL UROMAX ULTRA S STRL BALLOON ESOPHAGEAL S STRL BASKET WIREGUIDED S STRL BASKET, EXTRACTI S STRL BASKET, LITHOTRA S STRL BASKET,BAGLEY 3 W S STRL BASKET,GEMINI 330 S STRL BASKET,SEGURA 4 W S STRL BASKET,SEGURA 4 W S STRL BASKET,SEGURA 6 W S STRL BASKET,STONE HELI S STRL BENZION TINCTURE S STRL BIOPSY, FORCEPS S STRL BIOPSY,MONOPTY BA S STRL BLADE BEAVER S STRL BLADE CASPAR OSC S STRL BLADE CRANIOTOME S STRL BLADE LAMINECTOMY S STRL BLADE ROUTER S STRL BLADE SAW ALL S STRL BLADE, AGEE CARPAL S STRL BLADE, ALCON 57 S STRL BLADE, ALCON 66 S STRL BLADE, ARHT RAZOR S STRL BLADE, ARMSTRONG S STRL BLADE, ARTH BUR BA S STRL BLADE, ARTH INCIS S STRL BLADE, ARTH INCIS S STRL BLADE, ARTH INCIS S STRL BLADE, ARTH INCIS S STRL BLADE, ARTH INCIS S STRL BLADE, ARTH INCIS S STRL BLADE, ARTH RAZOR S STRL BLADE, ARTH STONE S STRL BLADE, ARTH SYNOV S STRL BLADE, ARTH SYNOV S STRL BLADE, ARTH. ABRAD

1447.00 1447.00 1447.00 1447.00 1447.00 1447.00 1365.00 2181.00 2181.00 2181.00 2181.00 176.00 183.00 88.00 2356.00 1060.00 1325.00 1125.00 1563.00 460.00 1534.00 852.00 757.00 716.00 838.00 822.00 885.00 9.00 428.00 180.00 314.00 3026.00 584.00 1889.00 627.00 517.00 221.00 113.00 110.00 298.00 81.00 263.00 358.00 298.00 358.00 451.00 298.00 453.00 298.00 298.00 298.00 336.00 344.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 194

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2365799 2365815 2365823 2366011 2366029 2365989 2365906 2365914 2365922 2365948 2366052 2365856 2365898 2366037 2365849 2365872 2366482 2365880 2365864 2365831 2366219 2365930 2365955 2365971 2365997 2366003 2366102 2366094 2366110 2366474 2340586 2366060 2366086 2366441 2366458 2366151 2366169 2366144 2366193 2366185 2366201 2348415 2348423 2348407 2347813 2347649 2347706 2365716 2366268 2365732 2366334 2366326 2366276

S STRL BLADE, ARTH. ABRAD S STRL BLADE, ARTH. ACROM S STRL BLADE, ARTH. ACROM S STRL BLADE, ARTH. BUR B S STRL BLADE, ARTH. BUR E S STRL BLADE, ARTH. BUR S S STRL BLADE, ARTH. CUTTE S STRL BLADE, ARTH. CUTTE S STRL BLADE, ARTH. CUTTE S STRL BLADE, ARTH. CUTTE S STRL BLADE, ARTH. CUTTE S STRL BLADE, ARTH. CUTTE S STRL BLADE, ARTH. CUTTE S STRL BLADE, ARTH. CUTTE S STRL BLADE, ARTH. FULL S STRL BLADE, ARTH. FULL S STRL BLADE, ARTH. FULL S STRL BLADE, ARTH. FULL S STRL BLADE, ARTH. FULL S STRL BLADE, ARTH. INCIS S STRL BLADE, ARTH. RAZOR S STRL BLADE, ARTH. RAZOR S STRL BLADE, ARTH. RAZOR S STRL BLADE, ARTH. SYNOV S STRL BLADE, ARTH. TURBO S STRL BLADE, ARTH. TURBO S STRL BLADE, BEAVER 5220 S STRL BLADE, BEAVER 6400 S STRL BLADE, BEAVER 6700 S STRL BLADE, BEAVER 6900 S STRL BLADE, BEAVER EAR S STRL BLADE, BEAVER EYE S STRL BLADE, BEAVERGUARD S STRL BLADE, DEPRESSOR T S STRL BLADE, DEPRESSOR T S STRL BLADE, DERMATOME B S STRL BLADE, DERMATONE S S STRL BLADE, EDINTRAK NE S STRL BLADE, ENDOTRAC HO S STRL BLADE, ENDOTRAC SY S STRL BLADE, ENDOTRAC TR S STRL BLADE, GRAFT KNIF S STRL BLADE, GRAFT KNIF S STRL BLADE, GRAFT KNIF S STRL BLADE, MICRO AVER S STRL BLADE, MICROAIRE S STRL BLADE, MICROAIRE S STRL BLADE, SAGITAL SAW S STRL BLADE, SAW SAGITTA S STRL BLADE, SAW, OSCILL S STRL BLADE, SAW, OSCILL S STRL BLADE, SAW, OSCILL S STRL BLADE, SAW, OSCILL

298.00 448.00 358.00 263.00 263.00 263.00 263.00 263.00 219.00 263.00 263.00 314.00 263.00 270.00 314.00 314.00 298.00 314.00 314.00 358.00 379.00 390.00 376.00 453.00 352.00 298.00 85.00 13.00 20.00 51.00 113.00 88.00 112.00 3.00 8.00 61.00 127.00 482.00 236.00 484.00 236.00 171.00 298.00 298.00 127.00 798.00 2196.00 63.00 71.00 69.00 31.00 134.00 63.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 195

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2366284 2366292 2366300 2366227 2366318 2366250 2366235 2366243 2366375 2366383 2366342 2366359 2366367 2340263 2365724 2366409 2366417 2366425 2366433 2366391 2365963 2320315 2341782 2355378 2355972 2355980 2356152 2356004 2356012 2355360 2355352 2355964 2355998 2341360 2311025 2311017 2311033 2311041 2311058 2311074 2311082 2311066 2311108 2311116 2311124 2311132 2311140 2311157 2311173 2311165 2341352 2311181 2341246

S STRL BLADE, SAW, OSCILL S STRL BLADE, SAW, OSCILL S STRL BLADE, SAW, OSCILL S STRL BLADE, SAW, RECIPR S STRL BLADE, SAW, SAGGIT S STRL BLADE, SAW, SAGITT S STRL BLADE, SAW, SAGITT S STRL BLADE, SAW, SAGITT S STRL BLADE, SINUS, 3.5M S STRL BLADE, SINUS, 3.5M S STRL BLADE, SINUS, 4.0M S STRL BLADE, SINUS, 4.0M S STRL BLADE, SINUS, 4.0M S STRL BLADE, SINUS, XOM S STRL BLADE, SRG EYE STE S STRL BLADE, SRG, #11 ST S STRL BLADE, SRG, #12 ST S STRL BLADE, SRG, #15 ST S STRL BLADE, SRG, #20 ST S STRL BLADE, SRG. #10, S S STRL BLAE, ARTH. CUTTER S STRL BLE ARTH 4.0 END S STRL BLLN, PREPERITONE S STRL BLLN,ACUCISE RP-3 S STRL BLLN,DILATATION C S STRL BLLN,URETERAL PAS S STRL BLLN,URO MAX II P S STRL BLLN,UROMAX 8-4 2 S STRL BLLN,UROMAX 9-8 2 S STRL BLLN,UROMAX CATH S STRL BLLN,UROMAX CATH S STRL BLLN,UROMAX ULTRA S STRL BLLN,UROMAX ULTRA S STRL BLLS, EXTRA VIEW S STRL BLN, BILLARY DIL S STRL BLN, BLN 11.5 OR S STRL BLN, COLON CRE 1 S STRL BLN, COLON CRE 8 S STRL BLN, DILATION 15 S STRL BLN, ESOPH CRE 1 S STRL BLN, ESOPH CRE 1 S STRL BLN, ESOPH CRE 5 S STRL BLN, ESOPH CRE 6 S STRL BLN, ESOPH CRE 8 S STRL BLN, EXTRACTOR 3 S STRL BLN, EXTRACTOR 3 S STRL BLN, EXTRACTOR 3 S STRL BLN, GASTRO TB 6 S STRL BLN, RETRIEVAL 2 S STRL BLN, RETRIEVAL 4 S STRL BLN, SPACEMAKER I S STRL BLN, STONETOME 3 S STRL BOVIE SCRATCH PAD

60.00 61.00 71.00 78.00 116.00 71.00 69.00 69.00 1037.00 448.00 448.00 448.00 372.00 439.00 88.00 9.00 11.00 9.00 9.00 9.00 263.00 519.00 691.00 2891.00 1153.00 1064.00 971.00 770.00 770.00 919.00 919.00 1253.00 1253.00 533.00 1037.00 536.00 961.00 961.00 1070.00 907.00 907.00 874.00 907.00 907.00 381.00 629.00 383.00 293.00 589.00 536.00 1176.00 1207.00 7.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 196

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2311223 2377216 2366508 2366490 2366532 2366524 2366540 2370476 2390474 2311322 2311330 2311272 2311314 2311280 2311298 2311306 2378776 2348589 2348605 2348571 2348662 2348613 2348621 2348597 2348647 2348704 2348654 2348639 2311363 2311348 2311355 2311371 2311389 2311397 2311405 2320323 2320331 2390482 2351088 2351096 2341063 2371177 2349165 2347698 2378743 2370674 2368835 2368967 2368843 2369155 2369122 2371557 2371128

S STRL BRSUH, COMBO CAT S STRL BRUSH INTRAMED CEM S STRL BUR, DIAMOND ROUND S STRL BUR, EGG SHAPE, 4. S STRL BUR, LONG ROUND 5. S STRL BUR, ROUND CUTTING S STRL BUR, SHANNON HP 44 S STRL BURRS ALL S STRL BUTT CERCL 4.5MM S STRL BUTTON, GASTRO 2 S STRL BUTTON, GASTRO 2 S STRL BUTTON, GASTRO 2 S STRL BUTTON, GASTRO 2 S STRL BUTTON, GASTRO 2 S STRL BUTTON, GASTRO 2 S STRL BUTTON, GASTRO 2 S STRL CANAL PRESSURIZER S STRL CANN, ACUFEX 22MM S STRL CANN, ACUFEX 38MM S STRL CANN, ACUFEX 8MM S STRL CANN, ACUFEX UNIV S STRL CANN, ACUFEX UNIV S STRL CANN, ACUFEX UNIV S STRL CANN, ACUFEX UNIV S STRL CANN, CLEAR, ARTH S STRL CANN, SHOULDER, T S STRL CANN, TIBIAL TUNN S STRL CANNSET, ARTHROSC S STRL CANNULA, CANNULA S STRL CANNULA, CANNULA S STRL CANNULA, CANNULA S STRL CANNULA, ERCP FL S STRL CANNULA, ERCP TR S STRL CANNULA, ULTRA T S STRL CANNULA, XL RAPI S STRL CAP 10 REDUCER S STRL CAP 5 REDUCER S STRL CAP ENDO S STRL CAP, END 0MM S STRL CAP, END 15MM S STRL CAPCEL/C SHEEHY P S STRL CARDIOTOMY FILTERD S STRL CARPAL TUNNEL KIT S STRL CAST SHOE S STRL CATH CATH PASSER M S STRL CATH FINLAYSON S STRL CATH HICKMAN DOUBL S STRL CATH INTRADISCAL C S STRL CATH MARHURKAR QUI S STRL CATH MEDTRONIC IND S STRL CATH MEDTRONIC PAS S STRL CATH PERITONEAL W/ S STRL CATH RADIAL ARTERY

553.00 110.00 203.00 96.00 174.00 152.00 76.00 660.00 1713.00 769.00 769.00 769.00 769.00 769.00 524.00 769.00 704.00 100.00 97.00 121.00 83.00 97.00 97.00 97.00 249.00 249.00 149.00 116.00 814.00 283.00 467.00 75.00 994.00 258.00 342.00 111.00 111.00 78.00 435.00 435.00 1115.00 974.00 664.00 81.00 710.00 1636.00 1248.00 2304.00 539.00 2510.00 545.00 1066.00 271.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 197

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2368140 2341915 2341923 2311413 2366987 2366995 2366979 2354066 2354058 2342210 2367282 2367183 2367027 2367035 2367043 2367050 2367175 2367068 2367092 2367084 2367126 2367118 2367100 2367142 2367134 2367159 2367019 2368157 2367167 2311421 2367191 2341790 2367233 2367241 2367258 2367266 2367274 2367225 2311439 2342525 2366763 2354116 2311447 2367324 2367332 2366946 2367316 2367290 2367308 2356145 2357622 2355931 2355949

S STRL CATH, BONNANO W/NE S STRL CATH, CLOSURE 6FR S STRL CATH, CLOSURE 8FR S STRL CATH, COMBO CATH S STRL CATH, COUDE 20FR S STRL CATH, COUDE 22FR S STRL CATH, COUDE, 18FR S STRL CATH, DENVER PLEU S STRL CATH, DENVER PLEU S STRL CATH, DUOCATH S STRL CATH, FOLEY SILICO S STRL CATH, FOLEY WITH U S STRL CATH, FOLEY, 10FR S STRL CATH, FOLEY, 12FR S STRL CATH, FOLEY, 14FR S STRL CATH, FOLEY, 16FR S STRL CATH, FOLEY, 18FR S STRL CATH, FOLEY, 18FR S STRL CATH, FOLEY, 20FR S STRL CATH, FOLEY, 20FR S STRL CATH, FOLEY, 22FR S STRL CATH, FOLEY, 22FR, S STRL CATH, FOLEY, 22FR, S STRL CATH, FOLEY, 24FR S STRL CATH, FOLEY, 24FR S STRL CATH, FOLEY, 28FR, S STRL CATH, FOLEY, 8FR 3 S STRL CATH, G.I.F.T.-R57 S STRL CATH, GROSHONG 9.5 S STRL CATH, LEHMAN WIR S STRL CATH, MALECOT 20FR S STRL CATH, MEDCOMP ASP S STRL CATH, ROB-NEL, 10F S STRL CATH, ROB-NEL, 12F S STRL CATH, ROB-NEL, 14F S STRL CATH, ROB-NEL, 16F S STRL CATH, ROB-NEL, 18F S STRL CATH, ROB-NEL, 8FR S STRL CATH, TAPERTOME S STRL CATH, TAUT S STRL CATH, THORACIC 20F S STRL CATH, THORACIC 40 S STRL CATH, UNIVERSAL S STRL CATH, URETHRAL CON S STRL CATH, URETHRAL CON S STRL CATH, URETHRAL DUA S STRL CATH, URETHRAL FLE S STRL CATH, URETHRAL OPE S STRL CATH, URETHRAL OPE S STRL CATH,ACUCISE WITH S STRL CATH,ASH SPLIT-CA S STRL CATH,BLLN DILATOR S STRL CATH,BLLN URO MAX

447.00 1122.00 1122.00 501.00 74.00 66.00 71.00 1021.00 1842.00 122.00 57.00 74.00 44.00 73.00 38.00 38.00 80.00 35.00 76.00 35.00 52.00 40.00 34.00 57.00 80.00 40.00 65.00 120.00 1431.00 558.00 165.00 1633.00 8.00 8.00 8.00 8.00 8.00 8.00 654.00 81.00 100.00 43.00 266.00 57.00 57.00 261.00 57.00 81.00 47.00 2319.00 1615.00 789.00 1178.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 198

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2355956 2356293 2357598 2357580 2357606 2357614 2356194 2356202 2356210 2356228 2356178 2356160 2356186 2357515 2356244 2357630 2356251 2356277 2356236 2356285 2356269 2370062 2348761 2348753 2390565 2390557 2379709 2379824 2390599 2390573 2390581 2390607 2390623 2390615 2320349 2370369 2341394 2342640 2342665 2342657 2342673 2371151 2371540 2371193 2342137 2342145 2311462 2355386 2367571 2367589 2343317 2368827 2342152

S STRL CATH,BLLN URO MAX S STRL CATH,COUNCIL TIP S STRL CATH,EMBOLECTOMY S STRL CATH,EMBOLECTOMY S STRL CATH,EMBOLECTOMY S STRL CATH,EMBOLECTOMY S STRL CATH,FOLEY SILICO S STRL CATH,FOLEY SILICO S STRL CATH,FOLEY SILICO S STRL CATH,FOLEY SILICO S STRL CATH,FOLEY SILICO S STRL CATH,FOLEY SILICO S STRL CATH,FOLEY SILICO S STRL CATH,OPTI-FLOW OF S STRL CATH,SUPRAPUBIC 1 S STRL CATH,TENCHKOFF S STRL CATH,URETERAL FLE S STRL CATH,URETERAL FLE S STRL CATH,URETERAL MEA S STRL CATH,URETERAL OPE S STRL CATH,URETERAL WHI S STRL CELL SAVER COMPL S STRL CEMENT MIXING SYS S STRL CEMENT, BONE RAD S STRL CLAMP 10 HOLE PIN S STRL CLAMP 5 HOLE PIN S STRL CLAMP ADJUSTABLE E S STRL CLAMP EXTERNAL FIX S STRL CLAMP LG OP ADJT S STRL CLAMP LG PIN 4 S STRL CLAMP LG PIN 6 S STRL CLAMP ROD/ROD S STRL CLAMP TRANSV S STRL CLAMP TUBE/TUBE S STRL CLIP DYNAM S STRL CLIP RANEY S STRL CLIP, HEMO LOCK 5 S STRL CLIP, WECK-LG S STRL CLIP, WECK-MED S STRL CLIP, WECK-MED/LG S STRL CLIP, WECK-SM S STRL COL ANTICOAG PHOS S STRL CONNECTOR STRAIGHT S STRL CONNECTORS PERFUSI S STRL CORD, BIPOLAR BOV S STRL CORD, DISP, FOR B S STRL CORD, ENDOSCOPIC S STRL CORD,ACTIVE,DISPO S STRL CORE BIOPSY SYST S STRL CORE BIOPSY SYST S STRL CORNEAL PROTECTOR S STRL CORNEAL SHIELD SUR S STRL COUNTER, NDL, MAG

1153.00 90.00 182.00 147.00 272.00 219.00 43.00 61.00 20.00 30.00 90.00 90.00 46.00 1269.00 270.00 1126.00 66.00 66.00 534.00 57.00 55.00 933.00 402.00 339.00 2584.00 1491.00 1605.00 2574.00 2147.00 2539.00 2713.00 1785.00 2452.00 2452.00 602.00 147.00 97.00 52.00 35.00 43.00 35.00 335.00 273.00 154.00 30.00 30.00 30.00 113.00 265.00 273.00 481.00 108.00 26.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 199

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2371300 2311470 2340610 2358612 2311488 2356368 2370591 2341386 2342293 2340305 2390649 2320372 2320380 2320398 2320406 2377752 2377992 2378313 2376200 2376226 2320414 2320422 2320430 2320448 2320455 2320463 2320489 2320471 2320497 2320505 2320513 2320521 2320539 2320547 2320554 2320562 2320570 2320661 2320679 2320588 2320612 2320646 2320596 2320604 2320620 2320638 2376135 2379097 2375863 2378271 2320653 2320687 2376234

S STRL CRANIO PLASTIC 1 U S STRL DASH, HOWELL DIR S STRL DCR SET (STRAIGHT S STRL DERMABOND DB-12 S STRL DEVICE, LOCKING S STRL DEVICE,TRANSFER 1 S STRL DIFFUSER MIDAS REX S STRL DRESSING, BIOBRAN S STRL DRESSING, EPISEAL S STRL DRESSING, NAS SIN S STRL DRI NEU 3 X 3.8MM S STRL DRILL 1.1MM S STRL DRILL 13MM BIT S STRL DRILL 2.0MM BIT S STRL DRILL 2.4MM BIT S STRL DRILL 2.8MM S STRL DRILL 3.2 X 125MM S STRL DRILL 3.2 X 30MM B S STRL DRILL 4.2 X 340MM S STRL DRILL 5.0 X 230MM S STRL DRILL BIT .070X3 S STRL DRILL BIT .76X5 S STRL DRILL BIT 1.1X110 S STRL DRILL BIT 1.1X12 S STRL DRILL BIT 1.1X6 S STRL DRILL BIT 1.1X8 S STRL DRILL BIT 1.5 S STRL DRILL BIT 1.5 S STRL DRILL BIT 1.5X110 S STRL DRILL BIT 1.5X12 S STRL DRILL BIT 1.5X4 S STRL DRILL BIT 1.5X6 S STRL DRILL BIT 1.5X8 S STRL DRILL BIT 1.8X80 S STRL DRILL BIT 1X4 S STRL DRILL BIT 1X6 S STRL DRILL BIT 1X8 S STRL DRILL BIT 2.4X100 S STRL DRILL BIT 2.4X125 S STRL DRILL BIT 2.5 S STRL DRILL BIT 3.2 S STRL DRILL BIT 3.2 S STRL DRILL BIT 3.2 S STRL DRILL BIT 3.5 S STRL DRILL BIT 310.44 S STRL DRILL BIT 4.5 S STRL DRILL BIT 5.0 X 18 S STRL DRILL BIT GAMMA 5. S STRL DRILL BIT QUICK RE S STRL DRILL BONE DRILL . S STRL DRILL J-LATCH 1.5 S STRL DRILL J-LATCH 2 S STRL DRILL NEURO TAPER

2451.00 791.00 243.00 133.00 265.00 13.00 87.00 371.00 64.00 293.00 937.00 552.00 1509.00 397.00 685.00 246.00 358.00 605.00 908.00 908.00 685.00 685.00 685.00 685.00 685.00 685.00 357.00 408.00 685.00 685.00 685.00 685.00 685.00 384.00 685.00 685.00 685.00 685.00 685.00 587.00 392.00 1055.00 702.00 587.00 392.00 583.00 730.00 908.00 618.00 583.00 371.00 371.00 937.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 200

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2376408 2376218 2376192 2320364 2371250 2347862 2347847 2348852 2348845 2348837 2347748 2347730 2349405 2342160 2342319 2366821 2366805 2366797 2366813 2342327 2342335 2366839 2342178 2342194 2342186 2342343 2342202 2366888 2366862 2366870 2366854 2348811 2366789 2366847 2348779 2348787 2348803 2348795 2370740 2356319 2356301 2369064 2369015 2369056 2390656 2320695 2320703 2390664 2343291 2348878 2342012 2340636 2340644

S STRL DRILL STERILE PINS S STRL DRILL STRYKER 4.2 S STRL DRILL STRYKER 4.2X S STRL DRILL TIP 2.5MM S STRL DRILL WIRE PASS S STRL DRILL, ARTHROTEK S STRL DRILL, BIOMET 3.6 S STRL DRILL, BOLD 1190S STRL DRILL, BOLD 12MM S STRL DRILL, BOLD 18MM S STRL DRILL, DRILL BIT S STRL DRILL, DRILL BIT S STRL DRILL, STAY FUSE S STRL DRN, 19G BUTTERFL S STRL DRN, BLAKE 10MM F S STRL DRN, BLAKE 7MM FLA S STRL DRN, HEMOVAC 15FR S STRL DRN, HEMOVAC SILIC S STRL DRN, HYSTERECTOMY S STRL DRN, J-VAC 10FR R S STRL DRN, J-VAC 10FR R S STRL DRN, J-VAC 10MM FL S STRL DRN, J-VAC 15FR 3 S STRL DRN, J-VAC 15FR 3 S STRL DRN, J-VAC 19FR 3 S STRL DRN, J-VAC 300CC S STRL DRN, J-VAC 7MM 3/ S STRL DRN, PENROSE, 1" * S STRL DRN, PENROSE, 1/2" S STRL DRN, PENROSE, 1/4" S STRL DRN, SNYDER 100CC S STRL DRN, TLS DRN SYST S STRL DRN, UNIT, CHEST,P S STRL DRN, WOUND, J-VAC S STRL DRS COMPRESSION DR S STRL DRS COMPRESSION DR S STRL DRS COMPRESSION DR S STRL DRS COMPRESSION DR S STRL EEA CURVED S STRL ELASTIC STAY,DULL S STRL ELASTIC STAY,SHAR S STRL ELE CUTTING LOOP 2 S STRL ELE ORATEC PROBE B S STRL ELE PISCES SCREENE S STRL ELEC ABC HAND S STRL ELEC ABC HANDCON S STRL ELEC BOVIE EXT MED S STRL ELEC HAR SCAL S STRL ELECT, ACCU-TEMP S STRL ELECT, ACROMIOPLA S STRL ELECT, BOVIE EXTE S STRL ELECT, EMG S STRL ELECT, EMG FACIAL

1345.00 908.00 908.00 373.00 662.00 165.00 221.00 363.00 392.00 392.00 200.00 200.00 326.00 12.00 87.00 87.00 152.00 55.00 134.00 215.00 170.00 172.00 156.00 155.00 155.00 107.00 191.00 25.00 25.00 8.00 83.00 154.00 376.00 74.00 448.00 448.00 448.00 505.00 3648.00 31.00 31.00 445.00 660.00 3469.00 372.00 433.00 96.00 1694.00 69.00 291.00 51.00 372.00 309.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 201

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2343168 2341980 2343309 2341899 2342228 2342384 2348910 2347888 2347870 2342046 2342020 2340685 2340693 2342038 2348928 2348951 2348902 2348894 2348944 2348936 2342053 2342061 2342079 2342087 2354413 2340594 2342095 2341402 2342103 2348969 2356129 2355451 2356335 2356343 2311504 2368165 2368173 2368272 2368256 2368249 2368264 2368314 2368322 2368348 2368330 2368181 2368355 2311496 2368199 2311512 2368447 2367639 2367621

S STRL ELECT, EYE STERIL S STRL ELECT, IS SENSOR S STRL ELECT, I-STAT (EY S STRL ELECT, KNIFE ULTR S STRL ELECT, L HOOK S STRL ELECT, MED. EZ AN S STRL ELECT, MENISCECTO S STRL ELECT, MENISCECTO S STRL ELECT, MENISCECTO S STRL ELECT, NDL PENCIL S STRL ELECT, NDL TIP S STRL ELECT, NDL TIP CO S STRL ELECT, NDL TIP CO S STRL ELECT, NDL TIP EX S STRL ELECT, ORASTAT SH S STRL ELECT, ORATEC ABL S STRL ELECT, ORATEC LIG S STRL ELECT, ORATEC LIG S STRL ELECT, ORATEC TAC S STRL ELECT, ORATEC TAC S STRL ELECT, PENCIL BIP S STRL ELECT, PENCIL FOO S STRL ELECT, PENCIL HAN S STRL ELECT, PENCIL HAN S STRL ELECT, STRATUM " S STRL ELECT, SUCTION W/ S STRL ELECT, TEFLON TIP S STRL ELECT, TIP E1475X S STRL ELECT, TIPOLISHER S STRL ELECT, TURBOVAC 9 S STRL ELECT,BIOPSY,TIGE S STRL ELECT,FORCEP HOT S STRL ELECT,KNIFE 28FR S STRL ELECT,LITHOTRIPTO S STRL ELECTROBE, INJ G S STRL ELECTRODE, CUTTING S STRL ELECTRODE, CUTTING S STRL ELECTRODE, ENDOPAT S STRL ELECTRODE, ENDOPAT S STRL ELECTRODE, ENDOPAT S STRL ELECTRODE, ENDOPAT S STRL ELECTRODE, EVEREST S STRL ELECTRODE, EVEREST S STRL ELECTRODE, EVEREST S STRL ELECTRODE, EVEREST S STRL ELECTRODE, EVEREST S STRL ELECTRODE, EVERSHE S STRL ELECTRODE, FLUOR S STRL ELECTRODE, ROLLER S STRL ELECTRODE, ULTRA S STRL ELECTRODE, ULTRACI S STRL ENDO CATCH, DISPOS S STRL ENDO GRASP 5MM DIS

57.00 79.00 53.00 1393.00 379.00 237.00 81.00 291.00 291.00 7.00 12.00 261.00 174.00 15.00 324.00 511.00 534.00 534.00 1508.00 997.00 38.00 26.00 67.00 27.00 56.00 65.00 56.00 34.00 9.00 675.00 435.00 435.00 384.00 591.00 1255.00 445.00 798.00 348.00 515.00 348.00 178.00 1364.00 583.00 1389.00 1389.00 369.00 689.00 745.00 602.00 894.00 1648.00 507.00 562.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 202

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2342236 2368280 2342244 2368298 2342368 2342285 2342277 2368306 2342269 2368231 2368223 2368215 2368207 2367647 2340297 2340289 2340651 2377182 2366664 2355857 2369312 2371334 2351104 2355402 2369304 2311520 2355428 2390672 2351674 2351757 2351864 2351963 2351948 2351856 2351823 2351815 2351807 2351955 2351799 2351781 2351831 2351773 2351930 2351765 2351922 2351914 2351906 2351898 2351880 2351872 2351971 2351989 2351997

S STRL ENDO KITNER S STRL ENDO, 1 SEAL S STRL ENDO, EITHICON RT S STRL ENDO, ENDOPATH RED S STRL ENDO, LAP/CHOLE K S STRL ENDO, MIMI RETRAC S STRL ENDO, RETRACT S STRL ENDO, SHEARS 5MM S STRL ENDO,ENDOPATH PRB S STRL ENDOCLIP, ENDOCLIP S STRL ENDOCLIP, ENDOCLIP S STRL ENDOCLIP, ENDOCLIP S STRL ENDOCLIP, ENDOCLIP S STRL ENDO-CLOSE, DISPOS S STRL ENDO-SCRUB SHEATH S STRL ENDO-SCRUB SHEATH S STRL ENDO-SCRUB SHEATH S STRL ETHIBOND 2-0 V-7 3 S STRL EVACUATOR, HEMOVAC S STRL EVACUATOR,UROVAC S STRL EVACYATION EXTENSI S STRL EXT VENT DRAINAGE S STRL EXTRACTOR SCREW 7 S STRL EXTRACTOR,STONE,R S STRL FILTER PREFILTER E S STRL FILTER, APC ENDO S STRL FILTER,UROLOGICAL S STRL FIXATOR ADJ S STRL FIXATOR, AGEE-WR S STRL FIXATOR, EBI DYO S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, ORTHOFI S STRL FIXATOR, POLARUS S STRL FIXATOR, POLARUS S STRL FIXATOR, POLARUS

153.00 57.00 855.00 136.00 2540.00 948.00 426.00 491.00 174.00 472.00 728.00 535.00 517.00 216.00 147.00 147.00 147.00 53.00 62.00 654.00 40.00 416.00 811.00 902.00 53.00 55.00 1.00 5437.00 3260.00 3729.00 342.00 1263.00 317.00 1038.00 237.00 237.00 613.00 317.00 1665.00 18.00 211.00 3723.00 1216.00 2046.00 1411.00 342.00 1902.00 1411.00 71.00 285.00 362.00 243.00 1883.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 203

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2351112 2341428 2341436 2379196 2379295 2311546 2311538 2356103 2356111 2356376 2311553 2311561 2356392 2356384 2311579 2376630 2369338 2369320 2370765 2377869 2311587 2311595 2356400 2356426 2356483 2356491 2355477 2355519 2356418 2356434 2355485 2370690 2349041 2352029 2349025 2349033 2366920 2366938 2347904 2352086 2376291 2390698 2390680 2354223 2347920 2368439 2390706 2377596 2377661 2390714 2390722 2390730 2377836

S STRL FIXATOR, STRYKER S STRL FLUID WARM SET, H S STRL FLUID WARM SET, L S STRL FORCEP GRASPING FO S STRL FORCEP GRASPING FO S STRL FORCEP, BIOPSY, S STRL FORCEP, BIOPSY, S STRL FORCEP,BIOPSY,HOT S STRL FORCEP,BIOPSY,PIR S STRL FORCEP,TRICEP MIN S STRL FORCEPS, BIOPSY, S STRL FORCEPS, NDL BX, S STRL FORCEPS,STONE RET S STRL FORCEPS,STONE RET S STRL GASTRO REPLACEME S STRL GEL PORT S STRL GELFOAM 100 ABSORA S STRL GELFOAM 12-7MM ABS S STRL GIA MULTI FIRE INS S STRL GLIDEWIRE .025 X 1 S STRL GLIDEWIRE, ERCP S STRL GLIDEWIRE, GLIDE S STRL GLIDEWIRE,ANGLED S STRL GLIDEWIRE,LT 46-3 S STRL GLIDEWIRE,PTFE .0 S STRL GLIDEWIRE,PTFE .0 S STRL GLIDEWIRE,STRAIGH S STRL GLIDEWIRE,STRAIGH S STRL GLIDEWIRE,STRAIGH S STRL GLIDEWIRE,STRAIGH S STRL GLIDEWIRE,STRAIGH S STRL GOOT RET BLADE -D S STRL GRAFT, ACHILLIS T S STRL GRAFT, COLLAGRAFT S STRL GRAFT, ILLIAC CRE S STRL GRAFT, PATELLAR T S STRL GROSHONG CATH, DOU S STRL GROSHONG CATH, SIN S STRL GUIDE BIOMET GUID S STRL GUIDE PIN, MINI L S STRL GUIDE ROD BALL TIP S STRL GUIDE WIRE 2.0MM S STRL GUIDE WIRE 3.2MM S STRL GUIDE WIRE, ACUTR S STRL GUIDE, BIOMET NAI S STRL GUIDE,TRANSVAGINAL S STRL GUIDES DRILL 2MM S STRL GUIDEWIRE 1.1 X 15 S STRL GUIDEWIRE 1.1 X 15 S STRL GUIDEWIRE 1.25MM S STRL GUIDEWIRE 1.6MM S STRL GUIDEWIRE 2.5MM S STRL GUIDEWIRE 2.8MM

1701.00 103.00 206.00 1027.00 1109.00 166.00 117.00 409.00 409.00 817.00 166.00 363.00 716.00 696.00 793.00 2376.00 91.00 25.00 2833.00 316.00 591.00 352.00 215.00 211.00 110.00 83.00 324.00 199.00 187.00 184.00 199.00 1869.00 3316.00 1008.00 1287.00 3401.00 1245.00 948.00 291.00 105.00 973.00 261.00 5094.00 26.00 263.00 120.00 1206.00 191.00 206.00 127.00 209.00 303.00 298.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 204

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2357507 2375897 2378966 2311603 2312783 2375905 2379170 2376283 2311611 2311629 2311637 2347714 2311645 2311652 2351633 2311660 2355907 2355493 2347938 2390516 2343119 2343192 2371284 2376341 2376382 2376333 2378842 2375814 2341477 2341485 2356459 2355535 2341279 2341261 2357655 2357523 2390771 2355543 2367431 2366607 2354249 2354165 2368793 2374262 2378008 2379568 2377919 2377828 2377984 2320950 2371052 2341501 2341519

S STRL GUIDEWIRE AMPLATZ S STRL GUIDEWIRE BULLET T S STRL GUIDEWIRE GAMMA DR S STRL GUIDEWIRE P.E.G. S STRL GUIDEWIRE ROADRUNN S STRL GUIDEWIRE SMOOTH G S STRL GUIDEWIRE SMOOTH T S STRL GUIDEWIRE STRYKER S STRL GUIDEWIRE, ANGLE S STRL GUIDEWIRE, GEENE S STRL GUIDEWIRE, IGUAN S STRL GUIDEWIRE, INTRAF S STRL GUIDEWIRE, JAGTA S STRL GUIDEWIRE, JAGWI S STRL GUIDEWIRE, THREAD S STRL GUIDEWIRE, ZEBRA S STRL GUIDEWIRE,AMPLATZ S STRL GUIDEWIRE,STRAIGH S STRL HANDIPIECE, SURGI S STRL HEMO 14.5 X 19CM S STRL HULKA CLIPS, WOLFE S STRL I & A KIT S STRL ICP/IVMCS MONIT S STRL IMPLANT EX FIXATOR S STRL IMPLANT EX FIXATOR S STRL IMPLANT EX FIXATOR S STRL IMPLANT INTERNAL S STRL IMPLANT X-FIX EXTE S STRL INSERT, BABCOCK 5 S STRL INSERT, GRIP INSE S STRL INSERTER, DILAMEZ S STRL INTERSTITUAL RADIO S STRL INTRO SET FOR CAT S STRL INTRO, SET FOR CA S STRL INTRO,CATHETER 9F S STRL INTRO,PACING LEAD S STRL INTROD PERITO SH S STRL IRRGATION,BULB PA S STRL IRRIG. PHYSIOSOL S STRL JACKSON PRATT SU S STRL K, WIRE TITANIUM S STRL KIRSCHNER WIRE S STRL KIT ANESTHESIA LTA S STRL KIT ANEUROPLASTIC S STRL KIT CENTRAL VENOUS S STRL KIT CRAINAL ACCESS S STRL KIT DRESSING KCI L S STRL KIT DRESSING KCI M S STRL KIT DRESSING VAC F S STRL KIT NOVASURE S STRL KIT STAPLEOSCOPY C S STRL KIT, ARTERIAL LIN S STRL KIT, ARTLINE VESS

254.00 653.00 836.00 584.00 760.00 674.00 974.00 973.00 612.00 854.00 358.00 133.00 2001.00 1105.00 171.00 394.00 201.00 230.00 212.00 1442.00 154.00 418.00 1536.00 1127.00 1327.00 1127.00 737.00 522.00 199.00 261.00 116.00 3917.00 54.00 54.00 276.00 290.00 226.00 221.00 16.00 30.00 215.00 63.00 30.00 2864.00 373.00 1491.00 346.00 288.00 365.00 3970.00 4388.00 153.00 675.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 205

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2341493 2347821 2347839 2367357 2367340 2341311 2311678 2368454 2353621 2353613 2311686 2347946 2366623 2349181 2354124 2342442 2342350 2311694 2311710 2311702 2311728 2311736 2353548 2348399 2355345 2356970 2357671 2355527 2356475 2355550 2357531 2355394 2371185 2371201 2349140 2349173 2379675 2370658 2390789 2365765 2366573 2366599 2366565 2365740 2311744 2343325 2366581 2349199 2354256 2354264 2354975 2354231 2354967

S STRL KIT, BLOOD GAS SA S STRL KIT, CARTILAGE BI S STRL KIT, CARTILAGE ES S STRL KIT, CATHETER CENT S STRL KIT, CATHETER, CEN S STRL KIT, ENDO CHOLE/L S STRL KIT, ENDOSCOPIC S STRL KIT, ENDOSCOPIC LA S STRL KIT, FILL FOR TIS S STRL KIT, FILL FOR TIS S STRL KIT, GASTRO GAST S STRL KIT, GRAFT HARVES S STRL KIT, HEMOVAC MIN S STRL KIT, KNEE POSITI S STRL KIT, NCP PATIENT S STRL KIT, NRV ROOT BLO S STRL KIT, ORIGIN, LAPA S STRL KIT, PERCUTANEOU S STRL KIT, SPEED BAND S STRL KIT, SPEED BAND S STRL KIT, STENT INTRO S STRL KIT, SUPERVIEW 4 S STRL KIT, TRANSFIX II S STRL KIT, TRANSTIBIAL S STRL KIT,ACCUCISE B100 S STRL KIT,ACESSORY TRUE S STRL KIT,ENDO SUTURING S STRL KIT,IN-FAST 78352 S STRL KIT,PERI-PATCH RE S STRL KIT,RECOVERY SEE S STRL KIT,REPAIR FOR HI S STRL KIT,TRANSDUCER CO S STRL KITCELLSAVER RESV S STRL KITCELLSAVER SUCT S STRL KNIFE ACL GRAFT S S STRL KNIFE ACL GRAFT S S STRL KNIFE BAYONETTE ME S STRL KNIFE ELECTRODE (A S STRL KNIFE ULTRA XL S STRL KNIFE, ACL GRAFT ( S STRL KNIFE, ALCON 15 80 S STRL KNIFE, ALCON 2.75 S STRL KNIFE, ALCON 3.0MM S STRL KNIFE, MICRO EYE M S STRL KNIFE, MICROKNIF S STRL KNIFE, SLIT I-KNI S STRL KNIFE, STORZ 22.5 S STRL KNOT, PUSHER, FIN S STRL K-WIRE .045, STE S STRL K-WIRE .062, STE S STRL K-WIRE, .035 S STRL K-WIRE, .035 S STRL K-WIRE, .045 THR

9.00 2025.00 426.00 349.00 136.00 1594.00 75.00 3443.00 483.00 317.00 330.00 400.00 266.00 119.00 293.00 79.00 2512.00 1163.00 1636.00 573.00 326.00 1176.00 1075.00 1216.00 1592.00 1145.00 1590.00 1189.00 272.00 220.00 264.00 61.00 1796.00 475.00 260.00 275.00 1517.00 1072.00 1111.00 275.00 75.00 67.00 67.00 38.00 501.00 67.00 75.00 742.00 63.00 63.00 53.00 53.00 54.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 206

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2352144 2354439 2351179 2367712 2368710 2368728 2356442 2370732 2354132 2357473 2343218 2390797 2376499 2390805 2311769 2311777 2311785 2341527 2357549 2357556 2357648 2367704 2390524 2367670 2368462 2375319 2340339 2377141 2342947 2369239 2369221 2371219 2370807 2368470 2379667 2367605 2342426 2311801 2355618 2355592 2355600 2341618 2343259 2341725 2341717 2341691 2341683 2341675 2341667 2341709 2341659 2341295 2341642

S STRL K-WIRE, BOLD 115 S STRL K-WIRE, STERILE S STRL K-WIRE, TITANIUM S STRL LAPAROSCOPIC MYOMA S STRL LASER ARGON LASER S STRL LASER YAG KASER RM S STRL LASER,CATHETER FI S STRL LDS POWERED S STRL LEAD, INTRO SET, S STRL LEAD,PERVENOUS IN S STRL LENS GLIDE (SHTS S STRL LIGHT DISP 6CM S STRL LIGHT DISPOSABLE 4 S STRL LIGHTMAT ILLUMIN S STRL LITHOTRIPTER, CA S STRL LITHOTRIPTER, SI S STRL LITHOTRIPTOR, HA S STRL LOOP, VESSEL, SM S STRL LOOP,VESSEL REGUL S STRL LOOP,VESSEL,SM RE S STRL M.R.I.DUAL IMPLED S STRL MAGNETIC RETRIEVER S STRL MALECOT 22FR S STRL MANIPUJECTOR, KRON S STRL MANIPULATOR, UTERI S STRL MASTISOL VIAL 3CC S STRL MCGEE LOOP PISTON S STRL MESH STAPLE LINE R S STRL MESH, ABSORBABLE I S STRL MESHGRAFT DERMA CA S STRL MESHGRAFT DERMA CA S STRL MICROFILTER BLOOD S STRL MIDAS REY DISS TOO S STRL MINIPORT, 2MM 1713 S STRL MONOLITH LITHOTRIP S STRL MULTIFIRE ENDO GIA S STRL MULTIFIRE, ENDO H S STRL NDL BIOPSY, SOFT S STRL NDL KIT,PERIURETH S STRL NDL KIT,TRANS S STRL NDL KIT,TRANS 101 S STRL NDL MAYO 1/2" TAP S STRL NDL, ANTERIOR CHA S STRL NDL, BIOPSY 6" X S STRL NDL, DAVIS TONSIL S STRL NDL, FERG 1/2", 1 S STRL NDL, FERG 1/2", 1 S STRL NDL, FERG 1/2", 1 S STRL NDL, FERG 1/2", 1 S STRL NDL, FERG 1/2", 1 S STRL NDL, FISTULA 1/2' S STRL NDL, FISTULA 1/2" S STRL NDL, FISTULA 1/2"

88.00 54.00 37.00 330.00 138.00 138.00 1021.00 2190.00 263.00 263.00 25.00 1290.00 1466.00 618.00 330.00 1626.00 773.00 12.00 11.00 12.00 2636.00 403.00 107.00 185.00 285.00 31.00 319.00 1072.00 579.00 127.00 127.00 252.00 1588.00 336.00 1512.00 1847.00 1003.00 301.00 167.00 113.00 131.00 13.00 18.00 103.00 22.00 18.00 16.00 17.00 16.00 15.00 17.00 15.00 15.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 207

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2341287 2311827 2311819 2342434 2343333 2341741 2341733 2343200 2343242 2341626 2341634 2341592 2341576 2341584 2341600 2311843 2311835 2343267 2343234 2311868 2311850 2341550 2341543 2341568 2341535 2343283 2355220 2356350 2355642 2355626 2368868 2312817 2368850 2368884 2368892 2368900 2368918 2368876 2368926 2368512 2368504 2368488 2368496 2368389 2367688 2368397 2368520 2370815 2340545 2368546 2368942 2368934 2368959

S STRL NDL, FISTULA 1/2" S STRL NDL, INJ THERAPY S STRL NDL, INJ THERAPY S STRL NDL, INTRO 183109 S STRL NDL, IRRIGATING C S STRL NDL, JAMSHIDI DIS S STRL NDL, JAMSHIDI ILL S STRL NDL, -JHSAPED HYD S STRL NDL, J-SHAPED HYD S STRL NDL, KEITH ABDOMI S STRL NDL, KEITH ABDOMI S STRL NDL, MAYO 1/2" TA S STRL NDL, MAYO 1/2" TA S STRL NDL, MAYO 1/2" TA S STRL NDL, MAYO 1/2" TA S STRL NDL, MENGHINI SO S STRL NDL, MENGHINI SO S STRL NDL, RETROBULBAR, S STRL NDL, RETROBULBAR, S STRL NDL, SCLEROTHERA S STRL NDL, SCLEROTHERA S STRL NDL, SRG 3/8", 18 S STRL NDL, SRG 3/8", 18 S STRL NDL, SRG 3/8", 18 S STRL NDL, STEALTH BIOP S STRL NDL, TERRY SQUEEG S STRL NDL,BX OF PROSTAT S STRL NDL,FASCIAL INCIS S STRL NDL,TRANSPERINEAL S STRL NDL,WILLIAMS TRAN S STRL NEEDLE ASO ECHOTIP S STRL NEEDLE INJ THER S STRL NEEDLE JAMSHIDI DI S STRL NEEDLE SPINAL DISP S STRL NEEDLE SPINAL DISP S STRL NEEDLE SPINAL DISP S STRL NEEDLE SPINAL DISP S STRL NEEDLE WHITACRE 25 S STRL NEEDLE WHITACRE 25 S STRL NEEDLE, ASP., ECHO S STRL NEEDLE, ASPIR.12GS STRL NEEDLE, GIFT-NORFO S STRL NEEDLE, GIFT-TROCA S STRL NEEDLE, VERRES 120 S STRL NEEDLE, VERRES 150 S STRL NEEDLE, VERRES 150 S STRL NEEDLE, VERRES STE S STRL NON-BLADED TROCAR S STRL NRV LOCATOR, SRG S STRL OVERTUBE, ENDOSCOP S STRL PACKING STRIP IODO S STRL PACKING STRIP IODO S STRL PACKING STRIP IODO

17.00 262.00 262.00 88.00 18.00 196.00 92.00 42.00 42.00 13.00 13.00 15.00 13.00 13.00 13.00 80.00 80.00 66.00 66.00 225.00 251.00 13.00 18.00 17.00 1820.00 42.00 100.00 9.00 110.00 92.00 309.00 249.00 240.00 36.00 36.00 36.00 36.00 44.00 53.00 309.00 389.00 262.00 311.00 108.00 212.00 108.00 155.00 793.00 204.00 62.00 30.00 30.00 36.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 208

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2341766 2341758 2370823 2311876 2311884 2311892 2311900 2311918 2311926 2343341 2343358 2343184 2375764 2349066 2349074 2349082 2378180 2371565 2352185 2352193 2351211 2352219 2352201 2349256 2348860 2352227 2352235 2347995 2350726 2350734 2351229 2348001 2351260 2352177 2350684 2349058 2349264 2349272 2349231 2349223 2349280 2355014 2351245 2350692 2350700 2350718 2350767 2349249 2350759 2340313 2340321 2370278 2370450

S STRL PATIL EMER CRICOT S STRL PATIL EMER RISCOT S STRL PEDUCER CAP S STRL PEG FEEDING TB 1 S STRL PEG FEEDING TB 2 S STRL PEG FEEDING TB 2 S STRL PEG GASTROS KIT, S STRL PEG, FEEDING TB S STRL PEG, PEG 20FR IN S STRL PHACO, PEA PACK A S STRL PHACO, PEA PACK M S STRL PHACOEMULSIFICATI S STRL PHARMASEAL S STRL PIN GUARD FOR .03 S STRL PIN GUARD FOR .04 S STRL PIN GUARD FOR .06 S STRL PIN HALF 5 X 150MM S STRL PIN SKULL STERILE S STRL PIN, ARTHREX ORT S STRL PIN, ARTHREX REG S STRL PIN, ASNIS GUIDE S STRL PIN, BUTTRESS 1. S STRL PIN, BUTTRESS 1. S STRL PIN, CLLRED, ARTH S STRL PIN, EBI ADJ JAC S STRL PIN, EBI BONE SC S STRL PIN, EBI BONE SC S STRL PIN, EXT FIX HOF S STRL PIN, EXT FIX HOF S STRL PIN, EXT FIX HOF S STRL PIN, EXT FIX HOF S STRL PIN, EXT FIX HOF S STRL PIN, EXT FIX HOF S STRL PIN, EXT FIX HOF S STRL PIN, EXT FIX, HO S STRL PIN, GUARD FOR 1/ S STRL PIN, GUIDE ARTHRE S STRL PIN, GUIDE, ARTHR S STRL PIN, GUIDE, ARTHR S STRL PIN, GUIDE, ARTHR S STRL PIN, GUIDE, ARTHR S STRL PIN, K-WIRE 1.1, S STRL PIN, NITINAL GUI S STRL PIN, RUSH 3/16 X S STRL PIN, RUSH 3/16 X S STRL PIN, STEINMANN 3 S STRL PIN, STEINMANN 7 S STRL PIN, SUTURE GUIDE S STRL PIN, THREADED 2. S STRL PKING, NAS RHINO S STRL PKING, NAS, MERO S STRL PLAST SM FRAG SET S STRL POINTS DRILL

69.00 15.00 118.00 187.00 187.00 187.00 544.00 125.00 520.00 264.00 291.00 69.00 252.00 22.00 22.00 15.00 513.00 624.00 265.00 265.00 88.00 161.00 161.00 476.00 120.00 397.00 397.00 687.00 204.00 204.00 827.00 145.00 221.00 204.00 193.00 18.00 243.00 212.00 265.00 265.00 276.00 35.00 297.00 231.00 217.00 28.00 17.00 418.00 136.00 63.00 42.00 878.00 694.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 209

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2378032 2367381 2367373 2370757 2340727 2352375 2340735 2340743 2340719 2357499 2355634 2357663 2371276 2390813 2321164 2311934 2367696 2311942 2357069 2357077 2357036 2349363 2355329 2376622 2374528 2370856 2370831 2321180 2321172 2376507 2356038 2311967 2311975 2390839 2311983 2355253 2390847 2390912 2390920 2390854 2390938 2378172 2390862 2390870 2390888 2390896 2379329 2379337 2379311 2379386 2379378 2379469 2390904

S STRL PORT SEAL S STRL PORTACATH, TITANIU S STRL PORTACATH, TITANIU S STRL POTICULATOR 30/55 S STRL PRB, EAR, ACCULIT S STRL PRB, ELECTRO THER S STRL PRB, FACIAL STIM S STRL PRB, PRASS MONOPO S STRL PRB, STIM 85-2510 S STRL PRB,CORONARY PARS S STRL PRB,ELECTROHYDRAU S STRL PRB,PARSONETTE 00 S STRL PREFORATOR CRANIO S STRL PRO STR BTIP S STRL PROBE DOP S STRL PROBE, APC FLEXI S STRL PROBE, CORSON DISP S STRL PROBE, LITHOTRIP S STRL PROSTHESIS,ACCESS S STRL PROSTHESIS,AMS PRE S STRL PROSTHESIS,PENILE S STRL PUMP, PAINBUSTER S STRL PUMP,SINGLE ACTIO S STRL RADIANCE ILLUMINAT S STRL RAIL LONG MINI S STRL RELOAD R458B 45CM S STRL RELOAD TR35W 35MM S STRL RET 10MM ENDO S STRL RET MINI ENDO S STRL RETRACTOR DISPOSAB S STRL RETRIEVAL FORCEP S STRL RETRIEVAL NET, 3 S STRL RETRIEVAL NET, R S STRL RETRIEVER SUT S STRL RETRIEVER, MINI S STRL RETRIEVER,STONE W S STRL ROD 11 X 450MM S STRL ROD 11MMX500MM S STRL ROD 11X550MM S STRL ROD 3.0 X 950MM S STRL ROD 350MM S STRL ROD 8 X 150MM CARB S STRL ROD 8 X 200MM S STRL ROD 8 X 240MM S STRL ROD 8 X 350MM S STRL ROD 8 X 400MM S STRL ROD CARBON FIBER 1 S STRL ROD CARBON FIBER 1 S STRL ROD CARBON FIBER 2 S STRL ROD CARBON FIBER 2 S STRL ROD CARBON FIBER 3 S STRL ROD CARBON FIBER 4 S STRL ROD LG CLAMP

437.00 1865.00 1244.00 3489.00 1151.00 1372.00 409.00 410.00 362.00 330.00 591.00 330.00 2133.00 1444.00 908.00 3536.00 472.00 1342.00 381.00 1940.00 701.00 613.00 273.00 2533.00 3515.00 1312.00 1146.00 701.00 585.00 1466.00 1743.00 224.00 219.00 99.00 639.00 583.00 1297.00 1246.00 1351.00 681.00 1193.00 488.00 603.00 796.00 571.00 653.00 1131.00 1131.00 1131.00 1147.00 1127.00 1247.00 1672.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 210

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2355683 2340412 2361921 2312510 2369270 2354314 2368975 2321388 2311991 2340750 2340768 2347854 2312007 2366730 2354074 2343226 2354082 2355444 2355436 2355725 2357572 2347722 2349330 2390946 2390953 2320117 2357267 2342459 2390961 2370245 2353696 2369080 2369569 2379741 2369551 2340354 2312023 2312031 2312049 2312056 2312080 2312072 2312064 2312098 2390532 2312676 2312650 2368819 2368801 2340271 2340404 2340396 2340362

S STRL RX DEVICE,SIMPLE S STRL S STRL SPLNT, NAS S STRL S STRL SUTURE,SURG S STRL S STRL TB, GASTRO S STRL SCREW COR INSTRTEK S STRL SCREW, HERBERT ABS S STRL SEPRA FILM BIOESOR S STRL SET TRANSFER SYS S STRL SET, BILIARY STE S STRL SET, CRAW LACRIMA S STRL SET, CRAW LACRIMA S STRL SET, DRILL AND PI S STRL SET, FEEDING, 24 S STRL SET, FLUID WARM S STRL SET, LIFE FORT IN S STRL SET, MONOCANALICU S STRL SET, THORACENTESI S STRL SET,IRRIGATION F S STRL SET,IRRIGATION F S STRL SET,PROSTATE STA S STRL SET,VASCULAR DILA S STRL SHEATH, INTRAFIX S STRL SHIELD, SPLASH, S S STRL SHUNT PASSER S STRL SHUNT PASSER S STRL SHUNT, 17-10FR JAV S STRL SHUNT,DENVER S STRL SIGMOIDOSCOPE SPE S STRL SILICONE SLE S STRL SIMPULSE IRIG W/TI S STRL SIZER, BREAST IMP S STRL SMOKE EVACUATION A S STRL SNARE PAPILLOTOME S STRL SNARE POLYPECTOMY S STRL SNARE POLYPECTOMY S STRL SNARE WIRE, #8 S STRL SNARE, MINI OVAL S STRL SNARE, OVAL MICR S STRL SNARE, PAPILLOTO S STRL SNARE, PAPILLOTO S STRL SNARE, POLYPECTO S STRL SNARE, POLYPECTO S STRL SNARE, POLYPECTO S STRL SNARE, SOFT WIRE S STRL SOEHE UNIVE S STRL SPHINCOTOME, CANNU S STRL SPHINOCOTOME TAPER S STRL SPLINT NASAL EXTER S STRL SPLINT NASAL INT S S STRL SPLNT, NAS DOYLE S STRL SPLNT, NAS, ACCUF S STRL SPLNT, NAS, ACCUF S STRL SPLNT, NAS, SILAC

403.00 76.00 48.00 1073.00 455.00 680.00 465.00 169.00 317.00 383.00 916.00 204.00 31.00 103.00 291.00 317.00 31.00 247.00 175.00 736.00 270.00 515.00 57.00 567.00 360.00 603.00 1655.00 18.00 243.00 667.00 237.00 71.00 473.00 1869.00 2124.00 8.00 1372.00 597.00 381.00 381.00 1712.00 1712.00 297.00 91.00 429.00 1322.00 1136.00 15.00 94.00 244.00 12.00 12.00 233.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 211

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2340222 2340388 2340370 2340800 2340446 2340453 2341444 2390979 2342467 2342475 2368553 2369072 2390995 2391001 2391019 2342517 2367738 2367662 2349397 2390987 2350148 2350130 2350155 2353563 2353555 2364917 2365013 2365005 2364990 2350114 2350098 2350106 2350080 2364909 2349371 2358521 2358737 2358687 2358752 2358505 2370849 2378024 2367613 2368561 2367746 2367720 2356327 2369536 2369346 2312130 2312114 2312122 2312148

S STRL SPLNT, NAS, SILAS S STRL SPLNT, NAS, SILAS S STRL SPLNT, NAS, SILAS S STRL SPNG, EAR WICK, P S STRL SPNG, GELFOAM, 12 S STRL SPNG, GELFOAM, SI S STRL SPNG, HELISTAT 16 S STRL SPO FEM WICK S STRL SPRING-GRIP 5-11M S STRL SPRING-GRIP 5-12M S STRL SPRING-GRIP 5MM (# S STRL STACKHOUSE VACUM T S STRL STAP GIA RE80/3.8 S STRL STAP PI 55 4.8 S STRL STAP PI-30 3.5 S STRL STAPLE GUN, TACKE S STRL STAPLE LOAD UNIT S STRL STAPLE LOAD UNIT S STRL STAPLE SURETAC WI S STRL STAPLE TI 8MM S STRL STAPLE, 3M, SPIKE S STRL STAPLE, 3M, SPIKE S STRL STAPLE, 3M, SPIKE S STRL STAPLE, ARTHREX 6 S STRL STAPLE, ARTHREX 8 S STRL STAPLE, LOAD UNIT S STRL STAPLE, RELOADING S STRL STAPLE, RELOADING S STRL STAPLE, RELOADING S STRL STAPLE, RICHARD F S STRL STAPLE, RICHARD F S STRL STAPLE, RICHARD F S STRL STAPLE, RICHARD FI S STRL STAPLE, SPIKED LEG S STRL STAPLE, SPIKED LI S STRL STAPLE,LOAD UNIT S STRL STAPLE,LOAD UNIT S STRL STAPLE,LOAD UNIT S STRL STAPLE,PI 30-3.5 S STRL STAPLE,SURGICLIP S STRL STAPLER LONG 45A 4 S STRL STAPLER PURSTRING S STRL STAPLER, ENDO CLIP S STRL STAPLER, ENDOPATH S STRL STAPLER, MULTIFIRE S STRL STAPLER, MULTIFIRE S STRL STAYS,ELASTIC,FOR S STRL STENT BILIARY LEUN S STRL STENT URETRAL LUBI S STRL STENT, BILIARY S S STRL STENT, BILIARY S S STRL STENT, BILIARY S S STRL STENT, BILIARY S

158.00 285.00 355.00 17.00 26.00 130.00 143.00 349.00 44.00 44.00 56.00 46.00 606.00 640.00 612.00 900.00 631.00 655.00 918.00 1580.00 260.00 235.00 537.00 456.00 456.00 91.00 510.00 510.00 510.00 315.00 315.00 324.00 324.00 691.00 691.00 391.00 296.00 558.00 364.00 1685.00 2679.00 429.00 834.00 1599.00 1407.00 1251.00 183.00 211.00 363.00 455.00 403.00 455.00 455.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 212

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2312155 2312163 2312197 2312189 2312171 2312205 2312213 2312221 2312239 2312247 2312254 2312262 2341220 2312270 2312288 2312296 2355733 2355766 2355758 2355741 2355337 2355790 2355808 2355782 2355774 2355717 2312106 2375269 2340487 2342251 2341964 2341972 2342491 2348118 2341345 2342483 2342509 2364925 2358711 2358745 2358729 2358695 2348357 2348365 2370666 2340503 2366706 2370724 2371235 2349215 2341451 2340495 2358760

S STRL STENT, BILIARY S S STRL STENT, BILLARY P S STRL STENT, BILLIARY, S STRL STENT, BILLIARY, S STRL STENT, BILLIARY, S STRL STENT, ESOPH REL S STRL STENT, ESOPH ULT S STRL STENT, ESOPH ULT S STRL STENT, ESOPH Z E S STRL STENT, OASIS ONE S STRL STENT, OASIS-ONE S STRL STENT, PERCUFLEX S STRL STENT, SINUS RAIN S STRL STENT, WALLSTENT S STRL STENT, WALLSTENT S STRL STENT, WALLSTENT S STRL STENT,CATH ANTEGR S STRL STENT,DUAL-FLEX D S STRL STENT,DUALFLEX DO S STRL STENT,DUALFLEX DO S STRL STENT,INDWELLING S STRL STENT,URETERAL 6F S STRL STENT,URETERAL 6F S STRL STENT,URETERAL BE S STRL STENT,URETERAL BE S STRL STENT,URETERAL,DO S STRL STENT. BILIARY L S STRL STERILE SUPPLIES S STRL STIM, VARI-STIM N S STRL STPLR, EMS STPLR S STRL STPLR, ENDO CUTTE S STRL STPLR, ENDO CUTTE S STRL STPLR, ENDO HERNI S STRL STPLR, MENISCAL 1 S STRL STPLR, MULTIFIRE S STRL STPLR, MULTI-FIRE S STRL STPLR, PROTAK 174 S STRL STPLR, SKIN VERSAT S STRL STPLR,SKIN MULTIF S STRL STPLR,SKIN SIGNET S STRL STPLR,SKIN VERSAT S STRL STPLR,SKIN VISIST S STRL STRAP, ANKLE ARTH S STRL STRAP, ANKLE DIST S STRL SUCTION BULBTIP VI S STRL SUCTION TIP, FRAZ S STRL SUCTION TUBE, YANK S STRL SUCTION VIAGUARD S STRL SUCTN DELTA FLO/SU S STRL SURETAC 014 S STRL SURGICEL ABSORBAB S STRL SURGICEL ABSORBAB S STRL SURGICLIP M-11.5

455.00 302.00 600.00 600.00 600.00 2296.00 2870.00 2373.00 2357.00 378.00 274.00 564.00 194.00 2515.00 2619.00 2552.00 46.00 842.00 842.00 817.00 894.00 718.00 718.00 603.00 603.00 769.00 171.00 0.00 185.00 874.00 1420.00 1583.00 675.00 1790.00 561.00 270.00 1166.00 472.00 146.00 57.00 472.00 82.00 191.00 233.00 1315.00 22.00 12.00 122.00 399.00 490.00 164.00 96.00 421.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 213

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2358778 2367795 2367779 2367753 2367787 2367761 2367803 2321404 2321412 2391027 2391035 2391043 2391050 2362044 2375400 2378016 2377174 2377745 2375368 2375301 2375384 2375418 2375392 2375327 2375350 2375343 2359990 2365146 2364404 2364420 2364396 2364412 2365377 2363950 2363877 2363968 2363943 2363885 2365088 2363703 2363570 2365062 2363935 2365054 2363927 2365047 2363869 2364172 2364933 2364941 2364966 2365476 2364982

S STRL SURGICLIP S-9.0 D S STRL SURGIGRIP SLEEVE, S STRL SURGIGRIP SLEEVE, S STRL SURGIGRIP SLEEVE, S STRL SURGIGRIP SLEEVE, S STRL SURGIGRIP SLEEVE, S STRL SURGINEEDLE 120MM, S STRL SUT 3-0 ENDO S STRL SUT ANCHOR 1 S STRL SUT CAPIO 0 S STRL SUT STEEL 5 S STRL SUT VIC 0 OS-6 S STRL SUT VIC 2-0 CT-1 S STRL SUTURE IOSYN 2-0 V S STRL SUTURE MERSILENE 6 S STRL SUTURE NYLON 4-0 P S STRL SUTURE NYLON 6-0 P S STRL SUTURE PDS II 1 CT S STRL SUTURE PDS II 5-0 S STRL SUTURE PLAIN 4-0 F S STRL SUTURE POLYDEK 1 S STRL SUTURE POLYDEK 3-0 S STRL SUTURE POLYSORB 5S STRL SUTURE PROLENE 2-0 S STRL SUTURE PROLENE 3-0 S STRL SUTURE PROLENE 3-0 S STRL SUTURE PROLENE 4S STRL SUTURE, BIOSYN 2-0 S STRL SUTURE, BIOSYN 3-0 S STRL SUTURE, BIOSYN 4-0 S STRL SUTURE, BIOSYN 4-0 S STRL SUTURE, BIOSYN 5-0 S STRL SUTURE, BONE WAX, S STRL SUTURE, CHROMIC 0, S STRL SUTURE, CHROMIC 1, S STRL SUTURE, CHROMIC 1, S STRL SUTURE, CHROMIC 2S STRL SUTURE, CHROMIC 2S STRL SUTURE, CHROMIC 2S STRL SUTURE, CHROMIC 2S STRL SUTURE, CHROMIC 2, S STRL SUTURE, CHROMIC 3S STRL SUTURE, CHROMIC 3S STRL SUTURE, CHROMIC 4S STRL SUTURE, CHROMIC 4S STRL SUTURE, CHROMIC 5S STRL SUTURE, CHROMIC GU S STRL SUTURE, CHROMIC LO S STRL SUTURE, DERMALON 4 S STRL SUTURE, DERMALON 6 S STRL SUTURE, ENDO SUTUR S STRL SUTURE, ETHIBOND 0 S STRL SUTURE, ETHIBOND 0

416.00 76.00 55.00 56.00 56.00 76.00 257.00 190.00 2702.00 193.00 142.00 143.00 108.00 13.00 93.00 375.00 48.00 244.00 55.00 30.00 74.00 104.00 81.00 32.00 53.00 32.00 25.00 15.00 24.00 24.00 24.00 24.00 30.00 22.00 22.00 22.00 22.00 22.00 24.00 24.00 119.00 22.00 22.00 22.00 22.00 11.00 22.00 173.00 36.00 36.00 743.00 24.00 171.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 214

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2364974 2365401 2365427 2365484 2365393 2365419 2365435 2365385 2365450 2363547 2363539 2363554 2360485 2363760 2363810 2363802 2363794 2363778 2363786 2363745 2363737 2363752 2365492 2365500 2365526 2365542 2365518 2365534 2363679 2363653 2363596 2363687 2363695 2364552 2364610 2364545 2364487 2364602 2364438 2364594 2364461 2364503 2364560 2364479 2364537 2364586 2364453 2364495 2364578 2364511 2364529 2364446 2363638

S STRL SUTURE, ETHIBOND 0 S STRL SUTURE, ETHIBOND 0 S STRL SUTURE, ETHIBOND 1 S STRL SUTURE, ETHIBOND 1 S STRL SUTURE, ETHIBOND 2 S STRL SUTURE, ETHIBOND 2 S STRL SUTURE, ETHIBOND 2 S STRL SUTURE, ETHIBOND 3 S STRL SUTURE, ETHIBOND 4 S STRL SUTURE, LIGACLIP, S STRL SUTURE, LIGACLIP, S STRL SUTURE, LIGACLIP, S STRL SUTURE, MAXON 0 P S STRL SUTURE, MERSILENE S STRL SUTURE, MERSILENE S STRL SUTURE, MERSILENE S STRL SUTURE, MERSILENE S STRL SUTURE, MERSILENE S STRL SUTURE, MERSILENE S STRL SUTURE, MERSILENE S STRL SUTURE, MERSILENE S STRL SUTURE, MERSILINE S STRL SUTURE, MONOCRYL 2 S STRL SUTURE, MONOCRYL 3 S STRL SUTURE, MONOCRYL 4 S STRL SUTURE, MONOCRYL 4 S STRL SUTURE, MONOCRYL 5 S STRL SUTURE, MONOCRYL 5 S STRL SUTURE, MONOF 10-0 S STRL SUTURE, MONOSOF 10 S STRL SUTURE, MONOSOF 10 S STRL SUTURE, MONOSOF 10 S STRL SUTURE, MONOSOF 10 S STRL SUTURE, MONOSOF 2S STRL SUTURE, MONOSOF 2S STRL SUTURE, MONOSOF 3S STRL SUTURE, MONOSOF 3S STRL SUTURE, MONOSOF 3S STRL SUTURE, MONOSOF 4S STRL SUTURE, MONOSOF 4S STRL SUTURE, MONOSOF 4S STRL SUTURE, MONOSOF 4S STRL SUTURE, MONOSOF 4S STRL SUTURE, MONOSOF 5S STRL SUTURE, MONOSOF 5S STRL SUTURE, MONOSOF 5S STRL SUTURE, MONOSOF 5S STRL SUTURE, MONOSOF 5S STRL SUTURE, MONOSOF 6S STRL SUTURE, MONOSOF 6S STRL SUTURE, MONOSOF 6S STRL SUTURE, MONOSOF 7S STRL SUTURE, MONOSOF 8-

171.00 20.00 31.00 24.00 24.00 25.00 26.00 18.00 21.00 47.00 42.00 60.00 13.00 37.00 53.00 171.00 146.00 37.00 157.00 21.00 24.00 22.00 26.00 35.00 35.00 35.00 43.00 30.00 62.00 79.00 73.00 63.00 66.00 11.00 11.00 11.00 20.00 11.00 21.00 11.00 20.00 21.00 11.00 21.00 20.00 11.00 20.00 20.00 11.00 20.00 20.00 21.00 57.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 215

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2363604 2363612 2363588 2365591 2365617 2365583 2365708 2365641 2365633 2365567 2365682 2365690 2365609 2365575 2365625 2365666 2365559 2363836 2363919 2363901 2364164 2363893 2364123 2363828 2364149 2365070 2364156 2364131 2365443 2363497 2363471 2363372 2365120 2363380 2363489 2363513 2363364 2364354 2365112 2365138 2363463 2364263 2363398 2364388 2364271 2364362 2364214 2363356 2364370 2364230 2364297 2364347 2364206

S STRL SUTURE, MONOSOF 9S STRL SUTURE, MONOSOF 9S STRL SUTURE, NYLON 10-0 S STRL SUTURE, PDS 0, CT S STRL SUTURE, PDS 1, CTX S STRL SUTURE, PDS 2-0, C S STRL SUTURE, PDS 2-0, S S STRL SUTURE, PDS 3-0, F S STRL SUTURE, PDS 3-0, F S STRL SUTURE, PDS 3-0, S S STRL SUTURE, PDS 4-0, P S STRL SUTURE, PDS 4-0, P S STRL SUTURE, PDS II 1, S STRL SUTURE, PDS II 2-0 S STRL SUTURE, PDS II 3-0 S STRL SUTURE, PDS II 5-0 S STRL SUTURE, PDS#2, CP S STRL SUTURE, PLAIN 0 TI S STRL SUTURE, PLAIN 0, T S STRL SUTURE, PLAIN 2-0 S STRL SUTURE, PLAIN 3-0 S STRL SUTURE, PLAIN 3-0 S STRL SUTURE, PLAIN 4-0 S STRL SUTURE, PLAIN 4-0 S STRL SUTURE, PLAIN 4-0 S STRL SUTURE, PLAIN 4-0, S STRL SUTURE, PLAIN 5-0 S STRL SUTURE, PLAIN 5-0 S STRL SUTURE, POLYDEK 0, S STRL SUTURE, POLYSORB 0 S STRL SUTURE, POLYSORB 0 S STRL SUTURE, POLYSORB 0 S STRL SUTURE, POLYSORB 0 S STRL SUTURE, POLYSORB 1 S STRL SUTURE, POLYSORB 1 S STRL SUTURE, POLYSORB 2 S STRL SUTURE, POLYSORB 2 S STRL SUTURE, POLYSORB 2 S STRL SUTURE, POLYSORB 2 S STRL SUTURE, POLYSORB 2 S STRL SUTURE, POLYSORB 3 S STRL SUTURE, POLYSORB 3 S STRL SUTURE, POLYSORB 3 S STRL SUTURE, POLYSORB 3 S STRL SUTURE, POLYSORB 3 S STRL SUTURE, POLYSORB 3 S STRL SUTURE, POLYSORB 3 S STRL SUTURE, POLYSORB 4 S STRL SUTURE, POLYSORB 4 S STRL SUTURE, POLYSORB 4 S STRL SUTURE, POLYSORB 4 S STRL SUTURE, POLYSORB 4 S STRL SUTURE, POLYSORB 4

55.00 55.00 135.00 28.00 28.00 28.00 96.00 27.00 27.00 27.00 43.00 16.00 28.00 27.00 27.00 43.00 24.00 17.00 22.00 22.00 12.00 22.00 21.00 22.00 11.00 22.00 12.00 21.00 48.00 37.00 37.00 12.00 13.00 12.00 37.00 37.00 12.00 12.00 13.00 13.00 36.00 22.00 36.00 13.00 22.00 12.00 22.00 37.00 12.00 22.00 22.00 22.00 22.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 216

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2365104 2364255 2363406 2363430 2364248 2365096 2364305 2364289 2364222 2364339 2364313 2364321 2364198 2364180 2363414 2363448 2363455 2363505 2364677 2364115 2363323 2363315 2363331 2363307 2363281 2363562 2363620 2363661 2363299 2363349 2363646 2348126 2364867 2364040 2364099 2364107 2364057 2364891 2364032 2364081 2364073 2364859 2364024 2364883 2364826 2363992 2364008 2364016 2364834 2364875 2364842 2363984 2364818

S STRL SUTURE, POLYSORB 4 S STRL SUTURE, POLYSORB 4 S STRL SUTURE, POLYSORB 5 S STRL SUTURE, POLYSORB 5 S STRL SUTURE, POLYSORB 5 S STRL SUTURE, POLYSORB 5 S STRL SUTURE, POLYSORB 5 S STRL SUTURE, POLYSORB 5 S STRL SUTURE, POLYSORB 5 S STRL SUTURE, POLYSORB 5 S STRL SUTURE, POLYSORB 6 S STRL SUTURE, POLYSORB 6 S STRL SUTURE, POLYSORB 6 S STRL SUTURE, POLYSORB 6 S STRL SUTURE, POLYSORB 6 S STRL SUTURE, POLYSORB 7 S STRL SUTURE, POLYSORB 7 S STRL SUTURE, POLYSORB 8 S STRL SUTURE, PROLENE 5S STRL SUTURE, SILK 0, TI S STRL SUTURE, SILK 0,SH S STRL SUTURE, SILK 2-0, S STRL SUTURE, SILK 3-0, S STRL SUTURE, SILK 3-0, S STRL SUTURE, SILK 4-0 R S STRL SUTURE, SILK 4-0, S STRL SUTURE, SILK 4-0, S STRL SUTURE, SILK 4-0, S STRL SUTURE, SILK 4-0, S STRL SUTURE, SILK 5-0, S STRL SUTURE, SILK 5-0, S STRL SUTURE, SINGLE #1 S STRL SUTURE, SOFSILK 0 S STRL SUTURE, SOFSILK 0 S STRL SUTURE, SOFSILK 0 S STRL SUTURE, SOFSILK 1 S STRL SUTURE, SOFSILK 1 S STRL SUTURE, SOFSILK 2S STRL SUTURE, SOFSILK 2S STRL SUTURE, SOFSILK 2S STRL SUTURE, SOFSILK 3S STRL SUTURE, SOFSILK 3S STRL SUTURE, SOFSILK 3S STRL SUTURE, SOFSILK 3S STRL SUTURE, SOFSILK 4S STRL SUTURE, SOFSILK 4S STRL SUTURE, SOFSILK 4S STRL SUTURE, SOFSILK 4S STRL SUTURE, SOFSILK 4S STRL SUTURE, SOFSILK 4S STRL SUTURE, SOFSILK 4S STRL SUTURE, SOFSILK 6S STRL SUTURE, SOFSILK 6-

12.00 18.00 47.00 47.00 22.00 12.00 22.00 24.00 22.00 22.00 22.00 22.00 22.00 22.00 44.00 54.00 54.00 63.00 40.00 22.00 16.00 21.00 21.00 21.00 28.00 66.00 20.00 20.00 21.00 28.00 13.00 191.00 11.00 7.00 9.00 9.00 7.00 9.00 11.00 13.00 15.00 11.00 11.00 11.00 20.00 37.00 34.00 11.00 21.00 11.00 20.00 34.00 21.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 217

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2363976 2364065 2349389 2364636 2364628 2365179 2364800 2363711 2364776 2365211 2364669 2365203 2364719 2365369 2364792 2364784 2364693 2365229 2365336 2364750 2365351 2364743 2365195 2365237 2364768 2364701 2364735 2365328 2364685 2365278 2365310 2365294 2365286 2365344 2365302 2364727 2364644 2365245 2365252 2364651 2365187 2363208 2363042 2363067 2363026 2363117 2363265 2363232 2362564 2362994 2363075 2363158 2362929

S STRL SUTURE, SOFSILK 7S STRL SUTURE, SOFSILK 8S STRL SUTURE, STATAK SO S STRL SUTURE, SUPRAMID # S STRL SUTURE, SUPRAMID 0 S STRL SUTURE, SURGIDAC # S STRL SUTURE, SURGIPRO 0 S STRL SUTURE, SURGIPRO 1 S STRL SUTURE, SURGIPRO 2 S STRL SUTURE, SURGIPRO 2 S STRL SUTURE, SURGIPRO 3 S STRL SUTURE, SURGIPRO 3 S STRL SUTURE, SURGIPRO 3 S STRL SUTURE, SURGIPRO 3 S STRL SUTURE, SURGIPRO 3 S STRL SUTURE, SURGIPRO 3 S STRL SUTURE, SURGIPRO 4 S STRL SUTURE, SURGIPRO 4 S STRL SUTURE, SURGIPRO 4 S STRL SUTURE, SURGIPRO 4 S STRL SUTURE, SURGIPRO 4 S STRL SUTURE, SURGIPRO 4 S STRL SUTURE, SURGIPRO 4 S STRL SUTURE, SURGIPRO 4 S STRL SUTURE, SURGIPRO 5 S STRL SUTURE, SURGIPRO 5 S STRL SUTURE, SURGIPRO 5 S STRL SUTURE, SURGIPRO 5 S STRL SUTURE, SURGIPRO 5 S STRL SUTURE, SURGIPRO 5 S STRL SUTURE, SURGIPRO 5 S STRL SUTURE, SURGIPRO 6 S STRL SUTURE, SURGIPRO 6 S STRL SUTURE, SURGIPRO 6 S STRL SUTURE, SURGIPRO 6 S STRL SUTURE, SURGIPRO 6 S STRL SUTURE, SURGIPRO 6 S STRL SUTURE, SURGIPRO 7 S STRL SUTURE, SURGIPRO 7 S STRL SUTURE, SURGIPRO 7 S STRL SUTURE, TICRON 3-0 S STRL SUTURE, VICRYL 0 C S STRL SUTURE, VICRYL 0 C S STRL SUTURE, VICRYL 0 C S STRL SUTURE, VICRYL 0 C S STRL SUTURE, VICRYL 0 C S STRL SUTURE, VICRYL 0 C S STRL SUTURE, VICRYL 0 C S STRL SUTURE, VICRYL 0 M S STRL SUTURE, VICRYL 0 O S STRL SUTURE, VICRYL 0 O S STRL SUTURE, VICRYL 0 T S STRL SUTURE, VICRYL 0 U

40.00 51.00 566.00 13.00 20.00 80.00 13.00 73.00 13.00 25.00 25.00 25.00 24.00 13.00 13.00 13.00 24.00 25.00 25.00 21.00 17.00 24.00 25.00 24.00 24.00 24.00 24.00 25.00 25.00 30.00 35.00 51.00 30.00 35.00 42.00 24.00 25.00 42.00 51.00 25.00 27.00 25.00 83.00 48.00 81.00 83.00 25.00 25.00 24.00 26.00 48.00 57.00 20.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 218

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2362879 2363240 2363257 2363000 2362952 2363166 2363216 2365161 2363190 2363018 2362937 2363224 2363059 2362861 2363034 2363273 2363083 2362804 2362911 2362598 2362614 2362812 2362580 2362713 2362606 2363133 2362796 2362986 2363091 2362705 2363182 2362697 2362770 2362572 2362663 2362754 2363174 2362895 2362788 2363109 2362630 2362739 2362887 2362689 2362903 2362978 2362762 2362655 2362671 2362846 2362747 2362721 2362648

S STRL SUTURE, VICRYL 0 X S STRL SUTURE, VICRYL 1 C S STRL SUTURE, VICRYL 1 C S STRL SUTURE, VICRYL 1 O S STRL SUTURE, VICRYL 1 T S STRL SUTURE, VICRYL 1 T S STRL SUTURE, VICRYL 1-0 S STRL SUTURE, VICRYL 10S STRL SUTURE, VICRYL 2-0 S STRL SUTURE, VICRYL 2-0 S STRL SUTURE, VICRYL 2-0 S STRL SUTURE, VICRYL 2-0 S STRL SUTURE, VICRYL 2-0 S STRL SUTURE, VICRYL 2-0 S STRL SUTURE, VICRYL 2-0 S STRL SUTURE, VICRYL 2-0 S STRL SUTURE, VICRYL 2-0 S STRL SUTURE, VICRYL 2-0 S STRL SUTURE, VICRYL 2-0 S STRL SUTURE, VICRYL 2-0 S STRL SUTURE, VICRYL 2-0 S STRL SUTURE, VICRYL 3-0 S STRL SUTURE, VICRYL 3-0 S STRL SUTURE, VICRYL 3-0 S STRL SUTURE, VICRYL 3-0 S STRL SUTURE, VICRYL 3-0 S STRL SUTURE, VICRYL 3-0 S STRL SUTURE, VICRYL 3-0 S STRL SUTURE, VICRYL 3-0 S STRL SUTURE, VICRYL 3-0 S STRL SUTURE, VICRYL 3-0 S STRL SUTURE, VICRYL 4-0 S STRL SUTURE, VICRYL 4-0 S STRL SUTURE, VICRYL 4-0 S STRL SUTURE, VICRYL 4-0 S STRL SUTURE, VICRYL 4-0 S STRL SUTURE, VICRYL 4-0 S STRL SUTURE, VICRYL 4-0 S STRL SUTURE, VICRYL 5-0 S STRL SUTURE, VICRYL 5-0 S STRL SUTURE, VICRYL 5-0 S STRL SUTURE, VICRYL 5-0 S STRL SUTURE, VICRYL 5-0 S STRL SUTURE, VICRYL 5-0 S STRL SUTURE, VICRYL 5-0 S STRL SUTURE, VICRYL 5-0 S STRL SUTURE, VICRYL 5-0 S STRL SUTURE, VICRYL 5-0 S STRL SUTURE, VICRYL 5-0 S STRL SUTURE, VICRYL 5-0 S STRL SUTURE, VICRYL 5-0 S STRL SUTURE, VICRYL 6-0 S STRL SUTURE, VICRYL 6-0

36.00 25.00 57.00 26.00 18.00 47.00 25.00 94.00 25.00 92.00 17.00 25.00 92.00 34.00 83.00 18.00 83.00 26.00 26.00 24.00 18.00 20.00 18.00 38.00 24.00 20.00 21.00 31.00 26.00 38.00 25.00 38.00 38.00 24.00 38.00 38.00 25.00 38.00 34.00 42.00 38.00 38.00 53.00 38.00 38.00 88.00 38.00 31.00 38.00 88.00 38.00 38.00 38.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 219

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2362622 2362853 2362820 2362838 2365153 2357796 2359529 2361814 2359230 2359610 2360964 2360972 2360980 2360998 2361947 2361939 2359701 2359693 2359636 2360717 2360238 2361897 2360725 2360246 2359644 2360253 2360261 2359651 2360733 2360709 2359628 2360279 2360287 2360295 2361889 2360691 2360329 2360741 2360303 2360311 2361954 2361871 2358018 2360352 2360345 2359602 2358000 2360360 2358075 2359354 2360378 2359347 2360337

S STRL SUTURE, VICRYL 6-0 S STRL SUTURE, VICRYL 6-0 S STRL SUTURE, VICRYL 7-0 S STRL SUTURE, VICRYL 8-0 S STRL SUTURE, VICRYL 9-0 S STRL SUTURE,#2 BRAIDED S STRL SUTURE,10-0 TG140 S STRL SUTURE,26G SURG ST S STRL SUTURE,5-0 P3 S STRL SUTURE,BRAIDED PO S STRL SUTURE,BRALON 0 G S STRL SUTURE,BRALON 0 H S STRL SUTURE,BRALON 0 H S STRL SUTURE,BRALON 0 H S STRL SUTURE,BRALON 4-0 S STRL SUTURE,BRALON 4-0 S STRL SUTURE,CAPIO 0 83 S STRL SUTURE,CAPIO CL83 S STRL SUTURE,CHROMIC 0 S STRL SUTURE,CHROMIC 0 S STRL SUTURE,CHROMIC 0 S STRL SUTURE,CHROMIC 0 S S STRL SUTURE,CHROMIC 1 S STRL SUTURE,CHROMIC 1 S STRL SUTURE,CHROMIC 1 S STRL SUTURE,CHROMIC 1 S STRL SUTURE,CHROMIC 2S STRL SUTURE,CHROMIC 2S STRL SUTURE,CHROMIC 2S STRL SUTURE,CHROMIC 2S STRL SUTURE,CHROMIC 2S STRL SUTURE,CHROMIC 2S STRL SUTURE,CHROMIC 2S STRL SUTURE,CHROMIC 2S STRL SUTURE,CHROMIC 2-0 S STRL SUTURE,CHROMIC 3S STRL SUTURE,CHROMIC 3S STRL SUTURE,CHROMIC 3S STRL SUTURE,CHROMIC 3S STRL SUTURE,CHROMIC 3S STRL SUTURE,CHROMIC 3-0 S STRL SUTURE,CHROMIC 3-0 S STRL SUTURE,CHROMIC 4S STRL SUTURE,CHROMIC 4S STRL SUTURE,CHROMIC 4S STRL SUTURE,CHROMIC 4S STRL SUTURE,CHROMIC 4S STRL SUTURE,CHROMIC 4S STRL SUTURE,CHROMIC 4S STRL SUTURE,CHROMIC 4S STRL SUTURE,CHROMIC 4S STRL SUTURE,CHROMIC 4S STRL SUTURE,CHROMIC 4-

31.00 88.00 101.00 107.00 118.00 752.00 115.00 56.00 37.00 101.00 35.00 35.00 35.00 57.00 35.00 35.00 91.00 1113.00 22.00 24.00 9.00 22.00 24.00 11.00 22.00 28.00 11.00 22.00 24.00 24.00 22.00 11.00 11.00 12.00 22.00 24.00 12.00 38.00 11.00 11.00 11.00 22.00 30.00 11.00 11.00 79.00 30.00 21.00 30.00 22.00 22.00 22.00 12.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 220

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2358059 2360386 2361863 2360402 2357994 2360394 2358232 2359164 2358067 2361855 2359586 2360410 2358257 2357986 2358208 2357721 2358240 2357911 2359305 2359297 2359289 2359420 2359321 2359271 2360568 2358638 2358620 2360873 2361756 2359263 2360493 2360519 2360501 2358513 2358869 2360535 2358943 2360527 2358836 2357879 2359057 2357887 2360543 2360550 2357861 2358372 2358224 2358463 2358216 2361772 2357788 2361665 2361657

S STRL SUTURE,CHROMIC 4S STRL SUTURE,CHROMIC 4S STRL SUTURE,CHROMIC 4-0 S STRL SUTURE,CHROMIC 5S STRL SUTURE,CHROMIC 5S STRL SUTURE,CHROMIC 5S STRL SUTURE,CHROMIC 5S STRL SUTURE,CHROMIC 5S STRL SUTURE,CHROMIC 5S STRL SUTURE,CHROMIC 5-0 S STRL SUTURE,CHROMIC 6S STRL SUTURE,CHROMIC 6S STRL SUTURE,CHROMIC 6S STRL SUTURE,CHROMIC 6S STRL SUTURE,CHROMIC 7S STRL SUTURE,CHROMIC DO S STRL SUTURE,DERMALON 3 S STRL SUTURE,DERMALON 5 S STRL SUTURE,DEXON 0 S S STRL SUTURE,DEXON 2-0 S STRL SUTURE,DEXON 3-0 S STRL SUTURE,DEXON 3-0 S STRL SUTURE,DEXON 3-0 S STRL SUTURE,DEXON 4-0 S STRL SUTURE,DEXON 4-0 S STRL SUTURE,ENDO STITC S STRL SUTURE,ENDO STITC S STRL SUTURE,FIBERWARE S STRL SUTURE,GORE-TEX CV S STRL SUTURE,GORTEX CVS STRL SUTURE,MAXON 0 TS STRL SUTURE,MAXON 1 TS STRL SUTURE,MAXON 1 TS STRL SUTURE,MAXON 2-0 S STRL SUTURE,MAXON 2-0 S STRL SUTURE,MAXON 2-0 S STRL SUTURE,MAXON 2-0 S STRL SUTURE,MAXON 2-0 S STRL SUTURE,MAXON 3-0 S STRL SUTURE,MAXON 3-0 S STRL SUTURE,MAXON 4-0 S STRL SUTURE,MAXON 4-0 S STRL SUTURE,MAXON 4-0 S STRL SUTURE,MAXON 5-0 S STRL SUTURE,MAXON 6-0 S STRL SUTURE,MERSILENE S STRL SUTURE,MERSILENE S STRL SUTURE,MERSILENE S STRL SUTURE,MERSILENE S STRL SUTURE,MERSILENE S S STRL SUTURE,MITEK SUPE S STRL SUTURE,MONOSOF 1 S STRL SUTURE,MONOSOF 2

28.00 21.00 22.00 21.00 28.00 11.00 73.00 37.00 28.00 27.00 56.00 43.00 28.00 28.00 91.00 39.00 34.00 36.00 22.00 25.00 26.00 24.00 18.00 25.00 24.00 545.00 157.00 94.00 92.00 121.00 15.00 21.00 15.00 115.00 156.00 15.00 17.00 15.00 15.00 22.00 55.00 24.00 15.00 25.00 22.00 43.00 71.00 38.00 67.00 128.00 899.00 17.00 20.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 221

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2360956 2360931 2360923 2359677 2357697 2360634 2360683 2358356 2360642 2358364 2360659 2359511 2360626 2358422 2357705 2360667 2359537 2358802 2359008 2358992 2358133 2359032 2358984 2358091 2358851 2357929 2357903 2358117 2359198 2357978 2359255 2358976 2358125 2358109 2358083 2357960 2359248 2359487 2359669 2358968 2358950 2359180 2358927 2358935 2359024 2359214 2359172 2359222 2358174 2358042 2358166 2358190 2358414

S STRL SUTURE,NUROLON 0 S STRL SUTURE,NUROLON 0 S STRL SUTURE,NUROLON 0 S STRL SUTURE,NYLON #1 T S STRL SUTURE,NYLON 10-0 S STRL SUTURE,NYLON 10-0 S STRL SUTURE,NYLON 10-0 S STRL SUTURE,NYLON 10-0 S STRL SUTURE,NYLON 10-0 S STRL SUTURE,NYLON 10-0 S STRL SUTURE,NYLON 10-0 S STRL SUTURE,NYLON 10-0 S STRL SUTURE,NYLON 10-0 S STRL SUTURE,NYLON 10-0 S STRL SUTURE,NYLON 10-0 S STRL SUTURE,NYLON 10-0 S STRL SUTURE,NYLON 10-0 S STRL SUTURE,NYLON 2 LR S STRL SUTURE,NYLON 2-0 S STRL SUTURE,NYLON 2-0 S STRL SUTURE,NYLON 3-0 S STRL SUTURE,NYLON 3-0 S STRL SUTURE,NYLON 3-0 S STRL SUTURE,NYLON 3-0 S STRL SUTURE,NYLON 3-0 S STRL SUTURE,NYLON 4-0 S STRL SUTURE,NYLON 4-0 S STRL SUTURE,NYLON 4-0 S STRL SUTURE,NYLON 4-0 S STRL SUTURE,NYLON 4-0 S STRL SUTURE,NYLON 4-0 S STRL SUTURE,NYLON 4-0 S STRL SUTURE,NYLON 5-0 S STRL SUTURE,NYLON 5-0 S STRL SUTURE,NYLON 5-0 S STRL SUTURE,NYLON 5-0 S STRL SUTURE,NYLON 5-0 S STRL SUTURE,NYLON 5-0 S STRL SUTURE,NYLON 5-0 S STRL SUTURE,NYLON 5-0 S STRL SUTURE,NYLON 5-0 S STRL SUTURE,NYLON 5-0 S STRL SUTURE,NYLON 6-0 S STRL SUTURE,NYLON 6-0 S STRL SUTURE,NYLON 6-0 S STRL SUTURE,NYLON 6-0 S STRL SUTURE,NYLON 6-0 S STRL SUTURE,NYLON 6-0 S STRL SUTURE,NYLON 6-0 S STRL SUTURE,NYLON 7-0 S STRL SUTURE,NYLON 7-0 S STRL SUTURE,NYLON 8-0 S STRL SUTURE,NYLON 9-0

79.00 74.00 78.00 15.00 157.00 120.00 133.00 165.00 143.00 165.00 143.00 120.00 120.00 139.00 157.00 143.00 143.00 36.00 21.00 21.00 31.00 21.00 21.00 30.00 20.00 30.00 44.00 30.00 37.00 15.00 31.00 9.00 30.00 30.00 30.00 24.00 74.00 75.00 21.00 21.00 9.00 37.00 9.00 21.00 21.00 37.00 37.00 37.00 30.00 37.00 30.00 83.00 122.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 222

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2359479 2360675 2358406 2358398 2359685 2361848 2361020 2359750 2360428 2359727 2362168 2362176 2360444 2360436 2358034 2358026 2358265 2359495 2357952 2357945 2359156 2360451 2357937 2359453 2359461 2358281 2360469 2358471 2358810 2361335 2361418 2361152 2361434 2361459 2361319 2361095 2361111 2361061 2361475 2361103 2361186 2361996 2361202 2361087 2361400 2361285 2361368 2361244 2361251 2361137 2361145 2361483 2361376

S STRL SUTURE,NYLON 9-0 S STRL SUTURE,NYLON 9-0 S STRL SUTURE,NYLON 9-0 S STRL SUTURE,NYLON 9-0 S STRL SUTURE,OPEN ACCES S STRL SUTURE,PDS II ENDO S STRL SUTURE,PLAIN 1 GS S STRL SUTURE,PLAIN 2-0 S STRL SUTURE,PLAIN 3-0 S STRL SUTURE,PLAIN 3-0 S STRL SUTURE,PLAIN 3-0 F S STRL SUTURE,PLAIN 3-0 F S STRL SUTURE,PLAIN 4-0 S STRL SUTURE,PLAIN 4-0 S STRL SUTURE,PLAIN 4-0 S STRL SUTURE,PLAIN 4-0 S STRL SUTURE,PLAIN 4-0 S STRL SUTURE,PLAIN 4-0 S STRL SUTURE,PLAIN 4-0 S STRL SUTURE,PLAIN 4-0 S STRL SUTURE,PLAIN 5-0 S STRL SUTURE,PLAIN 5-0 S STRL SUTURE,PLAIN 5-0 S STRL SUTURE,PLAIN 6-0 S STRL SUTURE,PLAIN 6-0 S STRL SUTURE,PLAIN 6-0 S STRL SUTURE,PLAIN 6-0 S STRL SUTURE,POLYDEK 2S STRL SUTURE,POLYPROPYL S STRL SUTURE,POLYSOORB S STRL SUTURE,POLYSOR 3S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 0 S STRL SUTURE,POLYSORB 1 S STRL SUTURE,POLYSORB 1 S STRL SUTURE,POLYSORB 1 S STRL SUTURE,POLYSORB 1

130.00 20.00 94.00 94.00 639.00 164.00 22.00 22.00 11.00 22.00 22.00 22.00 21.00 22.00 37.00 28.00 16.00 79.00 28.00 28.00 37.00 42.00 20.00 79.00 79.00 30.00 42.00 30.00 25.00 51.00 13.00 36.00 12.00 13.00 12.00 36.00 46.00 36.00 13.00 36.00 13.00 12.00 13.00 94.00 13.00 12.00 13.00 62.00 62.00 36.00 36.00 13.00 13.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 223

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2361467 2361269 2361194 2361210 2361343 2361293 2361160 2361426 2361384 2361228 2361178 2361392 2361277 2361079 2361442 2361301 2361053 2361236 2362036 2362002 2361350 2361970 2362028 2362010 2361988 2361962 2359735 2360204 2359743 2358182 2359552 2359800 2359768 2359792 2360618 2359891 2360584 2360196 2359925 2359933 2359867 2360212 2360022 2360006 2360600 2359776 2360063 2360220 2359982 2359818 2359834 2360105 2360139

S STRL SUTURE,POLYSORB 1 S STRL SUTURE,POLYSORB 1 S STRL SUTURE,POLYSORB 1 S STRL SUTURE,POLYSORB 1 S STRL SUTURE,POLYSORB 1 S STRL SUTURE,POLYSORB 2 S STRL SUTURE,POLYSORB 2 S STRL SUTURE,POLYSORB 2 S STRL SUTURE,POLYSORB 2 S STRL SUTURE,POLYSORB 2 S STRL SUTURE,POLYSORB 2 S STRL SUTURE,POLYSORB 2 S STRL SUTURE,POLYSORB 2 S STRL SUTURE,POLYSORB 2 S STRL SUTURE,POLYSORB 2 S STRL SUTURE,POLYSORB 2 S STRL SUTURE,POLYSORB 2 S STRL SUTURE,POLYSORB 2 S STRL SUTURE,POLYSORB 2S STRL SUTURE,POLYSORB 2S STRL SUTURE,POLYSORB 3 S STRL SUTURE,POLYSORB 3S STRL SUTURE,POLYSORB 3S STRL SUTURE,POLYSORB 3S STRL SUTURE,POLYSORB 4S STRL SUTURE,POLYSORB 4S STRL SUTURE,PROLENE 0 S STRL SUTURE,PROLENE 1 S STRL SUTURE,PROLENE 1 S STRL SUTURE,PROLENE 10 S STRL SUTURE,PROLENE 10 S STRL SUTURE,PROLENE 2S STRL SUTURE,PROLENE 2S STRL SUTURE,PROLENE 3S STRL SUTURE,PROLENE 3S STRL SUTURE,PROLENE 3S STRL SUTURE,PROLENE 3S STRL SUTURE,PROLENE 3S STRL SUTURE,PROLENE 3S STRL SUTURE,PROLENE 3S STRL SUTURE,PROLENE 3S STRL SUTURE,PROLENE 3S STRL SUTURE,PROLENE 3S STRL SUTURE,PROLENE 3S STRL SUTURE,PROLENE 4S STRL SUTURE,PROLENE 4S STRL SUTURE,PROLENE 4S STRL SUTURE,PROLENE 4S STRL SUTURE,PROLENE 4S STRL SUTURE,PROLENE 4S STRL SUTURE,PROLENE 4S STRL SUTURE,PROLENE 5S STRL SUTURE,PROLENE 5-

13.00 63.00 13.00 13.00 12.00 13.00 17.00 13.00 13.00 21.00 13.00 16.00 12.00 36.00 13.00 12.00 36.00 62.00 16.00 22.00 13.00 12.00 16.00 36.00 12.00 12.00 16.00 30.00 17.00 83.00 156.00 44.00 34.00 37.00 44.00 25.00 44.00 37.00 25.00 25.00 17.00 21.00 40.00 24.00 44.00 24.00 40.00 60.00 87.00 37.00 40.00 43.00 43.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 224

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2360097 2360154 2360121 2360576 2360055 2360014 2359966 2359826 2359842 2359909 2360592 2360188 2360170 2360162 2360147 2360113 2360089 2360048 2360030 2359958 2359859 2359883 2360071 2359719 2359784 2357804 2357812 2358794 2359065 2359073 2360840 2360808 2357762 2359131 2359149 2357895 2360899 2360824 2360782 2360774 2359123 2358844 2360907 2360915 2360816 2359313 2359115 2359545 2358158 2358273 2358901 2360766 2359099

S STRL SUTURE,PROLENE 5S STRL SUTURE,PROLENE 5S STRL SUTURE,PROLENE 5S STRL SUTURE,PROLENE 5S STRL SUTURE,PROLENE 5S STRL SUTURE,PROLENE 5S STRL SUTURE,PROLENE 5S STRL SUTURE,PROLENE 5S STRL SUTURE,PROLENE 5S STRL SUTURE,PROLENE 5S STRL SUTURE,PROLENE 5S STRL SUTURE,PROLENE 6S STRL SUTURE,PROLENE 6S STRL SUTURE,PROLENE 6S STRL SUTURE,PROLENE 6S STRL SUTURE,PROLENE 6S STRL SUTURE,PROLENE 6S STRL SUTURE,PROLENE 6S STRL SUTURE,PROLENE 6S STRL SUTURE,PROLENE 6S STRL SUTURE,PROLENE 6S STRL SUTURE,PROLENE 7S STRL SUTURE,PROLENE 7S STRL SUTURE,PROLENE O S STRL SUTURE,PROLYPROPY S STRL SUTURE,RAPIDLOC M S STRL SUTURE,RAPIDLOC M S STRL SUTURE,RETRIEVER S STRL SUTURE,SILK 0 FSL S STRL SUTURE,SILK 0 FSL S STRL SUTURE,SILK 1 TIE S STRL SUTURE,SILK 1 TIE S STRL SUTURE,SILK 2-0 E S STRL SUTURE,SILK 2-0 F S STRL SUTURE,SILK 2-0 F S STRL SUTURE,SILK 2-0 P S STRL SUTURE,SILK 2-0 S S STRL SUTURE,SILK 2-0 T S STRL SUTURE,SILK 2-0 T S STRL SUTURE,SILK 3-0 1 S STRL SUTURE,SILK 3-0 F S STRL SUTURE,SILK 3-0 K S STRL SUTURE,SILK 3-0 S S STRL SUTURE,SILK 3-0 S S STRL SUTURE,SILK 3-0 T S STRL SUTURE,SILK 4-0 C S STRL SUTURE,SILK 4-0 F S STRL SUTURE,SILK 4-0 G S STRL SUTURE,SILK 4-0 P S STRL SUTURE,SILK 4-0 P S STRL SUTURE,SILK 4-0 P S STRL SUTURE,SILK 4-0 T S STRL SUTURE,SILK 5-0 F

43.00 36.00 115.00 35.00 40.00 40.00 40.00 37.00 40.00 25.00 44.00 91.00 78.00 78.00 43.00 43.00 43.00 40.00 40.00 35.00 38.00 53.00 66.00 28.00 91.00 372.00 564.00 170.00 21.00 21.00 13.00 15.00 144.00 21.00 24.00 31.00 37.00 21.00 15.00 20.00 21.00 16.00 71.00 66.00 21.00 47.00 21.00 69.00 30.00 62.00 37.00 20.00 21.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 225

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2359107 2358893 2358885 2358141 2360758 2359081 2359446 2357689 2358877 2359438 2359503 2360790 2360832 2361749 2362135 2362127 2362077 2362119 2362101 2362085 2362069 2362051 2362093 2357754 2358828 2358380 2361673 2361038 2361046 2361129 2361830 2361012 2361004 2361780 2361798 2361764 2361913 2361905 2358299 2358307 2358315 2358323 2358331 2358349 2357770 2361699 2361707 2361731 2361715 2361723 2361681 2359594 2359412

S STRL SUTURE,SILK 5-0 F S STRL SUTURE,SILK 5-0 P S STRL SUTURE,SILK 5-0 P S STRL SUTURE,SILK 5-0 P S STRL SUTURE,SILK 5-0 T S STRL SUTURE,SILK 6-0 F S STRL SUTURE,SILK 6-0 G S STRL SUTURE,SILK 6-0 P S STRL SUTURE,SILK 6-0 P S STRL SUTURE,SILK 7-0 G S STRL SUTURE,SILK 8-0 T S STRL SUTURE,SILK O TIE S STRL SUTURE,SILK O TIE S STRL SUTURE,SOFSILK 0 G S STRL SUTURE,SOFSILK 1 V S STRL SUTURE,SOFSILK 2-0 S STRL SUTURE,SOFSILK 2-0 S STRL SUTURE,SOFSILK 3-0 S STRL SUTURE,SOFSILK 3-0 S STRL SUTURE,SOFSILK 3-0 S STRL SUTURE,SOFSILK 3-0 S STRL SUTURE,SOFSILK 4-0 S STRL SUTURE,SOFSILK 4-0 S STRL SUTURE,SOFSILK 7S STRL SUTURE,SRG STEEL S STRL SUTURE,STATAK SHO S STRL SUTURE,SUPRAMID # S STRL SUTURE,SUPRAMID 0 S STRL SUTURE,SUPRAMID 1 S STRL SUTURE,SUPRAMID 2 S STRL SUTURE,SURG STEEL S STRL SUTURE,SURGIDAC 2 S STRL SUTURE,SURGIDAC 2 S STRL SUTURE,SURGIDAC 4S STRL SUTURE,SURGIDAC 5S STRL SUTURE,SURGIDAC 6S STRL SUTURE,SURGIGUT 4S STRL SUTURE,SURGIGUT 6S STRL SUTURE,SURGILON 0 S STRL SUTURE,SURGILON 0 S STRL SUTURE,SURGILON 0 S STRL SUTURE,SURGILON 0 S STRL SUTURE,SURGILON 0 S STRL SUTURE,SURGILON 0 S STRL SUTURE,SURGILON 0 S STRL SUTURE,SURGIPRO 0 S STRL SUTURE,SURGIPRO 0 S STRL SUTURE,SURGIPRO 0 S STRL SUTURE,SURGIPRO 1 S STRL SUTURE,SURGIPRO 1 S STRL SUTURE,SURGIPRO 1 S STRL SUTURE,TEVDEK #5 S STRL SUTURE,TEVDEK 1 W

21.00 37.00 37.00 65.00 15.00 21.00 75.00 37.00 37.00 75.00 93.00 15.00 13.00 28.00 11.00 11.00 28.00 11.00 27.00 28.00 28.00 31.00 28.00 37.00 76.00 925.00 21.00 38.00 30.00 27.00 82.00 17.00 17.00 38.00 38.00 38.00 38.00 38.00 35.00 40.00 30.00 26.00 93.00 34.00 26.00 18.00 13.00 35.00 13.00 20.00 13.00 20.00 75.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 226

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2357713 2359388 2359396 2359578 2359560 2359404 2358562 2357838 2358588 2357853 2357846 2357820 2358596 2358547 2358554 2358539 2360477 2358570 2362283 2362424 2362309 2362374 2362408 2362481 2362218 2362440 2362291 2362416 2362382 2358430 2362366 2362556 2362473 2362200 2362358 2362432 2358448 2362259 2358455 2362275 2362192 2362267 2362317 2362242 2362341 2362531 2362465 2362515 2362507 2362549 2362523 2362457 2362234

S STRL SUTURE,TEVDEK II S STRL SUTURE,TEVDEK II S STRL SUTURE,TEVDEK II S STRL SUTURE,TEVDEK II S STRL SUTURE,TEVDEK II S STRL SUTURE,TEVDEK O S STRL SUTURE,TICRON 0 C S STRL SUTURE,TICRON 0 T S STRL SUTURE,TICRON 1 C S STRL SUTURE,TICRON 1 C S STRL SUTURE,TICRON 1 T S STRL SUTURE,TICRON 2 C S STRL SUTURE,TICRON 2-0 S STRL SUTURE,TICRON 2-0 S STRL SUTURE,TICRON 3-0 S STRL SUTURE,TICRON 3-0 S STRL SUTURE,TICRON 4-0 S STRL SUTURE,TICRON O T S STRL SUTURE,VICRYL 0 CP S STRL SUTURE,VICRYL 0 CT S STRL SUTURE,VICRYL 0 CT S STRL SUTURE,VICRYL 0 CT S STRL SUTURE,VICRYL 0 CT S STRL SUTURE,VICRYL 0 SH S STRL SUTURE,VICRYL 0 TI S STRL SUTURE,VICRYL 0 UR S STRL SUTURE,VICRYL 1 CP S STRL SUTURE,VICRYL 1 CT S STRL SUTURE,VICRYL 1 CT S STRL SUTURE,VICRYL 1 O S STRL SUTURE,VICRYL 2-0 S STRL SUTURE,VICRYL 2-0 S STRL SUTURE,VICRYL 2-0 S STRL SUTURE,VICRYL 2-0 S STRL SUTURE,VICRYL 2-0 S STRL SUTURE,VICRYL 2-0 S STRL SUTURE,VICRYL 2-0 S STRL SUTURE,VICRYL 2-0 S STRL SUTURE,VICRYL 2-0 S STRL SUTURE,VICRYL 2-0 S STRL SUTURE,VICRYL 3-0 S STRL SUTURE,VICRYL 3-0 S STRL SUTURE,VICRYL 3-0 S STRL SUTURE,VICRYL 3-0 S STRL SUTURE,VICRYL 3-0 S STRL SUTURE,VICRYL 3-0 S STRL SUTURE,VICRYL 3-0 S STRL SUTURE,VICRYL 3-0 S STRL SUTURE,VICRYL 4-0 S STRL SUTURE,VICRYL 4-0 S STRL SUTURE,VICRYL 4-0 S STRL SUTURE,VICRYL 4-0 S STRL SUTURE,VICRYL 4-0

28.00 65.00 54.00 34.00 54.00 26.00 12.00 13.00 28.00 16.00 35.00 18.00 64.00 13.00 17.00 18.00 21.00 16.00 25.00 24.00 54.00 17.00 25.00 24.00 42.00 20.00 20.00 20.00 17.00 26.00 12.00 24.00 18.00 55.00 20.00 21.00 17.00 18.00 26.00 21.00 54.00 17.00 24.00 17.00 24.00 38.00 24.00 24.00 24.00 15.00 38.00 18.00 9.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 227

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2362184 2362333 2362226 2362499 2361822 2361806 2312304 2355840 2321420 2347987 2355048 2370633 2312437 2312445 2312460 2312452 2312478 2312494 2312486 2312502 2312577 2312528 2312536 2312544 2312551 2312569 2371359 2371367 2371375 2371383 2371391 2371409 2371417 2371425 2371433 2371458 2371441 2371466 2371474 2371482 2371490 2371508 2371516 2371524 2371532 2342533 2343374 2343366 2343390 2343424 2343416 2343382 2343408

S STRL SUTURE,VICRYL 4-0 S STRL SUTURE,VICRYL 4-0 S STRL SUTURE,VICRYL 5-0 S STRL SUTURE,VICRYL 5-0 S STRL SUTURE,WIRE MONOFI S STRL SUTURE,WIRE MONOFI S STRL SYRINGE, GAUGE A S STRL SYRINGE,DURASPHER S STRL SYS ADJ GRA BAND S STRL SYSTEM, AUTOGRAFT S STRL SYSTEM, ONE GRAFT S STRL TA MULTI FIRE INST S STRL TB, FEEDING 8FR, S STRL TB, FEEDING, 5FR S STRL TB, GASTRO 24FR S STRL TB, GASTRO 24FR S STRL TB, GASTRO 24FR 4 S STRL TB, GASTRO TRI-FE S STRL TB, GASTRO TRI-FU S STRL TB, GASTRO, FLEXI S STRL TB, GASTRO, NON-B S STRL TB, JEJUNAL FEEDI S STRL TB, JEJUNAL FEEDI S STRL TB, JEJUNAL FEEDI S STRL TB, JEJUNAL FEEDI S STRL TB, JEJUNAL FEEDI S STRL TEMPLATE 14MM S STRL TEMPLATE 22MM S STRL TEMPLATE 24MM S STRL TEMPLATE 26MM S STRL TEMPLATE 28MM S STRL TEMPLATE 31MM S STRL TEMPLATE 34MM S STRL TEMPLATE 37MM S STRL TEMPLATE 40MM S STRL TEMPLATE 45MM S STRL TEMPLATE 46MM S STRL TEMPLATE 48MM S STRL TEMPLATE 51MM S STRL TEMPLATE 54MM S STRL TEMPLATE 57MM S STRL TEMPLATE 60MM S STRL TEMPLATE 63MM S STRL TEMPLATE 66MM S STRL TEMPLATE 69MM S STRL TIP, BOVIE, TEFLO S STRL TIP, MICRO, TURBO S STRL TIP, MICRO, TURBO S STRL TIP, MICRO, TURBO S STRL TIP, MICRO, TURBO S STRL TIP, MISCO, TURBO S STRL TIP, PHACO/TURBOS S STRL TIP, PHACO/TURBOS

56.00 24.00 17.00 24.00 56.00 56.00 218.00 131.00 9491.00 2428.00 1021.00 1701.00 372.00 5.00 534.00 534.00 534.00 249.00 271.00 252.00 183.00 209.00 363.00 239.00 426.00 211.00 206.00 206.00 206.00 206.00 226.00 226.00 226.00 226.00 226.00 265.00 226.00 265.00 265.00 265.00 265.00 265.00 265.00 265.00 265.00 46.00 300.00 363.00 333.00 300.00 397.00 300.00 73.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 228

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2348134 2342822 2367811 2367829 2321438 2370716 2371110 2341840 2367522 2366953 2366961 2366912 2367555 2367597 2341808 2342541 2341832 2312312 2312320 2312361 2312395 2312338 2312346 2312353 2312379 2312387 2367563 2367548 2367506 2367530 2312403 2312411 2312429 2341824 2341816 2367514 2354090 2356723 2356715 2321446 2378750 2321453 2378198 2378982 2370682 2379360 2368108 2367894 2341857 2341469 2342608 2368579 2342616

S STRL TIP, SURGILAV MUL S STRL TISSELL 5ML S STRL TIS-U-TRAP UTERINE S STRL TIS-U-TRAP UTERINE S STRL TOOL MEDAS REX S STRL TRACH TUBE-SHILEY S STRL TRANSDUCER PRESSUR S STRL TRAY, ARM BLOCK S STRL TRAY, BASIC BIOP S STRL TRAY, CATH FOLEY S STRL TRAY, CATH URETH S STRL TRAY, CATH URETH S STRL TRAY, CATH. DUAL S STRL TRAY, CV CATH 8F S STRL TRAY, EPI CONTIN S STRL TRAY, EPI SINGLE S STRL TRAY, EPI SINGLE S STRL TRAY, GASTRO 20F S STRL TRAY, GASTRO 24F S STRL TRAY, GASTRO 24F S STRL TRAY, GASTRO 24F S STRL TRAY, GASTRO 24F S STRL TRAY, GASTRO 24F S STRL TRAY, GASTRO 24F S STRL TRAY, GASTRO 24F S STRL TRAY, GASTRO 24F S STRL TRAY, JAMSHIDI S S STRL TRAY, LUMBAR PUN S STRL TRAY, LUMBAR PUN S STRL TRAY, LUMBAR PUN S STRL TRAY, PARACENTES S STRL TRAY, PEG TB S STRL TRAY, PEG, 20FR, S STRL TRAY, SPINAL ANE S STRL TRAY, SPINAL ANE S STRL TRAY, THORACENTE S STRL TRAY, THORACENTES S STRL TRAY,FOLEY CATH W S STRL TRAY,FOLEY CATH W S STRL TROCAR 100MM S STRL TROCAR 12MM ETHICO S STRL TROCAR 18MM S STRL TROCAR 5MM ETHICON S STRL TROCAR BALLOON 10M S STRL TROCAR SURGIPORT S STRL TROCAR SURGIPORT 3 S STRL TROCAR, BLUNT TIP S STRL TROCAR, BLUNTPORT S STRL TROCAR, ETHICON 1 S STRL TROCAR, ETHICON 5 S STRL TROCAR, ETHICON 5 S STRL TROCAR, ETHICON FL S STRL TROCAR, ETHICON O

105.00 1739.00 82.00 118.00 796.00 967.00 555.00 51.00 92.00 24.00 18.00 20.00 448.00 24.00 97.00 178.00 103.00 1039.00 1190.00 1190.00 1190.00 1190.00 1190.00 1190.00 1190.00 1190.00 221.00 92.00 99.00 92.00 263.00 253.00 639.00 135.00 142.00 203.00 179.00 80.00 80.00 639.00 723.00 940.00 539.00 875.00 1337.00 1109.00 325.00 691.00 453.00 409.00 273.00 582.00 409.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

Page 229

a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2368405 2368363 2368413 2368371 2368421 2342582 2342590 2342558 2341865 2368132 2368124 2368116 2367852 2367878 2367951 2367910 2367845 2367902 2367886 2367837 2367860 2367944 2368587 2368595 2368603 2368637 2368629 2368611 2368686 2367969 2368645 2368678 2342566 2368538 2342574 2370641 2312809 2377976 2369098 2370260 2321461 2366896 2369106 2391068 2348167 2342624 2348381 2348159 2348142 2366755 2366771 2366631 2340255

S STRL TROCAR, GIBBONS 11 S STRL TROCAR, GIBBONS 11 S STRL TROCAR, GIBBONS 5M S STRL TROCAR, GIBBONS 5M S STRL TROCAR, GIBBONS 5M S STRL TROCAR, ORIGIN 5M S STRL TROCAR, ORIGIN 5M S STRL TROCAR, ORIGIN BL S STRL TROCAR, ORIGIN TR S STRL TROCAR, STEP SLEEV S STRL TROCAR, STEP SLEEV S STRL TROCAR, STEP SLEEV S STRL TROCAR, SURGIPORT S STRL TROCAR, SURGIPORT S STRL TROCAR, SURGIPORT S STRL TROCAR, SURGIPORT S STRL TROCAR, SURGIPORT S STRL TROCAR, SURGIPORT S STRL TROCAR, SURGIPORT S STRL TROCAR, SURGIPORT S STRL TROCAR, SURGIPORT S STRL TROCAR, SURGIPORT S STRL TROCAR, VERSAPORT S STRL TROCAR, VERSAPORT S STRL TROCAR, VERSAPORT S STRL TROCAR, VERSAPORT S STRL TROCAR, VERSAPORT S STRL TROCAR, VERSAPORT S STRL TROCAR, VISIPORT ( S STRL TROCAR, VISIPORT 1 S STRL TROCAR, VISIPORT 5 S STRL TROCAR, VISIPORT 5 S STRL TROCAR,BLLN,GSI,L S STRL TROCAR,BURCH KIT,S STRL TROCAR,IOTEC 5MM S STRL TUBE CARTIOD BYPAS S STRL TUBE FE 8FR S STRL TUBE FEEDING GASTR S STRL TUBE FILTER TUBING S STRL TUBE ORTHO SUCTION S STRL TUBE REAMER S STRL TUBE SET, ARTHROSC S STRL TUBE SMOKE EVAC LA S STRL TUBE SUMP DRA S STRL TUBE, "Y" SET WIT S STRL TUBE, ANESTH. CAP S STRL TUBE, ARTH PUMP S S STRL TUBE, ARTHROSCOPY S STRL TUBE, BIOMET ALIG S STRL TUBE, CHEST 20FR S STRL TUBE, CHEST 32FR S S STRL TUBE, CHOLE T-TUBE S STRL TUBE, DISP, SINUS

218.00 225.00 133.00 215.00 133.00 324.00 64.00 664.00 426.00 527.00 511.00 481.00 469.00 542.00 482.00 473.00 482.00 524.00 458.00 552.00 467.00 529.00 488.00 391.00 454.00 512.00 467.00 416.00 729.00 511.00 489.00 462.00 1056.00 445.00 496.00 751.00 619.00 357.00 75.00 119.00 1153.00 330.00 92.00 272.00 180.00 22.00 263.00 153.00 153.00 42.00 52.00 53.00 78.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

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a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2366714 2341881 2341873 2366615 2366680 2366672 2366722 2340974 2340230 2340511 2341014 2341048 2340966 2340529 2340537 2340933 2341006 2340982 2340990 2340941 2355899 2369288 2368983 2369007 2371318 2367977 2367985 2356731 2357564 2357481 2354140 2370864 2312585 2312593 2312601 2390540 2355238 2370708 2367993 2368009 2368017 2368025 2368033 2368041 2368058 2366748 2312619 2341907 2356467 2342632 2343176 2343432 2312635

S STRL TUBE, FEEDING, 8 F S STRL TUBE, INSUFLOW S STRL TUBE, LAVACUATOR S STRL TUBE, SALEM SUMP, S STRL TUBE, SUMP, SALEM, S STRL TUBE, SUMP, SALEM, S STRL TUBE, VACURETTE CO S STRL TUBE, VENT DURAVE S STRL TUBE, VENT FOR MY S STRL TUBE, VENT, ARMST S STRL TUBE, VENT, CCLR S STRL TUBE, VENT, CLLR S STRL TUBE, VENT, CLLR S STRL TUBE, VENT, DONAL S STRL TUBE, VENT, DONAL S STRL TUBE, VENT, GOODE S STRL TUBE, VENT, GOODE S STRL TUBE, VENT, MORET S STRL TUBE, VENT, RICHA S STRL TUBE, VENT, SHEPA S STRL TUBE,ALTON DEAN S STRL TUBING IRRGATION T S STRL TUBING IRRIGATION S STRL TUBING MALIS BIPOL S STRL TUBING MALIS IRRIG S STRL TUBING, INSUFFLATI S STRL TUBING, SMOKE EVAC S STRL TUNA,VIDA MED SYS S STRL TUNNELER,BARD 060 S STRL TUNNELER,KELLY-WI S STRL TUNNELING, NCP TO S STRL ULTRA POART TROCAR S STRL ULTRATOME, 30MM S S STRL ULTRATOME, 3MM LO S STRL ULTRATOME, DOUBLE S STRL URETERAL 5FR S STRL URETERAL STENT S STRL URODATA PRESR SYST S STRL VACURETTE, 10MM CU S STRL VACURETTE, 11MM CU S STRL VACURETTE, 12MM CU S STRL VACURETTE, 4MM F-T S STRL VACURETTE, 6MM F-T S STRL VACURETTE, 8MM CUR S STRL VACURETTE, 9MM CUR S STRL VALVE, HEIMLICH CH S STRL VALVE, LOPEZ M900 S STRL VEIN STRIPPER, DI S STRL VESSICA KIT-BLADD S STRL VITAL VUE, EXTEND S STRL VITRECTOMY, S STRL VITRECTOMY, PR, I S STRL WALLSTENT BILIARY

7.00 355.00 40.00 63.00 18.00 18.00 42.00 155.00 97.00 101.00 78.00 78.00 47.00 62.00 82.00 100.00 178.00 73.00 155.00 113.00 220.00 67.00 43.00 212.00 591.00 81.00 18.00 1860.00 164.00 164.00 682.00 1285.00 572.00 555.00 667.00 101.00 660.00 227.00 44.00 44.00 44.00 31.00 31.00 44.00 44.00 44.00 18.00 770.00 1860.00 890.00 576.00 1397.00 5351.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES

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a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2312627 2355501 2355246 2340248 2357093 2375079 2375095 2375087 2375137 2375129 2375111 2375046 2375053 2375061 2367449 2367423 2367415 2367464 2040277 2040368 2040376 2040384 2040392 2013100 2040566 2010247 2040400 2040418 2013159 2013142 2040053 2040426 2040434 2040442 2040012 2040459 2040251 2040467 2040475 2040483 2040491 2040574 2013175 2013241 2013167 2013233 2013092 2040269 2040525 2040533 2040202 2013183 2013191

S STRL WALLSTENT BILIARY S STRL WIRE GUIDE,STRAIG S STRL WIRE GUIDE,STRAIG S STRL WIRE SNARE, TONSI S STRLPROSTHESIS,AMS OCC SEP LOWER LIMBS BIL SEP LOWER LIMBS BIL SEP LOWER LIMBS BIL SEP TRUNK/HEAD SEP TRUNK/HEAD SEP TRUNK/HEAD SEP UPPER LIMBS BIL SEP UPPER LIMBS BIL SEP UPPER LIMBS BIL SORBITOL IRRIG. SORB/MANN WATER IRRIG 1000ML WATER IRRIG 1500ML WATER IRRIG 3000ML ANORECTAL MANOMETRY ANOSCOPY ANOSCOPY INTERVENTN BRONCHOSCOPY BRONCHOSCOPY INTERVENTN BX LIVER CA ECHO TRANSESOPHAGEAL CATARACT LASER SURGERY COLONOSCOPY COLONOSCOPY INTERVENTN CPLX GENRL ANES ADD 15M CPLX GENRL ANES FIRST 30M EGD EGD INTERVENTN ENTEROSCOPY ENTEROSCOPY INTERVENTN ERCP ERCP INTERVENTN ESOPHAGEAL MOTILITY ESOPHAGOSCOPY ESOPHAGOSCOPY INTERVENTN GASTROSCOPY GASTROSCOPY INTERVENTN INS PH CAPSULE GERD MUCOS MAC/REG ADD 15M MAC/REG ADD 15M NONOR MAC/REG FIRST 30M MAC/REG FIRST 30M NONOR PARACENT ABD INI PH ESOPH NASAL CATH ELECT PROCTOSCOPY PROCTOSCOPY INTERVENTN S NSTRL BOUGIE USE SEDATION < 2 HRS SEDATION 2 HRS - 4 HRS

3944.00 25.00 107.00 7.00 2017.00 953.00 2858.00 1667.00 2858.00 1667.00 953.00 953.00 1667.00 2858.00 55.00 15.00 17.00 43.00 991.00 365.00 425.00 1173.00 1993.00 796.00 1894.00 179.00 1307.00 1480.00 247.00 792.00 1551.00 1709.00 1743.00 2179.00 1682.00 4573.00 771.00 1753.00 2191.00 1743.00 2179.00 2045.00 111.00 111.00 439.00 439.00 766.00 771.00 364.00 425.00 135.00 660.00 660.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20

SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SUPPLIES SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR

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a14002d2-9ffe-45ca-b8c9-0304238efd3a.XLS

CHARGE BILLING DESCRIPTION CODE

SEQ 999 SEQ 100 DEPARTMENT AMOUNT AMOUNT CODE

DEPARTMENT DESCRIPTION

2013209 2013217 2013225 2040129 2040541 2013266 2013258 2013134 2013126 2010213 2010205 2013282 2013274 2010114 2013316 2013308 2010106 2010130 2013332 2013324 2010122 2013357 2010155 2013340 2010148 2010171 2010163 2010197 2010189 2013084 2010254 2013118

SEDATION 4 HRS - 6 HRS SEDATION 6 HRS - 8 HRS SEDATION 8 HRS - 10 HRS SIGMOIDOSCOPY SIGMOIDOSCOPY INTERVENTN STND ANES ADD 15M NONOR STND ANES FIRST 30M NONOR STND GENRL ANES ADD 15M STND GENRL ANES FIRST 30M STND PACU LVL 1 ADD 15M STND PACU LVL 1 FIRST 30M STND PACU LVL 2 ADD 15M STND PACU LVL 2 FIRST 30M SURG LVL 1 ADD 15M SURG LVL 1 ADD 15M SURG LVL 1 FIRST 30M SURG LVL 1 FIRST 30M SURG LVL 2 ADD 15M SURG LVL 2 ADD 15M SURG LVL 2 FIRST 30M SURG LVL 2 FIRST 30M SURG LVL 3 ADD 15M SURG LVL 3 ADD 15M SURG LVL 3 FIRST 30M SURG LVL 3 FIRST 30M SURG LVL 4 ADD 15M SURG LVL 4 FIRST 30M SURG LVL 5 ADD 15M SURG LVL 5 FIRST 30M THORACENTESIS TRABECULOPLASTY LASER US NDL PLACE

660.00 660.00 660.00 584.00 730.00 165.00 660.00 165.00 528.00 298.00 719.00 99.00 393.00 765.00 238.00 721.00 2316.00 955.00 298.00 901.00 2894.00 372.00 1193.00 1126.00 3618.00 1492.00 4522.00 1865.00 5653.00 480.00 179.00 162.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 239.00 0.00 0.00 722.00 298.00 0.00 0.00 901.00 0.00 372.00 0.00 1126.00 1408.00 4267.00 1760.00 5333.00 0.00 0.00 0.00

20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20

SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR SURGICAL SVCS IP PROCEDUR

Page 233

Group Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services

CPT 36415 80048 80050 80051 80053 80055 80061 80069 80074 80076 80100 80101 80102 80150 80154 80156 80158 80160 80162 80164 80166 80168 80170 80176 80178 80182 80184 80185 80188 80194 80196 80197 80198 80200 80202 80299 81001 81002 81003 81005 81007 81015 81025 81050 82003 82009 82024 82030 82040 82042 82043

Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services

82055 82085 82088 82103 82105 82108 82128 82131 82135 82139 82140 82150 82157 82164 82175 82180 82232 82247 82248 82270 82273 82306 82308 82310 82330 82340 82374 82378 82379 82380 82384 82390 82435 82436 82438 82465 82480 82482 82491 82523 82530 82533 82540 82542 82550 82553 82565 82570 82575 82595 82600 82607

Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services

82608 82626 82627 82633 82634 82652 82668 82670 82672 82677 82679 82705 82710 82715 82725 82728 82731 82746 82747 82784 82785 82787 82941 82943 82945 82947 82950 82951 82952 82955 82977 82985 83001 83002 83003 83010 83018 83020 83036 83051 83070 83088 83090 83150 83491 83497 83498 83500 83505 83516 83520 83525

Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services

83540 83550 83586 83605 83615 83625 83655 83670 83690 83718 83735 83825 83835 83873 83874 83880 83883 83890 83891 83892 83893 83894 83896 83897 83898 83901 83903 83905 83906 83912 83915 83916 83918 83930 83935 83945 83970 83986 84022 84030 84060 84066 84075 84080 84100 84105 84106 84110 84120 84132 84133 84134

Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services

84135 84140 84143 84144 84146 84153 84154 84155 84156 84157 84165 84202 84206 84207 84210 84238 84244 84252 84260 84275 84295 84300 84302 84305 84315 84402 84403 84425 84432 84436 84439 84442 84443 84446 84450 84460 84466 84478 84479 84480 84481 84482 84484 84510 84520 84540 84550 84560 84580 84585 84586 84588

Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services

84590 84597 84600 84630 84681 84702 84703 84999 85004 85007 85013 85014 85018 85025 85027 85032 85044 85045 85048 85049 85130 85170 85210 85220 85230 85240 85245 85246 85247 85250 85260 85270 85280 85291 85300 85301 85302 85303 85305 85306 85335 85360 85362 85366 85378 85379 85384 85385 85410 85415 85420 85460

Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services

85475 85525 85540 85549 85555 85557 85576 85597 85610 85613 85635 85651 85652 85660 85670 85730 85732 85810 86000 86001 86003 86021 86022 86023 86038 86039 86060 86063 86140 86147 86148 86157 86160 86161 86162 86171 86225 86226 86235 86255 86304 86308 86316 86320 86331 86332 86334 86337 86341 86360 86361 86376

Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services

86403 86406 86431 86592 86593 86603 86606 86612 86617 86618 86622 86631 86635 86638 86641 86644 86645 86658 86664 86665 86677 86682 86687 86689 86692 86694 86695 86696 86698 86703 86704 86705 86706 86707 86708 86709 86710 86713 86720 86735 86738 86747 86757 86762 86765 86774 86777 86778 86781 86787 86790 86800

Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services

86803 86804 86812 86850 86870 86880 86886 86900 86901 86905 87015 87040 87045 87046 87070 87075 87076 87077 87081 87088 87102 87103 87106 87109 87110 87116 87118 87172 87177 87186 87187 87190 87197 87205 87206 87207 87210 87220 87252 87260 87265 87269 87270 87272 87274 87275 87276 87279 87280 87290 87299 87324

Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services Sacramento Sierra Lab Services

87328 87329 87340 87350 87390 87425 87430 87449 87450 87490 87491 87517 87522 87536 87590 87591 87798 88180 88182 88230 88235 88237 88262 88267 88271 88273 88274 88280 88285 88291 89050 89051 89055 89060 89125 89190 89320 89321 99001

CPT Description DRAWING BLOOD - 36415 BASIC METABOLIC PANEL GENERAL HEALTH PANEL - 80050 ELECTROLYTE PANEL COMPREHENSIVE METABOLIC PANEL OBSTETRIC PANEL - 80055 LIPID PANEL - 80061 RENAL FUNCTION PANEL (EFFECTIVE APRIL 1 2000) ACUTE HEPATITIS PANEL HEPATIC FUNCTION PANEL DRUG SCREEN - 80100 DRUG SCREEN - 80101 DRUG CONFIRMATION - 80102 ASSAY OF AMIKACIN - 80150 ASSAY OF BENZODIAZEPINES - 80154 ASSAY CARBAMAZEPINE - 80156 ASSAY OF CYCLOSPORINE - 80158 ASSAY OF DESIPRAMINE - 80160 ASSAY FOR DIGOXIN - 80162 ASSAY, DIPROPYLACETIC ACID - 80164 ASSAY OF DOXEPIN - 80166 ASSAY OF ETHOSUXIMIDE - 80168 GENTAMICIN - 80170 ASSAY FOR LIDOCAINE - 80176 ASSAY FOR LITHIUM - 80178 ASSAY FOR NORTRIPTYLINE - 80182 ASSAY FOR PHENOBARBITAL - 80184 ASSAY FOR PHENYTOIN - 80185 ASSAY FOR PRIMIDONE - 80188 ASSAY FOR QUINIDINE - 80194 ASSAY FOR SALICYLATE - 80196 TACROLIMUS ASSAY FOR THEOPHYLLINE - 80198 ASSAY FOR TOBRAMYCIN - 80200 ASSAY FOR VANCOMYCIN - 80202 QUANTITATIVE ASSAY, DRUG - 80299 URINALYSIS AUTO W/MICRO URINALYSIS NONAUTO W/O SCOPE - 81002 URINALYSIS, AUTO, W/O SCOPE - 81003 URINALYSIS - 81005 URINE SCREEN FOR BACTERIA - 81007 MICROSCOPIC EXAM OF URINE - 81015 URINE PREGNANCY TEST - 81025 URINALYSIS, VOLUME MEASURE - 81050 ASSAY ACETAMINOPHEN - 82003 TEST FOR ACETONE/KETONES - 82009 ACTH - 82024 ADP & AMP - 82030 ASSAY SERUM ALBUMIN - 82040 ASSAY URINE ALBUMIN - 82042 MICROALBUMIN, QUANTITATIVE - 82043

ASSAY ETHANOL - 82055 ASSAY OF ALDOLASE - 82085 ALDOSTERONE - 82088 ALPHA-1-ANTITRYPSIN, TOTAL - 82103 ALPHA-FETOPROTEIN, SERUM - 82105 ASSAY, ALUMINUM - 82108 TEST FOR AMINO ACIDS - 82128 AMINO ACIDS - 82131 ASSAY, AMINOLEVULINIC ACID - 82135 AMINO ACIDS 6/GRTR-QUAN-EA SPEC ASSAY OF AMMONIA - 82140 ASSAY OF AMYLASE - 82150 ASSAY OF ANDROSTENEDIONE - 82157 ANGIOTENSIN I ENZYME TEST - 82164 ASSAY OF ARSENIC - 82175 ASSAY OF ASCORBIC ACID - 82180 BETA-2 PROTEIN - 82232 BILIRUBIN TOTAL BILIRUBIN DIRECT TEST FECES FOR BLOOD - 82270 TEST FOR BLOOD, OTHER SOURCE - 82273 ASSAY OF VITAMIN D - 82306 ASSAY OF CALCITONIN - 82308 ASSAY CALCIUM - 82310 ASSAY CALCIUM - 82330 ASSAY CALCIUM IN URINE - 82340 ASSAY BLOOD CARBON DIOXIDE - 82374 CARCINOEMBRYONIC ANTIGEN - 82378 CARNITINE (TOT & FREE) QUAN EA SPEC ASSAY CAROTENE - 82380 ASSAY THREE CATECHOLAMINES - 82384 ASSAY CERULOPLASMIN - 82390 ASSAY BLOOD CHLORIDE - 82435 ASSAY URINE CHLORIDE - 82436 ASSAY OTHER FLUID CHLORIDES - 82438 ASSAY SERUM CHOLESTEROL - 82465 ASSAY SERUM CHOLINESTERASE - 82480 ASSAY RBC CHOLINESTERASE - 82482 CHROMOTOGRAPHY, QUANTITATIVE - 82491 COLLAGEN CROSS LINKS-ANY METHD CORTISOL, FREE - 82530 TOTAL CORTISOL - 82533 ASSAY CREATINE - 82540 COLUMN CHROMATOG/SPECTROM-ANALYTE NES; QUAN-SING ASSAY CK (CPK) - 82550 CREATINE, MB FRACTION - 82553 ASSAY CREATININE - 82565 ASSAY URINE CREATININE - 82570 CREATININE CLEARANCE TEST - 82575 ASSAY CRYOGLOBULIN - 82595 ASSAY CYANIDE - 82600 VITAMIN B-12 - 82607

B-12 BINDING CAPACITY - 82608 DEHYDROEPIANDROSTERONE - 82626 DEHYDROEPIANDROSTERONE - 82627 DESOXYCORTICOSTERONE - 82633 DEOXYCORTISOL - 82634 ASSAY, DIHYDROXYVITAMIN D - 82652 ERYTHROPOIETIN - 82668 ESTRADIOL - 82670 ESTROGEN ASSAY - 82672 ESTRIOL - 82677 ESTRONE - 82679 FATS/LIPIDS,FECES,QUALITATIV - 82705 FATS/LIPIDS,FECES,QUANTITATI - 82710 FECAL FAT ASSAY - 82715 ASSAY BLOOD FATTY ACIDS - 82725 ASSAY FERRITIN - 82728 FETAL FIBRONECTIN BLOOD FOLIC ACID SERUM - 82746 FOLIC ACID, RBC - 82747 ASSAY GAMMAGLOBULIN IGM - 82784 ASSAY, GAMMAGLOBULIN IGE - 82785 IGG1, 2, 3 AND 4 - 82787 ASSAY OF GASTRIN - 82941 ASSAY OF GLUCAGON - 82943 GLUCOSE, BODY FLUID, OTHER THAN BLOOD ASSAY QUANTITATIVE, GLUCOSE - 82947 GLUCOSE TEST - 82950 GLUCOSE TOLERANCE TEST (GTT) - 82951 GTT-ADDED SAMPLES - 82952 ASSAY G6PD ENZYME - 82955 ASSAY OF GGT - 82977 GLYCATED PROTEIN - 82985 GONADOTROPIN (FSH) - 83001 GONADOTROPIN (LH) - 83002 ASSAY GROWTH HORMONE (HGH) - 83003 QUANT ASSAY HAPTOGLOBIN - 83010 QUANTITATIVE SCREEN, METALS - 83018 ASSAY HEMOGLOBIN - 83020 GLYCATED HEMOGLOBIN TEST - 83036 ASSAY PLASMA HEMOGLOBIN - 83051 QUALT ASSAY HEMOSIDERIN - 83070 ASSAY HISTAMINE - 83088 HOMOCYSTINE ASSAY FOR HVA - 83150 ASSAY OF CORTICOSTEROIDS - 83491 ASSAY 5-HIAA - 83497 ASSAY OF PROGESTERONE - 83498 ASSAY FREE HYDROXYPROLINE - 83500 ASSAY TOTAL HYDROXYPROLINE - 83505 IMMUNOASSAY, NON ANTIBODY IMMUNOASSAY, RIA - 83520 ASSAY OF INSULIN - 83525

ASSAY IRON - 83540 IRON BINDING TEST - 83550 ASSAY 17-(17-KS)KETOSTEROIDS - 83586 LACTIC ACID ASSAY - 83605 LACTATE (LD) (LDH) ENZYME - 83615 ASSAY LDH ENZYMES - 83625 ASSAY FOR LEAD - 83655 ASSAY LAP ENZYME - 83670 ASSAY LIPASE - 83690 BLOOD LIPOPROTEIN ASSAY - 83718 ASSAY MAGNESIUM - 83735 ASSAY MERCURY - 83825 ASSAY METANEPHRINES - 83835 ASSAY, CSF PROTEIN - 83873 MYOGLOBIN - 83874 NATRIURETIC PEPTIDE NEPHELOMETRY, NOT SPECIFIED - 83883 MOLECULAR DIAGNOSTICS - 83890 MOLEC DX; ISOL/EXTRAC NUCLEIC ACID MOLECULAR DIAGNOSTICS - 83892 MOLEC DX; DOT/SLOT BLOT PRODUCTION MOLECULAR DIAGNOSTICS - 83894 MOLECULAR DIAGNOSTICS - 83896 MOLEC DX; NUCLEIC ACID TRANSF MOLECULAR DIAGNOSTICS - 83898 MOLEC DX; AMPL NUCLEIC ACID-MXPLEX MOLEC DX; MUTATION SCAN BY PHYS PROP-1 SEGMT EA MOLEC DX; MUTATION ID-ALLELE SPEC TRANSCRIP-1-EA MOLEC DX; MUTATION ID-ALLELE SPEC TRANSLAT-1-EA GENETIC EXAMINATION - 83912 ASSAY NUCLEOTIDASE - 83915 OLIGOCLONAL BANDS - 83916 ASSAY ORGANIC ACIDS - 83918 ASSAY BLOOD OSMOLALITY - 83930 ASSAY URINE OSMOLALITY - 83935 ASSAY OXALATE - 83945 ASSAY OF PARATHORMONE - 83970 ASSAY BODY FLUID ACIDITY - 83986 ASSAY OF PHENOTHIAZINE - 84022 ASSAY BLOOD PKU - 84030 ASSAY ACID PHOSPHATASE - 84060 ASSAY PROSTATE PHOSPHATASE - 84066 ASSAY ALKALINE PHOSPHATASE - 84075 ASSAY ALKALINE PHOSPHATASES - 84080 ASSAY PHOSPHORUS - 84100 ASSAY URINE PHOSPHORUS - 84105 TEST FOR PORPHOBILINOGEN - 84106 ASSAY PORPHOBILINOGEN - 84110 ASSAY URINE PORPHYRINS - 84120 ASSAY SERUM POTASSIUM - 84132 ASSAY URINE POTASSIUM - 84133 PREALBUMIN - 84134

ASSAY PREGNANEDIOL - 84135 ASSAY FOR PREGNENOLONE - 84140 ASSAY/17-HYDROXYPREGNENOLONE - 84143 ASSAY PROGESTERONE - 84144 ASSAY FOR PROLACTIN - 84146 PROSTATE SPECIFIC ANTIGEN - 84153 PROSTATE SPEC ANTIG; FREE ASSAY PROTEIN - 84155 PROTEIN TOTAL EXCEPT BY REFRACTOMETRY; URINE PROTEIN TOTAL OTHER SOURCE ASSAY SERUM PROTEINS - 84165 ASSAY RBC PROTOPORPHYRIN - 84202 ASSAY OF PROINSULIN - 84206 ASSAY VITAMIN B-6 - 84207 ASSAY PYRUVATE - 84210 ASSAY NON-ENDOCRINE RECEPTOR - 84238 ASSAY OF RENIN - 84244 ASSAY VITAMIN B-2 - 84252 ASSAY SEROTONIN - 84260 ASSAY SIALIC ACID - 84275 ASSAY SERUM SODIUM - 84295 ASSAY URINE SODIUM - 84300 ASSAY OF SODIUM OTHER SOURCE SOMATOMEDIN - 84305 BODY FLUID SPECIFIC GRAVITY - 84315 TESTOSTERONE - 84402 ASSAY TOTAL TESTOSTERONE - 84403 ASSAY VITAMIN B-1 - 84425 THYROGLOBULIN - 84432 ASSAY, TOTAL THYROXINE - 84436 ASSAY, FREE THYROXINE - 84439 THYROID ACTIVITY (TBG) ASSAY - 84442 ASSAY THYROID STIM HORMONE - 84443 ASSAY VITAMIN E - 84446 TRANSFERASE (AST) (SGOT) - 84450 ALANINE AMINO (ALT) (SGPT) - 84460 TRANSFERRIN - 84466 ASSAY TRIGLYCERIDES - 84478 ASSAY TRIIODOTHYRONINE (T-3) - 84479 TOTAL ASSAY, TT-3 - 84480 FREE ASSAY (FT-3) - 84481 T3 REVERSE - 84482 TROPONIN, QUAN ASSAY TYROSINE - 84510 ASSAY UREA NITROGEN - 84520 ASSAY URINE UREA-N - 84540 ASSAY BLOOD URIC ACID - 84550 ASSAY URINE URIC ACID - 84560 ASSAY URINE UROBILINOGEN - 84580 ASSAY URINE VMA - 84585 VIP ASSAY - 84586 ASSAY VASOPRESSIN - 84588

ASSAY VITAMIN-A - 84590 ASSAY VITAMIN-K - 84597 ASSAY FOR VOLATILES - 84600 ASSAY ZINC - 84630 ASSAY C-PEPTIDE - 84681 CHORIONIC GONADOTROPIN TEST - 84702 CHORIONIC GONADOTROPIN ASSAY - 84703 CLINICAL CHEMISTRY TEST - 84999 AUTOMATED DIFF WBC COUNT DIFFERENTIAL WBC COUNT - 85007 HEMATOCRIT - 85013 HEMATOCRIT - 85014 HEMOGLOBIN - 85018 AUTOMATED HEMOGRAM - 85025 AUTOMATED HEMOGRAM - 85027 MANUAL CELL COUNT EACH RETICULOCYTE COUNT - 85044 RETICULOCYTE COUNT - 85045 WHITE BLOOD CELL (WBC) COUNT - 85048 AUTOMATED PLATELET CHROMOGENIC SUBSTRATE ASSAY - 85130 BLOOD CLOT RETRACTION - 85170 BLOOD CLOT FACTOR II TEST - 85210 BLOOD CLOT FACTOR V TEST - 85220 BLOOD CLOT FACTOR VII TEST - 85230 BLOOD CLOT FACTOR VIII TEST - 85240 BLOOD CLOT FACTOR VIII TEST - 85245 BLOOD CLOT FACTOR VIII TEST - 85246 BLOOD CLOT FACTOR VIII TEST - 85247 BLOOD CLOT FACTOR IX TEST - 85250 BLOOD CLOT FACTOR X TEST - 85260 BLOOD CLOT FACTOR XI TEST - 85270 BLOOD CLOT FACTOR XII TEST - 85280 BLOOD CLOT FACTOR XIII TEST - 85291 ANTITHROMBIN III TEST - 85300 ANTITHROMBIN III TEST - 85301 BLOOD CLOT INHIBITOR ANTIGEN - 85302 BLOOD CLOT INHIBITOR TEST - 85303 BLOOD CLOT INHIBITOR ASSAY - 85305 BLOOD CLOT INHIBITOR TEST - 85306 FACTOR INHIBITOR TEST - 85335 EUGLOBULIN LYSIS - 85360 FIBRIN DEGRADATION PRODUCTS - 85362 FIBRINOGEN TEST - 85366 FIBRIN DEGRADATION - 85378 FIBRIN DEGRADATION - 85379 FIBRINOGEN - 85384 FIBRINOGEN - 85385 FIBRINOLYTIC ANTIPLASMIN - 85410 FIBRINOLYTIC PLASMINOGEN - 85415 FIBRINOLYTIC PLASMINOGEN - 85420 HEMOGLOBIN, FETAL - 85460

HEMOLYSIN - 85475 HEPARIN - 85525 WBC ALKALINE PHOSPHATASE - 85540 MURAMIDASE - 85549 RBC OSMOTIC FRAGILITY - 85555 RBC OSMOTIC FRAGILITY - 85557 BLOOD PLATELET AGGREGATION - 85576 PLATELET NEUTRALIZATION - 85597 PROTHROMBIN TIME - 85610 RUSSELL VIPER VENOM, DILUTED - 85613 REPTILASE TEST - 85635 RBC SEDIMENTATION RATE - 85651 SED RATE AUTO RBC SICKLE CELL TEST - 85660 THROMBIN TIME, PLASMA - 85670 THROMBOPLASTIN TIME, PARTIAL - 85730 THROMBOPLASTIN TIME, PARTIAL - 85732 BLOOD VISCOSITY EXAMINATION - 85810 AGGLUTININS; FEBRILE - 86000 ALLERGEN SPECIFIC IGG QUANTITATIVE OR SEMIQUANTITATIVE, EACH ALLERGEN SPECIFIC IGE - 86003 WBC ANTIBODY IDENTIFICATION - 86021 PLATELET ANTIBODIES - 86022 IMMUNOGLOBULIN ASSAY - 86023 ANTINUCLEAR ANTIBODIES - 86038 ANTINUCLEAR ANTIBODIES (ANA) - 86039 ANTISTREPTOLYSIN O TITER - 86060 ANTISTREPTOLYSIN O SCREEN - 86063 C-REACTIVE PROTEIN - 86140 CARDIOLIPIN ANTIBODY - 86147 ANTI-PHOSPHATIDYLSERINE ANTIBODY COLD AGGLUTININ, TITER - 86157 COMPLEMENT, ANTIGEN - 86160 COMPLEMENT/FUNCTION ACTIVITY - 86161 COMPLEMENT, TOTAL (CH50) - 86162 COMPLEMENT FIXATION, EACH - 86171 DNA ANTIBODY - 86225 DNA ANTIBODY, SINGLE STRAND - 86226 NUCLEAR ANTIGEN ANTIBODY - 86235 FLUORESCENT ANTIBODY; SCREEN - 86255 IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 125 HETEROPHILE ANTIBODIES - 86308 IMMUNOASSAY, TUMOR ANTIGEN - 86316 SERUM IMMUNOELECTROPHORESIS - 86320 IMMUNODIFFUSION OUCHTERLONY - 86331 IMMUNE COMPLEX ASSAY - 86332 IMMUNOFIXATION PROCEDURE - 86334 INSULIN ANTIBODIES - 86337 ISLET CELL ANTIBODY - 86341 T CELL RATIO - 86360 T CELLS; ABSOLUTE CD4 COUNT MICROSOMAL ANTIBODY - 86376

PARTICLE AGGLUTINATION TEST - 86403 PARTICLE AGGLUTINATION TEST RHEUMATOID FACTOR, QUANT - 86431 BLOOD SEROLOGY, QUALITATIVE - 86592 BLOOD SEROLOGY, QUANTITATIVE - 86593 ADENOVIRUS, ANTIBODY - 86603 ASPERGILLUS ANTIBODY - 86606 BLASTOMYCES, ANTIBODY - 86612 LYME DISEASE ANTIBODY LYME DISEASE ANTIBODY - 86618 BRUCELLA, ANTIBODY - 86622 CHLAMYDIA, ANTIBODY - 86631 COCCIDIOIDES, ANTIBODY - 86635 Q FEVER ANTIBODY - 86638 CRYPTOCOCCUS ANTIBODY - 86641 CMV ANTIBODY - 86644 CMV ANTIBODY, IGM - 86645 ENTEROVIRUS, ANTIBODY - 86658 EPSTEIN-BARR ANTIBODY - 86664 EPSTEIN-BARR, ANTIBODY - 86665 HELICOBACTER PYLORI - 86677 HELMINTH, ANTIBODY - 86682 HTLV I - 86687 HTLV/HIV CONFIRMATORY TEST - 86689 HEPATITIS, DELTA AGENT - 86692 HERPES SIMPLEX TEST - 86694 HERPES SIMPLEX TEST - 86695 ANTIBODY; HERPES SIMPLEX, TYPE 2 HISTOPLASMA - 86698 HIV-1/HIV-2, SINGLE ASSAY - 86703 HEPATITIS B CORE ANTIBODY;IGG & IGM HEPATITIS B CORE; IGM ANTIBODY HEPATITIS B SURFACE ANTIBODY HEPATITIS BE ANTIBODY HEPATITIS A ANTIBODY,IGG & IGM HEPATITIS A ANTIBODY;IGM INFLUENZA VIRUS - 86710 LEGIONELLA - 86713 LEPTOSPIRA - 86720 MUMPS - 86735 MYCOPLASMA - 86738 PARVOVIRUS - 86747 ANTIBODY; RICKETTSIA RUBELLA - 86762 RUBEOLA - 86765 TETANUS - 86774 TOXOPLASMA - 86777 TOXOPLASMA, IGM - 86778 TREPONEMA PALLIDUM CONFIRM - 86781 VARICELLA-ZOSTER - 86787 VIRUS, NOT SPECIFIED - 86790 THYROGLOBULIN ANTIBODY - 86800

HEPATITIS C ANTIBODY HEPATITIS C ANTIBODY; CONFIRM TEST HLA TYPING, A, B, OR C - 86812 RBC ANTIBODY SCREEN - 86850 RBC ANTIBODY IDENTIFICATION - 86870 COOMBS TEST - 86880 COOMBS TEST - 86886 BLOOD TYPING, ABO - 86900 BLOOD TYPING, RH (D) - 86901 BLOOD TYPING, RBC ANTIGENS - 86905 SPECIMEN CONCENTRATION - 87015 BLOOD CULTURE FOR BACTERIA - 87040 FECES CULTURE, BACTERIA CULTURE, BACTERIAL; STOOL, ADDITIONAL PATHOGENS, ISOLATION AND PRELIM EXA CULTURE SPECIMEN, BACTERIA - 87070 CULTURE SPECIMEN, BACTERIA - 87075 BACTERIA IDENTIFICATION - 87076 CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDTL METHODS REQ FOR DEFINITIVE ID BACTERIA CULTURE SCREEN - 87081 URINE BACTERIA CULTURE - 87088 FUNGUS ISOLATION CULTURE - 87102 BLOOD FUNGUS CULTURE - 87103 FUNGUS IDENTIFICATION - 87106 MYCOPLASMA CULTURE - 87109 CULTURE, CHLAMYDIA - 87110 MYCOBACTERIA CULTURE - 87116 MYCOBACTERIA IDENTIFICATION - 87118 PINWORM EXAM OVA AND PARASITES SMEARS - 87177 ANTIBIOTIC SENSITIVITY, MIC - 87186 ANTIBIOTIC SENSITIVITY, MBC - 87187 TB ANTIBIOTIC SENSITIVITY - 87190 BACTERICIDAL LEVEL, SERUM - 87197 SMEAR, STAIN & INTERPRET - 87205 SMEAR, STAIN & INTERPRET - 87206 SMEAR, STAIN & INTERPRET - 87207 SMEAR, STAIN & INTERPRET - 87210 TISSUE EXAM FOR FUNGI - 87220 VIRUS INOCULATION FOR TEST - 87252 INFEC AG-DIR FLUORES AB; ADENOVIRUS INFEC AG-DIR FLUORES AB; BORDATELLA PERTUSSIS INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; GIARDIA INFEC AG-DIR FLUORES AB; CHLAMYDIA TRACHOMATIS INFEC AG-DIR FLUORES AB; CRYPTOSPORIDUM/GIARDIA INFEC AG-DIR FLUORES AB; HERPES SIMPLEX VIRUS INFECTIOUS AGENT ANTIGEN DETECT BY IMMUNOFLUORESCENT; INFLUENZA B VIRUS INFEC AG-DIR FLUORES AB; INFLUENZA A VIRUS INFECTIOUS AGENT ANTIGEN DETECT BY IMMUNOFLUORESCENT; PARAINFLUENZA VIRUS INFEC AG-DIR FLUORES AB; RESP SYNCYTIAL VIRUS INFEC AG-DIR FLUORES AB; VARICELLA ZOSTER VIRUS INFEC AG-DIR FLUORES AB; NOS INFEC AG-IMMUNOASSAY; CLOSTRIDIUM DIFF-TOXIN A

INFEC AG-IMMUNOASSAY; CRYPTOSPORIDUM/GIARDIA GIARDIA AG ENZYME IMMUNO TECH HEPATITIS B SURFACE ANTIGEN INFEC AG-IMMUNOASSAY; HEP BE ANTIG INFEC AG-IMMUNOASSAY; HIV-1 INFEC AG-IMMUNOASSAY;ROTAVIRUS STREP SCREEN GROUP A IMMUNOASSAY MULTI-STEP NOS INF AG-IMMUNOASSAY;SNGL STEP METHD-NOS CHLAMYDIA TRACHO DIRECT PROBE INFEC AGT-DNA/RNA; CHLAMYDIA TRACHOMATIS-AMPLI INFEC AGT-DNA/RNA; HEP B VIRUS-QUAN INFEC AGT-DNA/RNA; HEP C-QUAN HIV-I QUANTIFICATION N GONORRHEA DIRECT PROBE INFEC AGT-DNA/RNA; NEISSERIA GONORRHEA-AMPL PROB INFEC AGT-DNA/RNA; NOS-AMPLIFIED PROBE TECH CELL MARKER STUDY - 88180 CELL MARKER STUDY - 88182 TISSUE CULTURE, LYMPHOCYTE - 88230 TISSUE CULTURE, PLACENTA - 88235 TISSUE CULTURE, BONE MARROW - 88237 CHROMOSOME COUNT:15-20 CELLS - 88262 CHROMOSOME ANALYSIS:PLACENTA - 88267 MOLEC CYTOGEN; DNA PROBE EA MOLEC CYTOGEN; CHROMOSOM HYBRID 10-30 CELLS MOLEC CYTOGEN; INTERPHASE IN SITU HYBRID 25-99 CHROMOSOME KARYOTYPE STUDY - 88280 CHROMOSOME COUNT: ADDITIONAL - 88285 CYTOGEN & MOLEC CYTOGEN/INTREP & REPO BODY FLUID CELL COUNT - 89050 BODY FLUID CELL COUNT - 89051 LEUKOCYTE COUNT FECAL EXAM,SYNOVIAL FLUID CRYSTALS - 89060 SPECIMEN FAT STAIN - 89125 NASAL SMEAR FOR EOSINOPHILS - 89190 SEMEN ANALYSIS - 89320 SEMEN ANALYSIS, PRESENCE AND/OR MOTILITY OF SPERM SPECIMEN HANDLING - 99001

Fee 14.00 46.00 195.00 40.00 62.00 290.00 45.00 55.00 350.00 43.00 33.00 20.00 75.00 22.00 26.50 85.00 65.00 26.11 70.00 80.00 28.32 20.50 85.00 40.55 55.00 22.65 85.00 85.00 85.00 45.00 45.00 125.00 75.00 85.00 85.00 14.75 34.00 19.00 19.00 20.00 45.00 15.00 30.00 14.00 60.00 25.00 33.00 80.00 6.45 6.45 10.00

50.00 10.50 36.00 13.25 14.80 46.54 21.71 59.00 31.15 96.50 35.00 50.00 29.75 15.50 33.98 47.20 19.95 28.00 28.00 32.00 32.00 28.70 27.50 30.00 15.00 40.00 15.00 70.00 30.39 24.00 33.55 11.55 15.00 15.00 15.00 18.00 18.88 24.00 59.94 42.00 21.25 115.00 34.46 245.00 45.00 35.00 20.00 30.00 45.00 7.25 27.85 50.00

22.50 44.20 15.68 50.98 43.90 65.00 18.00 90.00 29.97 39.50 37.29 17.80 64.00 16.45 20.77 60.00 200.00 85.00 19.90 6.45 21.50 43.95 15.00 33.04 27.00 27.00 32.00 71.00 27.00 16.30 43.00 17.09 103.00 103.00 11.50 13.50 22.00 25.00 61.00 12.25 17.34 66.50 72.00 33.51 31.15 24.00 24.75 48.30 50.98 26.00 29.10 12.00

32.00 40.00 18.50 40.00 42.00 10.75 9.20 23.60 36.00 18.00 28.00 23.70 28.00 25.20 23.45 150.00 30.78 26.00 6.00 6.00 0.00 15.00 6.00 0.00 26.00 18.00 6.00 6.00 15.53 6.00 16.05 18.45 134.30 64.00 64.00 12.50 45.11 17.00 34.46 28.32 9.50 10.50 20.00 20.00 15.00 6.61 8.00 20.30 41.54 15.00 20.00 24.54

51.50 31.15 31.30 14.00 88.00 89.00 25.00 8.50 9.00 9.00 18.96 31.50 56.61 51.00 21.71 56.64 19.90 64.50 72.69 25.90 15.00 20.00 20.00 28.90 10.00 25.88 78.00 56.30 16.07 60.00 42.00 24.90 85.00 25.52 28.00 28.00 12.50 18.00 6.61 9.75 22.55 48.14 95.00 40.00 15.00 45.00 15.00 20.00 9.32 19.50 55.00 58.53

15.77 105.00 18.00 15.00 21.00 20.00 30.00 0.00 15.00 20.00 20.00 15.00 15.00 50.00 35.00 30.00 40.00 30.00 25.00 25.00 121.00 10.00 125.00 125.00 125.00 125.00 135.00 135.00 126.00 125.00 125.00 125.00 125.00 90.00 100.00 45.00 115.00 140.00 85.00 85.00 227.00 55.00 60.00 50.00 95.00 95.00 50.00 60.00 125.00 82.50 45.85 100.00

26.90 13.00 135.00 41.54 38.00 45.00 175.00 85.00 30.00 29.10 49.50 30.00 25.00 5.66 45.00 40.00 50.00 20.30 13.20 11.47 7.35 15.29 27.16 27.16 8.00 8.00 9.44 9.44 43.00 29.10 29.10 25.00 22.18 17.00 19.90 47.16 18.50 31.15 21.00 13.20 110.00 45.00 15.00 18.96 43.20 34.65 25.00 41.08 31.15 70.00 35.00 11.77

16.50 77.00 55.00 9.25 40.00 22.21 6.17 19.35 11.25 13.88 18.87 23.00 25.25 5.21 22.18 14.00 14.00 21.24 14.45 14.45 10.84 50.40 38.45 20.75 27.88 24.10 20.15 20.15 18.47 115.00 10.75 98.00 55.00 14.99 88.00 95.00 21.30 11.50 16.99 12.00 44.20 21.25 12.03 20.00 13.90 28.00 12.32 12.32 8.85 20.00 20.15 10.00

88.00 63.98 25.80 75.00 150.00 38.00 115.00 30.00 18.00 45.00 45.00 75.00 103.00 103.00 69.00 105.00 25.00 25.00 79.00 51.00 107.00 75.00 35.00 25.00 25.00 120.00 30.00 30.00 52.00 40.00 40.00 41.00 40.00 50.00 55.00 17.00 30.00 30.00 21.40 35.00 26.00 25.00 35.00 25.00 13.80 35.00 35.00 50.00 50.00 23.00 29.40 85.00

20.00 20.00 17.00 11.00 23.50 30.60 48.00 8.25 23.00 85.00 48.00 95.45 111.00 76.30 85.00 48.00 100.30 35.00 135.00 200.00 275.00 275.00 200.00 275.00 150.00 150.00 75.00 54.00 35.00 75.00 45.00 65.00 42.00 25.00 16.45 35.00 85.00 40.00 60.00


				
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