CHLA Charge Master 06_15_2007 - Excel - Excel by azw20493

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									                                                                     CM 06/15/07


Effective Date: 06/15/2007
 Dept                                                                                                                    M/cal
           Cost Ctr.    SIM#                    Description                      Price          Stats/bill   CPT   Mod           Mod   Rev Code
 Code                                                                                                                    HCPCS
AAD              9808     1156   ADOL MED - PROCEDURE ROOM                           0.00   S                                                515
AAD              9808 21154      CARDIAC MONITOR EA 1/2 HR                           0.00   S                                                515
AAD              9808 30114      CASE CONFERENCE NURSE 1/4 HR                        0.00   S                                                515
AAD              9808 30130      CENTER COORD FEE                                    0.00   S                                                515
AAD              9808 65033      CHANGE OF GASTROSTOMY TUBE                          0.00   S                                                515
AAD              9808 30148      CHART REVIEW - COMPREHENSIVE                        0.00   S                                                515
AAD              9808 30155      CHARG REVIEW - PERIODIC                             0.00   S                                                515
AAD              9808 30106      CLINIC COUNSEL - FAMILY                             0.00   S                                                916
AAD              9808 30098      CLINIC COUNSEL - INDIVIDUAL                         0.00   S                                                914
AAD              9808 20751      DSG CHANGE PICC/CVC                                 0.00   S                                                272
AAD              9808     2054   HEARING SCREENING                                   0.00   S                                                471
AAD              9808 65128      HHN INITIAL TX                                      0.00   S                                                410
AAD              9808 65126      IM INJ ANTIBIOTIC                                   0.00   S                                                515
AAD              9808 65040      INJECTION IM/SUBQ                                   0.00   S                                                515
AAD              9808 65041      INJECTION IV                                        0.00   S                                                515
AAD              9808 65027      INTRO INTRACATH VEIN, UNI                           0.00   S                                                515
AAD              9808 65127      NONPRESSURIZED INH TX                               0.00   S                                                410
AAD              9808 30031      NURSE EVAL 1/2 HR                                   0.00   S                                                515
AAD              9808 32409      NURSE MONITORING - 15 MIN INTERVA                   0.00   S                                                515
AAD              9808 30010      NUTRITION EDUC 1/2 HR                               0.00   S                                                515
AAD              9808 30171      PHONE CALL NURSE 1/4 HR                             0.00   S                                                519
AAD              9808 10500      POC GLUCOSE                                         0.00   S                                                300
AAD              9808 10900      POC HEMATOCRIT                                      0.00   S                                                300
AAD              9808 20195      PULSE OXIM INTERMITTENT                             0.00   S                                                460
AAD              9808 30012      RD ADDL EVAL 1/4 HR                                 0.00   S                                                515
AAD              9808 30015      RD CASE CONF 1/4 HR                                 0.00   S                                                519
AAD              9808 30014      RD PHONE CALL ADDL 1/4 HR                           0.00   S                                                519
AAD              9808 30011      RD INIT EVAL 1/4 HR                                 0.00   S                                                515
AAD              9808 30013      RD PHONE CALL INIT 1/4 HR                           0.00   S                                                519
AAD              9808 65130      SELF CARE TRAIN, EA 15 MIN                          0.00   S                                                515
AAD              9808 65131      SKIN TEST, PPD                                      0.00   S                                                302
AAD              9808 65007      SOC WORK EVAL 1/2 HR                                0.00   S                                                561
AAD              9808 65009      SOC WORK PHONE CONSULT 1/4 HR                       0.00   S                                                561
AAD              9808 65008      SOC WORK TEAM CONF 1/4 HR                           0.00   S                                                561



                                                                     Page 1 of 676
                                                             CM 06/15/07


 Dept                                                                                                                     M/cal
        Cost Ctr.   SIM#                  Description                    Price          Stats/bill        CPT      Mod               Mod   Rev Code
 Code                                                                                                                     HCPCS
AAD          9808   65021   URINARY CATH SIMPLE                              0.00   S                                                            515
AAD          9808   61010   USE OF ROOM - NO CHARGE                          0.00   S                                                            515
ABG          7541   40852   LAB BLOOD GASES                                120.00                    1    82803   TC        82803   TC           301
ABG          7541   20000   PCX GLUCOSE                                     19.00                    1    82947   TC        82947   TC           301
ABG          7541   10200   POC BLOOD GAS                                  132.00                    1    82803   TC        82803   TC           301
ABG          7541   10250   POC CHLORIDE                                    24.00                    1    82435   TC        82435   TC           301
ABG          7541   10300   POC CREATININE                                  24.00                    1    82565   TC        82565   TC           301
ABG          7541   10500   POC GLUCOSE                                     24.00                    1    82947   TC        82947   TC           301
ABG          7541   10900   POC HEMATOCRIT                                  12.00                    1    85014   TC        85014   TC           301
ABG          7541   10450   POC IONIZED CA                                 124.00                    1    82330   TC        82330   TC           301
ABG          7541   10550   POC LACTATE                                     78.00                    1    83605   TC        83605   TC           301
ABG          7541   10650   POC POTASSIUM                                   24.00                    1    84132   TC        84132   TC           301
ABG          7541   10750   POC SODIUM                                      24.00                    1    84295   TC        84295   TC           301
ABG          7541   10800   POC UREA NITROGEN                               24.00                    1    84520   TC        84520   TC           301
ABL          7509      74   ADMINISTRATIVE FEE                               0.00   S                     86999             86999                391
ABL          7509       9   AUTOLOGOUS BONE MARROW LAB                       0.00   S                                                            310
ABL          7509    1056   AUTOLOGOUS W/ CHEMO PURGING 2                    0.00   S                                                            362
ABL          7509    1015   AUTOLOGOUS W/O CHEMO PURG 1                      0.00   S                                                            362
ABL          7509      66   BM IMMUNOBEAD PREP & TREAT                       0.00   S                     38211             38211 ZS             819
ABL          7509    1000   BM MOD/TR ELIMINAT CELL TYPE                17,004.00                    1    38211 ZS          38211 ZS             819
ABL          7509      58   BM SHIPPING                                    482.00                    1    86999 ZS          86999 ZS             391
ABL          7509    1304   BMT HARVEST (ASPIRATION)                         0.00   S                                                            362
ABL          7509      90   EVAL PBSC FOR HEM STEM CELLS                     0.00   S                     86999             86999                391
ABL          7509      33   EVAL PURGED BM FOR STEM CELLS                    0.00   S                     86999             86999                391
ABL          7509      82   ISO & CRYOPRESV PBSC                         5,475.00                    1    86999 ZS          86999 ZS             391
ABL          7509      25   ISOL PRESERV STEM CELLS MARROW                   0.00   S                     86999             86999                391
ABL          7509      17   LAB BM EVAL TUMOR CELLS                          0.00   S                     86999             86999                391
ABL          7509      41   LAB BM THAWING                                   0.00   S                     86999             86999                391
ABL          7509     256   PERI BLD STEM CELL INFUSION                    602.00                    1    38241             38241                940
ABL          7509    1205   T-CELL DEPLETED HAPLOIDENT                       0.00   S                                                            362
ADO          7394   30114   ADMED-CASE CONF NURSE 1/4 HR                    16.00                    1   Z5404           Z5404                   515
ADO          7394   30130   ADMED-CENTER COORD FEE                         135.00                    1   Z5428           Z5428                   515
ADO          7394   30148   ADMED-CHART REV 2YR COMP                       103.00                    1   Z5427           Z5427                   515
ADO          7394   30155   ADMED-CHART REV 4YR PERIODIC                    56.00                    1   Z5426           Z5426                   515
ADO          7394   30106   ADMED-CLINIC COUNSEL FAMILY                    294.00                    1    90847          X9508                   916



                                                             Page 2 of 676
                                                           CM 06/15/07


 Dept                                                                                                                    M/cal
        Cost Ctr.   SIM#                  Description                 Price            Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                                   HCPCS
ADO          7394   30080   ADMED-CLINIC COUNSEL GROUP                    205.00                    1    90853         X9506                   915
ADO          7394   30098   ADMED-CLINIC COUNSEL INDIVIDUAL               205.00                    1    90810         X9500                   914
ADO          7394   30064   ADMED-COMPREHENSIVE CHART REVIEW              103.00                    1   Z5427          Z5427                   515
ADO          7394   30056   ADMED-COORDINATOR EVALUATION                  135.00                    1   Z5400          Z5400                   515
ADO          7394   30031   ADMED-NURSE EVAL 1/2 HR                        31.00                    1   Z5402          Z5402                   515
ADO          7394   30171   ADMED-PHONE CALL NURSE 1/4HR                    0.00                    1   Z5406          Z5406                   519
ADO          7394   30049   ADMED-PHONE CONSULT 1/4 HR                      0.00   S                    Z5406          Z5406                   519
ADO          7394   30023   ADMED-TEAM CONFERENCE 1/2 HR                   31.00                    1   Z5404          Z5404                   515
ADO          7394   30072   ADMED-CHART REVIEW 1 HOUR                      56.00                    1   Z5426          Z5426                   515
ADO          7394   65128   HHN INITIAL TX                                221.00                    1    94640             94640               410
ADO          7394   65126   IM INJ ANTIBIOTIC                              29.00                    1    90772             90772               515
ADO          7394   65040   INJECTION IM/SUBQ                              35.00                    1    90772             90772               515
ADO          7394   65041   INJECTION IV                                  119.00                    1    90774             90774               515
ADO          7394   65015   MED NUTRITION THRPY GRP TEACHING               19.18                    1   Z4314          Z4314                   942
ADO          7394   65147   MED NUTRITION THRPY INITIAL ASSES              67.00                    1                                          942
ADO          7394   65148   MED NUTRITION THRPY REASSESMENT                67.00                    1                                          942
ADO          7394   65127   NONPRESSURIZED INH TX                         145.00                    1    94640             94640               410
ADO          7394   30010   NUTRITION EDUC. 1/2 HR.                        34.00                    1   Z5802          Z5802                   515
ADO          7394   30012   RD ADDL EVAL 1/4 HR.                           16.00                    1   Z5402          Z5402                   515
ADO          7394   30015   RD CASE CONF 1/4 HR.                           12.00                    1   Z5406          Z5406                   519
ADO          7394   30011   RD INIT EVAL 1/4 HR.                           16.00                    1   Z5402          Z5402                   515
ADO          7394   30014   RD PHONE CALL ADDL 1/4 HR.                      0.00   S                    Z5406          Z5406                   519
ADO          7394   30013   RD PHONE CALL INIT 1/4 HR.                      0.00   S                    Z5406          Z5406                   519
ADO          7394   65130   SELF CARE TRAIN, EA 15MIN                       0.00   S                     97535             97535               515
ADO          7394   65131   SKIN TEST ,PPD                                 64.00                    1    86580 TC          86580 TC            302
ADO          7394   65007   SOC WORK EVAL 1/2 HR                           24.10                    1   Z4307          Z4307                   561
ADO          7394   65009   SOC WORK PHONE CNSLT 1/4 HR                     0.00   S                    Z5406          Z5406                   561
ADO          7394   65008   SOC WORK TEAM CONF 1/4 HR                      12.05                    1   Z4311          Z4311                   561
ADO          7394   65021   URINARY CATH SIMPLE                             0.00   S                     53670             53670               515
ADO          7394   61010   USE OF ROOM - NO CHARGE                         0.00   S                     99211         Z7500                   515
ADO          7394   60600   USE OF ROOM CHARGE                             50.00                    1    99211         Z7500                   515
AGP          9807   21154   CARDIAC MONITOR EA 1/2 HR                       0.00   S                                                           515
AGP          9807   30114   CASE CONFERENCE NURSE 1/4 HR                    0.00   S                                                           515
AGP          9807   30130   CENTER COORD FEE                                0.00   S                                                           515
AGP          9807   65033   CHANGE OF GASTROSTOMY TUBE                      0.00   S                                                           515



                                                          Page 3 of 676
                                                            CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                   Description                  Price            Stats/bill     CPT     Mod               Mod   Rev Code
 Code                                                                                                                  HCPCS
AGP          9807   30148   CHART REVIEW - COMPREHENSIVE                      0.00   S                                                        515
AGP          9807   30155   CHART REVIEW - PERIODIC                           0.00   S                                                        515
AGP          9807   30106   CLINIC COUNSEL - FAMILY                           0.00   S                                                        916
AGP          9807   30098   CLINIC COUNSEL - INDIVIDUAL                       0.00   S                                                        914
AGP          9807   20751   DSG CHANGE PICC/CVC                               0.00   S                                                        272
AGP          9807    1156   GPS - PROCEDURE ROOM                              0.00   S                                                        515
AGP          9807    2054   HEARING SCREENING                                 0.00   S                                                        471
AGP          9807   65128   HHN INITIAL TX                                    0.00   S                                                        410
AGP          9807   65126   IM INJ ANTIBIOTIC                                 0.00   S                                                        515
AGP          9807   65040   INJECTION IM/SUBQ                                 0.00   S                                                        515
AGP          9807   65041   INJECTION IV                                      0.00   S                                                        515
AGP          9807   65027   INTRO INTRACATH VEIN, UNI                         0.00   S                                                        515
AGP          9807   65127   NONPRESSURIZED INH TX                             0.00   S                                                        410
AGP          9807   30031   NURSE EVAL 1/2 HR                                 0.00   S                                                        515
AGP          9807   32409   NURSE MONITORING-15-MIN INTERVALS                 0.00   S                                                        515
AGP          9807   30010   NUTRITION EDUC 1/2 HR                             0.00   S                                                        515
AGP          9807   30171   PHONE CALL NURSE 1/4 HR                           0.00   S                                                        519
AGP          9807   10500   POC GLUCOSE                                       0.00   S                                                        300
AGP          9807   10900   POC HEMATOCRIT                                    0.00   S                                                        300
AGP          9807   20195   PULSE OXIM INTERMITTENT                           0.00   S                                                        460
AGP          9807   30012   RD ADDL EVAL 1/4 HR                               0.00   S                                                        515
AGP          9807   30015   RD CASE CONF 1/4 HR                               0.00   S                                                        519
AGP          9807   30011   RD INIT EVAL 1/4 HR                               0.00   S                                                        515
AGP          9807   30014   RD PHONE CALL ADDL 1/4 HR                         0.00   S                                                        519
AGP          9807   30013   RD PHONE CALL INIT 1/4 HR                         0.00   S                                                        519
AGP          9807   65130   SELF CARE TRAIN, EA 15 MIN                        0.00   S                                                        515
AGP          9807   65131   SKIN TEST, PPD                                    0.00   S                                                        302
AGP          9807   65007   SOC WORK EVAL 1/2 HR                              0.00   S                                                        561
AGP          9807   65009   SOC WORK PHONE CONSULT 1/4 HR                     0.00   S                                                        561
AGP          9807   65008   SOC WORK TEAM CONF 1/4 HR                         0.00   S                                                        561
AGP          9807   65021   URINARY CATH SIMPLE                               0.00   S                                                        515
AGP          9807   61010   USE OF ROOM - NO CHARGE                           0.00   S                                                        515
AIC          7433   23200   ACETAMINOPHEN SUSP 80 MG                         10.00                    1 A4649         Z7610                   250
AIC          7433   65127   AEROSOL ACUTE                                   145.00                    1 94640             94640               412
AIC          7433   61586   AEROSOL NON-ACUTE                               117.00                    1 94642             94642               412



                                                            Page 4 of 676
                                                               CM 06/15/07


 Dept                                                                                                                       M/cal
        Cost Ctr.   SIM#                   Description                     Price            Stats/bill        CPT   Mod              Mod  Rev Code
 Code                                                                                                                      HCPCS
AIC          7433   65186   AEROSOL NON-ACUTE                                  227.00                    1    94642           94642             412
AIC          7433   20255   AIC ACCESS PORTA-CATH W/NEEDLE                       0.00   S                     93799           93799             515
AIC          7433   65125   BLOOD COLLECTION, ACCESS DEVICE                      0.00   S                     36540           36540             515
AIC          7433   21154   CARDIAC MONITOR EA 1/2 HR                            0.00   S                     93041       Z5416                 515
AIC          7433   65132   CENTRAL LINE CATH REPAIR                             0.00   S                     93799           93799             515
AIC          7433   65033   CHANGE OF GASTROSTOMY TUBE                           0.00   S                     43760           43760             515
AIC          7433   65031   DECLOT VASCULAR CATH                                 0.00   S                     36550           36550             515
AIC          7433   22707   DEXTROSE 50% WATER IV 50ML                          54.00                    1   A4649        X7700                 250
AIC          7433   20751   DSG CHANGE PICC/CVC                                  0.00   S                    A6219        A6219                 272
AIC          7433   65355   HEP B (ADULT)                                      216.00                    1    90746           90746             636
AIC          7433   23051   HEPARIN FLUSH 100U/ML                               54.00                    1   J1642        X6282                 250
AIC          7433   23069   HEPARIN FLUSH 50U/5ML VIAL                          54.00                    1   X6284        X6284                 250
AIC          7433   65374   HEPB (PED/ADULT)                                    48.00                    1    90744           90744             636
AIC          7433   65128   HHN INITIAL TX                                     221.00                    1    94640           94640             410
AIC          7433   65126   IM INJ ANTIBIOTIC                                   29.00                    1    90772           90772             515
AIC          7433   65357   INFLUENZA 3 YR+                                     55.00                    1    90658 SL        90658 SL          636
AIC          7433   65356   INFLUENZA 6-35 MO.                                  55.00                    1    90657 SL        90657 SL          636
AIC          7433   65040   INJ-IM/SUBQ                                         29.00                    1    90772           90772             515
AIC          7433   65041   INJECTION IV PUSH                                  119.00                    1    90774           90774             515
AIC          7433   65028   INTRO INTRACATH VEIN, BILAT                          0.00   S                     36000    50     36000    50       515
AIC          7433   65027   INTRO INTRACATH VEIN, UNI                            0.00   S                     36000           36000             515
AIC          7433   65184   IV FLUID/MEDS INFUSION INIT HR                     271.00                    1    90765           90765             260
AIC          7433   65185   IV FLUIDS/MEDS INFUSION ADDL HR                    140.00                    1    90766           90766             260
AIC          7433   65124   SEDATION,IV/IM/INH(BILL W/JCODE)                   549.00                    1    99143           99143             370
AIC          7433   65123   SEDATION,PO/PR (BILL W/JCODE)                      680.00                    1    99143           99143             370
AIC          7433   65130   SELF CARE TRAIN, EA 15 MIN                           0.00   S                     97535           97535             515
AIC          7433   65131   SKIN TEST, PPD INTRADERMAL                          64.00                    1    86580 TC        86580 TC          302
AIC          7433   23150   SOD CHLORIDE 0.9% INJ 10ML                          54.00                    1   J3490            90779             250
AIC          7433   65030   TRANSFUSION BLOOD/COMP EA                            0.00   S                     36430           36430             515
AIC          7433   23259   TYLENOL EL 160 MG/5 ML 4 OZ                         37.00                    1   A4649        Z7610                 250
AIC          7433   65021   URINARY CATH SIMPLE                                  0.00   S                     53670           53670             515
AIC          7433   61010   USE OF ROOM - NO CHARGE                              0.00   S                     99211       Z7500                 515
AIC          7433   60600   USE OF ROOM CHARGE                                  50.00                    1    99211       Z7500                 515
AIC          7433   65032   WITHDRAWL OF ARTERIAL BLOOD                        159.00                    1    36600       NC                    515
ALA          9809   30148   CHART REVIEW - COMPREHENSIVE                         0.00   S                                                       515



                                                               Page 5 of 676
                                                            CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                  Description                   Price            Stats/bill       CPT   Mod             Mod     Rev Code
 Code                                                                                                                  HCPCS
ALA          9809   30155   CHART REVIEW - PERIODIC                           0.00   S                                                        515
ALA          9809   30106   CLINIC COUNSEL - FAMILY                           0.00   S                                                        916
ALA          9809   30098   CLINIC COUNSEL - INDIVIDUAL                       0.00   S                                                        914
ALA          9809    2054   HEARING SCREENING                                 0.00   S                                                        471
ALA          9809   65128   HHN INITIAL TX                                    0.00   S                                                        410
ALA          9809   65126   IM INJ ANTIBIOTIC                                 0.00   S                                                        515
ALA          9809   65040   INJECTION IN/SUBQ                                 0.00   S                                                        515
ALA          9809   65127   NONPRESSURIZED INH TX                             0.00   S                                                        410
ALA          9809   30010   NUTRITION EDUC 1/2 HR                             0.00   S                                                        515
ALA          9809   10500   POC GLUCOSE                                       0.00   S                                                        300
ALA          9809   10900   POC HEMATOCRIT                                    0.00   S                                                        300
ALA          9809   20195   PULSE OXIM INTERMITTENT                           0.00   S                                                        460
ALA          9809   65130   SELF CARE TRAIN, EA 15 MIN                        0.00   S                                                        515
ALA          9809   65131   SKIN TEST, PPD                                    0.00   S                                                        302
ALA          9809   65007   SOC WORK EVAL 1/2 HR                              0.00   S                                                        561
ALA          9809   65009   SOC WORK PHONE CONSULT 1/4 HR                     0.00   S                                                        561
ALA          9809   65008   SOC WORK TEAM CONF 1/4 HR                         0.00   S                                                        561
ALA          9809   61010   USE OF ROOM - NO CHARGE                           0.00   S                                                        515
ALL          7182   40024   AEROSOL/VAPOR INHALATIONS. INITIA               104.00                    1   94640           94640               410
ALL          7182   40025   AEROSOL/VAPOR INHALATIONS. SUBSE                 83.00                    1   94640    76     94640    76         410
ALL          7182   66127   ALL IMM EXT, SINGLE INJ                          89.00                    1   95120       NC                      924
ALL          7182   66128   ALL IMM EXT, TWO OR MORE INJ                    133.00                    1   95125       NC                      924
ALL          7182   90772   ALLERGY SHOT                                     42.00                    1   95115           95115               515
ALL          7182   65125   BLOOD COLLECTION, ACCESS DEVICE                   0.00   S                    36540                               515
ALL          7182   65132   CENTRAL LINE CATH REPAIR                          0.00   S                    93799           93799               515
ALL          7182   65033   CHANGE OF GASTROSTOMY TUBE                        0.00   S                    43760           43760               515
ALL          7182   65031   DECLOT VASCULAR CATH                              0.00   S                    36550           36550               515
ALL          7182   13753   EAR EXAM/IRRIGATION                              68.00                    1   99199           99199               450
ALL          7182    4004   FLOW VOLUME LOOP                                109.00                    1   94375 TC        94375 TC            460
ALL          7182    1109   FLOW VOLUME LOOP-TIDAL BREATHING                276.00                    1   94375 TC        94375 TC            460
ALL          7182    2054   HEARING SCREENING                               104.00                    1   92551       V5008                   471
ALL          7182   65126   IM INJ ANTIOBIOTIC (BILL W/JCODE)                29.00                    1   90772           90772               515
ALL          7182   90657   INFLUENZA 3YR +                                  42.00                    1   90658           90658               636
ALL          7182   95356   INFLUENZA 6MO-35MO                               42.00                    1   90657           90657               636
ALL          7182   13159   INHALATION TREATMENT                             56.00                    1   94640           94640               412



                                                            Page 6 of 676
                                                            CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                  Description                   Price            Stats/bill       CPT   Mod              Mod   Rev Code
 Code                                                                                                                  HCPCS
ALL          7182   65040   INJ, IM/SUBQ (BILL W/JCODE)                      29.00                    1   90772           90772              515
ALL          7182   65041   INJ, IV (BILL W/JCODE)                          119.00                    1   90774           90774              515
ALL          7182   65028   INTRO INTRACATH VEIN, BILAT                       0.00   S                    36000           36000              515
ALL          7182   65027   INTRO INTRACATH VEIN, UNI                         0.00   S                    36000           36000              515
ALL          7182   65165   PATCH TEST                                      332.00                    1   95044           95044              515
ALL          7182   10203   PPD INTRADERMAL                                  14.00                    1   86580 TC        86580 TC           302
ALL          7182   66131   RAPID DESENSITIZATION EA HR                     411.00                    1   95180           95180              515
ALL          7182   65130   SELF CARE TRAIN, EA 15 MIN                        0.00   S                    97535           97535              515
ALL          7182   66129   SINGLE STINGING INSECT VENOM                    135.00                    1   95130       NC                     924
ALL          7182   65131   SKIN TEST (PRICK)                                 5.00                    1   86580 TC        86580 TC           302
ALL          7182   65030   TRANSFUSION BLOOD/COMP EA                         0.00   S                    36430           36430              515
ALL          7182   66130   TWO STINGING INSECT VENOMS                      181.00                    1   95131       NC                     924
ALL          7182   65021   URINARY CATH SIMPLE                               0.00   S                    53670           53670              515
ALL          7182   61010   USE OF ROOM                                       0.00   S                    99211       Z7500                  515
ALL          7182   60600   USE OF ROOM CHARGE                               50.00                    1   99211       Z7500                  515
ALL          7182   30010   VENIPUNCTURE                                     18.00                    1   36415 ZS        36415 ZS           300
AMA          9805   30148   CHART REVIEW - COMPREHENSIVE                      0.00   S                                                       515
AMA          9805   30155   CHART REVIEW - PERIODIC                           0.00   S                                                       515
AMA          9805   30106   CLINIC COUNSEL - FAMILY                           0.00   S                                                       916
AMA          9805   30098   CLINIC SOUNSEL - INDIVIDUAL                       0.00   S                                                       914
AMA          9805    2054   HERING SCREENING                                  0.00   S                                                       471
AMA          9805   65128   HHN INITIAL TX                                    0.00   S                                                       410
AMA          9805   65126   IM INJ ANTIBIOTIC                                 0.00   S                                                       515
AMA          9805   65040   INJECTION IM/SUBQ                                 0.00   S                                                       515
AMA          9805   65127   NONPRESSURIZED INH TX                             0.00   S                                                       410
AMA          9805   30010   NUTRITION EDUC 1/2 HR                             0.00   S                                                       515
AMA          9805   10500   POC GLUCOSE                                       0.00   S                                                       300
AMA          9805   10900   POC HEMATOCRIT                                    0.00   S                                                       300
AMA          9805   20195   PULSE OXIUM INTERMITTENT                          0.00   S                                                       460
AMA          9805   65130   SELF CARE TRAIN EA 15 MIN                         0.00   S                                                       515
AMA          9805   65131   SKIN TEST, PPD                                    0.00   S                                                       302
AMA          9805   65007   SOC WORK EVAL 1/2 HR                              0.00   S                                                       561
AMA          9805   65009   SOC WORK PHONE CONSULT 1/4 HR                     0.00   S                                                       561
AMA          9805   65008   SOC WORK TEAM CONF 1/4 HR                         0.00   S                                                       561
AMA          9805   61010   USE OF ROOM - NO CHARGE                           0.00   S                                                       515



                                                            Page 7 of 676
                                                                CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                   Description                    Price      Stats/bill        CPT     Mod             Mod   Rev Code
 Code                                                                                                                 HCPCS
ANE          7450    6193   AIRWAY, LARYNGEAL MASK (LMA)                     23.00                1   A4649          Z7610                 272
ANE          7450    5559   AIRWAY, NASAL                                   104.00                1   A4649          Z7610                 271
ANE          7450    5013   AIRWAY, ORAL                                      2.00                1   A4617          Z7610                 271
ANE          7450    6470   ANGIO CATHETER                                   34.00                1   A4649          X7700                 272
ANE          7450    6508   BASIC IV SET UP + INITIAL SOLUTIO               194.00                1   A4649          X7700                 272
ANE          7450    2050   BIOPATCH                                         40.00                1   A4649          Z7610                 272
ANE          7450    2648   BLOOD COMPONENT SET (PLATELETS)                  35.00                1   A4649          X7700                 272
ANE          7450    5070   BLOOD FILTER                                     64.00                1   A4649          X7700                 272
ANE          7450    2075   BRONCHIAL BLOCKER                               490.00                1   A4649          Z7610                 272
ANE          7450    5385   BURETROL (NO TUBING)                             31.00                1   A4649          X7700                 272
ANE          7450    3521   D10W 250CC                                       96.00                1   A4649          Z7610                 258
ANE          7450    3513   D5 LACTATED RINGERS 500CC                        96.00                1   J7120          X7700                 258
ANE          7450    3505   D5.33 NACL 250 CC                                96.00                1   A4649          Z7610                 258
ANE          7450    2465   D5W 250CC                                        96.00                1   A4649          Z7610                 258
ANE          7450   98241   D5W 500CC                                        96.00                1   J7060          X7700                 258
ANE          7450    2317   ENDOTRACHEAL TUBE                                77.00                1   A4649          Z7610                 272
ANE          7450    5476   ENDOTRACHEAL TUBE DOUBLE LUMEN                  633.00                1   A4649          Z7610                 272
ANE          7450    3025   ENDOTRACHEAL TUBE REINFORCED                    162.00                1   A4649          Z7610                 272
ANE          7450    3050   ESOPHOGEAL STETHESCOPE                           52.00                1   A4649          Z7610                 272
ANE          7450    5542   FLEXIBLE TRACHEAL ADAPTOR                        14.00                1   A4649          Z7610                 271
ANE          7450    5088   HUMIVENT                                         17.00                1   A4649          Z7610                 270
ANE          7450    5625   JACKSON-REESEBREATHING CIRCUIT                   86.00                1   A4618          Z7610                 270
ANE          7450   98548   LACTATED RINGERS 500 CC                          96.00                1   J7120          X7700                 258
ANE          7450    3067   LTA KIT                                          34.00                1   A4649          Z7610                 272
ANE          7450    1010   LVL 1 MINOR ANES 1 HOUR                       1,230.00                1   Z7610          Z7610                 370
ANE          7450    1015   LVL 1 MINR ANES EA ADD 1/4 HR                   321.00                1   Z7610          Z7610                 370
ANE          7450    1020   LVL 2 BASIC ANES 1 HOUR                       1,725.00                1   Z7610          Z7610                 370
ANE          7450    1025   LVL 2 BASIC ANES EA ADD 1/4 HR                  399.00                1   Z7610          Z7610                 370
ANE          7450    1030   LVL 3 COMPLEX ANES 1 HOUR                     1,975.00                1   Z7610          Z7610                 370
ANE          7450    1035   LVL 3 COMPLEX ANES EA ADD 1/4 HR                561.00                1    99070         Z7610                 370
ANE          7450    1045   LVL 4 EXTEN ANES EA ADD 1/4 HR                1,303.00                1   Z7610          Z7610                 370
ANE          7450    1040   LVL 4 EXTENSIVE ANES 1 HOUR                   3,561.00                1   Z7610          Z7610                 370
ANE          7450   38878   MANNITOL 20%                                    134.00                1   Z7610          Z7610                 258
ANE          7450    3075   NASAL CANNULA                                    10.00                1   A4615          Z7610                 271
ANE          7450    6177   NORMAL SALINE 0.45% 500CC                        96.00                1   J7040          X7700                 258



                                                            Page 8 of 676
                                                            CM 06/15/07


 Dept                                                                                                                       M/cal
        Cost Ctr.   SIM#                   Description                  Price            Stats/bill        CPT      Mod              Mod   Rev Code
 Code                                                                                                                      HCPCS
ANE          7450   98480   NORMAL SALINE 100 CC                             86.00                    1   A4649           Z7610                  258
ANE          7450   98522   NORMAL SALINE 1000 CC                            96.00                    1   J7030           X7700                  258
ANE          7450    3539   NORMAL SALINE 250 CC                             96.00                    1   J7050           X7700                  258
ANE          7450    3547   NORMAL SALINE 500 CC                             96.00                    1   A4217           Z7610                  258
ANE          7450    5658   O2 MASK W/ TUBING                                13.00                    1   A4620           Z7610                  271
ANE          7450    2663   PLASMA TRANSFER KIT                              31.00                    1   A4649           X7700                  272
ANE          7450    5217   PLASMALYTE 500 CC                               195.00                    1   J3490           X7704                  258
ANE          7450    6128   RESUSCITATION BAG                                89.00                    1   A4649           Z7610                  271
ANE          7450    5419   STOPCOCK                                         14.00                    1   A4649           X7700                  272
ANE          7450    6094   STOPCOCK 3GANG 4 WAY MANIFOLD                    38.00                    1   A4649           X7700                  272
ANE          7450    5526   SUCTION, YANKAUER                                18.00                    1   A4628           Z7610                  272
ANE          7450    5062   TRANSDUCER, SINGLE                              126.00                    1   A4649           Z7610                  272
ANE          7450    5799   TRANSDUCER, TRIPLE                              363.00                    1   A4649           Z7610                  272
ANE          7450    5591   TUBING, 48" PRESSURE                             29.00                    1   S1015           X7700                  272
ANE          7450    5609   TUBING, 6" PRESSURE/STOPCOCK                     23.00                    1   S1015           X7700                  272
ANE          7450    4050   TUBING, ALARIS BLOOD FILTER                       8.00                    1   A4649           X7700                  272
ANE          7450    5369   TUBING, ALARIS PUMP                              77.00                    1   A4649           X7700                  272
ANE          7450    5351   TUBING, ALARIS PUMP/BURETROL                    181.00                    1   A4649           X7700                  272
ANE          7450    5054   TUBING, BLOOD PUMP                               41.00                    1   A4649           X7700                  272
ANE          7450    6060   TUBING, HOT LINE                                 80.00                    1   A4649           X7700                  272
ANE          7450    4020   TUBING, LEVEL ONE                               131.00                    1   A4649           X7700                  272
ANE          7450    4040   TUBING, MEDFUSION PUMP                           10.00                    1   A4649           X7700                  272
ANE          7450    4060   TUBING, Y-BLOOD PUMP                             31.00                    1   A4649           X7700                  272
ANE          7450    4080   UNIVENT TUBE                                    554.00                    1   A4649           Z7610                  272
APT          7528    2241   ADDNL SPEC/FROZEN SECTION                        67.00                    1    88332   TC         88332 TC           312
APT          7528    2126   COMPLEX DX PROBLEM LEVEL VI                     367.00                    1    88309   TC         88309 TC           312
APT          7528    2373   CONSULT COMPREHENSIVE                             0.00   S                     88325                                 310
APT          7528    2134   CONSULT DURING SURGERY                            0.00   S                     88329                                 310
APT          7528    2324   CONSULT MAT RQRNG PREP                            0.00   S                     88323                                 310
APT          7528    2209   CONSULT REFERRED SLIDES                           0.00   S                     88321                                 310
APT          7528    2365   CONSULTATION FR OUTSIDE SRCE                      0.00   S                     88325                                 310
APT          7528    2159   CYTO EXCPT CERV-VAG SPEC                        146.00                    1    88104   TC        88104   TC          311
APT          7528    2092   DECAL PROCEDURE                                  73.00                    1    88311   TC        88311   TC          312
APT          7528    2084   FROZEN SECTION SINGLE SPEC                      174.00                    1    88331   TC        88331   TC          312
APT          7528    2001   GROSS & MICRO ABNAL UNCMP LEVEL I               216.00                    1    88304   TC        88304   TC          312



                                                            Page 9 of 676
                                                                CM 06/15/07


 Dept                                                                                                                      M/cal
        Cost Ctr.   SIM#                   Description                    Price            Stats/bill       CPT      Mod              Mod   Rev Code
 Code                                                                                                                      HCPCS
APT          7528    2027   GROSS & MICRO EXAM LEVEL II                       175.00                    1   88302   TC       88302   TC           312
APT          7528    2019   GROSS EXAM ONLY LEVEL I                            57.00                    1   88300   TC       88300   TC           312
APT          7528    2043   HISTOCHEM FROZEN SECTION                          132.00                    1   88314   TC       88314   TC           312
APT          7528    2076   IMMUNOCYTOCHEMISTRY, EACH                         200.00                    1   88342   TC       88342   TC           312
APT          7528    2050   IMMUNOFLUORESCENCE EACH DIRECT                    146.00                    1   88346   TC       88346   TC           312
APT          7528    2233   PHOTOGRAPHY-MACRO                                  48.00                    1   88399   TC       88399   TC           312
APT          7528    3074   RES CON MAT                                         0.00   S                                                          310
APT          7528    3116   RES HISOCHEM                                        0.00   S                    88314                                 310
APT          7528    3223   RES SPEC COLL                                       0.00   S                                                          310
APT          7528    2100   SINGLE COMP/MULT UNCOMP LEVEL IV                  267.00                    1   88305   TC       88305   TC           312
APT          7528    2118   SINGLE COMPLEX DISSECTION LEVEL V                 333.00                    1   88307   TC       88307   TC           312
APT          7528    2399   SPEC COLLECTION                                   130.00                    1   88399   TC       88399   TC           312
APT          7528    2035   SPECIAL STAIN GROUP I                             113.00                    1   88312   TC       88312   TC           312
APT          7528    2068   SPECIAL STAIN GROUP II                             72.00                    1   88313   TC       88313   TC           312
BCT          7502   31176   ADENOVIRUS (ENTERIC)DAA, EIA                       46.00                    1   87301   TC       87301   TC           306
BCT          7502   31358   ADENOVIRUS CULTURE                                 48.00                    1   87254   TC       87254   TC           306
BCT          7502   31267   ADENOVIRUS DAA, FA                                 34.00                    1   87260   TC       87260   TC           306
BCT          7502   37769   AFB CULTURE BODY FLUID                             73.00                    1   87116   TC       87116   TC           306
BCT          7502   31840   ANTIBIOTIC GRADIENT STRIP, EA                      19.00                    1   87181   TC       87181   TC           306
BCT          7502   36506   ANTIBIOTIC NEUTRAL CULT                             0.00   S                    87999            87999   TC           301
BCT          7502   31564   ANTIBIOTIC SUS DISC, EA PLATE                      88.00                    1   87184   TC       87184   TC           306
BCT          7502   31820   ANTIBIOTIC SUS DISK, EACH                           9.00                    1   87181   TC       87181   TC           306
BCT          7502   31838   ANTIBIOTIC SUS, MIC                                36.00                    1   87186   TC       87186   TC           306
BCT          7502   39825   ARTHROPOD EXAM                                     19.00                    1   87168   TC       87168   TC           306
BCT          7502   39880   ASPERGILLUS ANTIGEN EIA SERUM                     104.00                    1   87449   TC       87449   TC           306
BCT          7502   36852   BACTERIAL ID, AEROBIC                              31.00                    1   87077   TC       87077   TC           306
BCT          7502   36855   BACTERIAL ID, ANAEROBIC                            31.00                    1   87076   TC       87076   TC           306
BCT          7502   31903   BETA LACTAMASE TEST                                25.00                    1   87185   TC       87185   TC           306
BCT          7502   31952   BETA STREP SCREEN                                  37.00                    1   87081   TC       87081   TC           306
BCT          7502    2901   BILIRUBIN URINE                                    23.00                    1   81000   TC       81000   TC           307
BCT          7502   31978   C. DIFFICILE TOXIN A & B DAA, EIA                  37.00                    1   87324   TC       87324   TC           306
BCT          7502   31051   CHLAMYDIA CULTURE                                  85.00                    1   87110   TC       87110   TC           306
BCT          7502   31069   CHLAMYDIA DIRECT AG ASSAY                          38.00                    1   87270   TC       87270   TC           306
BCT          7502   31259   CRYPTOSPORIDIUM AG, IF                             95.00                    1   87269   TC       87269   TC           306
BCT          7502   32141   CULT ANAEROBE BLOOD                                47.00                    1   87075   TC       87075   TC           306



                                                            Page 10 of 676
                                                                CM 06/15/07


 Dept                                                                                                                      M/cal
        Cost Ctr.   SIM#                   Description                    Price          Stats/bill       CPT      Mod                Mod   Rev Code
 Code                                                                                                                     HCPCS
BCT          7502   32158   CULT DEFIN ANAEROBIC                              146.00                  1   87075   TC         87075   TC           306
BCT          7502   32604   CULT DEFIN BLOOD                                   45.00                  1   87040   TC         87040   TC           306
BCT          7502   33032   CULTURE DEFIN CSF                                  67.00                  1   87070   TC         87070   TC           306
BCT          7502   31390   CYTOMEGALOVIRUS CULTURE                            48.00                  1   87254   TC         87254   TC           306
BCT          7502    4402   FECAL OCCULT BLOOD IMMUNOASSAY                     41.00                  1   82274   TC         82274   TC           306
BCT          7502   36720   FUNGUS BLOOD CULTURE                               31.00                  1   87103   TC         87103   TC           306
BCT          7502   36712   FUNGUS CULTURE OTHER SOURCE                        43.00                  1   87102   TC         87102   TC           306
BCT          7502   38668   FUNGUS, FLUORESCENT STAIN                          31.00                  1   87206   TC         87206   TC           306
BCT          7502   36753   GC CULTURE                                         37.00                  1   87081   TC         87081   TC           306
BCT          7502   39872   GIARDIA DAA                                        55.00                  1   87329   TC         87329   TC           306
BCT          7502   31960   GROUP A STREP DAA                                  24.00                  1   87880   TC         87880   TC           306
BCT          7502   36894   GRP B STREP DAA, LA                                24.00                  1   86403   TC         86403   TC           302
BCT          7502   37637   H INFLU DAA, LA                                    71.00                  1   86403   TC         86403   TC           302
BCT          7502   39710   H PYLORI DAA, STOOL                               135.00                  1   87338   TC         87338   TC           300
BCT          7502   39724   HANDLING AND/OR CONVEYANCE                         38.00                  1   99001          Z5220                    300
BCT          7502   39700   HOMOGENIZATION TISSUE FOR CULT                      9.00                  1   87176   TC         87176   TC           306
BCT          7502   36860   IMMUNOFLUORESCENT TYPING/ID                        16.00                  1   87140   TC         87140   TC           306
BCT          7502   31920   INFLUENZA A DAA                                    47.00                  1   87804   TC         87804   TC           306
BCT          7502   31200   INFLUENZA A DAA, FA                                34.00                  1   87276   TC         87276   TC           306
BCT          7502   31940   INFLUENZA B DAA                                    47.00                  1   87804   TC         87804   TC           306
BCT          7502   31416   INFLUENZA B DAA, FA                                34.00                  1   87275   TC         87275   TC           306
BCT          7502   31986   LAB C. DIFF TOXINE CONFIRM                         55.00                  1   87230   TC         87230   TC           306
BCT          7502   33685   LAB CULT DEFIN FUNGUS                             124.00                  1   87106   TC         87106   TC           306
BCT          7502   36191   LAB CULT DEFIN GENITAL                             87.00                  1   87070   TC         87070   TC           306
BCT          7502   32802   LAB CULT DEFIN RESPIRATORY                         71.00                  1   87070   TC         87070   TC           306
BCT          7502   34501   LAB CULT DEFIN SPUTUM                              94.00                  1   87070   TC         87070   TC           306
BCT          7502   34725   LAB CULT DEFIN STERILYTIC                          53.00                  1   87070   TC         87070   TC           306
BCT          7502   34592   LAB CULT DEFIN STOOL SAL/SHIGELLA                  83.00                  1   87045   TC         87045   TC           306
BCT          7502   36126   LAB CULT DEFIN URINE QUANTITA                      93.00                  1   87086   TC         87086   TC           306
BCT          7502   36456   LAB CULT DEFIN WOUND                              131.00                  1   87070   TC         87070   TC           306
BCT          7502   36738   LAB FUNGUS CULT SKIN                               43.00                  1   87101   TC         87101   TC           306
BCT          7502   31192   LAB HSV CULTURE                                    38.00                  1   87252   TC         87252   TC           306
BCT          7502   38858   LAB MYCOLOGY SEN I ANTIBIO                          0.00 S                    87188              87188   TC           306
BCT          7502   31333   LAB RESP VIRUS CULT INOC/OBSERV                    87.00                  1   87252   TC         87252   TC           306
BCT          7502   37728   LAB SEROLOGIC GROUPING EACH                        12.00                  1   87147   TC         87147   TC           306



                                                            Page 11 of 676
                                                              CM 06/15/07


 Dept                                                                                                                    M/cal
        Cost Ctr.   SIM#                   Description                   Price           Stats/bill       CPT      Mod              Mod   Rev Code
 Code                                                                                                                    HCPCS
BCT          7502   37652   MENINGITIS EACH AG LA                              24.00                  1   86403   TC       86403   TC           302
BCT          7502   38882   MICROBIOLOGY MISC                                   0.00                  1   87999   TC       87999   TC           306
BCT          7502    8882   MISC URINALYSIS TEST                                0.00 S                    81099   TC       81099   TC           306
BCT          7502   36707   MOLD IDENTIFICATION, EA                            31.00                  1   87107   TC       87107   TC           306
BCT          7502   32005   MRSA SCREEN                                        43.00                  1   87081   TC       87081   TC           306
BCT          7502    8908   MYOGLOBIN SCREEN URINE                             43.00                  1   81000   TC       81000   TC           307
BCT          7502   36910   N MENIG DAA, LA                                    24.00                  1   86403   TC       86403   TC           302
BCT          7502    5420   OCCULT BLOOD, URINE                                 0.00 S                    81000   TC       81000   TC           307
BCT          7502    5409   OCCULT BLOOD,GASTRIC FLUID                         27.00                  1   82271   TC       82271   TC           306
BCT          7502   39831   OVA & PARASITES                                    85.00                  1   87177   TC       87177   TC           306
BCT          7502   31420   PARAINFLUENZA VIRUS DAA FA, EA                     34.00                  1   87279   TC       87279   TC           306
BCT          7502   39823   PARASITES, BLOOD                                   81.00                  1   87207   TC       87207   TC           306
BCT          7502   39856   PARASITES, WET MOUNT ONLY                          42.00                  1   87210   TC       87210   TC           306
BCT          7502   30913   PATHOGENIC E. COLI SCREEN                          25.00                  1   87081   TC       87081   TC           306
BCT          7502   33164   PERTUSSIS CULTURE                                  67.00                  1   87081   TC       87081   TC           306
BCT          7502   37686   PERTUSSIS DIRECT FA STAIN                          59.00                  1   87265   TC       87265   TC           306
BCT          7502    7082   PH, FECES                                          27.00                  1   83986   TC       83986   TC           301
BCT          7502    7108   PH, URINE                                          23.00                  1   81002   TC       81002   TC           307
BCT          7502   39827   PINWORM EXAM                                       24.00                  1   87172   TC       87172   TC           306
BCT          7502   31432   PNEUMOCYSTIS CARINII DAA, IF                       96.00                  1   87281   TC       87281   TC           301
BCT          7502   36472   QUANT BACT CULT NON UR,BL,S                        67.00                  1   87071   TC       87071   TC           306
BCT          7502    9112   RED SUBST QUAL STOOL                               53.00                  1   81005   TC       81005   TC           307
BCT          7502    9104   RED SUBST QUAL URINE                               20.00                  1   81005   TC       81005   TC           307
BCT          7502   31275   RESP SYNC VIRUS (RSV) DAA, IF                      34.00                  1   87280   TC       87280   TC           306
BCT          7502   31168   RESP SYNC VIRUS (RSV) DAA                          47.00                  1   87807   TC       87807   TC           306
BCT          7502   31242   RESPIRATORY VIRUS AG, FA                           34.00                  1   87299   TC       87299   TC           306
BCT          7502   31234   RESPIRATORY VIRUSCREEN, FA                         32.00                  1   87300   TC       87300   TC           306
BCT          7502   37702   ROTAVIRUS ASSAY                                    49.00                  1   87425   TC       87425   TC           306
BCT          7502   31160   RSV CULTURE, SHELL VIAL                            45.00                  1   87254   TC       87254   TC           306
BCT          7502   36902   S PNEUMO DAA, LA                                   24.00                  1   86403   TC       86403   TC           302
BCT          7502   36605   SCHLICTER TEST                                    164.00                  1   87197   TC       87197   TC           306
BCT          7502   37736   SEROLOGIC SPECIATION, EACH                         15.00                  1   87147   TC       87147   TC           306
BCT          7502   31340   SHELL VIAL IF ID EACH VIRUS                        45.00                  1   87254   TC       87254   TC           306
BCT          7502   37884   SMEAR GRAM STAIN                                   31.00                  1   87205   TC       87205   TC           306
BCT          7502   37751   SMEAR, ACID FAST                                   39.00                  1   87206   TC       87206   TC           306



                                                             Page 12 of 676
                                                            CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                  Description                  Price          Stats/bill       CPT      Mod                Mod   Rev Code
 Code                                                                                                                  HCPCS
BCT          7502    9450   SPEC GRAVITY URINE                            15.00                    1   81000   TC        81000    TC           307
BCT          7502   31077   SPECIMEN CONCENTRATION                        27.00                    1   87015   TC        87015    TC           306
BCT          7502   34595   STOOL, ADD. PATHOGEN, EA                       5.00                    1   87046   TC        87046    TC           306
BCT          7502   31845   SUSCEPT. MACRO BROTH DIL.                     72.00                    1   87188   TC        87188    TC           306
BCT          7502   36068   THROAT CULTURE                                94.00                    1   87070   TC        87070    TC           306
BCT          7502   39840   TRICHROME STAIN                               18.00                    1   88313   TC        88313    TC           312
BCT          7502    9393   URINALYSIS MICROSCOPIC ONLY                    9.00                    1   81015   TC        81015    TC           307
BCT          7502    9401   URINALYSIS W/MICROSCOPIC AUTO                 37.00                    1   81001   TC        81001    TC           307
BCT          7502    3701   URINALYSIS W/O MICROSCOPIC                    27.00                    1   81003   TC        81003    TC           307
BCT          7502   36886   URINE BACTERIAL IDENT                         31.00                    1   87088   TC        87088    TC           306
BCT          7502   31374   VARICELLA-ZOSTER VIRUS CULTURE                48.00                    1   87254   TC        87254    TC           306
BCT          7502   31226   VIRUS ADDITIONAL STUDY                       105.00                    1   87253   TC        87253    TC           306
BCT          7502   31317   VIRUS CULT INOC & OBSERV                     181.00                    1   87252   TC        87252    TC           306
BCT          7502   31085   VIRUS CULT SPECIFIC VIRUS                     48.00                    1   87253   TC        87253    TC           306
BCT          7502   31135   VIRUS IDENTIFICATION                          32.00                    1   87253   TC        87253    TC           306
BCT          7502   32000   VRE SCREEN                                    57.00                    1   87081   TC        87081    TC           306
BCT          7502   31127   VZV DIRECT AG ASSAY                          135.00                    1   87290   TC        87290    TC           306
BCT          7502   38791   WET MOUNT, INDIA INK                          31.00                    1   87210   TC        87210    TC           306
BCT          7502   36704   YEAST IDENTIFICATION                          31.00                    1   87106   TC        87106    TC           306
BDC          7545   30253   AUTO FFP (PANEL MASTER)                        0.00   S                                                            300
BDC          7545   30254   AUTO FFP IRR (PANEL MASTER)                    0.00   S                                                            300
BDC          7545   31304   AUTOLOGOUS LR RBC-WB                         723.00                    1 P9010            Z5204                    390
BDC          7545   30396   AUTOLOGOUS WB LR (PANEL MASTER)                0.00   S                                                            390
BDC          7545   31155   BDC CYTOPHERESIS THER                      1,118.00                    1   36512          Z7506                    940
BDC          7545   31007   BDC INTRA OP SALVAGE                         723.00                    1   86891          NC                       390
BDC          7545   31205   BDC THER LEUKOPHERESIS                     1,118.00                    1   36511          Z7506                    940
BDC          7545   31106   BDC THER PLASMA EXCHANGE                     895.00                    1   36514              36514                940
BDC          7545   30009   BLOOD DONOR CENTER                             0.00   S                                                            390
BDC          7545   33052   CMV SCREEN                                    34.00                    1 86644 TC             86644 TC             302
BDC          7545   30298   CRYOPRECIPITATE EA UNIT                       72.00                    1 P9012            Z5204                    390
BDC          7545   30251   DD FFP (PANEL MASTER)                          0.00   S                                                            390
BDC          7545   30252   DD FFP IR (PANEL MASTER)                       0.00   S                                                            390
BDC          7545   30088   DD PLP LR IRR (PANEL MASTER)                   0.00   S                                                            390
BDC          7545   30039   DD RBC LR (PANEL MASTER)                       0.00   S                                                            390
BDC          7545   30047   DD RBC LR DEGLYCED (PANEL MASTER)              0.00   S                                                            390



                                                           Page 13 of 676
                                                                CM 06/15/07


 Dept                                                                                                                      M/cal
        Cost Ctr.   SIM#                   Description                    Price          Stats/bill        CPT      Mod                Mod   Rev Code
 Code                                                                                                                      HCPCS
BDC          7545   30049   DD RBC LR IRR (PANEL MASTER)                      0.00   S                                                             390
BDC          7545   30048   DD RBC IRR DEGLYCED (PANEL)                       0.00   S                                                             390
BDC          7545   30043   DD RBC LR IRR WASH (PANEL MASTER)                 0.00   S                                                             390
BDC          7545   30051   DD RBC LR WASH (PANEL MASTER)                     0.00   S                                                             390
BDC          7545   30201   DD VRP PLP LR IRR (PANEL MASTER)                  0.00   S                                                             390
BDC          7545   30248   FFP (PANEL MASTER)                                0.00   S                                                             390
BDC          7545   30250   FFP IRR (PANEL MASTER)                            0.00   S                                                             390
BDC          7545   31254   GRANULOCYTE                                   2,000.00                    1 P9050             Z5204                    390
BDC          7545   31255   GRANULOCYTE IRR (PANEL MASTER)                    0.00   S                                                             390
BDC          7545   33250   HEPATITIS B CORE AB                              88.00                    1    86704   TC         86704   TC           302
BDC          7545   33201   HEPATITIS B SURFACE AG                           88.00                    1    87340   TC         87340   TC           306
BDC          7545   33300   HEPATITIS C ANITBODY                             88.00                    1    86803   TC         86803   TC           302
BDC          7545   33102   HIV ANTIBODY                                    101.00                    1    86703   TC         86703   TC           302
BDC          7545   33151   HIV ANTIGEN                                      88.00                    1    87390   TC         87390   TC           306
BDC          7545   31056   PBSC APHERESIS COLLECTION ALLO                2,500.00                    1    38205              38205                940
BDC          7545   31055   PBSC APHERESIS COLLECTION AUTO                2,500.00                    1    38206              38206                940
BDC          7545   30140   PEDI RBC LEUKO REDUCED                          145.00                    1   P9016           Z5204                    390
BDC          7545   30410   PEDI RBC LEUKO REDUCED                          145.00                    1   P9016           Z5204                    390
BDC          7545   30249   PLASMA FRESH FROZEN, EA                          88.00                    1   P9017           Z5204                    390
BDC          7545   30090   PLATELET CONC LEUKO REDUCE EA                   127.00                    1   P9031           Z5204                    390
BDC          7545   30110   PLATELET PHERE LR 1 RDE EA                      193.00                    1   P9035           Z5204                    390
BDC          7545   30120   PLATELET PHERE LR 2 RDE EA                      385.00                    1   P9035           Z5204                    390
BDC          7545   30130   PLATELET PHERE LR 4 RDE EA                      771.00                    1   P9035           Z5204                    390
BDC          7545   30199   PLATELET PHERESIS LR EA                         880.00                    1   P9035           Z5204                    390
BDC          7545   30089   PLP LR IRR (PANEL MASTER)                         0.00   S                                                             390
BDC          7545   33003   AUTOLOGOUS FFP                                  141.00                    1 P9017             Z5204                    390
BDC          7545   30040   RBC LR (PANEL MASTER)                             0.00   S                                                             390
BDC          7545   30045   RBC LR DEGLYCED (PANEL MASTER)                    0.00   S                                                             390
BDC          7545   30042   RBC LR IRR (PANEL MASTER)                         0.00   S                                                             390
BDC          7545   30046   RBC LR IRR DEGLYCED (PANEL)                       0.00   S                                                             390
BDC          7545   30050   RBC LR IRR WASH (PANEL MASTER)                    0.00   S                                                             390
BDC          7545   30052   RBC LR WASH (PANEL MASTER)                        0.00   S                                                             390
BDC          7545   30044   RBC LR WASHED                                   540.00                    1 P9022             Z5204                    390
BDC          7545   30041   RED BLOOD CELLS LEUKO REDUCE EA                 374.00                    1 P9016             Z5204                    390
BDC          7545   33359   SYPHILIS QUAL                                    38.00                    1 86592 TC              86592 TC             302



                                                            Page 14 of 676
                                                              CM 06/15/07


 Dept                                                                                                                       M/cal
        Cost Ctr.   SIM#                   Description                   Price             Stats/bill       CPT      Mod             Mod     Rev Code
 Code                                                                                                                       HCPCS
BDC          7545   33367   SYPHILIS QUANT                                     54.00                    1   86593 TC          86593 TC             302
BDC          7545   30200   VRP PLP LR IRR (PANEL MASTER)                       0.00   S                                                           390
BDC          7545   30399   WB LR PANEL MASTER                                  0.00   S                                                           390
BDC          7545   30398   WB LR IRR (PANEL MASTER)                            0.00   S                                                           390
BDC          7545   30397   WHOLE BLOOD LEUKO REDUCE EA                       578.00                    1 P9010            Z5204                   390
BLD          7540   22748   MONO SCREEN (HETEROPHILE)                          46.00                    1 86308 TC             86308 TC            302
BLD          7540   10530   ABO BLOOD TYPE                                     27.00                    1 86900                86900               300
BLD          7540   13302   ABO RETYPE UNIT                                    15.00                    1 86900                86900               390
BLD          7540   10531   ABORH (PANEL MASTER)                                0.00   S                                                           300
BLD          7540   20106   ALPHA-1 ANTITRYPSIN                                87.00                    1   82103   TC          82103   TC         301
BLD          7540   20262   ANA TITER                                         101.00                    1   86039   TC          86039   TC         302
BLD          7540   11108   ANTIBODY ELUTION, RBC EA                           74.00                    1   86860   TC          86860   TC         390
BLD          7540   11801   ANTIBODY PANEL EA                                 165.00                    1   86870   TC          86870   TC         390
BLD          7540   11207   ANTIGEN SCREEN PATIENT EA                          43.00                    1   86905   TC          86905   TC         390
BLD          7540   20502   ANTISTREPTOLYSIN TITER                             68.00                    1   86060   TC          86060   TC         302
BLD          7540   15851   ARC ANTIGEN SCREEN >7 AG                            0.00   S                    86999               86903   TC         300
BLD          7540   15828   ARC ANTIGEN SCREEN EACH                            55.00                    1   86903   TC          86903   TC         300
BLD          7540   15836   ARC STAT CHARGE                                   301.00                    1   86999   TC          86999   TC         300
BLD          7540   20700   B-2 MICROGLOBULIN                                  84.00                    1   82232   TC          82232   TC         301
BLD          7540   15786   BLOOD BANK MD CONSULT                               0.00   S                    86079                                  390
BLD          7540   18889   BLOOD BANK MISC                                     0.00   S                    86999               86999   TC         302
BLD          7540   21088   CERULOPLASMIN                                      87.00                    1   82390   TC          82390   TC         301
BLD          7540   21153   CMV ANTIBODY TOTAL                                 84.00                    1   86645   TC          86645   TC         302
BLD          7540   21252   COLD AGGLUTININ TITER                              53.00                    1   86157   TC          86157   TC         302
BLD          7540   21484   COMPLEMENT C3                                      87.00                    1   86160   TC          86160   TC         302
BLD          7540   21526   COMPLEMENT C4                                      87.00                    1   86160   TC          86160   TC         302
BLD          7540   21468   COMPLEMENT CH50 TITER                              93.00                    1   86162   TC          86162   TC         302
BLD          7540   11736   CROSSMATCH AHG                                    103.00                    1   86922   TC          86922   TC         390
BLD          7540   11728   CROSSMATCH HOLD                                    14.00                    1   86920   TC          86920   TC         390
BLD          7540   11702   CROSSMATCH IMMEDIATE SPIN                          78.00                    1   86920   TC          86920   TC         309
BLD          7540   11710   CROSSMATCH INFANT                                  19.00                    1   86920   TC          86920   TC         390
BLD          7540   12304   CRYO POOLING                                       36.00                    1   86965          NC                      390
BLD          7540   11406   DAT PANEL MASTER                                    0.00   S                                                           390
BLD          7540   15794   DIFFICULT XMATCH CH/AB                              0.00   S                                                           302
BLD          7540   11405   DIRECT ANTIGLOBULIN TEST - DAT                     44.00                    1   86880 TC            86880 TC           390



                                                             Page 15 of 676
                                                            CM 06/15/07


 Dept                                                                                                                     M/cal
        Cost Ctr.   SIM#                   Description                 Price           Stats/bill        CPT      Mod                 Mod   Rev Code
 Code                                                                                                                    HCPCS
BLD          7540   20270   DNA DS ANTIBODY                                  96.00                  1    86225   TC         86225    TC           302
BLD          7540   22136   EBV EAD-IGG AB                                   48.00                  1    86663   TC         86663    TC           302
BLD          7540   22128   EBV EBNA-IGG AB                                  48.00                  1    86664   TC         86664    TC           302
BLD          7540   22102   EBV VCA-IGG AB                                   48.00                  1    86665   TC         86665    TC           302
BLD          7540   22110   EBV VCA-IGM AB                                   48.00                  1    86665   TC         86665    TC           302
BLD          7540   22060   EPSTEIN-BAR VCA                                 107.00                  1    86665   TC         86665    TC           302
BLD          7540   14102   FRESH FRZN PLASMA THAW BR                        34.00                  1    86927   TC         86927    TC           300
BLD          7540   30348   FROZEN RBC THAWING                              300.00                  1    86931              86931                 390
BLD          7540   22201   FTB-ABS                                         103.00                  1    86781   TC         86781    TC           302
BLD          7540   22359   HAPTOGLOBIN                                      87.00                  1    83010   TC         83010    TC           301
BLD          7540   26301   HCG QUALITATIVE                                  55.00                  1    84703   TC         84703    TC           301
BLD          7540   26285   HEMOGLOBIN A1C                                   65.00                  1    83036   TC         83036    TC           301
BLD          7540   22409   HEMOGLOBIN A2                                    93.00                  1    83020   TC         83020    TC           301
BLD          7540   22052   HEMOGLOBIN ELECTR ACID                          104.00                  1    83020   TC         83020    TC           301
BLD          7540   22086   HEMOGLOBIN ELECTR ALK                           102.00                  1    83020   TC         83020    TC           301
BLD          7540   23258   HEMOGLOBIN PLASMA                                91.00                  1    83051   TC         83051    TC           301
BLD          7540   23241   HEMOGLOBIN-FETAL                                 34.00                  1    83030   TC         83030    TC           301
BLD          7540   23282   HEPATITIS A ANTIBODY                             88.00                  1    86708   TC         86708    TC           302
BLD          7540   23357   HEPATITIS B SURFACE AB                           88.00                  1    86706   TC         86706    TC           302
BLD          7540   22607   HERPES SIMPLEX IGG ANTIBODY NON-S               119.00                  1    86694   TC         86694    TC           302
BLD          7540   23407   HTLV-I/II ANTIBODY                                0.00 S                     86687              86687    TC           302
BLD          7540   22318   IGA                                              83.00                  1    82784   TC         82784    TC           301
BLD          7540   22326   IGG                                              83.00                  1    82784   TC         82784    TC           301
BLD          7540   22334   IGM                                              83.00                  1    82784   TC         82784    TC           301
BLD          7540   11407   INDIRECT ANTIGLOBULIN TEST WEAK D                40.00                  1    86885              86885                 390
BLD          7540   13807   IRRAD BLD PRODUCT                                45.00                  1    86945              86945                 300
BLD          7540   11959   ISOAGGLUTININS INCUBATED                         96.00                  1    86941   TC         86941    TC           390
BLD          7540   11553   LAB ANTIBODY SCREEN                              48.00                  1    86850   TC         86850    TC           309
BLD          7540   12460   LAB PROC CHG DIRECTED COMPONENT                  50.00                  1   P9010           P9010                     390
BLD          7540   28885   MISC SEROLOGY TEST                                0.00                  1    86849   TC         86849    TC           302
BLD          7540   24801   MYCOPLASMA ANTIBODY                             119.00                  1    86738   TC         86738    TC           302
BLD          7540   15448   PEDI SPLIT                                       50.00                  1    86965          NC                        300
BLD          7540   16016   PLASMA CHECK                                      0.00 S                                                              390
BLD          7540   14003   PLATELET SPLIT BLD PROD EA                       34.00                  1    86965          NC                        390
BLD          7540   15224   POOL RBC/FFP                                     75.00                  1    86965               86965                390



                                                           Page 16 of 676
                                                             CM 06/15/07


 Dept                                                                                                                     M/cal
        Cost Ctr.   SIM#                  Description                  Price            Stats/bill       CPT      Mod                Mod      Rev Code
 Code                                                                                                                    HCPCS
BLD          7540   26400   PREALBUMIN                                      87.00                    1   84134   TC         84134   TC              301
BLD          7540   15463   PREP WASHED RBC                                140.00                    1   86999   TC         86999   TC              300
BLD          7540   12452   PRO CHG DIRECTED                               125.00                    1   86999   TC         86999   TC              300
BLD          7540   22094   PROTEIN ELECTR                                 102.00                    1   84165   TC         84165   TC              301
BLD          7540   11090   RBC PRETREAT SERUM ABSORPTION                  136.00                    1   86978   TC         86978   TC              390
BLD          7540   10522   RH BLOOD TYPE                                   27.00                    1   86901              86901                   300
BLD          7540   13310   RH RETYPE UNIT                                  15.00                    1   86901              86901                   390
BLD          7540   24256   RHEUMATOID FACTOR QUANT.                        80.00                    1   86431   TC         86431   TC              302
BLD          7540   23688   RUBELLA ANITBODY                               119.00                    1   86762   TC         86762   TC              302
BLD          7540   23506   RUBEOLA ANTIBODY                               119.00                    1   86765   TC         86765   TC              302
BLD          7540   12007   SPLIT BLD/BLD PRODUCT EA                        42.00                    1   86985          NC                          390
BLD          7540   23738   TOXOPLASMA IGG ANTIBODY                        119.00                    1   86777   TC         86777   TC              302
BLD          7540   15778   TRANS RXN INVESTIGATION                         91.00                    1   86078   TC         86078        26         302
BLD          7540   27457   TRANSFERRIN                                     87.00                    1   84466   TC         84466   TC              301
BLD          7540   22656   VARICELLA-ZOSTER IGG ANTIBODY                   92.00                    1   86787   TC         86787   TC              302
BLD          7540   10761   VOLUME REDUCTION                               150.00                    1   86960              86960                   390
BMC          7396   20235   ALLOGENIC FAM COMPAT CORD #9                     0.00   S                                                               362
BMC          7396   20250   ALLOGENIC MUD FROM NMPD 6                        0.00   S                                                               362
BMC          7396   20243   ALLOGENIC NMDP CORD #10                          0.00   S                                                               362
BMC          7396   20102   ALLOGENIC/FAMILY HISTOCOMPAT 3                   0.00   S                                                               362
BMC          7396   20151   ALLOGENIC/FAMILY HISTOINCOMP 4                   0.00   S                                                               362
BMC          7396   20052   AUTOLOGOUS W/CHEMO PURGING 2                     0.00   S                                                               362
BMC          7396   20003   AUTOLOGOUS W/O CHEMO PURGING 1                   0.00   S                                                               362
BMC          7396     278   BMT DT INJ ADULT 5ML                            50.00                    1 90718                90718                   636
BMC          7396     260   BMT DT INJ PED                                  30.00                    1 90702                90702                   636
BMC          7396    3157   BMT GRP THERAPY 1ST PT                          70.00                    1 Z5402            Z5402                       515
BMC          7396    3165   BMT GRP THERAPY ADDL PATIENT                    38.00                    1 Z5402            Z5402                       515
BMC          7396   20300   BMT HARVEST ASPIRATION                           0.00   S                                                               362
BMC          7396     302   BMT MMR VACCINE                                143.00                    1 90707                90707                   636
BMC          7396     286   BMT POLIO VACCINE INACT                        171.00                    1 90713                90713                   636
BMC          7396     294   BMT TET TOX                                     50.00                    1 90703                90703                   636
BMC          7396   65002   COMP CHART REV & REPORT                         77.46                    1 Z4304            Z4304                       519
BMC          7396   65001   NURSE COORDINATOR                              103.23                    1 Z4300            Z4300                       519
BMC          7396   65004   NURSE EVALUATION 1/2 HR                         24.10                    1 Z4301            Z4301                       519
BMC          7396   65006   NURSE PHONE CNSLT 1/4 HR                         0.00   S                  Z5406            Z5406                       519



                                                         Page 17 of 676
                                                           CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                  Description                 Price          Stats/bill        CPT      Mod                Mod   Rev Code
 Code                                                                                                                  HCPCS
BMC          7396   65005   NURSE TEAM CONF 1/4 HR                       12.05                    1 Z4310             Z4310                    519
BMC          7396   65003   PERIOD CHART REV & REPORT                    43.03                    1 Z4303             Z4303                    519
BMC          7396   65007   SOC WORK EVAL 1/2 HR                         24.10                    1 Z4307             Z4307                    561
BMC          7396   65009   SOC WORK PHONE CNSLT 1/4 HR                   0.00   S                  Z5406             Z5406                    561
BMC          7396   65008   SOC WORK TEAM CONF 1/4 HR                    12.05                    1 Z4311             Z4311                    561
BMC          7396   65016   SW CASE COORD CONSULT 1/4 HR                  0.00   S                                                             515
BMC          7396   20201   T-CELL DEPLETED HAPLOIDENT 5                  0.00   S                                                             362
BMC          7396       5   TOWER-BONE MARROW                             0.00   S                                                             510
BMC          7396    7396   USE OF ROOM CHARGE                           50.00                    1    99211          Z7500                    515
BMC          7396   61010   USE OF ROOM - NO CHARGE                       0.00   S                     99211          Z7500                    515
BMC          7396   60600   USE OF ROOM CHARGE                           50.00                    1    99211          Z7500                    515
BML          7508   75030   BM ESTERASE                                 120.00                    1    88319   TC         88319   TC           312
BML          7508   75010   BM IRON STAIN, RBC/BM SMEARS                 84.00                    1    88313   TC         88313   TC           312
BML          7508   75040   BM MYELOPEROXIDASE                          120.00                    1    88319   TC         88319   TC           312
BML          7508   75020   BM SPECIAL STAIN                             84.00                    1    88313   TC         88313   TC           312
BMT          7397    7026   *X CA DONOR PHYSICAL EXAM                 1,916.00                    1   Z7318           Z7318                    819
BMT          7397   20004   *X GE-Z MARROW PROCURE (PER DONOR        27,222.00                    1    99199              38204                819
BMT          7397   65231   * X ENG PBSC DONOR PHYISCAL EXAM          3,154.00                    1    38204              38204                819
BMT          7397   65251   * X HUG MARROW PROCUREMENT               24,791.00                    1    38204              38204                819
BMT          7397   65273   * X IR PBSC DONOR INFO SESSION              723.00                    1    38204              38204                819
BMT          7397   65559   *X 151 CORD BLOOD SHIPMENT               25,010.00                    1   Z7318           Z7318                    819
BMT          7397   65560   *X 151 CORD BLOOD SHIPPING COST             394.00                    1   Z7318           Z7318                    819
BMT          7397   65873   *X 151 HR-A TYPING STANDARD (CORD           427.00                    1    38204              38204                819
BMT          7397   65891   *X 151 HR-A TYPING URGENT (CORD)            482.00                    1    38204              38204                819
BMT          7397   65688   *X 151 HR-A,B,DRB1/IR DRB3,4,5 UR         1,415.00                    1    38204              38204                819
BMT          7397   65909   *X 151 HR-B TYPING STANDARD (CORD           438.00                    1    38204              38204                819
BMT          7397   65927   *X 151 HR-B TYPING URGENT (CORD)            526.00                    1    38204              38204                819
BMT          7397   65702   *X 151 HR-C TYPING STANDARD (CORD           394.00                    1    38204              38204                819
BMT          7397   65734   *X 151 HR-C TYPING URGENT (CORD)            449.00                    1    38204              38204                819
BMT          7397   65839   *X 151 HR-DPB1 TYPING STANDARD (C           383.00                    1    38204              38204                819
BMT          7397   65856   *X 151 HR-DPB1 TYPING URGENT (COR           449.00                    1    38204              38204                819
BMT          7397   65769   *X 151 HR-DQB1 TYPING STANDARD (C           329.00                    1    38204              38204                819
BMT          7397   65787   *X 151 HR-DQB1 TYPING URGENT (COR           394.00                    1    38204              38204                819
BMT          7397   65735   *X 151 IR-C TYPING STANDARD (CORD           285.00                    1    38204              38204                819
BMT          7397   65752   *X 151 IR-C TYPING URGENT (CORD)            329.00                    1    38204              38204                819



                                                          Page 18 of 676
                                                                CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                   Description                    Price      Stats/bill     CPT     Mod               Mod   Rev Code
 Code                                                                                                              HCPCS
BMT          7397   65805   *X 151 IR-DQB1 TYPING STANDARD (C               132.00                1 38204             38204               819
BMT          7397   65822   *X 151 IR-DQB1 TYPING URGENT (COR               180.00                1 38204             38204               819
BMT          7397   65945   *X 151 IR-DRB3,4,5 STANDARD (CORD               263.00                1 38204             38204               819
BMT          7397   65963   *X 151 IR-DRB3,4,5 URGENT (CORD)                285.00                1 38204             38204               819
BMT          7397   65561   *X 153 CORD BLOOD SHIPMENT                   28,185.00                1 38204             38204               819
BMT          7397   65562   *X 153 CORD BLOOD SHIPPING COST                 394.00                1 Z7318         Z7318                   819
BMT          7397   65874   *X 153 HR-A TYPING STANDARD (CORD               427.00                1 38204             38204               819
BMT          7397   65892   *X 153 HR-A TYPING URGENT (CORD)                482.00                1 38204             38204               819
BMT          7397   65689   *X 153 HR-A,B,DRB1/IR DRB3,4,5 UR             1,415.00                1 38204             38204               819
BMT          7397   65910   *X 153 HR-B TYPING STANDARD (CORD               438.00                1 38204             38204               819
BMT          7397   65928   *X 153 HR-B TYPING URGENT (CORD)                526.00                1 38204             38204               819
BMT          7397   65704   *X 153 HR-C TYPING STANDARD (CORD               394.00                1 38204             38204               819
BMT          7397   65719   *X 153 HR-C TYPING URGENT (CORD)                449.00                1 38204             38204               819
BMT          7397   65840   *X 153 HR-DPB1 TYPING STANDARD (C               383.00                1 38204             38204               819
BMT          7397   65857   *X 153 HR-DPB1 TYPING URGENT (COR               449.00                1 38204             38204               819
BMT          7397   65770   *X 153 HR-DQB1 TYPING STANDARD (C               329.00                1 38204             38204               819
BMT          7397   65788   *X 153 HR-DQB1 TYPING URGENT (COR               394.00                1 38204             38204               819
BMT          7397   65736   *X 153 IR-C TYPING STANDARD (CORD               285.00                1 38204             38204               819
BMT          7397   65753   *X 153 IR-C TYPING URGENT (CORD)                329.00                1 38204             38204               819
BMT          7397   65806   *X 153 IR-DQB1 TYPING STANDARD (C               132.00                1 38204             38204               819
BMT          7397   65823   *X 153 IR-DQB1 TYPING URGENT (COR               180.00                1 38204             38204               819
BMT          7397   65946   *X 151 IR-DRB3,4,5 STANDARD (CORD               263.00                1 38204             38204               819
BMT          7397   65964   *X 153 IR-DRB3,4,5 URGENT (CORD)                285.00                1 38204             38204               819
BMT          7397   65563   *X 155 CORD BLOOD SHIPMENT                   22,710.00                1 Z7318         Z7318                   819
BMT          7397   65564   *X 155 CORD BLOOD SHPPING COST                  394.00                1 Z7318         Z7318                   819
BMT          7397   65875   *X 155 HR-A TYPING STANDARD (CORD               427.00                1 38204             38204               819
BMT          7397   65893   *X 155 HR-A TYPING URGENT (CORD)                482.00                1 38204             38204               819
BMT          7397   65690   *X 155 HR-A,B,DRB1/IR DRB3,4,5 UR             1,415.00                1 38204             38204               819
BMT          7397   65911   *X 155 HR-B TYPING STANDARD (CORD               438.00                1 38204             38204               819
BMT          7397   65929   *X 155 HR-B TYPING URGENT (CORD)                526.00                1 38204             38204               819
BMT          7397   65705   *X 155 HR-C TYPING STANDARD (CORD               240.00                1 38204             38204               819
BMT          7397   65720   *X 155 HR-C TYPING URGENT (CORD)                449.00                1 38204             38204               819
BMT          7397   65841   *X 155 HR-DPB1 TYPING STANDARD (C               383.00                1 38204             38204               819
BMT          7397   65858   *X 155 HR-DPB1 TYPING URGENT (COR               449.00                1 38204             38204               819
BMT          7397   65771   *X 155 HR-DQB1 TYPING STANDARD (C               329.00                1 38204             38204               819



                                                            Page 19 of 676
                                                                CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                   Description                    Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                                 HCPCS
BMT          7397   65789   *X 155 HR-DQB1 TYPING URGENT (COR               394.00                1    38204             38204               819
BMT          7397   65737   *X 155 IR-C TYPING STANDARD (CORD               285.00                1    38204             38204               819
BMT          7397   65754   *X 155 IR-C TYPING URGENT (CORD)                329.00                1    38204             38204               819
BMT          7397   65807   *X 155 IR-DQB1 TYPING STANDARD (C               132.00                1    38204             38204               819
BMT          7397   65824   *X 155 IR-DQB1 TYPING URGENT (COR               180.00                1    38204             38204               819
BMT          7397   65947   *X 153 IR-DRB3,4,5 STANDARD (CORD               263.00                1    38204             38204               819
BMT          7397   65965   *X 155 IR-DRB3,4,5 URGENT (CORD)                285.00                1    38204             38204               819
BMT          7397   65565   *X 156 CORD BLOOD SHIPMENT                   29,280.00                1   Z7318          Z7318                   819
BMT          7397   65566   *X 156 CORD BLOOD SHIPPING COST                 394.00                1   Z7318          Z7318                   819
BMT          7397   65876   *X 156 HR-A TYPING STANDARD (CORD               427.00                1    38204             38204               819
BMT          7397   65894   *X 156 HR-A TYPING URGENT (CORD)                482.00                1    38204             38204               819
BMT          7397   65675   *X 156 HR-A,B,DRB1/IR DRB3,4,5 ST             1,187.00                1    38204             38204               819
BMT          7397   65691   *X 156 HR-A,B,DRB1/IR DRB3,4,5 UR             1,415.00                1    38204             38204               819
BMT          7397   65912   *X 156 HR-B TYPING STANDARD (CORD               438.00                1    38204             38204               819
BMT          7397   65930   *X 156 HR-B TYPING URGENT (CORD)                526.00                1    38204             38204               819
BMT          7397   65706   *X 156 HR-C TYPING STANDARD (CORD               394.00                1    38204             38204               819
BMT          7397   65721   *X 156 HR-C TYPING URGENT (CORD)                449.00                1    38204             38204               819
BMT          7397   65842   *X 156 HR-DPB1 TYPING STANDARD (C               383.00                1    38204             38204               819
BMT          7397   65859   *X 156 HR-DPB1 TYPING URGENT (COR               449.00                1    38204             38204               819
BMT          7397   65772   *X 156 HR-DQB1 TYPING STANDARD (C               329.00                1    38204             38204               819
BMT          7397   65790   *X 156 HR-DQB1 TYPING URGENT (COR               394.00                1    38204             38204               819
BMT          7397   65738   *X 156 IR-C TYPING STANDARD (CORD               285.00                1    38204             38204               819
BMT          7397   65755   *X 156 IR-C TYPING URGENT (CORD)                329.00                1    38204             38204               819
BMT          7397   65808   *X 156 IR-DQB1 TYPING STANDARD (C               132.00                1    38204             38204               819
BMT          7397   65825   *X 156 IR-DQB1 TYPING URGENT (COR               180.00                1    38204             38204               819
BMT          7397   65948   *X 155 IR-DRB3,4,5 STANDARD (CORD               263.00                1    38204             38204               819
BMT          7397   65966   *X 156 IR-DRB3,4,5 URGENT (CORD)                285.00                1    38204             38204               819
BMT          7397   65567   *X 157 CORD BLOOD SHIPMENT                   20,520.00                1   Z7318          Z7318                   819
BMT          7397   65568   *X 157 CORD BLOOD SHIPPING COST                 394.00                1   Z7318          Z7318                   819
BMT          7397   65676   *X 157 HR-A,B,DRB1/IR DRB3,4,5 ST             1,187.00                1    38204             38204               819
BMT          7397   65692   *X 157 HR-A,B,DRB1/IR DRB3,4,5 UR             1,415.00                1    38204             38204               819
BMT          7397   65913   *X 157 HR-B TYPING STANDARD (CORD               438.00                1    38204             38204               819
BMT          7397   65931   *X 157 HR-B TYPING URGENT (CORD)                526.00                1    38204             38204               819
BMT          7397   65707   *X 157 HR-C TYPING STANDARD (CORD               394.00                1    38204             38204               819
BMT          7397   65722   *X 157 HR-C TYPING URGENT (CORD)                449.00                1    38204             38204               819



                                                            Page 20 of 676
                                                                CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                   Description                    Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                                 HCPCS
BMT          7397   65843   *X 157 HR-DPB1 TYPING STANDARD (C               383.00                1    99199             99199               819
BMT          7397   65860   *X 157 HR-DPB1 TYPING URGENT (COR               449.00                1    38204             38204               819
BMT          7397   65773   *X 157 HR-DQB1 TYPING STANDARD (C               329.00                1    38204             38204               819
BMT          7397   65791   *X 157 HR-DQB1 TYPING URGENT (COR               394.00                1    38204             38204               819
BMT          7397   65739   *X 157 IR-C TYPING STANDARD (CORD               285.00                1    38204             38204               819
BMT          7397   65756   *X 157 IR-C TYPING URGENT (CORD)                329.00                1    38204             38204               819
BMT          7397   65809   *X 157 IR-DQB1 TYPING STANDARD (C               132.00                1    38204             38204               819
BMT          7397   65826   *X 157 IR-DQB1 TYPING URGENT (COR               180.00                1    38204             38204               819
BMT          7397   65949   *X 156 IR-DRB3,4,5 STANDARD (CORD               263.00                1    38204             38204               819
BMT          7397   65967   *X 157 IR-DRB3,4,5 URGENT (CORD)                285.00                1    38204             38204               819
BMT          7397   65877   *X 157HR-A TYPING STANDARD (CORD)               427.00                1    38204             38204               819
BMT          7397   65895   *X 157HR-A TYPING URGENT (CORD)                 482.00                1    38204             38204               819
BMT          7397   65569   *X 159 CORD BLOOD SHIPMENT                   20,520.00                1   Z7318          Z7318                   819
BMT          7397   65570   *X 159 CORD BLOOD SHIPPING COST                 394.00                1   Z7318          Z7318                   819
BMT          7397   65878   *X 159 HR-A TYPING STANDARD (CORD               427.00                1    38204             38204               819
BMT          7397   65896   *X 159 HR-A TYPING URGENT (CORD)                482.00                1    38204             38204               819
BMT          7397   65677   *X 159 HR-A,B,DRB1/IR DRB3,4,5 ST             1,187.00                1    38204             38204               819
BMT          7397   65693   *X 159 HR-A,B,DRB1/IR DRB3,4,5 UR             1,415.00                1    38204             38204               819
BMT          7397   65914   *X 159 HR-B TYPING STANDARD (CORD               438.00                1    38204             38204               819
BMT          7397   65932   *X 159 HR-B TYPING URGENT (CORD)                526.00                1    38204             38204               819
BMT          7397   65708   *X 159 HR-C TYPING STANDARD (CORD               394.00                1    38204             38204               819
BMT          7397   65723   *X 159 HR-C TYPING URGENT (CORD)                449.00                1    38204             38204               819
BMT          7397   65844   *X 159 HR-DPB1 TYPING STANDARD (C               383.00                1    38204             38204               819
BMT          7397   65861   *X 159 HR-DPB1 TYPING URGENT (COR               449.00                1    38204             38204               819
BMT          7397   65774   *X 159 HR-DQB1 TYPING STANDARD (C               329.00                1    38204             38204               819
BMT          7397   65792   *X 159 HR-DQB1 TYPING URGENT (COR               394.00                1    38204             38204               819
BMT          7397   65740   *X 159 IR-C TYPING STANDARD (CORD               285.00                1    38204             38204               819
BMT          7397   65757   *X 159 IR-C TYPING URGENT (CORD)                329.00                1    38204             38204               819
BMT          7397   65810   *X 159 IR-DQB1 TYPING STANDARD (C               132.00                1    38204             38204               819
BMT          7397   65827   *X 159 IR-DQB1 TYPING URGENT (COR               180.00                1    38204             38204               819
BMT          7397   65950   *X 157 IR-DRB3,4,5 STANDARD (CORD               263.00                1    38204             38204               819
BMT          7397   65968   *X 159 IR-DRB3,4,5 URGENT (CORD)                285.00                1    38204             38204               819
BMT          7397   65571   *X 161 CORD BLOOD SHIPMENT                   20,520.00                1   Z7318          Z7318                   819
BMT          7397   65572   *X 161 CORD BLOOD SHIPPING COST                 394.00                1   Z7318          Z7318                   819
BMT          7397   65879   *X 161 HR-A TYPING STANDARD (CORD               427.00                1    38204             38204               819



                                                            Page 21 of 676
                                                                CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                   Description                    Price      Stats/bill     CPT     Mod               Mod   Rev Code
 Code                                                                                                              HCPCS
BMT          7397   65897   *X 161 HR-A TYPING URGENT (CORD)                482.00                1 38204             38204               819
BMT          7397   65678   *X 161 HR-A,B,DRB1/IR DRB3,4,5 ST             1,187.00                1 38204             38204               819
BMT          7397   65694   *X 161 HR-A,B,DRB1/IR DRB3,4,5 UR             1,415.00                1 38204             38204               819
BMT          7397   65915   *X 161 HR-B TYPING STANDARD (CORD               438.00                1 38204             38204               819
BMT          7397   65933   *X 161 HR-B TYPING URGENT (CORD)                526.00                1 38204             38204               819
BMT          7397   65709   *X 161 HR-C TYPING STANDARD (CORD               394.00                1 38204             38204               819
BMT          7397   65724   *X 161 HR-C TYPING URGENT (CORD)                449.00                1 38204             38204               819
BMT          7397   65845   *X 161 HR-DPB1 TYPING STANDARD (C               383.00                1 38204             38204               819
BMT          7397   65862   *X 161 HR-DPB1 TYPING URGENT (COR               449.00                1 38204             38204               819
BMT          7397   65775   *X 161 HR-DQB1 TYPING STANDARD (C               329.00                1 38204             38204               819
BMT          7397   65793   *X 161 HR-DQB1 TYPING URGENT (COR               394.00                1 38204             38204               819
BMT          7397   65741   *X 161 IR-C TYPING STANDARD (CORD               285.00                1 38204             38204               819
BMT          7397   65758   *X 161 IR-C TYPING URGENT (CORD)                329.00                1 38204             38204               819
BMT          7397   65811   *X 161 IR-DQB1 TYPING STANDARD (C               132.00                1 38204             38204               819
BMT          7397   65828   *X 161 IR-DQB1 TYPING URGENT (COR               180.00                1 38204             38204               819
BMT          7397   65951   *X 159 IR-DRB3,4,5 STANDARD (CORD               263.00                1 38204             38204               819
BMT          7397   65969   *X 161 IR-DRB3,4,5 URGENT (CORD)                285.00                1 38204             38204               819
BMT          7397   65573   *X 163 CORD BLOOD SHIPMENT                   28,185.00                1 Z7318         Z7318                   819
BMT          7397   65574   *X 163 CORD BLOOD SHIPPING COST                 394.00                1 Z7318         Z7318                   819
BMT          7397   65880   *X 163 HR-A TYPING STANDARD (CORD               427.00                1 38204             38204               819
BMT          7397   65898   *X 163 HR-A TYPING URGENT (CORD)                482.00                1 38204             38204               819
BMT          7397   65916   *X 163 HR-B TYPING STANDARD (CORD               438.00                1 38204             38204               819
BMT          7397   65934   *X 163 HR-B TYPING URGENT (CORD)                526.00                1 38204             38204               819
BMT          7397   65710   *X 163 HR-C TYPING STANDARD (CORD               394.00                1 38204             38204               819
BMT          7397   65725   *X 163 HR-C TYPING URGENT (CORD)                449.00                1 38204             38204               819
BMT          7397   65846   *X 163 HR-DPB1 TYPING STANDARD (C               383.00                1 38204             38204               819
BMT          7397   65863   *X 163 HR-DPB1 TYPING URGENT (COR               449.00                1 38204             38204               819
BMT          7397   65776   *X 163 HR-DQB1 TYPING STANDARD (C               329.00                1 38204             38204               819
BMT          7397   65794   *X 163 HR-DQB1 TYPING URGENT (COR               394.00                1 38204             38204               819
BMT          7397   65742   *X 163 IR-C TYPING STANDARD (CORD               285.00                1 38204             38204               819
BMT          7397   65759   *X 163 IR-C TYPING URGENT (CORD)                329.00                1 38204             38204               819
BMT          7397   65812   *X 163 IR-DQB1 TYPING STANDARD (C               132.00                1 38204             38204               819
BMT          7397   65829   *X 163 IR-DQB1 TYPING URGENT (COR               180.00                1 38204             38204               819
BMT          7397   65952   *X 161 IR-DRB3,4,5 STANDARD (CORD               263.00                1 38204             38204               819
BMT          7397   65970   *X 163 IR-DRB3,4,5 URGENT (CORD)                285.00                1 38204             38204               819



                                                            Page 22 of 676
                                                                CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                   Description                    Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                                 HCPCS
BMT          7397   65679   *X 163HR-A,B,DRB1/IR DRB3,4,5 STA             1,187.00                1    38204             38204               819
BMT          7397   65695   *X 163HR-A,B,DRB1/IR DRB3,4,5 URG             1,415.00                1    38204             38204               819
BMT          7397   65575   *X 164 CORD BLOOD SHIPMENT                   27,147.00                1   Z7318          Z7318                   819
BMT          7397   65576   *X 164 CORD BLOOD SHIPPING COST                 432.00                1   Z7318          Z7318                   819
BMT          7397   65881   *X 164 HR-A TYPING STANDARD (CORD               276.00                1    38204             38204               819
BMT          7397   65899   *X 164 HR-A TYPING URGENT (CORD)                336.00                1    38204             38204               819
BMT          7397   65680   *X 164 HR-A,B,DRB1/IR DRB3,4,5 ST             1,187.00                1    38204             38204               819
BMT          7397   65696   *X 164 HR-A,B,DRB1/IR DRB3,4,5 UR             1,415.00                1    38204             38204               819
BMT          7397   65917   *X 164 HR-B TYPING STANDARD (CORD               300.00                1    38204             38204               819
BMT          7397   65935   *X 164 HR-B TYPING URGENT (CORD)                384.00                1    38204             38204               819
BMT          7397   65847   *X 164 HR-DPB1 TYPING STANDARD (C               240.00                1    38204             38204               819
BMT          7397   65864   *X 164 HR-DPB1 TYPING URGENT (COR               288.00                1    38204             38204               819
BMT          7397   65777   *X 164 HR-DQB1 TYPING STANDARD (C               168.00                1    38204             38204               819
BMT          7397   65795   *X 164 HR-DQB1 TYPING URGENT (COR               240.00                1    38204             38204               819
BMT          7397   65743   *X 164 IR-C TYPING STANDARD (CORD               144.00                1    38204             38204               819
BMT          7397   65760   *X 164 IR-C TYPING URGENT (CORD)                180.00                1    38204             38204               819
BMT          7397   65813   *X 164 IR-DQB1 TYPING STANDARD (C               132.00                1    38204             38204               819
BMT          7397   65830   *X 164 IR-DQB1 TYPING URGENT (COR               180.00                1    38204             38204               819
BMT          7397   65953   *X 163 IR-DRB3,4,5 STANDARD (CORD               144.00                1    38204             38204               819
BMT          7397   65971   *X 164 IR-DRB3,4,5 URGENT (CORD)                180.00                1    38204             38204               819
BMT          7397   65711   *X 164HR-C TYPING STANDARD (CORD)               240.00                1    38204             38204               819
BMT          7397   65726   *X 164HR-C TYPING URGENT (CORD)                 300.00                1    38204             38204               819
BMT          7397   65577   *X 166 CORD BLOOD SHIPMENT                   24,900.00                1   Z7318          Z7318                   819
BMT          7397   65578   *X 166 CORD BLOOD SHIPPING COST                 394.00                1   Z7318          Z7318                   819
BMT          7397   65882   *X 166 HR-A TYPING STANDARD (CORD               427.00                1    38204             38204               819
BMT          7397   65900   *X 166 HR-A TYPING URGENT (CORD)                482.00                1    38204             38204               819
BMT          7397   65681   *X 166 HR-A,B,DRB1/IR DRB3,4,5 ST             1,187.00                1    38204             38204               819
BMT          7397   65697   *X 166 HR-A,B,DRB1/IR DRB3,4,5 UR             1,415.00                1    38204             38204               819
BMT          7397   65918   *X 166 HR-B TYPING STANDARD (CORD               438.00                1    38204             38204               819
BMT          7397   65936   *X 166 HR-B TYPING URGENT (CORD)                526.00                1    38204             38204               819
BMT          7397   65712   *X 166 HR-C TYPING STANDARD (CORD               394.00                1    38204             38204               819
BMT          7397   65727   *X 166 HR-C TYPING URGENT (CORD)                449.00                1    38204             38204               819
BMT          7397   65848   *X 166 HR-DPB1 TYPING STANDARD (C               383.00                1    38204             38204               819
BMT          7397   65865   *X 166 HR-DPB1 TYPING URGENT (COR               449.00                1    38204             38204               819
BMT          7397   65778   *X 166 HR-DQB1 TYPING STANDARD (C               329.00                1    38204             38204               819



                                                            Page 23 of 676
                                                                CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                   Description                    Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                                 HCPCS
BMT          7397   65796   *X 166 HR-DQB1 TYPING URGENT (COR               394.00                1    38204             38204               819
BMT          7397   65744   *X 166 IR-C TYPING STANDARD (CORD               285.00                1    38204             38204               819
BMT          7397   65761   *X 166 IR-C TYPING URGENT (CORD)                329.00                1    38204             38204               819
BMT          7397   65814   *X 166 IR-DQB1 TYPING STANDARD (C               132.00                1    38204             38204               819
BMT          7397   65831   *X 166 IR-DQB1 TYPING URGENT (COR               180.00                1    38204             38204               819
BMT          7397   65954   *X 164 IR-DRB3,4,5 STANDARD (CORD               263.00                1    38204             38204               819
BMT          7397   65972   *X 166 IR-DRB3,4,5 URGENT (CORD)                285.00                1    38204             38204               819
BMT          7397   65579   *X 167 CORD BLOOD SHIPMENT                   27,147.00                1   Z7318          Z7318                   819
BMT          7397   65580   *X 167 CORD BLOOD SHIPPING COST                 432.00                1   Z7318          Z7318                   819
BMT          7397   65883   *X 167 HR-A TYPING STANDARD (CORD               276.00                1    38204             38204               819
BMT          7397   65901   *X 167 HR-A TYPING URGENT (CORD)                336.00                1    38204             38204               819
BMT          7397   65682   *X 167 HR-A,B,DRB1/IR DRB3,4,5 ST             1,187.00                1    38204             38204               819
BMT          7397   65698   *X 167 HR-A,B,DRB1/IR DRB3,4,5 UR             1,415.00                1    38204             38204               819
BMT          7397   65919   *X 167 HR-B TYPING STANDARD (CORD               300.00                1    38204             38204               819
BMT          7397   65937   *X 167 HR-B TYPING URGENT (CORD)                384.00                1    38204             38204               819
BMT          7397   65713   *X 167 HR-C TYPING STANDARD (CORD               240.00                1    38204             38204               819
BMT          7397   65728   *X 167 HR-C TYPING URGENT (CORD)                300.00                1    38204             38204               819
BMT          7397   65849   *X 167 HR-DPB1 TYPING STANDARD (C               240.00                1    38204             38204               819
BMT          7397   65866   *X 167 HR-DPB1 TYPING URGENT (COR               288.00                1    38204             38204               819
BMT          7397   65779   *X 167 HR-DQB1 TYPING STANDARD (C               168.00                1    38204             38204               819
BMT          7397   65797   *X 167 HR-DQB1 TYPING URGENT (COR               240.00                1    38204             38204               819
BMT          7397   65745   *X 167 IR-C TYPING STANDARD (CORD               144.00                1    38204             38204               819
BMT          7397   65762   *X 167 IR-C TYPING URGNET (CORD)                180.00                1    38204             38204               819
BMT          7397   65815   *X 167 IR-DQB1 TYPING STANDARD (C               132.00                1    38204             38204               819
BMT          7397   65832   *X 167 IR-DQB1 TYPING URGENT (COR               180.00                1    38204             38204               819
BMT          7397   65955   *X 166 IR-DRB3,4,5 STANDARD (CORD               144.00                1    38204             38204               819
BMT          7397   65973   *X 167 IR-DRB3,4,5 URGENT (CORD)                180.00                1    38204             38204               819
BMT          7397   65581   *X 168 CORD BLOOD SHIPMENT                   20,520.00                1   Z7318          Z7318                   819
BMT          7397   65582   *X 168 CORD BLOOD SHIPPING COST                 394.00                1   Z7318          Z7318                   819
BMT          7397   65884   *X 168 HR-A TYPING STANDARD (CORD               427.00                1    38204             38204               819
BMT          7397   65902   *X 168 HR-A TYPING URGENT (CORD)                482.00                1    38204             38204               819
BMT          7397   65683   *X 168 HR-A,B,DRB1/IR DRB3,4,5 ST             1,187.00                1    38204             38204               819
BMT          7397   65699   *X 168 HR-A,B,DRB1/IR DRB3,4,5 UR             1,415.00                1    38204             38204               819
BMT          7397   65920   *X 168 HR-B TYPING STANDARD (CORD               438.00                1    38204             38204               819
BMT          7397   65938   *X 168 HR-B TYPING URGENT (CORD)                526.00                1    38204             38204               819



                                                            Page 24 of 676
                                                                CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                   Description                    Price      Stats/bill     CPT     Mod               Mod   Rev Code
 Code                                                                                                              HCPCS
BMT          7397   65714   *X 168 HR-C TYPING STANDARD (CORD               394.00                1 38204             38204               819
BMT          7397   65729   *X 168 HR-C TYPING URGENT (CORD)                449.00                1 38204             38204               819
BMT          7397   65850   *X 168 HR-DPB1 TYPING STANDARD (C               383.00                1 38204             38204               819
BMT          7397   65867   *X 168 HR-DPB1 TYPING URGENT (COR               449.00                1 38204             38204               819
BMT          7397   65780   *X 168 HR-DQB1 TYPING STANDARD (C               329.00                1 38204             38204               819
BMT          7397   65798   *X 168 HR-DQB1 TYPING URGENT (COR               394.00                1 38204             38204               819
BMT          7397   65746   *X 168 IR-C TYPING STANDARD (CORD               285.00                1 38204             38204               819
BMT          7397   65763   *X 168 IR-C TYPING URGENT (CORD)                329.00                1 38204             38204               819
BMT          7397   65816   *X 168 IR-DQB1 TYPING STANDARD (C               132.00                1 38204             38204               819
BMT          7397   65833   *X 168 IR-DQB1 TYPING URGENT (COR               180.00                1 38204             38204               819
BMT          7397   65956   *X 167 IR-DRB3,4,5 STANDARD (CORD               263.00                1 38204             38204               819
BMT          7397   65974   *X 168 IR-DRB3,4,5 URGENT (CORD)                285.00                1 38204             38204               819
BMT          7397   65583   *X 169 CORD BLOOD SHIPMENT                   32,018.00                1 Z7318         Z7318                   819
BMT          7397   65584   *X 169 CORD BLOOD SHIPPING COST                 394.00                1 Z7318         Z7318                   819
BMT          7397   65885   *X 169 HR-A TYPING STANDARD (CORD               427.00                1 38204             38204               819
BMT          7397   65903   *X 169 HR-A TYPING URGENT (CORD)                482.00                1 38204             38204               819
BMT          7397   65684   *X 169 HR-A,B,DRB1/IR DRB3,4,5 ST             1,187.00                1 38204             38204               819
BMT          7397   65700   *X 169 HR-A,B,DRB1/IR DRB3,4,5 UR             1,415.00                1 38204             38204               819
BMT          7397   65921   *X 169 HR-B TYPING STANDARD (CORD               438.00                1 38204             38204               819
BMT          7397   65939   *X 169 HR-B TYPING URGENT (CORD)                526.00                1 38204             38204               819
BMT          7397   65715   *X 169 HR-C TYPING STANDARD (CORD               394.00                1 38204             38204               819
BMT          7397   65730   *X 169 HR-C TYPING URGENT (CORD)                449.00                1 38204             38204               819
BMT          7397   65851   *X 169 HR-DPB1 TYPING STANDARD (C               383.00                1 38204             38204               819
BMT          7397   65868   *X 169 HR-DPB1 TYPING URGENT (COR               449.00                1 38204             38204               819
BMT          7397   65781   *X 169 HR-DQB1 TYPING STANDARD (C               329.00                1 38204             38204               819
BMT          7397   65799   *X 169 HR-DQB1 TYPING URGENT (COR               394.00                1 38204             38204               819
BMT          7397   65747   *X 169 IR-C TYPING STANDARD (CORD               285.00                1 38204             38204               819
BMT          7397   65764   *X 169 IR-C TYPING URGENT (CORD)                329.00                1 38204             38204               819
BMT          7397   65817   *X 169 IR-DQB1 TYPING STANDARD (C               132.00                1 38204             38204               819
BMT          7397   65834   *X 169 IR-DQB1 TYPING URGENT (COR               180.00                1 38204             38204               819
BMT          7397   65957   *X 168 IR-DRB3,4,5 STANDARD (CORD               263.00                1 38204             38204               819
BMT          7397   65975   *X 169 IR-DRB3,4,5 URGENT (CORD)                285.00                1 38204             38204               819
BMT          7397   65886   *X 170 HR-A TYPING STANDARD (CORD               427.00                1 38204             38204               819
BMT          7397   65904   *X 170 HR-A TYPING URGENT (CORD)                482.00                1 38204             38204               819
BMT          7397   65685   *X 170 HR-A,B,DRB1/IR DRB3,4,5 ST             1,187.00                1 38204             38204               819



                                                            Page 25 of 676
                                                            CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                  Description                  Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                              HCPCS
BMT          7397   65701   *X 170 HR-A,B,DRB1/IR DRB3,4,5 UR          1,415.00                1    38204             38204               819
BMT          7397   65922   *X 170 HR-B TYPING STANDARD (CORD            438.00                1    38204             38204               819
BMT          7397   65940   *X 170 HR-B TYPING URGENT (CORD)             526.00                1    38204             38204               819
BMT          7397   65716   *X 170 HR-C TYPING STANDARD (CORD            394.00                1    38204             38204               819
BMT          7397   65731   *X 170 HR-C TYPING URGENT (CORD)             449.00                1    38204             38204               819
BMT          7397   65852   *X 170 HR-DPB1 TYPING STANDARD (C            383.00                1    38204             38204               819
BMT          7397   65869   *X 170 HR-DPB1 TYPING URGENT (COR            449.00                1    38204             38204               819
BMT          7397   65782   *X 170 HR-DQB1 TYPING STANDARD (C            329.00                1    38204             38204               819
BMT          7397   65800   *X 170 HR-DQB1 TYPING URGENT (COR            394.00                1    38204             38204               819
BMT          7397   65748   *X 170 IR-C TYPING STANDARD (CORD            285.00                1    38204             38204               819
BMT          7397   65765   *X 170 IR-C TYPING URGENT (CORD)             329.00                1    38204             38204               819
BMT          7397   65818   *X 170 IR-DQB1 TYPING STANDARD (C            132.00                1    38204             38204               819
BMT          7397   65835   *X 170 IR-DQB1 TYPING URGENT (COR            180.00                1    38204             38204               819
BMT          7397   65958   *X 169 IR-DRB3,4,5 STANDARD (CORD            263.00                1    38204             38204               819
BMT          7397   65976   *X 170 IR-DRB3,4,5 URGENT (CORD)             285.00                1    38204             38204               819
BMT          7397   30655   *X AB SERIOLOGICAL                           107.00                1    38204             38204               819
BMT          7397   30952   *X ACTIVATION OF DONOR SEARCH                923.00                1   Z7318          Z7318                   819
BMT          7397   12042   *X AT ADDL PRECOLL SAMPLE                  1,533.00                1    38204             38204               819
BMT          7397   12071   *X AT AUTOLOGOUS BLOOD UNIT                1,172.00                1    38204             38204               390
BMT          7397   12034   *X AT CONFIRMATORY TYPE SAMPLE             1,533.00                1    38204             38204               819
BMT          7397   12069   *X AT DONOR INFO SESSION                       0.00                1    38204             38204               819
BMT          7397   12070   *X AT DONOR PHYSICAL EXAM                  1,894.00                1    38204             38204               819
BMT          7397   12068   *X AT EXT PROCURE & TYPING                   537.00                1   Z7318          Z7318                   819
BMT          7397   60081   *X AT FILGRASTIM INJECTION                 2,234.00                1    38204             38204               819
BMT          7397   12026   *X AT HLA/DR PROC AND TYPE                   495.00                1   Z7318          Z7318                   819
BMT          7397   66041   *X AT IDM SAMPLE COLL & CENTRAL L          1,829.00                1    38204             38204               819
BMT          7397   65985   *X AT IDM SAMPLE COLLECTION                1,686.00                1    38204             38204               819
BMT          7397   65463   *X AT INFECTIOUS DISEASE TESTS                 0.00                1   Z7318          Z7318                   819
BMT          7397   65208   *X AT IR-DR TYPING                           482.00                1    38204             38204               819
BMT          7397   12067   *X AT MARROW PROCURE (PER DONOR)          28,262.00                1    38204             38204               819
BMT          7397   65470   *X AT PBSC DONOR INFO SESSION                  0.00                1   Z7318          Z7318                   819
BMT          7397   65471   *X AT PBSC DONOR PHYSICAL EXAM             1,894.00                1    38204             38204               819
BMT          7397   65477   *X AT PBSC FILGRASTIM INJECTION P          2,234.00                1   Z7318          Z7318                   819
BMT          7397   65472   *X AT PBSC WORK UP CANCELLATION            1,369.00                1   Z7318          Z7318                   819
BMT          7397   65476   *X AT PBSC WORKUP CANCELLATION PE          2,290.00                1   Z7318          Z7318                   819



                                                           Page 26 of 676
                                                            CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                  Description                  Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                              HCPCS
BMT          7397   66013   *X AT PRE-COLL / IDM SAMP COLL CO          1,719.00                1    38204             38204               819
BMT          7397   65475   *X AT PRIMARY PBSC COLLECTION PER         29,970.00                1    38204             38204               819
BMT          7397   65464   *X AT SECONDARY PBSC COLLECTION P         29,970.00                1   Z7318          Z7318                   819
BMT          7397   65466   *X AT UL NMDP COURIER ADDL CHG             5,048.00                1   Z7318          Z7318                   819
BMT          7397   65467   *X AT UL NMDP SHIPPNG ADDL CHG               646.00                1   Z7318          Z7318                   819
BMT          7397   65473   *X AT UL PHYSICAL EXAM                     1,402.00                1   Z7318          Z7318                   819
BMT          7397   65474   *X AT UL WORK UP CANCELLATION              1,369.00                1   Z7318          Z7318                   819
BMT          7397   65478   *X AT UL WORKUP CANCELLATION PER           3,152.00                1   Z7318          Z7318                   819
BMT          7397   65465   *X AT UNSTIM LEUKAPHER PER DNR             7,994.00                1   Z7318          Z7318                   819
BMT          7397   65469   *X AT WB NMDP SHPPGN ADDL CHG                  0.00                1   Z7318          Z7318                   819
BMT          7397   65468   *X AT WB WHL BLD UNIT COL PER DNR              0.00                1   Z7318          Z7318                   819
BMT          7397   12072   *X AT WORKUP FEE (PER DONOR)               1,369.00                1    38204             38204               819
BMT          7397   40000   *X AU 2ND PBSC COLLECT PER DNR            32,576.00                1    38204             38204               819
BMT          7397    5046   *X AU ADDL PRECOLL SAMPLE                    580.00                1    38204             38204               819
BMT          7397    5103   *X AU AUTOLOGOUS BLOOD UNIT                  767.00                1    38204             38204               390
BMT          7397    5129   *X AU CONFIRMATORY TYPE SAMPLE               580.00                1    38204             38204               819
BMT          7397    5087   *X AU DONOR INFO SESSION                     613.00                1    38204             38204               819
BMT          7397    5095   *X AU DONOR PHYSICAL EXAM                  2,004.00                1   Z7318          Z7318                   819
BMT          7397    5062   *X AU EXT PROCURE & TYPING                   679.00                1   Z7318          Z7318                   819
BMT          7397    5020   *X AU HLA/DR PROC AND TYPE                   264.00                1   Z7318          Z7318                   819
BMT          7397   60042   *X AU IDM SAMPLE COLL & CENTRAL L            854.00                1    38204             38204               819
BMT          7397   65986   *X AU IDM SAMPLE COLLECTION                  580.00                1    38204             38204               819
BMT          7397    5137   *X AU INFECTIOUS DISEASE TESTS               296.00                1   Z7318          Z7318                   819
BMT          7397   65209   *X AU IR-DR TYPING                           449.00                1    38204             38204               819
BMT          7397    5061   *X AU MARROW PROCURE (PER DONOR)          33,310.00                1    38204             38204               819
BMT          7397   40006   *X AU PBSC INFO SESSION PR DNR               602.00                1    38204             38204               819
BMT          7397   40007   *X AU PBSC PHYS EXAM PER EXAM              1,927.00                1   Z7318          Z7318                   819
BMT          7397   40008   *X AU PBSC WORKUP FEE PER DNR              2,091.00                1   Z7318          Z7318                   819
BMT          7397   66014   *X AU PRE-COLL / IDM SAMP COLL CO            580.00                1    38204             38204               819
BMT          7397   40002   *X AU UL NMDP COURIER ADDL CHG             7,326.00                1    38204             38204               819
BMT          7397   40003   *X AU UL NMDP SHIPPNG ADDL CHG               756.00                1    38204             38204               819
BMT          7397   40010   *X AU UL PHYS EXAM PER EXAM                1,522.00                1   Z7318          Z7318                   819
BMT          7397   40011   *X AU UL WORKUP FEE PER DONOR              1,347.00                1    38204             38204               819
BMT          7397   40001   *X AU UNSTIM LEUKAPHER PER DNR            11,826.00                1    38204             38204               819
BMT          7397   40005   *X AU WB NMDP SHIPPNG ADDL CHG               756.00                1    38204             38204               819



                                                           Page 27 of 676
                                                           CM 06/15/07


 Dept                                                                                                              M/cal
        Cost Ctr.   SIM#                  Description                 Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                             HCPCS
BMT          7397   40004   *X AU WHL BLD UNIT COL PER DNR            4,511.00                1   Z7318          Z7318                   819
BMT          7397    5111   *X AU WORKUP FEE (PER DONOR)              2,081.00                1    38204             38204               819
BMT          7397    1739   *X BE ADDL CHARGE NMDP COURIER            6,537.00                1    38204             38204               819
BMT          7397    1740   *X BE ADDL CHARGE NMDP SHIPPING             602.00                1    38204             38204               819
BMT          7397    1706   *X BE ADDL PRECOLLECTION SAMPLE             876.00                1    38204             38204               819
BMT          7397    1742   *X BE AUTO BLOOD UNIT BM (PER UNI             0.00                1    38204             38204               819
BMT          7397    1744   *X BE DONOR PHYS EXAM PBSC/PER EX         1,588.00                1    38204             38204               819
BMT          7397    1741   *X BE DONOR PHYSICAL EXAM BM              1,588.00                1    38204             38204               819
BMT          7397    1704   *X BE EXT PROCURE & TYPING                  460.00                1   Z7318          Z7318                   819
BMT          7397   60043   *X BE IDM SAMPLE COLL & CENTRAL L         1,226.00                1    38204             38204               819
BMT          7397   65987   *X BE IDM SAMPLE COLLECTION               1,073.00                1    38204             38204               819
BMT          7397    1703   *X BE IR-DR TYPING                            0.00                1    38204             38204               819
BMT          7397    1735   *X BE MARROW PROCUREMENT (PER DNR        37,493.00                1   Z7318          Z7318                   819
BMT          7397    1746   *X BE PHYSICAL EXAM (PER EXAM) UL         1,588.00                1   Z7318          Z7318                   819
BMT          7397   66015   *X BE PRE-COLL / IDM SAMP COLL CO         1,139.00                1    38204             38204               819
BMT          7397    1736   *X BE PRIM PBSC COLLEC PER DNR           34,974.00                1    38204             38204               819
BMT          7397    1737   *X BE SEC PBSC COLLEC PER DNR            34,974.00                1    38204             38204               819
BMT          7397    1738   *X BE UNSTIM LEUKAPHER PER DNR            8,267.00                1    38204             38204               819
BMT          7397    1747   *X BE WORKUP CANCEL (PER DNR) UL            931.00                1    38204             38204               819
BMT          7397    1743   *X BE WORKUP CANCEL BM (PER DNR)            931.00                1    38204             38204               819
BMT          7397    1745   *X BE WORKUP CANCEL PBSC                    931.00                1    38204             38204               819
BMT          7397   11051   *X C-PL ADDL PRECOLL SAMPLE                 756.00                1    38204             38204               819
BMT          7397   11058   *X C-PL AUTOLOGOUS BLOOD UNIT               526.00                1    38204             38204               390
BMT          7397   11055   *X C-PL CONFIRMATORY TYPE SAMPLE            756.00                1    38204             38204               819
BMT          7397   11056   *X C-PL DONOR INFO SESSION                  329.00                1    38204             38204               819
BMT          7397   11057   *X C-PL DONOR PHYSICAL EXAM                 920.00                1    38204             38204               819
BMT          7397   11053   *X C-PL EXT DR PROCURE & TYPING             416.00                1    38204             38204               819
BMT          7397   11036   *X C-PL HLA/DR PROC AND TYPE                356.00                1   Z7318          Z7318                   819
BMT          7397   60046   *X C-PL IDM SAMPLE COLL & CENTRAL           832.00                1    38204             38204               819
BMT          7397   65990   *X C-PL IDM SAMPLE COLLECTION               712.00                1    38204             38204               819
BMT          7397   65221   *X C-PL IR-DR TYPING                          0.00                1    38204             38204               819
BMT          7397   11077   *X C-PL MARROW PROCURE(PER DONOR)        23,674.00                1    38204             38204               819
BMT          7397   40021   *X C-PL PBSC INFO SESSION PR DNR            329.00                1    38204             38204               819
BMT          7397   40022   *X C-PL PBSC PHYS EXAM PER EXAM             920.00                1   Z7318          Z7318                   819
BMT          7397   40023   *X C-PL PBSC WORKUP FEE PER DNR           1,018.00                1    38204             38204               819



                                                          Page 28 of 676
                                                           CM 06/15/07


 Dept                                                                                                           M/cal
        Cost Ctr.   SIM#                  Description                 Price      Stats/bill     CPT     Mod               Mod   Rev Code
 Code                                                                                                          HCPCS
BMT          7397   66018   *X C-PL PRE-COLL / IDM SAMP COLL            788.00                1 38204             38204               819
BMT          7397   40024   *X C-PL PRIM FILGRAS INJ PER DNR          2,475.00                1 38204             38204               819
BMT          7397   40017   *X C-PL PRIM PBSC COLLEC PER DNR         23,674.00                1 38204             38204               819
BMT          7397   40019   *X C-PL UL NMDP COURIER ADDL CHG          6,187.00                1 38204             38204               819
BMT          7397   40020   *X C-PL UL NMDP SHIPPNG ADDL CHG            756.00                1 38204             38204               819
BMT          7397   40025   *X C-PL UL PHYS EXAM PER EXAM               777.00                1 38204             38204               819
BMT          7397   40026   *X C-PL UL WORKUP FEE PER DONOR             646.00                1 38204             38204               819
BMT          7397   40018   *X C-PL UNSTIM LEUKAPHER PER DNR          6,997.00                1 38204             38204               819
BMT          7397   11059   *X C-PL WORKUP FEE (PER DONOR)            1,018.00                1 38204             38204               819
BMT          7397   40038   *X C-PR 2ND FILGRAS INJ PER DNR           4,424.00                1 99199         Z7318                   819
BMT          7397   40028   *X C-PR 2ND PBSC COLLECT PER DNR         32,970.00                1 38204             38204               819
BMT          7397   11052   *X C-PR ADDL PRECOLL SAMPLE               1,237.00                1 38204             38204               819
BMT          7397   11119   *X C-PR AUTOLOGOUS BLOOD UNIT               767.00                1 38204             38204               390
BMT          7397   11135   *X C-PR CONFIRMATORY TYPE SAMPLE          1,456.00                1 38204             38204               819
BMT          7397   11093   *X C-PR DONOR INFO SESSION                  613.00                1 38204             38204               819
BMT          7397   11101   *X C-PR DONOR PHYSICAL EXAM               2,004.00                1 Z7318         Z7318                   819
BMT          7397   11054   *X C-PR EXT DR PROCURE & TYPING             679.00                1 38204             38204               819
BMT          7397   11037   *X C-PR HLA/DR PROC AND TYPE                593.00                1 Z7318         Z7318                   819
BMT          7397   60047   *X C-PR IDM SAMPLE COLL & CENTRAL         2,059.00                1 38204             38204               819
BMT          7397   65991   *X C-PR IDM SAMPLE COLLECTION             1,872.00                1 38204             38204               819
BMT          7397   65222   *X C-PR IR-DR TYPING                        449.00                1 38204             38204               819
BMT          7397   11078   *X C-PR MARROW PROCURE(PER DONOR)        33,704.00                1 38204             38204               819
BMT          7397   40034   *X C-PR PBSC INFO SESSION PR DNR            602.00                1 38204             38204               819
BMT          7397   40035   *X C-PR PBSC PHYS EXAM PER EXAM           1,927.00                1 38204             38204               819
BMT          7397   40036   *X C-PR PBSC WORKUP FEE PER DNR           2,091.00                1 38204             38204               819
BMT          7397   66019   *X C-PR PRE-COLL / IDM SAMP COLL          1,872.00                1 38204             38204               819
BMT          7397   40037   *X C-PR PRIM FILGRAS INJ PER DNR          4,424.00                1 Z7318         Z7318                   819
BMT          7397   40027   *X C-PR PRIM PBSC COLLEC PER DNR         32,970.00                1 38204             38204               819
BMT          7397   40030   *X C-PR UL NMDP COURIER ADDL CHG          6,187.00                1 38204             38204               819
BMT          7397   40031   *X C-PR UL NMDP SHIPPNG ADDL CHG            756.00                1 38204             38204               819
BMT          7397   40039   *X C-PR UL PHYS EXAM PER EXAM             1,522.00                1 38204             38204               819
BMT          7397   40040   *X C-PR UL WORKUP FEE PER DONOR           1,347.00                1 38204             38204               819
BMT          7397   40029   *X C-PR UNSTIM LEUKAPHER PER DNR         11,826.00                1 38204             38204               819
BMT          7397   40033   *X C-PR WB NMDP SHIPPNG ADDL CHG            756.00                1 38204             38204               819
BMT          7397   40032   *X C-PR WHL BLD UNIT COL PER DNR          4,511.00                1 38204             38204               819



                                                          Page 29 of 676
                                                            CM 06/15/07


 Dept                                                                                                                 M/cal
        Cost Ctr.   SIM#                  Description                  Price        Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                                HCPCS
BMT          7397   11127   *X C-PR WORKUP FEE (PER DONOR)             2,081.00                  1   Z7318          Z7318                   819
BMT          7397    1441   *X CA ADDL PRECOLL SAMPLE                    646.00                  1   Z7318          Z7318                   819
BMT          7397    7034   *X CA AUTOLOGOUS BLOOD UNIT                  515.00                  1    38204             38204               390
BMT          7397    1474   *X CA CONFIRMATORY TYPE SAMPLE               646.00                  1   Z7318          Z7318                   819
BMT          7397    7018   *X CA DONOR INFO SESSION                     580.00                  1   Z7318          Z7318                   819
BMT          7397   65228   *X CA EXT PROCURE & TYPING                   657.00                  1   Z7318          Z7318                   819
BMT          7397   60082   *X CA FILGRASTIM INJECTION                 3,427.00                  1    38204             38204               819
BMT          7397    1465   *X CA HLA/DR PROC AND TYPE                   475.00                  1   Z7318          Z7318                   819
BMT          7397   60044   *X CA IDM SAMPLE COLL & CENTRAL L            931.00                  1    38204             38204               819
BMT          7397   65988   *X CA IDM SAMPLE COLLECTION                  745.00                  1    38204             38204               819
BMT          7397   60068   *X CA INFECTIOUS DISEASE TEST RES              0.00                  1    38204             38204               819
BMT          7397   65210   *X CA IR-DR TYPING                           405.00                  1   Z7318          Z7318                   819
BMT          7397    1466   *X CA MARROW PROCURE (PER DONOR)          33,627.00                  1   Z7318          Z7318                   819
BMT          7397   66016   *X CA PRE-COLL / IDM SAMP COLL CO            745.00                  1    38204             38204               819
BMT          7397   60079   *X CA PRIMARY PBSC COLLECTION             33,627.00                  1    38204             38204               819
BMT          7397   60080   *X CA SECONDARY PBSC COLLECTION           33,627.00                  1    38204             38204               819
BMT          7397   40013   *X CA UL NMDP COURIER ADDL CHG             3,964.00                  1   Z7318          Z7318                   819
BMT          7397   40014   *X CA UL NMDP SHIPPNG ADDL CHG               482.00                  1   Z7318          Z7318                   819
BMT          7397   40015   *X CA UL PHYS EXAM PER EXAM                1,916.00                  1   Z7318          Z7318                   819
BMT          7397   40016   *X CA UL WORKUP FEE PER DONOR              1,982.00                  1   Z7318          Z7318                   819
BMT          7397   40012   *X CA UNSTIM LEUKAPHER PER DNR             9,735.00                  1   Z7318          Z7318                   819
BMT          7397    7042   *X CA WORKUP FEE (PER DONOR)               1,982.00                  1   Z7318          Z7318                   819
BMT          7397   30606   *X CAITLAND, R. PATIENT TEST                   0.00 S                                                           302
BMT          7397   30002   *X CAITLAND,R DONOR TEST                       0.00 S                   86812           Z7318                   302
BMT          7397   66052   *X CH ADDTL PRECOLLECTION SAMPLE           1,369.00                  1 38204                38204               819
BMT          7397   66051   *X CH CONFIRMATORY TYPIING                 1,369.00                  1 38204                38204               819
BMT          7397   66050   *X CH EXT DR PROCE AND TYPING                526.00                  1 38204                38204               819
BMT          7397   66054   *X CH IDM SAMPLE COLLECTION                1,489.00                  1 38204                38204               819
BMT          7397   66053   *X CH INFECTIOUS DISEASE                     296.00                  1 38204                38204               819
BMT          7397   66049   *X CH IR DR TYPING                           449.00                  1 38204                38204               819
BMT          7397   66055   *X CH PRE COLL IDM SAMPLE COMBINA          1,489.00                  1 38204                38204               819
BMT          7397   30556   *X CONFIRMED BLD SMPL OUTSIDE US           2,119.00                  1 38204                38204               819
BMT          7397   30507   *X CONFIRMED BLOOD SAMPLE US                 825.00                  1 86849 TC             86849 TC            819
BMT          7397   30903   *X CORD BLOOD 1-NY                        29,664.00                  1 Z7318            Z7318                   819
BMT          7397   31109   *X CORD BLOOD 2-NY BLOOD CENTER                0.00 S                                                           302



                                                           Page 30 of 676
                                                          CM 06/15/07


 Dept                                                                                                                M/cal
        Cost Ctr.   SIM#                  Description                Price          Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                                HCPCS
BMT          7397   31000   *X CORD BLOOD-PRELIMINARY SEARCH1            0.00   S                                                           302
BMT          7397   31208   *X CORD BLOOD-PRELIMINARY SEARCH2            0.00   S                                                           302
BMT          7397   31059   *X CORD BLOOD-PROCUREMENT 1                  0.00   S                                                           302
BMT          7397   31257   *X CORD BLOOD-PROCUREMENT 2                  0.00   S                                                           302
BMT          7397    1764   *X CY ADDL CHARGE NMDP COURIER           5,617.00                    1   Z7318          Z7318                   819
BMT          7397    1765   *X CY ADDL CHARGE NMDP SHIPPING            756.00                    1   Z7318          Z7318                   819
BMT          7397    1710   *X CY ADDL PRECOLLECTION SAMPLE          1,095.00                    1   Z7318          Z7318                   819
BMT          7397    1768   *X CY AUTO BLOOD UNIT BM (PER UNI          767.00                    1   Z7318          Z7318                   819
BMT          7397    1709   *X CY CONFIRMATORY TYPING                1,095.00                    1   Z7318          Z7318                   819
BMT          7397    1770   *X CY DONOR INFO SESN PBSC/PER SE          602.00                    1   Z7318          Z7318                   819
BMT          7397    1766   *X CY DONOR INFO SESSION BM                613.00                    1   Z7318          Z7318                   819
BMT          7397    1767   *X CY DONOR PHYS EXAM BM/PER EXAM        2,004.00                    1   Z7318          Z7318                   819
BMT          7397    1771   *X CY DONOR PHYS EXAM PBSC/PER EX        1,927.00                    1   Z7318          Z7318                   819
BMT          7397    1708   *X CY EXT PROCURE & TYPING                 449.00                    1   Z7318          Z7318                   819
BMT          7397   60045   *X CY IDM SAMPLE COLL & CENTRAL L        1,314.00                    1    38204             38204               819
BMT          7397   65989   *X CY IDM SAMPLE COLLECTION              1,183.00                    1    38204             38204               819
BMT          7397    1707   *X CY IR-DR TYPING                         372.00                    1   Z7318          Z7318                   819
BMT          7397    1760   *X CY MARROW PROCUREMENT (PER DNR       28,788.00                    1   Z7318          Z7318                   819
BMT          7397    1775   *X CY PHYSICAL EXAM (PER EXAM) UL        1,522.00                    1   Z7318          Z7318                   819
BMT          7397   66017   *X CY PRE-COLL / IDM SAMP COLL CO        1,183.00                    1    38204             38204               819
BMT          7397    1773   *X CY PRIM FIL INJ (PER DNR) PBSC        4,424.00                    1   Z7318          Z7318                   819
BMT          7397    1761   *X CY PRIM PBSC COLLEC PER DNR          28,788.00                    1   Z7318          Z7318                   819
BMT          7397    1762   *X CY SEC PBSC COLLEC PER DNR           28,788.00                    1   Z7318          Z7318                   819
BMT          7397    1763   *X CY UNSTIM LEUKAPHER PER DNR          11,826.00                    1   Z7318          Z7318                   819
BMT          7397    1772   *X CY WORKUP CANCEL (PER DNR) PBS        2,091.00                    1   Z7318          Z7318                   819
BMT          7397    1776   *X CY WORKUP CANCEL (PER DNR) UL         1,347.00                    1   Z7318          Z7318                   819
BMT          7397    1769   *X CY WORKUP CANCEL BM (PER DNR)         2,081.00                    1   Z7318          Z7318                   819
BMT          7397    1748   *X EN EXT PROCURE & TYPING                 756.00                    1   Z7318          Z7318                   819
BMT          7397   65211   *X EN IR-DR TYPING                         482.00                    1   Z7318          Z7318                   819
BMT          7397    1649   *X ENG ADDL PRECOLL SAMPLE               1,489.00                    1   Z7318          Z7318                   819
BMT          7397    1722   *X ENG CONFIRMATORY TYPE SAMPLE          1,489.00                    1   Z7318          Z7318                   819
BMT          7397    1698   *X ENG DONOR PHYSICAL EXAM               3,154.00                    1   Z7318          Z7318                   819
BMT          7397    1623   *X ENG HLA/DR PROC AND TYPE                528.00                    1   Z7318          Z7318                   819
BMT          7397   60048   *X ENG IDM SAMPLE COLL & CENTRAL         1,730.00                    1    38204             38204               819
BMT          7397   65992   *X ENG IDM SAMPLE COLLECTION             1,555.00                    1    38204             38204               819



                                                         Page 31 of 676
                                                           CM 06/15/07


 Dept                                                                                                              M/cal
        Cost Ctr.   SIM#                  Description                 Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                             HCPCS
BMT          7397    1664   *X ENG MARROW PROCURE (PER DONOR)        33,365.00                1    38204             38204               819
BMT          7397   40042   *X ENG NMDP COURIER ADDL CHG              5,048.00                1   Z7318          Z7318                   819
BMT          7397   65230   *X ENG PBSC 2ND COLL PER DONOR           33,365.00                1   Z7318          Z7318                   819
BMT          7397   65229   *X ENG PBSC PRIN COLL PER DONOR          33,365.00                1   Z7318          Z7318                   819
BMT          7397   65232   *X ENG PBSC WORK-UP CANCELLATION          1,183.00                1   Z7318          Z7318                   819
BMT          7397   66020   *X ENG PRE-COLL / IDM SAMP COLL C         1,577.00                1    38204             38204               819
BMT          7397   40043   *X ENG UL NMDP SHIPPNG ADDL CHG             602.00                1   Z7318          Z7318                   819
BMT          7397   40044   *X ENG UL PHYS EXAM PER EXAM              3,154.00                1   Z7318          Z7318                   819
BMT          7397   40045   *X ENG UL WORKUP FEE PER DONOR            1,183.00                1    38204             38204               819
BMT          7397   40041   *X ENG UNSTIM LEUKAPHER PER DNR          12,122.00                1    38204             38204               819
BMT          7397    1714   *X ENG WORKUP FEE (PER DONOR)             1,183.00                1    38204             38204               819
BMT          7397   12703   *X ES HLA/DR PROC AND TYPE                  363.00                1   Z7318          Z7318                   819
BMT          7397    1540   *X FR ADDL PRECOLL SAMPLE                 1,018.00                1   Z7318          Z7318                   819
BMT          7397    1573   *X FR CONFIRMATORY TYPE SAMPLE              909.00                1   Z7318          Z7318                   819
BMT          7397    1599   *X FR EXT PROCURE & TYPING                  679.00                1    38204             38204               819
BMT          7397    1524   *X FR HLA/DR PROC AND TYPE                  429.00                1   Z7318          Z7318                   819
BMT          7397   65887   *X FR HR-A TYPING STANDARD (CORD)           396.00                1    38204             38204               819
BMT          7397   65905   *X FR HR-A TYPING URGENT (CORD)             336.00                1    38204             38204               819
BMT          7397   68686   *X FR HR-A,B,DRB1/IR DRB3,4,5 STA         1,499.00                1    38204             38204               819
BMT          7397   65923   *X FR HR-B TYPING STANDARD (CORD)           396.00                1    38204             38204               819
BMT          7397   65941   *X FR HR-B TYPING URGENT (CORD)             396.00                1    38204             38204               819
BMT          7397   65717   *X FR HR-C TYPING STANDARD (CORD)           396.00                1    38204             38204               819
BMT          7397   65732   *X FR HR-C TYPING URGENT (CORD)             300.00                1    38204             38204               819
BMT          7397   65783   *X FR HR-DQB1 TYPING STANDARD (CO           276.00                1    38204             38204               819
BMT          7397   65801   *X FR HR-DQB1 TYPING URGENT (CORD           240.00                1    38204             38204               819
BMT          7397   60049   *X FR IDM SAMPLE COLL & CENTRAL L         1,369.00                1    38204             38204               819
BMT          7397   65993   *X FR IDM SAMPLE COLLECTION               1,215.00                1    38204             38204               819
BMT          7397   65212   *X FR IR-DR TYPING                          416.00                1   Z7318          Z7318                   819
BMT          7397   65959   *X 170 IR-DRB3,4,5 STANDARD (CORD           144.00                1    38204             38204               819
BMT          7397   65977   *X FR IR-DRB3,4,5 URGENT (CORD)             192.00                1    38204             38204               819
BMT          7397    1565   *X FR MARROW PROCURE (PER DONOR)         26,663.00                1    38204             38204               819
BMT          7397   65981   *X FR MATERNAL IDM                          779.00                1    38204             38204               819
BMT          7397   65480   *X FR PBSC WORK UP CANCELLATION           2,343.00                1   Z7318          Z7318                   819
BMT          7397   66021   *X FR PRE-COLL / IDM SAMP COLL CO         1,215.00                1    38204             38204               819
BMT          7397   65446   *X FR SEC PBSC COLLECTION PER DON        26,663.00                1   Z7318          z7318                   819



                                                          Page 32 of 676
                                                            CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                  Description                  Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                              HCPCS
BMT          7397   40047   *X FR UL NMDP COURIER ADDL CHG             4,938.00                1    38204             38204               819
BMT          7397   65479   *X FR UL NMDP SHIPPNG ADDL CHG               723.00                1   Z7318          Z7318                   819
BMT          7397   40049   *X FR UL PHYS EXAM PER EXAM                    0.00                1   Z7318          Z7318                   819
BMT          7397   40050   *X FR UL WORKUP FEE PER DONOR              2,234.00                1    38204             38204               819
BMT          7397   40046   *X FR UNSTIM LEUKAPHER PER DNR             6,942.00                1    38204             38204               819
BMT          7397   40048   *X FR WB NMDP SHIPPNG ADDL CHG                 0.00                1   Z7318          Z7318                   819
BMT          7397    8040   *X FR WORKUP FEE (PER DONOR)               2,343.00                1    38204             38204               819
BMT          7397   40052   *X GE 2ND PBSC COLLECT PER DNR            25,733.00                1    38204             38204               819
BMT          7397   12100   *X GE ADDL PRECOLL SAMPLE                    712.00                1    38204             38204               819
BMT          7397   12112   *X GE AUTOLOGOUS BLOOD UNIT                  307.00                1    38204             38204               390
BMT          7397   12103   *X GE CONFIRMATORY TYPE SAMPLE               712.00                1    38204             38204               819
BMT          7397   66045   *X GE D IR DRB3,4,5 TYPING STD               372.00                1    38204             38204               819
BMT          7397   12110   *X GE DONOR INFO SESSION                       0.00                1   Z7318          Z7318                   819
BMT          7397   12111   *X GE DONOR PHYSICAL EXAM                  2,102.00                1    38204             38204               819
BMT          7397   12102   *X GE HLA/DR PROC AND TYPE                   198.00                1   Z7318          Z7318                   819
BMT          7397   65482   *X GE HR-A TYPING STD                        537.00                1   Z7318          Z7318                   819
BMT          7397   65483   *X GE HR-B TYPING STD                        504.00                1    38204             38204               819
BMT          7397   65484   *X GE HR-C TYPING STD                        482.00                1    38204             38204               819
BMT          7397   65486   *X GE HR-DQB1 TYPING STD                     416.00                1   Z7318          Z7318                   819
BMT          7397   65485   *X GE HR-DRB1 TYPING STD                     471.00                1   Z7318          Z7318                   819
BMT          7397   60050   *X GE IDM SAMPLE COLL & CENTRAL L          1,259.00                1    38204             38204               819
BMT          7397   65994   *X GE IDM SAMPLE COLLECTION                  810.00                1    38204             38204               819
BMT          7397   12104   *X GE INFECTIOUS DISEASE TESTS               230.00                1    38204             38204               819
BMT          7397   65487   *X GE IR-ABC TYPING STD                      734.00                1    38204             38204               819
BMT          7397   65213   *X GE IR-DR TYPING                           296.00                1    38204             38204               819
BMT          7397   12101   *X GE MARROW PROCURE (PER DONOR)          25,733.00                1    38204             38204               819
BMT          7397   65481   *X GE PBSC FILGRASTIM INJECTION            2,957.00                1    38204             38204               819
BMT          7397   40058   *X GE PBSC INFO SESSION PR DNR                 0.00                1   Z7318          Z7318                   819
BMT          7397   40059   *X GE PBSC PHYS EXAM PER EXAM              2,102.00                1    38204             38204               819
BMT          7397   40060   *X GE PBSC WORKUP FEE PER DNR              1,697.00                1    38204             38204               819
BMT          7397   66022   *X GE PRE-COLL / IDM SAMP COLL CO            876.00                1    38204             38204               819
BMT          7397   40051   *X GE PRIM PBSC COLLEC PER DNR            25,733.00                1    38204             38204               819
BMT          7397   40054   *X GE UL NMDP COURIER ADDL CHG             5,398.00                1    38204             38204               819
BMT          7397   40055   *X GE UL NMDP SHIPPNG ADDL CHG               602.00                1    38204             38204               819
BMT          7397   40061   *X GE UL PHYS EXAM PER EXAM                1,205.00                1    38204             38204               819



                                                           Page 33 of 676
                                                          CM 06/15/07


 Dept                                                                                                          M/cal
        Cost Ctr.   SIM#                  Description                Price      Stats/bill       CPT     Mod             Mod   Rev Code
 Code                                                                                                          HCPCS
BMT          7397   40062   *X GE UL WORKUP FEE PER DONOR              756.00                1   38204           38204               819
BMT          7397   40053   *X GE UNSTIM LEUKAPHER PER DNR           5,858.00                1   38204           38204               819
BMT          7397   40057   *X GE WB NMDP SHIPPNG ADDL CHG             602.00                1   38204           38204               819
BMT          7397   40056   *X GE WHL BLD UNIT COL PER DNR           3,296.00                1   38204           38204               819
BMT          7397   12114   *X GE WORKUP FEE (PER DONOR)             1,697.00                1   38204           38204               819
BMT          7397   65622   *X GE-D ADDL NMDP COURIER CHARGE,        4,161.00                1   38204           38204               819
BMT          7397   65623   *X GE-D ADDL NMDP COURIER SHIPPIN          602.00                1   38204           38204               819
BMT          7397   65591   *X GE-D ADDL PRECOLLECTION SAMPLE          350.00                1   38204           38204               819
BMT          7397   65590   *X GE-D CONFIRMATORY TYPING                350.00                1   38204           38204               819
BMT          7397   65593   *X GE-D HR-A TYPING, STD                   405.00                1   38204           38204               819
BMT          7397   65594   *X GE-D HR-B TYPING, STD                   405.00                1   38204           38204               819
BMT          7397   65595   *X GE-D HR-C TYPING, STD                   405.00                1   38204           38204               819
BMT          7397   65597   *X GE-D HR-DQB1 TYPING, STD                372.00                1   38204           38204               819
BMT          7397   65596   *X GE-D HR-DRB1 TYPING, STD                372.00                1   38204           38204               819
BMT          7397   60051   *X GE-D IDM SAMPLE COLL & CENTRAL          843.00                1   38204           38204               819
BMT          7397   65995   *X GE-D IDM SAMPLE COLLECTION              383.00                1   38204           38204               819
BMT          7397   65592   *X GE-D INFECTIOUS DISEASE                 219.00                1   38204           38204               819
BMT          7397   65598   *X GE-D IR-ABC TYPING, STD                 350.00                1   38204           38204               819
BMT          7397   65589   *X GE-D IR-DR TYPING                       318.00                1   38204           38204               819
BMT          7397   65629   *X GE-D MARROW AUTOLOGOUS BLOOD U          624.00                1   38204           38204               819
BMT          7397   65627   *X GE-D MARROW DONOR INFO SESSION          493.00                1   38204           38204               819
BMT          7397   65628   *X GE-D MARROW DONOR PHYSICAL EXA        1,533.00                1   38204           38204               819
BMT          7397   65619   *X GE-D MARROW PROCUREMENT              25,886.00                1   38204           38204               819
BMT          7397   65630   *X GE-D MARROW WORKUP CANCELLATIO        1,664.00                1   38204           38204               819
BMT          7397   65631   *X GE-D PBSC DONOR INFO SESSION            482.00                1   38204           38204               819
BMT          7397   65632   *X GE-D PBSC DONOR PHYSICAL EXAM         1,500.00                1   38204           38204               819
BMT          7397   65634   *X GE-D PBSC FILGRASTIM INJECTION        4,260.00                1   38204           38204               819
BMT          7397   65633   *X GE-D PBSC WORKUP CANCELLATION         1,697.00                1   38204           38204               819
BMT          7397   66023   *X GE-D PRE-COLL / IDM SAMP COLL           383.00                1   38204           38204               819
BMT          7397   65620   *X GE-D PRIMARY PBSC COLLECTION         26,532.00                1   38204           38204               819
BMT          7397   65621   *X GE-D SECONDARY PBSC COLLECTION       26,532.00                1   38204           38204               819
BMT          7397   65635   *X GE-D UL PHYSICAL EXAM                 1,172.00                1   38204           38204               819
BMT          7397   65636   *X GE-D UL WORKUP CANCELLATION             964.00                1   38204           38204               819
BMT          7397   65624   *X GE-D UNSTIMULATED LEUKAPHERESI        8,738.00                1   38204           38204               819
BMT          7397   65626   *X GE-D WHOLE BLOOD UNIT ADDL CHA          602.00                1   38204           38204               819



                                                         Page 34 of 676
                                                                CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                   Description                    Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                                 HCPCS
BMT          7397   65625   *X GE-D WHOLE BLOOD UNIT COLLECTI             3,022.00                1    38204             38204               819
BMT          7397   65244   *X GE-Z 2ND FILGRASTIM INJECTION              3,307.00                1   Z7318          Z7318                   819
BMT          7397   65237   *X GE-Z 2ND PBSC COLLECTION                  27,222.00                1    38204             38204               819
BMT          7397   20002   *X GE-Z ADDL PRECOLL SAMPLE                     898.00                1    38204             38204               819
BMT          7397   20001   *X GE-Z CONFIRMATORY TYPE SAMPLE                898.00                1    38204             38204               819
BMT          7397   65587   *X GE-Z CORD BLOOD SHIPMENT                  30,583.00                1   Z7318          Z7318                   819
BMT          7397   65588   *X GE-Z CORD BLOOD SHIPPING COST              2,792.00                1   Z7318          Z7318                   819
BMT          7397   65235   *X GE-Z EXT PROCURE & TYPING                    460.00                1    38204             38204               819
BMT          7397   65243   *X GE-Z FILGRASTIM INJECTION                  3,307.00                1    38204             38204               819
BMT          7397   20000   *X GE-Z HLA/DR PROC AND TYPE                    303.00                1   Z7318          Z7318                   819
BMT          7397   65888   *X GE-Z HR-A TYPING STANDARD (COR               427.00                1    38204             38204               819
BMT          7397   65503   *X GE-Z HR-A TYPING STD CORD                    303.00                1   Z7318          Z7318                   819
BMT          7397   65504   *X GE-Z HR-A TYPING URG CORD                    369.00                1   Z7318          Z7318                   819
BMT          7397   65906   *X GE-Z HR-A TYPING URGENT (CORD)               482.00                1    38204             38204               819
BMT          7397   65703   *X GE-Z HR-A,B,DRB1/IR DRB3,4,5 U             2,194.00                1    38204             38204               819
BMT          7397   65924   *X GE-Z HR-B TYPING STANDARD (COR               438.00                1    38204             38204               819
BMT          7397   65505   *X GE-Z HR-B TYPING STD CORD                    312.00                1   Z7318          Z7318                   819
BMT          7397   65507   *X GE-Z IR-DRB3,4,5 STD                         158.00                1   Z7318          Z7318                   819
BMT          7397   65942   *X GE-Z HR-B TYPING URGENT (CORD)               526.00                1    38204             38204               819
BMT          7397   65718   *X GE-Z HR-C TYPING STANDARD (COR               394.00                1    38204             38204               819
BMT          7397   65493   *X GE-Z HR-C TYPING STD                           0.00                1   Z7318          z7318                   819
BMT          7397   65494   *X GE-Z HR-C TYPING URG                         330.00                1   Z7318          z7318                   819
BMT          7397   65733   *X GE-Z HR-C TYPING URGENT (CORD)               449.00                1    38204             38204               819
BMT          7397   65853   *X GE-Z HR-DPB1 TYPING STANDARD (               383.00                1    38204             38204               819
BMT          7397   65501   *X GE-Z HR-DPB1 TYPING STD                      264.00                1   Z7318          Z7318                   819
BMT          7397   65502   *X GE-Z HR-DPB1 TYPING URG                      317.00                1   Z7318          Z7318                   819
BMT          7397   65870   *X GE-Z HR-DPB1 TYPING URGENT (CO               449.00                1    38204             38204               819
BMT          7397   65784   *X GE-Z HR-DQB1 TYPING STANDARD (               329.00                1    38204             38204               819
BMT          7397   65497   *X GE-Z HR-DQB1 TYPING STD                      185.00                1   Z7318          Z7318                   819
BMT          7397   65498   *X GE-Z HR-DQB1 TYPING URG                      264.00                1   Z7318          Z7318                   819
BMT          7397   65802   *X GE-Z HR-DQB1 TYPING URGENT (CO               394.00                1    38204             38204               819
BMT          7397   65491   *X GE-Z HR-Z,B,DRB1/IR DRB3,4,5 S             2,123.00                1    38204             38204               819
BMT          7397   65492   *X GE-Z HR-Z,B,DRB1/IR DRB3,4,5 U             2,374.00                1    38204             38204               819
BMT          7397   60052   *X GE-Z IDM SAMPLE COLL & CENTRAL             1,675.00                1    38204             38204               819
BMT          7397   65996   *X GE-Z IDM SAMPLE COLLECTION                 1,194.00                1    38204             38204               819



                                                            Page 35 of 676
                                                           CM 06/15/07


 Dept                                                                                                              M/cal
        Cost Ctr.   SIM#                  Description                 Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                             HCPCS
BMT          7397   20003   *X GE-Z INFECTIOUS DISEASE TESTS            219.00                1   Z7318          Z7318                   819
BMT          7397   65489   *X GE-Z IR-A,B,DRB3,4,5/HR-DRB1,          1,499.00                1   Z7318          Z7318                   819
BMT          7397   65490   *X GE-Z IR-A,B,DRB3,4,5/HR-DRB1,          1,775.00                1    38204             38204               819
BMT          7397   65495   *X GE-Z IR-C TYPING STD                     158.00                1   Z7318          Z7318                   819
BMT          7397   65496   *X GE-Z IR-C TYPING URG                     198.00                1    99199         Z7318                   819
BMT          7397   65766   *X GE-Z IR-C TYPING URGENT (CORD)           329.00                1    38204             38204               819
BMT          7397   65819   *X GE-Z IR-DQB1 TYPING STANDARD (           144.00                1    38204             38204               819
BMT          7397   65499   *X GE-Z IR-DQB1 TYPING STD                    0.00                1   Z7318          Z7318                   819
BMT          7397   65500   *X GE-Z IR-DQB1 TYPING URG                  198.00                1   Z7318          Z7318                   819
BMT          7397   65836   *X GE-Z IR-DQB1 TYPING URGENT (CO           180.00                1    38204             38204               819
BMT          7397   65214   *X GE-Z IR-DR TYPING                        339.00                1    38204             38204               819
BMT          7397   65960   *X FR IR-DRB3,4,5 STANDARD (CORD)           263.00                1    38204             38204               819
BMT          7397   65508   *X GE-Z IR-DRB3,4,5 URG                     198.00                1   Z7318          Z7318                   819
BMT          7397   65978   *X GE-Z IR-DRB3,4,5 URGENT (CORD)           285.00                1    38204             38204               819
BMT          7397   65982   *X GE-Z MATERNAL IDM                      1,007.00                1    38204             38204               819
BMT          7397   65242   *X GE-Z PBSC WORK-UP                      2,617.00                1    38204             38204               819
BMT          7397   66024   *X GE-Z PRE-COLL / IDM SAMP COLL          1,194.00                1    38204             38204               819
BMT          7397   65236   *X GE-Z PRIMARY PBSC COLLECTION          27,222.00                1    38204             38204               819
BMT          7397   65239   *X GE-Z UL NMDP COURIER                   5,398.00                1    38204             38204               819
BMT          7397   65240   *X GE-Z UL NMDP SHIPPING                    602.00                1    38204             38204               819
BMT          7397   65241   *X GE-Z UL WORK-UP CANCELLATION           1,774.00                1    38204             38204               819
BMT          7397   65233   *X GE-Z WB COLLECTION                     2,004.00                1    38204             38204               819
BMT          7397   65234   *X GE-Z WB SHIPPING                         602.00                1    38204             38204               819
BMT          7397   20005   *X GE-Z WORKUP FEE (PER DONOR)            2,617.00                1    38204             38204               819
BMT          7397   65506   *X GE-Z HR-B TYPING URG CORD                422.00                1   Z7318          Z7318                   819
BMT          7397   65550   *X GO 2ND PBSC COLLECT PER DNR           39,705.00                1   Z7318          Z7318                   819
BMT          7397   65546   *X GO ADDL PRECOLL SAMPLE                   690.00                1   Z7318          Z7318                   819
BMT          7397   65553   *X GO AUTOLOGOUS BLOOD UNIT (M)             460.00                1   Z7318          Z7318                   819
BMT          7397   65543   *X GO CONFIRMATORY SAMPLE STA               690.00                1   Z7318          Z7318                   819
BMT          7397   65551   *X GO DONOR INFO SESSION (M)              1,226.00                1   Z7318          Z7318                   819
BMT          7397   65552   *X GO DONOR PHYS EXAM (M)                 2,573.00                1   Z7318          Z7318                   819
BMT          7397   60069   *X GO EXTENDED DR PROCUREMENT AND           602.00                1    38204             38204               819
BMT          7397   65544   *X GO FORMAL SEARCH                         460.00                1   Z7318          Z7318                   819
BMT          7397   65997   *X GO IDM SAMPLE COLLECTION                   0.00                1    38204             38204               819
BMT          7397   65547   *X GO INFECTIOUS DISEASE TESTS              416.00                1   Z7318          Z7318                   819



                                                          Page 36 of 676
                                                           CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                  Description                 Price      Stats/bill        CPT      Mod                Mod   Rev Code
 Code                                                                                                              HCPCS
BMT          7397   65545   *X GO IR-DR TYPING                          405.00                1   Z7318           Z7318                    819
BMT          7397   65548   *X GO MARROW PROCUREMENT                 39,705.00                1   Z7318           Z7318                    819
BMT          7397   65555   *X GO PBSC DNR INFO SESSION               1,226.00                1   Z7318           Z7318                    819
BMT          7397   65556   *X GO PBSC DNR PHYS EXAM                  2,573.00                1   Z7318           Z7318                    819
BMT          7397   65558   *X GO PBSC FILGRAS INJ                    5,081.00                1   Z7318           Z7318                    819
BMT          7397   65557   *X GO PBSC WORKUP CANCELLATION            2,595.00                1   Z7318           Z7318                    819
BMT          7397   66025   *X GO PRE-COLL / IDM SAMP COLL CO             0.00                1    38204              38204                819
BMT          7397   65549   *X GO PRIM PBSC COLLECT PER DNR          39,705.00                1   Z7318           Z7318                    819
BMT          7397   65554   *X GO WORKUP CANCELLATION (M)             2,595.00                1   Z7318           Z7318                    819
BMT          7397   65687   *X GZ HR-A,B,DRB1/IR DRB3,4,5 STA         1,966.00                1    38204              38204                819
BMT          7397   30200   *X HIGH RESOLUTION DNA                      619.00                1    86225   TC         86225   TC           819
BMT          7397   30309   *X HIGH RESOLUTION DR ONLY                  321.00                1    86225   TC         86225   TC           819
BMT          7397   30754   *X HIGH RESOLUTION DR,DQ,DB                 536.00                1    86225   TC         86225   TC           819
BMT          7397   30259   *X HIGH RESOLUTION DR/DQ ONLY               412.00                1    86225   TC         86225   TC           819
BMT          7397   65250   *X HUG ADD'L/PREOLLECTION SAMPLE          1,029.00                1   Z7318           Z7318                    819
BMT          7397   65249   *X HUG CONFIRM TYPING PER SAMPLE          1,029.00                1   Z7318           Z7318                    819
BMT          7397   65447   *X HUG DONOR INFO SESSION (M)               449.00                1   Z7318           Z7318                    819
BMT          7397   65248   *X HUG EXT DR PROCUREMENT & TYPIN           624.00                1   Z7318           Z7318                    819
BMT          7397   60053   *X HUG IDM SAMPLE COLL & CENTRAL          1,413.00                1    38204              38204                819
BMT          7397   65998   *X HUG IDM SAMPLE COLLECTION              1,226.00                1    38204              38204                819
BMT          7397   65215   *X HUG IR-DR TYPING                         460.00                1   Z7318           Z7318                    819
BMT          7397   65261   *X HUG MARROW AUTO BLOOD PER UNIT           350.00                1   Z7318           Z7318                    819
BMT          7397   65260   *X HUG MARROW DNR PHY EXAM                1,456.00                1   Z7318           Z7318                    819
BMT          7397   65262   *X HUG MARROW DNR WORK-UP CANCEL          1,478.00                1   Z7318           Z7318                    819
BMT          7397   65267   *X HUG PBSC 2ND FILGRASTIM/DNR            2,803.00                1   Z7318           Z7318                    819
BMT          7397   65253   *X HUG PBSC 2NDCOLLECTION PER DON        20,367.00                1    38204              38204                819
BMT          7397   65252   *X HUG PBSC COLLECTION PER DONOR         23,751.00                1   Z7318           Z7318                    819
BMT          7397   65263   *X HUG PBSC DNR INFOR SESSION               339.00                1    38204              38204                819
BMT          7397   65264   *X HUG PBSC DNR PHYSICAL EXAM             1,347.00                1    38204              38204                819
BMT          7397   65265   *X HUG PBSC DNR WORK-UP CANCEL            1,369.00                1    38204              38204                819
BMT          7397   65266   *X HUG PBSC FILGRASTIM INJ PER DN         2,803.00                1   Z7318           Z7318                    819
BMT          7397   66026   *X HUG PRE-COLL / IDM SAMP COLL C         1,226.00                1    38204              38204                819
BMT          7397   65254   *X HUG UL LEUKAPHERESIS PER DONOR         6,044.00                1   Z7318           Z7318                    819
BMT          7397   65255   *X HUG UL NMDP COURIER                    7,413.00                1    38204              38204                819
BMT          7397   65256   *X HUG UL NMDP SHIPPING                     756.00                1    38204              38204                819



                                                          Page 37 of 676
                                                           CM 06/15/07


 Dept                                                                                                              M/cal
        Cost Ctr.   SIM#                  Description                 Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                             HCPCS
BMT          7397   65268   *X HUG UL PHYSICAL EXAM                   1,007.00                1   Z7318          Z7318                   819
BMT          7397   65269   *X HUG UL WORK-UP CANCEL PER DNR            646.00                1    38204             38204               819
BMT          7397   65257   *X HUG WHOLE BLOOD COLL PER DONOR         1,741.00                1    38204             38204               819
BMT          7397   65258   *X HUG WHOLE BLOOD NMDP SHIPPING            756.00                1    38204             38204               819
BMT          7397   40072   *X IL 2ND FILGRAS INJ PER DNR                 0.00                1   Z7318          Z7318                   819
BMT          7397   40064   *X IL 2ND PBSC COLLECT PER DNR                0.00                1   Z7318          Z7318                   819
BMT          7397   66048   *X IL ACTIVATION FEE                        460.00                1    38204             38204               819
BMT          7397    1342   *X IL ADDL PRECOLL SAMPLE                   777.00                1    38204             38204               819
BMT          7397    6036   *X IL AUTOLOGOUS BLOOD UNIT                   0.00                1    38204             38204               390
BMT          7397    1375   *X IL CONFIRMATORY TYPE SAMPLE              777.00                1    38204             38204               819
BMT          7397    6010   *X IL DONOR INFO SESSION                      0.00                1   Z7318          Z7318                   819
BMT          7397    6028   *X IL DONOR PHYSICAL EXAM                     0.00                1    38204             38204               819
BMT          7397   65270   *X IL EXT DR PROCUREMENT & TYPING           569.00                1   Z7318          Z7318                   819
BMT          7397    1326   *X IL HLA/DR PROC AND TYPE                  528.00                1   Z7318          Z7318                   819
BMT          7397   60054   *X IL IDM SAMPLE COLL & CENTRAL L         1,314.00                1    38204             38204               819
BMT          7397   65999   *X IL IDM SAMPLE COLLECTION               1,161.00                1    38204             38204               819
BMT          7397    1383   *X IL INFECTIOUS DISEASE TESTS                0.00                1    38204             38204               819
BMT          7397   65216   *X IL IR-DR TYPING                          679.00                1   Z7318          Z7318                   819
BMT          7397    1367   *X IL MARROW PROCURE (PER DONOR)         23,816.00                1    38204             38204               819
BMT          7397   40068   *X IL PBSC INFO SESSION PR DNR                0.00                1   Z7318          Z7318                   819
BMT          7397   40069   *X IL PBSC PHYS EXAM PER EXAM                 0.00                1   Z7318          Z7318                   819
BMT          7397   40070   *X IL PBSC WORKUP FEE PER DNR                 0.00                1    38204             38204               819
BMT          7397   66027   *X IL PRE-COLL / IDM SAMP COLL CO         1,161.00                1    38204             38204               819
BMT          7397   40071   *X IL PRIM FILGRAS INJ PER DNR                0.00                1   Z7318          Z7318                   819
BMT          7397   40063   *X IL PRIM PBSC COLLEC PER DNR                0.00                1   Z7318          Z7318                   819
BMT          7397   40066   *X IL UL NMDP COURIER ADDL CHG            5,048.00                1    38204             38204               819
BMT          7397   40067   *X IL UL NMDP SHIPPNG ADDL CHG              602.00                1    38204             38204               819
BMT          7397   40073   *X IL UL PHYS EXAM PER EXAM                   0.00                1   Z7318          Z7318                   819
BMT          7397   40074   *X IL UL WORKUP FEE PER DONOR             1,445.00                1    38204             38204               819
BMT          7397   40065   *X IL UNSTIM LEUKAPHER PER DNR            5,059.00                1    38204             38204               819
BMT          7397    6044   *X IL WORKUP FEE (PER DONOR)              1,445.00                1    38204             38204               819
BMT          7397   30358   *X INFECTIOUS PANEL                       1,411.00                1    38204             38204               819
BMT          7397   13500   *X IR ADDL PRECOLL SAMPLE                   482.00                1    38204             38204               819
BMT          7397   13507   *X IR AUTOLOGOUS BLOOD UNIT                   0.00                1    38204             38204               390
BMT          7397   13504   *X IR CONFIRMATORY TYPE SAMPLE              482.00                1    38204             38204               819



                                                          Page 38 of 676
                                                             CM 06/15/07


 Dept                                                                                                                M/cal
        Cost Ctr.   SIM#                   Description                  Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                               HCPCS
BMT          7397   13505   *X IR DONOR INFO SESSION                      723.00                1    38204             38204               819
BMT          7397   13506   *X IR DONOR PHYSICAL EXAM                     898.00                1    38204             38204               819
BMT          7397   13503   *X IR EXT DR PROCURE & TYPING                   0.00                1    38204             38204               819
BMT          7397   13502   *X IR HLA/DR PROC AND TYPE                    462.00                1   Z7318          Z7318                   819
BMT          7397   60055   *X IR IDM SAMPLE COLL & CENTRAL L             810.00                1    38204             38204               819
BMT          7397   66000   *X IR IDM SAMPLE COLLECTION                   679.00                1    38204             38204               819
BMT          7397   65488   *X IR INFECTIOUS DISEASE TEST               1,007.00                1   Z7318          Z7318                   819
BMT          7397   65217   *X IR IR-DR TYPING                            438.00                1    38204             38204               819
BMT          7397   13501   *X IR MARROW PROCURE (PER DONOR)           29,379.00                1    38204             38204               819
BMT          7397   65272   *X IR PBSC 2ND COLLECTION PER DNR          36,332.00                1    38204             38204               819
BMT          7397   65271   *X IR PBSC COLLECTION PER DNR              36,332.00                1    38204             38204               819
BMT          7397   65275   *X IR PBSC DNR WORK-UP CANCEL                   0.00                1   Z7318          Z7318                   819
BMT          7397   65274   *X IR PBSC DONOR PHYSICAL EXAM                898.00                1    38204             38204               819
BMT          7397   65277   *X IR PBSC FILGRAS #2 INJ PER DNR           2,102.00                1   Z7318          Z7318                   819
BMT          7397   65276   *X IR PBSC FILGRASTIM INJ PER DNR           2,102.00                1   Z7318          Z7318                   819
BMT          7397   66028   *X IR PRE-COLL / IDM SAMP COLL CO             679.00                1    38204             38204               819
BMT          7397   40076   *X IR UL NMDP COURIER ADDL CHG                  0.00                1   Z7318          Z7318                   819
BMT          7397   40077   *X IR UL NMDP SHIPPNG ADDL CHG                  0.00                1   Z7318          Z7318                   819
BMT          7397   40078   *X IR UL PHYS EXAM PER EXAM                     0.00                1   Z7318          Z7318                   819
BMT          7397   40079   *X IR UL WORKUP FEE PER DONOR                   0.00                1    38204             38204               819
BMT          7397   40075   *X IR UNSTIM LEUKAPHER PER DNR                  0.00                1   Z7318          Z7318                   819
BMT          7397   13508   *X IR WORKUP FEE (PER DONOR)                    0.00                1   Z7318          Z7318                   819
BMT          7397   12408   *X IT ACTIVATION FEE                          427.00                1   Z7318          Z7318                   819
BMT          7397   12407   *X IT ADDL PRECOLL SAMPLE                   2,091.00                1    38204             38204               819
BMT          7397   12416   *X IT AUTOLOGOUS BLOOD UNIT                     0.00                1    38204             38204               390
BMT          7397   12412   *X IT CONFIRMATORY TYPE SAMPLE              2,091.00                1    38204             38204               819
BMT          7397   12414   *X IT DONOR INFO SESSION                        0.00                1    38204             38204               819
BMT          7397   12415   *X IT DONOR PHYSICAL EXAM                   1,117.00                1    38204             38204               819
BMT          7397   12411   *X IT EXT DR PROCURE & TYPING                 591.00                1    38204             38204               819
BMT          7397   60086   *X IT FILGRASTIM INJECTION                    920.00                1    38204             38204               819
BMT          7397   12410   *X IT HLA/DR PROC AND TYPE                    429.00                1   Z7318          Z7318                   819
BMT          7397   60056   *X IT IDM SAMPLE COLL & CENTRAL L           2,464.00                1    38204             38204               819
BMT          7397   66001   *X IT IDM SAMPLE COLLECTION                 2,365.00                1    38204             38204               819
BMT          7397   65218   *X IT IR-DR TYPING                            427.00                1   Z7318          Z7318                   819
BMT          7397   12409   *X IT MARROW PROCURE (PER DONOR)           26,302.00                1    38204             38204               819



                                                            Page 39 of 676
                                                            CM 06/15/07


 Dept                                                                                                             M/cal
        Cost Ctr.   SIM#                  Description                  Price      Stats/bill        CPT   Mod              Mod   Rev Code
 Code                                                                                                            HCPCS
BMT          7397   66029   *X IT PRE-COLL / IDM SAMP COLL CO          2,365.00                1    38204           38204              819
BMT          7397   60083   *X IT PRIMARY PBSC COLLECTION             31,777.00                1    38204           38204              819
BMT          7397   60084   *X IT SECONDARY PBSC COLLECTION           31,777.00                1    38204           38204              819
BMT          7397   40081   *X IT UL NMDP COURIER ADDL CHG             5,048.00                1    38204           38204              819
BMT          7397   40082   *X IT UL NMDP SHIPPNG ADDL CHG               723.00                1    38204           38204              819
BMT          7397   40085   *X IT UL PHYS EXAM PER EXAM                1,117.00                1    38204           38204              819
BMT          7397   40086   *X IT UL WRKUP CANCEL FEE PER DNR          1,128.00                1    38204           38204              819
BMT          7397   40080   *X IT UNSTIM LEUKAPHER PER DNR             3,504.00                1    38204           38204              819
BMT          7397   40084   *X IT WB NMDP SHIPPNG ADDL CHG                 0.00                1   Z7318        Z7318                  819
BMT          7397   40083   *X IT WHL BLD UNIT COL PER DNR                 0.00                1   Z7318        Z7318                  819
BMT          7397   12417   *X IT WORKUP FEE (PER DONOR)               1,128.00                1    38204           38204              819
BMT          7397   12224   *X JP ACTIVATION FEE                       1,270.00                1   Z7318        Z7318                  819
BMT          7397   12281   *X JP ADDL PRECOLL SAMPLE                    657.00                1    38204           38204              819
BMT          7397   12380   *X JP AUTOLOGOUS BLOOD UNIT                  274.00                1    38204           38204              390
BMT          7397   12265   *X JP CONFIRMATORY TYPE SAMPLE               657.00                1    38204           38204              819
BMT          7397   12349   *X JP DONOR INFO SESSION                   1,500.00                1    38204           38204              819
BMT          7397   12364   *X JP DONOR PHYSICAL EXAM                  1,424.00                1    38204           38204              819
BMT          7397   60057   *X JP IDM SAMPLE COLL & CENTRAL L          1,664.00                1    38204           38204              819
BMT          7397   66002   *X JP IDM SAMPLE COLLECTION                1,434.00                1    38204           38204              819
BMT          7397   12323   *X JP MARROW PROCURE (PER DONOR)          31,328.00                1    38204           38204              819
BMT          7397   66030   *X JP PRE-COLL / IDM SAMP COLL CO          1,434.00                1    38204           38204              819
BMT          7397   40088   *X JP UL NMDP COURIER ADDL CHG             5,617.00                1    38204           38204              819
BMT          7397   40089   *X JP UL NMDP SHIPPNG ADDL CHG               756.00                1    38204           38204              819
BMT          7397   65517   *X JP UL PHYSICAL EXAM                     1,424.00                1   Z7318        Z7318                  819
BMT          7397   40087   *X JP UNSTIM LEUKAPHER PER DNR             4,884.00                1    38204           38204              819
BMT          7397   40091   *X JP WB NMDP SHIPPNG ADDL CHG               756.00                1    38204           38204              819
BMT          7397   40090   *X JP WHL BLD UNIT COL PER DNR             2,409.00                1    38204           38204              819
BMT          7397   12406   *X JP WORKUP FEE (PER DONOR)                   0.00                1    38204           38204              819
BMT          7397   30150   *X LOW RESOLUTION DNA                        371.00                1    86225 TC        86225 TC           819
BMT          7397   30705   *X LOW RESOLUTION DNA                        371.00                1    86225 ZS        86225 ZS           819
BMT          7397   30580   *X MARROW HARVEST                         36,271.00                1    38230           38230              819
BMT          7397    1243   *X NE ADDL PRECOLL SAMPLE                    537.00                1    38204           38204              819
BMT          7397   10038   *X NE AUTOLOGOUS BLOOD UNIT                  602.00                1    38204           38204              390
BMT          7397    1276   *X NE CONFIRMATORY TYPE SAMPLE               537.00                1    38204           38204              819
BMT          7397   10012   *X NE DONOR INFO SESSION                     482.00                1    38204           38204              819



                                                           Page 40 of 676
                                                            CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                  Description                  Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                              HCPCS
BMT          7397   10020   *X NE DONOR PHYSICAL EXAM                    821.00                1    38204             38204               819
BMT          7397    1227   *X NE HLA/DR PROC AND TYPE                   330.00                1   Z7318          Z7318                   819
BMT          7397   65509   *X NE HR-A TYPING STD                        493.00                1   Z7318          Z7318                   819
BMT          7397   65510   *X NE HR-B TYPING STD                        493.00                1   Z7318          Z7318                   819
BMT          7397   65511   *X NE HR-C TYPING STD                        493.00                1   Z7318          Z7318                   819
BMT          7397   65513   *X NE HR-DQB1 TYPING STD                     449.00                1    38204             38204               819
BMT          7397   65512   *X NE HR-DRB1 TYPING STD                     471.00                1   Z7318          Z7318                   819
BMT          7397   60058   *X NE IDM SAMPLE COLL & CENTRAL L          1,117.00                1    38204             38204               819
BMT          7397   66003   *X NE IDM SAMPLE COLLECTION                  953.00                1    38204             38204               819
BMT          7397    1284   *X NE INFECTIOUS DISEASE TESTS               307.00                1    38204             38204               819
BMT          7397   66046   *X NE IR DRB3,4,5 TYPING STD                 471.00                1    38204             38204               819
BMT          7397   65514   *X NE IR-ABC TYPING STD                      427.00                1    38204             38204               819
BMT          7397   65219   *X NE IR-DR TYPING                           449.00                1    38204             38204               819
BMT          7397   65278   *X NE LEUKAPHERESIS PER DONOR              7,282.00                1    38204             38204               819
BMT          7397    1268   *X NE MARROW PROCURE (PER DONOR)          29,050.00                1    38204             38204               819
BMT          7397   66031   *X NE PRE-COLL / IDM SAMP COLL CO            953.00                1    38204             38204               819
BMT          7397   60085   *X NE PRIMARY PBSC COLLECTION             29,050.00                1    38204             38204               819
BMT          7397   65279   *X NE UL NMDP COURIER                      5,847.00                1    38204             38204               819
BMT          7397   65280   *X NE UL NMDP SHIPPING                       602.00                1    38204             38204               819
BMT          7397   65281   *X NE UL PHYSICAL EXAM                       821.00                1    38204             38204               819
BMT          7397   65282   *X NE UL WORK-UP CANCELLATION              3,734.00                1    38204             38204               819
BMT          7397   65516   *X NE WHOLE BLOOD UNIT FOR SHIPPN            602.00                1   Z7318          Z7318                   819
BMT          7397   65515   *X NE WHOLE BLOOD UNIT PER DNR             5,092.00                1   Z7318          Z7318                   819
BMT          7397   10046   *X NE WORKUP FEE (PER DONOR)               3,734.00                1    38204             38204               819
BMT          7397   30853   *X NMDP ACTIVATION FEE (REGIS.)              989.00                1   Z7318          Z7318                   819
BMT          7397   12562   *X NO ADDL PRECOLL SAMPLE                    876.00                1    38204             38204               819
BMT          7397   12661   *X NO AUTOLOGOUS BLOOD UNIT                    0.00                1    38204             38204               390
BMT          7397   12547   *X NO CONFIRMATORY TYPE SAMPLE               876.00                1    38204             38204               819
BMT          7397   12620   *X NO DONOR INFO SESSION                   1,018.00                1    38204             38204               819
BMT          7397   12646   *X NO DONOR PHYSICAL EXAM                      0.00                1    38204             38204               819
BMT          7397   12505   *X NO HLA/DR PROC AND TYPE                   693.00                1   Z7318          Z7318                   819
BMT          7397   65518   *X NO HR-A TYPING STD                        767.00                1   Z7318          Z7318                   819
BMT          7397   65519   *X NO HR-B TYPING STD                        767.00                1   Z7318          Z7318                   819
BMT          7397   65520   *X NO HR-C TYPING STD                        767.00                1   Z7318          Z7318                   819
BMT          7397   65522   *X NO HR-DQB1 TYPING STD                     767.00                1   Z7318          Z7318                   819



                                                           Page 41 of 676
                                                           CM 06/15/07


 Dept                                                                                                              M/cal
        Cost Ctr.   SIM#                  Description                 Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                             HCPCS
BMT          7397   65521   *X NO HR-DRB1 TYPING STD                    767.00                1   Z7318          Z7318                   819
BMT          7397   60059   *X NO IDM SAMPLE COLL & CENTRAL L         1,566.00                1    38204             38204               819
BMT          7397   66004   *X NO IDM SAMPLE COLLECTION               1,391.00                1    38204             38204               819
BMT          7397   12588   *X NO INFECTIOUS DISEASE TESTS              416.00                1    38204             38204               819
BMT          7397   66047   *X NO IR DR3,4,5 TYPING STD                 723.00                1    38204             38204               819
BMT          7397   65523   *X NO IR-ABC TYPING STD                   2,004.00                1   Z7318          Z7318                   819
BMT          7397   65220   *X NO IR-DR TYPING                          690.00                1   Z7318          Z7318                   819
BMT          7397   65286   *X NO LEUKAPHERESIS PER DONOR            10,906.00                1    99199         Z7318                   819
BMT          7397   12604   *X NO MARROW PROCURE (PER DONOR)         29,138.00                1    38204             38204               819
BMT          7397   65284   *X NO PBSC 2ND COLLECTION PER DNR        30,572.00                1    38204             38204               819
BMT          7397   65293   *X NO PBSC 2ND FILGRASTIM INJ/DNR         7,183.00                1   Z7318          Z7318                   819
BMT          7397   65283   *X NO PBSC COLLECTION PER DNR            30,572.00                1   Z7318          Z7318                   819
BMT          7397   65290   *X NO PBSC DNR PHYSICAL EXAM                  0.00                1   Z7318          Z7318                   819
BMT          7397   65525   *X NO PBSC DONOR INFO SESSION             1,018.00                1   Z7318          Z7318                   819
BMT          7397   65292   *X NO PBSC FILGRASTIM INJ PER DNR         7,183.00                1    38204             38204               819
BMT          7397   65291   *X NO PBSC WORK-UP CANCELLATION           1,259.00                1    38204             38204               819
BMT          7397   66032   *X NO PRE-COLL / IDM SAMP COLL CO         1,391.00                1    38204             38204               819
BMT          7397   65524   *X NO UL NMDP COURIER                     5,048.00                1   Z7318          Z7318                   819
BMT          7397   65287   *X NO UL NMDP SHIPPING                      602.00                1    38204             38204               819
BMT          7397   65294   *X NO UL PHYSICAL EXAM                    1,325.00                1    38204             38204               819
BMT          7397   65295   *X NO UL WORK-UP CANCELLATION             1,259.00                1    38204             38204               819
BMT          7397   65289   *X NO WHOLE BLD NMDP SHIPPING               602.00                1    38204             38204               819
BMT          7397   65288   *X NO WHOLE BLD UNIT COLL PER DNR         3,208.00                1    38204             38204               819
BMT          7397   12687   *X NO WORKUP FEE (PER DONOR)              1,259.00                1    38204             38204               819
BMT          7397   60073   *X PO ADDITIONAL PRECOLL SAMPLE           1,577.00                1    38204             38204               819
BMT          7397   60097   *X PO AUTOLOGOUS BLOOD UNIT (M)             307.00                1    38204             38204               819
BMT          7397   60072   *X PO CONFIRMATORY TYPING SAMPLE          1,577.00                1    38204             38204               819
BMT          7397   60095   *X PO DONOR INFORMATION SESSION (           186.00                1    38204             38204               819
BMT          7397   60096   *X PO DONOR PHYSICAL EXAM (M)               482.00                1    38204             38204               819
BMT          7397   60071   *X PO EXTENDED DR PROCUREMENT AND           580.00                1    38204             38204               819
BMT          7397   60102   *X PO FILGRASTIM INJECTION                2,223.00                1    38204             38204               819
BMT          7397   60060   *X PO IDM SAMPLE COLL & CENTRAL L         1,960.00                1    38204             38204               819
BMT          7397   66005   *X PO IDM SAMPLE COLLECTION               1,686.00                1    38204             38204               819
BMT          7397   60070   *X PO IR-DR TYPING                          372.00                1    38204             38204               819
BMT          7397   60087   *X PO MARROW COLLECTION                  27,134.00                1    38204             38204               819



                                                          Page 42 of 676
                                                            CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                  Description                  Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                              HCPCS
BMT          7397   60099   *X PO PBSC DONOR INFO SESSION                186.00                1    38204             38204               819
BMT          7397   60100   *X PO PBSC DONOR PHYSICAL EXAM               482.00                1    38204             38204               819
BMT          7397   60101   *X PO PBSC WORK UP CANCELLATION            3,986.00                1    38204             38204               819
BMT          7397   66033   *X PO PRE-COLL / IDM SAMP COLL CO          1,686.00                1    38204             38204               819
BMT          7397   60088   *X PO PRIMARY PBSC COLLECTION (DO         27,134.00                1    38204             38204               819
BMT          7397   60089   *X PO SECONDARY PBSC COLLECTION (         27,134.00                1    38204             38204               819
BMT          7397   60091   *X PO UL ADDITIONAL CHG FOR NMDP           3,099.00                1    38204             38204               819
BMT          7397   60092   *X PO UL ADDITIONAL CHG FOR SHIPP            756.00                1    38204             38204               819
BMT          7397   60103   *X PO UL DONOR PHYSICAL EXAM                 482.00                1    38204             38204               819
BMT          7397   60104   *X PO UL WORKUP CANCELLATION               3,986.00                1    38204             38204               819
BMT          7397   60090   *X PO UNSTIMULATED LEUKAPHERESIS           9,954.00                1    38204             38204               819
BMT          7397   60094   *X PO WB ADDITIONAL CHG FOR SHIPP            756.00                1    38204             38204               819
BMT          7397   60093   *X PO WHOLE BLOOD UNIT COLLECTION          1,610.00                1    38204             38204               819
BMT          7397   60098   *X PO WORK UP CANCELLATION (M)             3,986.00                1    38204             38204               819
BMT          7397   30101   *X SEROLOGICAL TYPING                        371.00                1    38204             38204               819
BMT          7397   65297   *X SG PBSC COLLECTION PER DNR             35,423.00                1   Z7318          Z7318                   819
BMT          7397   13164   *X SG ADDL PRECOLL SAMPLE                    854.00                1    38204             38204               819
BMT          7397   13263   *X SG AUTOLOGOUS BLOOD UNIT                  767.00                1    38204             38204               390
BMT          7397   13207   *X SG CONFIRMATORY TYPE SAMPLE               854.00                1    38204             38204               819
BMT          7397   13222   *X SG DONOR INFO SESSION                     613.00                1    38204             38204               819
BMT          7397   13248   *X SG DONOR PHYSICAL EXAM                  2,004.00                1   Z7318          Z7318                   819
BMT          7397   13123   *X SG EXT PROCURE & TYPING                   558.00                1    38204             38204               819
BMT          7397   13107   *X SG HLA-B TYPING                           567.00                1   Z7318          Z7318                   819
BMT          7397   60061   *X SG IDM SAMPLE COLL & CENTRAL L          1,467.00                1    38204             38204               819
BMT          7397   66012   *X SG IDM SAMPLE COLLECTION                1,281.00                1    38204             38204               819
BMT          7397   65223   *X SG IR-DR TYPING                           318.00                1   Z7318          Z7318                   819
BMT          7397   65298   *X SG LEUKAPHERESIS PER DNR               11,826.00                1    38204             38204               819
BMT          7397   13206   *X SG MARROW PROCURE (PER DONOR)          35,522.00                1    38204             38204               819
BMT          7397   65306   *X SG PBSC 2N FILGRASTIM INJ/DNR           4,424.00                1    99199         Z7318                   819
BMT          7397   65296   *X SG PBSC COLLECTION PER DNR             35,423.00                1    38204             38204               819
BMT          7397   65305   *X SG PBSC DNR WORK-UP CANCEL              2,091.00                1   Z7318          Z7318                   819
BMT          7397   65303   *X SG PBSC DONOR INFOR SESSION               602.00                1    38204             38204               819
BMT          7397   65304   *X SG PBSC DONOR PHYSICAL EXAM             1,927.00                1   Z7318          Z7318                   819
BMT          7397   66034   *X SG PRE-COLL / IDM SAMP COLL CO          1,281.00                1    38204             38204               819
BMT          7397   60120   *X SG SECONDARY PBSC COLLECTION           35,423.00                1    38204             38204               819



                                                           Page 43 of 676
                                                           CM 06/15/07


 Dept                                                                                                           M/cal
        Cost Ctr.   SIM#                  Description                 Price      Stats/bill     CPT     Mod               Mod   Rev Code
 Code                                                                                                          HCPCS
BMT          7397   65309   *X SG UL DNR WORK-UP CANCELLATION         1,347.00                1 38204             38204               819
BMT          7397   65299   *X SG UL NMDP COURIER                     6,756.00                1 38204             38204               819
BMT          7397   65300   *X SG UL NMDP SHIPPING                      756.00                1 Z7318         Z7318                   819
BMT          7397   65308   *X SG UL PHYSICAL EXAM                    1,522.00                1 38204             38204               819
BMT          7397   65302   *X SG WHOLE BLOOD NMDP SHIPPING             756.00                1 38204             38204               819
BMT          7397   65301   *X SG WHOLE BOOD PER DNR                  4,511.00                1 38204             38204               819
BMT          7397   13289   *X SG WORKUP FEE (PER DONOR)              2,081.00                1 Z7318         Z7318                   819
BMT          7397   60110   *X SL ADDITIANAL CHG FOR NMDP SHI           588.00                1 38204             38204               819
BMT          7397   60109   *X SL ADDITIONAL CHG FOR NMDP COU         3,753.00                1 38204             38204               819
BMT          7397   60077   *X SL ADDITIONAL PRECOLL SAMPLE             707.00                1 38204             38204               819
BMT          7397   60113   *X SL AUTOLOGOUS BLOOD UNIT (M)             300.00                1 38204             38204               819
BMT          7397   60076   *X SL CONFIRMATORY TYPING                   707.00                1 38204             38204               819
BMT          7397   60111   *X SL DONOR INFO SESSION (M)                312.00                1 38204             38204               819
BMT          7397   60112   *X SL DONOR PHYSICAL EXAM (M)               911.00                1 38204             38204               819
BMT          7397   60075   *X SL EXTENDED DR PROCUREMENT AND         1,115.00                1 38204             38204               819
BMT          7397   60117   *X SL FILGRASTIM INJECTION                1,631.00                1 38204             38204               819
BMT          7397   60062   *X SL IDM SAMPLE COLL & CENTRAL L           911.00                1 38204             38204               819
BMT          7397   66006   *X SL IDM SAMPLE COLLECTION                 827.00                1 38204             38204               819
BMT          7397   60074   *X SL IR-DR TYPING                          971.00                1 38204             38204               819
BMT          7397   60105   *X SL MARROW COLLECTION                  31,786.00                1 38204             38204               819
BMT          7397   60115   *X SL PBSC DONOR INFO SESSION               312.00                1 38204             38204               819
BMT          7397   60116   *X SL PBSC WORK UP CANCELLATION           2,686.00                1 38204             38204               819
BMT          7397   66035   *X SL PRE-COLL / IDM SAMP COLL CO           911.00                1 38204             38204               819
BMT          7397   60106   *X SL PRIMARY PBSC COLLECTION            18,813.00                1 38204             38204               819
BMT          7397   60107   *X SL SECONDARY PBSC COLLECTION          14,652.00                1 38204             38204               819
BMT          7397   60118   *X SL UL DONOR PHYSICAL EXAM                911.00                1 38204             38204               819
BMT          7397   60119   *X SL UL WORKUP CANCELLATION              2,686.00                1 38204             38204               819
BMT          7397   60108   *X SL UNSTIMULATED LEUKAPHERESIS          5,000.00                1 38204             38204               819
BMT          7397   60114   *X SL WORK UP CANCELLATION (M)            2,686.00                1 38204             38204               819
BMT          7397   12760   *X SP ADDL PRECOLL SAMPLE                   821.00                1 38204             38204               819
BMT          7397   12869   *X SP AUTOLOGOUS BLOOD UNIT                   0.00                1 38204             38204               390
BMT          7397   12745   *X SP CONFIRMATORY TYPE SAMPLE              821.00                1 38204             38204               819
BMT          7397   65637   *X SP CORD BLOOD SHIPMENT                43,625.00                1 38204             38204               819
BMT          7397   65638   *X SP CORD BLOOD SHIPPING COST            4,928.00                1 38204             38204               819
BMT          7397   12828   *X SP DONOR INFO SESSION                    635.00                1 38204             38204               819



                                                          Page 44 of 676
                                                                CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                   Description                    Price      Stats/bill     CPT     Mod               Mod   Rev Code
 Code                                                                                                              HCPCS
BMT          7397   12844   *X SP DONOR PHYSICAL EXAM                     1,002.00                1 38204             38204               819
BMT          7397   12729   *X SP EXT PROCURE & TYPING                      613.00                1 Z7318         Z7318                   819
BMT          7397   65889   *X SP HR-A TYPING STANDARD (CORD)               276.00                1 38204             38204               819
BMT          7397   65907   *X SP HR-A TYPING URGENT (CORD)                 336.00                1 38204             38204               819
BMT          7397   65613   *X SP HR-A TYPING, STD CORD                     427.00                1 38204             38204               819
BMT          7397   65614   *X SP HR-A TYPING, URG CORD                     482.00                1 38204             38204               819
BMT          7397   65601   *X SP HR-A,B,DRB1/IR DRB3,4,5 STD             1,930.00                1 38204             38204               819
BMT          7397   65602   *X SP HR-A,B,DRB1/IR DRB3,4,5 URG             2,158.00                1 38204             38204               819
BMT          7397   65925   *X SP HR-B TYPING STANDARD (CORD)               312.00                1 38204             38204               819
BMT          7397   65943   *X SP HR-B TYPING URGENT (CORD)                 396.00                1 38204             38204               819
BMT          7397   65615   *X SP HR-B TYPING, STD CORD                     438.00                1 38204             38204               819
BMT          7397   65616   *X SP HR-B TYPING, URG CORD                     526.00                1 38204             38204               819
BMT          7397   65603   *X SP HR-C TYPING, STD CORD                     394.00                1 38204             38204               819
BMT          7397   65604   *X SP HR-C TYPING, URG CORD                     449.00                1 38204             38204               819
BMT          7397   65854   *X SP HR-DPB1 TYPING STANDARD (CO               240.00                1 38204             38204               819
BMT          7397   65871   *X SP HR-DPB1 TYPING URGENT (CORD               300.00                1 38204             38204               819
BMT          7397   65611   *X SP HR-DPB1 TYPING, STD CORD                  383.00                1 38204             38204               819
BMT          7397   65612   *X SP HR-DPB1 TYPING, URG CORD                  449.00                1 38204             38204               819
BMT          7397   65785   *X SP HR-DQB1 TYPING STANDARD (CO               168.00                1 38204             38204               819
BMT          7397   65803   *X SP HR-DQB1 TYPING URGENT (CORD               240.00                1 38204             38204               819
BMT          7397   65607   *X SP HR-DQB1 TYPING, STD CORD                  329.00                1 38204             38204               819
BMT          7397   65608   *X SP HR-DQB1 TYPING, URG CORD                  394.00                1 38204             38204               819
BMT          7397   60063   *X SP IDM SAMPLE COLL & CENTRAL L             1,215.00                1 38204             38204               819
BMT          7397   66007   *X SP IDM SAMPLE COLLECTION                   1,007.00                1 38204             38204               819
BMT          7397   65599   *X SP IR-A,B,DRB3,4,5/HR-DRB1, ST             1,463.00                1 38204             38204               819
BMT          7397   65600   *X SP IR-A,B,DRB3,4,5/HR-DRB1, UR             1,739.00                1 38204             38204               819
BMT          7397   65750   *X SP IR-C TYPING STANDARD (CORD)               156.00                1 38204             38204               819
BMT          7397   65767   *X SP IR-C TYPING URGENT (CORD)                 180.00                1 38204             38204               819
BMT          7397   65605   *X SP IR-C TYPING, STD CORD                     285.00                1 38204             38204               819
BMT          7397   65606   *X SP IR-C TYPING, URG CORD                     329.00                1 38204             38204               819
BMT          7397   65820   *X SP IR-DQB1 TYPING STANDARD (CO               144.00                1 38204             38204               819
BMT          7397   65837   *X SP IR-DQB1 TYPING URGENT (CORD               180.00                1 38204             38204               819
BMT          7397   65609   *X SP IR-DQB1 TYPING, STD CORD                  145.00                1 38204             38204               819
BMT          7397   65610   *X SP IR-DQB1 TYPING, URG CORD                  198.00                1 38204             38204               819
BMT          7397   65224   *X SP IR-DR TYPING                              405.00                1 38204             38204               819



                                                            Page 45 of 676
                                                            CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                  Description                  Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                              HCPCS
BMT          7397   65962   *X SP IR-DRB3,4,5 STANDARD (CORD)            144.00                1    38204             38204               819
BMT          7397   65617   *X SP IR-DRB3,4,5 STD CORD                   263.00                1    38204             38204               819
BMT          7397   65618   *X SP IR-DRB3,4,5 URG CORD                   285.00                1    38204             38204               819
BMT          7397   65980   *X SP IR-DRB3,4,5 URGENT (CORD)              192.00                1    38204             38204               819
BMT          7397   65312   *X SP LEUKAPHEREIS PER DONOR               5,880.00                1    38204             38204               819
BMT          7397   12802   *X SP MARROW PROCURE (PER DONOR)          23,499.00                1    38204             38204               819
BMT          7397   65983   *X SP MATERNAL IDM                         1,043.00                1    38204             38204               819
BMT          7397   65311   *X SP PBSC 2ND COLLECTION PER DNR         23,499.00                1    38204             38204               819
BMT          7397   65310   *X SP PBSC COLLECTION PER DNR             23,499.00                1   Z7318          Z7318                   819
BMT          7397   65315   *X SP PBSC DNR PHYSICAL EXAM                 865.00                1    38204             38204               819
BMT          7397   65316   *X SP PBSC DNR WORK-UP CANCEL              1,226.00                1    38204             38204               819
BMT          7397   65526   *X SP PBSC DONOR INFO SESSION                635.00                1   Z7318          Z7318                   819
BMT          7397   66036   *X SP PRE-COLL / IDM SAMP COLL CO          1,007.00                1    38204             38204               819
BMT          7397   65317   *X SP UL DNR PHYSICAL EXAM                   865.00                1    38204             38204               819
BMT          7397   65318   *X SP UL DNR WORK-UP CANCEL                1,226.00                1    38204             38204               819
BMT          7397   65313   *X SP UL NMDP COURIER                      5,048.00                1    38204             38204               819
BMT          7397   65314   *X SP UL NMDP SHIPPING                       679.00                1    38204             38204               819
BMT          7397   12885   *X SP WORKUP FEE (PER DONOR)               1,226.00                1    38204             38204               819
BMT          7397   40093   *X SWE 2ND PBSC COLLECT PER DNR           33,540.00                1    38204             38204               819
BMT          7397   14204   *X SWE ADDL PRECOLL SAMPLE                   953.00                1    38204             38204               819
BMT          7397   14214   *X SWE AUTOLOGOUS BLOOD UNIT                   0.00                1    38204             38204               390
BMT          7397   14154   *X SWE CONFIRMATORY TYPE SAMPLE              953.00                1    38204             38204               819
BMT          7397   14211   *X SWE DONOR INFO SESSION                      0.00                1   Z7318          Z7318                   819
BMT          7397   14212   *X SWE DONOR PHYSICAL EXAM                 2,267.00                1    38204             38204               819
BMT          7397   14105   *X SWE HLA/DR PROC AND TYPE                  330.00                1   Z7318          Z7318                   819
BMT          7397   65527   *X SWE HR-A TYPING STD                       734.00                1   Z7318          Z7318                   819
BMT          7397   65528   *X SWE HR-B TYPING STD                       734.00                1   Z7318          Z7318                   819
BMT          7397   65529   *X SWE HR-C TYPING STD                       734.00                1   Z7318          Z7318                   819
BMT          7397   65531   *X SWE HR-DQB1 TYPING STD                    734.00                1   Z7318          Z7318                   819
BMT          7397   65530   *X SWE HR-DRB1 TYPING STD                    734.00                1   Z7318          Z7318                   819
BMT          7397   60064   *X SWE IDM SAMPLE COLL & CENTRAL             701.00                1    38204             38204               819
BMT          7397   66008   *X SWE IDM SAMPLE COLLECTION                 548.00                1    38204             38204               819
BMT          7397   14210   *X SWE INFECTIOUS DISEASE TESTS                0.00                1   Z7318          Z7318                   819
BMT          7397   65532   *X SWE IR-ABC TYPING STD                     537.00                1   Z7318          Z7318                   819
BMT          7397   65225   *X SWE IR-DR TYPING                          602.00                1    38204             38204               819



                                                           Page 46 of 676
                                                          CM 06/15/07


 Dept                                                                                                             M/cal
        Cost Ctr.   SIM#                  Description                Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                            HCPCS
BMT          7397   14106   *X SWE MARROW PROCURE (PER DONOR)       33,540.00                1    38204             38204               819
BMT          7397   40099   *X SWE PBSC INFO SESSION PR DNR              0.00                1   Z7318          Z7318                   819
BMT          7397   50000   *X SWE PBSC PHYS EXAM PER EXAM           2,267.00                1    38204             38204               819
BMT          7397   65535   *X SWE PBSC WORKUP CANCELLATION          1,781.00                1   Z7318          Z7318                   819
BMT          7397   50001   *X SWE PBSC WORKUP FEE PER DNR           1,708.00                1   Z7318          Z7318                   819
BMT          7397   66037   *X SWE PRE-COLL / IDM SAMP COLL C          548.00                1    38204             38204               819
BMT          7397   40092   *X SWE PRIM PBSC COLLEC PER DNR         33,540.00                1    38204             38204               819
BMT          7397   65534   *X SWE UL ADDL NMDP SHIPPING               646.00                1   Z7318          Z7318                   819
BMT          7397   40095   *X SWE UL NMDP COURIER ADDL CHG          5,048.00                1    38204             38204               819
BMT          7397   40096   *X SWE WHL BLD UNIT COL PER DNR            679.00                1   Z7318          Z7318                   819
BMT          7397   50002   *X SWE UL PHYS EXAM PER EXAM             2,267.00                1    38204             38204               819
BMT          7397   50003   *X SWE UL WORKUP FEE PER DONOR           1,708.00                1    38204             38204               819
BMT          7397   40098   *X SWE WB NMDP SHIPPNG ADDL CHG            679.00                1    38204             38204               819
BMT          7397   40097   *X SWE WHL BLD UNIT COL PER DNR          3,088.00                1   Z7318          Z7318                   819
BMT          7397   14215   *X SWE WORKUP FEE (PER DONOR)            1,708.00                1    38204             38204               819
BMT          7397   40094   *X SWEUNSTIM LEUKAPHER PER DNR          12,133.00                1    38204             38204               819
BMT          7397   50005   *X SWI 2ND PBSC COLLECT PER DNR         40,121.00                1    38204             38204               819
BMT          7397   14205   *X SWI ADDL PRECOLL SAMPLE                 909.00                1    38204             38204               819
BMT          7397   14501   *X SWI AUTOLOGOUS BLOOD UNIT               690.00                1    38204             38204               390
BMT          7397   14207   *X SWI CONFIRMATORY TYPE SAMPLE            909.00                1    38204             38204               819
BMT          7397   14402   *X SWI DONOR INFO SESSION                  788.00                1    38204             38204               819
BMT          7397   14451   *X SWI DONOR PHYSICAL EXAM               4,238.00                1    38204             38204               819
BMT          7397   65319   *X SWI EXT PROCURE & TYPING                493.00                1   Z7318          Z7318                   819
BMT          7397   14206   *X SWI HLA/DR PROC AND TYPE                330.00                1   Z7318          Z7318                   819
BMT          7397   60065   *X SWI IDM SAMPLE COLL & CENTRAL         1,380.00                1    38204             38204               819
BMT          7397   66009   *X SWI IDM SAMPLE COLLECTION             1,205.00                1    38204             38204               819
BMT          7397   14303   *X SWI MARROW PROCURE (PER DONOR)       40,121.00                1    38204             38204               819
BMT          7397   50006   *X SWI PBSC INFO SESSION PR DNR            788.00                1    38204             38204               819
BMT          7397   50007   *X SWI PBSC PHYS EXAM PER EXAM           4,238.00                1    38204             38204               819
BMT          7397   50008   *X SWI PBSC WORKUP FEE PER DNR           2,770.00                1    38204             38204               819
BMT          7397   66038   *X SWI PRE-COLL / IDM SAMP COLL C        1,205.00                1    38204             38204               819
BMT          7397   50004   *X SWI PRIM PBSC COLLEC PER DNR         40,121.00                1    38204             38204               819
BMT          7397   14550   *X SWI WORKUP FEE (PER DONOR)            2,770.00                1    38204             38204               819
BMT          7397   65226   *X SWU IR-DR TYPING                        382.00                1    38204             38204               819
BMT          7397   50018   *X TW 2ND FILGRAS INJ PER DNR                0.00                1    38204             38204               819



                                                         Page 47 of 676
                                                              CM 06/15/07


 Dept                                                                                                                 M/cal
        Cost Ctr.   SIM#                     Description                 Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                                HCPCS
BMT          7397   50009   *X TW   2ND PBSC COLLECT PER DNR                 0.00                1    38204             38204               819
BMT          7397   13362   *X TW   ADDL PRECOLL SAMPLE                      0.00                1    38204             38204               819
BMT          7397   13461   *X TW   AUTOLOGOUS BLOOD UNIT                    0.00                1    38204             38204               390
BMT          7397   13347   *X TW   CONFIRMATORY TYPE SAMPLE               701.00                1    38204             38204               819
BMT          7397   65585   *X TW   CORD BLOOD SHIPMENT                 30,134.00                1   Z7318          Z7318                   819
BMT          7397   65586   *X TW   CORD BLOOD SHIPPING COST             4,468.00                1   Z7318          Z7318                   819
BMT          7397   13420   *X TW   DONOR INFO SESSION                       0.00                1    38204             38204               819
BMT          7397   13446   *X TW   DONOR PHYSICAL EXAM                      0.00                1   Z7318          Z7318                   819
BMT          7397   13321   *X TW   EXT PROCURE & TYPING                   613.00                1    38204             38204               819
BMT          7397   13305   *X TW   HLA/DR PROC AND TYPE                   264.00                1   Z7318          Z7318                   819
BMT          7397   65890   *X TW   HR-A TYPING STANDARD (CORD)            427.00                1    38204             38204               819
BMT          7397   65537   *X TW   HR-A TYPING STD                        303.00                1   Z7318          Z7318                   819
BMT          7397   65538   *X TW   HR-A TYPING URG                        369.00                1   Z7318          Z7318                   819
BMT          7397   65908   *X TW   HR-A TYPING URGENT (CORD)              482.00                1    38204             38204               819
BMT          7397   65450   *X TW   HR-A,B,DRB1/IR DRB3,4,5 STD          1,211.00                1   Z7318          Z7318                   819
BMT          7397   65451   *X TW   HR-A,B,DRB1/IR DRB3,4,5 URG          1,439.00                1    38204             38204               819
BMT          7397   65926   *X TW   HR-B TYPING STANDARD (CORD)            438.00                1    38204             38204               819
BMT          7397   65539   *X TW   HR-B TYPING STD                        330.00                1   Z7318          Z7318                   819
BMT          7397   65540   *X TW   HR-B TYPING URG                        422.00                1   Z7318          Z7318                   819
BMT          7397   65944   *X TW   HR-B TYPING URGENT (CORD)              526.00                1    38204             38204               819
BMT          7397   65452   *X TW   HR-C TYPING STD                        264.00                1    38204             38204               819
BMT          7397   65453   *X TW   HR-C TYPING URG                        330.00                1   Z7318          Z7318                   819
BMT          7397   65855   *X TW   HR-DPB1 TYPING STANDARD (CO            383.00                1    38204             38204               819
BMT          7397   65536   *X TW   HR-DPB1 TYPING URG                     317.00                1   Z7318          Z7318                   819
BMT          7397   65872   *X TW   HR-DPB1 TYPING URGENT (CORD            449.00                1    38204             38204               819
BMT          7397   65533   *X TW   HR-DPB1 TYPING STD                     264.00                1   Z7318          Z7318                   819
BMT          7397   65786   *X TW   HR-DQB1 TYPING STANDARD (CO            329.00                1    38204             38204               819
BMT          7397   65456   *X TW   HR-DQB1 TYPING STD                     185.00                1   Z7318          Z7318                   819
BMT          7397   65457   *X TW   HR-DQB1 TYPING URG                     264.00                1   Z7318          Z7318                   819
BMT          7397   65804   *X TW   HR-DQB1 TYPING URGENT (CORD            394.00                1    38204             38204               819
BMT          7397   60066   *X TW   IDM SAMPLE COLL & CENTRAL L          1,336.00                1    38204             38204               819
BMT          7397   66010   *X TW   IDM SAMPLE COLLECTION                1,062.00                1    38204             38204               819
BMT          7397   65448   *X TW   IR-A,B,DRB3,4,5/HR-DRB1, ST            743.00                1   Z7318          Z7318                   819
BMT          7397   65449   *X TW   IR-A,B,DRB3,4,5/HR-DRB1, UR          1,019.00                1   Z7318          Z7318                   819
BMT          7397   65454   *X TW   IR-C TYPING STD                        158.00                1   Z7318          Z7318                   819



                                                             Page 48 of 676
                                                            CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                  Description                  Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                              HCPCS
BMT          7397   65455   *X TW IR-C TYPING URG                        198.00                1   Z7318          Z7318                   819
BMT          7397   65768   *X TW IR-C TYPING URGENT (CORD)              329.00                1    38204             38204               819
BMT          7397   65821   *X TW IR-DQB1 TYPING STANDARD (CO            144.00                1    38204             38204               819
BMT          7397   65458   *X TW IR-DQB1 TYPING STD                     145.00                1   Z7318          Z7318                   819
BMT          7397   65459   *X TW IR-DQB1 TYPING URG                     198.00                1   Z7318          Z7318                   819
BMT          7397   65838   *X TW IR-DQB1 TYPING URGENT (CORD            180.00                1    38204             38204               819
BMT          7397   65227   *X TW IR-DR TYPING                           416.00                1   Z7318          Z7318                   819
BMT          7397   65961   *X GE-Z IR-DRB3,4,5 STANDARD (COR            263.00                1    38204             38204               819
BMT          7397   65541   *X TW IR-DRB3,4,5 STD                        158.00                1   Z7318          Z7318                   819
BMT          7397   65542   *X TW IR-DRB3,4,5 URG                        198.00                1   Z7318          Z7318                   819
BMT          7397   65979   *X TW IR-DRB3,4,5 URGENT (CORD)              285.00                1    99199             99199               819
BMT          7397   13404   *X TW MARROW PROCURE (PER DONOR)          34,197.00                1    38204             38204               819
BMT          7397   65984   *X TW MATERNAL IDM                           815.00                1    38204             38204               819
BMT          7397   50015   *X TW PBSC INFO SESSION PR DNR                 0.00                1    38204             38204               819
BMT          7397   50016   *X TW PBSC PHYS EXAM PER EXAM                  0.00                1    38204             38204               819
BMT          7397   50017   *X TW PBSC WORKUP FEE PER DNR              4,763.00                1    38204             38204               819
BMT          7397   66039   *X TW PRE-COLL / IDM SAMP COLL CO          1,062.00                1    38204             38204               819
BMT          7397   65643   *X TW PRIMARY PBSC COLLECTION             34,197.00                1    38204             38204               819
BMT          7397   50011   *X TW UL NMDP COURIER ADDL CHG             6,187.00                1    38204             38204               819
BMT          7397   50012   *X TW UL NMDP SHIPPNG ADDL CHG               756.00                1    38204             38204               819
BMT          7397   50019   *X TW UL PHYS EXAM PER EXAM                    0.00                1    38204             38204               819
BMT          7397   50020   *X TW UL WORKUP FEE PER DONOR                  0.00                1    38204             38204               819
BMT          7397   50010   *X TW UNSTIM LEUKAPHER PER DNR             8,782.00                1    38204             38204               819
BMT          7397   50014   *X TW WB NMDP SHIPPNG ADDL CHG               756.00                1    38204             38204               819
BMT          7397   50013   *X TW WHL BLD UNIT COL PER DNR             2,201.00                1    38204             38204               819
BMT          7397   13487   *X TW WORKUP FEE (PER DONOR)               4,763.00                1   Z7318          Z7318                   819
BMT          7397   50032   *X US 2ND FILGRAS INJ PER DNR              4,260.00                1   Z7318          Z7318                   819
BMT          7397   50022   *X US 2ND PBSC COLLECT PER DNR            25,097.00                1    38204             38204               819
BMT          7397    1178   *X US ADDL PRECOLL SAMPLE                    350.00                1    38204             38204               819
BMT          7397    9030   *X US AUTOLOGOUS BLOOD UNIT                  624.00                1    38204             38204               390
BMT          7397    1177   *X US CONFIRMATORY SAMPLE                    350.00                1    38204             38204               819
BMT          7397    9014   *X US DONOR INFO SESSION                     493.00                1    38204             38204               819
BMT          7397    9022   *X US DONOR PHYSICAL EXAM                  1,533.00                1    38204             38204               819
BMT          7397    1729   *X US HR-A TYPING (CORD) (STANDAR            409.00                1   Z7318          Z7318                   819
BMT          7397    1730   *X US HR-A TYPING (CORD) (URGENT)            488.00                1   Z7318          Z7318                   819



                                                           Page 49 of 676
                                                                CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                   Description                    Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                                 HCPCS
BMT          7397   65188   *X US HR-A TYPING (STANDARD)                    405.00                1   Z7318          Z7318                   819
BMT          7397   65189   *X US HR-A TYPING (URGENT)                      405.00                1   Z7318          Z7318                   819
BMT          7397   65202   *X US HR-A,B,DRB1/IR DRB3,4,5,(ST             1,372.00                1   Z7318          Z7318                   819
BMT          7397   65203   *X US HR-A,B,DRB1/IR DRB3,4,5,(UR             1,688.00                1   Z7318          Z7318                   819
BMT          7397    1731   *X US HR-B TYPING (CORD) (STANDAR               448.00                1   Z7318          Z7318                   819
BMT          7397    1732   *X US HR-B TYPING (CORD) (URGENT)               554.00                1   Z7318          Z7318                   819
BMT          7397   65190   *X US HR-B TYPING (STANDARD)                    405.00                1    38204             38204               819
BMT          7397   65191   *X US HR-B TYPING (URGENT)                      405.00                1    38204             38204               819
BMT          7397   65204   *X US HR-C TYPING (STANDARD)                    580.00                1    38204             38204               819
BMT          7397   65192   *X US HR-C TYPING (STANDARD)                    405.00                1   Z7318          Z7318                   819
BMT          7397   65193   *X US HR-C TYPING (URGENT)                      405.00                1    38204             38204               819
BMT          7397   65461   *X US HR-C TYPING CORD (STANDARD)               277.00                1   Z7318          Z7318                   819
BMT          7397   65462   *X US HR-C TYPING CORD (URGENT)                 356.00                1   Z7318          Z7318                   819
BMT          7397    1727   *X US HR-DPB1 TYPING (CORD) (STAN               356.00                1   Z7318          Z7318                   819
BMT          7397    1728   *X US HR-DPB1 TYPING (CORD) (URGE               435.00                1   Z7318          Z7318                   819
BMT          7397   65196   *X US HR-DQB1 TYPING (STANDARD)                 372.00                1    38204             38204               819
BMT          7397   65197   *X US HR-DQB1 TYPING (URGENT)                   372.00                1    38204             38204               819
BMT          7397   65206   *X US HR-DQB1 TYPING (STANDARD)                 185.00                1    38204             38204               819
BMT          7397   65207   *X US HR-DQB1 TYPING (URGENT)                   264.00                1    38204             38204               819
BMT          7397   65194   *X US HR-DRB1 TYPING (STANDARD)                 372.00                1    38204             38204               819
BMT          7397   65460   *X US HR-DRB1 TYPING (URGENT)                   607.00                1   Z7318          Z7318                   819
BMT          7397   65195   *X US INFECTIOUS DISEASE TESTS                  251.00                1   Z7318          Z7318                   819
BMT          7397   66043   *X US IR DRB3,4,5 TYPING STD                    372.00                1    38204             38204               819
BMT          7397   66044   *X US IR DRB3,4,5 TYPING URG                    383.00                1    38204             38204               819
BMT          7397   65200   *X US IR-A,B,DRB3, 4,5/HR-DRB1(ST               791.00                1    38204             38204               819
BMT          7397   65201   *X US IR-A,B,DRB3, 4,5/HR-DRB1(UR             1,095.00                1    38204             38204               819
BMT          7397   65198   *X US IR-ABC TYPING (STANDARD)                  350.00                1    38204             38204               819
BMT          7397   65199   *X US IR-ABC TYPING (URGENT)                    361.00                1    38204             38204               819
BMT          7397    1723   *X US IR-C TYPING (CORD) (STANDAR               224.00                1   Z7318          Z7318                   819
BMT          7397    1724   *X US IR-C TYPING (CORD) (URGENT)               277.00                1   Z7318          Z7318                   819
BMT          7397    1725   *X US IR-DQB1 TYPING (CORD) (STAN               211.00                1   Z7318          Z7318                   819
BMT          7397    1726   *X US IR-DQB1TYPING (CORD) (URGEN               264.00                1   Z7318          Z7318                   819
BMT          7397   65187   *X US IR-DR TYPING                              318.00                1    38204             38204               819
BMT          7397    1733   *X US IR-DRB3,4,5 (CORD) (STANDAR               224.00                1   Z7318          Z7318                   819
BMT          7397    1734   *X US IR-DRB3,4,5 (CORD) (URGENT)               303.00                1   Z7318          Z7318                   819



                                                            Page 50 of 676
                                                          CM 06/15/07


 Dept                                                                                                             M/cal
        Cost Ctr.   SIM#                 Description                 Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                            HCPCS
BMT          7397    1169   *X US MARROW PROCURE (PER DONOR)        31,390.00                1    38204             38204               819
BMT          7397   50028   *X US PBSC INFO SESSION PR DNR             482.00                1    38204             38204               819
BMT          7397   50029   *X US PBSC WORKUP FEE PER DNR            1,500.00                1   Z7318          Z7318                   819
BMT          7397   65247   *X US PBSC PHYSICAL EXAM PER DONO        1,807.00                1   Z7318          Z7318                   819
BMT          7397   50030   *X US PBSC WORKUP FEE PER DNR            1,697.00                1   Z7318          Z7318                   819
BMT          7397   50031   *X US PRIM FILGRAS INJ PER DNR           4,260.00                1    38204             38204               819
BMT          7397   50021   *X US PRIM PBSC COLLEC PER DNR          25,097.00                1    38204             38204               819
BMT          7397   50024   *X US UL NMDP COURIER ADDL CHG           2,256.00                1    38204             38204               819
BMT          7397   50025   *X US UL NMDP SHIPPNG ADDL CHG             318.00                1    38204             38204               819
BMT          7397   50033   *X US UL PHYS EXAM PER EXAM              1,172.00                1    38204             38204               819
BMT          7397   50034   *X US UL WORKUP FEE PER DONOR              964.00                1    38204             38204               819
BMT          7397   50023   *X US UNSTIM LEUKAPHER PER DNR           8,738.00                1    38204             38204               819
BMT          7397   50027   *X US WB NMDP SHIPPNG ADDL CHG             318.00                1    38204             38204               819
BMT          7397   50026   *X US WHL BLD UNIT COL PER DNR           3,022.00                1    38204             38204               819
BMT          7397    9048   *X US WORKUP FEE (PER DONOR)             1,664.00                1    38204             38204               819
BMT          7397    1781   *X WA ADDL CHARGE NMDP COURIER           5,048.00                1    38204             38204               819
BMT          7397    1782   *X WA ADDL CHARGE NMDP SHIPPING            756.00                1    38204             38204               819
BMT          7397    1713   *X WA ADDL PRECOLLECTION SAMPLE            810.00                1   Z7318          Z7318                   819
BMT          7397    1712   *X WA CONFIRMATORY TYPING                  810.00                1   Z7318          Z7318                   819
BMT          7397    1783   *X WA DONOR PHYS EXAM BM/PER EXAM        3,154.00                1    38204             38204               819
BMT          7397    1785   *X WA DONOR PHYS EXAM PBSC/PER EX        3,154.00                1    38204             38204               819
BMT          7397   60078   *X WA EXTENDED DR PROCUREMENT AND          537.00                1    38204             38204               819
BMT          7397   60067   *X WA IDM SAMPLE COLL & CENTRAL L        1,183.00                1    38204             38204               819
BMT          7397   66011   *X WA IDM SAMPLE COLLECTION                996.00                1    38204             38204               819
BMT          7397    1711   *X WA IR-DR TYPING                           0.00                1    38204             38204               819
BMT          7397    1777   *X WA MARROW PROCUREMENT (PER DNR       35,555.00                1    38204             38204               819
BMT          7397    1787   *X WA PHYSICAL EXAM (PER EXAM) UL        3,154.00                1    38204             38204               819
BMT          7397   66040   *X WA PRE-COLL / IDM SAMP COLL CO        1,007.00                1    38204             38204               819
BMT          7397    1778   *X WA PRIM PBSC COLLEC PER DNR          35,555.00                1    38204             38204               819
BMT          7397    1779   *X WA SEC PBSC COLLEC PER DNR           35,555.00                1    38204             38204               819
BMT          7397    1780   *X WA UNSTIM LEUKAPHER PER DNR          11,103.00                1    38204             38204               819
BMT          7397    1788   *X WA WORKUP CANCEL (PER DNR) UL         1,183.00                1    38204             38204               819
BMT          7397    1784   *X WA WORKUP CANCEL BM (PER DNR)         1,183.00                1    38204             38204               819
BMT          7397    1786   *X WA WORKUP CANCEL PBSC (PER DNR        1,183.00                1    38204             38204               819
BMT          7397   65749   *X GE-Z IR-C TYPING STANDARD (COR          156.00                1    38204             38204               819



                                                         Page 51 of 676
                                                                CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                   Description                    Price      Stats/bill       CPT     Mod             Mod   Rev Code
 Code                                                                                                               HCPCS
BMT          7397   65751   *XTW IR-C TYPING STANDARD (CORD)                156.00                1   38204           38204               819
BMT          7397   65238   *X GE-Z U LEUJAPHERESIS PER DONOR             8,217.00                1   38204           38204               819
BMT          7397   65672   151 HR A,B,DRB1 IR DRB3,4,5 STAND             1,187.00                1   38204           38204               819
BMT          7397   65644   151 IR A,B, DRB3,4,5 HR DR1 STAND               731.00                1   38204           38204               819
BMT          7397   65658   151 IRA,B,DRB3,3,4,5HR DRB1 URG                 995.00                1   38204           38204               819
BMT          7397   66264   151-178 HR-CT HR A-C & DRB1 STD                 996.00                1   38204           38204               819
BMT          7397   66265   151-178 HR-CT HR A-C & DRB1 URG               1,205.00                1   38204           38204               819
BMT          7397   66262   151-178 IR-CT IR A-C HR-DRB1 STD                558.00                1   38204           38204               819
BMT          7397   66263   151-178 IR-CT IR A-C HR-DRB1 URG                810.00                1   38204           38204               819
BMT          7397   65673   153 HR A,B,DRB1 IR DRB3,4,5 STAND             1,187.00                1   38204           38204               819
BMT          7397   65645   153 IR A,B,DRB3,4,5 HR DRB1 STAND               731.00                1   38204           38204               819
BMT          7397   65659   153 IR A,B,DRB3,4,5/HR DRB1 URG                 995.00                1   38204           38204               819
BMT          7397   65674   155 HR A,B,DRB1 IR DRB3,4,5 STAND             1,187.00                1   38204           38204               819
BMT          7397   65660   155 IR A,B,DRB3,4,5HR DRB1 URG                  995.00                1   38204           38204               819
BMT          7397   66266   155-178 HR-C TYPING STD                         394.00                1   38204           38204               819
BMT          7397   65661   156 IR A,B, DBRB3,4,5HR DRB1 URG                995.00                1   38204           38204               819
BMT          7397   65647   156 IR A,B,DRB3,4,5 HR DRB1 STAND               731.00                1   38204           38204               819
BMT          7397   65648   157 IR A,B,DRB3,4,5 HR DRB1 STAND               731.00                1   38204           38204               819
BMT          7397   65662   157 IR AB,BDRB3,4,5HR DRB1 URG                  995.00                1   38204           38204               819
BMT          7397   65663   159 IR A,B,DR3,4,5HR DRB1 URG                   995.00                1   38204           38204               819
BMT          7397   65649   159 IR A,B,DRB3,4,5 HR DRB1 STAND               731.00                1   38204           38204               819
BMT          7397   65650   161 IR A,B,DRB3,4,5 HR DRB1 STAND               731.00                1   38204           38204               819
BMT          7397   65664   161 IR A,B,DRB3,4,5HR DRB1 URG                  995.00                1   38204           38204               319
BMT          7397   65651   163 IR A,B,DRB3,4,5 HR DRB1 STAND               731.00                1   38204           38204               819
BMT          7397   65665   163 IR A,B,DRB3,4,5HR DRB1 URG                  995.00                1   38204           38204               819
BMT          7397   65652   164 IR A,B,DRB3,4,5 HR DRB1 STAND               731.00                1   38204           38204               819
BMT          7397   65666   164 IR A,B,DRB3,4,5HR DRB1 URG                  995.00                1   38204           38204               819
BMT          7397   65653   166 IR A,B,DRB3,4,5,DRB1 STAND                  731.00                1   38204           38204               819
BMT          7397   65667   166 IR A,B,DRB3,4,5HR DRB1 URG                  995.00                1   38204           38204               819
BMT          7397   65654   167 IR A,B,DRB3,4,5 HR DRB1 STAND               731.00                1   38204           38204               819
BMT          7397   65668   167 IR A,B,DRB3,4,5HR DRB1 URG                  995.00                1   38204           38204               819
BMT          7397   65655   168 IR A,B,DRB3,4,5 HR DRB1 STAND               731.00                1   38204           38204               819
BMT          7397   65669   168 IR A,B,DRB3,4,5HR DRB1 URG                  995.00                1   38204           38204               819
BMT          7397   65670   169 IR A,B,DRB3,4,5HR DRB1 URG                  995.00                1   38204           38204               819
BMT          7397   65656   169IR A,B,DRB3,4,5HR DRB1 STAND                 731.00                1   38204           38204               819



                                                            Page 52 of 676
                                                                 CM 06/15/07


 Dept                                                                                                                 M/cal
        Cost Ctr.   SIM#                    Description                     Price      Stats/bill     CPT     Mod               Mod   Rev Code
 Code                                                                                                                HCPCS
BMT          7397   66444   170 CORD BLOOD UNIT                            11,061.00                1 38204             38204               819
BMT          7397   65657   170 IR A,B,DRB3,4,5HR DRB1 STAND                  731.00                1 38204             38204               819
BMT          7397   65671   170 IR A,B,DRB3,4,5HR DRB1 URG                    995.00                1 38204             38204               919
BMT          7397   66437   171 CORD BLOOD UNIT                            24,353.00                1 38204             38204               819
BMT          7397   66273   171-178 IR-DRB3.4,5 TYPING URG                    449.00                1 38204             38204               819
BMT          7397   66271   171-178 HR DQB1 TYPING STD                        329.00                1 38204             38204               819
BMT          7397   66275   171-178 HR-A TYPING STD                           427.00                1 38204             38204               819
BMT          7397   66274   171-178 HR-A TYPING URG                           482.00                1 38204             38204               819
BMT          7397   66276   171-178 HR-B TYPING STD                           438.00                1 38204             38204               819
BMT          7397   66277   171-178 HR-B TYPING URG                           526.00                1 38204             38204               819
BMT          7397   66267   171-178 HR-C TYPING URG                           449.00                1 38204             38204               819
BMT          7397   66270   171-178 HR-DQB1 TYPING URG                        394.00                1 38204             38204               819
BMT          7397   66272   171-178 IR-DRB3,4,5 TYPING STD                    383.00                1 38204             38204               819
BMT          7397   66268   171-178 IR-C TYPING STD                           285.00                1 38204             38204               819
BMT          7397   66269   171-178 IR-C TYPING URG                           329.00                1 38204             38204               819
BMT          7397   66278   171-178 IR-DRB3,4,5 TYPING STD                    263.00                1 38204             38204               819
BMT          7397   66445   171-178 SHIPPING COST                             394.00                1 38204             38204               819
BMT          7397   66438   172 CORD BLOOD UNIT                            25,448.00                1 38204             38204               819
BMT          7397   66439   173 CORD BLOOD UNIT                            32,565.00                1 Z7318         Z7318                   819
BMT          7397   66440   174 CORD BLOOD UNIT                            28,185.00                1 38204             38204               819
BMT          7397   66441   175 CORD BLOOD UNIT                            22,710.00                1 38204             38204               819
BMT          7397   66442   176 CORD BLOOD UNIT                            32,018.00                1 38204             38204               819
BMT          7397   66443   178 CORD BLOOD UNIT                            32,018.00                1 38204             38204               819
BMT          7397    1705   *X BE CONFIRMATORY TYPING                         876.00                1 38204             38204               819
BMT          7397   65646   155 IR A,B,DRB3,4,5 HR DRB1 STAND                 731.00                1 38204             38204               819
BMT          7397   66113   AT PBSC ADD CHARGE COURIER                      5,048.00                1 38204             38204               819
BMT          7397   66489   AU HR-A TYPING STD                                394.00                1 38204             38204               819
BMT          7397   66477   AU HR-C TYPING STD                                394.00                1 38204             38204               819
BMT          7397   66501   AU HR-DRB1 TYPING STD                             339.00                1 38204             38204               819
BMT          7397   66510   AU IR-C TYPING STD                                274.00                1 38204             38204               819
BMT          7397   66506   AU IR-DRB3,4,5 TYPING STD                         307.00                1 38204             38204               819
BMT          7397   66112   AU PBSC ADD CHARGE COURIER                      7,326.00                1 38204             38204               819
BMT          7397   66465   AU SHIPPING COST                                3,756.00                1 38204             38204               819
BMT          7397   66225   AU WB ADD CHARGE FOR COURIER                    7,326.00                1 38204             38204               819
BMT          7397   66471   AU CORD BLOOD UNIT                             29,565.00                1 38204             38204               819



                                                                Page 53 of 676
                                                             CM 06/15/07


 Dept                                                                                                             M/cal
        Cost Ctr.   SIM#                   Description                  Price      Stats/bill     CPT     Mod               Mod   Rev Code
 Code                                                                                                            HCPCS
BMT          7397   66472   BE CORD BLOOD UNIT                         41,610.00                1 38204             38204               819
BMT          7397   66490   BE HR-A TYPING STD                            482.00                1 38204             38204               819
BMT          7397   66496   BE HR-B TYPING STD                            482.00                1 38204             38204               819
BMT          7397   66478   BE HR-C TYPING STD                            728.00                1 38204             38204               819
BMT          7397   66484   BE HR-DQB1 STD                                482.00                1 38204             38204               819
BMT          7397   66502   BE HR-DRB1 TYPING STD                         482.00                1 38204             38204               819
BMT          7397   66513   BE IR-DRB3,4,5 TYPING STD                     416.00                1 38204             38204               819
BMT          7397   66114   BE PBSC ADD CHARGE COURIER                  6,537.00                1 38204             38204               819
BMT          7397   66466   BE SHIPPING COST                            3,318.00                1 38204             38204               819
BMT          7397   66227   BE WB ADD CHARGE FOR COURIER                6,537.00                1 38204             38204               819
BMT          7397   66228   BE WB ADD CHARGE FOR SHIPPING                 602.00                1 38204             38204               819
BMT          7397   66226   BE WHOLE BLOOD UNIT COLL                    6,778.00                1 Z7318         Z7318                   819
BMT          7397   66507   BE IR-DRB3,4,5 TYPING STD                     482.00                1 38204             38204               819
BMT          7397   66170   MX MARROW WORK UP CANCEL                    2,595.00                1 38204             38204               819
BMT          7397   66118   C-PL PBSC ADD CHARGE COURIER                6,187.00                1 Z7318         Z7318                   819
BMT          7397   66233   C-PL WB ADD CHARGE FOR COURIER              6,187.00                1 38204             38204               819
BMT          7397   66234   C-PL WB ADD CHARGE FOR SHIPPING               756.00                1 38204             38204               819
BMT          7397   66232   C-PL WB UNIT COLLECTION                     1,851.00                1 38204             38204               819
BMT          7397   66117   C-PR PBSC ADD CHARGE COURIER                6,187.00                1 38204             38204               819
BMT          7397   66235   C-PR WB ADD CHARGE FOR COURIER              6,187.00                1 38204             38204               819
BMT          7397   66115   CA PBSC ADD CHARGE COURIER                  3,964.00                1 38204             38204               819
BMT          7397   66229   CA PBSC INFO SESSION                          580.00                1 38204             38204               819
BMT          7397   66230   CA PBSC PHYSICAL EXAM                       1,916.00                1 38204             38204               819
BMT          7397   66231   CA PBSC WORKUP CANCEL                       1,982.00                1 38204             38204               819
BMT          7397   68688   CAITLIN RAYMONT ACTIVATION FEE                602.00                1 38204             38204               819
BMT          7397   68687   CAITLIN RAYMOND CT SAMPLE                     438.00                1 38204             38204               819
BMT          7397   66094   CH ADD CHARGE PBSC COURIER                  6,187.00                1 38204             38204               819
BMT          7397   66096   CH ADD CHARGE UL COURIER                    6,187.00                1 38204             38204               819
BMT          7397   66097   CH ADD CHARGE UL SHIPPING                     756.00                1 38204             38204               819
BMT          7397   66056   CH IDM SAMPLE COLL AND CNTRL LABS           1,752.00                1 38204             38204               819
BMT          7397   66103   CH MARROW AUTOLOGOUS UNIT                     767.00                1 38204             38204               819
BMT          7397   66091   CH MARROW COLLECTION                       38,281.00                1 38204             38204               819
BMT          7397   66101   CH MARROW INFO SESSION                        613.00                1 38204             38204               819
BMT          7397   66102   CH MARROW PHYSICAL EXAM                       767.00                1 38204             38204               819
BMT          7397   66104   CH MARROW WORK-UP CANCEL                    2,059.00                1 38204             38204               819



                                                            Page 54 of 676
                                                           CM 06/15/07


 Dept                                                                                                           M/cal
        Cost Ctr.   SIM#                  Description                 Price      Stats/bill       CPT     Mod             Mod   Rev Code
 Code                                                                                                           HCPCS
BMT          7397   66108   CH PBSC FILGRASTIN INJ                    4,424.00                1   38204           38204               819
BMT          7397   66106   CH PBSC PHYSICAL EXAM                     1,851.00                1   38204           38204               819
BMT          7397   66109   CH PBSC UL PHYSICAL EXAM                  1,522.00                1   38204           38204               819
BMT          7397   66110   CH PBSC UL WORK UP CANCEL                 1,347.00                1   38204           38204               819
BMT          7397   66107   CH PBSC WORK UP CANCEL                    2,091.00                1   38204           38204               819
BMT          7397   66105   CH PBSC INFO SESSION                        602.00                1   38204           38204               819
BMT          7397   66092   CH PRIM PBSC COLL                        38,478.00                1   38204           38204               819
BMT          7397   66093   CH SEC PBSC COLL                         38,478.00                1   38204           38204               819
BMT          7397   66095   CH UNSTIMULATED LEUKAPHERESIS            11,826.00                1   38204           38204               819
BMT          7397   66099   CH WB ADDL CHARGE COURIER                 6,187.00                1   38204           38204               819
BMT          7397   66100   CH WB ADDL CHARGE SHIP                      756.00                1   38204           38204               819
BMT          7397   66098   CH WB UNIT COLLECTION                     4,511.00                1   38204           38204               819
BMT          7397   66116   CY PBSC ADD CHARGE COURIER                5,617.00                1   38204           38204               819
BMT          7397   66119   ENG PBSC ADD CHARGE COURIER               5,048.00                1   38204           38204               819
BMT          7397    1576   *X FR MARROW PROCURE (PER DONOR)          1,637.50                1   38204           38204               819
BMT          7397   66473   FR CORD BLOOD UNIT                       35,631.00                1   38204           38204               819
BMT          7397   66491   FR HR-A TYPING STD                          493.00                1   38204           38204               819
BMT          7397   66497   FR HR-B TYPING STD                          493.00                1   38204           38204               819
BMT          7397   66479   FR HR-C TYPING STD                          493.00                1   38204           38204               819
BMT          7397   66485   FR HR-DQB1 STD                              394.00                1   38204           38204               819
BMT          7397   66503   FR HR-DRB1 TYPING STD                       394.00                1   38204           38204               819
BMT          7397   66120   FR PBSC ADD CHARGE COURIER                4,938.00                1   38204           38204               819
BMT          7397   66467   FR SHIPPING COST                          3,197.00                1   38204           38204               819
BMT          7397   66236   GE ADD CHARGE FOR COURIER                 5,398.00                1   38204           38204               819
BMT          7397   66474   GE CORD BLOOD UNIT                       36,759.00                1   38204           38204               819
BMT          7397   66492   GE HR-A TYPING STD                          832.00                1   38204           38204               819
BMT          7397   66498   GE HR-B TYPING STD                          832.00                1   38204           38204               819
BMT          7397   66480   GE HR-C TYPING STD                          832.00                1   38204           38204               819
BMT          7397   66486   GE HR-DQB1 STD                              383.00                1   38204           38204               819
BMT          7397   66504   GE HR-DRB1 TYPING STD                       449.00                1   38204           38204               819
BMT          7397   66511   GE IR-C TYPING STD                          449.00                1   38204           38204               819
BMT          7397   66121   GE PBSC ADD CHARGE COURIER                5,398.00                1   38204           38204               819
BMT          7397   66468   GE SHIPPING COST                          3,405.00                1   38204           38204               819
BMT          7397   66237   GE-D ADD CHARGE FOR COURIER               4,161.00                1   38204           38204               819
BMT          7397   66122   GE-D PBSC ADD CHARGE COURIER              4,161.00                1   38204           38204               819



                                                          Page 55 of 676
                                                                 CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                   Description                      Price      Stats/bill       CPT     Mod               Mod   Rev Code
 Code                                                                                                                  HCPCS
BMT          7397   66238   GE-Z ADD CHARGE FOR COURIER                     5,398.00                1   38204             38204               819
BMT          7397   66453   GE-Z IR-CT IR-A,B,C,HR-DRB1 STD                 1,434.00                1   38204             38204               819
BMT          7397   66462   GE-Z HR-CT HR-A,B,C & DRB1 URG                  2,070.00                1   38204             38204               819
BMT          7397   66459   GE-Z HR-CT HR-A,B,C, & DRB1 STD                 1,862.00                1   38204             38204               819
BMT          7397   66456   GE-Z IR-CT IR-A,B,C,HR-DRB1 URG                 1,686.00                1   38204             38204               819
BMT          7397   66123   GE-Z PBSC ADD CHARGE COURIER                    5,398.00                1   38204             38204               819
BMT          7397   66124   GO PBSC ADD CHARGE COURIER                      2,256.00                1   38204             38204               819
BMT          7397   66220   GO UL ADD CHARGE FOR COURIER                    2,256.00                1   38204             38204               819
BMT          7397   66221   GO UL ADD CHARGE FOR SHIPPING                     318.00                1   38204             38204               819
BMT          7397   66222   GO UL PHYSICAL EXAM                             2,573.00                1   38204             38204               819
BMT          7397   33223   GO UL WORKUP CANCELLATION                       2,595.00                1   99199         Z7318                   819
BMT          7397   66219   GO UNSTIMULATED LEUKAPHERESIS                  19,338.00                1   38204             38204               819
BMT          7397   66239   HUG ADD CHARGE FOR COURIER                      7,413.00                1   38204             38204               819
BMT          7397   66125   HUG PBSC ADD CHARGE COURIER                     7,413.00                1   38204             38204               819
BMT          7397   66159   IDM SAMPLE COLL AND CNTRL LABS                    712.00                1   38204             38204               819
BMT          7397   66126   IL PBSC ADD CHARGE COURIER                      5,048.00                1   38204             38204               819
BMT          7397   66085   IR-H ADD CHARGE PBSC COURIER                    6,077.00                1   38204             38204               819
BMT          7397   66066   IR-H ADDL PRECOLL SAMPLE                          504.00                1   38204             38204               819
BMT          7397   66065   IR-H CONFIMATORY TYPING                           504.00                1   38204             38204               819
BMT          7397   66068   IR-H IDM SAMPLE                                   679.00                1   38204             38204               819
BMT          7397   66070   IR-H IDM SAMPLE COLL AND CNT LABS                 887.00                1   38204             38204               819
BMT          7397   66067   IR-H INFECTIOUS DISEASE                         1,007.00                1   38204             38204               819
BMT          7397   66064   IR-H IR-DR TYPING                                 438.00                1   38204             38204               819
BMT          7397   66071   IR-H MARROW COLLECTION                         24,550.00                1   38204             38204               819
BMT          7397   66086   IR-H MARROW INFO SESSION                          723.00                1   38204             38204               819
BMT          7397   66087   IR-H MARROW PHYSICAL EXAM                         898.00                1   38204             38204               819
BMT          7397   66090   IR-H PBSC FILGRASTIM INJ                        2,102.00                1   38204             38204               819
BMT          7397   66088   IR-H PBSC INFO SESSION                            723.00                1   38204             38204               819
BMT          7397   66089   IR-H PBSC PHYSICAL EXAM                           898.00                1   38204             38204               819
BMT          7397   66069   IR-H PRE COLL IDM SAMPLE COMBO                    679.00                1   38204             38204               819
BMT          7397   66083   IR-H PRIM PBSC COLL                            31,394.00                1   38204             38204               819
BMT          7397   66084   IR-H SEC PBSC COLL                             31,394.00                1   38204             38204               819
BMT          7397   66078   IR-M ADD CHARGE UL SHIPPING                       756.00                1   38204             38204               819
BMT          7397   66077   IR-M ADD CHARGE UL COURIER                      6,077.00                1   38204             38204               819
BMT          7397   66075   IR-M ADD CHRG PBSC COURIER                      6,077.00                1   38204             38204               819



                                                                Page 56 of 676
                                                                CM 06/15/07


 Dept                                                                                                                M/cal
        Cost Ctr.   SIM#                   Description                     Price      Stats/bill       CPT     Mod             Mod   Rev Code
 Code                                                                                                                HCPCS
BMT          7397   66060   IR-M ADDL PRECOLL SAMPLE                         361.00                1   38204           38204               819
BMT          7397   66059   IR-M CONFIRMATORY TYPING                         361.00                1   38204           38204               819
BMT          7397   66058   IR-M EXT DR PROC AND TYPING                      449.00                1   38204           38204               819
BMT          7397   66061   IR-M IDM SAMPLE COLLECTION                       438.00                1   38204           38204               819
BMT          7397   66057   IR-M IR-DR TYPING                                372.00                1   38204           38204               819
BMT          7397   66072   IR-M MARROW COLLECTION                        34,482.00                1   38204           38204               819
BMT          7397   66081   IR-M PBSC FILGRASTRIM INJ                      7,895.00                1   38204           38204               819
BMT          7397   66080   IR-M PBSC WORK UP CANCEL                       2,595.00                1   38204           38204               819
BMT          7397   66062   IR-M PRECOLL IDM SAMPLE COMBO                    438.00                1   38204           38204               819
BMT          7397   66073   IR-M PRIM PBSC COLL                           34,482.00                1   38204           38204               819
BMT          7397   66063   IR-M SAMPLE COLL AND CENTRAL LAB                 624.00                1   38204           38204               819
BMT          7397   66074   IR-M SEC PBSC COLL                            34,482.00                1   38204           38204               819
BMT          7397   66082   IR-M UL WORK UP CANCELLATION                   1,478.00                1   38204           38204               819
BMT          7397   66076   IR-M UNSTIMULATED LEUKAPHERESIS                7,380.00                1   38204           38204               819
BMT          7397   66079   IR-M WORK UP CANCEL (M)                        2,595.00                1   38204           38204               819
BMT          7397   66177   IT COURIER CHARGE FOR MARROW                   5,048.00                1   38204           38204               819
BMT          7397   66187   IT PBSC PHYSICAL EXAM                          1,139.00                1   38204           38204               819
BMT          7397   66188   IT PBSC WORKUP CANCELLATION                    1,128.00                1   38204           38204               819
BMT          7397   66182   JB WB ADD CHARGE COR COURIER                   5,617.00                1   38204           38204               819
BMT          7397   66178   JP COURIER CHARGE FOR MARROW                   5,617.00                1   38204           38204               819
BMT          7397   66129   KO ADD CONFIRMATORY SAMPLE                       558.00                1   38204           38204               819
BMT          7397   66145   KO AUTOLOGOUS UNIT                               767.00                1   38204           38204               819
BMT          7397   66128   KO CONFIRMATORY SAMPLE                           558.00                1   38204           38204               819
BMT          7397   66132   KO IDM SAMP COLL AND CENTRL LAB                  821.00                1   38204           38204               819
BMT          7397   66130   KO IDM SAMPLE COLLECTION                         635.00                1   38204           38204               819
BMT          7397   66133   KO MARROW COLLECTION                          34,000.00                1   38204           38204               819
BMT          7397   66143   KO MARROW DONOR INFO                             613.00                1   38204           38204               819
BMT          7397   66144   KO MARROW PHYSICAL EXAM                        1,905.00                1   38204           38204               819
BMT          7397   66146   KO MARROW WORK UP CANCEL                       2,059.00                1   38204           38204               819
BMT          7397   66136   KO PBSC ADD CHARGE                             6,187.00                1   38204           38204               819
BMT          7397   66147   KO PBSC DONOR INFO SESSION                       602.00                1   38204           38204               819
BMT          7397   66148   KO PBSC DONOR PHYSICAL EXAM                    1,872.00                1   38204           38204               819
BMT          7397   66150   KO PBSC FILGRASTIM INJ                         4,424.00                1   38204           38204               819
BMT          7397   66149   KO PBSC WORK UP CANCEL                         2,091.00                1   38204           38204               819
BMT          7397   66131   KO PRECOLL-IDM SAMP COLL COMBO                   635.00                1   38204           38204               819



                                                               Page 57 of 676
                                                             CM 06/15/07


 Dept                                                                                                             M/cal
        Cost Ctr.   SIM#                  Description                   Price      Stats/bill       CPT     Mod             Mod   Rev Code
 Code                                                                                                             HCPCS
BMT          7397   66134   KO PRIM PBSC COLLECTION                    36,715.00                1   38204           38204               819
BMT          7397   66135   KO SEC PBSC COLLECTION                     36,715.00                1   38204           38204               819
BMT          7397   66138   KO UL ADD CHARGE FOR COURIER                6,187.00                1   38204           38204               819
BMT          7397   66139   KO UL ADD CHARGE FOR SHIPPING                 756.00                1   38204           38204               819
BMT          7397   66151   KO UL DONOR PHYSICAL EXAM                   1,522.00                1   38204           38204               819
BMT          7397   66152   KO UL WORK UP CANCELLATION                  1,347.00                1   38204           38204               819
BMT          7397   66137   KO UNSTIMULATED LEUKAPHERESIS              11,826.00                1   38204           38204               819
BMT          7397   66141   KO WB ADD CHARGE FOR COURIER                6,187.00                1   38204           38204               819
BMT          7397   66142   KO WB ADD CHARGE FOR SHIPPING                 756.00                1   38204           38204               819
BMT          7397   66140   KO WB UNIT COLL                             4,511.00                1   38204           38204               819
BMT          7397   66160   MARROW COLLECTION                          29,554.00                1   38204           38204               819
BMT          7397   66156   MX ADD PRECOLL SAMPLE                         777.00                1   38204           38204               819
BMT          7397   66169   MX AUTOLOGOUS BLOOD UNIT                      263.00                1   38204           38204               819
BMT          7397   66154   MX EXT DR PROCURE AND TYPING                  449.00                1   38204           38204               819
BMT          7397   66155   MX CONFIRMATORY TYPING                        777.00                1   38204           38204               819
BMT          7397   66157   MX IDM SAMPLE COLL                            526.00                1   38204           38204               819
BMT          7397   66153   MX IR-DR TYPING                               339.00                1   38204           38204               819
BMT          7397   66167   MX MARROW INFO SESSION                        339.00                1   38204           38204               819
BMT          7397   66168   MX MARROW PHYSICAL EXAM                     1,007.00                1   38204           38204               819
BMT          7397   66163   MX PBSC ADD CHARGE COURIER                  3,909.00                1   38204           38204               819
BMT          7397   66174   MX PBSC FILGRASTIM INJ                        756.00                1   38204           38204               819
BMT          7397   66171   MX PBSC INFO SESSION                          339.00                1   38204           38204               819
BMT          7397   66172   MX PBSC PHYSICAL EXAM                       1,007.00                1   38204           38204               819
BMT          7397   66173   MX PBSC WORKUP CANCEL                       2,595.00                1   38204           38204               819
BMT          7397   66158   MX PRECOLL IDM SAMPLE COMB                    526.00                1   38204           38204               819
BMT          7397   66162   MX SEC PBSC COLL                           26,017.00                1   38204           38204               819
BMT          7397   66165   MX UL ADD CHARGE COURIER                    3,909.00                1   38204           38204               819
BMT          7397   66166   MX UL ADD CHARGE SHIPPING                     756.00                1   38204           38204               819
BMT          7397   66175   MX UL PHYSICAL EXAM                         1,007.00                1   38204           38204               819
BMT          7397   66176   MX UL WORKUP CANCELLATION                   2,595.00                1   38204           38204               819
BMT          7397   66164   MX UNSTIMULATED LEUKAPHERESIS               6,603.00                1   38204           38204               819
BMT          7397   66475   NE CORD BLOOD UNIT                         41,621.00                1   38204           38204               819
BMT          7397   66179   NE COURIER CHARGE FOR MARROW                5,847.00                1   38204           38204               819
BMT          7397   66487   NE HR DQB1 STD                                318.00                1   38204           38204               819
BMT          7397   66493   NE HR-A TYPING STD                            372.00                1   38204           38204               819



                                                            Page 58 of 676
                                                           CM 06/15/07


 Dept                                                                                                           M/cal
        Cost Ctr.   SIM#                  Description                 Price      Stats/bill     CPT     Mod               Mod   Rev Code
 Code                                                                                                          HCPCS
BMT          7397   66499   NE HR-B TYPING STD                          372.00                1 38204             38204               819
BMT          7397   66481   NE HR-C TYPING STD                          372.00                1 38204             38204               819
BMT          7397   66509   NE IR-DRB3,4,5 TYPING STD                   329.00                1 38204             38204               819
BMT          7397   66189   NE PBSC INFO SESSION                        482.00                1 38204             38204               819
BMT          7397   66190   NE PBSC PHYSICAL EXAM                       821.00                1 38204             38204               819
BMT          7397   66191   NE PBSC WORKUP CANCELLATION               3,734.00                1 38204             38204               819
BMT          7397   66469   NE SHIPPING COST                          3,416.00                1 38204             38204               819
BMT          7397   66180   NO COURIER CHARGE FOR MARROW              5,048.00                1 38204             38204               819
BMT          7397   66181   NO WB ADD CHARGE FOR MARROW               5,048.00                1 38204             38204               819
BMT          7397   66183   PO COURIER CHARGE FOR MARROW              3,099.00                1 38204             38204               819
BMT          7397   66184   PO WB ADD CHARGE FOR COURIER              3,099.00                1 38204             38204               819
BMT          7397   66214   SA ADD CONFIRMATORY TYPING                1,391.00                1 38204             38204               819
BMT          7397   66213   SA CONFIRMATORY TYPING                    1,391.00                1 38204             38204               819
BMT          7397   66212   SA EXT DR PROCURE AND TYPING                460.00                1 38204             38204               819
BMT          7397   66217   SA IDM SAMPLE COLL AND CNTRL LAB            986.00                1 38204             38204               819
BMT          7397   66215   SA IDM SAMPLE COLLECTION                    712.00                1 38204             38204               819
BMT          7397   66218   SA IR ABC TYPING STD                      1,062.00                1 38204             38204               819
BMT          7397   66211   SA IR DR TYPING                             416.00                1 Z7318         Z7318                   819
BMT          7397   66260   SA MARROW ADDL CHARGE COURIER             7,326.00                1 38204             38204               819
BMT          7397   66257   SA MARROW COLLECTION                     31,065.00                1 38204             38204               819
BMT          7397   66261   SA MARROW W-UP CANCEL                     2,267.00                1 38204             38204               819
BMT          7397   66216   SA PRECOLL IDM SAMPLE COMBO                 712.00                1 38204             38204               819
BMT          7397   66258   SA PRIM PBSC COLLECTION                  31,065.00                1 38204             38204               819
BMT          7397   66259   SA SEC PBSC COLLECTION                   31,065.00                1 38204             38204               819
BMT          7397   66185   SG COURIER CHARGE FOR MARROW              6,756.00                1 38204             38204               819
BMT          7397   66186   SG WB ADD CHARGE FOR COURIER              6,756.00                1 38204             38204               819
BMT          7397   66207   SL ADD CONFIRMATORY TYPING                  657.00                1 38204             38204               819
BMT          7397   66206   SL CONFIRMATORY TYPING                      657.00                1 38204             38204               819
BMT          7397   66205   SL EXT DR PROCE AND TYPING                1,128.00                1 38204             38204               819
BMT          7397   66210   SL IDM SAMPLE COLL AND CNTRL LAB          1,018.00                1 38204             38204               819
BMT          7397   66208   SL IDM SAMPLE COLLECTION                    854.00                1 38204             38204               819
BMT          7397   66204   SL IR-DR TYPING                             931.00                1 38204             38204               819
BMT          7397   66243   SL MARROW ADD CHARGE COURIER              4,117.00                1 38204             38204               819
BMT          7397   66161   MX PRIM PBSC COLL                        26,017.00                1 38204             38204               819
BMT          7397   66249   SL MARROW AUTOLOGOUS BLOOD UNIT             318.00                1 38204             38204               819



                                                          Page 59 of 676
                                                            CM 06/15/07


 Dept                                                                                                           M/cal
        Cost Ctr.   SIM#                 Description                  Price      Stats/bill       CPT     Mod             Mod   Rev Code
 Code                                                                                                           HCPCS
BMT          7397   66240   SL MARROW COLLECTION                     26,510.00                1   38204           38204               819
BMT          7397   66247   SL MARROW INFO SESSION                      307.00                1   38204           38204               819
BMT          7397   66248   SL MARROW PHYSICAL EXAM                     865.00                1   38204           38204               819
BMT          7397   66250   SL MARROW WORK-UP CANCEL                  2,529.00                1   38204           38204               819
BMT          7397   66254   SL PBSC FILGRASTIM INJ                    1,544.00                1   38204           38204               819
BMT          7397   66251   SL PBSC INFO SESSION                        307.00                1   38204           38204               819
BMT          7397   66252   SL PBSC PHYSICAL EXAM                       865.00                1   38204           38204               819
BMT          7397   66253   SL PBSC W-UP CANCEL                       2,529.00                1   38204           38204               819
BMT          7397   66209   SL PRECOLL IDM SAMPLE COMBO                 854.00                1   38204           38204               819
BMT          7397   66241   SL PRIM PBSC COLL                        14,662.00                1   38204           38204               819
BMT          7397   66242   SL SEC PBSC COLL                         10,862.00                1   38204           38204               819
BMT          7397   66245   SL UL ADD CHARGE COURIER                  4,117.00                1   38204           38204               819
BMT          7397   66246   SL UL ADD CHARGE SHIPPING                   756.00                1   38204           38204               819
BMT          7397   66255   SL UL PHYSICAL EXAM                         865.00                1   38204           38204               819
BMT          7397   66256   SL UL W-UP CANCEL                         2,529.00                1   38204           38204               819
BMT          7397   66244   SL UNSTIMULATED LEUKAPHERESIS             5,727.00                1   38204           38204               819
BMT          7397   66192   SP COURIER CHARGE FOR MARROW              5,048.00                1   38204           38204               819
BMT          7397   66460   SP HR-CT HR-A,B,C & DRB1 STD              1,577.00                1   38204           38204               819
BMT          7397   66463   SP HR-CT HR-A,B,C & DRB1 URG              1,785.00                1   38204           38204               819
BMT          7397   66454   SP IR-CT IR-A,B,C,HR-DRB1 STD             1,139.00                1   38204           38204               819
BMT          7397   66457   SP IR-CT IR-A,B,C,HR-DRB1 URG             1,391.00                1   38204           38204               819
BMT          7397   66193   SWE COURIER CHARGE FOR MARROW             5,048.00                1   38204           38204               819
BMT          7397   66194   SWE WB ADD CHARGE FOR COURIER             5,048.00                1   38204           38204               819
BMT          7397   66476   SWI CORD BLOOD UNIT                      43,351.00                1   38204           38204               819
BMT          7397   66195   SWI COURIER CHARGE FOR MARROW             5,048.00                1   38204           38204               819
BMT          7397   66494   SWI HR-A TYPING STD                         394.00                1   38204           38204               819
BMT          7397   66500   SWI HR-B TYPING STD                         383.00                1   38204           38204               819
BMT          7397   66482   SWI HR-C TYPING STD                         307.00                1   38204           38204               819
BMT          7397   66488   SWI HR-DQB1 STD                             471.00                1   38204           38204               819
BMT          7397   66505   SWI HR-DRB1 TYPING STD                      471.00                1   38204           38204               819
BMT          7397   66512   SWI IR-C TYPING STD                         339.00                1   38204           38204               819
BMT          7397   66127   SWI IR-DR TYPING                            350.00                1   38204           38204               819
BMT          7397   66508   SWI IR-DRB3,4,5 TYPING STD                  383.00                1   38204           38204               819
BMT          7397   66470   SWI SHIPPING COST                         3,121.00                1   38204           38204               819
BMT          7397   66197   SWI UL ADD CHARGE FOR COURIER             5,048.00                1   38204           38204               819



                                                        Page 60 of 676
                                                                CM 06/15/07


 Dept                                                                                                                    M/cal
        Cost Ctr.   SIM#                   Description                    Price          Stats/bill      CPT     Mod               Mod    Rev Code
 Code                                                                                                                   HCPCS
BMT          7397   66198   SWI UL ADD CHARGE FOR SHIPPING                  602.00                    1 38204              38204                819
BMT          7397   66199   SWI UL PHYSICAL EXAM                          4,238.00                    1 38204              38204                819
BMT          7397   66200   SWI UL WORKUP CANCELLATION                    2,770.00                    1 38204              38204                819
BMT          7397   66201   TW COURIER CHARGE FOR MARROW                  6,187.00                    1 38204              38204                819
BMT          7397   66461   TW HR-CT HR-A,B,C & DRB1 STD                  1,336.00                    1 38204              38204                819
BMT          7397   66464   TW HR-CT HR-A,B,C & DRB1 URG                  1,434.00                    1 38204              38204                819
BMT          7397   66455   TW IR-CT IR-A,B,C,HR-DRB1 STD                   799.00                    1 38204              38204                819
BMT          7397   66458   TW IR-CT IR-A,B,C,HR-DRB1 URG                 1,051.00                    1 38204              38204                819
BMT          7397   66202   TW WB ADD CHARGE FOR COURIER                  6,187.00                    1 38204              38204                819
BMT          7397    1128   US MARROW PROCEDURE PER DONOR                25,557.00                    1 Z7318          Z7318                    819
BMT          7397   66111   US PBSC ADD CHARGE COURIER                    2,256.00                    1 38204              38204                819
BMT          7397   66224   US WB ADD CHARGE FOR COURIER                  2,256.00                    1 38204              38204                819
BMT          7397   66203   WA COURIER CHARGE FOR MARROW                  5,048.00                    1 38204              38204                819
BUS          8530       3   CLAIM AUDIT ADJUSTMENT                            0.00                    1                                         999
BUS          8530       1   PBS PURCHASED SERVICES                            0.00                    1                                         810
CAR          7590   65014   ALLD HLTH PHN CNSLT 1/4 HR                        0.00   S                  Z5406          Z5406                    519
CAR          7590   65013   ALLD HLTH TEAM CONF 1/4 HR                       12.05                    1 Z4302          Z4302                    519
CAR          7590   65125   BLOOD COLLECTION, ACCESS DEVICE                   0.00   S                   36540                                  515
CAR          7590   65001   CENTER COORDINATOR                              103.28                    1 Z4300         Z4300                     519
CAR          7590   65132   CENTRAL LINE CATH REPAIR                          0.00   S                   93799            93799                 515
CAR          7590   65002   COMP CHART REV & RPT                             77.46                    1 Z4304         Z4304                     519
CAR          7590   65031   DECLOT VASCULAR CATH                              0.00   S                   36550            36550                 515
CAR          7590   65015   GROUP TEACHING/SUPPORT                            0.00   S                  Z4314         Z4314                     519
CAR          7590   65126   IM INJ ANTIBIOTIC                                 0.00   S                   90772            90772                 260
CAR          7590   65040   INJ, IM/SUBQ                                      0.00   S                   90772            90772                 260
CAR          7590   65041   INJ, IV PUSH                                      0.00   S                   90774            90774                 260
CAR          7590   65028   INTRO INTRACATH VEIN, BILAT                       0.00   S                   36000     50     36000      50         515
CAR          7590   65027   INTRO INTRACATH VEIN, UNI                         0.00   S                   36000            36000                 515
CAR          7590   65004   NURSE EVALUATION 1/2 HR                          24.10                    1 Z4301         Z4301                     519
CAR          7590   65006   NURSE PHONE CNSLT 1/4 HR                          0.00   S                  Z5406         Z5406                     519
CAR          7590   65005   NURSE TEAM CONF 1/4 HR                           12.05                    1 Z4310         Z4310                     519
CAR          7590   65003   PERIODIC CHART REV & RPT                         43.03                    1 Z4303         Z4303                     519
CAR          7590   66320   SEDATION <5YRS OLD 1ST 30 MINUTES               567.00                    1 99143             99143                 370
CAR          7590   66321   SEDATION >5YRS OLD 1ST 30 MINUTES               567.00                    1 99144             99144                 370
CAR          7590   66322   SEDATION EACH ADDL 15 MINUTES                   283.00                    1 99145             99145                 370



                                                            Page 61 of 676
                                                           CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                  Description                 Price          Stats/bill        CPT      Mod                Mod   Rev Code
 Code                                                                                                                  HCPCS
CAR          7590   65130   SELF CARE TRAIN, EA 15 MIN                    0.00   S                     97535              97535                515
CAR          7590   65131   SKIN TEST, PPD INTRADERMAL                    0.00   S                     86580              86580   TC           515
CAR          7590    7590   USE OF ROOM CHARGE                           50.00                    1    99211          Z7500                    515
CAR          7590   61010   USE OF ROOM - NO CHARGE                       0.00   S                     99211          Z7500                    515
CAR          7590   60600   USE OF ROOM CHARGE                           50.00                    1    99211          Z7500                    515
CAR          7590   65032   WITHDRAWL OF ARTERIAL BLOOD                 121.00   S                     36600              36600                515
CAT          7680   10196   ABS/PERTUM PERC DRAIN                     2,187.76                    1    49021   TC         49021   TC           761
CAT          7680   20088   ANESTH/SED 15 MIN                             0.00   S                    A4649           Z7610                    371
CAT          7680   10014   BX BONE DEEP (VERT/FEMUR)                 2,187.76                    1    20225   TC         20225   TC           761
CAT          7680   10154   BX LUNG/MEDSTM PERC NDL                   2,915.03                    1    32405              32405                761
CAT          7680    4611   CT ABD W CONTRAST                         2,478.08                    1    74160   TC         74160   TC           352
CAT          7680    4629   CT ABD W/WO CONTRAST                      2,915.03                    1    74170   TC         74170   TC           352
CAT          7680    4603   CT ABD WO CONTRAST                        2,274.19                    1    74150   TC         74150   TC           352
CAT          7680   65449   CT ANGIO HEAD W/WO CONTRAST               2,038.01                    1    70496          NC                       351
CAT          7680   65450   CT ANGIO NECK W/WO CONTRAST               2,038.01                    1    70498          NC                       352
CAT          7680   65446   CT ANGIOGRAM ABD W/WO CONTRAST            2,649.39                    1    74175          NC                       352
CAT          7680   65447   CT ANGIOGRAM CHEST W/WO CONTRAST          2,038.01                    1    71275   TC         72575   TC           350
CAT          7680   65445   CT ANGIOGRAM PELVIS W/WO CONTRAST         2,649.39                    1    72191          NC                       352
CAT          7680   65461   CT BIOPSY NEEDLE                            203.75                    1   A4649           Z7610                    621
CAT          7680   65458   CT BONE MINERAL DENSITY STUDY AXI           815.26                    1    77078          NC                       352
CAT          7680   65451   CT C-SPINE W/WO CONTRAST                  2,621.61                    1    72127   TC         72127   TC           352
CAT          7680    3712   CT CERVCL SPINE W CONTRAST                2,139.96                    1    72126   TC         72126   TC           352
CAT          7680    3704   CT CERVCL SPINE W/O CONTRAST              1,936.07                    1    72125   TC         72125   TC           352
CAT          7680    3514   CT CHEST W CONTRAST                       2,478.08                    1    71260   TC         71260   TC           352
CAT          7680    3506   CT CHEST W/O CONTRAST                     2,274.19                    1    71250   TC         71250   TC           352
CAT          7680    3522   CT CHEST W/WO CONTRAST                    2,915.03                    1    71270   TC         71270   TC           352
CAT          7680   65454   CT CYSTERNOGRAM                             877.02                    1    70015   TC         70015   TC           320
CAT          7680    3837   CT DRAINAGE OF SUB DIA/PHRE AB            2,422.52                    1    49021          Z7506                    352
CAT          7680    3316   CT FACIAL BONES/SINUS W/CONT              1,894.48                    1    70487   TC         70487   TC           351
CAT          7680    3308   CT FACIAL BONES/SINUS W/O CONT            1,690.59                    1    70486   TC         70486   TC           351
CAT          7680    3324   CT FACIAL BONES/SINUS W/WO CONT           2,187.76                    1    70488   TC         70488   TC           351
CAT          7680    4751   CT GUIDANCE FOR NEEDLE BIOPSY             1,080.77                    1    77012   TC         77012   TC           350
CAT          7680   65455   CT GUIDANCE FOR PLACEMENT OF RAD          1,019.01                    1    77014   TC         77014   TC           350
CAT          7680   65462   CT GUIDEWIRE                                209.95                    1   A4649           Z7610                    621
CAT          7680    3019   CT HEAD W/ CONTRAST                       1,894.48                    1    70460   TC         70460   TC           351



                                                          Page 62 of 676
                                                             CM 06/15/07


 Dept                                                                                                                     M/cal
        Cost Ctr.   SIM#                  Description                   Price          Stats/bill        CPT      Mod              Mod   Rev Code
 Code                                                                                                                    HCPCS
CAT          7680    3001   CT HEAD W/O CONTRAST                        1,690.59                    1    70450   TC         70450 TC           351
CAT          7680    3027   CT HEAD W/WO CONTRAST                       2,187.76                    1    70470   TC         70470 TC           351
CAT          7680    3845   CT HEPATO DRAIN/ABSCESS                     2,495.00                    1    47011          Z7506                  352
CAT          7680   65457   CT ISOVUE M 200/20 ML                           0.00   S                    A4641           A4641                  255
CAT          7680    7200   CT IV START                                     0.00   S                     36000                                 371
CAT          7680    7184   CT IV START (NURSE)                             0.00   S                     36000   TC         36000   TC         761
CAT          7680    7192   CT IV START (NURSE)                             0.00   S                     36000   YS         36000   YS         761
CAT          7680    5196   CT KANGAROO FEEDING BAG                        89.54                    1   A4649           Z7610                  271
CAT          7680   65453   CT L-SPINE W/WO CONTRAST                    2,621.61                    1    72133   TC         72133   TC         352
CAT          7680   65456   CT LIMITED/LOCALIZED STUDY                  1,120.95                    1    76380   TC         76380   TC         350
CAT          7680    4454   CT LOWER EXT W CONTRAST                     2,331.44                    1    73701   TC         73701   TC         352
CAT          7680    4447   CT LOWER EXT W/O CONTRAST                   2,127.55                    1    73700   TC         73700   TC         352
CAT          7680    4462   CT LOWER EXT W/WO CONTRAST                  2,769.80                    1    73702   TC         73702   TC         352
CAT          7680    3910   CT LUMBAR SPINE W CONTRAST                  2,139.96                    1    72132   TC         72132   TC         352
CAT          7680    3902   CT LUMBAR SPINE W/O CONTRAST                1,936.07                    1    72131   TC         72131   TC         352
CAT          7680   65444   CT MYELOGRAM TRAY                             174.42                    1   A4649           Z7610                  621
CAT          7680    3217   CT OBT/SEL/EAR W CONT                       1,894.48                    1    70481   TC         70481   TC         351
CAT          7680    3209   CT OBT/SEL/EAR W/O CONT                     1,690.59                    1    70480   TC         70480   TC         351
CAT          7680    3225   CT OBT/SEL/EAR W/WO CONT                    2,187.76                    1    70482   TC         70482   TC         351
CAT          7680    7119   CT ORAL CONTRAST                                0.00   S                    A4641           A4641       ZS         255
CAT          7680    4017   CT PELVIS W CONTRAST                        2,331.44                    1    72193   TC         72193   TC         352
CAT          7680    4009   CT PELVIS W/O CONTRAST                      2,127.55                    1    72192   TC         72192   TC         352
CAT          7680    4025   CT PELVIS W/WO CONTRAST                     2,769.80                    1    72194   TC         72194   TC         352
CAT          7680   65460   CT PERCUFIX                                    47.80                    1   A4649           Z7610                  621
CAT          7680    7283   CT PULSE OXIMETRY EACH (B)                      0.00   S                     94760              94760              460
CAT          7680    7275   CT PULSE OXIMETRY EACH (N)                      0.00   S                     94760              94760              460
CAT          7680   65463   CT PUNCTURE NEEDLE                             60.21                    1   A4649           Z7610                  621
CAT          7680    7234   CT RECOVERY ROOM                               72.62                    1   Z7512           Z7512                  710
CAT          7680    7259   CT RECOVERY ROOM                               72.62                    1   Z7512           Z7512                  710
CAT          7680    3415   CT SFT TISS NCK W CONTRAST                  1,980.91                    1    70491   TC         70491   TC         352
CAT          7680    3407   CT SFT TISS NCK W/O CONTRAST                1,777.02                    1    70490   TC         70490   TC         352
CAT          7680    3423   CT SFT TISS NCK W/WO CONTRAST               2,478.08                    1    70492   TC         70492   TC         352
CAT          7680   65452   CT T-SPINE W/WO CONTRAST                    3,060.12                    1    72130   TC         72130   TC         352
CAT          7680    7101   CT TEMPORAL BONES W/O CNTRST                1,690.59                    1    70480   TC         70480   TC         351
CAT          7680    3811   CT THORACIC SPINE W CONTRAST                2,343.70                    1    72129   TC         72129   TC         352



                                                            Page 63 of 676
                                                            CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                  Description                  Price          Stats/bill     CPT    Mod                Mod   Rev Code
 Code                                                                                                              HCPCS
CAT          7680    3803   CT THORACIC SPINE WO/CONT                  2,139.96                    1 72128 TC         72128   TC           352
CAT          7680   65443   CT TROCAR NEEDLE                             101.94                    1 A4649        Z7610                    621
CAT          7680    4314   CT UPPER EXT W CONTRAST                    2,331.44                    1 73201 TC         73201   TC           352
CAT          7680    4306   CT UPPER EXT W/O CONTRAST                  2,127.55                    1 73200 TC         73200   TC           352
CAT          7680    4322   CT UPPER EXT W/WO CONTRAST                 2,769.80                    1 73202 TC         73202   TC           352
CAT          7680   65459   CT VESSEL DILATOR                             47.80                    1 A4649        Z7610                    621
CAT          7680   10220   DRAIN PERIRENAL/RENAL ABS PERC             3,206.76                    1 50021 TC         50021   TC           761
CAT          7680   10212   DRAIN RETRO ABSCESS PERC                   3,351.85                    1 49061 TC         49061   TC           761
CAT          7680   10238   INCIS/DRN PELVIRECTAL ABSCESS              3,206.76                    1 45020 TC         45020   TC           761
CAT          7680   10170   LIVER BX DONE W/OTHER MAJ PROC             1,457.52                    1 47001        Z7506                    761
CAT          7680   10162   LUNG/PLEURA PERC DRN ABS/CYST              2,915.03                    1 32201            32201                761
CAT          7680    5998   OPTIRAY 320/50ML                               0.00   S                  A4641        A4641                    255
CAT          7680    6004   OPTIRAY 320/50ML                               0.00   S                  A4641        A4641                    255
CAT          7680   65154   PERC RADIOFREQUENCY ABLATION               3,362.71                    1 77013 TC         77013   TC           350
CAT          7680    5170   RD CT WRITTEN CONS OUTSD EXAM                  0.00   S                   76140                                350
CAT          7680   10246   THCENT W/INS TB W/WO WTR SEAL              2,915.03                    1 32002            32002                761
CAT          7680   10253   THORCENT PNCT PLEUR CAV ASP                    0.00                    1 32000        Z7506                    761
CAT          7680   10188   TUBE THARACOST W/WO WTR SEAL               2,915.03                    1 32020            32020                761
CCL          7592   43103   *X PACEMAKER, DBL CHMBR W/LEAD            18,200.00                    1 C1785        C1785                    275
CCL          7592   43102   *X PACEMAKER, SNGL CHMBR W/LEAD           15,200.00                    1 C1786        C1786                    275
CCL          7592   42095   ABLATION CATHETER                          1,812.50                    1 A4649        Z7610                    272
CCL          7592   66710   ACU NAV INTRACARDIAC ULTRASND CTH          5,600.00                    1 C1759        C1759                    272
CCL          7592   66295   AICID CAPSURE NOVUS                       13,000.00                    1 C1898        C1898                    278
CCL          7592   66372   AICD CAPSURE NOVUS LEAD NON COIL           1,812.50                    1 C1876        C1896                    278
CCL          7592   66294   AICD SPRINT FIDELIS                        1,812.50                    1 C1777        C1777                    278
CCL          7592   66373   AICD SPRINT FIDELIS LEAD ENDO DUA         14,000.00                    1 C1895        C1895                    278
CCL          7592   66371   AICD SPRINT FIDELIS LEAD, SINGLE          13,000.00                    1 C1777        C1777                    278
CCL          7592   66149   AICD, DOUBLE MEDTRONICS                   50,000.00                    1 C1721        C1721                    278
CCL          7592   66148   AICD, SINGLE MEDTRONICS                   46,000.00                    1 C1722        C1722                    278
CCL          7592   66145   AMPLATZER PLUG                               800.00                    1 C1817        L8699                    272
CCL          7592   66100   AMPLATZER VASCULAR PLUG                    1,125.00                    1 C1817        L8699                    272
CCL          7592   45551   ANGIOGRAPHY- OTHER                             0.00   S                   76499 TC        76499 TC             320
CCL          7592   42707   ANGIOPLASTY CATHS                            969.00                    1 C1725        Z7610                    272
CCL          7592   45613   AORTOGRAPHY, THORACIC                      1,642.50                    1 75600 TC         75600 TC             320
CCL          7592   42558   BALLOON CATHS/DIAGNOSTIC                      87.00                    1 A4649        Z7610                    272



                                                           Page 64 of 676
                                                           CM 06/15/07


 Dept                                                                                                                 M/cal
        Cost Ctr.   SIM#                  Description                 Price        Stats/bill        CPT      Mod              Mod   Rev Code
 Code                                                                                                                HCPCS
CCL          7592   45625   BILATERAL EXT VEIN                          733.65                  1 75822 TC              75822 TC           320
CCL          7592   42855   BIOPSY FORCEPS                              660.00                  1 A4649             Z7610                  272
CCL          7592   45643   CARDIAC FLUROSCOPY UP TO ONE HOUR           273.73                  1 76000 TC              76000 TC           320
CCL          7592    6604   CARDIAC OUTPUT MEASUREMENT                  427.05                  1 93561 TC              93561 TC           480
CCL          7592   66138   CARTO ELECTO ANATOMICAL CATH              4,200.00                  1 C1732             Z7610                  272
CCL          7592   66139   CARTO REFERENCE PATCH                       600.00                  1 C1893             Z7610                  272
CCL          7592   41006   CATH LAB                                      0.00 S                                                           481
CCL          7592   41253   CATH LAB TREATMENT ROOM                       0.00 S                                    Z7500                  481
CCL          7592   41303   CATH LAB TRTMNT RM EA ADD HR                  0.00 S                                    Z7500                  481
CCL          7592   41055   CATH PROC RM 1ST HR                         389.82                  1   Z7506           Z7506                  450
CCL          7592   41105   CATH PROC RM 1ST SUBSQ 30 MIN               223.38                  1   Z7508           Z7508                  480
CCL          7592   41154   CATH PROC RM 2ND SUBSQ 30 MIN               223.38                  1   Z7510           Z7510                  480
CCL          7592   41204   CATH PROC RM EA ADDL 1/2 HR                  82.13                  1   Z7506           Z7506                  480
CCL          7592   45642   CONG R & L HEART CATH VIA ASD OR          6,000.00                  1    93533   TC         93533   TC         481
CCL          7592   45641   CONG R W/TRANSEPTAL L CATH VIA IN         6,000.00                  1    93532   TC         93532   TC         481
CCL          7592   45640   CONGENITAL R & L HEART CATH               4,000.00                  1    93531   TC         93531   TC         481
CCL          7592   45639   CONGENITAL R HEART CATH                   2,700.00                  1    93530   TC         93530   TC         481
CCL          7592   43234   CONTRAST MEDIA                                4.00                  1   Q9950           Q9950                  636
CCL          7592   45634   CORONARY ART W/O L HEART CATH             1,900.00                  1    93508   TC         93508   TC         481
CCL          7592   66291   CRYOCATH ABLATION CATHETER                3,507.00                  1   C1733           Z7610                  272
CCL          7592   42459   DIAGNOSTIC CATH/STANDARD                     84.00                  1   A4649           Z7610                  272
CCL          7592   42509   DIAGNOSTIC CATHS/WOVEN                      252.00                  1   A4649           Z7610                  272
CCL          7592   42806   DILATORS                                     25.00                  1   A4649           Z7610                  272
CCL          7592   66147   DUCTUAL OCCLUDER                          1,600.00                  1   C1817           L8699                  272
CCL          7592   66146   DUCTAL OCCLUDER DELIVERY                    700.00                  1   C1887           Z7610                  272
CCL          7592   43106   ELECTRO PHYS SHEATH SETS                    480.00                  1   A4649           Z7610                  272
CCL          7592   43150   EMBOLIZATION DEVICE                         280.00                  1   A4649           Z7610                  272
CCL          7592   43107   EMBOLIZATION DEVICE DELIVERY SYST           360.00                  1   A4649           Z7610                  272
CCL          7592   45632   ENDOMYOCARDIAL BIOPSY                     2,100.00                  1    93505   TC         93505   TC         481
CCL          7592   45609   EP EVAL OF SING OR DUAL ICD LEAD&         2,100.00                  1    93641   TC         93641   TC         480
CCL          7592   45602   EPS W/INDUCTION/RA&RV PACING              3,700.00                  1    93620   TC         93620   TC         480
CCL          7592   45607   ESOPH RECORD/ATRIAL ELEC W/PACING           344.93                  1    93616   TC         93616   TC         480
CCL          7592   45606   ESOPH RECORD/ATRIAL ELEC W/WO VEN           219.00                  1    93615   TC         93615   TC         480
CCL          7592   45601   FLUOROSCOPY                                 219.00                  1    76000   TC         76000   TC         320
CCL          7592   68035   FLUORSCOPIC GUIDANCE FOR CVP PLAC           262.80                  1    78701   TC         78701   TC         320



                                                          Page 65 of 676
                                                            CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                  Description                  Price        Stats/bill        CPT      Mod                Mod   Rev Code
 Code                                                                                                                 HCPCS
CCL          7592   45610   FLUROSCOPY FOR INSERT OF ANTI-ARR            350.40                  1    71090   TC         71090   TC           320
CCL          7592   66141   HALO DEFLECT ELECTODE CATH                 2,000.00                  1   C1731           Z7610                    272
CCL          7592   42954   HEMOSTASIS VALVES                             25.00                  1   A4649           Z7610                    272
CCL          7592   65058   IC CATH ABLATION ARRHYT FOCUS              1,752.00                  1    93651   TC         93651   TC           480
CCL          7592   45615   IMAGING SUPER/ABD W/BILAT ILIOFEM          1,752.00                  1    75630   TC         75630   TC           320
CCL          7592   45614   IMAGING SUPER/ABDOMINAL AORTA              1,642.50                  1    75625   TC         75625   TC           320
CCL          7592   45617   IMAGING SUPER/BILAT EXTREMITY ART          1,642.50                  1    75716   TC         75716   TC           320
CCL          7592   45620   IMAGING SUPER/BILAT PULM/SELECTIV          2,080.50                  1    75743   TC         75743   TC           320
CCL          7592   45618   IMAGING SUPER/CARDIAC FLUROSCOPY             219.00                  1    76000   TC         76000   TC           320
CCL          7592   45612   IMAGING SUPER/PULM ASC AORTA, COR          1,423.50                  1    93556   TC         93556   TC           481
CCL          7592   45616   IMAGING SUPER/UNILAT EXTREMITY AR          1,642.50                  1    75710   TC         75710   TC           320
CCL          7592   45619   IMAGING SUPER/UNILAT PULM/SELECTI          1,642.50                  1    75741   TC         75741   TC           320
CCL          7592   45611   IMAGING SUPER/VENT AND/OR ATRIAL             985.50                  1    93555   TC         93555   TC           481
CCL          7592   45608   INDUCTION OF ARRHYTHMIA BY ELEC P          1,752.00                  1    93618   TC         93618   TC           480
CCL          7592   45622   INFERIOR VENA CAVA                         1,642.50                  1    75825   TC         75825   TC           320
CCL          7592   43358   INFLATION/HAND INJ/SYRINGE                    92.00                  1   A4649           Z7610                    272
CCL          7592   45626   INTERNAL MAMMARY ARTERY                    2,299.50                  1    75756   TC         75756   TC           320
CCL          7592   45604   INTRA-ATRIAL &/OR INTRA VENT MAPP          1,752.00                  1    93609   TC         93609   TC           480
CCL          7592   68030   INTRAVASCULAR ULTRASOUND                     372.30                  1    37250              37250                480
CCL          7592   68031   INTRAVASCULAR ULTRASOUND EA ADD              246.38                  1    37251              37251                480
CCL          7592   66142   IVUS CATHETER                              1,280.00                  1   C1753           Z7610                    272
CCL          7592   66143   IVUS CORNARY CATH                            260.00                  1   C1753           Z7610                    272
CCL          7592   66144   IVUS PULLBACK DEVICE                         150.00                  1   C1753           Z7610                    272
CCL          7592   45635   L HEART CATH                               5,000.00                  1    93510   TC         93510   TC           481
CCL          7592   45603   LA PACING & RECORD FROM COR SINUS          4,000.00                  1    93621   TC         93621   TC           480
CCL          7592   43457   MISCELLANEOUS CHARGES                          0.00 S                    A4649           Z7610                    270
CCL          7592   42152   MOV CORE/STEER GUIDEWIRE                     280.00                  1   A4649           Z7610                    272
CCL          7592   42061   MULTIPORT EP SHEATH                          140.00                  1   A4649           Z7610                    272
CCL          7592   43408   NELLCOR OXYSENSOR                             50.00                  1   A4649           Z7610                    272
CCL          7592   45621   NON SELECCTIVE PULM BY VENOUS INJ          1,642.50                  1    75746   TC         75746   TC           320
CCL          7592   43108   OCCLUSION BALLOON CATHETER                   600.00                  1   A4649           Z7610                    272
CCL          7592   43104   PACEMAKER LEAD                             2,750.00                  1   C1899           Z7610                    278
CCL          7592   43105   PATIENT WARMING DEVICE                         0.00 S                    A4649           Z7610                    481
CCL          7592   65056   PERC TRANSCATH CLOS ASD/FENEST             6,000.00                  1    93580   TC         93580   TC           481
CCL          7592   65057   PER TRNSCATH CLOS VSD                      7,000.00                  1    93581   TC         93581   TC           481



                                                           Page 66 of 676
                                                          CM 06/15/07


 Dept                                                                                                              M/cal
        Cost Ctr.   SIM#                 Description                 Price      Stats/bill        CPT      Mod                Mod   Rev Code
 Code                                                                                                             HCPCS
CCL          7592   42905   PERICARDIOCENTESIS TRAY                    330.00                1    33010   ZM         33010   ZM           272
CCL          7592   66140   POLARIS EP ABLATION CATH                 1,000.00                1   C1730           Z7610                    272
CCL          7592   43200   PROCEDURE TRAY                             120.00                1   A4649           Z7610                    272
CCL          7592   45605   PROGRAMMED STIMULATION                   1,204.50                1    93623   TC         93623   TC           480
CCL          7592   66711   PT ACTIVATED EVENT RECORDER IMPLT        5,600.00                1   C1764           C1764                    278
CCL          7592   45638   R & L HEART CATH VIA ASD OR VSD          6,000.00                1    93529   TC         93529   TC           481
CCL          7592   45636   R AND L HEART CATH                       6,500.00                1    93526   TC         93526   TC           481
CCL          7592   45637   R HEART CATH W/TRANSEPTAL L CATH         7,000.00                1    93527   TC         93527   TC           481
CCL          7592   45633   RIGHT HEART CATHETERIZATION              2,400.00                1    93501   TC         93501   TC           481
CCL          7592   66320   SEDATION <5YRS OF AGE 1ST 30MIN            567.00                1    99143              99143                370
CCL          7592   66321   SEDATION >5YRS OF AGE 1ST 30MIN            567.00                1    99144              99144                370
CCL          7592   66322   SEDATION EA ADDL 15MIN                     283.00                1    99145              99145                370
CCL          7592   43110   SEPTAL CLOSURE DELIVERY CATHETER         1,500.00                1   A4649           Z7610                    272
CCL          7592   43109   SEPTAL CLOSURE DEVICE                   11,000.00                1   C1817           C1817                    278
CCL          7592   43111   SEPTAL CLOSURE SIZING BALLOON CAT          900.00                1   A4649           Z7610                    272
CCL          7592   43002   SEPTOSTOMY BLADES                        1,663.00                1   A4649           Z7610                    272
CCL          7592   43051   SEPTOSTOMY CATHETER                        400.00                1   A4649           Z7610                    272
CCL          7592   42350   SHEATH SETS/BIOPSY                         175.00                1   A4649           Z7610                    272
CCL          7592   42400   SHEATH SETS/INTERVENT                      175.00                1   C1894           Z7610                    272
CCL          7592   42251   SHEATH SETS/STANDARD                        80.00                1   C1894           Z7610                    272
CCL          7592   42301   SHEATH SETS/TRANSEPTAL                     245.00                1   A4649           Z7610                    272
CCL          7592   42715   SPECIAL ANGIOPLASTY CATH                 1,438.00                1   A4649           Z7610                    272
CCL          7592   43309   SPECIAL RETRIEVER SETS                   1,125.00                1   A4649           Z7610                    272
CCL          7592   42079   STANDARD ELECTRODE CATHETER                725.00                1   A4649           Z7610                    272
CCL          7592   42103   STANDARD GUIDEWIRES                         54.00                1   C1769           Z7610                    272
CCL          7592   43259   STANDARD RETRIEVER SETS                    600.00                1   A4649           Z7610                    272
CCL          7592   42087   STEER/SPEC EP ELECTRODE CATH             1,375.00                1   A4649           Z7610                    272
CCL          7592   42756   STENTS                                   2,230.00                1   C1877           C1877                    278
CCL          7592   66046   SUBSEQUENT CARDIAC OUTPUT MEASURE          213.53                1    93562   TC         93562   TC           480
CCL          7592   45623   SUPERIOR VENA CAVA                       1,642.50                1    75827   TC         75827   TC           320
CCL          7592   45631   SUPERVISION COIL OCCLUSION               3,000.00                1    75894   TC         75894   TC           320
CCL          7592   45630   SUPERVISION INTRAVASC STENT NON-C        1,971.00                1    75960   TC         75960   TC           320
CCL          7592   45629   SUPERVISION PTA -VENOUS                  1,971.00                1    75978   TC         75978   TC           320
CCL          7592   45628   SUPERVISION PTA BRACHIALCEPHALIC         1,971.00                1    75962   TC         75962   TC           320
CCL          7592   45627   SUPERVISION PTA RENAL/VISCERAL AR        1,992.90                1    75966   TC         75966   TC           320



                                                         Page 67 of 676
                                                              CM 06/15/07


 Dept                                                                                                                       M/cal
        Cost Ctr.   SIM#                   Description                   Price             Stats/bill       CPT     Mod              Mod         Rev Code
 Code                                                                                                                      HCPCS
CCL          7592   43101   TEMP PACING WIRES                                 390.00                    1 A4649           Z7610                        272
CCL          7592   42608   THERMODILUTION CATHS                              605.00                    1 A4649           Z7610                        272
CCL          7592   42053   TIP DEFLECTOR GUIDEWIRE                           200.00                    1 A4649           Z7610                        272
CCL          7592   42202   TRACKER GUIDEWIRES                                245.00                    1 A4649           Z7610                        272
CCL          7592   43112   TRANSEPTAL NEEDLES                                250.00                    1 A4649           Z7610                        272
CCL          7592   45624   UNILATERAL EXT VEIN                               438.00                    1  75820 TC           75820 TC                 320
CFC          7393   65014   ALLD HLTH PHN CNSLT 1/4 HR                          0.00   S                  Z5406           Z5406                        519
CFC          7393   65013   ALLD HLTH TEAM CONF 1/4 HR                         12.05                    1 Z4302           Z4302                        519
CFC          7393   65001   CENTER COORDINATOR                                103.28                    1 Z4300           Z4300                        519
CFC          7393   65002   COMP CHART REV & RPT                               77.46                    1 Z4304           Z4304                        519
CFC          7393    1007   CYSTIC FIBROSIS                                     0.00   S                                                               510
CFC          7393   65015   GROUP TEACHING/SUPPORT                             19.18                    1 Z4314            Z4314                       519
CFC          7393   65004   NURSE EVALUATION 1/2 HR                            24.10                    1 Z4301            Z4301                       519
CFC          7393   65006   NURSE PHONE CNSLT 1/4 HR                            0.00   S                  Z5406            Z5406                       519
CFC          7393   65005   NURSE TEAM CONF 1/4 HR                             13.00                    1 Z4310            Z4310                       519
CFC          7393   65003   PERIODIC CHART REV & RPT                           43.03                    1 Z4303            Z4303                       519
CFC          7393    7393   USE OF ROOM CHARGE                                 50.00                    1 99211            Z7500                       515
CFC          7393   61010   USE OF ROOM - NO CHARGE                             0.00   S                   99211           Z7500                       515
CFC          7393   60600   USE OF ROOM CHARGE                                 50.00                    1 99211            Z7500                       515
CGS          7525   68004   BASELINE BRK 50-100 CELLS 2KS                     509.00                    1 88248    ZS          88248   ZS              311
CGS          7525   68024   CGS AND MOL CGS INTRPRT                            57.00                    1 88291         26     88291        26         311
CGS          7525   68025   CGS CELL PREP                                       0.00   S                   88299               88299   ZS              310
CGS          7525   68027   CHROM ANLYS 100 CELLS CLAST                       525.00                    1 88249    ZS          88249   ZS              311
CGS          7525   68005   CHROM ANLYS 15-20 CELLS 2KS                       380.00                    1 88262    ZS          88262   ZS              311
CGS          7525   68011   CHROM ANLYS 20-25 CELLS                           377.00                    1 88264    ZS          88264   ZS              311
CGS          7525   68010   CHROM ANLYS 45 CELLS 2KS                          442.00                    1 88263    ZS          88263   ZS              311
CGS          7525   68028   CHROM ANLYS 5 CELLS 1K                            457.00                    1 88261    ZS          88261   ZS              311
CGS          7525   68022   CHROM ANLYS ADD CELLS EACH                         49.00                    1 88285    ZS          88285   ZS              310
CGS          7525   68017   CHROM ANLYS ADD KS EACH                            76.00                    1 88280    ZS          88280   ZS              311
CGS          7525   68023   CHROM ANLYS HI RES                                 26.00                    1 88289    ZS          88289   ZS              311
CGS          7525   68012   CHROM ANLYS IS 6-12 COL 1K                        506.00                    1 88269    ZS          88269   ZS              311
CGS          7525   68014   MOL CGS CHROM ISH 10-30 CELLS                     578.00                    1 88273    ZS          88273   ZS              311
CGS          7525   68013   MOL CGS DNA PROBE EACH                            516.00                    1 88271    ZS          88271   ZS              311
CGS          7525   68015   MOL CGS INTER ISH 25-99 CELLS                     637.00                    1 88274    ZS          88274   ZS              311
CGS          7525   68016   MOL CGS INTR ISH 100-300 CELLS                    796.00                    1 88275    ZS          88275   ZS              311



                                                             Page 68 of 676
                                                               CM 06/15/07


 Dept                                                                                                                     M/cal
        Cost Ctr.   SIM#                  Description                     Price           Stats/bill       CPT      Mod              Mod   Rev Code
 Code                                                                                                                     HCPCS
CGS          7525   68002   TC AMNIO OR CVS                                    336.00                  1   88235   ZS       88235   ZS           311
CGS          7525   68026   TC FOR SOLID TUMOR                                 434.00                  1   88239   ZS       88239   ZS           311
CGS          7525   68003   TC NEOPLASTIC BM                                   326.00                  1   88237   ZS       88237   ZS           311
CGS          7525   68000   TC NON NEO, LYMPHS                                 300.00                  1   88230   ZS       88230   ZS           311
CGS          7525   68001   TC SKIN OR SOFT TISS BX                            364.00                  1   88233   ZS       88233   ZS           311
CHM          7503   43810   *X HGH (HUMAN GROWTH HORMONE )                      56.00                  1   83003   TC       83003   TC           301
CHM          7503   43807   5-HIAA URINE                                         0.00 S                    83497                                 301
CHM          7503   40027   ACETAMINOPHEN                                       57.00                  1   82003   TC       82003   TC           301
CHM          7503   40019   ACETONE QUAL SERUM                                  43.00                  1   82009   TC       82009   TC           301
CHM          7503   47089   ADDIT CORTISOL                                      42.00                  1   82533   TC       82533   TC           301
CHM          7503   40159   ALBUMIN SERUM                                       59.00                  1   82040   TC       82040   TC           301
CHM          7503   40209   ALCOHOL (ETHANOL) BLOOD                             54.00                  1   82055   TC       82055   TC           301
CHM          7503   40050   ALPHA-FETOPROTEIN SERUM (AFP)                       56.00                  1   82105   TC       82105   TC           301
CHM          7503   40340   AMIKACIN                                            72.00                  1   80150   TC       80150   TC           301
CHM          7503   40506   AMMONIA                                             60.00                  1   82140   TC       82140   TC           301
CHM          7503   40530   AMPHETAMINE QUAL SCREEN                             38.00                  1   80101   TC       80101   TC           301
CHM          7503   40571   AMYLASE                                             71.00                  1   82150   TC       82150   TC           301
CHM          7503   40700   B-TYPE NATRIURETIC PEPTID BNP                      128.00                  1   83880   TC       83880   TC           301
CHM          7503   40738   BARBITURATES QUAL SCREEN                            38.00                  1   80101   TC       80101   TC           301
CHM          7503   16020   BASIC METABOLIC PANEL                               93.00                  1   80048   TC       80048   TC           301
CHM          7503   40746   BENZODIAZEPINES QUAL SCREEN                         38.00                  1   80101   TC       80101   TC           301
CHM          7503   40756   BENZODIAZEPINES QUAL SCREEN                         35.00                  1   80101   TC       80101   TC           301
CHM          7503   40900   BETA-HCG, QUANTITATIVE                              49.00                  1   84702   TC       84702   TC           301
CHM          7503   40944   BILIRUBIN FRACTIONATED (DIRECT)                     48.00                  1   82248   TC       82248   TC           301
CHM          7503   40928   BILIRUBIN TOTAL                                     48.00                  1   82247   TC       82247   TC           301
CHM          7503   41058   C REACTIVE PROTEIN                                  78.00                  1   86140   TC       86140   TC           302
CHM          7503   41000   C-PEPTIDE                                           60.00                  1   84681   TC       84681   TC           301
CHM          7503   41413   CALCIUM IONIZED                                    112.00                  1   82330   TC       82330   TC           301
CHM          7503   41207   CALCIUM SERUM                                       59.00                  1   82310   TC       82310   TC           301
CHM          7503   41272   CALCIUM URINE                                       60.00                  1   82340   TC       82340   TC           301
CHM          7503   41504   CARBAMAZEPINE                                       92.00                  1   80156   TC       80156   TC           301
CHM          7503   40787   CARBON DIOXIDE (CO2)                                54.00                  1   82374   TC       82374   TC           301
CHM          7503   41520   CARBOXYHEMOGLOBIN (CO)                              68.00                  1   82375   TC       82375   TC           301
CHM          7503   48889   CHEMISTRY MISC                                       0.00                  1   84999   TC       84999   TC           300
CHM          7503   41835   CHLORIDES BLOOD                                     54.00                  1   82435   TC       82435   TC           301



                                                              Page 69 of 676
                                                               CM 06/15/07


 Dept                                                                                                                      M/cal
        Cost Ctr.   SIM#                  Description                     Price             Stats/bill       CPT     Mod              Mod   Rev Code
 Code                                                                                                                      HCPCS
CHM          7503   41900   CHLORIDES CSF                                       48.00                    1   82438   TC      82438   TC           301
CHM          7503   41975   CHLORIDES SWEAT OTHER                               84.00                    1   82438   TC      82438   TC           301
CHM          7503   42049   CHLORIDES URINE                                     60.00                    1   82436   TC      82436   TC           301
CHM          7503   42221   CHOLESTEROL HIGH DENSITY (HDL)                      61.00                    1   83718   TC      83718   TC           301
CHM          7503   42114   CHOLESTEROL TOTAL                                   59.00                    1   82465   TC      82465   TC           301
CHM          7503   42304   COCAINE QUAL SCREEN                                 38.00                    1   80101   TC      80101   TC           301
CHM          7503   16028   COMPREHENSIVE METABOLIC PANEL                      137.00                    1   80053   TC      80053   TC           301
CHM          7503   47071   CORTISOL TOTAL                                      86.00                    1   82533   TC      82533   TC           301
CHM          7503   42817   CREATINE KINASE MB ONLY (CKMB)                      59.00                    1   82553   TC      82553   TC           301
CHM          7503   42809   CREATINE KINASE TOTAL (CK)                          59.00                    1   82550   TC      82550   TC           301
CHM          7503   42601   CREATININE BLOOD                                    59.00                    1   82565   TC      82565   TC           301
CHM          7503   42742   CREATININE CLEARANCE                               108.00                    1   82575   TC      82575   TC           301
CHM          7503   42536   CREATININE URINE                                    60.00                    1   82570   TC      82570   TC           301
CHM          7503   42825   CYCLOSPORINE                                       224.00                    1   80158   TC      80158   TC           301
CHM          7503   42908   DIGOXIN                                             88.00                    1   80162   TC      80162   TC           301
CHM          7503   43005   ELECTROLYTES PANEL                                  71.00                    1   80051   TC      80051   TC           301
CHM          7503   43013   ELECTROLYTES, WHOLE BLOOD                           66.00                    1   80051   TC      80051   TC           301
CHM          7503   90002   ESRD-CD ALBUMIN                                      0.00   S                    82040   CD      82040   TC           301
CHM          7503   90004   ESRD-CD BICARBONATE (C02)                            0.00   S                    82374   CD      82374   TC           301
CHM          7503   90006   ESRD-CD BUN                                          0.00   S                    84520   CD      84520   TC           301
CHM          7503   90008   ESRD-CD CALCIUM SERUM                                0.00   S                    82310   CD      82310   TC           301
CHM          7503   90010   ESRD-CD CHLORIDE                                     0.00   S                    82435   CD      82435   TC           301
CHM          7503   90012   ESRD-CD CREATININE                                   0.00   S                    82565   CD      82565   TC           301
CHM          7503   90030   ESRD-CD DIALYSATE PROTEIN                            0.00   S                    84155   CD      84155   TC           301
CHM          7503   90014   ESRD-CD LDH                                          0.00   S                    83615   CD      83615   TC           301
CHM          7503   90016   ESRD-CD MAGNESIUM SERUM                              0.00   S                    83735   CD      83735   TC           301
CHM          7503   90018   ESRD-CD PHOSPHATASE ALK                              0.00   S                    84075   CD      84075   TC           301
CHM          7503   90020   ESRD-CD PHOSPHORUS                                   0.00   S                    84100   CD      84100   TC           301
CHM          7503   90022   ESRD-CD POTASSIUM                                    0.00   S                    84132   CD      84132   TC           301
CHM          7503   90024   ESRD-CD PROTEIN TOTAL                                0.00   S                    84155   CD      84155   TC           301
CHM          7503   90026   ESRD-CD SODIUM                                       0.00   S                    84295   CD      84295   TC           301
CHM          7503   90028   ESRD-CD TRANSAMINASE AST (SGOT)                      0.00   S                    84450   CD      84450   TC           301
CHM          7503   90003   ESRD-CE ALBUMIN                                     59.00                    1   82040   CE      82040   TC           301
CHM          7503   90005   ESRD-CE BICARBONATE (CO2)                           54.00                    1   82374   CE      82374   TC           301
CHM          7503   90007   ESRD-CE BUN                                         59.00                    1   84520   TC      84520   TC           301



                                                              Page 70 of 676
                                                           CM 06/15/07


 Dept                                                                                                                M/cal
        Cost Ctr.   SIM#                  Description                 Price           Stats/bill       CPT     Mod              Mod   Rev Code
 Code                                                                                                                HCPCS
CHM          7503   90011   ESRD-CE CHLORIDE                                54.00                  1   82435   CE      82435   TC           301
CHM          7503   90013   ESRD-CE CREATININE                              59.00                  1   82565   CE      82565   TC           301
CHM          7503   90031   ESRD-CE DIALYSATE PROTEIN                       59.00                  1   84155   TC      84155   TC           301
CHM          7503   90015   ESRD-CE LDH                                     59.00                  1   83615   CE      83615   TC           301
CHM          7503   90017   ESRD-CE MAGNESIUM SERUM                         59.00                  1   83735   CE      83735   TC           301
CHM          7503   90019   ESRD-CE PHOSPHATASE ALK                         59.00                  1   84075   TC      84075   TC           301
CHM          7503   90021   ESRD-CE PHOSPHORUS                              59.00                  1   84100   TC      84100   TC           301
CHM          7503   90023   ESRD-CE POTASSIUM                               54.00                  1   84132   TC      84132   TC           301
CHM          7503   90025   ESRD-CE PROTEIN TOTAL                           59.00                  1   84155   TC      84155   TC           301
CHM          7503   90027   ESRD-CE SODIUM                                  54.00                  1   84295   TC      84295   TC           301
CHM          7503   90029   ESRD-CE TRANSAMINAST AST (SGOT)                 59.00                  1   84450   TC      84450   TC           301
CHM          7503   90009   ESRD-CE CALCIUM SERUM                           59.00                  1   82310   CE      82310   TC           301
CHM          7503   43010   ESTRADIOL (E2)                                  60.00                  1   82670   TC      82670   TC           301
CHM          7503   46214   FERRITIN                                        59.00                  1   82728   TC      82728   TC           301
CHM          7503   43210   FOLLICLE STIM HORMONE (FSH)                     56.00                  1   83001   TC      83001   TC           301
CHM          7503   43450   GENTAMICIN                                      72.00                  1   80170   TC      80170   TC           301
CHM          7503   43609   GLUCOSE CSF                                     59.00                  1   82945   TC      82945   TC           301
CHM          7503   43534   GLUCOSE QUANT BLOOD                             59.00                  1   82947   TC      82947   TC           301
CHM          7503   43542   GLUCOSE URINE                                   60.00                  1   82945   TC      82945   TC           301
CHM          7503   43443   GLUTAMYLTRANSFERASE GAMMA -GGT                  72.00                  1   82977   TC      82977   TC           301
CHM          7503   43530   GTT (GLUCOSE TOLERANCE 3)                      116.00                  1   82951   TC      82951   TC           301
CHM          7503   43708   GTT GLUCOSE EACH ADDL SAMPLE                    29.00                  1   82952   TC      82952   TC           301
CHM          7503   43720   HELICOBACTER PYLORI AB                          60.00                  1   86677   TC      86677   TC           302
CHM          7503   43550   HEMOGLOBIN GLYCATED (HA1C)                      49.00                  1   83036   TC      83036   TC           301
CHM          7503   51008   HEPATIC (LIVER) FUNCTION PANEL                  82.00                  1   80076   TC      80076   TC           301
CHM          7503   43572   HEPATITIS A AB IGM                              88.00                  1   86709   TC      86709   TC           302
CHM          7503   43570   HEPATITIS A AB TOTAL                            88.00                  1   86708   TC      86708   TC           302
CHM          7503   43548   HEPATITIS B CORE AB                             88.00                  1   86704   TC      86704   TC           302
CHM          7503   43552   HEPATITIS B SURFACE AB (HBS AB)                 71.00                  1   86706   TC      86706   TC           302
CHM          7503   43554   HEPATITIS B SURFACE AG (HBS AG)                 71.00                  1   87340   TC      87340   TC           306
CHM          7503   43556   HEPATITIS C AB (HCV)                            71.00                  1   86803   TC      86803   TC           302
CHM          7503   43558   HIV AB (RAPID SCREEN)                           82.00                  1   86701   TC      86701   TC           302
CHM          7503   43560   HOMOCYSTEINE                                    71.00                  1   83090   TC      83090   TC           301
CHM          7503   41660   HS CRP (CARDIO CRP)                             87.00                  1   86141   TC      86141   TC           302
CHM          7503   43906   HVA URINE                                        0.00 S                    83150                                301



                                                          Page 71 of 676
                                                              CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                   Description                   Price         Stats/bill       CPT      Mod              Mod   Rev Code
 Code                                                                                                                  HCPCS
CHM          7503   44011   HYDROGEN BREATH, ADDTL                             36.00                1   91065   TC       91065   TC           750
CHM          7503   44003   HYDROGEN, BREATH                                  132.00                1   91065   TC       91065   TC           750
CHM          7503   44050   IGE TOTAL                                          60.00                1   82785   TC       82785   TC           301
CHM          7503   44060   INSULIN                                            60.00                1   83525   TC       83525   TC           301
CHM          7503   44615   IRON BINDING CAPACITY                              88.00                1   83550   TC       83550   TC           301
CHM          7503   44540   IRON SERUM                                         71.00                1   83540   TC       83540   TC           301
CHM          7503   44680   LACTATE (LACTIC ACID)                              71.00                1   83605   TC       83605   TC           301
CHM          7503   44748   LACTATE DEHYDROGENASE (LDH)                        59.00                1   83615   TC       83615   TC           301
CHM          7503   44896   LEAD BLOOD                                         43.00                1   83655   TC       83655   TC           301
CHM          7503   44995   LIPASE                                             38.00                1   83690   TC       83690   TC           301
CHM          7503   45100   LIPID PANEL                                       137.00                1   80061   TC       80061   TC           301
CHM          7503   44900   LUTEINIZING HORMONE (LH)                           56.00                1   83002   TC       83002   TC           301
CHM          7503   45360   MAGNESIUM IONIZED                                 115.00                1   83735   TC       83735   TC           301
CHM          7503   45372   MAGNESIUM-SERUM                                    59.00                1   83735   TC       83735   TC           301
CHM          7503   45380   MAGNESIUM-URINE                                    49.00                1   83735   TC       83735   TC           301
CHM          7503   45489   METHEMOGLOBIN QUANT                                70.00                1   83050   TC       83050   TC           301
CHM          7503   45505   METHOTREXATE                                      125.00                1   80299   TC       80299   TC           301
CHM          7503   45510   MICROALBUMIN QUANT URINE                           49.00                1   82043   TC       82043   TC           301
CHM          7503   40180   MICROSOMAL AB (ANTI-TPO)                           60.00                1   86376   TC       86376   TC           302
CHM          7503   45588   OPIATES, QUAL SCREEN                               38.00                1   80101   TC       80101   TC           301
CHM          7503   45687   OSMOLALITY BLOOD                                   65.00                1   83930   TC       83930   TC           301
CHM          7503   44070   PARATHYROID HORMONE (IPTH)                         82.00                1   83970   TC       83970   TC           301
CHM          7503   46990   PH BLOOD                                           65.00                1   82800   TC       82800   TC           301
CHM          7503   45802   PHENCYCLIDINES (PCP) QUAL SCRN                     38.00                1   80101   TC       80101   TC           301
CHM          7503   45885   PHENOBARBITAL                                      72.00                1   80184   TC       80184   TC           301
CHM          7503   45893   PHENYTOIN TOTAL (DILANTIN)                         88.00                1   80185   TC       80185   TC           301
CHM          7503   45943   PHOSPHATASE ALK                                    59.00                1   84075   TC       84075   TC           301
CHM          7503   46081   PHOSPHORUS SERUM                                   59.00                1   84100   TC       84100   TC           301
CHM          7503   46156   PHOSPHORUS URINE                                   60.00                1   84105   TC       84105   TC           301
CHM          7503   46297   POTASSIUM SERUM                                    54.00                1   84132   TC       84132   TC           301
CHM          7503   46362   POTASSIUM URINE                                    60.00                1   84133   TC       84133   TC           301
CHM          7503   46370   PREGNANCY QUALITATIVE SERUM                        43.00                1   84703   TC       84703   TC           301
CHM          7503   46372   PREGNANCY QUALITATIVE URINE                        43.00                1   84703   TC       84703   TC           301
CHM          7503   46400   PROLACTIN                                          60.00                1   84146   TC       84146   TC           301
CHM          7503   46719   PROTEIN CSF                                        59.00                1   84155   TC       84155   TC           301



                                                             Page 72 of 676
                                                              CM 06/15/07


 Dept                                                                                                                     M/cal
        Cost Ctr.   SIM#                  Description                    Price           Stats/bill       CPT      Mod               Mod   Rev Code
 Code                                                                                                                     HCPCS
CHM          7503   46644   PROTEIN SERUM OR URINE                             59.00                  1   84155   TC        84155   TC           301
CHM          7503   43203   PROTOPORPHYRIN RBC SCREEN                          59.00                  1   84203   TC        84203   TC           301
CHM          7503   47007   PTERIDINE (BIOPTERIN) BLOOD                        55.00                  1   84311   TC        84311   TC           301
CHM          7503   47006   PTERIDINE (BIOPTERIN) URINE                       164.00                  1   82486   TC        82486   TC           301
CHM          7503   47139   SALICYLATES QUANT                                  54.00                  1   80196   TC        80196   TC           301
CHM          7503   47200   SIROLIMUS (RAPAMUNE,RAPAMYCIN)                    224.00                  1   80195   TC        80195   TC           301
CHM          7503   47535   SODIUM SERUM                                       54.00                  1   84295   TC        84295   TC           301
CHM          7503   47402   SODIUM URINE                                       60.00                  1   84300   TC        84300   TC           301
CHM          7503   47543   TACROLIMUS (FK506)                                224.00                  1   80197   TC        80197   TC           301
CHM          7503   47550   THC (MARIJUANA) QUAL SCREEN                        38.00                  1   80101   TC        80101   TC           301
CHM          7503   47568   THEOPHYLLINE                                       55.00                  1   80198   TC        80198   TC           301
CHM          7503   40170   THYROGLOBULIN AB (ANTI-TG)                         60.00                  1   86800   TC        86800   TC           302
CHM          7503   48720   THYROID HORMONE (T3/T4 UPTAKE)                     38.00                  1   84479   TC        84479   TC           301
CHM          7503   48236   THYROID STIM HORMONE (TSH)                        104.00                  1   84443   TC        84443   TC           301
CHM          7503   47820   THYROXINE FREE (FREE T4)                           65.00                  1   84439   TC        84439   TC           301
CHM          7503   47824   THYROXINE TOTAL - T4                               59.00                  1   84436   TC        84436   TC           301
CHM          7503   47857   TOBRAMYCIN                                         72.00                  1   80200   TC        80200   TC           301
CHM          7503   47725   TOTAL T3                                           98.00                  1   84480   TC        84480   TC           301
CHM          7503   48012   TRANSAMINASE ALT (SGPT)                            59.00                  1   84460   TC        84460   TC           301
CHM          7503   47949   TRANSAMINASE AST (SGOT)                            59.00                  1   84450   TC        84450   TC           301
CHM          7503   48152   TRIGLYCERIDES                                      59.00                  1   84478   TC        84478   TC           301
CHM          7503   48170   TROPONIN I                                        128.00                  1   84484   TC        84484   TC           301
CHM          7503   48178   TROPONIN QUAL                                     128.00                  1   84512   TC        84512   TC           301
CHM          7503   48228   TRYPSIN GASTRIC EA SPEC                           125.00                  1   84485   TC        84485   TC           301
CHM          7503   48293   UREA N QUANT BLOOD                                 59.00                  1   84520   TC        84520   TC           301
CHM          7503   48368   UREA N URINE                                       60.00                  1   84540   TC        84540   TC           301
CHM          7503   48509   URIC ACID BLOOD                                    48.00                  1   84550   TC        84550   TC           301
CHM          7503   48632   URIC ACID URINE & OTHER SOURCE                     60.00                  1   84560   TC        84560   TC           301
CHM          7503   48707   VALPROIC ACID                                      88.00                  1   80164   TC        80164   TC           301
CHM          7503   48723   VANCOMYCIN                                        108.00                  1   80202   TC        80202   TC           301
CHM          7503   48715   VMA URINE                                           0.00 S                    84585                                  301
CHM          7503   48800   ZINC                                               49.00                  1   84630   TC         84630 TC            301
CLO          7510   30015   COLLECT/HANDLING BLD ONLY                          27.00                  1   99001          Z5218                   300
CLO          7510   31200   INFLUENZA A DAA, FA                                31.00                  1   87276   ZS         87276 ZS            306
CLO          7510   31201   INFLUENZA B DAA                                    43.00                  1   87804   ZS         87804 ZS            306



                                                             Page 73 of 676
                                                         CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                 Description                Price           Stats/bill       CPT      Mod              Mod   Rev Code
 Code                                                                                                               HCPCS
CLO          7510   31100   MISCELLANEOUS                                  0.00                  1   84999   ZS       84999   ZS           306
CLO          7510   31210   RESP SYNC VIRUS (RSV) DAA                     43.00                  1   87899   ZS       87899   ZS           306
CLO          7510   30010   VENIPUNCTURE                                  16.00                  1   36415   ZS       36415   ZS           300
CNI          7591   45056   AFTER HOURS ECG OR ECHO                        0.00 S                    99050            99050                730
CNI          7591   45007   BEDSIDE ECG OR ECHO                            0.00 S                    99056            99056                730
CNI          7591   67180   BILATERAL DUPLEX STUDY                       448.95                  1   93880   TC       93880   TC           483
CNI          7591   44554   COLOR FLOW MAPPING                           219.00                  1   93325   TC       93325   TC           483
CNI          7591   44505   COMPLETE DOPPLER                             262.80                  1   93320   TC       93320   TC           483
CNI          7591   44455   COMPLETE ECHO 2-D M MODE                     383.25                  1   93307   TC       93307   TC           483
CNI          7591   44703   COMPLETE FETAL ECHO 2-D M MODE               301.13                  1   76825   TC       76825   TC           402
CNI          7591   44752   COMPLETE FETAL ECHO-DOPPLER                  266.09                  1   76827   TC       76827   TC           402
CNI          7591   44968   DUAL CHMB PACEMKR TELEPHON ANAL              114.98                  1   93733   TC       93733   TC           480
CNI          7591   44273   ECG LOOP RECORDING                           190.53                  1   93270   TC       93270   TC           480
CNI          7591   44109   ECG STRESS TEST                              259.52                  1   93017            93017                482
CNI          7591   44422   ECHO COMP CONGENITAL ANOMALY                 602.25                  1   93303   TC       93303   TC           483
CNI          7591   44430   ECHO LTD CONGENITAL ANOMALY                  301.13                  1   93304   TC       93304   TC           483
CNI          7591   44059   EKG TRACING                                   67.89                  1   93005            93005                730
CNI          7591   44760   FETAL DOPPLER FOLLOW-UP                      170.82                  1   76828   TC       76828   TC           402
CNI          7591   44711   FETAL ECHO FOLLOW-UP                         108.41                  1   76826   TC       76826   TC           402
CNI          7591   44158   HOLTER MONITOR 12-24 HR RECORD               190.53                  1   93225            93225                731
CNI          7591   44208   HOLTER MONITOR SCANNING                      328.50                  1   93226            93226                731
CNI          7591   44653   LIMITED DOPPLER                               98.55                  1   93321   TC       93321   TC           483
CNI          7591   44604   LIMITED ECHO 2-D M MODE                      298.94                  1   93308   TC       93308   TC           483
CNI          7591   44901   PERICARDIOCENTESIS ECHO GUIDANCE             238.43                  1   76930   TC       76930   TC           402
CNI          7591   44257   PHONE ECG TRANS POST SYMPTOM                 328.50                  1   93012            93012                730
CNI          7591   44083   RHYTHM STRIP                                  23.00                  1   93041            93041                730
CNI          7591   66320   SEDATION <5YRS OF AGE 1ST 30MIN              567.00                  1   99143            99143                370
CNI          7591   66321   SEDATION >5YRS OF AGE 1ST 30MIN              567.00                  1   99144            99144                370
CNI          7591   66322   SEDATION EACH ADDL 15MIN                     283.00                  1   99145            99145                370
CNI          7591   44976   SNGL CHMBR PACEMKR TELPHN ANAL                98.55                  1   93736   TC       93736   TC           480
CNI          7591   44802   TRANSESOPH ECHO COM 2-D M MODE               584.73                  1   93312   TC       93312   TC           483
CNI          7591   44406   TRANSESOPHAGEAL ECG W/PACING                 147.83                  1   93616   TC       93616   TC           480
CNI          7591   44414   TRANSESOPHAGEAL ECHO CONGNTL ANOM            585.83                  1   93315   TC       93315   TC           483
CNI          7591   44356   TRANSESOPHAGEAL EKG                           49.28                  1   93615   TC       93615   TC           480
CNI          7591   67181   UNILATERAL DUPLEX STUDY                      279.23                  1   93882   TC       93882   TC           483



                                                        Page 74 of 676
                                                             CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                   Description                  Price        Stats/bill     CPT     Mod               Mod   Rev Code
 Code                                                                                                              HCPCS
CNI          7591   44307   UPRIGHT BODY TILT TABLE                       249.66                  1 93660             93660               480
CNS          8735   40044   ANN CL NSG PRECEPTED ED/DAY                   290.00                  1               NC                      230
CNS          8735   40101   CONSULT RESP TX PER HOUR                      145.00                  1 X4700         X4700                   230
CNS          8735   40028   CONSULTATION NURSING PER HOUR                 145.00                  1               NC                      230
CNS          8735   40002   ASBESTOSIS TESTING                              0.00                  1                                       230
CNS          8735   40085   DEVELOPMENT OF CHART FORMS/HER                145.00                  1               NC                      230
CNS          8735   40051   DIDACTIC NSG ORIENTATION/DAY                1,451.00                  1               NC                      230
CNS          8735   40036   IND. CLINICAL NSG ED PER DAY                  290.00                  1               NC                      230
CNS          8735   40069   PER ADV LIFE SUPPORT-CHLA                     145.00                  1               NC                      230
CNS          8735   40077   PED ADV LIFE SUPPORT/OUTSIDE                  290.00                  1               NC                      230
CNS          8735   40150   R.T. SUPPLIES                                   0.00                  1                                       410
CNS          8735   40010   STAFF NURSING PER HOUR                         73.00                  1               NC                      230
CPD          7743   65152   ADD CAPD HOME TRNG. (>15 SESSIONS             728.00                  1 90993         Z6040                   841
CPD          7743   65153   ADD CCPD HOME TRNG. (>15 SESSIONS             728.00                  1 90993         Z6040                   851
CPD          7743   65014   ALLD HLTH PHN CNSLT 1/4 HR                      0.00 S                  Z5406         Z5406                   519
CPD          7743   65013   ALLD HLTH TEAM CONF 1/4 HR                     19.18                  1 Z4302         Z4302                   519
CPD          7743   65001   CENTER COORDINATOR                            103.28                  1 Z4300         Z4300                   519
CPD          7743   65540   CHRONIC IPD                                   749.00                  1 90945         Z6004                   802
CPD          7743   65002   COMP CHART REV & RPT                           77.46                  1 Z4304         Z4304                   519
CPD          7743   12155   CONNECTING TUBE                                29.00                  1 A4649         Z7610                   270
CPD          7743   65010   DIETITIAN EVAL 1/2 HR                          12.05                  1 Z4308         Z4308                   519
CPD          7743   65012   DIETITIAN PHN CNSLT 1/4HR                       0.00 S                  Z5406         Z5406                   519
CPD          7743   65011   DIETITIAN TEAM CONF 1/4 HR                     13.00                  1 Z4312         Z4312                   519
CPD          7743   65015   GROUP TEACHING/SUPPORT                         19.18                  1 Z4314         Z4314                   519
CPD          7743   12072   HOME CAPD/SUPPLIES                            285.00                  1 99601         Z6030                   842
CPD          7743   12080   HOME CCPD/SUPPLIES                            285.00                  1 99601         Z6030                   852
CPD          7743   65151   HOME EQUIPMENT REPAIR/SERVICE                   0.00                  1 90999         Z6034                   843
CPD          7743   12122   HOME TRAINING/CAPD                            728.00                  1 90993         Z6040                   841
CPD          7743   12114   HOME TRAINING/CCPD                            728.00                  1 90993         Z6040                   851
CPD          7743   12130   HOME UNIT INSTALLATION                        950.00                  1 90999         Z6032                   853
CPD          7743   65541   INPT. - CAPD                                  871.00                  1               NC                      803
CPD          7743   65542   INPT. - CCPD                                  911.00                  1               NC                      804
CPD          7743   13039   INPT. PERITONEAL (NON-CAPD)                   911.00                  1 NC            NC                      802
CPD          7743   12205   NURSE EVAL ADDL 1/2HR                          22.00                  1 Z4300         Z5400                   515
CPD          7743   65004   NURSE EVALUATION 1/2 HR                        24.10                  1 Z4301         Z4301                   519



                                                            Page 75 of 676
                                                               CM 06/15/07


 Dept                                                                                                                       M/cal
        Cost Ctr.   SIM#                   Description                    Price             Stats/bill      CPT     Mod               Mod   Rev Code
 Code                                                                                                                      HCPCS
CPD          7743   65006   NURSE PHONE CNSLT 1/4 HR                             0.00   S                  Z5406          Z5406                   519
CPD          7743   18665   NURSE SEMIANNUAL CHART REVIEW                       72.00                    1 Z4303          Z4303                   515
CPD          7743   65005   NURSE TEAM CONF 1/4 HR                              12.05                    1 Z4310          Z4310                   519
CPD          7743   20455   NUTR EDUC 1/2 HR                                    23.00                    1 Z4301          Z4301                   515
CPD          7743   20505   PD ROOM CHARGE                                       0.00   S                                                         515
CPD          7743   65003   PERIODIC CHART REV & RPT                            43.03                    1 Z4303          Z4303                   519
CPD          7743   21453   PLASMAPHORESIS                                       0.00                    1                                        515
CPD          7743   65131   SKIN TEST, PPD INTRADERMAL                          58.00                    1 86580 TC           86580 TC            302
CPD          7743   65007   SOC WORK EVAL 1/2 HR                                24.10                    1 Z4307          Z4307                   561
CPD          7743   65009   SOC WORK PHONE CNSLT 1/4 HR                          0.00   S                  Z5406          Z5406                   561
CPD          7743   65008   SOC WORK TEAM CONF 1/4 HR                           12.05                    1 Z4311          Z4311                   561
CPD          7743   65016   SW CASE COORD CONSULT 1/4HR                          0.00   S                                                         515
CRF          7203   65001   CENTER COORDINATOR                                 103.28                    1 Z4300          Z4300                   519
CRF          7203   65002   COMP CHART REV & RPT                                77.46                    1 Z4304          Z4304                   519
CRF          7203   20085   CRANIO FACIAL POST-OP                                0.00   S                                                         515
CRF          7203   65015   GROUP TEACHING/SUPORT                               19.18                    1                Z4314                   515
CRF          7203   65004   NURSE EVALUATION 1/2 HR                             24.10                    1 Z4301          Z4301                   519
CRF          7203   65006   NURSE PHONE CNSLT 1/4 HR                             0.00   S                  Z5406          Z5406                   519
CRF          7203   65005   NURSE TEAM CONF 1/4 HR                              12.05                    1 Z4310          Z4310                   519
CRF          7203   65003   PERIODIC CHART REV & RPT                            43.03                    1 Z4303          Z4303                   519
CRF          7203   65007   SOC WORK EVAL 1/2 HR                                24.10                    1 Z4307          Z4307                   561
CRF          7203   65009   SOC WORK PHONE CNSLT 1/4 HR                          0.00                    1 Z5406          Z5406                   561
CRF          7203   65008   SOC WORK TEAM CONF 1/4 HR                           12.05                    1 Z4311          Z4311                   561
CRF          7203   65016   SW CASE COORD CONSULT 1/4 HR                         0.00                    1 Z4314          Z4314                   515
CRF          7203    7203   USE OF ROOM CHARGE                                  50.00                    1 99211          Z7500                   515
CRF          7203   61010   USE OF ROOM - NO CHARGE                              0.00   S                   99211         Z7500                   515
CRF          7203   60600   USE OF ROOM CHARGE                                  50.00                    1 99211          Z7500                   515
CST          7470   80001   *X HEARTMATE ACTIVATION FEES                         0.00   S                   99199             99199               270
CST          7470   80076   *X HEARTMATE BACKUP DLY LEVEL I                      0.00   S                   99199             99199               270
CST          7470   80019   *X HEARTMATE HAND PUMP                               0.00   S                   99199             99199               270
CST          7470   80027   *X HEARTMATE IP LVAS RENT 48HR                       0.00   S                   99199             99199               270
CST          7470   80035   *X HEARTMATE IP LVAS RENT EXT                        0.00   S                   99199             99199               270
CST          7470   80084   *X HRTMATE BACKUP DLY LEV II                         0.00   S                   99199             99199               270
CST          7470   80092   *X HRTMATE BACKUP DLY LEV III                        0.00   S                   99199             99199               270
CST          7470   80050   *X HRTMATE DRV CNSL DLY LEV II                       0.00   S                   99199             99199               270



                                                              Page 76 of 676
                                                              CM 06/15/07


 Dept                                                                                                                      M/cal
        Cost Ctr.   SIM#                  Description                    Price           Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                                     HCPCS
CST          7470   80068   *X HRTMATE DRV CNSL DLY LV III                      0.00 S                     99199             99199               270
CST          7470   80043   *X HRTMATE DRV CNSOL DLY LEV 1                      0.00 S                     99199             99199               270
CST          7470   99999   *X MISC SUPPLY                                      0.00                  1   A4649          Z7610                   279
CST          7470   82648   *X SHOE ORTHOSIS 10.5                             427.00                  1   L3649          L3649                   274
CST          7470   82564   *X SHOE ORTHOSIS 7.5                              593.00                  1   L3649          L3649                   274
CST          7470   82598   *X SHOE ORTHOSIS 8.5                              593.00                  1   L3649          L3649                   274
CST          7470   82614   *X SHOE ORTHOSIS 9.5                              593.00                  1   L3649          L3649                   274
CST          7470   98654   0.9% NACL IRRIG 1L BAG NU                          96.00                  1   J3490          X7704                   270
CST          7470   98621   0.9% NACL IRRIG 1L POUR NU                         96.00                  1   J3490          X7704                   270
CST          7470   98639   0.9% NACL IRRIG 5L BAG NU                         157.00                  1   J3490          X7704                   270
CST          7470   34094   10 FR SILICONE CATH                                17.00                  1   A4344          Z7610                   272
CST          7470   98589   10% D/0.45 NACL 1L GLS NU                          96.00                  1   A4649          X7700                   258
CST          7470   98449   10% D/0.9% NACL 1000ML BAG NU                      96.00                  1   A4649          X7700                   258
CST          7470   98431   10% D/0.9% NACL 500ML BAG NU                       96.00                  1   A4649          X7700                   258
CST          7470   34102   12 FR SILICONE CATH                                17.00                  1   A4649          Z7610                   272
CST          7470   34128   14FR SILICONE CATH                                 17.00                  1   A4649          Z7610                   272
CST          7470   34078   16 FR SILICONE CATH                                17.00                  1   A4649          Z7610                   272
CST          7470   98597   20% D/W 500 ML GL 2A0213 NU                        96.00                  1   A4649          X7700                   258
CST          7470   11357   5 X 30 SPLINT                                      62.00                  1   A4649          Z7610                   271
CST          7470   98282   5% D/0.2% NACL 1000ML BAG NU                       96.00                  1   A4649          X7700                   258
CST          7470   98274   5% D/0.2% NACL 500ML BAG NU                        96.00                  1   A4649          X7700                   258
CST          7470   34011   7 TPN DOUBLE LUMEN CATH                           341.00                  1   A4649          Z7610                   272
CST          7470   34086   8FR SILICONE CATH                                  17.00                  1   A4649          Z7610                   272
CST          7470   80188   ABDUCTION MEDIUM                                  301.00                  1   A4649          Z7610                   271
CST          7470   80154   ABDUCTION SMALL                                   221.00                  1   A4649          Z7610                   271
CST          7470   31129   ACCUAIR MATT REPLACE RENTAL                       157.00                  1   A4649          Z7610                   270
CST          7470   31079   ACCUAIR MATTRESS RENTAL                           127.00                  1   A4649          Z7610                   270
CST          7470   47166   ACUCAIR MATTRESS OVERLAY RENT                     205.00                  1   A4649          Z7610                   270
CST          7470   47158   ACUCAIR MATTRESS OVERLAY SET                       90.00                  1   A4649          Z7610                   270
CST          7470   82523   ADAPTER, FEEDING TUBE                              24.00                  1   A4649          Z7610                   272
CST          7470   21117   ADAPTER, 90 18FR                                   38.00                  1   A4649          Z7610                   272
CST          7470   21133   ADAPTER, 90 24FR                                   35.00                  1   A4649          Z7610                   272
CST          7470   21174   ADAPTER, 90 28FR                                   38.00                  1   A4649          Z7610                   272
CST          7470     129   ADAPTOR CO2 NEONATAL (12919)                       84.00                  1   A4649          Z7610                   272
CST          7470     145   ADAPTOR CO2 PEDIATRIC (12977)                      89.00                  1   A4649          Z7610                   272



                                                             Page 77 of 676
                                                            CM 06/15/07


 Dept                                                                                                                      M/cal
        Cost Ctr.   SIM#                   Description                 Price             Stats/bill        CPT     Mod             Mod   Rev Code
 Code                                                                                                                     HCPCS
CST          7470   10169   ADMIN SET BURETROL 150ML LATFR                   31.00                    1   A4649          X7700                 272
CST          7470    8288   ADMIN SET AVI 4203 W/O BURETTE                   77.00                    1   A4649          X7700                 272
CST          7470    8262   ADMIN SET AVI 4303 W/BURETTE                    181.00                    1   A4649          X7700                 272
CST          7470   31785   ADMIN SET BASIC (INTERLINK)                      17.00                    1   A4649          Z7610                 272
CST          7470    9518   ADMIN SET BLOOD PUMP 8954-58                     14.00                    1   A4649          Z7610                 272
CST          7470    9484   ADMIN SET BLOOD WARMER 4C2480                    68.00                    1   A4649          X7700                 272
CST          7470   10144   ADMIN SET BURETROL ADD-ON VALV                   31.00                    1   A4649          X7700                 272
CST          7470    9708   ADMIN SET ENEMA                                   5.00                    1   A4649          Z7610                 272
CST          7470    9476   ADMIN SET HEMOSET 8C195                          40.00                    1   A4649          X7700                 272
CST          7470   10342   ADMIN SET IV SOL 2C5401                          31.00                    1   A4649          X7700                 272
CST          7470    9757   ADMIN SET PLATE INFUS 4C2223                     24.00                    1   A4649          Z7610                 272
CST          7470    9252   ADMIN SET PLATE RECIP 4C2100                     31.00                    1   A4649          X7700                 272
CST          7470   10102   ADMIN SET PREDILUTION M60 PRIS                  869.00                    1   A4649          Z7610                 271
CST          7470   10177   ADMIN SET TRANSFER 2C0415                        31.00                    1   A4649          X7700                 272
CST          7470   32200   ADMIN SET, INFUSION 20 DROP                      11.00                    1   E0781          Z7610                 270
CST          7470   32221   ADMIN SET, SECONDARY 40"                         17.00                    1   A4649          Z7610                 272
CST          7470   32205   ADMIN SET, SECONDARY W/ FILTER                   24.00                    1   A4649          Z7610                 272
CST          7470   30030   AIR FLUIDIZED BED                               453.00                    1   A4649          Z7610                 947
CST          7470    5511   AIRFLO PUMP PER DAY                               0.00   S                    A4649          Z7610                 272
CST          7470    5503   AIRFLO PUMP SETUP #AFP355                       176.00                    1   A4649          Z7610                 270
CST          7470     415   ALARIS DUAL-CHANNEL PUMP RENTAL                 224.00                    1    99070         Z7610                 270
CST          7470     414   ALARIS SINGLE CHANNEL PUMP SET-UP               143.00                    1   A4649          Z7610                 270
CST          7470   10714   ARM SLING LG                                     16.00                    1   A4565          A4565                 274
CST          7470   10698   ARM SLING MED                                    16.00                    1   A4565          A4565                 274
CST          7470   10706   ARM SLING SM                                     16.00                    1   A4565          A4565                 274
CST          7470   10748   ARM SLING X-LARGE                                14.00                    1   A4565          A4565                 271
CST          7470    8361   ARMBOARD IV 1.5 X 4" UNBREAKAB                    0.00   S                    A4649          Z7610                 272
CST          7470    8254   ARMBOARD IV 2X6" UNBREAKABLE                      0.00   S                    A4649          X7700                 272
CST          7470    8304   ARMBOARD IV 3X9" UNBREAKABLE                      0.00   S                    A4649          X7700                 271
CST          7470    8387   ARMBOARD IV UNBREAKABLE                           0.00   S                    A4649          Z7610                 272
CST          7470   25118   ARTER CATH 22G 2.5                               79.00                    1   A4649          Z7610                 272
CST          7470   45053   ASPIRATION SET-UP                                56.00                    1   A4649          Z7610                 272
CST          7470   45095   AUTOSYRINGE RENTAL                               35.00                    1   A4649          Z7610                 270
CST          7470   45087   AUTOSYRINGE SET-UP                               56.00                    1   A4649          Z7610                 270
CST          7470    4142   AVI PUMP RENTAL                                  71.00                    1   A4649          X7700                 261



                                                           Page 78 of 676
                                                               CM 06/15/07


 Dept                                                                                                                     M/cal
        Cost Ctr.   SIM#                    Description                   Price          Stats/bill        CPT    Mod              Mod   Rev Code
 Code                                                                                                                    HCPCS
CST          7470   47018   AVI PUMP RENTAL-HOURLY                           16.00                    1   A4649         Z7610                  270
CST          7470    4159   AVI PUMP SET-UP                                  60.00                    1   A4649         Z7610                  270
CST          7470    1069   BAG FEEDING POLAR 500 ML                         13.00                    1   A4649         Z7610                  272
CST          7470     798   BAG ILEO/COLO 1 1/2"                             66.00                    1   A5052         Z7610                  272
CST          7470     814   BAG ILEO/COLO 1 3/4"                            156.00                    1   A5052         Z7610                  272
CST          7470     822   BAG ILEO/COLO 2 1/4"                             66.00                    1   A5052         Z7610                  272
CST          7470     889   BAG UROSTOMY 1 1/2"                              97.00                    1   A5052         Z7610                  272
CST          7470    7628   BANDAGE, ACE LG                                  17.00                    1   A4649         Z7610                  270
CST          7470    7610   BANDAGE, ACE MED                                 13.00                    1   A4649         Z7610                  270
CST          7470    7602   BANDAGES, ACE SM                                  7.00                    1   A4649         Z7610                  270
CST          7470   30089   BED, LOW AIR LOSS                               398.00                    1   A4649         Z7610                  947
CST          7470   30097   BED, ROTATIONAL THERAPY                           0.00   S                    A4649         Z7610                  270
CST          7470   96838   BELLOWS HFOV 3100A (5470)                       445.00                    1   A4649         Z7610                  270
CST          7470   81731   BIOPSY NDL 14G X 3                              120.00                    1   A4649         Z7610                  272
CST          7470   81756   BIOPSY NDL 14X4 1/2                             116.00                    1   A4649         Z7610                  272
CST          7470   82689   BIOPSY SYSTEM RADIAL                            300.00                    1   A4649         Z7610                  272
CST          7470   82663   BIOPSY SYSTEM RADIAL (1260)                     315.00                    1   A4649         Z7610                  272
CST          7470    5131   BLANKETROL RENTAL                                 0.00   S                    A4649         Z7610                  270
CST          7470    5123   BLANKETROL SET-UP                               157.00                    1   A4649         Z7610                  270
CST          7470   95509   BLOOD RESERVOIR, VENOUS                       1,023.00                    1   A4649         Z7610                  272
CST          7470   45079   BLOOD WARMER RENTAL                               0.00   S                    A4649         Z7610                  270
CST          7470   45061   BLOOD WARMER SET-UP                              64.00                    1   A4649         Z7610                  270
CST          7470   13205   BRACE ANKLE PONY GEL 50/50 LEF                  308.00                    1   A4649         Z7610                  271
CST          7470   13213   BRACE ANKLE PONY GEL 50/50 RT                   308.00                    1   A4649         Z7610                  271
CST          7470   42162   BREATHING EXERCISER 2500 VOL                     14.00                    1   A4649         Z7610                  272
CST          7470   30175   BROV REPAIR 0.5 MM                              457.00                    1   A4649         Z7610                  272
CST          7470   10003   BUTTERFLY 23G X 3/4 12" TUBING                   31.00                    1   A4649         X7700                  272
CST          7470    9807   BUTTERFLY 23G X 3/4" 3 1/2" TUB                  31.00                    1   A4649         X7700                  272
CST          7470    9955   BUTTERFLY 25G X 3/4" 12" TUBING                  31.00                    1   A4649         X7700                  272
CST          7470   80501   BUTTON, 24FR 3.4CM                                0.00   S                    A4649             43760 ZM           278
CST          7470   21232   BUTTON 24FR 2.4CM                                 0.00   S                    A4649             43760 ZM           271
CST          7470   80873   BUTTON, 18FR 2.4CM                                0.00   S                    A4649             43760 ZM           278
CST          7470   42170   BUTTON, G-TUBE 18FR                               0.00   S                    A4649         Z7610                  278
CST          7470       9   C S EQUIPMENT                                     0.00   S                    A4649         Z7610                  270
CST          7470     632   CANNISTER SUCTION 1000CC                          5.00                    1   A4649         Z7610                  271



                                                              Page 79 of 676
                                                                 CM 06/15/07


 Dept                                                                                                                      M/cal
        Cost Ctr.   SIM#                   Description                      Price         Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                     HCPCS
CST          7470   96551   CANNULA ARTER 14FR PED (013150)                      815.00                1   A4649         Z7610                 272
CST          7470   96552   CANNULA ARTER 15FR ADULT (015586)                    978.00                1   A4649         Z7610                 272
CST          7470   96553   CANNULA ARTER 17FR ADULT (015587)                    978.00                1   A4649         Z7610                 272
CST          7470   96554   CANNULA ARTER 19FR ADULT (015588)                    978.00                1   A4649         Z7610                 272
CST          7470   96555   CANNULA ARTER 21FR ADULT (015589)                    978.00                1   A4649         Z7610                 272
CST          7470   95202   CANNULA, ARTERIAL 12FR                               815.00                1   A4300         Z7610                 272
CST          7470   96069   CANNULA, ARTERIAL 8FR                                815.00                1   A4300         Z7610                 272
CST          7470   96580   CANNULA DL 12FR (ECMO) (11955)                       787.00                1   A4649         Z7610                 270
CST          7470     103   CANNULA DL 18FR (11865)                              787.00                1   A4649         Z7610                 272
CST          7470   18204   CANNULA INNER TRACH #4DIC                             18.00                1   A4649         Z7610                 272
CST          7470   18246   CANNULA INNER TRACH #6DIC                              1.00                1   A4649         Z7610                 272
CST          7470   18279   CANNULA INNER TRACH #8DIC                              1.00                1   A4649         Z7610                 272
CST          7470   96564   CANNULA TANDEM XL (015420)                           326.00                1   A4649         Z7610                 272
CST          7470   96566   CANNULA VEN 15FR ADULT (015590)                      978.00                1   A4649         Z7610                 272
CST          7470   96567   CANNULA VEN 17FR ADULT (015591)                      978.00                1   A4649         Z7610                 272
CST          7470   96568   CANNULA VEN 19FR ADULT (015592)                      978.00                1   A4649         Z7610                 272
CST          7470   96569   CANNULA VEN 21FR ADULT (015593)                      978.00                1   A4649         Z7610                 272
CST          7470   96028   CANNULA, VENOUS 10FR                                 815.00                1   A4300         Z7610                 272
CST          7470   95244   CANNULA, VENOUS 14FR                                 219.00                1   A4300         Z7610                 272
CST          7470   95228   CANNULA, VENOUS 8FR                                  219.00                1   A4300         Z7610                 272
CST          7470   96127   CANNULA, ARTERIAL 10FR                               815.00                1   A4300         Z7610                 272
CST          7470   95137   CANNULA, ARTERIAL 10FR                               219.00                1   A4300         Z7610                 272
CST          7470   95152   CANNULA, ARTERIAL 12FR                               219.00                1   A4300         Z7610                 272
CST          7470   95178   CANNULA, ARTERIAL 14FR                               219.00                1   A4300         Z7610                 272
CST          7470   95194   CANNULA, ARTERIAL 16FR                               219.00                1   A4300         Z7610                 272
CST          7470   95145   CANNULA, ARTERIAL 8FR                                219.00                1   A4300         Z7610                 272
CST          7470   95210   CANNULA, DL 15FR JOSTRA                              820.00                1   A4300         Z7610                 272
CST          7470   96101   CANNULA, EXTENSION                                    90.00                1   A4649         Z7610                 272
CST          7470   95525   CANNULA, VENOUS 10FR                                 219.00                1   A4300         Z7610                 272
CST          7470   96002   CANNULA, VENOUS 12FR                                 815.00                1   A4300         Z7610                 272
CST          7470   95236   CANNULA, VENOUS 12FR                                 219.00                1   A4300         Z7610                 272
CST          7470   96143   CANNULA, VENOUS 14FR                                 815.00                1   A4300         Z7610                 272
CST          7470   95269   CANNULA, VENOUS 16FR                                 219.00                1   A4300         Z7610                 272
CST          7470   96044   CANNULA, VENOUS 8FR                                  815.00                1   A4300         Z7610                 272
CST          7470    3131   CAP BROVIAC INJ                                       38.00                1   A4300         Z7610                 272



                                                                Page 80 of 676
                                                            CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                  Description                  Price          Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                                  HCPCS
CST          7470    3123   CAP NON-INJECTABLE PLUG                        0.00   S                    A4649          Z7610                   272
CST          7470   30014   CARDIAC MONITOR                               61.00   S                    A4649          Z7610                   270
CST          7470   47026   CARDIAC MONITOR RENTAL-HOURLY                  0.00   S                    A4649          Z7610                   270
CST          7470   32189   CASSETTE, MINIBORE PUMP SET                   90.00                    1   A4649          Z7610                   272
CST          7470    3404   CASSETTE, RESEVOIR W/SPIKE BAG               116.00                    1   A4649          Z7610                   272
CST          7470    3685   CASH SHOE LG                                 161.00                    1    29425   ZM        29425   ZM          271
CST          7470    3545   CAST SHOE MED                                161.00                    1    29425   ZM        29425   ZM          271
CST          7470    3529   CAST SHOE SM                                 161.00                    1    29425   ZM        29425   ZM          271
CST          7470    3511   CAST SHOE XSM                                161.00                    1    29425   ZM        29425   ZM          271
CST          7470       3   CASTS AND SPLINTS                              0.00   S                                                           270
CST          7470    3537   CATH ANGIO 24G X 3/4"                         31.00                    1   A4649          X7700                   272
CST          7470      24   CATH ESOPHAGEAL (017015)                     680.00                    1   A4649          Z7610                   272
CST          7470   63127   CATH REPAIR KIT                              354.00                    1   A4649          Z7610                   272
CST          7470    5904   CATH SWAN-GANZ 5.5FRX75CM OXIM             1,440.00                    1   A4649          Z7610                   272
CST          7470    5862   CATH SWAN-GANZ 5FR 75CM THERMO               996.00                    1   A4649          Z7610                   272
CST          7470    5847   CATH SWAN-GANZ 7FR 15CM                      996.00                    1   A4649          Z7610                   272
CST          7470   25258   VENOUS CATH DL 5FR                           285.00                    1   A4649          Z7610                   272
CST          7470   25357   CATH, VENOUS DL 7.5FR 15CM                   221.00                    1   A4649          Z7610                   272
CST          7470   25274   CATH, VENOUS TL 7FR 20CM                     228.00                    1   A4649          Z7610                   272
CST          7470    4352   CATHETER 10FR MALECOT                         53.00                    1   B4084          Z7610                   272
CST          7470    4451   CATHETER 14FR MALECOT                         53.00                    1   B4084          Z7610                   272
CST          7470    4501   CATHETER 16FR MALECOT                         84.00                    1   B4084          Z7610                   272
CST          7470    4543   CATHETER 18FR MALECOT                         53.00                    1   B4084          Z7610                   272
CST          7470    3594   CATHETER ANGIO 14G X 1 1/4                    31.00                    1   A4649          X7700                   272
CST          7470    3586   CATHETER ANGIO 18G X 1 1/4"                   34.00                    1   A4649          X7700                   272
CST          7470    3552   CATHETER ANGIO 20GAX1 1/4                     34.00                    1   A4649          X7700                   272
CST          7470   10292   CATHETER ARTERIAL 3FR 5CM                     89.00                    1   A4649          Z7610                   272
CST          7470    3321   CATHETER BROVIAC S.L2.7FR                    341.00                    1   A4300          Z7610                   272
CST          7470    3289   CATHETER BROVIAC S.L4.2FR                    342.00                    1   A4300          Z7610                   272
CST          7470    3305   CATHETER BROVIAC S.L6.6FR                    342.00                    1   A4300          Z7610                   272
CST          7470    3362   CATHETER COUDE 22FR                           23.00                    1   A4649          Z7610                   272
CST          7470   97083   CATHETER DILATION 10-12MM BALLOON          1,059.00                    1   A4649          Z7610                   270
CST          7470   97133   CATHETER DILATION 12-15MM BALLOON          1,059.00                    1   A4649          Z7610                   270
CST          7470   97182   CATHETER DILATION 15-18MM BALLOON          1,059.00                    1   A4649          Z7610                   270
CST          7470   96986   CATHETER DILATION 6-8MM BALLOON            1,059.00                    1   A4649          Z7610                   270



                                                           Page 81 of 676
                                                               CM 06/15/07


 Dept                                                                                                                M/cal
        Cost Ctr.   SIM#                  Description                    Price      Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                               HCPCS
CST          7470   97034   CATHETER DILATION 8-10MM BALLOON             1,059.00                1   A4649         Z7610                 270
CST          7470    3818   CATHETER FOLEY 10 FR                            37.00                1   A4649         Z7610                 272
CST          7470    3859   CATHETER FOLEY 12 FR                            18.00                1   A4649         Z7610                 272
CST          7470    3875   CATHETER FOLEY 14 FR                            18.00                1   A4649         Z7610                 272
CST          7470    3909   CATHETER FOLEY 16 FR                            18.00                1   A4649         Z7610                 272
CST          7470    4105   CATHETER FOLEY 16FR 3 WAY                       64.00                1   A4346         Z7610                 272
CST          7470    3958   CATHETER FOLEY 18 FR                            31.00                1   A4649         Z7610                 272
CST          7470    4121   CATHETER FOLEY 18FR 3 WAY                       64.00                1   A4346         Z7610                 272
CST          7470    3974   CATHETER FOLEY 20FR                             18.00                1   A4649         Z7610                 272
CST          7470    4162   CATHETER FOLEY 20FR 3 WAY                       64.00                1   A4346         Z7610                 272
CST          7470    4014   CATHETER FOLEY 22FR                             30.00                1   A4649         Z7610                 272
CST          7470    4022   CATHETER FOLEY 24FR                             31.00                1   A4649         Z7610                 272
CST          7470    4048   CATHETER FOLEY 6FR LATEX/SILC                   87.00                1   A4649         Z7610                 272
CST          7470    4006   CATHETER FOLEY 8 FR                             37.00                1   A4649         Z7610                 272
CST          7470    3313   CATHETER HICKMAN S.L9.6FR                      341.00                1   A4300         Z7610                 272
CST          7470   25720   CATHETER KIT W/ INSERTION                      229.00                1   A4649         Z7610                 272
CST          7470    4618   CATHETER MALECOT 20 FR                         121.00                1   B4084         Z7610                 272
CST          7470    4758   CATHETER PEZZER 10FR                            56.00                1   B4084         Z7610                 272
CST          7470    4857   CATHETER PEZZER 14 FR                           35.00                1   B4084         Z7610                 272
CST          7470    4907   CATHETER PEZZER 16 FR                           37.00                1   B4084         Z7610                 272
CST          7470    4956   CATHETER PEZZER 18FR                            37.00                1   B4084         Z7610                 272
CST          7470    5003   CATHETER PEZZER 20 FR                           35.00                1   B4084         Z7610                 272
CST          7470    5052   CATHETER PEZZER 22FR                            37.00                1   B4084         Z7610                 272
CST          7470    5227   CATHETER ROBINSON 10 FR                          1.00                1   A4649         Z7610                 272
CST          7470    5243   CATHETER ROBINSON 12 FR                          1.00                1   A4649         Z7610                 272
CST          7470    5276   CATHETER ROBINSON 14FR                           1.00                1   A4649         Z7610                 272
CST          7470    5318   CATHETER ROBINSON 16 FR                          1.00                1   A4649         Z7610                 272
CST          7470    5326   CATHETER ROBINSON 18FR                           1.00                1   A4649         Z7610                 272
CST          7470    5359   CATHETER ROBINSON 20FR                           1.00                1   A4649         Z7610                 272
CST          7470    5201   CATHETER ROBINSON 8 FR                           1.00                1   A4649         Z7610                 272
CST          7470    6134   CATHETER SLOT-VENT MCCOMB                      516.00                1   A4649         Z7610                 272
CST          7470    5508   CATHETER SUCT 10FR                               1.00                1   A4624         Z7610                 272
CST          7470    5482   CATHETER SUCT GLOVE ST 10 FR                     1.00                1   A4624         Z7610                 272
CST          7470    5771   CATHETER SUCTION 6FR                             1.00                1   A4649         Z7610                 272
CST          7470    5805   CATHETER SUCTION 8 FR                            1.00                1   A4649         Z7610                 272



                                                           Page 82 of 676
                                                               CM 06/15/07


 Dept                                                                                                                    M/cal
        Cost Ctr.   SIM#                  Description                     Price         Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                   HCPCS
CST          7470    5516   CATHETER SUCTION KIT 12 FR                           1.00                1   A4624         Z7610                 272
CST          7470    5565   CATHETER SUCTION KIT 14FR                            1.00                1   A4649         Z7610                 272
CST          7470    5458   CATHETER SUCTION KIT 5FR                             2.00                1   A4624         Z7610                 272
CST          7470    5466   CATHETER SUCTION KIT 6FR                             1.00                1   A4624         Z7610                 272
CST          7470    5474   CATHETER SUCTION KIT 8FR                             1.00                1   A4624         Z7610                 272
CST          7470    5813   CATHETER SWAN-GANZ 5FR 75CM TR                     457.00                1   A4649         Z7610                 272
CST          7470    5821   CATHETER THORACIC 12 FR                             22.00                1   A4649         Z7610                 272
CST          7470    5839   CATHETER THORACIC 16FR                              22.00                1   A4649         Z7610                 272
CST          7470   34003   CATHETER TPN DL 12FR 90CM                          341.00                1   A4649         Z7610                 272
CST          7470   34151   CATHETER TPN DL 9FR 80CM                           341.00                1   A4300         Z7610                 272
CST          7470   20663   CATHETER TROCAR 10FR                                54.00                1   B4085         Z7610                 272
CST          7470   20671   CATHETER TROCAR 12 FR                               54.00                1   B4085         Z7610                 272
CST          7470   20689   CATHETER TROCAR 20FR                                54.00                1   B4085         Z7610                 272
CST          7470   20705   CATHETER TROCAR 24FR                                54.00                1   B4085         Z7610                 272
CST          7470   34052   CATHETER URI 5FR SILICONE                           56.00                1   A4649         Z7610                 272
CST          7470   34045   CATHETER URI 8FR SILICONE                           56.00                1   A4351         Z7610                 272
CST          7470   83372   CATHETER VASCATH 12FR 15CM DUAL                    489.00                1   A4649         Z7610                 272
CST          7470    3719   CATHETER VENOUS DL 5FR 8CM                         213.00                1   A4300         Z7610                 272
CST          7470   10359   CATHETER VENOUS SL 3FR 8CM                         103.00                1   A4649         Z7610                 272
CST          7470   31629   CATHETER, AIRWAY 11FR                              152.00                1   A4649         Z7610                 272
CST          7470   31603   CATHETER, AIRWAY 8FR                               152.00                1   A4624         Z7610                 272
CST          7470    3578   CATHETER, ANGIO 22GX1"                              31.00                1   A4649         X7700                 272
CST          7470   25704   CATHETER, BALLARD SUCTION 6FR                       73.00                1   A4649         Z7610                 272
CST          7470   25688   CATHETER, BALLARD SUCTION 8 FR                      70.00                1   A4649         Z7610                 272
CST          7470   31504   CATHETER, FOLEY SILICONE 20FR                       38.00                1   A4649         Z7610                 272
CST          7470   42196   CATHETER, NAS-CATH 10.8FR 20CM                     525.00                1   A4649         Z7610                 272
CST          7470   25878   CATHETER, ROBINSON 30FR                             23.00                1   A4649         Z7610                 272
CST          7470   31934   CATHETER, SUCTION 12FR                               1.00                1   A4649         Z7610                 272
CST          7470   31553   CATHETER, TROCAR 28FR                               54.00                1   A4649         Z7610                 272
CST          7470   31579   CATHETER, TROCAR 32FR                               54.00                1   A4649         Z7610                 272
CST          7470   31991   CATHETER, VENOUS DL 4FR 12CM                       213.00                1   A4649         Z7610                 272
CST          7470   32056   CATHETER, VENOUS DL 4FR 20CM                       221.00                1   A4300         Z7610                 272
CST          7470   32072   CATHETER, VENOUS DL 4FR 30CM                       221.00                1   A4649         Z7610                 272
CST          7470   31975   CATHETER, VENOUS DL 4FR 5CM                        221.00                1   A4649         Z7610                 272
CST          7470   10391   CATHETER, VENOUS SL 5FR/15CM                       156.00                1   A4649         Z7610                 272



                                                              Page 83 of 676
                                                                CM 06/15/07


 Dept                                                                                                                     M/cal
        Cost Ctr.   SIM#                   Description                    Price          Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                    HCPCS
CST          7470   25738   CATHETER, BALLARD SUCTION 10FR                     77.00                  1   A4649         Z7610                 272
CST          7470    3388   CATHTER COUDE 20FR                                 24.00                  1   A4649         Z7610                 272
CST          7470   82911   CAUTERY CORD 12                                    17.00                  1   A4649         Z7610                 272
CST          7470   82895   CAUTERY NEEDLE                                      5.00                  1   A4649         Z7610                 272
CST          7470   82937   CAUTERY PENCIL                                     17.00                  1   A4649         Z7610                 272
CST          7470   95392   CELLS, 1/4" ECMO                                  163.00                  1   A4649         Z7610                 272
CST          7470       4   CENTRAL STORES                                      0.00 S                                                        270
CST          7470    6233   CERVICAL COLLAR MED 4"X20                          64.00                  1   L0120         L0120                 274
CST          7470   96424   CHEST DRAIN VALVE, HEIMLICH                        65.00                  1   A4649         Z7610                 272
CST          7470   20515   CHEST DRAINAGE ADULT                              159.00                  1   A4649         Z7610                 272
CST          7470   20523   CHEST DRAINAGE INFANT/PED                         193.00                  1   A4649         Z7610                 272
CST          7470    7735   CHILD CLAVICLE STRAP                              215.00                  1   A4649         Z7610                 270
CST          7470   97234   CIRCUIT BREATHING OXICLIQ (CUSTOM                  31.00                  1   A4649         Z7610                 270
CST          7470   96887   CIRCUIT HFOV 3100A (5472)                         699.00                  1   A4649         Z7610                 270
CST          7470   96416   CIRCUIT TRANSPORT NEONATAL                         35.00                  1   A4649         Z7610                 272
CST          7470    3164   CLAMP BROVIAC BLUE                                  2.00                  1   A4649         Z7610                 272
CST          7470   31210   CLENSICAIR BED RENTAL                             493.00                  1   A4649         Z7610                 947
CST          7470   31194   CLENSICARE BED SET UP                               0.00 S                    A4649         Z7610                 270
CST          7470   36347   CLIPS (ILIZAROV)                                  132.00                  1   A4649         Z7610                 278
CST          7470   31462   CLIPS, ILIZAROV (RED)                              41.00                  1   A4649         Z7610                 272
CST          7470   80691   CLO-TEST                                           31.00                  1   A4649         Z7610                 271
CST          7470   96550   COLLAR ASPEN ADULT REG (016466)                   299.00                  1   A4649         Z7610                 272
CST          7470   96549   COLLAR ASPEN ADULT SHORT (016463)                 299.00                  1   A4649         Z7610                 272
CST          7470   96548   COLLAR ASPEN CHILD REG (016462)                   299.00                  1   A4649         Z7610                 272
CST          7470   96547   COLLAR ASPEN CHILD SHORT (016465)                 299.00                  1   A4649         Z7610                 272
CST          7470   96546   COLLAR ASPEN CHILD TOT (016461)                   299.00                  1   A4649         Z7610                 272
CST          7470    6241   COLLAR CERVICAL LG 5"                              64.00                  1   L0120         L0120                 274
CST          7470    6225   COLLAR CERVICAL MED 4"                             64.00                  1   L0120         L0120                 274
CST          7470   80014   COLLECTION BAG, 5TH VENTRICLE                     106.00                  1   A4649         Z7610                 272
CST          7470   81517   COLOPL BARRIER 4X4                                 80.00                  1   A4649         Z7610                 272
CST          7470   34995   CONNECTOR 3 WAY TRI-FUSE                           11.00                  1   A4649         Z7610                 271
CST          7470    6738   CONNECTOR T-EXTENSION LATEX-FR                     31.00                  1   A4649         X7700                 272
CST          7470    6753   CONNECTOR T-EXTENSION W/MLL                        11.00                  1   A4649         Z7610                 272
CST          7470   10615   CONNECTOR Y-EXTENSION DOUBLE                       31.00                  1   A4649         X7700                 270
CST          7470    6704   CONNECTOR, SIMS                                    13.00                  1   A4649         Z7610                 272



                                                            Page 84 of 676
                                                              CM 06/15/07


 Dept                                                                                                                M/cal
        Cost Ctr.   SIM#                   Description                   Price        Stats/bill      CPT    Mod             Mod   Rev Code
 Code                                                                                                               HCPCS
CST          7470   11001   COVER ILFELD FELT MED                          197.00                  1 A4649         Z7610                 271
CST          7470   80733   COVER, ILFELD SPLINT                           163.00                  1 A4649         Z7610                 271
CST          7470   10961   COVERL ILFELD FELT SM                          197.00                  1 A4649         Z7610                 271
CST          7470   30055   CPM THERAPY                                      0.00 S                  A4649         Z7610                 270
CST          7470   20502   CPM THERAPY SET UP                               0.00                  1 A4649         Z7610                 270
CST          7470    7231   CRUTCHES ADULT MED                              66.00                  1 E0116         E0116                 271
CST          7470    7256   CRUTCHES, ADULT                                 66.00                  1 E0116         E0116                 271
CST          7470    7306   CRUTCHES, CHILD                                 90.00                  1 E0116         E0116                 271
CST          7470    7355   CRUTCHES, YOUTH                                150.00                  1 E0116         E0116                 271
CST          7470   83034   DERMAGRAN OINTMENT                              86.00                  1 A4649         Z7610                 271
CST          7470   81533   DERMAGRAN SPRAY                                 55.00                  1 A4649         Z7610                 272
CST          7470   96542   DILATION BALLOON 4MM (015432)                1,358.00                  1 A4649         Z7610                 272
CST          7470   96543   DILATION BALLOON 6MM (015433)                1,358.00                  1 A4649         Z7610                 272
CST          7470   96544   DILATION BALLOON 8MM (015434)                1,358.00                  1 A4649         Z7610                 272
CST          7470   80923   DILATOR BALLOON 10MM                           680.00                  1 A4649         Z7610                 272
CST          7470   80907   DILATOR BALLOON 6MM                            734.00                  1 A4649         Z7610                 272
CST          7470   80915   DILATOR BALLOON 8MM                            734.00                  1 A4649         Z7610                 272
CST          7470   80956   DILATOR ESOPHAGEAL 15MM                        854.00                  1 A4649         Z7610                 272
CST          7470   80931   DILATOR ESOPHAGEAL 18MM                        854.00                  1 A4649         Z7610                 272
CST          7470   95947   DOUBLE PUMPING KIT                             119.00                  1 A4649         Z7610                 272
CST          7470   81228   DRAIN, ONE-PIECE                               159.00                  1 A4649         Z7610                 272
CST          7470     418   DRAIN PREMIE 1 3/8"                             97.00                  1 A4421         Z7610                 272
CST          7470   32163   DRAINAGE SYSTEM II                             759.00                  1 A4649         Z7610                 272
CST          7470    7504   DRESSING ADAPTIC 3X8"                            5.00                  1 A4649         Z7610                 272
CST          7470     244   DRESSING COMFEEL 4X4" STRL ULC                 103.00                  1 A4362         Z7610                 272
CST          7470    7603   DRESSING FLUFF KERLIX                            1.00                  1 A4649         Z7610                 272
CST          7470    2257   DRESSING KERLIX 2.25                             2.00                  1 A4649         Z7610                 272
CST          7470   96573   DRESSING KIT MEDIUM (017786)                   174.00                  1 A4649         Z7610                 272
CST          7470   96572   DRESSING KIT SMALL (017785)                    126.00                  1 A4649         Z7610                 272
CST          7470    7546   DRESSING OPSITE 10 X 28 CM                      30.00                  1 A4649         Z7610                 272
CST          7470    7538   DRESSING OPSITE 14 X 10 CM                      16.00                  1 A4649         Z7610                 271
CST          7470    7512   DRESSING OPSITE 5 X 7.5CM                       22.00                  1 A4649         Z7610                 271
CST          7470    7629   DRESSING PET 3 X 9"                              5.00                  1 A4649         Z7610                 272
CST          7470    7611   DRESSING PETROLEUM 1/2 X 72"                     7.00                  1 A4649         Z7610                 272
CST          7470    7694   DRESSING TEGADERM 1 3/4 X 13/4                   1.00                  1 A4649         Z7610                 272



                                                             Page 85 of 676
                                                               CM 06/15/07


 Dept                                                                                                                        M/cal
        Cost Ctr.   SIM#                    Description                   Price             Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                       HCPCS
CST          7470    7702   DRESSING TEGADERM 2 3/8 X 2 3/4                      1.00                    1   A4649         Z7610                 272
CST          7470    7744   DRESSING TEGADERM 4 X 10"                           10.00                    1   A4649         Z7610                 271
CST          7470    7728   DRESSING TEGADERM 4 X 4 3/4                          5.00                    1   A4649         Z7610                 272
CST          7470    7678   DRESSING XEROFORM 4X4                                5.00                    1   A4649         Z7610                 272
CST          7470    7652   DRESSING XEROFORM 5 X 9"                             5.00                    1   A4649         Z7610                 272
CST          7470   43152   DRESSING, CLEAR 3.5 X 5.5                          175.00                    1   A6257         Z7610                 272
CST          7470    7553   DRESSING COMB 5 X 9 IN                               0.00                    1   A4649         Z7610                 271
CST          7470    7561   DRESSING, KERLIX ROLL                                2.00                    1   A4649         Z7610                 272
CST          7470   25753   DRESSING, LYOFOAM 4X4                               17.00                    1   A4649         Z7610                 272
CST          7470   81574   DUBBHOFF FEEDING TUBE                              192.00                    1   A4649         Z7610                 272
CST          7470   81947   DUO DERM X-THIN 6 X 6                               23.00                    1   A4649         Z7610                 272
CST          7470   96168   DUOFLO DISPENSER KIT                               227.00                    1   A4649         Z7610                 272
CST          7470   96432   EASY-CAP                                            49.00                    1   A4649         Z7610                 272
CST          7470   96085   ECMO PRIME SET                                     307.00                    1   A4550         Z7610                 272
CST          7470   31350   EFICA CC W/O SCALE RENTAL                          650.00                    1   A4649         Z7610                 947
CST          7470   31343   EFICA CC W/O SCALE SETUP                             0.00   S                    A4649         Z7610                 270
CST          7470   31376   EFICA CC WITH SCALE RENTAL                         734.00                    1   A4649         Z7610                 947
CST          7470   31368   EFICA CC WITH SCALE SET UP                           0.00   S                    A4649         Z7610                 270
CST          7470    5748   EGGCRATE FOAM PAD 3"                                38.00                    1   A4649         Z7610                 271
CST          7470    5722   EGGCRATE FOAM PAD 1 3/4"                            17.00                    1   A4649         Z7610                 271
CST          7470   47216   EGGCRATE FOAM PAD 1-3/4"                             0.00   S                    A4649         Z7610                 270
CST          7470   47224   EGGCRATE FOAM PAD 3"                                 0.00   S                    A4649         Z7610                 270
CST          7470   96259   ELBOW, PEDIATRIC 10FR 3.3MM                         53.00                    1   A4649         Z7610                 272
CST          7470   96309   ELBOW, TRACH CARE 12FR 4.0MM                        38.00                    1   A4649         Z7610                 272
CST          7470   25522   ELECTRODE, PICU                                      0.00   S                    A4649         Z7610                 271
CST          7470   80998   ENDO INJECTORS                                     227.00                    1   A4649         Z7610                 272
CST          7470    5149   ENTERAL PUMP SET-UP (CORPAK)                        53.00                    1   A4649         Z7610                 270
CST          7470   80261   ENTERO-TEST (PED)                                   34.00                    1   A4649         Z7610                 279
CST          7470    5631   EQ BRYANTS PORT TRAC                                 0.00   S                    A4649         Z7610                 270
CST          7470    5649   EQ BUCKS TRACT UNILATERAL                            0.00   S                    A4649         Z7610                 270
CST          7470    5656   EQ CV TRAC SUG TONGS                                 0.00   S                    A4649         Z7610                 272
CST          7470    5664   EQ PELVIC SLING IN T                               110.00                    1   A4649         Z7610                 270
CST          7470    5615   EQUIP BALANCED TRAC                                  0.00   S                    A4649         Z7610                 270
CST          7470    5623   EQUIP BRADFORD FRAME                                 0.00   S                    A4649         Z7610                 270
CST          7470   30048   EQUIP RENTAL, MISC                                   0.00   S                    A4649         Z7610                 270



                                                              Page 86 of 676
                                                                CM 06/15/07


 Dept                                                                                                                          M/cal
        Cost Ctr.   SIM#                   Description                     Price             Stats/bill        CPT     Mod             Mod   Rev Code
 Code                                                                                                                         HCPCS
CST          7470   80972   ESOPHAGEAL DILATOR 12M                              854.00                    1   A4649          Z7610                 272
CST          7470   95459   EXT SET 60" (NICU)                                    2.00                    1   A4649          Z7610                 272
CST          7470   22396   EXT SET AMBULATORY SE3Y 16                           31.00                    1   A4649          X7700                 272
CST          7470   22156   EXTEN SET MALE/FEMALE LUER 33"                       17.00                    1   A4649          Z7610                 272
CST          7470   36131   EXTENSION SET CHECK-FLO                              50.00                    1   A4649          Z7610                 272
CST          7470    9732   EXTENSION SET ENTERAL "Y"                            13.00                    1   A4649          Z7610                 272
CST          7470   31538   EXTENSION SET MICRO 55/60"                           17.00                    1   A4649          Z7610                 272
CST          7470   32148   EXTENSION SET PED 72" (BMT)                          31.00                    1   A4649          Z7610                 272
CST          7470   96533   EXTRACTOR XL 11.5MM (015423)                        689.00                    1   A4649          Z7610                 272
CST          7470   96534   EXTRACTOR XL 15MM (015424)                          689.00                    1   A4649          Z7610                 272
CST          7470   96532   EXTRACTOR XL 8.5MM (015422)                         650.00                    1   A4649          Z7610                 272
CST          7470   81384   FECAL INCONTINENCE COLLECTOR                        290.00                    1   A4649          Z7610                 271
CST          7470   21216   FEEDING BUTTON 18FR                                 869.00                    1   A4649          Z7610                 278
CST          7470   21208   FEEDING BUTTON 24F BR4101                           842.00                    1    43760         Z7610                 278
CST          7470    7827   FILTER IV ULTRAPORE                                  31.00                    1   A4649          X7700                 272
CST          7470   95434   FILTER, ECMO                                          7.00                    1   A4649          Z7610                 272
CST          7470   31145   FLEXCAIR ECLIPSE RENTAL                             180.00                    1   A4649          Z7610                 947
CST          7470   31228   FLEXICAIR 12500 SET UP                                0.00   S                    A4649          Z7610                 270
CST          7470   31251   FLEXICAIR 13000 RENTAL                              239.00                    1   A4649          Z7610                 947
CST          7470   31244   FLEXICAIR 13000 SET UP                                0.00   S                    A4649          Z7610                 270
CST          7470   31137   FLEXCAIR ECLIPSE SET UP                               0.00   S                    A4649          Z7610                 270
CST          7470   31269   FLEXICAIR MC3 (W/SCALE) SETUP                         0.00   S                    A4649          Z7610                 270
CST          7470   96562   FLURO TIP .035 STANDARD (015417)                    277.00                    1   A4649          Z7610                 272
CST          7470   96563   FLURO TIP .035 TAPERED (015419)                     277.00                    1   A4649          Z7610                 272
CST          7470   35026   FORCEP BIOPSY 2MMX1.88MMX160MM                      245.00                    1   A4649          Z7610                 272
CST          7470   35000   FORCEP BIOPSY ENDOGLIDE SHEATH                      245.00                    1   A4649          Z7610                 272
CST          7470   96556   FORCEP COLON EXL 2.8 (015411)                       141.00                    1   A4649          Z7610                 272
CST          7470   35042   FORCEP HOT BIOPSY SERRATED 2.8                      462.00                    1   A4649          Z7610                 272
CST          7470   81491   GASTRO TUBE 16 FR                                   211.00                    1   B4085          Z7610                 272
CST          7470   80139   GASTRO TUBE 16FR                                     84.00                    1   A4649          Z7610                 272
CST          7470   83398   GASTRO TUBE 18FR                                    144.00                    1   B4086          B4086                 272
CST          7470   80899   GASTRO TUBE 20 FR                                   211.00                    1   B4085          Z7610                 272
CST          7470   80113   GASTRO TUBE 20FR                                    157.00                    1   B4085          Z7610                 272
CST          7470   81905   GASTROSTOMY KIT 18F                                 595.00                    1   B4086          B4086                 272
CST          7470   83828   GASTROSTOMY KIT MIC-KEY 24FR                        516.00                    1   A4550          Z7610                 272



                                                               Page 87 of 676
                                                                 CM 06/15/07


 Dept                                                                                                                        M/cal
        Cost Ctr.   SIM#                    Description                     Price             Stats/bill      CPT    Mod             Mod   Rev Code
 Code                                                                                                                       HCPCS
CST          7470   80717   GAUDERER PEG TRAY                                    641.00                    1 A4649         Z7610                 272
CST          7470    5115   GAYMAR T PUMP RENTAL                                   0.00   S                  A4649         Z7610                 270
CST          7470   47257   GEL-E DONUT (6518)                                     0.00   S                  A4649         Z7610                 270
CST          7470   81285   GI BUTTON 24E 4.4                                    707.00                    1 A4649         Z7610                 278
CST          7470   82317   GI SNARE 1.8 CATH                                    978.00                    1 A4649         Z7610                 272
CST          7470   96538   GLIDE WIRE .018 ANGLED (015428)                      682.00                    1 A4649         Z7610                 272
CST          7470   96537   GLIDE WIRE .025 STRAIGHT (015427)                    682.00                    1 A4649         Z7610                 272
CST          7470   96535   GLIDE WIRE .035 ANGLED (015425)                      682.00                    1 A4649         Z7610                 272
CST          7470   96536   GLIDE WIRE .035 STRAIGHT (015426)                    682.00                    1 A4649         Z7610                 272
CST          7470   83075   GORTEX LINER 2"                                      141.00                    1 A4649         Z7610                 272
CST          7470   83091   GORTEX LINER 3"                                      180.00                    1 A4649         Z7610                 272
CST          7470    4865   GRAD-U-FEED, 60ML                                      0.00   S                  A4649         Z7610                 272
CST          7470   82978   GROUNDING PAD ADULT                                    0.00   S                  A4649         Z7610                 271
CST          7470   82994   GROUNDING PAD PED                                      0.00   S                  A4649         Z7610                 271
CST          7470   45020   HARVARD SET -UP                                       56.00                    1 A4649         Z7610                 270
CST          7470   82275   HARVEST NDL 11G 4"                                   120.00                    1 A4649         Z7610                 272
CST          7470   82291   HARVEST NDL 13G 3 1/2"                               120.00                    1 A4649         Z7610                 272
CST          7470   43103   HEAD SUPPORT, GEL-E DONUT                             34.00                    1 A4649         Z7610                 271
CST          7470     947   HELMET SOFT SHELL LG                                 341.00                    1 A4649         Z7610                 271
CST          7470     939   HELMET SOFT SHELL MD                                 341.00                    1 A4649         Z7610                 271
CST          7470     921   HELMET SOFT SHELL SM                                 341.00                    1 A4649         Z7610                 271
CST          7470     913   HELMET SOFT SHELL XSM                                341.00                    1 A4649         Z7610                 271
CST          7470     905   HELMET SOFT SHELL XXSM                               341.00                    1 A4649         Z7610                 271
CST          7470   80832   HEMAFILTER KIT                                       380.00                    1 A4649         Z7610                 272
CST          7470   95111   HEMO BLOOD FILTER                                     16.00                    1 A4649         Z7610                 272
CST          7470   95921   HEMOFILTER, MINI                                     680.00                    1 A4649         Z7610                 272
CST          7470   82184   HOLLISTER POUCH 3/4                                  167.00                    1 A4649         Z7610                 272
CST          7470   80543   HUBER NDL 19G 3/4"                                     0.00   S                  A4215         Z7610                 272
CST          7470   24715   HUMIDIFIERS                                           11.00                    1 A4649         Z7610                 271
CST          7470   82002   ILEX PROTECT CREAM                                    16.00                    1 A4649         Z7610                 271
CST          7470   25811   IMMOBILIZER, SHOULDER MED                             97.00                    1 L3650         L3650                 274
CST          7470   25795   IMMOBILIZER, SHOULDER SM                              97.00                    1 L3650         L3650                 274
CST          7470   25779   IMMOBILIZER, SHOULDER XSM                             97.00                    1 L3650         L3650                 274
CST          7470   24079   INCONTINENCE PADS                                      0.00   S                  A4649         Z7610                 271
CST          7470    7727   INFANT CLAVICLE STRAP                                215.00                    1 L3670         L3670                 270



                                                                Page 88 of 676
                                                              CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                   Description                   Price         Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                  HCPCS
CST          7470   96545   INFLATOR W/GAUGE 10CC (015435)                    326.00                1   A4649         Z7610                 272
CST          7470   20226   INFUSOR PRESSURE BG 500CC                          82.00                1   A4649         X7700                 272
CST          7470   83018   INSERT, CONVEX ALL                                 35.00                1   A4649         Z7610                 272
CST          7470   36115   INTRAOSSEOUS NDL                                  114.00                1   A4649         Z7610                 272
CST          7470   32098   INTRODUCER, 3.5FR                                 228.00                1   A4649         Z7610                 272
CST          7470   32114   INTRODUCER, 4.0FR                                 228.00                1   A4649         Z7610                 272
CST          7470   83588   INTRODUCER, DESILET 6.0 35E                       158.00                1   A4649         Z7610                 272
CST          7470   83604   INTRODUCER, DESILET 7.0 35E                       158.00                1   A4649         Z7610                 272
CST          7470   83638   INTRODUCER, DESILET 8.0 35E                       158.00                1   A4649         Z7610                 272
CST          7470   98464   IV 0.45% NACL 1000ML                               96.00                1   A4649         X7700                 258
CST          7470   98456   IV 0.45% NACL 500ML                                96.00                1   A4649         X7700                 258
CST          7470   98522   IV 0.9% NACL 1000ML                                96.00                1   A4649         X7700                 258
CST          7470   98480   IV 0.9% NACL 100ML                                 86.00                1   A4649         X7700                 258
CST          7470   98498   IV 0.9% NACL 150ML                                 86.00                1   A4649         X7700                 258
CST          7470   98506   IV 0.9% NACL 250ML                                 96.00                1   A4649         X7700                 258
CST          7470   98514   IV 0.9% NACL 500ML                                 96.00                1   A4649         X7700                 258
CST          7470   98472   IV 0.9% NACL 50ML BAG                              86.00                1   A4649         X7700                 258
CST          7470   98423   IV 10% D/W 1000ML BAG                              96.00                1   A4649         X7700                 258
CST          7470   98407   IV 10% D/W 250ML BAG                               96.00                1   A4649         X7700                 258
CST          7470   98415   IV 10% D/W 500ML BAG                               96.00                1   A4649         X7700                 258
CST          7470   98316   IV 5% D/0.33% NACL 1000ML BAG                      96.00                1   A4649         X7700                 258
CST          7470   98290   IV 5% D/0.33% NACL 250ML BAG                       96.00                1   A4649         X7700                 258
CST          7470   98308   IV 5% D/0.33% NACL 500ML BAG                       96.00                1   A4649         X7700                 258
CST          7470   98340   IV 5% D/0.45% NACL 1000ML BAG                      96.00                1   A4649         X7700                 258
CST          7470   98324   IV 5% D/0.45% NACL 250ML BAG                       96.00                1   A4649         X7700                 258
CST          7470   98332   IV 5% D/0.45% NACL 500ML BAG                       96.00                1   A4649         X7700                 258
CST          7470   98357   IV 5% D/0.9% NACL 250ML BAG                        97.00                1   A4649         X7700                 258
CST          7470   98365   IV 5% D/0.9% NACL 500ML BAG                        96.00                1   A4649         X7700                 258
CST          7470   98399   IV 5% D/LACT RING 1000ML BAG                       96.00                1   A4649         X7700                 258
CST          7470   98381   IV 5% D/LACT RING 500ML BAG                        96.00                1   A4649         X7700                 258
CST          7470   98258   IV 5% D/W 1000ML BAG                               96.00                1   A4649         X7700                 258
CST          7470   98217   IV 5% D/W 100ML BAG                                86.00                1   A4649         X7700                 258
CST          7470   98225   IV 5% D/W 150ML BAG                                86.00                1   A4649         X7700                 258
CST          7470   98233   IV 5% D/W 250ML BAG                                96.00                1   A4649         Z7610                 258
CST          7470   98241   IV 5% D/W 500ML BAG                                96.00                1   A4649         X7700                 258



                                                             Page 89 of 676
                                                                 CM 06/15/07


 Dept                                                                                                                       M/cal
        Cost Ctr.   SIM#                    Description                     Price          Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                      HCPCS
CST          7470   98209   IV 5% D/W 50ML BAG                                 86.00                    1   A4649         X7700                 258
CST          7470   98373   IV D/0.9% NACL 1000ML BAG                          96.00                    1   A4649         X7700                 258
CST          7470    6555   IV DRESSING 1 1/2 X 2                              31.00                    1   A4649         X7700                 272
CST          7470    7124   IV FLOW REGULATOR                                  31.00                    1   A4649         X7700                 272
CST          7470   98555   IV LACT RING 1000ML BAG                            96.00                    1   A4649         X7700                 258
CST          7470   98530   IV LACT RING 250ML BAG                             96.00                    1   A4649         X7700                 258
CST          7470   98548   IV LACT RING 500ML BAG                             96.00                    1   A4649         X7700                 258
CST          7470   98563   IV MANNITOL 20% 250ML BAG                         121.00                    1   J2150         X6520                 258
CST          7470   98571   IV MANNITOL 20% 500ML BAG                         152.00                    1   J2150         X6522                 258
CST          7470   98647   IV STRL H2O IRRIG 1000ML BAG                       96.00                    1   J3490         X7704                 270
CST          7470   98613   IV STRL H2O IRRIG 100ML BT                         96.00                    1   J3490         X7704                 270
CST          7470   96465   IVAC STANDARD FULL SET                             22.00                    1   A4649         Z7610                 272
CST          7470   96457   IVAC STANDARD HALF SET                             16.00                    1   A4649         Z7610                 272
CST          7470   96473   IVAC STANDARD MINI SET                              2.00                    1   A4649         Z7610                 272
CST          7470   96539   JAGWIRE .025 STRAIGHT (015429)                    713.00                    1   A4649         Z7610                 272
CST          7470   96541   JAGWIRE .035 ANGLED (015431)                      713.00                    1   A4649         Z7610                 272
CST          7470   96540   JAGWIRE .035 STRAIGHT (015430)                    713.00                    1   A4649         Z7610                 272
CST          7470   25746   KATHETER EPICUTANEO CAVA                          135.00                    1   A4649         Z7610                 272
CST          7470   96571   KCI VACUUM MACHINE RENTAL                           0.00   S                    A4649         Z7610                 272
CST          7470   31293   KEANE BED RENTAL                                  446.00                    1   A4649         Z7610                 947
CST          7470   31285   KEANE BED SET UP                                    0.00   S                    A4649         Z7610                 270
CST          7470   98266   KIT 5% D/0.2% NACL 250ML BAG                       96.00                    1   A4649         X7700                 258
CST          7470   96531   KIT ICP ADULT DISP AKA TWISTDR                    954.00                    1   A4649         Z7610                 272
CST          7470   96570   KIT PERFUS 3/8" LONG-TERM(016508)               1,765.00                    1   A4649         Z7610                 272
CST          7470      12   KIT VAS-CATH 10FR X 19.5 CM                       396.00                    1   A4649         Z7610                 278
CST          7470      20   KIT VAS-CATH 8FR X 15CM                           396.00                    1   A4649         Z7610                 278
CST          7470   35067   KIT, GASTROSTOMY                                  640.00                    1   A4649         Z7610                 272
CST          7470   10508   KIT, MICROSENSOR NEURO                          1,623.00                    1   A4649         Z7610                 272
CST          7470   11191   KNEE IMMOBILIZER 19"                              207.00                    1   L1831         L1831                 274
CST          7470   11183   KNEE IMMOBILIZER 12"                              207.00                    1   L1830         L1830                 274
CST          7470   25837   LANDMARK CATH 22G 6"                              212.00                    1   A4649         Z7610                 272
CST          7470   25852   LANDMARK CATH 24G 6"                              228.00                    1   A4649         Z7610                 272
CST          7470   95608   LIMBOARD 1 X 4                                      0.00   S                    A4649         Z7610                 271
CST          7470   95624   LIMBOARD 1-1/2 X 4 1/2                              0.00   S                    Z7610         Z7610                 271
CST          7470   42154   LITTLE ONES, FEMALE URINE COLL                      0.00   S                    A4649         Z7610                 271



                                                                Page 90 of 676
                                                               CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                   Description                    Price          Stats/bill      CPT    Mod             Mod   Rev Code
 Code                                                                                                                  HCPCS
CST          7470   42147   LITTLE ONES, MALE URINE COLL                      0.00   S                  A4649         Z7610                 271
CST          7470   47083   LOS AIR W/SCALE SETUP                            87.00                    1 A4649         Z7610                 270
CST          7470   47075   LOW AIR LOSS BED W/BLT-IN SCLE                  909.00                    1 A4649         Z7610                 947
CST          7470   31319   MAGNUM I BARIATRIC BED RENTAL                   311.00                    1 A4649         Z7610                 947
CST          7470   31301   MAGNUM I BARIATRIC BED SET UP                     0.00   S                  A4649         Z7610                 270
CST          7470   31335   MAGNUM II BARIATRIC BED RENTAL                  462.00                    1 A4649         Z7610                 947
CST          7470   31327   MAGNUM II BARIATRIC BED SET UP                    0.00   S                  A4649         Z7610                 270
CST          7470   95095   MANIFOLD, 3 GANG 4 WAY                          121.00                    1 A4649         Z7610                 272
CST          7470    8601   MASK BILL-PHOTO #876                              0.00   S                  A4649         Z7610                 271
CST          7470    8544   MASK ISOLATION                                    0.00   S                  A4649         Z7610                 271
CST          7470   96937   MASK RESPIRONICS SM CHILD BIPAP                 386.00                    1 A4649         Z7610                 270
CST          7470    8551   MASK SURGEON DUCK-BILL 3M1838                     0.00   S                  A4649         Z7610                 271
CST          7470   95939   MINIFILTER HEMO KIT                             596.00                    1 A4649         Z7610                 272
CST          7470   24897   N25 PULSE-OX PROBE                               68.00                    1 A4649         Z7610                 271
CST          7470    8700   NDL JAMSHIDI MENGHINI 17GX100M                   56.00                    1 A4649         Z7610                 272
CST          7470   24608   NEBULIZER KIT                                    23.00                    1 A4649         Z7610                 272
CST          7470   24582   NEBULIZER, MEDS                                   5.00                    1 A4649         Z7610                 272
CST          7470    8692   NEEDLE JAMSHIDI 13GX2" W/LUER                    89.00                    1 A4649         Z7610                 272
CST          7470    8201   NEEDLE ART/VEN PERCUT 15GX5CM                   106.00                    1 A4215         Z7610                 270
CST          7470    8200   NEEDLE ART/VEN PERCUT 17GX5CM                   102.00                    1 A4215         Z7610                 270
CST          7470    8202   NEEDLE ART/VEN PERCUT 19GX5CM                   114.00                    1 A4215         Z7610                 270
CST          7470    8791   NEEDLE BONE MARROW ASP 15G                      167.00                    1 A4649         Z7610                 272
CST          7470    8148   NEEDLE HUBER 20G 1"                              30.00                    1 A4649         Z7610                 272
CST          7470    8189   NEEDLE HUBER 20G 3/4"                            30.00                    1 A4649         Z7610                 272
CST          7470    8160   NEEDLE HUBER 20GX 1 1/2"                         30.00                    1 A4215         X7702                 270
CST          7470    8163   NEEDLE HUBER 20GX 1 1/4"                         30.00                    1 A4649         Z7610                 272
CST          7470    8775   NEEDLE HAMSHIDI 13G X 3 1/2"                     89.00                    1 A4649         Z7610                 272
CST          7470    8767   NEEDLE JAMSHIDI 70MM 17G                        171.00                    1 A4649         Z7610                 272
CST          7470   82234   NEEDLE VASTAK 20G X 1"                           26.00                    1 A4649         Z7610                 272
CST          7470   82218   NEEDLE VASTAK 20G X 3/4"                         26.00                    1 A4649         Z7610                 272
CST          7470   81988   NEEDLE, HUBER BENT 20G X 2                       24.00                    1 Z7610         Z7610                 272
CST          7470   82424   NEEDLE, JAMSHIDI 16G X 100MM                     82.00                    1 A4649         Z7610                 272
CST          7470   31801   NEPHROSTOMY SET                                 571.00                    1 A4649         Z7610                 272
CST          7470   95988   OPEN HEART PACK                              10,321.00                    1 A4550         Z7610                 272
CST          7470    5151   ORTHO EQ BARDENH. DUNLAP                          0.00   S                  A4649         Z7610                 270



                                                              Page 91 of 676
                                                                CM 06/15/07


 Dept                                                                                                                     M/cal
        Cost Ctr.   SIM#                   Description                    Price          Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                    HCPCS
CST          7470    5300   ORTHO EQ BUCKS TRACT BILA                         0.00   S                    A4649         Z7610                 270
CST          7470    5250   ORTHO EQUIP BRYANTS TRACT                         0.00   S                    A4649         Z7610                 270
CST          7470    5409   ORTHO EQUIP CIRCLE BED NC                         0.00   S                    A4649         Z7610                 270
CST          7470    5557   ORTHO EQUIP RUSSELL TRACT                         0.00   S                    A4649         Z7610                 270
CST          7470    5607   ORTHO EQUIP STRYKER FRAME                         0.00   S                    A4649         Z7610                 270
CST          7470   81269   OSTOMY BELT LTL-1                                23.00                    1   A4649         Z7610                 271
CST          7470   83356   OSTOMY, SPECIAL ORDER                           192.00                    1   A4649         Z7610                 272
CST          7470   83315   OXYGENATOR 0.4M                               2,571.00                    1   A4649         Z7610                 279
CST          7470   95004   OXYGENATOR 0.8                                3,793.00                    1   A4649         Z7610                 279
CST          7470   95764   OXYGENATOR 1.5M2                              3,559.00                    1   A4649         Z7610                 272
CST          7470   94999   OXYGENATOR 2.5M2                              2,896.00                    1   A4649         Z7610                 272
CST          7470   94981   OXYGENATOR 3.5M2                              3,076.00                    1   A4649         Z7610                 272
CST          7470   94973   OXYGENATOR 4.5M2                              3,188.00                    1   A4649         Z7610                 272
CST          7470   96184   OXYGENATOR, CARMEDA MINI-MAX                  1,608.00                    1   A4649         Z7610                 272
CST          7470   69184   OXYGENATOR, CARMEDA MINI-MAX                      0.00                    1   A4649         Z7610                 272
CST          7470   96630   PACK DEVELOP LRG>2000G (14491)                  596.00                    1   A4649         Z7610                 270
CST          7470   96689   PACK DEVELOP MED>1500-2000G 14492               596.00                    1   A4649         Z7610                 270
CST          7470   96739   PACK DEVELOP SML<1000-1500G 14493               596.00                    1   A4649         Z7610                 270
CST          7470   96788   PACK DEVELOP XSM<1000G (14494)                  596.00                    1   A4649         Z7610                 270
CST          7470    8106   PAD AIR FLOW PLUS PAF 350                         0.00   S                    A4649         Z7610                 271
CST          7470    8825   PAD CPM THERAPY                                 126.00                    1   A4649         Z7610                 271
CST          7470   20614   PAD HYPOTHERMIA 25X60" DHP-810                   74.00                    1   A4649         Z7610                 279
CST          7470   10649   PAD SHEEPSKIN KODEL 30X40"                       35.00                    1   A4649         Z7610                 271
CST          7470   20531   PAD TEMP THERAPY TP 22E                          29.00                    1   A4649         Z7610                 271
CST          7470   10417   PAD WOOLIE 18X10"                                47.00                    1   A4649         Z7610                 271
CST          7470   10425   PAD WOOLIE 24X14"                                56.00                    1   A4649         Z7610                 271
CST          7470     202   PASTE STOMAHESIVE 2 OZ                           34.00                    1   A6250         Z7610                 272
CST          7470   40104   PATIENT RAIL PROTECTORS                           0.00   S                    A4649         Z7610                 270
CST          7470   70064   PAVLIK HARNESS LG                               294.00                    1   L1620         L1620                 274
CST          7470   70049   PAVLIK HARNESS MED                              294.00                    1   L1620         L1620                 274
CST          7470   70023   PAVLIK HARNESS SM                               294.00                    1   L1620         L1620                 274
CST          7470   70007   PAVLIK HARNESS XSM                              294.00                    1   L1620         L1620                 274
CST          7470   46010   PCA PUMP RENTAL                                   0.00   S                    A4649         Z7610                 270
CST          7470   46028   PCA PUMP SET-UP                                  58.00                    1   A4649         Z7610                 270
CST          7470   24103   PCA SET MINIBORE                                 31.00                    1   A4649         X7700                 272



                                                            Page 92 of 676
                                                           CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                  Description                 Price        Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                              HCPCS
CST          7470   83273   PED DIALYSIS KIT                             34.00                  1   A4649         Z7610                 272
CST          7470   96440   PEDI-CAP                                     49.00                  1   A4649         Z7610                 271
CST          7470   83794   PEDI-PACK, CARMEDA-COATED                 5,432.00                  1   A4550         Z7610                 272
CST          7470   25944   PEDI-WRAP, NEWBORN                           82.00                  1   A4649         Z7610                 271
CST          7470   25969   PEDI-WRAP, X-LARGE                           92.00                  1   A4649         Z7610                 271
CST          7470   81475   PEDIWRAP, LARGE                              92.00                  1   A4649         Z7610                 271
CST          7470   81459   PEDIWRAP, MEDIUM                             92.00                  1   A4649         Z7610                 271
CST          7470   81434   PEDIWRAP, SMALL                              92.00                  1   A4649         Z7610                 271
CST          7470   83448   PEG REPAIR TRAY 16FR                        695.00                  1   A4649         Z7610                 272
CST          7470   83752   PEG TRAY 20 FR                              695.00                  1   A4649         Z7610                 272
CST          7470   25894   PER-Q-CATH, 3.8F DL                         608.00                  1   A4649         Z7610                 272
CST          7470   95079   PERFUSION PACK                            2,770.00                  1   A4550         Z7610                 272
CST          7470   96523   PERFUSION PACK 3/8" LONG TERM             2,523.00                  1   A4550         Z7610                 270
CST          7470   83505   PERI-PATCH EXTENSION SET                    240.00                  1   A4649         Z7610                 272
CST          7470   43053   PERI-WASH II 8OZ MEDICATED                    0.00 S                    A4649         Z7610                 271
CST          7470   80675   PERITONEAL DIALYSIS CATH                    255.00                  1   A4649         Z7610                 278
CST          7470   98605   PLASMA-LYTE A PH 7.4 500ML NU                96.00                  1   A4649         X7700                 258
CST          7470   33179   POCKET PEAK FLOW METER, STANDARD             44.00                  1   A4649         Z7610                 271
CST          7470   81178   PORTA-WARM MATTRESS                         140.00                  1   A4649         Z7610                 271
CST          7470   81079   POST-OP OSTOMY POUCH                         17.00                  1   A5051         Z7610                 272
CST          7470   80303   POUCH 1/2 X 2 1/2" 1-PC COLOPL              168.00                  1   A4649         Z7610                 271
CST          7470   80204   POUCH 1/2X1 1/2" 1-PIECE COLOP              181.00                  1   A4649         Z7610                 271
CST          7470   82333   POUCH DRAINAGE 1"                            94.00                  1   A4649         Z7610                 272
CST          7470   82044   POUCH LITTLE-ONES                           127.00                  1   A4649         Z7610                 272
CST          7470   25472   PROBE ACCUTEMP SKIN                          23.00                  1   A4649         Z7610                 272
CST          7470   83836   PROBE, PH W/REF ELECTRODE                   212.00                  1   A4649         Z7610                 272
CST          7470   83257   PROBE SCHUSTER ANORECTAL                    261.00                  1   A4649         Z7610                 272
CST          7470   24863   PROBE, PULSE-OX D20                          53.00                  1   A4649         Z7610                 271
CST          7470   24889   PROBE, PULSE-OX D25                          53.00                  1   A4649         Z7610                 271
CST          7470   24848   PROBE, PULSE-OX I20                          68.00                  1   A4649         Z7610                 271
CST          7470   31095   PULMONEX MATT REPLACE RENTAL                279.00                  1   A4649         Z7610                 270
CST          7470   47141   PULSE OX PROBE RENTAL                       114.00                  1   A4649         Z7610                 270
CST          7470   47133   PULSE OX PROBE SETUP                         86.00                  1   A4649         Z7610                 270
CST          7470      53   PUMP BVS 5000 DISPOSABLE                 41,555.00                  1   A4649         Z7610                 272
CST          7470   24905   QUIK PRES MONITOR                             0.00 S                    A4649         Z7610                 279



                                                          Page 93 of 676
                                                                 CM 06/15/07


 Dept                                                                                                                        M/cal
        Cost Ctr.   SIM#                   Description                      Price             Stats/bill      CPT    Mod             Mod   Rev Code
 Code                                                                                                                       HCPCS
CST          7470    5065   RAZZLE PUMP RENTAL                                     0.00   S                  A4649         Z7610                 270
CST          7470   31012   RENTAL, CLINITRON CII                                277.00                    1 A4649         Z7610                 947
CST          7470   31053   RENTAL, CLINITRON FLEXIS                             658.00                    1 A4649         Z7610                 947
CST          7470   31038   RENTAL, CLINITRON UP-LIFT                            393.00                    1 A4649         Z7610                 947
CST          7470   30071   RENTAL, ENTERAL PUMP (CORPAK)                          0.00   S                  A4649         Z7610                 270
CST          7470   31236   RENTAL, FLEXICAIR 12500                              180.00                    1 A4649         Z7610                 947
CST          7470   31277   RENTAL, FLEXICAIR MC3 (W/SCALE)                      365.00                    1 A4649         Z7610                 947
CST          7470   47182   RENTAL, OMNIFLOW PUMP                                  0.00   S                  A4649         Z7610                 270
CST          7470    3198   REPAIR KIT BROVIAC 0.7MM                             457.00                    1 A4649         Z7610                 272
CST          7470    3149   REPAIR KIT BROVIAC 1.6MM                             354.00                    1 A4649         Z7610                 272
CST          7470      26   REPAIR KIT RED LEG ADPTR (016667)                    341.00                    1 A4649         Z7610                 272
CST          7470    3214   REPAIR KIT TPN COOK DL                               332.00                    1 A4649         Z7610                 272
CST          7470    3206   REPAIR KIT TPN COOK DL 7.0                           343.00                    1 A4649         Z7610                 272
CST          7470    3222   REPAIR KIT TPN COOK DL 9.0                           343.00                    1 A4649         Z7610                 272
CST          7470      25   REPAIR KIT WHTE LEG ADPTR(016666)                    341.00                    1 A4649         Z7610                 272
CST          7470   83331   RESERVOIR, VENOUS ECMO                               869.00                    1 A4649         Z7610                 272
CST          7470   25456   RESTRAINT, ADULT                                      22.00                    1 A4649         Z7610                 271
CST          7470   36263   RESTRAINT, VEST LG                                    35.00                    1 A4649         Z7610                 271
CST          7470   36248   RESTRAINT, VEST MED                                   34.00                    1 A4649         Z7610                 271
CST          7470   36222   RESTRAINT, VEST SM                                    31.00                    1 A4649         Z7610                 271
CST          7470   36289   RESTRAINT, VEST XLG                                   35.00                    1 A4649         Z7610                 271
CST          7470   36669   RESUS BAG, ADULT                                      66.00                    1 A4649         Z7610                 271
CST          7470   36628   RESUS BAG, INFANT                                     87.00                    1 A4649         Z7610                 271
CST          7470   36644   RESUS BAG, PEDIATRIC                                  89.00                    1 A4649         Z7610                 271
CST          7470   31392   SCALE IN BED RENTAL                                   82.00                    1 A4649         Z7610                 270
CST          7470   31384   SCALE IN BED SET UP                                    0.00   S                  A4649         Z7610                 270
CST          7470   81418   SCLEROTHERAPY NDL                                    189.00                    1 A4649         Z7610                 272
CST          7470   95384   SENSORS, ECMO                                        341.00                    1 A4649         Z7610                 271
CST          7470   47125   SEQUENTIAL COMP DEVICE RENTAL                          0.00   S                  A4649         Z7610                 270
CST          7470   47117   SEQUENTIAL COMP DEVICE SETUP                          56.00                    1 A4649         Z7610                 270
CST          7470      22   SET PERICARDIO 5.0 (003400)                          419.00                    1 A4649         Z7610                 272
CST          7470      23   SET PERICARDIO 8.3 (016518)                          631.00                    1 A4649         Z7610                 272
CST          7470   31061   ACCUAIR MATTRESS SET UP                                0.00   S                  A4649         Z7610                 270
CST          7470   31111   ACCUAIR MATT REPLACE SET UP                            0.00   S                  A4649         Z7610                 270
CST          7470   31004   SET UP, CLINITRON CII                                  0.00   S                  A4649         Z7610                 270



                                                                Page 94 of 676
                                                            CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                   Description                 Price          Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                 HCPCS
CST          7470   31046   SET UP, CLINITRON FLEXIS                       0.00   S                    A4649         Z7610                 270
CST          7470   31020   SET UP, CLINITRON UP-LIFT                      0.00   S                    A4649         Z7610                 270
CST          7470   30063   SET UP, GAYMAR T PUMP                        140.00                    1   A4649         Z7610                 270
CST          7470   47174   SET UP, OMNIFLOW PUMP                         71.00                    1   A4649         Z7610                 270
CST          7470   31087   PULMONEX MATT REPLACE SET UP                   0.00   S                    A4649         Z7610                 270
CST          7470   10375   SET, PRESSURE MONITOR 401T N/S               126.00                    1   A4649         Z7610                 272
CST          7470   24814   SET-UP IPPB                                   10.00                    1   A4649         Z7610                 271
CST          7470    5172   SETUP AIR FLUIDIZED BED                       87.00                    1   A4649         Z7610                 270
CST          7470    5214   SETUP CARDIAC MONITOR                         53.00                    1   A4649         Z7610                 270
CST          7470    5222   SETUP ISOLETTE                                87.00                    1   A4649         Z7610                 270
CST          7470    5180   SETUP LOW AIR LOSS BED                        87.00                    1   A4649         Z7610                 270
CST          7470    5198   SETUP ROTATIONAL BED                          87.00                    1   A4649         Z7610                 270
CST          7470   82408   SHEATH REPLACEMENT 240CM (GI)                141.00                    1   A4649         Z7610                 272
CST          7470   25431   SHEATH/SLEEVE 65CM (COOK)                     40.00                    1   A4649         Z7610                 272
CST          7470   43004   SKIN PASTE CRITICAID 6OZ                      56.00                    1   A4649         Z7610                 272
CST          7470      54   SLEEPGEAR BREEZE                             884.00                    1   E0618         E0618                 271
CST          7470   15234   SLEEVE, THIGH LENGTH MED                     266.00                    1   A4649         Z7610                 271
CST          7470   83224   SLING & SWATHE, MED                           37.00                    1   A4649         Z7610                 271
CST          7470   83208   SLING & SWATHE, SM                            53.00                    1   A4649         Z7610                 271
CST          7470   82374   SNARE JUMBO OVAL (GI)                        163.00                    1   A4649         Z7610                 272
CST          7470   82358   SNARE JUMBO OVAL 24MM (GI)                   163.00                    1   A4649         Z7610                 272
CST          7470   35109   SNARE, PROFILE PED .27MM                      71.00                    1   A4649         Z7610                 272
CST          7470   35083   SNARE, SENSATION .33MM                        87.00                    1   A4649         Z7610                 272
CST          7470   47208   SOFTCARE MATTRESS                              0.00   S                    A4649         Z7610                 270
CST          7470    6332   SPECIMEN MEASURE TOILET TOP                    0.00   S                    A4649         Z7610                 271
CST          7470   20549   SPECIMEN TRAP                                  0.00   S                    A4649         Z7610                 272
CST          7470    2307   SPEEDBAND BOX 2                            1,290.00                    1   A4649         Z7610                 271
CST          7470    2315   SPEEDBAND MULTI LITIGATOR 3BND             1,019.00                    1   A4649         Z7610                 272
CST          7470   96565   SPHICTEROME ULTRATON XL (015421)             869.00                    1   A4649         Z7610                 272
CST          7470   12967   SPLINT CLAVICLE XSM                          261.00                    1   L3670         L3670                 274
CST          7470    7552   SPLINT HAND/FINGER/TOE/BNJO LARGE             50.00                    1   A4570         A4570                 270
CST          7470    7545   SPLINT HAND/FINGER/TOE/BNJO MED               47.00                    1   A4570         A4570                 270
CST          7470   10953   SPLINT ILFELD XSM                            644.00                    1   A4570         A4570                 274
CST          7470   11076   SPLINT ILFIELD LG                            697.00                    1   A4570         A4570                 271
CST          7470   11035   SPLINT ILFIELD MED                           671.00                    1   A4570         A4570                 274



                                                           Page 95 of 676
                                                                 CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                   Description                      Price      Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                  HCPCS
CST          7470   10995   SPLINT ILFIELD SM                                 658.00                1   A4570         A4570                 274
CST          7470   11258   SPLINT PLASTER 3 X 15"                             30.00                1   A4570         A4570                 271
CST          7470   11308   SPLINT PLASTER 4"X15" (103)                        35.00                1   A4570         A4570                 271
CST          7470   11365   SPLINT PLASTER 5" X 30" (104)                      62.00                1   A4570         A4570                 271
CST          7470   11134   SPLINT SYSTEM LG MULTI                            538.00                1   A4570         Z7610                 274
CST          7470   11100   SPLINT SYSTEM, MEDIUM                             538.00                1   A4570         Z7610                 274
CST          7470   11118   SPLINT SYSTEM, SMALL                              538.00                1   A4570         Z7610                 274
CST          7470   11084   SPLINT SYSTEM, TODDLER                            484.00                1   A4570         Z7610                 274
CST          7470   11092   SPLINT SYSTEM, CHILD                              484.00                1   A4570         Z7610                 274
CST          7470    7370   SPLINT, ARM ABDUCTION LARGE                       948.00                1   L3960         L3960                 270
CST          7470    7362   SPLINT, ARM ABDUCTION MED                         948.00                1   L3960         L3960                 270
CST          7470    7404   SPLINT, ARM ANT/POST LARGE                      1,050.00                1   L3986         L3986                 270
CST          7470    7438   SPLINT, ARM ELBOW MOLD LG                          74.00                1   A4570         A4570                 270
CST          7470    7420   SPLINT, ARM ELBOW MOLD MED                         64.00                1   A4570         A4570                 270
CST          7470    7412   SPLINT, ARM ELBOW MOLD SM                          50.00                1   A4570         A4570                 270
CST          7470    7446   SPLINT, ARM SUGAR TONG SM                          37.00                1   A4570         A4570                 270
CST          7470    7529   SPLINT, HAND/FINGER/TOE.SIMPLE LG                  18.00                1   A4570         A4570                 270
CST          7470    7503   SPLINT, HAND/FINGER/TOE/SIMPLE SM                  18.00                1   A4570         A4570                 270
CST          7470    7495   SPLINT, LEG LG                                    110.00                1   A4570         A4570                 270
CST          7470    7487   SPLINT, LEG MED.                                   87.00                1   A4570         A4570                 270
CST          7470    7479   SPLINT, LEG SM                                     64.00                1   A4570         A4570                 270
CST          7470   80394   SPLINT, WRIST SM L                                137.00                1   A4570         A4570                 274
CST          7470   24921   SPLIT CATH SET                                    128.00                1   A4649         Z7610                 272
CST          7470    7537   SPLNT HAND/FINGER/TOE,BNJO SM                      37.00                1   A4570         A4570                 270
CST          7470   36339   SPONGES (ILIZAROV)                                161.00                1   A4649         Z7610                 272
CST          7470   83562   STAPLER, SKIN 15 COUNT                            469.00                1   A4649         Z7610                 272
CST          7470   83547   STAPLER, SKIN 5-COUNT                              34.00                1   A4649         Z7610                 272
CST          7470   96561   STENT GEENEN (015416)                             490.00                1   A4649         Z7610                 272
CST          7470   96559   STENT SET 7MMX5CM (015414)                        490.00                1   A4649         Z7610                 272
CST          7470   96558   STENT SET 7MMX6CM (015413)                        490.00                1   A4649         Z7610                 272
CST          7470   96557   STENT SET 7MMX9CM (015412)                        490.00                1   A4649         Z7610                 272
CST          7470   96560   STENT ZIMMON (015415)                             490.00                1   A4649         Z7610                 272
CST          7470   81103   STIFNECK BABY NO-NECK                             114.00                1   L0140         L0140                 274
CST          7470   81145   STIFNECK NO-NECK                                  114.00                1   L0140         L0140                 274
CST          7470   81129   STIFNECK PEDIATRIC                                114.00                1   L0140         L0140                 274



                                                                Page 96 of 676
                                                              CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                   Description                   Price        Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                 HCPCS
CST          7470   14047   STOCKING TED LG LONG                            56.00                  1   A4649         Z7610                 271
CST          7470   14039   STOCKING TED LG REG                             47.00                  1   A4649         Z7610                 271
CST          7470   14021   STOCKING TED LG SHT                             47.00                  1   A4649         Z7610                 271
CST          7470   14013   STOCKING TED MED LG                             34.00                  1   A4649         Z7610                 271
CST          7470   13999   STOCKING TED MED SHT                            34.00                  1   A4649         Z7610                 271
CST          7470   14005   STOCKING TED MEDIUM REG                         34.00                  1   A4649         Z7610                 271
CST          7470   13981   STOCKING TED SM LG                              18.00                  1   A4649         Z7610                 271
CST          7470   13973   STOCKING TED SM REG                             18.00                  1   A4649         Z7610                 271
CST          7470   13965   STOCKING TED SM SHT                             56.00                  1   A4649         Z7610                 271
CST          7470   12868   STOPCOCK, 3 WAY                                 31.00                  1   A4649         X7700                 272
CST          7470   13007   STRAP MONTGOMERY 8X11" W/TIES                   22.00                  1   A4649         Z7610                 272
CST          7470   12991   STRAP, CLAVICLE ADULT                          215.00                  1   L3670         L3670                 274
CST          7470   12975   STRAP, CLAVICLE CHILD                          261.00                  1   L3670         L3670                 274
CST          7470   12983   STRAP, CLAVICLE YOUTH                          261.00                  1   L3670         L3670                 274
CST          7470   82952   SUCTION COAGULATOR                              34.00                  1   A4649         Z7610                 272
CST          7470   96200   SUCTION SYSTEM, TRACH "Y"2.6MM                  66.00                  1   A4649         Z7610                 272
CST          7470   30006   SUCTION, ASPIRATION                             35.00                  1   A4649         Z7610                 270
CST          7470   13627   SUPPORT, SCROTAL LG                             30.00                  1   A4649         Z7610                 271
CST          7470   13619   SUPPORT, SCROTAL MED                            30.00                  1   A4649         Z7610                 271
CST          7470   13601   SUPPORT, SCROTAL SMALL                          24.00                  1   A4649         Z7610                 271
CST          7470    5920   SWAN-GANZ 7.5 FR X 110CM                     1,059.00                  1   A4649         Z7610                 272
CST          7470   14807   SYRINGE 2 OZ CATH-TIP                            0.00 S                    A4649         Z7610                 272
CST          7470   14922   TAPE CASTING 2" FIBERGLASS                      13.00                  1   A4649         Z7610                 271
CST          7470   14948   TAPE CASTING 3" FIBERGLASS                      16.00                  1   A4649         Z7610                 271
CST          7470   14963   TAPE CASTING 4" FIBERGLASS                      18.00                  1   A4649         Z7610                 271
CST          7470   45038   THERMOTIC SET-UP                                56.00                  1   A4649         Z7610                 270
CST          7470    4035   THERMOTIC SUCTION                               35.00                  1   A4649         Z7610                 270
CST          7470   42113   TRACH TUBE ADULT CUFFLESS 5.0                  223.00                  1   A4649         Z7610                 272
CST          7470   83844   TRACH TUBE BIVONA W/ CUFF                    1,494.00                  1   A4649         Z7610                 272
CST          7470   80568   TRACH TUBE CUSTOM                            1,085.00                  1   A4649         Z7610                 272
CST          7470   40224   TRACH TUBE NEONATAL 2/5                        245.00                  1   A4649         Z7610                 272
CST          7470   18261   TRACH TUBE, #4PT                               161.00                  1   A4649         Z7610                 272
CST          7470   42121   TRACH TUBE, ADULT CUFFLESS 6.0                 223.00                  1   A4649         Z7610                 272
CST          7470   42139   TRACH TUBE, ADULT CUFFLESS 7.0                 152.00                  1   A4649         Z7610                 272
CST          7470   42014   TRACH TUBE, NEONATAL 3.0                       272.00                  1   A4649         Z7610                 272



                                                             Page 97 of 676
                                                              CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                   Description                   Price         Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                  HCPCS
CST          7470   42022   TRACH TUBE, NEONATAL 3.5                          272.00                1   A4649         Z7610                 272
CST          7470   42030   TRACH TUBE, NEONATAL 4.0                          272.00                1   A4649         Z7610                 272
CST          7470   19004   TRACH TUBE, NEONATE 3.0 CUFFED                    897.00                1   A4649         Z7610                 272
CST          7470   19020   TRACH TUBE, NEONATE 3.5 CUFFED                    897.00                1   A4649         Z7610                 272
CST          7470   19046   TRACH TUBE, NEONATE 4.0 CUFFED                    897.00                1   A4649         Z7610                 272
CST          7470   19061   TRACH TUBE, PED 3.0 CUFFED                        897.00                1   A4649         Z7610                 272
CST          7470   19087   TRACH TUBE, PED 3.5 CUFFED                        809.00                1   A4649         Z7610                 272
CST          7470   19103   TRACH TUBE, PED 4.0 CUFFED                        809.00                1   A4649         Z7610                 272
CST          7470   19129   TRACH TUBE, PED 4.5 CUFFED                        809.00                1   A4649         Z7610                 272
CST          7470   19145   TRACH TUBE, PED 5.0 CUFFED                        897.00                1   A4649         Z7610                 272
CST          7470   19160   TRACH TUBE, PED 5.5 CUFFED                        897.00                1   A4649         Z7610                 272
CST          7470   42048   TRACH TUBE, PED CUFFLESS 2.5                      272.00                1   A4649         Z7610                 272
CST          7470   42055   TRACH TUBE, PED CUFFLESS 3.0                      272.00                1   A4649         Z7610                 272
CST          7470   42063   TRACH TUBE, PED CUFFLESS 3.5                      272.00                1   A4649         Z7610                 272
CST          7470   42071   TRACH TUBE, PED CUFFLESS 4.0                      245.00                1   A4649         Z7610                 272
CST          7470   42089   TRACH TUBE, PED CUFFLESS 4.5                      245.00                1   A4649         Z7610                 272
CST          7470   42097   TRACH TUBE, PED CUFFLESS 5.0                      272.00                1   A4649         Z7610                 272
CST          7470   42105   TRACH TUBE, PED CUFFLESS 5.5                      272.00                1   A4649         Z7610                 272
CST          7470   82788   TRACTION BOOT, LG                                  86.00                1   E0944         E0944                 274
CST          7470   82762   TRACTION BOOT, MED                                 86.00                1   E0944         E0944                 274
CST          7470   82747   TRACTION BOOT, SM                                  77.00                1   E0944         E0944                 274
CST          7470   82721   TRACTION BOOT, X-SM                                77.00                1   E0944         Z7610                 274
CST          7470   82705   TRACTION BOOT, X-X-SM                             104.00                1   E0944         E0944                 274
CST          7470   20481   TRANSDUCER KIT OR/PICU                             54.00                1   A4649         Z7610                 271
CST          7470   20473   TRANSDUCER NEONATE KIT                             41.00                1   A4649         Z7610                 271
CST          7470   20499   TRANSDUCER TNF-R                                   70.00                1   A4649         Z7610                 271
CST          7470   44069   TRANSDUCER, IXICLIQ NEONATAL                       48.00                1   A4649         Z7610                 271
CST          7470   44028   TRANSDUCER, OXICLIQ ADULT                          38.00                1   A4649         Z7610                 271
CST          7470   44002   TRANSDUCER, OXICLIQ INFANT                         48.00                1   A4649         Z7610                 271
CST          7470   44044   TRANSDUCER, OXICLIQ PEDIATRIC                      38.00                1   A4649         Z7610                 271
CST          7470   42188   TRANSDUCER, TRIFURCATED KIT                       145.00                1   A4649         Z7610                 271
CST          7470    3263   TRAY BONE MARROW DISP                             101.00                1   A4649         Z7610                 272
CST          7470   83740   TRAY CVC DUAL LUM 4FRX15CM                        291.00                1   A4550         Z7610                 270
CST          7470   20655   TRAY FOLEY CATHETER INSERTION                      10.00                1   A4310         Z7610                 272
CST          7470   22248   TRAY LACERATION                                    50.00                1   A4649         Z7610                 272



                                                             Page 98 of 676
                                                                CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                   Description                    Price        Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                  HCPCS
CST          7470   20556   TRAY LUMBAR PUNCTURE INFANT                        37.00                1   A4550         A4550                 272
CST          7470   20572   TRAY LUMBAR PUNCTURE PEDIATRIC                     62.00                1   A4550         A4550                 272
CST          7470    8437   TRAY PER-Q-CATH 2FR                               251.00                1   A4649         Z7610                 272
CST          7470   80238   TRAY PER-Q-CATH 3 FR                              233.00                1   A4649         Z7610                 272
CST          7470    8452   TRAY PER-Q-CATH 4FR W/LEAD WIR                    233.00                1   A4649         Z7610                 272
CST          7470   10326   TRAY SUTURE REMOVAL                                10.00                1   A4649         Z7610                 272
CST          7470   20598   TRAY TPN/DRESSING CHANGE                           14.00                1   A4649         Z7610                 272
CST          7470   83653   TRAY, CATH VENOUS SL 4FR 12CM                     156.00                1   A4300         Z7610                 272
CST          7470   83679   TRAY, CATH VENOUS SL 5FR 15CM                     156.00                1   A4300         Z7610                 272
CST          7470   83695   TRAY, CATH VENOUS SL 5FR 25CM                     156.00                1   A4300         Z7610                 272
CST          7470   83711   TRAY, CATH VENOUS SL 6FR 15CM                      89.00                1   A4300         Z7610                 272
CST          7470   83737   TRAY, CATH VENOUS SL 6FR 25CM                     156.00                1   A4300         Z7610                 272
CST          7470   51460   TRAY, INTUBATION INFANT & YOUNG                   963.00                1   A4649         Z7610                 272
CST          7470   51478   TRAY, INTUBATION OLDER CHILD                      713.00                1   A4649         Z7610                 272
CST          7470   50256   TRAY, MANOMETER                                    18.00                1   A4649         Z7610                 272
CST          7470   83778   TRAY, PEG 16FR                                    695.00                1   A4649         Z7610                 272
CST          7470   83414   TRAY, PEG REPAIR 20FR CORPAK                      451.00                1   A4649         Z7610                 272
CST          7470   50355   TRAY, THORACENTESIS SET                            58.00                1   A4649         Z7610                 272
CST          7470   83489   TRAY, THORACOSTOMY PROCEDURE                       92.00                1   A4649         Z7610                 272
CST          7470   50405   TRAY, TRANSFUSION EXCHANGE                        188.00                1   A4550         Z7610                 272
CST          7470   34177   TRIPLE LUMEN CATH TRAY 13G                        236.00                1   A4649         Z7610                 272
CST          7470   20697   TROCAR CATHETER 20 FR                              54.00                1   B4085         Z7610                 272
CST          7470   81343   TUBE DECOMPRESS 18FR 1.7CM (1157)                  41.00                1   A4649         Z7610                 271
CST          7470   21075   TUBE FEEDING 6FR X 22" CORPAK                      68.00                1   B4082         Z7610                 272
CST          7470   21067   TUBE FEEDING 6FR X 36" CORPAK                      68.00                1   B4082         Z7610                 272
CST          7470   20952   TUBE FEEDING 8FR X 15"                              1.00                1   B4081         Z7610                 272
CST          7470   21059   TUBE FEEDING 8FR X 36" CORPAK                      68.00                1   B4082         Z7610                 272
CST          7470   20945   TUBE FEEDING 8FR X 42"                              1.00                1   B4081         Z7610                 272
CST          7470   82549   TUBE GASTRO ENTERIC 16FR LOW-V                    516.00                1   B4086         B4086                 272
CST          7470   20739   TUBE LUKI SPECIMEN                                 14.00                1   A4649         Z7610                 272
CST          7470   18378   TUBE TRACH #4 FEN SHILEY                          341.00                1   A4649         Z7610                 272
CST          7470   18444   TUBE TRACH #41LPC SHILEY                          306.00                1   A4649         Z7610                 272
CST          7470   18436   TUBE TRACH #4CFN SHILEY                           233.00                1   A4649         Z7610                 272
CST          7470   18139   TUBE TRACH #4CFS SHILEY                           187.00                1   A4649         Z7610                 272
CST          7470   18485   TUBE TRACH #5SCT SHILEY                           167.00                1   A4649         Z7610                 272



                                                            Page 99 of 676
                                                               CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                  Description                    Price        Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                 HCPCS
CST          7470   18394   TUBE TRACH #6 FEN SHILEY                         341.00                1   A4649         Z7610                 272
CST          7470   18428   TUBE TRACH #6CFN SHILEY                          233.00                1   A4649         Z7610                 272
CST          7470   18147   TUBE TRACH #6CFS SHILEY                          219.00                1   A4649         Z7610                 272
CST          7470   18113   TUBE TRACH #6DCT SHILEY                          197.00                1   A4649         Z7610                 272
CST          7470   18469   TUBE TRACH #7SCT SHILEY                          180.00                1   A4649         Z7610                 272
CST          7470   18162   TUBE TRACH #8CFS SHILEY                          219.00                1   A4649         Z7610                 272
CST          7470   18121   TUBE TRACH #8LPC SHILEY                          306.00                1   A4649         Z7610                 272
CST          7470   18097   TUBE TRACH #DCT SHILEY                           317.00                1   A4649         Z7610                 272
CST          7470   18311   TUBE TRACH 3.0 NEONATE SHILEY                    156.00                1   A4649         Z7610                 272
CST          7470   18014   TUBE TRACH 3.0 PEDIATRIC SHILE                   156.00                1   A4649         Z7610                 272
CST          7470   18337   TUBE TRACH 3.5 NEONATE SHILEY                    161.00                1   A4649         Z7610                 272
CST          7470   18048   TUBE TRACH 3.5 PEDIATRIC SHILE                   156.00                1   A4649         Z7610                 272
CST          7470   18352   TUBE TRACH 4.0 NEONATE SHILEY                    156.00                1   A4649         Z7610                 272
CST          7470   18063   TUBE TRACH 4.0 PEDIATRIC SHILE                   156.00                1   A4649         Z7610                 272
CST          7470   18071   TUBE TRACH 4.5 PEDIATRIC SHILE                   161.00                1   A4649         Z7610                 272
CST          7470   18089   TUVE TRACH 5.0 PEDIATRIC SHILE                   161.00                1   A4649         Z7610                 272
CST          7470   16745   TUBE TRACH STERLING (ALL SIZES                   341.00                1   A4649         Z7610                 272
CST          7470   22172   TUBE VENO 10 FT N/S                               24.00                1   A4649         Z7610                 272
CST          7470   81368   TUBE, DECOMPRESSION 18FRX2.4CM                    41.00                1   A4649         Z7610                 278
CST          7470   80527   TUBE, DECOMPRESSION 24FR 1.7                      41.00                1   A4649         Z7610                 278
CST          7470   80857   TUBE, DECOMPRESSION 24FR X 2.44                   48.00                1   A4649         Z7610                 278
CST          7470   81301   TUBE, DECOMPRESSION 24FRX3.4CM                    34.00                1   A4649         Z7610                 278
CST          7470   81327   TUBE, DECOMPRESSION 24FRX4.4CM                    34.00                1   A4649         Z7610                 278
CST          7470   80147   TUBE, GASTRO 14FR                                135.00                1   B4085         Z7610                 272
CST          7470   82069   TUBE, GASTRO ENTERIC 22FR                        516.00                1   B4085         Z7610                 272
CST          7470   83059   TUBE, GASTROENTERIC 20FR LOW VOL                 211.00                1   B4086         B4086                 272
CST          7470   21356   TUBE, REPLOGLE 10FR X 24                          38.00                1   B4081         Z7610                 272
CST          7470   22206   TUBE, WIRE GUIDED JEJUNAL                        369.00                1   B4084         Z7610                 272
CST          7470   21521   TUBE, YANKAUER FINE TIP                            5.00                1   A4649         Z7610                 272
CST          7470   21505   TUBE, YANKAUER HIGH CAP                            5.00                1   A4649         Z7610                 272
CST          7470   20754   TUBES CONNECTING 3/16"X6'                          1.00                1   A4649         Z7610                 272
CST          7470   20903   TUBES FEEDING 5FR X 15"                            1.00                1   B4081         Z7610                 272
CST          7470   22503   TUBING, ARTERIAL                                  58.00                1   A4649         Z7610                 272
CST          7470   21901   TUBING, PENROSE 1/4IN X 12                        17.00                1   A4649         Z7610                 270
CST          7470   21851   TUBING, PENROSE 1/2IN X 12IN                      17.00                1   A4649         Z7610                 270



                                                          Page 100 of 676
                                                              CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                  Description                     Price        Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                  HCPCS
CST          7470   22529   TUBING, VENOUS                                   49.00                  1   A4649         Z7610                 272
CST          7470   95798   UMBIL ARTERY CATH                                84.00                  1   A4300         Z7610                 272
CST          7470   95848   UMBILICAL CATH 3.5                               84.00                  1   A4300         Z7610                 272
CST          7470   95749   UMBILICAL KIT 5 FR                              311.00                  1   A4300         Z7610                 272
CST          7470   95905   UMBILICAL TRAY 3.5                              311.00                  1   A4300         Z7610                 272
CST          7470   24004   UNDERPADS/CHUX                                    0.00 S                    A4649         Z7610                 271
CST          7470   95038   URI-CATH KIT 5 FR                               103.00                  1   A4351         Z7610                 272
CST          7470   95053   URI-CATH KIT 8 FR                               103.00                  1   A4351         Z7610                 272
CST          7470    8759   URINE METER 300/2000ML BAG                       37.00                  1   A4649         Z7610                 271
CST          7470   96574   VACUUM CANNISTER (017787)                       150.00                  1   A4649         Z7610                 272
CST          7470    6639   VALVE ANTI-REFLUX                                26.00                  1   A4649         Z7610                 272
CST          7470   80048   VALVE SPEAK PASSYMUIR WHITE CO                  231.00                  1   A4649         Z7610                 272
CST          7470   82259   VASTAK NDL 20G 1 1/4"                            26.00                  1   A4649         Z7610                 272
CST          7470   25613   VENOUS CATH 4F DL                               221.00                  1   A4300         Z7610                 272
CST          7470   25639   VENOUS CATH 5F DL                               221.00                  1   A4300         Z7610                 272
CST          7470   25654   VENOUS CATH 7.5 DL                              209.00                  1   A4300         Z7610                 272
CST          7470   25597   VENOUS CATH 7F TL                               222.00                  1   A4300         Z7610                 272
CST          7470   25373   VENOUS CATH DL 20C                              213.00                  1   A4300         Z7610                 272
CST          7470   25191   VENOUS CATH DL 4 FR                             213.00                  1   A4300         Z7610                 272
CST          7470   25233   VENOUS CATH DL 4 FR                             221.00                  1   A4300         Z7610                 272
CST          7470   25324   VENOUS CATH DL 7 FR                             221.00                  1   A4300         Z7610                 272
CST          7470   25134   VENOUS CATH SL 3 FR                             150.00                  1   A4300         Z7610                 272
CST          7470   25159   VENOUS CATH SL 4 FR                             150.00                  1   A4300         Z7610                 272
CST          7470   25399   VENOUS CATH SL 5.0                              120.00                  1   A4300         Z7610                 272
CST          7470   25175   VENOUS CATH SL 5 FR                             150.00                  1   A4300         Z7610                 272
CST          7470   81673   VENOUS CATH TL 7F                               163.00                  1   A4300         Z7610                 272
CST          7470   25308   VENOUS CATH TR 5 FR                             290.00                  1   A4300         Z7610                 272
CST          7470   95962   VENOVENOUS CANNULA                              924.00                  1   A4300         Z7610                 272
CST          7470   82168   VIGILON 4 X 4                                   143.00                  1   A4649         Z7610                 272
CST          7470   82028   WAFER LITTLE-ONES                                90.00                  1   A4649         Z7610                 272
CST          7470     723   WAFER STOMA 1 1/2"                               58.00                  1   A4421         Z7610                 272
CST          7470     731   WAFER STOMA 1 3/4"                               58.00                  1   A4421         Z7610                 272
CST          7470     749   WAFER STOMA 2 1/4"                               58.00                  1   A4421         Z7610                 272
CST          7470    4084   WALL SUCTION SETUP                              128.00                  1   A4649         Z7610                 270
CST          7470      21   WATERTRAP (016943)                               70.00                  1   A4649         Z7610                 272



                                                             Page 101 of 676
                                                           CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                 Description                   Price          Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                 HCPCS
CST          7470   25001   WIRE GUIDE 18-50-0-2                          77.00                    1   A4649         Z7610                 272
CST          7470   25027   WIRE GUIDE 21-60-0-2                          77.00                    1   A4649         Z7610                 272
CST          7470   25043   WIRE GUIDE 35-50-0-3                          77.00                    1   A4649         Z7610                 272
CST          7470   25068   WIRE GUIDE 38-50-0-3                          50.00                    1   A4649         Z7610                 272
CST          7470   47232   WOOLIE PAD 18X10(729)                          0.00   S                    A4649         Z7610                 270
CST          7470   47240   WOOLIE PAD 24X10 (730)                         0.00   S                    A4649         Z7610                 270
CST          7470   83299   WOUND MANAGER, LARGE                         126.00                    1   A4649         Z7610                 272
CST          7470   81053   WOUND MGMT SYSTEM POST-OP                     10.00                    1   A4649         Z7610                 272
CST          7470   81814   WRAP SEMI-RIGID 2" (1176)                     38.00                    1   A4649         Z7610                 271
CST          7470   81848   WRAP, SEMI-RIGID 3"                           48.00                    1   A4649         Z7610                 271
CST          7470   80485   WRIST SPLINT LG L                            137.00                    1   A4570         A4570                 274
CST          7470   80469   WRIST SPLINT LG R                            137.00                    1   A4570         A4570                 274
CST          7470   80444   WRIST SPLINT MED L                           137.00                    1   A4570         A4570                 274
CST          7470   80428   WRIST SPLINT MED R                           137.00                    1   A4570         A4570                 274
CST          7470   80378   WRIST SPLINT SM R                            137.00                    1   A4570         A4570                 274
CST          7470   80345   WRIST SPLINT X SM L                          137.00                    1   A4570         A4570                 274
CST          7470   80329   WRIST SPLINT X SM R                          137.00                    1   A4570         A4570                 274
CST          7470    7743   YOUTH CLAVICLE STRAP                         215.00                    1   L3670         L3670                 270
CST          7470   31160   ZONEAIRE W/O SCALE RENTAL                    189.00                    1   A4649         Z7610                 270
CST          7470   31152   ZONEAIRE W/O SCALE SET UP                      0.00   S                    A4649         Z7610                 270
CST          7470   31186   ZONEAIRE W/SCALE RENTAL                      245.00                    1   A4649         Z7610                 270
CST          7470   31178   ZONEAIRE W/SCALE SET UP                        0.00   S                    A4649         Z7610                 270
CTS          7423   65014   ALLD HLTH PHN CNSLT 1/4 HR                     0.00   S                    Z5406         Z5406                 519
CTS          7423   65013   ALLD HLTH TEAM CONF 1/4 HR                    12.05                    1   Z4302         Z4302                 519
CTS          7423   65001   CENTER COORDINATOR                           103.28                    1   Z4300         Z4300                 519
CTS          7423   40002   CLOSED HEART SURGERY                           0.00   S                                                        360
CTS          7423   40101   COMPLEX BYPASS/OPEN SURGERY                    0.00   S                                                        360
CTS          7423   60372   CT CASE CONF 1/4 HR                           13.00                    1 Z4302           Z4302                 515
CTS          7423   65002   COMP CHART REVIEW & REPORT                    77.46                    1 Z4304           Z4304                 519
CTS          7423   65535   CTS F/UP USE OF ROOM                           0.00   S                                  Z7500                 515
CTS          7423   65015   GROUP TEACHING/SUPPORT                        19.18                    1 Z4314           Z4314                 519
CTS          7423   65004   NURSE EVALUATION 1/2 HR                       24.10                    1 Z4301           Z4301                 519
CTS          7423   65006   NURSE PHONE CNSLT 1/4 HR                       0.00   S                  Z5406           Z5406                 519
CTS          7423   65005   NURSE TEAM CONF 1/4 HR                        12.05                    1 Z4310           Z4310                 519
CTS          7423   65003   PERIODIC CHART REV & RPT                      43.03                    1 Z4303           Z4303                 519



                                                          Page 102 of 676
                                                          CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                  Description                 Price       Stats/bill        CPT     Mod                Mod    Rev Code
 Code                                                                                                               HCPCS
CTS          7423   40051   SIMPLE BYPASS/OPEN SURGERY                   0.00 S                                                             360
CTS          7423   40150   SPECIAL PROCEDURES                           0.00 S                                                             480
CTS          7423    7423   USE OF ROOM CHARGE                          50.00                  1    99211          Z7500                    515
CTS          7423   61010   USE OF ROOM - NO CHARGE                      0.00 S                     99211          Z7500                    515
CTS          7423   60600   USE OF ROOM CHARGE                          50.00                  1    99211          Z7500                    515
CTT          7861   50159   *X H/L ORGAN PROCUREMENT A             100,000.00                  1   Z7312               38250                812
CTT          7861   50134   *X DL ORGAN PROCUREMENT A               80,000.00                  1   Z7316               38250                812
CTT          7861   51207   *X DONOR TRANSPORT AIR A                 5,280.00                  1    99082          Z7310                    810
CTT          7861   51215   *X DONOR TRANSPORT AIR B                 7,920.00                  1    99082          Z7310                    810
CTT          7861   51223   *X DONOR TRANSPORT AIR C                13,200.00                  1    99082          Z7310                    810
CTT          7861   51231   *X DONOR TRANSPORT AIR D                21,120.00                  1    99082          Z7310                    810
CTT          7861   51249   *X DONOR TRANSPORT AIR E                26,400.00                  1    99082          Z7310                    810
CTT          7861   51256   *X DONOR TRANSPORT AIR F                33,000.00                  1    99082          Z7310                    810
CTT          7861   51306   *X DONOR TRANSPORT GROUND A              1,320.00                  1    99082              99082                810
CTT          7861   51314   *X DONOR TRANSPORT GROUND B              1,980.00                  1    99082              99082                810
CTT          7861   51322   *X DONOR TRANSPORT GROUND C              3,300.00                  1    99082              99082                810
CTT          7861   51330   *X DONOR TRANSPORT GROUND D              3,960.00                  1    99082              99082                810
CTT          7861   51348   *X DONOR TRANSPORT GROUND E              5,280.00                  1    99082              99082                810
CTT          7861   60018   *X UNOS LISTING FEE                      1,162.00                  1    99199          Z7304                    810
CTT          7861   63499   ADD LIVING DONOR ACQUIRED LUNG          60,000.00                  1   Z7314           Z7314                    812
CTT          7861   65013   ALLD HLTH TEAM CONF 1/4 HR                  12.05                  1   Z4302           Z4302                    519
CTT          7861   65001   CENTER COORDINATOR                         103.28                  1   Z4300           Z4300                    519
CTT          7861   65002   COMP CHART REV & RPT                        77.46                  1   Z4304           Z4304                    519
CTT          7861   65015   GROUP TEACHING/SUPPORT                      19.18                  1   Z4314           Z4314                    519
CTT          7861   63494   HEART PERFUSION EACH ADD HOUR              200.00                  1    99190              99190                480
CTT          7861   63493   HEART PERFUSION UP TO 6 HOURS            1,500.00                  1    99190              99190                480
CTT          7861   63491   HEART,LUNG PERF STND BY 1ST HR             150.00                  1    99190              99190                480
CTT          7861   63492   HRT,LUNG PRF STND Y ECH AD HR              150.00                  1    99190              99190                480
CTT          7861   63498   LIVING DONOR ACQUISITION LUNG           60,000.00                  1   Z7314           Z7314                    812
CTT          7861   63496   LUNG PERFUSION EACH ADD HOUR               200.00                  1    99190              99190                480
CTT          7861   63495   LUNG PERFUSION UP TO 6 HOURS             1,500.00                  1    99190              99190                480
CTT          7861   60232   METIC CROSSMATCH FLOW CYTOMETRY            430.00                  1    86806     90       86806     90         302
CTT          7861   15059   METIC CROSSMATCH LYMPHOCYTOTOXICI          600.00                  1    86806     90       86806     90         302
CTT          7861   15158   METIC CYTOTOXIC PRA                        300.00                  1    86807     90       86807     90         302
CTT          7861   61380   METIC FLOW PRA                             430.00                  1    86807     90       86807     90         302



                                                         Page 103 of 676
                                                            CM 06/15/07


 Dept                                                                                                                    M/cal
        Cost Ctr.   SIM#                   Description                  Price          Stats/bill       CPT     Mod                Mod    Rev Code
 Code                                                                                                                   HCPCS
CTT          7861   65050   METIC HLA A TYPING DNA CLASS I                300.00                    1 86817       90       86817     90         302
CTT          7861   65051   METIC HLA B TYPING DNA CLASS I                440.00                    1 86817       90       86817     90         302
CTT          7861   65052   METIC HLA C TYPING DNA CLASS I                300.00                    1 86817       90       86817     90         302
CTT          7861   65054   METIC HLA CLASS 1 ANTIBODY SPECIF             400.00                    1 86813       90       86813     90         302
CTT          7861   65055   METIC HLA CLASS II ANTIBODY SPECI             400.00                    1 86813       90       86813     90         302
CTT          7861   61378   METIC HLA TYPING AC MULTI ANTIGEN             400.00                    1 86813       90       86813     90         302
CTT          7861   15356   METIC HLA TYPING DNA CLASS II                 660.00                    1 86817       90       86817     90         302
CTT          7861   61377   METIC HLA TYPING DR0MYULT ANTIGEN             600.00                    1 86812       90       86812     90         302
CTT          7861   65004   NURSE EVALUATION 1/2 HR                        24.10                    1 Z4301            Z4301                    519
CTT          7861   65006   NURSE PHONE CNSLT 1/4 HR                        0.00   S                  Z5406            Z5406                    519
CTT          7861   65005   NURSE TEAM CONF 1/4 HR                         12.05                    1 Z4310            Z4310                    519
CTT          7861   65003   PERIODIC CHART REV & RPT                       43.03                    1 Z4303            Z4303                    519
CTT          7861   65053   SERUM STORAGE                                  60.00                    1                                           302
CTT          7861   65007   SOC WORK EVAL 1/2 HR                           24.10                    1 Z4307            Z4307                    561
CTT          7861   65008   SOC WORK TEAM CONF 1/4HR                       12.05                    1 Z4311            Z4311                    561
CTT          7861   61388   TRANSPLANT HOME CARE                          240.00                    1 NC               NC                       589
CTT          7861   61389   TRANSPLANT HOME CARE                          480.00                    1 NC               NC                       589
CTT          7861   61390   TRANSPLANT HOME CARE                          720.00                    1 NC               NC                       589
CTT          7861   61391   TRANSPLANT HOME CARE                          960.00                    1 NC               NC                       589
CTT          7861   61392   TRANSPLANT HOME CARE                        1,200.00                    1 NC               NC                       589
CTT          7861   61382   TRANSPLANT PHARMACY                         2,400.00                    1 NC               NC                       250
CTT          7861   61383   TRANSPLANT PHARMACY                         3,600.00                    1 NC               NC                       250
CTT          7861   61384   TRANSPLANT PHARMACY                         4,800.00                    1 NC               NC                       250
CTT          7861   61385   TRANSPLANT PHARMACY                         6,000.00                    1 NC               NC                       250
CTT          7861   61386   TRANSPLANT PHARMACY                         8,400.00                    1 NC               NC                       250
CTT          7861   61387   TRANSPLANT PHARMACY                        12,000.00                    1 NC               NC                       250
CTT          7861   63497   USE OF ROOM - PROSTIN PATIENTS                 50.00                    1 Z7500            Z7500                    515
CTT          7861   60600   USE OF ROOM CHARGE                             50.00                    1 99211            Z7500                    515
CTT          7861   50142   X HEART ORGAN PROCUREMENT                  59,000.00                    1 Z7304                38250                812
DHP          7390   71024   BONE MARROW ASPIRATION                          0.00   S                                                            519
DHP          7390   71025   BONE MARROW BIOPSY                              0.00   S                                                            519
DHP          7390   71030   CHEMO ADM INTO CNS INC SPINAL                   0.00   S                                                            519
DHP          7390   71004   # OF IV STARTS                                  0.00   S                                                            519
DHP          7390   36709   AEROSOL PENTAMIDINE                           227.00                    1   94642              94642                410
DHP          7390   36758   AEROSOL TREATMENT INIT                         48.00                    1   94640              94640                410



                                                           Page 104 of 676
                                                            CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                  Description                   Price          Stats/bill       CPT     Mod                Mod    Rev Code
 Code                                                                                                                   HCPCS
DHP          7390   65138   AEROSOL TREATMENT SUBSEQUENT                   34.00                    1   94640     76      94640      76         410
DHP          7390   71010   CALLS - APPT SCHEDULING                         0.00   S                                                            519
DHP          7390   71011   CALLS - HOME CARE COORDINATION                  0.00   S                                                            519
DHP          7390   71012   CALLS - MED ADJUSTMENT                          0.00   S                                                            519
DHP          7390   71013   CALLS - PRESCRIPTION REFILLS                    0.00   S                                                            519
DHP          7390   71001   CENTRAL LINE ACCESS/CARE                        0.00   S                                                            519
DHP          7390   65140   CHEMO ADM INTO CNS REQ&INC SPINAL             350.00                    1   96450              96450                335
DHP          7390   65141   CHEMO ADM SQ OR IM W W/O LOCAL AN              34.00                    1   96401              96401                335
DHP          7390   35818   CHEMO ADMIN IV PUSH                           126.00                    1   96409              96409                331
DHP          7390   65045   CHEMO IV INFUSION 1ST HR                      429.00                    1   96413              96413                335
DHP          7390   65047   CHEMO IV INFUSION EA ADDL HR                  212.00                    1   96415              96415                335
DHP          7390   65510   CHEMO IV PUSH, EA ADDL DRUG                    65.70                    1   96411              96411                335
DHP          7390   65401   DECLOT VASC ACCESS DEVICE                      58.10                    1   36550              36550                515
DHP          7390   65139   DEMO A/OP EVAL PT AEROSOL DEVICE               26.00                    1   94664              94664                410
DHP          7390   71002   FACILITY TRANSFER                               0.00   S                                                            519
DHP          7390   65015   GROUP TEACHING/SUPPORT                         19.18                    1 Z4314            Z4314                    519
DHP          7390   65126   INJECTION IM ANTIOBIOTIC                       22.00                    1 90772                90772                515
DHP          7390   65040   INJECTION IM/SQ (BILL W/JCODE)                 22.00                    1 90772                90772                515
DHP          7390   65041   INJECTION IV (BILL W/JCODE)                    90.00                    1 90774                90774                515
DHP          7390   71003   INPATIENT ADMISSION                             0.00   S                                                            519
DHP          7390   65500   INSERTION OF PICC <5YRS W/SED                 205.70                    1   36568              36568                361
DHP          7390   65501   INSERTION OF PICC >5YRS                       172.50                    1   36569              36569                361
DHP          7390   65301   IV HYDRATION EA ADDL HR                        43.50                    1   90761              90761                940
DHP          7390   65300   IV HYDRATION INIT UP TO 1HR                    79.50                    1   90760              90760                940
DHP          7390   65132   IV INFUSION NON CHEMO 1ST HOUR                237.00                    1   90765              90765                260
DHP          7390   65133   IV INFUSION NON CHEMO EA ADDL HR               58.00                    1   90766              90766                260
DHP          7390   65200   IV NON-CHEMO ADDD SEQ INF TO 1HR              135.00                    1   90767              90767                940
DHP          7390   65201   IV NON CHEMO CONCURENT INFUS                   76.00                    1   90768              90768                940
DHP          7390   65202   IV PUSH EA ADDL DRUG(BILL W/J CD)              88.70                    1   90775              90775                940
DHP          7390   71005   NG TUBE PLACEMENT                               0.00   S                                                            519
DHP          7390   71000   OMMAYA TAP                                      0.00   S                                                            519
DHP          7390   71006   PATIENT/FAMILY EDUCATION>20 MIN                 0.00   S                                                            519
DHP          7390   71007   PBSC COLLECTION                                 0.00   S                                                            519
DHP          7390   71032   PBSC INFUSION                                   0.00   S                                                            519
DHP          7390   65003   PERIODIC CHRT REV & REPORT                     24.10                    1 Z4303            Z4303                    519



                                                           Page 105 of 676
                                                           CM 06/15/07


 Dept                                                                                                                 M/cal
        Cost Ctr.   SIM#                  Description                  Price          Stats/bill       CPT     Mod              Mod   Rev Code
 Code                                                                                                                 HCPCS
DHP          7390   71008   PHARMACOKINETICS                               0.00   S                                                         519
DHP          7390   36055   PHLEB. THERAPEUTIC (SEP PROC)                 47.00                    1   99195            99195               940
DHP          7390   71009   PICC REMOVAL                                   0.00   S                                                         519
DHP          7390   71014   PO MED ADMISISTRATION                          0.00   S                                                         519
DHP          7390   71015   RBC EXCHANGE                                   0.00   S                                                         519
DHP          7390   65504   REPAIR OF CVC WO PORT                        136.90                    1 36575               36575              515
DHP          7390   65004   RN ASSESSMNT,EVAL,OR INTERVENTION             24.10                    1 Z4301           Z4301                  519
DHP          7390   66320   SEDATION <5YRS OF AGE 1ST 30MIN              621.00                    1 99143               99143              370
DHP          7390   66321   SEDATION >5YRS OF AGE 1ST 30MIN              621.00                    1 99144               99144              370
DHP          7390   66322   SEDATION EA ADDL 15MIN                       310.00                    1 99145               99145              370
DHP          7390   65131   SKIN TEST, PPD INTRADERMAL                    48.00                    1 86580 TC            86580 TC           515
DHP          7390   65506   SKIN TEST, CANDIDA                            58.20                    1 86485               86485              335
DHP          7390   65007   SOC WORK EVAL 1/2 HR                          24.10                    1 Z4307           Z4307                  561
DHP          7390   65009   SOC WORK PHONE CNSLT 1/4 HR                    0.00   S                  Z5406           Z5406                  561
DHP          7390   65008   SOC WORK TEAM CONF 1/4 HR                     12.05                    1 Z4311           Z4311                  561
DHP          7390   65136   SPINAL PUNCTURE,LUMBAR DIAGNOSTIC            108.00                    1 62270               62270              361
DHP          7390   37608   TRANSFUSION - 1 HR                            64.00                    1 36430           Z7514                  391
DHP          7390   37624   TRANSFUSION - 3 HR                           150.00                    1 36430           Z7514                  391
DHP          7390   37632   TRANSFUSION - 4 HR                           198.00                    1 36430           Z7514                  391
DHP          7390   37640   TRANSFUSION - 5 HR                           248.00                    1 36430           Z7514                  391
DHP          7390   37657   TRANSFUSION - 6 HR                           300.00                    1 36430           Z7514                  391
DHP          7390   37665   TRANSFUSION - 7 HR                           348.00                    1 36430           Z7514                  391
DHP          7390   37673   TRANSFUSION - 8 HR                           398.00                    1 36430           Z7514                  391
DHP          7390   37681   TRANSFUSION - 9 HR                           448.00                    1 36430           Z7514                  391
DHP          7390   37699   TRANSFUSION 10 HR                            499.00                    1 36430           Z7514                  391
DHP          7390   37616   TRANSFUSION 2 HR                             101.00                    1 36430           Z7514                  391
DHP          7390   71018   UNEXPECTED COMP-FEVER                          0.00   S                                                         519
DHP          7390   71019   UNEXPECTED COMP-MED RXN                        0.00   S                                                         519
DHP          7390   71017   UNEXPECTED COMP-TRANSF RXN                     0.00   S                                                         519
DHP          7390   71016   URINARY CATHETERIZATION                        0.00   S                                                         519
DHP          7390   61010   USE OF ROOM - NO CHARGE                        0.00   S                    99211         Z7500                  515
DHP          7390   60600   USE OF ROOM CHARGE                            50.00                    1   99211         Z7500                  515
DHP          7390   71020   WBC INFUSION                                   0.00   S                                                         519
DMH          7843   61324   COLLATERAL                                     4.00                    1   90887            90887               915
DMH          7843   61346   COS-COMM CLIENT SVCS 1 HR                    140.00                    1                                        910



                                                          Page 106 of 676
                                                              CM 06/15/07


 Dept                                                                                                                 M/cal
        Cost Ctr.   SIM#                  Description                   Price          Stats/bill        CPT   Mod             Mod   Rev Code
 Code                                                                                                                 HCPCS
DMH          7843   61345   COS-MENTAL HLTH PROMO 1 HR                      140.00                  1                                      910
DMH          7843   61344   DAY REHAB FULL DAY                              189.00                  1   H2012        H2012                 912
DMH          7843   61319   FAMILY PSYCHOTHERAPY PT PRESENT                   4.00                  1    90847           90847             916
DMH          7843   61321   GRP PSYCHOTHERAPY                                 4.00                  1    90853           90853             915
DMH          7843   61323   GRP REHAB                                         4.00                  1   H2015        H2015                 915
DMH          7843   61322   IA GRP PSYCHOTHERAPY                              4.00                  1    90857           90857             915
DMH          7843   61306   IA PSYCHOTHERAPY 20-44 MIN                      120.00                  1    90810           90810             914
DMH          7843   61307   IA PSYCHOTHERAPY 45-74 MIN                      224.00                  1    90812           90812             914
DMH          7843   61310   IA PSYCHOTHERAPY 75 OR MORE MIN                 282.00                  1    90814           90814             914
DMH          7843   61314   IA PSYCHOTHERAPY EM 20-44 MIN                   120.00                  1    90811           90811             914
DMH          7843   61315   IAPSYCHOTHERAPY EM 45-74 MIN                    224.00                  1    90813           90813             914
DMH          7843   61316   IAPSYCHOTHERAPY EM 75 MIN >                     282.00                  1    90815           90815             914
DMH          7843   61325   IND PHARMACOLOGIC MED MGMT                        6.00                  1    90862           90862             910
DMH          7843   61317   IND REHAB CLIENT FUNCTIONAL                       4.00                  1   H2015        H2015                 914
DMH          7843   61318   IND REHAB EMPLOYMENT SUPPORT                      4.00                  1   H2025        H2025                 914
DMH          7843   61327   MED EDU & ADMIN                                   6.00                  1   H2010        H2010                 910
DMH          7843   61320   MULTI-FAMILY GRP PSYCHOTHERAPY                    4.00                  1    90849           90849             915
DMH          7843   61300   PSYCH DX INTERVIEW                                4.00                  1    90801           90801             910
DMH          7843   61301   PSYCH DX INTERVIEW NON VERBAL                     4.00                  1    90802           90802             910
DMH          7843   61302   PSYCH TESTING                                     4.00                  1    96101           96101             918
DMH          7843   61303   PSYCHOTHERAPY 20-44 MINUTES                     120.00                  1    90804           90804             914
DMH          7843   61304   PSYCHOTHERAPY 45 - 74 MINUTES                   224.00                  1    90806           90806             914
DMH          7843   61305   PSYCHOTHERAPY 75 - OR MORE                      282.00                  1    90808           90808             914
DMH          7843   61311   PSYCHOTHERAPY EM 20- 44 MIN                     120.00                  1    90805           90805             914
DMH          7843   61312   PSYCHOTHERAPY EM 45 - 74 MIN                    224.00                  1    90807           90807             914
DMH          7843   61313   PSYCHOTHERAPY EM 75 MIN >                       282.00                  1    90809           90809             914
DMH          7843   61326   PSYCHOTROPIC PRESCRIPTION MGMT                    6.00                  1   M0064        M0064                 910
DMH          7843   61343   REPORT WRITING NO CONTACT                         2.00                  1    90889           90889             910
DMH          7843   61340   TARGET CASE MGMT                                  2.00                  1   T1017        T1017                 910
DMH          7843   61341   TEAM CONFERENCE 30 MIN <                         87.00                  1    99361           99361             515
DMH          7843   61342   TEAM CONFERENCE OVER >                          131.00                  1    99362           99362             910
DNT          7184   30906   CEPHALOMETRIC X-RAY                              70.00                  1    70350 TC        70350 TC          320
DNT          7184   30252   DENTAL F/UP ROOM USE                              0.00 S                                 Z7500                 512
DNT          7184   65110   EXTRA-ORAL X-RAY                                 96.00                  1    70100 TC        70100 TC          320
DNT          7184   30807   FULL MOUTH X-RAYS                               132.00                  1    70320 TC        70320 TC          320



                                                          Page 107 of 676
                                                           CM 06/15/07


 Dept                                                                                                                    M/cal
        Cost Ctr.   SIM#                  Description                  Price          Stats/bill        CPT      Mod                Mod   Rev Code
 Code                                                                                                                   HCPCS
DNT          7184   65109   LESS THAN FULL MOUTH X-RAYS                   77.00                    1    70310   TC         70310   TC           320
DNT          7184   66220   NAM(NASAL AVALOLAR MOLDING) CONTR          1,095.00                    1    21080              21080                515
DNT          7184   65488   ORTHODONTIC CONTRACT LEVEL VIII              600.00                    1   Z5418           Z5418                    512
DNT          7184   65134   ORTHODONTIC CONTRACT LEVEL I                 100.00                    1   Z5418           Z5418                    512
DNT          7184   65135   ORTHODONTIC CONTRACT LEVEL II                200.00                    1   Z5418           Z5418                    512
DNT          7184   65136   ORTHODONTIC CONTRACT LEVEL III               280.00                    1   Z5418           Z5418                    512
DNT          7184   65137   ORTHODONTIC CONTRACT LEVEL IV                340.00                    1   Z5418           Z5418                    512
DNT          7184   65489   ORTHODONTIC CONTRACT LEVEL IX                700.00                    1   Z5418           Z5418                    512
DNT          7184   65138   ORTHODONTIC CONTRACT LEVEL V                 420.00                    1   Z5418           Z5418                    512
DNT          7184   65486   ORTHODONTIC CONTRACT LEVEL VI                500.00                    1   Z5418           Z5418                    512
DNT          7184   65487   ORTHODONTIC CONTRACT LEVEL VII               560.00                    1   Z5418           Z5418                    512
DNT          7184   30856   PANOGRAPHIC X-RAY                            107.00                    1    70355   TC         70355   TC           320
DNT          7184   30559   SINGLE VIEW/SINGLE DENTAL X-RAY               49.00                    1    70300   TC         70300   TC           320
DNT          7184   65112   TEMPOROMANDIB JOINT BILAT X-RAY              158.00                    1    70330   TC         70330   TC           320
DNT          7184   65111   TEMPOROMANDIB JOINT UNILAT X-RAY              92.00                    1    70328   TC         70328   TC           320
DNT          7184   61010   USE OF ROOM - NO CHARGE                        0.00   S                     99211          Z7500                    515
DNT          7184   60600   USE OF ROOM CHARGE                            50.00                    1    99211          Z7500                    515
DRM          7202   65125   BLOOD COLLECTION, ACCESS DEVICE                0.00   S                     36540                                   515
DRM          7202   65132   CENTRAL LINE CATH REPAIR                       0.00   S                     93799              93799                515
DRM          7202   65033   CHANGE OF GASTROSTOMY TUBE                     0.00   S                     43760              43760                515
DRM          7202   65031   DECLOT VASCULAR CATH                           0.00   S                     36550              36550                515
DRM          7202   65128   HHN INITIAL TX                               221.00                    1    94640              94640                410
DRM          7202   65126   IM INJ ANTIOBIOTIC (BILL W/JCODE)             29.00                    1    90772              90772                515
DRM          7202   65040   INJ, IM/SUBQ (BILL W/JCODE)                   29.00                    1    90772              90772                515
DRM          7202   65041   INJ, IV (BILL W/JCODE)                       119.00                    1    90774              90774                515
DRM          7202   65028   INTRO INTRACATH VEIN, BILAT                    0.00   S                     36000              36000                515
DRM          7202   65027   INTRO INTRACATH VEIN, UNI                      0.00   S                     36000              36000                515
DRM          7202   65127   NONPRESSURIZED INH TX                        145.00                    1    94640              94640                410
DRM          7202   65124   SEDATION,IV/IM/INH(BILL W/JCODE)             549.00                    1    99143              99143                370
DRM          7202   65123   SEDATION,PO/PR (BILL W/JCODE)                680.00                    1    99143              99143                370
DRM          7202   65130   SELF CARE TRAIN, EA 15 MIN                     0.00   S                     97535              97535                515
DRM          7202   65131   SKIN TEST, PPD INTRADERMAL                    64.00                    1    86580   TC         86580 TC             302
DRM          7202       4   TOWER-PLASTIC SURGERY                          0.00   S                                                             510
DRM          7202   65030   TRANSFUSION BLOOD/COMP EA                      0.00   S                     36430              36430                515
DRM          7202   65021   URINARY CATH SIMPLE                            0.00   S                     53670              53670                515



                                                          Page 108 of 676
                                                          CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                  Description                 Price          Stats/bill        CPT      Mod                Mod   Rev Code
 Code                                                                                                                  HCPCS
DRM          7202   61010   USE OF ROOM - NO CHARGE                       0.00   S                     99211          Z7500                    515
DRM          7202   60600   USE OF ROOM CHARGE                           50.00                    1    99211          Z7500                    515
DRM          7202   65032   WITHDRAWL OF ARTERIAL BLOOD                 159.00                    1    36600          NC                       515
EEG          7506   65077   16 CHANNEL EEG EA 24 HOURS                1,550.00                    1    95953   TC         95953   TC           740
EEG          7506   10165   AUDITORY EVOKED POTENTIALS COMPRH           698.00                    1    92585   TC         92585   TC           471
EEG          7506   65122   AUDITORY EVOKED POTENTIALS LIMITE           451.00                    1    92586   TC         92586   TC           471
EEG          7506   30650   DIGITAL EEG (EPIL SPIKE ANAL)               905.00                    1    95957   TC         95957   TC           740
EEG          7506   10116   ECS ELECTROCEREB/SILENCE                    766.00                    1    95824   TC         95824   TC           740
EEG          7506   65076   EEG ALL NIGHT SLEEP ONLY                    559.00                    1    95827   TC         95827   TC           740
EEG          7506    1016   EEG AWAKE & ASLEEP                          868.00                    1    95819   TC         95819   TC           740
EEG          7506   65078   EEG AWAKE & DROWSY                          564.00                    1    95816   TC         95816   TC           740
EEG          7506   20099   EEG EXTENDED MONITOR > 1 HR                 782.00                    1    95813   TC         95813   TC           740
EEG          7506   20016   EEG EXTENDED MONITOR UP TO 1 HR             616.00                    1    95812   TC         95812   TC           740
EEG          7506    1024   EEG SLEEP ONLY                              465.00                    1    95822   TC         95822   TC           740
EEG          7506    2089   EEG VIDEOTELEMETRY                        2,603.00                    1    95951   TC         95951   TC           740
EEG          7506   10132   EVOKED POTENTIALS SEP M                     715.00                    1    95925   TC         95925   TC           922
EEG          7506   10140   EVOKED POTENTIALS SEP T                     715.00                    1    95926   TC         95926   TC           922
EEG          7506   65120   EVOKED POTENTIALS TRUNK OR HEAD             715.00                    1    95927   TC         95927   TC           922
EEG          7506   65040   INJ, IM/SUBQ                                 29.00                    1    90772              90772                515
EEG          7506   65119   NEURO JUNCTION TEST EA NERVE                 84.00                    1    95937   TC         95937   TC           922
EEG          7506   65139   NEURO LAB USE OF ROOM                         0.00   S                                                             515
EEG          7506   65123   SEDATION, PO/PR                             680.00                    1    99143              99143                370
EEG          7506   61010   USE OF ROOM - NO CHARGE                       0.00   S                     99211          Z7500                    515
EEG          7506   60600   USE OF ROOM CHARGE                           50.00                    1    99211          Z7500                    515
EEG          7506   10173   VISUAL EVOKED POTENTIAL                     470.00                    1    95930   TC         95930   TC           922
EMC          7529    2308   DIAG ELECTRON MICROSCOPY                  1,304.00                    1    88348   TC         88348   TC           312
EMC          7529    2340   EM DX TRNSMSSN EPON BLK DX                1,172.00                    1    88348   TC         88348   TC           312
EMC          7529    2316   EM PROCESS ONLY DX                          275.00                    1    88348   TC         88348   TC           312
EMC          7529    2381   EM THICK SECTION EPON BLK DX                275.00                    1    88348   TC         88348   TC           312
EMC          7529    2332   EM THICK SECTION ONLY DX                    275.00                    1    88348   TC         88348   TC           312
EMC          7529    3488   POST EM FULL                                  0.00   S                     88348                                   310
EMC          7529    4015   POST EM PROCESS                               0.00   S                                                             310
EMC          7529    3496   POST EM SCAN                                  0.00   S                     88349                                   310
EMC          7529    3470   POST EM THICK SECTION                         0.00   S                     88348                                   310
ENM          7189   65014   ALLD HLTH PHN CNSLT 1/4 HR                    0.00   S                    Z5406           Z5406                    519



                                                         Page 109 of 676
                                                                CM 06/15/07


 Dept                                                                                                                        M/cal
        Cost Ctr.   SIM#                   Description                    Price            Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                                       HCPCS
ENM          7189   65013   ALLD HLTH TEAM CONF 1/4 HR                         12.05                    1   Z4302          Z4302                   519
ENM          7189   65001   CENTER COORDINATOR                                103.28                    1   Z4300          Z4300                   519
ENM          7189   65002   COMP CHART REV & RPT                               77.46                    1   Z4304          Z4304                   519
ENM          7189   63825   DIABETES SELF MGMT TRNG GRP 30 MI                  93.00                    1   Z4314          Z4314                   942
ENM          7189   63824   DIABETES SELF MGMT TRNG IND 30 MI                  93.00                    1   Z4314          Z4314                   942
ENM          7189       6   ENDO-METABOLIC                                      0.00   S                                                           510
ENM          7189    1054   GCRC PATIENT VISIT                                  0.00   S                                                           515
ENM          7189   65015   GROUP TEACHING/SUPPORT                             19.18                    1 Z4314            Z4314                   519
ENM          7189   65040   INJ, IM/SUBQ (BILL W/JCODE)                        29.00                    1 90772                90772               515
ENM          7189   65041   INJ,IV (BILL W/JCODE)                             119.00                    1 90774                90774               515
ENM          7189   65027   INTRO INTRACATH VEIN,UNI                            0.00   S                   36000               36000               515
ENM          7189   65004   NURSE EVALUATION 1/2 HR                            24.10                    1 Z4301            Z4301                   519
ENM          7189   65006   NURSE PHONE CNSLT 1/4 HR                            0.00   S                  Z5406            Z5406                   519
ENM          7189   65005   NURSE TEAM CONF 1/4 HR                             12.05                    1 Z4310            Z4310                   519
ENM          7189   65003   PERIODIC CHART REV & RPT                           43.03                    1 Z4303            Z4303                   519
ENM          7189   65147   RD MNT INIT ASSESS/INTERV 1/4                      67.00                    1 97802            NC                      515
ENM          7189   65148   RD MNT REASSESS/INTERV 1/4                         67.00                    1 97803            NC                      515
ENM          7189   65123   SEDATION,PO/PR (BILL W/JCODE)                     680.00                    1 99143                99143               370
ENM          7189   65130   SELFCARE TRAIN,EA 15 MIN                            0.00   S                   97535               97535               515
ENM          7189   65007   SOC WORK EVAL 1/2 HR                               24.10                    1 Z4307            Z4307                   561
ENM          7189   65009   SOC WORK PHONE CNSLT 1/4 HR                         0.00                    1 Z5406            Z5406                   561
ENM          7189   65008   SOC WORK TEAM CONF 1/4 HR                          12.05                    1 Z4311            Z4311                   561
ENM          7189   65016   SW CASE COORD CONSULT 1/4 HR                        0.00   S                                                           515
ENM          7189   61010   USE OF ROOM - NO CHARGE                             0.00   S                     99211         Z7500                   515
ENM          7189   60600   USE OF ROOM CHARGE                                 50.00                    1    99211         Z7500                   515
ENT          7073   66151   DRAINAGE OF PERITONSILIAR ABCESS                  240.00                    1    42700             42700               515
ENT          7073   66150   FINE NEEDLE ASPIRATION                            241.00                    1    10021             10021               515
ENT          7073   65417   FLEXIBLE LARYNGOSCOPY                             345.00                    1    31575             31575               515
ENT          7073   65419   FOREIGN BODY EAR                                  186.00                    1    69200             69200               515
ENT          7073   65418   FOREIGN BODY NOSE                                 223.00                    1    31300             31300               515
ENT          7073   68084   NASOPHARYNGOSCOPY (NP EXAM)                       237.00                    1    92511             92511               515
ENT          7073      97   OTOLARYNGOLOGY POST-OP                              0.00   S                                                           515
ENT          7073   61010   USE OF ROOM CHARGE                                  0.00   S                     99211         Z7500                   515
ENT          7073   60600   USE OF ROOM CHARGE                                 50.00                    1    99211         Z7500                   515
ERS          7010   12300   BURN CARE I                                       237.00                    1    16020         Z7506                   450



                                                           Page 110 of 676
                                                           CM 06/15/07


 Dept                                                                                                                 M/cal
        Cost Ctr.   SIM#                  Description                  Price          Stats/bill        CPT   Mod                Mod   Rev Code
 Code                                                                                                                HCPCS
ERS          7010   12318   BURN CARE II                                 317.00                    1 16025          Z7506                    450
ERS          7010   12326   BURN CARE III                                475.00                    1 16030          Z7506                    450
ERS          7010   54629   DERMABOND SKIN GLUE                          435.00                    1 G0168          G0168                    450
ERS          7010   10353   ED CAST ROOM                                  94.00                    1 Z7504          Z7504                    700
ERS          7010   13100   ED CAST SHOE                                 103.00                    1 A4649          Z7610                    271
ERS          7010   12656   ED CAST SUPP HIP/SPICA                       598.00                    1 29305 ZM           29305   ZM           270
ERS          7010   12664   ED CAST SUPP HIP/SPICA BILATERAL             465.00                    1 29325 ZM           29325   ZM           270
ERS          7010   12458   ED CAST SUPP LONG ARM                        181.00                    1 29065 ZM           29065   ZM           270
ERS          7010   12557   ED CAST SUPP LONG LEG                        227.00                    1 29345 ZM           29345   ZM           270
ERS          7010   12508   ED CAST SUPP SHORT ARM                       159.00                    1 29075 ZM           29075   ZM           270
ERS          7010   12607   ED CAST SUPP SHORT LEG                       165.00                    1 29405 ZM           29405   ZM           270
ERS          7010   12672   ED CAST SUPP/OTHER                             0.00   S                                                          450
ERS          7010   12722   ED CERVICAL COLLAR                            38.00                    1   A4649        Z7610                    271
ERS          7010   13316   ED CONTINUOUS AEROSOL TREATMENT              341.00                    1    94640           94640                410
ERS          7010   13050   ED CRUTCHES/ADULT                            150.00                    1   A4649        Z7610                    271
ERS          7010   13001   ED CRUTCHES/YOUTH                            150.00                    1   A4649        Z7610                    271
ERS          7010   13134   ED CUTDOWN TRAY                              475.00                    1   A4550        A4550                    272
ERS          7010   13183   ED CUTDOWN TRAY < 1 YEAR                     475.00                    1   A4550        Z7610                    272
ERS          7010   12151   ED CVP CARE/ACCESS                             0.00   S                     99199           99199                450
ERS          7010   13753   ED EAR EXAM/IRRIGATION                        68.00                    1   A4649        Z7610                    272
ERS          7010   12276   ED EKG - 12 LEAD                             141.00                    1    93005           93005                730
ERS          7010   13704   ED EYE EXAM/IRRIGATION                        68.00                    1   A4649        Z7610                    272
ERS          7010   12714   ED FIGURE 8 SPLINT                           235.00                    1    29049 ZM        29049   ZM           270
ERS          7010   13688   ED HCT EXAM                                   13.00                    1   A4649        Z7610                    272
ERS          7010   12904   ED IMMOBILIZER/KNEE SMALL                    239.00                    1   A4649        Z7610                    271
ERS          7010   13159   ED INHALATION TREATMENT                       56.00                    1    94640           94640                412
ERS          7010   12102   ED IV START COMPLEX                            0.00   S                     36000           36000   YS           450
ERS          7010   12110   ED IV START INFANT                             0.00   S                     36000           36000   YS           450
ERS          7010   12052   ED IV START SIMPLE                             0.00   S                     36000           36000   YS           450
ERS          7010   13555   ED LACERATION LEVEL I                        135.00                    1   A4550        Z7610                    272
ERS          7010   13605   ED LACERATION LEVEL II                       181.00                    1   A4550        Z7610                    272
ERS          7010   13654   ED LACERATION LEVEL III                      227.00                    1   A4550        Z7610                    272
ERS          7010   10000   ED LEVEL I                                   127.00                    1    99281       Z7502                    450
ERS          7010   10001   ED LEVEL II                                  171.00                    1    99282       Z7502                    450
ERS          7010   10002   ED LEVEL III                                 317.00                    1    99283       Z7502                    450



                                                          Page 111 of 676
                                                           CM 06/15/07


 Dept                                                                                                                M/cal
        Cost Ctr.   SIM#                  Description                  Price        Stats/bill       CPT     Mod               Mod   Rev Code
 Code                                                                                                               HCPCS
ERS          7010   10003   ED LEVEL IV                                  435.00                  1   99284         Z7502                   450
ERS          7010   10004   ED LEVEL V                                   633.00                  1   99285         Z7502                   450
ERS          7010   10304   ED NO CHARGE                                   0.00 S                                                          450
ERS          7010   13126   ED PERITONEAL LAVAGE TRAY                    341.00                  1 A4550           A4550                   272
ERS          7010   12169   ED PORT A CATH CARE/ACCESS                     0.00 S                   99199              99199               450
ERS          7010   12805   ED SPLINT/ARM                                124.00                  1 29105     ZM        29105   ZM          270
ERS          7010   12706   ED SPLINT/FINGER                              56.00                  1 29130     ZM        29130   ZM          270
ERS          7010   12870   ED SPLINT/LEG SHORT                          126.00                  1 29515     ZM        29515   ZM          270
ERS          7010   12854   ED SPLINT/LONG LEG                           133.00                  1 29505     ZM        29505   ZM          270
ERS          7010   12755   ED SPLINT/WRIST SHORT ARM                    103.00                  1 29125     ZM        29125   ZM          270
ERS          7010   13761   ED STREPT TEST                                23.00                  1 A4649           Z7610                   272
ERS          7010   13175   ED THORACOSTOMY TRAY                         228.00                  1 32020     ZM        32020   ZM          272
ERS          7010   13142   ED THORACOTOMY TRAY                          442.00                  1 A4550           Z7610                   272
ERS          7010   13167   ED TRACHEOSTOMY TRAY                         272.00                  1 31603     ZM        31603   ZM          272
ERS          7010   10107   ED TRIAGE VISIT                               56.00                  1 Z7502           Z7502                   451
ERS          7010   63950   INSRT TEMP INDWELLNG BLADDER CATH            165.00                  1 51702               51702               450
ERS          7010   41258   KC INJECTION ANTIBIOTIC                       23.00                  1 90772               90772               450
ERS          7010   41111   KC INJECTION THERAPEUTIC                      23.00                  1 90772               90772               450
ERS          7010   40656   KC MAJOR DRESING CHANGE                      144.00                  1 A4649           Z7610                   272
ERS          7010   40607   KC MINOR DRESSING CHANGE                     108.00                  1 A4649           Z7610                   272
ERS          7010   40904   KC OXYGEN 1ST 30MIN                          116.00                  1 A4649           Z7610                   272
ERS          7010   40953   KC OXYGEN EA ADDL 15MIN                       30.00                  1 A4649           Z7610                   272
ERS          7010   41357   KC STAPLE REMOVAL                             23.00                  1 A4649           Z7610                   271
ERS          7010   41308   KC SUTURE REMOVAL                             23.00                  1 A4649           Z7610                   272
ERS          7010   41201   KC URINE DIPSTICK                              7.00                  1 A4649           Z7610                   272
FEF          6292   16525   4EAST 12 HOURS OF CARE                     4,654.00                  1                                         123
FEF          6292   16517   4EAST 24 HOURS OF CARE                     5,498.00                  1                                         123
FEF          6292   16533   4EAST 8 HOURS OF CARE                      2,973.00                  1                                         123
FEF          6292   16400   4EAST HEM/ONC 12 HRS OF CARE               4,654.00                  1                                         127
FEF          6292   16426   4EAST HEM/ONC 24 HRS OF CARE               4,996.00                  1                                         127
FEF          6292   16509   4EAST HEM/ONC 8 HRS OF CARE                2,973.00                  1                                         127
FEF          6292   16655   4EAST HEMA/ONC ISOLATION ADDL.               288.00                  1 Z7514           Z7514                   164
FEF          6292   16705   4EAST HEMA/ONC PRIVATE ADDL                  192.00                  1 Z7514           Z7514                   164
FFE          6298   18109   5EAST 12 HOURS OF CARE                     4,654.00                  1                                         123
FFE          6298   18125   5EAST 24 HOURS OF CARE                     5,498.00                  1                                         123



                                                          Page 112 of 676
                                                              CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                  Description                     Price        Stats/bill        CPT    Mod            Mod   Rev Code
 Code                                                                                                                  HCPCS
FFE          6298   18158   5EAST 8 HOURS OF CARE                         2,973.00                  1                                      123
FFE          6298   18406   5EAST HEM/ONC 12 HRS OF CARE                  4,654.00                  1                                      127
FFE          6298   18422   5EAST HEM/ONC 24 HRS OF CARE                  5,498.00                  1                                      127
FFE          6298   18455   5EAST HEM/ONC 8 HRS OF CARE                   2,973.00                  1                                      127
FFE          6298   18305   5EAST ISOLATION ADDL.                           288.00                  1   Z7514         Z7514                164
FFE          6298   18354   5EAST PRIVATE ADDL.                             192.00                  1   Z7514         Z7514                164
FFW          6294   19131   5WEST 12 HRS OF CARE                          4,654.00                  1                                      123
FFW          6294   19107   5WEST 24 HRS OF CARE                          5,498.00                  1                                      123
FFW          6294   19156   5WEST 8 HRS OF CARE                           2,973.00                  1                                      123
FFW          6294   19701   5WEST HEM/ONC 12 HRS OF CARE                  4,654.00                  1                                      127
FFW          6294   19735   5WEST HEM/ONC 24 HRS OF CARE                  5,498.00                  1                                      127
FFW          6294   19743   5WEST HEM/ONC 8 HRS OF CARE                   2,973.00                  1                                      127
FFW          6294   19857   5WEST ISOLATION ADDL.                           288.00                  1   Z7514         Z7514                164
FFW          6294   19907   5WEST PRIVATE ADDL.                             192.00                  1   Z7514         Z7514                164
FWF          6291   16228   4WEST 12 HOURS OF CARE                        4,654.00                  1                                      123
FWF          6291   33454   4WEST 12 HRS OF CARE MEDI-CAL                 4,654.00                  1                                      123
FWF          6291   16210   4WEST 24 HOURS OF CARE                        5,498.00                  1                                      123
FWF          6291   33405   4WEST 24 HRS OF CARE MEDI-CAL                 5,498.00                  1                                      123
FWF          6291   16236   4WEST 8 HOURS OF CARE                         2,973.00                  1                                      123
FWF          6291   33504   4WEST 8 HRS OF CARE MEDI-CAL                  2,973.00                  1                                      123
FWF          6291   16103   4WEST HEM/ONC 12 HRS OF CARE                  4,654.00                  1                                      127
FWF          6291   16129   4WEST HEM/ONC 24 HOURS                        4,996.00                  1                                      127
FWF          6291   16202   4WEST HEM/ONC 8 HRS OF CARE                   2,973.00                  1                                      127
FWF          6291   16507   4WEST HEMA/ONC ISOLATION ADDL.                  288.00                  1   Z7514         Z7514                164
FWF          6291   16606   4WEST HEMA/ONC PRIVATE ADDL.                    192.00                  1   Z7514         Z7514                164
FWF          6291   16251   BMT 12HRS-M/CAL                               4,654.00                  1   RM012                              123
FWF          6291   16252   BMT 18HRS-M/CAL                               5,075.00                  1   RM018                              123
FWF          6291   16253   BMT 24HRS-M/CAL                               5,498.00                  1   RM024                              123
FWF          6291   16254   BMT 48HRS-M/CAL                               6,638.00                  1   RM048                              123
FWF          6291   16250   BMT 8HRS-M/CAL                                2,973.00                  1   RM008                              123
GCR          7878   49995   G.C.R.C                                           0.00                  1                                      515
GCR          7878   50100   G.C.R.C. PATIENT                                  0.00 S                                                       510
GCR          7878   50050   GCRC PROCEDURE UNIT/HR                           87.00                  1 Z7500           Z7500                490
GCR          7878   61010   USE OF ROOM - NO CHARGE                           0.00 S                   99211          Z7500                515
GCR          7878   60600   USE OF ROOM CHARGE                               50.00                  1 99211           Z7500                515



                                                             Page 113 of 676
                                                              CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                  Description                   Price          Stats/bill     CPT    Mod               Mod      Rev Code
 Code                                                                                                              HCPCS
GIC          7761   65014   ALLD HLTH PHN CNSLT 1/4 HR                      0.00   S                  Z5406       Z5406                       519
GIC          7761   65013   ALLD HLTH TEAM CONF 1/4 HR                     12.05                    1 Z4302       Z4302                       519
GIC          7761   65099   BERNSTEIN TEST                                 55.00                    1 91030 TC        91030   TC              750
GIC          7761   65125   BLOOD COLLECTION, ACCESS DEVICE                 0.00   S                   36540          36540                   515
GIC          7761   65098   BREATH HYDROGEN EA                             87.00                    1 91065 TC        91065   TC              750
GIC          7761   65464   CAUTERY - GRANULATION TISS.                   119.00                    1 17250       Z7506                       515
GIC          7761   65001   CENTER COORDINATOR                            103.28                    1 Z4300       Z4300                       519
GIC          7761   65132   CENTRAL LINE CATH REPAIR                        0.00   S                   93799          93799                   515
GIC          7761   65002   COMP CHART REV & RPT                           77.46                    1 Z4304       Z4304                       519
GIC          7761   91110   G.I. TRACT CAPSULE ENDOSCOPY                2,767.00                    1 91110 TC        91110   TC              750
GIC          7761    6500   PERIODIC CHART REV & RPT                       39.00                    1 Z4303       Z4303                       519
GIC          7761   65015   GROUP TEACHING/SUPPORT                         19.18                    1 Z4314       Z4314                       519
GIC          7761   65126   IM INJ ANTIBIOTIC                              29.00                    1 90772           90772                   515
GIC          7761   65040   INJ-IM/SUBQ                                    29.00                    1 90772           90772                   515
GIC          7761   65041   INJECTION IV PUSH                             119.00                    1 90774           90774                   515
GIC          7761   65028   INTRO INTRACATH VEIN, BILAT                     0.00   S                   36000   50     36000        50         515
GIC          7761   65027   INTRO INTRACATH VEIN, UNI                       0.00   S                   36000          36000                   515
GIC          7761   65184   IV FLUID/MEDS INFUSION INIT HR                271.00                    1 90765           90765                   260
GIC          7761   65185   IV FLUIDS/MEDS INFUSION ADDL HR               140.00                    1 90766           90766                   260
GIC          7761   65004   NURSE EVALUATION 1/2 HR                        24.10                    1 Z4301       Z4301                       519
GIC          7761   65006   NURSE PHONE CNSLT 1/4 HR                        0.00   S                  Z5406       Z5406                       519
GIC          7761   65005   NURSE TEAM CONF 1/4 HR                         12.05                    1 Z4310       Z4310                       519
GIC          7761   20057   OCC BLOOD 1-3 SIMULT DETERM                    53.00                    1 82270 TC        82270   TC              301
GIC          7761   65003   PERIODIC CHART REV & RPT                       43.03                    1 Z4303       Z4303                       519
GIC          7761   65097   PH PROBE PROLONGED REC                        331.00                    1 91034 TC        91034   TC              750
GIC          7761   65130   SELF CARE TRAIN, EA 15 MIN                      0.00   S                   97535          97535                   515
GIC          7761   65021   URINARY CATH SIMPLE                             0.00   S                   53670          53670                   515
GIC          7761   61010   USE OF ROOM - NO CHARGE                         0.00   S                   99211      Z7500                       515
GIC          7761   60600   USE OF ROOM CHARGE                             50.00                    1 99211       Z7500                       515
GPD          7077   65125   BLOOD COLLECTION, ACCESS DEVICE                 0.00   S                   36540                                  515
GPD          7077   65132   CENTRAL LINE CATH REPAIR                        0.00   S                   93799          93799                   515
GPD          7077   65033   CHANGE OF GASTROSTOMY TUBE                      0.00   S                   43760          43760                   515
GPD          7077   65031   DECLOT VASCULAR CATH                            0.00   S                   36550          36550                   515
GPD          7077    1156   GEN PEDS- PROCEDURE ROOM                      227.00                    1 Z7506       Z7506                       515
GPD          7077   65128   HHN INITIAL TX                                221.00                    1 94640           94640                   410



                                                          Page 114 of 676
                                                           CM 06/15/07


 Dept                                                                                                                    M/cal
        Cost Ctr.   SIM#                  Description                  Price          Stats/bill        CPT      Mod                Mod   Rev Code
 Code                                                                                                                   HCPCS
GPD          7077   65126   IM INJ ANTIOBIOTIC (BILL W/JCODE)             29.00                    1  90772                90772                515
GPD          7077   65040   INJ, IM/SUBQ (BILL W/JCODE)                   29.00                    1  90772                90772                515
GPD          7077   65041   INJ, IV (BILL W/JCODE)                       119.00                    1  90774                90774                515
GPD          7077   65028   INTRO INTRACATH VEIN, BILAT                    0.00   S                   36000                36000                515
GPD          7077   65027   INTRO INTRACATH VEIN, UNI                      0.00   S                   36000                36000                515
GPD          7077   65127   NONPRESSURIZED INH TX                        145.00                    1 94640                 94640                410
GPD          7077   32409   NURSE MONITORING-15 MIN INTERVALS             90.00                    1 Z4302             Z4302                    515
GPD          7077   32359   NURSE PHONE CALL TRIAGE                        0.00   S                                                             515
GPD          7077   65124   SEDATION,IV/IM/INH(BILL W/JCODE)             549.00                    1    99143   TC         99143   TC           370
GPD          7077   65123   SEDATION,PO/PR (BILL W/JCODE)                680.00                    1    99143   TC         99143   TC           370
GPD          7077   65130   SELF CARE TRAIN, EA 15 MIN                     0.00   S                     97535              97535                515
GPD          7077   65131   SKIN TEST, PPD INTRADERMAL                    64.00                    1    86580   TC         86580   TC           302
GPD          7077   65030   TRANSFUSION BLOOD/COMP EA                      0.00   S                     36430              36430                515
GPD          7077   65021   URINARY CATH SIMPLE                            0.00   S                     53670              53670                515
GPD          7077   61010   USE OF ROOM - NO CHARGE                        0.00   S                     99211          Z7500                    515
GPD          7077   60600   USE OF ROOM CHARGE                            50.00                    1    99211          Z7500                    515
GPD          7077   65032   WITHDRAWL OF ARTERIAL BLOOD                  159.00                    1    36600          NC                       515
GTL          7507   65155   COMPREHENSIVE MOTION ANALYSIS              1,977.00                    1    96000              96000                929
GTL          7507   65156   COMPREHENSIVE MOTION ANALYSIS WIT          2,352.00                    1    96001              96001                929
GTL          7507   10160   COMPUTER INFO ANALYSIS                       264.00                    1    99090              99090                929
GTL          7507   65158   DYNAMIC FINE WIRE EMG - EA MUSCLE            348.00                    1    96003              96003                922
GTL          7507   65157   DYNAMIC SURFACE EMG UP TO 12 MUSC            522.00                    1    96002              96002                922
GTL          7507   10170   EXHALED AIR ANALYSIS                         630.70                    1    94681   TC         94681   TC           419
GTL          7507   10152   FINE WIRE EMG - EACH MUSCLE                  348.00                    1    95870   ZS         95870   ZS           922
GTL          7507    1105   GAIT LAB USE OF ROOM                           0.00   S                                                             515
GTL          7507   11016   GTL - P.T. TEAM CONFERENCE - 30 M            119.40                    1    99361          X3926                    429
GTL          7507   10135   MOTION & FORCE DATA COLLECT. ONLY            500.00                    1    95999              95999                929
GTL          7507    1006   ORTHO-GAIT LAB                                 0.00   S                                                             515
GTL          7507   20108   PHYSICAL THERAPY EVAL                        355.90                    1    97001              97001                420
GTL          7507   61010   USE OF ROOM - NO CHARGE                        0.00   S                     99211          Z7500                    515
GTL          7507   60600   USE OF ROOM CHARGE                            50.00                    1    99211          Z7500                    515
GTL          7507   10180   X-BODY MUSCLE TEST - FORCE BAREFO             72.30                    1   X3922           X3922                    424
GTL          7507   10181   X-BODY MUSCLE TEST - FORCE BRACED             63.50                    1   X3922           X3922                    424
GTL          7507   10130   X-COMP MOTION EVAL BAREFOOT (UNLI          1,280.00                    1    95999              95999                929
GTL          7507   10131   X-COMP MOTION EVAL BRACED (UNLIST            779.00                    1    95999              95999                929



                                                          Page 115 of 676
                                                                 CM 06/15/07


 Dept                                                                                                                     M/cal
        Cost Ctr.   SIM#                    Description                      Price          Stats/bill     CPT    Mod                Mod   Rev Code
 Code                                                                                                                    HCPCS
GTL          7507   10150   X-ELECTROMYOGRAPHY - 1 LIMB                        313.00                    1 95860 ZS         95860   ZS           922
GTL          7507   10151   X-ELECTROMYOGRAPHY - 2 LIMBS                       522.00                    1 95861 ZS         95861   ZS           922
GTL          7507   10125   X-PHYS THER EVAL - EA.ADD. 15 MIN                   89.80                    1 X3922        X3922                    424
GTL          7507   10140   X-PHYS. PERF. TEST- 15 MIN. (VIDE                   58.00                    1 X3922        X3922                    424
GTL          7507   10117   X-PHYSICAL THERAPY EVAL - 30 MIN.                  177.40                    1 X3920        X3920                    424
HEM          7501   50503   ANTI-THROMBIN III ACTIVITY                         225.00                    1 85300 TC         85300   TC           305
HEM          7501   50101   ANTI-XA HEPARIN ASSAY                              164.00                    1 85520 TC         85520   TC           305
HEM          7501   51006   BLEEDING TIME                                       63.00                    1 85002 TC         85002   TC           305
HEM          7501   91601   MANUAL BLOOD SMEAR EXAM                              5.00                    1 85008 TC         85008   TC           305
HEM          7501   91046   CBC (HEMOGRAM+PLT) W/AUTO DIFF                      43.00                    1 85025 TC         85025   TC           305
HEM          7501   93208   CELL COUNT, CSF/BODY FLUID                          43.00                    1 89050 TC         89050   TC           309
HEM          7501   93802   CSF/BODY FLUID DIFF                                 40.00                    1 89051 TC         89051   TC           300
HEM          7501   93703   CYSTOSP/C.P. CONSULT                                89.00                    1 88104 TC         88104   TC           311
HEM          7501   57508   D-DIMER, QUANTITATIVE                               57.00                    1 85379 TC         85379   TC           305
HEM          7501   90030   ESRD-CD CBC (H & &-RBC-WBC-PLT)                      0.00   S                   85027 CD        85027   TC           305
HEM          7501   90022   ESRD-CD HEMATOCRIT                                   0.00   S                   85014 CD        85014   TC           305
HEM          7501   30025   ESRD-CD HEMOGLOBIN                                   0.00   S                   85018 CD        85018   TC           305
HEM          7501   90004   ESRD-CD PROTHROMBIN TIME                             0.00   S                   85610 CD        85610   TC           305
HEM          7501   90031   ESRD-CE CBC (H & H-RBC-WBC-PLT)                     37.00                    1 85027 TC         85027   TC           305
HEM          7501   90023   ESRD-CE HEMATOCRIT                                  22.00                    1 85014 TC         85014   TC           305
HEM          7501   90025   ESRD-CE HEMOGLOBIN                                  24.00                    1 85018 TC         85018   TC           305
HEM          7501   90005   ESRD-CE PROTHROMBIN TIME                            53.00                    1 86510 TC         85610   TC           305
HEM          7501   52202   FACTOR II ASSAY                                     73.00                    1 85210 TC         85210   TC           305
HEM          7501   53218   FACTOR INHIBITOR TEST                              275.00                    1 85335 TC         85335   TC           305
HEM          7501   52509   FACTOR IX ASSAY                                    151.00                    1 85250 TC         85250   TC           305
HEM          7501   52301   FACTOR V ASSAY                                     117.00                    1 85220 TC         85220   TC           305
HEM          7501   52368   FACTOR VII ASSAY                                   119.00                    1 85230 TC         85230   TC           305
HEM          7501   52400   FACTOR VIII ASSAY                                  129.00                    1 85240 TC         85240   TC           305
HEM          7501   55403   FACTOR VIII,RISTOCETIN COFACTOR                    234.00                    1 85245 TC         85245   TC           305
HEM          7501   52608   FACTOR X ASSAY                                     129.00                    1 85260 TC         85260   TC           305
HEM          7501   52707   FACTOR XI ASSAY                                    131.00                    1 85270 TC         85270   TC           305
HEM          7501   52806   FACTOR XII ASSAY                                   130.00                    1 85280 TC         85280   TC           305
HEM          7501   52905   FACTOR XIII SCREEN                                  34.00                    1 85291 TC         85291   TC           305
HEM          7501   52954   FIBRIN DEGRADATION PRODUCTS                         63.00                    1 85362 TC         85362   TC           305
HEM          7501   53200   FIBRINOGEN ACTIVITY                                 54.00                    1 85384 TC         85384   TC           305



                                                                Page 116 of 676
                                                          CM 06/15/07


 Dept                                                                                                                M/cal
        Cost Ctr.   SIM#                  Description                 Price          Stats/bill       CPT      Mod              Mod   Rev Code
 Code                                                                                                                HCPCS
HEM          7501   91418   HEINZ BODIES, DIRECT                         43.00                    1   85441   TC       85441   TC           305
HEM          7501   92754   HEMATOCRIT                                   22.00                    1   85014   TC       85014   TC           305
HEM          7501   98884   HEMATOLOGY (MISC)                             0.00                    1   85999   TC       85999   TC           305
HEM          7501   91400   HEMOGLOBIN                                   24.00                    1   85018   TC       85018   TC           305
HEM          7501   91095   HEMOGRAM+PLATELET, AUTO                      37.00                    1   85027   TC       85027   TC           305
HEM          7501   52913   LAB FACTOR VIII ANTIGEN BR                    0.00   S                    85244                                 305
HEM          7501   55270   LAB FREE PROTEIN S                            0.00   S                    85306            85306 TC             305
HEM          7501   58886   LAB MISC COAG TEST                            0.00                    1   85999   TC       85999 TC             305
HEM          7501   54307   LAB PLATELET AGGREGATION                    431.00                    1   85576   TC       85576 TC             305
HEM          7501   55254   LAB PROTEIN C AG ASSAY                        0.00   S                    85302                                 305
HEM          7501   55262   LAB TOTAL PROTEIN S                           0.00   S                    85305                                 305
HEM          7501   91558   LAB WHITE CELL COUNT                         24.00                    1   85048   TC       85048   TC           305
HEM          7501   53507   LUPUS ANTICOAG                               84.00                    1   85597   TC       85597   TC           305
HEM          7501   91061   MANUAL BLOOD SMEAR EXAM                       5.00                    1   85008   TC       85008   TC           305
HEM          7501   91079   MANUAL DIFFERENTIAL+RBC MORPH                18.00                    1   85007   TC       85007   TC           305
HEM          7501   97704   NASAL SMEAR FOR EOSINOPHILS                  26.00                    1   89190   TC       89190   TC           309
HEM          7501   95807   NITOBLUE TETRAZOLIUM DYE TEST               101.00                    1   86384   TC       86384   TC           302
HEM          7501   54208   PARTIAL THROMBOPLASTIN TIME                  61.00                    1   85730   TC       85730   TC           305
HEM          7501   54224   PLASMINOGEN (FUNCTIONAL)                    128.00                    1   85420   TC       85420   TC           305
HEM          7501   54308   PLATELET AGGREGATION EACH REAGENT           137.00                    1   85576   TC       85576   TC           305
HEM          7501   96359   PLATELET COUNT, AUTO                         22.00                    1   85049   TC       85049   TC           305
HEM          7501   55205   PPP PARACOAGULATION                          54.00                    1   85366   TC       85366   TC           305
HEM          7501   55251   PROTEIN C ACTIVITY                           71.00                    1   85303   TC       85303   TC           305
HEM          7501   55252   PROTEIN S ACTIVITY                           71.00                    1   85306   TC       85306   TC           305
HEM          7501   55304   PROTHROMBIN TIME                             53.00                    1   85610   TC       85610   TC           305
HEM          7501   55353   REPTILASE TEST                              222.00                    1   85635   TC       85635   TC           305
HEM          7501   96953   RETICULOCYTE COUNT, FLOW                     42.00                    1   85045   TC       85045   TC           305
HEM          7501   97100   SEDIMENTATION RATE, NON-AUTO                 34.00                    1   85651   TC       85651   TC           305
HEM          7501   97258   SICKLE CELL SCREEN                           26.00                    1   85660   TC       85660   TC           305
HEM          7501   98009   SMEAR,GRAM/GIEMSA STAIN (POLY)               21.00                    1   87205   TC       87205   TC           306
HEM          7501   56203   THROMBIN TIME                                57.00                    1   85670   TC       85670   TC           305
HLA          7542   29768   B CELL PRA                                  239.00                    1   86807   TC       86807   TC           302
HLA          7542   30451   B CELL PRA DTT                              239.00                    1   86807   TC       86807   TC           302
HLA          7542   30469   B CELL PRA PLT ABS                          239.00                    1   86807   TC       86807   TC           302
HLA          7542   30634   BMT CYTOTOX XMATCH AUTO                     393.00                    1   86805   TC       86805   TC           302



                                                         Page 117 of 676
                                                          CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                  Description                 Price      Stats/bill       CPT      Mod                 Mod      Rev Code
 Code                                                                                                               HCPCS
HLA          7542   30642   BMT CYTOTOX XMATCH DONOR                    393.00                1   86805   TC          86805   TC              302
HLA          7542   30717   BMT DQ-DNA INTERPRETATION                    36.00                1   83912        26     83912        26         301
HLA          7542   30709   BMT DQ-DNA PCR                               48.00                1   83898   TC          83898   TC              301
HLA          7542   30691   BMT DQ-DNA SEPARATION                        36.00                1   83894   TC          83894   TC              301
HLA          7542   30659   BMT DR-DNA EXTRACTION                        48.00                1   83890   TC          83890   TC              301
HLA          7542   30683   BMT DR-DNA INTERPRETATION                   120.00                1   83912        26     83912        26         301
HLA          7542   30675   BMT DR-DNA PCR                              265.00                1   83898   TC          83898   TC              301
HLA          7542   30667   BMT DR-DNA SEPARATION                        48.00                1   83894   TC          83894   TC              301
HLA          7542   30600   BMT HLA ABC-TYPING                          361.00                1   86813   TC          86813   TC              302
HLA          7542   30618   BMT HLA DR/DQ- TYPING                       482.00                1   86817   TC          86817   TC              302
HLA          7542   30626   BMT HLA T CELL PRA                          239.00                1   86807   TC          86807   TC              302
HLA          7542   31100   CL I DNA EXTRACTION                          48.00                1   83890   TC          83890   TC              301
HLA          7542   31102   CL I DNA PCR                                325.00                1   83898   TC          83898   TC              301
HLA          7542   31110   CL I DNA SUB TYPE PCR                        43.00                1   83898   TC          83898   TC              301
HLA          7542   31104   CLASS 1 DNA PCR                              12.00                1   83898   TC          83898   TC              301
HLA          7542   31101   CLASS 1 DNA SEPARATION                       48.00                1   83894   TC          83894   TC              301
HLA          7542   31111   CLASS 1 DNA SUBTYPE INTERP                   43.00                1   83912   TC          83912   TC              301
HLA          7542   31112   CLASS 1 DNA SUBTYPE PCR                      12.00                1   83898   TC          83898   TC              301
HLA          7542   29701   CLASS 2 DNA INTERP                          120.00                1   83912   TC          83912   TC              301
HLA          7542   29751   CLASS 2 DNA PCR                              12.00                1   83898   TC          83898   TC              301
HLA          7542   29818   CLASS 2 DNA SEPARATION                       48.00                1   83894   TC          83894   TC              301
HLA          7542   31121   CLASS 2 DNA SUBTYPE INTERP                   43.00                1   83912   TC          83912   TC              301
HLA          7542   31122   CLASS 2 DNA SUBTYPE PCR                      12.00                1   83898   TC          83898   TC              301
HLA          7542   31103   CLASS I DNA INTERP                          120.00                1   83912   TC          83912   TC              301
HLA          7542   30345   CT CYTOTOX XMATCH AUTO                      393.00                1   86805   TC          86805   TC              302
HLA          7542   30352   CT CYTOTOX XMATCH DONOR                     393.00                1   86805   TC          86805   TC              302
HLA          7542   30428   CT DQ-DNA INTERPRETATION                     36.00                1   83912        26     83912        26         301
HLA          7542   30410   CT DQ-DNA PCR                                48.00                1   83898   TC          83898   TC              301
HLA          7542   30402   CT DQ-DNA SEPARATION                         36.00                1   83894   TC          83894   TC              301
HLA          7542   30394   CT DR-DNA INTERPRETATION                    120.00                1   83912        26     83912        26         301
HLA          7542   30386   CT DR-DNA PCR                               265.00                1   83898   TC          83898   TC              301
HLA          7542   30378   CT DR-DNA SEPARATION                         36.00                1   83894   TC          83894   TC              301
HLA          7542   30360   CT DT-DNA EXTRACTION                         48.00                1   83890   TC          83890   TC              301
HLA          7542   30329   CT HLA B CELL PRA                           239.00                1   86807   TC          86807   TC              302
HLA          7542   30337   CT HLA T CELL PRA                           239.00                1   86807   TC          86807   TC              302



                                                         Page 118 of 676
                                                           CM 06/15/07


 Dept                                                                                                                    M/cal
        Cost Ctr.   SIM#                  Description                  Price        Stats/bill       CPT      Mod                   Mod      Rev Code
 Code                                                                                                                   HCPCS
HLA          7542   30303   CT UNOS HLA ABC SEROLOGY                     361.00                  1   86813   TC            86813   TC              302
HLA          7542   30311   CT UNOS HLA DR DQ SEROLOGY                   482.00                  1   86817   TC            86817   TC              302
HLA          7542   29800   DNA EXTRACTION                                48.00                  1   83890   TC            83890   TC              301
HLA          7542   29735   DQ DNA INTERP                                 36.00                  1   83912   TC            83912   TC              301
HLA          7542   29728   DQ DNA PCR                                    12.00                  1   83898   TC            83898   TC              301
HLA          7542   29719   DQ DNA SEPARATION                             36.00                  1   83894   TC            83894   TC              301
HLA          7542   31120   DR DNA SUB TYPE PCR                           43.00                  1   83898   TC            83898   TC              301
HLA          7542   29826   HLA ABC SEROLOGY                             361.00                  1   86813   TC            86813   TC              302
HLA          7542   29834   HLA ABC TYPING MUD                           361.00                  1   86813   TC            86813   TC              302
HLA          7542   29867   HLA B27                                       93.00                  1   86812   TC            86812   TC              302
HLA          7542   29743   HLA CYTOTOX XMATCH AUTO                      393.00                  1   86805   TC            86805   TC              302
HLA          7542   29792   HLA CYTOTOXIC XMATCH DONOR                   393.00                  1   86805   TC            86805   TC              302
HLA          7542   29727   HLA DQ-DNA PCR                                48.00                  1   83898   TC            83898   TC              301
HLA          7542   29842   HLA DR DQ SEROLOGY                           482.00                  1   86817   TC            86817   TC              302
HLA          7542   30014   HLA DR-DNA HANDLING FEE                       96.00                  1   99001             Z5220                       302
HLA          7542   30022   HLA DR-DNA MUD HANDLING FEE                   96.00                  1   99001             Z5220                       302
HLA          7542   29750   HLA DR-DNA PCR                               265.00                  1   83898   TC            83898   TC              301
HLA          7542   29859   HLA DR/DQ MUD                                482.00                  1   86817   TC            86817   TC              302
HLA          7542   30006   HLA LABORATORY                                 0.00 S                                                                  302
HLA          7542   29868   HLA SINGLE ANTIGEN SEROLOGY                   93.00                  1   86812   TC            86812   TC              302
HLA          7542   30089   K CYTOTOX XMATCH AUTO                        393.00                  1   86805   TC            86805   TC              302
HLA          7542   30097   K CYTOTOX XMATCH DONOR                       393.00                  1   86805   TC            86805   TC              302
HLA          7542   30162   K DQ-DNA INTERPRETATION                       36.00                  1   83912        26       83912        26         301
HLA          7542   30154   K DQ-DNA PCR                                  48.00                  1   83898   TC            83898   TC              301
HLA          7542   30147   K DQ-DNA SEPARATION                           36.00                  1   83894   TC            83894   TC              301
HLA          7542   30105   K DR-DNA EXTRACTION                           48.00                  1   83890   TC            83890   TC              301
HLA          7542   30139   K DR-DNA INTERPRETATION                      120.00                  1   83912        26       83912        26         301
HLA          7542   30121   K DR-DNA PCR                                 265.00                  1   83898   TC            83898   TC              301
HLA          7542   30113   K DR-DNA SEPARATION                           48.00                  1   83894   TC            83894   TC              301
HLA          7542   30055   K HLA ABC-TYPING                             361.00                  1   86813   TC            86813   TC              302
HLA          7542   30063   K HLA DR/DQ-TYPING                           482.00                  1   86817   TC            86817   TC              302
HLA          7542   30071   K HLA T CELL PRA                             239.00                  1   86807   TC            86807   TC              302
HLA          7542   29784   CYTOTOX X-MATCH FRAC                         380.00                  1   86805   TC            86805   TC              302
HLA          7542   31105   MUD CLASS 1 DNA INTERP                       120.00                  1   83912   TC            83912   TC              301
HLA          7542   31106   MUD CLASS 1 DNA PCR                           12.00                  1   83898   TC            83898   TC              301



                                                          Page 119 of 676
                                                          CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                  Description                 Price        Stats/bill      CPT      Mod                Mod   Rev Code
 Code                                                                                                              HCPCS
HLA          7542   31107   MUD CLASS 1 DNA SEPARATION                   48.00                  1 83894    TC         83894   TC           301
HLA          7542   30980   MUD CLASS 2 DNA INTERP                      120.00                  1 83912    TC         83912   TC           301
HLA          7542   30970   MUD CLASS 2 DNA PCR                          12.00                  1 83898    TC         83898   TC           301
HLA          7542   30964   MUD CLASS 2 DNA SEPARATION                   48.00                  1 83894    TC         83894   TC           301
HLA          7542   30931   MUD CYTOTOX XMATCH AUTO                     393.00                  1 86805    TC         86805   TC           302
HLA          7542   30949   MUD CYTOTOX XMATCH DONOR                    393.00                  1 86805    TC         86805   TC           302
HLA          7542   30956   MUD DNA EXTRACTION                           48.00                  1 83890    TC         83890   TC           301
HLA          7542   31012   MUD DQ DNA INTERP                            36.00                  1 83912    TC         83912   TC           301
HLA          7542   31010   MUD DQ DNA PCR                               12.00                  1 83898    TC         83898   TC           301
HLA          7542   31004   MUD DQ-DNA PCR                               48.00                  1 83898    TC         83898   TC           301
HLA          7542   30998   MUD DQ-DNA SEPARATION                        36.00                  1 83894    TC         83894   TC           301
HLA          7542   30972   MUD DR-DNA PCR                              265.00                  1 83898    TC         83898   TC           301
HLA          7542   30907   MUD HLA ABC SEROLOGY                        361.00                  1 86813    TC         86813   TC           301
HLA          7542   30915   MUD HLA DR/DQ-TYPING                        482.00                  1 86817    TC         86817   TC           302
HLA          7542   30923   MUD HLA T CELL PRA                          239.00                  1 86807    TC         86807   TC           302
HLA          7542   29776   T CELL PRA                                  239.00                  1 86807    TC         86807   TC           302
HLA          7542   30436   T CELL PRA DTT                              239.00                  1 86807    TC         86807   TC           302
HLA          7542   30444   T CELL PRA PLT ABS                          239.00                  1 86807    TC         86807   TC           302
HMD          7740   65001   CENTER COORDINATOR                          103.28                  1 Z4300           Z4300                    519
HMD          7740   10027   CHRONIC HEMODIALYSIS                        935.00                  1 90935           Z6020                    821
HMD          7740   65002   COMP CHART REV & RPT                         77.46                  1 Z4304           Z4304                    519
HMD          7740   65010   DIETITIAN EVAL 1/2 HR                        24.10                  1 Z4308           Z4308                    519
HMD          7740   65012   DIETITIAN PHN CNSLT 1/4HR                     0.00 S                  Z5406           Z5406                    519
HMD          7740   65011   DIETITIAN TEAM CONF 1/4 HR                   12.05                  1 Z4312           Z4312                    519
HMD          7740   10142   EPO <10000 UNITS 100U                         1.00                  1 90779               90779                634
HMD          7740   65015   GROUP TEACHING/SUPPORT                       19.18                  1 Z4314           Z4314                    519
HMD          7740   21958   HEMODIALYSIS USE OF ROOM                      0.00 S                   99211          Z7500                    515
HMD          7740   22501   INPT. HEMODIALYSIS                          813.00                  1 NC              NC                       801
HMD          7740   65004   NURSE EVALUATION 1/2 HR                      24.10                  1 Z4301           Z4301                    519
HMD          7740   65006   NURSE PHONE CNSLT 1/4 HR                      0.00 S                  Z5406           Z5406                    519
HMD          7740   65005   NURSE TEAM CONF 1/4 HR                       12.05                  1 Z4310           Z4310                    519
HMD          7740   65003   PERIODIC CHART REV & RPT                     43.03                  1 Z4303           Z4303                    519
HMD          7740   10456   R.D. SEMI ANNUAL CHART REV                   72.00                  1 Z5427           Z5427                    515
HMD          7740   65131   SKIN TEST, PPD INTRADERMAL                   58.00                  1 86580    TC         86580   TC           515
HMD          7740   65007   SOC WORK EVAL 1/2 HR                         24.10                  1 Z4307           Z4307                    561



                                                         Page 120 of 676
                                                            CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                  Description                   Price          Stats/bill       CPT     Mod               Mod   Rev Code
 Code                                                                                                                  HCPCS
HMD          7740   65009   SOC WORK PHONE CNSLT 1/4 HR                     0.00   S                  Z5406           Z5406                   561
HMD          7740   65008   SOC WORK TEAM CONF 1/4 HR                      12.05                    1 Z4311           Z4311                   561
HMD          7740   65016   SW CASE COORD CONSULT 1/4 HR                    0.00   S                                                          515
HNS          7780    3346   ABR MOD SEDATION - EA ADDL 15 MIN             283.00                    1   99150             99150               370
HNS          7780    3102   ABR MOD SEDATION < 5YRS 1ST 30MIN             567.00                    1   99148             99148               370
HNS          7780    3223   ABR MOD SEDATION > 5YRS 1ST 30MIN             567.00                    1   99149             99149               370
HNS          7780    2104   AURAL REHAB                                   170.80                    1   92507         X4526                   470
HNS          7780    2153   COMPREHENSIVE LANGUAGE EVAL                   597.90                    1   92506         X4300                   440
HNS          7780    2021   DIAGNOSTIC AUDIO EVAL                         184.00                    1   92557         X4500                   471
HNS          7780    2856   EVAL ALTERNATIVE COMMUNICATION                  0.00   S                    92597             92597               470
HNS          7780    2427   EVOKED ACOUSTIC EM, LIMITED                   302.20                    1   92587 TC          92587 TC            471
HNS          7780    2336   EVOKED RESP AUDIO COMPREHENSIVE               427.10                    1   92585 TC          92585 TC            471
HNS          7780    2161   EVOKED RESPONSE AUDIO MEAS COMP               722.70                    1   92585 TC          92585 TC            471
HNS          7780    2294   FLUENCY EVALUATION                            597.90                    1   92506         X4300                   444
HNS          7780    2286   GROUP THERAPY 1HR PER PERSON                   85.40                    1   92508         X4302                   443
HNS          7780       9   HEARING & SPEECH CLINIC                         0.00                    1                                         440
HNS          7780    2096   HEARING AID EVAL AUTO-AC BINAURAL             144.50                    1   92595         V5010                   471
HNS          7780    2070   HEARING AID EVAL BINAURAL                     256.20                    1   92591         V5010                   471
HNS          7780    2054   HEARING SCREENING                              86.50                    1   92551         V5008                   471
HNS          7780    2302   HEARING TEST ASSIST                             0.00   S                    92557         X4544                   471
HNS          7780     248   HRNGSP CASE MANAGEMENT 15 MIN                   0.00   S                                                          470
HNS          7780     247   HRNGSP CASE MANAGEMENT 5 MIN                    0.00   S                                                          470
HNS          7780    2534   HRNGSP CCS TEAM CONF 1/4 HR                     8.40                    1   99361         X3926                   440
HNS          7780    2559   HRNGSP CCS PHONE CONSULT 1/4 HR                 8.40   S                    99371         Z5406                   519
HNS          7780     246   HRNGSP DOCUMENTATION 15 MIN                     0.00   S                                                          470
HNS          7780     245   HRNGSP DOCUMENTATION 5 MIN                      0.00   S                                                          470
HNS          7780     249   HRNGSP DOWNTIME 10 MIN                          0.00   S                                                          470
HNS          7780    2542   HRNGSP PAR COUNS CONF 1/2HR                   289.10                    1 X4320           X4320                   440
HNS          7780    2112   MIDDLE EAR IMPEDANCE BILAT                    102.90                    1 92567           X4530                   471
HNS          7780    2906   MODIF ALT COMMUNICAT DEVICE                     0.00   S                   92598              92598               470
HNS          7780   11001   NHSP I/P INITIAL AABR                         262.80                    1 Z9725           Z9725                   471
HNS          7780   11012   NHSP I/P INITIAL OAE                          262.80                    1 Z9725           Z9725                   471
HNS          7780   11203   NHSP O/P INITIAL AABR                         262.80                    1 Z9726           Z9726                   471
HNS          7780   11214   NHSP O/P INITIAL OAE                          320.80                    1 Z9726           Z9726                   471
HNS          7780   11305   NHSP O/P RE-SCREEN AABR                       262.80                    1 Z9727           Z9727                   471



                                                           Page 121 of 676
                                                              CM 06/15/07


 Dept                                                                                                                      M/cal
        Cost Ctr.   SIM#                  Description                     Price          Stats/bill        CPT     Mod               Mod    Rev Code
 Code                                                                                                                     HCPCS
HNS          7780   11316   NHSP O/P RE-SCREEN OAE                          262.80                    1 Z9727            Z9727                    471
HNS          7780    2187   ORAL LANGUAGE EVAL                              308.80                    1 92506            X4300                    444
HNS          7780    2013   PED DIAG AUDIO EVAL-7YRS                        197.10                    1 92557            X4506                    471
HNS          7780    2567   PRELIM AUDIO EVAL                                94.20                    1 92552            X4308                    471
HNS          7780    2575   PRELIM SPEECH EVAL                               98.60                    1 92506            X4308                    440
HNS          7780    2131   SLP SWALLOWING EVAL                             355.90                    1 92610            X4301                    444
HNS          7780    2147   SLP SWALLOWING EVAL-FLUORO                      355.90                    1 92611            X4301                    444
HNS          7780    2225   SLP SWALLOWING TREATMENT                        249.70                    1 92526            X4303                    440
HNS          7780    2237   SPL-NMES FOR SWALLOWING 15 MIN                   76.70                    1 97032                97032                440
HNS          7780    2500   SP PATH CASE CONFERENCE BR                       52.60                    1 92700            X4320                    442
HNS          7780    2526   SP PATH CASE CONSULE +15MIN BR                    0.00   S                   92599           X4320                    442
HNS          7780    2518   SP PATH CASE CONSULT 30 MIN BR                    0.00   S                   92599           X4320                    442
HNS          7780    2385   SPEECH EVAL-BRIEF                               132.50                    1 92506            X4301                    444
HNS          7780    2179   SPEECH EVALUATION                               236.50                    1 92506            X4301                    444
HNS          7780    2203   SPEECH/LANG THRPY IND HR                        158.80                    1 92507            X4303                    440
HNS          7780    2211   SPEECH/LANGUAGE THER 1/2 HR                      79.90                    1 92507            X4304                    440
HNS          7780    2583   ST SCC GROUP COUNSEL/TEACH                       14.60                    1 Z4314            Z4314                    433
HOC          7190   71024   BONE MARROW ASPIRATION                            0.00   S                                                            400
HOC          7190   71025   BONE MARROW BIOPSY                                0.00   S                                                            400
HOC          7190   71004   # OF IV STARTS                                    0.00   S                                                            410
HOC          7190   11462   AEROSOL PENTAMIDINE                             227.00                    1    94642            94642                 410
HOC          7190   11413   INJECTION - IM/SUBQ                              23.00                    1    90772            90772                 515
HOC          7190   11215   ACCESS PICC LINE                                  0.00   S                     93799            93799                 515
HOC          7190   36709   AEROSOL PENTAMIDINE                             227.00                    1    94642            94642                 410
HOC          7190   36758   AEROSOL TREATMENT INITIAL                        48.00                    1    94640            94640                 410
HOC          7190   65138   AEROSOL TREATMENT SUBSEQUENT                     34.00                    1    94640     76     94640      76         410
HOC          7190   65013   ALLD HLTH TEAM CONF 1/4 HR                       12.05                    1   Z4302         Z4302                     519
HOC          7190   71010   CALLS - APPT SCHEDULING                           0.00   S                                                            410
HOC          7190   71011   CALLS - HOME CARE COORDINATION                    0.00   S                                                            410
HOC          7190   71012   CALLS - MED ADJUSTMENT                            0.00   S                                                            400
HOC          7190   71013   CALLS - PRESCRIPTION REFILLS                      0.00   S                                                            400
HOC          7190   65001   CENTER COORDINATOR                              103.28                    1 Z4300            Z4300                    519
HOC          7190   71001   CENTRAL LINE ACCESS/CARE                          0.00   S                                                            410
HOC          7190   51062   CHART REVIEW <1/4HR                               0.00   S                                                            515
HOC          7190   71030   CHEMO ADM INTO CNS INC SPINAL                     0.00   S                                                            400



                                                             Page 122 of 676
                                                            CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                  Description                  Price           Stats/bill       CPT     Mod               Mod   Rev Code
 Code                                                                                                                  HCPCS
HOC          7190   65141   CHEMO ADM SQ OR IM W W/O LOCAL AN              34.00                    1   96401            96401                335
HOC          7190   35818   CHEMO ADMIN, IV PUSH                          126.00                    1   96409            96409                331
HOC          7190   65045   CHEMO IV INFUSION 1ST HR                      429.00                    1   96413            96413                335
HOC          7190   65047   CHEMO IV INFUSION EA ADDL HR                  212.00                    1   96415            96415                335
HOC          7190   65510   CHEMO IV PUSH, EA ADDL DRUG                    65.70                    1   96411            96411                335
HOC          7190   65401   DECLOT VASC ACCESS DEVICE                      58.10                    1   36550            36550                515
HOC          7190   65139   DEMO A/O EVAL OF PT AEROSOL DVCE               26.00                    1   94664            94664                410
HOC          7190   71002   FACILITY TRANSFER                               0.00   S                                                          410
HOC          7190   65015   GROUP TEACHING/SUPPORT                         19.18                    1 Z4314           Z4314                   519
HOC          7190   65126   INJECTION IM ANTIOBIOTIC                       22.00                    1 90772               90772               515
HOC          7190   65040   INJECTION IM/SQ                                22.00                    1 90772               90772               515
HOC          7190   65041   INJECTION IV                                   90.00                    1 90774               90774               515
HOC          7190   71003   INPATIENT ADMISSION                             0.00   S                                                          410
HOC          7190   65501   INSRT PICC W/O PORT >5YRS W/O SED             172.50                    1                     36569               361
HOC          7190   65500   INSRT PICC W/O PORT <5 YRS W SED              205.70                    1 36568               36568               361
HOC          7190   65003   INTERMEDIATE CHART REVIEW & RPT                43.03                    1 Z4303           Z4303                   519
HOC          7190   65301   IV HYDRATION EACH ADDL HR                      43.50                    1 90761               90761               940
HOC          7190   65300   IV HYDRATION INITIAL UP TO 1HR                 79.50                    1 90760               90760               940
HOC          7190   65132   IV INFUSION NON CHEMO 1ST HR                  237.00                    1 90765               90765               260
HOC          7190   65133   IV INFUSION NON-CHEMO ADDL HR                  58.00                    1 90766               90766               260
HOC          7190   65201   IV NON-CHEMO CONCURRENT INFUSION               76.00                    1 90768                                   940
HOC          7190   65200   IV NONCHEMO AD SEQNTAL INF TO 1HR             135.00                    1 90767               90767               940
HOC          7190   65202   IV PUSH EA ADD DRUG-BILL W/ JCODE              88.70                    1 90755               90755               940
HOC          7190   65530   NEUROPSY TESTING BY PSYCH PER HR              485.00                    1 96118               96118               940
HOC          7190   71005   NG TUBE PLACEMENT                               0.00   S                                                          410
HOC          7190   65004   NURSE EVALUATION 1/2 HR                        24.10                    1 Z4301           Z4301                   519
HOC          7190   65005   NURSE TEAM CONF 1/4 HR                         12.05                    1 Z4310           Z4310                   519
HOC          7190   71000   OMMAYA TAP                                      0.00   S                                                          410
HOC          7190   71006   PATIENT/FAMILY EDUCATION >20 MIN                0.00   S                                                          410
HOC          7190   71007   PBSC COLLECTION                                 0.00   S                                                          410
HOC          7190   71032   PBSC INFUSION                                   0.00   S                                                          410
HOC          7190   71008   PHARMACOKINETICS                                0.00   S                                                          410
HOC          7190   71009   PICC REMOVAL                                    0.00   S                                                          519
HOC          7190   71014   PO MED ADMINISTRATION                           0.00   S                                                          400
HOC          7190   65504   REPAIR OF CVC W/O PORT                        136.90                    1   36575             36575               515



                                                          Page 123 of 676
                                                            CM 06/15/07


  Dept                                                                                                                  M/cal
         Cost Ctr.   SIM#                  Description                  Price          Stats/bill        CPT     Mod             Mod   Rev Code
  Code                                                                                                                  HCPCS
HOC           7190   71015   RBC EXCHANGE                                   0.00   S                                                         400
HOC           7190   65125   SEDATION EA ADDL 15 MIN                      283.00                    1 99145                99145             370
HOC           7190   65124   SEDATION IV/IM/INH                           567.00                    1 99143 TC             99143 TC          370
HOC           7190   65123   SEDATION PO/PR                               567.00                    1 99143 TC             99143 TC          370
HOC           7190   65131   SKIN TEST, PPD INTRADERMAL                    48.00                    1 86580 TC             86580 TC          300
HOC           7190   65506   SKIN TEST- CANDIDA                            58.20                    1 86485                86485             335
HOC           7190   65007   SOC WORK EVAL 1/2 HR                          24.10                    1 Z4307            Z4307                 561
HOC           7190   65009   SOC WORK PHONE CNSLT 1/4 HR                    0.00   S                  Z5406            Z5406                 561
HOC           7190   65008   SOC WORK TEAM CONF 1/4 HR                     12.05                    1 Z4311            Z4311                 561
HOC           7190   65136   SPINAL PUNCTURE LUMBAR DIAGNOSTIC            108.00                    1 62270                62270             361
HOC           7190       2   TOWER-HEM/ONC DIVISION                         0.00   S                                                         510
HOC           7190   12205   TRANSFUSION - 1 HR                            64.00                    1    36430         Z7514                 391
HOC           7190   12296   TRANSFUSION - 10 HR                          499.00                    1    36430         Z7514                 391
HOC           7190   12213   TRANSFUSION - 2 HR                           101.00                    1    36430         Z7514                 391
HOC           7190   12221   TRANSFUSION - 3 HR                           150.00                    1    36430         Z7514                 391
HOC           7190   12239   TRANSFUSION - 4 HR                           198.00                    1    36430         Z7514                 391
HOC           7190   12247   TRANSFUSION - 5 HR                           248.00                    1    36430         Z7514                 391
HOC           7190   12254   TRANSFUSION - 6 HR                           300.00                    1    36430         Z7514                 391
HOC           7190   12262   TRANSFUSION - 7 HR                           348.00                    1    36430         Z7514                 391
HOC           7190   12270   TRANSFUSION - 8 HR                           398.00                    1    36430         Z7514                 391
HOC           7190   12288   TRANSFUSION - 9 HR                           448.00                    1    36430         Z7514                 391
HOC           7190   71018   UNEXPECTED COMP-FEVER                          0.00   S                                                         400
HOC           7190   71019   UNEXPECTED COMP-MED RXN                        0.00   S                                                         400
HOC           7190   71017   UNEXPECTED COMP-TRANSF RXN                     0.00   S                                                         400
HOC           7190   71016   URINARY CATHETERIZATION                        0.00   S                                                         400
HOC           7190   61010   USE OF ROOM - NO CHARGE                        0.00   S                     99211         Z7500                 515
HOC           7190   60600   USE OF ROOM CHARGE                            50.00                    1    99211         Z7500                 515
HOC           7190   71020   WBC INFUSION                                   0.00   S                                                         400
ICU           6052   12508   2W CICU 12 HRS OF CARE                     4,832.00                    1   RM012                                210
ICU           6052   12458   2W CICU 24 HRS OF CARE                     5,745.00                    1   RM024                                210
ICU           6052   12409   2W CICU 48 HRS OF CARE                     7,661.00                    1   RM048                                219
ICU           6052   12755   2W CICU H/C 8 HRS OF CARE                  2,973.00                    1                                        210
ICU           6052   12803   2W CICU ISOLATION ADDL.                      288.00                    1   Z7514          Z7514                 164
ICU           6052   12852   2W CICU LEVEL IV RECOVERY ROOM               671.00                    1   Z7512          Z7512                 710
ICU           6052   12902   2W CICU LVL IV PAS RECOVERY RM               671.00                    1   Z7512          Z7512                 710



                                                           Page 124 of 676
                                                              CM 06/15/07


  Dept                                                                                                                   M/cal
         Cost Ctr.   SIM#                  Description                    Price          Stats/bill        CPT    Mod            Mod   Rev Code
  Code                                                                                                                   HCPCS
ICU           6052   30104   2WCICU HRT TRANS 12 HRS M/CAL                4,654.00                    1   RM012                              213
ICU           6052   30054   2WCICU HRT TRANS 24 HRS M/CAL                5,498.00                    1   RM024                              213
ICU           6052   30005   2WCICU HRT TRANS 48 HRS M/CAL                6,638.00                    1   RM048                              213
ICU           6052   30401   2WCICU HRT/LNG T 12 HRS M/CAL                4,654.00                    1   RM012                              213
ICU           6052   30351   2WCICU HRT/LNG T 24 HRS M/CAL                5,498.00                    1   RM024                              213
ICU           6052   30302   2WCICU HRT/LNG T 48 HRS M/CAL                6,638.00                    1   RM048                              213
ICU           6052   30252   2WCICU LNG TRANS 12 HRS M/CAL                4,654.00                    1   RM012                              213
ICU           6052   30203   2WCICU LNG TRANS 24 HRS M/CAL                5,498.00                    1   RM024                              213
ICU           6052   30153   2WCICU LNG TRANS 48 HRS M/CAL                6,638.00                    1   RM048                              213
ICU           6052   12201   CICU 12 HRS OF CARE                          4,654.00                    1   RM012                              210
ICU           6052   12151   CICU 24 HRS OF CARE                          5,498.00                    1   RM024                              210
ICU           6052   12102   CICU 48 HRS OF CARE                          6,638.00                    1   RM048                              219
ICU           6052   60026   DOUBLE LUNG TRANSPLANT                           0.00   S                                                       213
ICU           6052   14700   ECMO PERFUSION SET UP                        1,322.00                    1 99070           Z7610                220
ICU           6052   14809   ECMO STAND BY                                  576.00                    1 A4649           Z7610                270
ICU           6052   12936   EXTRACORPOREAL CIRC 1ST DAY                  4,597.00                    1 33960           Z0312                940
ICU           6052   12951   EXTRACORPOREAL CIRC EA AD DAY                4,597.00                    1 33961           Z0312                940
ICU           6052   60018   HEART TRANSPLANT                                 0.00   S                                                       213
ICU           6052   60034   HEART/LUNG TRANSPLANT                            0.00   S                                                       213
ICU           6052   60042   SINGLE LUNG TRANSPLANT                           0.00   S                                                       213
IFD           7089   65014   ALLD HLTH PHN CNSLT 1/4 HR                       0.00   S                  Z5406           Z5406                519
IFD           7089   65013   ALLD HLTH TEAM CONF 1/4 HR                      12.05                    1 Z4302           Z4302                519
IFD           7089   65001   CENTER COORDINATOR                             103.28                    1 Z4300           Z4300                519
IFD           7089   65002   COMP CHART REV & RPT                            77.46                    1 Z4304           Z4304                519
IFD           7089   10063   COMPLICATED VP SHUNT                             0.00   S                                                       515
IFD           7089   65015   GROUP TEACHING/SUPPORT                          19.18                    1 Z4314           Z4314                519
IFD           7089      62   ID NURSE CASE CONFERENCE                        64.00                    1 Z5404           Z5404                515
IFD           7089     997   ID WRITE IN                                      0.00   S                                                       515
IFD           7089       5   INFECTIOUS DISEASES                              0.00   S                                                       510
IFD           7089    1250   NURS PHONE CALL ADDL 1/4 HR                      0.00   S                  Z5406           Z5406                519
IFD           7089    1201   NURS PHONE CALL INIT 1/4 HR                      0.00   S                  Z5406           Z5406                519
IFD           7089   65004   NURSE EVALUATION 1/2 HR                         24.10                    1 Z4301           Z4301                519
IFD           7089   65006   NURSE PHONE CNSLT 1/4 HR                         0.00   S                  Z5406           Z5406                519
IFD           7089   65005   NURSE TEAM CONF 1/4 HR                          12.05                    1 Z4310           Z4310                519
IFD           7089   65003   PERIODIC CHART REV & RPT                        43.03                    1 Z4303           Z4303                519



                                                             Page 125 of 676
                                                                 CM 06/15/07


  Dept                                                                                                                        M/cal
         Cost Ctr.   SIM#                   Description                    Price            Stats/bill        CPT     Mod               Mod   Rev Code
  Code                                                                                                                       HCPCS
IFD           7089    2100   PPD INTRADERM                                       0.00   S                  A4649            Z7610                   515
IFD           7089    2110   PPD INTRADERM                                       0.00   S                  A4649            Z7610                   515
IFD           7089    1904   RD PHONE CALL ADDL 1/4 HR                           0.00   S                  Z5406            Z5406                   519
IFD           7089    1854   RD PHONE CALL INIT 1/4 HR                           0.00   S                  Z5406            Z5406                   519
IFD           7089   65007   SOC WORK EVAL 1/2 HR                               24.10                    1 Z4307            Z4307                   561
IFD           7089   65009   SOC WORK PHONE CNSLT 1/4 HR                         0.00   S                  Z5406            Z5406                   561
IFD           7089   65008   SOC WORK TEAM CONF 1/4 HR                          12.05                    1 Z4311            Z4311                   561
IFD           7089   10071   UNCOMPLICATED VP SHUNT                              0.00   S                                                           515
IFD           7089   61010   USE OF ROOM - NO CHARGE                             0.00   S                     99211         Z7500                   515
IFD           7089   60600   USE OF ROOM CHARGE                                 50.00                    1    99211         Z7500                   515
IMC           7180   65127   AEROSOL ACUTE                                     145.00                    1    94640             94640               410
IMC           7180   61586   AEROSOL NON-ACUTE                                 227.00                    1    94642             94642               412
IMC           7180   40024   AEROSOL/VAPOR INHALATIONS, INIT                   104.00                    1    94640             94640               410
IMC           7180   65014   ALLD HLTH PHN CNSLT 1/4 HR                          0.00   S                    Z5406          Z5406                   519
IMC           7180   65013   ALLD HLTH TEAM CONF 1/4 HR                         12.05                    1   Z4302          Z4302                   519
IMC           7180   90772   ALLERGY SHOT                                       42.00                    1    95115             95115               515
IMC           7180   65125   BLOOD COLLECTION, ACCESS DEVICE                     0.00   S                     36540                                 515
IMC           7180   65001   CENTER COORDINATOR                                103.28                    1   Z4300          Z4300                   519
IMC           7180   65132   CENTRAL LINE CATH REPAIR                            0.00   S                     93799             93799               515
IMC           7180   65033   CHANGE OF GASTROSTOMY TUBE                          0.00   S                     43760             43760               515
IMC           7180   65002   COMP CHART REV & RPT                               77.46                    1   Z4304          Z4304                   519
IMC           7180   65031   DECLOT VASCULAR CATH                                0.00   S                     36550             36550               515
IMC           7180   13753   EAR EXAM/IRRIGATION                                 0.00   S                    A4649          Z7610                   272
IMC           7180    4004   FLOW VOLUME LOOP                                   97.00                    1    94375 TC          94375 TC            460
IMC           7180   65015   GROUP TEACHING/SUPPORT                             19.18                    1   Z4314          Z4314                   519
IMC           7180    2054   HEARING SCREENING                                 104.00                    1    92551         V5008                   471
IMC           7180    2302   HEARING TEST ASSIST                                 0.00   S                     92557         X4544                   471
IMC           7180   65126   IM INJ ANTIOBIOTIC (BILL W/JCODE)                  29.00                    1    90772             90772               515
IMC           7180    2110   IMM DEF ADD L USE OF ROOM                           0.00   S                                   Z7500                   515
IMC           7180   90657   INFLUENZA 3YRS+                                    42.00                    1    90658             90658               636
IMC           7180   95356   INFLUENZA 6MO-36MO                                 42.00                    1    90657             90657               636
IMC           7180   65040   INJ, IM/SUBQ (BILL W/JCODE)                        29.00                    1    90772             90772               515
IMC           7180   65041   INJ, IV (BILL W/JCODE)                            119.00                    1    90774             90774               515
IMC           7180   65028   INTRO INTRACATH VEIN, BILAT                         0.00   S                     36000             36000               515
IMC           7180   65027   INTRO INTRACATH VEIN, UNI                           0.00   S                     36000             36000               515



                                                             Page 126 of 676
                                                         CM 06/15/07


 Dept                                                                                                                 M/cal
        Cost Ctr.   SIM#                 Description                 Price          Stats/bill        CPT   Mod                Mod    Rev Code
 Code                                                                                                                HCPCS
IMC          7180   65185   IV FLUID/MEDS INFUSION ADDL HR             140.00                    1 90766                90766               260
IMC          7180   65184   IV FLUID/MEDS INFUSION INIT HR             271.00                    1 90765                90765               260
IMC          7180   65004   NURSE EVALUATION 1/2 HR                     24.10                    1 Z4301            Z4301                   519
IMC          7180   65006   NURSE PHONE CNSLT 1/4 HR                     0.00   S                  Z5406            Z5406                   519
IMC          7180   65005   NURSE TEAM CONF 1/4 HR                      12.05                    1 Z4310            Z4310                   519
IMC          7180   65165   PATCH TEST                                 332.00                    1 95044                95044               515
IMC          7180   65003   PERIODIC CHART REV & RPT                    43.03                    1 Z4303            Z4303                   519
IMC          7180   10203   PPD INTRADERMAL                             14.00                    1 86580 TC             86580 TC            302
IMC          7180   99175   RECOMB HEP B VAC PED 0.5ML                 180.00                    1 90744                90744               636
IMC          7180   65130   SELF CARE TRAIN, EA 15 MIN                   0.00   S                   97535               97535               515
IMC          7180   65131   SKIN TEST (PRICK)                            5.00                    1 86580 TC             86580 TC            302
IMC          7180   65007   SOC WORK EVAL 1/2 HR                        24.10                    1 Z4307            Z4307                   561
IMC          7180   65009   SOC WORK PHONE CNSLT 1/4 HR                  0.00   S                  Z5406            Z5406                   561
IMC          7180   65008   SOC WORK TEAM CONF 1/4 HR                   12.05                    1 Z4311            Z4311                   561
IMC          7180   65016   SW CASE COORD CONSULT 1/4 HR                 0.00   S                                                           515
IMC          7180   65030   TRANSFUSION BLOOD/COMP EA                    0.00   S                     36430             36430               515
IMC          7180   65021   URINARY CATH SIMPLE                          0.00   S                     53670             53670               515
IMC          7180   61010   USE OF ROOM - NO CHARGE                      0.00   S                     99211         Z7500                   515
IMC          7180   60600   USE OF ROOM CHARGE                          50.00                    1    99211         Z7500                   515
IMC          7180   30010   VENIPUNCTURE                                18.00                    1    36415 ZS          36415 ZS            300
IML          7512   10003   CYTOSPIN PREPARATION                        96.00                    1    88108 ZS          88108 ZS            312
IML          7512   10005   IMMUNOCYTECHOMESTRY 5 ANTIBODIES           145.00                    1    88342 ZS          88342 ZS            312
IML          7512   10001   IMMUNOCYTOLOGY TEST (PANEL MSTR)             0.00   S                                                           305
IML          7512   10006   IMMUNOCYTOLOGY TEST NB-NEW PRICE           575.00                    1                                          305
IML          7512   10000   IMMUNOCYTOLOGY TEST-NEUROBLASTOMA          535.00                    1    85999 TC          85999 TC            305
IML          7512   10004   MORPHOMETRIC ANALYSIS                      290.00                    1    88358 ZS          88358 ZS            312
IML          7512   10002   WHITE BLOOD CELL COUNT                      17.00                    1    85025 ZS          85025 ZS            305
KAC          7862   18095   *X KIDNEY ACQUISITION FEE               58,000.00                    1    50300         Z7308                   812
KAC          7862   18129   *X KIDNEY UNOS LISTING                   1,162.00                    1   Z7308          Z7308                   810
KAC          7862   65001   CENTER COORDINATOR CHARGE                  103.28                    1   Z4300          Z4300                   515
KAC          7862   65002   COMP CHAT REV & RPT                         77.46                    1   Z4304          Z4304                   515
KAC          7862   65015   GROUP TEACHING/SUPPORT                      19.18                    1   Z4314          Z4314                   515
KAC          7862   15059   METIC CROSSMATCH LYMPHOCYTOTOXICI          600.00                    1    86806             86806               302
KAC          7862   60232   METIC CROSSMATCH, FLOW CYTOMETRY           430.00                    1    86806             86806               302
KAC          7862   15158   METIC CYTOTOXIC PRA                        300.00                    1    86807    90       86807    90         302



                                                        Page 127 of 676
                                                                CM 06/15/07


 Dept                                                                                                                     M/cal
        Cost Ctr.   SIM#                   Description                    Price          Stats/bill      CPT     Mod                Mod    Rev Code
 Code                                                                                                                    HCPCS
KAC          7862   65050   METIC HLA A TYPING DNA CLASS 1                  300.00                    1 86817               86817                302
KAC          7862   65051   METIC HLA B TYPING DNA CLASS 1                  440.00                    1 86817               86817                302
KAC          7862   65052   METIC HLA C TYPING DNA CLASS 1                  300.00                    1 86817               86817                302
KAC          7862   61378   METIC HLA TYPING ABC MULTI ANTIGE               400.00                    1 86813               86813                302
KAC          7862   15356   METIC HLA TYPING DNA CLASS II                   660.00                    1 86817      90       86817     90         302
KAC          7862   61377   METIC HLA TYPING DR-MULTI ANTIGEN               600.00                    1 86817               86817                302
KAC          7862   15307   METIC DTT PRA                                   220.00                    1 86807      90       86807     90         302
KAC          7862   61380   METIC FLOW PRA                                  430.00                    1 86807      90       86807     90         302
KAC          7862   61379   METIC PRONASE CROSSMATCH                        430.00                    1 86806      90       86806     90         302
KAC          7862   65004   NURSE EVALUATION 1/2 HOUR                        24.10                    1 Z4301           Z4301                    515
KAC          7862   65006   NURSE PHONE CNSLT 1/4 HOUR                        0.00   S                  Z5406           Z5406                    515
KAC          7862   65005   NURSE TEAM CONF 1/4 HOUR                         12.05                    1 Z4310           Z4310                    515
KAC          7862   65003   PERIODIC CHARG REV & RPT                         43.03                    1 Z4303           Z4303                    515
KAC          7862   65130   SELF MANAGE TEACHING EACH 15 MIN                  0.00   S                   97535              97535                515
KAC          7862   65009   SOC WORK PHONE CNSLT 1/4 HOUR                     0.00   S                  Z5406           Z5406                    515
KAC          7862   65016   SW CASE COORD CONSULT 1/4 HOUR                    0.00   S                                                           515
KAC          7862   61010   USE OF ROON - NO CHARGE                           0.00   S                   99211          Z7500                    515
KAC          7862   60600   USE OF ROOM CHARGE                               50.00                    1 99211           Z7500                    515
LTP          7422    2001   *X LIVER AIR TRANSPORT A                      2,649.90                    1 99082           Z7306                    810
LTP          7422    2019   *X LIVER AIR TRANSPORT B                      4,769.80                    1 99082           Z7306                    810
LTP          7422    2027   *X LIVER AIR TRANSPORT C                      6,359.80                    1 99082           Z7306                    810
LTP          7422    2035   *X LIVER AIR TRANSPORT D                      7,949.70                    1 99082           Z7306                    810
LTP          7422    2043   *X LIVER AIR TRANSPORT E                     11,924.60                    1 99082           Z7306                    810
LTP          7422    2050   *X LIVER AIR TRANSPORT F                     15,899.40                    1 Z7306           Z7306                    810
LTP          7422    1003   *X LIVER GROUND TRANSPORT A                     795.00                    1 99082               99082                810
LTP          7422    1011   *X LIVER GROUND TRANSPORT B                   1,192.50                    1 99082               99082                810
LTP          7422    1029   *X LIVER GROUND TRANSPORT C                   1,589.90                    1 99082               99082                810
LTP          7422    1037   *X LIVER GROUND TRANSPORT D                   2,384.90                    1 99082               99082                810
LTP          7422    1045   *X LIVER GROUND TRANSPORT E                   3,179.90                    1 99082               99082                812
LTP          7422    1046   *X LIVER GROUND TRANSPORT F                   3,974.90                    1 99082               99082                812
LTP          7422    1047   *X LIVER GROUND TRANSPORT G                   4,769.80                    1 99082               99082                812
LTP          7422   67141   *X LIVER/SB AIR TRANSPORT A                   3,179.90                    1 99082               99082                810
LTP          7422   67142   *X LIVER/SB AIR TRANSPORT B                   4,769.80                    1 99082               99082                810
LTP          7422   67143   *X LIVER/SB AIR TRANSPORT C                   6,359.80                    1 99082               99082                810
LTP          7422   67144   *X LIVER/SB AIR TRANSPORT D                   7,949.70                    1 99082               99082                810



                                                            Page 128 of 676
                                                               CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                  Description                      Price      Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                                  HCPCS
LTP          7422   67145   *X LIVER/SB AIR TRANSPORT E                   11,924.60                1    99082             99082               810
LTP          7422   67146   *X LIVER/SB AIR TRANSPORT F                   15,899.40                1    99082             99082               810
LTP          7422   67134   *X LIVER/SB GRD TRANSPORT A                      795.00                1    99082             99082               810
LTP          7422   67135   *X LIVER/SB GRD TRANSPORT B                    1,192.50                1    99082             99082               810
LTP          7422   67136   *X LIVER/SB GRD TRANSPORT C                    1,589.90                1    99082             99082               810
LTP          7422   67137   *X LIVER/SB GRD TRANSPORT D                    2,384.90                1    99082             99082               810
LTP          7422   67138   *X LIVER/SB GRD TRANSPORT E                    3,179.90                1    99082             99082               810
LTP          7422   67139   *X LIVER/SB GRD TRANSPORT F                    3,974.90                1    99082             99082               810
LTP          7422   67140   *X LIVER/SB GRD TRANSPORT G                    4,769.80                1    99082             99082               810
LTP          7422   67117   *X SMALL BOWEL AIR TRANSPORT A                 3,179.90                1    99082             99082               810
LTP          7422   67118   *X SMALL BOWEL AIR TRANSPORT B                 4,769.80                1    99082             99082               810
LTP          7422   67119   *X SMALL BOWEL AIR TRANSPORT C                 6,359.80                1    99082             99082               810
LTP          7422   67120   *X SMALL BOWEL AIR TRANSPORT D                 7,949.70                1    99082             99082               810
LTP          7422   67121   *X SMALL BOWEL AIR TRANSPORT E                11,924.60                1    99082             99082               810
LTP          7422   67122   *X SMALL BOWEL AIR TRANSPORT F                15,899.40                1    99082             99082               810
LTP          7422   67110   *X SMALL BOWEL GRD TRANSPORT A                   795.00                1    99082             99082               810
LTP          7422   67111   *X SMALL BOWEL GRD TRANSPORT B                 1,192.50                1    99082             99082               810
LTP          7422   67112   *X SMALL BOWEL GRD TRANSPORT C                 1,589.90                1    99082             99082               810
LTP          7422   67113   *X SMALL BOWEL GRD TRANSPORT D                 2,384.90                1    99082             99082               810
LTP          7422   67114   *X SMALL BOWEL GRD TRANSPORT E                 3,179.90                1    99082             99082               810
LTP          7422   67115   *X SMALL BOWEL GRD TRANSPORT F                 3,974.90                1    99082             99082               810
LTP          7422   67116   *X SMALL BOWEL GRD TRANSPORT G                 4,769.80                1    99082             99082               810
LTP          7422   65002   COMP CHART REV & RPT                              77.46                1   Z4304          Z4304                   519
LTP          7422   65040   INJ-IM/SUBQ                                       26.30                1    90772             90772               515
LTP          7422   65041   INJECTION IV PUSH                                108.40                1    90774             90774               515
LTP          7422   65184   IV FLUIDS /MED INFUSION 1ST HR                   247.50                1    90765             90765               260
LTP          7422   65185   IV FLUIDS/MEDS INFUSION ADDL HR                  128.10                1    90766             90766               260
LTP          7422    3009   LIVER PERFUSION A                                795.00                1   Z7306          Z7306                   812
LTP          7422    3017   LIVER PERFUSION B                                953.70                1   Z7306          Z7306                   812
LTP          7422    3025   LIVER PERFUSION C                              1,112.50                1   Z7306          Z7306                   812
LTP          7422    3033   LIVER PERFUSION D                              1,272.40                1   Z7306          Z7306                   812
LTP          7422   67147   LIVER/SB PERFUSION A                             795.00                1   Z7322          Z7322                   812
LTP          7422   67148   LIVER/SB PERFUSION B                             953.70                1   Z7322          Z7322                   812
LTP          7422   67149   LIVER/SB PERFUSION C                           1,112.50                1   Z7322          Z7322                   812
LTP          7422   67150   LIVER/SB PERFUSION D                           1,272.40                1   Z7322          Z7322                   812



                                                              Page 129 of 676
                                                          CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                 Description                 Price          Stats/bill        CPT   Mod             Mod   Rev Code
 Code                                                                                                              HCPCS
LTP          7422   65001   NURSE COORDINATOR                          103.28                    1   Z4300        Z4300                 519
LTP          7422   65004   NURSE EVALUATION 1/2 HR                     24.10                    1   Z4301        Z4301                 519
LTP          7422   65005   NURSE TEAM CONF 1/4 HR                      12.05                    1   Z4310        Z4310                 519
LTP          7422   65003   PERIODIC CHART REV & RPT                    43.03                    1   Z4303        Z4303                 519
LTP          7422   67123   SMALL BOWEL PERFUSION A                    795.00                    1   Z7320        Z7320                 812
LTP          7422   67124   SMALL BOWEL PERFUSION B                    953.70                    1   Z7320        Z7320                 812
LTP          7422   67125   SMALL BOWEL PERFUSION C                  1,112.50                    1   Z7320        Z7320                 812
LTP          7422   67126   SMALL BOWEL PERFUSION D                  1,272.40                    1   Z7320        Z7320                 812
LTP          7422   65008   SOC WORK TEAM CONF 1/4 HR                   12.05                    1   Z4311        Z4311                 561
LTP          7422      54   UNOS LISTING FEE LIVER                   1,162.00                    1   Z7306        Z7306                 810
LTP          7422   67102   UNOS LISTING FEE SMALL BOWEL             1,162.00                    1   Z7320        Z7320                 810
LTP          7422   61010   USE OF ROOM - NO CHARGE                      0.00   S                     99211       Z7500                 515
LTP          7422   60600   USE OF ROOM CHARGE                          50.00                    1    99211       Z7500                 515
LTP          7422      70   X LIVER ORGAN PROCUREMENT               59,000.00                    1    47133       Z7306                 812
LTP          7422   67104   X SMALL BOWEL ORGAN PROCUREMENT         59,000.00                    1    44132       Z7320                 812
MDX          7526   90028   LAB CHROM ANAL SOL TUM 1K                    0.00   S                     88261                             920
MDX          7526   90044   LAB CHROM ANAL SOL TUM ADD C                 0.00   S                     88285                             920
MDX          7526   90036   LAB CHROM ANAL SOL TUM ADD K                 0.00   S                     88280                             920
MDX          7526   90127   LAB FISH-CHROM. PAINTING                     0.00   S                     88365                             920
MDX          7526   90119   LAB FISH-SAT./TEL. PROBE                     0.00   S                     88365                             920
MDX          7526   90135   LAB FISH-UNIQUE SEQ. PROBE                   0.00   S                     88365                             920
MDX          7526   90051   LAB TISS. CULT.-BLOOD                        0.00   S                     88230                             920
MDX          7526   90077   LAB TISS. CULT.-BONE MARROW                  0.00   S                     88237                             920
MDX          7526   90093   LAB TISS. CULT.-CONT CULT                    0.00   S                     88399                             920
MDX          7526   90101   LAB TISS. CULT.-RESTABLISH                   0.00   S                     88399                             920
MDX          7526   90085   LAB TISS. CULT.-STORAGE                      0.00   S                     88399                             920
MDX          7526   90069   LAB TISS. CULT.-TISSUE                       0.00   S                     88233                             920
MDX          7526   80045   LAB TUM PROC HANDLING FEE                    0.00   S                     99002                             920
MDX          7526   80029   LAB TUM-ENZYME DIGESTION                     0.00   S                     83892                             920
MDX          7526   80011   LAB TUM-EXTRACTION OF SAMPLE                 0.00   S                     83890                             920
MDX          7526   80060   LAB TUM-INTERP & REPORT                      0.00   S                     83912                             920
MDX          7526   80052   LAB TUM-PROBE, EA                            0.00   S                     83896                             920
MDX          7526   80037   LAB TUM-SEPARATION                           0.00   S                     83894                             920
MDX          7526   71285   MCM CMV QUANTITATIVE PCR                   290.00                    1    87497 TC       87497 TC           306
MDX          7526   71345   MCM EBV QUANTITATIVE PCR                   290.00                    1    87799 TC       87799 TC           306



                                                        Page 130 of 676
                                                             CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                 Description                   Price          Stats/bill      CPT      Mod                Mod   Rev Code
 Code                                                                                                                 HCPCS
MDX          7526   71410   MCM HHV6 QUANTITATIVE PCR                    310.00                    1 87533    TC         87533   TC           306
MDX          7526   71141   MCM ULTRA SENS HIV-1 QUANT                   164.00                    1 87536    TC         87536   TC           306
MDX          7526   70500   MCM-ADENOVIRUS, AMP PROBE                    192.00                    1 87798    TC         87798   TC           306
MDX          7526   70590   MCM-AFB CONCENTRATION                         55.00                    1 87015    TC         87015   TC           306
MDX          7526   70582   MCM-AFB DIRECT SMEAR                          33.00                    1 87206    TC         87206   TC           306
MDX          7526   50006   MCM-B. PERTUSSIS, AMP PROBE                  192.00                    1 87798    TC         87798   TC           306
MDX          7526   50022   MCM-CHLAMY DNA PROBE                          30.00                    1 87490    TC         87490   TC           306
MDX          7526   50014   MCM-CHLAMY TRACH DIR NAA                      36.00                    1 87490    TC         87490   TC           306
MDX          7526   71283   MCM-CMV, AMPLIFIED PROBE                     192.00                    1 87496    TC         87496   TC           306
MDX          7526   71322   MCM-DNA ISOLATION                             82.00                    1 83891    TC         83891   TC           920
MDX          7526   71341   MCM-EBV, AMPLIFIED PROBE                     192.00                    1 87798    TC         87798   TC           306
MDX          7526   71358   MCM-ENTEROVIRUS, AMP PROBE                   208.00                    1 87798    TC         87798   TC           306
MDX          7526   50030   MCM-GC DIR NAA                                33.00                    1 87590    TC         87590   TC           306
MDX          7526   70160   MCM-GC DNA PROBE                              30.00                    1 87590    TC         87590   TC           306
MDX          7526   79906   MCM-HANDLE/CONVEY SPEC COMPLEX                36.00                    1 99001           Z5220                    300
MDX          7526   79914   MCM-HANDLE/CONVEY SPEC ROUTINE                66.00                    1 99001           Z5220                    300
MDX          7526   71408   MCM-HHV-6, AMPLIFIED PROBE                   192.00                    1 87532    TC         87532   TC           306
MDX          7526   71168   MCM-HIV-1 DNA, AMP PROBE                     164.00                    1 87535    TC         87535   TC           306
MDX          7526   71150   MCM-HIV-1 QUANTITATION                       164.00                    1 87536    TC         87536   TC           306
MDX          7526   71200   MCM-HSV, AMPLIFIED PROBE                     192.00                    1 87529    TC         87529   TC           306
MDX          7526   71432   MCM-MAC, AMPLIFIED PROBE                     208.00                    1 87561    TC         87561   TC           306
MDX          7526   71465   MCM-MTB, AMPLIFIED PROBE                     208.00                    1 87556    TC         87556   TC           306
MDX          7526   71473   MCM-MYCOBACTERIA SP.AMP PROBE                208.00                    1 87551    TC         87551   TC           306
MGN          7087   65001   CENTER COORDINATOR                           103.28                    1 Z4300           Z4300                    519
MGN          7087   65002   COMP CHART REV & RPT                          77.46                    1 Z4304           Z4304                    519
MGN          7087   65004   NURSE EVALUATION 1/2 HR                       24.10                    1 Z4301           Z4301                    519
MGN          7087   65006   NURSE PHONE CNSLT 1/4 HR                       0.00   S                  Z5406           Z5406                    519
MGN          7087   65005   NURSE TEAM CONF 1/4 HR                        12.05                    1 Z4310           Z4310                    519
MGN          7087   65003   PERIODIC CHART REV & RPT                      43.03                    1 Z4303           Z4303                    519
MGN          7087   60600   USE OF ROOM CHARGE                            50.00                    1 99211           Z7500                    515
MRI          7660   20045   ANEST/SED 15 MIN                               0.00   S                  A4649           Z7610                    371
MRI          7660    2282   IV START (NURSE) (B)                           0.00   S                   36000              36000                270
MRI          7660     500   MAGNAVIST CONTRAST 20ML BR8815                 0.00   S                  Q9952           Q9952                    255
MRI          7660   65430   MR SPECTROSCOPY                            1,763.39                    1 76390           NC                       610
MRI          7660    2415   MRA ABDOMEN                                1,261.11                    1 74185    TC         74185   TC           610



                                                        Page 131 of 676
                                                          CM 06/15/07


 Dept                                                                                                                M/cal
        Cost Ctr.   SIM#                  Description                 Price        Stats/bill       CPT      Mod                Mod   Rev Code
 Code                                                                                                               HCPCS
MRI          7660   65429   MRA CHEST W/WO CONTRAST                   3,438.57                  1   71555          NC                       618
MRI          7660   65418   MRA HEAD W/CONTRAST                       2,116.09                  1   70545   TC         70545   TC           615
MRI          7660   65417   MRA HEAD W/O CONTRAST                     1,921.01                  1   70544   TC         70544   TC           615
MRI          7660   65419   MRA HEAD W/WO CONTRAST                    2,997.78                  1   70546   TC         70546   TC           615
MRI          7660   65331   MRA LOWER EXT W/WO CONTRAST               3,438.57                  1   73725          NC                       610
MRI          7660   65420   MRA NECK W/O CONTRAST                     1,921.01                  1   70547   TC         70547   TC           615
MRI          7660   65432   MRA NECK W/WO CONTRAST                    3,438.57                  1   70549   TC         70549   TC           615
MRI          7660   65431   MRA NECK WITH CONTRAST                    2,498.19                  1   70548   TC         70548   TC           615
MRI          7660   65413   MRA PELVIS W/WO CONTRAST                  2,496.85                  1   72198          NC                       610
MRI          7660   65428   MRA SPINAL CANAL & CONTENTS W/WO          3,438.57                  1   72159          NC                       618
MRI          7660   65414   MRA UPPER EXTRM. W/WO CONTRAST            2,496.85                  1   73225          NC                       610
MRI          7660   65332   MRI ABD W/CONTRAST                        2,747.93                  1   74182   TC         74182   TC           610
MRI          7660   65333   MRI ABD W/WO CONTRAST                     3,438.57                  1   74183   TC         74183   TC           610
MRI          7660     252   MRI ABD WO CONT                           2,496.85                  1   74181   TC         74181   TC           610
MRI          7660    2407   MRI BRAIN W/WO CONTRAST                   3,781.88                  1   70553   TC         70553   TC           611
MRI          7660    2399   MRI BRAIN WITH CONTRAST                   2,747.93                  1   70552   TC         70552   TC           611
MRI          7660     203   MRI BRAIN WO CONT                         2,454.03                  1   70551   TC         70551   TC           611
MRI          7660   65335   MRI CARDIAC FOR MORPHOLOGY W/CONT         2,951.06                  1   75553          NC                       610
MRI          7660   65334   MRI CARDIAC FOR MORPHOLOGY W/O CO         2,645.08                  1   75552          NC                       610
MRI          7660   65336   MRI CARDIAC FUNC W/WO MORP. COMP          2,742.56                  1   75554          NC                       610
MRI          7660   65337   MRI CARDIAC FUNC. W/WO MORP. LTD          2,645.08                  1   75555          NC                       610
MRI          7660     401   MRI CERVICAL SPINE WO CONT                2,496.85                  1   72141   TC         72141   TC           612
MRI          7660   65422   MRI CERVICAL W/ CONTRAST                  2,747.93                  1   72142   TC         72142   TC           612
MRI          7660   65423   MRI CERVICAL W/WO CONTRAST                3,438.57                  1   72156   TC         72156   TC           612
MRI          7660   65434   MRI CHEST W/ CONTRAST                     3,041.83                  1   71551   TC         71551   TC           610
MRI          7660   65433   MRI CHEST W/WO CONTRAST                   3,379.89                  1   71552   TC         71552   TC           610
MRI          7660     245   MRI CHEST WO CONT                         2,747.93                  1   71550   TC         71550   TC           610
MRI          7660   65338   MRI FOR VELOCITY FLOW MAPPING               582.43                  1   75556          NC                       610
MRI          7660     278   MRI IV SET                                   69.42                  1   99070          Z7610                    270
MRI          7660    2290   MRI IV START (NURSE) (N)                      0.00 S                    36000              36000                270
MRI          7660   65329   MRI LOWER EXT ANY JT W/CONTRAST           2,571.64                  1   73722   TC         73722   TC           610
MRI          7660   65330   MRI LOWER EXT ANY JT W/WO CONTRAS         3,438.57                  1   73723   TC         73723   TC           610
MRI          7660   65328   MRI LOWER EXT W/CONTRAST                  2,571.64                  1   73719   TC         73719   TC           610
MRI          7660   65327   MRI LOWER EXT W/O CONTRAST                2,247.00                  1   73718   TC         73718   TC           610
MRI          7660     427   MRI LUMBAR SPINE WO CONT                  2,496.85                  1   72148   TC         72148   TC           612



                                                         Page 132 of 676
                                                            CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                  Description                  Price          Stats/bill       CPT      Mod                 Mod      Rev Code
 Code                                                                                                                  HCPCS
MRI          7660   65426   MRI LUMBAR W/CONTRAST                      2,747.93                    1   72149   TC         72149    TC              612
MRI          7660   65427   MRI LUMBAR W/WO CONTRAST                   3,438.57                    1   72158   TC         72158    TC              612
MRI          7660    2241   MRI LWR EXT JT WO CONT                     2,247.00                    1   73721   TC         73721    TC              610
MRI          7660     336   MRI LWR EXT NOT JT WO/W CONT               3,438.57                    1   73720   TC         73720    TC              610
MRI          7660    3363   MRI MONITORING RM/CARE (B)                     0.00   S                                   Z7514                        610
MRI          7660    2365   MRI MONITORING ROOM/CARE                       0.00   S                                   Z7514                        610
MRI          7660     211   MRI ORBIT FACE NECK WO CONT                2,351.18                    1   70540   TC         70540    TC              610
MRI          7660   65415   MRI ORBIT, FACE, NECK W/CONTRAST           2,645.08                    1   70542   TC         70542    TC              610
MRI          7660   65416   MRI ORBIT, FACE, NECK W/WO CONTRA          3,379.89                    1   70543   TC         70543    TC              610
MRI          7660     260   MRI PELVIS W/CONT                          2,747.93                    1   72196   TC         72196    TC              610
MRI          7660   65435   MRI PELVIS W/O CONTRAST                    2,496.85                    1   72195   TC         72195    TC              610
MRI          7660   65408   MRI PELVIS W/WO CONTRAST                   3,438.57                    1   72197   TC         72197    TC              610
MRI          7660   65339   MRI PELVIS W/WO CONTRAST                   3,438.57                    1   72197   TC         72197    TC              610
MRI          7660    3371   MRI PULSE OXIMETRY EACH (B)                    0.00   S                    94760              94760                    460
MRI          7660    2373   MRI PULSE OXIMETRY EACH (N)                    0.00   S                    94760              94760                    460
MRI          7660    2225   MRI SPINE-COMPLETE(INFANT)                 2,747.93                    1   76499   TC         76499    TC              610
MRI          7660     419   MRI THORACIC SPINE WO CONT                 2,496.85                    1   72146   TC         72146    TC              612
MRI          7660   65424   MRI THORACIC W/ CONTRAST                   2,747.93                    1   72147   TC         72147    TC              612
MRI          7660   65425   MRI THORACIC W/WO CONTRAST                 3,438.57                    1   72157   TC         72157    TC              612
MRI          7660   65412   MRI TMJ JOINTS                             2,496.85                    1   70336          NC                           610
MRI          7660    2233   MRI UP EXT JT WO CONT                      2,247.00                    1   73221   TC         73221    TC              610
MRI          7660     328   MRI UP EXT NOT JT WO/W CONT                3,438.57                    1   73220   TC         73220    TC              610
MRI          7660   65411   MRI UPPER EXT ANY JT W/CONTRAST            2,571.64                    1   73222   TC         73222    TC              610
MRI          7660   65421   MRI UPPER EXT ANY JT W/WO CONTRAS          3,438.57                    1   73223   TC         73223    TC              610
MRI          7660   65410   MRI UPPER EXT W/CONTRAST                   2,571.64                    1   73219   TC         73219    TC              610
MRI          7660   65409   MRI UPPER EXT W/O CONTRAST                 2,247.00                    1   73218   TC         73218    TC              610
MRI          7660     195   MRI VENTS WO CONT                          1,462.78                    1   70551   TC         70551    TC              611
MRI          7660     567   RD WRITTEN CONS OUTSIDE MRI                    0.00   S                    76140                                       610
MRI          7660     559   RD WRITTEN CONSLT OUTSD MRI                    0.00   S                    76140                                       610
NEO          7392   61010   USE OF ROOM - NO CHARGE                        0.00   S                    99211           Z7500                       515
NEO          7392   60600   USE OF ROOM CHARGE                            50.00                    1   99211           Z7500                       515
NEU          7611   65040   INJ, IM/SUBQ                                  29.00                    1   90772               90772                   515
NEU          7611   65041   INJ. IV                                      119.00                    1   90774               90774                   515
NEU          7611   65028   INTRO INTRACATH VEIN, BILAT                    0.00   S                    36000        50     36000        50         515
NEU          7611   65027   INTRO INTRACATH VEIN, UNI                      0.00   S                    36000               36000                   515



                                                          Page 133 of 676
                                                              CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                  Description                   Price          Stats/bill       CPT   Mod               Mod    Rev Code
 Code                                                                                                                 HCPCS
NEU          7611   65124   SEDATION, IV/IM/INH                           549.00                    1  99143 TC          99143 TC            370
NEU          7611   65123   SEDATION, PO/PR                               680.00                    1  99143 TC          99143 TC            370
NEU          7611   65130   SELF CARE TRAIN, EA 15 MIN                      0.00   S                   97535             97535               515
NEU          7611   65021   URINARY CATH SIMPLE                             0.00   S                   53670             53670               515
NEU          7611   61010   USE OF ROOM - NO CHARGE                         0.00   S                   99211         Z7500                   515
NEU          7611   60600   USE OF ROOM CHARGE                             50.00                    1 99211          Z7500                   515
NIC          6070   14256   3 W NICU 12 HRS OF CARE                     4,654.00                    1 RM012                                  174
NIC          6070   14207   3W NICU 24 HRS OF CARE                      5,498.00                    1 RM024                                  174
NIC          6070   14306   3W NICU 8 HRS OF CARE                       2,973.00                    1                                        173
NIC          6070   14108   3W NICU ECMO 48 HRS OF CARE                 6,638.00                    1 RM048                                  179
NIC          6070   14700   3W NICU ECMO PERFUSION SET UP               1,322.00                    1 99070          Z7610                   220
NIC          6070   14809   3W NICU ECMO STAND BY                         576.00                    1 A4649          Z7610                   270
NIC          6070   14504   3W NICU H/C 8 HOURS OF CARE                 2,973.00                    1                                        173
NIC          6070   14601   3W NICU ISOLATION ADDL.                       288.00                    1 Z7514          Z7514                   164
NIC          6070   12936   EXTRACORPOREAL CIRC 1ST DAY                 4,597.00                    1 33960          Z0312                   940
NIC          6070   12951   EXTRACORPOREAL CIRC EA AD DAY               4,597.00                    1 33961          Z0312                   940
NPH          7745   65014   ALLD HLTH PHN CNSLT 1/4 HR                      0.00   S                  Z5406          Z5406                   519
NPH          7745   65013   ALLD HLTH TEAM CONF 1/4 HR                     12.05                    1 Z4302          Z4302                   519
NPH          7745   65125   BLOOD COLLECTION, ACCESS DEVICE                 0.00   S                   36540             36540               515
NPH          7745   65001   CENTER COORDINATOR                            103.28                    1 Z4300          Z4300                   519
NPH          7745   65132   CENTRAL LINE CATH REPAIR                        0.00   S                   93799             93799               515
NPH          7745   65033   CHANGE OF GASTROSTOMY TUBE                      0.00   S                   43760             43760               515
NPH          7745   65002   COMP CHART REV & RPT                           77.46                    1 Z4304          Z4304                   519
NPH          7745   65010   DIETITIAN EVAL 1/2 HR                          24.10                    1 Z4308          Z4308                   519
NPH          7745   65012   DIETITIAN PHN CNSLT 1/4HR                       0.00   S                  Z5406          Z5406                   519
NPH          7745   65011   DIETITIAN TEAM CONF 1/4 HR                     12.05                    1 Z4312          Z4312                   519
NPH          7745   65015   GROUP TEACHING/SUPPORT                         19.18                    1 Z4314          Z4314                   519
NPH          7745   65126   IM INJ ANTIBIOTIC                              29.00                    1 90772              90772               515
NPH          7745   65040   INJ-IM/SUBQ                                    29.00                    1 90772              90772               515
NPH          7745   65041   INJECTION IV PUSH                             119.00                    1 90774              90774               515
NPH          7745   65028   INTRO INTRACATH VEIN, BILAT                     0.00   S                   36000    50       36000    50         515
NPH          7745   65027   INTRO INTRACATH VEIN, UNI                       0.00   S                   36000             36000               515
NPH          7745   65184   IV FLUID/MEDS INFUSION INIT HR                271.00                    1 90765              90765               260
NPH          7745   65185   IV FLUIDS/MEDS INFUSION ADDL HR               140.00                    1 90766              90766               260
NPH          7745   65485   NPH-USE OF ROOM                                 0.00   S                                                         515



                                                          Page 134 of 676
                                                              CM 06/15/07


 Dept                                                                                                                    M/cal
        Cost Ctr.   SIM#                  Description                     Price          Stats/bill      CPT     Mod              Mod   Rev Code
 Code                                                                                                                   HCPCS
NPH          7745   65004   NURSE EVALUATION 1/2 HR                          24.10                    1 Z4301          Z4301                  519
NPH          7745   65006   NURSE PHONE CNSLT 1/4 HR                          0.00   S                  Z5406          Z5406                  519
NPH          7745   65005   NURSE TEAM CONF 1/4 HR                           12.05                    1 Z4310          Z4310                  519
NPH          7745   65003   PERIODIC CHART REV & RPT                         43.03                    1 Z4303          Z4303                  519
NPH          7745   65130   SELF CARE TRAIN, EA 15 MIN                        0.00   S                   97535             97535              515
NPH          7745   65131   SKIN TEST, PPD INTRADERMAL                       64.00                    1 86580 TC           86580 TC           302
NPH          7745   65007   SOC WORK EVAL 1/2 HR                             24.10                    1 Z4307          Z4307                  561
NPH          7745   65009   SOC WORK PHONE CNSLT 1/4 HR                       0.00   S                  Z5406          Z5406                  561
NPH          7745   65008   SOC WORK TEAM CONF 1/4 HR                        12.05                    1 Z4311          Z4311                  561
NPH          7745   65016   SW CASE COORD CONSULT 1/4HR                       0.00   S                                                        515
NPH          7745   16198   TX NURS EVAL INIT 1/2 HR                         24.00                    1 Z5402          Z5402                  515
NPH          7745   65021   URINARY CATH SIMPLE                               0.00   S                   53670             53670              515
NPH          7745   61010   USE OF ROOM - NO CHARGE                           0.00   S                   99211         Z7500                  515
NPH          7745   60600   USE OF ROOM CHARGE                               50.00                    1 99211          Z7500                  515
NSR          7424   61010   USE OF ROOM - NO CHARGE                           0.00   S                   99211         Z7500                  515
NSR          7424   60600   USE OF ROOM CHARGE                               50.00                    1 99211          Z7500                  515
NUC          7650   66740   NM PULM VENT/PERF STDY (PANEL)                    0.00   S                                                        341
NUC          7650   66172   1-131 CAP DIANOSTIC P/MCI                       132.00                    1 A9528          A9528                  341
NUC          7650   66171   1-131 CAP THERAPY P/MCI                          32.00                    1 A9517          A9517                  342
NUC          7650    5073   ACUTE GI BLEEDING                             1,984.96                    1 78278 TC           78278   TC         341
NUC          7650   20049   ANESTH/SED 15 MIN                                 0.00   S                  A4649          Z7610                  371
NUC          7650    5354   ANGIO RBC/VASC LESIONS                        2,482.56                    1 78445 TC           78445   TC         341
NUC          7650    1072   BONE IMAGING MULTIPLE                         1,653.92                    1 78305 TC           78305   TC         341
NUC          7650    1080   BONE IMAGING WHOLE BODY                       2,482.56                    1 78306 TC           78306   TC         341
NUC          7650    1130   BONE MARROW WHOLE BODY-BR                     1,785.28                    1 78104 TC           78104   TC         341
NUC          7650    1122   BONE SCAN-SPECT-BR 9129T                      3,307.84                    1 78320 TC           78320   TC         341
NUC          7650    1106   BONE SCAN-VASCUL FLOW ONLY                    1,573.28                    1 78445 TC           78445   TC         341
NUC          7650    1098   BONE/JT LIMITED AREA                          1,322.72                    1 78300 TC           78300   TC         341
NUC          7650    1346   BRAIN IMG PERFUSION EVAL                      7,859.52                    1 78609 TC           78609   TC         404
NUC          7650    1254   NM BRAIN SCAN CREBRAL VAS FLOW                1,322.72                    1 78615 TC           78615   TC         341
NUC          7650    1395   BRAIN SCAN SPECT                              2,482.56                    1 78607          NC                     341
NUC          7650    1387   BRAIN VASC STUDY (RBC)                        1,804.64                    1 78610 TC           78610   TC         341
NUC          7650    5107   C-14 BREATH UREA                                828.64                    1 78267 TC           78267   TC         300
NUC          7650    5081   C-14 BREATH UREA KIT                            259.50                    1 A4641 TC       A4641       TC         255
NUC          7650    5388   CARDIAC FIRST PASS/EF SNGL                    1,984.96                    1 78481 TC           78481   TC         341



                                                             Page 135 of 676
                                                                 CM 06/15/07


 Dept                                                                                                                        M/cal
        Cost Ctr.   SIM#                    Description                      Price          Stats/bill      CPT      Mod              Mod   Rev Code
 Code                                                                                                                       HCPCS
NUC          7650    5180   CARDIAC SHUNT DETECT                             1,871.20                    1 78428    TC         78428 TC           341
NUC          7650    1585   CATH TRAY                                            0.00                    1 A4550           Z7610                  272
NUC          7650    1858   CATHETERIZATION STERILE                              0.00   S                   53670                                 340
NUC          7650    2419   COMPLEX MANIPULATION<30 MIN.                       497.60                    1 78890           NC                     341
NUC          7650    2427   COMPLEX MANIPULATION>30MIN                         828.64                    1 78891           NC                     341
NUC          7650    1312   IN-111 DTPA DIAGNOSTIC PER 0.5MCI                1,023.80                    1 A9548           A9548                  341
NUC          7650    1379   CSF LEAKAGE                                      2,247.84                    1 78650    TC         78650   TC         341
NUC          7650    1411   CSF LEAKAGE-SPECT BR                             1,110.72                    1 78647           NC                     341
NUC          7650    1353   CSF SHUNT EVALUATION                             1,604.80                    1 78645    TC         78645   TC         341
NUC          7650   10156   DICOPAC                                            930.80                    1 99070           Z7610                  255
NUC          7650    1486   DIFFERENTIAL RENAL SCAN                          1,785.28                    1 78707    TC         78707   TC         341
NUC          7650    5032   ESOPH MOTILITY STUDY                               660.48                    1 78258    TC         78258   TC         341
NUC          7650    5115   FLURODEGXYG PDOSE 4-40 MCI/ML                      903.40                    1 A9552           A9552                  255
NUC          7650    2054   GALLIUM GA-67 CITRATE, DX PR MCI                   207.00                    1 A9556           A9556                  255
NUC          7650   20254   GALLIUM GA-67 CITRATE, DX PR MCI                   130.00                    1 A9556           A9556                  255
NUC          7650    5065   GASTRIC EMPTYING STUDY                             993.44                    1 78264    TC         78264   TC         341
NUC          7650    5057   GASTRO-ESOPH REFLEX STUDY                        1,653.92                    1 78262    TC         78262   TC         341
NUC          7650    5040   GI MECKEL (BLOOD LOSS)                           1,322.72                    1 78290    TC         78290   TC         341
NUC          7650    1049   HEPATOBIL SERIAL IMAGES                            656.96                    1 78220    TC         78220   TC         341
NUC          7650    1056   HEPATOBILIARY GALLBLADDER                        2,233.76                    1 78223    TC         78223   TC         341
NUC          7650    2062   I-123 SOD LOD CAP DIAG PER 100UCI                   66.80                    1 A9516           A9516                  255
NUC          7650    5537   INDIUM 111 OCTREOSCAN                            1,527.50                    1 A9565           A9565                  255
NUC          7650    2112   IN-111 OXYQUINOLINE PER 0.5 MCI                    848.60                    1 A9547           A9547                  255
NUC          7650    5560   INFECTION LIMITED AREA                             660.48                    1 78805    TC         78805   TC         341
NUC          7650    5578   INFLAM GALLIUM-WHOLE BODY                        2,482.56                    1 78806    TC         78806   TC         341
NUC          7650     207   INJ PROC CSF FL/CSF LEAK STUDY                       0.00   S                   62284                                 340
NUC          7650     157   INJ PROC CSF SHUNT EVAL                              0.00   S                   61070                                 340
NUC          7650    1338   INJ PROC FOR CSF FLOW                                0.00   S                   62288                                 340
NUC          7650    1544   INJECTION CYSTOGRAPHY                                0.00   S                   51600                                 340
NUC          7650   30022   INPATIENT VISIT/ (H/P)                               0.00   S                   99231                                 340
NUC          7650    5206   INTRA-ART RADIOPHARM THERAPY                     1,653.92                    1 79440    TC          79440 TC          342
NUC          7650    5214   INTRA-ART RADIOPHARMACEUTICAL                    4,959.84                    1 79440    TC          79440 TC          255
NUC          7650    5800   IV START                                             0.00   S                   36000                                 371
NUC          7650    1452   KIDNEY GFR STUDY                                 1,110.72                    1 78725    TC          78725 TC          341
NUC          7650    1510   KIDNEY IMAGING-SPECT BR                          2,247.84                    1 78710           NC                     341



                                                                Page 136 of 676
                                                          CM 06/15/07


 Dept                                                                                                                 M/cal
        Cost Ctr.   SIM#                 Description                  Price        Stats/bill        CPT      Mod                Mod   Rev Code
 Code                                                                                                                HCPCS
NUC          7650    1494   KIDNEY VASCULAR FLOW-BR 9108T             1,322.72                  1    78701   TC         78701   TC           341
NUC          7650    5016   LIVER SPLEEN IMAGING SPECT-BR             2,447.52                  1    78205   TC         78205   TC           341
NUC          7650    4993   LIVER SPLEEN W/FLOW, STATIC               2,281.12                  1    78216   TC         78216   TC           341
NUC          7650    5602   LOCALIZA TUMOR LTD AREA                   1,322.72                  1    78800   TC         78800   TC           341
NUC          7650    5453   LUNG V/Q PULM PERF W/VENT                 2,974.88                  1    78588   TC         78585   TC           341
NUC          7650     884   LYMPH ANGIOGRAM                           2,645.60                  1    78195   TC         78195   TC           341
NUC          7650    5594   MIBG SCAN-WHOLE BODY                      3,143.04                  1    78802   TC         78802   TC           341
NUC          7650    5164   NM MUGA REST OR STRESS - MNMUGA           2,233.76                  1    78472   TC         78472   TC           341
NUC          7650    5438   NM MUGA REST & STRESS                     2,864.48                  1    78473   TC         78473   TC           341
NUC          7650    5420   MYOCARD INFARCT-SPECT                     2,864.48                  1    78469          NC                       341
NUC          7650    5412   MYOCARIDAL IMAGE-INFARCT                  2,498.40                  1    78466   TC         78466   TC           341
NUC          7650    5792   N/R IV START (NURSE)                          0.00 S                     36000              36000   YS           760
NUC          7650    1916   I-123 MIGB                                4,760.00                  1   A4641    TC     A4641       TC           255
NUC          7650   66752   NM ANGIO RBC VASCULAR SPECT               3,307.84                  1    78803   TC         78803   TC           341
NUC          7650   66738   NM BONE MARROW MULTI AREAS                1,576.80                  1    78103   TC         78103   TC           341
NUC          7650   66733   NM BONE THREE PHASE STUDY                 1,051.20                  1    78315   TC         78315   TC           341
NUC          7650   66736   NM BRAIN IMG W VAS FLOW                   1,051.20                  1    78606   TC         78606   TC           341
NUC          7650   65375   NM CARDIAC PERF REST OR STRESS            1,532.96                  1    78464   TC         78464   TC           341
NUC          7650   66741   NM DACRYOCYSTOGRAPHY                        525.60                  1    78660   TC         78660   TC           341
NUC          7650   66755   NM GASTRIC EMPTYING REFLUX STD PN             0.00                  1                                            341
NUC          7650   66731   NM LIVER IMG STATIC ONLY                    613.28                  1    78201   TC         78201   TC           341
NUC          7650   66732   NM LIVER/SPLEEN IMG STATIC ONLY             718.40                  1    78215   TC         78215   TC           341
NUC          7650   66735   NM MYOCARD PERF RST STRES MULT            1,270.24                  1    78461   TC         78461   TC           341
NUC          7650   66734   NM MYOCARD PERF RST/STRES SNGL              788.48                  1    78460   TC         78460   TC           341
NUC          7650   66795   NM PARATHYROID IMAGING                      480.00                  1    78070   TC         78070   TC           341
NUC          7650   66739   NM THYR UPTAKE & SCAN W/24HR                  0.00                  1                                            341
NUC          7650   66754   NM TMR IMA FLORODEGXYG W/SPECT            2,812.00                  1    78803   TC         78803   TC           341
NUC          7650   66753   NM TMR IMG FLURODEGXYG WHOLE BODY         3,143.04                  1    78802   TC         78802   TC           341
NUC          7650   66737   NM WBC S/SPECT                            1,576.80                  1    78807   TC         78807   TC           341
NUC          7650    5941   NUCLEAR DACRYOCYSTO                         993.44                  1    78660   TC         78660   TC           341
NUC          7650   66730   NW BONE MARROW MULTI WB (PANEL)               0.00 S                                                             341
NUC          7650    5487   OCTEREOSCAN                               3,153.60 S                   78802 TC             78802 TC             340
NUC          7650    1890   PERCHLORATE/CAP                              42.70                  1 A4649             Z7610                    255
NUC          7650    1403   PERFUSION BRAIN SCAN SPECT                2,531.68                  1 78607             NC                       341
NUC          7650    5446   NM PULMONARY VENT AEROSOL                 1,573.28                  1 78580 TC              78580 TC             341



                                                         Page 137 of 676
                                                            CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                  Description                  Price          Stats/bill        CPT      Mod                Mod   Rev Code
 Code                                                                                                                   HCPCS
NUC          7650    5461   NM PULMONARY PERF W/AEROSOL                1,489.28                    1    78587   TC        78587    TC           341
NUC          7650    5875   PULSE OXIMETRY EACH                            0.00   S                     94760             94760                 460
NUC          7650    2393   PORTABLE NUCLEAR CAMERA                        0.00   S                     78999   TC        78999    TC           341
NUC          7650     751   R-PHARM HYPERTHYR INIT                     1,653.92                    1    79005   TC        79005    TC           342
NUC          7650    1536   RADIONUCLIDE VOID CYSTOGRAM                  993.44                    1    78740   TC        78740    TC           341
NUC          7650    1809   RADIOPHARM/SUPPLIES                            0.00   S                                                             340
NUC          7650    1882   RBC LABEL KIT                                424.90                    1    99070          Z7610                    621
NUC          7650    2179   RD WRIT CNSLT OTSIDE EXAM *BR*                 0.00   S                     76140                                   340
NUC          7650     850   RED CELL SPLEEN HEAT DEN.                  1,653.92                    1    78140   TC         78140   TC           341
NUC          7650    1429   RENAL DMSA W/ VASC FLOW                    1,904.48                    1    78701   TC         78701   TC           341
NUC          7650    1502   NM KIDNEY FUNC W/WO DIURETIC               2,216.32                    1    78708   TC         78708   TC           341
NUC          7650    1445   RENAL SCAN-GLUCO/DTPA W/ VASC FLO          2,216.32                    1    78701   TC         78701   TC           341
NUC          7650   10057   SCHILLING TEST W/O                         2,482.56                    1    78270   TC         78270   TC           341
NUC          7650   10107   SCHILLING W/ & W/O INTRINSIC               2,482.56                    1    78272   TC         78272   TC           341
NUC          7650    4977   NW SPLEEN IMG W/WO VAS FLOW                1,951.68                    1    78185   TC         78185   TC           341
NUC          7650    1866   TECH TC 99M SESTI 20MCI P/DOSE               273.80                    1   A9500    TC     A9500       TC           255
NUC          7650    1874   TC-99M-HMPAO (CERETEC) - BR                1,092.80                    1   A9512           A9512                    255
NUC          7650   66744   TECH TC 99M CHOLETEC P/STDY 15MCI            117.20                    1   A9537           A9537                    341
NUC          7650   66742   TECH TC 99M DSMA PER STUDY 10MCI             237.60                    1   A9551           A9551                    341
NUC          7650   66745   TECH TC 99M DTPAP/STDY 25MCI                  56.90                    1   A9539           A9539                    340
NUC          7650   66748   TECH TC 99M GH P/STUDY 25MCI                 132.50                    1   A9550           A9550                    341
NUC          7650   66746   TECH TC 99M MAA P/STDY 10MCI                  58.00                    1   A9540           A9540                    341
NUC          7650   66750   TECH TC 99M MAG 3 P/STDY 15MCI               255.10                    1   A9562           A9562                    341
NUC          7650   66749   TECH TC 99M NEUROLITE P/S 25MCI              941.70                    1   A9557           A9557                    341
NUC          7650   66743   TECH TC 99M PERTECHNATAT P/M CI                1.10                    1   A9512           A9512                    341
NUC          7650   66751   TECH TC 99M RBC P/STDY 30MCI                 124.80                    1   A9560           A9560                    341
NUC          7650   67784   TECH TC-99 SULFUR COLLOID 20MCI               58.00                    1   A9541           A9541                    341
NUC          7650    2021   TECHNETIUM-99M 10MCI                         434.70                    1   A4641    TC     A4641       TC           255
NUC          7650    2039   TECH 99M 15MCI 23 P/M CI                      15.30                    1   A4641    TC     A4641       TC           255
NUC          7650    2047   TECH 99M MDP 20MCI UP TO 30 MCI               36.10                    1   A9503           A9503                    255
NUC          7650    2013   TECH 99M 5MCI 23PER MCI                        5.50                    1   A4641    TC     A4641       TC           255
NUC          7650    2104   THALLIUM 201 PER MCI PER UNIT                 52.60                    1   A9505           A9505                    255
NUC          7650    5404   THALLIUM SPECT MULTI STUDY                 2,796.16                    1    78465   TC         78465   TC           341
NUC          7650    5396   THALLIUM SPECT SINGLE STUDY                2,645.60                    1    78464   TC         78464   TC           341
NUC          7650     686   THYROID DISCHARGE                            793.60                    1    78003   TC         78003   TC           341



                                                          Page 138 of 676
                                                                CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                   Description                    Price          Stats/bill      CPT    Mod                Mod   Rev Code
 Code                                                                                                                  HCPCS
NUC          7650     744   THYROID IMAGE MULT UPTAKE                     1,573.28                    1 78007 TC          78007   TC           341
NUC          7650     678   THYROID IMAGE ONLY                              828.64                    1 78010 TC          78010   TC           341
NUC          7650     736   THYROID IMAGING SINGLE UPTAKE                 1,322.72                    1 78006 TC          78006   TC           341
NUC          7650    5552   TUMOR LOCAL W/SPECT                           2,812.00                    1 78803         NC                       341
NUC          7650    5503   TUMOR MULTIPLE                                1,322.72                    1 78801 TC          78801   TC           341
NUC          7650    5511   TUMOR WB IMAGING                              3,143.04                    1 78802 TC          78802   TC           341
NUC          7650     835   WBC LTD                                       1,653.92                    1 78805 TC          78805   TC           341
NUC          7650     843   WBC WHOLE BODY                                2,482.56                    1 78806 TC          78806   TC           341
NUC          7650    1908   WHITE BLOOD CELL LABEL 9158T                    826.70                    1 A4641 TC      A4641       TC           255
NUC          7650     660   WHOLE BODY THYROID                            2,465.12                    1 78018 TC          78018   TC           341
NUT          7870   65001   CENTER COORDINATOR                              103.28                    1 Z4300         Z4300                    519
NUT          7870   65012   DIETITIAN PHN CNSLT 1/4HR                         0.00   S                  Z5406         Z5406                    519
NUT          7870   65011   DIETITIAN TEAM CONF 1/4 HR                       12.05                    1 Z4312         Z4312                    519
NUT          7870    2022   DT NUTR EVALUATION INIT30 MIN-I/P                 0.00   S                                                         942
NUT          7870    2154   DT NUTR FOLLOW UP 15 MIN- I/P                     0.00   S                                                         942
NUT          7870    2162   DT NUTR FOLLOW UP ADDL 15 MIN                     0.00   S                                                         510
NUT          7870    2030   DT NUTR SCREEN ADDL 15 MIN                        0.00   S                                                         510
NUT          7870   65015   GROUP TEACHING/SUPPORT                           19.18                    1 Z4314         Z4314                    519
NUT          7870    2071   NUTR ANALYSIS 15 MIN- I/P                         0.00   S                                                         942
NUT          7870    2089   NUTR ANALYSIS ADDL 15 MIN                         0.00   S                                                         510
NUT          7870    2097   NUTR COUNSELING 15 MIN- I/P                       0.00   S                                                         942
NUT          7870    2105   NUTR COUNSELING ADDL 15 MIN                       0.00   S                                                         510
NUT          7870   65010   RD ASSES, EVAL, INTER-CCS                       112.00                    1 Z4308         Z4308                    519
NUT          7870   65320   RD INITIAL ASSES 30MIN-M/CAL                    176.00                    1 Z6200         Z6200                    942
NUT          7870   65147   RD MNT INITIAL ASSESSMENT (1/4 HR                56.00                    1 97802         NC                       942
NUT          7870   65148   RD MNT/M-CAL REASSESSMENT (1/4 HR                56.00                    1 97803         NC                       942
NUT          7870    2048   RD NUTR ASSESS INIT 30 MIN- 1/P                   0.00   S                                                         942
NUT          7870    2139   RD NUTR FOLLOW UP 15 MIN- I/P                     0.00   S                                                         942
NUT          7870    2147   RD NUTR FOLLOW UP ADDL 15 MIN                     0.00   S                                                         510
NUT          7870     661   SPECIAL FORMULA                                  16.00                    1 A4649         Z7610                    271
NUT          7870     422   TOLEREX PKG                                      35.00                    1 A4649         Z7610                    271
NUT          7870     448   VIVONEX PEDIATRIC PKG                            35.00                    1 A4649         Z7610                    271
OPT          7264   63676   CORNEAL TOPOGRAPHER, BOTH EYES                  106.00                    1 92499 TC          92499 TC             922
OPT          7264   63675   CORNEAL TOPOGRAPHER, LEFT EYE                   106.00                    1 92499 TC          92499 TC             922
OPT          7264   63674   CORNEAL TOPOGRAPHER, RIGHT EYE                  106.00                    1 92499 TC          92499 TC             922



                                                           Page 139 of 676
                                                            CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                  Description                  Price        Stats/bill        CPT      Mod                Mod   Rev Code
 Code                                                                                                                 HCPCS
OPT          7264   63671   ELECTRO-OCULOGRAPHY                          100.00                  1    92270   TC         92270   TC           922
OPT          7264   65092   EXTENDED VISUAL FIELDS                       195.00                  1    92083   TC         92083   TC           515
OPT          7264   65087   FLUORESCEIN ANGIOGRAPHY                      405.00                  1    92235   TC         92235   TC           515
OPT          7264   65086   FUNDUS PHOTOGRAPHY                           282.00                  1    92250   TC         92250   TC           515
OPT          7264   65446   LASIK PROCEDURE ONE EYE                    1,780.00                  1   S0800           NC                       361
OPT          7264   65117   LASIK PROCEDURE TWO EYES                   3,580.00                  1   S0800           NC                       361
OPT          7264   65660   LASIK SCREENING ROOM CHARGE                   20.00                  1    99211          Z7500                    515
OPT          7264   65140   LASIK SURGERY CUSTOM VIEW PER EYE            219.00                  1    66999              66999                361
OPT          7264   63673   OPHTHALMIC BIOMETRY (IOL)                    201.00                  1    92136   TC         92136   TC           922
OPT          7264   66123   OPTICAL COHERENCE TOMOGRAPHY                 149.00                  1    92135   TC         92135   TC           515
OPT          7264   65220   PHOTO KERATECTOMY (PRK) 1 EYE              1,780.00                  1   S0810           NC                       361
OPT          7264   65222   PHOTO KERATECTOMY (PRK) 2 EYES             3,580.00                  1   S0810           NC                       361
OPT          7264   65118   PHOTO KERATECTOMY (PTK) 1 EYE              1,780.00                  1   S0812           NC                       361
OPT          7264   65119   PHOTO KERATECTOMY (PTK) 2 EYES             3,580.00                  1   S0812           NC                       361
OPT          7264   66320   SEDATION <5YEARS OLD 1ST 30 MIN              621.00                  1    99143              99143                370
OPT          7264   66321   SEDATION >5YEARS OLD 1ST 30 MIN              621.00                  1    99144              99144                370
OPT          7264   66322   SEDATION EACH ADDL 15 MINUTES                310.00                  1    99145              99145                370
OPT          7264   63672   SENSORIMOTOR EXAM                            101.00                  1    92060   TC         92060   TC           922
OPT          7264   65131   SKIN TEST, PPD INTRADERMAL                    64.00                  1    86580   TC         86580   TC           302
OPT          7264   65085   SLIT LAMP PHOTOGRAPHY                        327.00                  1    92285          NC                       515
OPT          7264   66124   TENSILON TEST                                209.00                  1    95857              95857                922
OPT          7264   65088   ULTRASOUND, A SCAN                           324.00                  1    76511   TC         76511   TC           402
OPT          7264   65089   ULTRASOUND, B SCAN                           378.00                  1    76512   TC         76512   TC           402
OPT          7264   61010   USE OF ROOM - NO CHARGE                        0.00 S                     99211          Z7500                    515
OPT          7264   60600   USE OF ROOM CHARGE                            50.00                  1    99211          Z7500                    515
OPT          7264   63670   VISUAL EVOKED POTENTIAL                      103.00                  1    95930   TC         95930   TC           922
ORA          7420   62301   *X ACE SCREW                               1,019.00                  1   A4649           Z7610                    278
ORA          7420    6546   *X ADAPTERS, TITANIUM                      1,147.00                  1   A4649           Z7610                    278
ORA          7420   44505   *X AHMED GL. VALVE                         3,254.00                  1   L8699           L8699                    278
ORA          7420      77   *X ALLODERM 10 X 10                        3,820.00                  1   L8699           L8699                    278
ORA          7420      51   *X ALLODERM 3 X 7                          2,716.00                  1    99199          Z7610                    278
ORA          7420    3228   *X ALLOMATRIX INJECTABLE PUTTY 10          4,867.00                  1   L8699           L8699                    278
ORA          7420    4100   *X ANATOMICAL CHIN                           951.00                  1   A4649           Z7610                    278
ORA          7420   32005   *X ANNUTOPLASTY RING                       6,995.00                  1   L8699           L8699                    278
ORA          7420   65304   *X ANTERIOR SPINE IMPLANTS                12,601.00                  1   L8699           L8699                    278



                                                          Page 140 of 676
                                                            CM 06/15/07


 Dept                                                                                                              M/cal
        Cost Ctr.   SIM#                  Description                   Price     Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                             HCPCS
ORA          7420    8138   *X ARC CADAVER FRZN SKIN ALLOG               900.00                1   A4649         Z7610                 278
ORA          7420   62400   *X ASNIS SCREW                             1,358.00                1   A4649         Z7610                 278
ORA          7420   62509   *X BAILEY ROD                              3,962.00                1   L8699         L8699                 278
ORA          7420    3923   *X BALLOON CATHETER, INT-AORTIC            3,663.00                1   A4649         Z7610                 272
ORA          7420   41055   *X BARRVELT IMPLANT                        2,370.00                1   L8612         L8612                 278
ORA          7420   30068   *X BIO INTERFACE SCREW                       918.00                1   A4649         Z7610                 278
ORA          7420    4137   *X BONE CEMENT                               480.00                1   A4649         Z7610                 278
ORA          7420    4095   *X BONE GRAFT, RED CROSS                   2,376.00                1   A4649         Z7610                 278
ORA          7420   30991   *X BONE MATRIX, GRAFTON 10CC               4,827.00                1   L8699         L8699                 278
ORA          7420   30892   *X BONE MATRIX, GRAFTON 1CC                  804.00                1   A4649         Z7610                 278
ORA          7420   30900   *X BONE MATRIX, GRAFTON 5CC                3,117.00                1   A4649         Z7610                 278
ORA          7420   44042   *X BONESOURCE 10G                          5,128.00                1   L8699         L8699                 278
ORA          7420   44034   *X BONESOURCE 25G                          9,678.00                1   L8699         L8699                 278
ORA          7420   44059   *X BONESOURCE 5G                           3,253.00                1   A4649         Z7610                 278
ORA          7420   60701   *X CANNULATED SCREW                          787.00                1   A4649         Z7610                 278
ORA          7420    3329   *X CORNEA TRANSPLANT                       7,694.00                1   V2785         V2785                 810
ORA          7420    3224   *X CRS BONE CEMENT 10CC                    8,984.00                1   L8699         L8699                 278
ORA          7420    3216   *X CRS BONE CEMENT 5CC                     5,629.00                1   L8699         L8699                 278
ORA          7420    9102   *X CRYOLIFE AORTIC VALUE W/WO CON         21,477.00                1   L8699         L8699                 278
ORA          7420   32419   *X CUSTOM INT JAW DISTRACTOR               6,790.00                1   L8699         L8699                 278
ORA          7420   76700   *X DEFLUX BIOIMPLANT                       3,135.00                1   L8699         L8699                 278
ORA          7420    8112   *X DIAPHRAGM PACE ELEC/REC-BILAT         262,541.00                1   L8699         L8699                 278
ORA          7420    4110   *X DIAPHRAGM PACE ELEC/REC-UNILAT         71,973.00                1   L8699         L8699                 278
ORA          7420    8179   *X DIAPHRAGM PACER SYS-UNILAT            131,270.00                1   L8699         L8699                 278
ORA          7420   43507   *X EP ELECTRODES W/BURR HOLES              7,998.00                1   L8699         L8699                 278
ORA          7420   61808   *X EXTERNAL FIXATORS                       6,677.00                1   L8699         L8699                 278
ORA          7420   63309   *X FEMORAL IMPLANT 1                      49,792.00                1   L8699         L8699                 278
ORA          7420   64208   *X FEMORAL IMPLANT 10                     90,531.00                1   L8699         L8699                 278
ORA          7420   63408   *X FEMORAL IMPLANT 2                      54,318.00                1   L8699         L8699                 278
ORA          7420   63507   *X FEMORAL IMPLANT 3                      58,846.00                1   L8699         L8699                 278
ORA          7420   63606   *X FEMORAL IMPLANT 4                      63,372.00                1   L8699         L8699                 278
ORA          7420   63705   *X FEMORAL IMPLANT 5                      67,898.00                1   L8699         L8699                 278
ORA          7420   63804   *X FEMORAL IMPLANT 6                      72,425.00                1   L8699         L8699                 278
ORA          7420   63903   *X FEMORAL IMPLANT 7                      76,951.00                1   L8699         L8699                 278
ORA          7420   64000   *X FEMORAL IMPLANT 8                      81,479.00                1   L8699         L8699                 278



                                                           Page 141 of 676
                                                             CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                   Description                   Price     Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                              HCPCS
ORA          7420   64109   *X FEMORAL IMPLANT 9                       86,005.00                1   L8699         L8699                 278
ORA          7420   40255   *X FLEX BLOCK                               2,784.00                1   A4649         Z7610                 278
ORA          7420   63002   *X FREEZE DRIED BONE GRAFT                  2,017.00                1   A4649         Z7610                 278
ORA          7420   62905   *X FRESH BONE GRAFT                        14,484.00                1   L8699         L8699                 278
ORA          7420   40909   *X GRAFT, ABD SOFT TISS 1MM                 4,074.00                1   L8699         L8699                 278
ORA          7420   40958   *X GRAFT, ABD SOFT TISS 2MM                 5,885.00                1   L8699         L8699                 278
ORA          7420    5167   *X GRAFT, DEBAKEY WOVEN STR                   836.00                1   A4649         Z7610                 278
ORA          7420   40800   *X GRAFT, GORTEX 4 X 7                      3,137.00                1   A4649         Z7610                 278
ORA          7420   40859   *X GRAFT, GORTEX 6 X 7                      3,634.00                1   A4649         Z7610                 278
ORA          7420    7403   *X GRAFT, TEFLON                            1,651.00                1   A4649         Z7610                 278
ORA          7420   30041   *X HEARTMATE                               24,715.00                1   L8699         L8699                 278
ORA          7420   30009   *X HEARTMATE IMPLANT                      203,695.00                1   L8699         L8699                 278
ORA          7420    3899   *X HYDROXY APPETITE SPHERE                  3,679.00                1   A4649         Z7610                 278
ORA          7420   32104   *X HYDROXY APPETITE/INTA PORE               3,679.00                1   A4649         Z7610                 278
ORA          7420   61907   *X IM NAIL/RODS                             3,084.00                1   A4649         Z7610                 278
ORA          7420   60602   *X IMPLANT SCREW                              144.00                1   A4649         Z7610                 278
ORA          7420    6884   *X MALAR IMPLANTS                           1,933.00                1   A4649         Z7610                 278
ORA          7420    8120   *X MAMMARY IMPLANT                          1,811.00                1   A4649         Z7610                 278
ORA          7420   44091   *X MED PACER LEAD 4951                      4,526.00                1   L8699         L8699                 278
ORA          7420   44109   *X MED PACER LEAD 4965                      4,980.00                1   L8699         L8699                 278
ORA          7420    3265   *X MEDIPORE OCULAR IMPLANT                  2,831.00                1   L8610         L8610                 278
ORA          7420   30918   *X MEDPOR BLOC 3 IN                         1,936.00                1   A4649         Z7610                 278
ORA          7420   30926   *X MEDPOR BLOC 6 IN                         2,309.00                1   A4649         Z7610                 278
ORA          7420   30967   *X MEDPORE BASE (EAR)                       2,887.00                1   A4649         Z7610                 278
ORA          7420   30975   *X MEDPORE RIM (EAR)                        1,324.00                1   A4649         Z7610                 278
ORA          7420   30983   *X MEDPORE SHEET                            1,393.00                1   A4649         Z7610                 278
ORA          7420   61501   *X MINI PLATES                                333.00                1   A4649         Z7610                 278
ORA          7420   76750   *X MISC. IMPLANTS                               0.00                1   L8699         L8699                 278
ORA          7420   62806   *X MITEK ANCHOR                             1,358.00                1   A4649         Z7610                 278
ORA          7420    6900   *X NEURO WIRE MESH                            668.00                1   A4649         Z7610                 278
ORA          7420   43457   *X PATCH, BAXTER PERICARDIAL                1,529.00                1   A4649         Z7610                 278
ORA          7420   30280   *X PATCH, CARDIOVASCULAR                    1,393.00                1   A4649         Z7610                 278
ORA          7420   30355   *X PATCH, POLYESTER                           538.00                1   A4649         Z7610                 278
ORA          7420   32054   *X PATCH, PULMONARY                        10,864.00                1   L8699         L8699                 278
ORA          7420   30358   *X PATCH, SCLERAL                             737.00                1   A4649         Z7610                 278



                                                            Page 142 of 676
                                                                CM 06/15/07


 Dept                                                                                                                 M/cal
        Cost Ctr.   SIM#                   Description                    Price      Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                HCPCS
ORA          7420   30348   *X PATCH, VASCULAR THIN WALL                  3,920.00                1   L8699         L8699                 278
ORA          7420   20679   *X PINS, RUSH                                   420.00                1   A4649         Z7610                 278
ORA          7420   20687   *X PINS, STEINMAN (ALL)                          97.00                1   A4649         Z7610                 278
ORA          7420    8104   *X PLATES, LEIBINGER                          1,024.00                1   A4649         Z7610                 278
ORA          7420    9318   *X PORT-A-CATH                                2,008.00                1   A4300         Z7610                 272
ORA          7420    3253   *X PROS, DYNOROD EYELID                         492.00                1   A4649         Z7610                 278
ORA          7420   62707   *X QUIFEX PIN                                 4,526.00                1   L8699         L8699                 278
ORA          7420   61709   *X REGULAR PLATES                             1,040.00                1   A4649         Z7610                 278
ORA          7420   65353   *X RUSH RODS                                    254.00                1   A4649         Z7610                 278
ORA          7420    8096   *X SCREW, LEIBINGER                             272.00                1   A4649         Z7610                 278
ORA          7420   61600   *X SMALL PLATES                                 752.00                1   A4649         Z7610                 278
ORA          7420   40206   *X SPECTRUM MAMMARY                           5,376.00                1   L8699         L8699                 278
ORA          7420   44018   *X STENT P204M (CORDIS)                       4,640.00                1   L8699         L8699                 278
ORA          7420   41154   *X STENTS, BILIARY                              475.00                1   A4649         Z7610                 278
ORA          7420    9201   *X TISSUE EXPANDER                            3,113.00                1   A4649         Z7610                 278
ORA          7420   64406   *X TOTAL HIP IMPLANT CUSTOM                  31,685.00                1   L8699         L8699                 278
ORA          7420   64307   *X TOTAL HIP IMPLANT STANDARD                29,033.00                1   L8699         L8699                 278
ORA          7420   64505   *X TOTAL KNEE IMPLANT                        18,106.00                1   L8699         L8699                 278
ORA          7420   11462   *X VALVE, AORTIC MITRAL                      16,863.00                1   L8699         L8699                 278
ORA          7420    8591   *X VALVE, NEURO                               3,408.00                1   L8699         L8699                 278
ORA          7420   11470   *X VALVE, RED CROSS HUMAN                    31,459.00                1   L8699         L8699                 278
ORA          7420   31502   *X VALVE, ST JUDE AORTIC                     20,189.00                1   L8699         L8699                 278
ORA          7420    8161   *X VENTRICULAR ASSIST DEVICE                203,695.00                1   L8699         L8699                 278
ORA          7420   61303   *X WASHER                                     1,358.00                1   A4649         Z7610                 278
ORA          7420   62608   *X WILLIAM ROD                                2,716.00                1   A4649         Z7610                 278
ORA          7420   72550   10 HOLE PLATE - SYNTHES                         535.00                1   A4649         Z7610                 278
ORA          7420   30025   1000CC NORMAL SALINE BAG IRRIG                   96.00                1   J3490         X7704                 272
ORA          7420   76325   10MM C-REAMER                                   345.00                1   A4649         Z7610                 270
ORA          7420   73575   20G MVR BLADE                                     0.00                1   A4649         Z7610                 270
ORA          7420   73325   23 GAUZE TAPERED TIP BIPOLAL PENC                 0.00                1   A4649         Z7610                 270
ORA          7420   73650   25G ASPIRATING PICK ( BAUSCH & LO               277.00                1   A4649         Z7610                 270
ORA          7420   73675   25G ENTRY SITE ALIGNMENT SYSTEM (               499.00                1   A4649         Z7610                 270
ORA          7420   73625   25G EXTENDIBLE PICK ( BAUSCH & LO               499.00                1   A4649         Z7610                 270
ORA          7420   73700   25G LIGHTNING CUTTER TIP / SILICO               760.00                1   A4649         Z7610                 270
ORA          7420    5336   3 IN 1 IV "T" CONNECTOR                          29.00                1   A4649         Z7610                 272



                                                            Page 143 of 676
                                                               CM 06/15/07


 Dept                                                                                                                      M/cal
        Cost Ctr.   SIM#                   Description                     Price          Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                     HCPCS
ORA          7420    5500   36 INCH COLOR-CODED DBL T CONN                    47.00                    1   A4649         Z7610                 272
ORA          7420   30033   5000CC NORMAL SALINE BAG IRRIG                   157.00                    1   A4649         Z7610                 258
ORA          7420   74350   57 BLADE (___________)                            87.00                    1   A4649         Z7610                 270
ORA          7420   75075   5MM SLEEVE                                       169.00                    1   A4649         Z7610                 270
ORA          7420    5427   6 INCH T CONNECTOR                                14.00                    1   A4649         Z7610                 272
ORA          7420    5492   60 INCH LOW VOL IV TUBING                         30.00                    1   A4649         Z7610                 272
ORA          7420    6140   ABD PADS                                          24.00                    1   A4649         Z7610                 272
ORA          7420   65551   ACL KIT                                        3,373.00                    1   A4649         Z7610                 272
ORA          7420   40404   ADAPTER, NEURO GUIDE                             451.00                    1   A4649         Z7610                 272
ORA          7420    7056   ADKINS STRUT                                     227.00                    1   A4649         Z7610                 278
ORA          7420   30108   ADULT VENT                                       149.00                    1   A4649         Z7610                 272
ORA          7420   10144   AESCULAP DRILL                                     0.00   S                    A4649         Z7610                 272
ORA          7420   73775   AHMED GLAUCOMA IMPLANT - LARGE                 2,370.00                    1   A4649         Z7610                 278
ORA          7420   73800   AHMED GLAUCOMA IMPLANT - SMALL                 1,187.00                    1   A4649         Z7610                 278
ORA          7420   74100   ALCON INTRA OCULAR LENS                          950.00                    1   A4649         Z7610                 276
ORA          7420   74075   ALCON LENS FOLDER                                 36.00                    1   A4649         Z7610                 270
ORA          7420   74125   ALCON SEW - IN INTRAOCULAR LENS                  950.00                    1   A4649         Z7610                 276
ORA          7420   10110   ALL DRILLS/BURRS                                   0.00   S                    A4649         Z7610                 272
ORA          7420   54678   ALUMINUM HAND                                    163.00                    1   A4649         Z7610                 272
ORA          7420   74200   AMMIOTIC MEMBRANE 2 X 3 CM                     2,267.00                    1   A4649         Z7610                 278
ORA          7420   73150   AMPLATZ RENAL DILATOR                            882.00                    1   A4649         Z7610                 270
ORA          7420   71000   ANAL MOTILITY CATHETER                         1,662.00                    1   A4649         Z7610                 270
ORA          7420   74325   ANGLED LASER ENDOPROBE 20G                       831.00                    1   A4649         Z7610                 270
ORA          7420   74275   ANTERIOR VITRECTOMY CUTTER                     1,306.00                    1   A4649         Z7610                 270
ORA          7420   76650   ANTHROSCOPY DRAPE                                144.00                    1   A4649         Z7610                 270
ORA          7420    1275   ARGON COAGULATOR/SUPPLIES                          0.00   S                    A4649         Z7610                 272
ORA          7420    5377   ARMBOARD                                           0.00   S                    A4649         Z7610                 271
ORA          7420    5740   ARTERIAL GUIDE WIRE                               56.00                    1   A4649         Z7610                 272
ORA          7420   75300   ARTERIOTOMY CANNULA                               35.00                    1   A4649         Z7610                 270
ORA          7420   10128   ARTHROSCOPE SET UP                                 0.00   S                    A4649         Z7610                 279
ORA          7420    1333   ARTHROSCOPY PUMP TUBING                          121.00                    1   A4649         Z7610                 272
ORA          7420    5449   ASEPTO                                             0.00   S                    A4649         Z7610                 272
ORA          7420   44802   ATW35 CUTTER 35MM                              4,463.00                    1   A4649         Z7610                 270
ORA          7420    6250   AUTO BP MONITOR W/CUFF                             0.00   S                    A4649         Z7610                 271
ORA          7420    3208   AUTOMATED B.P.                                     0.00   S                    A4649         Z7610                 370



                                                              Page 144 of 676
                                                           CM 06/15/07


 Dept                                                                                                                M/cal
        Cost Ctr.   SIM#                  Description                  Price        Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                               HCPCS
ORA          7420   75575   BAERVELDT GLAUCOMA IMPLANT-LG              2,370.00                  1   A4649         Z7610                 278
ORA          7420   75550   BAERVELDT GLAUCOMA IMPLANT-SM              2,370.00                  1   A4649         Z7610                 278
ORA          7420    6967   BAG DECANTER                                  22.00                  1   A4649         Z7610                 272
ORA          7420    5456   BAG, COLOSTOMY/UROSTOMY                      240.00                  1   A4649         Z7610                 272
ORA          7420    6017   BAG, INTESTINAL                              109.00                  1   A4421         Z7610                 272
ORA          7420    5472   BAG, URETERAL DRAINAGE                        74.00                  1   A4649         Z7610                 272
ORA          7420    5464   BAG, URINARY DRAINAGE                         77.00                  1   A4649         Z7610                 272
ORA          7420    2729   BAIR HUGGER BLANKET                           84.00                  1   A4649         Z7610                 271
ORA          7420   31452   BAIR HUGGER INTRAOP                          134.00                  1   A4649         Z7610                 272
ORA          7420   71050   BALLOON DILATORS (PACKED SINGLE 6            743.00                  1   A4649         Z7610                 270
ORA          7420   71025   BALLOON DILATORS (PACKED TOGETHER            926.00                  1   A4649         Z7610                 270
ORA          7420   30769   BALLOON RETRACTOR, CABOT                     475.00                  1   A4649         Z7610                 272
ORA          7420    4293   BANDAGE, COBAN ALL SIZES                      34.00                  1   A4649         Z7610                 272
ORA          7420    6272   BANDAGE, ELASTOPLAST                          37.00                  1   A4649         Z7610                 272
ORA          7420    4145   BANDAGE, KLING                                23.00                  1   A4649         Z7610                 272
ORA          7420    4152   BANDAGE, WEBRIL                               16.00                  1   A4649         Z7610                 272
ORA          7420   74625   BARD DISPOZ - BAG CATH #150719               393.00                  1   A4649         Z7610                 270
ORA          7420   73850   BARRON MARKING DONOR PUNCH                   314.00                  1   A4649         Z7610                 270
ORA          7420      93   BEAR VESSEL CLIP                             271.00                  1   A4649         Z7610                 272
ORA          7420    7007   BETA CAPS/CLAMPS                              26.00                  1   A4649         Z7610                 272
ORA          7420   30710   BETADINE SCRUB                                 0.00 S                    A4649         Z7610                 272
ORA          7420   54876   BILAT SILICONE CHIN IMPLANT                1,054.00                  1   A4649         Z7610                 278
ORA          7420   71075   BILIARY BALLOON DILATORS                   1,187.00                  1   A4649         Z7610                 270
ORA          7420    9656   BIO BRANE                                  1,066.00                  1   A4649         Z7610                 272
ORA          7420   76275   BIO SCREW/INTERFERENCE                       484.00                  1   A4649         Z7610                 278
ORA          7420   65650   BIOFEX ABS FIX DEVICE .                      747.00                  1   A4649         Z7610                 278
ORA          7420   30076   BIOFEX ABS FIX DEVICE                        747.00                  1   A4649         Z7610                 278
ORA          7420   71100   BIOPSY FORCEPS, DISPOSABLE                   361.00                  1   A4649         Z7610                 270
ORA          7420   71125   BIOPSY FORCEPS, DISPOSABLE HOT             1,390.00                  1   A4649         Z7610                 270
ORA          7420   74850   BIOPSY VALVE PORT                             11.00                  1   A4649         Z7610                 270
ORA          7420    8021   BIPOLAR CORDS (DISP)                          56.00                  1   A4649         Z7610                 272
ORA          7420   74600   BIPOLAR PENCIL CAUTERY                         0.00 S                    A4649         Z7610                 270
ORA          7420   72200   BIPOLAR PENCIL TIP                           158.00                  1   A4649         Z7610                 270
ORA          7420   62202   BLADE PLATE OSTEOTOMY                      4,368.00                  1   L8699         L8699                 278
ORA          7420   32302   BLADE, ARTHROSCOPY SHAVER                    633.00                  1   A4649         Z7610                 272



                                                          Page 145 of 676
                                                             CM 06/15/07


 Dept                                                                                                                 M/cal
        Cost Ctr.   SIM#                  Description                  Price        Stats/bill        CPT     Mod             Mod   Rev Code
 Code                                                                                                                HCPCS
ORA          7420   32351   BLADE, CUDA                                  555.00                  1   A4649          Z7610                 272
ORA          7420    6223   BLADE, DERMATOME                             157.00                  1   A4649          Z7610                 272
ORA          7420    9284   BLADES, BEAVER                                13.00                  1   A4649          Z7610                 272
ORA          7420   43655   BLADES, CLIPPER (NEURO) DISP                  87.00                  1   A4649          Z7610                 271
ORA          7420    8005   BLADES, CRANIO                               595.00                  1   A4649          Z7610                 272
ORA          7420    8013   BLADES, HEMOSTATIC SHAW                      483.00                  1   A4649          Z7610                 272
ORA          7420    3451   BLADES, HOUSE                                 70.00                  1   A4649          Z7610                 272
ORA          7420    5001   BLADES, STERNUM                              998.00                  1   A4649          Z7610                 272
ORA          7420   44752   BLUNT CHERRY BCD10                           154.00                  1   A4649          Z7610                 270
ORA          7420    1234   BMT ASPIRATION SETUP/TRAY                    157.00                  1   A4649          Z7610                 272
ORA          7420   75875   BODY MAGNET                                   95.00                  1   A4649          Z7610                 270
ORA          7420    7015   BONDNET-ALL                                   53.00                  1   A4649          Z7610                 272
ORA          7420    8674   BONE BOTTLE, EACH                            683.00                  1   A4649          Z7610                 272
ORA          7420   40305   BONE BOTTLES                                  40.00                  1   A4649          Z7610                 270
ORA          7420    6538   BONEWAX                                       66.00                  1   A4649          Z7610                 272
ORA          7420   74900   BRONCHOSCOPY SET UP                          475.00                  1   A4649          Z7610                 270
ORA          7420    2406   BROVIAC INJECTABLE CAPS                       31.00                  1   A4649          X7700                 272
ORA          7420   75950   BUFFALO FILTER TUBING                         31.00                  1   A4649          Z7610                 270
ORA          7420   76425   C3F8 CAS                                     116.00                  1   A4649          Z7610                 270
ORA          7420   30058   CANNULA, AORTIC                              223.00                  1   A4649          Z7610                 272
ORA          7420   30082   CANNULA, AORTIC ROOT                         124.00                  1   A4649          Z7610                 272
ORA          7420   32252   CANNULA, LINVATEC                            158.00                  1   A4649          Z7610                 272
ORA          7420   30066   CANNULA, VENOUS                              223.00                  1   A4649          Z7610                 272
ORA          7420   61006   CANNULATED DRILL BIT                       1,108.00                  1   A4649          Z7610                 272
ORA          7420   61204   CANNULATED TAP                             1,358.00                  1   A4649          Z7610                 272
ORA          7420   72025   CARBOMEDICS VALVE/PROSTHESIS              17,201.00                  1   L8699          L8699                 278
ORA          7420    6201   CARDIAC MONITORING W/ELECTRODE                 0.00 S                    A4649          Z7610                 271
ORA          7420   71150   CARTRIDGE W/ SILOCONE TUBING                 528.00                  1   A4649          Z7610                 270
ORA          7420   10151   CASE SET UP & CANCELLED                      490.00                  1    99070         Z7610                 272
ORA          7420   41451   CAST SHORT LEG INFANT                         82.00                  1   A4649          Z7610                 271
ORA          7420   42954   CAST, A-FRAME ADOLESCENT                     625.00                  1   A4649          Z7610                 271
ORA          7420   43002   CAST, A-FRAME ADULT                          688.00                  1   A4649          Z7610                 271
ORA          7420   42905   CAST, A-FRAME CHILD                          475.00                  1   A4649          Z7610                 271
ORA          7420   42855   CAST, A-FRAME INFANT                         374.00                  1   A4649          Z7610                 271
ORA          7420   43200   CAST, BODY ADOLESCENT                        462.00                  1   A4649          Z7610                 271



                                                         Page 146 of 676
                                                             CM 06/15/07


 Dept                                                                                                                M/cal
        Cost Ctr.   SIM#                  Description                    Price      Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                               HCPCS
ORA          7420   43259   CAST, BODY ADULT                               510.00                1   A4649         Z7610                 271
ORA          7420   43150   CAST, BODY CHILD                               417.00                1   A4649         Z7610                 271
ORA          7420   43101   CAST, BODY INFANT                              227.00                1   A4649         Z7610                 271
ORA          7420   42350   CAST, DOUBLE SPICA ADOLESCENT                  699.00                1   A4649         Z7610                 271
ORA          7420   42400   CAST, DOUBLE SPICA ADULT                       769.00                1   A4649         Z7610                 271
ORA          7420   42301   CAST, DOUBLE SPICA CHILD                       585.00                1   A4649         Z7610                 271
ORA          7420   42251   CAST, DOUBLE SPICA INFANT                      367.00                1   A4649         Z7610                 271
ORA          7420   41758   CAST, LONG ARM ADOLESCENT                      154.00                1   A4649         Z7610                 271
ORA          7420   41808   CAST, LONG ARM ADULT                           169.00                1   A4649         Z7610                 271
ORA          7420   41709   CAST, LONG ARM CHILD                           143.00                1   A4649         Z7610                 271
ORA          7420   41659   CAST, LONG ARM INFANT                          116.00                1   A4649         Z7610                 271
ORA          7420   41956   CAST, LONG LEG ADOLESCENT                      312.00                1   A4649         Z7610                 271
ORA          7420   42004   CAST, LONG LEG ADULT                           343.00                1   A4649         Z7610                 271
ORA          7420   41907   CAST, LONG LEG CHILD                           237.00                1   A4649         Z7610                 271
ORA          7420   41857   CAST, LONG LEG INFANT                          187.00                1   A4649         Z7610                 271
ORA          7420   41352   CAST, SHORT ARM ADOLESCENT                     110.00                1   A4649         Z7610                 271
ORA          7420   41402   CAST, SHORT ARM ADULT                          117.00                1   A4649         Z7610                 271
ORA          7420   41303   CAST, SHORT ARM CHILD                           87.00                1   A4649         Z7610                 271
ORA          7420   41253   CAST, SHORT ARM INFANT                          56.00                1   A4649         Z7610                 271
ORA          7420   41550   CAST, SHORT LEG ADOLESCENT                     161.00                1   A4649         Z7610                 271
ORA          7420   41600   CAST, SHORT LEG ADULT                          180.00                1   A4649         Z7610                 271
ORA          7420   41501   CAST, SHORT LEG CHILD                          110.00                1   A4649         Z7610                 271
ORA          7420   42152   CAST, SINGLE SPICA ADOLESCENT                  453.00                1   A4649         Z7610                 271
ORA          7420   42202   CAST, SINGLE SPICA ADULT                       500.00                1   A4649         Z7610                 271
ORA          7420   42053   CAST, SINGLE SPICA CHILD                       223.00                1   A4649         Z7610                 271
ORA          7420   42558   CAST, SPLINT ARM ADOLESCENT                    110.00                1   A4649         Z7610                 271
ORA          7420   42608   CAST, SPLINT ARM ADULT                         121.00                1   A4649         Z7610                 271
ORA          7420   42509   CAST, SPLINT ARM CHILD                          90.00                1   A4649         Z7610                 271
ORA          7420   42459   CAST, SPLINT ARM INFANT                         58.00                1   A4649         Z7610                 271
ORA          7420   42756   CAST, SPLINT LEG ADOLESCENT                    119.00                1   A4649         Z7610                 271
ORA          7420   42806   CAST, SPLINT LEG ADULT                         128.00                1   A4649         Z7610                 271
ORA          7420   42707   CAST, SPLINT LEG CHILD                          97.00                1   A4649         Z7610                 271
ORA          7420   42657   CAST, SPLINT LEG INFANT                         66.00                1   A4649         Z7610                 271
ORA          7420    7114   CATH, CUTDOWN                                   31.00                1   A4649         X7700                 272
ORA          7420   71200   CATHETER / CYTOLOGY BRUSH                      438.00                1   A4649         Z7610                 270



                                                            Page 147 of 676
                                                             CM 06/15/07


 Dept                                                                                                                M/cal
        Cost Ctr.   SIM#                   Description                   Price      Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                               HCPCS
ORA          7420    6066   CATHETER, BROVIAC 201                          510.00                1   A4300         Z7610                 272
ORA          7420    6033   CATHETER, BROVIAC 204                          934.00                1   A4300         Z7610                 272
ORA          7420   71225   CATHETER CONNECTORS                            114.00                1   A4649         Z7610                 270
ORA          7420    5597   CATHETER, COUDE                                 40.00                1   A4649         Z7610                 272
ORA          7420    5480   CATHETER, FOLEY                                109.00                1   A4649         Z7610                 272
ORA          7420    6090   CATHETER, HICKMAN 206                          749.00                1   A4300         Z7610                 272
ORA          7420    6108   CATHETER INTRODUCER                            500.00                1   A4649         Z7610                 272
ORA          7420    5498   CATHETER MALECOT                               133.00                1   A4649         Z7610                 272
ORA          7420    5506   CATHETER, PEZZER                                89.00                1   A4649         Z7610                 272
ORA          7420   76200   CATHETER PLUG                                   10.00                1   A4649         Z7610                 270
ORA          7420    5514   CATHETER ROBINSON                               13.00                1   A4649         Z7610                 272
ORA          7420   71175   CATHETER SNARES 1.8 FR.                        855.00                1   A4649         Z7610                 270
ORA          7420    5522   CATHETER, UMBILICAL                            133.00                1   A4649         Z7610                 272
ORA          7420    5530   CATHETER, URETERAL #3, #4                      109.00                1   A4649         Z7610                 272
ORA          7420    6470   CATHETER, ANGIO                                 34.00                1   A4649         X7700                 272
ORA          7420    6751   CATHETER, DOUBLE LUMEN                         729.00                1   A4649         X7700                 272
ORA          7420   30421   CATHETER, MALECOT NON LATEX                    397.00                1   A4649         Z7610                 272
ORA          7420   43358   CATHETER, NEURO PERITONEAL                     571.00                1   A4649         Z7610                 278
ORA          7420    7205   CATHETER, OLIVE/WHISTLE TIP                    133.00                1   A4649         Z7610                 272
ORA          7420   40453   CATHETER, PEEL AWAY                            285.00                1   A4649         Z7610                 272
ORA          7420    6363   CATHETER, QUINTON PERITONEAL                   640.00                1   A4649         Z7610                 278
ORA          7420    7213   CATHETER, SILICONE                             185.00                1   A4649         Z7610                 272
ORA          7420   30603   CATHETER, SILICONE DBL LUM 28                  783.00                1   A4649         Z7610                 272
ORA          7420   43408   CATHETER, ST VENTRICULAR                       438.00                1   A4649         Z7610                 278
ORA          7420   30736   CATHETER, SUCTION                               29.00                1   A4649         Z7610                 272
ORA          7420    6769   CATHETER, SWAN NECK P.D.                     1,043.00                1   A4649         X7700                 272
ORA          7420    7189   CATHETER, TENCKHOFF                            531.00                1   A4649         Z7610                 272
ORA          7420    5373   CATHETER, TROCAR                               180.00                1   A4340         Z7610                 272
ORA          7420   30652   CATHETER, TROCAR 10/11 511S                    753.00                1   A4649         Z7610                 272
ORA          7420   30645   CATHETER, TROCAR 5MM 355S                      657.00                1   A4649         Z7610                 272
ORA          7420    7254   CATHETER, URET STENTING                      1,038.00                1   A4649         Z7610                 278
ORA          7420   40503   CATHETER, VENTRICULAR                          435.00                1   A4649         Z7610                 278
ORA          7420   30744   CATHETER, ANGIO                                 34.00                1   A4649         X7700                 272
ORA          7420    3550   CAUTERY, EYE                                    65.00                1   A4649         Z7610                 272
ORA          7420    6157   CAUTERY, HOTTEMP                               137.00                1   A4649         Z7610                 272



                                                            Page 148 of 676
                                                               CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                  Description                    Price          Stats/bill      CPT    Mod             Mod   Rev Code
 Code                                                                                                                 HCPCS
ORA          7420    2091   CELL SAVER MACHINE                               0.00   S                  A4649         Z7610                 272
ORA          7420    2109   CELL SAVER SUPPLIES                          2,831.00                    1 A4649         Z7610                 272
ORA          7420   76125   CEMENT MIXER                                   374.00                    1 A4649         Z7610                 270
ORA          7420   75675   CENTRIFUGE                                       0.00   S                  A4649         Z7610                 270
ORA          7420   72400   CHANNEL SCOPE                                3,102.00                    1 A4649         Z7610                 270
ORA          7420    6827   CHEST TUBE, THORACIC ATRIUM                    267.00                    1 A4649         Z7610                 272
ORA          7420    6843   CHEST TUBE, THORACIC NEONATAL                  212.00                    1 A4649         Z7610                 272
ORA          7420    6801   CHEST TUBE, THORACIC ST/ANG                    121.00                    1 A4649         Z7610                 272
ORA          7420    6835   CHEST TUBE, THORACIC VENOUS                    185.00                    1 A4649         Z7610                 272
ORA          7420    7544   CHILD ELBOW RESTRAINT PLASTIC                  189.00                    1 A4649         Z7610                 271
ORA          7420   71800   CHLOROPAED                                      42.00                    1 A4649         Z7610                 270
ORA          7420    3709   CILIA BRUSH                                    121.00                    1 A4649         Z7610                 272
ORA          7420    3261   CIRCLING BAND                                  538.00                    1 A4649         Z7610                 278
ORA          7420   74150   CIVA - VISION MEMORY LENS                      593.00                    1 A4649         Z7610                 278
ORA          7420    9342   CLIP, ANEURYSM                               1,182.00                    1 A4649         Z7610                 278
ORA          7420   30298   CLIP, GREY                                      54.00                    1 A4649         Z7610                 272
ORA          7420    6132   CLIPS, LIGA/ALL                                 40.00                    1 A4649         Z7610                 272
ORA          7420    6116   CLIPS, HEMO/ALL                                 56.00                    1 A4649         Z7610                 272
ORA          7420    4541   CLIPS, ILLIZAROV                               231.00                    1 A4649         Z7610                 272
ORA          7420   71250   CLO-TEST                                     1,377.00                    1 A4649         Z7610                 270
ORA          7420   75750   COLORADO NEEDLE                                266.00                    1 A4649         Z7610                 270
ORA          7420   74750   COLUMELLA 400 - 5343 - STYLES                    0.00                    1 A4649         Z7610                 278
ORA          7420   72900   COMPRESSING SCREW - SYNTHES                    535.00                    1 A4649         Z7610                 278
ORA          7420   75800   COMPRESSION VEST                               317.00                    1 A4649         Z7610                 270
ORA          7420    8203   CONNECTORS                                     371.00                    1 A4649         Z7610                 272
ORA          7420   30264   CONNECTORS, THORACIC                            40.00                    1 A4649         Z7610                 272
ORA          7420   75625   COOK REUSABLE HANDLE                             0.00   S                  A4649         Z7610                 270
ORA          7420   75900   COOK-SURGISIS GOLD HERNIA REPAIR             2,751.00                    1 A4649         Z7610                 270
ORA          7420   75525   CORNEA TRANSPLANT                            9,021.00                    1 V2785         V2785                 810
ORA          7420   75000   COROTEX SCREW - SYNTHES                         95.00                    1 A4649         Z7610                 278
ORA          7420   72325   CORRECTOR                                    2,296.00                    1 A4649         Z7610                 270
ORA          7420    6165   COTTON ELASTIC BANDAGE                          29.00                    1 A4649         Z7610                 272
ORA          7420   75325   COUNTER SUNK 100 X 100                       3,418.00                    1 A4649         Z7610                 278
ORA          7420    4343   COVER, C-ARM                                     0.00   S                  A4649         Z7610                 272
ORA          7420   43705   COVER, SOLU WARMER SMALL                         0.00   S                  A4649         Z7610                 271



                                                           Page 149 of 676
                                                              CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                   Description                    Price          Stats/bill      CPT    Mod             Mod   Rev Code
 Code                                                                                                                  HCPCS
ORA          7420   74400   CRAWFORD TUBE                                   171.00                    1 A4649         Z7610                 270
ORA          7420   73550   CRESCENT KNIFE                                   74.00                    1 A4649         Z7610                 270
ORA          7420    3232   CRS 12 GAUGE NEEDLE                           1,085.00                    1 A4649         Z7610                 272
ORA          7420    2059   CRYO SURGERY UNIT                                 0.00   S                  A4649         Z7610                 271
ORA          7420    2117   CUSA MACHINE                                      0.00   S                  A4649         Z7610                 271
ORA          7420   30553   CUTTER RELOAD, LINEAR                           528.00                    1 A4649         Z7610                 272
ORA          7420   30546   CUTTER, LINEAR                                  940.00                    1 A4649         Z7610                 272
ORA          7420    5732   CVP TRAY                                        378.00                    1 A4550         Z7610                 272
ORA          7420    6163   CYSTO CONRAY                                    169.00                    1 A4649         Z7610                 254
ORA          7420   76150   CYSTO GRAFIN                                    141.00                    1 A4649         Z7610                 270
ORA          7420   71275   CYTOLOGY BRUSH                                    0.00   S                  A4649         Z7610                 270
ORA          7420   63101   DALL MILES CABLE                              1,059.00                    1 A4649         Z7610                 278
ORA          7420   63200   DALL MILLS SLEEVE                               694.00                    1 A4649         Z7610                 278
ORA          7420   62103   DCS                                           2,621.00                    1 A4649         Z7610                 278
ORA          7420   60511   DEFIBRILLATOR                                     0.00   S                  A4649         Z7610                 271
ORA          7420    1184   DENTAL SET UP TRAYS                             157.00                    1 A4649         Z7610                 272
ORA          7420   73275   DEPUY / ISOLA ROD                             1,000.00                    1 A4649         Z7610                 278
ORA          7420   76625   DEPUY SINGLE LEAD CABLE                       3,418.00                    1 A4649         Z7610                 278
ORA          7420   54629   DERMABOND                                       227.00                    1 A4649         Z7610                 272
ORA          7420    6736   DERMACARRIERS                                   239.00                    1 A4649         Z7610                 272
ORA          7420    9045   DERMATOME ALL                                   157.00                    1 A4649         Z7610                 272
ORA          7420   62004   DHS                                           2,292.00                    1 A4649         Z7610                 278
ORA          7420   30587   DIALYSIS ACCESS NO CUFF 11.5FR                  516.00                    1 A4649         Z7610                 272
ORA          7420   30595   DIALYSIS ACCESS NO CUFF 8.0FR                   918.00                    1 A4649         Z7610                 272
ORA          7420   30579   DIALYSIS ACCESS W/CUFF 12.5FR                 1,005.00                    1 A4649         Z7610                 272
ORA          7420   30561   DIALYSIS ACCESS W/CUFF 8FRFR                  1,099.00                    1 A4649         Z7610                 272
ORA          7420    5344   DISCOFIX "T" WITH STOPCOCK                       16.00                    1 A4649         Z7610                 272
ORA          7420    5450   DISP BP CUFF                                      0.00   S                  A4649         Z7610                 370
ORA          7420    5682   DISP ESOPH STETH TEMP                            53.00                    1 A4649         Z7610                 271
ORA          7420    5005   DISP HUMID CIRCUIT                              240.00                    1 A4649         Z7610                 272
ORA          7420    5112   DISP PRESSURE BAG                               121.00                    1 A4649         Z7610                 271
ORA          7420    5690   DISP REC TEMP STETH                              53.00                    1 A4649         Z7610                 271
ORA          7420    5708   DISP TYHP TEMP STETH                             53.00                    1 A4649         Z7610                 271
ORA          7420   30504   DISP. BASIN                                       0.00   S                  A4649         Z7610                 272
ORA          7420    2622   DISPO MASK                                       22.00                    1 A4649         Z7610                 271



                                                             Page 150 of 676
                                                         CM 06/15/07


 Dept                                                                                                              M/cal
        Cost Ctr.   SIM#                  Description                Price          Stats/bill      CPT    Mod             Mod   Rev Code
 Code                                                                                                             HCPCS
ORA          7420   75175   DISPOSABLE CAUTERY                         158.00                    1 A4649         Z7610                 270
ORA          7420   74975   DLP CANNULA                                157.00                    1 A4649         Z7610                 270
ORA          7420   30751   DOPPLER MONITOR & PROBE                      0.00   S                  A4649         Z7610                 270
ORA          7420    6744   DOUBLE J STENT                           1,211.00                    1 A4649         Z7610                 278
ORA          7420    5617   DOUBLE STOPCOCK                             31.00                    1 A4649         X7700                 272
ORA          7420    3428   DRAIN EYE WICK                              53.00                    1 A4649         Z7610                 272
ORA          7420    6199   DRAIN PENROSE                               11.00                    1 A4649         Z7610                 272
ORA          7420    8302   DRAIN SET EXTERNAL UNIT                  1,451.00                    1 A4649         Z7610                 272
ORA          7420   30884   DRAINS, BLAKE SILICON                      219.00                    1 A4649         Z7610                 272
ORA          7420    6215   DRAPE                                       89.00                    1 A4649         Z7610                 272
ORA          7420    5571   DRAPE SKYTRON                                0.00   S                  A4649         Z7610                 272
ORA          7420    4350   DRAPE, ARTHROSCOPE                           0.00   S                  A4649         Z7610                 272
ORA          7420    4376   DRAPE, CASSETTE                              0.00   S                  A4649         Z7610                 272
ORA          7420    8336   DRAPE, IOBAN STERILE                        73.00                    1 A4649         Z7610                 272
ORA          7420   30496   DRAPE, MAGNA                                 0.00   S                  A4649         Z7610                 272
ORA          7420    8385   DRAPE, NEURO                               233.00                    1 A4649         Z7610                 272
ORA          7420    4418   DRAPE, ORTHO                               127.00                    1 A4649         Z7610                 272
ORA          7420    6249   DRESSING, ADAPTIC                           23.00                    1 A4649         Z7610                 272
ORA          7420    4509   DRESSING, KERLIX                            24.00                    1 A4649         Z7610                 272
ORA          7420   60909   DRILL BIT                                  245.00                    1 A4649         Z7610                 272
ORA          7420   75450   DUAL LUMEN CATHETER                         90.00                    1 A4649         Z7610                 270
ORA          7420   75700   DUODERM                                     42.00                    1 A4649         Z7610                 270
ORA          7420    5100   DUOFLOW                                    761.00                    1 A4649         Z7610                 272
ORA          7420   74450   DURA GEN - DURAL GRAFT                   2,224.00                    1 A4649         Z7610                 278
ORA          7420    6850   DURA POUCH                                 169.00                    1 A4649         Z7610                 272
ORA          7420   30728   DURA PREP.                                  54.00                    1 A4649         Z7610                 272
ORA          7420   44950   EBCO2 CORD                                 713.00                    1 A4649         Z7610                 270
ORA          7420   44901   EBFO2 MICROBIPOLAR                       3,032.00                    1 A4649         Z7610                 270
ORA          7420    9334   EGGCRATE                                   103.00                    1 A4649         Z7610                 271
ORA          7420   74650   ELASTIC NAIL                               444.00                    1 A4649         Z7610                 270
ORA          7420    4335   ELBOW PROTECTORS                            56.00                    1 E0191         Z7610                 271
ORA          7420   75425   ELECTRODE LEAD SET                           4.00                    1 A4649         Z7610                 270
ORA          7420   40354   ELECTRODE, MICRO ENDO                    1,019.00                    1 A4649         Z7610                 272
ORA          7420   40107   ELECTRODE, TEFLON                           53.00                    1 A4649         Z7610                 271
ORA          7420    3238   ELECTRODES, NIM                            152.00                    1 A4556         Z7610                 271



                                                        Page 151 of 676
                                                           CM 06/15/07


 Dept                                                                                                                M/cal
        Cost Ctr.   SIM#                  Description                  Price        Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                               HCPCS
ORA          7420   66054   ELECTRODES, WIRE (M)                          35.00                  1   A4649         Z7610                 272
ORA          7420   30876   ELVIS DEFOGGER                                80.00                  1   A4649         Z7610                 272
ORA          7420   76550   ENDO CATCH                                 1,146.00                  1   A4649         Z7610                 270
ORA          7420   54777   ENDO CLIP                                  1,886.00                  1   A4649         Z7610                 272
ORA          7420   76525   ENDO VERESS NEEDLE                           133.00                  1   A4649         Z7610                 270
ORA          7420   30793   ENDOLOOP EL06                                793.00                  1   A4649         Z7610                 272
ORA          7420   30801   ENDOPATH BABCOCK BB10                        918.00                  1   A4649         Z7610                 272
ORA          7420   30785   ENDOPATH CHOL CATHETER EBC04                 417.00                  1   A4649         Z7610                 272
ORA          7420   30868   ENDOPATH CURVED SCISSORS DCS12               785.00                  1   A4649         Z7610                 272
ORA          7420   30694   ENDOPATH INTRODUCER ELI10                    127.00                  1   A4649         Z7610                 272
ORA          7420   30843   ENDOPATH LINEAR CUTTER ELC35               1,480.00                  1   A4649         Z7610                 272
ORA          7420   30686   ENDOPATH LUNG FORCEP ENDLC                   588.00                  1   A4649         Z7610                 272
ORA          7420   30850   ENDOPATH MULTIFEED STAPLER-EMS             1,605.00                  1   A4649         Z7610                 272
ORA          7420   30819   ENDOPATH TROCAR B1011                        730.00                  1   A4649         Z7610                 272
ORA          7420   30660   ENDOPOUCH EP44                               609.00                  1   A4649         Z7610                 272
ORA          7420   40602   ENDOSCOPE DISPO FLEXIBLE                   3,113.00                  1   A4649         Z7610                 272
ORA          7420   40552   ENDOSCOPE, DISPO RIGID                     2,376.00                  1   A4649         Z7610                 272
ORA          7420   76225   ENDOSCOPE-GASTRIC ACCESS PORT KIT            526.00                  1   A4649         Z7610                 270
ORA          7420   44158   EPICEL CEA                                 2,954.00                  1   A4649         Z7610                 278
ORA          7420    3766   ERASERS                                       50.00                  1   A4649         Z7610                 272
ORA          7420    4426   ESMARK                                       169.00                  1   A6452         Z7610                 272
ORA          7420   76025   EXTENDED BLADE ELECTRODE                      38.00                  1   A4649         Z7610                 270
ORA          7420   76375   EXTERNAL BROVIC PAD                           43.00                  1   A4649         Z7610                 270
ORA          7420    6231   EXTRACTOR                                     77.00                  1   A4649         Z7610                 272
ORA          7420   75925   EXTREMITY PREP SHEET                          35.00                  1   A4649         Z7610                 270
ORA          7420    3287   EYE BANK SCLERA                            1,011.00                  1   A4649         Z7610                 278
ORA          7420   30397   EYE BUNDLE                                   900.00                  1   A4649         Z7610                 272
ORA          7420    3279   EYE CONFORMER                                233.00                  1   A4649         Z7610                 278
ORA          7420   60545   EYE LASER                                      0.00 S                    A4649         Z7610                 271
ORA          7420    3204   EYE PADS                                       0.00 S                    A4649         Z7610                 272
ORA          7420   41006   EYE SHIELD YELL/WHITE                        181.00                  1   A4649         Z7610                 271
ORA          7420    3212   EYE SHIELDS METAL                             87.00                  1   A4649         Z7610                 271
ORA          7420   45007   EZ45 CUTTER - ALL                          4,972.00                  1   A4649         Z7610                 270
ORA          7420    3501   FASCIA LATA (OPTH)                           552.00                  1   A4649         Z7610                 278
ORA          7420   74700   FEMORAL ARTERIAL CANNULA                     633.00                  1   A4649         Z7610                 270



                                                          Page 152 of 676
                                                             CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                   Description                   Price          Stats/bill     CPT     Mod               Mod   Rev Code
 Code                                                                                                                 HCPCS
ORA          7420    5294   FEMORAL ARTERY TRAY                            227.00                    1 A4550         Z7610                   272
ORA          7420    3026   FIBEROPTIC SCOPE                                 0.00   S                  A4649         Z7610                   272
ORA          7420   60529   FIBRILLATOR                                      0.00   S                  A4649         Z7610                   271
ORA          7420   75275   FIBRIN SEALANT 1CC                             471.00                    1 A4649         Z7610                   278
ORA          7420    3378   FILTER SWINNEX/MILTEX                           23.00                    1 A4649         Z7610                   272
ORA          7420   30488   FILTER, SMOKE EVAC                             135.00                    1 A4649         Z7610                   272
ORA          7420    5542   FLEXIBLE TRACH ADAPT                            14.00                    1 A4649         Z7610                   272
ORA          7420    3303   FLOW CONTROL                                    82.00                    1 A4649         Z7610                   272
ORA          7420   71300   FLURO BALL TIPS                                284.00                    1 A4649         Z7610                   270
ORA          7420    8369   FLUSH TIP PROBE                              1,604.00                    1 A4649         Z7610                   272
ORA          7420    6918   FOGERTY CATH                                   596.00                    1 A4649         Z7610                   272
ORA          7420    4434   FOOT PROTECTORS                                 24.00                    1 E0191         Z7610                   271
ORA          7420   44703   FPO15 THORACIC PORT                            374.00                    1 A4649         Z7610                   270
ORA          7420   76075   G4-340 MIDAS DISSECTING TOOLS                  378.00                    1 A4649         Z7610                   270
ORA          7420   76050   G4-360 MIDAS DISSECTING TOOLS                  412.00                    1 A4649         Z7610                   270
ORA          7420   44000   GAS FOR FLUID EXCHANGE                         397.00                    1 A4649         Z7610                   270
ORA          7420    6280   GAUZE STRIPS (PL, 10DZ)                         48.00                    1 A4649         Z7610                   272
ORA          7420    6652   GAUZE, VASELINE                                 24.00                    1 A6222         Z7610                   272
ORA          7420    6678   GAUZE, XEROFORM                                 14.00                    1 A6251         Z7610                   272
ORA          7420   71325   GB BIPOLAR INJECTION CATHETER                1,116.00                    1 A4649         Z7610                   270
ORA          7420    3410   GLASSOCK EAR KIT                               233.00                    1 A4649         Z7610                   272
ORA          7420   30462   GLIDE WIRE                                     555.00                    1 A4649         Z7610                   272
ORA          7420   31205   GLOVE LINER                                    171.00                    1 A4649         Z7610                   271
ORA          7420   43267   GLOVES, LIGHT                                    0.00   S                  A4649         Z7610                   272
ORA          7420    6086   GLUCOSE ACCU CHECK                              56.00                    1 82948             82948               300
ORA          7420   74825   GORETEX THIN WALLED GRAFT                    2,742.00                    1 A4649         Z7610                   278
ORA          7420    6371   GRAFT, MESH                                    200.00                    1 A4649         Z7610                   278
ORA          7420    1325   GRIESHUBER LIGHT SOURCE                          0.00   S                  A4649         Z7610                   271
ORA          7420    6306   GROUND PAD                                       0.00   S                  A4649         Z7610                   271
ORA          7420    6755   GUIDEWIRE                                      135.00                    1 A4649         Z7610                   272
ORA          7420   72225   GYNETEX SOFT TISSUE PATCH                    3,141.00                    1 A4649         Z7610                   278
ORA          7420   64604   HALO TRACTION                                    0.00   S                  A4649         Z7610                   274
ORA          7420   75200   HAND PIECE / BIPOLAR CORD                        0.00   S                  A4649         Z7610                   270
ORA          7420   44075   HARMONIC SCALPEL                               673.00                    1 A4649         Z7610                   272
ORA          7420   44083   HARMONIC SCALPEL LCS                         3,583.00                    1 A4649         Z7610                   272



                                                            Page 153 of 676
                                                           CM 06/15/07


 Dept                                                                                                              M/cal
        Cost Ctr.   SIM#                  Description                  Price        Stats/bill      CPT    Mod             Mod   Rev Code
 Code                                                                                                             HCPCS
ORA          7420   75050   HASSAN TROCAR                                174.00                  1 A4649         Z7610                 270
ORA          7420    5548   HEART BANDING MATERIAL                       314.00                  1 A4649         Z7610                 278
ORA          7420    7306   HEART PUMP SUPPLIES                        7,018.00                  1 A4649         Z7610                 272
ORA          7420   60537   HEART SOLU/SLUSH WARMER                        0.00 S                  A4649         Z7610                 271
ORA          7420    6151   HEEL WARMER                                    0.00 S                  A4649         Z7610                 271
ORA          7420   76450   HELIUM LASER                                   0.00 S                  A4649         Z7610                 270
ORA          7420   75225   HEMA MYST AERESOL SPRAY                    1,187.00                  1 A4649         Z7610                 270
ORA          7420   75250   HEMA SEAL                                    807.00                  1 A4649         Z7610                 270
ORA          7420   75150   HEMA SEAL 5CC                              1,682.00                  1 A4649         Z7610                 270
ORA          7420   30330   HEMASHIELD                                 1,969.00                  1 A4649         Z7610                 272
ORA          7420    4475   HEMOVAC                                      500.00                  1 A4649         Z7610                 272
ORA          7420   73825   HESS BURG - BARRON VACUUM TREPHIN            314.00                  1 A4649         Z7610                 270
ORA          7420    7122   HICKMAN/BROVIAC CAPS                          38.00                  1 A4649         X7700                 272
ORA          7420   76400   HYPAFIX                                      117.00                  1 A4649         Z7610                 270
ORA          7420    3949   IABP SET-UP                                1,209.00                  1 A4649         Z7610                 270
ORA          7420   65007   ILIZAROV FOUR LEVELS                      81,479.00                  1 L8699         L8699                 278
ORA          7420   64703   ILIZAROV ONE LEVEL                        20,369.00                  1 L8699         L8699                 278
ORA          7420   64901   ILIZAROV THREE LEVELS                     61,108.00                  1 L8699         L8699                 278
ORA          7420   64802   ILIZAROV TWO LEVELS                       40,739.00                  1 L8699         L8699                 278
ORA          7420    3307   INFUSION PUMP SYRINGE                        171.00                  1 A4649         Z7610                 272
ORA          7420   74575   INFUSSION CANNULA                            282.00                  1 A4649         Z7610                 270
ORA          7420   73350   INFUSSION CANNULA ( MURPHY )                 317.00                  1 A4649         Z7610                 270
ORA          7420   73375   INFUSSION CANNULA ( WRIGHT )                 332.00                  1 A4649         Z7610                 270
ORA          7420   73450   INFUSSION CANNULA 2.5MM ( EAGLE L            317.00                  1 A4649         Z7610                 270
ORA          7420   73425   INFUSSION CANNULA 4MM ( EAGLE LAB            282.00                  1 A4649         Z7610                 270
ORA          7420   73400   INFUSSION CANNULA 6MM                        282.00                  1 A4649         Z7610                 270
ORA          7420    6409   INHALATION SET UP LEVEL I                     62.00                  1 A4649         Z7610                 272
ORA          7420    6458   INHALATION SET UP LEVEL II                   246.00                  1 A4649         Z7610                 272
ORA          7420   44356   INNERDYNE 10 MM CANNULA                      576.00                  1 A4649         Z7610                 270
ORA          7420   44406   INNERDYNE 12 MM CANNULA                      628.00                  1 A4649         Z7610                 270
ORA          7420   44307   INNERDYNE 5 MM CANNULA                       519.00                  1 A4649         Z7610                 270
ORA          7420   44208   INNERDYNE ACCESS NEEDLE                      195.00                  1 A4649         Z7610                 270
ORA          7420   44257   INNERDYNE EXPAND SLEEVE                      417.00                  1 A4649         Z7610                 270
ORA          7420    2382   INTRAVENOUS CATHETER/ANGIO                    28.00                  1 A4649         X7700                 272
ORA          7420    6656   INTRODUCER KIT/CORDIS                        245.00                  1 A4649         Z7610                 272



                                                          Page 154 of 676
                                                              CM 06/15/07


 Dept                                                                                                                   M/cal
        Cost Ctr.   SIM#                   Description                    Price        Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                  HCPCS
ORA          7420   31254   IRIS RETRACTOR (FLEXIBLE)                       650.00                  1   A4649         Z7610                 272
ORA          7420   72300   ISOLAD ROD                                    1,000.00                  1   A4649         Z7610                 278
ORA          7420   71350   JAG WIRE (STRAIGHT OR ANGLED)                   622.00                  1   A4649         Z7610                 270
ORA          7420   71400   JAMSHIDI NEEDLE 17G X 100                       189.00                  1   A4649         Z7610                 270
ORA          7420   71375   JAMSHIDI NEEDLE 17G X 70                        504.00                  1   A4649         Z7610                 270
ORA          7420    8419   KIT, CRANIOPLASTIC                              561.00                  1   A4649         Z7610                 272
ORA          7420   30306   KIT, HEART COOLING                              263.00                  1   A4649         Z7610                 272
ORA          7420   40750   KIT, NEURO GUIDE PLACEMENT                    3,362.00                  1   A4649         Z7610                 272
ORA          7420    6579   KIT, SUBCLAVIAN DIALYSIS                        958.00                  1   A4820         Z7610                 272
ORA          7420    5589   KIT, SUTURE REMOVAL                              22.00                  1   A4649         Z7610                 272
ORA          7420    4517   KIT, ZIM BONE CEMENT                            710.00                  1   A4649         Z7610                 278
ORA          7420   73075   KLS & MARTIN PLATES                             493.00                  1   A4649         Z7610                 278
ORA          7420   73050   KLS - MARTIN / RESORB-X SCREWS                  531.00                  1   A4649         Z7610                 278
ORA          7420   73100   KLS SCREWS                                      205.00                  1   A4649         Z7610                 278
ORA          7420    9250   KNEE IMMOBILIZER LG                             295.00                  1   L1834         L1834                 274
ORA          7420    9243   KNEE IMMOBILIZER MED                            295.00                  1   L1830         L1830                 274
ORA          7420    9235   KNEE IMMOBILIZER SM                             231.00                  1   L1832         L1832                 274
ORA          7420    1192   L AND B SET UP                                  157.00                  1   A4649         Z7610                 272
ORA          7420    5084   L.A. LINE                                       213.00                  1   A4649         X7700                 272
ORA          7420   73975   LACRICATH BALLOON CATHETER                    1,163.00                  1   A4649         Z7610                 270
ORA          7420   74000   LACRICATH PRESSURE GAUGE                        315.00                  1   A4649         Z7610                 270
ORA          7420   74050   LACRIMAL PLUG, SILICONE                          71.00                  1   A4649         Z7610                 270
ORA          7420    3554   LACT RINGERS 5OOML BAG 2B2323                    80.00                  1   A4649         X7700                 258
ORA          7420    2000   LAMINAR FLOW UNIT                                 0.00 S                    A4649         Z7610                 270
ORA          7420   76000   LAP DRAPE                                        95.00                  1   A4649         Z7610                 270
ORA          7420   30629   LAP, SETUP & INSTRUMENTS                          0.00 S                    A4649         Z7610                 272
ORA          7420   72975   LAPAROSCOPIC SET                                356.00                  1   A4649         Z7610                 270
ORA          7420    2018   LASER                                             0.00 S                    A4649         Z7610                 270
ORA          7420    5633   LATEX-FREE IV SET UP                             90.00                  1   A4649         Z7610                 272
ORA          7420    4129   LCS 16 LAPAR COAG SHEAR                         317.00                  1   A4649         Z7610                 272
ORA          7420      62   LEVEL I EA ADDL 30 MIN                          905.00                  1   Z7508         Z7508                 360
ORA          7420      54   LEVEL I OR BASE 1 HR                          2,716.00                  1   Z7506         Z7506                 360
ORA          7420      80   LEVEL II OR BASE 1 HR                         3,622.00                  1   Z7506         Z7506                 360
ORA          7420      88   LEVEL II OR EA ADDL 30 MIN                    1,472.00                  1   Z7508         Z7508                 360
ORA          7420      96   LEVEL III OR BASE 1 HR                        4,526.00                  1   Z7506         Z7506                 360



                                                             Page 155 of 676
                                                             CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                 Description                     Price          Stats/bill     CPT     Mod             Mod   Rev Code
 Code                                                                                                                 HCPCS
ORA          7420     104   LEVEL III OR EA ADDL 30 MIN                  1,924.00                    1 Z7508         Z7508                 360
ORA          7420    6110   LEVL I BLOOD-FL-WARMER EQ                        0.00   S                  A4649         Z7610                 271
ORA          7420   75650   LI POSUCTION TAP KIT                           222.00                    1 A4649         Z7610                 270
ORA          7420   30827   LIGACLIP APPLIER ER320                         847.00                    1 A4649         Z7610                 272
ORA          7420   31403   LIGHT PIPE, MICROLIGHT                         414.00                    1 A4649         Z7610                 272
ORA          7420    9029   LIGHT, FIBER OPTIC                               0.00   S                  A4649         Z7610                 271
ORA          7420    6330   LIGHTS, FLEX SURG                                0.00   S                  A4649         Z7610                 272
ORA          7420   71875   LINCOFT CYLINDRICAL SPONGE                     318.00                    1 A4649         Z7610                 270
ORA          7420   73125   LIPOSUCTION CANNULA                            189.00                    1 A4649         Z7610                 270
ORA          7420   75775   LIPOSUCTION IRRIGATION TUBING                  104.00                    1 A4649         Z7610                 270
ORA          7420    1317   LITHOTRIPTOR/SUPPLIES                            0.00   S                  A4649         Z7610                 272
ORA          7420   75475   LUER LOCK-PRESSURE TRANSDUCER                   54.00                    1 A4649         Z7610                 270
ORA          7420    6348   LUER STUB ADAPTER                               16.00                    1 A4649         Z7610                 272
ORA          7420   74475   LUMBAR CATHETER                                712.00                    1 A4649         Z7610                 270
ORA          7420   54520   LYSONIX ASP. TUBING                             29.00                    1 99090         Z7610                 272
ORA          7420   54470   LYSONIX FILTER                                  71.00                    1 A4649         Z7610                 272
ORA          7420   54421   LYSONIX IRR. TUBING                            121.00                    1 A4649         Z7610                 272
ORA          7420   72375   MACRO - PORE SCREWS                            570.00                    1 A4649         Z7610                 278
ORA          7420   72850   MACRO POSE POWER BATH DRAPE                    215.00                    1 A4649         Z7610                 270
ORA          7420   72000   MACROPLATE                                   2,532.00                    1 A4649         Z7610                 278
ORA          7420   74375   MACROPORE PLATE                              2,374.00                    1 A4649         Z7610                 278
ORA          7420    1291   MALIS BIPOLAR IRRIG                            181.00                    1 A4649         Z7610                 272
ORA          7420    1309   MALIS CMC BIPOLAR                              181.00                    1 A4649         Z7610                 272
ORA          7420    3873   MANDIBLE DISTRACTION-BILAT                   5,658.00                    1 L8699         L8699                 278
ORA          7420    3881   MANDIBLE DISTRACTION-UNILAT                  2,376.00                    1 A4649         Z7610                 278
ORA          7420    5401   MASTISOL                                         0.00   S                  A4649         Z7610                 271
ORA          7420   76250   MAXILLO FACIAL-PLATES-SCREWS                 2,014.00                    1 A4649         Z7610                 278
ORA          7420   72475   MAXUM ALLIGATOR FORCEPS                          0.00   S                  A4649         Z7610                 270
ORA          7420   74950   MEAGE PISTON 140333                            593.00                    1 A4649         Z7610                 278
ORA          7420   75375   MEASUREMENT TUBING SET                          38.00                    1 A4649         Z7610                 270
ORA          7420   44604   MED FIX LEAD 5068                            5,517.00                    1 A4649         Z7610                 270
ORA          7420   44554   MED THERA PACER                             29,423.00                    1 L8699         L8699                 278
ORA          7420    6462   MEDICINE DROPPER                                 0.00   S                  A4649         Z7610                 271
ORA          7420   73250   MEDPOR / SURGICAL IMPLANT                    2,572.00                    1 L8699         L8699                 278
ORA          7420   73875   MEDPOR ORBITAL IMPLANT                       1,092.00                    1 A4649         Z7610                 278



                                                            Page 156 of 676
                                                           CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                  Description                  Price          Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                 HCPCS
ORA          7420   73900   MEDPOR SHEET / MEDPORE BARRIER SH            506.00                    1   A4649         Z7610                 278
ORA          7420   73950   MEDPOR SHEET G - PROBE LASER               1,947.00                    1   A4649         Z7610                 278
ORA          7420   73925   MEDPOR SHEET ORBITAL IMPLANT               1,092.00                    1   A4649         Z7610                 278
ORA          7420    6397   MESH MARLEX                                  697.00                    1   A4649         Z7610                 278
ORA          7420    9169   MESH, DEXON                                  110.00                    1   A4649         Z7610                 278
ORA          7420   65452   MICRO DEBRIDOR CUTTERS                       522.00                    1   A4649         Z7610                 272
ORA          7420   73025   MICRO PORE / COUNTER SUNK 50 X 50          2,532.00                    1   A4649         Z7610                 278
ORA          7420   73000   MICRO PORE / PROTECTIVE SHEET              1,504.00                    1   A4649         Z7610                 270
ORA          7420    3733   MICRODRAPE                                   103.00                    1   A4649         Z7610                 272
ORA          7420    6686   MICROMAT                                     195.00                    1   A4649         Z7610                 272
ORA          7420    2026   MICROSCOPE-ENT                                 0.00   S                    A4649         Z7610                 271
ORA          7420    2042   MICROSCOPE-NEUROLOGY                           0.00   S                    A4649         Z7610                 271
ORA          7420    2034   MICROSCOPE-OPTHAL                              0.00   S                    A4649         Z7610                 271
ORA          7420    2125   MICROSCOPE-PLASTIC                             0.00   S                    A4649         Z7610                 272
ORA          7420   74925   MIDAS REX 54-212                             315.00                    1   A4649         Z7610                 270
ORA          7420   10045   MIDAS REX B-3 DIAMOND                        501.00                    1   A4649         Z7610                 272
ORA          7420   10052   MIDAS REX C-1                                393.00                    1   A4649         Z7610                 272
ORA          7420   10086   MIDAS REX M 15                               885.00                    1   A4649         Z7610                 272
ORA          7420   10060   MIDAS REX M 2 3 6 8 12                       512.00                    1   A4649         Z7610                 272
ORA          7420   10094   MIDAS REX M 52                               790.00                    1   A4649         Z7610                 272
ORA          7420   10078   MIDAS REX M 8 DIAMOND                        570.00                    1   A4649         Z7610                 271
ORA          7420    9989   MIDAS REX TIPS A14                           686.00                    1   A4649         Z7610                 272
ORA          7420    9997   MIDAS REX TIPS A15                           725.00                    1   A4649         Z7610                 272
ORA          7420   10029   MIDAS REX TIPS AF 5-7-8                      434.00                    1   A4649         Z7610                 272
ORA          7420   10037   MIDAS REX TIPS AM 8                          434.00                    1   A4649         Z7610                 272
ORA          7420   10011   MIDAS REX TIPS B-1-2-3-5                     434.00                    1   A4649         Z7610                 272
ORA          7420    9971   MIDAS REX TIPS MBI-32-33-35                  765.00                    1   A4649         Z7610                 272
ORA          7420   10003   MIDAS REX UNIT                               857.00                    1   A4649         Z7610                 271
ORA          7420    6144   MINI CAUDAL TRAY W/ CATH                     168.00                    1   A4649         Z7610                 272
ORA          7420   72125   MINIE MONOKA                                 158.00                    1   A4649         Z7610                 270
ORA          7420    4533   MIX EVAC                                     299.00                    1   A4649         Z7610                 272
ORA          7420    6763   MOBERG MONITOR                                 0.00   S                    A4649         Z7610                 271
ORA          7420    6771   MOBERG MONITOR ELEC                          173.00                    1   A4649         Z7610                 272
ORA          7420   72875   MOBILE LASER TECHNOLOGIES / MLT                0.00   S                    A4649         Z7610                 270
ORA          7420    6405   MONTGOMERY STRAPS                             18.00                    1   A4649         Z7610                 272



                                                          Page 157 of 676
                                                           CM 06/15/07


 Dept                                                                                                               M/cal
        Cost Ctr.   SIM#                  Description                 Price        Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                              HCPCS
ORA          7420   43952   MORSE MANIFOLD                               54.00                  1   A4649         Z7610                 272
ORA          7420   71425   MULTIBAND LIGATORS                          950.00                  1   A4649         Z7610                 270
ORA          7420   41204   MULTICLIP APPLIER                         4,676.00                  1   A4649         Z7610                 272
ORA          7420   54355   NCP VAGAL NERV STIMULATOR GNRATOR        41,886.00                  1   C1767         C1767                 278
ORA          7420   54363   NCP/VAGAL NERVE STIMULATOR LEAD           9,189.00                  1   C1778         C1778                 278
ORA          7420   54371   NCP/VNS TUNNELER                          1,133.00                  1   A4649         Z7610                 278
ORA          7420    6934   NEEDLE TIPS                                  50.00                  1   A4649         Z7610                 272
ORA          7420    6009   NEEDLE, FILTER                               13.00                  1   A4649         Z7610                 272
ORA          7420   54124   NEEDLE, HUBER                                54.00                  1   A4649         X7700                 272
ORA          7420   32401   NEEDLE, MENISCAL REPAIR                     209.00                  1   A4649         Z7610                 272
ORA          7420    3485   NEEDLE, RETROBULBAR                          64.00                  1   A4649         Z7610                 272
ORA          7420    5233   NEEDLE, SLOTTED                              89.00                  1   A4649         Z7610                 272
ORA          7420   31353   NEEDLE, SOFT TIP                             40.00                  1   A4649         Z7610                 272
ORA          7420    6413   NEEDLE, SPINAL                                0.00 S                    A4649         Z7610                 272
ORA          7420    6439   NEEDLE, TRU-CUT BX                           71.00                  1   A4649         Z7610                 272
ORA          7420    6926   NEEDLEMAGNET                                 29.00                  1   A4649         Z7610                 272
ORA          7420   71450   NEEDLES, BLUNT                              235.00                  1   A4649         Z7610                 270
ORA          7420     654   NERVE STIMULATORS                           238.00                  1   A4649         Z7610                 270
ORA          7420    6454   NERVE STIMULATORS                           378.00                  1   A4649         Z7610                 270
ORA          7420   43903   NEUROPEN                                  2,309.00                  1   A4649         Z7610                 272
ORA          7420    6169   NORMAL SALINE 1000CC                         96.00                  1   J7030         X7700                 258
ORA          7420    9981   O.R. EMERGENCY CHARGE                         0.00 S                    A4649         Z7610                 270
ORA          7420   73175   OIL INFUSION SET                            514.00                  1   A4649         Z7610                 270
ORA          7420   76785   ON Q 100ML 2ML/HR PM039                     719.00                  1   A4306         Z7610                 270
ORA          7420   76795   ON Q 270ML 2ML/HR PM013                     630.00                  1   A4306         Z7610                 270
ORA          7420   76805   ON Q 400ML 4HR 2.5" PM018                 1,061.00                  1   A4306         Z7610                 270
ORA          7420   76825   ON Q 400ML 4ML/HR 10" PM048               1,529.00                  1   A4306         Z7610                 270
ORA          7420   76815   ON Q 400ML 4ML/HR 5" PM028                1,349.00                  1   A4306         Z7610                 270
ORA          7420   76775   ON Q 65ML 0.5ML/HR PM001                    540.00                  1   A4306         Z7610                 270
ORA          7420     119   ONE STEP GASTROSTOMY BUTTON               1,631.00                  1   A4649         Z7610                 278
ORA          7420    6003   ONE-SHOT CAUDAL                             254.00                  1   A4649         Z7610                 272
ORA          7420    4105   OPEN HEART PERFUSION SUPPLIES             2,356.00                  1   A4649         Z7506                 272
ORA          7420       2   OR-EQUIP/SUPP                                 0.00                  1   A4649         Z7610                 279
ORA          7420   74175   ORBITAL IMPRESSION KIT                      264.00                  1   A4649         Z7610                 270
ORA          7420    6715   ORTHO SETUP PACK                            405.00                  1   A4649         Z7610                 272



                                                         Page 158 of 676
                                                             CM 06/15/07


 Dept                                                                                                                M/cal
        Cost Ctr.   SIM#                  Description                    Price        Stats/bill      CPT    Mod             Mod   Rev Code
 Code                                                                                                               HCPCS
ORA          7420   54926   ORTHO TOURNIQUET DISPOSABLE                    275.00                  1 A4649         Z7610                 271
ORA          7420   72175   OTOMED RICE SAFE TRAP                          251.00                  1 A4649         Z7610                 270
ORA          7420    2075   OTOTOME                                        662.00                  1 A4649         Z7610                 272
ORA          7420   30173   PACEMAKER, TEMP                                  0.00 S                  A4649         Z7610                 275
ORA          7420    5365   PACING WIRE, TEMP                              127.00                  1 A4649         Z7610                 272
ORA          7420    5357   PACING WIRE, TEMP (MED)                        229.00                  1 A4649         Z7610                 272
ORA          7420   30389   PACK, ARTHROSCOPY                              607.00                  1 A4649         Z7610                 272
ORA          7420   31155   PACK, BONE MARROW HARVEST                      227.00                  1 A4649         Z7610                 272
ORA          7420   31106   PACK, BRONCHOSCOPY                             312.00                  1 A4649         Z7610                 272
ORA          7420   30363   PACK, ECMO                                     504.00                  1 A4649         Z7610                 272
ORA          7420    9383   PACK, GENERAL LAP                              499.00                  1 A4649         Z7610                 272
ORA          7420    9128   PACK, HEART                                  1,380.00                  1 A4649         Z7610                 272
ORA          7420    9425   PACK, INSERTION                                446.00                  1 A4649         Z7610                 272
ORA          7420    9227   PACK, MAJOR NEURO                            1,171.00                  1 A4649         Z7610                 272
ORA          7420   30371   PACK, MAJOR ORTHO                              741.00                  1 A4649         Z7610                 272
ORA          7420    6876   PACK, MASTOID                                  588.00                  1 A4649         Z7610                 272
ORA          7420   30959   PACK, MINI GENERAL                             168.00                  1 A4649         Z7610                 272
ORA          7420   31007   PACK, MINI PLASTIC                             211.00                  1 A4649         Z7610                 272
ORA          7420    9417   PACK, MINOR LAP                                371.00                  1 A4649         Z7610                 272
ORA          7420    9508   PACK, PLASTIC                                  469.00                  1 A4649         Z7610                 272
ORA          7420    9409   PACK, SPINAL FUSION                          1,046.00                  1 A4649         Z7610                 272
ORA          7420   30405   PACK, STRABISMUS                               300.00                  1 A4649         Z7610                 272
ORA          7420   30090   PACK, THORACIC                                 529.00                  1 A4649         Z7610                 272
ORA          7420   31056   PACK, TONSIL                                   410.00                  1 A4649         Z7610                 272
ORA          7420    9607   PACK, TRACHEOSTOMY                             333.00                  1 A4649         Z7610                 272
ORA          7420   32153   PACK, VITRECTOMY BASIC                         701.00                  1 A4649         Z7610                 272
ORA          7420   32203   PACK, VITRECTOMY DELUXE                      1,085.00                  1 A4649         Z7610                 272
ORA          7420    9219   PACK, VP SHUNT/MINOR NEURO                     761.00                  1 A4649         Z7610                 272
ORA          7420   30439   PACKING, MEROCEL                                54.00                  1 A4649         Z7610                 272
ORA          7420   45106   PACU LINE REMOVAL                                0.00 S                  A4649         Z7610                 270
ORA          7420   72925   PAIN MANAGEMENT SYSTEM ON - Q                  712.00                  1 A4649         Z7610                 278
ORA          7420    2655   PED TRANSFUSION SET                             44.00                  1 A4649         X7700                 272
ORA          7420   30074   PED VENT                                       145.00                  1 A4649         Z7610                 272
ORA          7420   72150   PEDIATRIC BLADE                                593.00                  1 A4649         Z7610                 270
ORA          7420    5443   PEEP VALVE                                     552.00                  1 A4649         Z7610                 272



                                                            Page 159 of 676
                                                            CM 06/15/07


 Dept                                                                                                              M/cal
        Cost Ctr.   SIM#                  Description                  Price        Stats/bill     CPT     Mod               Mod   Rev Code
 Code                                                                                                             HCPCS
ORA          7420   71475   PEG TRAY 16 FR.                            1,216.00                  1 A4649         Z7610                   270
ORA          7420   71500   PEG TRAY 20 FR.                              528.00                  1 A4649         Z7610                   270
ORA          7420    6488   PENCILETTE                                   133.00                  1 A4649         Z7610                   272
ORA          7420    6504   PENS, MARKER                                   0.00 S                  A4649         Z7610                   271
ORA          7420    6561   PER-Q-CATH                                   157.00                  1 A4649         X7700                   272
ORA          7420   74225   PERFLUORON                                 1,781.00                  1 A4649         Z7610                   270
ORA          7420   30207   PERFUSION ADAPTORS                            40.00                  1 A4649         Z7610                   272
ORA          7420   30249   PERICARDIAL SUMP                              87.00                  1 A4649         Z7610                   272
ORA          7420   44455   PERICARDIUM (OPHTH)                        1,257.00                  1 A4649         Z7610                   278
ORA          7420   73600   PERICARDIUM PATCH SCLERAL PATCH C            974.00                  1 A4649         Z7610                   278
ORA          7420    7361   PIGTAIL URETERAL STENT                       821.00                  1 A4649         Z7610                   278
ORA          7420    3568   PISTON WIRE                                  327.00                  1 A4649         Z7610                   272
ORA          7420    6496   PLASTIBELL                                    24.00                  1 A4649         Z7610                   272
ORA          7420    5282   PLEUR-E-VAC (INFANT/ADULT)                   920.00                  1 A4649         Z7610                   272
ORA          7420   75100   PMT CORP - ADAPTER                            95.00                  1 A4649         Z7610                   270
ORA          7420   71525   POLYPECTOMY SNARES (ALL)                     253.00                  1 A4649         Z7610                   270
ORA          7420   76675   POREX NOSTRIL RETAINERS                      332.00                  1 A4649         Z7610                   272
ORA          7420   76175   POSEY STRAPS                                  38.00                  1 A4649         Z7610                   270
ORA          7420   40156   POUCH, STERIDRAPE                             77.00                  1 A4649         Z7610                   272
ORA          7420    2358   PRECORDIAL DOPPLER                             0.00 S                  A4649         Z7610                   272
ORA          7420    2083   PREMIER / MILLENIUM OCUTOME                  905.00                  1 A4649         Z7610                   270
ORA          7420   74800   PRESSURE GAUGE                               380.00                  1 A4649         Z7610                   270
ORA          7420   30777   PROBE IRRIG, CABOT CARSON                    490.00                  1 A4649         Z7610                   272
ORA          7420   30611   PROBE, ELECATH BIPOLAR                       593.00                  1 A4649         Z7610                   272
ORA          7420   31304   PROBE, ENDO LASER                          1,188.00                  1 A4649         Z7610                   272
ORA          7420    7429   PROS, TESTICULAR                           1,553.00                  1 99199             99199               278
ORA          7420    3725   PROS, TORP                                 1,198.00                  1 A4649         Z7610                   278
ORA          7420    4040   PULSE OXIMETER SENSORS                       119.00                  1 A4649         Z7610                   271
ORA          7420   75350   PUMP TUBING SET WITH INFUSSION LI             86.00                  1 A4649         Z7610                   270
ORA          7420    3220   Q TIPS                                         0.00 S                  A4649         Z7610                   271
ORA          7420   30934   RA320 RT ANGLE LIGACLIP                      884.00                  1 A4649         Z7610                   272
ORA          7420   74425   RANDINDID BLADE                              593.00                  1 A4649         Z7610                   270
ORA          7420   74675   RAT TOOTH FORCEPS - MAXUM                  1,424.00                  1 A4649         Z7610                   270
ORA          7420   75400   RECTAL BALLOON (SILICONE)                    135.00                  1 A4649         Z7610                   270
ORA          7420   72450   RECTAL CARTH                                  24.00                  1 A4649         Z7610                   270



                                                          Page 160 of 676
                                                           CM 06/15/07


 Dept                                                                                                                 M/cal
        Cost Ctr.   SIM#                  Description                  Price        Stats/bill        CPT     Mod               Mod   Rev Code
 Code                                                                                                                HCPCS
ORA          7420   65957   RECTAL EMG CATHETER 22FR                   1,733.00                  1   A4649          Z7610                   272
ORA          7420   30835   REDUCER CAP MS512                            150.00                  1   A4649          Z7610                   272
ORA          7420    6029   REINFORCED ET TUBE                           141.00                  1   A4649          Z7610                   272
ORA          7420   41105   RELOAD ERU35                                 777.00                  1   A4649          Z7610                   272
ORA          7420   30447   RESERVOIR, JACKSON PRATT                      82.00                  1   A4649          Z7610                   272
ORA          7420    8443   RESERVOIR, NEURO CATH                        815.00                  1   A4649          Z7610                   278
ORA          7420   72250   RETINARL CAMERA                                0.00 S                    A4649          Z7610                   270
ORA          7420   71925   RUBBER DAM 36 / BOX                            0.00 S                    A4649          Z7610                   270
ORA          7420   76100   S4-330 MIDAS DISSECTING TOOLS                378.00                  1   A4649          Z7610                   270
ORA          7420    5807   SALINE FLUSH SYRINGES                         14.00                  1    90779             90779               250
ORA          7420   71950   SALIVA EJECTOR ( $11.55 & 100 )              317.00                  1   A4649          Z7610                   270
ORA          7420    4624   SAW, GIGLI                                   174.00                  1   A4649          Z7610                   272
ORA          7420    3584   SCLERAL BUCKLE                               158.00                  1   A4649          Z7610                   278
ORA          7420   71575   SCLERO THERAPY NEEDLE                        222.00                  1   A4649          Z7610                   270
ORA          7420    6603   SCROTAL SUPPORT (SM,MED,LG)                   89.00                  1   A4649          Z7610                   271
ORA          7420   75725   SELECTOR & TUBING                          2,101.00                  1   A4649          Z7610                   270
ORA          7420   76500   SELECTOR ASPIRATOR                         2,101.00                  1   A4649          Z7610                   270
ORA          7420   72650   SELF TAPPING SCREW - SYNTHES - 21            617.00                  1   A4649          Z7610                   278
ORA          7420   71550   SENSATION SHORT SNARE                        807.00                  1   A4649          Z7610                   270
ORA          7420    2141   SENSORY EVOKE POTENTIAL                        0.00 S                     95920                                 270
ORA          7420    7304   SET, EXTENSION                                77.00                  1   A4649          X7700                   272
ORA          7420    4855   SET, INJECTOR                                213.00                  1   A4649          Z7610                   272
ORA          7420   30199   SET, MULT PERFUSION                          145.00                  1   A4649          Z7610                   272
ORA          7420   30256   SET, PRESSURE CATH PLACEMENT                 168.00                  1   A4649          Z7610                   272
ORA          7420   30314   SET, ULTRAFILTRATION                         715.00                  1   A4649          Z7610                   272
ORA          7420    4830   SHEEPSKIN                                    127.00                  1   E0188          Z7610                   271
ORA          7420    8047   SHUNT PASSER DISP.                           318.00                  1   A4649          Z7610                   272
ORA          7420   40057   SHUNT, LUMBAR PERI                         1,005.00                  1   A4649          Z7610                   278
ORA          7420   30181   SILASTIC SHEETING                            674.00                  1   A4649          Z7610                   272
ORA          7420    6520   SILASTIC SHEETING CUSTOM                     734.00                  1   A4649          Z7610                   272
ORA          7420   71975   SILASTIC TUBING ESOPHAGOSCOPY SET            475.00                  1   A4649          Z7610                   270
ORA          7420    8070   SILATIC SHEET GEL                             56.00                  1   A4649          Z7610                   272
ORA          7420   54827   SILICONE CHIN IMPLANT                        951.00                  1   A4649          Z7610                   278
ORA          7420   74550   SILICONE FLUID PACK                          277.00                  1   A4649          Z7610                   270
ORA          7420   72050   SILICONE OIL                               1,504.00                  1   A4649          Z7610                   270



                                                          Page 161 of 676
                                                           CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                  Description                  Price          Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                 HCPCS
ORA          7420   73750   SILICONE OIL 1000 ( ALCON )                1,894.00                    1   A4649         Z7610                 270
ORA          7420   73725   SILICONE OIL 5000                          1,894.00                    1   A4649         Z7610                 270
ORA          7420   30140   SILICONE RETRACT-O-TAPE                       47.00                    1   A4649         Z7610                 272
ORA          7420    3295   SILICONE SLEEVES                             254.00                    1   A4649         Z7610                 272
ORA          7420    3196   SILICONE TIRE                                261.00                    1   A4649         Z7610                 278
ORA          7420   54728   SILO BAG                                   1,358.00                    1   A4649         Z7610                 272
ORA          7420   72525   SIM PULSE SOLO SYSTEM                        273.00                    1   A4649         Z7610                 270
ORA          7420   73255   SINGLE LUMEN PICK                            192.00                    1   A4649         Z7610                 270
ORA          7420   73225   SINGLE LUMEN PICK                            303.00                    1   A4649         Z7610                 270
ORA          7420   71850   SINGLE LUMEN POLYURETHONE                    332.00                    1   A4649         Z7610                 270
ORA          7420    6185   SITE RITE ULTRASONIC                          92.00                    1   A4649         Z7610                 270
ORA          7420   76575   SKIMMER BLADE                              1,324.00                    1   A4649         Z7610                 270
ORA          7420    8211   SLOTTED FIFTH VENT SYSTEM                    730.00                    1   A4649         Z7610                 278
ORA          7420   10102   SLUSH UNIT                                     0.00   S                    A4649         Z7610                 270
ORA          7420   75825   SMART NEEDLE                                 621.00                    1   A4649         Z7610                 270
ORA          7420   76475   SOFT TIP CANNULA                             119.00                    1   A4649         Z7610                 270
ORA          7420   72275   SOFT TIP NEEDLE                              119.00                    1   A4649         Z7610                 270
ORA          7420    1283   SOL/SEN WARMER                                 0.00   S                    A4649         Z7610                 271
ORA          7420   30215   SOLU COVER                                     0.00   S                    A4649         Z7610                 272
ORA          7420    2424   SOLUTION ADMINISTRATION SET                   38.00                    1   A4649         X7700                 272
ORA          7420    1176   SOLUTION WARMER                                0.00   S                    A4649         Z7610                 271
ORA          7420   71825   SOMUS PROBE PULSE                            276.00                    1   A4649         Z7610                 270
ORA          7420   72500   SONG CABLE DUPUY                           3,271.00                    1   A4649         Z7610                 278
ORA          7420   74725   SPECTRUM DESIGNS - DURSAL                    855.00                    1   A4649         Z7610                 270
ORA          7420   71600   SPEED 5 BAND LIGATORS                        617.00                    1   A4649         Z7610                 270
ORA          7420   76300   SPHERICAL BURR 4.5                           299.00                    1   A4649         Z7610                 270
ORA          7420    5120   SPINAL TRAY                                  185.00                    1   A4649         Z7610                 272
ORA          7420    4848   SPLINT, FINGER                                34.00                    1   A4649         Z7610                 274
ORA          7420    3576   SPLINTS, NASAL                               180.00                    1   A4570         Z7610                 271
ORA          7420   30512   SPONGE, RAYTEX                                 0.00   S                    A4649         Z7610                 272
ORA          7420    4558   SPONGES, ILLIZAROV                           150.00                    1   A4649         Z7610                 272
ORA          7420   30702   SPONGES, LAP                                   0.00   S                    A4649         Z7610                 272
ORA          7420    3600   SPONGES, SCLERAL                             245.00                    1   A4649         Z7610                 272
ORA          7420    3634   SPONGES, WECKEL                                0.00   S                    A4649         Z7610                 272
ORA          7420   30637   STABILITY THREAD T355                        200.00                    1   A4649         Z7610                 272



                                                          Page 162 of 676
                                                           CM 06/15/07


 Dept                                                                                                                  M/cal
        Cost Ctr.   SIM#                  Description                  Price          Stats/bill        CPT    Mod             Mod   Rev Code
 Code                                                                                                                 HCPCS
ORA          7420   30520   STAPLE, LINEAR                               710.00                    1   A4649         Z7610                 272
ORA          7420   30538   STAPLER RELOAD, LINEAR                       657.00                    1   A4649         Z7610                 272
ORA          7420    6512   STAPLER, SKIN                                102.00                    1   A4649         Z7610                 272
ORA          7420   11058   STAPLES, 3M                                  855.00                    1   A4649         Z7610                 278
ORA          7420   11074   STAPLES, RICHARDS                            317.00                    1   A4649         Z7610                 278
ORA          7420   11066   STAPLES, ZIMMER                              390.00                    1   A4649         Z7610                 278
ORA          7420    1341   STEALTH SYSTEM                                 0.00   S                    A4649         Z7610                 270
ORA          7420   71625   STENT SET                                    480.00                    1   A4649         Z7610                 278
ORA          7420    3469   STENT, D'BOUKER                            1,494.00                    1   A4649         Z7610                 278
ORA          7420    2158   STEREOTATIC                                    0.00   S                    A4649         Z7610                 272
ORA          7420    6959   STERILE CLEAR BAGS                             0.00   S                    A4649         Z7610                 272
ORA          7420    6130   STERILE SALINE                               101.00                    1   J3490         X7704                 272
ORA          7420    6122   STERILE WATER                                101.00                    1   J3490         X7704                 272
ORA          7420    6389   STERISTRIPS                                   18.00                    1   A4649         Z7610                 272
ORA          7420   76350   STERNUM SAW                                    0.00   S                    A4649         Z7610                 270
ORA          7420    4889   STOCKINETTE, TUBULAR-ALL                     176.00