106311000-CDM_2005.xls - OSHPD - Excel

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					                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9709874   ADJ - ACCT CONSOLIDATION           0.00        0.00   97         AR ADJUSTMENTS
9708652   ADJ - INTEREST CHARGE              0.00        0.00   97         AR ADJUSTMENTS
9701582   ADJ. INSURED SERVICES REC          0.00        0.00   97         AR ADJUSTMENTS
9700972   ADJUSTMENT - MSIC CONV             0.00        0.00   97         AR ADJUSTMENTS
9701590   ADJUSTMENT - SUTTER HOSPI          0.00        0.00   97         AR ADJUSTMENTS
9708678   ALLOWANCE - C.O.B.                 0.00        0.00   97         AR ADJUSTMENTS
9709957   ALLOWANCE - INSURANCE C/A          0.00        0.00   97         AR ADJUSTMENTS
9700477   ALLOWANCE-ADMINISTRATIVE           0.00        0.00   97         AR ADJUSTMENTS
9701970   CHARITY CARE-CATASTROPHIC          0.00        0.00   97         AR ADJUSTMENTS
9701988   CHARITY CARE-CATASTROPHIC          0.00        0.00   97         AR ADJUSTMENTS
9701921   CHARITY CARE-FULL CHARITY          0.00        0.00   97         AR ADJUSTMENTS
9701913   CHARITY CARE-FULL CHARITY          0.00        0.00   97         AR ADJUSTMENTS
9701939   CHARITY CARE-PARTIAL CHAR          0.00        0.00   97         AR ADJUSTMENTS
9701962   CHARITY CARE-PARTIAL CHAR          0.00        0.00   97         AR ADJUSTMENTS
9701244   DENIAL - CHARGES W/O               0.00        0.00   97         AR ADJUSTMENTS
9701285   DENIAL - DAYS W/O                  0.00        0.00   97         AR ADJUSTMENTS
9708975   DENIAL - NON-AUTH W/O              0.00        0.00   97         AR ADJUSTMENTS
9707167   EMPLOYEE PHYSICALS                 0.00        0.00   97         AR ADJUSTMENTS
9708983   ERROR - CBO W/O                    0.00        0.00   97         AR ADJUSTMENTS
9709973   ERROR - CM/UR W/O                  0.00        0.00   97         AR ADJUSTMENTS
9700899   ERROR - IT W/O                     0.00        0.00   97         AR ADJUSTMENTS
9708967   ERROR - MEDICAL REC W/O            0.00        0.00   97         AR ADJUSTMENTS
9708942   ERROR - REGISTRATION W/O           0.00        0.00   97         AR ADJUSTMENTS
9701616   ERROR-VENDOR                       0.00        0.00   97         AR ADJUSTMENTS
9706268   ESCHEAT TO STATE                   0.00        0.00   97         AR ADJUSTMENTS
9709866   ESCHEATMENT-INSURANCE W/O          0.00        0.00   97         AR ADJUSTMENTS
9709569   ESCHEATMENT-PRIVATE PAY W          0.00        0.00   97         AR ADJUSTMENTS
9708694   MESSAGE - APPEAL SENT              0.00        0.00   97         AR ADJUSTMENTS
9708629   REFUND - INSURANCE                 0.00        0.00   97         AR ADJUSTMENTS
9708587   REFUND - PATIENT                   0.00        0.00   97         AR ADJUSTMENTS
9708561   RETURNED CHECK - INSURANC          0.00        0.00   97         AR ADJUSTMENTS
9708538   RETURNED CHECK - PATIENT           0.00        0.00   97         AR ADJUSTMENTS
9708488   TRANSFER - BABY CHARGES            0.00        0.00   97         AR ADJUSTMENTS
9708603   TRANSFER - INS PAYMENT             0.00        0.00   97         AR ADJUSTMENTS
9700444   TRANSFER - INTER HOSPTIAL          0.00        0.00   97         AR ADJUSTMENTS
9708611   TRANSFER - PRIVATE PMT             0.00        0.00   97         AR ADJUSTMENTS
9700642   TRANSFER - SUTTER ENTITY           0.00        0.00   97         AR ADJUSTMENTS
9799990   TRANSFER FROM AR TO BD             0.00        0.00   97         AR ADJUSTMENTS
9799917   TRANSFER FROM BD TO AR             0.00        0.00   97         AR ADJUSTMENTS
9708579   TRANSFER-ACCOUNT BALANCE           0.00        0.00   97         AR ADJUSTMENTS
9701434   W/O - ANCILLARY DEPTMENT           0.00        0.00   97         AR ADJUSTMENTS
9709916   W/O - BAD DEBT                     0.00        0.00   97         AR ADJUSTMENTS
9708660   W/O - INSURANCE INTEREST           0.00        0.00   97         AR ADJUSTMENTS
9701400   W/O - LATE CHARGES                 0.00        0.00   97         AR ADJUSTMENTS
9701467   W/O - MEDICARE SECONDARY           0.00        0.00   97         AR ADJUSTMENTS
9701475   W/O - SUB ACUTE MISC CON           0.00        0.00   97         AR ADJUSTMENTS
9702390   W/O - SUTTER SNF                   0.00        0.00   97         AR ADJUSTMENTS
9704008   W/O - VARIANCE                     0.00        0.00   97         AR ADJUSTMENTS
9701608   W/O ARBITRATION VARIANCE           0.00        0.00   97         AR ADJUSTMENTS
9700709   W/O DISCOUNT-EMPLOYEE ALL          0.00        0.00   97         AR ADJUSTMENTS
9701442   W/O DISCOUNT-NEGOTIATED I          0.00        0.00   97         AR ADJUSTMENTS
9708645   W/O DISCOUNT-PRIVATE PAY           0.00        0.00   97         AR ADJUSTMENTS
9707225   W/O DISCOUNT-SPECIAL PACK          0.00        0.00   97         AR ADJUSTMENTS




                                                Page 1
                               85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9707522   W/O EMPLOYEE INJURY               0.00        0.00   97         AR ADJUSTMENTS
9701483   W/O KAISER VARIANCE               0.00        0.00   97         AR ADJUSTMENTS
9704842   W/O OVER 360 CRITERIA             0.00        0.00   97         AR ADJUSTMENTS
9700683   W/O SMALL BALANCE                 0.00        0.00   97         AR ADJUSTMENTS
9701277   W/O UNBILLABLE CHARGES            0.00        0.00   97         AR ADJUSTMENTS
9708926   W/O UNCOMPENSATED CARE            0.00        0.00   97         AR ADJUSTMENTS
9707209   W/O-DISCOUNT-EXPERIMENTAL         0.00        0.00   97         AR ADJUSTMENTS
9701293   W/O-OVERLAPPING STAY              0.00        0.00   97         AR ADJUSTMENTS
9704107   W/O-SPECIAL CIRCUMSTANCES         0.00        0.00   97         AR ADJUSTMENTS
9704222   W/O-TRANSPLANT DONOR-HEAR         0.00        0.00   97         AR ADJUSTMENTS
9704180   W/O-TRANSPLANT DONOR-KIDN         0.00        0.00   97         AR ADJUSTMENTS
9704206   W/O-TRANSPLANT DONOR-LIVE         0.00        0.00   97         AR ADJUSTMENTS
9704123   W/O-TRANSPLANT GLOBAL RAT         0.00        0.00   97         AR ADJUSTMENTS
9704149   W/O-TRANSPLANT GLOBAL RAT         0.00        0.00   97         AR ADJUSTMENTS
9704164   W/O-TRANSPLANT GLOBAL RAT         0.00        0.00   97         AR ADJUSTMENTS
9980012   AARP                              0.00        0.00   99         AR PAYMENTS
9971110   ACCORDIA BENEFIT SERVICES         0.00        0.00   99         AR PAYMENTS
9970013   ADMAR PPO                         0.00        0.00   99         AR PAYMENTS
9999988   ADMINISTRATION CONVERSION         0.00        0.00   99         AR PAYMENTS
9999558   ADMINISTRATIVE DUMMY ACCO         0.00        0.00   99         AR PAYMENTS
9970039   AENTA PPO                         0.00        0.00   99         AR PAYMENTS
9970021   AETNA EPO MANAGED CHOICE          0.00        0.00   99         AR PAYMENTS
9960014   AETNA HMO                         0.00        0.00   99         AR PAYMENTS
9960642   AETNA HMO GOULD                   0.00        0.00   99         AR PAYMENTS
9967373   AETNA HMO SIP IPA                 0.00        0.00   99         AR PAYMENTS
9967365   AETNA HMO SMG IPA                 0.00        0.00   99         AR PAYMENTS
9966201   AETNA HMO SMG IPA                 0.00        0.00   99         AR PAYMENTS
9967381   AETNA HMO SWMG IPA                0.00        0.00   99         AR PAYMENTS
9980020   AETNA INDEMNITY                   0.00        0.00   99         AR PAYMENTS
9973025   AETNA NAP PPO                     0.00        0.00   99         AR PAYMENTS
9970070   AETNA SELECT PPO                  0.00        0.00   99         AR PAYMENTS
9915018   AETNA SENIOR CHOICE MEDIC         0.00        0.00   99         AR PAYMENTS
9977018   AETNA WORKERS COMP PPO            0.00        0.00   99         AR PAYMENTS
9971003   AFFORDABLE FIRST HEALTH P         0.00        0.00   99         AR PAYMENTS
9977026   AFFORDABLE FIRST HEALTH W         0.00        0.00   99         AR PAYMENTS
9980178   ALLSTATE                          0.00        0.00   99         AR PAYMENTS
9980038   ALTA REGIONAL                     0.00        0.00   99         AR PAYMENTS
9971102   AMERICAN HEALTH NETWORK A         0.00        0.00   99         AR PAYMENTS
9950023   ASSOCIATED CLAIMS WORKERS         0.00        0.00   99         AR PAYMENTS
9980137   AUTO INSURANCE MISC PAY           0.00        0.00   99         AR PAYMENTS
9971201   BEECH STREET PPO                  0.00        0.00   99         AR PAYMENTS
9977034   BEECH STREET WORKERS COMP         0.00        0.00   99         AR PAYMENTS
9970062   BENEFIT PANEL SERVICE EPO         0.00        0.00   99         AR PAYMENTS
9971300   BENEFIT PANEL SERVICES PP         0.00        0.00   99         AR PAYMENTS
9977042   BENEFIT RISK MNGMENT W/C          0.00        0.00   99         AR PAYMENTS
9970641   BLUE CORSS OUT OF STATE           0.00        0.00   99         AR PAYMENTS
9973009   BLUE CROSS CAL PERS PYMNT         0.00        0.00   99         AR PAYMENTS
9960022   BLUE CROSS CALIF CARE HMO         0.00        0.00   99         AR PAYMENTS
9964123   BLUE CROSS CALIFORNIA CAR         0.00        0.00   99         AR PAYMENTS
9971540   BLUE CROSS DELTA BENE SCH         0.00        0.00   99         AR PAYMENTS
9970732   BLUE CROSS FEDERAL PPO            0.00        0.00   99         AR PAYMENTS
9966052   BLUE CROSS HILL HMO IPA           0.00        0.00   99         AR PAYMENTS
9966086   BLUE CROSS HMO MDCL               0.00        0.00   99         AR PAYMENTS




                                               Page 2
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9966755   BLUE CROSS HMO OTHER IPA           0.00        0.00   99         AR PAYMENTS
9966011   BLUE CROSS HMO SIP IPA             0.00        0.00   99         AR PAYMENTS
9966029   BLUE CROSS HMO SMG IPA             0.00        0.00   99         AR PAYMENTS
9966045   BLUE CROSS HMO SNMG IPA            0.00        0.00   99         AR PAYMENTS
9966037   BLUE CROSS HMO SWMG IPA            0.00        0.00   99         AR PAYMENTS
9966060   BLUE CROSS HMO UCDMG IPA           0.00        0.00   99         AR PAYMENTS
9971557   BLUE CROSS INTERPLN CEMNT          0.00        0.00   99         AR PAYMENTS
9971599   BLUE CROSS MCS NETWORK             0.00        0.00   99         AR PAYMENTS
9971573   BLUE CROSS OF CA CARPENTE          0.00        0.00   99         AR PAYMENTS
9977315   BLUE CROSS OTHER W/C PPO           0.00        0.00   99         AR PAYMENTS
9970633   BLUE CROSS OUT OF STATE            0.00        0.00   99         AR PAYMENTS
9980053   BLUE CROSS OUT OF STATE            0.00        0.00   99         AR PAYMENTS
9970096   BLUE CROSS PBP                     0.00        0.00   99         AR PAYMENTS
9970849   BLUE CROSS PERS CARE               0.00        0.00   99         AR PAYMENTS
9921040   BLUE CROSS SAC COUNTY GMC          0.00        0.00   99         AR PAYMENTS
9970138   BLUE CROSS STANDARD                0.00        0.00   99         AR PAYMENTS
9964115   BLUE SHIELD CAP                    0.00        0.00   99         AR PAYMENTS
9964131   BLUE SHIELD HLTHY FAMILIE          0.00        0.00   99         AR PAYMENTS
9960030   BLUE SHIELD HMO                    0.00        0.00   99         AR PAYMENTS
9966136   BLUE SHIELD HMO HILL IPA           0.00        0.00   99         AR PAYMENTS
9966169   BLUE SHIELD HMO MDCL               0.00        0.00   99         AR PAYMENTS
9966763   BLUE SHIELD HMO OTHER IPA          0.00        0.00   99         AR PAYMENTS
9966094   BLUE SHIELD HMO SIP IPA            0.00        0.00   99         AR PAYMENTS
9966102   BLUE SHIELD HMO SMG IPA            0.00        0.00   99         AR PAYMENTS
9960501   BLUE SHIELD HMO ST JOSEPH          0.00        0.00   99         AR PAYMENTS
9966110   BLUE SHIELD HMO SWMG IPA           0.00        0.00   99         AR PAYMENTS
9960659   BLUE SHIELD HMO UCD                0.00        0.00   99         AR PAYMENTS
9966144   BLUE SHIELD HMO UCDMG IPA          0.00        0.00   99         AR PAYMENTS
9960527   BLUE SHIELD IFP HMO                0.00        0.00   99         AR PAYMENTS
9960576   BLUE SHIELD MERCY                  0.00        0.00   99         AR PAYMENTS
9970625   BLUE SHIELD OUT OF STATE           0.00        0.00   99         AR PAYMENTS
9970716   BLUE SHIELD OUT OF STATE           0.00        0.00   99         AR PAYMENTS
9970146   BLUE SHIELD PERF SR PLAN           0.00        0.00   99         AR PAYMENTS
9970104   BLUE SHIELD PERS PPO               0.00        0.00   99         AR PAYMENTS
9960683   BLUE SHIELD PERSCHOICE PY          0.00        0.00   99         AR PAYMENTS
9970112   BLUE SHIELD PPO                    0.00        0.00   99         AR PAYMENTS
9980046   BLUE SHILED OUT OF STATE           0.00        0.00   99         AR PAYMENTS
9932187   CA FORENSIC GROUP CFMG             0.00        0.00   99         AR PAYMENTS
9970153   CALIF YOUTH AUTHORITY              0.00        0.00   99         AR PAYMENTS
9931098   CANCER STUDIES                     0.00        0.00   99         AR PAYMENTS
9970161   CAPPCARE BEECH ST PPO              0.00        0.00   99         AR PAYMENTS
9931106   CARDIAC REHAB                      0.00        0.00   99         AR PAYMENTS
9970187   CCN GLOBAL PPO                     0.00        0.00   99         AR PAYMENTS
9971409   CCN PPO                            0.00        0.00   99         AR PAYMENTS
9977059   CCN WORKERS COMP PPO               0.00        0.00   99         AR PAYMENTS
9923046   CCS BUTTE COUNTY                   0.00        0.00   99         AR PAYMENTS
9923988   CCS CONVERSION                     0.00        0.00   99         AR PAYMENTS
9923996   CCS OTHER COUNTIES                 0.00        0.00   99         AR PAYMENTS
9923038   CCS PLACER COUNTY                  0.00        0.00   99         AR PAYMENTS
9900234   CCS REFERRED                       0.00        0.00   99         AR PAYMENTS
9923020   CCS REGIONAL                       0.00        0.00   99         AR PAYMENTS
9923012   CCS SACRAMENTO COUNTY              0.00        0.00   99         AR PAYMENTS
9923061   CCS SAN JOAQUIN COUNTY             0.00        0.00   99         AR PAYMENTS




                                                Page 3
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9923053   CCS SOLANO COUNTY                  0.00        0.00   99         AR PAYMENTS
9971581   CEMENT MASONS/HLTH/WELFAR          0.00        0.00   99         AR PAYMENTS
9930025   CHAMP VA                           0.00        0.00   99         AR PAYMENTS
9930983   CHAMPUS CONVERSION                 0.00        0.00   99         AR PAYMENTS
9930058   CHAMPUS MTF ACTIVE DUTY            0.00        0.00   99         AR PAYMENTS
9930017   CHAMPUS TRICARE                    0.00        0.00   99         AR PAYMENTS
9960592   CHARTER BEHAV HEALTH OF N          0.00        0.00   99         AR PAYMENTS
9927039   CHDP                               0.00        0.00   99         AR PAYMENTS
9980202   CIGNA CONNECTICUT GENERAL          0.00        0.00   99         AR PAYMENTS
9960048   CIGNA HMO                          0.00        0.00   99         AR PAYMENTS
9966854   CIGNA HMO UCDMG IPA                0.00        0.00   99         AR PAYMENTS
9980095   CIGNA INDEMNITY                    0.00        0.00   99         AR PAYMENTS
9910035   CIGNA NG                           0.00        0.00   99         AR PAYMENTS
9970237   CIGNA PPO                          0.00        0.00   99         AR PAYMENTS
9932021   CITY OF ROSEVILLE                  0.00        0.00   99         AR PAYMENTS
9977141   CITY OF SACRAMENTO W/C PP          0.00        0.00   99         AR PAYMENTS
9977075   CLAIMS MANAGEMENT W/C PPO          0.00        0.00   99         AR PAYMENTS
9927013   CMISP SAC CO MIA                   0.00        0.00   99         AR PAYMENTS
9927021   CMSP                               0.00        0.00   99         AR PAYMENTS
9927989   CMSP CONVERSION                    0.00        0.00   99         AR PAYMENTS
9977083   COMPRO PHN W/C PPO                 0.00        0.00   99         AR PAYMENTS
9980426   CORRECTIONAL HEALTH SERVI          0.00        0.00   99         AR PAYMENTS
9900267   COSMETIC SURGERY                   0.00        0.00   99         AR PAYMENTS
9932195   COUNTY OF SACRAMENTO               0.00        0.00   99         AR PAYMENTS
9931015   COWELL                             0.00        0.00   99         AR PAYMENTS
9980152   CSAA                               0.00        0.00   99         AR PAYMENTS
9990011   DEPT OF REHAB                      0.00        0.00   99         AR PAYMENTS
9932096   DEPT OF SOCIAL SERVICES            0.00        0.00   99         AR PAYMENTS
9931270   DONORS FAMILY RELATED              0.00        0.00   99         AR PAYMENTS
9999228   EMPLOYEE PAYROLL DEDUCTIO          0.00        0.00   99         AR PAYMENTS
9999053   EMPLOYEE PHYSICALS                 0.00        0.00   99         AR PAYMENTS
9900317   ENTITLEMENT                        0.00        0.00   99         AR PAYMENTS
9900994   EQUIFAX                            0.00        0.00   99         AR PAYMENTS
9931189   EVALUATION KIDNEY                  0.00        0.00   99         AR PAYMENTS
9960428   EXCEL MED GROUP                    0.00        0.00   99         AR PAYMENTS
9980434   FAMILY STATIONS INC                0.00        0.00   99         AR PAYMENTS
9933029   FEDERAL GOVERNMENT MISC            0.00        0.00   99         AR PAYMENTS
9964057   FHP TAKECARE CAPITATION            0.00        0.00   99         AR PAYMENTS
9960188   FHP TAKECARE HMO                   0.00        0.00   99         AR PAYMENTS
9966656   FHP TAKECARE HMO HILL IPA          0.00        0.00   99         AR PAYMENTS
9960394   FHP TAKECARE HMO LODI MEM          0.00        0.00   99         AR PAYMENTS
9960410   FHP TAKECARE HMO MARSHALL          0.00        0.00   99         AR PAYMENTS
9966607   FHP TAKECARE HMO MODESTO           0.00        0.00   99         AR PAYMENTS
9966805   FHP TAKECARE HMO OTHER IP          0.00        0.00   99         AR PAYMENTS
9966615   FHP TAKECARE HMO SIP IPA           0.00        0.00   99         AR PAYMENTS
9966623   FHP TAKECARE HMO SMG IPA           0.00        0.00   99         AR PAYMENTS
9966649   FHP TAKECARE HMO SNMG IPA          0.00        0.00   99         AR PAYMENTS
9966631   FHP TAKECARE HMO SWMG IPA          0.00        0.00   99         AR PAYMENTS
9960386   FHP TAKECARE HMO UCD               0.00        0.00   99         AR PAYMENTS
9966664   FHP TAKECARE HMO UCDMG IP          0.00        0.00   99         AR PAYMENTS
9900101   FINANCIAL AGREEMENT                0.00        0.00   99         AR PAYMENTS
9971011   FIRST HEALTH PPO                   0.00        0.00   99         AR PAYMENTS
9960477   FOUNDATION HEALTH 65 PLUS          0.00        0.00   99         AR PAYMENTS




                                                Page 4
                               85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9960055   FOUNDATION HEALTH HMO             0.00        0.00   99         AR PAYMENTS
9960105   FOUNDATION HEALTH MERCY           0.00        0.00   99         AR PAYMENTS
9960139   FOUNDATION HEALTH UCD             0.00        0.00   99         AR PAYMENTS
9977091   FOUNDATION HEALTH W/C PPO         0.00        0.00   99         AR PAYMENTS
9971037   GEHA GOV EMP HEALTH ASSOC         0.00        0.00   99         AR PAYMENTS
9980004   GENERIC INSURANCE                 0.00        0.00   99         AR PAYMENTS
9950007   GENERIC WORKERS COMPENSAT         0.00        0.00   99         AR PAYMENTS
9923079   GHPP                              0.00        0.00   99         AR PAYMENTS
9990128   GOLDEN STATE DONOR SERVIC         0.00        0.00   99         AR PAYMENTS
9933987   GOVERNMENT OTHER CONVERSI         0.00        0.00   99         AR PAYMENTS
9931981   GRANTS/APPROVED RESEARCH          0.00        0.00   99         AR PAYMENTS
9971722   GREAT WEST LIFE                   0.00        0.00   99         AR PAYMENTS
9971912   GREAT WEST LIFE OHP               0.00        0.00   99         AR PAYMENTS
9990250   HEALTH CARE LEGAL SERVICE         0.00        0.00   99         AR PAYMENTS
9970294   HEALTHCARE FOUND OF SUP C         0.00        0.00   99         AR PAYMENTS
9970286   HEALTHCARE FOUND OF SUP C         0.00        0.00   99         AR PAYMENTS
9900184   HEALTHCASH                        0.00        0.00   99         AR PAYMENTS
9921131   HEALTHNET GMC/EHS                 0.00        0.00   99         AR PAYMENTS
9966599   HEALTHNET GOULD IPA               0.00        0.00   99         AR PAYMENTS
9964149   HEALTHNET HLTHY FAMILIES          0.00        0.00   99         AR PAYMENTS
9960063   HEALTHNET HMO                     0.00        0.00   99         AR PAYMENTS
9960402   HEALTHNET HMO GOULD               0.00        0.00   99         AR PAYMENTS
9966300   HEALTHNET HMO HILL IPA            0.00        0.00   99         AR PAYMENTS
9966334   HEALTHNET HMO MEDCLINIC I         0.00        0.00   99         AR PAYMENTS
9960246   HEALTHNET HMO MERCY               0.00        0.00   99         AR PAYMENTS
9966268   HEALTHNET HMO SIP IPA             0.00        0.00   99         AR PAYMENTS
9966276   HEALTHNET HMO SMG IPA             0.00        0.00   99         AR PAYMENTS
9966284   HEALTHNET HMO SWMG IPA            0.00        0.00   99         AR PAYMENTS
9960253   HEALTHNET HMO UCD                 0.00        0.00   99         AR PAYMENTS
9966318   HEALTHNET HMO UCDMG IPA           0.00        0.00   99         AR PAYMENTS
9970831   HEALTHNET OPTIONS PPO             0.00        0.00   99         AR PAYMENTS
9960626   HEALTHNET OTHER HOSPITAL          0.00        0.00   99         AR PAYMENTS
9960287   HEALTHNET SELECT HMO              0.00        0.00   99         AR PAYMENTS
9970864   HEALTHNET SELECT PPO              0.00        0.00   99         AR PAYMENTS
9970856   HEALTHNET SELECT PPO POS          0.00        0.00   99         AR PAYMENTS
9967399   HEALTHNET SELECT SIP              0.00        0.00   99         AR PAYMENTS
9967407   HEALTHNET SELECT SMG              0.00        0.00   99         AR PAYMENTS
9914011   HEALTHNET SR CAP                  0.00        0.00   99         AR PAYMENTS
9916560   HEALTHNET SR DELTA IPA            0.00        0.00   99         AR PAYMENTS
9916578   HEALTHNET SR EL DORADO IP         0.00        0.00   99         AR PAYMENTS
9916545   HEALTHNET SR GOLDEN ST IP         0.00        0.00   99         AR PAYMENTS
9915208   HEALTHNET SR GOULD                0.00        0.00   99         AR PAYMENTS
9916511   HEALTHNET SR GOULD IPA            0.00        0.00   99         AR PAYMENTS
9916040   HEALTHNET SR HILL IPA             0.00        0.00   99         AR PAYMENTS
9916503   HEALTHNET SR LODI PRI IPA         0.00        0.00   99         AR PAYMENTS
9915190   HEALTHNET SR LODI PRIMARY         0.00        0.00   99         AR PAYMENTS
9916057   HEALTHNET SR MEDCLINIC IP         0.00        0.00   99         AR PAYMENTS
9915067   HEALTHNET SR MEDICARE HMO         0.00        0.00   99         AR PAYMENTS
9915166   HEALTHNET SR OTHER HOSP           0.00        0.00   99         AR PAYMENTS
9916214   HEALTHNET SR OTHER IPA            0.00        0.00   99         AR PAYMENTS
9915042   HEALTHNET SR PLUS MERCY H         0.00        0.00   99         AR PAYMENTS
9916529   HEALTHNET SR SIERRA NV IP         0.00        0.00   99         AR PAYMENTS
9915216   HEALTHNET SR SIERRA NV ME         0.00        0.00   99         AR PAYMENTS




                                               Page 5
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9916537   HEALTHNET SR SIERRA V IPA          0.00        0.00   99         AR PAYMENTS
9916024   HEALTHNET SR SIP IPA               0.00        0.00   99         AR PAYMENTS
9916016   HEALTHNET SR SMG IPA               0.00        0.00   99         AR PAYMENTS
9916032   HEALTHNET SR SWNG IPA              0.00        0.00   99         AR PAYMENTS
9915059   HEALTHNET SR UCD HMO               0.00        0.00   99         AR PAYMENTS
9916495   HEALTHNET SR UCD IPA               0.00        0.00   99         AR PAYMENTS
9916552   HEALTHNET SR WOODLAND IPA          0.00        0.00   99         AR PAYMENTS
9977109   HEALTHNET WORKERS COMP PP          0.00        0.00   99         AR PAYMENTS
9933078   HEALTHY FAMILIES BC PMT            0.00        0.00   99         AR PAYMENTS
9960543   HEALTHY FAMILIES BLUE CRO          0.00        0.00   99         AR PAYMENTS
9960550   HEALTHY FAMILIES BLUE SHI          0.00        0.00   99         AR PAYMENTS
9933086   HEALTHY FAMILIES BS PMT            0.00        0.00   99         AR PAYMENTS
9960568   HEALTHY FAMILIES HEALTHNE          0.00        0.00   99         AR PAYMENTS
9933094   HEALTHY FAMILIES HN PMT            0.00        0.00   99         AR PAYMENTS
9933128   HEALTHY FAMILIES MISC PMT          0.00        0.00   99         AR PAYMENTS
9967415   HELATHNET SELECT SWMG              0.00        0.00   99         AR PAYMENTS
9970971   HIGH DOLLAR                        0.00        0.00   99         AR PAYMENTS
9960972   HIGH DOLLAR                        0.00        0.00   99         AR PAYMENTS
9999202   HIGH DOLLAR PROJECT                0.00        0.00   99         AR PAYMENTS
9966987   HMO CAPITATION CONVERSION          0.00        0.00   99         AR PAYMENTS
9964982   HMO CAPITATION HOSPITAL C          0.00        0.00   99         AR PAYMENTS
9960980   HMO CONVERSION                     0.00        0.00   99         AR PAYMENTS
9967985   HMO CPAITATION IPA CONVER          0.00        0.00   99         AR PAYMENTS
9960006   HMO NON CONTRACTING OTHER          0.00        0.00   99         AR PAYMENTS
9977158   INDUSTRIAL INDEMNITY/IND           0.00        0.00   99         AR PAYMENTS
9970310   INTEGRATED HEALTHCARE ADM          0.00        0.00   99         AR PAYMENTS
9971508   INTERPLAN PPO                      0.00        0.00   99         AR PAYMENTS
9977117   INTERPLAN WORKERS COMP PP          0.00        0.00   99         AR PAYMENTS
9970385   IPM HEALTH AND WELFARE ST          0.00        0.00   99         AR PAYMENTS
9960071   KAISER HMO                         0.00        0.00   99         AR PAYMENTS
9921057   KAISER SACRAMENTO COUNTY           0.00        0.00   99         AR PAYMENTS
9915026   KAISER SR ADVANTAGE                0.00        0.00   99         AR PAYMENTS
9915182   KAISER SR ADVANTAGE PSYCH          0.00        0.00   99         AR PAYMENTS
9960519   KASIER NEONATAL TRANSPORT          0.00        0.00   99         AR PAYMENTS
9970930   LABORERS HEALTH & WELFARE          0.00        0.00   99         AR PAYMENTS
9900119   LEGAL                              0.00        0.00   99         AR PAYMENTS
9960089   LIFEGUARD HMO                      0.00        0.00   99         AR PAYMENTS
9970948   MAILHANDLERS BENEFIT TRUS          0.00        0.00   99         AR PAYMENTS
9960113   MAXICARE HMO                       0.00        0.00   99         AR PAYMENTS
9966342   MAXICARE HMO SIP IPA               0.00        0.00   99         AR PAYMENTS
9966359   MAXICARE HMO SMG IPA               0.00        0.00   99         AR PAYMENTS
9917048   MCARE HMO CARD/SIP/SMG/SW          0.00        0.00   99         AR PAYMENTS
9990078   MED FIN                            0.00        0.00   99         AR PAYMENTS
9960121   MEDCLINIC BEHAVORAL HMO            0.00        0.00   99         AR PAYMENTS
9920018   MEDI-CAL                           0.00        0.00   99         AR PAYMENTS
9924986   MEDI-CAL CAPITATION CONV           0.00        0.00   99         AR PAYMENTS
9922055   MEDI-CAL CCS BUTTE COUNTY          0.00        0.00   99         AR PAYMENTS
9922980   MEDI-CAL CCS CONVERSION            0.00        0.00   99         AR PAYMENTS
9922022   MEDI-CAL CCS GMC                   0.00        0.00   99         AR PAYMENTS
9922097   MEDI-CAL CCS OTHER COUNTI          0.00        0.00   99         AR PAYMENTS
9922048   MEDI-CAL CCS PLACER COUNT          0.00        0.00   99         AR PAYMENTS
9922030   MEDI-CAL CCS REGIONAL              0.00        0.00   99         AR PAYMENTS
9922014   MEDI-CAL CCS SACRAMENTO C          0.00        0.00   99         AR PAYMENTS




                                                Page 6
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9922063   MEDI-CAL CCS SOLANO COUNT          0.00        0.00   99         AR PAYMENTS
9970393   MEDICAL CONTROL INC PPO            0.00        0.00   99         AR PAYMENTS
9920984   MEDI-CAL CONVERSION                0.00        0.00   99         AR PAYMENTS
9922089   MEDI-CAL GHPP                      0.00        0.00   99         AR PAYMENTS
9921982   MEDI-CAL GMC CONVERSION            0.00        0.00   99         AR PAYMENTS
9925983   MEDI-CAL HMO CONVERSION            0.00        0.00   99         AR PAYMENTS
9925017   MEDI-CAL HMO OTHER                 0.00        0.00   99         AR PAYMENTS
9920083   MEDI-CAL I/P CROSSOVER             0.00        0.00   99         AR PAYMENTS
9925058   MEDI-CAL OMNI HMO                  0.00        0.00   99         AR PAYMENTS
9920075   MEDI-CAL OUT OF STATE              0.00        0.00   99         AR PAYMENTS
9900093   MEDI-CAL REFERRED                  0.00        0.00   99         AR PAYMENTS
9914987   MEDICARE CAPITATION CONVE          0.00        0.00   99         AR PAYMENTS
9910985   MEDICARE CONVERSION                0.00        0.00   99         AR PAYMENTS
9910076   MEDICARE DRG ADJUSTMENT            0.00        0.00   99         AR PAYMENTS
9915984   MEDICARE HMO CONVERSION            0.00        0.00   99         AR PAYMENTS
9915141   MEDICARE HMO OTHER                 0.00        0.00   99         AR PAYMENTS
9917022   MEDICARE HMO REHAB/SIP             0.00        0.00   99         AR PAYMENTS
9917030   MEDICARE HMO REHAB/SMG             0.00        0.00   99         AR PAYMENTS
9917014   MEDICARE HMO REHAB/SWMG            0.00        0.00   99         AR PAYMENTS
9916982   MEDICARE HMO/IPA CONVERSI          0.00        0.00   99         AR PAYMENTS
9910019   MEDICARE PART A & B                0.00        0.00   99         AR PAYMENTS
9910068   MEDICARE PART A ONLY               0.00        0.00   99         AR PAYMENTS
9910050   MEDICARE PART B ONLY               0.00        0.00   99         AR PAYMENTS
9910027   MEDICARE PHYSICIAN                 0.00        0.00   99         AR PAYMENTS
9910084   MEDICARE SECONDARY PAYOR           0.00        0.00   99         AR PAYMENTS
9980186   MEDI-PLUS HEALTH                   0.00        0.00   99         AR PAYMENTS
9977406   MEDRISK, INC                       0.00        0.00   99         AR PAYMENTS
9960436   MERCY RECIPROCOL HEALTH C          0.00        0.00   99         AR PAYMENTS
9960469   METRAHEALTH HMO                    0.00        0.00   99         AR PAYMENTS
9926981   MIA CONVERSION                     0.00        0.00   99         AR PAYMENTS
9926015   MIA PLACER COUNTY                  0.00        0.00   99         AR PAYMENTS
9900044   MIA REFERRED BUTTE CO              0.00        0.00   99         AR PAYMENTS
9900085   MIA REFERRED OTHER COUNTI          0.00        0.00   99         AR PAYMENTS
9900051   MIA REFERRED PLACER CO             0.00        0.00   99         AR PAYMENTS
9900036   MIA REFERRED SACRAMENTO C          0.00        0.00   99         AR PAYMENTS
9900077   MIA REFERRED SAN JOARUIN           0.00        0.00   99         AR PAYMENTS
9900069   MIA REFERRED SOLANO CO             0.00        0.00   99         AR PAYMENTS
9926023   MIA YOLO COUNTY                    0.00        0.00   99         AR PAYMENTS
9921107   MOLINA GMC                         0.00        0.00   99         AR PAYMENTS
9925033   MOLINA PCCM OUT OF COUNTY          0.00        0.00   99         AR PAYMENTS
9980343   MUTUAL OF OMAHA                    0.00        0.00   99         AR PAYMENTS
9931023   NAT MARROW DONOE PROG              0.00        0.00   99         AR PAYMENTS
9971052   NATIONAL ACCS LTR CAR NON          0.00        0.00   99         AR PAYMENTS
9970906   NATIONAL ASSOC LETTER CAR          0.00        0.00   99         AR PAYMENTS
9900143   NATIONAL BUSINESS FACTORS          0.00        0.00   99         AR PAYMENTS
9960147   NATIONAL MED HMO                   0.00        0.00   99         AR PAYMENTS
9999285   NCO RESEARCHING                    0.00        0.00   99         AR PAYMENTS
9999137   NCO TPL MEDICARE                   0.00        0.00   99         AR PAYMENTS
9999269   NHR SPECIAL PROJECT                0.00        0.00   99         AR PAYMENTS
9970427   NN INVESTORS LIFE PPO AIC          0.00        0.00   99         AR PAYMENTS
9999046   NO PATIENT CHARGE                  0.00        0.00   99         AR PAYMENTS
9980988   NON CONTRACT PAYERS CONVE          0.00        0.00   99         AR PAYMENTS
9970450   NORTHERN CALIF BUTCHERS P          0.00        0.00   99         AR PAYMENTS




                                                Page 7
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9932112   OFFICE OF FAMILY PLANNING          0.00        0.00   99         AR PAYMENTS
9966730   ONE HEALTH HMO HILL IPA            0.00        0.00   99         AR PAYMENTS
9966748   ONE HEALTH HMO MDCL IPA            0.00        0.00   99         AR PAYMENTS
9966813   ONE HEALTH HMO OTHER IPA           0.00        0.00   99         AR PAYMENTS
9966698   ONE HEALTH HMO SIP IPA             0.00        0.00   99         AR PAYMENTS
9966706   ONE HEALTH HMO SMG IPA             0.00        0.00   99         AR PAYMENTS
9966722   ONE HEALTH HMO SNMG IPA            0.00        0.00   99         AR PAYMENTS
9966714   ONE HEALTH HMO SWMG IPA            0.00        0.00   99         AR PAYMENTS
9960279   ONE HEALTH PLAN HMO                0.00        0.00   99         AR PAYMENTS
9970666   ONE HEALTH PLAN PPO                0.00        0.00   99         AR PAYMENTS
9970484   OPERATING ENG LOCAL #3 PP          0.00        0.00   99         AR PAYMENTS
9932989   OTHER CO SPONS AGENCIES C          0.00        0.00   99         AR PAYMENTS
9971607   OUCH PPO                           0.00        0.00   99         AR PAYMENTS
9970492   PACIFIC HEALTH ALLIANCE P          0.00        0.00   99         AR PAYMENTS
9960535   PACIFICARE BEHABIORAL HEA          0.00        0.00   99         AR PAYMENTS
9964040   PACIFICARE CAPITATION              0.00        0.00   99         AR PAYMENTS
9960295   PACIFICARE CHOICE                  0.00        0.00   99         AR PAYMENTS
9960162   PACIFICARE HMO                     0.00        0.00   99         AR PAYMENTS
9960360   PACIFICARE HMO GOULD               0.00        0.00   99         AR PAYMENTS
9966425   PACIFICARE HMO GOULD IPA           0.00        0.00   99         AR PAYMENTS
9966482   PACIFICARE HMO HILL IPA            0.00        0.00   99         AR PAYMENTS
9960352   PACIFICARE HMO LODI MEMOR          0.00        0.00   99         AR PAYMENTS
9966516   PACIFICARE HMO MDCL                0.00        0.00   99         AR PAYMENTS
9960337   PACIFICARE HMO MERCY               0.00        0.00   99         AR PAYMENTS
9966433   PACIFICARE HMO MODESTO IP          0.00        0.00   99         AR PAYMENTS
9966789   PACIFICARE HMO OTHER IPA           0.00        0.00   99         AR PAYMENTS
9966441   PACIFICARE HMO SIP IPA             0.00        0.00   99         AR PAYMENTS
9966458   PACIFICARE HMO SMG IPA             0.00        0.00   99         AR PAYMENTS
9966474   PACIFICARE HMO SNMG IPA            0.00        0.00   99         AR PAYMENTS
9966466   PACIFICARE HMO SWMG IPA            0.00        0.00   99         AR PAYMENTS
9960345   PACIFICARE HMO UCD                 0.00        0.00   99         AR PAYMENTS
9966490   PACIFICARE HMO UCDMG IPA           0.00        0.00   99         AR PAYMENTS
9960634   PACIFICARE OTHER HOSP CAP          0.00        0.00   99         AR PAYMENTS
9967464   PACIFICARE OTHER IPA CAPP          0.00        0.00   99         AR PAYMENTS
9970500   PACIFICARE PPO                     0.00        0.00   99         AR PAYMENTS
9970542   PARCELSUS HEALTHCARE PPO           0.00        0.00   99         AR PAYMENTS
9925025   PARTNERSHIP HEALTH PLAN            0.00        0.00   99         AR PAYMENTS
9999020   PATIENT INCIDENT AT HOSPI          0.00        0.00   99         AR PAYMENTS
9900127   PENDING LIABILITY INFO             0.00        0.00   99         AR PAYMENTS
9900242   PENDING MEDI-CAL OTSD VND          0.00        0.00   99         AR PAYMENTS
9970518   PENSIONED OPERATING ENG P          0.00        0.00   99         AR PAYMENTS
9970575   PERFERRED HEALTH NETWORK           0.00        0.00   99         AR PAYMENTS
9999194   PHYSICIAN STUDY PMT                0.00        0.00   99         AR PAYMENTS
9970534   PILOT LIFE INS CO BPS PPO          0.00        0.00   99         AR PAYMENTS
9932054   PLACER CO BLOOD ALCOHOL            0.00        0.00   99         AR PAYMENTS
9932047   PLACER CO DISTRICT ATTORN          0.00        0.00   99         AR PAYMENTS
9932039   PLACER CO MENTAL HEALTH            0.00        0.00   99         AR PAYMENTS
9921115   PLACER COUNTY MANAGED CAR          0.00        0.00   99         AR PAYMENTS
9932013   PLACER COUNTY PRE BOOKING          0.00        0.00   99         AR PAYMENTS
9932062   PLCAER CO S.A.R.T.                 0.00        0.00   99         AR PAYMENTS
9970559   PPO ALLIANCE                       0.00        0.00   99         AR PAYMENTS
9971987   PPO CONVERSION                     0.00        0.00   99         AR PAYMENTS
9977984   PPO/WORK COMP CONVERSION           0.00        0.00   99         AR PAYMENTS




                                                Page 8
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9977299   PREF HEALTH NETWORK WORK           0.00        0.00   99         AR PAYMENTS
9970583   PREFERRED HEALTH NETWORK           0.00        0.00   99         AR PAYMENTS
9971706   PRIVATE HEALTHCARE SYS LT          0.00        0.00   99         AR PAYMENTS
9900010   PRIVATE PAY                        0.00        0.00   99         AR PAYMENTS
9900986   PRIVATE PAY CONVERSION             0.00        0.00   99         AR PAYMENTS
9900002   PRIVATE PAY DEFAULT                0.00        0.00   99         AR PAYMENTS
9900150   PRIVATE PAY FACILITY BILL          0.00        0.00   99         AR PAYMENTS
9960170   PRUCARE HMO                        0.00        0.00   99         AR PAYMENTS
9966565   PRUCARE HMO HILL IPA               0.00        0.00   99         AR PAYMENTS
9966581   PRUCARE HMO MDCL IPA               0.00        0.00   99         AR PAYMENTS
9966797   PRUCARE HMO OTHER IPA              0.00        0.00   99         AR PAYMENTS
9966524   PRUCARE HMO SIP IPA                0.00        0.00   99         AR PAYMENTS
9966532   PRUCARE HMO SMG IPA                0.00        0.00   99         AR PAYMENTS
9966540   PRUCARE HMO SWMG IPA               0.00        0.00   99         AR PAYMENTS
9915133   PRUCARE SENIOR HMO                 0.00        0.00   99         AR PAYMENTS
9916248   PRUCARE SENIOR OTHER IPA           0.00        0.00   99         AR PAYMENTS
9916198   PRUCARE SENIOR SIP IPA             0.00        0.00   99         AR PAYMENTS
9916180   PRUCARE SENIOR SMG IPA             0.00        0.00   99         AR PAYMENTS
9916206   PRUCARE SENIOR SWMG IPA            0.00        0.00   99         AR PAYMENTS
9966557   PRUCARE SNMG IPA                   0.00        0.00   99         AR PAYMENTS
9967357   PRUCARE UCDMG                      0.00        0.00   99         AR PAYMENTS
9980384   PRUDENTIAL                         0.00        0.00   99         AR PAYMENTS
9970617   PRUDENTIAL PRU NET PPO             0.00        0.00   99         AR PAYMENTS
9999244   RADIOLOGICAL ASSOC                 0.00        0.00   99         AR PAYMENTS
9990151   RADIOLOGICAL ASSOCIATE MR          0.00        0.00   99         AR PAYMENTS
9990094   RADIOLOGICAL ASSOCIATES            0.00        0.00   99         AR PAYMENTS
9900135   RETURN MAIL                        0.00        0.00   99         AR PAYMENTS
9921016   RIVER CITY HEALTHNET               0.00        0.00   99         AR PAYMENTS
9921081   RIVER CITY MAXICARE GMC            0.00        0.00   99         AR PAYMENTS
9921099   RIVER CITY MCAL GROUP GMC          0.00        0.00   99         AR PAYMENTS
9931031   ROBODOC                            0.00        0.00   99         AR PAYMENTS
9932070   ROSEVILLE POLICE DEPT              0.00        0.00   99         AR PAYMENTS
9990144   RUSSIAN NATIONAL PROGRAM           0.00        0.00   99         AR PAYMENTS
9932104   SACRAMENTO CO DISTRICT AT          0.00        0.00   99         AR PAYMENTS
9980996   SECONDARY SAME AS PRIMARY          0.00        0.00   99         AR PAYMENTS
9930991   SECONDARY SAME AS PRIMARY          0.00        0.00   99         AR PAYMENTS
9970997   SECONDARY SAME AS PRIMARY          0.00        0.00   99         AR PAYMENTS
9966995   SECONDARY SAME AS PRIMARY          0.00        0.00   99         AR PAYMENTS
9960998   SECONDARY SAME AS PRIMARY          0.00        0.00   99         AR PAYMENTS
9964990   SECONDARY SAME AS PRIMARY          0.00        0.00   99         AR PAYMENTS
9971995   SECONDARY SAME AS PRIMARY          0.00        0.00   99         AR PAYMENTS
9914029   SECURE HORIZONS CAP                0.00        0.00   99         AR PAYMENTS
9915232   SECURE HORIZONS DELTA              0.00        0.00   99         AR PAYMENTS
9916651   SECURE HORIZONS DELTA IPA          0.00        0.00   99         AR PAYMENTS
9916669   SECURE HORIZONS EL DOR IP          0.00        0.00   99         AR PAYMENTS
9916677   SECURE HORIZONS GLDN S IP          0.00        0.00   99         AR PAYMENTS
9915224   SECURE HORIZONS GOULD              0.00        0.00   99         AR PAYMENTS
9916644   SECURE HORIZONS GOULD IPA          0.00        0.00   99         AR PAYMENTS
9916099   SECURE HORIZONS HILLS IPA          0.00        0.00   99         AR PAYMENTS
9916107   SECURE HORIZONS MDCL IPA           0.00        0.00   99         AR PAYMENTS
9915075   SECURE HORIZONS MEDICARE           0.00        0.00   99         AR PAYMENTS
9915091   SECURE HORIZONS MERCY HMO          0.00        0.00   99         AR PAYMENTS
9916222   SECURE HORIZONS OTHER IPA          0.00        0.00   99         AR PAYMENTS




                                                Page 9
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9916073   SECURE HORIZONS SIP IPA            0.00      0.00   99           AR PAYMENTS
9916065   SECURE HORIZONS SMG IPA            0.00      0.00   99           AR PAYMENTS
9916081   SECURE HORIZONS SWMG IPA           0.00      0.00   99           AR PAYMENTS
9915109   SECURE HORIZONS UCD HMO            0.00      0.00   99           AR PAYMENTS
9916636   SECURE HORIZONS WDLND IPA          0.00      0.00   99           AR PAYMENTS
9900978   SELF PAY ADMIN REVIEW PMT          0.00      0.00   99           AR PAYMENTS
9932179   SHORT DOYLE - CLINIC               0.00      0.00   99           AR PAYMENTS
9931080   SIMR                               0.00      0.00   99           AR PAYMENTS
9966821   SIP PT/OT CONSORTIUM               0.00      0.00   99           AR PAYMENTS
9966839   SMG PT/OT CONSORTIUM               0.00      0.00   99           AR PAYMENTS
9900309   SNF PRIVATE PAY                    0.00      0.00   99           AR PAYMENTS
9999236   SPECIAL PROJECT                    0.00      0.00   99           AR PAYMENTS
9900192   SPIRIT PROJECT                     0.00      0.00   99           AR PAYMENTS
9960196   ST JOSEPH'S HMO                    0.00      0.00   99           AR PAYMENTS
9977257   STATE COMP SCIF BX                 0.00      0.00   99           AR PAYMENTS
9980392   STATE FARM AUTO                    0.00      0.00   99           AR PAYMENTS
9977067   STATE FUNG W/C PPO                 0.00      0.00   99           AR PAYMENTS
9932211   STATE PERINATAL AFP PROGR          0.00      0.00   99           AR PAYMENTS
9977273   STATE+B715 COMP STATE EMP          0.00      0.00   99           AR PAYMENTS
9977174   SUTTER EMPLOYEE W/C PPO            0.00      0.00   99           AR PAYMENTS
9990086   SUTTER HOSPICE                     0.00      0.00   99           AR PAYMENTS
9931122   SUTTER MED FOUNDATION CLA          0.00      0.00   99           AR PAYMENTS
9925041   SUTTER SENIOR CARE HMO             0.00      0.00   99           AR PAYMENTS
9915034   SUTTER SENIOR MEDICARE HM          0.00      0.00   99           AR PAYMENTS
9967308   SWMG PT/OT CONSORTIUM              0.00      0.00   99           AR PAYMENTS
9960378   TAKECARE HMO MERCY                 0.00      0.00   99           AR PAYMENTS
9999996   TEST CARRIER FOR HDX               0.00      0.00   99           AR PAYMENTS
9971748   THE GUARDIAN                       0.00      0.00   99           AR PAYMENTS
9971755   THE NEW ENGLAND PPO                0.00      0.00   99           AR PAYMENTS
9999103   THIRD PARTY AUDIT IN PROG          0.00      0.00   99           AR PAYMENTS
9910043   TRANS AMERICA NG                   0.00      0.00   99           AR PAYMENTS
9980145   TRAVELERS                          0.00      0.00   99           AR PAYMENTS
9960238   TRAVELERS HMO                      0.00      0.00   99           AR PAYMENTS
9977133   TRAVELERS WORKERS COMP PP          0.00      0.00   99           AR PAYMENTS
9970898   TRI COUNTY SCHOOLS PPO             0.00      0.00   99           AR PAYMENTS
9921065   UCD WESTERN HEALTH ADVANT          0.00      0.00   99           AR PAYMENTS
9970922   UFCW NO CA H&W                     0.00      0.00   99           AR PAYMENTS
9900028   UNCOMPENSATED CARE                 0.00      0.00   99           AR PAYMENTS
9980335   UNICARE                            0.00      0.00   99           AR PAYMENTS
9980400   UNITED AMERCIAN                    0.00      0.00   99           AR PAYMENTS
9970674   UNITED HEALTH CARE PPO             0.00      0.00   99           AR PAYMENTS
9960485   UNITED HEALTHCARE HMO              0.00      0.00   99           AR PAYMENTS
9977190   UNITED HEALTHCARE W/C              0.00      0.00   99           AR PAYMENTS
9971086   UNIVERSAL HEALTH NETWORK           0.00      0.00   99           AR PAYMENTS
9960204   US BEHAVIORAL HEALTH               0.00      0.00   99           AR PAYMENTS
9977166   US COMP SERVICES AHN W/C           0.00      0.00   99           AR PAYMENTS
9950031   US DEPARTMENT OF LABOR W/          0.00      0.00   99           AR PAYMENTS
9970955   USA HEALTHNET PPO                  0.00      0.00   99           AR PAYMENTS
9933011   VA NORTHERN CA HEALTH CAR          0.00      0.00   99           AR PAYMENTS
9960212   VALUE OPTIONS                      0.00      0.00   99           AR PAYMENTS
9932088   VICTIM WITNESS                     0.00      0.00   99           AR PAYMENTS
9990169   VINCE AQUISTO REFERRAL             0.00      0.00   99           AR PAYMENTS
9999210   VIP PROGRAM                        0.00      0.00   99           AR PAYMENTS




                                                Page 10
                               85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9999038   VISITOR INJURY AT HOSPITA         0.00      0.00   99           AR PAYMENTS
9977398   W/C CACHE CREEK                   0.00      0.00   99           AR PAYMENTS
9970690   WEIMAR INSTITUE PPO               0.00      0.00   99           AR PAYMENTS
9960675   WESTERN HEALTH ADV/HMO/UC         0.00      0.00   99           AR PAYMENTS
9960865   WESTERN HEALTH ADV/MERCY          0.00      0.00   99           AR PAYMENTS
9970799   WESTERN HEALTH NETWORK PP         0.00      0.00   99           AR PAYMENTS
9915257   WESTERN HLTH ADV SR GLDN          0.00      0.00   99           AR PAYMENTS
9915273   WESTERN HLTH ADV SR HILLS         0.00      0.00   99           AR PAYMENTS
9915265   WESTERN HLTH ADV SR MED           0.00      0.00   99           AR PAYMENTS
9915281   WESTERN HLTH ADV SR UCD           0.00      0.00   99           AR PAYMENTS
9960881   WESTERN HLTH ADV/NON CONT         0.00      0.00   99           AR PAYMENTS
9915240   WESTERNHLTH ADV SR GLD ST         0.00      0.00   99           AR PAYMENTS
9950981   WORKERS COMP NON CONTRACT         0.00      0.00   99           AR PAYMENTS
9823022   AUDIT REVIEW INCOME               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9800079   BAD DEBT ADMIN W/O                0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9809955   BAD DEBT C/A                      0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9800038   BAD DEBT CONVERSION ADJ           0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9800061   BAD DEBT INS REFUND               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9810052   BAD DEBT NSF                      0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9800053   BAD DEBT PATIENT REFUND           0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9800012   BAD DEBT PURGE W/O                0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9810029   BAD DEBT REC DIRECT CASH          0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9810037   BAD DEBT RECOVERY AGENCY          0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9800046   BAD DEBT SMALL BAL W/O            0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9800020   BAD DEBT W/O                      0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9810060   BAD DEBT-INSURANCE PAYMNT         0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823030   BADGE REVENUE                     0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823055   CAFETERIA SALES                   0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823063   CANCER CLINICAL                   0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823105   CAP-RAS                           0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823139   CASH OVER/SHORT                   0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823865   CENTRAL INFUSION THRPY 19         0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9800087   CHARITY-BILLED BD W/O             0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9800095   CHARITY-UNBILLED BD W/O           0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9808924   CHARITY-UNBILLED W/O BD           0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823147   CHIPS                             0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823162   CMSP- PT CLAIMS WITHHOLD          0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823154   CMSP-COST RPT SETTLEMENT          0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823170   COLLECTION AGENCY FEE             0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823196   COPY REVENUE-XRAYS                0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823188   COPY REV-MED REC&SUBPEONA         0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823204   DONATION                          0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823931   EAP CASH                          0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823949   EAP RENT                          0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823238   EDUC - DIETARY                    0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823253   EDUC - IN SERVICE                 0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823261   EDUC-MISC COMMUNITY ED            0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823279   ENVIR SVC-HSK REVENUE             0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9806266   ESCHEAT TO STATE-BD               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9800400   FINANCE CHARGE ADJUSTMENT         0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9809864   INSURANCE ESCHEATMENT BD          0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823311   INTEREST INCOME                   0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823915   LACTATION OP-OTHER OP REV         0.00      0.00   98           BD PYMTS/ADJ & MISC CASH




                                               Page 11
                                     85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9823907   LACTATION OP-RETAIL SALES               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823386   MCAL COST REPORT SETTLEMN               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823394   MCAL PATIENT CLAIMS WITHH               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823402   MCARE COST REPORT SETTLEM               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823824   MCARE PASS THRU - BAD DEB               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823428   MCARE PASS THRU-KIDNEY AC               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823436   MCARE PASS THRU-RETURN ON               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823410   MCARE PA-THRU-GME/DME/IME               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823444   MCARE PATIENT CLAIMS W/H                0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823451   MCARE TOPPS                             0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823360   MED STAFF DUES/FEES 13100               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823352   MED STAFF SRV 118710-5578               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9800525   MEDICARE (MEDICAL BD)                   0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823014   MISC CASH RECEIPTS                      0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823519   PHARMACY - OP MOB                       0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823493   PHARMACY-LTC MCARE ENTRA1               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823501   PHARMACY-OP HOSPITAL                    0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823527   PHYSICAL THERAPY-CLASSES                0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823543   PHYSICAL THERAPY-MASSAGE                0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9809567   PRIVATE PAY ESCH W/O BD                 0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823576   RADIOLOGICAL ASSOC (RAS)                0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823584   REBATES-MEDICAL SUPPLIES                0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823592   REBATES-PHAMACY                         0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9815069   RECOVERY RESOURCES PAYMNT               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823899   REFUND-PRO FEES PHY,TRAUM               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823600   RENT RECEIPTS 131000=1069               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823618   SCRAP & WASTE SALES                     0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823626   SENIOR SVC/SR PARTNER REV               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823634   SPA LAB CAP                             0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823642   SUPPLIES SOLD-NON PATIENT               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823659   TELEPHONE REVENUE                       0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823972   TPA REVENUE                             0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823956   UNCOMPENSATED CARE REFUND               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823964   URGENT CARE CAP REFUNDS                 0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823667   VENDING MACHINE COMMISSIO               0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823758   YOLO PERINATAL CLINIC 10                0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
9823378                                           0.00      0.00   98           BD PYMTS/ADJ & MISC CASH
4740163   AB ID                                 185.50      0.00   47           BLOOD SERVICES
4740171   AB ID 2                                79.50      0.00   47           BLOOD SERVICES
4740155   AB SCRN                                53.00      0.00   47           BLOOD SERVICES
4740197   ABO TYP                                21.20      0.00   47           BLOOD SERVICES
4740213   AG SCRN PER UNIT PT SPEC               42.40      0.00   47           BLOOD SERVICES
4740031   AG SCRN PER UNIT RGNT                  53.00      0.00   47           BLOOD SERVICES
4740007   AG SCRN PER UNIT RGNT                 291.50      0.00   47           BLOOD SERVICES
4740114   APHERESIS PLASMA                        0.00      0.00   47           BLOOD SERVICES
4740122   APHERESIS PLATELET                      0.00      0.00   47           BLOOD SERVICES
4740064   CMV AB                                 37.10      0.00   47           BLOOD SERVICES
4710034   CRYO PS                                85.85      0.00   47           BLOOD SERVICES
4710281   FFP DR PS                              96.45      0.00   47           BLOOD SERVICES
4710042   FFP PS                                 85.85      0.00   47           BLOOD SERVICES
4740080   HLA TYP A B OR C MULT                 424.00      0.00   47           BLOOD SERVICES
4740098   HLA TYP DR/DQ MULT                    318.00      0.00   47           BLOOD SERVICES
4710240   IG RHO D MINI                         164.00      0.00   47           BLOOD SERVICES




                                                     Page 12
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4740056   IRRADIATION BLD PROD EA            58.30      0.00   47           BLOOD SERVICES
4710315   MISC TS PROC                      132.50      0.00   47           BLOOD SERVICES
4710323   MISC TS PROC                      323.30      0.00   47           BLOOD SERVICES
4740148   MISC TS PROC                      106.00      0.00   47           BLOOD SERVICES
4710190   MISC TS PROC                      822.55      0.00   47           BLOOD SERVICES
4710182   MISC TS PROC                        0.00      0.00   47           BLOOD SERVICES
4710166   MISC TS PROC                      884.05      0.00   47           BLOOD SERVICES
4710133   MISC TS PROC                      290.45      0.00   47           BLOOD SERVICES
4740130   MISC TS PROC                       79.50      0.00   47           BLOOD SERVICES
4710059   MISC TS PROC                       42.40      0.00   47           BLOOD SERVICES
4710026   MISC TS PROC                      296.80      0.00   47           BLOOD SERVICES
4710232   MISC TS PROC                     1127.85      0.00   47           BLOOD SERVICES
4710000   MISC TS PROC                      330.00      0.00   47           BLOOD SERVICES
4710018   MISC TS PROC                      530.00      0.00   47           BLOOD SERVICES
4710273   MISC TS PROC                      164.30      0.00   47           BLOOD SERVICES
4740106   MISC TS PROC                       53.00      0.00   47           BLOOD SERVICES
4740254   MISC TS PROC                       40.00      0.00   47           BLOOD SERVICES
4710299   MISC TS PROC                      884.05      0.00   47           BLOOD SERVICES
4710364   PHER IRRADIATED PS                727.15      0.00   47           BLOOD SERVICES
4710083   PHER L/D HLA MATCHED PS          1076.95      0.00   47           BLOOD SERVICES
4710356   PHER L/D IRRADIATED PS            727.15      0.00   47           BLOOD SERVICES
4710414   PHER L/D IRRADIATED PS            727.15      0.00   47           BLOOD SERVICES
4710075   PHER PS                           668.85      0.00   47           BLOOD SERVICES
4710307   PLAS CRYO REDUCED PS              100.70      0.00   47           BLOOD SERVICES
4710380   PLTC IRRADIATED PS                101.75      0.00   47           BLOOD SERVICES
4710372   PLTC L/D IRRADIATED PS            101.75      0.00   47           BLOOD SERVICES
4710398   PLTC L/D PS                        85.85      0.00   47           BLOOD SERVICES
4710216   PLTC PS                            85.85      0.00   47           BLOOD SERVICES
4710091   RBC DG PS                         393.25      0.00   47           BLOOD SERVICES
4710422   RBC FRZ/DEGLYC/WASHED PS          451.55      0.00   47           BLOOD SERVICES
4710349   RBC IRRADIATED PS                 281.95      0.00   47           BLOOD SERVICES
4710224   RBC L/D CMV NEG PS                 95.40      0.00   47           BLOOD SERVICES
4710406   RBC L/D IRRADIATED PS             315.90      0.00   47           BLOOD SERVICES
4710331   RBC L/D IRRADIATED PS             300.00      0.00   47           BLOOD SERVICES
4710265   RBC L/D PS                        257.60      0.00   47           BLOOD SERVICES
4740221   RBC PRETRTMT DENSITY GRAD         212.00      0.00   47           BLOOD SERVICES
4710109   RBC PS                            211.00      0.00   47           BLOOD SERVICES
4740205   RH PHENOTYP COMPLETE               79.50      0.00   47           BLOOD SERVICES
4740189   RH TYP                             21.20      0.00   47           BLOOD SERVICES
4740239   SER PRETRTMT INC/INHIB             84.80      0.00   47           BLOOD SERVICES
4740247   SPEC HANDL FEE                    106.00      0.00   47           BLOOD SERVICES
4710117   WASHED RBC PS                     324.35      0.00   47           BLOOD SERVICES
4710125   WB PS                             249.10      0.00   47           BLOOD SERVICES
1640002   CT EMERGENCY CALL BACK              0.00      0.00   16           BREAST CLINIC
1610005   HC SERVICE AFTER HOURS              0.00      0.00   16           BREAST CLINIC
1621028   IC MD CANCELLED RAD                 0.00      0.00   16           BREAST CLINIC
1621036   IC NO SHOW RAD                      0.00      0.00   16           BREAST CLINIC
1621044   IC PT CANCELLED RAD                 0.00      0.00   16           BREAST CLINIC
1621051   IC PT LEFT AMA RAD                  0.00      0.00   16           BREAST CLINIC
1621069   IC PT REFUSED RAD                   0.00      0.00   16           BREAST CLINIC
1621077   IC REQ LOC CANCELLED RAD            0.00      0.00   16           BREAST CLINIC
1621085   IC RESCHEDULED RAD                  0.00      0.00   16           BREAST CLINIC
1621093   IC TECHNICAL CANCEL RAD             0.00      0.00   16           BREAST CLINIC




                                                 Page 13
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



1621135   IC USED RESIDENCE RAD              0.00      0.00   16           BREAST CLINIC
1621119   IC WRONG DATE RAD                  0.00      0.00   16           BREAST CLINIC
1621101   IC WRONG PATIENT RAD               0.00      0.00   16           BREAST CLINIC
1621127   IC WRONG PROCEDURE RAD             0.00      0.00   16           BREAST CLINIC
1621143   ICC COMPLAINT NURSING RAD          0.00      0.00   16           BREAST CLINIC
1621150   ICC COMPLAINT PHYSICIAN R          0.00      0.00   16           BREAST CLINIC
1621168   ICC COMPLAINT RADIOLOGIST          0.00      0.00   16           BREAST CLINIC
1621176   ICC COMPLAINT RN RAD               0.00      0.00   16           BREAST CLINIC
1621184   ICC COMPLAINT SECTION RAD          0.00      0.00   16           BREAST CLINIC
1621192   ICC DELAY OF PATIENT RAD           0.00      0.00   16           BREAST CLINIC
1621200   ICC INFO MISS H&P RAD              0.00      0.00   16           BREAST CLINIC
1621218   ICC NO RADIOLOGIST AVAIL           0.00      0.00   16           BREAST CLINIC
1621226   ICC NO RN AVAIL RAD                0.00      0.00   16           BREAST CLINIC
1621234   ICC PATIENT COMPLAINTS RA          0.00      0.00   16           BREAST CLINIC
1621242   ICC PATIENT INFO ERROR RA          0.00      0.00   16           BREAST CLINIC
1621259   ICC PREP INCORRECT RAD             0.00      0.00   16           BREAST CLINIC
1621267   ICC SATISFACTION SURVEY R          0.00      0.00   16           BREAST CLINIC
221523    IR CON N/C 100S 10ML               0.00      0.00   2            BREAST CLINIC
223529    IR CON N/C 300S 10ML               0.00      0.00   2            BREAST CLINIC
1925536   IR GALACTOGRAM 1 DUCT              0.00      0.00   19           BREAST CLINIC
1660000   IR SERVICE AFTER HOURS             0.00      0.00   16           BREAST CLINIC
1652957   MR CARDIAC VELOCITY FLOW           0.00      0.00   16           BREAST CLINIC
1675750   NI DUPLEX EXT UPP BIL            592.00      0.00   16           BREAST CLINIC
1630003   NM EMERGENCY CALL BACK             0.00      0.00   16           BREAST CLINIC
1632850   NM GASTRIC EMPTYING             1278.00   1120.00   16           BREAST CLINIC
1630052   NO CHARGE PROCEDURE NMED           0.00      0.00   16           BREAST CLINIC
1620004   RAD EMERGENCY CALL BACK            0.00      0.00   16           BREAST CLINIC
1670025   US 1/2 HOUR ROOM TIME`             0.00      0.00   16           BREAST CLINIC
1670017   US BEDSIDE                         0.00      0.00   16           BREAST CLINIC
1973502   US BREAST UNI OR BIL             384.00      0.00   19           BREAST CLINIC
1973551   US BREAST UNI OR BIL             384.00      0.00   19           BREAST CLINIC
1972439   US NC BIOPSY CORE MRS              0.00      0.00   19           BREAST CLINIC
1973510   US NC BREAST BILAT MRS             0.00      0.00   19           BREAST CLINIC
1973569   US NC BREAST UNILAT MRS            0.00      0.00   19           BREAST CLINIC
1977024   US NDL PLACE                     952.00      0.00   19           BREAST CLINIC
1670033   US OB LTD 1/MORE FETUSES         616.00    541.00   16           BREAST CLINIC
1670009   US SERVICE AFTER HOURS             0.00      0.00   16           BREAST CLINIC
1972066   USC ASP BREAST ADD               226.00      0.00   19           BREAST CLINIC
1972058   USC ASP BREAST CYST              380.00      0.00   19           BREAST CLINIC
1973106   USC ASP BREAST CYST              391.00      0.00   19           BREAST CLINIC
1972017   USC BREAST NDL WIRE ADD            0.00      0.00   19           BREAST CLINIC
1972025   USC NC ASPIRATN BRST MRS           0.00      0.00   19           BREAST CLINIC
1621705   XR ABD 1V AP                     538.00    130.00   16           BREAST CLINIC
1621788   XR ABD CMPL W 1V CHEST          1208.00    338.00   16           BREAST CLINIC
1621804   XR ABD W OBLIQUES CONE          1009.00    151.00   16           BREAST CLINIC
1621861   XR AC JNT                        829.00    294.00   16           BREAST CLINIC
1621929   XR ANKLE 2V                      494.00    121.00   16           BREAST CLINIC
1621903   XR ANKLE 3V OR MORE              662.00    163.00   16           BREAST CLINIC
1622182   XR ARTHRO SHOULDER              1072.00      0.00   16           BREAST CLINIC
1622208   XR ARTHRO TMJ                   1230.00    402.00   16           BREAST CLINIC
1622323   XR BE                           1974.00    368.00   16           BREAST CLINIC
1622307   XR BE THRP                      1005.00    881.00   16           BREAST CLINIC
1622349   XR BE W AIR CON                 1978.00      0.00   16           BREAST CLINIC




                                                Page 14
                               85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



1622802   XR BONE AGE STDY                656.00    577.00   16           BREAST CLINIC
1622844   XR BONE LENGTH STDY             656.00    577.00   16           BREAST CLINIC
1622869   XR BONE SURVEY INF              227.00      0.00   16           BREAST CLINIC
1622901   XR BONE SURVEY LTD              730.00    640.00   16           BREAST CLINIC
1623008   XR BREAST MAMMOGRAPHY LOC       490.00    462.00   16           BREAST CLINIC
1923002   XR BREAST MAMMOGRAPHY LOC       445.00      0.00   19           BREAST CLINIC
1623461   XR CHEST 1V                     391.00    106.00   16           BREAST CLINIC
1623305   XR CHEST 2V                     638.00    162.00   16           BREAST CLINIC
1623388   XR CHEST 2V W AP LORDOTIC       666.00    267.00   16           BREAST CLINIC
1623404   XR CHEST 2V W OBLIQUES          719.00      0.00   16           BREAST CLINIC
1623362   XR CHEST SPECIAL V EA           638.00      0.00   16           BREAST CLINIC
1623560   XR CHOL EXISTING CATH          1582.00    801.00   16           BREAST CLINIC
1623537   XR CHOL IN OR                  1582.00    801.00   16           BREAST CLINIC
1623545   XR CHOL IN OR ADD SET           852.00    480.00   16           BREAST CLINIC
1623586   XR CHOL TRANSHEPAT PRC         1582.00    801.00   16           BREAST CLINIC
1623602   XR CHOLECYSTOGRAM ORAL          537.00    473.00   16           BREAST CLINIC
1623685   XR CINE/VIDEO COMPLEMENT        314.00    273.00   16           BREAST CLINIC
1925510   XR GALACTOGRAM 1 DUCT           669.00      0.00   19           BREAST CLINIC
1925502   XR GALACTOGRAM MULTI            920.00      0.00   19           BREAST CLINIC
1925528   XR GALACTOGRAM MULTI              0.00      0.00   19           BREAST CLINIC
1622687   XR GI TUBE INSERT LONG         1690.00   1483.00   16           BREAST CLINIC
1622828   XR JNT SURVEY 1V                656.00      0.00   16           BREAST CLINIC
1927110   XR MAMMO BIL                    479.00      0.00   19           BREAST CLINIC
1927102   XR MAMMO BIL                    371.00      0.00   19           BREAST CLINIC
1927144   XR MAMMO UNI                    388.00      0.00   19           BREAST CLINIC
1927151   XR MAMMO UNI                    388.00      0.00   19           BREAST CLINIC
1923010   XR NC BRST/NDL LC/STE/MRS         0.00      0.00   19           BREAST CLINIC
1929496   XR NC SPECIMEN MRS                0.00      0.00   19           BREAST CLINIC
1927128   XR SCRN MAMMO                   198.00      0.00   19           BREAST CLINIC
1929504   XR SPECIMEN SURGICAL            118.00      0.00   19           BREAST CLINIC
1623024   XR STEREO LOC                  1927.00      0.00   16           BREAST CLINIC
1923028   XR STEREO LOC                  1752.00      0.00   19           BREAST CLINIC
1622364   XR SWALLOWING FNCTN             821.00    720.00   16           BREAST CLINIC
1622000   XRC ASP BREAST CYST             418.00    394.00   16           BREAST CLINIC
1622380   XRC BILI CATH CHNG              709.00      0.00   16           BREAST CLINIC
1622406   XRC BILI STONE EXTRACT         1328.00      0.00   16           BREAST CLINIC
1623040   XRC BREAST NDL WIRE            1009.00    952.00   16           BREAST CLINIC
1926021   XRC BREAST NDL WIRE             917.00      0.00   19           BREAST CLINIC
1923044   XRC BREAST NDL WIRE             917.00      0.00   19           BREAST CLINIC
1623081   XRC BREAST NDL WIRE ADD         440.00    416.00   16           BREAST CLINIC
1926039   XRC BREAST NDL WIRE ADD         400.00      0.00   19           BREAST CLINIC
1923085   XRC BREAST NDL WIRE ADD         400.00      0.00   19           BREAST CLINIC
1623149   XRC BRONCHOGRAM W-W/O CON       447.00    392.00   16           BREAST CLINIC
1622505   XRC BX BONE DEEP               3181.00    952.00   16           BREAST CLINIC
1622521   XRC BX BONE SUPER              1084.00    354.00   16           BREAST CLINIC
1922418   XRC BX BREAST VAC ASSIST       2391.00      0.00   19           BREAST CLINIC
1922533   XRC BX BREAST W IMAG              0.00      0.00   19           BREAST CLINIC
1622620   XRC BX MUSCLE                   876.00    283.00   16           BREAST CLINIC
1622612   XRC BX NASOPHARNYX              983.00      0.00   16           BREAST CLINIC
1622638   XRC BX PANCREAS                2880.00    938.00   16           BREAST CLINIC
1622653   XRC BX PLEURA                  1242.00    406.00   16           BREAST CLINIC
1622679   XRC BX RENL                     905.00    793.00   16           BREAST CLINIC
1622422   XRC EXCSN BREAST W LOC         1812.00   1593.00   16           BREAST CLINIC




                                               Page 15
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



1922434   XRC EXCSN BREAST W LOC          1648.00      0.00   19           BREAST CLINIC
1923036   XRC IMAG LOC CLIP W BX           537.00      0.00   19           BREAST CLINIC
1922020   XRC NC ASPIRA/BREAST MRS           0.00      0.00   19           BREAST CLINIC
1610708   XRC PERICARDIOCENT INI          3731.00   3275.00   16           BREAST CLINIC
1623487   XRC THORACENTESIS W TUBE         718.00    631.00   16           BREAST CLINIC
3415858   CA ANGIO ADD VESSEL EA             0.00      0.00   34           CARDIAC CATH
3415809   CA ANGIO PULM NONSELECT          953.00    838.00   34           CARDIAC CATH
3414802   CA BIOPSY ENDOMYOCARDIAL         421.00      0.00   34           CARDIAC CATH
3413051   CA CARDIOVERT ELCTVE EXT         647.00      0.00   34           CARDIAC CATH
3412103   CA EP ABLTN AV NDE/CNDCTN       4548.00      0.00   34           CARDIAC CATH
3412152   CA EP ABLTN OF SVT              6929.00      0.00   34           CARDIAC CATH
3414257   CA EP HIS BUNDLE RECORD         3772.00      0.00   34           CARDIAC CATH
3413507   CA EP INTRA ATR RECORD          1317.00      0.00   34           CARDIAC CATH
3416401   CA EP TILT TABLE TEST              0.00      0.00   34           CARDIAC CATH
3414000   CA HEART CATH LEFT              5631.00      0.00   34           CARDIAC CATH
3414158   CA HEART CATH LEFT              7726.00      0.00   34           CARDIAC CATH
3414208   CA HEART CATH RIGHT             3534.00      0.00   34           CARDIAC CATH
3414356   CA INJ AORTOGRAPHY               837.00      0.00   34           CARDIAC CATH
3414406   CA INJ CORO ANGIO               1820.00      0.00   34           CARDIAC CATH
3413309   CA INJ CORO ANGIO               7726.00      0.00   34           CARDIAC CATH
3414307   CA INJ GRAFT ANGIO              2513.00      0.00   34           CARDIAC CATH
3413705   CA INJ GRAFT ANGIO              7726.00      0.00   34           CARDIAC CATH
3414505   CA INJ L VENT/ATR ANGIO         1879.00      0.00   34           CARDIAC CATH
3414554   CA INJ PULM ANGIO                143.00      0.00   34           CARDIAC CATH
3414604   CA INJ R VENT/ATR ANGIO          143.00      0.00   34           CARDIAC CATH
3415882   CA INSERT SWAN GANZ             3533.00      0.00   34           CARDIAC CATH
3412806   CA INSERT SWAN GANZ              955.00    840.00   34           CARDIAC CATH
3417185   CA PLACE OCC DEV VEIN ART        429.00    347.00   34           CARDIAC CATH
3410107   CA PTC ATHERCTMY ADD VSL        4314.00      0.00   34           CARDIAC CATH
3412905   CA PTC ATHERCTMY ADD VSL        1414.00      0.00   34           CARDIAC CATH
3412954   CA PTC ATHERCTMY SNGL VSL       5189.00      0.00   34           CARDIAC CATH
3413259   CA PTCA ADD VSL                 4314.00      0.00   34           CARDIAC CATH
3413200   CA PTCA SNGL VSL                4738.00      0.00   34           CARDIAC CATH
3414216   CA RHC CNGNITL ANMLES           3534.00      0.00   34           CARDIAC CATH
3415650   CA RHC/LHC CNGNITL ANMLES          0.00      0.00   34           CARDIAC CATH
3414109   CA RHC/LHC RETRO                7153.00      0.00   34           CARDIAC CATH
3414059   CA RHC/LHC RETRO               10099.00      0.00   34           CARDIAC CATH
3414265   CA RHC/LHC THRU OPN SEPTM       9828.00      0.00   34           CARDIAC CATH
3415601   CA RHC/LHC THRU OPN SEPTM          0.00      0.00   34           CARDIAC CATH
3414224   CA RHC/TS LHC INTCT SEP         9828.00      0.00   34           CARDIAC CATH
3414240   CA RHC/TS LHC OPN SEP CNG      10099.00      0.00   34           CARDIAC CATH
3415940   CA S/I ANGIO PULM/AO/CORO       2055.00      0.00   34           CARDIAC CATH
3415924   CA S/I ANGIO PULM/AO/CORO       2055.00      0.00   34           CARDIAC CATH
3415965   CA S/I ANGIO VENTRCLR/ATR         60.00      0.00   34           CARDIAC CATH
3415908   CA S/I ANGIO VENTRCLR/ATR        607.00      0.00   34           CARDIAC CATH
3416005   CA SEPTOSTMY ATR TV METHD          0.00      0.00   34           CARDIAC CATH
3416203   CA STENT IC SNGL VSL PRC        6336.00      0.00   34           CARDIAC CATH
3416252   CA STNT IC ADD VSL PRC          1794.00      0.00   34           CARDIAC CATH
3413606   CA THROMBLYSIS CORO INFSN       2598.00      0.00   34           CARDIAC CATH
3415106   CA TMP TRNSCUTANEOUS PACE        183.00    161.00   34           CARDIAC CATH
3416609   CA VALVULOPLSTY AORTC PRC       6689.00      0.00   34           CARDIAC CATH
3416625   CA VALVULOPLSTY MITRL PRC       6891.00      0.00   34           CARDIAC CATH
3416641   CA VALVULOPLSTY PULM PRC        5321.00      0.00   34           CARDIAC CATH




                                                Page 16
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



3416500   CAC EMBOL OCC NONHEAD NEC       5673.00      0.00   34           CARDIAC CATH
3414703   CAC INSERT IABP PRC             2111.00      0.00   34           CARDIAC CATH
3415205   CAC INSERT PACER DUAL LDS       3584.00   3144.00   34           CARDIAC CATH
3415254   CAC INSERT PACER GEN SNGL       2265.00   1989.00   34           CARDIAC CATH
3415353   CAC INSERT PACER GEN SNGL       3519.00   3089.00   34           CARDIAC CATH
3415304   CAC INSERT PACER TMP SNGL       2126.00   1867.00   34           CARDIAC CATH
3415551   CAC INSERT PACER/ELEC VNT       3476.00      0.00   34           CARDIAC CATH
3415700   CAC PERICARDIOCENT INI          3731.00      0.00   34           CARDIAC CATH
3412608   CAC RMV ICD PACING GEN SQ       2780.00   2441.00   34           CARDIAC CATH
3412509   CAC RMV ICD PACING GEN SQ       1496.00      0.00   34           CARDIAC CATH
3415049   CAC RMVL PERM PACER GEN         3757.00      0.00   34           CARDIAC CATH
3415403   CAC RMVL TV PACR ELC SNGL       1171.00   1029.00   34           CARDIAC CATH
3412558   CAC RMVL TV PACR ELC SNGL       1496.00      0.00   34           CARDIAC CATH
3415007   CAC UPGRD PACE SNGL DUAL         105.00      0.00   34           CARDIAC CATH
3415056   CAC UPGRD PACE SNGL DUAL          74.00      0.00   34           CARDIAC CATH
3474731   S IMP HCG PTCA COATED STE       4585.00      0.00   34           CARDIAC CATH
3474749   S IMP HCG PTCA NON-COATED       4062.00      0.00   34           CARDIAC CATH
3491404   S NSTRL HC COVER SNAP             26.00      0.00   34           CARDIAC CATH
3491115   S NSTRL HC DEFIB PADS             92.00      0.00   34           CARDIAC CATH
3480753   S NSTRL HC DEFIBRILLATOR         183.00      0.00   34           CARDIAC CATH
3452406   S NSTRL HC IABP INSERTION        433.00      0.00   34           CARDIAC CATH
3452307   S PCR HC PACEMAKER DUAL        15394.00      0.00   34           CARDIAC CATH
3450590   S PCR HC PACEMAKER LEAD         2542.00      0.00   34           CARDIAC CATH
3452208   S PCR HC PACEMAKER SINGL       13809.00      0.00   34           CARDIAC CATH
3452109   S PCR HC PACEMAKER TRANS         669.00      0.00   34           CARDIAC CATH
3433307   S STRL ELECT, I-STAT (EYE         53.00      0.00   34           CARDIAC CATH
3440302   S STRL HC BALLOON PACING         590.00      0.00   34           CARDIAC CATH
3452414   S STRL HC IABP CATHETER         2791.00      0.00   34           CARDIAC CATH
3481959   S STRL HC INDEFLATOR PACK        262.00      0.00   34           CARDIAC CATH
3485448   S STRL HC MICROPUNCTURE S        157.00      0.00   34           CARDIAC CATH
3450582   S STRL HC PACEMAKER CABLE        131.00      0.00   34           CARDIAC CATH
3490752   S STRL HC PADS GROUNDING          26.00      0.00   34           CARDIAC CATH
3490901   S STRL HC PRESSURE TUBING         13.00      0.00   34           CARDIAC CATH
3461001   S STRL HC SLEEVER STERILE         53.00      0.00   34           CARDIAC CATH
3462215   S STRL HC TORQUE DEVICE           39.00      0.00   34           CARDIAC CATH
3460516   S STRL HC TOUHY BORST            118.00      0.00   34           CARDIAC CATH
3491438   S STRL HC TRANSDUCER DISP         53.00      0.00   34           CARDIAC CATH
3480555   S STRL HC TRAY HEART CATH        315.00      0.00   34           CARDIAC CATH
3480019   S STRL HC TRAY PACEMAKER         249.00      0.00   34           CARDIAC CATH
3480076   S STRL HC TRAY PERICARDIO        629.00      0.00   34           CARDIAC CATH
3431715   S STRL HCG BALLOON PTCA         1284.00      0.00   34           CARDIAC CATH
3435435   S STRL HCG CATH CORONARY          53.00      0.00   34           CARDIAC CATH
3435427   S STRL HCG CATH MICROCATH       1297.00      0.00   34           CARDIAC CATH
3485638   S STRL HCG CATH SNARE           1061.00      0.00   34           CARDIAC CATH
3435658   S STRL HCG CATH THERMODIL        262.00      0.00   34           CARDIAC CATH
3460524   S STRL HCG DILATORS ALL           26.00      0.00   34           CARDIAC CATH
3491446   S STRL HCG DISC COMPRESSO         26.00      0.00   34           CARDIAC CATH
3469202   S STRL HCG GUIDEWIRE              79.00      0.00   34           CARDIAC CATH
3469251   S STRL HCG GUIDEWIRE HYDR        236.00      0.00   34           CARDIAC CATH
3469301   S STRL HCG GUIDEWIRE INFU        891.00      0.00   34           CARDIAC CATH
3469350   S STRL HCG GUIDEWIRE MICR        787.00      0.00   34           CARDIAC CATH
3441086   S STRL HCG INDEFLATOR            262.00      0.00   34           CARDIAC CATH
3469657   S STRL HCG INTRODUCER PEE        262.00      0.00   34           CARDIAC CATH




                                                Page 17
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



3481652   S STRL HCG MANIFOLD               53.00      0.00   34           CARDIAC CATH
3481108   S STRL HCG NEEDLE VASCULA         13.00      0.00   34           CARDIAC CATH
3440203   S STRL HCG PACING WIRE           472.00      0.00   34           CARDIAC CATH
3444056   S STRL HCG PTCA GUIDE            289.00      0.00   34           CARDIAC CATH
3469608   S STRL HCG SHEATH FIXED C        315.00      0.00   34           CARDIAC CATH
3469558   S STRL HCG SHEATH LONG           183.00      0.00   34           CARDIAC CATH
3469509   S STRL HCG SHEATH REGULAR         53.00      0.00   34           CARDIAC CATH
3440252   S STRL HGG CATH BERMAN           222.00      0.00   34           CARDIAC CATH
3487006   S STRL HGG VASCULAR CLOSE        983.00      0.00   34           CARDIAC CATH
3620127   CA TILT TABLE TEST              1412.00      0.00   36           CARDIOLOGY SERVICES
3610250   CARD REHAB ED GROUP                0.00      0.00   36           CARDIOLOGY SERVICES
3610037   CARD REHAB EXIT EVAL               0.00      0.00   36           CARDIOLOGY SERVICES
3610011   CARD REHAB NEW EVAL                0.00      0.00   36           CARDIOLOGY SERVICES
3610045   CARDIAC REHAB W EKG              148.00      0.00   36           CARDIOLOGY SERVICES
3620069   CARDIAC STRESS TEST              649.00      0.00   36           CARDIOLOGY SERVICES
3620143   CARDIAC STRESS TEST              119.00      0.00   36           CARDIOLOGY SERVICES
3620051   EKG 12 LEAD TRACING              284.00      0.00   36           CARDIOLOGY SERVICES
3620093   EKG SIGNAL AVERAGED              488.00      0.00   36           CARDIOLOGY SERVICES
3620077   INVOICED SERVICE                 556.00      0.00   36           CARDIOLOGY SERVICES
3310240   CA ANGIO INT MAMMARY            1213.00      0.00   33           CATH LAB
3310018   CA INJ AORTOGRAPHY               837.00      0.00   33           CATH LAB
3310307   CA STENT IC SNGL VSL PRC        7398.00      0.00   33           CATH LAB
3310315   CA STNT IC ADD VSL PRC          1619.00      0.00   33           CATH LAB
3310158   CA TMP TRNSCUTANEOUS PACE       2556.00      0.00   33           CATH LAB
225102    CON IONIC 300ML                   62.00      0.00   2            CENTRAL SUPPLIES
223800    CON NI 300S 150ML                527.00      0.00   2            CENTRAL SUPPLIES
223404    CON NI 300S 50ML                 326.00      0.00   2            CENTRAL SUPPLIES
232520    S CATH INFSN NO HD              1822.00      0.00   2            CENTRAL SUPPLIES
231480    S CATH TRNSML ANG NOLSR         1202.00      0.00   2            CENTRAL SUPPLIES
231464    S CATH TRNSML ANG NOLSR         1113.00      0.00   2            CENTRAL SUPPLIES
231449    S CATH TRNSML ANG NOLSR         1128.00      0.00   2            CENTRAL SUPPLIES
231407    S CATH TRNSML ANG NOLSR         1202.00      0.00   2            CENTRAL SUPPLIES
231506    S CATH TRNSML ANG NOLSR         1128.00      0.00   2            CENTRAL SUPPLIES
232645    S CATH TRNSML ANG NOLSR         1080.00      0.00   2            CENTRAL SUPPLIES
231563    S CATH TRNSML ANG NOLSR         1125.00      0.00   2            CENTRAL SUPPLIES
232686    S CATH TRNSML ANG NOLSR         1148.00      0.00   2            CENTRAL SUPPLIES
232728    S CATH TRNSML ANG NOLSR         1080.00      0.00   2            CENTRAL SUPPLIES
232769    S CATH TRNSML ANG NOLSR         1148.00      0.00   2            CENTRAL SUPPLIES
232801    S CATH TRNSML ANG NOLSR         1148.00      0.00   2            CENTRAL SUPPLIES
232843    S CATH TRNSML ANG NOLSR         1080.00      0.00   2            CENTRAL SUPPLIES
232884    S CATH TRNSML ANG NOLSR         1148.00      0.00   2            CENTRAL SUPPLIES
232165    S CATH TRNSML ANG NOLSR         1837.00      0.00   2            CENTRAL SUPPLIES
231662    S CATH TRNSML ANG NOLSR         1081.00      0.00   2            CENTRAL SUPPLIES
233247    S CATH TRNSML ANG NOLSR         1080.00      0.00   2            CENTRAL SUPPLIES
232140    S CATH TRNSML ANG NOLSR         1837.00      0.00   2            CENTRAL SUPPLIES
233585    S CATH TRNSML ANG NOLSR         1534.00      0.00   2            CENTRAL SUPPLIES
233569    S CATH TRNSML ANG NOLSR         1392.00      0.00   2            CENTRAL SUPPLIES
233551    S CATH TRNSML ANG NOLSR         1534.00      0.00   2            CENTRAL SUPPLIES
231522    S CATH TRNSML ANG NOLSR         1202.00      0.00   2            CENTRAL SUPPLIES
232009    S CATH TRNSML ANG NOLSR         1383.00      0.00   2            CENTRAL SUPPLIES
232124    S CATH TRNSML ANG NOLSR         1837.00      0.00   2            CENTRAL SUPPLIES
231647    S CATH TRNSML ANG NOLSR         1128.00      0.00   2            CENTRAL SUPPLIES
231621    S CATH TRNSML ANG NOLSR         1047.00      0.00   2            CENTRAL SUPPLIES




                                                Page 18
                                     85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



231605   S CATH TRNSML ANG NOLSR               1128.00      0.00   2            CENTRAL SUPPLIES
231589   S CATH TRNSML ANG NOLSR                984.00      0.00   2            CENTRAL SUPPLIES
231381   S CATH TRNSML ANG NOLSR               1128.00      0.00   2            CENTRAL SUPPLIES
231548   S CATH TRNSML ANG NOLSR               1202.00      0.00   2            CENTRAL SUPPLIES
232025   S CATH TRNSML ANG NOLSR               1726.00      0.00   2            CENTRAL SUPPLIES
233445   S CATH TRNSML ANG NOLSR                129.00      0.00   2            CENTRAL SUPPLIES
232108   S CATH TRNSML ANG NOLSR               1837.00      0.00   2            CENTRAL SUPPLIES
233163   S CATH TRNSML ANG NOLSR               1080.00      0.00   2            CENTRAL SUPPLIES
233288   S CATH TRNSML ANG NOLSR               1148.00      0.00   2            CENTRAL SUPPLIES
233346   S CATH TRNSML ANG NOLSR               1148.00      0.00   2            CENTRAL SUPPLIES
233361   S CATH TRNSML ANG NOLSR               1253.00      0.00   2            CENTRAL SUPPLIES
233080   S CATH TRNSML ANG NOLSR               1080.00      0.00   2            CENTRAL SUPPLIES
233429   S CATH TRNSML ANG NOLSR               1148.00      0.00   2            CENTRAL SUPPLIES
233049   S CATH TRNSML ANG NOLSR               1148.00      0.00   2            CENTRAL SUPPLIES
233460   S CATH TRNSML ANG NOLSR               1148.00      0.00   2            CENTRAL SUPPLIES
233486   S CATH TRNSML ANG NOLSR               1154.00      0.00   2            CENTRAL SUPPLIES
233502   S CATH TRNSML ANG NOLSR               1148.00      0.00   2            CENTRAL SUPPLIES
233528   S CATH TRNSML ANG NOLSR               1154.00      0.00   2            CENTRAL SUPPLIES
233536   S CATH TRNSML ANG NOLSR               1148.00      0.00   2            CENTRAL SUPPLIES
233544   S CATH TRNSML ANG NOLSR               1392.00      0.00   2            CENTRAL SUPPLIES
232926   S CATH TRNSML ANG NOLSR               1080.00      0.00   2            CENTRAL SUPPLIES
231068   S CATH TRNSML ANG NOLSR                902.00      0.00   2            CENTRAL SUPPLIES
232066   S CATH TRNSML ANG NOLSR               1837.00      0.00   2            CENTRAL SUPPLIES
231126   S CATH TRNSML ANG NOLSR               1203.00      0.00   2            CENTRAL SUPPLIES
231365   S CATH TRNSML ANG NOLSR               1127.00      0.00   2            CENTRAL SUPPLIES
231340   S CATH TRNSML ANG NOLSR               1643.00      0.00   2            CENTRAL SUPPLIES
231324   S CATH TRNSML ANG NOLSR               1128.00      0.00   2            CENTRAL SUPPLIES
233122   S CATH TRNSML ANG NOLSR               1148.00      0.00   2            CENTRAL SUPPLIES
231142   S CATH TRNSML ANG NOLSR                902.00      0.00   2            CENTRAL SUPPLIES
233403   S CATH TRNSML ANG NOLSR               1253.00      0.00   2            CENTRAL SUPPLIES
232041   S CATH TRNSML ANG NOLSR               1837.00      0.00   2            CENTRAL SUPPLIES
231084   S CATH TRNSML ANG NOLSR               1203.00      0.00   2            CENTRAL SUPPLIES
231100   S CATH TRNSML ANG NOLSR               1203.00      0.00   2            CENTRAL SUPPLIES
231043   S CATH TRNSML ANG NOLSR               1203.00      0.00   2            CENTRAL SUPPLIES
232967   S CATH TRNSML ANG NOLSR               1149.00      0.00   2            CENTRAL SUPPLIES
233007   S CATH TRNSML ANG NOLSR               1078.00      0.00   2            CENTRAL SUPPLIES
231308   S CATH TRNSML ANG NOLSR               1207.00      0.00   2            CENTRAL SUPPLIES
233320   S CATH TRNSML ANG NOLSR               1080.00      0.00   2            CENTRAL SUPPLIES
243188   S IMP EMBO COIL SPRING 2.              121.00      0.00   2            CENTRAL SUPPLIES
243204   S IMP EMBO COIL SPRING 4.              278.00      0.00   2            CENTRAL SUPPLIES
243220   S IMP EMBOLI COIL SPRING               121.00      0.00   2            CENTRAL SUPPLIES
243246   S IMP IR EMBOLI COI SPRIN              209.00      0.00   2            CENTRAL SUPPLIES
243105   S IMP IR EMBOLI COIL 2X20              362.00      0.00   2            CENTRAL SUPPLIES
243121   S IMP IR EMBOLI COIL 2X40              398.00      0.00   2            CENTRAL SUPPLIES
243147   S IMP IR EMBOLI COIL 3X60              398.00      0.00   2            CENTRAL SUPPLIES
246009   S IMP IR G01 VENA CAVA FI             2529.00      0.00   2            CENTRAL SUPPLIES
252304   S IMP IR NEURO GDC COIL 2             2122.00      0.00   2            CENTRAL SUPPLIES
252403   S IMP IR NEURO GDC COIL 3             3537.00      0.00   2            CENTRAL SUPPLIES
252106   S IMP IR NEURO GDC COIL S             2542.00      0.00   2            CENTRAL SUPPLIES
252205   S IMP IR NEURO GDC COIL S             2673.00      0.00   2            CENTRAL SUPPLIES
252502   S IMP IR NEURO GDC COIL U             2909.00      0.00   2            CENTRAL SUPPLIES
276006   S IMP IR STENT BILIARY 20             4563.00      0.00   2            CENTRAL SUPPLIES
276022   S IMP IR STENT BILIARY 80             4563.00      0.00   2            CENTRAL SUPPLIES




                                                     Page 19
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



276485   S IMP IR STENT SMART 10X2         3558.00      0.00   2            CENTRAL SUPPLIES
276568   S IMP IR STENT SMART 10X2         3558.00      0.00   2            CENTRAL SUPPLIES
276501   S IMP IR STENT SMART 10X4         5434.00      0.00   2            CENTRAL SUPPLIES
276584   S IMP IR STENT SMART 10X4         3558.00      0.00   2            CENTRAL SUPPLIES
276600   S IMP IR STENT SMART 10X6         3558.00      0.00   2            CENTRAL SUPPLIES
276527   S IMP IR STENT SMART 10X6         4448.00      0.00   2            CENTRAL SUPPLIES
276543   S IMP IR STENT SMART 10X8         3558.00      0.00   2            CENTRAL SUPPLIES
276626   S IMP IR STENT SMART 12X4         2844.00      0.00   2            CENTRAL SUPPLIES
276642   S IMP IR STENT SMART 12X6         3917.00      0.00   2            CENTRAL SUPPLIES
276667   S IMP IR STENT SMART 14X4         3917.00      0.00   2            CENTRAL SUPPLIES
276683   S IMP IR STENT SMART 14X6         3917.00      0.00   2            CENTRAL SUPPLIES
276105   S IMP IR STENT SMART 7X20         4147.00      0.00   2            CENTRAL SUPPLIES
276121   S IMP IR STENT SMART 7X40         4147.00      0.00   2            CENTRAL SUPPLIES
276162   S IMP IR STENT SMART 7X40         4147.00      0.00   2            CENTRAL SUPPLIES
276147   S IMP IR STENT SMART 7X60         4147.00      0.00   2            CENTRAL SUPPLIES
276188   S IMP IR STENT SMART 7X60         4147.00      0.00   2            CENTRAL SUPPLIES
276204   S IMP IR STENT SMART 7X80         4147.00      0.00   2            CENTRAL SUPPLIES
276220   S IMP IR STENT SMART 8X20         3521.00      0.00   2            CENTRAL SUPPLIES
276303   S IMP IR STENT SMART 8X40         4147.00      0.00   2            CENTRAL SUPPLIES
276246   S IMP IR STENT SMART 8X40         4147.00      0.00   2            CENTRAL SUPPLIES
276329   S IMP IR STENT SMART 8X60         4147.00      0.00   2            CENTRAL SUPPLIES
276261   S IMP IR STENT SMART 8X60         4147.00      0.00   2            CENTRAL SUPPLIES
276287   S IMP IR STENT SMART 8X80         4147.00      0.00   2            CENTRAL SUPPLIES
276345   S IMP IR STENT SMART 9X20         4147.00      0.00   2            CENTRAL SUPPLIES
276469   S IMP IR STENT SMART 9X40         3558.00      0.00   2            CENTRAL SUPPLIES
276360   S IMP IR STENT SMART 9X40         4147.00      0.00   2            CENTRAL SUPPLIES
276402   S IMP IR STENT SMART 9X60         3558.00      0.00   2            CENTRAL SUPPLIES
276048   S IMP IR STENT UNISTEP 60         4685.00      0.00   2            CENTRAL SUPPLIES
276063   S IMP IR STENT UNISTEP LL         3521.00      0.00   2            CENTRAL SUPPLIES
274563   S IMP IR STENT URETERAL 8          529.00      0.00   2            CENTRAL SUPPLIES
274522   S IMP IR STENT URETERAL 8          445.00      0.00   2            CENTRAL SUPPLIES
274548   S IMP IR STENT URETERAL 8          552.00      0.00   2            CENTRAL SUPPLIES
274845   S IMP IR STENT VASCULAR 1         4264.00      0.00   2            CENTRAL SUPPLIES
274829   S IMP IR STENT VASCULAR 1         3544.00      0.00   2            CENTRAL SUPPLIES
274803   S IMP IR STENT VASCULAR 1         4264.00      0.00   2            CENTRAL SUPPLIES
274860   S IMP IR STENT VASCULAR 2         3733.00      0.00   2            CENTRAL SUPPLIES
274886   S IMP IR STENT VASCULAR 3         2955.00      0.00   2            CENTRAL SUPPLIES
274902   S IMP IR STENT VASCULAR 6         4108.00      0.00   2            CENTRAL SUPPLIES
276089   S IMP IR STENT WALL 7X40          3521.00      0.00   2            CENTRAL SUPPLIES
243055   S IMP IRG EMOBILIZATION C          275.00      0.00   2            CENTRAL SUPPLIES
243071   S IMP IRG EMOBILIZATION C          419.00      0.00   2            CENTRAL SUPPLIES
274738   S IMP IRG STENT MOUNTED           4192.00      0.00   2            CENTRAL SUPPLIES
274753   S IMP IRG STENT SELF-EXPA         3944.00      0.00   2            CENTRAL SUPPLIES
274704   S IMP IRG STENT UN-MOUNTE         3275.00      0.00   2            CENTRAL SUPPLIES
274407   S IMP IRG URETERAL STENT           694.00      0.00   2            CENTRAL SUPPLIES
251389   S IMP NR GDC 10MM X 30CM          2084.00      0.00   2            CENTRAL SUPPLIES
251603   S IMP NR GDC 10MM X30CM 2         2147.00      0.00   2            CENTRAL SUPPLIES
251405   S IMP NR GDC 12MM X 30CM          2084.00      0.00   2            CENTRAL SUPPLIES
251629   S IMP NR GDC 12MMX30CM 2D         2147.00      0.00   2            CENTRAL SUPPLIES
251421   S IMP NR GDC 14MM X 30CM          2084.00      0.00   2            CENTRAL SUPPLIES
251447   S IMP NR GDC 16MM X 30CM          2230.00      0.00   2            CENTRAL SUPPLIES
251660   S IMP NR GDC 16MMX30CM 2D         2147.00      0.00   2            CENTRAL SUPPLIES
251462   S IMP NR GDC 18MM X 30CM          2230.00      0.00   2            CENTRAL SUPPLIES




                                                 Page 20
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



251686   S IMP NR GDC 18MMX30CM 2D        2293.00      0.00   2            CENTRAL SUPPLIES
251488   S IMP NR GDC 20MM X 30CM         2230.00      0.00   2            CENTRAL SUPPLIES
251728   S IMP NR GDC 2MM X 2CM SO        2152.00      0.00   2            CENTRAL SUPPLIES
251025   S IMP NR GDC 2MM X 4CM SO        2152.00      0.00   2            CENTRAL SUPPLIES
251744   S IMP NR GDC 2MMX3CM SOFT        2152.00      0.00   2            CENTRAL SUPPLIES
251769   S IMP NR GDC 2MMX6CM SOFT        2152.00      0.00   2            CENTRAL SUPPLIES
251041   S IMP NR GDC 2MMX8CM SOFT        2152.00      0.00   2            CENTRAL SUPPLIES
251785   S IMP NR GDC 3MMX3CM SOFT        2152.00      0.00   2            CENTRAL SUPPLIES
251066   S IMP NR GDC 3MMX4CM SOFT        2152.00      0.00   2            CENTRAL SUPPLIES
251082   S IMP NR GDC 3MMX8CM SOFT        2152.00      0.00   2            CENTRAL SUPPLIES
251124   S IMP NR GDC 4MMX10CM SOF        2278.00      0.00   2            CENTRAL SUPPLIES
251108   S IMP NR GDC 4MMX6CM SOFT        2278.00      0.00   2            CENTRAL SUPPLIES
251223   S IMP NR GDC 5MMX15CM COI        2278.00      0.00   2            CENTRAL SUPPLIES
251504   S IMP NR GDC 5MMX20CM 2D         2354.00      0.00   2            CENTRAL SUPPLIES
251140   S IMP NR GDC 5MMX8CM SOFT        2278.00      0.00   2            CENTRAL SUPPLIES
251520   S IMP NR GDC 6MM X 20CM 2        2480.00      0.00   2            CENTRAL SUPPLIES
251264   S IMP NR GDC 6MM X 20CM C        2405.00      0.00   2            CENTRAL SUPPLIES
251181   S IMP NR GDC 6MMX10CM SOF        2405.00      0.00   2            CENTRAL SUPPLIES
251207   S IMP NR GDC 6MMX15CM SOF        2405.00      0.00   2            CENTRAL SUPPLIES
251546   S IMP NR GDC 7MM X 30CM 2        2480.00      0.00   2            CENTRAL SUPPLIES
251280   S IMP NR GDC 7MM X 30CM C        2405.00      0.00   2            CENTRAL SUPPLIES
251306   S IMP NR GDC 8MM X 20CM C        2405.00      0.00   2            CENTRAL SUPPLIES
251561   S IMP NR GDC 8MM X 30CM 2        2480.00      0.00   2            CENTRAL SUPPLIES
251322   S IMP NR GDC 8MM X 30CM C        2405.00      0.00   2            CENTRAL SUPPLIES
251587   S IMP NR GDC 9MM X 30CM 2        2480.00      0.00   2            CENTRAL SUPPLIES
251363   S IMP NR GDC 9MM X 30CM C        2405.00      0.00   2            CENTRAL SUPPLIES
251165   S IMP S IMP NR GDC 5MMX12        2278.00      0.00   2            CENTRAL SUPPLIES
235713   S IMP STENT,URETERAL,DOUB         769.00      0.00   2            CENTRAL SUPPLIES
246108   S IMP VENA CAVA FILTER GF        4425.00      0.00   2            CENTRAL SUPPLIES
252320   S NSTRL NR STENT/NEURO 3         6789.00      0.00   2            CENTRAL SUPPLIES
252122   S NSTRL NR STENT/NEURO 3         6789.00      0.00   2            CENTRAL SUPPLIES
252361   S NSTRL NR STENT/NEURO 4         6789.00      0.00   2            CENTRAL SUPPLIES
252346   S NSTRL NR STENT/NEURO 4         6789.00      0.00   2            CENTRAL SUPPLIES
252163   S NSTRL NR STENT/NEURO 4         6789.00      0.00   2            CENTRAL SUPPLIES
252148   S NSTRL NR STENT/NEURO 4         6789.00      0.00   2            CENTRAL SUPPLIES
252049   S NSTRL NR WIRE 300 FLOP         1443.00      0.00   2            CENTRAL SUPPLIES
234047   S STRL CATH AORTIC FLUS           126.00      0.00   2            CENTRAL SUPPLIES
234070   S STRL CATH BERENSTINE            107.00      0.00   2            CENTRAL SUPPLIES
234088   S STRL CATH BERENSTINE            109.00      0.00   2            CENTRAL SUPPLIES
234963   S STRL CATH BERENSTINE 4F         107.00      0.00   2            CENTRAL SUPPLIES
234187   S STRL CATH COBRA C2 5F           117.00      0.00   2            CENTRAL SUPPLIES
234120   S STRL CATH COBRA WITH            100.00      0.00   2            CENTRAL SUPPLIES
234245   S STRL CATH GUIDE 4FRAN           269.00      0.00   2            CENTRAL SUPPLIES
234708   S STRL CATH MPA 5FR               109.00      0.00   2            CENTRAL SUPPLIES
234823   S STRL CATH PIGTAIL 6FR            72.00      0.00   2            CENTRAL SUPPLIES
234906   S STRL CATH SIMMONS I 5           100.00      0.00   2            CENTRAL SUPPLIES
235002   S STRL CATH SIMMONS S2            109.00      0.00   2            CENTRAL SUPPLIES
235028   S STRL CATH SOS OMNI              111.00      0.00   2            CENTRAL SUPPLIES
235101   S STRL CATH STRAIGHT 5F           103.00      0.00   2            CENTRAL SUPPLIES
235127   S STRL CATH STRAIGHT 5F           100.00      0.00   2            CENTRAL SUPPLIES
235085   S STRL CATH STRAIGHT 5F           102.00      0.00   2            CENTRAL SUPPLIES
283101   S STRL HI-PRESSURE TUBI            21.00      0.00   2            CENTRAL SUPPLIES
231209   S STRL IR BALLOON OCCLU           557.00      0.00   2            CENTRAL SUPPLIES




                                                Page 21
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



231159   S STRL IR BALLOONS OCCL             1061.00      0.00   2            CENTRAL SUPPLIES
234427   S STRL IR CAHT FOGARTY               129.00      0.00   2            CENTRAL SUPPLIES
234005   S STRL IR CATH 5FR 65CM              116.00      0.00   2            CENTRAL SUPPLIES
234260   S STRL IR CATH BERN GLD              296.00      0.00   2            CENTRAL SUPPLIES
234526   S STRL IR CATH COBRAGD               529.00      0.00   2            CENTRAL SUPPLIES
234443   S STRL IR CATH COBRAGD               502.00      0.00   2            CENTRAL SUPPLIES
232546   S STRL IR CATH DIAL ACC              840.00      0.00   2            CENTRAL SUPPLIES
282756   S STRL IR CATH DRAIN PI              260.00      0.00   2            CENTRAL SUPPLIES
234401   S STRL IR CATH FAST TRA              387.00      0.00   2            CENTRAL SUPPLIES
235309   S STRL IR CATH H1                    107.00      0.00   2            CENTRAL SUPPLIES
234583   S STRL IR CATH HOOK VIS               70.00      0.00   2            CENTRAL SUPPLIES
234625   S STRL IR CATH JB2                    67.00      0.00   2            CENTRAL SUPPLIES
234344   S STRL IR CATH MPC GD 6              556.00      0.00   2            CENTRAL SUPPLIES
234765   S STRL IR CATH PIGTAIL                51.00      0.00   2            CENTRAL SUPPLIES
234690   S STRL IR CATH RAPID TR             1443.00      0.00   2            CENTRAL SUPPLIES
234542   S STRL IR CATH RESSGD 8              529.00      0.00   2            CENTRAL SUPPLIES
234955   S STRL IR CATH SIM1 5FR              100.00      0.00   2            CENTRAL SUPPLIES
234328   S STRL IR CATH SIM2 GD               557.00      0.00   2            CENTRAL SUPPLIES
243048   S STRL IR CATH TRACKER              1336.00      0.00   2            CENTRAL SUPPLIES
243022   S STRL IR CATH TRACKER              1292.00      0.00   2            CENTRAL SUPPLIES
235200   S STRL IR CATH TRACKER              1466.00      0.00   2            CENTRAL SUPPLIES
235226   S STRL IR CATH VENTURE              1560.00      0.00   2            CENTRAL SUPPLIES
241091   S STRL IR CATHETER INFU              760.00      0.00   2            CENTRAL SUPPLIES
243303   S STRL IR CONTOUR 250-3              418.00      0.00   2            CENTRAL SUPPLIES
261420   S STRL IR DILATOR 10FR                38.00      0.00   2            CENTRAL SUPPLIES
261008   S STRL IR DILATOR 11FR                40.00      0.00   2            CENTRAL SUPPLIES
261024   S STRL IR DILATOR 12FR                40.00      0.00   2            CENTRAL SUPPLIES
261040   S STRL IR DILATOR 13FR                40.00      0.00   2            CENTRAL SUPPLIES
261065   S STRL IR DILATOR 14FR                40.00      0.00   2            CENTRAL SUPPLIES
261081   S STRL IR DILATOR 16FR                40.00      0.00   2            CENTRAL SUPPLIES
261206   S STRL IR DILATOR 20FR                38.00      0.00   2            CENTRAL SUPPLIES
261222   S STRL IR DILATOR 22FR                61.00      0.00   2            CENTRAL SUPPLIES
261289   S STRL IR DILATOR 4FR                 39.00      0.00   2            CENTRAL SUPPLIES
261305   S STRL IR DILATOR 5FR                 35.00      0.00   2            CENTRAL SUPPLIES
261321   S STRL IR DILATOR 6FR                 33.00      0.00   2            CENTRAL SUPPLIES
261347   S STRL IR DILATOR 7FR                 33.00      0.00   2            CENTRAL SUPPLIES
261362   S STRL IR DILATOR 8FR                 35.00      0.00   2            CENTRAL SUPPLIES
261388   S STRL IR DILATOR 9FR                 33.00      0.00   2            CENTRAL SUPPLIES
281907   S STRL IR DRAIN CAST BI              384.00      0.00   2            CENTRAL SUPPLIES
281808   S STRL IR DRAIN CATH AP              439.00      0.00   2            CENTRAL SUPPLIES
281956   S STRL IR DRAIN CATH BI              419.00      0.00   2            CENTRAL SUPPLIES
281857   S STRL IR DRAIN CATH BI              419.00      0.00   2            CENTRAL SUPPLIES
282053   S STRL IR DRAIN CATH NE              476.00      0.00   2            CENTRAL SUPPLIES
282004   S STRL IR DRAIN CATH NE              476.00      0.00   2            CENTRAL SUPPLIES
282152   S STRL IR DRAIN CATH NE              371.00      0.00   2            CENTRAL SUPPLIES
282103   S STRL IR DRAIN CATH NE              292.00      0.00   2            CENTRAL SUPPLIES
282509   S STRL IR DRAIN CATH VA              552.00      0.00   2            CENTRAL SUPPLIES
281774   S STRL IR DRAINAGE CATH              105.00      0.00   2            CENTRAL SUPPLIES
243386   S STRL IR EMBO WIRE TAP              669.00      0.00   2            CENTRAL SUPPLIES
243287   S STRL IR EMBOLI CONTOU              418.00      0.00   2            CENTRAL SUPPLIES
243329   S STRL IR EMBOLI CONTOU              418.00      0.00   2            CENTRAL SUPPLIES
243345   S STRL IR EMBOLI CONTOU              418.00      0.00   2            CENTRAL SUPPLIES
241067   S STRL IR FLO-SWITCH                  33.00      0.00   2            CENTRAL SUPPLIES




                                                   Page 22
                                     85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



250209   S STRL IR GELFOAM                       39.00      0.00   2            CENTRAL SUPPLIES
234195   S STRL IR GLIDE CATH C2                267.00      0.00   2            CENTRAL SUPPLIES
263301   S STRL IR INTRODUCER 4F                 62.00      0.00   2            CENTRAL SUPPLIES
263004   S STRL IR INTRODUCER 5F                112.00      0.00   2            CENTRAL SUPPLIES
263020   S STRL IR INTRODUCER 6F                112.00      0.00   2            CENTRAL SUPPLIES
263327   S STRL IR INTRODUCER 7F                110.00      0.00   2            CENTRAL SUPPLIES
263046   S STRL IR INTRODUCER 7F                356.00      0.00   2            CENTRAL SUPPLIES
263368   S STRL IR INTRODUCER 8F                206.00      0.00   2            CENTRAL SUPPLIES
263343   S STRL IR INTRODUCER 8F                201.00      0.00   2            CENTRAL SUPPLIES
263285   S STRL IR INTRODUCER 9F                206.00      0.00   2            CENTRAL SUPPLIES
263061   S STRL IR INTRODUCER BA                196.00      0.00   2            CENTRAL SUPPLIES
263160   S STRL IR INTRODUCER PE                249.00      0.00   2            CENTRAL SUPPLIES
263087   S STRL IR INTRODUCER PE                280.00      0.00   2            CENTRAL SUPPLIES
263103   S STRL IR INTRODUCER PE                236.00      0.00   2            CENTRAL SUPPLIES
263145   S STRL IR INTRODUCER PE                236.00      0.00   2            CENTRAL SUPPLIES
263129   S STRL IR INTRODUCER PE                276.00      0.00   2            CENTRAL SUPPLIES
263202   S STRL IR INTRODUCER PE                249.00      0.00   2            CENTRAL SUPPLIES
263228   S STRL IR INTRODUCER PE                236.00      0.00   2            CENTRAL SUPPLIES
263186   S STRL IR INTRODUCER PE                236.00      0.00   2            CENTRAL SUPPLIES
246504   S STRL IR IVC FILTER SE               3669.00      0.00   2            CENTRAL SUPPLIES
285445   S STRL IR MICROPUNCTURE                144.00      0.00   2            CENTRAL SUPPLIES
241109   S STRL IR MONITORING TU                 17.00      0.00   2            CENTRAL SUPPLIES
282558   S STRL IR NEPHROSTOMY K                694.00      0.00   2            CENTRAL SUPPLIES
256107   S STRL IR NEURO CEM KIT               1965.00      0.00   2            CENTRAL SUPPLIES
256206   S STRL IR NEURO CEM KIT               1572.00      0.00   2            CENTRAL SUPPLIES
252809   S STRL IR NEURO CONNECT                222.00      0.00   2            CENTRAL SUPPLIES
250605   S STRL IR NEURO CRANIOP               1139.00      0.00   2            CENTRAL SUPPLIES
283309   S STRL IR NEURO, BARIUM                354.00      0.00   2            CENTRAL SUPPLIES
285056   S STRL IR SET GASTROJEJ                742.00      0.00   2            CENTRAL SUPPLIES
285155   S STRL IR SET GROSHONG                1907.00      0.00   2            CENTRAL SUPPLIES
285403   S STRL IR SET M-R FEEDI                278.00      0.00   2            CENTRAL SUPPLIES
285759   S STRL IR SNARE 25MM                  1743.00      0.00   2            CENTRAL SUPPLIES
244004   S STRL IR STONE BASKET                 946.00      0.00   2            CENTRAL SUPPLIES
244020   S STRL IR STONE BASKET                1198.00      0.00   2            CENTRAL SUPPLIES
244061   S STRL IR STONE BASKET                1085.00      0.00   2            CENTRAL SUPPLIES
244046   S STRL IR STONE BASKET                 919.00      0.00   2            CENTRAL SUPPLIES
235143   S STRL IR STRAIGHT 5FR                  97.00      0.00   2            CENTRAL SUPPLIES
241125   S STRL IR T-FASTENER B-                260.00      0.00   2            CENTRAL SUPPLIES
245506   S STRL IR TORQUE DEVICE                 45.00      0.00   2            CENTRAL SUPPLIES
245605   S STRL IR TRANSDUCER NA                103.00      0.00   2            CENTRAL SUPPLIES
286203   S STRL IR TRAY PNEUMOTH                194.00      0.00   2            CENTRAL SUPPLIES
286302   S STRL IR TRAY THORACEN                229.00      0.00   2            CENTRAL SUPPLIES
266007   S STRL IR TUB GASTRO 18                697.00      0.00   2            CENTRAL SUPPLIES
266106   S STRL IR TUB GASTRO 22                697.00      0.00   2            CENTRAL SUPPLIES
266148   S STRL IR TUBE GJ 16FR                 697.00      0.00   2            CENTRAL SUPPLIES
266163   S STRL IR TUBE GJ 22FR                 697.00      0.00   2            CENTRAL SUPPLIES
287201   S STRL IR VASC CLOS VAS                987.00      0.00   2            CENTRAL SUPPLIES
285007   S STRL IR VASCULAR ACCE                393.00      0.00   2            CENTRAL SUPPLIES
287003   S STRL IR VASCULAR CLOS                983.00      0.00   2            CENTRAL SUPPLIES
287144   S STRL IR VASCULAR CLOS                329.00      0.00   2            CENTRAL SUPPLIES
287102   S STRL IR VASCULAR CLOS                255.00      0.00   2            CENTRAL SUPPLIES
246157   S STRL IR VENA CAVA FILTE             3263.00      0.00   2            CENTRAL SUPPLIES
267203   S STRL IR WIRE AMPLATZ                 206.00      0.00   2            CENTRAL SUPPLIES




                                                     Page 23
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



267260   S STRL IR WIRE AMPLATZ             166.00      0.00   2            CENTRAL SUPPLIES
267245   S STRL IR WIRE AMPLATZ             255.00      0.00   2            CENTRAL SUPPLIES
267302   S STRL IR WIRE BENTSON              91.00      0.00   2            CENTRAL SUPPLIES
267500   S STRL IR WIRE COONS BENS           98.00      0.00   2            CENTRAL SUPPLIES
267807   S STRL IR WIRE EXCHANGE             87.00      0.00   2            CENTRAL SUPPLIES
268128   S STRL IR WIRE GLD 38X1            278.00      0.00   2            CENTRAL SUPPLIES
268102   S STRL IR WIRE GLD ANGL            267.00      0.00   2            CENTRAL SUPPLIES
268003   S STRL IR WIRE GLD ANGL            190.00      0.00   2            CENTRAL SUPPLIES
268045   S STRL IR WIRE GLD ANGL            190.00      0.00   2            CENTRAL SUPPLIES
268227   S STRL IR WIRE GLD GOLD            835.00      0.00   2            CENTRAL SUPPLIES
268029   S STRL IR WIRE GLD STRG            190.00      0.00   2            CENTRAL SUPPLIES
268060   S STRL IR WIRE GLD STRG            166.00      0.00   2            CENTRAL SUPPLIES
268144   S STRL IR WIRE GLDANGLE            294.00      0.00   2            CENTRAL SUPPLIES
268086   S STRL IR WIRE GLDSTRGH            166.00      0.00   2            CENTRAL SUPPLIES
268508   S STRL IR WIRE HTF 180             603.00      0.00   2            CENTRAL SUPPLIES
268524   S STRL IR WIRE HTF 300             603.00      0.00   2            CENTRAL SUPPLIES
268565   S STRL IR WIRE INFUSION            334.00      0.00   2            CENTRAL SUPPLIES
268540   S STRL IR WIRE INFUSION            742.00      0.00   2            CENTRAL SUPPLIES
267104   S STRL IR WIRE J MVBL C              8.00      0.00   2            CENTRAL SUPPLIES
267708   S STRL IR WIRE MICROPUN             93.00      0.00   2            CENTRAL SUPPLIES
268649   S STRL IR WIRE NEWTON L             64.00      0.00   2            CENTRAL SUPPLIES
268706   S STRL IR WIRE ROSEN               126.00      0.00   2            CENTRAL SUPPLIES
268805   S STRL IR WIRE SEEKER              718.00      0.00   2            CENTRAL SUPPLIES
268169   S STRL IR WIRE TRANSEND            919.00      0.00   2            CENTRAL SUPPLIES
268847   S STRL IR WIRE WHOLEY              673.00      0.00   2            CENTRAL SUPPLIES
281758   S STRL IRG BAG DRAINAGE             39.00      0.00   2            CENTRAL SUPPLIES
231738   S STRL IRG BALLOON PTA            1088.00      0.00   2            CENTRAL SUPPLIES
231704   S STRL IRG BALLOON PTA            1088.00      0.00   2            CENTRAL SUPPLIES
231753   S STRL IRG BALLOONS               1088.00      0.00   2            CENTRAL SUPPLIES
234054   S STRL IRG CATH BERGMAN            222.00      0.00   2            CENTRAL SUPPLIES
235705   S STRL IRG CATHETER                  0.00      0.00   2            CENTRAL SUPPLIES
235507   S STRL IRG CATHETER HYD            301.00      0.00   2            CENTRAL SUPPLIES
235457   S STRL IRG CATHETER LON            131.00      0.00   2            CENTRAL SUPPLIES
235556   S STRL IRG CATHETER MAR            131.00      0.00   2            CENTRAL SUPPLIES
235606   S STRL IRG CATHETER MIC           1284.00      0.00   2            CENTRAL SUPPLIES
235408   S STRL IRG CATHETER SHO             92.00      0.00   2            CENTRAL SUPPLIES
260505   S STRL IRG DILATORS                 26.00      0.00   2            CENTRAL SUPPLIES
234419   S STRL IRG EMBOLECTOMY             236.00      0.00   2            CENTRAL SUPPLIES
243162   S STRL IRG EMBOLI COIL             616.00      0.00   2            CENTRAL SUPPLIES
250506   S STRL IRG EMOBILIZATIO            930.00      0.00   2            CENTRAL SUPPLIES
269209   S STRL IRG GUIDEWIRES              787.00      0.00   2            CENTRAL SUPPLIES
269258   S STRL IRG GUIDEWIRES H            249.00      0.00   2            CENTRAL SUPPLIES
269308   S STRL IRG GUIDEWIRES I            891.00      0.00   2            CENTRAL SUPPLIES
269357   S STRL IRG GUIDEWIRES M            171.00      0.00   2            CENTRAL SUPPLIES
241083   S STRL IRG INDEFLATOR              262.00      0.00   2            CENTRAL SUPPLIES
269654   S STRL IRG INTRODUCER S            262.00      0.00   2            CENTRAL SUPPLIES
269605   S STRL IRG INTRODUCERS             315.00      0.00   2            CENTRAL SUPPLIES
269555   S STRL IRG INTRODUCERS             183.00      0.00   2            CENTRAL SUPPLIES
269506   S STRL IRG INTRODUCERS              53.00      0.00   2            CENTRAL SUPPLIES
234641   S STRL IRG NEEDLE TLA              131.00      0.00   2            CENTRAL SUPPLIES
285809   S STRL IRG SET RING TRA           1821.00      0.00   2            CENTRAL SUPPLIES
286351   S STRL IRG THROMBOLYTIC           2293.00      0.00   2            CENTRAL SUPPLIES
241166   S STRL IRG TORQUE DEVIC             39.00      0.00   2            CENTRAL SUPPLIES




                                                 Page 24
                               85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



286005   S STRL IRG TRAY ANGIO            171.00      0.00   2            CENTRAL SUPPLIES
240408   S STRL IRG VASCULAR EMB          930.00      0.00   2            CENTRAL SUPPLIES
285700   S STRL IRG VASCULAR SNA          983.00      0.00   2            CENTRAL SUPPLIES
285452   S STRL MICRO PUNCTURE 5          143.00      0.00   2            CENTRAL SUPPLIES
284208   S STRL NEEDLE 18GA THIN           34.00      0.00   2            CENTRAL SUPPLIES
284158   S STRL NEEDLE SMART LAR          390.00      0.00   2            CENTRAL SUPPLIES
284257   S STRL NEEDLE WESTCOTT            65.00      0.00   2            CENTRAL SUPPLIES
252288   S STRL NR BATTERIES                0.00      0.00   2            CENTRAL SUPPLIES
252247   S STRL NR GDC POWER SUP            0.00      0.00   2            CENTRAL SUPPLIES
253104   S STRL NR KYPHOPAK 15/3        10192.00      0.00   2            CENTRAL SUPPLIES
253153   S STRL NR KYPHOPAK 15/3         6932.00      0.00   2            CENTRAL SUPPLIES
253252   S STRL NR KYPHOPAK 20/3         6932.00      0.00   2            CENTRAL SUPPLIES
253203   S STRL NR KYPHOPAK 20/3        10192.00      0.00   2            CENTRAL SUPPLIES
253450   S STRL NR KYPHX INFLAT          4006.00      0.00   2            CENTRAL SUPPLIES
253401   S STRL NR KYPHX TOOL KI         3752.00      0.00   2            CENTRAL SUPPLIES
285502   S STRL PERCU-FIX SET              82.00      0.00   2            CENTRAL SUPPLIES
264465   S STRL RF PROBE 2CMX15CM         758.00      0.00   2            CENTRAL SUPPLIES
264523   S STRL RF PROBE 3.5CMX15C       1152.00      0.00   2            CENTRAL SUPPLIES
264481   S STRL RF PROBE 3CMX15CM         983.00      0.00   2            CENTRAL SUPPLIES
264549   S STRL RF PROBE 4CMX15CM        1348.00      0.00   2            CENTRAL SUPPLIES
234021   S STRL S STRL CATH AORT          122.00      0.00   2            CENTRAL SUPPLIES
285353   S STRL SET LIVER BIOPSY          361.00      0.00   2            CENTRAL SUPPLIES
266205   S STRL TUBE TRANSGASTRI          987.00      0.00   2            CENTRAL SUPPLIES
675611   CA ECHO 2D CMPL                 1327.00      0.00   6            DIAG IMAGING PROCEDURES
675678   CA ECHO 2D LTD                   778.00      0.00   6            DIAG IMAGING PROCEDURES
675694   CA ECHO 2D W STRES               374.00      0.00   6            DIAG IMAGING PROCEDURES
675645   CA ECHO DPPLER CMPL              587.00      0.00   6            DIAG IMAGING PROCEDURES
675637   CA ECHO DPPLER COLOR FLOW        611.00      0.00   6            DIAG IMAGING PROCEDURES
675884   CA ECHO TRANSESOPHAGEAL         1509.00      0.00   6            DIAG IMAGING PROCEDURES
629998   CONV. MISC. DIAG RAD               0.00      0.00   6            DIAG IMAGING PROCEDURES
644906   CT 3D RECONSTRUCTION            1812.00   1593.00   6            DIAG IMAGING PROCEDURES
646208   CT ABD W/CON                    2179.00    956.00   6            DIAG IMAGING PROCEDURES
646158   CT ABD W/O CON                  2044.00    887.00   6            DIAG IMAGING PROCEDURES
646109   CT ABD W-W/O CON                2542.00   1041.00   6            DIAG IMAGING PROCEDURES
641449   CT BONE DENSITY STDY APPN        390.00      0.00   6            DIAG IMAGING PROCEDURES
640144   CT BONE DENSTY STDY AXIAL        646.00      0.00   6            DIAG IMAGING PROCEDURES
641431   CT BONE DENSTY STDY AXIAL        400.00      0.00   6            DIAG IMAGING PROCEDURES
641605   CT BRAIN W CON                  2939.00   1441.00   6            DIAG IMAGING PROCEDURES
641555   CT BRAIN W/O CON                2636.00   1119.00   6            DIAG IMAGING PROCEDURES
641506   CT BRAIN W-W/O CON              3728.00   1535.00   6            DIAG IMAGING PROCEDURES
648725   CT CARDIAC SCORING               479.00      0.00   6            DIAG IMAGING PROCEDURES
648774   CT COLONOSCOPY VIRTL SCRN        801.00      0.00   6            DIAG IMAGING PROCEDURES
646224   CT DRN W CATH PLACE PRC         2124.00   1866.00   6            DIAG IMAGING PROCEDURES
642835   CT EXT LOW W CON                3160.00   1456.00   6            DIAG IMAGING PROCEDURES
642827   CT EXT LOW W/O CON              2748.00   1296.00   6            DIAG IMAGING PROCEDURES
642819   CT EXT LOW W-W/O CON            3639.00   1897.00   6            DIAG IMAGING PROCEDURES
642934   CT EXT UPP W CON                2525.00      0.00   6            DIAG IMAGING PROCEDURES
642926   CT EXT UPP W/O CON              1817.00   1594.00   6            DIAG IMAGING PROCEDURES
642918   CT EXT UPP W-W/O CON            3261.00      0.00   6            DIAG IMAGING PROCEDURES
641407   CT GUIDE NDL PLACEMENT          1086.00   1025.00   6            DIAG IMAGING PROCEDURES
640193   CT GUIDE RAD TX FIELDS          1556.00      0.00   6            DIAG IMAGING PROCEDURES
646851   CT GUIDE RAD TX FIELDS           400.00      0.00   6            DIAG IMAGING PROCEDURES
643338   CT LTD OR FU STDY               1298.00   1140.00   6            DIAG IMAGING PROCEDURES




                                               Page 25
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



648758   CT LUNG SCREENING                  801.00      0.00   6            DIAG IMAGING PROCEDURES
643908   CT MAXILLOFACIAL W CON            3116.00   1441.00   6            DIAG IMAGING PROCEDURES
643858   CT MAXILLOFACIAL W/O CON          2852.00   1251.00   6            DIAG IMAGING PROCEDURES
644054   CT NEC W CON                      3116.00   1441.00   6            DIAG IMAGING PROCEDURES
644005   CT NEC W/O CON                    2794.00   1225.00   6            DIAG IMAGING PROCEDURES
643957   CT NEC W-W/O CON                  3874.00   1504.00   6            DIAG IMAGING PROCEDURES
644757   CT ORBIT SELLA FOSA W-W/O         3874.00   1504.00   6            DIAG IMAGING PROCEDURES
644807   CT ORBIT SELLA FOSSA W            3116.00   1441.00   6            DIAG IMAGING PROCEDURES
644856   CT ORBIT/SELLA/FOSSA W/O          2794.00   1225.00   6            DIAG IMAGING PROCEDURES
644708   CT PELV W CON                     2166.00    891.00   6            DIAG IMAGING PROCEDURES
644658   CT PELV W/O CON                   2069.00    807.00   6            DIAG IMAGING PROCEDURES
644609   CT PELV W-W/O CON                 2310.00   1117.00   6            DIAG IMAGING PROCEDURES
641472   CT PERFUSION W/CON CBF            5280.00      0.00   6            DIAG IMAGING PROCEDURES
641274   CT SEDATION IV/IM/INH              544.00      0.00   6            DIAG IMAGING PROCEDURES
646265   CT SEDATION MONITORING               0.00      0.00   6            DIAG IMAGING PROCEDURES
641282   CT SEDATION PO/PR/INASAL           362.00      0.00   6            DIAG IMAGING PROCEDURES
646455   CT SPINE CERV W CON               3116.00   1757.00   6            DIAG IMAGING PROCEDURES
646406   CT SPINE CERV W/O CON             3901.00   1597.00   6            DIAG IMAGING PROCEDURES
646356   CT SPINE CERV W-W/O CON           4661.00   1916.00   6            DIAG IMAGING PROCEDURES
646604   CT SPINE LUMB W CON               3180.00   1794.00   6            DIAG IMAGING PROCEDURES
646554   CT SPINE LUMB W/O CON             3978.00   1630.00   6            DIAG IMAGING PROCEDURES
646505   CT SPINE LUMB W-W/O CON           4569.00   1916.00   6            DIAG IMAGING PROCEDURES
646752   CT SPINE THOR W CON               3116.00   1757.00   6            DIAG IMAGING PROCEDURES
646703   CT SPINE THOR W/O CON             4033.00   1597.00   6            DIAG IMAGING PROCEDURES
646653   CT SPINE THOR W-W/O               4569.00   1916.00   6            DIAG IMAGING PROCEDURES
646802   CT STEREOTACTIC LOC               3160.00   2775.00   6            DIAG IMAGING PROCEDURES
643601   CT THORAX W CON                   3921.00   1608.00   6            DIAG IMAGING PROCEDURES
643551   CT THORAX W/O CON                 3720.00   1519.00   6            DIAG IMAGING PROCEDURES
643502   CT THORAX W-W/O                   4123.00   1689.00   6            DIAG IMAGING PROCEDURES
646315   CT VERTEBROPLASTY                  290.00      0.00   6            DIAG IMAGING PROCEDURES
646216   CTA ABD W-W/O CON                 6088.00      0.00   6            DIAG IMAGING PROCEDURES
643627   CTA CHEST W-W/O CON               6007.00      0.00   6            DIAG IMAGING PROCEDURES
642850   CTA EXT LOW W-W/O CON             1430.00      0.00   6            DIAG IMAGING PROCEDURES
642959   CTA EXT UPP W-W/O CON             6087.00      0.00   6            DIAG IMAGING PROCEDURES
641621   CTA HEAD W-W/O CON                5025.00      0.00   6            DIAG IMAGING PROCEDURES
644070   CTA NEC W-W/O CON                 6088.00      0.00   6            DIAG IMAGING PROCEDURES
644724   CTA PELV W-W/O CON                6088.00      0.00   6            DIAG IMAGING PROCEDURES
642744   CTC ABLTN CRYO OPN LIVER          4297.00      0.00   6            DIAG IMAGING PROCEDURES
642736   CTC ABLTN RENAL RF PRC            4475.00      0.00   6            DIAG IMAGING PROCEDURES
647560   CTC ABSCSS CYST LIVER PRC         3921.00      0.00   6            DIAG IMAGING PROCEDURES
647628   CTC ABSCSS DRN PELV PRC           1206.00   1059.00   6            DIAG IMAGING PROCEDURES
647701   CTC ABSCSS DRN PERITNL            2621.00      0.00   6            DIAG IMAGING PROCEDURES
647669   CTC ABSCSS DRN RENL               4367.00      0.00   6            DIAG IMAGING PROCEDURES
647743   CTC ABSCSS DRN RETROPE            1321.00   1160.00   6            DIAG IMAGING PROCEDURES
647784   CTC ABSCSS DRN SUBDIAP            1426.00   1252.00   6            DIAG IMAGING PROCEDURES
647503   CTC ABSCSS INC SFT TISSUE         1057.00    929.00   6            DIAG IMAGING PROCEDURES
642462   CTC ASP BREAST ADD                 160.00      0.00   6            DIAG IMAGING PROCEDURES
642454   CTC ASP BREAST CYST                378.00      0.00   6            DIAG IMAGING PROCEDURES
667253   CTC ASP RENL CYST                  338.00    319.00   6            DIAG IMAGING PROCEDURES
642488   CTC ASP SPINAL CYST PRC           1787.91      0.00   6            DIAG IMAGING PROCEDURES
648139   CTC BX ABD RETROPE                 661.00    623.00   6            DIAG IMAGING PROCEDURES
642538   CTC BX BM NDL/TROCAR               660.00      0.00   6            DIAG IMAGING PROCEDURES
642504   CTC BX BONE DEEP                   836.00    732.00   6            DIAG IMAGING PROCEDURES




                                                 Page 26
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



648006   CTC BX BONE DEEP                  819.00    718.00   6            DIAG IMAGING PROCEDURES
642520   CTC BX BONE SUPER                 966.00    460.00   6            DIAG IMAGING PROCEDURES
648113   CTC BX BRAIN W BURR HOLE         3656.00      0.00   6            DIAG IMAGING PROCEDURES
648261   CTC BX EXCSN LYMPH NODE           887.85      0.00   6            DIAG IMAGING PROCEDURES
648147   CTC BX LIVER                      675.00      0.00   6            DIAG IMAGING PROCEDURES
648154   CTC BX LUNG MEDIASTNM            1395.00    531.00   6            DIAG IMAGING PROCEDURES
640060   CTC BX MUSCLE                     758.00      0.00   6            DIAG IMAGING PROCEDURES
648162   CTC BX NASOPHARNYX               1828.00    682.00   6            DIAG IMAGING PROCEDURES
648170   CTC BX PANCREAS                  1166.00      0.00   6            DIAG IMAGING PROCEDURES
648196   CTC BX PLEURA                     498.00      0.00   6            DIAG IMAGING PROCEDURES
642645   CTC BX PROSTATE                   774.00      0.00   6            DIAG IMAGING PROCEDURES
648204   CTC BX RENL                       459.00    433.00   6            DIAG IMAGING PROCEDURES
642470   CTC BX STEREO ASPIR HEAD         4044.00      0.00   6            DIAG IMAGING PROCEDURES
642694   CTC BX THYROID                    388.00      0.00   6            DIAG IMAGING PROCEDURES
648659   CTC ENDO SB W JEJ TUB PRC         726.33      0.00   6            DIAG IMAGING PROCEDURES
642991   CTC EXCHANGE DRN CATH             280.00      0.00   6            DIAG IMAGING PROCEDURES
642405   CTC FNA W IMAG GUIDANCE           506.00      0.00   6            DIAG IMAGING PROCEDURES
643056   CTC INJ CON ABSCSS                157.00      0.00   6            DIAG IMAGING PROCEDURES
643106   CTC INJ FACET C/T 1 LVL           765.00    671.00   6            DIAG IMAGING PROCEDURES
643155   CTC INJ FACET L/S ADD LVL         331.00    294.00   6            DIAG IMAGING PROCEDURES
648279   CTC INJ NRV BLK C/T 1 LVL         765.00      0.00   6            DIAG IMAGING PROCEDURES
648287   CTC INJ NRV BLK C/T ADD          1005.00      0.00   6            DIAG IMAGING PROCEDURES
643312   CTC INTRO CATH IVC SVC            428.00      0.00   6            DIAG IMAGING PROCEDURES
647453   CTC PARACENT ABD INI              725.00    684.00   6            DIAG IMAGING PROCEDURES
647461   CTC PARACENT ABD SUBSQ            507.00      0.00   6            DIAG IMAGING PROCEDURES
643478   CTC PNMNSTOMY W DRN PRC           695.00      0.00   6            DIAG IMAGING PROCEDURES
647487   CTC PUNCTURE DRN LESION           230.67      0.00   6            DIAG IMAGING PROCEDURES
644385   CTC REMV TUNN CV CATH W/O         531.57      0.00   6            DIAG IMAGING PROCEDURES
649566   CTC THORACENTESIS                 610.00      0.00   6            DIAG IMAGING PROCEDURES
669713   IC DUPLICATE ORDER ANGIO            0.00      0.00   6            DIAG IMAGING PROCEDURES
649012   IC DUPLICATE ORDER CT               0.00      0.00   6            DIAG IMAGING PROCEDURES
678144   IC DUPLICATE ORDER NINV             0.00      0.00   6            DIAG IMAGING PROCEDURES
638015   IC DUPLICATE ORDER NMED             0.00      0.00   6            DIAG IMAGING PROCEDURES
678011   IC DUPLICATE ORDER US               0.00      0.00   6            DIAG IMAGING PROCEDURES
669721   IC MD CANCELLED ANGIO               0.00      0.00   6            DIAG IMAGING PROCEDURES
649020   IC MD CANCELLED CT                  0.00      0.00   6            DIAG IMAGING PROCEDURES
678151   IC MD CANCELLED NINV                0.00      0.00   6            DIAG IMAGING PROCEDURES
638023   IC MD CANCELLED NMED                0.00      0.00   6            DIAG IMAGING PROCEDURES
678029   IC MD CANCELLED US                  0.00      0.00   6            DIAG IMAGING PROCEDURES
669739   IC NO SHOW ANGIO                    0.00      0.00   6            DIAG IMAGING PROCEDURES
649038   IC NO SHOW CT                       0.00      0.00   6            DIAG IMAGING PROCEDURES
678169   IC NO SHOW NINV                     0.00      0.00   6            DIAG IMAGING PROCEDURES
638031   IC NO SHOW NMED                     0.00      0.00   6            DIAG IMAGING PROCEDURES
678037   IC NO SHOW US                       0.00      0.00   6            DIAG IMAGING PROCEDURES
669747   IC PT CANCELLED ANGIO               0.00      0.00   6            DIAG IMAGING PROCEDURES
649046   IC PT CANCELLED CT                  0.00      0.00   6            DIAG IMAGING PROCEDURES
678177   IC PT CANCELLED NINV                0.00      0.00   6            DIAG IMAGING PROCEDURES
638049   IC PT CANCELLED NMED                0.00      0.00   6            DIAG IMAGING PROCEDURES
678045   IC PT CANCELLED US                  0.00      0.00   6            DIAG IMAGING PROCEDURES
669754   IC PT LEFT AMA ANGIO                0.00      0.00   6            DIAG IMAGING PROCEDURES
649053   IC PT LEFT AMA CT                   0.00      0.00   6            DIAG IMAGING PROCEDURES
678185   IC PT LEFT AMA NINV                 0.00      0.00   6            DIAG IMAGING PROCEDURES
638056   IC PT LEFT AMA NMED                 0.00      0.00   6            DIAG IMAGING PROCEDURES




                                                Page 27
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



678052   IC PT LEFT AMA US                   0.00      0.00   6            DIAG IMAGING PROCEDURES
649061   IC PT REFUSED CT                    0.00      0.00   6            DIAG IMAGING PROCEDURES
678193   IC PT REFUSED NINV                  0.00      0.00   6            DIAG IMAGING PROCEDURES
638130   IC PT REFUSED NMED                  0.00      0.00   6            DIAG IMAGING PROCEDURES
678060   IC PT REFUSED US                    0.00      0.00   6            DIAG IMAGING PROCEDURES
669762   IC REFUSED ANGIO                    0.00      0.00   6            DIAG IMAGING PROCEDURES
669770   IC REQ LOC CANCELLED ANGI           0.00      0.00   6            DIAG IMAGING PROCEDURES
649079   IC REQ LOC CANCELLED CT             0.00      0.00   6            DIAG IMAGING PROCEDURES
678250   IC REQ LOC CANCELLED NINV           0.00      0.00   6            DIAG IMAGING PROCEDURES
678078   IC REQ LOC CANCELLED US             0.00      0.00   6            DIAG IMAGING PROCEDURES
669788   IC RESCHEDULED ANGIO                0.00      0.00   6            DIAG IMAGING PROCEDURES
649087   IC RESCHEDULED CT                   0.00      0.00   6            DIAG IMAGING PROCEDURES
678201   IC RESCHEDULED NINV                 0.00      0.00   6            DIAG IMAGING PROCEDURES
678086   IC RESCHEDULED US                   0.00      0.00   6            DIAG IMAGING PROCEDURES
678524   IC SATISFACTION NINV                0.00      0.00   6            DIAG IMAGING PROCEDURES
669960   IC SATISFACTION SURVEY AN           0.00      0.00   6            DIAG IMAGING PROCEDURES
669796   IC TECHNICAL CANCEL ANGIO           0.00      0.00   6            DIAG IMAGING PROCEDURES
649095   IC TECHNICAL CANCEL CT              0.00      0.00   6            DIAG IMAGING PROCEDURES
678219   IC TECHNICAL CANCEL NINV            0.00      0.00   6            DIAG IMAGING PROCEDURES
638080   IC TECHNICAL CANCEL NMED            0.00      0.00   6            DIAG IMAGING PROCEDURES
678094   IC TECHNICAL CANCEL US              0.00      0.00   6            DIAG IMAGING PROCEDURES
669838   IC USED RESIDENCE ANGIO             0.00      0.00   6            DIAG IMAGING PROCEDURES
649137   IC USED RESIDENCE CT                0.00      0.00   6            DIAG IMAGING PROCEDURES
678268   IC USED RESIDENCE NINV              0.00      0.00   6            DIAG IMAGING PROCEDURES
638114   IC USED RESIDENCE NMED              0.00      0.00   6            DIAG IMAGING PROCEDURES
678136   IC USED RESIDENCE US                0.00      0.00   6            DIAG IMAGING PROCEDURES
669812   IC WRONG DATE ANGIO                 0.00      0.00   6            DIAG IMAGING PROCEDURES
649111   IC WRONG DATE CT                    0.00      0.00   6            DIAG IMAGING PROCEDURES
638122   IC WRONG DATE NMED                  0.00      0.00   6            DIAG IMAGING PROCEDURES
678110   IC WRONG DATE US                    0.00      0.00   6            DIAG IMAGING PROCEDURES
669804   IC WRONG PATIENT ANGIO              0.00      0.00   6            DIAG IMAGING PROCEDURES
649103   IC WRONG PATIENT CT                 0.00      0.00   6            DIAG IMAGING PROCEDURES
678227   IC WRONG PATIENT NINV               0.00      0.00   6            DIAG IMAGING PROCEDURES
638098   IC WRONG PATIENT NMED               0.00      0.00   6            DIAG IMAGING PROCEDURES
678102   IC WRONG PATIENT US                 0.00      0.00   6            DIAG IMAGING PROCEDURES
669820   IC WRONG PROCEDURE ANGIO            0.00      0.00   6            DIAG IMAGING PROCEDURES
649129   IC WRONG PROCEDURE CT               0.00      0.00   6            DIAG IMAGING PROCEDURES
678243   IC WRONG PROCEDURE NINV             0.00      0.00   6            DIAG IMAGING PROCEDURES
638106   IC WRONG PROCEDURE NMED             0.00      0.00   6            DIAG IMAGING PROCEDURES
678128   IC WRONG PROCEDURE US               0.00      0.00   6            DIAG IMAGING PROCEDURES
638155   ICC COMPLAING PHYSICIAN N           0.00      0.00   6            DIAG IMAGING PROCEDURES
638163   ICC COMPLAING RADIOLOGIST           0.00      0.00   6            DIAG IMAGING PROCEDURES
678409   ICC COMPLAINT NURSING NIN           0.00      0.00   6            DIAG IMAGING PROCEDURES
638148   ICC COMPLAINT NURSING NMD           0.00      0.00   6            DIAG IMAGING PROCEDURES
678276   ICC COMPLAINT NURSING US            0.00      0.00   6            DIAG IMAGING PROCEDURES
678417   ICC COMPLAINT PHYSICIAN N           0.00      0.00   6            DIAG IMAGING PROCEDURES
678284   ICC COMPLAINT PHYSICIAN U           0.00      0.00   6            DIAG IMAGING PROCEDURES
678292   ICC COMPLAINT RADIOLOGIST           0.00      0.00   6            DIAG IMAGING PROCEDURES
669861   ICC COMPLAINT RADIOLOGIST           0.00      0.00   6            DIAG IMAGING PROCEDURES
678425   ICC COMPLAINT RADIOLOGIST           0.00      0.00   6            DIAG IMAGING PROCEDURES
649178   ICC COMPLAINT RN CT                 0.00      0.00   6            DIAG IMAGING PROCEDURES
678433   ICC COMPLAINT RN NINV               0.00      0.00   6            DIAG IMAGING PROCEDURES
638171   ICC COMPLAINT RN NMED               0.00      0.00   6            DIAG IMAGING PROCEDURES




                                                Page 28
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



678300   ICC COMPLAINT RN US                 0.00      0.00   6            DIAG IMAGING PROCEDURES
669887   ICC COMPLAINT SECTION ANG           0.00      0.00   6            DIAG IMAGING PROCEDURES
649186   ICC COMPLAINT SECTION CT            0.00      0.00   6            DIAG IMAGING PROCEDURES
678441   ICC COMPLAINT SECTION NIN           0.00      0.00   6            DIAG IMAGING PROCEDURES
638189   ICC COMPLAINT SECTION NMD           0.00      0.00   6            DIAG IMAGING PROCEDURES
678318   ICC COMPLAINT SECTION US            0.00      0.00   6            DIAG IMAGING PROCEDURES
669895   ICC DELAY OF PATIENT ANGI           0.00      0.00   6            DIAG IMAGING PROCEDURES
649194   ICC DELAY OF PATIENT CT             0.00      0.00   6            DIAG IMAGING PROCEDURES
678458   ICC DELAY OF PATIENT NINV           0.00      0.00   6            DIAG IMAGING PROCEDURES
638197   ICC DELAY OF PATIENT NMED           0.00      0.00   6            DIAG IMAGING PROCEDURES
678326   ICC DELAY OF PATIENT US             0.00      0.00   6            DIAG IMAGING PROCEDURES
669903   ICC INFO MISS H&P ANGIO             0.00      0.00   6            DIAG IMAGING PROCEDURES
649202   ICC INFO MISS H&P CT                0.00      0.00   6            DIAG IMAGING PROCEDURES
678466   ICC INFO MISS H&P NINV              0.00      0.00   6            DIAG IMAGING PROCEDURES
638205   ICC INFO MISS H&P NMED              0.00      0.00   6            DIAG IMAGING PROCEDURES
678334   ICC MISS H&P US                     0.00      0.00   6            DIAG IMAGING PROCEDURES
638213   ICC NO RADIOLOGIST AVAIL            0.00      0.00   6            DIAG IMAGING PROCEDURES
678342   ICC NO RADIOLOGIST AVAIL            0.00      0.00   6            DIAG IMAGING PROCEDURES
678474   ICC NO RADIOLOGIST AVAIL            0.00      0.00   6            DIAG IMAGING PROCEDURES
669911   ICC NO RADIOLOGIST AVAIL            0.00      0.00   6            DIAG IMAGING PROCEDURES
649210   ICC NO RADIOLOGIST AVAIL            0.00      0.00   6            DIAG IMAGING PROCEDURES
669929   ICC NO RN AVAIL ANGIO               0.00      0.00   6            DIAG IMAGING PROCEDURES
649228   ICC NO RN AVAIL CT                  0.00      0.00   6            DIAG IMAGING PROCEDURES
678482   ICC NO RN AVAIL NINV                0.00      0.00   6            DIAG IMAGING PROCEDURES
638221   ICC NO RN AVAIL NMED                0.00      0.00   6            DIAG IMAGING PROCEDURES
678359   ICC NO RN AVAIL US                  0.00      0.00   6            DIAG IMAGING PROCEDURES
669937   ICC PATIENT COMPLAINTS AN           0.00      0.00   6            DIAG IMAGING PROCEDURES
679233   ICC PATIENT COMPLAINTS CT           0.00      0.00   6            DIAG IMAGING PROCEDURES
678490   ICC PATIENT COMPLAINTS NI           0.00      0.00   6            DIAG IMAGING PROCEDURES
638239   ICC PATIENT COMPLAINTS NM           0.00      0.00   6            DIAG IMAGING PROCEDURES
678367   ICC PATIENT COMPLAINTS US           0.00      0.00   6            DIAG IMAGING PROCEDURES
669945   ICC PATIENT INFO ERROR AN           0.00      0.00   6            DIAG IMAGING PROCEDURES
649244   ICC PATIENT INFO ERROR CT           0.00      0.00   6            DIAG IMAGING PROCEDURES
678508   ICC PATIENT INFO ERROR NI           0.00      0.00   6            DIAG IMAGING PROCEDURES
638247   ICC PATIENT INFO ERROR NM           0.00      0.00   6            DIAG IMAGING PROCEDURES
678375   ICC PATIENT INFO ERROR US           0.00      0.00   6            DIAG IMAGING PROCEDURES
669952   ICC PREP INCORRECT ANGIO            0.00      0.00   6            DIAG IMAGING PROCEDURES
649251   ICC PREP INCORRECT CT               0.00      0.00   6            DIAG IMAGING PROCEDURES
678516   ICC PREP INCORRECT NINV             0.00      0.00   6            DIAG IMAGING PROCEDURES
638254   ICC PREP INCORRECT NMED             0.00      0.00   6            DIAG IMAGING PROCEDURES
678383   ICC PREP INCORRECT US               0.00      0.00   6            DIAG IMAGING PROCEDURES
649269   ICC SATISFACTION SURVEY C           0.00      0.00   6            DIAG IMAGING PROCEDURES
638262   ICC SATISFACTION SURVEY N           0.00      0.00   6            DIAG IMAGING PROCEDURES
678391   ICC SATISFACTION SURVEY U           0.00      0.00   6            DIAG IMAGING PROCEDURES
678235   ICC WRONG DATE NINV                 0.00      0.00   6            DIAG IMAGING PROCEDURES
626648   INTERP OF FOREIGN FILMS             0.00      0.00   6            DIAG IMAGING PROCEDURES
625103   IR ABSCSS FIST SIN TRACT          847.00      0.00   6            DIAG IMAGING PROCEDURES
661140   IR ABSCSS FIST SIN TRACT         1617.00      0.00   6            DIAG IMAGING PROCEDURES
661157   IR ANGIO ADD VESSEL EA           1388.00      0.00   6            DIAG IMAGING PROCEDURES
661207   IR ANGIO ADRENAL BIL             4418.00   3877.00   6            DIAG IMAGING PROCEDURES
661256   IR ANGIO ADRENAL UNI             4418.00   3877.00   6            DIAG IMAGING PROCEDURES
661306   IR ANGIO AVS SHUNT               1699.00      0.00   6            DIAG IMAGING PROCEDURES
661355   IR ANGIO BRACH                   4418.00      0.00   6            DIAG IMAGING PROCEDURES




                                                Page 29
                               85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



662155   IR ANGIO CAROTD CERE BIL        5874.00      0.00   6            DIAG IMAGING PROCEDURES
662254   IR ANGIO CAROTD CERE UNI        4418.00      0.00   6            DIAG IMAGING PROCEDURES
662205   IR ANGIO CAROTD CERV BIL        4418.00      0.00   6            DIAG IMAGING PROCEDURES
662304   IR ANGIO CAROTD CERV UNI        3689.00      0.00   6            DIAG IMAGING PROCEDURES
661405   IR ANGIO CAROTD XTL BIL         4418.00   3877.00   6            DIAG IMAGING PROCEDURES
661454   IR ANGIO CAROTD XTL UNI         3689.00      0.00   6            DIAG IMAGING PROCEDURES
661504   IR ANGIO CERVICOCEREBRAL        5145.00      0.00   6            DIAG IMAGING PROCEDURES
662601   IR ANGIO EXT BIL                7328.00      0.00   6            DIAG IMAGING PROCEDURES
662650   IR ANGIO EXT UNI                2345.00      0.00   6            DIAG IMAGING PROCEDURES
669200   IR ANGIO FU EXISTING CATH       1569.00      0.00   6            DIAG IMAGING PROCEDURES
668350   IR ANGIO PELV SELECT            4418.00   3877.00   6            DIAG IMAGING PROCEDURES
668400   IR ANGIO PULM NONSELECT         3689.00      0.00   6            DIAG IMAGING PROCEDURES
668509   IR ANGIO PULM UNI SELECT        3689.00      0.00   6            DIAG IMAGING PROCEDURES
668608   IR ANGIO RENL BIL               5145.00      0.00   6            DIAG IMAGING PROCEDURES
668657   IR ANGIO RENL UNI               2345.00      0.00   6            DIAG IMAGING PROCEDURES
668905   IR ANGIO SPINAL SELECT          4418.00   3877.00   6            DIAG IMAGING PROCEDURES
669606   IR ANGIO VERTEBRAL              5145.00      0.00   6            DIAG IMAGING PROCEDURES
669655   IR ANGIO VISC                   5145.00      0.00   6            DIAG IMAGING PROCEDURES
661850   IR AORTOGRAM ABD BIL EXT        2545.00      0.00   6            DIAG IMAGING PROCEDURES
661801   IR AORTOGRAM ABD W SER          3689.00      0.00   6            DIAG IMAGING PROCEDURES
661959   IR AORTOGRAM THOR W SER         2294.00      0.00   6            DIAG IMAGING PROCEDURES
661900   IR AORTOGRAM THOR W/O SER       4418.00   3877.00   6            DIAG IMAGING PROCEDURES
661975   IR ARTHRO SI JNT                 284.00      0.00   6            DIAG IMAGING PROCEDURES
662742   IR ATHERECTOMY PERIPH ADD       1136.00      0.00   6            DIAG IMAGING PROCEDURES
662767   IR ATHERECTOMY RENL             2133.00      0.00   6            DIAG IMAGING PROCEDURES
662783   IR ATHERECTOMY VISC ADD         1136.00      0.00   6            DIAG IMAGING PROCEDURES
662775   IR ATHERECTOMY VISC INI         2133.00      0.00   6            DIAG IMAGING PROCEDURES
662007   IR BILI DRN INT XTL             3874.00   3400.00   6            DIAG IMAGING PROCEDURES
662056   IR BILI DRN PRC                 3874.00      0.00   6            DIAG IMAGING PROCEDURES
662064   IR BILI DUCT DILATE PRC          827.00      0.00   6            DIAG IMAGING PROCEDURES
662080   IR BRONCHOGRAM BIL               300.00      0.00   6            DIAG IMAGING PROCEDURES
662072   IR BRONCHOGRAM UNI               197.00      0.00   6            DIAG IMAGING PROCEDURES
662106   IR BX TRANSCATHETER             5452.00   1777.00   6            DIAG IMAGING PROCEDURES
668707   IR CATH RENL PELV PRC           2176.00      0.00   6            DIAG IMAGING PROCEDURES
662429   IR CHOL EXISTING CATH            107.00      0.00   6            DIAG IMAGING PROCEDURES
662403   IR CHOL TRANSHEPAT PRC          1582.00    801.00   6            DIAG IMAGING PROCEDURES
667733   IR CINE/VIDEO COMPLEMENT         107.00      0.00   6            DIAG IMAGING PROCEDURES
662437   IR CISTERNOGRAM                  184.00      0.00   6            DIAG IMAGING PROCEDURES
662445   IR CORPORA CAVERNOSOGRAM         153.00      0.00   6            DIAG IMAGING PROCEDURES
668301   IR DILATE NEPHROSTOMY           4908.00      0.00   6            DIAG IMAGING PROCEDURES
662452   IR DISKOGRAM CERV THOR          4096.00    752.00   6            DIAG IMAGING PROCEDURES
662502   IR DISKOGRAM LUMB               1144.00      0.00   6            DIAG IMAGING PROCEDURES
661108   IR DRN W CATH PLACE PRC         1933.00      0.00   6            DIAG IMAGING PROCEDURES
662551   IR EMBOL TX                     7194.00      0.00   6            DIAG IMAGING PROCEDURES
660001   IR EMERGENCY CALL BACK             0.00      0.00   6            DIAG IMAGING PROCEDURES
662635   IR ENDO BILI DUCT                428.00      0.00   6            DIAG IMAGING PROCEDURES
661058   IR ENDOVAS REPR ABD AO           841.00      0.00   6            DIAG IMAGING PROCEDURES
662577   IR EPIDUROGRAM                   294.00      0.00   6            DIAG IMAGING PROCEDURES
662585   IR FALLOPN TUBE TRANSCERV        428.00      0.00   6            DIAG IMAGING PROCEDURES
662668   IR FLUORO 1HR OR LES            1213.00      0.00   6            DIAG IMAGING PROCEDURES
662536   IR FLUORO NDL PLACE              172.00      0.00   6            DIAG IMAGING PROCEDURES
667824   IR G TUBE PRC                    428.00      0.00   6            DIAG IMAGING PROCEDURES
668806   IR GALACTOGRAM 1 DUCT            354.00      0.00   6            DIAG IMAGING PROCEDURES




                                               Page 30
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



662684   IR HYSTEROSALPINGOGRAM            177.00      0.00   6            DIAG IMAGING PROCEDURES
665646   IR INJECTION IM/SQ EA              58.23      0.00   6            DIAG IMAGING PROCEDURES
669259   IR IVC FILTER PLACE              6601.00      0.00   6            DIAG IMAGING PROCEDURES
667931   IR IVUS NONCO ADD                 311.00      0.00   6            DIAG IMAGING PROCEDURES
667923   IR IVUS NONCO INI                 618.00      0.00   6            DIAG IMAGING PROCEDURES
668269   IR LYMPHANGIO ABD UNI             827.00      0.00   6            DIAG IMAGING PROCEDURES
668152   IR LYMPHANGIO EXT BIL            3022.00    988.00   6            DIAG IMAGING PROCEDURES
668251   IR LYMPHANGIO PELV BIL           3322.00   1090.00   6            DIAG IMAGING PROCEDURES
660050   IR N/C PROCEDURE                    0.00      0.00   6            DIAG IMAGING PROCEDURES
660852   IR PLACE OCC DEV VEIN ART         429.00    347.00   6            DIAG IMAGING PROCEDURES
661066   IR PLACE PROS REPR AAA            307.00      0.00   6            DIAG IMAGING PROCEDURES
669051   IR PORTOGRAM W HEM EVAL          1596.00      0.00   6            DIAG IMAGING PROCEDURES
668376   IR PORTOGRAM W/O HEM EVAL        1705.00      0.00   6            DIAG IMAGING PROCEDURES
661553   IR PTA PERIPH ART                7162.00      0.00   6            DIAG IMAGING PROCEDURES
661603   IR PTA PERIPH ART ADD            2944.00      0.00   6            DIAG IMAGING PROCEDURES
661652   IR PTA RENL VISC                 5703.00      0.00   6            DIAG IMAGING PROCEDURES
661751   IR PTA VEN                       2773.00      0.00   6            DIAG IMAGING PROCEDURES
661702   IR PTA VISC ADD                  2944.00      0.00   6            DIAG IMAGING PROCEDURES
662700   IR RETRIEVAL VASCULAR FB         4779.00   4192.00   6            DIAG IMAGING PROCEDURES
661272   IR SEDATION IV/IM/INH             594.00      0.00   6            DIAG IMAGING PROCEDURES
661280   IR SEDATION PO/PR/INASAL          395.00      0.00   6            DIAG IMAGING PROCEDURES
668855   IR SHUNTOGRAM NONVASC             493.00    432.00   6            DIAG IMAGING PROCEDURES
668939   IR SIALOGRAM                      243.00      0.00   6            DIAG IMAGING PROCEDURES
668954   IR SPLENOPORTOGRAM               6081.00   1982.00   6            DIAG IMAGING PROCEDURES
660902   IR STENT NOCORO/CAR/VERT        13723.00      0.00   6            DIAG IMAGING PROCEDURES
669168   IR STENT NOCORO/CAR/VERT         4779.00   4192.00   6            DIAG IMAGING PROCEDURES
669002   IR SUBTRACTION SERIES             361.00      0.00   6            DIAG IMAGING PROCEDURES
669150   IR TRANSCATHETER TX IV           8094.00   3386.00   6            DIAG IMAGING PROCEDURES
667550   IR TUBE CATH CHNG                2178.00   1912.00   6            DIAG IMAGING PROCEDURES
669101   IR URETERAL STENT PRC            2973.00      0.00   6            DIAG IMAGING PROCEDURES
666115   IR URETHROCYSTOGRAM VOID          215.00      0.00   6            DIAG IMAGING PROCEDURES
674432   IR US VASC ACCESS ADD ON          190.50      0.00   6            DIAG IMAGING PROCEDURES
668756   IR VEN SAMPLING                  1610.00      0.00   6            DIAG IMAGING PROCEDURES
669275   IR VENOGRAM ADRENAL BIL          1705.00      0.00   6            DIAG IMAGING PROCEDURES
669283   IR VENOGRAM ADRENAL UNI          1705.00      0.00   6            DIAG IMAGING PROCEDURES
669374   IR VENOGRAM EPID                 1705.00      0.00   6            DIAG IMAGING PROCEDURES
669408   IR VENOGRAM EXT BIL              2440.00   2142.00   6            DIAG IMAGING PROCEDURES
669457   IR VENOGRAM EXT UNI              2078.00      0.00   6            DIAG IMAGING PROCEDURES
669382   IR VENOGRAM HEP W EVAL           1705.00      0.00   6            DIAG IMAGING PROCEDURES
669390   IR VENOGRAM HEP W/O EVAL         1705.00      0.00   6            DIAG IMAGING PROCEDURES
669309   IR VENOGRAM IVC                  3689.00      0.00   6            DIAG IMAGING PROCEDURES
669465   IR VENOGRAM ORBITAL               129.00      0.00   6            DIAG IMAGING PROCEDURES
669507   IR VENOGRAM RENL BIL             4418.00      0.00   6            DIAG IMAGING PROCEDURES
669556   IR VENOGRAM RENL UNI             2621.00   2301.00   6            DIAG IMAGING PROCEDURES
669481   IR VENOGRAM SAG SINUS            1705.00      0.00   6            DIAG IMAGING PROCEDURES
669473   IR VENOGRAM SIN JUGULAR          1705.00      0.00   6            DIAG IMAGING PROCEDURES
669358   IR VENOGRAM SVC                  3689.00      0.00   6            DIAG IMAGING PROCEDURES
660829   IRC ABLTN RENAL RF PRC           4475.00      0.00   6            DIAG IMAGING PROCEDURES
661132   IRC ABSCSS CYST LIVER PRC        1907.00    882.00   6            DIAG IMAGING PROCEDURES
663062   IRC ABSCSS DRN PELV PRC           593.00      0.00   6            DIAG IMAGING PROCEDURES
663104   IRC ABSCSS DRN PERITNL           6453.00   2102.00   6            DIAG IMAGING PROCEDURES
663153   IRC ABSCSS DRN RENL              4571.00      0.00   6            DIAG IMAGING PROCEDURES
663187   IRC ABSCSS DRN RETROPE            645.00      0.00   6            DIAG IMAGING PROCEDURES




                                                Page 31
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



663203   IRC ABSCSS DRN SUBDIAP           3389.00   2974.00   6            DIAG IMAGING PROCEDURES
666180   IRC ASP BLADDER SP CATH          1219.00      0.00   6            DIAG IMAGING PROCEDURES
664235   IRC ASP BREAST ADD                160.00      0.00   6            DIAG IMAGING PROCEDURES
664227   IRC ASP BREAST CYST               378.00      0.00   6            DIAG IMAGING PROCEDURES
663682   IRC ASP SPINAL CYST PRC          1787.91      0.00   6            DIAG IMAGING PROCEDURES
663708   IRC AVS DIAL SHUNT                902.00    792.00   6            DIAG IMAGING PROCEDURES
663757   IRC BILI CATH CHNG                430.00      0.00   6            DIAG IMAGING PROCEDURES
663807   IRC BILI ENDO W/O STENT          1997.00   1753.00   6            DIAG IMAGING PROCEDURES
663906   IRC BILI STENT PLACE             5204.00   1696.00   6            DIAG IMAGING PROCEDURES
664003   IRC BILI STONE EXTRACT           1733.00      0.00   6            DIAG IMAGING PROCEDURES
663856   IRC BILI STONE RMVL              2184.00   1915.00   6            DIAG IMAGING PROCEDURES
664441   IRC BRONCH W BX                  1217.00      0.00   6            DIAG IMAGING PROCEDURES
664052   IRC BX ABD RETROPE                661.00      0.00   6            DIAG IMAGING PROCEDURES
664029   IRC BX BM NDL/TROCAR              660.00      0.00   6            DIAG IMAGING PROCEDURES
662528   IRC BX BONE SUPER                 783.00      0.00   6            DIAG IMAGING PROCEDURES
664086   IRC BX LIVER                      675.00      0.00   6            DIAG IMAGING PROCEDURES
664102   IRC BX LIVER W MAJOR             1216.00   1067.00   6            DIAG IMAGING PROCEDURES
662627   IRC BX MUSCLE                     545.00      0.00   6            DIAG IMAGING PROCEDURES
664151   IRC BX NASOPHARNYX                854.00    750.00   6            DIAG IMAGING PROCEDURES
664201   IRC BX PANCREAS                  2505.00   1237.00   6            DIAG IMAGING PROCEDURES
664250   IRC BX PLEURA                     654.00    573.00   6            DIAG IMAGING PROCEDURES
664276   IRC BX PROSTATE                   774.00      0.00   6            DIAG IMAGING PROCEDURES
664292   IRC BX SALIVARY GLAND NDL         333.00      0.00   6            DIAG IMAGING PROCEDURES
664409   IRC BX THYROID                    388.00    366.00   6            DIAG IMAGING PROCEDURES
664458   IRC CATH ABD LOW 1ST             1191.00      0.00   6            DIAG IMAGING PROCEDURES
664508   IRC CATH ABD LOW 2ND             1490.00      0.00   6            DIAG IMAGING PROCEDURES
664557   IRC CATH ABD LOW 3RD             1771.00      0.00   6            DIAG IMAGING PROCEDURES
667709   IRC CATH ABD LOW ADD              284.00      0.00   6            DIAG IMAGING PROCEDURES
667642   IRC CATH PORTAL VEIN PRC         1907.00      0.00   6            DIAG IMAGING PROCEDURES
664607   IRC CATH THOR 1ST ART             509.00      0.00   6            DIAG IMAGING PROCEDURES
664656   IRC CATH THOR 2ND ART            1490.00      0.00   6            DIAG IMAGING PROCEDURES
664755   IRC CATH THOR 3RD ART            1771.00      0.00   6            DIAG IMAGING PROCEDURES
664706   IRC CATH THOR ADD ART             339.00      0.00   6            DIAG IMAGING PROCEDURES
666172   IRC CHNG GT TUBE                  362.00      0.00   6            DIAG IMAGING PROCEDURES
666610   IRC CHNG GT TUBE                  362.00      0.00   6            DIAG IMAGING PROCEDURES
666693   IRC CYSTO TUBE CHNG CMPLX         645.00      0.00   6            DIAG IMAGING PROCEDURES
666685   IRC CYSTO TUBE CHNG SMPL          440.00      0.00   6            DIAG IMAGING PROCEDURES
663666   IRC DECLOT XTL CAN W BLN         5363.00      0.00   6            DIAG IMAGING PROCEDURES
663021   IRC DRN ABSCESS COMP/MULT         256.00      0.00   6            DIAG IMAGING PROCEDURES
665166   IRC DRN APPNCL ABSCSS OPN        1993.00      0.00   6            DIAG IMAGING PROCEDURES
664805   IRC EMBOL OCC NONHEAD NEC        4363.00   5793.00   6            DIAG IMAGING PROCEDURES
667873   IRC ENDO SB W JEJ TUB PRC         726.33      0.00   6            DIAG IMAGING PROCEDURES
664961   IRC ENDO UPPER GI TUBE            801.00      0.00   6            DIAG IMAGING PROCEDURES
669853   IRC ERCP RMVL CALC               1608.00      0.00   6            DIAG IMAGING PROCEDURES
669879   IRC ERCP W/BIOPSY                1141.00      0.00   6            DIAG IMAGING PROCEDURES
665059   IRC ESOPH DILATE RETRO           2531.00    825.00   6            DIAG IMAGING PROCEDURES
664573   IRC EXCHANGE DRN CATH             280.00      0.00   6            DIAG IMAGING PROCEDURES
664219   IRC FNA W IMAG GUIDANCE           506.00      0.00   6            DIAG IMAGING PROCEDURES
665372   IRC INJ C1 C2 MYELOGRAM           466.00      0.00   6            DIAG IMAGING PROCEDURES
665208   IRC INJ CELIAC PLEX BLK             0.00      0.00   6            DIAG IMAGING PROCEDURES
665257   IRC INJ CHOL TRANSHEPAT          1410.00    460.00   6            DIAG IMAGING PROCEDURES
665307   IRC INJ CHOL VIA CATH            1301.00    424.00   6            DIAG IMAGING PROCEDURES
665638   IRC INJ CON ABSCSS                157.00      0.00   6            DIAG IMAGING PROCEDURES




                                                Page 32
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



666107   IRC INJ CYSTO RETRO               476.00      0.00   6            DIAG IMAGING PROCEDURES
665331   IRC INJ DACROCYSTOGRAM           2229.00      0.00   6            DIAG IMAGING PROCEDURES
665356   IRC INJ DISKOGRAM CERV           2773.00   2434.00   6            DIAG IMAGING PROCEDURES
665406   IRC INJ DISKOGRAM LUMB            681.00      0.00   6            DIAG IMAGING PROCEDURES
665448   IRC INJ EPID CERV THOR            883.00      0.00   6            DIAG IMAGING PROCEDURES
665455   IRC INJ EPID L/S                  765.00    671.00   6            DIAG IMAGING PROCEDURES
669846   IRC INJ ERCP                     1085.00      0.00   6            DIAG IMAGING PROCEDURES
665976   IRC INJ EXT VENOGRAM             1215.00      0.00   6            DIAG IMAGING PROCEDURES
664474   IRC INJ FACET C/T 1 LVL           765.00      0.00   6            DIAG IMAGING PROCEDURES
665505   IRC INJ FACET L/S 1 LVL           722.00    671.00   6            DIAG IMAGING PROCEDURES
665653   IRC INJ ILEAL CONDUIT             476.00    419.00   6            DIAG IMAGING PROCEDURES
665703   IRC INJ LP                        781.00    685.00   6            DIAG IMAGING PROCEDURES
665752   IRC INJ LYMPHANGIO                575.00      0.00   6            DIAG IMAGING PROCEDURES
665737   IRC INJ MYELOGRAM                 841.00      0.00   6            DIAG IMAGING PROCEDURES
665851   IRC INJ NEPHROGRAM                551.00    180.00   6            DIAG IMAGING PROCEDURES
665877   IRC INJ NRV BLK C/T 1 LVL         765.00      0.00   6            DIAG IMAGING PROCEDURES
665885   IRC INJ NRV BLK C/T ADD          1005.00      0.00   6            DIAG IMAGING PROCEDURES
665901   IRC INJ NRV BLK L/S 1 LVL         765.00    671.00   6            DIAG IMAGING PROCEDURES
665950   IRC INJ NRV BLK L/S ADD          1005.00    881.00   6            DIAG IMAGING PROCEDURES
665604   IRC INJ NRV BLK LUMB THOR           0.00      0.00   6            DIAG IMAGING PROCEDURES
665968   IRC INJ PANCREAT INTRAOP          342.00      0.00   6            DIAG IMAGING PROCEDURES
665430   IRC INJ SPINE W CATH L/S          876.00      0.00   6            DIAG IMAGING PROCEDURES
665687   IRC INJ TND SHEATH/LG             194.00      0.00   6            DIAG IMAGING PROCEDURES
665661   IRC INJ TRG PT 1 OR 2 MCL         185.00      0.00   6            DIAG IMAGING PROCEDURES
665679   IRC INJ TRIG PT GT 2 MCL          211.00      0.00   6            DIAG IMAGING PROCEDURES
666057   IRC INJ URETERO PYELOGRAM         355.00      0.00   6            DIAG IMAGING PROCEDURES
666099   IRC INJ URETHROCYST CHAIN        1491.00      0.00   6            DIAG IMAGING PROCEDURES
664243   IRC INJ/ASP GANGLION CYST         188.00      0.00   6            DIAG IMAGING PROCEDURES
666198   IRC INS INTRA ART PUMP           2013.00      0.00   6            DIAG IMAGING PROCEDURES
667782   IRC INS NON-TUN CV CATH<5        3512.00      0.00   6            DIAG IMAGING PROCEDURES
667790   IRC INS NON-TUN CV CATH5+        3512.00      0.00   6            DIAG IMAGING PROCEDURES
666362   IRC INS PICC W/O PORT 5+         1207.00      0.00   6            DIAG IMAGING PROCEDURES
666370   IRC INS PICC W/O PORT LT5        1329.00      0.00   6            DIAG IMAGING PROCEDURES
666388   IRC INS PICC W/PORT 5+YRS        5363.00      0.00   6            DIAG IMAGING PROCEDURES
666396   IRC INS PICC W/PORT LT 5         5968.00      0.00   6            DIAG IMAGING PROCEDURES
667808   IRC INS TUN CV NO PRT LT5        3512.00      0.00   6            DIAG IMAGING PROCEDURES
667667   IRC INS TUNN CV DEV 5+           4602.00      0.00   6            DIAG IMAGING PROCEDURES
667675   IRC INS TUNN CV DEV LT 5         4644.00      0.00   6            DIAG IMAGING PROCEDURES
667816   IRC INS TUNN CV NO PORT5+        3512.00      0.00   6            DIAG IMAGING PROCEDURES
666263   IRC INTRO AORTA                    45.00      0.00   6            DIAG IMAGING PROCEDURES
666255   IRC INTRO BRACH ART              1151.00   1008.00   6            DIAG IMAGING PROCEDURES
666859   IRC INTRO CAROTD VERT ART          82.00     72.00   6            DIAG IMAGING PROCEDURES
666206   IRC INTRO CATH AORTA             1187.00      0.00   6            DIAG IMAGING PROCEDURES
666453   IRC INTRO CATH BILI DRN          1855.00      0.00   6            DIAG IMAGING PROCEDURES
666297   IRC INTRO CATH FALLOPN            947.00      0.00   6            DIAG IMAGING PROCEDURES
666305   IRC INTRO CATH IVC /SVC           428.00    404.00   6            DIAG IMAGING PROCEDURES
666354   IRC INTRO CATH PULM               788.00      0.00   6            DIAG IMAGING PROCEDURES
666404   IRC INTRO CATH RENL PELV         1108.00      0.00   6            DIAG IMAGING PROCEDURES
666750   IRC INTRO EXT ART                 693.00      0.00   6            DIAG IMAGING PROCEDURES
666651   IRC INTRO G TUBE                 6512.00      0.00   6            DIAG IMAGING PROCEDURES
666602   IRC INTRO G TUBE LONG             354.00      0.00   6            DIAG IMAGING PROCEDURES
666701   IRC INTRO IVC FILTER             4737.00      0.00   6            DIAG IMAGING PROCEDURES
666909   IRC INTRO NEPHROSTOMY            1661.00      0.00   6            DIAG IMAGING PROCEDURES




                                                Page 33
                              85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



666958   IRC INTRO STENT CATH URET      1315.00      0.00   6            DIAG IMAGING PROCEDURES
666156   IRC IVCH RETRIEVE FB           1572.00      0.00   6            DIAG IMAGING PROCEDURES
667006   IRC NEPHROSTOMY MANOMETRY      1052.00    342.00   6            DIAG IMAGING PROCEDURES
667055   IRC NEPHROSTOMY TUBE CHNG       317.00      0.00   6            DIAG IMAGING PROCEDURES
665109   IRC NONTHROMBOLYSIS IV         1778.00      0.00   6            DIAG IMAGING PROCEDURES
667378   IRC OPN INTRVAS STENT ADD       752.00      0.00   6            DIAG IMAGING PROCEDURES
667360   IRC OPN INTRVS STENT INIT      1560.00      0.00   6            DIAG IMAGING PROCEDURES
663534   IRC OPN TRANS ANGIO ILIAC      1209.00      0.00   6            DIAG IMAGING PROCEDURES
663518   IRC OPN TRANS ANGIO RENAL      1863.00      0.00   6            DIAG IMAGING PROCEDURES
663575   IRC OPN TRANS ANGIO TIBIO      1674.00      0.00   6            DIAG IMAGING PROCEDURES
667105   IRC PARACENT ABD INI            725.00    684.00   6            DIAG IMAGING PROCEDURES
667113   IRC PARACENT ABD SUBSQ          507.00      0.00   6            DIAG IMAGING PROCEDURES
664953   IRC PERM EMBOL OCC CNS         6299.00      0.00   6            DIAG IMAGING PROCEDURES
664763   IRC PNMNSTOMY W DRN OPN        3226.00      0.00   6            DIAG IMAGING PROCEDURES
667840   IRC PNMNSTOMY W DRN PRC         695.00      0.00   6            DIAG IMAGING PROCEDURES
664854   IRC PRM EMBL OCC HEAD NEC      6299.00   5531.00   6            DIAG IMAGING PROCEDURES
664987   IRC PROCTOSIGMOID W/DIL        2540.00      0.00   6            DIAG IMAGING PROCEDURES
664979   IRC PROCTOSIGMOIDOSCPY DX       245.00      0.00   6            DIAG IMAGING PROCEDURES
667832   IRC PSEUDOANEURYSM INJ          638.00      0.00   6            DIAG IMAGING PROCEDURES
663252   IRC PTA AORTIC                 2156.00   1892.00   6            DIAG IMAGING PROCEDURES
663302   IRC PTA BRACHIOCEPH EA         2672.00      0.00   6            DIAG IMAGING PROCEDURES
663351   IRC PTA FEMPOP                 2057.00      0.00   6            DIAG IMAGING PROCEDURES
665984   IRC PTA FEMPOP OPN             1449.00      0.00   6            DIAG IMAGING PROCEDURES
663450   IRC PTA IL                     1690.00      0.00   6            DIAG IMAGING PROCEDURES
663500   IRC PTA RENL VISC              4375.00   3841.00   6            DIAG IMAGING PROCEDURES
663559   IRC PTA TIBEOPERONEAL EA       3819.00   3353.00   6            DIAG IMAGING PROCEDURES
663609   IRC PTA VEN                    1155.00      0.00   6            DIAG IMAGING PROCEDURES
667477   IRC PTATHER AORTIC             2914.00      0.00   6            DIAG IMAGING PROCEDURES
667485   IRC PTATHER FEMPOP             2972.00      0.00   6            DIAG IMAGING PROCEDURES
664797   IRC PTATHER IL                 2914.00      0.00   6            DIAG IMAGING PROCEDURES
667568   IRC PTATHER RENL               2914.00      0.00   6            DIAG IMAGING PROCEDURES
667519   IRC PTATHER TIBIA              2914.00      0.00   6            DIAG IMAGING PROCEDURES
667154   IRC PULM ART L/R                946.00      0.00   6            DIAG IMAGING PROCEDURES
667204   IRC PULM ART SEG SUB           1105.00      0.00   6            DIAG IMAGING PROCEDURES
668723   IRC REM TUNN CVA DEV W PT      1148.61      0.00   6            DIAG IMAGING PROCEDURES
669598   IRC REMOVE PERM CAN/CATH       1103.88      0.00   6            DIAG IMAGING PROCEDURES
669580   IRC REMV TUNN CV CATH W/O       597.00      0.00   6            DIAG IMAGING PROCEDURES
668517   IRC RMVL INTHCL/EPID CATH      1159.00      0.00   6            DIAG IMAGING PROCEDURES
663542   IRC RMVL INTRA ART PUMP         917.00      0.00   6            DIAG IMAGING PROCEDURES
662726   IRC RMVL KDY STN PRC GT 2      4252.00      0.00   6            DIAG IMAGING PROCEDURES
662734   IRC RMVL KDY STN PRC/LES2      2980.00      0.00   6            DIAG IMAGING PROCEDURES
667691   IRC RPLC COMP NON-TUNN CV      1061.00      0.00   6            DIAG IMAGING PROCEDURES
667683   IRC RPLC COMP TUN CV CATH       739.00      0.00   6            DIAG IMAGING PROCEDURES
667717   IRC RPLC COMP TUN CV W/PT      3718.62      0.00   6            DIAG IMAGING PROCEDURES
666164   IRC RVSN INTRA ART PUMP        1222.00      0.00   6            DIAG IMAGING PROCEDURES
667303   IRC SELECT CATH 1ST VEN        1278.00   1120.00   6            DIAG IMAGING PROCEDURES
667352   IRC SELECT CATH 2ND VEN        1105.00      0.00   6            DIAG IMAGING PROCEDURES
667402   IRC STENT NOCORO/CAR/VERT      5736.00      0.00   6            DIAG IMAGING PROCEDURES
667451   IRC STENT PLACE NONCO ADD      2866.00      0.00   6            DIAG IMAGING PROCEDURES
663773   IRC TEMP BAL ARTERIAL OCC      1867.00      0.00   6            DIAG IMAGING PROCEDURES
669564   IRC THORACENTESIS               610.00      0.00   6            DIAG IMAGING PROCEDURES
667469   IRC THROMBOLYSIS CEREB IV      1685.00   1480.00   6            DIAG IMAGING PROCEDURES
665158   IRC THROMBOLYSIS IV NONCO      2267.00      0.00   6            DIAG IMAGING PROCEDURES




                                              Page 34
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



665000   IRC TUBE PLACE JEJUNUM           1457.00   1280.00   6            DIAG IMAGING PROCEDURES
663005   IRC TUBE THORACOSTOMY            1349.00   1184.00   6            DIAG IMAGING PROCEDURES
667600   IRC URETERAL TUBE CHNG            303.00    268.00   6            DIAG IMAGING PROCEDURES
667501   IRC VEN ANAST PORT OPN           5780.00      0.00   6            DIAG IMAGING PROCEDURES
667634   IRC VEN CATH BLOOD SAMPLE         589.00      0.00   6            DIAG IMAGING PROCEDURES
666149   IRC VERTEPLASTY ADD PRC          2594.00      0.00   6            DIAG IMAGING PROCEDURES
666131   IRC VERTEPLASTY LUMB PRC         3603.00      0.00   6            DIAG IMAGING PROCEDURES
666123   IRC VERTEPLASTY THOR PRC         3603.00      0.00   6            DIAG IMAGING PROCEDURES
654905   MR 3D RECONSTRUCTION             1265.00      0.00   6            DIAG IMAGING PROCEDURES
654913   MR 3D RECONSTRUCTION             1265.00      0.00   6            DIAG IMAGING PROCEDURES
652107   MR ABD W/O CON                   2031.00      0.00   6            DIAG IMAGING PROCEDURES
650515   MR BONE MARROW                   2651.00      0.00   6            DIAG IMAGING PROCEDURES
652727   MR BRAIN OPN W CON                555.00      0.00   6            DIAG IMAGING PROCEDURES
652719   MR BRAIN OPN W/O CON              502.00      0.00   6            DIAG IMAGING PROCEDURES
652735   MR BRAIN OPN W-W/O CON            557.00      0.00   6            DIAG IMAGING PROCEDURES
652800   MR BRAIN W STEM W CON            3231.00   2781.00   6            DIAG IMAGING PROCEDURES
652750   MR BRAIN W STEM W/O CON          2633.00      0.00   6            DIAG IMAGING PROCEDURES
652701   MR BRAIN W STEM W-W/O CON        3506.00      0.00   6            DIAG IMAGING PROCEDURES
652859   MR CARDIAC FNCTN CMPL            4260.00   3740.00   6            DIAG IMAGING PROCEDURES
652909   MR CARDIAC FNCTN LTD             4260.00   3740.00   6            DIAG IMAGING PROCEDURES
652958   MR CARDIAC VELOCITY FLOW            0.00      0.00   6            DIAG IMAGING PROCEDURES
653055   MR CARDIAC W CON                 4260.00   3740.00   6            DIAG IMAGING PROCEDURES
653006   MR CARDIAC W/O CON               3893.00      0.00   6            DIAG IMAGING PROCEDURES
652255   MR CHEST W/O CON                 2331.00   2048.00   6            DIAG IMAGING PROCEDURES
650572   MR CHEST W/O CON                 2380.00      0.00   6            DIAG IMAGING PROCEDURES
640748   MR DENTAL PARTIAL EXAM           1451.00      0.00   6            DIAG IMAGING PROCEDURES
652503   MR EXT LOW JT W/O CON            3717.00      0.00   6            DIAG IMAGING PROCEDURES
652453   MR EXT LOW W-W/O CON             3717.00      0.00   6            DIAG IMAGING PROCEDURES
652651   MR EXT UPP JNT W/O CON           3717.00      0.00   6            DIAG IMAGING PROCEDURES
652602   MR EXT UPP NO JNT W-W/O          3644.00   3198.00   6            DIAG IMAGING PROCEDURES
654962   MR GUIDE NDL PLACE               1514.00      0.00   6            DIAG IMAGING PROCEDURES
654988   MR GUIDE VISCL TISS ABLTN        1860.00      0.00   6            DIAG IMAGING PROCEDURES
653105   MR ORBIT FACE NEC W/O            2380.00      0.00   6            DIAG IMAGING PROCEDURES
653204   MR ORBIT FACE NEC W/O            2331.00   2048.00   6            DIAG IMAGING PROCEDURES
653303   MR PELV W CON                    1991.00      0.00   6            DIAG IMAGING PROCEDURES
654947   MR SPECTROSCOPY                  2070.00      0.00   6            DIAG IMAGING PROCEDURES
653501   MR SPINE CERV W CON              3717.00      0.00   6            DIAG IMAGING PROCEDURES
653451   MR SPINE CERV W/O CON            2380.00      0.00   6            DIAG IMAGING PROCEDURES
653600   MR SPINE CERV W-W/O CON          3893.00      0.00   6            DIAG IMAGING PROCEDURES
653709   MR SPINE LUMB W CON              3644.00      0.00   6            DIAG IMAGING PROCEDURES
653659   MR SPINE LUMB W/O CON            2331.00      0.00   6            DIAG IMAGING PROCEDURES
653758   MR SPINE LUMB W-W/O              3893.00      0.00   6            DIAG IMAGING PROCEDURES
653907   MR SPINE THOR W CON              3644.00      0.00   6            DIAG IMAGING PROCEDURES
653857   MR SPINE THOR W/O CON            2331.00      0.00   6            DIAG IMAGING PROCEDURES
653808   MR SPINE THOR W-W/O              3893.00      0.00   6            DIAG IMAGING PROCEDURES
652776   MR VENOGRAM BRAIN                 557.00      0.00   6            DIAG IMAGING PROCEDURES
652404   MRA CHEST W-W/O CON              2331.00   2048.00   6            DIAG IMAGING PROCEDURES
652552   MRA EXT LOW W-W/O CON            3644.00   3198.00   6            DIAG IMAGING PROCEDURES
655506   MRA HEAD W-W/O CON               2589.00      0.00   6            DIAG IMAGING PROCEDURES
653352   MRA PELV W-W/O CON               2331.00   2048.00   6            DIAG IMAGING PROCEDURES
653402   MRA SPNAL CANAL W-W/O CON        2589.00   2272.00   6            DIAG IMAGING PROCEDURES
652693   MRC BX STEREO ASPIR HEAD         4044.00      0.00   6            DIAG IMAGING PROCEDURES
675702   NI AORTA IVC IL CMPL             1457.00      0.00   6            DIAG IMAGING PROCEDURES




                                                Page 35
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



675215   NI AORTA IVC IL LTD              1474.00      0.00   6            DIAG IMAGING PROCEDURES
675355   NI DIAL ACCES                    1278.00      0.00   6            DIAG IMAGING PROCEDURES
676379   NI DPPLER EXT VEINS BIL           738.00    163.00   6            DIAG IMAGING PROCEDURES
675942   NI DPPLER EXTRACRAN BIL           339.00      0.00   6            DIAG IMAGING PROCEDURES
675108   NI DUPLEX ABD PELV CMPL          1090.00      0.00   6            DIAG IMAGING PROCEDURES
675157   NI DUPLEX ABD PELV LTD            869.00      0.00   6            DIAG IMAGING PROCEDURES
675462   NI DUPLEX EXT LOW BIL            1596.00    707.00   6            DIAG IMAGING PROCEDURES
675470   NI DUPLEX EXT LOW UNI            1596.00    584.00   6            DIAG IMAGING PROCEDURES
675256   NI DUPLEX EXT UPP BIL            1596.00    707.00   6            DIAG IMAGING PROCEDURES
675801   NI DUPLEX EXT UPP BIL             592.00      0.00   6            DIAG IMAGING PROCEDURES
675306   NI DUPLEX EXT UPP UNI            1596.00    584.00   6            DIAG IMAGING PROCEDURES
676403   NI DUPLEX EXT VEINS BIL          1596.00    682.00   6            DIAG IMAGING PROCEDURES
676387   NI DUPLEX EXT VEINS UNI             0.00      0.00   6            DIAG IMAGING PROCEDURES
676452   NI DUPLEX EXT VEINS UNI          1596.00    584.00   6            DIAG IMAGING PROCEDURES
675850   NI DUPLEX EXTRACRAN BIL          1596.00    682.00   6            DIAG IMAGING PROCEDURES
675868   NI DUPLEX EXTRACRAN UNI          1117.00    654.00   6            DIAG IMAGING PROCEDURES
675413   NI EXT ART 1 LVL BIL              603.00      0.00   6            DIAG IMAGING PROCEDURES
675603   NI EXT ART MULTI BIL             1596.00    960.00   6            DIAG IMAGING PROCEDURES
676254   NI INTRACRAN CMPL                1806.00      0.00   6            DIAG IMAGING PROCEDURES
670505   NI INTRACRAN LTD                 1772.00    745.00   6            DIAG IMAGING PROCEDURES
675504   NI PENILE VESSELS CMPL           1457.00      0.00   6            DIAG IMAGING PROCEDURES
675553   NI PENILE VESSELS LTD            1628.00      0.00   6            DIAG IMAGING PROCEDURES
675017   NINV BEDSIDE                        0.00      0.00   6            DIAG IMAGING PROCEDURES
675058   NINV EMERGENCY CALL BACK            0.00      0.00   6            DIAG IMAGING PROCEDURES
675009   NINV SERVICE AFTER HOURS            0.00      0.00   6            DIAG IMAGING PROCEDURES
631002   NM ABSCSS LOC LTD                 611.00      0.00   6            DIAG IMAGING PROCEDURES
637918   NM ABSCSS LOC LTD                1037.00      0.00   6            DIAG IMAGING PROCEDURES
631101   NM ABSCSS LOC WB                 2147.00   1348.00   6            DIAG IMAGING PROCEDURES
631150   NM ADD V X 1                        0.00      0.00   6            DIAG IMAGING PROCEDURES
631200   NM ADD V X 2                        0.00      0.00   6            DIAG IMAGING PROCEDURES
632828   NM ADDL IMAGING/FUSION            247.00      0.00   6            DIAG IMAGING PROCEDURES
631309   NM ADRENAL                       2371.00   2080.00   6            DIAG IMAGING PROCEDURES
632505   NM AUTO DATA GEN GT 30              0.00      0.00   6            DIAG IMAGING PROCEDURES
636985   NM BMA BODY FAT ANALYSIS            0.00      0.00   6            DIAG IMAGING PROCEDURES
631606   NM BMA HIP                          0.00      0.00   6            DIAG IMAGING PROCEDURES
631655   NM BMA SPINE AP                     0.00      0.00   6            DIAG IMAGING PROCEDURES
631705   NM BMA SPINE LATERAL                0.00      0.00   6            DIAG IMAGING PROCEDURES
631754   NM BMA WB                           0.00      0.00   6            DIAG IMAGING PROCEDURES
631457   NM BONE MARROW LTD               1005.00    881.00   6            DIAG IMAGING PROCEDURES
631507   NM BONE MARROW MULTI             1367.00   1200.00   6            DIAG IMAGING PROCEDURES
631556   NM BONE MARROW WB                1731.00   1521.00   6            DIAG IMAGING PROCEDURES
631408   NM BONE SCAN LTD                 1122.00    699.00   6            DIAG IMAGING PROCEDURES
631804   NM BONE SCAN MULTI AREAS         1223.00    743.00   6            DIAG IMAGING PROCEDURES
631903   NM BONE SCAN W SPECT              691.00    517.00   6            DIAG IMAGING PROCEDURES
631952   NM BONE SCAN WB                  1494.00    894.00   6            DIAG IMAGING PROCEDURES
630053   NM BONE SCAN WB                  1494.00    894.00   6            DIAG IMAGING PROCEDURES
631853   NM BONE THREE PHASE              1436.00    827.00   6            DIAG IMAGING PROCEDURES
634550   NM BOWEL (MECKELS)               1346.00      0.00   6            DIAG IMAGING PROCEDURES
632059   NM BRAIN CISTERNOGRAM             475.00      0.00   6            DIAG IMAGING PROCEDURES
632109   NM BRAIN CMPL STATIC             1367.00      0.00   6            DIAG IMAGING PROCEDURES
632158   NM BRAIN CMPL W FLOW             1457.00      0.00   6            DIAG IMAGING PROCEDURES
632208   NM BRAIN CMPL W SPECT             691.00      0.00   6            DIAG IMAGING PROCEDURES
632406   NM BRAIN CSF SHUNT EVAL          1278.00      0.00   6            DIAG IMAGING PROCEDURES




                                                Page 36
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



632257   NM BRAIN FLOW ONLY                730.00      0.00   6            DIAG IMAGING PROCEDURES
632307   NM BRAIN LTD                     1278.00      0.00   6            DIAG IMAGING PROCEDURES
632356   NM BRAIN LTD W FLOW              1278.00      0.00   6            DIAG IMAGING PROCEDURES
633701   NM CARDIAC SHUNT EVAL            1135.00    995.00   6            DIAG IMAGING PROCEDURES
637140   NM CARDIAC STRESS                   0.00      0.00   6            DIAG IMAGING PROCEDURES
632554   NM COMP AUTO DATA SMPL              0.00      0.00   6            DIAG IMAGING PROCEDURES
636746   NM CONSULT 1-131 THERAPY            0.00      0.00   6            DIAG IMAGING PROCEDURES
636761   NM CONSULT MOAB TX                  0.00      0.00   6            DIAG IMAGING PROCEDURES
632075   NM CSF FLOW W SPECT               778.00      0.00   6            DIAG IMAGING PROCEDURES
632455   NM CSF LEAKAGE DETECT            2098.00      0.00   6            DIAG IMAGING PROCEDURES
632653   NM CYSTOGRAM VOIDING              984.00      0.00   6            DIAG IMAGING PROCEDURES
632752   NM ESOPH MOTILITY                 861.00      0.00   6            DIAG IMAGING PROCEDURES
632869   NM GASTRIC EMPTYING              1165.00      0.00   6            DIAG IMAGING PROCEDURES
632950   NM GASTROESOPH REFLUX             854.00      0.00   6            DIAG IMAGING PROCEDURES
633008   NM GI BLEEDING SCAN              1373.00      0.00   6            DIAG IMAGING PROCEDURES
633107   NM HEART 1S PASS SNGL            1457.00      0.00   6            DIAG IMAGING PROCEDURES
633206   NM HEART GATED MULTIVIEW         2900.00      0.00   6            DIAG IMAGING PROCEDURES
633149   NM HEART GATED SNGL               748.00      0.00   6            DIAG IMAGING PROCEDURES
633156   NM HEART GATED SNGL              2262.00   1296.00   6            DIAG IMAGING PROCEDURES
633552   NM HEART MI PLANAR               1210.00   1042.00   6            DIAG IMAGING PROCEDURES
633602   NM HEART MI W EF                 1731.00      0.00   6            DIAG IMAGING PROCEDURES
633651   NM HEART MI W SPECT               691.00    490.00   6            DIAG IMAGING PROCEDURES
633354   NM HEART MP MULTI PLANAR         2138.00   1877.00   6            DIAG IMAGING PROCEDURES
638379   NM HEART MP MULTI W SPECT        3075.00      0.00   6            DIAG IMAGING PROCEDURES
636878   NM HEART MP SNGL PLANAR          1136.00    996.00   6            DIAG IMAGING PROCEDURES
636860   NM HEART MP SNGL W SPEC             0.00      0.00   6            DIAG IMAGING PROCEDURES
636852   NM HEART MP SNGL W SPEC          2960.00   2597.00   6            DIAG IMAGING PROCEDURES
633057   NM HEART MP W EF                  616.00      0.00   6            DIAG IMAGING PROCEDURES
633750   NM HEART MP WALL MOTION          1120.00    674.00   6            DIAG IMAGING PROCEDURES
633800   NM HEPATOBILIARY DUCTAL          1397.00    801.00   6            DIAG IMAGING PROCEDURES
631051   NM INFLAM LOCAL W SPECT          2006.00      0.00   6            DIAG IMAGING PROCEDURES
634006   NM LIVER FNCTN STDY              1731.00   1521.00   6            DIAG IMAGING PROCEDURES
634253   NM LIVER SPLEEN STATIC           1367.00   1200.00   6            DIAG IMAGING PROCEDURES
634303   NM LIVER SPLEEN W FLOW           1373.00    810.00   6            DIAG IMAGING PROCEDURES
634055   NM LIVER STATIC                  1112.00    976.00   6            DIAG IMAGING PROCEDURES
634154   NM LIVER W SPECT                 2006.00   1762.00   6            DIAG IMAGING PROCEDURES
634204   NM LIVER W SPECT                 2282.00   1607.00   6            DIAG IMAGING PROCEDURES
634105   NM LIVER W VASCULAR FLOW         1278.00   1120.00   6            DIAG IMAGING PROCEDURES
634352   NM LUNG PERF                     1253.00    729.00   6            DIAG IMAGING PROCEDURES
634493   NM LUNG QUAN DIFF FNCTN           931.00      0.00   6            DIAG IMAGING PROCEDURES
634402   NM LUNG VENT W GAS                733.00      0.00   6            DIAG IMAGING PROCEDURES
634436   NM LUNG VENT W GAS MULTI          976.00    617.00   6            DIAG IMAGING PROCEDURES
634451   NM LUNG VENTI1V                  1094.00      0.00   6            DIAG IMAGING PROCEDURES
634501   NM LYMPHATIC PATHWAY             1731.00   1521.00   6            DIAG IMAGING PROCEDURES
635615   NM MONOCLONAL AB IV INFSN        1153.00      0.00   6            DIAG IMAGING PROCEDURES
637173   NM NM MOBILE                        0.00      0.00   6            DIAG IMAGING PROCEDURES
634600   NM PARATHYROID                    931.00    817.00   6            DIAG IMAGING PROCEDURES
634659   NM PLASMA VOLUME MULTI           1373.00      0.00   6            DIAG IMAGING PROCEDURES
634782   NM PLATELET SURVIVAL STDY         540.00      0.00   6            DIAG IMAGING PROCEDURES
634709   NM RED CELL MASS MULTI           1202.00      0.00   6            DIAG IMAGING PROCEDURES
634758   NM RED CELL SURVIVAL             1278.00   1120.00   6            DIAG IMAGING PROCEDURES
634857   NM RENL FNCTN NONIMAG             931.00      0.00   6            DIAG IMAGING PROCEDURES
635185   NM RENL FNCTN W-W/O DRG M         784.00      0.00   6            DIAG IMAGING PROCEDURES




                                                Page 37
                               85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



634907   NM RENL STATIC ONLY             1005.00      0.00   6            DIAG IMAGING PROCEDURES
635052   NM RENL W FLOW                  1457.00      0.00   6            DIAG IMAGING PROCEDURES
635151   NM RENL W SPECT                 2188.00      0.00   6            DIAG IMAGING PROCEDURES
635201   NM RENOGRAM NO FLOW              825.00      0.00   6            DIAG IMAGING PROCEDURES
634816   NM RENOGRAM SNGL W DRG          1154.00    924.00   6            DIAG IMAGING PROCEDURES
635219   NM RENOGRAM SNGL W/O DRG        1527.00    893.00   6            DIAG IMAGING PROCEDURES
636621   NM RESEARCH IN111-IDEC             0.00      0.00   6            DIAG IMAGING PROCEDURES
636670   NM RESEARCH LEUTECH                0.00      0.00   6            DIAG IMAGING PROCEDURES
636654   NM RESEARCH LUNAR FACET            0.00      0.00   6            DIAG IMAGING PROCEDURES
636613   NM RESEARCH PROSTATE/PERI          0.00      0.00   6            DIAG IMAGING PROCEDURES
632901   NM SALIVARY ASP                    0.00      0.00   6            DIAG IMAGING PROCEDURES
635250   NM SALIVARY GLND W SER          1367.00   1200.00   6            DIAG IMAGING PROCEDURES
631267   NM SEDATION MONITORING             0.00      0.00   6            DIAG IMAGING PROCEDURES
635409   NM SPLEEN                       1112.00    976.00   6            DIAG IMAGING PROCEDURES
635458   NM TESTICULAR W FLOW            1071.00    691.00   6            DIAG IMAGING PROCEDURES
635706   NM THERAPY CATH/LOCAL              0.00      0.00   6            DIAG IMAGING PROCEDURES
636001   NM THYROID IMAG ONLY             931.00    817.00   6            DIAG IMAGING PROCEDURES
635953   NM THYROID IMAG UPT MULTI       1036.00    584.00   6            DIAG IMAGING PROCEDURES
635979   NM THYROID IMAG UPT SNGL         902.00    567.00   6            DIAG IMAGING PROCEDURES
636050   NM THYROID IMAG W FLOW          1112.00    976.00   6            DIAG IMAGING PROCEDURES
635839   NM THYROID METS LTD              339.00      0.00   6            DIAG IMAGING PROCEDURES
636100   NM THYROID METS WB              1391.00      0.00   6            DIAG IMAGING PROCEDURES
636159   NM THYROID SUPP STIM             729.00    639.00   6            DIAG IMAGING PROCEDURES
636209   NM THYROID UPTAKE MULTI          729.00      0.00   6            DIAG IMAGING PROCEDURES
636258   NM THYROID UPTAKE SNGL           379.00      0.00   6            DIAG IMAGING PROCEDURES
636308   NM TUMOR LOC LTD W RP           1031.00    478.00   6            DIAG IMAGING PROCEDURES
636407   NM TUMOR LOC MULTI W RP         1049.00      0.00   6            DIAG IMAGING PROCEDURES
636456   NM TUMOR LOC SPECT W RP          626.00      0.00   6            DIAG IMAGING PROCEDURES
636514   NM TUMOR LOC WB SNGL DAY        1715.00      0.00   6            DIAG IMAGING PROCEDURES
636480   NM TUMOR LOC WB SNGL DAY        3601.00      0.00   6            DIAG IMAGING PROCEDURES
635607   NM TX INTRACAVITY                912.00      0.00   6            DIAG IMAGING PROCEDURES
635755   NM TX RADIOPHARM IV ADM         2400.00      0.00   6            DIAG IMAGING PROCEDURES
635656   NM TX RADIOPHARM IV ADM          912.00      0.00   6            DIAG IMAGING PROCEDURES
635805   NM TX RADIOPHARM ORAL ADM        912.00      0.00   6            DIAG IMAGING PROCEDURES
635854   NM TX RADIOPHARM ORAL ADM        912.00      0.00   6            DIAG IMAGING PROCEDURES
635508   NM TX RADIOPHARM ORAL ADM        507.00      0.00   6            DIAG IMAGING PROCEDURES
635557   NM TX RADIOPHARM ORAL ADM        765.00      0.00   6            DIAG IMAGING PROCEDURES
635904   NM TX RADIOPHARM ORAL ADM        912.00      0.00   6            DIAG IMAGING PROCEDURES
634675   NM UREA TEST C14 ANALYSIS         84.00      0.00   6            DIAG IMAGING PROCEDURES
632802   NM VASCULAR FLOW NCARDIO         343.00    229.00   6            DIAG IMAGING PROCEDURES
631119   NM VEN THROMBOSIS ACUTE          873.00      0.00   6            DIAG IMAGING PROCEDURES
631135   NM VEN THROMBOSIS STDY           540.00      0.00   6            DIAG IMAGING PROCEDURES
636555   NM VENOGRAM BIL                 1731.00   1521.00   6            DIAG IMAGING PROCEDURES
636605   NM VENOGRAM UNI                  778.00    491.00   6            DIAG IMAGING PROCEDURES
634378   NM VENT/PER REBRTH/WASHOU        763.00      0.00   6            DIAG IMAGING PROCEDURES
635300   NM VIT B12 COMBINED             1112.00    976.00   6            DIAG IMAGING PROCEDURES
633958   NM VP SHUNT PATENCY             1278.00   1120.00   6            DIAG IMAGING PROCEDURES
634774   NM WB VOL DETERMINATION          624.00      0.00   6            DIAG IMAGING PROCEDURES
636464   NM WHOLE BODY 2+ DAYS           3975.00      0.00   6            DIAG IMAGING PROCEDURES
633842   NMC INJ ASP SHUNT                253.00      0.00   6            DIAG IMAGING PROCEDURES
633834   NMC INJ VP SHUNT                 177.00      0.00   6            DIAG IMAGING PROCEDURES
633891   NMC INSERT CATH TMP SMPL         100.00      0.00   6            DIAG IMAGING PROCEDURES
633875   NMC NODE IDENTIFICATION          122.00      0.00   6            DIAG IMAGING PROCEDURES




                                               Page 38
                               85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



681056   PS BRAIN METBLC EVAL            1150.00      0.00   6            DIAG IMAGING PROCEDURES
681155   PS BRAIN PERF EVAL              1150.00      0.00   6            DIAG IMAGING PROCEDURES
684050   PS HEART METBLC EVAL            1150.00      0.00   6            DIAG IMAGING PROCEDURES
684100   PS HEART PERF MULTI             1150.00      0.00   6            DIAG IMAGING PROCEDURES
684159   PS HEART PERF SNGL              1150.00      0.00   6            DIAG IMAGING PROCEDURES
683714   PS TUMOR FULL BODY              1150.00      0.00   6            DIAG IMAGING PROCEDURES
682179   PS TUMOR FULL BODY              1150.00      0.00   6            DIAG IMAGING PROCEDURES
682161   PS TUMOR FULL BODY              1150.00      0.00   6            DIAG IMAGING PROCEDURES
684662   PS TUMOR FULL BODY              1150.00      0.00   6            DIAG IMAGING PROCEDURES
684829   PS TUMOR LIMITED AREA           1150.00      0.00   6            DIAG IMAGING PROCEDURES
684845   PS TUMOR SKULL TO THIGH         1150.00      0.00   6            DIAG IMAGING PROCEDURES
684860   PS TUMOR W/CT LTD               1150.00      0.00   6            DIAG IMAGING PROCEDURES
684886   PS TUMOR W/CT SKULL THIGH       1150.00      0.00   6            DIAG IMAGING PROCEDURES
684902   PS TUMOR W/CT WHOLE BODY        1150.00      0.00   6            DIAG IMAGING PROCEDURES
699520   RO APLY INTRACV RAD CMPLX        926.00      0.00   6            DIAG IMAGING PROCEDURES
699512   RO APLY INTRACV RAD INTRM        745.00      0.00   6            DIAG IMAGING PROCEDURES
699504   RO APLY INTRACV RAD SMPL         519.00      0.00   6            DIAG IMAGING PROCEDURES
699462   RO APLY INTRSTL RAD INTRM        873.00      0.00   6            DIAG IMAGING PROCEDURES
699454   RO APLY INTRSTL RAD SMPL         451.00      0.00   6            DIAG IMAGING PROCEDURES
699165   RO BRACHY DOSE PLAN CMPLX       1021.00      0.00   6            DIAG IMAGING PROCEDURES
699140   RO BRACHY DOSE PLAN INTRM        717.00      0.00   6            DIAG IMAGING PROCEDURES
699124   RO BRACHY DOSE PLAN SMPL         489.00      0.00   6            DIAG IMAGING PROCEDURES
699629   RO CONSULT CONT MED PHYSC        615.00      0.00   6            DIAG IMAGING PROCEDURES
699801   RO DOSIMETRY SPECIAL             105.00      0.00   6            DIAG IMAGING PROCEDURES
699926   RO DVCS CONSTRUCT CMPLX 4        670.00      0.00   6            DIAG IMAGING PROCEDURES
699918   RO DVCS CONSTRUCT INTRM          392.00      0.00   6            DIAG IMAGING PROCEDURES
699900   RO DVCS CONSTRUCT SMPL           278.00      0.00   6            DIAG IMAGING PROCEDURES
699421   RO IMRT DLVR EA SESSION         1430.78      0.00   6            DIAG IMAGING PROCEDURES
699405   RO INFUSE RADIOELMNT SOLN        275.00      0.00   6            DIAG IMAGING PROCEDURES
699850   RO INTRSTIT RADIAT CMPLX        1057.00      0.00   6            DIAG IMAGING PROCEDURES
699470   RO INTRSTIT RADIAT CMPLX        1057.00      0.00   6            DIAG IMAGING PROCEDURES
699579   RO ISODOSE PLAN CMPLX            549.00      0.00   6            DIAG IMAGING PROCEDURES
699561   RO ISODOSE PLAN INTRM            482.00      0.00   6            DIAG IMAGING PROCEDURES
699553   RO ISODOSE PLAN SMPL             383.00      0.00   6            DIAG IMAGING PROCEDURES
699835   RO LOADING RAD SOURCE            105.00      0.00   6            DIAG IMAGING PROCEDURES
699645   RO RAD PORT FILM(S)              124.00      0.00   6            DIAG IMAGING PROCEDURES
699272   RO RAD TX 2 AREA 11-19MEV        433.00      0.00   6            DIAG IMAGING PROCEDURES
699256   RO RAD TX 2 AREA 1-5MEV          433.00      0.00   6            DIAG IMAGING PROCEDURES
699264   RO RAD TX 2 AREA 6-10MEV         433.00      0.00   6            DIAG IMAGING PROCEDURES
699280   RO RAD TX 2 AREA GT 19MEV        433.00      0.00   6            DIAG IMAGING PROCEDURES
699322   RO RAD TX 3/MORE 11-19MEV        482.00      0.00   6            DIAG IMAGING PROCEDURES
699306   RO RAD TX 3/MORE 1-5MEV          482.00      0.00   6            DIAG IMAGING PROCEDURES
699314   RO RAD TX 3/MORE 6-10MEV         482.00      0.00   6            DIAG IMAGING PROCEDURES
699330   RO RAD TX 3/MORE GT 19MEV        482.00      0.00   6            DIAG IMAGING PROCEDURES
699223   RO RAD TX SNGL 11-19MEV          366.00      0.00   6            DIAG IMAGING PROCEDURES
699207   RO RAD TX SNGL 1-5MEV            366.00      0.00   6            DIAG IMAGING PROCEDURES
699215   RO RAD TX SNGL 6-10MEV           366.00      0.00   6            DIAG IMAGING PROCEDURES
699231   RO RAD TX SNGL GT 19MEV          366.00      0.00   6            DIAG IMAGING PROCEDURES
699355   RO RAD TX SUPERFICIAL            366.00      0.00   6            DIAG IMAGING PROCEDURES
699108   RO RADIAT DOSIMETRY CALC         278.00      0.00   6            DIAG IMAGING PROCEDURES
699603   RO RADIATION PHYSICS CNSL        615.00      0.00   6            DIAG IMAGING PROCEDURES
699660   RO SIMULATION 3D                5758.00      0.00   6            DIAG IMAGING PROCEDURES
699744   RO SIMULATION CMPLX                0.00      0.00   6            DIAG IMAGING PROCEDURES




                                               Page 39
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



699728   RO SIMULATION INTRM                 0.00      0.00   6            DIAG IMAGING PROCEDURES
699702   RO SIMULATION SMPL                717.00      0.00   6            DIAG IMAGING PROCEDURES
699819   RO SPECIAL PORT PLAN BODY         834.00      0.00   6            DIAG IMAGING PROCEDURES
699827   RO SPECIAL TX PROCEDURE           772.00      0.00   6            DIAG IMAGING PROCEDURES
633859   RP SUPPLY DX                        0.00      0.00   6            DIAG IMAGING PROCEDURES
649145   S STRL ICC COMPLAINT NU             0.00      0.00   6            DIAG IMAGING PROCEDURES
649152   S STRL ICC COMPLAINT PH             0.00      0.00   6            DIAG IMAGING PROCEDURES
649160   S STRL ICC COMPLAINT RA             0.00      0.00   6            DIAG IMAGING PROCEDURES
672253   US ABD CMPL                      1293.00    493.00   6            DIAG IMAGING PROCEDURES
674713   US AMNIOCENTESIS                  607.00    551.00   6            DIAG IMAGING PROCEDURES
673004   US AMNIOCENTESIS                  616.00    541.00   6            DIAG IMAGING PROCEDURES
673152   US ASP OVA                       1047.00    295.00   6            DIAG IMAGING PROCEDURES
674606   US BIO PROFILE W NONSTRES         548.00      0.00   6            DIAG IMAGING PROCEDURES
674150   US BIO PROFILE WO NOSTRES         214.00      0.00   6            DIAG IMAGING PROCEDURES
673558   US BREAST UNI OR BIL              618.00    584.00   6            DIAG IMAGING PROCEDURES
672766   US BX ENDOMYOCARDIAL             1047.00    371.00   6            DIAG IMAGING PROCEDURES
673608   US CHEST                          870.00      0.00   6            DIAG IMAGING PROCEDURES
670901   US CONSULT FOREIGN FLM              0.00      0.00   6            DIAG IMAGING PROCEDURES
673657   US CONSULTATION PHYSICIST           0.00      0.00   6            DIAG IMAGING PROCEDURES
673707   US CRYOSURGERY                      0.00      0.00   6            DIAG IMAGING PROCEDURES
673756   US DPPLER ECHO FETAL              870.00    404.00   6            DIAG IMAGING PROCEDURES
673806   US DPPLER ECHO FETAL FU           870.00    127.00   6            DIAG IMAGING PROCEDURES
672931   US DRN W CATH PLACE PRC           889.00      0.00   6            DIAG IMAGING PROCEDURES
672303   US ECHO ABD LTD                   679.00    611.00   6            DIAG IMAGING PROCEDURES
674127   US ECHO FETAL                     890.00    763.00   6            DIAG IMAGING PROCEDURES
674184   US ECHO FETAL FU REPEAT           870.00      0.00   6            DIAG IMAGING PROCEDURES
674044   US ECHO INF HIPS                  201.00      0.00   6            DIAG IMAGING PROCEDURES
674069   US ECHO INF HIPS LTD              187.00      0.00   6            DIAG IMAGING PROCEDURES
672154   US ECHO RETROPE LTD               866.00    761.00   6            DIAG IMAGING PROCEDURES
674143   US ENCEPHALOGRAM                  933.00      0.00   6            DIAG IMAGING PROCEDURES
673954   US EXT NONVASCULAR               1484.00      0.00   6            DIAG IMAGING PROCEDURES
674002   US EXT NONVASCULAR                616.00    541.00   6            DIAG IMAGING PROCEDURES
674200   US FETAL TRANSFUSION IUT          201.00      0.00   6            DIAG IMAGING PROCEDURES
674259   US FU STDY                        220.00    193.00   6            DIAG IMAGING PROCEDURES
674192   US GUIDE ART PSEUDOANEUR          830.00      0.00   6            DIAG IMAGING PROCEDURES
670851   US GUIDE VISCRL TISS ABLN         221.00      0.00   6            DIAG IMAGING PROCEDURES
667857   US GUIDE VISCRL TISS ABLN         221.00      0.00   6            DIAG IMAGING PROCEDURES
674903   US HEAD & NEC SFT TISSUE          906.00    514.00   6            DIAG IMAGING PROCEDURES
674309   US IN OR                          510.00      0.00   6            DIAG IMAGING PROCEDURES
672733   US NDL PLACE                      502.00      0.00   6            DIAG IMAGING PROCEDURES
674564   US OB 1ST TRI 1 GEST              143.00      0.00   6            DIAG IMAGING PROCEDURES
674572   US OB 1ST TRI EA GEST             100.00      0.00   6            DIAG IMAGING PROCEDURES
674630   US OB AFTR 1ST TRI 1 GEST         731.00      0.00   6            DIAG IMAGING PROCEDURES
674721   US OB AFTR 1ST TRI EA GES         878.00      0.00   6            DIAG IMAGING PROCEDURES
674580   US OB DTLD FTL EXAM 1 GES         483.00      0.00   6            DIAG IMAGING PROCEDURES
674598   US OB DTLD FTL EXM EA GES         165.00      0.00   6            DIAG IMAGING PROCEDURES
674663   US OB FU/REEVAL EA FETUS          501.00    473.00   6            DIAG IMAGING PROCEDURES
674697   US OB LTD 1/MORE FETUSES         1057.00    411.00   6            DIAG IMAGING PROCEDURES
674747   US OB TRANSVAGINAL                198.00      0.00   6            DIAG IMAGING PROCEDURES
674507   US PELV CMPL NONOB               1049.00    404.00   6            DIAG IMAGING PROCEDURES
674523   US PELV LTD FU NONOB              279.00      0.00   6            DIAG IMAGING PROCEDURES
674556   US PERICARDIOCENT                 870.00    136.00   6            DIAG IMAGING PROCEDURES
670703   US RADIATION FIELD PLACE          889.00    299.00   6            DIAG IMAGING PROCEDURES




                                                Page 40
                               85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



672857   US RENL TRANSPLANT              1319.00      0.00   6            DIAG IMAGING PROCEDURES
676155   US RENL TRANSPLANT               616.00      0.00   6            DIAG IMAGING PROCEDURES
672808   US RETROPE CMPL                  951.00    835.00   6            DIAG IMAGING PROCEDURES
670000   US SERVICE AFTER HOURS             0.00      0.00   6            DIAG IMAGING PROCEDURES
674820   US SPINAL CANAL                  870.00    763.00   6            DIAG IMAGING PROCEDURES
674846   US TESTICULAR SCROTUM           1049.00    383.00   6            DIAG IMAGING PROCEDURES
670752   US TRANSRECTAL                  1627.00      0.00   6            DIAG IMAGING PROCEDURES
673905   US TRANSVAGINAL                  521.00    233.00   6            DIAG IMAGING PROCEDURES
674218   US VILLUS SAMPLING               201.00      0.00   6            DIAG IMAGING PROCEDURES
670836   USC ABLTN CRYO OPN LIVER        4297.00      0.00   6            DIAG IMAGING PROCEDURES
670844   USC ABLTN PROSTATE CRYO         3752.00      0.00   6            DIAG IMAGING PROCEDURES
670828   USC ABLTN RENAL RF PRC          4475.00      0.00   6            DIAG IMAGING PROCEDURES
672501   USC ABSCSS CYST LIVER PRC       8396.00   3142.00   6            DIAG IMAGING PROCEDURES
673376   USC ABSCSS DRN PELV PRC          593.00      0.00   6            DIAG IMAGING PROCEDURES
673335   USC ABSCSS DRN PERITNL           591.00      0.00   6            DIAG IMAGING PROCEDURES
672949   USC ABSCSS DRN RENL              588.00      0.00   6            DIAG IMAGING PROCEDURES
673384   USC ABSCSS DRN RETROPE           645.00      0.00   6            DIAG IMAGING PROCEDURES
673350   USC ABSCSS DRN SUBDIAP           697.00      0.00   6            DIAG IMAGING PROCEDURES
672956   USC AMNIOCENTESIS DX            1017.00    325.00   6            DIAG IMAGING PROCEDURES
672063   USC ASP BREAST ADD               160.00      0.00   6            DIAG IMAGING PROCEDURES
673228   USC ASP RENL CYST                338.00      0.00   6            DIAG IMAGING PROCEDURES
672493   USC ASP SPINAL CYST PRC         1787.91      0.00   6            DIAG IMAGING PROCEDURES
673251   USC ASP THYROID CYST             323.00      0.00   6            DIAG IMAGING PROCEDURES
670406   USC BREAST NDL WIRE ADD          337.00    123.00   6            DIAG IMAGING PROCEDURES
672758   USC BX ABD RETROPE               661.00      0.00   6            DIAG IMAGING PROCEDURES
672592   USC BX BM NDL/TROCAR             660.00      0.00   6            DIAG IMAGING PROCEDURES
670034   USC BX BONE DEEP                2545.00    936.00   6            DIAG IMAGING PROCEDURES
672600   USC BX BONE SUPER                783.00      0.00   6            DIAG IMAGING PROCEDURES
670026   USC BX BONE SUPER                934.00    350.00   6            DIAG IMAGING PROCEDURES
670067   USC BX BREAST PRC W/O            649.00    233.00   6            DIAG IMAGING PROCEDURES
622530   USC BX BREAST W IMAG            1315.00      0.00   6            DIAG IMAGING PROCEDURES
672584   USC BX LIVER                     675.00      0.00   6            DIAG IMAGING PROCEDURES
672535   USC BX MUSCLE                    405.00    356.00   6            DIAG IMAGING PROCEDURES
670075   USC BX PANCREAS                 2513.00    936.00   6            DIAG IMAGING PROCEDURES
670083   USC BX PLEURA                   1065.00    398.00   6            DIAG IMAGING PROCEDURES
672550   USC BX PROSTATE                  629.00    551.00   6            DIAG IMAGING PROCEDURES
672790   USC BX THYROID                   388.00      0.00   6            DIAG IMAGING PROCEDURES
672972   USC CORDOCENTESIS IUT            709.00      0.00   6            DIAG IMAGING PROCEDURES
673368   USC DRN ABD ABSCSS OPN           665.00      0.00   6            DIAG IMAGING PROCEDURES
673301   USC DRN ABSCESS COMP/MULT        256.00      0.00   6            DIAG IMAGING PROCEDURES
673343   USC DRN PANC PSEUDOCYST          696.00      0.00   6            DIAG IMAGING PROCEDURES
673921   USC ENDO SB W JEJ TUB PRC        726.33      0.00   6            DIAG IMAGING PROCEDURES
674036   USC EXCHANGE DRN CATH            280.00      0.00   6            DIAG IMAGING PROCEDURES
672485   USC FNA W IMAG GUIDANCE          506.00      0.00   6            DIAG IMAGING PROCEDURES
679001   USC INJ CON ABSCSS               157.00      0.00   6            DIAG IMAGING PROCEDURES
670323   USC INJ DUCT GALACTOGRAM         210.00    167.00   6            DIAG IMAGING PROCEDURES
672576   USC INJ NEC BX                   750.00      0.00   6            DIAG IMAGING PROCEDURES
676007   USC INJ PENILE CAVERNOUS         549.00    481.00   6            DIAG IMAGING PROCEDURES
671107   USC INJ SINOGRAM                 494.00      0.00   6            DIAG IMAGING PROCEDURES
674325   USC INS PICC W/O PORT 5+        1207.00      0.00   6            DIAG IMAGING PROCEDURES
674317   USC INS PICC W/O PORT LT5       1329.00      0.00   6            DIAG IMAGING PROCEDURES
674788   USC LAP ABLATION RF LIVER       3652.00      0.00   6            DIAG IMAGING PROCEDURES
674796   USC LAP ABLTN CRYO LIVER        3653.00      0.00   6            DIAG IMAGING PROCEDURES




                                               Page 41
                              85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



674408   USC NEPHROSTOMY TUBE CHNG      1436.00      0.00   6            DIAG IMAGING PROCEDURES
671628   USC PARACENT ABD INI            725.00      0.00   6            DIAG IMAGING PROCEDURES
671644   USC PARACENT ABD SUBSQ          507.00      0.00   6            DIAG IMAGING PROCEDURES
674945   USC PLC NDL PROSTATE INST      2436.00      0.00   6            DIAG IMAGING PROCEDURES
676585   USC PSEUDOANEURYSM INJ          638.00      0.00   6            DIAG IMAGING PROCEDURES
674879   USC THORACENTESIS               610.00      0.00   6            DIAG IMAGING PROCEDURES
674960   USC URINE CAPACITY MEASUR       101.49      0.00   6            DIAG IMAGING PROCEDURES
676353   USC VASOTOMY FOR VASOGRAM      1257.00   1103.00   6            DIAG IMAGING PROCEDURES
672980   USC VILLUS SAMPLING             528.00      0.00   6            DIAG IMAGING PROCEDURES
621698   XR ABD 1V AP                    551.00    133.00   6            DIAG IMAGING PROCEDURES
621763   XR ABD CMPL DECUB ERECT        1090.00    258.00   6            DIAG IMAGING PROCEDURES
643007   XR ABSCSS FIST SIN TRACT        847.00    743.00   6            DIAG IMAGING PROCEDURES
621888   XR AC JNT                       847.00    744.00   6            DIAG IMAGING PROCEDURES
621912   XR ANKLE 2V                     505.00      0.00   6            DIAG IMAGING PROCEDURES
622100   XR ARTHRO ANKLE                1072.00    940.00   6            DIAG IMAGING PROCEDURES
622126   XR ARTHRO ELBOW                1072.00    940.00   6            DIAG IMAGING PROCEDURES
622142   XR ARTHRO HIP                  1530.00    404.00   6            DIAG IMAGING PROCEDURES
622167   XR ARTHRO KNEE                 1072.00    940.00   6            DIAG IMAGING PROCEDURES
622225   XR ARTHRO WRIST                1072.00    940.00   6            DIAG IMAGING PROCEDURES
622258   XR ATHERECTOMY PERIPH ADD      1136.00      0.00   6            DIAG IMAGING PROCEDURES
622241   XR ATHERECTOMY RENL            2133.00      0.00   6            DIAG IMAGING PROCEDURES
622274   XR ATHERECTOMY VISC INI        2133.00      0.00   6            DIAG IMAGING PROCEDURES
622266   XR ATHRECTOMY VISC ADD         1136.00      0.00   6            DIAG IMAGING PROCEDURES
620807   XR BE W AIR CON                2018.00      0.00   6            DIAG IMAGING PROCEDURES
625582   XR BILE STONE EXTRACTION        241.00      0.00   6            DIAG IMAGING PROCEDURES
624387   XR BILI DUCT DILATE PRC         538.00    175.00   6            DIAG IMAGING PROCEDURES
622886   XR BONE SURVEY CMPL             914.00      0.00   6            DIAG IMAGING PROCEDURES
622084   XR BONE SURVEY LTD              746.00    654.00   6            DIAG IMAGING PROCEDURES
671057   XR BREAST MAMMOGRAPHY LOC       613.00    303.00   6            DIAG IMAGING PROCEDURES
627604   XR CALCANEOUS 2V OR MORE        494.00    121.00   6            DIAG IMAGING PROCEDURES
623165   XR CEPHALOGRAM ORDO             257.00     83.00   6            DIAG IMAGING PROCEDURES
623223   XR CHEST 1V                     341.00      0.00   6            DIAG IMAGING PROCEDURES
623280   XR CHEST 2V                     580.00    147.00   6            DIAG IMAGING PROCEDURES
623355   XR CHEST 2V                     561.00      0.00   6            DIAG IMAGING PROCEDURES
623322   XR CHEST 2V W FLUORO            638.00      0.00   6            DIAG IMAGING PROCEDURES
623413   XR CHEST 4V CMPL                107.00    101.00   6            DIAG IMAGING PROCEDURES
623421   XR CHEST 4V MORE W FLUORO       719.00    633.00   6            DIAG IMAGING PROCEDURES
603522   XR CHOL IN OR                  1612.00    817.00   6            DIAG IMAGING PROCEDURES
623629   XR CHOLECYSTOGRAM ORAL FU       364.00    320.00   6            DIAG IMAGING PROCEDURES
623660   XR CINE/VIDEO                   314.00      0.00   6            DIAG IMAGING PROCEDURES
623686   XR CINE/VIDEO COMPLEMENT        319.00    281.00   6            DIAG IMAGING PROCEDURES
623702   XR CISTERNOGRAM                1416.00    427.00   6            DIAG IMAGING PROCEDURES
623710   XR CISTERNOGRAM                 300.00      0.00   6            DIAG IMAGING PROCEDURES
623769   XR CLAVICLE CMPL                597.00    153.00   6            DIAG IMAGING PROCEDURES
629899   XR CORPORA CAVERNOSOGRAM        153.00      0.00   6            DIAG IMAGING PROCEDURES
623868   XR CYSTOGRAM 3V OR MORE        1097.00      0.00   6            DIAG IMAGING PROCEDURES
627430   XR DACRYOCYSTOGRAPHY            129.00      0.00   6            DIAG IMAGING PROCEDURES
622951   XR DEXA APPEN                   104.00      0.00   6            DIAG IMAGING PROCEDURES
636969   XR DEXA AXIAL SKELETON         1861.00   1632.00   6            DIAG IMAGING PROCEDURES
622944   XR DEXA AXIAL SKELETON          421.00    397.00   6            DIAG IMAGING PROCEDURES
627174   XR DIAG MAMMO DIG W COMP         28.00      0.00   6            DIAG IMAGING PROCEDURES
627521   XR DILATE NEPHROSTOMY           788.00      0.00   6            DIAG IMAGING PROCEDURES
627075   XR DISKOGRAM CERV THOR         1134.00      0.00   6            DIAG IMAGING PROCEDURES




                                              Page 42
                               85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



627083   XR DISKOGRAM LUMB               1063.00      0.00   6            DIAG IMAGING PROCEDURES
623983   XR DUODENOGRAM HYPOTONIC        1436.00    480.00   6            DIAG IMAGING PROCEDURES
622969   XR DXA BONE DENS VRT FRAC        537.00    537.00   6            DIAG IMAGING PROCEDURES
624049   XR ELBOW 2V                      528.00    133.00   6            DIAG IMAGING PROCEDURES
624007   XR ELBOW 3V OR MORE              721.00    177.00   6            DIAG IMAGING PROCEDURES
624288   XR ENDO BILI DUCT               1879.00    695.00   6            DIAG IMAGING PROCEDURES
624221   XR ENTEROCLYSIS TUBE PRC        1690.00   1483.00   6            DIAG IMAGING PROCEDURES
626135   XR EPIDUROGRAM                   294.00      0.00   6            DIAG IMAGING PROCEDURES
624320   XR ERCP BILI PANC DUCT          2098.00    779.00   6            DIAG IMAGING PROCEDURES
624304   XR ERCP PANC DUCT               1890.00    729.00   6            DIAG IMAGING PROCEDURES
624429   XR ESOPH                         917.00    226.00   6            DIAG IMAGING PROCEDURES
624106   XR EXAM OF MIDDLE EAR            101.00      0.00   6            DIAG IMAGING PROCEDURES
626747   XR EXT INF LOW LES 1YR           560.00    144.00   6            DIAG IMAGING PROCEDURES
626762   XR EXT INF UPP LES 1YR           475.00      0.00   6            DIAG IMAGING PROCEDURES
624809   XR EYE FOR FB                    993.00      0.00   6            DIAG IMAGING PROCEDURES
624825   XR FACIAL BONE 3V OR MORE        951.00      0.00   6            DIAG IMAGING PROCEDURES
624841   XR FACIAL BONE LES 3V            835.00      0.00   6            DIAG IMAGING PROCEDURES
625137   XR FALLOPN TUBE TRANSCERV        428.00      0.00   6            DIAG IMAGING PROCEDURES
625467   XR FB LOC CHLD                   376.00      0.00   6            DIAG IMAGING PROCEDURES
625483   XR FB RMVL ESOPH                 866.00      0.00   6            DIAG IMAGING PROCEDURES
624908   XR FEMUR 2V                      709.00    172.00   6            DIAG IMAGING PROCEDURES
625004   XR FINGER(S) 2V OR MORE          434.00    106.00   6            DIAG IMAGING PROCEDURES
625053   XR FLUORO 1-2 HRS                616.00      0.00   6            DIAG IMAGING PROCEDURES
625251   XR FLUORO 1HR OR LES             704.00    682.00   6            DIAG IMAGING PROCEDURES
625061   XR FLUORO 2-3 HRS                616.00      0.00   6            DIAG IMAGING PROCEDURES
625079   XR FLUORO 3-4 HRS                616.00      0.00   6            DIAG IMAGING PROCEDURES
625087   XR FLUORO 4-5 HRS                616.00      0.00   6            DIAG IMAGING PROCEDURES
625095   XR FLUORO 5-6 HRS                616.00      0.00   6            DIAG IMAGING PROCEDURES
625186   XR FLUORO CVC PLC/RMV/RPR        180.00      0.00   6            DIAG IMAGING PROCEDURES
625194   XR FLUORO GUIDE SPINE INJ        177.00      0.00   6            DIAG IMAGING PROCEDURES
622746   XR FLUORO NDL PLACE              172.00    163.00   6            DIAG IMAGING PROCEDURES
625335   XR FOOT 2V                       474.00    118.00   6            DIAG IMAGING PROCEDURES
625301   XR FOOT 3V OR MORE               622.00    160.00   6            DIAG IMAGING PROCEDURES
625400   XR FOREARM 2V                    545.00    134.00   6            DIAG IMAGING PROCEDURES
625541   XR G TUBE PRC                   6512.00   2121.00   6            DIAG IMAGING PROCEDURES
625517   XR GALACTOGRAM 1 DUCT           1365.00    446.00   6            DIAG IMAGING PROCEDURES
625509   XR GALACTOGRAM MULTI            1863.00    597.00   6            DIAG IMAGING PROCEDURES
623827   XR GI TUBE INSERT LONG          1726.00   1513.00   6            DIAG IMAGING PROCEDURES
625616   XR HAND 2V                       436.00    111.00   6            DIAG IMAGING PROCEDURES
625608   XR HAND 3V OR MORE               696.00    137.00   6            DIAG IMAGING PROCEDURES
625699   XR HIP OR                        545.00    134.00   6            DIAG IMAGING PROCEDURES
625707   XR HIP UNI 1V                    534.00    131.00   6            DIAG IMAGING PROCEDURES
625715   XR HIP UNI 1V                    545.00    134.00   6            DIAG IMAGING PROCEDURES
625673   XR HIP UNI 2V OR MORE            798.00    294.00   6            DIAG IMAGING PROCEDURES
625665   XR HIPS BIL 2V W PELV            980.00    301.00   6            DIAG IMAGING PROCEDURES
625814   XR HUMERUS 2V OR MORE            599.00    144.00   6            DIAG IMAGING PROCEDURES
625848   XR HYSTEROSALPINGOGRAM          1039.00      0.00   6            DIAG IMAGING PROCEDURES
624403   XR INTRALUMINAL DILATE           428.00    407.00   6            DIAG IMAGING PROCEDURES
626846   XR IVP W DRIP + OR BOLUS        1704.00      0.00   6            DIAG IMAGING PROCEDURES
626804   XR IVP W-W/O TOMOGRAM           1636.00    404.00   6            DIAG IMAGING PROCEDURES
626861   XR IVP W-W/O TOMOGRAM           1855.00    476.00   6            DIAG IMAGING PROCEDURES
626937   XR KNEE 1 OR 2V                  500.00    124.00   6            DIAG IMAGING PROCEDURES
626887   XR KNEE 3V                       763.00    186.00   6            DIAG IMAGING PROCEDURES




                                               Page 43
                               85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



626903   XR KNEE 4V OR MORE               793.00      0.00   6            DIAG IMAGING PROCEDURES
626960   XR KNEES STANDING AP             251.00      0.00   6            DIAG IMAGING PROCEDURES
627000   XR LARYNGOGRAM W CON            1026.00    335.00   6            DIAG IMAGING PROCEDURES
627109   XR MAMMO BIL                     617.00      0.00   6            DIAG IMAGING PROCEDURES
627117   XR MAMMO BIL                     527.00      0.00   6            DIAG IMAGING PROCEDURES
627158   XR MAMMO UNI                     397.00      0.00   6            DIAG IMAGING PROCEDURES
627141   XR MAMMO UNI                     536.00      0.00   6            DIAG IMAGING PROCEDURES
626879   XR MAN APP STRS ANY JNT           81.00      0.00   6            DIAG IMAGING PROCEDURES
627208   XR MANDIBLE 4V OR MORE          1094.00      0.00   6            DIAG IMAGING PROCEDURES
627224   XR MANDIBLE LES 4V               853.00      0.00   6            DIAG IMAGING PROCEDURES
627240   XR MASTOIDS 3V OR MORE          1094.00    960.00   6            DIAG IMAGING PROCEDURES
627265   XR MASTOIDS LES 3V               853.00    749.00   6            DIAG IMAGING PROCEDURES
627307   XR MYELOGRAM CERV               2079.00    762.00   6            DIAG IMAGING PROCEDURES
627349   XR MYELOGRAM LUMB               1047.00      0.00   6            DIAG IMAGING PROCEDURES
627380   XR MYELOGRAM POST FOSSA         1912.00    861.00   6            DIAG IMAGING PROCEDURES
627364   XR MYELOGRAM THOR               1912.00    762.00   6            DIAG IMAGING PROCEDURES
627323   XR MYELOGRM 1 OR MORE REG       1510.00      0.00   6            DIAG IMAGING PROCEDURES
627406   XR NASAL BONES 3V OR MORE        729.00    181.00   6            DIAG IMAGING PROCEDURES
627448   XR NEC SOFT TISSUE               767.00      0.00   6            DIAG IMAGING PROCEDURES
620054   XR NO CHRG TRAUMA SERIES           0.00      0.00   6            DIAG IMAGING PROCEDURES
627547   XR OPTIC FORAMINA                682.00    176.00   6            DIAG IMAGING PROCEDURES
627562   XR ORBITS 4V OR MORE             960.00      0.00   6            DIAG IMAGING PROCEDURES
627588   XR ORTHOPANTOGRAM                355.00    119.00   6            DIAG IMAGING PROCEDURES
627620   XR PACEMAKER INSERT             1213.00   1064.00   6            DIAG IMAGING PROCEDURES
627752   XR PELV 1 OR 2V                  545.00    134.00   6            DIAG IMAGING PROCEDURES
627703   XR PELV 3V OR MORE              1003.00    300.00   6            DIAG IMAGING PROCEDURES
625749   XR PELV HIP 2V INF CHLD           78.00      0.00   6            DIAG IMAGING PROCEDURES
627794   XR PELVIMETRY                    144.00      0.00   6            DIAG IMAGING PROCEDURES
627687   XR PERINEOGRAM                   197.00      0.00   6            DIAG IMAGING PROCEDURES
627695   XR PERITONEOGRAM                 177.00      0.00   6            DIAG IMAGING PROCEDURES
627844   XR PHARYNGEAL SPEECH EVAL       1410.00    460.00   6            DIAG IMAGING PROCEDURES
627869   XR PHARYNXLARYNX W FLUORO        344.00      0.00   6            DIAG IMAGING PROCEDURES
621821   XR RADIO ABSORPTIOMETRY          104.00      0.00   6            DIAG IMAGING PROCEDURES
627901   XR RIBS BIL 3V                   560.00      0.00   6            DIAG IMAGING PROCEDURES
627984   XR RIBS BIL W PA CXR             121.00      0.00   6            DIAG IMAGING PROCEDURES
627950   XR RIBS UNI & PA CHEST           838.00    202.00   6            DIAG IMAGING PROCEDURES
627943   XR RIBS UNI 2V                   421.00      0.00   6            DIAG IMAGING PROCEDURES
628123   XR SACRUM COCCYX 2 V MORE        757.00      0.00   6            DIAG IMAGING PROCEDURES
628180   XR SALIVARY GLAND CALC           354.00      0.00   6            DIAG IMAGING PROCEDURES
628206   XR SCAPULA CMPL                  734.00      0.00   6            DIAG IMAGING PROCEDURES
627125   XR SCRN MAMMO                    140.00      0.00   6            DIAG IMAGING PROCEDURES
627182   XR SCRN MAMMO DIG W COMP          28.00      0.00   6            DIAG IMAGING PROCEDURES
628164   XR SELLA TURCICA                  55.00      0.00   6            DIAG IMAGING PROCEDURES
628289   XR SHOULDER 1V                   510.00    130.00   6            DIAG IMAGING PROCEDURES
628958   XR SHOULDER 1V                   521.00    133.00   6            DIAG IMAGING PROCEDURES
628263   XR SHOULDER 2V OR MORE           716.00    225.00   6            DIAG IMAGING PROCEDURES
628107   XR SI JNT 1 OR 2V                156.00      0.00   6            DIAG IMAGING PROCEDURES
628008   XR SI JNT 3V OR MORE             192.00    167.00   6            DIAG IMAGING PROCEDURES
628198   XR SIALOGRAM                     715.00      0.00   6            DIAG IMAGING PROCEDURES
627646   XR SIN PARA 3V OR MORE          1115.00      0.00   6            DIAG IMAGING PROCEDURES
627661   XR SIN PARA LES 3V               866.00      0.00   6            DIAG IMAGING PROCEDURES
628909   XR SKULL 4V OR MORE             1484.00      0.00   6            DIAG IMAGING PROCEDURES
628941   XR SKULL LES 4V                  697.00      0.00   6            DIAG IMAGING PROCEDURES




                                               Page 44
                               85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



624205   XR SM BOWEL ENTEROCLYSIS         821.00    720.00   6            DIAG IMAGING PROCEDURES
628982   XR SM BOWEL SERIES              1407.00    343.00   6            DIAG IMAGING PROCEDURES
629501   XR SPECIMEN SURGICAL             130.00      0.00   6            DIAG IMAGING PROCEDURES
629063   XR SPINE C 4V & FLEX/EXT        1470.00    379.00   6            DIAG IMAGING PROCEDURES
629097   XR SPINE CERV 2-3V               788.00    388.00   6            DIAG IMAGING PROCEDURES
629048   XR SPINE CERV 4V OR MORE        1169.00    329.00   6            DIAG IMAGING PROCEDURES
629253   XR SPINE LUMB 2-3V               776.00    243.00   6            DIAG IMAGING PROCEDURES
629220   XR SPINE LUMB 2-3V               807.00    236.00   6            DIAG IMAGING PROCEDURES
629162   XR SPINE LUMB 4V OR MORE        1483.00    437.00   6            DIAG IMAGING PROCEDURES
629188   XR SPINE LUMB 4V W BEND         1483.00    437.00   6            DIAG IMAGING PROCEDURES
629147   XR SPINE LUMB BEND ONLY         1278.00    272.00   6            DIAG IMAGING PROCEDURES
629261   XR SPINE SCOLIOSIS STNDNG        633.00    165.00   6            DIAG IMAGING PROCEDURES
629287   XR SPINE SCOLIOSIS SUP ER        807.00    236.00   6            DIAG IMAGING PROCEDURES
629022   XR SPINE SNGL V CERV             646.00    171.00   6            DIAG IMAGING PROCEDURES
629303   XR SPINE SURVEY ENTIRE           633.00    165.00   6            DIAG IMAGING PROCEDURES
629329   XR SPINE THOR 2V                 981.00    243.00   6            DIAG IMAGING PROCEDURES
629345   XR SPINE THOR 3V                1019.00    236.00   6            DIAG IMAGING PROCEDURES
629360   XR SPINE THOR 4V OR MORE         512.00      0.00   6            DIAG IMAGING PROCEDURES
629402   XR SPINE THOR LUMB 2V            807.00    236.00   6            DIAG IMAGING PROCEDURES
671065   XR STEREO LOC                   1455.00      0.00   6            DIAG IMAGING PROCEDURES
629428   XR STERNOCLAVIC 3V MORE          254.00      0.00   6            DIAG IMAGING PROCEDURES
629444   XR STERNUM 2V OR MORE            740.00      0.00   6            DIAG IMAGING PROCEDURES
624460   XR SWALLOWING FNCTN              960.00    726.00   6            DIAG IMAGING PROCEDURES
629600   XR TIBIA FIBULA 2V               575.00    141.00   6            DIAG IMAGING PROCEDURES
629527   XR TMJ BIL                       836.00    732.00   6            DIAG IMAGING PROCEDURES
629543   XR TMJ UNI                       653.00    572.00   6            DIAG IMAGING PROCEDURES
629667   XR TOE(S) 2V OR MORE             434.00    106.00   6            DIAG IMAGING PROCEDURES
629741   XR TOMOGRAM                      788.00      0.00   6            DIAG IMAGING PROCEDURES
629725   XR TOMOGRAM CMPLX                969.00    314.00   6            DIAG IMAGING PROCEDURES
629717   XR TOMOGRAM CMPLX BIL           1112.00    358.00   6            DIAG IMAGING PROCEDURES
629790   XR UGI W AIR CON                1122.00    436.00   6            DIAG IMAGING PROCEDURES
629816   XR UGI W AIR CON KUB            1669.00      0.00   6            DIAG IMAGING PROCEDURES
629824   XR UGI W AIR CON SM BOWEL        772.00      0.00   6            DIAG IMAGING PROCEDURES
629832   XR UGI W KUB                    1669.00    431.00   6            DIAG IMAGING PROCEDURES
629840   XR UGI W SM BOWEL               1810.00    445.00   6            DIAG IMAGING PROCEDURES
629808   XR UGI W/O KUB                  1052.00    342.00   6            DIAG IMAGING PROCEDURES
629865   XR URETHROCYSTOGRAM             1129.00    275.00   6            DIAG IMAGING PROCEDURES
629873   XR URETHROCYSTOGRAM VOID        1406.00    374.00   6            DIAG IMAGING PROCEDURES
627505   XR UROGRAM ANTEGRADE            1383.00      0.00   6            DIAG IMAGING PROCEDURES
629881   XR UROGRAM RETRO                1535.00    391.00   6            DIAG IMAGING PROCEDURES
629907   XR VASOGRAM VESICULOGRAM         548.00    480.00   6            DIAG IMAGING PROCEDURES
629980   XR WRIST 2V                      480.00    118.00   6            DIAG IMAGING PROCEDURES
629949   XR WRIST 3V OR MORE              429.00    190.00   6            DIAG IMAGING PROCEDURES
629931   XR XERORADIOGRAPHY                55.00      0.00   6            DIAG IMAGING PROCEDURES
623520   X-RAY TECH 2HRS                    0.00      0.00   6            DIAG IMAGING PROCEDURES
623561   X-RAY TECH SURGERY                 0.00      0.00   6            DIAG IMAGING PROCEDURES
622043   XRC ASP BREAST ADD               160.00    151.00   6            DIAG IMAGING PROCEDURES
622001   XRC ASP BREAST CYST              378.00    357.00   6            DIAG IMAGING PROCEDURES
622068   XRC ASP RENL CYST                338.00      0.00   6            DIAG IMAGING PROCEDURES
622076   XRC ASP SPINAL CYST PRC         1787.91   1787.91   6            DIAG IMAGING PROCEDURES
624247   XRC BILI ENDO W/O STENT         1997.00   1753.00   6            DIAG IMAGING PROCEDURES
622563   XRC BILI STENT PLACE            5308.00   1729.00   6            DIAG IMAGING PROCEDURES
624262   XRC BILI STONE RMVL             2184.00   1915.00   6            DIAG IMAGING PROCEDURES




                                               Page 45
                               85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



626028   XRC BREAST NDL WIRE              716.00    345.00   6            DIAG IMAGING PROCEDURES
623082   XRC BREAST NDL WIRE ADD          716.00      0.00   6            DIAG IMAGING PROCEDURES
622555   XRC BX ABD RETROPE               661.00    623.00   6            DIAG IMAGING PROCEDURES
622514   XRC BX BM NDL/TROCAR             660.00      0.00   6            DIAG IMAGING PROCEDURES
622480   XRC BX LIVER                     675.00      0.00   6            DIAG IMAGING PROCEDURES
622571   XRC BX LIVER W MAJOR            1216.00   1067.00   6            DIAG IMAGING PROCEDURES
622670   XRC BX RENL                      459.00      0.00   6            DIAG IMAGING PROCEDURES
622795   XRC BX SKIN LESION EA ADD         98.00      0.00   6            DIAG IMAGING PROCEDURES
622787   XRC BX SKIN LESION SNGL          271.00      0.00   6            DIAG IMAGING PROCEDURES
622779   XRC BX SOFT TISS NEC THOR        750.00    707.00   6            DIAG IMAGING PROCEDURES
622696   XRC BX THYROID                   388.00    366.00   6            DIAG IMAGING PROCEDURES
621326   XRC CHANGE TUBE                  362.00      0.00   6            DIAG IMAGING PROCEDURES
629857   XRC CYSTOMETROGRAM CMPLX         307.00      0.00   6            DIAG IMAGING PROCEDURES
625558   XRC ENDO SB W JEJ TUB PRC        726.33      0.00   6            DIAG IMAGING PROCEDURES
626150   XRC ERCP BLN DILATION           1338.00      0.00   6            DIAG IMAGING PROCEDURES
624163   XRC ERCP INS BIL/PAN TUBE       1351.00      0.00   6            DIAG IMAGING PROCEDURES
624155   XRC ERCP INS NASO TUBE          1338.00      0.00   6            DIAG IMAGING PROCEDURES
624361   XRC ERCP RETRO DESTRUCTN        1800.00      0.00   6            DIAG IMAGING PROCEDURES
624353   XRC ERCP RMVL CALC              1608.00      0.00   6            DIAG IMAGING PROCEDURES
624171   XRC ERCP RMVL FB/CHNG           1474.00      0.00   6            DIAG IMAGING PROCEDURES
624379   XRC ERCP W/ABLATION             1339.00      0.00   6            DIAG IMAGING PROCEDURES
624338   XRC ERCP W/BIOPSY               1141.00      0.00   6            DIAG IMAGING PROCEDURES
624346   XRC ERCP W/SPHINC/PAPIL         1339.00      0.00   6            DIAG IMAGING PROCEDURES
624601   XRC ESOPH DILATE BLN <30M       3333.00   1085.00   6            DIAG IMAGING PROCEDURES
624650   XRC ESOPH DILATE BLN >30M        925.00    811.00   6            DIAG IMAGING PROCEDURES
623033   XRC IMAG LOC CLIP W BX           591.00      0.00   6            DIAG IMAGING PROCEDURES
625905   XRC INJ ARTHRO ANKLE             297.00    259.00   6            DIAG IMAGING PROCEDURES
625921   XRC INJ ARTHRO ELBOW             357.00    314.00   6            DIAG IMAGING PROCEDURES
625947   XRC INJ ARTHRO HIP               429.00    375.00   6            DIAG IMAGING PROCEDURES
625962   XRC INJ ARTHRO KNEE              613.00    199.00   6            DIAG IMAGING PROCEDURES
625988   XRC INJ ARTHRO SHOULDER          302.00    267.00   6            DIAG IMAGING PROCEDURES
626002   XRC INJ ARTHRO WRIST             380.00    335.00   6            DIAG IMAGING PROCEDURES
626564   XRC INJ ASP SHUNT                274.00    242.00   6            DIAG IMAGING PROCEDURES
626424   XRC INJ BLOOD PATCH             1047.00    648.00   6            DIAG IMAGING PROCEDURES
626408   XRC INJ BRONCH W SCOPE           921.00    299.00   6            DIAG IMAGING PROCEDURES
626044   XRC INJ C1 C2 MYELOGRAM         1279.00    417.00   6            DIAG IMAGING PROCEDURES
626630   XRC INJ CYSTO RETRO              363.00      0.00   6            DIAG IMAGING PROCEDURES
626069   XRC INJ CYSTO VCUG               355.00    118.00   6            DIAG IMAGING PROCEDURES
626085   XRC INJ DACROCYSTOGRAM           561.00    182.00   6            DIAG IMAGING PROCEDURES
626101   XRC INJ DISKOGRAM CERV          2773.00      0.00   6            DIAG IMAGING PROCEDURES
626127   XRC INJ DISKOGRAM LUMB          2294.00    748.00   6            DIAG IMAGING PROCEDURES
625863   XRC INJ DUCT GALACTOGRAM        1927.00   1818.00   6            DIAG IMAGING PROCEDURES
626143   XRC INJ EPIDL L/S               1256.00    409.00   6            DIAG IMAGING PROCEDURES
624312   XRC INJ ERCP                    1085.00      0.00   6            DIAG IMAGING PROCEDURES
626168   XRC INJ FACET C/T 1 LVL          765.00    671.00   6            DIAG IMAGING PROCEDURES
626184   XRC INJ FACET LS ADDL LVL       1024.00    299.00   6            DIAG IMAGING PROCEDURES
626580   XRC INJ HIP W ANESTHESIA         493.00    432.00   6            DIAG IMAGING PROCEDURES
626218   XRC INJ ILEAL CONDUIT           2215.00      0.00   6            DIAG IMAGING PROCEDURES
626242   XRC INJ LP                       369.00    323.00   6            DIAG IMAGING PROCEDURES
626440   XRC INJ MAJOR JNT BURSA          247.00    219.00   6            DIAG IMAGING PROCEDURES
626267   XRC INJ MYELOGRAM                520.00      0.00   6            DIAG IMAGING PROCEDURES
626341   XRC INJ NRV BLK C/T 1 LVL        765.00    671.00   6            DIAG IMAGING PROCEDURES
626366   XRC INJ NRV BLK L/S 1 LVL       1005.00    881.00   6            DIAG IMAGING PROCEDURES




                                               Page 46
                               85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



626507   XRC INJ NRV BLK SCTC SNGL        428.00    374.00   6            DIAG IMAGING PROCEDURES
626283   XRC INJ NRV BLK SUBARACH         765.00    671.00   6            DIAG IMAGING PROCEDURES
626374   XRC INJ PANCREAT INTRAOP         342.00      0.00   6            DIAG IMAGING PROCEDURES
626473   XRC INJ SI JNT ARTHROGRAM       1404.00      0.00   6            DIAG IMAGING PROCEDURES
626481   XRC INJ SIALOGRAM                330.00    288.00   6            DIAG IMAGING PROCEDURES
626523   XRC INJ SINOGRAM                 375.00    147.00   6            DIAG IMAGING PROCEDURES
626549   XRC INJ TRANSTRACH BRONCH        315.00    275.00   6            DIAG IMAGING PROCEDURES
626622   XRC INJ URETHROCYST CHAIN       1491.00      0.00   6            DIAG IMAGING PROCEDURES
621524   XRC INS NON-TUN CV CATH<5       3512.00      0.00   6            DIAG IMAGING PROCEDURES
621532   XRC INS NON-TUN CV CATH5+       3512.00      0.00   6            DIAG IMAGING PROCEDURES
621656   XRC INS PICC W/O PORT 5+        1207.00      0.00   6            DIAG IMAGING PROCEDURES
621649   XRC INS PICC W/O PORT LT5       1329.00   1253.00   6            DIAG IMAGING PROCEDURES
621672   XRC INS PICC W/PORT 5+YRS       5363.00      0.00   6            DIAG IMAGING PROCEDURES
621664   XRC INS PICC W/PORT LT 5        5968.00   5631.00   6            DIAG IMAGING PROCEDURES
621540   XRC INS TUN CV NO PRT LT5       3512.00      0.00   6            DIAG IMAGING PROCEDURES
621615   XRC INS TUNN CV DEV 5+          4602.00      0.00   6            DIAG IMAGING PROCEDURES
621607   XRC INS TUNN CV DEV LT 5        4644.00   4382.00   6            DIAG IMAGING PROCEDURES
621557   XRC INS TUNN CV NO PORT5+       3512.00      0.00   6            DIAG IMAGING PROCEDURES
621417   XRC INSERT CATH TMP CMPLX        176.06      0.00   6            DIAG IMAGING PROCEDURES
621409   XRC INSERT CATH TMP SMPL         110.24    110.24   6            DIAG IMAGING PROCEDURES
626671   XRC INTRO CAROTD VERT ART          0.00      0.00   6            DIAG IMAGING PROCEDURES
626655   XRC INTRO CATH BILI DRN         1855.00   1628.00   6            DIAG IMAGING PROCEDURES
626689   XRC INTRO CATH FALLOPN          3548.00   1156.00   6            DIAG IMAGING PROCEDURES
626697   XRC INTRO CATH IVC /SVC          428.00      0.00   6            DIAG IMAGING PROCEDURES
627026   XRC LP THRP                      489.00    430.00   6            DIAG IMAGING PROCEDURES
627802   XRC PARACENT ABD INI             725.00    684.00   6            DIAG IMAGING PROCEDURES
627828   XRC PARACENT ABD SUBSQ           507.00    478.00   6            DIAG IMAGING PROCEDURES
627893   XRC REMV TUNN CV CATH W/O        531.57      0.00   6            DIAG IMAGING PROCEDURES
621334   XRC REPOSITION G TUBE            369.00    348.00   6            DIAG IMAGING PROCEDURES
627877   XRC RPLC COMP NON-TUNN CV       1061.00      0.00   6            DIAG IMAGING PROCEDURES
626200   XRC SAL INFN SONOHYSTER          666.00    214.00   6            DIAG IMAGING PROCEDURES
621391   XRC URINE VOIDING PRESSUR        184.11      0.00   6            DIAG IMAGING PROCEDURES
623884   XRC UROFLOWMETRY COMPLEX         142.00      0.00   6            DIAG IMAGING PROCEDURES
851113   ADENOSINE 30MG IJ                293.00      0.00   8            DIAG IMAGING SUPPLIES
851105   ADENOSINE 6MG INJ                105.00     99.00   8            DIAG IMAGING SUPPLIES
824300   CON IONIC 50ML                   186.00    174.00   8            DIAG IMAGING SUPPLIES
823351   CON IONIC 50ML                   186.00    174.00   8            DIAG IMAGING SUPPLIES
822700   CON NI 200S 100ML               1045.00    971.00   8            DIAG IMAGING SUPPLIES
822551   CON NI 200S 20ML                 524.00    487.00   8            DIAG IMAGING SUPPLIES
824102   CON NI 300S 150ML                  0.00      0.00   8            DIAG IMAGING SUPPLIES
824151   CON NI 300S 150ML               1553.00   1445.00   8            DIAG IMAGING SUPPLIES
824250   CON NI 300S 200ML               2084.00   1941.00   8            DIAG IMAGING SUPPLIES
824029   CON NI 300S 20ML                 173.00      0.00   8            DIAG IMAGING SUPPLIES
824003   CON NI 300S 50ML                 524.00    487.00   8            DIAG IMAGING SUPPLIES
851204   HEPARIN 1000U/ML INJ              13.00      0.00   8            DIAG IMAGING SUPPLIES
851303   HEPARIN 10U/ML INJ                 5.00      0.00   8            DIAG IMAGING SUPPLIES
850131   NM HEART MI PLANAR              1210.00      0.00   8            DIAG IMAGING SUPPLIES
852103   NM RP I-123 200 UCI                0.00      0.00   8            DIAG IMAGING SUPPLIES
852806   NM RP I-131 UTAKE CAP              0.00      0.00   8            DIAG IMAGING SUPPLIES
853259   NM RP IN-111 MYOSCINT              0.00      0.00   8            DIAG IMAGING SUPPLIES
853507   NM RP IN-111 OCTREOSCAN            0.00      0.00   8            DIAG IMAGING SUPPLIES
854158   NM RP SR-89 UP TO 4 MCI            0.00      0.00   8            DIAG IMAGING SUPPLIES
858100   NM RP TL-201 PER MCI               0.00      0.00   8            DIAG IMAGING SUPPLIES




                                               Page 47
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



858209   NM RP XE-133 GAS                    0.00      0.00   8            DIAG IMAGING SUPPLIES
850123   NM TUMOR LOC LTD W RP            4903.00      0.00   8            DIAG IMAGING SUPPLIES
850172   NM VASCULAR FLOW NCARDIO            0.00      0.00   8            DIAG IMAGING SUPPLIES
851485   RP C14 UREA/TEST                  164.00      0.00   8            DIAG IMAGING SUPPLIES
851519   RP CO57 COBALT CHLORIDE           547.00      0.00   8            DIAG IMAGING SUPPLIES
851493   RP CO57/0.5MCI ORAL               547.00      0.00   8            DIAG IMAGING SUPPLIES
851501   RP CO57/CO58 0.5UCI               611.00    535.00   8            DIAG IMAGING SUPPLIES
851527   RP CR51 PER 50 MCI                589.00      0.00   8            DIAG IMAGING SUPPLIES
851543   RP CR51 PER 50 MCI                611.00    535.00   8            DIAG IMAGING SUPPLIES
852509   RP DX I-131 CAP PER MCI           501.00    473.00   8            DIAG IMAGING SUPPLIES
852525   RP DX I131 SOD SOL/MCI            415.00      0.00   8            DIAG IMAGING SUPPLIES
860007   RP FDG/DOSE 4-40MCI/ML            225.00      0.00   8            DIAG IMAGING SUPPLIES
851709   RP GALLIUM GA 67 MCI               79.00      0.00   8            DIAG IMAGING SUPPLIES
851659   RP GALLIUM GA 67 MCI              217.00    189.00   8            DIAG IMAGING SUPPLIES
852020   RP I123/100UCI                      2.00      0.00   8            DIAG IMAGING SUPPLIES
852608   RP I-131 BASE CHGE 1-6MCI           0.00      0.00   8            DIAG IMAGING SUPPLIES
852467   RP I-131 BEXXAR DX DS            4740.00      0.00   8            DIAG IMAGING SUPPLIES
852475   RP I-131 BEXXAR TX DS           41082.00      0.00   8            DIAG IMAGING SUPPLIES
852657   RP I-131 HIPPURAN 300 UCI           0.00      0.00   8            DIAG IMAGING SUPPLIES
853200   RP IN111 DTPA/0.5MCI             1965.00   1854.00   8            DIAG IMAGING SUPPLIES
853523   RP IN111 OCTREOSC/3 MCI          3381.00      0.00   8            DIAG IMAGING SUPPLIES
853002   RP IN111 ONCOSCINT/DS            5612.00   5295.00   8            DIAG IMAGING SUPPLIES
853309   RP IN111 PROSTASCN/DS            4585.00   4326.00   8            DIAG IMAGING SUPPLIES
853408   RP IN111 WBC/0.5MCI              1965.00   1854.00   8            DIAG IMAGING SUPPLIES
853630   RP IN-111 ZEVALIN/DOSE           3809.00      0.00   8            DIAG IMAGING SUPPLIES
854018   RP P32 CHROMIC/MCI               2620.00      0.00   8            DIAG IMAGING SUPPLIES
854026   RP P32 SODIUM PHO/MCI             852.00      0.00   8            DIAG IMAGING SUPPLIES
854059   RP SM153 QUADR/50MCI             4585.00   4326.00   8            DIAG IMAGING SUPPLIES
854109   RP SR89 PER MCI                  3275.00      0.00   8            DIAG IMAGING SUPPLIES
855056   RP TC99M ACUTECT/VL              2358.00   2225.00   8            DIAG IMAGING SUPPLIES
855452   RP TC99M CEA SCAN/VL             4878.00   4601.00   8            DIAG IMAGING SUPPLIES
855601   RP TC99M CERETEC/DS              1638.00   1545.00   8            DIAG IMAGING SUPPLIES
855502   RP TC99M CERETEWBC/DS            2097.00      0.00   8            DIAG IMAGING SUPPLIES
855700   RP TC99M CHOLETEC/VL              209.00      0.00   8            DIAG IMAGING SUPPLIES
855759   RP TC99M DISOFENIN/VL             209.00    197.00   8            DIAG IMAGING SUPPLIES
855908   RP TC99M DTPA/VL                   73.00     69.00   8            DIAG IMAGING SUPPLIES
856104   RP TC99M GLUCOHEP/VL               73.00     69.00   8            DIAG IMAGING SUPPLIES
856328   RP TC99M MAA/1MCI                  14.00      0.00   8            DIAG IMAGING SUPPLIES
856427   RP TC99M MAGIII/MCI               142.00      0.00   8            DIAG IMAGING SUPPLIES
856500   RP TC99M MDP 1-30MCI               99.00      0.00   8            DIAG IMAGING SUPPLIES
857300   RP TC99M MERALUMA                 524.00    494.00   8            DIAG IMAGING SUPPLIES
856609   RP TC99M MYOVIEW/DS               475.00      0.00   8            DIAG IMAGING SUPPLIES
856658   RP TC99M NEOTECT/1MCI            3171.00      0.00   8            DIAG IMAGING SUPPLIES
856674   RP TC99M NEOTECT/1MCI             202.00      0.00   8            DIAG IMAGING SUPPLIES
856708   RP TC99M NEUROLITE/DS            1703.00   1607.00   8            DIAG IMAGING SUPPLIES
858258   RP TC99M NEUTROSPEC/DS              0.00      0.00   8            DIAG IMAGING SUPPLIES
856757   RP TC99M NEUTROSPEC/DS           2022.00      0.00   8            DIAG IMAGING SUPPLIES
855007   RP TC99M PERTECH/DS                74.00     70.00   8            DIAG IMAGING SUPPLIES
856807   RP TC99M PYP/VL                   236.00    223.00   8            DIAG IMAGING SUPPLIES
856906   RP TC99M RBC/TAG/MCI               21.00      0.00   8            DIAG IMAGING SUPPLIES
856955   RP TC99M RBC/TAG/MCI              209.00    197.00   8            DIAG IMAGING SUPPLIES
856914   RP TC99M RBC/TAG/MCI               21.00      0.00   8            DIAG IMAGING SUPPLIES
857003   RP TC99M SC                        99.00      0.00   8            DIAG IMAGING SUPPLIES




                                                Page 48
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



857102    RP TC99M SC/EGG/DS                197.00      0.00   8            DIAG IMAGING SUPPLIES
855551    RP TC99M SC/FILTER/DS             505.00      0.00   8            DIAG IMAGING SUPPLIES
855304    RP TC99M SESTAMIBI/DS             371.00    371.00   8            DIAG IMAGING SUPPLIES
858001    RP TL-201 PER MCI                 112.00      0.00   8            DIAG IMAGING SUPPLIES
852541    RP TX I-131 CAP PER MCI            54.00      0.00   8            DIAG IMAGING SUPPLIES
852574    RP TX I131 SOD SOL/MCI             40.00      0.00   8            DIAG IMAGING SUPPLIES
858225    RP XE133/10MCI                     16.00      0.00   8            DIAG IMAGING SUPPLIES
857607    RP Y-90 IBRITUM/DOSE            32975.00      0.00   8            DIAG IMAGING SUPPLIES
850107    SINCALIDE                        4486.00      0.00   8            DIAG IMAGING SUPPLIES
851352    THYROTHROPIN 1.1MG VL            1312.00      0.00   8            DIAG IMAGING SUPPLIES
5050034   DIALYS CAPD IP                    258.00      0.00   50           DIALYSIS SERVICES
5050075   DIALYS CAPD OP                    258.00      0.00   50           DIALYSIS SERVICES
5050042   DIALYS CCPD IP                    716.00      0.00   50           DIALYSIS SERVICES
5050000   DIALYS HEMO IP                   2493.00      0.00   50           DIALYSIS SERVICES
5050018   DIALYS PRITNEAL NOCAPD IP         207.00      0.00   50           DIALYSIS SERVICES
5060009   S STRL ARTIFICIAL KIDNEY          201.00      0.00   50           DIALYSIS SERVICES
5060033   S STRL GUIDE WIRE                 113.00      0.00   50           DIALYSIS SERVICES
3810025   AD EVAL ABR                       811.00      0.00   38           EEG
3810330   AD EVAL PEDS <3 VRA               812.00      0.00   38           EEG
3810322   AD EVAL PEDS >3 VRA               652.00      0.00   38           EEG
3810157   EEG AWAKE AND ASLEEP             1230.00   1001.00   38           EEG
3810017   EEG AWAKE AND DROWSY             1139.00    937.00   38           EEG
3810140   EEG CEREBRAL DEATH EVAL          1412.00      0.00   38           EEG
3810355   EEG DIGITAL ANALYSIS              782.00      0.00   38           EEG
3810165   EEG DURING SURGERY               1713.00      0.00   38           EEG
3810249   EEG GT 1 HR                       812.00      0.00   38           EEG
3810348   EEG INSERT SPHEN ELECTR           545.00      0.00   38           EEG
3810074   EEG MONITOR AMB EA 24HR           829.00      0.00   38           EEG
3810314   EEG MONITOR W/DRG/ACTIVTN         545.00      0.00   38           EEG
3810066   EEG RCRD/INTERP/24HR             1663.00      0.00   38           EEG
3810256   EEG SLEEP                         870.00      0.00   38           EEG
3810306   EEG UP TO 1HR                     782.00      0.00   38           EEG
3810272   EEG W/VIDEO RCRD/24HR            1511.00      0.00   38           EEG
3810298   ELCTRDE STIM BRAIN 1ST HR         782.00      0.00   38           EEG
3810181   ELCTRDE STIM BRAIN EA HR          782.00      0.00   38           EEG
3810264   ELECTROCORTICOGRAM SURG          1713.00      0.00   38           EEG
3810199   H REFLX TEST GSTR/SOL UNI         652.00      0.00   38           EEG
3810207   NEUROLOGICAL PROCEDURE            652.00      0.00   38           EEG
3810116   SEP LOWER LIMBS BIL              1312.00      0.00   38           EEG
3810124   SEP LOWER LIMBS BIL               893.00      0.00   38           EEG
3810280   SEP LOWER LIMBS UNI               545.00      0.00   38           EEG
3810231   SEP TRUNK/HEAD                   1193.00      0.00   38           EEG
3810108   SEP UPPER LIMBS BIL               893.00      0.00   38           EEG
3810090   SEP UPPER LIMBS UNI              1312.00      0.00   38           EEG
3810215   SLEEP STUDY ATTENDED              812.00      0.00   38           EEG
3810223   SLEEP STUDY UNATTENDED            652.00      0.00   38           EEG
3810033   VISUAL EVOKED POTENT TEST         717.00      0.00   38           EEG
3810173   WADA ACTIVATION TEST             1193.00      0.00   38           EEG
5521414   ALCOHOL (ETHANOL) BREATH           71.00      0.00   55           ER/URGENT CARE/TRAUMA
5570379   APP LONG LEG SPLNT                574.00      0.00   55           ER/URGENT CARE/TRAUMA
5570387   APP LOW LEG SPLNT                 287.00      0.00   55           ER/URGENT CARE/TRAUMA
5570361   APP SPLNT FINGER STA               84.00      0.00   55           ER/URGENT CARE/TRAUMA
5570346   APP SPLNT LONG ARM                383.00      0.00   55           ER/URGENT CARE/TRAUMA




                                                 Page 49
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



5570353   APP SPLNT SHRT ARM STA            287.00      0.00   55           ER/URGENT CARE/TRAUMA
5570155   APPLY LONG ARM CAST               417.00      0.00   55           ER/URGENT CARE/TRAUMA
5570163   APPLY SHORT ARM CAST              304.00      0.00   55           ER/URGENT CARE/TRAUMA
5570189   APPLY SHORT LEG CAST              344.00      0.00   55           ER/URGENT CARE/TRAUMA
5570171   APPY LONG LEG CAST                456.00      0.00   55           ER/URGENT CARE/TRAUMA
5520200   BLOOD TRANSFUSN 2-4 HR              0.00      0.00   55           ER/URGENT CARE/TRAUMA
5520218   BLOOD TRANSFUSN 4-6 HR              0.00      0.00   55           ER/URGENT CARE/TRAUMA
5520226   BLOOD TRANSFUSN GT 6HR              0.00      0.00   55           ER/URGENT CARE/TRAUMA
5520192   BLOOD TRANSFUSN LT 2 HR           458.00      0.00   55           ER/URGENT CARE/TRAUMA
5510904   BLOOD TRANSFUSN LT 2 HR           432.50      0.00   55           ER/URGENT CARE/TRAUMA
5510508   CARDIOVERT ELECTIVE EXT           596.00      0.00   55           ER/URGENT CARE/TRAUMA
5540422   D51/2NS 1000ML/KCL 20             247.00      0.00   55           ER/URGENT CARE/TRAUMA
5540414   D5NS 1000ML/KCL 20                310.00      0.00   55           ER/URGENT CARE/TRAUMA
5540463   D5W 100ML                         120.00      0.00   55           ER/URGENT CARE/TRAUMA
5570569   DEBRIDE SKIN&SUBCUT TISS          262.00      0.00   55           ER/URGENT CARE/TRAUMA
5570502   DRAIN ABSCESS COMP/MULT          1179.00      0.00   55           ER/URGENT CARE/TRAUMA
5570494   DRAIN ABSCESS SMPL/SNGL           262.00      0.00   55           ER/URGENT CARE/TRAUMA
5521406   DRG SCRN EA DRG                    71.00      0.00   55           ER/URGENT CARE/TRAUMA
5510334   ED CC 1ST 30-74 MN               3352.00      0.00   55           ER/URGENT CARE/TRAUMA
5510342   ED CC EA ADD 30 MN               1206.00      0.00   55           ER/URGENT CARE/TRAUMA
5510011   ED LEVEL 1                        335.00      0.00   55           ER/URGENT CARE/TRAUMA
5510029   ED LEVEL 2                        579.00      0.00   55           ER/URGENT CARE/TRAUMA
5510037   ED LEVEL 3                       1054.00      0.00   55           ER/URGENT CARE/TRAUMA
5510045   ED LEVEL 4                       1406.00      0.00   55           ER/URGENT CARE/TRAUMA
5510052   ED LEVEL 5                       1658.00      0.00   55           ER/URGENT CARE/TRAUMA
5510391   ED PROC MAJOR                    1179.00      0.00   55           ER/URGENT CARE/TRAUMA
5510383   ED PROC MINOR                     262.00      0.00   55           ER/URGENT CARE/TRAUMA
5520317   EKG 12 LEAD TRACING ONLY          284.00      0.00   55           ER/URGENT CARE/TRAUMA
5510474   GASTRIC LAVAGE                    590.00      0.00   55           ER/URGENT CARE/TRAUMA
5510466   GI INTUB CONT HEM                 157.00      0.00   55           ER/URGENT CARE/TRAUMA
5510755   GLUCOSE FINGERSTICK                 0.00      0.00   55           ER/URGENT CARE/TRAUMA
5510409   INFSN W-W/O MED 0-60 MN           131.00      0.00   55           ER/URGENT CARE/TRAUMA
5510417   INFSN W-W/O MED EA ADD HR          99.00      0.00   55           ER/URGENT CARE/TRAUMA
5510425   INFUSN W/VASOACT 0-60 MN          262.00      0.00   55           ER/URGENT CARE/TRAUMA
5510433   INFUSN W/VASOACT EA AD            197.00      0.00   55           ER/URGENT CARE/TRAUMA
5570593   INJ MAJOR JNT BURSA               262.00      0.00   55           ER/URGENT CARE/TRAUMA
5570585   INJ/ASP INT JNT/BURSA             262.00      0.00   55           ER/URGENT CARE/TRAUMA
5570577   INJ/ASP JNT/BURSA                 262.00      0.00   55           ER/URGENT CARE/TRAUMA
5570072   INJECTION IM/SQ EA                118.00      0.00   55           ER/URGENT CARE/TRAUMA
5510458   INJECTION IM/SQ EA                111.00      0.00   55           ER/URGENT CARE/TRAUMA
5570080   INJECTION IV EA                    65.00      0.00   55           ER/URGENT CARE/TRAUMA
5510441   INJECTION IV EA                    61.00      0.00   55           ER/URGENT CARE/TRAUMA
5570130   INSERT CATH NONINDWLLNG           262.00      0.00   55           ER/URGENT CARE/TRAUMA
5570148   INSERT CATH TEMP INDWLLNG         262.00      0.00   55           ER/URGENT CARE/TRAUMA
5510557   IPECAC ADMINISTRATION             131.00      0.00   55           ER/URGENT CARE/TRAUMA
5570510   LAC SMPL 2.5CM/LESS               262.00      0.00   55           ER/URGENT CARE/TRAUMA
5570528   LAC SMPL 2.6-7.5CM                262.00      0.00   55           ER/URGENT CARE/TRAUMA
5570536   LAC SMPL 7.6-12.5CM               262.00      0.00   55           ER/URGENT CARE/TRAUMA
5570544   LAC SMPL/F,E,N 2.5CM/LESS         262.00      0.00   55           ER/URGENT CARE/TRAUMA
5570551   LAC SMPL/F,E,N 2.6-5.0CM          262.00      0.00   55           ER/URGENT CARE/TRAUMA
5570007   LEVEL 1 EST PATIENT                70.00      0.00   55           ER/URGENT CARE/TRAUMA
5550058   LEVEL 1 NEW PATIENT                 0.00      0.00   55           ER/URGENT CARE/TRAUMA
5550025   LEVEL 1 NEW PATIENT                70.00      0.00   55           ER/URGENT CARE/TRAUMA




                                                 Page 50
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



5570015   LEVEL 2 EST PATIENT               119.00      0.00   55           ER/URGENT CARE/TRAUMA
5550033   LEVEL 2 NEW PATIENT               119.00      0.00   55           ER/URGENT CARE/TRAUMA
5570023   LEVEL 3 EST PATIENT               169.00      0.00   55           ER/URGENT CARE/TRAUMA
5550041   LEVEL 3 NEW PATIENT               169.00      0.00   55           ER/URGENT CARE/TRAUMA
5570031   LEVEL 4 EST PATIENT               218.00      0.00   55           ER/URGENT CARE/TRAUMA
5570049   LEVEL 5 EST PATIENT               267.00      0.00   55           ER/URGENT CARE/TRAUMA
5540471   NA CL 0.9% 100ML                  120.00      0.00   55           ER/URGENT CARE/TRAUMA
5510136   NO TREATMENT                        0.00      0.00   55           ER/URGENT CARE/TRAUMA
5520184   OBSERVATION PER-HOUR              238.00      0.00   55           ER/URGENT CARE/TRAUMA
5510482   OPHTHALMOLOGY EXAM                393.00      0.00   55           ER/URGENT CARE/TRAUMA
5510565   PHLEBOTOMY THERAPEUTIC            524.00      0.00   55           ER/URGENT CARE/TRAUMA
5510078   PT LEFT AFTER TRIAGE                0.00      0.00   55           ER/URGENT CARE/TRAUMA
5520234   REGIONAL BLOCK FINGERS            262.00      0.00   55           ER/URGENT CARE/TRAUMA
5520267   REGIONAL BLOCK TOES               262.00      0.00   55           ER/URGENT CARE/TRAUMA
5570486   REMOVAL FB SUBQ TISS COMP        1179.00      0.00   55           ER/URGENT CARE/TRAUMA
5570478   REMOVAL FB SUBQ TISS SMPL         262.00      0.00   55           ER/URGENT CARE/TRAUMA
5510524   RHYTHM EKG 3 LEAD TRACING         328.00      0.00   55           ER/URGENT CARE/TRAUMA
5570197   RMV/BIVLVE BOOT/BODYCAST          169.00      0.00   55           ER/URGENT CARE/TRAUMA
5521208   S NSTRL ANKLE STIRRUP             211.00      0.00   55           ER/URGENT CARE/TRAUMA
5540034   S NSTRL CAN NASAL 7FT              42.00      0.00   55           ER/URGENT CARE/TRAUMA
5540356   S NSTRL CASE LOWER EXTREM         846.00      0.00   55           ER/URGENT CARE/TRAUMA
5540158   S NSTRL CAST LONG LOWER           838.00      0.00   55           ER/URGENT CARE/TRAUMA
5540364   S NSTRL CAST UPPER EXTREM         525.00      0.00   55           ER/URGENT CARE/TRAUMA
5570395   S NSTRL CERV COL THERMPLA        1269.00      0.00   55           ER/URGENT CARE/TRAUMA
5570403   S NSTRL CERV COL THERMPLA         117.00      0.00   55           ER/URGENT CARE/TRAUMA
5540166   S NSTRL COLLAR ASPEN             1269.00      0.00   55           ER/URGENT CARE/TRAUMA
5540182   S NSTRL COLLAR CERV SFT           211.00      0.00   55           ER/URGENT CARE/TRAUMA
5540174   S NSTRL COLLAR PHIL USE           117.00      0.00   55           ER/URGENT CARE/TRAUMA
5521216   S NSTRL COLLAR,HARD OR P          117.00      0.00   55           ER/URGENT CARE/TRAUMA
5521224   S NSTRL COLLAR,SOFT               211.00      0.00   55           ER/URGENT CARE/TRAUMA
5540075   S NSTRL CURETTER EAR DISP          76.00      0.00   55           ER/URGENT CARE/TRAUMA
5521026   S NSTRL CURRETE, EAR DIS           76.00      0.00   55           ER/URGENT CARE/TRAUMA
5540257   S NSTRL DIGITAL SPLINT             16.00      0.00   55           ER/URGENT CARE/TRAUMA
5570221   S NSTRL DIGITAL SPLINT             16.00      0.00   55           ER/URGENT CARE/TRAUMA
5540208   S NSTRL IMBLR LOWER               282.00      0.00   55           ER/URGENT CARE/TRAUMA
5540216   S NSTRL IMMOBILIZER UPPER         211.00      0.00   55           ER/URGENT CARE/TRAUMA
5521232   S NSTRL IMMOBILIZER,KNEE          211.00      0.00   55           ER/URGENT CARE/TRAUMA
5521240   S NSTRL IMMOBILIZER,LOWE          211.00      0.00   55           ER/URGENT CARE/TRAUMA
5521257   S NSTRL IMMOBILIZER,UPPE          211.00      0.00   55           ER/URGENT CARE/TRAUMA
5540190   S NSTRL KNEE IMBLR                207.00      0.00   55           ER/URGENT CARE/TRAUMA
5540059   S NSTRL MASK 02 7' TUBE            65.00      0.00   55           ER/URGENT CARE/TRAUMA
5521034   S NSTRL NOSE CLIP                  34.00      0.00   55           ER/URGENT CARE/TRAUMA
5521075   S NSTRL PULSE OX SPOT CH           47.00      0.00   55           ER/URGENT CARE/TRAUMA
5540497   S NSTRL RESUS ADULT               502.00      0.00   55           ER/URGENT CARE/TRAUMA
5570312   S NSTRL SHOE POST OP              302.00      0.00   55           ER/URGENT CARE/TRAUMA
5540224   S NSTRL SHOE POST OP              302.00      0.00   55           ER/URGENT CARE/TRAUMA
5521265   S NSTRL SHOE,POST-OP              302.00      0.00   55           ER/URGENT CARE/TRAUMA
5521273   S NSTRL SLING                     147.00      0.00   55           ER/URGENT CARE/TRAUMA
5521281   S NSTRL SLING & SWATH             272.00      0.00   55           ER/URGENT CARE/TRAUMA
5570320   S NSTRL SLING ARM                 147.00      0.00   55           ER/URGENT CARE/TRAUMA
5540232   S NSTRL SLING ARM                 147.00      0.00   55           ER/URGENT CARE/TRAUMA
5570338   S NSTRL SLING SWATHE              272.00      0.00   55           ER/URGENT CARE/TRAUMA
5540240   S NSTRL SLING SWATHE              272.00      0.00   55           ER/URGENT CARE/TRAUMA




                                                 Page 51
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



5570213   S NSTRL SPIROMTR INCNTV           167.00      0.00   55           ER/URGENT CARE/TRAUMA
5540141   S NSTRL SPLINT ANKLE              211.00      0.00   55           ER/URGENT CARE/TRAUMA
5540307   S NSTRL SPLINT CLAV                93.00      0.00   55           ER/URGENT CARE/TRAUMA
5521349   S NSTRL SPLINT ELBOW/FOR          197.00      0.00   55           ER/URGENT CARE/TRAUMA
5521307   S NSTRL SPLINT LONG ARM           417.00      0.00   55           ER/URGENT CARE/TRAUMA
5521323   S NSTRL SPLINT LONG LEG           574.00      0.00   55           ER/URGENT CARE/TRAUMA
5570239   S NSTRL SPLINT LOWER EXT          361.00      0.00   55           ER/URGENT CARE/TRAUMA
5540273   S NSTRL SPLINT LOWER EXT          361.00      0.00   55           ER/URGENT CARE/TRAUMA
5521315   S NSTRL SPLINT SHORT ARM          383.00      0.00   55           ER/URGENT CARE/TRAUMA
5521331   S NSTRL SPLINT SHORT LEG          287.00      0.00   55           ER/URGENT CARE/TRAUMA
5540281   S NSTRL SPLINT UPPER EXT          256.00      0.00   55           ER/URGENT CARE/TRAUMA
5570247   S NSTRL SPLINT UPPER EXT          256.00      0.00   55           ER/URGENT CARE/TRAUMA
5540299   S NSTRL SPLINT WRIST              102.00      0.00   55           ER/URGENT CARE/TRAUMA
5521299   S NSTRL SPLINT,DIGITAL             16.00      0.00   55           ER/URGENT CARE/TRAUMA
5521356   S NSTRL SPLINT,LOWER EXT          361.00      0.00   55           ER/URGENT CARE/TRAUMA
5521364   S NSTRL SPLINT,UPPER EXT          256.00      0.00   55           ER/URGENT CARE/TRAUMA
5521372   S NSTRL SPLINT,VELCRO WR          102.00      0.00   55           ER/URGENT CARE/TRAUMA
5540265   S NSTRL SPLINT/HARE/TRACT         525.00      0.00   55           ER/URGENT CARE/TRAUMA
5521380   S NSTRL STRAP,CLAVICLE            100.00      0.00   55           ER/URGENT CARE/TRAUMA
5540042   S NSTRL SYRINGE EAR & ULC          55.00      0.00   55           ER/URGENT CARE/TRAUMA
5521000   S NSTRL VAGINAL SPECULUM           76.00      0.00   55           ER/URGENT CARE/TRAUMA
5570411   S OT FM COLLAR CERV FLEX          211.00      0.00   55           ER/URGENT CARE/TRAUMA
5570288   S OT KO ADJ KNEE JT RGD           211.00      0.00   55           ER/URGENT CARE/TRAUMA
5570270   S OT KO IMMOB CNVS LONG           211.00      0.00   55           ER/URGENT CARE/TRAUMA
5570296   S OT NON-PNEUM WALK BOOT          135.00      0.00   55           ER/URGENT CARE/TRAUMA
5570262   S OT SO FIG 8 ABDC REST            93.00      0.00   55           ER/URGENT CARE/TRAUMA
5570304   S OT SO SNGL EL PREFAB            282.00      0.00   55           ER/URGENT CARE/TRAUMA
5570254   S OT WHO WRST EXTN C-UP           102.00      0.00   55           ER/URGENT CARE/TRAUMA
5570122   S PR BAG URN LEG/ABDOMEN          117.00      0.00   55           ER/URGENT CARE/TRAUMA
5570106   S PR CATH INTERMITT URIN          108.00      0.00   55           ER/URGENT CARE/TRAUMA
5570114   S PR CATH W/DRAIN 2WAY LX         400.00      0.00   55           ER/URGENT CARE/TRAUMA
5521182   S STRL .9% NACI IRR SOL 1         211.00      0.00   55           ER/URGENT CARE/TRAUMA
5521190   S STRL .9% NACI IRR SOL 2         147.00      0.00   55           ER/URGENT CARE/TRAUMA
5521083   S STRL AEROCHAMBER                162.00      0.00   55           ER/URGENT CARE/TRAUMA
5540539   S STRL CATH BARTHLN GLAND         105.00      0.00   55           ER/URGENT CARE/TRAUMA
5540117   S STRL CATH IN & OUT              108.00      0.00   55           ER/URGENT CARE/TRAUMA
5540125   S STRL CATH INDWELLING            400.00      0.00   55           ER/URGENT CARE/TRAUMA
5540000   S STRL CATH IV ANGIO               83.00      0.00   55           ER/URGENT CARE/TRAUMA
5570056   S STRL CATH IV ANGIO              144.00      0.00   55           ER/URGENT CARE/TRAUMA
5540505   S STRL CATH KIT SUCTION            40.00      0.00   55           ER/URGENT CARE/TRAUMA
5570445   S STRL CATH TROCAR THORA          353.00      0.00   55           ER/URGENT CARE/TRAUMA
5540554   S STRL CATH TROCAR THORA          353.00      0.00   55           ER/URGENT CARE/TRAUMA
5521018   S STRL CATH WARD BARTHOLI         105.00      0.00   55           ER/URGENT CARE/TRAUMA
5540570   S STRL CAUTERY PEN                211.00      0.00   55           ER/URGENT CARE/TRAUMA
5521109   S STRL CAUTERY-HAND HELD          162.00      0.00   55           ER/URGENT CARE/TRAUMA
5540398   S STRL CENTRAL VEIN KIT           772.00      0.00   55           ER/URGENT CARE/TRAUMA
5540521   S STRL DEFIB PADS                 135.00      0.00   55           ER/URGENT CARE/TRAUMA
5540513   S STRL DEFIB PD EXT PACE          202.00      0.00   55           ER/URGENT CARE/TRAUMA
5521117   S STRL DERMABOND SKIN ADH         196.00      0.00   55           ER/URGENT CARE/TRAUMA
5540547   S STRL DRAIN CHEST VAC           1610.00      0.00   55           ER/URGENT CARE/TRAUMA
5570452   S STRL DRAIN CHEST VAC           1610.00      0.00   55           ER/URGENT CARE/TRAUMA
5521125   S STRL DRESSING XEROFORM           38.00      0.00   55           ER/URGENT CARE/TRAUMA
5540372   S STRL KIT ART LINE 20G           484.00      0.00   55           ER/URGENT CARE/TRAUMA




                                                 Page 52
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



5540083   S STRL KIT NASOSTAT              574.00      0.00   55           ER/URGENT CARE/TRAUMA
5521166   S STRL LENS MORGAN DISP          388.00      0.00   55           ER/URGENT CARE/TRAUMA
5540562   S STRL LENS MORGAN DISP          345.00      0.00   55           ER/URGENT CARE/TRAUMA
5521067   S STRL NEBULIZER KIT             181.00      0.00   55           ER/URGENT CARE/TRAUMA
5521133   S STRL NUGAUZE-PACKING           154.00      0.00   55           ER/URGENT CARE/TRAUMA
5521091   S STRL PEAKFLOW METER            174.00      0.00   55           ER/URGENT CARE/TRAUMA
5570601   S STRL PIN SKULL STERILE         624.00      0.00   55           ER/URGENT CARE/TRAUMA
5570098   S STRL PROBE OXIMETER DIS        120.00      0.00   55           ER/URGENT CARE/TRAUMA
5540067   S STRL PROBE OXIMETR DISP        120.00      0.00   55           ER/URGENT CARE/TRAUMA
5540109   S STRL RHINO ROCKET              440.00      0.00   55           ER/URGENT CARE/TRAUMA
5521042   S STRL RHINOROCKET-SUPP          440.00      0.00   55           ER/URGENT CARE/TRAUMA
5540406   S STRL SET BLOOD TUBNG           265.00      0.00   55           ER/URGENT CARE/TRAUMA
5521174   S STRL SET THERAPEUTIC DL        147.00      0.00   55           ER/URGENT CARE/TRAUMA
5521141   S STRL SKIN STAPLER DISP         290.00      0.00   55           ER/URGENT CARE/TRAUMA
5540430   S STRL SOL .9NACL WO MEQ         340.00      0.00   55           ER/URGENT CARE/TRAUMA
5570429   S STRL SOL IRR NACL/H20           96.00      0.00   55           ER/URGENT CARE/TRAUMA
5540448   S STRL SOL IRR NACL/H2O           96.00      0.00   55           ER/URGENT CARE/TRAUMA
5540026   S STRL SOL IV 500CC ALL          178.00      0.00   55           ER/URGENT CARE/TRAUMA
5570064   S STRL SOL IV IL ALL             211.00      0.00   55           ER/URGENT CARE/TRAUMA
5540018   S STRL SOL IV IL ALL             211.00      0.00   55           ER/URGENT CARE/TRAUMA
5540331   S STRL STAPLE SIGNET SKIN        290.00      0.00   55           ER/URGENT CARE/TRAUMA
5570437   S STRL SUTURE CUTICILAR          142.00      0.00   55           ER/URGENT CARE/TRAUMA
5540323   S STRL SUTURE CUTICULAR          142.00      0.00   55           ER/URGENT CARE/TRAUMA
5540315   S STRL SUTURE DERAMOND           196.00      0.00   55           ER/URGENT CARE/TRAUMA
5521158   S STRL SUTURE,SINGLE PKG         142.00      0.00   55           ER/URGENT CARE/TRAUMA
5540455   S STRL TRACH TUBE LWP            978.00      0.00   55           ER/URGENT CARE/TRAUMA
5540380   S STRL TRANSDUCR PRES DSP        555.00      0.00   55           ER/URGENT CARE/TRAUMA
5540349   S STRL TRAY LUMBAR DISP          409.00      0.00   55           ER/URGENT CARE/TRAUMA
5540489   S STRL TRAY THORA DISP           588.00      0.00   55           ER/URGENT CARE/TRAUMA
5540091   S STRL TUBE FEED DOBHOFF         555.00      0.00   55           ER/URGENT CARE/TRAUMA
5540588   S STRL TUBE INFANT FED            83.00      0.00   55           ER/URGENT CARE/TRAUMA
5540133   S STRL URINARY BAG LG DRN        117.00      0.00   55           ER/URGENT CARE/TRAUMA
5510300   SART EXAM                        442.00      0.00   55           ER/URGENT CARE/TRAUMA
5510912   SEDATION IV/IM                   466.00      0.00   55           ER/URGENT CARE/TRAUMA
5520242   SEDATION IV/IM                   494.00      0.00   55           ER/URGENT CARE/TRAUMA
5510920   SEDATION PO/PR/INTRANASAL        247.00      0.00   55           ER/URGENT CARE/TRAUMA
5520259   SEDATION PO/PR/INTRANASAL        262.00      0.00   55           ER/URGENT CARE/TRAUMA
5520168   SEEN NO CHARGE                     0.00      0.00   55           ER/URGENT CARE/TRAUMA
5521430   SKIN TEST TB                      18.00      0.00   55           ER/URGENT CARE/TRAUMA
5510532   SLIT LAMP PROCEDURE               34.00      0.00   55           ER/URGENT CARE/TRAUMA
5510490   TEMP TRANSCUTANEOUS PACE         364.00      0.00   55           ER/URGENT CARE/TRAUMA
5510516   THROMBOLYSIS CORO IV             655.00      0.00   55           ER/URGENT CARE/TRAUMA
5530118   TRAUMA ACT EVAL LVL 2           3180.00      0.00   55           ER/URGENT CARE/TRAUMA
5530092   TRAUMA ACT FULL LVL 2           8321.00      0.00   55           ER/URGENT CARE/TRAUMA
5530100   TRAUMA ACT PARTL LVL 2          7261.00      0.00   55           ER/URGENT CARE/TRAUMA
5510888   TRAUMA EXT 1ST 30-74MN FF       8034.00      0.00   55           ER/URGENT CARE/TRAUMA
5510896   TRAUMA EXT EA ADD 30MN FF       4017.00      0.00   55           ER/URGENT CARE/TRAUMA
5510870   TRAUMA HIGH FF                  6890.00      0.00   55           ER/URGENT CARE/TRAUMA
5510854   TRAUMA LOW FF                   2120.00      0.00   55           ER/URGENT CARE/TRAUMA
5510862   TRAUMA MEDIUM FF                5830.00      0.00   55           ER/URGENT CARE/TRAUMA
5570460   TUBE THORACOSTOMY               1179.00      0.00   55           ER/URGENT CARE/TRAUMA
5510573   UC INJECTION IM/SQ EA            118.00      0.00   55           ER/URGENT CARE/TRAUMA
5520051   UC LEVEL 1 EST PATIENT           112.00      0.00   55           ER/URGENT CARE/TRAUMA




                                                Page 53
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



5520069   UC LEVEL 2 EST PATIENT            127.00      0.00   55           ER/URGENT CARE/TRAUMA
5520010   UC LEVEL 2 NEW PATIENT            135.00      0.00   55           ER/URGENT CARE/TRAUMA
5520077   UC LEVEL 3 EST PATIENT            135.00      0.00   55           ER/URGENT CARE/TRAUMA
5520028   UC LEVEL 3 NEW PATIENT            144.00      0.00   55           ER/URGENT CARE/TRAUMA
5520085   UC LEVEL 4 EST PATIENT            158.00      0.00   55           ER/URGENT CARE/TRAUMA
5520036   UC LEVEL 4 NEW PATIENT            167.00      0.00   55           ER/URGENT CARE/TRAUMA
5520093   UC LEVEL 5 EST PATIENT            174.00      0.00   55           ER/URGENT CARE/TRAUMA
5520044   UC LEVEL 5 NEW PATIENT            183.00      0.00   55           ER/URGENT CARE/TRAUMA
5520002   UC LEVEL I NEW PATIENT            119.00      0.00   55           ER/URGENT CARE/TRAUMA
5520309   UC PROC MINOR                     262.00      0.00   55           ER/URGENT CARE/TRAUMA
5520176   URG CARE PT SENT TO ER              0.00      0.00   55           ER/URGENT CARE/TRAUMA
5521422   VENIPUNCTURE                       16.00      0.00   55           ER/URGENT CARE/TRAUMA
5570205   WINDOWING OF CAST                 107.00      0.00   55           ER/URGENT CARE/TRAUMA
721704    XR ABD 1V AP                      126.00      0.00   7            IMAGINIG MOB
721761    XR ABD CMPL DECUB ERECT           247.00      0.00   7            IMAGINIG MOB
721886    XR AC JNT                         709.00      0.00   7            IMAGINIG MOB
721860    XR AC JNT                         746.00      0.00   7            IMAGINIG MOB
721928    XR ANKLE 2V                       458.00      0.00   7            IMAGINIG MOB
721902    XR ANKLE 3V OR MORE               596.00      0.00   7            IMAGINIG MOB
722843    XR BONE LENGTH STDY               591.00      0.00   7            IMAGINIG MOB
727602    XR CALCANEOUS 2V OR MORE          117.00      0.00   7            IMAGINIG MOB
723247    XR CHEST 1V                       329.00      0.00   7            IMAGINIG MOB
723288    XR CHEST 2V                       510.00      0.00   7            IMAGINIG MOB
723387    XR CHEST 2V W AP LORDOTIC         599.00      0.00   7            IMAGINIG MOB
723403    XR CHEST 2V W OBLIQUES            647.00      0.00   7            IMAGINIG MOB
723528    XR CHOL IN OR                       0.00      0.00   7            IMAGINIG MOB
723767    XR CLAVICLE CMPL                  147.00      0.00   7            IMAGINIG MOB
724047    XR ELBOW 2V                       127.00      0.00   7            IMAGINIG MOB
724005    XR ELBOW 3V OR MORE               172.00      0.00   7            IMAGINIG MOB
724823    XR FACIAL BONE 3V OR MORE         864.00      0.00   7            IMAGINIG MOB
724849    XR FACIAL BONE LES 3V             758.00      0.00   7            IMAGINIG MOB
724906    XR FEMUR 2V                       165.00      0.00   7            IMAGINIG MOB
725002    XR FINGER(S) 2V OR MORE           101.00      0.00   7            IMAGINIG MOB
725200    XR FLUORO 1HR OR LES                0.00      0.00   7            IMAGINIG MOB
725325    XR FOOT 2V                        113.00      0.00   7            IMAGINIG MOB
725309    XR FOOT 3V OR MORE                154.00      0.00   7            IMAGINIG MOB
725408    XR FOREARM 2V                     128.00      0.00   7            IMAGINIG MOB
725614    XR HAND 2V                        107.00      0.00   7            IMAGINIG MOB
725606    XR HAND 3V OR MORE                133.00      0.00   7            IMAGINIG MOB
725705    XR HIP UNI 1V                     126.00      0.00   7            IMAGINIG MOB
725671    XR HIP UNI 2V OR MORE             282.00      0.00   7            IMAGINIG MOB
725663    XR HIPS BIL 2V W PELV             291.00      0.00   7            IMAGINIG MOB
725812    XR HUMERUS 2V OR MORE             138.00      0.00   7            IMAGINIG MOB
722827    XR JNT SURVEY 1V                  591.00      0.00   7            IMAGINIG MOB
726919    XR KNEE 1 OR 2V                   118.00      0.00   7            IMAGINIG MOB
726901    XR KNEE 4V OR MORE                720.00      0.00   7            IMAGINIG MOB
726968    XR KNEES STANDING AP              227.00      0.00   7            IMAGINIG MOB
727404    XR NASAL BONES 3V OR MORE         174.00      0.00   7            IMAGINIG MOB
727446    XR NEC SOFT TISSUE                697.00      0.00   7            IMAGINIG MOB
727560    XR ORBITS 4V OR MORE              873.00      0.00   7            IMAGINIG MOB
727743    XR PELV 1 OR 2V                   127.00      0.00   7            IMAGINIG MOB
727701    XR PELV 3V OR MORE                290.00      0.00   7            IMAGINIG MOB
727909    XR RIBS BIL 3V                    509.00      0.00   7            IMAGINIG MOB




                                                 Page 54
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



727941     XR RIBS UNI 2V                    383.00      0.00   7                 IMAGINIG MOB
728121     XR SACRUM COCCYX 2 V MORE         689.00      0.00   7                 IMAGINIG MOB
728204     XR SCAPULA CMPL                   667.00      0.00   7                 IMAGINIG MOB
728287     XR SHOULDER 1V                    125.00      0.00   7                 IMAGINIG MOB
728261     XR SHOULDER 2V OR MORE            217.00      0.00   7                 IMAGINIG MOB
728105     XR SI JNT 1 OR 2V                 142.00      0.00   7                 IMAGINIG MOB
728006     XR SI JNT 3V OR MORE              161.00      0.00   7                 IMAGINIG MOB
728907     XR SKULL 4V OR MORE              1349.00      0.00   7                 IMAGINIG MOB
728949     XR SKULL LES 4V                   634.00      0.00   7                 IMAGINIG MOB
729061     XR SPINE C 4V & FLEX/EXT          365.00      0.00   7                 IMAGINIG MOB
729087     XR SPINE CERV 2-3V                374.00      0.00   7                 IMAGINIG MOB
729046     XR SPINE CERV 4V OR MORE          316.00      0.00   7                 IMAGINIG MOB
729244     XR SPINE LUMB 2-3V                227.00      0.00   7                 IMAGINIG MOB
729160     XR SPINE LUMB 4V OR MORE          421.00      0.00   7                 IMAGINIG MOB
729186     XR SPINE LUMB 4V W BEND           421.00      0.00   7                 IMAGINIG MOB
729269     XR SPINE SCOLIOSIS STNDNG         160.00      0.00   7                 IMAGINIG MOB
729285     XR SPINE SCOLIOSIS SUP ER         227.00      0.00   7                 IMAGINIG MOB
729327     XR SPINE THOR 2V                  234.00      0.00   7                 IMAGINIG MOB
729368     XR SPINE THOR 4V OR MORE          465.00      0.00   7                 IMAGINIG MOB
729400     XR SPINE THOR LUMB 2V             227.00      0.00   7                 IMAGINIG MOB
729426     XR STERNOCLAVIC 3V MORE           231.00      0.00   7                 IMAGINIG MOB
729442     XR STERNUM 2V OR MORE             673.00      0.00   7                 IMAGINIG MOB
729608     XR TIBIA FIBULA 2V                136.00      0.00   7                 IMAGINIG MOB
729665     XR TOE(S) 2V OR MORE              101.00      0.00   7                 IMAGINIG MOB
729954     XR WRIST 2V                       113.00      0.00   7                 IMAGINIG MOB
729947     XR WRIST 3V OR MORE               183.00      0.00   7                 IMAGINIG MOB
 9480013   ACYCLOVIR 50MG IV                 $0.00     $0.00                 94   INFUSION THERAPY
 9483165   ALBUMIN 25%/50ML                  $0.00     $0.00                 94   INFUSION THERAPY
 9483363   ALTEPLASE 1MG IJ                  $0.00     $0.00                 94   INFUSION THERAPY
 9483520   ALTEPLASE 1MG IJ                $101.25     $0.00                 94   INFUSION THERAPY
 9483173   AMPHO B LPD CMPLX 10MG IJ         $0.00     $0.00                 94   INFUSION THERAPY
 9480070   AMPICILLIN NA 500MG INJ           $0.00     $0.00                 94   INFUSION THERAPY
 9450404   ASPIRATION BONE MARROW          $476.41     $0.00                 94   INFUSION THERAPY
 9480104   ATROPINE SO4 TO 0.3MG IV         $16.33     $0.00                 94   INFUSION THERAPY
 9482241   AUROTHIOGLUCOSE TO 50MG           $0.00     $0.00                 94   INFUSION THERAPY
 9470022   BLEOMYCIN 15U IJ                  $0.00     $0.00                 94   INFUSION THERAPY
 9450024   BLOOD TRANSFUSN 2-4 HR          $857.98     $0.00                 94   INFUSION THERAPY
 9450511   BLOOD TRANSFUSN 4-6 HR        $1,286.30     $0.00                 94   INFUSION THERAPY
 9450032   BLOOD TRANSFUSN GT 6HR        $1,651.94     $0.00                 94   INFUSION THERAPY
 9450016   BLOOD TRANSFUSN LT 2 HR         $488.32     $0.00                 94   INFUSION THERAPY
 9450412   BX BONE MARROW                  $512.14     $0.00                 94   INFUSION THERAPY
 9483322   CALCIUM GLUCONATE 10ML IJ         $0.00     $0.00                 94   INFUSION THERAPY
 9470048   CARBOPLATIN 50MG IJ               $0.00     $0.00                 94   INFUSION THERAPY
 9480203   CEFAZOLIN 500MG IV                $0.00     $0.00                 94   INFUSION THERAPY
 9480252   CEFOTAXIME PER 1GM IJ             $0.00     $0.00                 94   INFUSION THERAPY
 9480260   CEFOTETAN PER 500MG IV            $0.00     $0.00                 94   INFUSION THERAPY
 9480278   CEFTAZIDIME PER 500MG IV          $0.00     $0.00                 94   INFUSION THERAPY
 9480286   CEFTIZOXIMENA/500MG IV            $0.00     $0.00                 94   INFUSION THERAPY
 9480294   CEFTRIAXONE NA/250MG IV           $0.00     $0.00                 94   INFUSION THERAPY
 9450594   CHEMO CNS W/SPINAL PUNC       $1,263.67     $0.00                 94   INFUSION THERAPY
 9450602   CHEMO INJ BRAIN/HEART SQ        $742.00     $0.00                 94   INFUSION THERAPY
 9450628   CHEMO IV PMP INFSN GT 8HR       $668.16     $0.00                 94   INFUSION THERAPY
 9450610   CHEMO IV PUSH                   $410.90     $0.00                 94   INFUSION THERAPY




                                                  Page 55
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



 9450586   CHEMO PERITNL W/PERITONEO    $1,286.30     $0.00                 94   INFUSION THERAPY
 9450578   CHEMO PLURAL CAV W/THOR      $1,263.67     $0.00                 94   INFUSION THERAPY
 9450065   CHEMO SQ/IM                    $512.14     $0.00                 94   INFUSION THERAPY
 9480336   CIMETIDINE 300MG IV              $0.00     $0.00                 94   INFUSION THERAPY
 9480328   CIPRO 200MG IV                   $0.00     $0.00                 94   INFUSION THERAPY
 9470063   CISPLATIN 10MG IJ                $0.00     $0.00                 94   INFUSION THERAPY
 9480351   CLINDAMYCIN 300MG IV             $0.00     $0.00                 94   INFUSION THERAPY
 9483181   CMV IMM GLOB/SGL DOSE IJ         $0.00     $0.00                 94   INFUSION THERAPY
 9450396   COLLECT BLD VNS ACCES DVC      $297.75     $0.00                 94   INFUSION THERAPY
 9480427   COSYNTROPIN/0.25MG INJ           $0.00     $0.00                 94   INFUSION THERAPY
 9480435   CYANOCOBALAMIN 1000MCG IN        $0.00     $0.00                 94   INFUSION THERAPY
 9470089   CYCLOPHOSPHAMID 100MG IV         $0.00     $0.00                 94   INFUSION THERAPY
 9470097   CYCLOPHOSPHAMID 1GM IV           $0.00     $0.00                 94   INFUSION THERAPY
 9470105   CYCLOPHOSPHAMID 200MG IV         $0.00     $0.00                 94   INFUSION THERAPY
 9470113   CYCLOPHOSPHAMID 2GM IV           $0.00     $0.00                 94   INFUSION THERAPY
 9410101   D51/2NS 1000ML                  $75.76     $0.00                 94   INFUSION THERAPY
 9410127   D51/2NS 1000ML/KCL 20           $37.10     $0.00                 94   INFUSION THERAPY
 9410184   D5LR 1000ML                     $75.88     $0.00                 94   INFUSION THERAPY
 9410200   D5LR/KCL 20MEQ 1000ML           $89.22     $0.00                 94   INFUSION THERAPY
 9410150   D5NS 1000ML                     $37.10     $0.00                 94   INFUSION THERAPY
 9410028   D5W 1000ML                      $75.90     $0.00                 94   INFUSION THERAPY
 9410069   D5W 250ML                        $3.10     $0.00                 94   INFUSION THERAPY
 9470568   DACARBAZINE 100MG IJ             $0.00     $0.00                 94   INFUSION THERAPY
 9482548   DACLIZUMAB 25MG IJ               $0.00     $0.00                 94   INFUSION THERAPY
 9483074   DARBEPOETIN 1MCG NON-ESRD        $0.00     $0.00                 94   INFUSION THERAPY
 9470170   DAUNORUBICIN 10MG IJ             $0.00     $0.00                 94   INFUSION THERAPY
 9450446   DECLOT VASC DEVICE             $438.29     $0.00                 94   INFUSION THERAPY
 9480468   DEFEROXAMINE MESYL 500MG         $0.00     $0.00                 94   INFUSION THERAPY
 9480500   DESMOPRESSIN ACET/1MCG           $0.00     $0.00                 94   INFUSION THERAPY
 9480518   DEXAMETHASONE 1MG INJ           $12.69     $0.00                 94   INFUSION THERAPY
 9480559   DIPHENHYDRAMINE TO 50MG         $50.42     $0.00                 94   INFUSION THERAPY
 9480567   DOBUTAMINE 250/D5W250            $0.00     $0.00                 94   INFUSION THERAPY
 9470188   DOCETAXEL 20MG IJ                $0.00     $0.00                 94   INFUSION THERAPY
 9480096   DOLASETRON 12.5MG               $39.43     $0.00                 94   INFUSION THERAPY
 9470196   DOXORUBICIN 10MG IJ              $0.00     $0.00                 94   INFUSION THERAPY
 9470204   DOXORUBICIN LIPID 10MG IJ        $0.00     $0.00                 94   INFUSION THERAPY
 9480575   DOXYCYCLINE HYCLATE 100MG        $0.00     $0.00                 94   INFUSION THERAPY
 9480583   DROPERIDOL TO 5MG,IV            $56.50     $0.00                 94   INFUSION THERAPY
 9482951   ENOXAPARIN SOC 10MG INJ          $0.00     $0.00                 94   INFUSION THERAPY
 9480625   EPINEPHRINE 1:1000 TO 1ML       $49.28     $0.00                 94   INFUSION THERAPY
 9482969   EPOETIN ESRD                     $0.00     $0.00                 94   INFUSION THERAPY
 9482985   EPOETIN NON-ESRD/1000U IJ        $0.00     $0.00                 94   INFUSION THERAPY
 9482993   EPOETIN NON-ESRD/1000U IJ        $0.00     $0.00                 94   INFUSION THERAPY
 9483348   ERTAPENEM 500MG IJ               $0.00     $0.00                 94   INFUSION THERAPY
 9483009   ETOPOSIDE 10MG IV                $0.00     $0.00                 94   INFUSION THERAPY
 9483355   FE GLUCONATE 12.5MG IJ           $0.00     $0.00                 94   INFUSION THERAPY
 9481839   FILGRASTIM 300MCG IJ             $0.00     $0.00                 94   INFUSION THERAPY
 9481821   FILGRASTIM 480MCG IJ             $0.00     $0.00                 94   INFUSION THERAPY
 9483314   FLU VACC >3YRS                   $0.00     $0.00                 94   INFUSION THERAPY
 9470238   FLUDARABINE 50MG IJ              $0.00     $0.00                 94   INFUSION THERAPY
 9470246   FLUOROURACIL 500MG IJ            $0.00     $0.00                 94   INFUSION THERAPY
 9480963   FUROSEMIDE 20MG TAB              $9.00     $0.00                 94   INFUSION THERAPY
 9480971   FUROSEMIDE TO 20 MG IV          $24.81     $0.00                 94   INFUSION THERAPY




                                                 Page 56
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



 9483033   GATIFLOXACIN 200MG IV            $0.00     $0.00                 94   INFUSION THERAPY
 9470253   GEMCITABINE 200MG IJ             $0.00     $0.00                 94   INFUSION THERAPY
 9481102   GENTAMICIN TO 80MG IV            $0.00     $0.00                 94   INFUSION THERAPY
 9483223   GOLD SODIUM THIOMALATE 50        $0.00     $0.00                 94   INFUSION THERAPY
 9483264   GOSERELIN/3.6MG IP               $0.00     $0.00                 94   INFUSION THERAPY
 9481136   GRANISETRON 100MCG IJV          $43.84     $0.00                 94   INFUSION THERAPY
 9481144   HEP B IMMGLOB/1ML IJ         $2,073.35     $0.00                 94   INFUSION THERAPY
 9483371   HEP B VACC ADULT 2 DOSE          $0.00     $0.00                 94   INFUSION THERAPY
 9481193   HEPARIN 100U/ML FLUSH            $0.00     $0.00                 94   INFUSION THERAPY
 9480377   HEPARIN LOCK FLUSH PER 10        $8.05     $0.00                 94   INFUSION THERAPY
 9480369   HEPARIN NA PER 1000U            $12.28     $0.00                 94   INFUSION THERAPY
 9481276   HYDROCORT NA SUCC TO 100        $51.90     $0.00                 94   INFUSION THERAPY
 9481284   HYDROXYZINE HCL 50MG/1ML         $2.65     $0.00                 94   INFUSION THERAPY
 9481292   IMIPENEM/CILAST 250MG INJ        $0.00     $0.00                 94   INFUSION THERAPY
 9483199   IMMUNE GLOB 10MG IJ              $0.00     $0.00                 94   INFUSION THERAPY
 9482944   IMMUNE GLOBULIN 1GM              $0.00     $0.00                 94   INFUSION THERAPY
 9482944   IMMUNE GLOBULIN 1GM              $0.00     $0.00                 94   INFUSION THERAPY
 9450123   INF CHEM INTRA ART 1-8 HR      $333.48     $0.00                 94   INFUSION THERAPY
 9450115   INF CHEM INTRA ART PROLNG      $668.16     $0.00                 94   INFUSION THERAPY
 9450131   INF CHEM INTRA ART TO 1HR      $668.16     $0.00                 94   INFUSION THERAPY
 9482118   INFLIXIMAB/10MG IJ               $0.00     $0.00                 94   INFUSION THERAPY
 9450271   INFSN W-W/O MED 0-60 MN        $557.40     $0.00                 94   INFUSION THERAPY
 9450172   INFSN W-W/O MED EA ADD HR      $262.02     $0.00                 94   INFUSION THERAPY
 9450073   INFUSN CHEMO 0-60 MN           $668.16     $0.00                 94   INFUSION THERAPY
 9450503   INFUSN CHEMO EA ADD HR         $333.48     $0.00                 94   INFUSION THERAPY
 9450305   INJECTION ANTIBIOTIC IM        $178.65     $0.00                 94   INFUSION THERAPY
 9450198   INJECTION IM/SQ EA             $178.65     $0.00                 94   INFUSION THERAPY
 9450453   INJECTION IV EA                $343.01     $0.00                 94   INFUSION THERAPY
 9450636   INS PICC W/O PORT 5+ YR      $2,939.43     $0.00                 94   INFUSION THERAPY
 9450651   INSRT NON-TUNN CV CATH<5     $4,130.44     $0.00                 94   INFUSION THERAPY
 9481425   INTERFERON B-1B/.25MG IJ       $365.15     $0.00                 94   INFUSION THERAPY
 9470030   IRINOTECAN 20MG IJ               $0.00     $0.00                 94   INFUSION THERAPY
 9481441   IRON DEXTRAN 50MG INJ            $0.00     $0.00                 94   INFUSION THERAPY
 9483140   IRON SUCROSE IV PER 1MG         $51.30     $0.00                 94   INFUSION THERAPY
 9483389   K CL 20 MEQ IJ                   $0.00     $0.00                 94   INFUSION THERAPY
 9483306   KETOROLAC TROMETHAMINE 30        $0.00     $0.00                 94   INFUSION THERAPY
 9410218   LACTATED RINGERS 1000ML         $75.50     $0.00                 94   INFUSION THERAPY
 9481474   LEUCOVORIN 50MG IV               $0.00     $0.00                 94   INFUSION THERAPY
 9483207   LEUPROLIDE 7.5MG IJ              $0.00     $0.00                 94   INFUSION THERAPY
 9450164   LEVEL 1 EST PATIENT            $319.19     $0.00                 94   INFUSION THERAPY
 9450529   LEVEL 1 NEW PATIENT            $357.30     $0.00                 94   INFUSION THERAPY
 9450461   LEVEL 2 EST PATIENT            $571.69     $0.00                 94   INFUSION THERAPY
 9450537   LEVEL 2 NEW PATIENT            $714.61     $0.00                 94   INFUSION THERAPY
 9450479   LEVEL 3 EST PATIENT            $911.13     $0.00                 94   INFUSION THERAPY
 9450545   LEVEL 3 NEW PATIENT            $911.13     $0.00                 94   INFUSION THERAPY
 9450487   LEVEL 4 EST PATIENT          $1,163.62     $0.00                 94   INFUSION THERAPY
 9450552   LEVEL 4 NEW PATIENT          $1,163.62     $0.00                 94   INFUSION THERAPY
 9450495   LEVEL 5 EST PATIENT          $1,458.99     $0.00                 94   INFUSION THERAPY
 9450560   LEVEL 5 NEW PATIENT          $1,905.63     $0.00                 94   INFUSION THERAPY
 9480393   LIDOCAINE HCL 50CC              $48.75     $0.00                 94   INFUSION THERAPY
 9481557   LORAZEPAM 2MG IV                $54.88     $0.00                 94   INFUSION THERAPY
 9450420   LP DIAGNOSTIC                  $843.24     $0.00                 94   INFUSION THERAPY
 9482845   MAG SO4 SL4/500MG INJ            $0.00     $0.00                 94   INFUSION THERAPY




                                                 Page 57
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



 9481565   MEPERIDINE HCL/100MG INJ         $2.15     $0.00                 94   INFUSION THERAPY
 9470360   METHOTREXATE 50MG IV             $0.00     $0.00                 94   INFUSION THERAPY
 9481664   METHYLPRED 125MG                 $0.00     $0.00                 94   INFUSION THERAPY
 9482902   METHYLPRED 1GM IV                $0.00     $0.00                 94   INFUSION THERAPY
 9481649   METHYLPRED ACET 40MG IV          $0.00     $0.00                 94   INFUSION THERAPY
 9481623   METHYLPRED ACET 80MG IV         $21.45     $0.00                 94   INFUSION THERAPY
 9481672   METOCLOPRAMIDE HCL TO10MG       $52.71     $0.00                 94   INFUSION THERAPY
 9482035   MIDAZOLAM HCL PER 1MG INJ       $18.37     $0.00                 94   INFUSION THERAPY
 9483231   MILRINONE 5MG IV                 $0.00     $0.00                 94   INFUSION THERAPY
 9470402   MITOXANTRONE/5MG IJ              $0.00     $0.00                 94   INFUSION THERAPY
 9470402   MITOXANTRONE/5MG IJ              $0.00     $0.00                 94   INFUSION THERAPY
 9482191   NA CL 0.9% 10ML FTVL            $31.06     $0.00                 94   INFUSION THERAPY
 9410283   NA CL 0.9% 250ML                 $2.80     $0.00                 94   INFUSION THERAPY
 9410291   NA CL 0.9% 500ML                $37.10     $0.00                 94   INFUSION THERAPY
 9481888   ONDANSETRON/1MG IV              $25.36     $0.00                 94   INFUSION THERAPY
 9470550   OXALIPLATIN PER 5MG INJ          $0.00     $0.00                 94   INFUSION THERAPY
 9470428   PACLITAXEL 30MG IJ               $0.00     $0.00                 94   INFUSION THERAPY
 9481896   PAMIDRONATE/30MG IJ              $0.00     $0.00                 94   INFUSION THERAPY
 9483157   PEGFILGRASTIM 6MG IJ             $0.00     $0.00                 94   INFUSION THERAPY
 9450255   PHLEBOTOMY THERAPEUTIC         $357.30     $0.00                 94   INFUSION THERAPY
 9481938   PHYTONADIONE/1MG INJ             $5.84     $0.00                 94   INFUSION THERAPY
 9460171   PROCHLORPERAZIN 10MG TAB        $13.62     $0.00                 94   INFUSION THERAPY
 9482019   PROTEINASE INHB 10MG IJ          $0.00     $0.00                 94   INFUSION THERAPY
 9482084   RABIES ANTIGEN VACC              $0.00     $0.00                 94   INFUSION THERAPY
 9450297   REFILL PORTABLE PUMP           $742.00     $0.00                 94   INFUSION THERAPY
 9482308   RETEPLASE (TPA) 2MG/2ML          $0.00     $0.00                 94   INFUSION THERAPY
 9470436   RITUXIMAB 100MG IJ               $0.00     $0.00                 94   INFUSION THERAPY
 9450644   RPLC COMP NON-TUN CV CATH    $4,130.44     $0.00                 94   INFUSION THERAPY
 9450669   RPLC COMP TUNN PICC W/O      $2,939.43     $0.00                 94   INFUSION THERAPY
 9431750   S STRL APPL CHL SWABSTICK        $0.00     $0.00                 94   INFUSION THERAPY
 9431776   S STRL BLD Y-TYPE SET N-V       $62.85     $0.00                 94   INFUSION THERAPY
 9430083   S STRL BLOOD SET Y-TYPE         $34.25     $0.00                 94   INFUSION THERAPY
 9430208   S STRL CATH AUTOGURD 22X1        $5.10     $0.00                 94   INFUSION THERAPY
 9431594   S STRL CATH IV 14GX1/75"        $11.60     $0.00                 94   INFUSION THERAPY
 9431628   S STRL CATH IV PROT 18G         $13.15     $0.00                 94   INFUSION THERAPY
 9431602   S STRL CATH IV PROT 22G         $13.15     $0.00                 94   INFUSION THERAPY
 9431610   S STRL CATH PROT IV 20G         $13.15     $0.00                 94   INFUSION THERAPY
 9430273   S STRL CATH SAF 24GA/3/4         $9.75     $0.00                 94   INFUSION THERAPY
 9430240   S STRL CATH SAF-T18GA X 1        $9.75     $0.00                 94   INFUSION THERAPY
 9430257   S STRL CATH SAF-T20GA X 1        $9.75     $0.00                 94   INFUSION THERAPY
 9430265   S STRL CATH SAF-T-INTIMA         $9.75     $0.00                 94   INFUSION THERAPY
 9430331   S STRL DRESS BIOPATCH 1IN       $12.50     $0.00                 94   INFUSION THERAPY
 9430349   S STRL DRESS BIOPATCH 3/4       $12.50     $0.00                 94   INFUSION THERAPY
 9430786   S STRL GROSHONG PICC 3FR       $258.20     $0.00                 94   INFUSION THERAPY
 9430794   S STRL GROSHONG PICC 4FR       $258.20     $0.00                 94   INFUSION THERAPY
 9430752   S STRL GRSHNG CATH REP 8       $350.55     $0.00                 94   INFUSION THERAPY
 9430760   S STRL GRSHNG CATH RP 9.5      $350.55     $0.00                 94   INFUSION THERAPY
 9430224   S STRL GRSHNG REP CON 8FR       $34.05     $0.00                 94   INFUSION THERAPY
 9430232   S STRL GRSHNG REP CON 9.5       $34.05     $0.00                 94   INFUSION THERAPY
 9430745   S STRL GRSHNG REP KIT DL       $288.90     $0.00                 94   INFUSION THERAPY
 9430828   S STRL INTRD NDL PICC 3FR       $43.85     $0.00                 94   INFUSION THERAPY
 9430844   S STRL INTRD NDL PICC 4FR       $43.85     $0.00                 94   INFUSION THERAPY
 9430836   S STRL INTRD NDL PICC 5FR       $43.85     $0.00                 94   INFUSION THERAPY




                                                 Page 58
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



 9431065   S STRL LUMBAR TRAY 20G           $48.55     $0.00                 94   INFUSION THERAPY
 9431552   S STRL MICR INTRD KT 3 FR       $144.95     $0.00                 94   INFUSION THERAPY
 9431560   S STRL MICR INTRD KT 4 FR       $144.95     $0.00                 94   INFUSION THERAPY
 9431578   S STRL MICR INTRD KT 5 FR       $144.95     $0.00                 94   INFUSION THERAPY
 9431099   S STRL MIDLINE CATH 3FR         $134.85     $0.00                 94   INFUSION THERAPY
 9431107   S STRL MIDLINE CATH 4FR         $134.85     $0.00                 94   INFUSION THERAPY
 9431115   S STRL NDL GRIP 20G X 3/4        $18.55     $0.00                 94   INFUSION THERAPY
 9431123   S STRL NDL GRIP 22G X 3/4        $18.55     $0.00                 94   INFUSION THERAPY
 9431180   S STRL NDL HUB LP 20G X.5        $18.55     $0.00                 94   INFUSION THERAPY
 9431198   S STRL NDL HUB LP 22GX.75        $18.55     $0.00                 94   INFUSION THERAPY
 9431172   S STRL NDL HUBER LP 20GX1         $0.00     $0.00                 94   INFUSION THERAPY
 9431214   S STRL PICC CONN 4FR              $0.00     $0.00                 94   INFUSION THERAPY
 9431206   S STRL PICC CONN 5FR              $0.00     $0.00                 94   INFUSION THERAPY
 9431420   S STRL SET PHLEBTYM DONAT       $123.25     $0.00                 94   INFUSION THERAPY
 9430034   S STRL SNGLE LUMN CATH KT        $59.10     $0.00                 94   INFUSION THERAPY
 9431545   S STRL THORACENTESIS TRAY        $72.35     $0.00                 94   INFUSION THERAPY
 9431727   S STRL TRAY GRSHNG PIC3FR       $618.90     $0.00                 94   INFUSION THERAPY
 9431735   S STRL TRAY GRSHNG PIC4FR       $618.90     $0.00                 94   INFUSION THERAPY
 9431743   S STRL TRAY GRSHNG PIC5FR       $821.35     $0.00                 94   INFUSION THERAPY
 9430315   S STRL TRAY MAHRKR DL DSP       $783.70     $0.00                 94   INFUSION THERAPY
 9430323   S STRL TRAY MAHRKR DL DSP       $784.30     $0.00                 94   INFUSION THERAPY
 9483272   SECRETIN 0.2MCG INJ               $0.00     $0.00                 94   INFUSION THERAPY
 9482365   TOBRAMYCIN SO4 TO 80MG            $0.00     $0.00                 94   INFUSION THERAPY
 9470477   TOPOTECAN 4MG IJ                  $0.00     $0.00                 94   INFUSION THERAPY
 9481755   TRACE ELEM-5 10ML IV             $82.50     $0.00                 94   INFUSION THERAPY
 9482415   VANCOMYCIN 500MG IV               $0.00     $0.00                 94   INFUSION THERAPY
 9450248   VENIPUNCTURE                     $59.55     $0.00                 94   INFUSION THERAPY
 9470485   VINBLASTINE 1MG IJ                $0.00     $0.00                 94   INFUSION THERAPY
 9470501   VINCRISTINE SULF 2MG IV           $0.00     $0.00                 94   INFUSION THERAPY
 9470410   VINORELBINE/10MG IJ               $0.00     $0.00                 94   INFUSION THERAPY
 9482530   WINRHO 100IU IJ                   $0.00     $0.00                 94   INFUSION THERAPY
 9483249   ZOLEDRONIC ACID 1MG INJ           $0.00     $0.00                 94   INFUSION THERAPY
9540394    S STRL BLOOD LEUK FTR/100         298.00      0.00   95                IV THERAPY
9540402    S STRL BLOOD LEUK FTR/50Y         201.00      0.00   95                IV THERAPY
9530635    S STRL CATH ARROW CVC TL          318.00      0.00   95                IV THERAPY
9530098    S STRL GRSHNG PICC-DL LMN        1239.00      0.00   95                IV THERAPY
9530296    S STRL HUBER NEEDLE W/EXT          52.00      0.00   95                IV THERAPY
9530106    S STRL HUBER NEEDLE W/EXT         103.00      0.00   95                IV THERAPY
9530346    S STRL INTIMA IV CATHETER          22.00      0.00   95                IV THERAPY
9530080    S STRL INTRODUCER NDL PIC          52.00      0.00   95                IV THERAPY
9550088    S STRL PERIPHRL IV INSER            0.00      0.00   95                IV THERAPY
9550054    S STRL PERIPHRL IV INSRTN           0.00      0.00   95                IV THERAPY
9530171    S STRL PICC INSERTIN TRAY         580.00      0.00   95                IV THERAPY
9500562    S STRL PICC INSERTION               0.00      0.00   95                IV THERAPY
9550567    S STRL PICC INSERTION OP          275.00      0.00   95                IV THERAPY
9550070    S STRL PORT ACCES INSERTN          78.00      0.00   95                IV THERAPY
4093340    11 DEOXYCORTICOSTERONE             49.00      0.00   40                LAB
4093001    11 DEOXYCORTISOL                   36.00      0.00   40                LAB
4096988    11 DEOXYCORTISOL                   20.00      0.00   40                LAB
4093019    17 OH CORTICOSTERIODS              32.00      0.00   40                LAB
4093035    17 OH PREGNENOLONE                 33.25      0.00   40                LAB
4097002    17 OH PREGNENOLONE                 20.00      0.00   40                LAB
4096996    17 OH PROGESTRONE                  20.00      0.00   40                LAB




                                                  Page 59
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4010880   17 OH PROGESTRONE                 142.00     29.00   40           LAB
4094793   5 HIAA UR                          15.60      0.00   40           LAB
4095071   5 HIAA UR                          24.07      0.00   40           LAB
4094579   5 NUCLEOTIDASE                     17.00      0.00   40           LAB
4092060   AB ELUTION                        150.00      0.00   40           LAB
4040051   AB ELUTION                        220.00      0.00   40           LAB
4012050   AB ELUTION                        220.00     53.00   40           LAB
4040028   AB ID                             544.00      0.00   40           LAB
4092201   AB ID                             170.00      0.00   40           LAB
4040101   AB SCRN                           301.00      0.00   40           LAB
4040093   AB TTR                            264.00     71.00   40           LAB
4012068   AB TTR                            264.00     71.00   40           LAB
4011086   AB TTR 3                           37.00      0.00   40           LAB
4040077   ABO TYP                           121.00     17.00   40           LAB
4011094   ABO TYP                           142.00      0.00   40           LAB
4090585   ACE (ANGIOTN CONVR ENZ)            12.00      0.00   40           LAB
4010054   ACETAMINOPHEN                     354.00      0.00   40           LAB
4095592   ACETYLCHOLINE MODULE AB            48.00      0.00   40           LAB
4098281   ACETYLCHOLINE RECEPT AB            45.00      0.00   40           LAB
4093043   ACID PHOS PROSTATIC                12.00      0.00   40           LAB
4090551   ACTH                               25.00      0.00   40           LAB
4098273   ACYLCARNITINES QN EA              116.22      0.00   40           LAB
4094082   ADENOVIRUS AB                      22.00      0.00   40           LAB
4081279   ADENOVIRUS DFA                    122.00      0.00   40           LAB
4090569   ADH (VASOPRESSIN)                  25.00      0.00   40           LAB
4094090   ADRENAL AB SCRN                    25.00      0.00   40           LAB
4095139   ADRENAL AB SCRN                     0.00      0.00   40           LAB
4094983   ADRENAL AB SCRN                   371.88      0.00   40           LAB
4094173   ADRENAL AB SCRN                    17.00      0.00   40           LAB
4094447   ADRENAL AB TTR                     32.00      0.00   40           LAB
4081378   AFB CULT                          235.00      0.00   40           LAB
4094645   AFB CULT                           33.45      0.00   40           LAB
4090999   AFB CULT                           24.25      0.00   40           LAB
4081360   AFB CULT BLD                      235.00      0.00   40           LAB
4094520   AFB CULT BLD                       26.00      0.00   40           LAB
4050001   AFP TUMOR MARKER                  154.00      0.00   40           LAB
4091922   AG DETECT EIA MULT STEP            27.97      0.00   40           LAB
4095998   AG DETECT EIA MULT STEP            24.00      0.00   40           LAB
4040127   AG SCRN PER UNIT PT SPEC          178.00      0.00   40           LAB
4012084   AG SCRN PER UNIT PT SPEC          178.00     53.00   40           LAB
4040119   AG SCRN PER UNIT RGNT             220.00      0.00   40           LAB
4012092   AG SCRN PER UNIT RGNT             220.00     71.00   40           LAB
4012076   AG TYP PT RBC EA                  110.00     27.00   40           LAB
4040010   AG TYP PT RBC EA                  110.00      0.00   40           LAB
4010070   ALBUMIN                            39.00     21.00   40           LAB
4097051   ALBUMIN                             8.90      0.00   40           LAB
4097069   ALBUMIN FLD                         8.90      0.00   40           LAB
4010088   ALCOHOL (ETHANOL)                 130.00     51.00   40           LAB
4090577   ALDOLASE                            8.50      0.00   40           LAB
4093050   ALDOSTERONE                        27.00      0.00   40           LAB
4095295   ALDOSTERONE UR 24HR                39.00      0.00   40           LAB
4095089   ALK PHOS ISOENZYMES                20.00      0.00   40           LAB
4094801   ALK PHOS ISOENZYMES                17.00      0.00   40           LAB




                                                 Page 60
                                     85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4010096   ALK PHOSPHATASE                        39.00     21.00   40           LAB
4096020   ALLERGEN SPECIFIC IGE QN                5.93      0.00   40           LAB
4096038   ALLERGEN SPECIFIC IGE QN                5.93      0.00   40           LAB
4096046   ALLERGEN SPECIFIC IGE QN                5.93      0.00   40           LAB
4096012   ALLERGEN SPECIFIC IGE QN                5.93      0.00   40           LAB
4096004   ALLERGEN SPECIFIC IGE QN                5.93      0.00   40           LAB
4095568   ALPHA 1 ANTITRYP PHENO                 22.00      0.00   40           LAB
4094785   ALPHA 1 ANTITRYPSIN                    13.25      0.00   40           LAB
4095055   ALPHA 1 ANTITRYPSIN                    13.75      0.00   40           LAB
4096947   ALPHA 1 ANTITRYPSIN                    57.00      0.00   40           LAB
4092250   ALPHA 2 ANTIPLASMIN                    50.50      0.00   40           LAB
4011383   ALT (SGPT)                             39.00     21.00   40           LAB
4098224   AMEBIC AB                              19.00      0.00   40           LAB
4093076   AMIKACIN                               22.00      0.00   40           LAB
4093092   AMINO ACIDS CSF >5 QN                  63.00      0.00   40           LAB
4093100   AMINO ACIDS MULT QL                    76.00      0.00   40           LAB
4093118   AMINO ACIDS UR >5 QN                   76.00      0.00   40           LAB
4093084   AMINO ACIDS UR MULT QL                 19.00      0.00   40           LAB
4093126   AMIODARONE                             29.00      0.00   40           LAB
4096681   AMITRIPTYLINE                          23.00      0.00   40           LAB
4010104   AMMONIA                               138.00     61.00   40           LAB
4010997   AMPHETAMINE SCRN                      260.00      0.00   40           LAB
4011102   AMPHETAMINE SCRN                       38.00      0.00   40           LAB
4016192   AMPHETAMINE SCRN                       48.00     11.00   40           LAB
4012142   AMPHETAMINE SCRN                       48.00     39.00   40           LAB
4098091   AMYLASE                                14.50      0.00   40           LAB
4010120   AMYLASE                               153.00     29.00   40           LAB
4010138   AMYLASE FLD                           199.00      0.00   40           LAB
4010146   AMYLASE UR RAN                        243.00     43.00   40           LAB
4012233   AMYLASE UR TIM                        167.00     36.00   40           LAB
4096236   ANA (ANTI NUCLEAR AB)                  11.62      0.00   40           LAB
4095394   ANA (ANTI NUCLEAR AB)                   7.27      0.00   40           LAB
4096962   ANDROSTENEDIONE                        20.00      0.00   40           LAB
4093159   ANDROSTENEDIONE                        21.00      0.00   40           LAB
4091039   ANTI DNA DBL STRAND                    12.00      0.00   40           LAB
4094140   ANTI DNA SINGL STRAND                  32.00      0.00   40           LAB
4098356   ANTI RNP AB                            18.00      0.00   40           LAB
4098240   ANTI RNP AB                            26.00      0.00   40           LAB
4098349   ANTI SM AB                             18.00      0.00   40           LAB
4092409   ANTINEUTROPHILIC AB                    15.30      0.00   40           LAB
4094108   ANTINEUTROPHILIC AB                    37.00      0.00   40           LAB
4095519   ANTINEUTROPHILIC AB                    16.62      0.00   40           LAB
4092391   ANTINEUTROPHILIC AB                    15.29      0.00   40           LAB
4096616   ANTIRETICULIN AB W/RFX                 13.20      0.00   40           LAB
4092482   APOLIPOPROTEIN A1                      14.25      0.00   40           LAB
4093209   ARSENIC BLD                            19.00      0.00   40           LAB
4094041   ASCORBIC ACID                          14.00      0.00   40           LAB
4095220   ASO TTR                                 9.75      0.00   40           LAB
4091328   ASO TTR                                10.07      0.00   40           LAB
4092433   ASPERGILLUS AB                          6.16      0.00   40           LAB
4095535   ASPERGILLUS AB                          6.17      0.00   40           LAB
4092441   ASPERGILLUS AB                          6.17      0.00   40           LAB
4094199   ASPERGILLUS AB                         26.00      0.00   40           LAB




                                                     Page 61
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4092458   ASPERGILLUS AB                       6.17      0.00   40           LAB
4011375   AST (SGOT)                          37.00     21.00   40           LAB
4090197   AT3 ACTIVITY                        19.00      0.00   40           LAB
4096475   AT3 AG IMMUNOLOGIC                  26.00      0.00   40           LAB
4094553   B PERTUSSIS/PARAPERT DFA            20.00      0.00   40           LAB
4020285   B PERTUSSIS/PARAPERT DFA           125.00     36.00   40           LAB
4080156   BACTERIAL AG EA AG                 142.00     56.00   40           LAB
4097028   BACTERIAL AG EA AG                  42.00      0.00   40           LAB
4098265   BACTERIAL AG EA AG                   8.00      0.00   40           LAB
4013140   BARBITURATES SCRN                   48.00     11.00   40           LAB
4011821   BASIC METABOLIC PNL                297.00    163.00   40           LAB
4013157   BENZODIAZEPINE SCRN                 48.00     11.00   40           LAB
4090668   BENZODIAZEPINES                     16.50      0.00   40           LAB
4093746   BENZODIAZEPINES                     37.00      0.00   40           LAB
4092573   BETA 2 GLYCOPROTN I AB EA           23.15      0.00   40           LAB
4011110   BETA HCG QL                        272.00     56.00   40           LAB
4010377   BETA HCG QN                        434.00    116.00   40           LAB
4093225   BETA HCG QN                         11.00      0.00   40           LAB
4094884   BETA2 MICROGLOBULIN                 22.50      0.00   40           LAB
4010195   BILIRUBIN DIRECT                    37.00     21.00   40           LAB
4010211   BILIRUBIN NEONATAL                  39.00     21.00   40           LAB
4096640   BLD CNT RBC AUTO                     5.04      0.00   40           LAB
4030383   BLD SMR EXAM W MAN DIFF            215.00     23.00   40           LAB
4030052   BLEEDING TIME TEST                 197.00     93.00   40           LAB
4030102   BLEEDING TIME TEST                 197.00      0.00   40           LAB
4098018   BORRELIA BURGD CONF                 10.66      0.00   40           LAB
4092292   BORRELIA BURGD CONF                 20.29      0.00   40           LAB
4094959   BORRELIA BURGD CONF                 60.10      0.00   40           LAB
4094207   BRUCELLA AB                         13.00      0.00   40           LAB
4010245   BUN                                 37.00     21.00   40           LAB
4010385   C DIFFICILE TOXIN EIA              171.00     65.00   40           LAB
4080362   C DIFFICILE TOXIN EIA              171.00      0.00   40           LAB
4095113   C PEPTIDE                           21.50      0.00   40           LAB
4094835   C PEPTIDE                           16.00      0.00   40           LAB
4016176   C REACTIVE PROTEIN                 104.00     37.00   40           LAB
4050027   CA 125                             164.00      0.00   40           LAB
4095667   CA 15 3 (27.29)                     14.00      0.00   40           LAB
4095402   CA 15 3 (27.29)                     28.90      0.00   40           LAB
4094686   CA 15 3 (27.29)                     15.00      0.00   40           LAB
4090502   CA 19 9                             15.30      0.00   40           LAB
4020244   CALC ANALYSIS CHEM QN               44.00      0.00   40           LAB
4094827   CALCITONIN                          27.50      0.00   40           LAB
4095105   CALCITONIN                          27.50      0.00   40           LAB
4010260   CALCIUM                             39.00     21.00   40           LAB
4013082   CALCIUM FLD                        135.00      0.00   40           LAB
4090270   CALCIUM IONIZED                     10.00      0.00   40           LAB
4010013   CALCIUM UR 24HR                    167.00     36.00   40           LAB
4012282   CALCIUM UR RAN                     138.00     25.00   40           LAB
4013165   CANNABINOID SCRN                    48.00     11.00   40           LAB
4010278   CARBAMAZEPINE TOTAL                330.00     83.00   40           LAB
4094603   CARDIOLIPIN AB                      19.50      0.00   40           LAB
4092615   CARDIOLIPIN IGA AB                  23.14      0.00   40           LAB
4092599   CARDIOLIPIN IGG AB                  23.14      0.00   40           LAB




                                                  Page 62
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4092607   CARDIOLIPIN IGM AB                 23.14      0.00   40           LAB
4095899   CARDIOLIPIN IGM AB                 26.13      0.00   40           LAB
4093233   CARNITINE FREE & TOTAL             31.00      0.00   40           LAB
4095303   CAROTENE                           15.00      0.00   40           LAB
4093373   CATECHOL FRAC PLAS                 25.00      0.00   40           LAB
4096798   CATECHOL FRAC PLAS                 41.09      0.00   40           LAB
4090635   CATECHOL FRAC UR                   41.25      0.00   40           LAB
4090643   CATECHOLAMINES TOTAL UR            27.50      0.00   40           LAB
4030193   CBC AUTO                          144.00     17.00   40           LAB
4030185   CBC AUTO W AUTO DIFF WBC          248.00     23.00   40           LAB
4030367   CBC AUTO W AUTO DIFF WBC          124.00      0.00   40           LAB
4010286   CEA                               329.00     91.00   40           LAB
4050035   CEA                               262.00      0.00   40           LAB
4050803   CEA                               329.00     91.00   40           LAB
4030136   CELL CNT FLD W/ DIFF               78.00      0.00   40           LAB
4030128   CELL CNT FLD W/ DIFF              147.00     34.00   40           LAB
4030144   CELL CNT FLD W/ DIFF               78.00      0.00   40           LAB
4030110   CELL CNT FLD W/O DIFF              78.00     33.00   40           LAB
4098497   CELL MARKR TECH EA ADDL            85.95      0.00   40           LAB
4055380   CELL MARKR TECH EA ADDL            35.00      0.00   40           LAB
4055372   CELL MARKR TECH ONLY 1ST           70.00      0.00   40           LAB
4098489   CELL MARKR TECH ONLY 1ST           85.95      0.00   40           LAB
4094132   CENTROMERE AB SCRN                 19.00      0.00   40           LAB
4090296   CERULOPLASMIN                       9.75      0.00   40           LAB
4094876   CHLAMYDIA AB                       17.50      0.00   40           LAB
4096376   CHLAMYDIA AB IGA                   20.00      0.00   40           LAB
4096541   CHLAMYDIA AB IGG                   20.00      0.00   40           LAB
4096384   CHLAMYDIA AB IGG                   20.00      0.00   40           LAB
4094405   CHLAMYDIA AB IGM                   23.00      0.00   40           LAB
4096392   CHLAMYDIA AB IGM                   20.00      0.00   40           LAB
4098463   CHLAMYDIA AB IGM                   17.38      0.00   40           LAB
4096558   CHLAMYDIA AB IGM                   20.00      0.00   40           LAB
4081089   CHLAMYDIA AG DFA                  105.00     40.00   40           LAB
4090965   CHLAMYDIA CULT                     30.61      0.00   40           LAB
4096533   CHLAMYDIA PNEUMO AB                20.00      0.00   40           LAB
4081410   CHLAMYDIA TRACH AMP PRB            90.00     39.00   40           LAB
4095261   CHLAMYDIA TRACH AMP PRB            30.00      0.00   40           LAB
4081006   CHLAMYDIA TRACH DIR PRB            99.00     40.00   40           LAB
4010351   CHLORIDE                           39.00     21.00   40           LAB
4013371   CHLORIDE UR                        39.00      0.00   40           LAB
4016226   CHLORIDE UR TIM                     0.00      0.00   40           LAB
4010369   CHOLESTEROL                        39.00     21.00   40           LAB
4093258   CHOLINESTERASE RBC                 24.00      0.00   40           LAB
4098539   CHOLINESTERASE RBC                  9.44      0.00   40           LAB
4098521   CHOLINESTERASE SER                  9.44      0.00   40           LAB
4096442   CHRMOSOM CNT/KARY                 165.00      0.00   40           LAB
4055307   CHRMOSOM CNT/KARY                 334.00      0.00   40           LAB
4094942   CITRATE UR 24HR                    18.00      0.00   40           LAB
4010476   CK MB FRACTION                    343.00     98.00   40           LAB
4010484   CK TOTAL                          130.00     25.00   40           LAB
4030151   CLOT RETRACTION                   119.00      0.00   40           LAB
4091062   CMV AB                             55.44      0.00   40           LAB
4098117   CMV AB IGG                         16.34      0.00   40           LAB




                                                 Page 63
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4095873   CMV AB IGG                           11.00      0.00   40           LAB
4098125   CMV AB IGM                           16.34      0.00   40           LAB
4095881   CMV AB IGM                           11.00      0.00   40           LAB
4096079   CMV AMP PRB                          87.50      0.00   40           LAB
4095980   CMV DNA QN                          109.00      0.00   40           LAB
4010401   CO2 (BICARBONATE)                    39.00     21.00   40           LAB
4013173   COCAINE SCRN                         48.00     11.00   40           LAB
4095147   COCCI AB COMP FIX                    34.00      0.00   40           LAB
4094470   COCCI IMMUNO DIFFUSION               44.00      0.00   40           LAB
4095162   COCCI IMMUNO DIFFUSION               29.00      0.00   40           LAB
4096368   COCCIDIOIDES AB                      43.50      0.00   40           LAB
4094231   COCCIDIOIDES AB                      51.00      0.00   40           LAB
4096350   COCCIDIOIDES AB                      43.50      0.00   40           LAB
4096095   COCCIDIOIDES AB CSF                  43.50      0.00   40           LAB
4055216   COLD AGGLUTININ TTR                 253.00      0.00   40           LAB
4040135   COMPATIBILITY TEST AHG              363.00      0.00   40           LAB
4040069   COMPATIBILITY TEST IS               299.00      0.00   40           LAB
4096244   COMPLEMENT C1                        11.62      0.00   40           LAB
4098323   COMPLEMENT C3                        16.00      0.00   40           LAB
4051041   COMPLEMENT C3                        67.00     21.00   40           LAB
4051058   COMPLEMENT C4                        67.00     21.00   40           LAB
4098331   COMPLEMENT C4                        16.00      0.00   40           LAB
4091088   COMPLEMENT TOT (CH50)                11.00      0.00   40           LAB
4011896   COMPR MET PNL                       519.00    285.00   40           LAB
4040176   COOMBS DIRECT C3                     56.00     30.00   40           LAB
4040044   COOMBS DIRECT IG                    153.00     32.00   40           LAB
4092011   COOMBS DIRECT IG                     20.00      0.00   40           LAB
4040036   COOMBS DIRECT POLY                  153.00     32.00   40           LAB
4090304   COPPER                               15.00      0.00   40           LAB
4020350   COPPER                               86.00      0.00   40           LAB
4050068   CORTISOL (AM DRAW)                  128.00      0.00   40           LAB
4050076   CORTISOL (PM DRAW)                  128.00      0.00   40           LAB
4093274   CORTISOL FREE UR                     22.00      0.00   40           LAB
4096053   CORTISOL FREE UR                     21.25      0.00   40           LAB
4050050   CORTISOL TOTAL                      128.00      0.00   40           LAB
4050043   CORTISOL TOTAL                      128.00      0.00   40           LAB
4096954   CORTISOL TOTAL                       50.00      0.00   40           LAB
4098513   CORTISOL TOTAL                       11.11      0.00   40           LAB
4098067   COXSACKIE AB TYP B                    5.81      0.00   40           LAB
4098026   COXSACKIE AB TYP B                    5.81      0.00   40           LAB
4098034   COXSACKIE AB TYP B                    5.81      0.00   40           LAB
4098042   COXSACKIE AB TYP B                    5.81      0.00   40           LAB
4098059   COXSACKIE AB TYP B                    5.81      0.00   40           LAB
4098075   COXSACKIE AB TYP B                    5.81      0.00   40           LAB
4016168   C-REACTIVE PROTEIN HS               169.00     53.00   40           LAB
4010500   CREATININE                           37.00     21.00   40           LAB
4010492   CREATININE CLEARANCE                376.00     72.00   40           LAB
4016119   CREATININE FLD                       42.00      0.00   40           LAB
4093282   CREATININE FLD                       13.00      0.00   40           LAB
4010518   CREATININE UR 24HR                  357.00     65.00   40           LAB
4012274   CREATININE UR RAN                   153.00     25.00   40           LAB
4096749   CREATININE UR RAN                    17.50      0.00   40           LAB
4096517   CRYOGLOB QL OR SEMI QL                7.00      0.00   40           LAB




                                                   Page 64
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4090205   CRYOGLOB QL OR SEMI QL             6.77      0.00   40           LAB
4091229   CRYOGLOBULIN QN                   18.00      0.00   40           LAB
4081097   CRYPTO AG DFA                     27.00     24.00   40           LAB
4081345   CRYPTOCOCCAL AG AGGL             122.00      0.00   40           LAB
4094538   CRYPTOSPORIDIUM                   25.00      0.00   40           LAB
4081402   CRYPTOSPORIDIUM AG EIA            54.00     34.00   40           LAB
4010641   CRYSTALS FLD                     211.00     43.00   40           LAB
4081253   CULT ABCESS                      238.00     49.00   40           LAB
4080305   CULT BACT AEROBIC ID              53.00     17.00   40           LAB
4080214   CULT BACT ANAEROBIC              312.00     64.00   40           LAB
4080503   CULT BACT ANAEROBIC ID           131.00      0.00   40           LAB
4080180   CULT BETA STREP A ONLY           125.00     36.00   40           LAB
4080016   CULT BLD BACTERIA                295.00     71.00   40           LAB
4081246   CULT BLD BACTERIA                238.00     49.00   40           LAB
4081220   CULT BX                          238.00     49.00   40           LAB
4081048   CULT CAPD                        238.00     49.00   40           LAB
4081071   CULT CATHETER TIP                238.00     49.00   40           LAB
4091070   CULT CMV                          57.83      0.00   40           LAB
4096830   CULT CMV                          20.00      0.00   40           LAB
4081063   CULT CSF                         238.00     49.00   40           LAB
4081105   CULT EAR                         238.00     49.00   40           LAB
4080024   CULT ENVIRONMENT                  12.00      0.00   40           LAB
4081113   CULT EYE                         238.00     49.00   40           LAB
4081030   CULT FLUID                       238.00     49.00   40           LAB
4081022   CULT FLUID (ANAEROBIC)           271.00     61.00   40           LAB
4081147   CULT FUNGUS BLD                  146.00     46.00   40           LAB
4080529   CULT FUNGUS MOLD ID               53.00      0.00   40           LAB
4081139   CULT FUNGUS OTHER SOURCE         146.00     46.00   40           LAB
4080222   CULT FUNGUS OTHER SOURCE         171.00     50.00   40           LAB
4080321   CULT FUNGUS YEAST ID              53.00     17.00   40           LAB
4080230   CULT GC SCRN                     115.00     39.00   40           LAB
4081162   CULT GENITAL                     238.00     49.00   40           LAB
4080354   CULT GRP B STREP SCRN            100.00     81.00   40           LAB
4080040   CULT H20                          47.00     33.00   40           LAB
4090973   CULT HERPES                       27.73      0.00   40           LAB
4096418   CULT HSV                          21.00      0.00   40           LAB
4094546   CULT LEGIONELLA                   56.00      0.00   40           LAB
4096574   CULT LEGIONELLA                   30.00      0.00   40           LAB
4081212   CULT LOWER RESPIRATORY           108.00     33.00   40           LAB
4081170   CULT MISC                        238.00     49.00   40           LAB
4080339   CULT MRSA SCRN                   138.00    109.00   40           LAB
4080271   CULT NOSE/THROAT                 219.00     50.00   40           LAB
4081188   CULT SCRN B PERTUSSUS            238.00     49.00   40           LAB
4080263   CULT SPUTUM/BRONCH WASH          240.00     49.00   40           LAB
4080461   CULT STL OTHER EA PLATE          105.00      0.00   40           LAB
4080479   CULT STL OTHER EA PLATE          105.00      0.00   40           LAB
4080545   CULT STL OTHER EA PLATE           96.00      0.00   40           LAB
4080164   CULT STL SALM & SHIG             306.00     69.00   40           LAB
4020103   CULT STL SALM & SHIG              25.00      0.00   40           LAB
4080453   CULT STL SALM & SHIG             306.00      0.00   40           LAB
4081238   CULT TISSUE (ANAEROBIC)          238.00     49.00   40           LAB
4080537   CULT TYP AGGL                    131.00      0.00   40           LAB
4081352   CULT TYP BY NA PRB               144.00      0.00   40           LAB




                                                Page 65
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4080289   CULT UR COLONY CT ONLY           153.00     39.00   40           LAB
4080313   CULT UR ID ISOLATES               50.00     17.00   40           LAB
4080347   CULT VRE SCRN                     52.00     40.00   40           LAB
4081261   CULT WND/ABSCESS ANAEROBE        238.00     49.00   40           LAB
4093308   CYANIDE                           28.00      0.00   40           LAB
4096756   CYANIDE SCRN                      35.99      0.00   40           LAB
4093134   CYCLIC AMP                        45.00      0.00   40           LAB
4090676   CYCLOSPORINE (PROGRAF)            32.10      0.00   40           LAB
4094249   CYSTICERCOSIS AB                  50.00      0.00   40           LAB
4093316   CYSTINE UR QN                     49.00      0.00   40           LAB
4020160   CYTO CL BLK 5 CNT/1 KARY         188.00      0.00   40           LAB
4020012   CYTOLOGY FLD                     260.00      0.00   40           LAB
4020061   CYTOLOGY OTHER SOURCE            157.00      0.00   40           LAB
4020384   CYTOLOGY PREP & INTERP           118.00      0.00   40           LAB
4020368   CYTOLOGY SEL CELL ENHANCE        118.00      0.00   40           LAB
4020004   CYTOLOGY SMR & FILTER            266.00      0.00   40           LAB
4020020   CYTOLOGY SMR & FILTER            125.00      0.00   40           LAB
4020038   CYTOLOGY SMR & FILTER            207.00      0.00   40           LAB
4020053   CYTOLOGY SMR & FILTER            206.00      0.00   40           LAB
4020079   CYTOLOGY UR                      211.00      0.00   40           LAB
4092094   CYTOTOXIC AB SCRN QUICK          120.00      0.00   40           LAB
4092037   CYTOTOXIC AB SCRN STND           200.00      0.00   40           LAB
4030003   D DIMER QN                       197.00      0.00   40           LAB
4030417   D DIMER SEMI QN/QL                50.00     18.00   40           LAB
4093324   DELTA ALA                         28.00      0.00   40           LAB
4098455   DEOXYRIBNUCLEASE AB               33.51      0.00   40           LAB
4090692   DESIPRAMINE                       18.25      0.00   40           LAB
4090700   DHEA                              25.00      0.00   40           LAB
4096970   DHEA                              20.00      0.00   40           LAB
4090718   DHEA SULFATE                      12.00      0.00   40           LAB
4098000   DIGITOXIN                         57.00      0.00   40           LAB
4093357   DIGITOXIN                         22.00      0.00   40           LAB
4010559   DIGOXIN                          376.00     83.00   40           LAB
4090783   DISOPYRAMIDE                      15.00      0.00   40           LAB
4055414   DNA CL CYCLE                     170.00      0.00   40           LAB
4096269   DNA DBL STRAND AB SCRN            11.62      0.00   40           LAB
4093365   DOXEPIN                           22.00      0.00   40           LAB
4010112   DRG CONF                         135.00     41.00   40           LAB
4011854   DRG SCRN QL CHROM EA             358.00      0.00   40           LAB
4011862   DRG SCRN QL CHROM EA             235.00      0.00   40           LAB
4091344   EBV AB EARLY AG                   28.90      0.00   40           LAB
4096327   EBV AB EBNA                        9.69      0.00   40           LAB
4096897   EBV AB EBNA                       38.00      0.00   40           LAB
4091351   EBV AB EBNA                       38.00      0.00   40           LAB
4091336   EBV VCA AB IGG                    25.49      0.00   40           LAB
4096301   EBV VCA AB IGG                     9.69      0.00   40           LAB
4096491   EBV VCA AB IGM                    12.00      0.00   40           LAB
4096319   EBV VCA AB IGM                     9.69      0.00   40           LAB
4010583   ELECTROLYTE PNL FLD              148.00     82.00   40           LAB
4020343   ELECTRON MICROSCOPY              649.00      0.00   40           LAB
4095527   ENA AB                            36.00      0.00   40           LAB
4094157   ENA AB                            27.00      0.00   40           LAB
4096624   ENDOMYSIAL AB SCRN                43.00      0.00   40           LAB




                                                Page 66
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4096459   ENDOMYSIAL AB SCRN                   43.00      0.00   40           LAB
4098547   EOSINOPHIL COUNT URINE               20.75      0.00   40           LAB
4030201   EOSINPHILS SMR NASAL                 26.00      0.00   40           LAB
4090338   ERYTHROPOIETIN                       20.43      0.00   40           LAB
4051124   ESTRADIOL (E2)                      169.00     37.00   40           LAB
4093399   ESTRIOL                              17.00      0.00   40           LAB
4090734   ESTROGEN TOTAL                       26.00      0.00   40           LAB
4093407   ESTRONE                              27.00      0.00   40           LAB
4093415   ETHOSUXIMIDE                         17.10      0.00   40           LAB
4092623   EUGLOBULIN LYSIS                     41.40      0.00   40           LAB
4094892   FAT STL QL                           14.63      0.00   40           LAB
4095691   FAT STL QL                           16.45      0.00   40           LAB
4093423   FAT STL QN                           44.80      0.00   40           LAB
4051223   FCTR II                             109.00      0.00   40           LAB
4092896   FCTR II                             127.50      0.00   40           LAB
4092631   FCTR II                              78.00      0.00   40           LAB
4092730   FCTR INHIBITOR TEST                 110.00      0.00   40           LAB
4092748   FCTR INHIBITOR TEST                 117.00      0.00   40           LAB
4092763   FCTR INHIBITOR TEST                 114.30      0.00   40           LAB
4092672   FCTR IX                              67.50      0.00   40           LAB
4092938   FCTR IX                             127.50      0.00   40           LAB
4055356   FCTR IX                              96.60      0.00   40           LAB
4092649   FCTR V                               49.00      0.00   40           LAB
4094678   FCTR V                               92.45      0.00   40           LAB
4092904   FCTR V                              127.50      0.00   40           LAB
4055265   FCTR V                              107.00      0.00   40           LAB
4092912   FCTR VII                            127.50      0.00   40           LAB
4092656   FCTR VII                             59.00      0.00   40           LAB
4055273   FCTR VII                            107.00      0.00   40           LAB
4051116   FCTR VIII                           281.00    133.00   40           LAB
4092664   FCTR VIII                            45.00      0.00   40           LAB
4092920   FCTR VIII                           127.50      0.00   40           LAB
4051215   FCTR VIII VW                        121.00      0.00   40           LAB
4092862   FCTR VIII VW AG                      59.00      0.00   40           LAB
4055349   FCTR VIII VW AG                     102.46      0.00   40           LAB
4098372   FCTR VIII VW MULTIMER               187.75      0.00   40           LAB
4092870   FCTR VIII VW MULTIMER                69.00      0.00   40           LAB
4055281   FCTR X                              109.00      0.00   40           LAB
4092680   FCTR X                               59.00      0.00   40           LAB
4092946   FCTR X                              127.50      0.00   40           LAB
4055315   FCTR XA AB CHROMGN                   97.40      0.00   40           LAB
4092698   FCTR XI                              49.00      0.00   40           LAB
4055364   FCTR XI                              96.60      0.00   40           LAB
4092953   FCTR XI                             127.50      0.00   40           LAB
4051140   FCTR XII                            109.00      0.00   40           LAB
4092961   FCTR XII                            127.50      0.00   40           LAB
4092706   FCTR XII                             49.00      0.00   40           LAB
4092714   FCTR XIII                            40.00      0.00   40           LAB
4092979   FCTR XIII SCRN                       50.00      0.00   40           LAB
4050084   FERRITIN                            108.00      0.00   40           LAB
4055257   FETAL FIBRONECTIN                   382.00      0.00   40           LAB
4050811   FETAL FIBRONECTIN                     7.00      0.00   40           LAB
4051157   FETAL RBC SMR (K B)                 101.00      0.00   40           LAB




                                                   Page 67
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4050878   FETAL RBC SMR (K B)                73.00      0.00   40           LAB
4040143   FETAL SCRN ROSETTE                106.00      0.00   40           LAB
4030169   FIBRIN DEGRAD PROD                197.00     49.00   40           LAB
4096673   FIBRINOGEN QN                      15.00      0.00   40           LAB
4030177   FIBRINOGEN QN                     184.00     37.00   40           LAB
4092722   FIBRINOGEN QN                      15.00      0.00   40           LAB
4094710   FLECAINIDE                         20.10      0.00   40           LAB
4094165   FLUOR AB SCRN EA AB SCRN           30.00      0.00   40           LAB
4020392   FNA ADEQUACY EVAL                 243.00      0.00   40           LAB
4020111   FNA INTERP & RPT                   38.00      0.00   40           LAB
4050092   FOLATE                            108.00      0.00   40           LAB
4090361   FOLATE RBC                         19.90      0.00   40           LAB
4090866   FREE T4                            19.90      0.00   40           LAB
4050894   FREE T4                           121.00      0.00   40           LAB
4093449   FRUCTOSAMINE                       10.25      0.00   40           LAB
4050100   FSH                               135.00      0.00   40           LAB
4095956   FTA ABS (TPPA)                      8.85      0.00   40           LAB
4095063   G6PD QN                             0.00      0.00   40           LAB
4094934   G6PD QN                            14.00      0.00   40           LAB
4093183   GANGLIOSIDE GMI AUTO AB            50.00      0.00   40           LAB
4093597   GANGLIOSIDE GMI AUTO AB            26.00      0.00   40           LAB
4090379   GASTRIN                            15.00      0.00   40           LAB
4098364   GBM AB                             42.00      0.00   40           LAB
4093175   GBM AB                             42.00      0.00   40           LAB
4095279   GC AMP PRB                         30.00      0.00   40           LAB
4081428   GC AMP PRB                         90.00     39.00   40           LAB
4091013   GC DIR PRB                         21.12      0.00   40           LAB
4081154   GC DIR PRB                         93.00     35.00   40           LAB
4010682   GENTAMICIN                        380.00      0.00   40           LAB
4010674   GENTAMICIN                        380.00      0.00   40           LAB
4010666   GGT                               138.00     25.00   40           LAB
4081055   GIARDIA AG DFA                     97.00     17.00   40           LAB
4081394   GIARDIA AG EIA                     54.00     34.00   40           LAB
4010757   GLUC PRENAT 50 GM SCRN             37.00      0.00   40           LAB
4093456   GLUCAGON                           25.00      0.00   40           LAB
4010690   GLUCOSE                            37.00     21.00   40           LAB
4010716   GLUCOSE 2HR PP                     46.00      0.00   40           LAB
4010765   GLUCOSE FLD                       142.00     29.00   40           LAB
4016150   GLUCOSE UR QN                     128.00      0.00   40           LAB
4096582   GLUT ACID DECARB AUTO AB           69.00      0.00   40           LAB
4050308   GLYCOHEMOGLOBIN                    75.00      0.00   40           LAB
4094702   GROWTH HORMONE                     12.50      0.00   40           LAB
4012134   GTT 2HR 1ST 3 SPEC                 63.00     51.00   40           LAB
4010740   GTT ADDED SAMPLE                   26.00      0.00   40           LAB
4080057   H PYLORI AB IGA                    11.00      0.00   40           LAB
4081451   H PYLORI STL EIA                  110.00    110.00   40           LAB
4095311   HANTAVIRUS AB                      25.00      0.00   40           LAB
4094397   HANTAVIRUS AB                      48.00      0.00   40           LAB
4090080   HAPTOGLOBIN QN                     10.00      0.00   40           LAB
4051017   HAV AB IGM                         76.00      0.00   40           LAB
4050985   HAV AB TOTAL                       47.00      0.00   40           LAB
4051009   HB CORE AB IGM                     96.00      0.00   40           LAB
4096848   HBE AB                             10.00      0.00   40           LAB




                                                 Page 68
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4091146   HBE AB                            15.10      0.00   40           LAB
4091153   Hbe AG                            11.00      0.00   40           LAB
4095782   HBE AG                            10.00      0.00   40           LAB
4050977   HBS AG                            65.00      0.00   40           LAB
4050993   HBS AG                            65.00      0.00   40           LAB
4097044   HBS AG NEUTRALIZATION             43.20      0.00   40           LAB
4050845   HCV AB                           120.00      0.00   40           LAB
4094280   HCV AB CONF                       66.00      0.00   40           LAB
4013223   HDL CHOLESTEROL                   36.00     19.00   40           LAB
4094298   HDV (DELTA) AB                    25.00      0.00   40           LAB
4093464   HEAVY METALS BLD QN EA            75.00      0.00   40           LAB
4090387   HEAVY METALS UR QN EA             30.00      0.00   40           LAB
4030250   HEMATOCRIT                        71.00      8.00   40           LAB
4096665   HEMATOCRIT                         5.04      0.00   40           LAB
4030268   HEMOGLOBIN                        71.00      8.00   40           LAB
4096657   HEMOGLOBIN                         5.04      0.00   40           LAB
4096632   HEMOGLOBIN FRACTION QN             5.04      0.00   40           LAB
4098257   HEMOGLOBIN FRACTION QN            30.00      0.00   40           LAB
4092243   HEMOGLOBIN FRACTION QN            15.40      0.00   40           LAB
4093779   HEMOGLOBIN PLAS                   14.65      0.00   40           LAB
4094504   HEMOLYSIN ACID (HAM'S)            42.50      0.00   40           LAB
4092466   HEP B PCR QN                     355.00      0.00   40           LAB
4092219   HEP B PCR QN                     104.98      0.00   40           LAB
4092276   HEP B VIRUS BDNA QN               81.12      0.00   40           LAB
4095600   HEP C VIRAL RNA GENOTYPE         145.35      0.00   40           LAB
4095790   HEP C VIRUS BDNA QN               92.86      0.00   40           LAB
4094629   HEP C VIRUS BDNA QN              135.66      0.00   40           LAB
4094918   HEP C VIRUS PCR QN                94.35      0.00   40           LAB
4092268   HEPARIN ASSAY                     76.50      0.00   40           LAB
4092888   HEPARIN ASSAY                     82.00      0.00   40           LAB
4016184   HEPATIC FUNCTION PNL             173.00     53.00   40           LAB
4011904   HEPATIC FUNCTION PNL             275.00    144.00   40           LAB
4050852   HEPATITIS PNL ACUTE              143.00      0.00   40           LAB
4092755   HEXAGONAL PHASE NEUTRALIZ         46.73      0.00   40           LAB
4090395   HGB ELECTRO                       11.05      0.00   40           LAB
4093472   HISTAMINE                         67.00      0.00   40           LAB
4020400   HISTO STAIN FRZN SECTION          50.00      0.00   40           LAB
4093191   HISTONE AB                        20.00      0.00   40           LAB
4094314   HISTOPLAS AB                      40.50      0.00   40           LAB
4016127   HIV 1 AB                          74.00      0.00   40           LAB
4016093   HIV 1 AB                         238.00    106.00   40           LAB
4097036   HIV 1 QN BDNA                    113.05      0.00   40           LAB
4094751   HIV 1 QN PCR                      76.30      0.00   40           LAB
4096871   HIV 1 QN PCR ULTRA                84.15      0.00   40           LAB
4050860   HIV 1/HIV 2 AB                    74.00      0.00   40           LAB
4094637   HIV 1/HIV 2 AB                     8.75      0.00   40           LAB
4055232   HIV 1/HIV 2 AB                    56.00     27.00   40           LAB
4091179   HLA B27                           25.00      0.00   40           LAB
4092151   HLA TYP A B OR C MULT            400.00      0.00   40           LAB
4092110   HLA TYP DR/DQ MULT               300.00      0.00   40           LAB
4051033   HOMOCYSTINE                      124.00     32.00   40           LAB
4051132   HOMOCYSTINE                       61.00      0.00   40           LAB
4092342   HSV 1 AB IGG                      21.46      0.00   40           LAB




                                                Page 69
                                    85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4091161   HSV 1 AB IGG                          28.50      0.00   40           LAB
4095469   HSV 1 AB IGG                          15.20      0.00   40           LAB
4098141   HSV 1 AB IGM                          16.34      0.00   40           LAB
4095477   HSV 2 AB IGG                          15.20      0.00   40           LAB
4098158   HSV 2 AB IGG                          16.34      0.00   40           LAB
4092359   HSV 2 AB IGG                          21.47      0.00   40           LAB
4092367   HSV AB                                21.47      0.00   40           LAB
4095485   HSV AB                                15.20      0.00   40           LAB
4094306   HSV AB                                41.00      0.00   40           LAB
4098133   HSV AB IGM                            16.34      0.00   40           LAB
4098208   HSV AB IGM                            24.10      0.00   40           LAB
4095584   HSV AMP PRB                          109.25      0.00   40           LAB
4091385   HTLV 1 AB                             25.00      0.00   40           LAB
4094116   HTLV II AB                            51.25      0.00   40           LAB
4093480   HYDROXYPROLINE TOTAL                 109.00      0.00   40           LAB
4091286   IGA                                   40.00      0.00   40           LAB
4095436   IGA                                    8.00      0.00   40           LAB
4092318   IGA                                    7.00      0.00   40           LAB
4093514   IGD                                   21.00      0.00   40           LAB
4091187   IGE                                    3.12      0.00   40           LAB
4095444   IGG                                    8.00      0.00   40           LAB
4091195   IGG                                   40.00      0.00   40           LAB
4097077   IGG                                    8.90      0.00   40           LAB
4092326   IGG                                    7.00      0.00   40           LAB
4097085   IGG                                    8.90      0.00   40           LAB
4093555   IGG SUBCLASSES                        44.00      0.00   40           LAB
4093605   IGG SUBCLASSES                        33.00      0.00   40           LAB
4092334   IGM                                    7.00      0.00   40           LAB
4091971   IGM                                   40.00      0.00   40           LAB
4095451   IGM                                    8.00      0.00   40           LAB
4091278   IGM                                    8.00      0.00   40           LAB
4090759   IMIPRAMINE                            22.00      0.00   40           LAB
4094215   IMMUNE COMPLEX CIQ BIND               16.25      0.00   40           LAB
4098406   IMMUNOASSAY ANALYTE QN               234.00      0.00   40           LAB
4096608   IMMUNOASSAY NONINFECT                 14.25      0.00   40           LAB
4096590   IMMUNOASSAY NONINFECT                 14.25      0.00   40           LAB
4098083   IMMUNOASSAY NONINFECT                 13.00      0.00   40           LAB
4051090   IMMUNOASSAY TUM AG EA                169.00     48.00   40           LAB
4096061   IMMUNOASSAY TUM AG EA                 29.00      0.00   40           LAB
4091211   IMMUNOELCTRO IEP SER                  22.00      0.00   40           LAB
4091203   IMMUNOELCTRO IEP UR                   41.58      0.00   40           LAB
4094595   IMMUNOFIX SER                         89.00      0.00   40           LAB
4094728   IMMUNOFIX UR                          30.25      0.00   40           LAB
4095832   IMMUNOFIX UR                          16.37      0.00   40           LAB
4020277   IMMUNOFL STUDY DIRECT                306.00      0.00   40           LAB
4020335   IMMUNOFL STUDY DIRECT                449.00      0.00   40           LAB
4020269   IMMUNOFL STUDY DIRECT                388.00      0.00   40           LAB
4020210   IMMUNOHISTOCHEMISTRY                 110.00      0.00   40           LAB
4080065   INDIA INK PREP CSF                   112.00     21.00   40           LAB
4081121   INDIA INK PREP CSF                   146.00     46.00   40           LAB
4095725   INFECT AGENT DETECT DFA               19.05      0.00   40           LAB
4094330   INFLUENZA A AB                        16.00      0.00   40           LAB
4081287   INFLUENZA A DFA                      122.00      0.00   40           LAB




                                                    Page 70
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4081436   INFLUENZA AG A OR B EACH           79.00     37.00   40           LAB
4081444   INFLUENZA AG A OR B EACH           79.00     37.00   40           LAB
4094348   INFLUENZA B AB                     16.00      0.00   40           LAB
4081295   INFLUENZA B DFA                   122.00      0.00   40           LAB
4094926   INSULIN                            10.50      0.00   40           LAB
4094355   INSULIN ANTIBODIES                 42.00      0.00   40           LAB
4020376   INTERP BLD SMR                    138.00      0.00   40           LAB
4020087   INTERP BM SMR                     219.00      0.00   40           LAB
4010849   IRON                              142.00     25.00   40           LAB
4010831   IRON BINDING CAPACITY             161.00     33.00   40           LAB
4094900   IRON LIVER TISSUE                  82.55      0.00   40           LAB
4094363   ISLET CL AB                        25.00      0.00   40           LAB
4096723   JO 1 AB                            31.00      0.00   40           LAB
4093027   KETOGENIC STEROIDS FX              31.00      0.00   40           LAB
4010062   KETONES QN                        138.00     17.00   40           LAB
4080081   KOH PREP SKIN HAIR NAIL           112.00     21.00   40           LAB
4095758   LA (SS B) AB                       11.50      0.00   40           LAB
4010872   LACTIC ACID                       130.00     24.00   40           LAB
4010898   LDH                               130.00     25.00   40           LAB
4090932   LDH ISOENZYMES                     14.75      0.00   40           LAB
4092490   LDL BY DIRECT MEASURE              14.00      0.00   40           LAB
4090494   LEAD BLD                            8.08      0.00   40           LAB
4090411   LEGIONELLA AB                      35.00      0.00   40           LAB
4096566   LEGIONELLA AB                      10.50      0.00   40           LAB
4096855   LEGIONELLA PNEUMO DFA              35.00      0.00   40           LAB
4094371   LEPTOSPIRA AN                      32.00      0.00   40           LAB
4093647   LEUCINE AMINOPEOTIDASE             32.00      0.00   40           LAB
4098232   LEUK ALK PHOS                      15.00      0.00   40           LAB
4050209   LH                                145.00      0.00   40           LAB
4094975   LIDOCAINE                          20.30      0.00   40           LAB
4016218   LIPASE                            136.00      0.00   40           LAB
4012290   LIPASE                            153.00     29.00   40           LAB
4010914   LIPID PNL                         148.00     61.00   40           LAB
4010922   LITHIUM                           130.00     29.00   40           LAB
4092284   LYME DISEASE AB                    25.00      0.00   40           LAB
4091302   LYME DISEASE AB                    29.62      0.00   40           LAB
4095410   LYME DISEASE AB                    19.46      0.00   40           LAB
4096764   LYME DISEASE AB IGG WB             25.00      0.00   40           LAB
4092300   LYME DISEASE AB IGM WB             20.29      0.00   40           LAB
4092136   LYMPHOCYTOTOX TTR                  60.00      0.00   40           LAB
4092144   LYMPHOCYTOTOX TTR                  60.00      0.00   40           LAB
4010948   MAGNESIUM                         144.00     25.00   40           LAB
4016200   MAGNESIUM UR                      153.00      0.00   40           LAB
4016234   MAGNESIUM UR TIM                  149.00     34.00   40           LAB
4096467   MASS SPECT/TANDEM QN NES          142.50      0.00   40           LAB
4093662   MERCURY                            19.50      0.00   40           LAB
4095964   MERCURY                            18.00      0.00   40           LAB
4095659   METANEPHRINES BLOOD               118.40      0.00   40           LAB
4096731   METANEPHRINES UR                   17.50      0.00   40           LAB
4093688   METANEPHRINES UR                   37.00      0.00   40           LAB
4090775   METANEPHRINES UR 24HR              23.68      0.00   40           LAB
4095675   METANEPHRINES UR 24HR              28.00      0.00   40           LAB
4051231   METHOTREXATE                      393.00    159.00   40           LAB




                                                 Page 71
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4095972   METHYLMALONIC ACID QN               31.49      0.00   40           LAB
4050407   MICROALBUMIN UR 24HR                82.00      0.00   40           LAB
4050506   MICROALBUMIN UR RAN                 82.00      0.00   40           LAB
4050829   MICROALBUMIN UR RAN                 82.00      0.00   40           LAB
4094769   MICROSOMAL AB                        9.35      0.00   40           LAB
4098109   MISC CHEM TEST                      14.50      0.00   40           LAB
4091377   MISC CHEM TEST                       0.00      0.00   40           LAB
4095048   MISC LAB PROC *1                     0.00      0.00   40           LAB
4013058   MISC TS PROC                       138.00      0.00   40           LAB
4013033   MISC TS PROC                        46.00     40.00   40           LAB
4013025   MISC TS PROC                        34.00     29.00   40           LAB
4013041   MISC TS PROC                       138.00      0.00   40           LAB
4091047   MITOCHONDRIAL AB TTR                11.00      0.00   40           LAB
4098448   MOL DX AMP PATIENT NA               49.88      0.00   40           LAB
4096210   MOL DX AMP PT NA MULTIPLX           28.26      0.00   40           LAB
4095931   MOL DX AMP PT NA MULTIPLX           22.00      0.00   40           LAB
4092532   MOL DX AMP PT NA MULTIPLX           25.57      0.00   40           LAB
4096186   MOL DX ENZ DIGESTION                28.26      0.00   40           LAB
4095907   MOL DX ENZ DIGESTION                22.00      0.00   40           LAB
4094843   MOL DX EXTRACTION                  186.91      0.00   40           LAB
4096178   MOL DX EXTRACTION HI PUR            28.26      0.00   40           LAB
4098414   MOL DX EXTRACTION HI PUR            11.97      0.00   40           LAB
4095923   MOL DX EXTRACTION HI PUR            22.00      0.00   40           LAB
4092508   MOL DX EXTRACTION HI PUR            23.11      0.00   40           LAB
4095915   MOL DX GEL ELECTRO SEP              22.00      0.00   40           LAB
4096194   MOL DX GEL ELECTRO SEP              28.26      0.00   40           LAB
4098422   MOL DX INTERP & RPT                 13.96      0.00   40           LAB
4095949   MOL DX INTERP & RPT                 22.00      0.00   40           LAB
4096228   MOL DX INTERP & RPT                 28.26      0.00   40           LAB
4092540   MOL DX INTERP & RPT                 23.11      0.00   40           LAB
4098430   MOL DX NUC ACID PRB                 11.97      0.00   40           LAB
4092524   MOL DX NUC ACID PRB                 25.57      0.00   40           LAB
4092516   MOL DX NUC ACID PRB                 25.57      0.00   40           LAB
4080370   MONO TEST SCRN                     161.00      0.00   40           LAB
4091237   MUMPS AB IGG                        22.85      0.00   40           LAB
4094389   MUMPS AB IGM                        17.25      0.00   40           LAB
4096293   MURAMIDASE                          18.00      0.00   40           LAB
4094512   MURAMIDASE                          43.00      0.00   40           LAB
4091245   MYCOPLAS AB                         52.00      0.00   40           LAB
4095493   MYCOPLAS AB IGG                     15.00      0.00   40           LAB
4092375   MYCOPLAS AB IGG                     22.10      0.00   40           LAB
4095501   MYCOPLAS AB IGM                     15.00      0.00   40           LAB
4092383   MYCOPLAS AB IGM                     22.10      0.00   40           LAB
4098505   MYCOPLAS CULT                       24.15      0.00   40           LAB
4080107   MYCOPLAS CULT                       47.00      0.00   40           LAB
4093696   MYELIN BASIC PROTEIN CSF            19.00      0.00   40           LAB
4095774   MYOGLOBIN                           26.50      0.00   40           LAB
4090429   MYOGLOBIN UR                        15.00      0.00   40           LAB
4013207   NATRIURETIC PEPTIDE                458.00      0.00   40           LAB
4093217   NATRIURETIC PEPTIDE                 73.00      0.00   40           LAB
4095196   NB GENETIC SCR GALACT               15.40      0.00   40           LAB
4096913   NEURONAL AB (HU AB) SCRN            75.00      0.00   40           LAB
4093704   NEURONTIN                           25.00      0.00   40           LAB




                                                  Page 72
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4090809   NEWBORN SCRN PANEL                  6.00      0.00   40           LAB
4090791   NORTRIPTYLINE                      16.40      0.00   40           LAB
4080388   OCCULT BLD GASTRIC QL              16.00      0.00   40           LAB
4080115   OCCULT BLD STL QL DIAG             71.00     15.00   40           LAB
4097093   OLIGOCLONAL BANDS CSF               8.90      0.00   40           LAB
4093720   OLIGOCLONAL BANDS CSF              17.50      0.00   40           LAB
4013181   OPIATES SCRN                       48.00     11.00   40           LAB
4093738   ORGANIC ACIDS QN TOTAL            125.00      0.00   40           LAB
4011011   OSMOLALITY SER                    138.00     29.00   40           LAB
4011029   OSMOLALITY UR                     142.00     29.00   40           LAB
4080248   OVA & PARASITES W CONC            231.00     61.00   40           LAB
4090437   OXALATE UR                         12.00      0.00   40           LAB
4096483   OXYCARBAZEPINE                     27.00      0.00   40           LAB
4020046   PAP SCRN C/V MD INTERP             20.00      0.00   40           LAB
4081303   PARAINFLUENZA TYP 1 FA            122.00      0.00   40           LAB
4081311   PARAINFLUENZA TYP 2 FA            122.00      0.00   40           LAB
4081329   PARAINFLUENZA TYP 3 FA            122.00      0.00   40           LAB
4096822   PARVOVIRUS B 19 DNA PCR            85.00      0.00   40           LAB
4095709   PARVOVIRUS B19 AB IGG              15.00      0.00   40           LAB
4095717   PARVOVIRUS B19 AB IGM              15.00      0.00   40           LAB
4020095   PATH CONSULT INTRAOP               57.00      0.00   40           LAB
4020129   PATH FRZN SECTION 1 BLK            82.00      0.00   40           LAB
4013199   PCP SCRN                            0.00      0.00   40           LAB
4012035   PH FLD                             13.00      0.00   40           LAB
4092474   PH FLD                             20.00      0.00   40           LAB
4011045   PHENOBARBITAL                     354.00     83.00   40           LAB
4093761   PHENYLALANINE BLOOD                37.50      0.00   40           LAB
4095188   PHENYLALANINE BLOOD                15.40      0.00   40           LAB
4010567   PHENYTOIN TOTAL                   354.00     83.00   40           LAB
4092581   PHOSPHOLIPID AB                    23.14      0.00   40           LAB
4094611   PHOSPHOLIPID AB                   120.36      0.00   40           LAB
4090445   PHOSPHOROUS UR RAN                  9.24      0.00   40           LAB
4016143   PHOSPHOROUS UR RAN                 36.00      0.00   40           LAB
4016135   PHOSPHOROUS UR RAN                 36.00      0.00   40           LAB
4011052   PHOSPHORUS (PO4)                   37.00     21.00   40           LAB
4010021   PHOSPHORUS UR 24HR                167.00     36.00   40           LAB
4080123   PINWORM CELLOPHANE TAPE            42.00      0.00   40           LAB
4096335   PLT AB DIR IGG                     54.09      0.00   40           LAB
4094660   PLT AB DRG INDUCED                 70.80      0.00   40           LAB
4095733   PLT AB HEPARIN                     60.00      0.00   40           LAB
4096087   PLT AB INDIRECT                    10.00      0.00   40           LAB
4051199   PLT AGGREGATION EA AGENT           67.00      0.00   40           LAB
4051165   PLT AGGREGATION EA AGENT           67.00      0.00   40           LAB
4051207   PLT AGGREGATION EA AGENT           67.00      0.00   40           LAB
4051173   PLT AGGREGATION EA AGENT           67.00      0.00   40           LAB
4051181   PLT AGGREGATION EA AGENT           67.00      0.00   40           LAB
4030219   PLT CNT AUTO                      138.00     17.00   40           LAB
4092771   PLT NEUTRALIZATION                 27.07      0.00   40           LAB
4095550   PNEUMOCYSTIS CARINII DFA           40.50      0.00   40           LAB
4093795   PORPHOBILINOGEN QN                 25.00      0.00   40           LAB
4096525   PORPHYRINS UR QN&FX                 5.93      0.00   40           LAB
4093803   PORPHYRINS UR QN&FX                46.50      0.00   40           LAB
4011078   POTASSIUM                          39.00     21.00   40           LAB




                                                 Page 73
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4012258   POTASSIUM UR 24 HR                167.00     36.00   40           LAB
4016242   POTASSIUM UR TIM                  149.00     34.00   40           LAB
4093811   PREALBUMIN                          9.75      0.00   40           LAB
4093837   PREGNENOLONE                       36.50      0.00   40           LAB
4090817   PRIMIDONE                          22.85      0.00   40           LAB
4011136   PROCAINAMIDE & NAPA               376.00     91.00   40           LAB
4093845   PROINSULIN                        126.00      0.00   40           LAB
4051025   PROLACTIN                         169.00     37.00   40           LAB
4093787   PROPHOBILINOGEN UR QL              21.50      0.00   40           LAB
4096715   PROTEIN C ACTIVATED                45.00      0.00   40           LAB
4050951   PROTEIN C ACTIVITY                171.00      0.00   40           LAB
4092789   PROTEIN C AG                       35.00      0.00   40           LAB
4093860   PROTEIN ELECTRO CSF                71.00      0.00   40           LAB
4090940   PROTEIN ELECTRO SER                18.00      0.00   40           LAB
4095576   PROTEIN ELECTRO SER                14.25      0.00   40           LAB
4096103   PROTEIN ELECTRO SER                 5.00      0.00   40           LAB
4090312   PROTEIN ELECTRO UR                 34.00      0.00   40           LAB
4095824   PROTEIN ELECTRO UR                 16.37      0.00   40           LAB
4096137   PROTEIN NEPHELOMET                  5.00      0.00   40           LAB
4096129   PROTEIN NEPHELOMET                  5.00      0.00   40           LAB
4050969   PROTEIN S ACTIVITY                198.00      0.00   40           LAB
4092797   PROTEIN S AG TOTAL                 35.00      0.00   40           LAB
4092805   PROTEIN S FREE                     91.00      0.00   40           LAB
4096111   PROTEIN TOTAL BLOOD                 5.00      0.00   40           LAB
4012118   PROTEIN TOTAL BLOOD               133.00     24.00   40           LAB
4095808   PROTEIN TOTAL BLOOD                16.37      0.00   40           LAB
4011185   PROTEIN TOTAL CSF                 142.00     29.00   40           LAB
4011177   PROTEIN TOTAL FLD                  39.00     21.00   40           LAB
4095816   PROTEIN UR QN 24 HR                16.37      0.00   40           LAB
4012225   PROTEIN UR QN 24 HR               167.00     36.00   40           LAB
4012266   PROTEIN UR QN RAN                 142.00     25.00   40           LAB
4096905   PROTEIN WESTERN BLOT               75.00      0.00   40           LAB
4092813   PROTHROMBIN TIME                    7.86      0.00   40           LAB
4030235   PROTHROMBIN TIME                  165.00     25.00   40           LAB
4092821   PROTHROMBIN TIME SUBT EA           26.10      0.00   40           LAB
4055430   PSA FREE                           75.00      0.00   40           LAB
4095170   PSA FREE                           20.19      0.00   40           LAB
4055422   PSA TOTAL                          89.00      0.00   40           LAB
4050837   PSA TOTAL                         278.00     77.00   40           LAB
4011144   PSA TOTAL DIAG                    262.00     77.00   40           LAB
4093753   PTH C TERMINAL                     39.00      0.00   40           LAB
4090841   PTH INTACT                         14.25      0.00   40           LAB
4096426   PTH RELATED PROTEIN                55.00      0.00   40           LAB
4092839   PTT PLAS OR WB                      6.77      0.00   40           LAB
4030243   PTT PLAS OR WB                    176.00     32.00   40           LAB
4092847   PTT SUBSTITUTION EA                20.00      0.00   40           LAB
4030409   PTT SUBSTITUTION EA                94.75      0.00   40           LAB
4093878   PYRUVATE BLD                       15.00      0.00   40           LAB
4094421   Q FEVER AB                         30.00      0.00   40           LAB
4094413   Q FEVER AB                         30.00      0.00   40           LAB
4095683   QN DRG MISC                        47.14      0.00   40           LAB
4090288   QN DRG MISC                       100.50      0.00   40           LAB
4093431   QN DRG MISC                        36.00      0.00   40           LAB




                                                 Page 74
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4093613   QN DRG MISC                        25.00      0.00   40           LAB
4093654   QN DRG MISC                        30.00      0.00   40           LAB
4093852   QN DRG MISC                        31.50      0.00   40           LAB
4096921   QN DRG MISC                        76.00      0.00   40           LAB
4096939   QN DRG MISC                        82.55      0.00   40           LAB
4096343   QN DRG MISC                       124.50      0.00   40           LAB
4090536   QN DRG MISC                        20.50      0.00   40           LAB
4095204   QUINIDINE                         270.00      0.00   40           LAB
4011227   QUINIDINE                         354.00     83.00   40           LAB
4092565   RAPAMYCIN (SIROLIMUS)              55.00      0.00   40           LAB
4090031   RBC PRETRTMT CHEM/DRG              80.00      0.00   40           LAB
4090049   RBC PRETRTMT DENSITY GRAD         125.00      0.00   40           LAB
4090023   RBC PRETRTMT ENZYME                80.00      0.00   40           LAB
4020228   RECEPT ASSAY ESTROGEN             681.00      0.00   40           LAB
4020251   RECEPT ASSAY PROGEST              524.00      0.00   40           LAB
4051108   RECEPT ASSAY PROGEST              169.00     37.00   40           LAB
4013116   RENAL FUNCTION PNL                371.00    184.00   40           LAB
4095741   RENIN                              18.00      0.00   40           LAB
4090858   RENIN                              16.50      0.00   40           LAB
4030284   RETICULOCYTE MAN                  172.00     30.00   40           LAB
4090015   RH PHENOTYP COMPLETE               15.00      0.00   40           LAB
4040085   RH TYP                            104.00     16.00   40           LAB
4050704   RHEUMATOID FCTR QL                133.00      0.00   40           LAB
4098307   RHEUMATOID FCTR QN                 11.25      0.00   40           LAB
4050605   RHEUMATOID FCTR QN                110.00      0.00   40           LAB
4097010   RIBOSOMAL P AB                     33.00      0.00   40           LAB
4098315   RIBOSOMAL P AB                     11.25      0.00   40           LAB
4092987   RISTOCETIN COFACTOR                87.00      0.00   40           LAB
4092854   RISTOCETIN COFACTOR               108.00      0.00   40           LAB
4095766   RO(SS A) AB                        11.50      0.00   40           LAB
4080412   ROTAVIRUS AG EIA                  161.00      0.00   40           LAB
4080396   RPR QL                            105.00      0.00   40           LAB
4080404   RSV AG EIA                        161.00      0.00   40           LAB
4081196   RSV DFA                           142.00     40.00   40           LAB
4092177   RUBELLA AB                         73.15      0.00   40           LAB
4051082   RUBELLA AB                         84.00     21.00   40           LAB
4098174   RUBELLA AB IGG                     16.34      0.00   40           LAB
4098166   RUBELLA AB IGM                     16.34      0.00   40           LAB
4091369   RUBEOLA AB                         20.00      0.00   40           LAB
4055240   RUSSELL VIPER VENOM DILU          208.00      0.00   40           LAB
4011342   SALICYLATE                        354.00     83.00   40           LAB
4094652   SCLERODERMA AB                      9.00      0.00   40           LAB
4030292   SEDIMENTATION RATE MAN            138.00     22.00   40           LAB
4011474   SEM MOT/CNT (NO HUHNER)            35.00      0.00   40           LAB
4011367   SEMEN ANALYSIS COMPLETE            94.00      0.00   40           LAB
4030391   SEMEN PRESENCE/MOT POST            39.00     37.00   40           LAB
4013009   SEMEN PRESENCE/MOT POST            31.00     27.00   40           LAB
4090650   SER BACTERICIDAL TTR               42.95      0.00   40           LAB
4081337   SER BACTERICIDAL TTR              227.00      0.00   40           LAB
4092045   SER PRETRTMT ABSORB                75.00      0.00   40           LAB
4020319   SER PRETRTMT ABSORB               179.00      0.00   40           LAB
4090064   SER PRETRTMT ABSORB                70.00      0.00   40           LAB
4040168   SER PRETRTMT ABSORB               179.00      0.00   40           LAB




                                                 Page 75
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4092052   SER PRETRTMT INCUB/ DRG             65.00      0.00   40           LAB
4096889   SEROTONIN BLD                       50.00      0.00   40           LAB
4093886   SEROTONIN BLD                       49.00      0.00   40           LAB
4096251   SJOGRENS AB                         11.62      0.00   40           LAB
4030300   SKIN TEST CANDIDA                  113.00     19.00   40           LAB
4030318   SKIN TEST COCCI                    113.00     19.00   40           LAB
4030342   SKIN TEST HISTO                    113.00     19.00   40           LAB
4030326   SKIN TEST MUMPS                    113.00     19.00   40           LAB
4030375   SKIN TEST TB                       113.00     19.00   40           LAB
4092425   SMITH AB                            12.50      0.00   40           LAB
4092417   SMITH AB                            12.50      0.00   40           LAB
4091054   SMOOTH MUSCLE AB SCRN               22.50      0.00   40           LAB
4081386   SMR AFB STAIN                       80.00      0.00   40           LAB
4080446   SMR FLUOR + OR ACID FAST            79.00      0.00   40           LAB
4030359   SMR GIEMSA                         125.00     17.00   40           LAB
4080032   SMR GRAM STAIN                     112.00     17.00   40           LAB
4081014   SMR INCL BODIES PARASITE            63.00     56.00   40           LAB
4080206   SMR WET MOUNT                       94.00     15.00   40           LAB
4011441   SODIUM                              39.00     21.00   40           LAB
4011433   SODIUM FLD                          37.00      0.00   40           LAB
4096145   SODIUM OTHER SOURCE                  8.00      0.00   40           LAB
4096152   SODIUM OTHER SOURCE                  8.00      0.00   40           LAB
4096160   SODIUM OTHER SOURCE                  8.00      0.00   40           LAB
4012241   SODIUM UR 24HR                     167.00     36.00   40           LAB
4011458   SODIUM UR RAN                      142.00      0.00   40           LAB
4093894   SOMATOMEDIN C                       25.00      0.00   40           LAB
4080420   SPEC CONCENTRATION                  53.00      0.00   40           LAB
4080511   SPEC CONCENTRATION                 131.00      0.00   40           LAB
4011466   SPEC GRAVITY FLD                    37.00      0.00   40           LAB
4010906   SPEC HANDL LGL BLD ALC              42.00     33.00   40           LAB
4011540   SPEC HANDL UR DRG SCRN              80.00      0.00   40           LAB
4020194   SPEC STAIN GRP I MICROORG           40.00      0.00   40           LAB
4020202   SPEC STAIN GRP II                   42.00      0.00   40           LAB
4080487   SPEC STAIN GRP II                   79.00      0.00   40           LAB
4081204   STREP GRP A AG EIA                  88.00     76.00   40           LAB
4098299   STRIATED MUSCLE AB SCRN             17.00      0.00   40           LAB
4094181   STRIATED MUSCLE AB TTR              17.00      0.00   40           LAB
4020186   SURG PATH LVL I                     46.00      0.00   40           LAB
4020178   SURG PATH LVL II                   161.00      0.00   40           LAB
4020152   SURG PATH LVL III                  179.00      0.00   40           LAB
4020327   SURG PATH LVL IV                   197.00      0.00   40           LAB
4020137   SURG PATH LVL V                    574.00      0.00   40           LAB
4020145   SURG PATH LVL V                    278.00      0.00   40           LAB
4081469   SUSCEPT BY E TEST                   10.00      0.00   40           LAB
4080438   SUSCEPT BY ENZYME DETECT            79.00      0.00   40           LAB
4080131   SUSCEPT BY MIC                     263.00     49.00   40           LAB
4080149   SUSCEPT KB DISK <=12               156.00      0.00   40           LAB
4055406   T LMPH TOT CNT                      70.00      0.00   40           LAB
4055323   T LYMPH CD4 (HELPER) CNT            70.00      0.00   40           LAB
4055398   T LYMPH CD4/8 CNT&RATIO             70.00      0.00   40           LAB
4055331   T LYMPH CD4/8 CNT&RATIO            105.00      0.00   40           LAB
4093902   T3 FREE                             11.00      0.00   40           LAB
4093910   T3 REVERSE                          29.00      0.00   40           LAB




                                                  Page 76
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4093928   T3 TOTAL                           10.00      0.00   40           LAB
4011581   T3 UPTAKE                         147.00      0.00   40           LAB
4092557   TACROLIMUS (FK506)                 49.88      0.00   40           LAB
4095006   TACROLIMUS (FK506)                 83.25      0.00   40           LAB
4051074   TACROLIMUS (FK506)                169.00     80.00   40           LAB
4094819   TESTOSTERONE FREE                  21.80      0.00   40           LAB
4095097   TESTOSTERONE TOTAL                 48.00      0.00   40           LAB
4051066   TESTOSTERONE TOTAL                169.00     32.00   40           LAB
4040150   THAWING PROD PER UNIT              37.00      0.00   40           LAB
4011508   THEOPHYLLINE                      354.00     89.00   40           LAB
4030227   THROMBIN TIME                     179.00     29.00   40           LAB
4030334   THROMBIN TIME                     179.00     18.00   40           LAB
4093936   THYR BINDING GLOB (TBG)            18.25      0.00   40           LAB
4096707   THYR STIM IG                       71.25      0.00   40           LAB
4090882   THYROGLOBULIN AB                   19.75      0.00   40           LAB
4095543   THYROGLOBULIN AB                    8.00      0.00   40           LAB
4096277   THYROID PEROXIDASE AB               8.27      0.00   40           LAB
4011490   THYROXINE (T4)                    139.00     36.00   40           LAB
4055299   TISSUE CULT BM/BLD                334.00      0.00   40           LAB
4096434   TISSUE CULT LYMPH                 165.00      0.00   40           LAB
4080495   TISSUE HOMOGENIZATION              53.00      0.00   40           LAB
4011524   TOBRAMYCIN                        380.00     89.00   40           LAB
4091260   TOXOPLAS AB                        24.65      0.00   40           LAB
4095840   TOXOPLAS AB IGG                     8.75      0.00   40           LAB
4098182   TOXOPLAS AB IGG                    16.34      0.00   40           LAB
4098190   TOXOPLAS AB IGM                    16.34      0.00   40           LAB
4091310   TOXOPLAS AB IGM                     3.12      0.00   40           LAB
4095857   TOXOPLAS AB IGM                     8.75      0.00   40           LAB
4093951   TRANSFERRIN                        11.00      0.00   40           LAB
4093969   TRAZODONE (DESYREL)                32.00      0.00   40           LAB
4096509   TRAZODONE (DESYREL)                24.00      0.00   40           LAB
4011557   TRICYCLICS SER                    183.00      0.00   40           LAB
4011565   TRIGLYCERIDE                       39.00     21.00   40           LAB
4012191   TROPONIN I QN                     300.00    269.00   40           LAB
4098216   TRYPSIN                            45.31      0.00   40           LAB
4013215   TSH                                14.00      0.00   40           LAB
4092235   TSH                                15.40      0.00   40           LAB
4092227   TYROSINE                           15.40      0.00   40           LAB
4010039   UR NITROGEN UR 24HR               167.00     36.00   40           LAB
4011599   UR NITROGEN UR RAN                 31.00      0.00   40           LAB
4090486   UR NITROGEN UR RAN                  9.24      0.00   40           LAB
4011607   URIC ACID                         138.00     25.00   40           LAB
4020293   URIC ACID FLD                     138.00     25.00   40           LAB
4010047   URIC ACID UR 24 HR                167.00      0.00   40           LAB
4011672   URNALYSIS AUTO W/O MICRO           13.00      0.00   40           LAB
4011656   URNALYSIS AUTO W/O MICRO           13.00      0.00   40           LAB
4011706   URNALYSIS AUTO W/O MICRO           13.00      0.00   40           LAB
4011714   URNALYSIS AUTO W/O MICRO           37.00      0.00   40           LAB
4011649   URNALYSIS AUTO W/O MICRO           37.00      0.00   40           LAB
4011276   URNALYSIS AUTO W/O MICRO           22.00      0.00   40           LAB
4011680   URNALYSIS AUTO W/O MICRO           35.00      0.00   40           LAB
4011664   URNALYSIS AUTO W/O MICRO           13.00      0.00   40           LAB
4012209   URNALYSIS MAN W/ MICRO            120.00     19.00   40           LAB




                                                 Page 77
                                      85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



4011631   URNALYSIS MAN W/O MICRO                 94.00     19.00   40           LAB
4013363   URNALYSIS SGL ASSAY                     13.00      0.00   40           LAB
4013124   URNALYSIS VOL MEASURE                    0.00      0.00   40           LAB
4011722   VALPROIC ACID                          298.00      0.00   40           LAB
4011730   VANCOMYCIN                             354.00     90.00   40           LAB
4093993   VASOACT INTEST PEPT (VIP)               49.00      0.00   40           LAB
4091294   VDRL CSF QL                              6.00      0.00   40           LAB
4010435   VENIPUNCTURE                            16.00      0.00   40           LAB
4098398   VIRUS AB NOT SPEC                       37.50      0.00   40           LAB
4096400   VIRUS AB NOT SPEC                       42.56      0.00   40           LAB
4098380   VIRUS AB NOT SPEC                       37.50      0.00   40           LAB
4090981   VIRUS CULT ID                           30.00      0.00   40           LAB
4096863   VIRUS CULT SHELL VIAL                   20.00      0.00   40           LAB
4092193   VISCOSITY                               15.00      0.00   40           LAB
4094009   VITAMIN A                               15.77      0.00   40           LAB
4094017   VITAMIN B1 (THIAMINE)                   38.00      0.00   40           LAB
4050019   VITAMIN B12                            119.00      0.00   40           LAB
4094025   VITAMIN B12 BINDING CAP                 15.00      0.00   40           LAB
4090890   VITAMIN B6                              28.00      0.00   40           LAB
4096780   VITAMIN D (125 DI HYDROX)               27.59      0.00   40           LAB
4090916   VITAMIN D (125 DI HYDROX)               35.00      0.00   40           LAB
4096772   VITAMIN D 25HYDROXY                     27.60      0.00   40           LAB
4090908   VITAMIN D 25HYDROXY                     20.19      0.00   40           LAB
4094058   VITAMIN E                               15.75      0.00   40           LAB
4094066   VITAMIN K                               60.00      0.00   40           LAB
4090924   VMA UR                                  20.62      0.00   40           LAB
4094777   VZV AB                                  24.07      0.00   40           LAB
4095865   VZV AB IGM                              12.50      0.00   40           LAB
4096699   WBC CNT AUTO                            10.00      0.00   40           LAB
4096806   WEST NILE VIRUS AB IGG                  28.00      0.00   40           LAB
4096814   WEST NILE VIRUS AB IGM                  28.00      0.00   40           LAB
4094074   ZINC                                    12.00      0.00   40           LAB
1103332   S NSTRL CAST CYLINDER                  270.00      0.00   11           MISC NURSING CHARGES (TRA
1103308   S NSTRL CAST LONG ARM                  304.00      0.00   11           MISC NURSING CHARGES (TRA
1103324   S NSTRL CAST LONG LEG                  344.00      0.00   11           MISC NURSING CHARGES (TRA
1103357   S NSTRL CAST PTB                       363.00      0.00   11           MISC NURSING CHARGES (TRA
1103373   S NSTRL CAST SHORT ARM                 417.00      0.00   11           MISC NURSING CHARGES (TRA
1103316   S NSTRL CAST SHORT LEG                 210.00      0.00   11           MISC NURSING CHARGES (TRA
1103431   S NSTRL SPLINT APP LONG L              574.00      0.00   11           MISC NURSING CHARGES (TRA
1103423   S NSTRL SPLINT APP SHORT               287.00      0.00   11           MISC NURSING CHARGES (TRA
1103407   S NSTRL SPLINT LONG ARM                383.00      0.00   11           MISC NURSING CHARGES (TRA
1103415   S NSTRL SPLINT/APP SHORT               287.00      0.00   11           MISC NURSING CHARGES (TRA
6230056   CIRCUMCISION                           217.00      0.00   62           NEONATAL/NEWBORN SERVICES
6120117   CERCLAGE, VAGINAL                      767.00      0.00   61           OB/GYN SERVICES - IP
6120026   DELIVERY VAGINAL LEVEL 1              2870.00      0.00   61           OB/GYN SERVICES - IP
6120125   DELIVERY VAGINAL LEVEL 2              4305.00      0.00   61           OB/GYN SERVICES - IP
6120083   EXTERNAL VERSION                       489.00      0.00   61           OB/GYN SERVICES - IP
6120109   INJ BLOOD PATCH                        767.00      0.00   61           OB/GYN SERVICES - IP
6120000   LABOR LEVEL 1 / HR-IP                   91.00      0.00   61           OB/GYN SERVICES - IP
6120091   LABOR LEVEL 2 / HR-IP                  142.00      0.00   61           OB/GYN SERVICES - IP
6120182   NST (NON-STRESS TEST)                  405.00      0.00   61           OB/GYN SERVICES - IP
6120216   NST MULTI GEST                         810.00      0.00   61           OB/GYN SERVICES - IP
6120208   NST MULTI GEST                         608.00      0.00   61           OB/GYN SERVICES - IP




                                                      Page 78
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



6140370   PULSE OXIMETRY-SINGLE             110.00      0.00   61           OB/GYN SERVICES - IP
6130132   REG ADD 15M                        39.00      0.00   61           OB/GYN SERVICES - IP
6130124   REG FIRST 30M                      79.00      0.00   61           OB/GYN SERVICES - IP
6140305   S STRL AMNIHOOK                    65.00      0.00   61           OB/GYN SERVICES - IP
6140214   S STRL BOVIE PENCIL DISPO         179.00      0.00   61           OB/GYN SERVICES - IP
6140065   S STRL CATH UMBILICAL             426.00      0.00   61           OB/GYN SERVICES - IP
6140347   S STRL ELECTRODE FETAL SP          34.00      0.00   61           OB/GYN SERVICES - IP
6140032   S STRL KIT BREAST PUMP             46.06      0.00   61           OB/GYN SERVICES - IP
6140339   S STRL NEEDLE FERGUSON             63.00      0.00   61           OB/GYN SERVICES - IP
6140008   S STRL NEEDLE SPINAL 25G          167.00      0.00   61           OB/GYN SERVICES - IP
6140206   S STRL NEEDLE SPINAL WHIT         188.00      0.00   61           OB/GYN SERVICES - IP
6140388   S STRL NIPPLE SHIELD               15.00      0.00   61           OB/GYN SERVICES - IP
6140297   S STRL NURSE SYS SUPPLMNT         525.00      0.00   61           OB/GYN SERVICES - IP
6140073   S STRL PAD GROUND PT              181.00      0.00   61           OB/GYN SERVICES - IP
6140016   S STRL STAPLE SKIN 35W            290.00      0.00   61           OB/GYN SERVICES - IP
6140354   S STRL STRAP FETAL MONITO          12.00      0.00   61           OB/GYN SERVICES - IP
6140172   S STRL SUTURE 0 GS21 POLY         101.00      0.00   61           OB/GYN SERVICES - IP
6140123   S STRL SUTURE 0 GS24 POLY         101.00      0.00   61           OB/GYN SERVICES - IP
6140230   S STRL SUTURE 0 POLY TIES         102.00      0.00   61           OB/GYN SERVICES - IP
6140248   S STRL SUTURE 2-0 CHROMIC          90.00      0.00   61           OB/GYN SERVICES - IP
6140164   S STRL SUTURE 2-0 GS21 PO         101.00      0.00   61           OB/GYN SERVICES - IP
6140149   S STRL SUTURE 2-0 GS-24 P         101.00      0.00   61           OB/GYN SERVICES - IP
6140131   S STRL SUTURE 2-0 GS-25 P         101.00      0.00   61           OB/GYN SERVICES - IP
6140198   S STRL SUTURE 2-0 POLYSOR         215.00      0.00   61           OB/GYN SERVICES - IP
6140289   S STRL SUTURE 2-0 V20 POL          90.00      0.00   61           OB/GYN SERVICES - IP
6140255   S STRL SUTURE 3-0 CHROMIC          90.00      0.00   61           OB/GYN SERVICES - IP
6140156   S STRL SUTURE 3-0 GS21 PO         101.00      0.00   61           OB/GYN SERVICES - IP
6140222   S STRL SUTURE 3-0 POLY TI         102.00      0.00   61           OB/GYN SERVICES - IP
6140081   S STRL SUTURE 3-0 POLYSOR         101.00      0.00   61           OB/GYN SERVICES - IP
6140263   S STRL SUTURE 4-0 CHROMIC          90.00      0.00   61           OB/GYN SERVICES - IP
6140180   S STRL SUTURE 4-0 P12 POL         257.00      0.00   61           OB/GYN SERVICES - IP
6140099   S STRL SUTURE 4-0 POLYSOR         101.00      0.00   61           OB/GYN SERVICES - IP
6140115   S STRL SUTURE BIOSYN 0 GS         101.00      0.00   61           OB/GYN SERVICES - IP
6140107   S STRL SUTURE GEN CL TAPE         101.00      0.00   61           OB/GYN SERVICES - IP
6140271   S STRL SUTURE GI SINGLE            90.00      0.00   61           OB/GYN SERVICES - IP
6140321   S STRL TRANDUCER INTERUTE         183.00      0.00   61           OB/GYN SERVICES - IP
6140040   S STRL TRAY EPIDURAL              416.00      0.00   61           OB/GYN SERVICES - IP
6140313   S STRL TRAY PUDENDAL ANES         403.00      0.00   61           OB/GYN SERVICES - IP
6140057   S STRL TRAY SPINAL W/DRUG         416.00      0.00   61           OB/GYN SERVICES - IP
6140024   S STRL VACUUM EXTRACTOR           291.00      0.00   61           OB/GYN SERVICES - IP
6140362   STATISTICAL TRACKING                0.00      0.00   61           OB/GYN SERVICES - IP
6130116   STND GENRL ANES ADD 15M           275.00      0.00   61           OB/GYN SERVICES - IP
6130108   STND GENRL ANES FIRST 30M         551.00      0.00   61           OB/GYN SERVICES - IP
6120059   STND PACU LVL 1 ADD 15M           217.00      0.00   61           OB/GYN SERVICES - IP
6130140   STND PACU LVL 1 FIRST 30M         433.00      0.00   61           OB/GYN SERVICES - IP
6130025   SURG LVL 1 ADD 15M                767.00      0.00   61           OB/GYN SERVICES - IP
6130017   SURG LVL 1 FIRST 30M             1534.00      0.00   61           OB/GYN SERVICES - IP
6130041   SURG LVL 2 ADD 15M               1003.00      0.00   61           OB/GYN SERVICES - IP
6130033   SURG LVL 2 FIRST 30M             2006.00      0.00   61           OB/GYN SERVICES - IP
6130066   SURG LVL 3 ADD 15M               1140.00      0.00   61           OB/GYN SERVICES - IP
6130058   SURG LVL 3 FIRST 30M             2962.00      0.00   61           OB/GYN SERVICES - IP
6120174   TRANSFUSION SRV FETAL               0.00      0.00   61           OB/GYN SERVICES - IP
6010086   AMNIOCENTESIS DX                 1170.00      0.00   60           OB/GYN SERVICES - OP




                                                 Page 79
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



6020135   CERCLAGE, VAGINAL                767.00      0.00   60           OB/GYN SERVICES - OP
6020143   CORDOCENTESIS                    767.00      0.00   60           OB/GYN SERVICES - OP
6020366   CST (CONTRAC STRESS TEST)        461.00      0.00   60           OB/GYN SERVICES - OP
6020150   CST (CONTRAC STRESS TEST)        489.00      0.00   60           OB/GYN SERVICES - OP
6020010   CST (CONTRAC STRESS TEST)        414.00      0.00   60           OB/GYN SERVICES - OP
6020374   CST (CONTRAC STRESS TEST)        461.00      0.00   60           OB/GYN SERVICES - OP
6020168   EXTERNAL VERSION                 489.00      0.00   60           OB/GYN SERVICES - OP
6020176   GLUCOSE FINGERSTICK               37.00      0.00   60           OB/GYN SERVICES - OP
6020317   INFSN W-W/O MED 0-60 MN          131.00      0.00   60           OB/GYN SERVICES - OP
6020325   INFSN W-W/O MED EA ADD HR         99.00      0.00   60           OB/GYN SERVICES - OP
6020184   INJECTION IM/SQ EA               118.00      0.00   60           OB/GYN SERVICES - OP
6020192   INJECTION IV EA                   65.00      0.00   60           OB/GYN SERVICES - OP
6020267   LEVEL 1 EST PATIENT              105.00      0.00   60           OB/GYN SERVICES - OP
6020218   LEVEL 1 NEW PATIENT               99.00      0.00   60           OB/GYN SERVICES - OP
6020275   LEVEL 2 EST PATIENT              116.00      0.00   60           OB/GYN SERVICES - OP
6020226   LEVEL 2 NEW PATIENT              116.00      0.00   60           OB/GYN SERVICES - OP
6020283   LEVEL 3 EST PATIENT              126.00      0.00   60           OB/GYN SERVICES - OP
6020234   LEVEL 3 NEW PATIENT              119.00      0.00   60           OB/GYN SERVICES - OP
6020291   LEVEL 4 EST PATIENT              139.00      0.00   60           OB/GYN SERVICES - OP
6020242   LEVEL 4 NEW PATIENT              139.00      0.00   60           OB/GYN SERVICES - OP
6020309   LEVEL 5 EST PATIENT              154.00      0.00   60           OB/GYN SERVICES - OP
6020259   LEVEL 5 NEW PATIENT              154.00      0.00   60           OB/GYN SERVICES - OP
6020382   NST (NON-STRESS TEST)            573.00      0.00   60           OB/GYN SERVICES - OP
6020358   NST (NON-STRESS TEST)            382.00      0.00   60           OB/GYN SERVICES - OP
6020028   NST (NON-STRESS TEST)            405.00      0.00   60           OB/GYN SERVICES - OP
6020390   NST MULTI GEST                   764.00      0.00   60           OB/GYN SERVICES - OP
6010045   OBSERVATION PER HOUR              96.00      0.00   60           OB/GYN SERVICES - OP
6050009   OBSERVATION PER HOUR             164.00      0.00   60           OB/GYN SERVICES - OP
6010037   OBSERVATION PER HOUR             337.00      0.00   60           OB/GYN SERVICES - OP
6020077   OCT (OXYTOCIN CHLNG TEST)        626.00      0.00   60           OB/GYN SERVICES - OP
6020200   PULSE OXIMETRY-SINGLE            110.00      0.00   60           OB/GYN SERVICES - OP
6041008   S STRL RESUS NEONATL DISP       1029.00      0.00   60           OB/GYN SERVICES - OP
6040000   S STRL STRAP FETAL MONITO         11.00      0.00   60           OB/GYN SERVICES - OP
1230010   RO CONSULT CONT MED PHYSC        405.00      0.00   12           ONCOLOGY SERVICES
1230127   RO DOSIMETRY SPECIAL             498.00      0.00   12           ONCOLOGY SERVICES
1230028   RO IMRT DLVR EA SESSION            0.00      0.00   12           ONCOLOGY SERVICES
1230036   RO IMRT DLVR EA SESSION            0.00      0.00   12           ONCOLOGY SERVICES
1230044   RO ISODOSE PLAN SMPL             717.00      0.00   12           ONCOLOGY SERVICES
1230101   RO RAD PORT FILM(S)              552.00      0.00   12           ONCOLOGY SERVICES
1230069   RO RAD TX 2 AREA 1-5MEV          364.00      0.00   12           ONCOLOGY SERVICES
1230051   RO RAD TX 3/MORE 1-5MEV          426.00      0.00   12           ONCOLOGY SERVICES
1230077   RO RAD TX SNGL 1-5MEV            301.00      0.00   12           ONCOLOGY SERVICES
1230085   RO RAD TX SUPERFICIAL            271.00      0.00   12           ONCOLOGY SERVICES
1230002   RO RADIAT DOSIMETRY CALC        1188.00      0.00   12           ONCOLOGY SERVICES
1230093   RO RADIATION PHYSICS CNSL        829.00      0.00   12           ONCOLOGY SERVICES
1230119   RO SIMULATION SMPL               649.00      0.00   12           ONCOLOGY SERVICES
1260033   S STRL MAMMOTOME 11 GAUGE       1167.00      0.00   12           ONCOLOGY SERVICES
1260041   S STRL MAMMOTOME 11 PROBE       1395.00      0.00   12           ONCOLOGY SERVICES
1260066   S STRL MAMMTM VAC CAN DSP         37.00      0.00   12           ONCOLOGY SERVICES
1260017   S STRL NDL BREAST20X2.5IN         94.00      0.00   12           ONCOLOGY SERVICES
1260025   S STRL NDL BREAST20X3.5           96.00      0.00   12           ONCOLOGY SERVICES
1260009   S STRL NDL BREAST2OX1.5IN         96.00      0.00   12           ONCOLOGY SERVICES
1260074   S STRL TISSUE MARKER             540.00      0.00   12           ONCOLOGY SERVICES




                                                Page 80
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9168907   A & D OINT UD PACKET                $0.00       0.00                91   PHARMACY
9168923   A & D OINTMENT 45GM                 $0.00       0.00                91   PHARMACY
9197385   ABACAVIR 300MG TABLET              $26.88       0.00                91   PHARMACY
9189200   ABCIXIMAB 2MG/ML INJ            $1,181.80       0.00                91   PHARMACY
9107426   ACARBOSE 50MG TABLET               $14.11       0.00                91   PHARMACY
9107798   ACEBUTOLOL 200MG CAPSULE           $14.73       0.00                91   PHARMACY
9179698   ACETAMINOPHEN 100MG/ML DROPS 15ML$0.00          0.00                91   PHARMACY
9128281   ACETAMINOPHEN 120MG SUPP            $0.00       0.00                91   PHARMACY
9128299   ACETAMINOPHEN 325MG SUPP            $0.00       0.00                91   PHARMACY
9100124   ACETAMINOPHEN 325MG TABLET          $0.00       0.00                91   PHARMACY
9137001   ACETAMINOPHEN 325MG/10.15ML CUP     $0.00       0.00                91   PHARMACY
9179706   ACETAMINOPHEN 32MG/ML LIQ 120ML     $0.00       0.00                91   PHARMACY
9100025   ACETAMINOPHEN 500MG TABLET          $0.00       0.00                91   PHARMACY
9128307   ACETAMINOPHEN 650MG SUPP            $0.00       0.00                91   PHARMACY
9100082   ACETAMINOPHEN 80MG CHEW TAB         $0.00       0.00                91   PHARMACY
9155003                                      $
          ACETAMINOPHEN/CODEINE 300/15MG TAB26.05         0.00                91   PHARMACY
9155011                                      $
          ACETAMINOPHEN/CODEINE 300/30MG TAB26.09         0.00                91   PHARMACY
9155029                                      $
          ACETAMINOPHEN/CODEINE 300/60MG TAB26.72         0.00                91   PHARMACY
9159047   ACETAMINOPHEN/CODEINE LIQ 5ML UDCUP$26.36       0.00                91   PHARMACY
9100132   ACETAZOLAMIDE 125MG TABLET         $13.40       0.00                91   PHARMACY
9100140   ACETAZOLAMIDE 250MG TABLET         $13.59       0.00                91   PHARMACY
9310012   ACETAZOLAMIDE 500MG INJ            $95.88       0.00                91   PHARMACY
9100157   ACETAZOLAMIDE SR 500MG CAPSULE $15.52           0.00                91   PHARMACY
9170101   ACETIC ACID 0.25% IRRIG. 1000ML    $31.60       0.00                91   PHARMACY
9173923   ACETIC ACID 2% OTIC SOLN 15ML      $45.44       0.00                91   PHARMACY
9113358   ACETOHYDROXAMIC 250MG TAB          $14.78       0.00                91   PHARMACY
9173865   ACETYLCHOLINE 1% OP SOLN 2ML       $96.94       0.00                91   PHARMACY
9187568   ACETYLCYSTEINE 20% SOLN 30ML       $55.06       0.00                91   PHARMACY
9168162   ACID MANTLE CREAM 120GM            $45.12       0.00                91   PHARMACY
9100033   ACYCLOVIR 200MG CAPSULE            $14.96       0.00                91   PHARMACY
9179714   ACYCLOVIR 40MG/ML SUSP 120ML       $80.95       0.00                91   PHARMACY
9169012   ACYCLOVIR 5% OINTMENT 15GM        $189.26       0.00                91   PHARMACY
9305616   ACYCLOVIR 500MG INJ               $199.76       0.00                91   PHARMACY
9100165   ACYCLOVIR 800MG TABLET             $21.15       0.00                91   PHARMACY
9187519   ADENOSINE 6MG/2ML INJ             $132.76       0.00                91   PHARMACY
9174269   ADVAIR 100/50 DISKUS #28 DISKS    $183.52       0.00                91   PHARMACY
9174277   ADVAIR 250/50 DISKUS #28 DISKS    $220.52       0.00                91   PHARMACY
9174285   ADVAIR 500/50 DISKUS #28 DISKS    $299.82       0.00                91   PHARMACY
9112871   ALBENDAZOLE 200MG TABLET           $15.59       0.00                91   PHARMACY
9195009   ALBUMIN (HUMAN) 5% INJ 500ML      $686.40       0.00                93   PHARMACY
9195017   ALBUMIN 25% INJ 50ML              $461.90       0.00                93   PHARMACY
9132002   ALBUTEROL 0.083% 2.5MG/3ML INH     $15.14       0.00                91   PHARMACY
9179417   ALBUTEROL 0.4MG/ML SYRUP 120ML     $41.06       0.00                91   PHARMACY
9132184   ALBUTEROL 2.5MG/0.5ML INH          $14.52       0.00                91   PHARMACY
9100199   ALBUTEROL 2MG TABLET               $13.36       0.00                91   PHARMACY
9100207   ALBUTEROL 4MG TABLET               $13.66       0.00                91   PHARMACY
9173014   ALBUTEROL INHALER 17GM             $68.26       0.00                91   PHARMACY
9103185   ALBUTEROL SR 4MG TABLET            $14.90       0.00                91   PHARMACY
9310533   ALCOHOL (ETHYL) DEHYD. 98% AMPUL $118.02        0.00                91   PHARMACY
9151093   ALCOHOL 10% /DEXTROSE 5% IV SOLN $123.84        0.00                91   PHARMACY
9107319   ALENDRONATE 10MG TABLET            $17.62       0.00                91   PHARMACY
9100710   ALENDRONATE 35MG TABLET            $47.01       0.00                91   PHARMACY
9108754   ALENDRONATE 5MG TABLET             $17.62       0.00                91   PHARMACY




                                                   Page 81
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9108762   ALENDRONATE 70MG TABLET            $47.01       0.00                91   PHARMACY
9163486   ALFENTANIL 1000MCG/2ML INJ         $93.82       0.00                91   PHARMACY
9103268   ALKA-SELTZER GOLD EFF TABLET        $0.00       0.00                91   PHARMACY
9113325   ALLBEE PLUS VIT C TABLET            $0.00       0.00                91   PHARMACY
9100231   ALLOPURINOL 100MG TABLET           $13.17       0.00                91   PHARMACY
9100249   ALLOPURINOL 300MG TABLET           $13.94       0.00                91   PHARMACY
9170200   ALOE VESTA 2-N-1 OINT 56GM         $32.70       0.00                91   PHARMACY
9155052   ALPRAZOLAM 0.25MG TABLET           $26.71       0.00                91   PHARMACY
9155045   ALPRAZOLAM 0.5MG TABLET            $26.96       0.00                91   PHARMACY
9310004   ALPROSTADIL 500MCG/ML INJ         $300.88       0.00                91   PHARMACY
9193012   ALTEPLASE (TPA) 1MG/ML INJ        $159.51       0.00                91   PHARMACY
9193038   ALTEPLASE 50MG VIAL             $2,989.26       0.00                91   PHARMACY
9100256   ALUMINUM HYDROX 400MG CAP           $0.00       0.00                91   PHARMACY
9178245   ALUMINUM HYDROXIDE GEL              $0.00       0.00                91   PHARMACY
9100264   AMANTADINE 100MG CAPSULE           $13.92       0.00                91   PHARMACY
9168964   AMERICAINE OINTMENT 30GM            $0.00       0.00                91   PHARMACY
9189218   AMIFOSTINE 500MG INJ            $1,055.39       0.00                91   PHARMACY
9305004   AMIKACIN 500MG/2ML INJ            $170.28       0.00                93   PHARMACY
9100272   AMILORIDE 5MG (MIDAMOR) TABLET     $13.67       0.00                91   PHARMACY
9147901   AMINO ACIDS - HBC 7% IV SOLN      $198.72       0.00                91   PHARMACY
9147745   AMINO ACIDS 10% IV SOLN            $99.12       0.00                91   PHARMACY
9147752   AMINO ACIDS 7% IV SOLN             $96.64       0.00                91   PHARMACY
9147760   AMINO ACIDS 8% IV SOLN            $306.62       0.00                91   PHARMACY
9147778   AMINO ACIDS-RF 5.2% IV SOLN       $115.64       0.00                91   PHARMACY
9100280   AMINOCAPROIC ACID 500MG TABLET     $16.20       0.00                91   PHARMACY
9310020   AMINOCAPROIC ACID 5GM/20ML INJ    $105.12       0.00                93   PHARMACY
9310038   AMINOPHYLLINE 250MG/10ML INJ      $103.38       0.00                93   PHARMACY
9310541   AMIODARONE 150MG/3ML INJ          $313.18       0.00                93   PHARMACY
9100215   AMIODARONE 200MG TABLET            $18.66       0.00                91   PHARMACY
9183427   AMITRIPTYLINE 100MG/10ML INJ       $76.20       0.00                91   PHARMACY
9100298   AMITRIPTYLINE 10MG TABLET          $13.08       0.00                91   PHARMACY
9100306   AMITRIPTYLINE 25MG TABLET          $13.45       0.00                91   PHARMACY
9100314   AMITRIPTYLINE 50MG TABLET          $14.02       0.00                91   PHARMACY
9105040   AMLODIPINE (NORVASC) 5MG TABLET $15.62          0.00                91   PHARMACY
9174095   AMMONIA AROMATIC AMPUL             $13.34       0.00                91   PHARMACY
9168246   AMMONIUM LACTATE 12% LOT 400GM $158.78          0.00                91   PHARMACY
9137324   AMOXICILLIN 200MG/5ML UD SUSP      $29.44       0.00                91   PHARMACY
9100330   AMOXICILLIN 250MG CAPSULE          $13.25       0.00                91   PHARMACY
9100348   AMOXICILLIN 500MG CAPSULE          $13.70       0.00                91   PHARMACY
9178021   AMOXICILLIN 50MG/ML SUSP 150ML     $39.60       0.00                91   PHARMACY
9305939   AMPHOTERICIN B INJ                $141.52       0.00                93   PHARMACY
9306317                                     $155.62
          AMPHOTERICIN B LIPID CMPLX (ABELCET) INJ        0.00                93   PHARMACY
9305012                                     $494.26
          AMPHOTERICIN B LIPOSOME (AMBISONE) INJ          0.00                93   PHARMACY
9306242   AMPICILLIN 125MG INJ              $104.92       0.00                93   PHARMACY
9305376   AMPICILLIN 1GM INJ                $105.59       0.00                93   PHARMACY
9306267   AMPICILLIN 1GM/50ML NS (FBC)      $103.76       0.00                93   PHARMACY
9100363   AMPICILLIN 250 MG CAPSULE          $13.19       0.00                91   PHARMACY
9305046   AMPICILLIN 250MG INJ              $103.01       0.00                93   PHARMACY
9305384   AMPICILLIN 2GM INJ                $107.19       0.00                93   PHARMACY
9100371   AMPICILLIN 500MG CAPSULE           $13.52       0.00                91   PHARMACY
9305368   AMPICILLIN 500MG INJ              $105.34       0.00                93   PHARMACY
9179656   AMPICILLIN 50MG/ML SUSP 100ML      $39.52       0.00                91   PHARMACY
9306408   AMPICILLIN SYRINGE in NS          $114.16       0.00                93   PHARMACY




                                                   Page 82
                                    85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9305954   AMPICILLIN/SULBACTAM 3GM INJ       $132.47       0.00                93   PHARMACY
9108598   ANAGRELIDE 0.5MG CAPSULE            $24.07       0.00                91   PHARMACY
9168055   ANALGESIC BALM OINT 30GM             $0.00       0.00                91   PHARMACY
9107285   ANASTROZOLE 1MG TABLET              $27.30       0.00                91   PHARMACY
9310780   ANTITHROMBIN 3 INJ                 $257.16       0.00                93   PHARMACY
9186107   ANTIVENIN(LATRODECTUS) INJ         $115.68       0.00                91   PHARMACY
9186123   ANTIVENIN,CROTALIDAE (SNAKE) INJ $2,200.88       0.00                91   PHARMACY
9128018   ANUSOL HC 25MG SUPP                 $14.60       0.00                91   PHARMACY
9168097   ANUSOL OINTMENT                      $0.00       0.00                91   PHARMACY
9128315   ANUSOL SUPPOSITORY                   $0.00       0.00                91   PHARMACY
9174301   APRACLONIDINE 0.5% OP SOLN 5ML     $150.44       0.00                91   PHARMACY
9173030   APRACLONIDINE 1% OP SOLN 0.1ML      $66.94       0.00                91   PHARMACY
9170176   AQUAPHOR OINTMENT 60GM              $30.06       0.00                91   PHARMACY
9112871   ARIPIPRAZOLE 5MG TABLET             $34.67       0.00                91   PHARMACY
9178047   ASCORBIC ACID 100MG/ML DROPS 50ML $62.86         0.00                91   PHARMACY
9113366   ASCORBIC ACID 500MG CHEW TAB         $0.00       0.00                91   PHARMACY
9100389   ASCORBIC ACID 500MG TABLET           $0.00       0.00                91   PHARMACY
9310053   ASCORBIC ACID 500MG/2ML INJ        $106.00       0.00                93   PHARMACY
9316118   ASPARAGINASE 10,000 UNITS INJ      $577.02       0.00                93   PHARMACY
9168428   ASPERCREME 10% 90GM                 $32.02       0.00                91   PHARMACY
9128265   ASPIRIN 300MG SUPP                   $0.00       0.00                91   PHARMACY
9109414   ASPIRIN 325MG TABLET                 $0.00       0.00                91   PHARMACY
9128273   ASPIRIN 600MG SUPP                   $0.00       0.00                91   PHARMACY
9100058   ASPIRIN 81MG CHEW TABLET             $0.00       0.00                91   PHARMACY
9100652   ASPIRIN BUFFERED 325MG TABLET        $0.00       0.00                91   PHARMACY
9102468   ASPIRIN EC 325MG TABLET              $0.00       0.00                91   PHARMACY
9113291   ASPIRIN EC 81MG TABLET               $0.00       0.00                91   PHARMACY
9100405   ATENOLOL 25MG TABLET                $13.93       0.00                91   PHARMACY
9100397   ATENOLOL 50MG TABLET                $14.50       0.00                91   PHARMACY
9187865   ATENOLOL 5MG/10ML INJ               $67.64       0.00                91   PHARMACY
9106071   ATORVASTATIN 10MG TABLET            $17.34       0.00                91   PHARMACY
9108580   ATORVASTATIN 20MG TABLET            $19.95       0.00                91   PHARMACY
9179813   ATOVAQUONE 750MG/5ML LIQ 120ML $869.60           0.00                91   PHARMACY
9183591   ATRACURIUM 100MG/10ML INJ          $163.66       0.00                91   PHARMACY
9189481   ATROPINE 0.4MG/1ML INJ              $51.76       0.00                91   PHARMACY
9173063   ATROPINE 1% OPHTH SOLN 15ML         $34.36       0.00                91   PHARMACY
9187758   ATROPINE 1MG/10ML SYRINGE           $56.14       0.00                91   PHARMACY
9187022   ATROPINE 1MG/1ML INJ                $51.86       0.00                91   PHARMACY
9100462   AUGMENTIN 250MG TABLET              $18.58       0.00                91   PHARMACY
9178716   AUGMENTIN 400MG/5ML SUSP 75ML      $129.48       0.00                91   PHARMACY
9100447   AUGMENTIN 500MG TABLET              $21.34       0.00                91   PHARMACY
9178062   AUGMENTIN 50MG/ML SUSP 150ML       $183.88       0.00                91   PHARMACY
9107715   AUGMENTIN 875MG TABLET              $24.22       0.00                91   PHARMACY
9173709   AURALGAN OTIC SOLN 15ML             $31.60       0.00                91   PHARMACY
9100421   AURANOFIN 3MG CAP                   $18.40       0.00                91   PHARMACY
9172040   AVITENE 1GM SHEET                  $230.20       0.00                91   PHARMACY
9100470   AZATHIOPRINE 50MG TABLET            $15.60       0.00                91   PHARMACY
9174608   AZELASTINE 137MCG NASAL SPRAY 34ML $144.58       0.00                91   PHARMACY
9113820   AZITHROMYCIN 250MG TABLET           $27.37       0.00                91   PHARMACY
9112871   AZITHROMYCIN 40MG/ML SUSP 15ML      $87.46       0.00                91   PHARMACY
9178732   AZITHROMYCIN 40MG/ML SUSP 30ML      $87.46       0.00                91   PHARMACY
9305913   AZITHROMYCIN 500MG INJ             $153.73       0.00                93   PHARMACY
9305020   AZTREONAM 1GM INJ                  $142.94       0.00                93   PHARMACY




                                                    Page 83
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9305038   AZTREONAM 2GM INJ                 $183.92       0.00                93   PHARMACY
9112871   B COMPLEX W/VITAMIN C TABLET       $12.85       0.00                91   PHARMACY
9305053   BACITRACIN 50,000 UNITS INJ       $125.52       0.00                93   PHARMACY
9169855   BACITRACIN OINT 30GM               $31.42       0.00                91   PHARMACY
9173097   BACITRACIN OPHTH OINT 3.5GM        $33.34       0.00                91   PHARMACY
9172057   BACITRACIN/POLYMYXIN B OINT PKT    $13.10       0.00                91   PHARMACY
9169947   BACITRACIN/POLYMYXIN OINT 30GM     $33.04       0.00                91   PHARMACY
9100512   BACLOFEN 10MG TABLET               $13.51       0.00                91   PHARMACY
9168980   BAG BALM OINTMENT 300GM             $0.00       0.00                91   PHARMACY
9100686   BARIUM SULFATE 9.5GM PACKET        $25.44       0.00                91   PHARMACY
9112871   BB UNLISTED DRUG                    $0.00       0.00                91   PHARMACY
9112871   BBATROPINE 0.4MG/ML 20ML VIAL      $53.88       0.00                91   PHARMACY
9112871   BBGLYCOPYRROLATE 0.2MG/ML 20ML INJ $86.48       0.00                91   PHARMACY
9112871   BBINSULIN HUMAN 70/30               $0.00       0.00                91   PHARMACY
9112871   BBINSULIN HUMAN LENTE               $0.00       0.00                91   PHARMACY
9112871   BBINSULIN HUMAN REGULAR             $0.00       0.00                91   PHARMACY
9112871   BBINSULIN NPH HUMAN                 $0.00       0.00                91   PHARMACY
9112871   BBINSULIN, LISPRO                   $0.00       0.00                91   PHARMACY
9112871   BBNACL 0.9% 10ML VIAL #25           $0.00       0.00                91   PHARMACY
9168154   BECAPLERMIN 0.01% GEL 15GM      $1,026.66       0.00                91   PHARMACY
9175050                                     $120.12
          BECLOMETHASONE 40MCG ORAL INH 7.3GM             0.00                91   PHARMACY
9173121   BECLOMETHASONE 42MCG NASAL INHALER$139.64       0.00                91   PHARMACY
9173105   BECLOMETHASONE 42MCG ORAL INHALER $126.45       0.00                91   PHARMACY
9175068                                     $144.70
          BECLOMETHASONE 80MCG ORAL INH 7.3GM             0.00                91   PHARMACY
9173113   BECLOMETHASONE AQ 42MCG NASAL SPY $153.56       0.00                91   PHARMACY
9174749   BECLOMETHASONE AQ 84MCG NASAL SPY $140.88       0.00                91   PHARMACY
9174806                                     $132.10
          BECLOMETHASONE DS 84MCG ORAL INHALER            0.00                91   PHARMACY
9100538   BENAZEPRIL 10MG TABLET             $14.76       0.00                91   PHARMACY
9100546   BENAZEPRIL 20MG TABLET             $14.76       0.00                91   PHARMACY
9100520   BENAZEPRIL 5MG TABLET              $14.76       0.00                91   PHARMACY
9170440   BENGAY OINTMENT 57GM               $32.52       0.00                91   PHARMACY
9173683   BENOXINATE/FLUORESCEIN OP SOLN 15ML$48.32       0.00                91   PHARMACY
9168956   BENZALKONIUM CHLOR 1:750 SOL       $57.66       0.00                91   PHARMACY
9182114   BENZOCAINE 10% DENTAL GEL 5.3GM $32.04          0.00                91   PHARMACY
9170184   BENZOCAINE 20% (DERMOPLAST) SPRAY $0.00         0.00                91   PHARMACY
9170010   BENZOCAINE 20% (HURRICAINE) GEL    $30.40       0.00                91   PHARMACY
9175076   BENZOCAINE 20% OTIC DROPS 15ML     $50.22       0.00                91   PHARMACY
9100587   BENZONATATE 100MG CAPSULE          $14.63       0.00                91   PHARMACY
9100553   BENZTROPINE 0.5MG TABLET           $13.15       0.00                91   PHARMACY
9100561   BENZTROPINE 1MG TABLET             $13.20       0.00                91   PHARMACY
9189473   BENZTROPINE 2MG/2ML INJ            $67.32       0.00                91   PHARMACY
9132127   BERACTANT INTRATRACHEAL SUSP $1,622.68          0.00                91   PHARMACY
9169079   BETAMETHASONE DP 0.05% CRM 15GM $40.44          0.00                91   PHARMACY
9168543   BETAMETHASONE DP 0.05% OINT 15GM $40.44         0.00                91   PHARMACY
9183609   BETAMETHASONE SOLU 6MG/ML INJ     $103.24       0.00                91   PHARMACY
9168972   BETAMETHASONE VAL 0.1% CRM 15GM $35.34          0.00                91   PHARMACY
9169061   BETAMETHASONE VAL 0.1% LOT 60ML $50.04          0.00                91   PHARMACY
9169053   BETAMETHASONE VAL 0.1% OINT 15GM $35.96         0.00                91   PHARMACY
9173089   BETAXOLOL S 0.25% OPSOL            $95.94       0.00                91   PHARMACY
9100603   BETHANECHOL 10MG TABLET            $15.10       0.00                91   PHARMACY
9100611   BETHANECHOL 25MG TABLET            $15.89       0.00                91   PHARMACY
9100595   BETHANECHOL 5MG TABLET             $13.99       0.00                91   PHARMACY
9187063   BETHANECHOL 5MG/1ML INJ            $62.12       0.00                91   PHARMACY




                                                   Page 84
                                    85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9316613   BEVACIZUMAB 400MG/16ML INJ       $5,945.20       0.00                93   PHARMACY
9197104   BICALUTAMIDE 50MG TABLET            $39.73       0.00                91   PHARMACY
9306515   BICILLIN CR 600,000U/ML INJ         $73.28       0.00                91   PHARMACY
9137019   BICITRA SOLN 30ML UDCUP             $26.66       0.00                91   PHARMACY
9112871   BIMATOPROST 0.03% OP SOL 2.5ML     $149.64       0.00                91   PHARMACY
9113457   BIRTH CONTROL PILL                  $17.77       0.00                91   PHARMACY
9112771   BIRTH CONTROL PILLS (PT OWN)         $0.00       0.00                91   PHARMACY
9128323   BISACODYL 10MG SUPP                  $0.00       0.00                91   PHARMACY
9100637   BISACODYL EC 5MG TABLET              $0.00       0.00                91   PHARMACY
9100629   BISMUTH SUBSALICYLATE CHEW TABLET $0.00          0.00                91   PHARMACY
9178534   BISMUTH SUBSALICYLATE SUSP 240ML $0.00           0.00                91   PHARMACY
9103623   BISOPROLOL 10MG/HCTZ 6.25MG TAB     $15.00       0.00                91   PHARMACY
9113341   BISOPROLOL 2.5MG/HCTZ 6.25MG TAB $15.43          0.00                91   PHARMACY
9108440   BISOPROLOL 5MG/HCTZ 6.25MG TAB      $15.43       0.00                91   PHARMACY
9316027   BLEOMYCIN 15 UNITS INJ           $1,056.76       0.00                93   PHARMACY
9173139   BLEPHAMIDE 0.2% OP SOLN 5ML         $99.86       0.00                91   PHARMACY
9189507   BOTULINUM TOX TYPE A INJ         $1,030.88       0.00                91   PHARMACY
9310061   BRETYLIUM 500MG/10ML INJ            $95.76       0.00                91   PHARMACY
9174616   BRIMONIDINE 0.15% OP SOLN 5ML      $101.62       0.00                91   PHARMACY
9174251   BRINZOLAMIDE 1% OP SOLN 5ML         $84.70       0.00                91   PHARMACY
9100645   BROMOCRIPTINE 2.5MG TABLET          $18.20       0.00                91   PHARMACY
9173188   BSS OPHTH SOLN 30ML                 $44.68       0.00                91   PHARMACY
9132085   BUDESONIDE 0.5MG/2ML RESPULE        $21.88       0.00                91   PHARMACY
9174343   BUDESONIDE 200MCG TURBUHALER $307.22             0.00                91   PHARMACY
9187089   BUMETANIDE 0.5MG/2ML INJ            $54.26       0.00                91   PHARMACY
9107020   BUMETANIDE 1MG TABLET               $13.54       0.00                91   PHARMACY
9183625   BUMETANIDE 2.5MG/10ML INJ           $63.38       0.00                91   PHARMACY
9183807   BUPIVACAINE 0.25% INJ 10ML          $56.30       0.00                91   PHARMACY
9183526   BUPIVACAINE 0.25% INJ 30ML          $62.35       0.00                91   PHARMACY
9183054   BUPIVACAINE 0.25% W/EPI INJ 30ML    $59.36       0.00                91   PHARMACY
9183054   BUPIVACAINE 0.25% W/EPI INJ 30ML    $65.50       0.00                91   PHARMACY
9183567   BUPIVACAINE 0.5% INJ 30ML           $54.82       0.00                91   PHARMACY
9112871   BUPIVACAINE 0.5% 10ML INJ           $57.14       0.00                91   PHARMACY
9183476   BUPIVACAINE 0.5% W/EPI INJ 30ML     $56.92       0.00                91   PHARMACY
9183476   BUPIVACAINE 0.5% W/EPI INJ 30ML     $65.94       0.00                91   PHARMACY
9183047   BUPIVACAINE 0.75% INJ 30ML          $59.56       0.00                91   PHARMACY
9189408   BUPIVACAINE 0.75% W/EPI INJ 30ML    $67.10       0.00                91   PHARMACY
9189663   BUPIVACAINE PF (FOR EPIDURAL - (MG) $71.44       0.00                91   PHARMACY
9187659   BUPIVACAINE PF 0.75%/ DEXTROSE INJ $60.16        0.00                91   PHARMACY
9189515   BUPRENORPHINE 0.3MG/ML INJ          $57.00       0.00                91   PHARMACY
9113853   BUPROPION 100MG TABLET              $14.66       0.00                91   PHARMACY
9101916   BUPROPION 75MG TABLET               $14.18       0.00                91   PHARMACY
9107681   BUPROPION CR 100MG TABLET           $16.29       0.00                91   PHARMACY
9107699   BUPROPION CR 150MG TABLET           $16.55       0.00                91   PHARMACY
9100660   BUSPIRONE 5MG TABLET                $14.26       0.00                91   PHARMACY
9128430   BUTOCONAZOLE 2% VAG CRM 20GM        $50.36       0.00                91   PHARMACY
9182023   BUTORPHANOL 10MG/ML NASAL SPY 2.5ML$220.96       0.00                91   PHARMACY
9310558   BUTORPHANOL 1MG/ML INJ              $92.54       0.00                91   PHARMACY
9187071   BUTORPHANOL 2MG/ML INJ              $92.82       0.00                91   PHARMACY
9108606   CABERGOLINE 0.5MG TABLET            $83.00       0.00                91   PHARMACY
9168527   CADEXOMER GEL WOUND DRESSING $107.28             0.00                91   PHARMACY
9187576   CAFF/SOD BENZOATE 500MG VL          $88.38       0.00                91   PHARMACY
9169871   CALAMINE LOTION 120ML                $0.00       0.00                91   PHARMACY




                                                    Page 85
                                    85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9187097   CALCITONIN 200 UNITS/ML INJ        $135.10       0.00                91   PHARMACY
9173568   CALCITONIN 200IU/AC NASAL SPRAY 2ML$98.57        0.00                91   PHARMACY
9101973   CALCITRIOL 0.25MCG CAPSULE          $15.14       0.00                91   PHARMACY
9187675   CALCITRIOL 1MCG/ML AMPUL            $81.50       0.00                91   PHARMACY
9103771   CALCIUM ACETATE 667MG TABLET        $13.01       0.00                91   PHARMACY
9106626   CALCIUM CARB/VIT D 250MG/125 IU TAB $12.84       0.00                91   PHARMACY
9113689   CALCIUM CARB/VIT D 500MG/200IU TAB $12.83        0.00                91   PHARMACY
9182106   CALCIUM CARBONATE 500MG CHEW TAB $0.00           0.00                91   PHARMACY
9113630   CALCIUM CARBONATE 600MG TABLET $12.84            0.00                91   PHARMACY
9104514   CALCIUM CARBONATE 650MG TABLET $12.75            0.00                91   PHARMACY
9310079   CALCIUM CHLORIDE 10% INJ            $52.46       0.00                91   PHARMACY
9187766   CALCIUM CHLORIDE 10% SYRINGE        $56.48       0.00                91   PHARMACY
9113697   CALCIUM CITRATE 200MG TABLET        $12.84       0.00                91   PHARMACY
9310087   CALCIUM GLUCONATE 0.465MEQ/ML INJ $27.22         0.00                91   PHARMACY
9310087   CALCIUM GLUCONATE 100MG/ML INJ      $27.22       0.00                91   PHARMACY
9101932   CALCIUM GLUCONATE 500MG TABLET $13.17            0.00                91   PHARMACY
9113861   CALCIUM LACTATE 650MG TABLET        $12.78       0.00                91   PHARMACY
9116351   CALCIUM/MAG 426/246MG TABLET        $12.83       0.00                91   PHARMACY
9168550   CALMOSEPTINE OINTMENT 113GM         $36.06       0.00                91   PHARMACY
9109273   CANDESARTAN 16MG TABLET             $15.61       0.00                91   PHARMACY
9109711   CAPECITABINE 500MG TABLET           $34.25       0.00                91   PHARMACY
9168170   CAPSAICIN 0.025% CREAM 60GM         $39.34       0.00                91   PHARMACY
9101999   CAPTOPRIL 12.5MG TABLET             $14.18       0.00                91   PHARMACY
9113895   CAPTOPRIL 25MG TABLET               $15.15       0.00                91   PHARMACY
9113218   CAPTOPRIL/HCTZ 25/15 TABLET         $14.27       0.00                91   PHARMACY
9174814   CARBACHOL 0.01% OP SOLN 1.5ML       $80.44       0.00                91   PHARMACY
9173766   CARBACHOL 3% OP SOLN 15ML           $98.56       0.00                91   PHARMACY
9102021   CARBAMAZEPINE 100MG CHEW TABLET $13.32           0.00                91   PHARMACY
9113929   CARBAMAZEPINE 200MG TABLET          $13.63       0.00                91   PHARMACY
9178476   CARBAMAZEPINE 20MG/ML SUSP 120ML $41.29          0.00                91   PHARMACY
9107863   CARBAMAZEPINE XR 100MG TABLET       $13.29       0.00                91   PHARMACY
9107871   CARBAMAZEPINE XR 200MG TABLET       $13.85       0.00                91   PHARMACY
9173261   CARBAMIDE PEROX 6.5% OTIC SOLN 15ML $29.84       0.00                91   PHARMACY
9168691   CARBAMIDE PEROXIDE 10% LIQ 15ML     $34.60       0.00                91   PHARMACY
9106808   CARBIDOPA/LEVODOPA CR 50/200 TAB $16.98          0.00                91   PHARMACY
9105859   CARBIDOPA/LEVODOPA 10/100 TAB       $14.16       0.00                91   PHARMACY
9106790   CARBIDOPA/LEVODOPA 25/100 TAB       $14.62       0.00                91   PHARMACY
9105867   CARBIDOPA/LEVODOPA 25/250 TAB       $14.87       0.00                91   PHARMACY
9108549   CARBIDOPA/LEVODOPA CR 25/100 TAB $14.92          0.00                91   PHARMACY
9316183   CARBOPLATIN 50MG INJ               $731.46       0.00                93   PHARMACY
9310095   CARBOPROST 250MCG/ML INJ           $165.18       0.00                91   PHARMACY
9174954   CARBOXYMETHYLCELL 1% OP SOL 3ML $27.36           0.00                91   PHARMACY
9105891   CARISOPRODOL 350MG TABLET           $13.92       0.00                91   PHARMACY
9170507   CARMEX LIP OINTMENT 7.5GM           $27.82       0.00                91   PHARMACY
9316019   CARMUSTINE 100MG INJ               $713.12       0.00                93   PHARMACY
9174350   CARTEOLOL 1% OPHTH SOLN 5ML         $64.72       0.00                91   PHARMACY
9100041   CARVEDILOL 12.5MG TABLET            $16.16       0.00                91   PHARMACY
9107491   CARVEDILOL 3.125MG TABLET           $16.16       0.00                91   PHARMACY
9109430   CARVEDILOL 6.25MG TABLET            $16.16       0.00                91   PHARMACY
9305822   CASPOFUNGIN INJ                    $201.76       0.00                93   PHARMACY
9179466   CASTOR OIL 120ML                    $32.84       0.00                91   PHARMACY
9102039   CEFACLOR 250MG CAPSULE              $16.70       0.00                91   PHARMACY
9178054   CEFACLOR 50MG/ML SUSP 75ML          $83.50       0.00                91   PHARMACY




                                                    Page 86
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9116369   CEFADROXIL 1GM TABLET            $33.35        0.00                91   PHARMACY
9116377   CEFADROXIL 500MG CAPSULE         $23.68        0.00                91   PHARMACY
9305574   CEFAMANDOL 1GM INJ              $119.89        0.00                93   PHARMACY
9306424   CEFAMANDOLE 2GM INJ             $138.02        0.00                93   PHARMACY
9305491   CEFAZOLIN 1GM INJ               $114.74        0.00                93   PHARMACY
9305491   CEFAZOLIN 1GM/10ML SW SYRINGE   $115.76        0.00                93   PHARMACY
9306366   CEFAZOLIN 1GM/20ML SYRINGE      $115.76        0.00                93   PHARMACY
9306275   CEFAZOLIN 1GM/50ML D5W          $115.76        0.00                93   PHARMACY
9305475   CEFAZOLIN 500MG INJ             $108.24        0.00                93   PHARMACY
9305699   CEFEPIME 1GM INJ                $135.86        0.00                93   PHARMACY
9305707   CEFEPIME 2GM INJ                $169.44        0.00                93   PHARMACY
9305525   CEFOTAXIME 1GM INJ              $122.96        0.00                93   PHARMACY
9305525   CEFOTAXIME 1GM/10ML SW SYRINGE $122.96         0.00                93   PHARMACY
9305525   CEFOTAXIME 1GM/20ML SW SYRINGE $122.96         0.00                93   PHARMACY
9305418   CEFOTAXIME 2GM INJ              $146.24        0.00                93   PHARMACY
9306432   CEFOTAXIME 500MG INJ            $116.26        0.00                93   PHARMACY
9305061   CEFOTETAN 1000MG INJ            $127.04        0.00                93   PHARMACY
9305061   CEFOTETAN 1GM INJ               $127.04        0.00                93   PHARMACY
9305079   CEFOTETAN 2GM INJ               $154.42        0.00                93   PHARMACY
9305517   CEFOXITIN 1GM VIAL              $124.26        0.00                93   PHARMACY
9305533   CEFOXITIN 2GM VIAL              $146.76        0.00                93   PHARMACY
9178781   CEFPROZIL 50MG/ML SUSP 100ML    $171.16        0.00                91   PHARMACY
9305392   CEFTAZIDIME 1GM INJ             $130.21        0.00                93   PHARMACY
9305400   CEFTAZIDIME 2GM INJ             $158.67        0.00                93   PHARMACY
9306440   CEFTAZIDINE 500MG INJ           $115.99        0.00                93   PHARMACY
9305558   CEFTIZOXIME 1000MG INJ          $125.48        0.00                93   PHARMACY
9305558   CEFTIZOXIME 1GM INJ             $125.48        0.00                93   PHARMACY
9306382   CEFTIZOXIME 1GM/20ML SYRINGE    $125.48        0.00                93   PHARMACY
9305566   CEFTIZOXIME 2GM INJ             $145.82        0.00                93   PHARMACY
9305426   CEFTRIAXONE 1GM INJ             $203.98        0.00                93   PHARMACY
9305442   CEFTRIAXONE 250MG INJ           $134.72        0.00                93   PHARMACY
9305434   CEFTRIAXONE 2GM INJ             $304.89        0.00                93   PHARMACY
9305459   CEFTRIAXONE 500MG INJ           $161.50        0.00                93   PHARMACY
9305467   CEFUROXIME 1.5GM INJ            $128.68        0.00                93   PHARMACY
9102088   CEFUROXIME 250MG TABLET          $22.69        0.00                91   PHARMACY
9179474   CEFUROXIME 25MG/ML SUSP 100ML   $107.02        0.00                91   PHARMACY
9113960   CEFUROXIME 500MG TABLET          $30.89        0.00                91   PHARMACY
9305343   CEFUROXIME 750MG INJ            $233.64        0.00                93   PHARMACY
9305343   CEFUROXIME 750MG/10ML SW SYRINGE$127.56        0.00                93   PHARMACY
9306374   CEFUROXIME 750MG/20ML SYRINGE   $233.64        0.00                93   PHARMACY
9108622   CELECOXIB 100MG CAPSULE          $16.00        0.00                91   PHARMACY
9113374   CENTRUM SILVER TABLET             $0.00        0.00                91   PHARMACY
9113382   CENTRUM TABLET                    $0.00        0.00                91   PHARMACY
9182072   CEPACOL SORE THROAT LOZENGE       $0.00        0.00                91   PHARMACY
9102062   CEPHALEXIN 250MG CAPSULE         $14.42        0.00                91   PHARMACY
9102070   CEPHALEXIN 500MG CAPSULE         $16.18        0.00                91   PHARMACY
9179482   CEPHALEXIN 50MG/ML SUSP          $63.24        0.00                91   PHARMACY
9169095   CETACAINE SPRAY 56GM            $129.44        0.00                91   PHARMACY
9170432   CETAPHIL MOIST LOTION 60ML       $27.63        0.00                91   PHARMACY
9107897   CETIRIZINE 10MG TABLET           $16.80        0.00                91   PHARMACY
9178559   CHARCOAL-AQUA 50GM LIQ 240ML     $48.54        0.00                91   PHARMACY
9178559   CHARCOAL-SORBITOL 50GM LIQ 240ML $51.74        0.00                91   PHARMACY
9112871   CHERRY SYRUP                      $0.00        0.00                91   PHARMACY




                                                  Page 87
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9158056   CHLORAL HYDRATE 100MG/ML LIQ      $25.50        0.00                91   PHARMACY
9159070   CHLORAL HYDRATE 500MG/5ML UD CUP $27.05         0.00                91   PHARMACY
9197047   CHLORAMBUCIL 2MG TABLET           $16.68        0.00                91   PHARMACY
9168824   CHLORASEPTIC THROAT SPRAY 180ML $0.00           0.00                91   PHARMACY
9155102   CHLORDIAZEPOXIDE 10MG CAPSULE     $25.88        0.00                91   PHARMACY
9155110   CHLORDIAZEPOXIDE 25MG CAPSULE     $25.90        0.00                91   PHARMACY
9155094   CHLORDIAZEPOXIDE 5MG CAPSULE      $25.82        0.00                91   PHARMACY
9178112   CHLORHEXIDINE 0.12% MOUTHWASH     $49.08        0.00                91   PHARMACY
9183450   CHLOROPROCAINE 3% 20ML INJ       $101.88        0.00                91   PHARMACY
9102120   CHLOROQUINE 250MG TABLET          $17.70        0.00                91   PHARMACY
9113317   CHLOROQUINE 500MG TABLET          $20.82        0.00                91   PHARMACY
9102146   CHLOROTHIAZIDE 250MG TABLET       $13.02        0.00                91   PHARMACY
9310756   CHLOROTHIAZIDE 500MG INJ          $72.96        0.00                91   PHARMACY
9102161   CHLORPHENIRAMINE 4MG TABLET        $0.00        0.00                91   PHARMACY
9102203   CHLORPROMAZINE 10MG TABLET        $13.42        0.00                91   PHARMACY
9102179   CHLORPROMAZINE 25MG TABLET        $13.29        0.00                91   PHARMACY
9178096   CHLORPROMAZINE 30MG/ML CONC 120ML $37.34        0.00                91   PHARMACY
9102195   CHLORPROMAZINE 50MG TABLET        $13.31        0.00                91   PHARMACY
9189499   CHLORPROMAZINE 50MG/2ML INJ       $60.14        0.00                91   PHARMACY
9102229   CHLORPROPAMIDE 250MG TABLET       $13.94        0.00                91   PHARMACY
9102237   CHLORTHALIDONE 25MG TABLET        $13.07        0.00                91   PHARMACY
9109455   CHOLESTYRAMINE LIGHT PACKET       $16.04        0.00                91   PHARMACY
9105685   CHOLESTYRAMINE PACKET             $17.46        0.00                91   PHARMACY
9106360   CHOLINE/MAG SALIC 500MG TABLET    $13.64        0.00                91   PHARMACY
9106378   CHOLINE/MAG SALIC 750MG TABLET    $14.18        0.00                91   PHARMACY
9168584   CICLOPIROX 0.77% CREAM 15GM       $69.66        0.00                91   PHARMACY
9109752   CILOSTAZOL 100MG TABLET           $16.16        0.00                91   PHARMACY
9114026   CIMETIDINE 300MG TABLET           $14.77        0.00                91   PHARMACY
9310715   CIMETIDINE 300MG/2ML INJ         $108.52        0.00                93   PHARMACY
9100009   CIMETIDINE 400MG TABLET           $16.06        0.00                91   PHARMACY
9174590   CIPROFLOXACIN 0.3% OP OINT 3.5GM $117.94        0.00                91   PHARMACY
9173733   CIPROFLOXACIN 0.3% OP SOLN 5ML   $108.06        0.00                91   PHARMACY
9179722   CIPROFLOXACIN 100MG/ML SUSP 100ML$244.20        0.00                91   PHARMACY
9306325   CIPROFLOXACIN 200MG/100ML D5W    $132.98        0.00                93   PHARMACY
9102245   CIPROFLOXACIN 250MG TABLET        $22.40        0.00                91   PHARMACY
9306309   CIPROFLOXACIN 400MG/200ML D5W    $161.78        0.00                93   PHARMACY
9305673   CIPROFLOXACIN 400MG/40ML INJ     $159.38        0.00                93   PHARMACY
9102252   CIPROFLOXACIN 500MG TABLET        $23.66        0.00                91   PHARMACY
9102260   CIPROFLOXACIN 750MG TABLET        $24.23        0.00                91   PHARMACY
9175126   CIPROFLOXACIN HC OTIC SUSP 10ML $175.44         0.00                91   PHARMACY
9316035   CISPLATIN INJ                    $480.20        0.00                93   PHARMACY
9108523   CITALOPRAM 20MG TABLET            $17.54        0.00                91   PHARMACY
9316282   CLADRIBINE 1MG/ML VIAL           $587.18        0.00                93   PHARMACY
9104068   CLARITHROMYCIN 250MG TABLET       $21.48        0.00                91   PHARMACY
9104076   CLARITHROMYCIN 500MG TABLET       $21.48        0.00                91   PHARMACY
9178823   CLARITHROMYCIN 50MG/ML SUSP      $168.66        0.00                91   PHARMACY
9117037   CLARITHROMYCIN XL 500MG TABLET    $21.90        0.00                91   PHARMACY
9169103   CLINDAMYCIN 1% LOTION 60ML       $114.80        0.00                91   PHARMACY
9102286   CLINDAMYCIN 150MG CAPSULE         $17.48        0.00                91   PHARMACY
9178138   CLINDAMYCIN 15MG/ML SUSP          $73.62        0.00                91   PHARMACY
9305103   CLINDAMYCIN 600MG/4ML INJ        $117.34        0.00                93   PHARMACY
9305624   CLINDAMYCIN 900MG/6ML INJ        $122.18        0.00                93   PHARMACY
9169152   CLOBETASOL 0.05% CREAM 30GM       $92.10        0.00                91   PHARMACY




                                                   Page 88
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9168592   CLOBETASOL 0.05% OINT 15GM        $71.98       0.00                91   PHARMACY
9170515                                    $104.64
          CLOBETASOL 0.05% TOPICAL SOLN 50ML             0.00                91   PHARMACY
9105776   CLOFAZIMINE 50MG CAPSULE          $13.13       0.00                91   PHARMACY
9155128   CLONAZEPAM 0.5MG TABLET           $27.04       0.00                91   PHARMACY
9155136   CLONAZEPAM 1MG TABLET             $27.25       0.00                91   PHARMACY
9102310   CLONIDINE 0.1MG TABLET            $13.19       0.00                91   PHARMACY
9171000   CLONIDINE-TTS 1 PATCH             $37.05       0.00                91   PHARMACY
9171018   CLONIDINE-TTS 2 PATCH             $53.68       0.00                91   PHARMACY
9171026   CLONIDINE-TTS 3 PATCH             $69.54       0.00                91   PHARMACY
9107608   CLOPIDOGREL 75MG TABLET           $20.61       0.00                91   PHARMACY
9155144   CLORAZEPATE 3.75MG TABLET         $28.32       0.00                91   PHARMACY
9169707   CLORPACTIN WCS-90 POWDER 2GM      $35.34       0.00                91   PHARMACY
9169111   CLOTRIMAZOLE 1% CREAM 30GM        $52.24       0.00                91   PHARMACY
9169137   CLOTRIMAZOLE 1% LOTION 30ML       $87.56       0.00                91   PHARMACY
9169145   CLOTRIMAZOLE 1% VAG CRM 45GM      $39.84       0.00                91   PHARMACY
9104738   CLOTRIMAZOLE 10MG TROCHE          $15.93       0.00                91   PHARMACY
9169459                                     $71.18
          CLOTRIMAZOLE/BETAMETHASONE CRM 15GM            0.00                91   PHARMACY
9170218                                    $127.20
          CLOTRIMAZOLE/BETAMETHASONE LOTION 30ML         0.00                91   PHARMACY
9170390   COAL TAR SOLUTION 473ML           $55.64       0.00                91   PHARMACY
9159062   COCAINE 10% TOP SOLN 4ML          $95.04       0.00                91   PHARMACY
9159054   COCAINE 4% SOLUTION 4ML           $66.18       0.00                91   PHARMACY
9155169   CODEINE 30MG TABLET               $26.33       0.00                91   PHARMACY
9163494   CODEINE 30MG/2ML INJ              $78.18       0.00                91   PHARMACY
9102369   COLCHICINE 0.6MG TABLET           $13.11       0.00                91   PHARMACY
9187113   COLCHICINE 1MG/2ML INJ            $66.38       0.00                91   PHARMACY
9109703   COLESEVELAM 625MG TABLET          $14.36       0.00                91   PHARMACY
9170192   COLLAGENASE 250UNIT/GM OINT 30GM $155.26       0.00                91   PHARMACY
9174293   COMBIVENT 14.7GM INHALER         $128.20       0.00                91   PHARMACY
9112871   CORTISONE ACETATE 25MG TABLET     $13.64       0.00                91   PHARMACY
9174921   CORTISPORIN OPHTH OINT 3.5GM     $104.42       0.00                91   PHARMACY
9174202   CORTISPORIN OPHTH SOLN 7.5ML     $134.60       0.00                91   PHARMACY
9173238   CORTISPORIN OTIC SUSP 10ML        $87.04       0.00                91   PHARMACY
9187121   COSYNTROPIN 0.25MG INJ            $86.15       0.00                91   PHARMACY
9107905   CREON 10 CAP DELAYED RELEASE      $14.64       0.00                91   PHARMACY
9107913   CREON 20 CAP DELAYED RELEASE      $16.44       0.00                91   PHARMACY
9173824   CROMOLYN 4% NASAL SPRAY 13ML      $40.38       0.00                91   PHARMACY
9173816   CROMOLYN 800MCG INHALER 8GM      $132.62       0.00                91   PHARMACY
9132028   CROMOLYN NEBULIZER SOL 2ML        $14.12       0.00                91   PHARMACY
9175084   CROMOLYN SOD 4% OPHTH SOL 10ML $99.84          0.00                91   PHARMACY
9169186   CROTAMITON 10% CREAM 60GM         $52.16       0.00                91   PHARMACY
9170226   CURASOL GEL WOUND DRESSING 30GM $39.94         0.00                91   PHARMACY
9187147   CYANOCOBALAMIN 1000MCG/ML INJ     $52.16       0.00                91   PHARMACY
9107921   CYANOCOBALAMIN 250MCG TABLET      $12.79       0.00                91   PHARMACY
9102377   CYCLOBENZAPRINE 10MG TABLET       $14.66       0.00                91   PHARMACY
9173832   CYCLOPENTOLATE 0.5% OP SOLN 15ML $96.32        0.00                91   PHARMACY
9173246   CYCLOPENTOLATE 1% OP SOLN 2ML     $50.32       0.00                91   PHARMACY
9175043   CYCLOPENTOLATE 2% OP SOLN 2ML     $58.06       0.00                91   PHARMACY
9316043   CYCLOPHOSHAMIDE 100MG INJ        $457.58       0.00                93   PHARMACY
9197054   CYCLOPHOSPHAMIDE 25MG TABLET      $17.24       0.00                91   PHARMACY
9103250   CYCLOSPORINE 100MG CAPSULE        $26.59       0.00                91   PHARMACY
9178831   CYCLOSPORINE 100MG/ML LIQ 50ML   $698.72       0.00                91   PHARMACY
9103243   CYCLOSPORINE 25MG CAPSULE         $16.19       0.00                91   PHARMACY
9189119   CYCLOSPORINE 50MG/ML INJ         $156.76       0.00                93   PHARMACY




                                                  Page 89
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9107277                                      CAP
          CYCLOSPORINE MICRO (NEORAL) 100MG$24.93       0.00                  91   PHARMACY
9179839                                    $691.10
          CYCLOSPORINE MICRO (NEORAL) 100MG/ML LIQ 50ML 0.00                  91   PHARMACY
9107269                                     $15.78
          CYCLOSPORINE MICRO (NEORAL) 25MG CAP          0.00                  91   PHARMACY
9179821                                    $648.12
          CYCLOSPORINE MICRO(GENGRAF)100MG/ML 50ML      0.00                  91   PHARMACY
9102401   CYPROHEPTADINE 4MG TABLET         $13.58      0.00                  91   PHARMACY
9316050   CYTARABINE 100MG INJ             $452.20      0.00                  93   PHARMACY
9316365   CYTARABINE LIPOSOME 10MG INJ   $1,227.20      0.00                  93   PHARMACY
9147331   D10NS 1000ML                      $91.94      0.00                  91   PHARMACY
9147331   D10NS 1000ML (FLOORSTOCK)         $91.94      0.00                  91   PHARMACY
9147042   D10W 1000ML                       $79.88      0.00                  91   PHARMACY
9147042   D10W 1000ML (FLOORSTOCK)          $79.88      0.00                  91   PHARMACY
9147190   D10W 250ML                        $80.32      0.00                  91   PHARMACY
9147190   D10W 250ML (FLOORSTOCK)           $80.32      0.00                  91   PHARMACY
9147034   D10W 500ML                        $80.18      0.00                  91   PHARMACY
9147034   D10W 500ML (FLOORSTOCK)           $80.18      0.00                  91   PHARMACY
9147620   D20W 500ML                       $100.64      0.00                  91   PHARMACY
9147786   D50W 500ML                        $85.54      0.00                  91   PHARMACY
9147026   D5W 1000ML                        $80.22      0.00                  91   PHARMACY
9147026   D5W 1000ML (FLOORSTOCK)           $80.22      0.00                  91   PHARMACY
9134016   D5W 100ML                          $4.06      0.00                  91   PHARMACY
9147000   D5W 250ML                          $3.00      0.00                  91   PHARMACY
9147000   D5W 250ML (FLOORSTOCK)            $79.32      0.00                  91   PHARMACY
9147018   D5W 500ML                         $79.38      0.00                  91   PHARMACY
9147018   D5W 500ML (FLOORSTOCK)            $79.38      0.00                  91   PHARMACY
9134008   D5W 50ML                           $4.02      0.00                  91   PHARMACY
9147513   D5W W/20MEQ KCL                   $82.38      0.00                  91   PHARMACY
9147521   D5W W/30MEQ KCL                  $109.90      0.00                  91   PHARMACY
9147539   D5W W/40MEQ KCL                   $82.38      0.00                  91   PHARMACY
9147448   D5W/0.22%NACL W/10MEQ KCL         $82.38      0.00                  91   PHARMACY
9147455   D5W/0.22%NACL W/20MEQ KCL         $82.38      0.00                  91   PHARMACY
9147463   D5W/0.22%NACL W/30MEQ KCL         $82.38      0.00                  91   PHARMACY
9147471   D5W/0.22%NACL W/40MEQ KCL         $82.38      0.00                  91   PHARMACY
9147240   D5W/0.225% NACL 1000ML            $79.82      0.00                  91   PHARMACY
9147240                                     $
          D5W/0.225% NACL 1000ML(FLOORSTOCK) 79.82      0.00                  91   PHARMACY
9147232   D5W/0.225% NACL 500ML             $79.92      0.00                  91   PHARMACY
9147232   D5W/0.225% NACL 500ML (FLOORSTOCK)$79.92      0.00                  91   PHARMACY
9147729   D5W/0.45% NACL 1000ML             $80.06      0.00                  91   PHARMACY
9147729   D5W/0.45% NACL 1000ML (FLOORSTOCK)$80.06      0.00                  91   PHARMACY
9147257   D5W/0.45% NACL 250ML              $79.94      0.00                  91   PHARMACY
9147257   D5W/0.45% NACL 250ML (FLOORSTOCK) $79.94      0.00                  91   PHARMACY
9147265   D5W/0.45% NACL 500ML              $79.92      0.00                  91   PHARMACY
9147265   D5W/0.45% NACL 500ML(FLOORSTOCK) $79.92       0.00                  91   PHARMACY
9147281   D5W/0.45% NACL W/10MEQ KCL        $82.38      0.00                  91   PHARMACY
9147299   D5W/0.45% NACL W/20MEQ KCL        $80.42      0.00                  91   PHARMACY
9147422   D5W/0.45% NACL W/30MEQ KCL        $82.38      0.00                  91   PHARMACY
9147430   D5W/0.45% NACL W/40MEQ KCL        $82.38      0.00                  91   PHARMACY
9147315   D5W/0.9% NACL 1000ML              $79.72      0.00                  91   PHARMACY
9147315   D5W/0.9% NACL 1000ML(FLOORSTOCK) $79.72       0.00                  91   PHARMACY
9147307   D5W/0.9% NACL 500ML               $79.92      0.00                  91   PHARMACY
9147307   D5W/0.9% NACL 500ML (FLOORSTOCK) $79.92       0.00                  91   PHARMACY
9147091   D5W/0.9% NACL W/20MEQ KCL         $84.64      0.00                  91   PHARMACY
9147109   D5W/0.9% NACL W/40MEQ KCL         $84.64      0.00                  91   PHARMACY
9151093   D5W/ALCOHOL 5%                   $101.76      0.00                  93   PHARMACY




                                                   Page 90
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9147216   D5W/LACTATED RINGERS 1000ML      $80.18        0.00                91   PHARMACY
9147208   D5W/LACTATED RINGERS 500ML       $80.34        0.00                91   PHARMACY
9147117   D5W/LACTATED RINGERS W/20MEQ KCL $93.54        0.00                91   PHARMACY
9147562   D5W/LACTATED RINGERS W/40MEQ KCL $93.54        0.00                91   PHARMACY
9147216   D5W/LR 1000ML (FLOORSTOCK)       $80.18        0.00                91   PHARMACY
9147208   D5W/LR 500ML (FLOORSTOCK)        $80.34        0.00                91   PHARMACY
9147794   D70W 500ML                       $86.98        0.00                91   PHARMACY
9316068   DACARBAZINE 100MG INJ           $468.82        0.00                93   PHARMACY
9112863   DACRIOSE OPHTH SOLN 15ML         $33.98        0.00                91   PHARMACY
9316076   DACTINOMYCIN 0.5MG INJ          $474.40        0.00                93   PHARMACY
9169194   DAKIN'S SOLN ( FULL STRENGTH)    $33.50        0.00                91   PHARMACY
9169202   DAKIN'S SOLN ( HALF STRENGTH)    $33.50        0.00                91   PHARMACY
9187584   DANTROLENE 20MG INJ             $216.04        0.00                91   PHARMACY
9102419   DANTROLENE 25MG CAPSULE          $14.80        0.00                91   PHARMACY
9104696   DAPSONE 25MG TABLET              $13.10        0.00                91   PHARMACY
9316290   DAUNORUBICIN INJ                $622.08        0.00                93   PHARMACY
9173303   DDAVP 0.01% NASAL SPRAY 5ML     $347.56        0.00                91   PHARMACY
9310400   DEFEROXAMINE 500MG INJ          $134.24        0.00                93   PHARMACY
9102534   DEMECLOCYLINE 150MG TABLET       $23.29        0.00                91   PHARMACY
9187881   DEPO-MEDROL 40MG/ML INJ          $65.58        0.00                91   PHARMACY
9187162   DEPO-MEDROL 80MG/ML INJ          $75.14        0.00                91   PHARMACY
9102443   DESIPRAMINE 10MG TABLET          $13.52        0.00                91   PHARMACY
9102450   DESIPRAMINE 25MG TABLET          $13.68        0.00                91   PHARMACY
9169897   DESITIN OINTMENT 120GM           $31.64        0.00                91   PHARMACY
9187600   DESMOPRESSIN 4MCG/ML INJ         $96.66        0.00                91   PHARMACY
9173717   DESONIDE 0.05% CREAM 15GM        $56.38        0.00                91   PHARMACY
9169004   DESONIDE 0.05% LOTION 59ML       $91.10        0.00                91   PHARMACY
9168618   DESONIDE 0.05% OINT 15GM         $50.34        0.00                91   PHARMACY
9170234   DESOXIMETASONE 0.25% CRM 15GM    $77.16        0.00                91   PHARMACY
9173279   DEXAMETHASONE 0.1% OP SOLN 5ML $93.20          0.00                91   PHARMACY
9178146   DEXAMETHASONE 0.1MG/ML LIQ 120ML $52.03        0.00                91   PHARMACY
9102484   DEXAMETHASONE 0.5MG TABLET       $13.05        0.00                91   PHARMACY
9102492   DEXAMETHASONE 0.75MG TABLET      $13.01        0.00                91   PHARMACY
9187956   DEXAMETHASONE 10MG/1ML INJ       $55.54        0.00                91   PHARMACY
9178856                                    $60.04
          DEXAMETHASONE 1MG/ML INTENSOL 30ML             0.00                91   PHARMACY
9102518   DEXAMETHASONE 2MG TABLET         $13.90        0.00                91   PHARMACY
9102526   DEXAMETHASONE 4MG TABLET         $13.96        0.00                91   PHARMACY
9187170   DEXAMETHASONE 4MG/1ML INJ        $53.64        0.00                91   PHARMACY
9190018   DEXRAZOXANE 250MG INJ           $577.72        0.00                93   PHARMACY
9147083   DEXTRAN 40/NS IV SOLN.          $349.68        0.00                91   PHARMACY
9147075   DEXTRAN 40-DEXTROSE 5% IV SOLN. $348.36        0.00                91   PHARMACY
9189457   DEXTROSE 10% 5ML INJ             $53.66        0.00                91   PHARMACY
9187188   DEXTROSE 25% SYRINGE 10ML        $64.38        0.00                91   PHARMACY
9189267   DEXTROSE 50% SYRINGE 50ML        $60.88        0.00                91   PHARMACY
9189259   DEXTROSE 50% VIAL 50ML           $53.16        0.00                91   PHARMACY
9147646   DIANEAL W/1.5% DEXTROSE         $147.72        0.00                91   PHARMACY
9147646                                   $147.72
          DIANEAL W/1.5% DEXTROSE(FLOORSTOCK)            0.00                91   PHARMACY
9147653   DIANEAL W/2.5% DEXTROSE         $149.62        0.00                91   PHARMACY
9147653                                   $149.62
          DIANEAL W/2.5% DEXTROSE(FLOORSTOCK)            0.00                91   PHARMACY
9147661   DIANEAL W/4.25% DEXTROSE        $151.42        0.00                91   PHARMACY
9147661                                   $151.42
          DIANEAL W/4.25% DEXTROSE (FLOORSTOCK)          0.00                91   PHARMACY
9112871   DIATRIZOATE 50% 50ML VIAL        $64.24        0.00                91   PHARMACY
9160045   DIAZEPAM 10MG RECTAL GEL        $424.86        0.00                91   PHARMACY




                                                  Page 91
                                    85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9163015   DIAZEPAM 10MG/2ML INJ               $80.04       0.00                91   PHARMACY
9300450   DIAZEPAM 1MG/ML ORAL SOLN           $26.18       0.00                91   PHARMACY
9155201   DIAZEPAM 2MG TABLET                 $25.92       0.00                91   PHARMACY
9155227   DIAZEPAM 5MG TABLET                 $26.08       0.00                91   PHARMACY
9159104   DIAZEPAM 5MG/5ML UD CUP             $46.98       0.00                91   PHARMACY
9310103   DIAZOXIDE 300MG/20ML INJ           $309.72       0.00                91   PHARMACY
9174632   DICLOFENAC 0.1% OP SOLN 2.5ML       $86.48       0.00                91   PHARMACY
9114216   DICLOFENAC EC 25MG TABLET           $13.65       0.00                91   PHARMACY
9114208   DICLOFENAC EC 50MG TABLET           $14.53       0.00                91   PHARMACY
9102914   DICLOFENAC EC 75MG TABLET           $14.81       0.00                91   PHARMACY
9178872   DICLOXACILLIN 12.5MG/ML SUSP 100ML $45.60        0.00                91   PHARMACY
9102542   DICLOXACILLIN 250MG CAPSULE         $14.04       0.00                91   PHARMACY
9102559   DICLOXACILLIN 500MG CAPSULE         $15.12       0.00                91   PHARMACY
9114232   DICYCLOMINE 10MG CAPSULE            $13.25       0.00                91   PHARMACY
9102567   DICYCLOMINE 20MG TABLET             $13.42       0.00                91   PHARMACY
9188814   DICYCLOMINE 20MG/2ML INJ            $84.36       0.00                91   PHARMACY
9179847   DIDANOSINE 10MG/ML LIQ 200ML       $190.80       0.00                91   PHARMACY
9168253   DIFLORASONE 0.05% OINT 60GM        $305.74       0.00                91   PHARMACY
9179649   DIGOXIN 0.05MG/ML ORAL SOLN 60ML $46.24          0.00                91   PHARMACY
9102583   DIGOXIN 0.125MG TABLET              $13.39       0.00                91   PHARMACY
9106519   DIGOXIN 0.1MG CAPSULE               $13.31       0.00                91   PHARMACY
9102591   DIGOXIN 0.25MG TABLET               $13.39       0.00                91   PHARMACY
9187204   DIGOXIN 0.5MG/2ML INJ               $54.64       0.00                91   PHARMACY
9189150   DIGOXIN IMMUNE FAB               $1,618.24       0.00                93   PHARMACY
9174962   DIHYDROERGOT 4MG/ML NASAL SPY 4ML  $250.04       0.00                91   PHARMACY
9188145   DIHYDROERGOTAMINE 1MG/ML INJ       $117.30       0.00                91   PHARMACY
9310319   DILTIAZEM 25MG/5ML INJ             $109.02       0.00                93   PHARMACY
9102633   DILTIAZEM 30MG TABLET               $13.62       0.00                91   PHARMACY
9102633   DILTIAZEM 60MG TABLET               $14.13       0.00                91   PHARMACY
9102658   DILTIAZEM 90MG TABLET               $14.43       0.00                91   PHARMACY
9109471   DILTIAZEM CD 120MG CAPSULE          $15.60       0.00                91   PHARMACY
9103938   DILTIAZEM CD 180MG CAPSULE          $16.18       0.00                91   PHARMACY
9103946   DILTIAZEM CD 240MG CAPSULE          $17.64       0.00                91   PHARMACY
9103953   DILTIAZEM CD 300MG CAPSULE          $19.06       0.00                91   PHARMACY
9102690   DILTIAZEM SR 120MG CAPSULE          $15.04       0.00                91   PHARMACY
9102187   DILTIAZEM SR 60MG CAPSULE           $14.91       0.00                91   PHARMACY
9102682   DILTIAZEM SR 90MG CAPSULE           $14.45       0.00                91   PHARMACY
9113655   DILTIAZEM XR 120MG CAPSULE          $15.64       0.00                91   PHARMACY
9113663   DILTIAZEM XR 180MG CAPSULE          $16.16       0.00                91   PHARMACY
9113671   DILTIAZEM XR 240MG CAPSULE          $16.40       0.00                91   PHARMACY
9179854   DIMETANE DX COUGH SYRUP 120ML       $34.63       0.00                91   PHARMACY
9178195   DIMETAPP ELIXIR 120ML               $33.02       0.00                91   PHARMACY
9128364   DINOPROSTONE 10MG VAG SUPP         $417.56       0.00                91   PHARMACY
9168626   DINOPROSTONE CERVICAL GEL          $396.92       0.00                91   PHARMACY
9168493   DIPHENHYDRAMINE 1% CRM 28.3GM       $32.28       0.00                91   PHARMACY
9137266   DIPHENHYDRAMINE 12.5MG/5ML LIQ UDCUP$25.92       0.00                91   PHARMACY
9170242   DIPHENHYDRAMINE 2% CRM 15GM         $31.76       0.00                91   PHARMACY
9102716   DIPHENHYDRAMINE 25MG CAPSULE         $0.00       0.00                91   PHARMACY
9102724   DIPHENHYDRAMINE 50MG CAPSULE        $12.99       0.00                91   PHARMACY
9187774   DIPHENHYDRAMINE 50MG/ML INJ         $53.28       0.00                91   PHARMACY
9179862   DIPHENHYDRAMINE LIQ DF,AF,SF 120ML $34.00        0.00                91   PHARMACY
9159039   DIPHENOXY/ATROPINE LIQ 5ML UDCUP $27.22          0.00                91   PHARMACY
9155276   DIPHENOXYLATE/ATROPINE TABLET       $26.98       0.00                91   PHARMACY




                                                    Page 92
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9112871   DIPHTHERIA/TETANUS (PEDIATRIC)     $69.90       0.00                91   PHARMACY
9174129   DIPIVEFRIN 0.1% OP SOLN 5ML        $53.64       0.00                91   PHARMACY
9102732   DIPYRIDAMOLE 25MG TABLET           $13.12       0.00                91   PHARMACY
9187139   DIPYRIDAMOLE 5MG/ML INJ            $62.88       0.00                91   PHARMACY
9108796   DIPYRIDAMOLE SR 200MG/ASPIRIN 25MG$16.37        0.00                91   PHARMACY
9102773   DISOPYRAMIDE 100MG CAPSULE         $14.11       0.00                91   PHARMACY
9102781   DISOPYRAMIDE 150MG CAPSULE         $14.36       0.00                91   PHARMACY
9102740   DISOPYRAMIDE CR 100MG CAPSULE      $14.95       0.00                91   PHARMACY
9102757   DISOPYRAMIDE CR 150MG CAPSULE      $15.34       0.00                91   PHARMACY
9107061                                      $13.83
          DIVALPROEX EC 125MG DELAYED RELEASE TAB         0.00                91   PHARMACY
9107079                                      $14.87
          DIVALPROEX EC 250MG DELAYED RELEASE TAB         0.00                91   PHARMACY
9107087                                      $16.65
          DIVALPROEX EC 500MG DELAYED RELEASE TAB         0.00                91   PHARMACY
9107095   DIVALPROEX SPRINKLE 125MG CAPSULE$13.84         0.00                91   PHARMACY
9310111   DOBUTAMINE 250MG/20ML INJ         $121.54       0.00                93   PHARMACY
9151002   DOBUTAMINE 500MG/250ML D5W        $185.76       0.00                91   PHARMACY
9316480   DOCETAXEL 20MG/0.5ML INJ        $1,136.48       0.00                93   PHARMACY
9170457   DOCOSANOL 10% CREAM 2GM            $52.80       0.00                91   PHARMACY
9114315   DOCUSATE CALCIUM 240MG CAPSULE      $0.00       0.00                91   PHARMACY
9179490   DOCUSATE SOD 10MG/ML LIQ 120ML      $0.00       0.00                91   PHARMACY
9105123                                      CAP
          DOCUSATE SOD/CASANTHRANOL 100/30 $13.06         0.00                91   PHARMACY
9102674   DOCUSATE SODIUM 100MG CAPSULE       $0.00       0.00                91   PHARMACY
9113283   DOCUSATE SODIUM 250MG CAPSULE       $0.00       0.00                91   PHARMACY
9102666   DOCUSATE SODIUM 50MG CAPSULE        $0.00       0.00                91   PHARMACY
9108804   DOFETILIDE 0.125MG CAPSULE         $16.54       0.00                91   PHARMACY
9108812   DOFETILIDE 0.25MG CAPSULE          $16.54       0.00                91   PHARMACY
9108820   DOFETILIDE 500MCG CAPSULE          $16.54       0.00                91   PHARMACY
9113390   DOLASETRON 100MG TABLET           $165.20       0.00                91   PHARMACY
9189762   DOLASETRON 100MG/5ML VIAL         $397.20       0.00                91   PHARMACY
9189093   DOLASETRON 12.5MG AMP              $88.28       0.00                91   PHARMACY
9174822   DOMEBORO OTIC SOLN 60ML            $40.20       0.00                91   PHARMACY
9172073   DOMEBORO PACKET                    $14.18       0.00                91   PHARMACY
9107509   DONEPEZIL 5MG TABLET               $22.18       0.00                91   PHARMACY
9178583   DONNATAL ELIXIR 120ML              $32.82       0.00                91   PHARMACY
9151051   DOPAMINE 400MG/250ML D5W          $114.02       0.00                91   PHARMACY
9310368   DOPAMINE 400MG/5ML INJ            $109.94       0.00                93   PHARMACY
9174152   DORZOLAMIDE 2% OP SOLN 5ML         $79.32       0.00                91   PHARMACY
9163163   DOXAPRAM 20MG/ML INJ              $245.64       0.00                91   PHARMACY
9102872   DOXAZOSIN 1MG TABLET               $14.57       0.00                91   PHARMACY
9102898   DOXAZOSIN 2MG TABLET               $14.57       0.00                91   PHARMACY
9102831   DOXEPIN 10MG CAPSULE               $13.45       0.00                91   PHARMACY
9114364   DOXEPIN 25MG CAPSULE               $13.58       0.00                91   PHARMACY
9170259   DOXEPIN 5% CREAM 45GM             $117.24       0.00                91   PHARMACY
9102856   DOXEPIN 50MG CAPSULE               $13.86       0.00                91   PHARMACY
9316084   DOXORUBICIN 2MG/ML INJ            $467.70       0.00                93   PHARMACY
9305111   DOXYCYCLINE 100MG INJ             $131.26       0.00                93   PHARMACY
9102880   DOXYCYCLINE 100MG TABLET           $13.76       0.00                91   PHARMACY
9155243   DRONABINOL 2.5MG CAPSULE           $34.27       0.00                91   PHARMACY
9187253   DROPERIDOL 5MG/2ML INJ             $59.38       0.00                91   PHARMACY
9310897   DROTRECOGIN ALFA 20MG INJ       $2,117.76       0.00                93   PHARMACY
9310905   DROTRECOGIN ALFA 5MG INJ          $605.76       0.00                93   PHARMACY
9132150   DUONEB 2.5-0.5MG SOL 3ML           $16.72       0.00                91   PHARMACY
9189606   DUOVISC VISCOELASTIC SYSTEM       $370.44       0.00                91   PHARMACY
9168105   ECONAZOLE 1% CREAM 30GM            $89.72       0.00                91   PHARMACY




                                                   Page 93
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9187964   EDROPHONIUM 150MG/10ML INJ         $72.38       0.00                91   PHARMACY
9170069   EMLA CREAM 5GM                     $43.32       0.00                91   PHARMACY
9102948   ENALAPRIL 10MG TABLET              $14.86       0.00                91   PHARMACY
9102955   ENALAPRIL 5MG TABLET               $14.76       0.00                91   PHARMACY
9188830   ENALAPRILAT 1.25MG/ML INJ          $62.64       0.00                91   PHARMACY
9188616   ENOXAPARIN 100MG /1ML INJ         $173.34       0.00                91   PHARMACY
9187030   ENOXAPARIN 30MG/0.3ML INJ          $87.58       0.00                91   PHARMACY
9188574   ENOXAPARIN 40MG/0.4ML INJ          $99.80       0.00                91   PHARMACY
9188624   ENOXAPARIN 60MG/0.6ML INJ         $124.36       0.00                91   PHARMACY
9188665   ENOXAPARIN 80MG/0.8ML INJ         $148.84       0.00                91   PHARMACY
9109778   ENTACAPONE 200MG TABLET            $16.36       0.00                91   PHARMACY
9310145   EPHEDRINE 50MG/ML INJ              $51.88       0.00                91   PHARMACY
9183658   EPINEPHRINE 1:1000 INJ 30ML        $69.38       0.00                91   PHARMACY
9187790   EPINEPHRINE 1MG/10ML SYRINGE      $107.04       0.00                93   PHARMACY
9188517   EPINEPHRINE 1MG/ML INJ             $59.64       0.00                91   PHARMACY
9174970   EPINEPHRINE 2% OP SOLN 15ML       $134.16       0.00                91   PHARMACY
9132119   EPINEPHRINE INH 2.25% 0.5ML        $15.22       0.00                91   PHARMACY
9188020   EPOETIN ALFA 20,000 UNITS/ML INJ   $81.03       0.00                91   PHARMACY
9188731   EPTIFIBATIDE 20MG/10ML INJ        $236.76       0.00                93   PHARMACY
9151119   EPTIFIBATIDE 75MG/100ML PREMIX    $524.26       0.00                93   PHARMACY
9311010   ER-AMIODARONE 300MG/20ML D5W KIT $528.62        0.00                93   PHARMACY
9113408   ERGOCALCIFEROL 400IU CAPSULE       $12.77       0.00                91   PHARMACY
9102963   ERGOCALCIFEROL 50,000 UNITS CAP    $13.44       0.00                91   PHARMACY
9306457   ERTAPENEM 1GM INJ                 $197.14       0.00                93   PHARMACY
9173311   ERYTHROMYCIN 0.5% OPH OINT 3.5GM $36.68         0.00                91   PHARMACY
9305129   ERYTHROMYCIN 1GM INJ              $117.06       0.00                93   PHARMACY
9305137   ERYTHROMYCIN 500MG INJ            $109.16       0.00                93   PHARMACY
9102997   ERYTHROMYCIN EC 250MG TABLET       $13.22       0.00                91   PHARMACY
9114422   ERYTHROMYCIN EC 333MG TABLET       $13.46       0.00                91   PHARMACY
9102989   ERYTHROMYCIN EC 500MG TABLET       $13.57       0.00                91   PHARMACY
9178625   ERYTHROMYCIN EST 50MG/ML SUSP      $58.81       0.00                91   PHARMACY
9113192   ERYTHROMYCIN ETH 400MG TABLET      $13.23       0.00                91   PHARMACY
9179870   ERYTHROMYCIN ETH 40MG/ML SUSP      $34.96       0.00                91   PHARMACY
9116385   ESCITALOPRAM 10MG TABLET           $17.26       0.00                91   PHARMACY
9310137   ESMOLOL 100MG/10ML INJ            $144.28       0.00                93   PHARMACY
9310855   ESMOLOL 2500MG/10ML INJ           $303.24       0.00                93   PHARMACY
9113051   ESOMEPRAZOLE 20MG CAP              $21.56       0.00                91   PHARMACY
9116401   ESOMEPRAZOLE 40MG CAP              $21.56       0.00                91   PHARMACY
9171158                                      $
          ESTRADIOL (CLIMARA) 0.05MG/24HR PTCH28.88       0.00                91   PHARMACY
9171174                                      $28.88
          ESTRADIOL (CLIMARA) 0.075MG/24HR PTCH           0.00                91   PHARMACY
9171042   ESTRADIOL (CLIMARA) 0.1MG/24HR PTCH$28.88       0.00                91   PHARMACY
9169269   ESTRADIOL 0.01% VAG CRM 42.5GM    $134.66       0.00                91   PHARMACY
9171158   ESTRADIOL 0.05MG PATCH (BI-WEEKLY) $19.93       0.00                91   PHARMACY
9171042   ESTRADIOL 0.1MG PATCH (BI-WEEKLY) $20.20        0.00                91   PHARMACY
9107962   ESTRADIOL 0.5MG TABLET             $13.23       0.00                91   PHARMACY
9109505   ESTRADIOL 1MG TABLET               $13.41       0.00                91   PHARMACY
9103029   ESTRADIOL 2MG TABLET               $14.59       0.00                91   PHARMACY
9112871   ESTRADIOL CYPIONATE 25MG/5ML VIAL$101.66        0.00                91   PHARMACY
9183773   ESTRADIOL VAL 200MG/5ML INJ       $317.38       0.00                91   PHARMACY
9183781   ESTRADIOL VAL 50MG/5ML INJ        $164.88       0.00                91   PHARMACY
9107350   ESTRATEST TABLET                   $16.14       0.00                91   PHARMACY
9103037   ESTROGENS,CON 0.3MG TABLET         $14.01       0.00                91   PHARMACY
9114448   ESTROGENS,CON 0.625MG TABLET       $14.36       0.00                91   PHARMACY




                                                   Page 94
                                    85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9103045   ESTROGENS,CON 0.9MG TABLET          $14.69       0.00                91   PHARMACY
9103052   ESTROGENS,CON 1.25MG TABLET         $14.99       0.00                91   PHARMACY
9188152   ESTROGENS,CONJ 25MG INJ            $170.36       0.00                91   PHARMACY
9169251   ESTROGENS,CONJ VAG CRM 42.5GM $152.20            0.00                91   PHARMACY
9107970   ESTROPIPATE 0.75MG TAB (OGEN 0.625) $13.58       0.00                91   PHARMACY
9105008   ESTROPIPATE 1.5MG TAB (OGEN 1.25) $15.16         0.00                91   PHARMACY
9188160   ETHACRYNATE SOD 50MG INJ            $98.48       0.00                91   PHARMACY
9103086   ETHAMBUTOL 100MG TABLET             $13.91       0.00                91   PHARMACY
9103094   ETHAMBUTOL 400MG TABLET             $16.69       0.00                91   PHARMACY
9188756   ETHANOLAMINE 5% INJ 2ML            $185.84       0.00                91   PHARMACY
9103110   ETHOSUXIMIDE 250MG CAPSULE          $14.75       0.00                91   PHARMACY
9107988   ETODOLAC 400MG TABLET               $15.66       0.00                91   PHARMACY
9189424   ETOMIDATE 40MG/20ML INJ            $112.58       0.00                91   PHARMACY
9316167   ETOPOSIDE 100MG/5ML INJ            $482.70       0.00                93   PHARMACY
9197393   ETOPOSIDE 50MG CAPSULE             $108.00       0.00                91   PHARMACY
9169905   EUCERIN CREAM 120GM                 $35.54       0.00                91   PHARMACY
9168261   EUCERIN LOTION 240ML                 $0.00       0.00                91   PHARMACY
9106105   EXCEDRIN MIGRAINE TABLET             $0.00       0.00                91   PHARMACY
9174830   EYE WASH OPHTH SOLN 120ML           $33.02       0.00                91   PHARMACY
9100736   EZETIMIBE 10MG TABLET               $17.55       0.00                91   PHARMACY
9196098   FACTOR 7 (NOVOSEVEN)             $5,152.10       0.00                93   PHARMACY
9196056   FACTOR 8 (HEMOFIL)                 $500.40       0.00                93   PHARMACY
9109281   FAMCICLOVIR 500MG TABLET            $29.03       0.00                91   PHARMACY
9103144   FAMOTIDINE 20MG TABLET              $16.20       0.00                91   PHARMACY
9188178   FAMOTIDINE 20MG/20ML SYRINGE        $53.86       0.00                91   PHARMACY
9188178   FAMOTIDINE 20MG/2ML INJ            $104.74       0.00                93   PHARMACY
9151242   FAT EMULSIONS 10% 200ML            $104.24       0.00                91   PHARMACY
9151234   FAT EMULSIONS 10% 500ML             $97.80       0.00                91   PHARMACY
9151267   FAT EMULSIONS 20% 200ML            $110.24       0.00                91   PHARMACY
9151226   FAT EMULSIONS 20% 500ML            $136.90       0.00                91   PHARMACY
9108853   FELODIPINE CR 2.5MG TABLET          $15.18       0.00                91   PHARMACY
9100074   FELODIPINE CR 5MG TABLET            $15.18       0.00                91   PHARMACY
9109398   FENOFIBRATE, MICR 160MG TAB         $17.99       0.00                91   PHARMACY
9112871   FENOLDOPAM 10MG/ML INJ             $570.88       0.00                91   PHARMACY
9163056   FENTANYL 100MCG/2ML INJ             $78.02       0.00                91   PHARMACY
9161035   FENTANYL 100MCG/HR PATCH           $118.64       0.00                91   PHARMACY
9112871   FENTANYL 1250MCG/250ML NS DRIP     $156.40       0.00                93   PHARMACY
9155854   FENTANYL 200MCG LOZENGE             $41.11       0.00                91   PHARMACY
9166174                                      $209.08
          FENTANYL 200MCG/BUPIVAC 0.1% /100ML NS           0.00                93   PHARMACY
9163031   FENTANYL 250MCG/5ML INJ             $78.64       0.00                91   PHARMACY
9161001   FENTANYL 25MCG/HR PATCH             $53.44       0.00                91   PHARMACY
9155755   FENTANYL 400MCG LOZENGE             $45.52       0.00                91   PHARMACY
9161019   FENTANYL 50MCG/HR PATCH             $72.13       0.00                91   PHARMACY
9161027   FENTANYL 75MCG/HR PATCH             $99.54       0.00                91   PHARMACY
9178187   FERROUS 15MG/0.6ML DROPS 50ML       $34.48       0.00                91   PHARMACY
9113200   FERROUS FUMARATE 90MG TABLET        $12.77       0.00                91   PHARMACY
9103177   FERROUS GLUCONATE 325MG TABLET $12.88            0.00                91   PHARMACY
9179664   FERROUS SULF 300MG/5ML LIQ          $13.54       0.00                91   PHARMACY
9179664   FERROUS SULF 44MG/ML LIQ 120ML       $0.00       0.00                91   PHARMACY
9103193   FERROUS SULFATE 325MG TABLET         $0.00       0.00                91   PHARMACY
9114505   FERROUS SULFATE CR 160MG TAB         $0.00       0.00                91   PHARMACY
9113416   FEXOFENADINE 180MG TABLET           $17.42       0.00                91   PHARMACY
9107590   FEXOFENADINE 60MG TABLET            $15.43       0.00                91   PHARMACY




                                                    Page 95
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9113622                                       $15.48
          FEXOFENADINE/PSEUD (ALLEGRA-D) 60/120 TAB       0.00                91   PHARMACY
9188087   FILGRASTIM 300MCG/ML INJ           $465.88      0.00                91   PHARMACY
9188095   FILGRASTIM 480MCG/1.6ML INJ        $712.14      0.00                91   PHARMACY
9100066   FINASTERIDE 5MG TABLET              $18.05      0.00                91   PHARMACY
9103011   FIORICET TABLET                     $14.39      0.00                91   PHARMACY
9155284   FIORINAL/CODEINE #3 CAPSULE         $28.94      0.00                91   PHARMACY
9116419   FISH OIL 1000MG CAPSULE             $12.86      0.00                91   PHARMACY
9103227   FLAVOXATE 100MG TABLET              $15.63      0.00                91   PHARMACY
9103219   FLECAINIDE 100MG TABLET             $18.79      0.00                91   PHARMACY
9109521   FLECAINIDE 50MG TABLET              $16.59      0.00                91   PHARMACY
9128166   FLEET ENEMA 133ML                   $27.30      0.00                91   PHARMACY
9128158   FLEET MINERAL OIL ENEMA 133ML       $28.66      0.00                91   PHARMACY
9316092   FLOXURIDINE 500MG INJ              $742.70      0.00                93   PHARMACY
9104647   FLUCONAZOLE 100MG TABLET            $29.23      0.00                91   PHARMACY
9305848   FLUCONAZOLE 2MG/ML NS PREMIX       $296.88      0.00                93   PHARMACY
9178963   FLUCONAZOLE 40MG/ML SUSP 35ML      $270.70      0.00                91   PHARMACY
9316191   FLUDARABINE 50MG INJ             $1,132.96      0.00                93   PHARMACY
9103276   FLUDROCORTISONE 0.1MG TABLET        $14.39      0.00                91   PHARMACY
9187907   FLUMAZENIL 1MG/10ML INJ            $250.84      0.00                91   PHARMACY
9173469   FLUNISOLIDE 0.025% NASAL SPY 25ML $118.42       0.00                91   PHARMACY
9173519   FLUNISOLIDE INHALER 7GM            $167.50      0.00                91   PHARMACY
9169277   FLUOCINOLONE 0.01% CRM 15GM         $29.88      0.00                91   PHARMACY
9170408   FLUOCINOLONE 0.01% TOP SOLN 60ML $47.44         0.00                91   PHARMACY
9169285   FLUOCINOLONE 0.025% CRM 15GM        $31.54      0.00                91   PHARMACY
9168998   FLUOCINOLONE 0.025% OINT 60GM      $144.70      0.00                91   PHARMACY
9168295   FLUOCINONIDE 0.05% CRM 15GM         $52.54      0.00                91   PHARMACY
9168683   FLUOCINONIDE 0.05% SOL 60ML         $73.74      0.00                91   PHARMACY
9112871   FLUORESCEIN 0.6MG EYE STRIP         $25.69      0.00                91   PHARMACY
9188186   FLUORESCEIN 10% INJ 5ML             $92.00      0.00                91   PHARMACY
9174434   FLUORESCEIN 9MG STRIP               $13.24      0.00                91   PHARMACY
9170275   FLUORI-METHANE 85/15 SPRAY 103ML $89.20         0.00                91   PHARMACY
9174442   FLUOROMETHOLONE 0.1% OP SOL 15ML $95.80         0.00                91   PHARMACY
9173683                                       $
          FLUOROMETHONLONE 0.25% OP SOL 5ML68.26          0.00                91   PHARMACY
9170267   FLUOROURACIL 5% CRM 25GM           $235.82      0.00                91   PHARMACY
9316100   FLUOROURACIL 500MG/10ML INJ        $452.70      0.00                93   PHARMACY
9107996   FLUOXETINE 10MG CAPSULE             $17.92      0.00                91   PHARMACY
9114570   FLUOXETINE 20MG CAPSULE             $18.06      0.00                91   PHARMACY
9178971   FLUOXETINE 4MG/ML LIQ              $261.44      0.00                91   PHARMACY
9109539   FLUOXYMESTERONE 10MG TABLET         $31.78      0.00                91   PHARMACY
9106493   FLUPHENAZINE 1MG TABLET             $13.72      0.00                91   PHARMACY
9183351   FLUPHENAZINE 25MG/10ML INJ         $138.68      0.00                91   PHARMACY
9103292   FLUPHENAZINE 5MG TABLET             $15.37      0.00                91   PHARMACY
9173170   FLURBIPROFEN 0.03% OP SOL 2.5ML     $66.40      0.00                91   PHARMACY
9113044   FLURBIPROFEN 50MG TABLET            $14.30      0.00                91   PHARMACY
9197062   FLUTAMIDE 125MG CAPSULE             $16.90      0.00                91   PHARMACY
9173998   FLUTICASONE 0.05% NASAL SPY 16GM $155.46        0.00                91   PHARMACY
9174178   FLUTICASONE 110MCG INH 13GM        $179.84      0.00                91   PHARMACY
9174186   FLUTICASONE 220MCG INH 13GM        $304.69      0.00                91   PHARMACY
9174194   FLUTICASONE 44MCG INH 13GM         $162.55      0.00                91   PHARMACY
9116427   FLUVASTATIN XL 80MG SR TAB          $17.04      0.00                91   PHARMACY
9107459   FLUVOXAMINE 50MG TABLET             $19.38      0.00                91   PHARMACY
9107301   FLUVSTATIN 20MG CAPSULE             $16.09      0.00                91   PHARMACY
9114612   FOLIC ACID 1MG TABLET               $13.03      0.00                91   PHARMACY




                                                   Page 96
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9310590   FOLIC ACID 5MG/ML INJ             $27.91        0.00                91   PHARMACY
9174624   FORMOTEROL AEROLIZER 12MCG CAP #12$69.84        0.00                91   PHARMACY
9100090   FOSINOPRIL 10MG TABLET            $15.19        0.00                91   PHARMACY
9187477   FOSPHENYTOIN PE 100MG/2ML INJ     $92.30        0.00                91   PHARMACY
9187493   FOSPHENYTOIN PE 500MG/10ML INJ   $175.14        0.00                91   PHARMACY
9187824   FUROSEMIDE 100MG/10ML INJ         $55.46        0.00                91   PHARMACY
9178203   FUROSEMIDE 10MG/ML LIQ 60ML       $46.24        0.00                91   PHARMACY
9103318   FUROSEMIDE 20MG TABLET            $13.03        0.00                91   PHARMACY
9103326   FUROSEMIDE 40MG TABLET            $13.07        0.00                91   PHARMACY
9187816   FUROSEMIDE 40MG/4ML INJ           $53.64        0.00                91   PHARMACY
9107194   GABAPENTIN 100MG CAPSULE          $13.95        0.00                91   PHARMACY
9107186   GABAPENTIN 300MG CAPSULE          $15.62        0.00                91   PHARMACY
9107673   GABAPENTIN 400MG CAPSULE          $16.08        0.00                91   PHARMACY
9179888   GABAPENTIN 50MG/ML SOLN 120ML     $76.86        0.00                91   PHARMACY
9109786   GALANTAMINE 4MG TABLET            $17.44        0.00                91   PHARMACY
9112871   GANCICLOVIR 250MG CAPSULE         $22.36        0.00                91   PHARMACY
9305632   GANCICLOVIR 500MG INJ            $522.49        0.00                93   PHARMACY
9108861   GATIFLOXACIN 200MG TABLET         $30.63        0.00                91   PHARMACY
9305798   GATIFLOXACIN 200MG/100ML D5W     $137.76        0.00                93   PHARMACY
9108879   GATIFLOXACIN 400MG TABLET         $30.63        0.00                91   PHARMACY
9305889   GATIFLOXACIN 400MG/200ML D5W     $177.86        0.00                93   PHARMACY
9306416   GATIFLOXACIN 400MG/40ML VIAL     $177.86        0.00                93   PHARMACY
9103334   GAVISCON FOAMTAB                   $0.00        0.00                91   PHARMACY
9178211   GAVISCON SUSP 360ML                $0.00        0.00                91   PHARMACY
9169319   GELATIN POWDER 1GM               $181.64        0.00                91   PHARMACY
9169327   GELFILM OPHTHALMIC DRESSING       $88.18        0.00                91   PHARMACY
9316415   GEMCITABINE 200MG INJ            $699.96        0.00                93   PHARMACY
9103409   GEMFIBROZIL 600MG TABLET          $14.91        0.00                91   PHARMACY
9316464   GEMTUZUMAB 5MG INJ             $4,870.20        0.00                93   PHARMACY
9170135   GENTAMICIN 0.1% CREAM 15GM        $32.64        0.00                91   PHARMACY
9169350   GENTAMICIN 0.1% OINT 15GM         $32.64        0.00                91   PHARMACY
9173329   GENTAMICIN 0.3% OP OINT 3.5GM     $64.78        0.00                91   PHARMACY
9173337   GENTAMICIN 0.3% OP SOLN 5ML       $64.94        0.00                91   PHARMACY
9305145   GENTAMICIN 80MG/2ML INJ          $106.92        0.00                93   PHARMACY
9305160   GENTAMICIN PEDI 20MG/2ML INJ     $104.12        0.00                93   PHARMACY
9306101   GENTAMINCIN PEDI SYRINGE IN NS   $102.94        0.00                93   PHARMACY
9137217   GI COCKTAIL 40ML                  $31.44        0.00                91   PHARMACY
9316449   GLATIRAMER 20MG INJ            $2,660.58        0.00                93   PHARMACY
9108002   GLIMEPIRIDE 2MG TABLET            $13.72        0.00                91   PHARMACY
9109299   GLIMEPIRIDE 4MG TABLET            $14.62        0.00                91   PHARMACY
9103375   GLIPIZIDE 10MG TABLET             $14.06        0.00                91   PHARMACY
9114620   GLIPIZIDE 5MG TABLET              $13.47        0.00                91   PHARMACY
9108564   GLIPIZIDE XL 10MG TABLET          $14.31        0.00                91   PHARMACY
9113077   GLIPIZIDE XL 2.5MG TABLET         $13.53        0.00                91   PHARMACY
9107343   GLIPIZIDE XL 5MG TABLET           $13.53        0.00                91   PHARMACY
9188202   GLUCAGON 1MG INJ                 $199.60        0.00                91   PHARMACY
9108887   GLUCOSAMINE 500MG CAPSULE         $13.12        0.00                91   PHARMACY
9113705   GLUCOSAMINE/CHONDROIT 500/400 CAP$13.55         0.00                91   PHARMACY
9112871   GLUCOSE 40% GEL 37.5GM            $31.12        0.00                91   PHARMACY
9113275   GLUTAMINE 10GM PACKET             $16.10        0.00                91   PHARMACY
9103359   GLYBURIDE 2.5MG TABLET            $13.33        0.00                91   PHARMACY
9103425   GLYBURIDE 3MG TABLET              $14.20        0.00                91   PHARMACY
9114638   GLYBURIDE 5MG TABLET              $13.77        0.00                91   PHARMACY




                                                   Page 97
                                    85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9179516   GLYCERIN 50% ORAL LIQ 220ML          $87.94      0.00                91   PHARMACY
9128026   GLYCERIN ADULT SUPP                  $12.98      0.00                91   PHARMACY
9128034   GLYCERIN PEDIATRIC SUPP              $12.93      0.00                91   PHARMACY
9178997   GLYCERIN SOLN 480ML                  $32.86      0.00                91   PHARMACY
9188210   GLYCOPYRROLATE 0.2MG/ML INJ          $52.66      0.00                91   PHARMACY
9103367   GLYCOPYRROLATE 1MG TABLET            $14.04      0.00                91   PHARMACY
9178229   GOLYTELY SOLUTION 4000ML             $62.32      0.00                91   PHARMACY
9187246   GOSERELIN 3.6MG IMPLANT SYRN      $1,385.18      0.00                93   PHARMACY
9306119   GRANISETRON 1MG/ML INJ              $441.28      0.00                91   PHARMACY
9168709   GRANULEX SPRAY 56.7ML                $53.24      0.00                91   PHARMACY
9109844   GUAIFED CAP                          $15.56      0.00                91   PHARMACY
9100751   GUAIFEN/PHENYL 600/30MG SR TAB       $15.54      0.00                91   PHARMACY
9116435   GUAIFEN/PSEUDO 600/120 SR TAB        $14.68      0.00                91   PHARMACY
9179896                                        $32.94
          GUAIFENESIN (SF,AF,SF,DF) 100MG/5ML LIQ 118ML    0.00                91   PHARMACY
9137068   GUAIFENESIN 200MG/10ML UD CUP        $26.28      0.00                91   PHARMACY
9137159   GUAIFENESIN DM SYRUP 10ML UD CUP $26.18          0.00                91   PHARMACY
9178252   GUAIFENESIN DM SYRUP 10ML UD CUP $29.40          0.00                91   PHARMACY
9106634   GUAIFENESIN LA 600MG TABLET          $13.30      0.00                91   PHARMACY
9159112   GUAIFENESIN W/CODEINE 10ML CUP       $26.40      0.00                91   PHARMACY
9158130   GUAIFENESIN W/CODEINE 10ML CUP       $25.50      0.00                91   PHARMACY
9113267   GUAIFENESIN/PSEUDO 300/60 SR CAP $13.63          0.00                91   PHARMACY
9103391   GUANFACINE 1MG TABLET                $14.46      0.00                91   PHARMACY
9186099   HAEMOPHILUS B CONJUGATE VACCINE$104.96           0.00                91   PHARMACY
9103466   HALOPERIDOL 0.5MG TABLET             $13.29      0.00                91   PHARMACY
9103474   HALOPERIDOL 1MG TABLET               $13.63      0.00                91   PHARMACY
9178260   HALOPERIDOL 2MG/ML CONC LIQ 120ML $95.66         0.00                91   PHARMACY
9103482   HALOPERIDOL 5MG TABLET               $14.63      0.00                91   PHARMACY
9188228   HALOPERIDOL 5MG/ML INJ               $65.86      0.00                91   PHARMACY
9189523   HALOPERIDOL DEC 50MG/ML INJ         $129.72      0.00                91   PHARMACY
9183708   HEPARIN 1,000 UNITS/ML 10ML INJ      $53.88      0.00                91   PHARMACY
9183716   HEPARIN 1,000 UNITS/ML 30ML INJ      $29.98      0.00                91   PHARMACY
9183823   HEPARIN 10 UNITS/ML 10ML INJ         $26.62      0.00                91   PHARMACY
9188236   HEPARIN 10,000 UNITS/ML INJ          $54.26      0.00                91   PHARMACY
9183682   HEPARIN 100 UNITS/ML 10ML INJ        $52.38      0.00                91   PHARMACY
9151069   HEPARIN 1,000 UNITS/500ML NS         $83.82      0.00                91   PHARMACY
9151044   HEPARIN 25,000 UNITS/250ML D5W DRIP$88.44        0.00                91   PHARMACY
9189184   HEPARIN 5,000 UNITS/ML INJ           $52.80      0.00                91   PHARMACY
9145046   HEPARIN PF 10 UNITS/ML INJ           $26.68      0.00                91   PHARMACY
9145004   HEPARIN PF 100 UNITS/ML INJ          $26.84      0.00                91   PHARMACY
9194002   HEPATITIS B IMMUNE GLOBULIN INJ     $589.40      0.00                93   PHARMACY
9186198   HEPATITIS B VACCINE                 $111.84      0.00                91   PHARMACY
9147182   HETASTARCH (HESPAN) 6%/NS 500ML $133.92          0.00                91   PHARMACY
9188244   HISTOPLASMIN SKIN TEST               $72.13      0.00                91   PHARMACY
9173352   HOMATROPINE 5% OP SOLN 5ML           $51.90      0.00                91   PHARMACY
9170002   HURRICAINE 20% AEROSOL 60ML          $59.64      0.00                91   PHARMACY
9189531   HYALURONATE 10MG/ML OP INJ 0.55ML $288.38        0.00                91   PHARMACY
9158148   HYCODAN SYRUP                        $25.54      0.00                91   PHARMACY
9158155   HYCOTUSS SYRUP                       $25.62      0.00                91   PHARMACY
9114737   HYDRALAZINE 10MG TABLET              $12.84      0.00                91   PHARMACY
9188277   HYDRALAZINE 20MG/1ML INJ             $80.88      0.00                91   PHARMACY
9103540   HYDRALAZINE 25MG TABLET              $13.06      0.00                91   PHARMACY
9103557   HYDRALAZINE 50MG TABLET              $13.15      0.00                91   PHARMACY
9114711   HYDROCHLOROTHIAZIDE 25MG TABLET $13.02           0.00                91   PHARMACY




                                                    Page 98
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9155540                                      $28.33
          HYDROCODONE/APAP (LORCET) 10/650 TAB            0.00                91   PHARMACY
9155599                                      $27.33
          HYDROCODONE/APAP (LORTAB) 7.5/500 TAB           0.00                91   PHARMACY
9155664   HYDROCODONE/APAP (NORCO) 10/325 TAB$27.53       0.00                91   PHARMACY
9155839                                      $
          HYDROCODONE/APAP (NORCO) 5/325 TAB26.78         0.00                91   PHARMACY
9155722                                      $27.42
          HYDROCODONE/APAP (VICODIN) 10/500 TAB           0.00                91   PHARMACY
9155581                                      $27.14
          HYDROCODONE/APAP (VICODIN) 5/500 TAB            0.00                91   PHARMACY
9159013   HYDROCODONE/APAP LIQ 15ML UDCUP $31.64          0.00                91   PHARMACY
9155763                                      $28.10
          HYDROCODONE/IBUPROFEN 7.5/200 TABLET            0.00                91   PHARMACY
9169301   HYDROCORTISONE 0.2% CRM 45GM       $98.14       0.00                91   PHARMACY
9169392   HYDROCORTISONE 0.5% CRM 30GM        $0.00       0.00                91   PHARMACY
9169376   HYDROCORTISONE 1% CREAM 30GM       $33.70       0.00                91   PHARMACY
9169400   HYDROCORTISONE 1% OINT 28GM        $32.52       0.00                91   PHARMACY
9128414   HYDROCORTISONE 1% RECTAL CRM 30GM $118.52       0.00                91   PHARMACY
9170465                                     15GM
          HYDROCORTISONE 10% RECTAL FOAM $192.70          0.00                91   PHARMACY
9128141   HYDROCORTISONE 100MG ENEMA         $49.68       0.00                91   PHARMACY
9169418   HYDROCORTISONE 2.5% CRM 30GM       $43.12       0.00                91   PHARMACY
9168725   HYDROCORTISONE 2.5% OINT 30GM      $43.12       0.00                91   PHARMACY
9128448   HYDROCORTISONE 2.5% RECTAL CRM 30GM$99.70       0.00                91   PHARMACY
9188285                                      $
          HYDROCORTISONE SOD SUCC 100MG INJ 55.36         0.00                91   PHARMACY
9188301                                      $
          HYDROCORTISONE SOD SUCC 250MG INJ 58.80         0.00                91   PHARMACY
9188293                                      $
          HYDROCORTISONE SOD SUCC 500MG INJ 68.78         0.00                91   PHARMACY
9103599   HYDROCORTONE 10MG TABLET           $13.22       0.00                91   PHARMACY
9169590   HYDROGEN PEROXIDE 3% SOL 120ML $26.90           0.00                91   PHARMACY
9163122   HYDROMORPHONE 1 - 4MG INJ          $86.96       0.00                91   PHARMACY
9163320   HYDROMORPHONE 10MG/ML INJ          $83.40       0.00                91   PHARMACY
9163122   HYDROMORPHONE 1-2MG INJ            $78.98       0.00                91   PHARMACY
9163395   HYDROMORPHONE 1MG/ML INJ           $78.40       0.00                91   PHARMACY
9158361   HYDROMORPHONE 1MG/ML LIQ           $25.89       0.00                91   PHARMACY
9155334   HYDROMORPHONE 2MG TABLET           $26.69       0.00                91   PHARMACY
9163122   HYDROMORPHONE 2MG/ML INJ           $78.98       0.00                91   PHARMACY
9166125   HYDROMORPHONE 30MG/30ML NS PCA $178.20          0.00                93   PHARMACY
9128042   HYDROMORPHONE 3MG SUPP             $32.63       0.00                91   PHARMACY
9155342   HYDROMORPHONE 4MG TABLET           $27.34       0.00                91   PHARMACY
9163130   HYDROMORPHONE 4MG/ML INJ           $78.60       0.00                91   PHARMACY
9166018   HYDROMORPHONE 50MG/100ML NS       $180.12       0.00                93   PHARMACY
9163551   HYDROMORPHONE 50MG/5ML INJ        $109.90       0.00                91   PHARMACY
9168311   HYDROPHILIC WOUND CREAM 75GM       $54.58       0.00                91   PHARMACY
9103615   HYDROXYCHLOROQUINE 200MG TABLET$15.18           0.00                91   PHARMACY
9197070   HYDROXYUREA 500MG CAPSULE          $15.37       0.00                91   PHARMACY
9189416   HYDROXYZINE 100MG/2ML INJ          $53.46       0.00                91   PHARMACY
9103649   HYDROXYZINE HCL 10MG TABLET        $13.97       0.00                91   PHARMACY
9114752   HYDROXYZINE HCL 25MG TABLET        $14.55       0.00                91   PHARMACY
9179680   HYDROXYZINE HCL 2MG/ML LIQ 120ML $38.19         0.00                91   PHARMACY
9108465   HYDROXYZINE PAMOATE 25MG CAP       $13.13       0.00                91   PHARMACY
9108457   HYDROXYZINE PAMOATE 50MG CAP       $13.99       0.00                91   PHARMACY
9113713   HYOSCYAMINE SL 0.125MG TABLET      $14.02       0.00                91   PHARMACY
9102435   HYOSCYAMINE SR 0.375MG CAPSULE     $13.80       0.00                91   PHARMACY
9147638   HYSKON IRRIG SOLN 100ML            $78.56       0.00                91   PHARMACY
9103664   IBUPROFEN 200MG TABLET              $0.00       0.00                91   PHARMACY
9178237   IBUPROFEN 20MG/ML LIQ 120ML         $0.00       0.00                91   PHARMACY
9114778   IBUPROFEN 400MG TABLET             $13.15       0.00                91   PHARMACY
9103680   IBUPROFEN 600MG TABLET             $13.33       0.00                91   PHARMACY
9189366   IBUTILIDE 1MG/10ML INJ            $602.08       0.00                91   PHARMACY




                                                   Page 99
                                     85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9316258   IDARUBICIN INJ                     $1,427.50      0.00                93   PHARMACY
9316225   IFOSFAMIDE 1GM INJ                   $784.88      0.00                93   PHARMACY
9305178   IMIPENEM/CILASTATIN 500MG INJ        $164.63      0.00                93   PHARMACY
9103730   IMIPRAMINE 10MG TABLET                $13.29      0.00                91   PHARMACY
9103748   IMIPRAMINE 25MG TABLET                $14.47      0.00                91   PHARMACY
9194044   IMMUNE GLOB (HUMAN) 10% INJ          $456.90      0.00                93   PHARMACY
9194093   IMMUNE GLOBULIN, GAMMA (IGG)         $314.40      0.00                93   PHARMACY
9103722   INDAPAMIDE 2.5MG TABLET               $14.43      0.00                91   PHARMACY
9188327   INDIGO CARMINE 0.8% INJ 5ML           $67.58      0.00                91   PHARMACY
9197138   INDINAVIR 400MG CAPSULE               $18.79      0.00                91   PHARMACY
9114828   INDOMETHACIN 25MG CAPSULE             $13.52      0.00                91   PHARMACY
9103821   INDOMETHACIN 50MG CAPSULE             $14.08      0.00                91   PHARMACY
9189358   INFLIXIMAB 10MG INJ                  $240.08      0.00                93   PHARMACY
9186081   INFLUENZA VACCINE                     $68.38      0.00                91   PHARMACY
9145020   INSULIN HUMAN NPH                     $50.93      0.00                91   PHARMACY
9145038   INSULIN HUMAN REGULAR                 $50.93      0.00                91   PHARMACY
9183039   INSULIN NPL/LISPRO 75/25 MIX (VIAL) $159.08       0.00                91   PHARMACY
9112871   INSULIN, ASPART (VIAL)               $159.08      0.00                91   PHARMACY
9183302   INSULIN, GLARGINE (VIAL)             $144.86      0.00                91   PHARMACY
9145111   INSULIN, HUMAN 70/30 MIX              $50.93      0.00                91   PHARMACY
9145095   INSULIN, HUMAN LENTE                  $50.93      0.00                91   PHARMACY
9183096   INSULIN, HUMAN ULTRALENTE (VIAL) $104.00          0.00                91   PHARMACY
9145061   INSULIN, LISPRO                       $50.99      0.00                91   PHARMACY
9189549   INTERFERON BETA-1B 0.3MG INJ         $211.08      0.00                91   PHARMACY
9179011   IODINE MILD TINCTURE 480ML            $45.98      0.00                91   PHARMACY
9112871   IOTHALAMATE-43 50ML VIAL              $41.82      0.00                91   PHARMACY
9137076   IPECAC SYRUP 30ML UDCUP               $28.24      0.00                91   PHARMACY
9132051   IPRATROPIUM 0.02% SOL 2.5ML           $16.24      0.00                91   PHARMACY
9174756   IPRATROPIUM 0.03% NASAL SPY 30ML $125.54          0.00                91   PHARMACY
9174764   IPRATROPIUM 0.06% NASAL SPY 15ML $111.26          0.00                91   PHARMACY
9173162   IPRATROPIUM INHALER 14GM             $123.54      0.00                91   PHARMACY
9108515   IRBESARTAN 150MG TABLET               $15.89      0.00                91   PHARMACY
9114844   IRBESARTAN 75MG TABLET                $15.73      0.00                91   PHARMACY
9316506   IRINOTECAN 20MG/ML INJ               $764.81      0.00                93   PHARMACY
9188335   IRON DEXTRAN 100MG/2ML INJ           $177.16      0.00                93   PHARMACY
9173436   ISOETHARINE 1% SOLN 10ML              $61.94      0.00                91   PHARMACY
9182080   ISOFLURANE 100ML                     $100.88      0.00                91   PHARMACY
9179730   ISONIAZID 10MG/ML LIQ 120ML           $35.59      0.00                91   PHARMACY
9103847   ISONIAZID 300MG TABLET                $13.02      0.00                91   PHARMACY
9169848   ISOPROPYL ALCOHOL 70% SOLN 480ML $27.92           0.00                91   PHARMACY
9310707   ISOPROTERENOL 1MG/5ML INJ            $142.54      0.00                93   PHARMACY
9103862   ISOSORBIDE DINITRATE 10MG TAB         $13.08      0.00                91   PHARMACY
9103870   ISOSORBIDE DINITRATE 20MG TAB         $13.17      0.00                91   PHARMACY
9103888   ISOSORBIDE DINITRATE 5MG SL TAB       $12.83      0.00                91   PHARMACY
9103854   ISOSORBIDE DINITRATE 5MG TAB          $13.04      0.00                91   PHARMACY
9116443   ISOSORBIDE DN 40MG SR TAB             $13.85      0.00                91   PHARMACY
9107152   ISOSORBIDE MONONITRATE 20MG TAB $14.81            0.00                91   PHARMACY
9107160   ISOSORBIDE MONONITRATE SR 30MG TAB    $16.68      0.00                91   PHARMACY
9108424   ISOSORBIDE MONONITRATE SR 60MG TAB    $15.45      0.00                91   PHARMACY
9112871   ISOSULFAN BLUE 1% 5ML VIAL           $330.88      0.00                91   PHARMACY
9114877   ISRADIPINE 2.5MG CAPSULE              $15.41      0.00                91   PHARMACY
9103672   ITRACONAZOLE 100MG CAPSULE            $29.72      0.00                91   PHARMACY
9179441   ITRACONAZOLE 10MG/ML LIQ 150ML       $270.02      0.00                91   PHARMACY




                                                     Page 100
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9306358   ITRACONAZOLE 250MG INJ           $471.50        0.00                93   PHARMACY
9109943   IVERMECTIN 3MG TABLET             $23.60        0.00                91   PHARMACY
9306234   KANAMYCIN 1GM/3ML INJ            $115.62        0.00                93   PHARMACY
9179524   KAOPECTATE SUSPENSION 240ML       $31.90        0.00                91   PHARMACY
9163379   KETAMINE 500MG/10ML INJ          $108.82        0.00                91   PHARMACY
9169582   KETOCONAZOLE 2% CREAM 15GM        $58.36        0.00                91   PHARMACY
9170093   KETOCONAZOLE 2% SHAMPOO 120ML $77.28            0.00                91   PHARMACY
9114919   KETOCONAZOLE 200MG TABLET         $19.04        0.00                91   PHARMACY
9173444   KETOROLAC 0.5% OP SOLN 5ML       $137.96        0.00                91   PHARMACY
9103714   KETOROLAC 10MG TABLET             $14.58        0.00                91   PHARMACY
9188061   KETOROLAC 30MG/1ML INJ            $58.88        0.00                91   PHARMACY
9188038   KETOROLAC 60MG/2ML INJ            $63.38        0.00                91   PHARMACY
9114893   K-LYTE/CL EFF 25MEQ TABLET        $15.59        0.00                91   PHARMACY
9106683   KU-ZYME CAPSULE                   $13.91        0.00                91   PHARMACY
9103987   LABETALOL 100MG TABLET            $13.68        0.00                91   PHARMACY
9183112   LABETALOL 100MG/20ML INJ          $60.88        0.00                91   PHARMACY
9103961   LABETALOL 200MG TABLET            $14.08        0.00                91   PHARMACY
9173378   LACRI-LUBE OPHTH OINT             $38.66        0.00                91   PHARMACY
9147141   LACTATED RINGERS 1000ML           $79.82        0.00                91   PHARMACY
9147141   LACTATED RINGERS 1L (FLOORSTOCK) $79.82         0.00                91   PHARMACY
9113259   LACTOBACILLUS ACIDOPH PACKET      $13.83        0.00                91   PHARMACY
9103979   LACTOBACILLUS CHEW TABLET         $12.96        0.00                91   PHARMACY
9137092   LACTULOSE 20GM/30ML UD CUP        $31.40        0.00                91   PHARMACY
9197211   LAMIVUDINE 150MG TABLET           $23.25        0.00                91   PHARMACY
9108036   LAMOTRIGINE 25MG TABLET           $18.44        0.00                91   PHARMACY
9107434   LANSOPRAZOLE 15MG SR CAPSULE      $21.46        0.00                91   PHARMACY
9108044   LANSOPRAZOLE 30MG SR CAPSULE      $21.63        0.00                91   PHARMACY
9199043   LANSOPRAZOLE 3MG/ML SUSP 50ML $101.44           0.00                91   PHARMACY
9174715   LATANOPROST 0.005% OP SOLN 2.5ML $131.44        0.00                91   PHARMACY
9116450   LEFLUNOMIDE 10MG TABLET           $32.97        0.00                91   PHARMACY
9188632   LEPIRUDIN 50MG INJ               $340.26        0.00                91   PHARMACY
9170481   LET SOLUTION 5ML                  $21.02        0.00                91   PHARMACY
9109984   LETROZOLE 2.5MG TABLET            $27.65        0.00                91   PHARMACY
9101957   LEUCOVORIN 25MG TABLET            $40.10        0.00                91   PHARMACY
9189226   LEUCOVORIN 50MG INJ              $109.26        0.00                93   PHARMACY
9101940   LEUCOVORIN 5MG TABLET             $19.22        0.00                91   PHARMACY
9316530   LEUPROLIDE 2-WK 1MG/0.2ML KIT    $934.58        0.00                91   PHARMACY
9132069   LEVALBUTEROL 0.63MG/3ML INH SOLN $17.40         0.00                91   PHARMACY
9108945   LEVETIRACETAM 500MG TABLET        $16.76        0.00                91   PHARMACY
9173402   LEVOBUNOLOL 0.25% OP SOLN 5ML     $57.08        0.00                91   PHARMACY
9173386   LEVOBUNOLOL 0.5% OP SOLN 5ML      $58.72        0.00                91   PHARMACY
9174707   LEVOCABASTINE 0.05% OP SOLN 5ML $122.22         0.00                91   PHARMACY
9174988   LEVOFLOXACIN 0.5% OP SOLN 5ML     $99.74        0.00                91   PHARMACY
9107822   LEVOFLOXACIN 500MG TABLET         $31.93        0.00                91   PHARMACY
9305814   LEVOFLOXACIN 500MG/100ML D5W     $187.98        0.00                93   PHARMACY
9104019   LEVOTHYROXINE 100MCG TAB          $13.27        0.00                91   PHARMACY
9104027   LEVOTHYROXINE 112MCG TAB          $13.32        0.00                91   PHARMACY
9104035   LEVOTHYROXINE 125MCG TAB          $13.36        0.00                91   PHARMACY
9114950   LEVOTHYROXINE 150MCG TAB          $13.38        0.00                91   PHARMACY
9109547   LEVOTHYROXINE 175MCG TAB          $13.46        0.00                91   PHARMACY
9188343   LEVOTHYROXINE 200MCG INJ         $120.76        0.00                91   PHARMACY
9103995   LEVOTHYROXINE 25MCG TABLET        $13.37        0.00                91   PHARMACY
9114943   LEVOTHYROXINE 50MCG TAB           $13.20        0.00                91   PHARMACY




                                                  Page 101
                                     85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9104001   LEVOTHYROXINE 75MCG TAB               $13.38      0.00                91   PHARMACY
9104043   LEVOTHYROXINE 88MCG TAB               $13.27      0.00                91   PHARMACY
9114984   LIBRAX CAP                            $16.86      0.00                91   PHARMACY
9183120   LIDOCAINE 0.5% INJ 50ML               $55.38      0.00                91   PHARMACY
9183187   LIDOCAINE 0.5%/EPI 1:200000 INJ 50ML $56.80       0.00                91   PHARMACY
9183138   LIDOCAINE 1% INJ 20ML                 $56.04      0.00                91   PHARMACY
9183195   LIDOCAINE 1%/EPI 1:100000 INJ 20ML    $53.64      0.00                91   PHARMACY
9189432   LIDOCAINE 1.5%/EPI 1:200000 INJ 10ML $65.42       0.00                91   PHARMACY
9187857   LIDOCAINE 100MG SYRINGE               $55.40      0.00                91   PHARMACY
9183161   LIDOCAINE 2% INJ 20ML                 $51.66      0.00                91   PHARMACY
9170168   LIDOCAINE 2% JELLY 30ML               $64.18      0.00                91   PHARMACY
9179789   LIDOCAINE 2% VISCOUS 100ML            $30.70      0.00                91   PHARMACY
9137290   LIDOCAINE 2% VISCOUS 20ML UDCUP $27.96            0.00                91   PHARMACY
9183203   LIDOCAINE 2%/EPI 1:100000 INJ 20ML    $54.10      0.00                91   PHARMACY
9151390   LIDOCAINE 2GM/250ML D5W PREMIX        $97.92      0.00                91   PHARMACY
9188384   LIDOCAINE 4% INJ 5ML                  $55.50      0.00                91   PHARMACY
9169442   LIDOCAINE 4% TOPICAL SOLN 50ML        $39.52      0.00                91   PHARMACY
9169434   LIDOCAINE 5% OINTMENT 35GM            $53.06      0.00                91   PHARMACY
9171190   LIDOCAINE 5% PATCH                    $74.69      0.00                91   PHARMACY
9189465   LIDOCAINE 5%-GLUCOSE 7.5% INJ 2ML $56.28          0.00                91   PHARMACY
9189614   LIDOCAINE MPF 1% INJ 5ML              $55.62      0.00                91   PHARMACY
9188400   LIDOCAINE MPF 1.5% INJ 20ML           $75.82      0.00                91   PHARMACY
9189622   LIDOCAINE MPF 2% 10ML INJ             $56.10      0.00                91   PHARMACY
9189630   LIDOCAINE MPF 2%/EPI 1:200000 10ML $67.84         0.00                91   PHARMACY
9112871   LINEZOLID 100MG/5ML SUSP 150ML       $669.60      0.00                91   PHARMACY
9109257   LINEZOLID 600MG TABLET               $131.99      0.00                91   PHARMACY
9306291   LINEZOLID 600MG/300ML SW PREMIX $263.14           0.00                93   PHARMACY
9104092   LIOTHYRONINE 25MCG TABLET             $13.98      0.00                91   PHARMACY
9104084   LIOTHYRONINE 5MCG TABLET              $13.77      0.00                91   PHARMACY
9104118   LIOTRIX 60MG TABLET                   $14.07      0.00                91   PHARMACY
9104126   LIOTRIX 120MG TABLET                  $14.31      0.00                91   PHARMACY
9104134   LIOTRIX 180MG TABLET                  $14.66      0.00                91   PHARMACY
9114992   LIOTRIX 30MG TABLET                   $13.80      0.00                91   PHARMACY
9103805   LISINOPRIL 10MG TABLET                $14.95      0.00                91   PHARMACY
9103813   LISINOPRIL 20MG TABLET                $14.74      0.00                91   PHARMACY
9103797   LISINOPRIL 5MG TABLET                 $14.88      0.00                91   PHARMACY
9113424   LISINOPRIL/HCTZ 20/12.5 TABLET        $15.39      0.00                91   PHARMACY
9109976   LISINOPRIL/HCTZ 20/25 TABLET          $15.42      0.00                91   PHARMACY
9104175   LITHIUM CARB 150MG CAPSULE            $13.06      0.00                91   PHARMACY
9115007   LITHIUM CARB 300MG CAPSULE            $13.14      0.00                91   PHARMACY
9104167   LITHIUM CARB SR (LITHOBID) 300MG TAB$13.61        0.00                91   PHARMACY
9104159   LITHIUM CARB SR 450MG TABLET          $13.86      0.00                91   PHARMACY
9179037   LITHIUM CITRATE 60MG/ML LIQ 120ML     $34.81      0.00                91   PHARMACY
9174996   LODOXAMIDE 0.1% OP SOLN 10ML         $151.20      0.00                91   PHARMACY
9103763   LOPERAMIDE 2MG CAPSULE                $14.13      0.00                91   PHARMACY
9137191   LOPERAMIDE 2MG/10ML LIQ UDCUP         $27.84      0.00                91   PHARMACY
9104209   LORATADINE 10MG TABLET                $19.18      0.00                91   PHARMACY
9106824   LORATADINE/PSEUDO SR 12HR TABLET $16.36           0.00                91   PHARMACY
9106816   LORATADINE/PSEUDO SR 24HR TABLET $20.00           0.00                91   PHARMACY
9155060   LORAZEPAM 0.5MG TABLET                $26.83      0.00                91   PHARMACY
9155078   LORAZEPAM 1MG TABLET                  $27.25      0.00                91   PHARMACY
9163452   LORAZEPAM 20MG/10ML INJ              $195.64      0.00                91   PHARMACY
9163254   LORAZEPAM 2MG/1 ML INJ                $93.08      0.00                91   PHARMACY




                                                     Page 102
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9158080   LORAZEPAM 2MG/ML ORAL SOLN       $28.12        0.00                91   PHARMACY
9107327   LOSARTAN 50MG TABLET             $15.75        0.00                91   PHARMACY
9175001   LOTEPREDNOL 0.2% OP SOLN 5ML     $98.52        0.00                91   PHARMACY
9175019   LOTEPREDNOL 0.5% OP SOLN 5ML     $83.00        0.00                91   PHARMACY
9108093   LOVASTATIN 10MG TABLET           $15.41        0.00                91   PHARMACY
9104233   LOVASTATIN 20MG TABLET           $18.09        0.00                91   PHARMACY
9137282   MAALOX PLUS EX-STR 30ML UD CUP    $0.00        0.00                91   PHARMACY
9168329   MAFENIDE 8.5% CREAM 453.6GM     $333.88        0.00                91   PHARMACY
9199035   MAGIC MOUTHWASH 120ML            $43.44        0.00                91   PHARMACY
9115114   MAGNESIUM CHLORIDE CR 64MG TAB $12.95          0.00                91   PHARMACY
9178120   MAGNESIUM CITRATE LIQ 300ML      $28.64        0.00                91   PHARMACY
9104290   MAGNESIUM OXIDE 400MG TABLET     $13.12        0.00                91   PHARMACY
9188418   MAGNESIUM SULF 8MEQ/2ML INJ      $26.62        0.00                91   PHARMACY
9188418   MAGNESIUM SULFATE 1GM/2ML INJ    $26.62        0.00                91   PHARMACY
9151408                                    $91.82
          MAGNESIUM SULFATE 40GM/1000ML SWFI             0.00                91   PHARMACY
9169467   MAGNESIUM SULFATE CRYSTALS 454GM$27.80         0.00                91   PHARMACY
9151010   MANNITOL 20% IV SOLN 500ML      $112.88        0.00                91   PHARMACY
9310509   MANNITOL 25% 50ML VIAL           $55.16        0.00                91   PHARMACY
9173394   MAXITROL OPHTH OINT 3.5GM       $131.94        0.00                91   PHARMACY
9173410   MAXITROL OPHTH SOLN 5ML         $123.32        0.00                91   PHARMACY
9112871   MD-GASTROVIEW 66/10 SOL 240ML   $110.30        0.00                91   PHARMACY
9112871   MEASLES,MUMPS&RUBELLA VACCINE $91.98           0.00                91   PHARMACY
9115171   MEBENDAZOLE 100MG CHEW TABLET $23.36           0.00                91   PHARMACY
9316423   MECHLORETHAMINE 10MG INJ        $470.48        0.00                93   PHARMACY
9104365   MECLIZINE 12.5MG TABLET          $13.04        0.00                91   PHARMACY
9104373   MECLIZINE 25MG TABLET            $13.07        0.00                91   PHARMACY
9187931   MEDROXYPROGESTERONE 150MG/ML INJ$163.10        0.00                91   PHARMACY
9104399   MEDROXYPROGESTERONE 2.5MG TABLET $13.32        0.00                91   PHARMACY
9108101   MEDROXYPROGESTERONE 5MG TABLET$13.62           0.00                91   PHARMACY
9104407   MEGESTROL 40MG TABLET            $14.86        0.00                91   PHARMACY
9179078   MEGESTROL 40MG/ML LIQ 240ML     $313.34        0.00                91   PHARMACY
9113481   MELATONIN 3MG TABLET             $12.84        0.00                91   PHARMACY
9109802   MELOXICAM 7.5MG TABLET           $17.44        0.00                91   PHARMACY
9104415   MELPHALAN 2MG TABLET             $18.20        0.00                91   PHARMACY
9112871   MEMANTINE 10MG TABLET            $17.37        0.00                91   PHARMACY
9163197   MEPERIDINE 100MG/1ML INJ         $78.98        0.00                91   PHARMACY
9158320   MEPERIDINE 10MG/ML SYRUP         $25.75        0.00                91   PHARMACY
9163155   MEPERIDINE 25 - 50MG INJ         $78.98        0.00                91   PHARMACY
9163171   MEPERIDINE 25 - 75MG INJ         $78.98        0.00                91   PHARMACY
9163148   MEPERIDINE 25MG/1ML INJ          $78.22        0.00                91   PHARMACY
9166133   MEPERIDINE 300MG/30ML NS PCA    $150.80        0.00                93   PHARMACY
9163197   MEPERIDINE 50 - 100MG INJ        $78.98        0.00                91   PHARMACY
9163171   MEPERIDINE 50 - 75MG INJ         $78.98        0.00                91   PHARMACY
9155359   MEPERIDINE 50MG TABLET           $26.68        0.00                91   PHARMACY
9163155   MEPERIDINE 50MG/1ML INJ          $77.68        0.00                91   PHARMACY
9163197   MEPERIDINE 75 - 100MG INJ        $78.98        0.00                91   PHARMACY
9163171   MEPERIDINE 75MG/ML INJ           $78.38        0.00                91   PHARMACY
9183484   MEPIVACAINE 1% INJ 30ML          $66.38        0.00                91   PHARMACY
9183831   MEPIVACAINE 1.5% INJ 30ML        $71.88        0.00                91   PHARMACY
9183237   MEPIVACAINE 2% INJ 20ML          $68.08        0.00                91   PHARMACY
9106840   MEPROBAMATE 400MG TABLET         $26.13        0.00                91   PHARMACY
9197120   MERCAPTOPURINE 50MG TABLET       $20.70        0.00                91   PHARMACY
9306283   MEROPENEM 1GM INJ               $205.44        0.00                93   PHARMACY




                                                 Page 103
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9107392   MESALAMINE 250MG CAPSULE         $13.92        0.00                91   PHARMACY
9128067   MESALAMINE 4GM/60ML ENEMA        $55.92        0.00                91   PHARMACY
9128216   MESALAMINE 500MG SUPP            $20.91        0.00                91   PHARMACY
9104894   MESALAMINE EC 400MG TABLET       $14.60        0.00                91   PHARMACY
9316233   MESNA 100MG/ML INJ              $185.97        0.00                93   PHARMACY
9112871   MESSAGE                           $0.00        0.00                91   PHARMACY
9132192   METAPROTERENOL 0.4% INH 2.5ML    $15.18        0.00                91   PHARMACY
9132200   METAPROTERENOL 0.6% INH 2.5ML    $15.18        0.00                91   PHARMACY
9104423   METAPROTERENOL 10MG TABLET       $13.40        0.00                91   PHARMACY
9174939   METAPROTERENOL INHALER 14GM      $88.94        0.00                91   PHARMACY
9108432   METAXALONE 400MG TABLET          $14.84        0.00                91   PHARMACY
9107467   METFORMIN 500MG TABLET           $14.13        0.00                91   PHARMACY
9107293   METFORMIN 850MG TABLET           $15.11        0.00                91   PHARMACY
9109315   METFORMIN XR 500MG TABLET        $14.25        0.00                91   PHARMACY
9155375   METHADONE 10MG TABLET            $26.22        0.00                91   PHARMACY
9158205   METHADONE 1MG/ML LIQUID          $25.56        0.00                91   PHARMACY
9155367   METHADONE 5MG TABLET             $26.12        0.00                91   PHARMACY
9158015   METHADONE INTENSOL 10MG/ML LIQ   $26.94        0.00                91   PHARMACY
9113473   METHAZOLAMIDE 25MG TABLET        $13.68        0.00                91   PHARMACY
9104431   METHAZOLAMIDE 50MG TABLET        $14.30        0.00                91   PHARMACY
9104449   METHENAMINE HIPPURATE 1GM TAB    $15.50        0.00                91   PHARMACY
9104456   METHENAMINE MANDELATE 1GM TAB    $13.78        0.00                91   PHARMACY
9104464                                    $13.38
          METHENAMINE MANDELATE EC 500MG TAB             0.00                91   PHARMACY
9106501   METHIMAZOLE 10MG TABLET          $14.26        0.00                91   PHARMACY
9104472   METHIMAZOLE 5MG TABLET           $13.61        0.00                91   PHARMACY
9183492   METHOCARBAMOL 1000MG/10ML INJ    $81.98        0.00                91   PHARMACY
9115239   METHOCARBAMOL 500MG TABLET       $13.47        0.00                91   PHARMACY
9104480   METHOCARBAMOL 750MG TABLET       $13.71        0.00                91   PHARMACY
9163098   METHOHEXITAL 500MG INJ          $141.14        0.00                91   PHARMACY
9197088   METHOTREXATE 2.5MG TABLET        $20.16        0.00                91   PHARMACY
9316548   METHOTREXATE PF 25MG/ML INJ     $453.96        0.00                93   PHARMACY
9109463   METHYLCELLULOSE PACKET           $13.27        0.00                91   PHARMACY
9104522   METHYLDOPA 250MG TABLET          $13.46        0.00                91   PHARMACY
9104530   METHYLDOPA 500MG TABLET          $14.07        0.00                91   PHARMACY
9310731   METHYLDOPATE 250MG/5ML INJ      $126.76        0.00                93   PHARMACY
9188426   METHYLENE BLUE 1% INJ            $64.88        0.00                91   PHARMACY
9104548   METHYLERGONOVINE 0.2MG TABLET    $14.20        0.00                91   PHARMACY
9187691   METHYLERGONOVINE 0.2MG/ML INJ    $59.04        0.00                91   PHARMACY
9155409   METHYLPHENIDATE 5MG TABLET       $26.11        0.00                91   PHARMACY
9104555   METHYLPREDNISOLONE 4MG TABLET    $13.69        0.00                91   PHARMACY
9183294   METHYLPREDNISOLONE SS 125MG INJ $57.66         0.00                91   PHARMACY
9183260   METHYLPREDNISOLONE SS 1GM INJ    $89.44        0.00                91   PHARMACY
9187154   METHYLPREDNISOLONE SS 40MG INJ   $55.09        0.00                91   PHARMACY
9183252   METHYLPREDNISOLONE SS 500MG INJ $69.96         0.00                91   PHARMACY
9115270   METHYSERGIDE 2MG TABLET          $18.40        0.00                91   PHARMACY
9174657   METIPRANOLOL 0.3% OP SOLN 5ML    $65.30        0.00                91   PHARMACY
9104571   METOCLOPRAMIDE 10MG TABLET       $13.35        0.00                91   PHARMACY
9188434   METOCLOPRAMIDE 10MG/2ML INJ     $106.46        0.00                93   PHARMACY
9179532   METOCLOPRAMIDE 1MG/ML LIQ 120ML $35.08         0.00                91   PHARMACY
9104563   METOCLOPRAMIDE 5MG TABLET        $13.53        0.00                91   PHARMACY
9151424   METOCLOPROMIDE 50MG/50ML D5W    $182.84        0.00                93   PHARMACY
9104589   METOLAZONE 2.5MG TABLET          $15.19        0.00                91   PHARMACY
9104597   METOLAZONE 5MG TABLET            $15.46        0.00                91   PHARMACY




                                                 Page 104
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9104605   METOPROLOL 50MG TABLET            $13.86        0.00                91   PHARMACY
9188442   METOPROLOL 5MG/5ML INJ            $57.76        0.00                91   PHARMACY
9109901   METOPROLOL XL 25MG SR TAB         $14.17        0.00                91   PHARMACY
9115296   METOPROLOL XL 50MG TABLET         $14.17        0.00                91   PHARMACY
9168774   METRONIDAZOLE 0.75% GEL 28.4GM   $103.94        0.00                91   PHARMACY
9170036   METRONIDAZOLE 0.75% VAG GEL 70GM$115.08         0.00                91   PHARMACY
9104639   METRONIDAZOLE 250MG TABLET        $13.30        0.00                91   PHARMACY
9104621   METRONIDAZOLE 500MG TABLET        $14.38        0.00                91   PHARMACY
9305541   METRONIDAZOLE 5MG/ML PREMIX      $106.66        0.00                93   PHARMACY
9104498   MEXILETINE 150MG CAPSULE          $14.10        0.00                91   PHARMACY
9168345   MICONAZOLE 2% CREAM 15GM          $64.72        0.00                91   PHARMACY
9170150   MICONAZOLE 2% POWDER 45GM         $32.94        0.00                91   PHARMACY
9169491   MICONAZOLE 2% VAG CREAM 45GM      $51.92        0.00                91   PHARMACY
9128356   MICONAZOLE 3 200MG VAG SUPP #3    $85.94        0.00                91   PHARMACY
9128349   MICONAZOLE 7 100MG VAG SUPP #7    $48.58        0.00                91   PHARMACY
9128422   MICONAZOLE DUAL PACK              $82.92        0.00                91   PHARMACY
9163304   MIDAZOLAM 2MG/2ML INJ             $77.70        0.00                91   PHARMACY
9163288   MIDAZOLAM 10MG/10ML INJ           $85.08        0.00                91   PHARMACY
9158221   MIDAZOLAM 2MG/ML SYRUP            $27.63        0.00                91   PHARMACY
9163460   MIDAZOLAM 50MG/10ML INJ          $103.50        0.00                91   PHARMACY
9107533   MIDODRINE 2.5MG TABLET            $15.22        0.00                91   PHARMACY
9108408   MIDODRINE 5MG TABLET              $17.75        0.00                91   PHARMACY
9310129   MILRINONE 20MG/20ML INJ          $296.76        0.00                93   PHARMACY
9137126   MINERAL OIL ( ORAL) 30ML UDCUP    $26.34        0.00                91   PHARMACY
9174780   MINERAL OIL LIGHT SOLN 10ML       $28.14        0.00                91   PHARMACY
9112871   MINOCYCLINE 100MG CAPSULE         $17.64        0.00                91   PHARMACY
9306838   MINOCYCLINE 100MG INJ            $194.52        0.00                93   PHARMACY
9107004   MINOCYCLINE PELLETIZED 50MG CAP $17.39          0.00                91   PHARMACY
9104688   MINOXIDIL 10MG TABLET             $15.30        0.00                91   PHARMACY
9104670   MINOXIDIL 2.5MG TABLET            $13.90        0.00                91   PHARMACY
9199019   MIRACLE MOUTHWASH 120ML           $43.44        0.00                91   PHARMACY
9116468   MIRALAX 17GM PACKET               $16.70        0.00                91   PHARMACY
9170283   MIRALAX POWDER 255GM              $65.00        0.00                91   PHARMACY
9107566   MIRTAZAPINE 15MG TABLET           $18.26        0.00                91   PHARMACY
9112871   MIRTAZAPINE 30MG TABLET           $18.43        0.00                91   PHARMACY
9113432   MIRTAZAPINE SOL 15MG TABLET       $17.53        0.00                91   PHARMACY
9113440   MIRTAZAPINE SOL 30MG TABLET       $17.67        0.00                91   PHARMACY
9104274   MISOPROSTOL 200MCG TABLET         $15.54        0.00                91   PHARMACY
9109562   MISOPROSTOL 25MCG DOSE            $15.52        0.00                91   PHARMACY
9316134   MITOMYCIN 5MG INJ                $585.20        0.00                93   PHARMACY
9316324   MITOXANTRONE 2MG/ML INJ        $1,005.60        0.00                93   PHARMACY
9183286   MIVACURIUM 20MG/10ML INJ          $88.14        0.00                91   PHARMACY
9137100   MOM 30ML UDCUP                     $0.00        0.00                91   PHARMACY
9168808   MOMETASONE 0.1% CREAM 15GM        $70.30        0.00                91   PHARMACY
9168477   MOMETASONE 0.1% LOTION 60ML      $118.30        0.00                91   PHARMACY
9170317   MOMETASONE 0.1% OINT 15GM         $70.30        0.00                91   PHARMACY
9174483   MOMETASONE 50MCG NASAL SPY 17GM  $160.34        0.00                91   PHARMACY
9107558   MONTELUKAST 10MG TABLET           $18.55        0.00                91   PHARMACY
9108952   MONTELUKAST 4MG CHEW TAB          $18.55        0.00                91   PHARMACY
9163445   MORPHINE 1 - 10MG INJ             $78.72        0.00                91   PHARMACY
9163445   MORPHINE 1 - 5MG INJ              $78.72        0.00                91   PHARMACY
9166141   MORPHINE 100MG/100ML NS DRIP     $154.72        0.00                93   PHARMACY
9163445   MORPHINE 10MG/ML INJ              $78.04        0.00                91   PHARMACY




                                                  Page 105
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9163478   MORPHINE 15MG/ML 20ML INJ       $101.08        0.00                91   PHARMACY
9163445   MORPHINE 2 - 10MG INJ            $78.72        0.00                91   PHARMACY
9163221   MORPHINE 2 - 4MG INJ             $78.72        0.00                91   PHARMACY
9163445   MORPHINE 2 - 5MG INJ             $78.72        0.00                91   PHARMACY
9112871   MORPHINE 2 - 6MG INJ             $78.72        0.00                91   PHARMACY
9163445   MORPHINE 2 - 8MG INJ             $78.72        0.00                91   PHARMACY
9158023   MORPHINE 20MG/ML ORAL SOLN       $26.68        0.00                91   PHARMACY
9163189   MORPHINE 2MG/ML INJ              $78.52        0.00                91   PHARMACY
9163445   MORPHINE 3 - 8MG INJ             $78.72        0.00                91   PHARMACY
9166158   MORPHINE 30MG/30ML NS PCA       $152.32        0.00                93   PHARMACY
9163445   MORPHINE 4 - 8MG INJ             $78.72        0.00                91   PHARMACY
9163221   MORPHINE 4MG/ML INJ              $78.58        0.00                91   PHARMACY
9166166   MORPHINE 50MG/100ML DRIP        $150.62        0.00                93   PHARMACY
9163437   MORPHINE 50MG/ML 20ML INJ       $254.36        0.00                91   PHARMACY
9163429   MORPHINE PF 10MG/10ML INJ        $94.78        0.00                91   PHARMACY
9163544   MORPHINE PF 200MG/20ML INJ      $388.32        0.00                91   PHARMACY
9163569   MORPHINE PF 500MG/20ML AMP      $638.32        0.00                91   PHARMACY
9163528   MORPHINE PF 5MG/10ML INJ         $93.52        0.00                91   PHARMACY
9155391   MORPHINE SR 100MG TABLET         $36.38        0.00                91   PHARMACY
9155383   MORPHINE SR 15MG TABLET          $27.43        0.00                91   PHARMACY
9155433   MORPHINE SR 30MG TABLET          $29.23        0.00                91   PHARMACY
9155300   MORPHINE SR 60MG TABLET          $32.83        0.00                91   PHARMACY
9183419   MORRHUATE 50MG/ML INJ           $175.88        0.00                91   PHARMACY
9115379   MOXIFLOXACIN 400MG TABLET        $31.57        0.00                91   PHARMACY
9178427   MULTIVITAMIN LIQ 120ML           $36.30        0.00                91   PHARMACY
9310335   MULTIVITAMIN INJ                 $44.80        0.00                91   PHARMACY
9100702   MULTIVITAMIN TABLET               $0.00        0.00                91   PHARMACY
9109570   MULTIVITAMIN,THER W/MIN TABLET    $0.00        0.00                91   PHARMACY
9174848   MUPIROCIN 2% NASAL OINT 1GM      $37.22        0.00                91   PHARMACY
9169574   MUPIROCIN 2% OINTMENT 22GM      $116.80        0.00                91   PHARMACY
9174673   MURO-128 5% OPHT SOL 15ML        $54.24        0.00                91   PHARMACY
9106600   MYCOPHENALATE 250MG CAPSULE      $18.59        0.00                91   PHARMACY
9179904   MYCOPHENOLATE 200MG/ML LIQ 175ML$847.30        0.00                91   PHARMACY
9106667   NABUMETONE 500MG TABLET          $15.72        0.00                91   PHARMACY
9108143   NABUMETONE 750MG TABLET          $16.26        0.00                91   PHARMACY
9108150   NADOLOL 20MG TABLET              $14.57        0.00                91   PHARMACY
9104746   NADOLOL 40MG TABLET              $14.88        0.00                91   PHARMACY
9305582   NAFCILLIN 1GM INJ               $107.42        0.00                93   PHARMACY
9306465   NAFCILLIN 500MG INJ             $106.14        0.00                93   PHARMACY
9187709   NALBUPHINE 10MG/ML INJ           $53.16        0.00                91   PHARMACY
9108473   NALIDIXIC ACID 1GM TABLET        $17.93        0.00                91   PHARMACY
9187717   NALOXONE 0.4MG/ML INJ            $53.68        0.00                91   PHARMACY
9188475   NALOXONE 2MG/2ML INJ             $60.86        0.00                91   PHARMACY
9106576   NALTREXONE 50MG TABLET           $21.27        0.00                91   PHARMACY
9163619   NANDROLONE DE 200MG/2ML INJ     $105.38        0.00                91   PHARMACY
9174665   NAPHAZOLINE 0.1% OP SOLN 15ML    $72.74        0.00                91   PHARMACY
9173915   NAPHAZOLINE/ANTAZOLINE EYE DROPS $41.70        0.00                91   PHARMACY
9173873   NAPHAZOLINE/PHENIRAMINE OPSOL    $41.20        0.00                91   PHARMACY
9108481   NAPROXEN 220MG TABLET            $12.90        0.00                91   PHARMACY
9104753   NAPROXEN 250MG TABLET            $14.32        0.00                91   PHARMACY
9104761   NAPROXEN 275MG TABLET            $14.41        0.00                91   PHARMACY
9104779   NAPROXEN 375MG TABLET            $14.91        0.00                91   PHARMACY
9104787   NAPROXEN 500MG TABLET            $15.40        0.00                91   PHARMACY




                                                 Page 106
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9108499   NAPROXEN 550MG TABLET             $15.31       0.00                91   PHARMACY
9173980   NEDOCROMIL INHALER 16.2GM        $110.88       0.00                91   PHARMACY
9103631   NEFAZODONE 100MG TABLET           $15.76       0.00                91   PHARMACY
9108168   NEFAZODONE 150MG TABLET           $15.82       0.00                91   PHARMACY
9179136   NEOMYCIN 25MG/ML LIQ 120ML        $38.69       0.00                91   PHARMACY
9104795   NEOMYCIN 500MG TABLET             $16.67       0.00                91   PHARMACY
9169558   NEOSPORIN OINT 30GM               $30.64       0.00                91   PHARMACY
9172024   NEOSPORIN OINT PACKET             $12.94       0.00                91   PHARMACY
9173485   NEOSPORIN OPHTH OINT 3.5GM        $56.98       0.00                91   PHARMACY
9173477   NEOSPORIN OPHTH SOLN 10ML         $89.70       0.00                91   PHARMACY
9183310   NEOSTIGMINE 1MG (1:1000) INJ      $68.74       0.00                91   PHARMACY
9107335   NEPHROCAPS CAPSULE                 $0.00       0.00                91   PHARMACY
9107111   NEPHRO-VITE TABLET                $13.04       0.00                91   PHARMACY
9189648   NESIRITIDE INJ                   $405.76       0.00                93   PHARMACY
9106592   NEUTRA PHOS K PWD (250MG PHOS)    $13.76       0.00                91   PHARMACY
9105644   NEUTRA-PHOS PKT (250MG PHOS)      $13.59       0.00                91   PHARMACY
9197377   NEVIRAPINE 200MG TABLET           $24.94       0.00                91   PHARMACY
9170291   NEW SKIN LIQUID 2.55GM             $0.00       0.00                91   PHARMACY
9108507   NIACIN 100MG TABLET               $12.77       0.00                91   PHARMACY
9104837   NIACIN 500MG TABLET               $12.81       0.00                91   PHARMACY
9104829   NIACIN 50MG TABLET                $12.76       0.00                91   PHARMACY
9109372   NIACIN SR 250MG CAPSULE           $12.84       0.00                91   PHARMACY
9104837   NIACIN SR 500MG TABLET            $12.84       0.00                91   PHARMACY
9104852   NICARDIPINE 20MG CAPSULE          $13.51       0.00                91   PHARMACY
9310913   NICARDIPINE 25MG/10ML INJ        $146.50       0.00                91   PHARMACY
9104845   NICARDIPINE 30MG CAPSULE          $13.97       0.00                91   PHARMACY
9109992   NICARDIPINE SR 30MG CAPSULE       $14.54       0.00                91   PHARMACY
9107103   NICARDIPINE SR 45MG CAPSULE       $15.60       0.00                91   PHARMACY
9171067   NICOTINE 11MG PATCH               $18.43       0.00                91   PHARMACY
9171067   NICOTINE 14MG PATCH               $19.46       0.00                91   PHARMACY
9171075   NICOTINE 21MG PATCH               $20.99       0.00                91   PHARMACY
9171075   NICOTINE 22MG PATCH               $18.43       0.00                91   PHARMACY
9182098   NICOTINE 2MG GUM #12              $35.92       0.00                91   PHARMACY
9171059   NICOTINE 7MG PATCH                $19.46       0.00                91   PHARMACY
9104860   NIFEDIPINE 10MG CAPSULE           $14.05       0.00                91   PHARMACY
9104886   NIFEDIPINE 20MG CAPSULE           $14.74       0.00                91   PHARMACY
9113721   NIFEDIPINE SR 30MG TABLET         $15.67       0.00                91   PHARMACY
9113739   NIFEDIPINE SR 60MG TABLET         $17.98       0.00                91   PHARMACY
9115445   NIFEDIPINE XL 30MG TABLET         $16.10       0.00                91   PHARMACY
9104878   NIFEDIPINE XL 60MG TABLET         $18.57       0.00                91   PHARMACY
9113754   NIFEDIPINE XL 90MG TABLET         $19.47       0.00                91   PHARMACY
9113242   NIFEREX-150 CAPSULE               $13.45       0.00                91   PHARMACY
9107038   NIFEREX-150 FORTE CAPSULE         $13.49       0.00                91   PHARMACY
9104902   NIMODIPINE 30MG CAPSULE           $27.81       0.00                91   PHARMACY
9130071   NITRAZINE PAPER W/DISPENSER       $85.46       0.00                91   PHARMACY
9179912   NITROFURANTOIN 25MG/5ML LIQ 60ML $57.28        0.00                91   PHARMACY
9104910   NITROFURANTOIN MACRO 50MG CAP     $14.19       0.00                91   PHARMACY
9108689                                     $16.68
          NITROFURANTOIN SR (MACROBID) 100MG CAP         0.00                91   PHARMACY
9171083   NITROGLYCERIN 0.1MG/HR PATCH      $16.90       0.00                91   PHARMACY
9171091   NITROGLYCERIN 0.2MG/HR PATCH      $15.95       0.00                91   PHARMACY
9182064   NITROGLYCERIN 0.4MG SPRAY 12GM    $97.58       0.00                91   PHARMACY
9171109   NITROGLYCERIN 0.4MG/HR PATCH      $16.41       0.00                91   PHARMACY
9171117   NITROGLYCERIN 0.6MG/HR PATCH      $16.79       0.00                91   PHARMACY




                                                 Page 107
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9172016   NITROGLYCERIN 2% OINT UD PKT     $14.00        0.00                91   PHARMACY
9310517   NITROGLYCERIN 50MG/10ML INJ     $129.88        0.00                93   PHARMACY
9151085   NITROGLYCERIN 50MG/D5W 250ML DRIP$90.24        0.00                91   PHARMACY
9182015   NITROGLYCERIN SL 0.3MG TABLET    $42.18        0.00                91   PHARMACY
9182049   NITROGLYCERIN SL 0.4MG TAB #25   $34.56        0.00                91   PHARMACY
9182007   NITROGLYCERIN SL 0.6MG TABLET    $42.18        0.00                91   PHARMACY
9104928   NITROGLYCERIN SR 2.5MG CAPSULE   $13.02        0.00                91   PHARMACY
9104936   NITROGLYCERIN SR 6.5MG CAPSULE   $13.07        0.00                91   PHARMACY
9310152   NITROPRESS 50MG/2ML INJ         $105.26        0.00                93   PHARMACY
9115460   NIZATIDINE 150MG CAPSULE         $19.01        0.00                91   PHARMACY
9310434   NOREPINEPHRINE 4MG/4ML INJ      $127.92        0.00                93   PHARMACY
9106618   NORETHINDRONE 5MG TABLET         $15.95        0.00                91   PHARMACY
9147489   NORMOSOL R/D5W 1000ML            $82.62        0.00                91   PHARMACY
9147323   NORMOSOL-R 1000ML(FLOORSTOCK)    $82.46        0.00                91   PHARMACY
9147323   NORMOSOL-R IV SOLN               $82.46        0.00                91   PHARMACY
9147489   NORMOSOL-R/D5W (FLOORSTOCK)      $82.62        0.00                91   PHARMACY
9104951   NORTRIPTYLINE 10MG CAPSULE       $13.61        0.00                91   PHARMACY
9104969   NORTRIPTYLINE 25MG CAPSULE       $14.49        0.00                91   PHARMACY
9168444   NYSTATIN 100,000 U/GM OINT 15GM  $30.94        0.00                91   PHARMACY
9178344   NYSTATIN 100,000 U/ML SUSP 60ML  $58.24        0.00                91   PHARMACY
9128059   NYSTATIN 100,000 UNITS VAG TAB   $16.81        0.00                91   PHARMACY
9169616   NYSTATIN 100,000U/GM POWDER      $80.36        0.00                91   PHARMACY
9168352   NYSTATIN 100,000UN/GM CRM 30GM   $37.44        0.00                91   PHARMACY
9169525   NYSTATIN/TRIAMCINOLONE CRM 30GM $38.70         0.00                91   PHARMACY
9187626   OCTREOTIDE 0.05MG/1 ML INJ       $69.70        0.00                91   PHARMACY
9188608   OCTREOTIDE 1000MCG/5ML INJ      $427.54        0.00                91   PHARMACY
9113465   OCUVITE TABLET                   $12.99        0.00                91   PHARMACY
9174699   OFLOXACIN 0.3% OPHTH SOLN 5ML   $104.54        0.00                91   PHARMACY
9113648   OFLOXACIN 200MG TABLET           $22.20        0.00                91   PHARMACY
9103698   OLANZAPINE 5MG TABLET            $24.97        0.00                91   PHARMACY
9100728   OLMESARTAN 20MG TABLET           $15.35        0.00                91   PHARMACY
9112871   OLMESARTAN 5MG TABLET            $15.35        0.00                91   PHARMACY
9175092   OLOPATADINE 0.1% OPH SOLN 5ML   $159.20        0.00                91   PHARMACY
9105206   OLSALAZINE 250MG CAPSULE         $15.20        0.00                91   PHARMACY
9102328   OMEPRAZOLE 20MG SR CAPSULE       $21.95        0.00                91   PHARMACY
9102336   OMEPRAZOLE 40MG SR CAPSULE       $25.96        0.00                91   PHARMACY
9103441   ONDANSETRON 4MG TABLET           $50.68        0.00                91   PHARMACY
9188509   ONDANSETRON 4MG/2ML INJ         $105.94        0.00                91   PHARMACY
9106832   ONDANSETRON ODT 4MG TABLET       $47.44        0.00                91   PHARMACY
9160003   OPIUM & BELLADONNA 60MG SUPP     $30.76        0.00                91   PHARMACY
9112871   OPIUM TINCTURE 10MG/ML           $26.50        0.00                91   PHARMACY
9189275   OPRELVEKIN 5MG INJ              $642.04        0.00                93   PHARMACY
9112871   ORAL BALANCE MOUTH MOIST GEL     $35.38        0.00                91   PHARMACY
9105016   ORPHENADRINE CR 100MG TABLET     $17.07        0.00                91   PHARMACY
9101924   OSCAL 500 TAB ( 1.25GM CA CARB)   $0.00        0.00                91   PHARMACY
9306473   OXACILLIN 1GM VIAL              $108.46        0.00                93   PHARMACY
9306499   OXACILLIN 2GM VIAL              $114.60        0.00                93   PHARMACY
9316555   OXALIPLATIN 5MG INJ             $644.05        0.00                93   PHARMACY
9108986   OXANDROLONE 2.5MG TABLET         $34.09        0.00                91   PHARMACY
9104704   OXAPROZIN 600MG TABLET           $16.93        0.00                91   PHARMACY
9155441   OXAZEPAM 10MG CAPSULE            $27.16        0.00                91   PHARMACY
9155458   OXAZEPAM 15MG CAPSULE            $27.62        0.00                91   PHARMACY
9109000   OXCARBAZEPINE 300MG TABLET       $16.56        0.00                91   PHARMACY




                                                 Page 108
                                     85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9178179   OXCARBAZEPINE 300MG/5ML LIQ 250ML$203.32          0.00                91   PHARMACY
9179771   OXYBUTYNIN 1MG/ML LIQ 120ML           $52.07      0.00                91   PHARMACY
9105032   OXYBUTYNIN 5MG TABLET                 $13.61      0.00                91   PHARMACY
9109265   OXYBUTYNIN XL 5MG TABLET              $18.06      0.00                91   PHARMACY
9158098   OXYCODONE 20MG/ML ORAL SOLN           $27.77      0.00                91   PHARMACY
9155557   OXYCODONE 5MG TABLET                  $26.26      0.00                91   PHARMACY
9155615   OXYCODONE SR 10MG TABLET              $28.36      0.00                91   PHARMACY
9155565   OXYCODONE SR 20MG TABLET              $31.03      0.00                91   PHARMACY
9155771   OXYCODONE SR 40MG TABLET              $35.36      0.00                91   PHARMACY
9155466   OXYCODONE/APAP 5/325MG TABLET         $27.84      0.00                91   PHARMACY
9174061   OXYMETAZOLINE 0.05% NASAL SPY 30ML$30.74          0.00                91   PHARMACY
9310475   OXYTOCIN 10 UNITS/ML INJ              $52.94      0.00                91   PHARMACY
9316209   PACLITAXEL 6MG/ML INJ                $790.64      0.00                93   PHARMACY
9188111   PAMIDRONATE 30MG INJ                 $661.48      0.00                93   PHARMACY
9168519   PANAFIL OINTMENT 30GM                $201.44      0.00                91   PHARMACY
9105073   PANCREASE EC CAPSULE                  $13.62      0.00                91   PHARMACY
9108192   PANCREASE MT-10 EC CAPSULE            $14.71      0.00                91   PHARMACY
9103565   PANCREASE MT-16 CAPSULE EC            $15.91      0.00                91   PHARMACY
9183328   PANCURONIUM 1MG/ML VIAL               $59.64      0.00                91   PHARMACY
9310814   PANTOPRAZOLE 40MG INJ                $151.76      0.00                93   PHARMACY
9109018   PANTOPRAZOLE SR 40MG TABLET           $19.75      0.00                91   PHARMACY
9168147   PAPAIN/UREA OINTMENT 30GM            $123.64      0.00                91   PHARMACY
9187279   PAPAVERINE 60MG/2ML INJ               $57.88      0.00                91   PHARMACY
9188657   PARICALCITOL 5MCG/ML INJ             $108.56      0.00                91   PHARMACY
9113747   PAROXETINE 10MG TABLET                $18.13      0.00                91   PHARMACY
9103508   PAROXETINE 20MG TABLET                $18.48      0.00                91   PHARMACY
9103516   PAROXETINE 30MG TABLET                $18.54      0.00                91   PHARMACY
9113762   PAROXETINE CR 12.5MG TABLET           $18.13      0.00                91   PHARMACY
9112871   PEDIATRIC MULTIVITAMINS 1ML INJ       $30.82      0.00                91   PHARMACY
9189598   PEGFILGRASTIM INJ                  $1,428.53      0.00                93   PHARMACY
9189309   PEGFILGRASTIM INJ                  $6,345.20      0.00                93   PHARMACY
9155789   PEMOLINE 18.75MG TABLET               $27.75      0.00                91   PHARMACY
9155797   PEMOLINE 37.5MG TABLET                $29.07      0.00                91   PHARMACY
9168139   PENCICLOVIR 1% CREAM 1.5GM            $73.54      0.00                91   PHARMACY
9105107   PENICILLAMINE 250MG CAP               $15.04      0.00                91   PHARMACY
9306523   PENICILLIN G BENZ 1.2MUN/2ML INJ     $106.06      0.00                91   PHARMACY
9305350   PENICILLIN G BENZ 2.4MUN/4ML INJ     $163.94      0.00                91   PHARMACY
9305905   PENICILLIN G BENZ 600,000 UNITS/ML INJ$82.74      0.00                91   PHARMACY
9305194   PENICILLIN G POT 1 MUNIT INJ         $103.61      0.00                93   PHARMACY
9305202   PENICILLIN G POT 5MUNIT INJ          $108.65      0.00                93   PHARMACY
9112871   PENICILLIN G SODIUM 5MUNIT INJ       $186.12      0.00                93   PHARMACY
9105115   PENICILLIN VK 250MG TABLET            $12.97      0.00                91   PHARMACY
9115585   PENICILLIN VK 500MG TABLET            $12.99      0.00                91   PHARMACY
9179748   PENICILLIN VK 50MG/ML SUSP 100ML      $31.02      0.00                91   PHARMACY
9306507   PENTAMIDINE 300MG INHALATION         $222.94      0.00                91   PHARMACY
9305855   PENTAMIDINE 300MG INJ                $196.16      0.00                93   PHARMACY
9163411   PENTAZOCINE 30MG/ML INJ               $85.08      0.00                91   PHARMACY
9155730   PENTAZOCINE/NALOLONE TABLET           $27.97      0.00                91   PHARMACY
9163536   PENTOBARBITAL 1000MG/20ML INJ        $108.84      0.00                91   PHARMACY
9163502   PENTOBARBITAL 2500MG/50ML INJ        $137.02      0.00                91   PHARMACY
9109810   PENTOSAN 100MG CAP                    $16.99      0.00                91   PHARMACY
9106675   PENTOXIFYLLINE CR 400MG TABLET        $14.03      0.00                91   PHARMACY
9107400   PERGOLIDE 0.05MG TABLET               $15.22      0.00                91   PHARMACY




                                                     Page 109
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9107418   PERGOLIDE 0.25MG TABLET           $16.86        0.00                91   PHARMACY
9169780   PERMETHRIN 1% LIQUID 60ML         $38.19        0.00                91   PHARMACY
9169798   PERMETHRIN 5% CREAM 60GM          $81.52        0.00                91   PHARMACY
9105131   PERPHENAZINE 2MG TABLET           $13.80        0.00                91   PHARMACY
9105149   PERPHENAZINE 4MG TABLET           $14.21        0.00                91   PHARMACY
9105164   PHENAZOPYRIDINE 100MG TABLET      $13.62        0.00                91   PHARMACY
9105172   PHENAZOPYRIDINE 200MG TABLET      $14.39        0.00                91   PHARMACY
9105180   PHENELZINE 15MG TABLET            $13.80        0.00                91   PHARMACY
9159005   PHENOBARB 30MG/7.5ML LIQ UDCUP    $26.28        0.00                91   PHARMACY
9102807   PHENOBARB/BELLADONNA SR TABLET $14.58           0.00                91   PHARMACY
9102815   PHENOBARB/BELLADONNA TABLET       $13.38        0.00                91   PHARMACY
9155508   PHENOBARBITAL 100MG TABLET        $25.61        0.00                91   PHARMACY
9163080   PHENOBARBITAL 130MG/ML INJ        $80.36        0.00                91   PHARMACY
9155482   PHENOBARBITAL 15MG TABLET         $25.52        0.00                91   PHARMACY
9155490   PHENOBARBITAL 30MG TABLET         $25.59        0.00                91   PHARMACY
9155847   PHENOBARBITAL 60MG TABLET         $25.56        0.00                91   PHARMACY
9163072   PHENOBARBITAL 65MG/ML INJ         $79.72        0.00                91   PHARMACY
9187287   PHENTOLAMINE 5MG INJ             $120.88        0.00                91   PHARMACY
9174517   PHENYLEPHRINE 0.25% NASAL SPY 15ML$32.42        0.00                91   PHARMACY
9174012   PHENYLEPHRINE 0.5% NASAL SPY 15ML $32.42        0.00                91   PHARMACY
9174541   PHENYLEPHRINE 1% NASAL SPY 15ML $33.34          0.00                91   PHARMACY
9173501   PHENYLEPHRINE 10% OP SOLN 5ML     $38.84        0.00                91   PHARMACY
9188491   PHENYLEPHRINE 10MG/ML INJ        $108.02        0.00                93   PHARMACY
9174863   PHENYLEPHRINE 2.5% OP SOLN 5ML    $66.06        0.00                91   PHARMACY
9187915   PHENYTOIN 100MG/2ML INJ           $58.78        0.00                91   PHARMACY
9137274   PHENYTOIN 100MG/4ML UD CUP        $26.55        0.00                91   PHARMACY
9187923   PHENYTOIN 250MG/5ML INJ           $60.26        0.00                91   PHARMACY
9179540   PHENYTOIN 25MG/ML LIQ 120ML       $58.74        0.00                91   PHARMACY
9105230   PHENYTOIN 50MG CHEW TABLET        $13.48        0.00                91   PHARMACY
9105222   PHENYTOIN SR 100MG CAPSULE        $13.38        0.00                91   PHARMACY
9105214   PHENYTOIN SR 30MG CAPSULE         $13.24        0.00                91   PHARMACY
9112871   PHOSPHATE PROTOCOL                 $0.00        0.00                91   PHARMACY
9179557   PHOSPHO-SODA SOLUTION 45ML        $27.84        0.00                91   PHARMACY
9187295   PHYSOSTIGMINE 2MG/2ML INJ         $60.60        0.00                91   PHARMACY
9187311   PHYTONADIONE 10MG/1ML INJ         $61.24        0.00                91   PHARMACY
9187303   PHYTONADIONE 1MG/0.5ML INJ        $56.30        0.00                91   PHARMACY
9115668   PHYTONADIONE 5MG TABLET           $14.03        0.00                91   PHARMACY
9174103   PILOCARPINE 0.5% OP SOLN 15ML     $38.68        0.00                91   PHARMACY
9173527   PILOCARPINE 1% OP SOLN 15ML       $43.84        0.00                91   PHARMACY
9173535   PILOCARPINE 2% OP SOLN 15ML       $49.04        0.00                91   PHARMACY
9173543   PILOCARPINE 3% OP SOLN 15ML       $46.80        0.00                91   PHARMACY
9173550   PILOCARPINE 4% OP SOLN 15ML       $47.74        0.00                91   PHARMACY
9113119   PILOCARPINE 5MG TABLET            $15.65        0.00                91   PHARMACY
9174137   PILOCARPINE HS 4% OP GEL 4GM     $107.44        0.00                91   PHARMACY
9171182   PIMECROLIMUS 1% CREAM 15GM        $75.48        0.00                91   PHARMACY
9105198   PIMOZIDE 2MG TABLET               $14.79        0.00                91   PHARMACY
9109026   PIOGLITAZONE 15MG TABLET          $19.38        0.00                91   PHARMACY
9305228   PIPERACILLIN 2GM INJ             $131.26        0.00                93   PHARMACY
9305236   PIPERACILLIN 3GM INJ             $146.00        0.00                93   PHARMACY
9305251   PIPERACILLIN 4GM INJ             $160.74        0.00                93   PHARMACY
9175035   PIRBUTEROL INHALER 14GM          $153.00        0.00                91   PHARMACY
9106717   PIROXICAM 10MG CAPSULE            $15.54        0.00                91   PHARMACY
9115684   PIROXICAM 20MG CAPSULE            $18.16        0.00                91   PHARMACY




                                                  Page 110
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9195025   PLASMA PROTEIN 5% IV SOLN         $384.40       0.00                93   PHARMACY
9186008   PNEUMOCOCCAL VACCINE ADULT INJ $82.14           0.00                91   PHARMACY
9170143   PODOFILOX 0.5% TOPICAL SOLN 3.5ML $246.50       0.00                91   PHARMACY
9108614   POLYCARBOPHIL CAL 625MG TABLET     $12.99       0.00                91   PHARMACY
9306341   POLYMYXIN B SULF 50,000 UNITS INJ  $68.88       0.00                91   PHARMACY
9174558   POLYMYXIN B/TMP OP SOLN 10ML       $60.28       0.00                91   PHARMACY
9174855   POLY-PRED OPHTH SOLN 5ML           $82.54       0.00                91   PHARMACY
9173584   POLYSPORIN OPHTH OINT 3.5GM        $87.96       0.00                91   PHARMACY
9310160   POTASSIUM ACETATE 2MEQ/ML INJ      $28.64       0.00                91   PHARMACY
9109588   POTASSIUM BICARB EFF 25MEQ TABLET $13.37        0.00                91   PHARMACY
9188996   POTASSIUM CHLORIDE 10MEQ/50ML SWFI$107.08       0.00                93   PHARMACY
9310939   POTASSIUM CHLORIDE 2MEQ/ML INJ     $26.52       0.00                91   PHARMACY
9113002   POTASSIUM CITRATE SR 5 MEQ TAB     $13.22       0.00                91   PHARMACY
9137142   POTASSIUM CL 10% 40MEQ/30ML UDCUP$26.22         0.00                91   PHARMACY
9105271   POTASSIUM CL 20MEQ PACKET          $15.69       0.00                91   PHARMACY
9112871   POTASSIUM CL 30MEQ/100ML SW       $107.02       0.00                93   PHARMACY
9105289   POTASSIUM CL SR 10MEQ CAPSULE      $13.36       0.00                91   PHARMACY
9105305   POTASSIUM CL SR 20MEQ TABLET       $13.85       0.00                91   PHARMACY
9114901   POTASSIUM CL SR 8MEQ CAPSULE       $13.36       0.00                91   PHARMACY
9178377   POTASSIUM IODIDE 1GM/ML LIQ 30ML   $49.64       0.00                91   PHARMACY
9183336   POTASSIUM PHOS 3MM0L/ML INJ        $28.22       0.00                91   PHARMACY
9183336   POTASSIUM PHOS 4.4MEQ/ML INJ       $28.22       0.00                91   PHARMACY
9115643   POTASSIUM PHOSPHOROUS 250MG TAB $13.02          0.00                91   PHARMACY
9168360   POVIDONE IODINE 5% SPRAY 88ML      $42.14       0.00                91   PHARMACY
9168014   POVIDONE-IODINE 10% OINT 30GM      $28.88       0.00                91   PHARMACY
9168501   POVIDONE-IODINE 10% SOLN 240ML     $29.60       0.00                91   PHARMACY
9107749   PRAMIPEXOLE 0.125MG TABLET         $14.50       0.00                91   PHARMACY
9168071   PRAMOXINE 1% FOAM 15GM             $80.30       0.00                91   PHARMACY
9170333   PRAMOXINE 1% GEL 118GM             $38.62       0.00                91   PHARMACY
9106550   PRAVASTATIN 20MG TABLET            $18.61       0.00                91   PHARMACY
9105313   PRAZIQUANTEL 600MG TABLET          $36.52       0.00                91   PHARMACY
9115700   PRAZOSIN 1MG CAPSULE               $13.31       0.00                91   PHARMACY
9105321   PRAZOSIN 2MG CAPSULE               $13.48       0.00                91   PHARMACY
9115718   PRAZOSIN 5MG CAPSULE               $14.03       0.00                91   PHARMACY
9173899   PREDNISOLONE 1% OP SOLN 10ML       $71.64       0.00                91   PHARMACY
9137332   PREDNISOLONE 15MG/5ML UD CUP       $27.80       0.00                91   PHARMACY
9179565   PREDNISOLONE 1MG/ML LIQ 120ML      $82.48       0.00                91   PHARMACY
9178526   PREDNISOLONE 3MG/ML LIQ 30ML       $39.63       0.00                91   PHARMACY
9106691   PREDNISOLONE 5MG TABLET            $13.00       0.00                91   PHARMACY
9105362   PREDNISONE 10MG TABLET             $12.90       0.00                91   PHARMACY
9105354   PREDNISONE 1MG TABLET              $13.14       0.00                91   PHARMACY
9179201   PREDNISONE 1MG/ML LIQ 120ML        $61.43       0.00                91   PHARMACY
9105347   PREDNISONE 2.5MG TABLET            $12.88       0.00                91   PHARMACY
9105370   PREDNISONE 20MG TABLET             $12.98       0.00                91   PHARMACY
9115742   PREDNISONE 5MG TABLET              $12.86       0.00                91   PHARMACY
9109513   PREMPRO 0.625/2.5MG TABLET         $15.32       0.00                91   PHARMACY
9105396   PRENATAL VIT/FE/FA TABLET          $13.25       0.00                91   PHARMACY
9128182   PREPARATION H OINT 30GM             $0.00       0.00                91   PHARMACY
9128380   PREPARATION H SUPP                 $13.68       0.00                91   PHARMACY
9189556   PRE-PEN 0.25MG INJ                $109.58       0.00                91   PHARMACY
9117045   PRIMAQUINE 26.3MG TABLET           $14.53       0.00                91   PHARMACY
9175100   PRIMATENE MIST INHALER 15GM        $49.16       0.00                91   PHARMACY
9105404   PRIMIDONE 250MG TABLET             $15.95       0.00                91   PHARMACY




                                                  Page 111
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9106709   PRIMIDONE 50MG TABLET             $13.52        0.00                91   PHARMACY
9105412   PROBENECID 500MG TABLET           $14.69        0.00                91   PHARMACY
9183377   PROCAINAMIDE 1000MG/10ML INJ      $53.24        0.00                91   PHARMACY
9183344   PROCAINAMIDE 1000MG/2ML INJ       $54.50        0.00                91   PHARMACY
9105420   PROCAINAMIDE 250MG CAPSULE        $14.38        0.00                91   PHARMACY
9105446   PROCAINAMIDE 375MG CAPSULE        $15.02        0.00                91   PHARMACY
9105453                                     $14.65
          PROCAINAMIDE ER 500MG TAB (PROCANBID)           0.00                91   PHARMACY
9105453   PROCAINAMIDE SR 500MG TABLET      $14.32        0.00                91   PHARMACY
9105479   PROCAINAMIDE SR 750MG TABLET      $14.51        0.00                91   PHARMACY
9105487   PROCARBAZINE 50MG CAPSULE         $14.11        0.00                91   PHARMACY
9105503   PROCHLORPERAZINE 10MG TABLET      $14.56        0.00                91   PHARMACY
9187337   PROCHLORPERAZINE 10MG/2ML INJ     $69.18        0.00                91   PHARMACY
9128075   PROCHLORPERAZINE 25MG SUPP        $18.97        0.00                91   PHARMACY
9128398   PROCHLORPERAZINE 5MG SUPP         $18.63        0.00                91   PHARMACY
9105495   PROCHLORPERAZINE 5MG TABLET       $13.95        0.00                91   PHARMACY
9169624   PROCTOFOAM-HC FOAM 10GM          $114.50        0.00                91   PHARMACY
9179227   PROMETHAZINE 1.25MG/ML LIQ 120ML $32.46         0.00                91   PHARMACY
9128091   PROMETHAZINE 12.5MG SUPP          $21.10        0.00                91   PHARMACY
9128083   PROMETHAZINE 25MG SUPP            $19.93        0.00                91   PHARMACY
9105511   PROMETHAZINE 25MG TABLET          $13.85        0.00                91   PHARMACY
9187345   PROMETHAZINE 25MG/1ML INJ         $55.64        0.00                91   PHARMACY
9128109   PROMETHAZINE 50MG SUPP            $22.50        0.00                91   PHARMACY
9187352   PROMETHAZINE 50MG/ML INJ          $58.54        0.00                91   PHARMACY
9159021   PROMETHAZINE W/COD 5ML UDCUP      $26.62        0.00                91   PHARMACY
9179235   PROMETHAZINE W/DM LIQ 120ML       $36.30        0.00                91   PHARMACY
9179672                                     $42.99
          PROMETHAZINE-PHENYLEPHRINE LIQ 120ML            0.00                91   PHARMACY
9105438   PROPAFENONE 150MG TABLET          $15.99        0.00                91   PHARMACY
9115833   PROPANTHELINE 15MG TABLET         $14.00        0.00                91   PHARMACY
9173592   PROPARACAINE 0.5% OP SOLN 15ML    $42.76        0.00                91   PHARMACY
9189101   PROPOFOL 1000MG/100ML INJ        $184.32        0.00                91   PHARMACY
9187444   PROPOFOL 200MG/20ML INJ           $77.56        0.00                91   PHARMACY
9187469   PROPOFOL 500MG/50ML INJ          $117.60        0.00                91   PHARMACY
9155516   PROPOXYPHENE 65MG CAPSULE         $26.67        0.00                91   PHARMACY
9155524   PROPOXYPHENE-N/APAP 100/650 TAB   $26.56        0.00                91   PHARMACY
9105529   PROPRANOLOL 10MG TABLET           $13.13        0.00                91   PHARMACY
9310228   PROPRANOLOL 1MG/1ML INJ           $88.00        0.00                91   PHARMACY
9105537   PROPRANOLOL 20MG TABLET           $13.26        0.00                91   PHARMACY
9108226   PROPRANOLOL LA 60MG CAPSULE       $15.13        0.00                91   PHARMACY
9105552   PROPRANOLOL LA 80MG CAPSULE       $15.54        0.00                91   PHARMACY
9105586   PROPYLTHIOURACIL 50MG TABLET      $13.03        0.00                91   PHARMACY
9187378   PROTAMINE SULF 250MG/25ML INJ     $75.86        0.00                91   PHARMACY
9187360   PROTAMINE SULF 50MG/5ML INJ       $59.20        0.00                91   PHARMACY
9105602   PSEUDOEPHEDRINE 30MG TABLET        $0.00        0.00                91   PHARMACY
9105610   PSYLLIUM PACKET                    $0.00        0.00                91   PHARMACY
9105628   PYRAZINAMIDE 500MG TABLET         $14.92        0.00                91   PHARMACY
9179250   PYRIDOSTIGMINE 12MG/ML LIQ 120ML $51.84         0.00                91   PHARMACY
9105636   PYRIDOSTIGMINE 60MG TABLET        $13.97        0.00                91   PHARMACY
9107442   PYRIDOSTIGMINE SR 180MG TABLET    $14.82        0.00                91   PHARMACY
9105651   PYRIDOXINE 100MG TABLET           $12.80        0.00                91   PHARMACY
9310665   PYRIDOXINE 100MG/ML INJ           $57.48        0.00                91   PHARMACY
9115924   PYRIMETHAMINE 25MG TABLET         $13.83        0.00                91   PHARMACY
9107582   QUETIAPINE 100MG TABLET           $18.53        0.00                91   PHARMACY
9107616   QUETIAPINE 25MG TABLET            $15.91        0.00                91   PHARMACY




                                                  Page 112
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9104340   QUINAPRIL 10MG TABLET              $15.02       0.00                91   PHARMACY
9104324   QUINAPRIL 20MG TABLET              $15.02       0.00                91   PHARMACY
9104332   QUINAPRIL 5MG TABLET               $15.02       0.00                91   PHARMACY
9183393   QUINIDINE GLUC 80MG/ML INJ         $91.94       0.00                91   PHARMACY
9105701   QUINIDINE GLUC SR 324MG TABLET     $13.92       0.00                91   PHARMACY
9115940   QUINIDINE SULF 200MG TABLET        $13.12       0.00                91   PHARMACY
9105727   QUINIDINE SULF 300MG TABLET        $13.49       0.00                91   PHARMACY
9105693   QUINIDINE SULF SR 300MG TABLET     $14.48       0.00                91   PHARMACY
9105735   QUININE 200MG CAPSULE              $13.18       0.00                91   PHARMACY
9105669   QUININE 260MG TABLET               $13.14       0.00                91   PHARMACY
9105743   QUININE 325MG CAPSULE              $13.35       0.00                91   PHARMACY
9109042   RABEPRAZOLE 20MG TABLET            $21.27       0.00                91   PHARMACY
9194069   RABIES IMMUNE GLOBULIN INJ        $573.90       0.00                93   PHARMACY
9186164   RABIES VACCINE INJ                $362.68       0.00                91   PHARMACY
9108234   RALOXIFENE 60MG TABLET             $17.63       0.00                91   PHARMACY
9108242   RAMIPRIL 1.25MG CAPSULE            $14.75       0.00                91   PHARMACY
9107129   RAMIPRIL 2.5 MG CAPSULE            $15.17       0.00                91   PHARMACY
9105750   RANITIDINE 150MG TABLET            $16.89       0.00                91   PHARMACY
9179268   RANITIDINE 15MG/ML LIQ 120ML      $133.68       0.00                91   PHARMACY
9310442   RANITIDINE 50MG/2ML INJ           $109.74       0.00                93   PHARMACY
9107723   REPAGLINIDE 2MG TABLET             $14.58       0.00                91   PHARMACY
9115957   RESERPINE 0.1MG TABLET             $13.36       0.00                91   PHARMACY
9193020   RETEPLASE 10 UNITS (18.1MG) KIT $2,851.76       0.00                93   PHARMACY
9117029   RIBOFLAVIN 25MG TABLET             $12.76       0.00                91   PHARMACY
9105792   RIFABUTIN (MYCOBUTIN) 150MG CAP    $25.30       0.00                91   PHARMACY
9108267   RIFAMPIN 150MG CAPSULE             $15.88       0.00                91   PHARMACY
9105784   RIFAMPIN 300MG CAPSULE             $16.67       0.00                91   PHARMACY
9187238   RIFAMPIN 600MG INJ                $256.76       0.00                93   PHARMACY
9106766   RIMANTADINE 100MG TABLET           $16.38       0.00                91   PHARMACY
9174871   RIMEXOLONE 1% OP SOLN 5ML          $81.20       0.00                91   PHARMACY
9113614   RISEDRONATE (ACTONEL) 35MG TAB     $45.30       0.00                91   PHARMACY
9109224   RISEDRONATE (ACTONEL) 5MG TAB      $17.37       0.00                91   PHARMACY
9107202   RISPERIDONE 1MG TABLET             $18.84       0.00                91   PHARMACY
9179755   RISPERIDONE 1MG/ML LIQ 30ML       $250.96       0.00                91   PHARMACY
9316498   RITUXIMAB 10MG/ML INJ           $1,445.22       0.00                93   PHARMACY
9109638   RIVASTIGMINE 1.5MG CAPSULE         $17.56       0.00                91   PHARMACY
9179920   RIVASTIGMINE 2MG/ML LIQ 120ML     $560.02       0.00                91   PHARMACY
9183211   ROCURONIUM 100MG/10ML INJ         $114.78       0.00                91   PHARMACY
9109067   ROFECOXIB 12.5MG TABLET            $18.22       0.00                91   PHARMACY
9109075   ROFECOXIB 25MG TABLET              $18.22       0.00                91   PHARMACY
9113010   ROPINIROLE 0.25MG TABLET           $15.23       0.00                91   PHARMACY
9113028   ROPINIROLE 1MG TABLET              $15.23       0.00                91   PHARMACY
9109083   ROSIGLITAZONE 2MG TABLET           $16.72       0.00                91   PHARMACY
9109091   ROSIGLITAZONE 4MG TABLET           $18.27       0.00                91   PHARMACY
9117151   ROSUVASTATIN 20MG TAB              $17.97       0.00                91   PHARMACY
9112871   ROSUVASTATIN 5MG TABLET            $17.97       0.00                91   PHARMACY
9194036   RSV IMMUNOGLOBULIN INJ            $289.24       0.00                93   PHARMACY
9186073   RUBELLA VACCINE                    $67.77       0.00                91   PHARMACY
9178294   SALIVA SUBSTITUTE LIQ 120ML        $35.08       0.00                91   PHARMACY
9175118   SALMETEROL 50MCG DISKUS #28       $133.94       0.00                91   PHARMACY
9173204   SALMETEROL INHALER 13GM           $193.10       0.00                91   PHARMACY
9106774   SALSALATE 500MG TABLET             $13.39       0.00                91   PHARMACY
9310921   SARGRAMOSTIM 500MCG/ML INJ        $713.58       0.00                93   PHARMACY




                                                  Page 113
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9168485   SARNA ANTI-ITCH LOTION 222ML       $40.46      0.00                91   PHARMACY
9173600   SCOPOLAMINE 0.25% OP SOLN 5ML      $64.20      0.00                91   PHARMACY
9187402   SCOPOLAMINE 0.4MG/ML INJ           $54.84      0.00                91   PHARMACY
9171133   SCOPOLAMINE 1.5MG PATCH            $23.13      0.00                91   PHARMACY
9105800   SELEGILINE 5MG CAPSULE             $17.58      0.00                91   PHARMACY
9105818   SENNA/DSS TABLET                   $13.57      0.00                91   PHARMACY
9112871   SENNOSIDES 15MG CHEW TAB           $13.20      0.00                91   PHARMACY
9178567   SENNOSIDES ORAL LIQ 74ML           $37.58      0.00                91   PHARMACY
9113333   SENNOSIDES TABLET                   $0.00      0.00                91   PHARMACY
9105677   SERTRALINE 50MG TABLET             $17.76      0.00                91   PHARMACY
9109109   SEVELAMER 403MG CAPSULE            $14.00      0.00                91   PHARMACY
9112871   SEVELAMER 800MG TABLET             $15.18      0.00                91   PHARMACY
9112871   SILDENAFIL 50MG TABLET             $33.98      0.00                91   PHARMACY
9169640   SILVER SULFADIAZINE 1% CRM 50GM    $37.84      0.00                91   PHARMACY
9178385   SIMETHICONE 40MG/0.6ML DROPS       $32.62      0.00                91   PHARMACY
9105842   SIMETHICONE 80MG CHEW TABLET        $0.00      0.00                91   PHARMACY
9112871   SIMPLE SYRUP                        $0.00      0.00                91   PHARMACY
9106659   SIMVASTATIN 20MG TABLET            $21.54      0.00                91   PHARMACY
9113499   SIMVASTATIN 40MG TABLET            $21.54      0.00                91   PHARMACY
9108846   SIMVASTATIN 5MG TABLET             $16.49      0.00                91   PHARMACY
9187725   SINCALIDE 5MCG INJ                $120.08      0.00                91   PHARMACY
9310970   SODIUM ACETATE 2MEQ/ML INJ         $30.22      0.00                91   PHARMACY
9310384   SODIUM BICARB 4.2% SYRINGE         $61.74      0.00                91   PHARMACY
9105875   SODIUM BICARB 650MG TABLET         $12.75      0.00                91   PHARMACY
9310376   SODIUM BICARB 8.4% SYRINGE 10ML    $56.66      0.00                91   PHARMACY
9310251   SODIUM BICARB 8.4% SYRINGE 50ML    $57.70      0.00                91   PHARMACY
9310251   SODIUM BICARB 8.4% VIAL 50ML       $30.04      0.00                91   PHARMACY
9147711   SODIUM CHL 0.45% 1000ML(FLOORSTOCK)$79.08      0.00                91   PHARMACY
9147349   SODIUM CHL 0.9% 250ML (FLOORSTOCK) $2.80       0.00                91   PHARMACY
9147356   SODIUM CHL 0.9% 500ML(FLOORSTOCK) $78.88       0.00                91   PHARMACY
9147414                                      $33.96
          SODIUM CHL 0.9% FOR IRRG 1L (FLOORSTOCK)       0.00                91   PHARMACY
9147570                                      $28.92
          SODIUM CHL 0.9% FOR IRRIG 250ML(FLOORSTOCK)    0.00                91   PHARMACY
9147505   SODIUM CHL 0.9% IRRIG 3000ML       $42.60      0.00                91   PHARMACY
9147414   SODIUM CHL 0.9% IRRIG. 1000ML      $33.96      0.00                91   PHARMACY
9147570   SODIUM CHL 0.9% IRRIG. 250ML       $28.92      0.00                91   PHARMACY
9147166   SODIUM CHL O.45% 500ML (FLOORSTOCK)$79.08      0.00                91   PHARMACY
9174020   SODIUM CHLOR 0.65% NASAL SPY 45ML $29.64       0.00                91   PHARMACY
9132218   SODIUM CHLOR 10% PILLOW 15ML       $14.32      0.00                91   PHARMACY
9145079   SODIUM CHLORIDE 0.9% FLUSH         $26.80      0.00                91   PHARMACY
9147711   SODIUM CHLORIDE 0.45% 1000ML       $79.08      0.00                91   PHARMACY
9147166   SODIUM CHLORIDE 0.45% 500ML        $79.08      0.00                91   PHARMACY
9147364   SODIUM CHLORIDE 0.9% 1000ML        $79.94      0.00                91   PHARMACY
9134032   SODIUM CHLORIDE 0.9% 100ML          $4.06      0.00                91   PHARMACY
9310269   SODIUM CHLORIDE 0.9% 10ML VIAL     $26.40      0.00                91   PHARMACY
9147364                                      $79.94
          SODIUM CHLORIDE 0.9% 1L (FLOORSTOCK)           0.00                91   PHARMACY
9147349   SODIUM CHLORIDE 0.9% 250ML          $2.80      0.00                91   PHARMACY
9132143   SODIUM CHLORIDE 0.9% 3ML PILLOW    $13.00      0.00                91   PHARMACY
9147356   SODIUM CHLORIDE 0.9% 500ML         $78.88      0.00                91   PHARMACY
9134024   SODIUM CHLORIDE 0.9% 50ML           $4.06      0.00                91   PHARMACY
9134024   SODIUM CHLORIDE 0.9% 50ML VIAL      $2.38      0.00                91   PHARMACY
9106857   SODIUM CHLORIDE 1GM TABLET         $12.85      0.00                91   PHARMACY
9147679   SODIUM CHLORIDE 3% IV SOLN        $226.07      0.00                91   PHARMACY
9310954   SODIUM CHLORIDE 4MEQ/ML INJ        $29.04      0.00                91   PHARMACY




                                                 Page 114
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9147554   SODIUM CHLORIDE W/20MEQ KCL       $93.54       0.00                91   PHARMACY
9147547   SODIUM CHLORIDE W/40MEQ KCL       $93.54       0.00                91   PHARMACY
9310947   SODIUM PHOSPHATE 3MMOL/ML INJ     $28.30       0.00                91   PHARMACY
9310947   SODIUM PHOSPHATE 4MEQ/ML INJ      $28.30       0.00                91   PHARMACY
9128406                                     $64.78
          SODIUM POLYSTYRENE ENEMA 30GM/120ML            0.00                91   PHARMACY
9179623                                     $48.41
          SODIUM POLYSTYRENE SUSP 30GM/120 ML            0.00                91   PHARMACY
9137308   SORBITOL 70% LIQUID 30ML CUP      $27.44       0.00                91   PHARMACY
9179573   SORBITOL 70% LIQUID 30ML CUP      $29.22       0.00                91   PHARMACY
9104712   SOTALOL 80MG TABLET               $18.74       0.00                91   PHARMACY
9105909   SPIRONOLACTONE 25MG TABLET        $13.58       0.00                91   PHARMACY
9107541   SPIRONOLACTONE/HCTZ 25/25 TABLET $14.07        0.00                91   PHARMACY
9179938   STAVUDINE 1MG/ML LIQ 200ML       $154.46       0.00                91   PHARMACY
9197237   STAVUDINE 40MG CAPSULE            $24.30       0.00                91   PHARMACY
9310996   STERILE WATER FOR INJ             $80.82       0.00                91   PHARMACY
9187527   STERILE WATER FOR INJ 10ML         $0.00       0.00                91   PHARMACY
9189564   STERILE WATER FOR INJ 20ML         $1.80       0.00                91   PHARMACY
9189572   STERILE WATER FOR INJ 50ML         $3.50       0.00                91   PHARMACY
9147398                                     $29.20
          STERILE WATER FOR IRR.1000ML(FLOORSTOCK)       0.00                91   PHARMACY
9147398   STERILE WATER FOR IRRIG. 1000ML   $29.20       0.00                91   PHARMACY
9306259   STREPTOMYCIN 1GM INJ             $114.66       0.00                93   PHARMACY
9306259   STREPTOZOCIN 1GM INJ             $733.00       0.00                93   PHARMACY
9183401   SUCCINYLCHOLINE 200MG/10ML INJ    $52.98       0.00                91   PHARMACY
9179581   SUCRALFATE 0.1GM/ML LIQ 120ML     $48.19       0.00                91   PHARMACY
9105933   SUCRALFATE 1GM TABLET             $14.26       0.00                91   PHARMACY
9182122   SUCRETS LOZENGE                   $30.28       0.00                91   PHARMACY
9163510   SUFENTANIL 50MCG/ML INJ           $98.74       0.00                91   PHARMACY
9168634   SULCONAZOLE 1% CREAM 30GM         $69.64       0.00                91   PHARMACY
9168642   SULCONAZOLE 1% LIQUID 30ML        $79.54       0.00                91   PHARMACY
9173626   SULFACETAMIDE 10% OP OINT 3.5GM   $41.64       0.00                91   PHARMACY
9173618   SULFACETAMIDE 10% OP SOLN 15ML    $35.60       0.00                91   PHARMACY
9106873   SULFADIAZINE 500MG TABLET         $15.33       0.00                91   PHARMACY
9105826   SULFAMETHOXAZOLE/TMP DS TABLET $15.00          0.00                91   PHARMACY
9305921   SULFAMETHOXAZOLE/TMP INJ         $103.04       0.00                93   PHARMACY
9179599   SULFAMETHOXAZOLE/TMP SUSP 100ML $50.70         0.00                91   PHARMACY
9105958   SULFASALAZINE 500MG TABLET        $13.23       0.00                91   PHARMACY
9100694   SULFASALAZINE EC 500MG TABLET     $13.49       0.00                91   PHARMACY
9113507   SULFINPYRAZONE 100MG TABLET       $14.63       0.00                91   PHARMACY
9105974   SULINDAC 150MG TABLET             $14.74       0.00                91   PHARMACY
9105982   SULINDAC 200MG TABLET             $15.20       0.00                91   PHARMACY
9182031   SUMATRIPTAN 20MG NASAL SPRAY      $75.14       0.00                91   PHARMACY
9107368   SUMATRIPTAN 25MG TABLET           $50.95       0.00                91   PHARMACY
9187667   SUMATRIPTAN 6MG/0.5ML INJ        $166.98       0.00                91   PHARMACY
9310962   SYNERCID 500MG INJ               $323.06       0.00                93   PHARMACY
9108572   TACRINE 10MG CAPSULE              $15.64       0.00                91   PHARMACY
9103524   TACROLIMUS 1MG CAPSULE            $19.35       0.00                91   PHARMACY
9189283   TACROLIMUS 5MG/ML INJ            $351.86       0.00                93   PHARMACY
9170341   TALC POWDER 70.9GM                $30.88       0.00                91   PHARMACY
9154014   TALC POWDER-STERILE 5GM          $102.03       0.00                93   PHARMACY
9105990   TAMOXIFEN 10MG TABLET             $16.77       0.00                91   PHARMACY
9107525   TAMSULOSIN CR 0.4MG CAPSULE       $16.52       0.00                91   PHARMACY
9170358   TAZAROTENE 0.1% GEL 30GM         $181.84       0.00                91   PHARMACY
9112871   TAZOROTENE 0.1% CREAM 30GM       $181.84       0.00                91   PHARMACY
9173048   TEARS, ARTIFICIAL OP SOLN 15ML    $30.34       0.00                91   PHARMACY




                                                 Page 115
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9112871   TEGASEROD 2MG TABLET               $17.85       0.00                91   PHARMACY
9112871   TEGASEROD 6MG TABLET               $17.85       0.00                91   PHARMACY
9109646   TELMISARTAN 40MG TABLET            $15.73       0.00                91   PHARMACY
9155532   TEMAZEPAM 15MG CAPSULE             $26.87       0.00                91   PHARMACY
9155623   TEMAZEPAM 7.5MG CAPSULE            $28.58       0.00                91   PHARMACY
9113515   TEMOZOLOMIDE 100MG CAPSULE        $314.33       0.00                91   PHARMACY
9197401   TEMOZOLOMIDE 20MG CAPSULE          $73.04       0.00                91   PHARMACY
9197419   TEMOZOLOMIDE 5MG CAPSULE           $27.80       0.00                91   PHARMACY
9193004   TENECTEPLASE 50MG INJ           $5,601.76       0.00                93   PHARMACY
9105834   TERAZOSIN 1MG CAPSULE              $15.93       0.00                91   PHARMACY
9108317   TERAZOSIN 5MG CAPSULE              $15.93       0.00                91   PHARMACY
9168865   TERBINAFINE 1% CREAM 12GM          $42.42       0.00                91   PHARMACY
9104100   TERBINAFINE 250MG TABLET           $30.81       0.00                91   PHARMACY
9187428   TERBUTALINE 1MG/ML INJ            $110.28       0.00                91   PHARMACY
9116039   TERBUTALINE 2.5MG TABLET           $13.68       0.00                91   PHARMACY
9106006   TERBUTALINE 5MG TABLET             $14.11       0.00                91   PHARMACY
9169483   TERCONAZOLE 0.4% VAG CRM 45GM      $99.34       0.00                91   PHARMACY
9170416   TERCONAZOLE 0.8% VAG CRM 20GM      $99.34       0.00                91   PHARMACY
9128372   TERCONAZOLE 3 80MG SUPP            $99.34       0.00                91   PHARMACY
9155813   TESTOLACTONE 50MG TABLET           $29.62       0.00                91   PHARMACY
9163346   TESTOSTERONE 200MG/ML INJ         $110.52       0.00                91   PHARMACY
9193996   TETANUS IMM GLOB 250 UNIT/ML INJ $504.40        0.00                93   PHARMACY
9186065   TETANUS TOXOID 0.5ML INJ           $68.40       0.00                91   PHARMACY
9186032   TETANUS/DIPHTHERIA (ADULT) INJ     $69.90       0.00                91   PHARMACY
9173634   TETRACAINE 0.5% OP SOLN 2ML        $35.94       0.00                91   PHARMACY
9189077   TETRACAINE 1% 20MG/2ML INJ         $62.58       0.00                91   PHARMACY
9106014   TETRACYCLINE 250MG CAPSULE         $12.88       0.00                91   PHARMACY
9179763   TETRACYCLINE 25MG/ML LIQ 120ML     $60.37       0.00                91   PHARMACY
9174046   TETRAHYDROZOLINE 0.05% OP SOLN 15ML$31.06       0.00                91   PHARMACY
9113234   THEOPHYLLINE 200MG SR CAP          $13.33       0.00                91   PHARMACY
9116054   THEOPHYLLINE 300MG SR CAP          $13.76       0.00                91   PHARMACY
9151200   THEOPHYLLINE 400MG/250ML D5W       $88.54       0.00                91   PHARMACY
9179607   THEOPHYLLINE 80MG/15ML LIQ 120ML $28.95         0.00                91   PHARMACY
9113234                                      $
          THEOPHYLLINE SR (THEO-24) 200MG CAP14.06        0.00                91   PHARMACY
9116054   THEOPHYLLINE SR (THEO-24) 300MG CAP$14.29       0.00                91   PHARMACY
9106048   THEOPHYLLINE SR (THEODUR) 200MG TAB$13.22       0.00                91   PHARMACY
9106063   THEOPHYLLINE SR (THEODUR) 300MG TAB$13.34       0.00                91   PHARMACY
9113226   THEOPHYLLINE SR (THEODUR) 450MG TAB$13.76       0.00                91   PHARMACY
9106055   THEOPHYLLINE SR (UNIPHYL) 400MG TAB$14.88       0.00                91   PHARMACY
9106030   THEOPHYLLINE SR(THEODUR)100MG TAB  $13.13       0.00                91   PHARMACY
9170325   THERA-GESIC ANALGESIC CRM 150GM     $0.00       0.00                91   PHARMACY
9106097   THIAMINE 100MG TABLET               $0.00       0.00                91   PHARMACY
9187436   THIAMINE 200MG/2ML INJ             $55.64       0.00                91   PHARMACY
9108648   THIAMINE 50MG TABLET                $0.00       0.00                91   PHARMACY
9106089   THIETHYLPERAZINE 10MG TABLET       $13.83       0.00                91   PHARMACY
9197112   THIOGUANINE 40MG TABLET            $22.36       0.00                91   PHARMACY
9163312   THIOPENTAL 500MG INJ               $84.24       0.00                91   PHARMACY
9106113   THIORIDAZINE 10MG TABLET           $13.40       0.00                91   PHARMACY
9116096   THIORIDAZINE 25MG TABLET           $13.68       0.00                91   PHARMACY
9179797   THIORIDAZINE 30MG/ML LIQ 120ML     $56.00       0.00                91   PHARMACY
9106121   THIORIDAZINE 50MG TABLET           $13.92       0.00                91   PHARMACY
9316175   THIOTEPA 15MG INJ                 $691.46       0.00                93   PHARMACY
9106154   THIOTHIXENE 1MG CAPSULE            $13.66       0.00                91   PHARMACY




                                                  Page 116
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9300401   THIOTHIXENE 5MG CAPSULE            $13.67       0.00                91   PHARMACY
9169822   THROMBIN 5,000 UNITS POWDER VIAL $114.52        0.00                91   PHARMACY
9106188   THYROID 30MG TABLET                $12.99       0.00                91   PHARMACY
9106196   THYROID 60MG TABLET                $13.22       0.00                91   PHARMACY
9113523   TIAGABINE 2MG TABLET               $15.56       0.00                91   PHARMACY
9108325   TIAGABINE 4MG TABLET               $15.56       0.00                91   PHARMACY
9305608   TICARCILLIN 3GM INJ               $125.70       0.00                93   PHARMACY
9105719   TICLOPIDINE 250MG TABLET           $16.64       0.00                91   PHARMACY
9306333   TIMENTIN 3.1GM INJ                $133.16       0.00                93   PHARMACY
9173659   TIMOLOL 0.5% OPHTH SOLN 5ML        $59.44       0.00                91   PHARMACY
9173642   TIMOLOL 0.25% OPHTH SOLN 5ML       $55.44       0.00                91   PHARMACY
9174244                                     $
          TIMOLOL 0.5%/DORZOLAMIDE 2% OPSOL117.42         0.00                91   PHARMACY
9106246   TIMOLOL 10MG TABLET                $13.49       0.00                91   PHARMACY
9174681   TIMOLOL XE 0.25% OPHTH GEL 5ML     $77.38       0.00                91   PHARMACY
9174228   TIMOLOL-XE 0.5% OPHT SOL 2.5ML     $64.14       0.00                91   PHARMACY
9169772   TIOCONAZOLE 6.5% OINT 4.6GM        $54.22       0.00                91   PHARMACY
9151416   TIROFIBAN INJ                     $562.80       0.00                91   PHARMACY
9107707   TIZANIDINE 4MG TABLET              $15.98       0.00                91   PHARMACY
9173964   TOBRAMYCIN 0.3% OP OINT 3.5GGM    $116.70       0.00                91   PHARMACY
9173956   TOBRAMYCIN 0.3% OP SOLN 5ML        $55.44       0.00                91   PHARMACY
9183005   TOBRAMYCIN 1.2GM POWDER VIAL      $690.84       0.00                91   PHARMACY
9305277   TOBRAMYCIN 20MG/2ML INJ           $109.06       0.00                93   PHARMACY
9174731   TOBRAMYCIN 300MG/5ML INHAL SOLN $115.62         0.00                91   PHARMACY
9305269   TOBRAMYCIN 80MG/2ML INJ           $128.04       0.00                93   PHARMACY
9173790   TOBRAMYCIN/DEXAMETH OP OINT 3.5GM $132.94       0.00                91   PHARMACY
9173808   TOBRAMYCIN/DEXAMETH OP SOLN 2.5ML  $75.06       0.00                91   PHARMACY
9116161   TOCAINIDE 400MG TABLET             $14.80       0.00                91   PHARMACY
9106253   TOLAZAMIDE 100MG TABLET            $13.65       0.00                91   PHARMACY
9106261   TOLAZAMIDE 250MG TABLET            $13.62       0.00                91   PHARMACY
9108697   TOLCAPONE 100MG TABLET             $17.78       0.00                91   PHARMACY
9169988   TOLNAFTATE 1% AEROSOL 120ML        $35.44       0.00                91   PHARMACY
9169962   TOLNAFTATE 1% CREAM 15GM           $30.90       0.00                91   PHARMACY
9108531   TOLTERODINE 2MG TABLET             $16.17       0.00                91   PHARMACY
9113531   TOLTERODINE LA 2MG CAPSULE         $18.50       0.00                91   PHARMACY
9113549   TOPIRAMATE 200MG TABLET            $21.07       0.00                91   PHARMACY
9113556   TOPIRAMATE 25MG SPRINKLE CAPSULE $16.20         0.00                91   PHARMACY
9109125   TOPIRAMATE 25MG TABLET             $15.76       0.00                91   PHARMACY
9316274   TOPOTECAN 4MG INJ               $2,045.56       0.00                93   PHARMACY
9310301   TRACE ELEMENTS INJ                 $27.93       0.00                91   PHARMACY
9116203   TRAMADOL 50MG TABLET               $14.77       0.00                91   PHARMACY
9113564                                      $14.77
          TRAMADOL/APAP (ULTRACET) 37.5/325 TAB           0.00                91   PHARMACY
9113572   TRANDOLAPRIL 2MG TABLET            $14.64       0.00                91   PHARMACY
9106287   TRANYLCYPROMINE 10MG TABLET        $14.09       0.00                91   PHARMACY
9316472   TRASTUZUMAB INJ                   $560.88       0.00                93   PHARMACY
9175027   TRAVOPROST 0.004% OP SOLN 2.5ML $129.44         0.00                91   PHARMACY
9106303   TRAZODONE 100MG TABLET             $14.19       0.00                91   PHARMACY
9106295   TRAZODONE 50MG TABLET              $13.57       0.00                91   PHARMACY
9170424   TRETINOIN 0.01% GEL 45GM          $189.48       0.00                91   PHARMACY
9170366   TRETINOIN 0.025% CREAM 45GM       $146.92       0.00                91   PHARMACY
9169657   TRIAMCINOLONE 0.025% CRM 15GM      $29.08       0.00                91   PHARMACY
9168873   TRIAMCINOLONE 0.1% CREAM 80GM      $35.64       0.00                91   PHARMACY
9169673   TRIAMCINOLONE 0.1% CRM 15GM        $30.84       0.00                91   PHARMACY
9169756   TRIAMCINOLONE 0.1% LOTION 60ML     $45.88       0.00                91   PHARMACY




                                                  Page 117
                                    85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9169764   TRIAMCINOLONE 0.1% OINT 15GM        $30.84       0.00                91   PHARMACY
9170374   TRIAMCINOLONE 0.1% PASTE 5GM        $45.24       0.00                91   PHARMACY
9168899   TRIAMCINOLONE 0.5% CRM 15GM         $34.66       0.00                91   PHARMACY
9168949   TRIAMCINOLONE 0.5% OINT 15GM        $35.42       0.00                91   PHARMACY
9187451   TRIAMCINOLONE 40MG/ML INJ           $63.80       0.00                91   PHARMACY
9174566   TRIAMCINOLONE 55MCG NASAL INH 10GM $136.80       0.00                91   PHARMACY
9175142   TRIAMCINOLONE AQ 55MCG NASAL 16.5GM$148.62       0.00                91   PHARMACY
9174160   TRIAMCINOLONE ORAL INHALER 20GM $162.60          0.00                91   PHARMACY
9106311   TRIAMTERENE 50MG CAPSULE            $14.69       0.00                91   PHARMACY
9104357                                       $13.98
          TRIAMTERENE/HCTZ (MAXZIDE) 37.5/25 TAB           0.00                91   PHARMACY
9102930   TRIAMTERENE/HCTZ 37.5/25 CAPSULE $13.86          0.00                91   PHARMACY
9109489   TRIAMTERENE/HCTZ 50/25 CAPSULE      $13.28       0.00                91   PHARMACY
9109554   TRIAMTERENE/HCTZ 75/50 TABLET       $15.20       0.00                91   PHARMACY
9155573   TRIAZOLAM 0.125MG TABLET            $26.72       0.00                91   PHARMACY
9174897   TRIETHANOLAMINE 10% OTIC SOLN 12ML $114.38       0.00                91   PHARMACY
9106345   TRIFLUOPERAZINE 10MG TABLET         $16.08       0.00                91   PHARMACY
9106329   TRIFLUOPERAZINE 2MG TABLET          $14.49       0.00                91   PHARMACY
9106337   TRIFLUOPERAZINE 5MG TABLET          $14.95       0.00                91   PHARMACY
9173667   TRIFLURIDINE 1% OP SOLN 7.5ML      $223.46       0.00                91   PHARMACY
9106352   TRIHEXYPHENIDYL 2MG TABLET          $13.09       0.00                91   PHARMACY
9116229   TRIHEXYPHENIDYL 5MG TABLET          $13.45       0.00                91   PHARMACY
9128117   TRIMETHOBENZAMIDE 100MG SUPP        $13.91       0.00                91   PHARMACY
9128125   TRIMETHOBENZAMIDE 200MG SUPP        $14.00       0.00                91   PHARMACY
9187485   TRIMETHOBENZAMIDE 200MG/2ML INJ $61.84           0.00                91   PHARMACY
9106386   TRIMETHOBENZAMIDE 250MG CAPSULE $14.27           0.00                91   PHARMACY
9106923   TRIMETHOPRIM 100MG TABLET           $14.09       0.00                91   PHARMACY
9113580   TRIMIPRAMINE 25MG CAPSULE           $14.53       0.00                91   PHARMACY
9108721   TRIMIPRAMINE 50MG CAPSULE           $15.68       0.00                91   PHARMACY
9106931   TRINSICON CAPSULE                    $0.00       0.00                91   PHARMACY
9170473   TRIPLE ANTIBIOTIC SOLN 120ML        $92.64       0.00                91   PHARMACY
9100181   TRIPROLIDINE/PSEUDO TABLET          $12.81       0.00                91   PHARMACY
9113598   TRIZIVIR TABLET                     $49.72       0.00                91   PHARMACY
9108895   TROLEANDOMYCIN 250MG CAPSULE        $15.37       0.00                91   PHARMACY
9151333   TROMETHAMINE IV SOLN 500ML         $455.62       0.00                91   PHARMACY
9174905   TROPICAMIDE 0.5% OP SOLN 15ML       $90.06       0.00                91   PHARMACY
9174913   TROPICAMIDE 1% OP SOLN 15ML        $103.56       0.00                91   PHARMACY
9187998   TUBERCULIN 5 TUNIT INJ              $54.49       0.00                91   PHARMACY
9189580   TUBOCURARINE 30MG/10ML INJ          $62.88       0.00                91   PHARMACY
9158288   TUSSIONEX PENNKINETIC SUSP          $26.18       0.00                91   PHARMACY
9186206   TYPHOID 25MCG/0.5ML VACCINE INJ    $146.26       0.00                91   PHARMACY
9170382   UREA 10% CREAM 90GM                 $43.24       0.00                91   PHARMACY
9168782   UREA 10% LOTION 480ML               $57.04       0.00                91   PHARMACY
9170499   UREA 40 CREAM 28.35GM               $76.00       0.00                91   PHARMACY
9168790   UREACIN-20 CREAM 120GM              $44.44       0.00                91   PHARMACY
9113606   URISED TABLET                       $13.80       0.00                91   PHARMACY
9105925   URSODIOL 300MG CAPSULE              $18.37       0.00                91   PHARMACY
9100116   VALACYCLOVIR 500MG TABLET           $20.96       0.00                91   PHARMACY
9112871   VALGANCICLOVIR 450MG TABLET         $72.67       0.00                91   PHARMACY
9178609   VALPROATE 50MG/ML LIQ 120ML         $57.15       0.00                91   PHARMACY
9189028   VALPROATE 500MG/5ML INJ            $126.58       0.00                93   PHARMACY
9106956   VALPROIC ACID 250MG CAPSULE         $13.28       0.00                91   PHARMACY
9107814   VALSARTAN 80MG TABLET               $15.65       0.00                91   PHARMACY
9108911   VANCOMYCIN 125MG CAPSULE            $26.85       0.00                91   PHARMACY




                                                   Page 118
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9305301   VANCOMYCIN 1GM INJ                $113.89       0.00                93   PHARMACY
9102625   VANCOMYCIN 250MG CAPSULE           $40.97       0.00                91   PHARMACY
9179615   VANCOMYCIN 25MG/ML LIQ 40ML       $179.68       0.00                91   PHARMACY
9305293   VANCOMYCIN 500MG INJ              $107.82       0.00                93   PHARMACY
9174889   VASOCIDIN 0.25% OP SOLN 10ML       $79.36       0.00                91   PHARMACY
9310483   VASOPRESSIN 20 UNITS/1ML INJ       $65.38       0.00                91   PHARMACY
9310426   VECURONIUM 10MG INJ                $66.38       0.00                91   PHARMACY
9108358   VENLAFAXINE 25MG TABLET            $15.73       0.00                91   PHARMACY
9107244   VENLAFAXINE 37.5MG TABLET          $15.82       0.00                91   PHARMACY
9107236   VENLAFAXINE 50MG TABLET            $15.91       0.00                91   PHARMACY
9107632   VENLAFAXINE XR 37.5MG CAPSULE      $17.55       0.00                91   PHARMACY
9107640   VENLAFAXINE XR 75MG CAPSULE        $18.13       0.00                91   PHARMACY
9106972   VERAPAMIL 120MG TABLET             $13.51       0.00                91   PHARMACY
9113150   VERAPAMIL 24H SR 120MG CAPSULE     $16.68       0.00                91   PHARMACY
9113168   VERAPAMIL 24H SR 180MG CAPSULE     $16.87       0.00                91   PHARMACY
9113176   VERAPAMIL 24H SR 240MG CAPSULE     $17.40       0.00                91   PHARMACY
9106949   VERAPAMIL 40MG TABLET              $13.27       0.00                91   PHARMACY
9310491   VERAPAMIL 5MG/2ML INJ              $55.76       0.00                91   PHARMACY
9106964   VERAPAMIL 80MG TABLET              $13.86       0.00                91   PHARMACY
9108556   VERAPAMIL SR 120MG TABLET          $14.59       0.00                91   PHARMACY
9106998   VERAPAMIL SR 180MG TABLET          $15.12       0.00                91   PHARMACY
9106980   VERAPAMIL SR 240MG TABLET          $15.83       0.00                91   PHARMACY
9109729   VICON FORTE CAPSULE                 $0.00       0.00                91   PHARMACY
9107376   VICON-C CAPSULE                     $0.00       0.00                91   PHARMACY
9173675   VIDARABINE 3% OP OINT 3.5GM        $79.54       0.00                91   PHARMACY
9316316   VINBLASTINE INJ                   $451.83       0.00                93   PHARMACY
9316142   VINCRISTINE INJ                   $508.70       0.00                93   PHARMACY
9316332   VINORELBINE 10MG/ML INJ           $673.96       0.00                93   PHARMACY
9105065   VIOKASE TAB                        $13.53       0.00                91   PHARMACY
9189655   VISCOAT SYRINGE 0.5ML             $313.38       0.00                91   PHARMACY
9109679   VITAMIN A 10000IU CAP              $12.78       0.00                91   PHARMACY
9100488   VITAMIN B COMPLEX CAPSULE          $12.81       0.00                91   PHARMACY
9106410   VITAMIN E 200IU CAPSULE            $12.82       0.00                91   PHARMACY
9106428   VITAMIN E 400IU CAPSULE            $12.85       0.00                91   PHARMACY
9109307   VI-ZAC CAP                         $13.40       0.00                91   PHARMACY
9305830   VORICONAZOLE 200MG INJ            $314.26       0.00                93   PHARMACY
9113093   VORICONAZOLE 200MG TABLET          $75.22       0.00                91   PHARMACY
9173931   VOSOL HC OTIC SOLN 10ML            $79.00       0.00                91   PHARMACY
9106436   WARFARIN 1MG TABLET                $14.15       0.00                91   PHARMACY
9106444   WARFARIN 2.5MG TABLET              $14.26       0.00                91   PHARMACY
9116252   WARFARIN 2MG TABLET                $14.21       0.00                91   PHARMACY
9108366   WARFARIN 3MG TABLET                $14.27       0.00                91   PHARMACY
9106451   WARFARIN 5MG TABLET                $14.33       0.00                91   PHARMACY
9106469   WARFARIN 7.5MG TABLET              $14.97       0.00                91   PHARMACY
9112871   WARFARIN PER PROTOCOL               $0.00       0.00                91   PHARMACY
9112871                                   $
          WINRHO (IMM GLOB)RHO(D) 5000UNITS2,417.40       0.00                93   PHARMACY
9112871   XENADERM OINTMENT                 $124.64       0.00                91   PHARMACY
9107483   ZAFIRLUKAST 20MG TABLET            $15.24       0.00                91   PHARMACY
9197195   ZALCITABINE 0.375MG TABLET         $17.26       0.00                91   PHARMACY
9197203   ZIDOVUDINE 100MG CAPSULE           $16.82       0.00                91   PHARMACY
9169996   ZINC OXIDE OINTMENT 30GM           $28.64       0.00                91   PHARMACY
9310343   ZINC SULFATE 1MG/ML INJ            $25.94       0.00                91   PHARMACY
9106477   ZINC SULFATE 220MG CAPSULE         $12.96       0.00                91   PHARMACY




                                                  Page 119
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



9109174   ZIPRASIDONE 40MG CAPSULE          $21.29       0.00                91   PHARMACY
9310988   ZOLEDRONIC 4MG INJ             $1,958.10       0.00                91   PHARMACY
9108739   ZOLMITRIPTAN 2.5MG TABLET         $44.60       0.00                91   PHARMACY
9155821   ZOLPIDEM 5MG TABLET               $29.80       0.00                91   PHARMACY
9109141   ZONISAMIDE 100MG CAPSULE          $16.70       0.00                91   PHARMACY
9305319   ZOSYN 2.25GM INJ                 $123.38       0.00                93   PHARMACY
9305327   ZOSYN 3.375GM INJ                $134.18       0.00                93   PHARMACY
9305327   ZOSYN 3.375GM/20ML SYRINGE       $134.18       0.00                93   PHARMACY
9305863   ZOSYN 4.5GM INJ                  $142.83       0.00                93   PHARMACY
3020211   *TECH TIME-STANDARD                  0.00      0.00   30                PULMONARY SERVICES
3020302   *TECH TIME-TRAUMA                    0.00      0.00   30                PULMONARY SERVICES
3021375   ABG--CALIBRATION                     0.00      0.00   30                PULMONARY SERVICES
3021417   ABG-CHANGE MEMBRANES                 0.00      0.00   30                PULMONARY SERVICES
3021425   ABG-CHANGE TUBES                     0.00      0.00   30                PULMONARY SERVICES
3021409   ABG--DEPRTOTINIZE                    0.00      0.00   30                PULMONARY SERVICES
3021458   ABG--MONTHLY QC REPORT               0.00      0.00   30                PULMONARY SERVICES
3021391   ABG--QC--AM                          0.00      0.00   30                PULMONARY SERVICES
3021441   ABG--QC--NOC                         0.00      0.00   30                PULMONARY SERVICES
3021433   ABG--QC--PM                          0.00      0.00   30                PULMONARY SERVICES
3021219   AEROSOL EQUIPMENT CHANGE             0.00      0.00   30                PULMONARY SERVICES
3021607   AEROSOL SYSTEM INITIATION            0.00      0.00   30                PULMONARY SERVICES
3020971   AEROSOL TX DEMO/EVAL               125.00      0.00   30                PULMONARY SERVICES
3020989   AEROSOL TX SUBSQ                   119.00      0.00   30                PULMONARY SERVICES
3021235   AIRWAY CHANGE                        0.00      0.00   30                PULMONARY SERVICES
3010485   AIRWAY RESISTANCE                  236.00      0.00   30                PULMONARY SERVICES
3021037   AIRWAY SUCTION                       0.00      0.00   30                PULMONARY SERVICES
3021383   AS PART OF DAILY MAINT/QC            0.00      0.00   30                PULMONARY SERVICES
3021722   ASTHMA PATIENT EDUCATION             0.00      0.00   30                PULMONARY SERVICES
3020872   BD CONTINUOUS INITIAL DAY          174.00      0.00   30                PULMONARY SERVICES
3020880   BD CONTINUOUS SUBSQ DAY            174.00      0.00   30                PULMONARY SERVICES
3020278   BIPAP INITIAL DAY                 2620.00      0.00   30                PULMONARY SERVICES
3020260   BIPAP SUBSEQUENT DAY              2620.00      0.00   30                PULMONARY SERVICES
3010444   BLD GASES W/02 SAT                 341.00      0.00   30                PULMONARY SERVICES
3021177   BLOOD GAS -- ARTERIAL PUN            0.00      0.00   30                PULMONARY SERVICES
3021201   BLOOD GAS --OBSERVATION              0.00      0.00   30                PULMONARY SERVICES
3021185   BLOOD GAS--ARTERIAL LINE             0.00      0.00   30                PULMONARY SERVICES
3021193   BLOOD GAS--CORD                      0.00      0.00   30                PULMONARY SERVICES
3021169   BODY PLETHYSMOGRAPHY                 0.00      0.00   30                PULMONARY SERVICES
3010493   BRONCHIAL PROVOCATION              507.00      0.00   30                PULMONARY SERVICES
3010097   BRONCHOSCOPY                      1583.00      0.00   30                PULMONARY SERVICES
3010519   CALCIUM IONIZED                    136.00      0.00   30                PULMONARY SERVICES
3010469   CARDIOVERT ELECTIVE EXT              0.00      0.00   30                PULMONARY SERVICES
3021888   CATH LAB STANDBY - 15 MIN            0.00      0.00   30                PULMONARY SERVICES
3021334   CATH LAB STANDBY-30 MINU             0.00      0.00   30                PULMONARY SERVICES
3010188   CO DIFFUSING CAPACITY              236.00      0.00   30                PULMONARY SERVICES
3020757   COMPREHEN PT. ASSESSMENT             0.00      0.00   30                PULMONARY SERVICES
3021664   CONT PULSE OX SYSTM CHECK            0.00      0.00   30                PULMONARY SERVICES
3020013   CONTINUOUS VENT SET-UP               0.00      0.00   30                PULMONARY SERVICES
3021730   COPD PATIENT EDUCATION               0.00      0.00   30                PULMONARY SERVICES
3020807   CPR                                571.00      0.00   30                PULMONARY SERVICES
3021847   CPT INITIAL                        248.00      0.00   30                PULMONARY SERVICES
3020815   CPT INITIAL                        192.00      0.00   30                PULMONARY SERVICES
3021854   CPT SUBSEQUENT                     248.00      0.00   30                PULMONARY SERVICES




                                                 Page 120
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



3020823   CPT SUBSEQUENT                   192.00      0.00   30           PULMONARY SERVICES
3021870   CT SCAN STANDBY - 15 MIN           0.00      0.00   30           PULMONARY SERVICES
3021318   CT SCAN STANDBY - 30 MIN           0.00      0.00   30           PULMONARY SERVICES
3021268   DISCHARGE PLANNING-HOME 2          0.00      0.00   30           PULMONARY SERVICES
3021276   DISCHARGE PLANNING-PULMOA          0.00      0.00   30           PULMONARY SERVICES
3021284   DOCTOR WAITING TIME                0.00      0.00   30           PULMONARY SERVICES
3020203   EKG-RT                             0.00      0.00   30           PULMONARY SERVICES
3021250   ET TUBE CARE                       0.00      0.00   30           PULMONARY SERVICES
3021599   ETC02 PT/SYS CHECK                 0.00      0.00   30           PULMONARY SERVICES
3021581   ETC02 SYSTEM INITIATION            0.00      0.00   30           PULMONARY SERVICES
3020724   ETCO2 INIT DAY                  1405.00      0.00   30           PULMONARY SERVICES
3021052   EXTUBATION                         0.00      0.00   30           PULMONARY SERVICES
3010477   FUNCTIONAL RES CAP/VOL           236.00      0.00   30           PULMONARY SERVICES
3020856   INCENTIVE SPIROM, INITIAL          0.00      0.00   30           PULMONARY SERVICES
3020864   INCENTIVE SPIROM, SUBSEQT          0.00      0.00   30           PULMONARY SERVICES
3021698   INHALATION TX PENTAMIDINE        361.00      0.00   30           PULMONARY SERVICES
3021243   INTUBATION ASSIST                  0.00      0.00   30           PULMONARY SERVICES
3030202   INTUBATION EMERGENCY             420.00      0.00   30           PULMONARY SERVICES
3020104   IPPB DEMO/EVAL                   113.00      0.00   30           PULMONARY SERVICES
3020096   IPPB TX SUBSEQUENT               119.00      0.00   30           PULMONARY SERVICES
3020831   IPV DEMO/EVAL                    146.00      0.00   30           PULMONARY SERVICES
3020849   IPV SUBSEQUENT                   146.00      0.00   30           PULMONARY SERVICES
3021862   L & D STBY - 15 MINUTES            0.00      0.00   30           PULMONARY SERVICES
3021292   L&D STBY - 30 MINUTES              0.00      0.00   30           PULMONARY SERVICES
3010527   LACTIC ACID                      133.00      0.00   30           PULMONARY SERVICES
3020740   LIMITED PT. ASSESSMENT             0.00      0.00   30           PULMONARY SERVICES
3030160   LUNG REC MAN 20 MIN                0.00      0.00   30           PULMONARY SERVICES
3021227   MANUAL VENTILATION                 0.00      0.00   30           PULMONARY SERVICES
3021714   MDI SELF MEDICATION                0.00      0.00   30           PULMONARY SERVICES
3020138   MDI/NEB DEMO/EVAL                128.00      0.00   30           PULMONARY SERVICES
3021821   MDI/NEB DEMO/EVAL                125.00      0.00   30           PULMONARY SERVICES
3020229   MDI/NEB SUBSQ                    121.00      0.00   30           PULMONARY SERVICES
3021839   MDI/NEB SUBSQ                    126.00      0.00   30           PULMONARY SERVICES
3021326   MRI STANDBY-30 MINUTES             0.00      0.00   30           PULMONARY SERVICES
3021896   NUC MED STANDBY - 15 MIN           0.00      0.00   30           PULMONARY SERVICES
3021342   NUC MED STANDBY-30 MINUTE          0.00      0.00   30           PULMONARY SERVICES
3021904   OR STANDBY - 15 MINUTES            0.00      0.00   30           PULMONARY SERVICES
3021359   OR STANDBY-30 MINUTES              0.00      0.00   30           PULMONARY SERVICES
3021086   OXYGEN EQUIPMENT CHANGE            0.00      0.00   30           PULMONARY SERVICES
3021078   OXYGEN PT/SYS CHECK                0.00      0.00   30           PULMONARY SERVICES
3010204   OXYGEN UPTAKE SIMPLE             391.00      0.00   30           PULMONARY SERVICES
3021573   PAPR UNIT                          0.00      0.00   30           PULMONARY SERVICES
3021367   PASSY-MUIR EVAL                    0.00      0.00   30           PULMONARY SERVICES
3021060   PATIENT TRANSPORT-INTERNA          0.00      0.00   30           PULMONARY SERVICES
3021748   PEAK FLOW MEASUREMENT              0.00      0.00   30           PULMONARY SERVICES
3010253   PH BLD                            46.00      0.00   30           PULMONARY SERVICES
3010451   PH FLD                            46.00      0.00   30           PULMONARY SERVICES
3021128   PRE-OP EKG -- DR.JAMMAL            0.00      0.00   30           PULMONARY SERVICES
3021136   PRE-OP EKG -- DR.PETERS            0.00      0.00   30           PULMONARY SERVICES
3021144   PRE-OP EKG -- DR.WAMPOLD           0.00      0.00   30           PULMONARY SERVICES
3021813   PRE-OP EKG DR YADLAPALLI           0.00      0.00   30           PULMONARY SERVICES
3021102   PRE-OP EKG DR.EBENEZER             0.00      0.00   30           PULMONARY SERVICES
3021110   PRE-OP EKG--DR.FEHRENBACH          0.00      0.00   30           PULMONARY SERVICES




                                               Page 121
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



3010261   PUL FUNCT DIFF. CAP                0.00      0.00   30           PULMONARY SERVICES
3030095   PULMONARY REHAB EVAL INIT          0.00      0.00   30           PULMONARY SERVICES
3010345   PULMONARY STRESS COMPLEX         555.00    520.00   30           PULMONARY SERVICES
3010287   PULMONARY STRESS SIMPLE          501.00      0.00   30           PULMONARY SERVICES
3030038   PULSE OXIMETRY MULTIPLE          247.00      0.00   30           PULMONARY SERVICES
3010196   PULSE OXIMETRY MULTIPLE          148.00    146.00   30           PULMONARY SERVICES
3020377   PULSE OXIMETRY SINGLE             45.00      0.00   30           PULMONARY SERVICES
3021656   PULSE OX-OVERNIGHT CONT          288.00      0.00   30           PULMONARY SERVICES
3030046   REHAB PULSE OX PER CHECK           0.00      0.00   30           PULMONARY SERVICES
3010295   RESP FLOW VOLUME LOOP            170.00      0.00   30           PULMONARY SERVICES
3021672   S N OXIDE INIT DAY             19770.00      0.00   30           PULMONARY SERVICES
3033818   S N OXIDE PER HOUR               420.00      0.00   30           PULMONARY SERVICES
3021680   S N OXIDE SUBSQ DAY            11791.00      0.00   30           PULMONARY SERVICES
3021797   S NSTRL HFOV BELLOWS TRA         496.00      0.00   30           PULMONARY SERVICES
3021771   S NSTRL HFOV CIRCUIT             783.00      0.00   30           PULMONARY SERVICES
3021789   S NSTRL HFOV DISPHRAGM           207.00      0.00   30           PULMONARY SERVICES
3021706   S NSTRL PENTAMIDINE NEBU         173.00      0.00   30           PULMONARY SERVICES
3020708   S O2 BRONCHSCOPY                 145.00      0.00   30           PULMONARY SERVICES
3020369   S O2 CATH LAB                    145.00      0.00   30           PULMONARY SERVICES
3020328   S O2 CONT AEROSOL INIT DA        318.00      0.00   30           PULMONARY SERVICES
3020310   S O2 CONT AEROSOL SUBSQ D        318.00      0.00   30           PULMONARY SERVICES
3020393   S O2 ER                          145.00      0.00   30           PULMONARY SERVICES
3020955   S O2 INITIAL DAY                 754.00      0.00   30           PULMONARY SERVICES
3020344   S O2 OB                          145.00      0.00   30           PULMONARY SERVICES
3020401   S O2 PACU 2HOURS                 145.00      0.00   30           PULMONARY SERVICES
3020443   S O2 SPA 2 HOURS                 145.00      0.00   30           PULMONARY SERVICES
3020419   S O2 SPA.                        145.00      0.00   30           PULMONARY SERVICES
3020963   S O2 SUBSEQUENT DAY              754.00      0.00   30           PULMONARY SERVICES
3020930   S O2 TENT HUMID INIT DAY         318.00      0.00   30           PULMONARY SERVICES
3020948   S O2 TENT HUMID SUBS DAY         318.00      0.00   30           PULMONARY SERVICES
3030186   SMIKING CESSATION - SUBSQ          0.00      0.00   30           PULMONARY SERVICES
3030178   SMOKING CESSATION - INIT         146.00      0.00   30           PULMONARY SERVICES
3030194   SMOKING CESSATION - INIT         124.00      0.00   30           PULMONARY SERVICES
3020567   SPIROMETRY                       170.00      0.00   30           PULMONARY SERVICES
3010279   SPIROMETRY PRE/POST BD           201.00    188.00   30           PULMONARY SERVICES
3020922   SPUTUM INDCTN VIA AEROSOL        225.00      0.00   30           PULMONARY SERVICES
3021029   SUCTION NASOTRACHEAL              61.00      0.00   30           PULMONARY SERVICES
3030145   TCM INITIAL DAY                 1879.00      0.00   30           PULMONARY SERVICES
3030152   TCM SUBSEQUENT DAY              1876.00      0.00   30           PULMONARY SERVICES
3030129   THER PROC RESP FNCTN 15M          70.00      0.00   30           PULMONARY SERVICES
3030137   THER PROC RESP FNCTN GRP          67.00      0.00   30           PULMONARY SERVICES
3021805   THER PROC RESP FNCTN GRP           0.00      0.00   30           PULMONARY SERVICES
3030111   THER PROC STRNTH/ENDR 15M         70.00      0.00   30           PULMONARY SERVICES
3010428   THORACENTESIS INIT/SUBSQ         528.00      0.00   30           PULMONARY SERVICES
3010303   THORACIC GAS VOLUME              471.00    441.00   30           PULMONARY SERVICES
3010378   TILT TABLE-PF                      0.00      0.00   30           PULMONARY SERVICES
3021045   TRACH TUBE CARE                    0.00      0.00   30           PULMONARY SERVICES
3021300   TRAUMA CALL                        0.00      0.00   30           PULMONARY SERVICES
3020617   TRAUMA VENT SET-UP                 0.00      0.00   30           PULMONARY SERVICES
3010386   TREADMILL-PF                       0.00      0.00   30           PULMONARY SERVICES
3020765   VENT MGMNT INITIAL              2375.00      0.00   30           PULMONARY SERVICES
3021755   VENT MGMNT INITIAL HF           3401.00      0.00   30           PULMONARY SERVICES
3020781   VENT MGMNT INITIAL TRAUMA       2362.00      0.00   30           PULMONARY SERVICES




                                               Page 122
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



3020773   VENT MGMNT SUBSEQUENT            2228.00      0.00   30           PULMONARY SERVICES
3021763   VENT MGMNT SUBSEQUENT HF         3401.00      0.00   30           PULMONARY SERVICES
3020799   VENT MGMNT SUBSQ TRAUMA          2362.00      0.00   30           PULMONARY SERVICES
3021094   VENT SYSTEM CALIBRATION             0.00      0.00   30           PULMONARY SERVICES
3020252   VITAL CAPACITY                     15.00      0.00   30           PULMONARY SERVICES
2810182   CPLX PACU ADD 15M                 298.00      0.00   28           RECOVERY SERVICES
2810174   CPLX PACU FIRST 30M               719.00      0.00   28           RECOVERY SERVICES
2810166   STND PACU LVL 1 ADD 15M           147.00      0.00   28           RECOVERY SERVICES
2810158   STND PACU LVL 1 FIRST 30M         590.00      0.00   28           RECOVERY SERVICES
2810208   STND PACU LVL 2 ADD 15M            99.00      0.00   28           RECOVERY SERVICES
2810190   STND PACU LVL 2 FIRST 30M         393.00      0.00   28           RECOVERY SERVICES
3212651   OT ADL TRAIN ADD 15                60.00      0.00   32           REHAB SERVICES
3211224   OT ADL TRAIN EA 15                157.00     58.00   32           REHAB SERVICES
3212644   OT ADL TRAIN INIT 30              125.00     75.00   32           REHAB SERVICES
3213428   OT COMPU ASSIST TRAIN >30          80.00      0.00   32           REHAB SERVICES
3210317   OT CONTRAST BATH INIT 30           42.00      0.00   32           REHAB SERVICES
3210309   OT CONTRAST BATHS EA 15            42.00      0.00   32           REHAB SERVICES
3212768   OT DEBRIDE NON-SELECT 15          191.00    125.00   32           REHAB SERVICES
3212776   OT DEBRIDE NON-SELECT 30          243.00    165.00   32           REHAB SERVICES
3212784   OT DEBRIDE NON-SELECT 45          296.00    205.00   32           REHAB SERVICES
3212792   OT DEBRIDE NON-SELECT 60          348.00    245.00   32           REHAB SERVICES
3213261   OT DEBRIDE SEL<=20CM 15MN         160.00     80.00   32           REHAB SERVICES
3213287   OT DEBRIDE SEL<=20CM 30MN         193.60     96.80   32           REHAB SERVICES
3213303   OT DEBRIDE SEL<=20CM 45MN         234.26    117.13   32           REHAB SERVICES
3213329   OT DEBRIDE SEL<=20CM 60MN         283.45    141.72   32           REHAB SERVICES
3213279   OT DEBRIDE SEL>20CM 15MN          176.00     88.00   32           REHAB SERVICES
3213295   OT DEBRIDE SEL>20CM 30MN          212.96    106.48   32           REHAB SERVICES
3213311   OT DEBRIDE SEL>20CM 45MN          257.68    128.84   32           REHAB SERVICES
3213337   OT DEBRIDE SEL>20CM 60MN          311.79    155.90   32           REHAB SERVICES
3212693   OT DEBRIDE SKIN FULL              393.00    275.00   32           REHAB SERVICES
3212800   OT DEBRIDE SKIN/TISSUE            470.00    230.00   32           REHAB SERVICES
3210903   OT E-STIM EA 15                    47.00      0.00   32           REHAB SERVICES
3211679   OT E-STIM MANUAL INIT 30           47.00      0.00   32           REHAB SERVICES
3212511   OT E-STIM SUPERVISED 15            60.00      0.00   32           REHAB SERVICES
3212610   OT E-STIM SUPERVISED 30           105.00      0.00   32           REHAB SERVICES
3212222   OT EVAL 15                        210.00      0.00   32           REHAB SERVICES
3212230   OT EVAL 30                        262.00      0.00   32           REHAB SERVICES
3212453   OT EVAL 45                        315.00      0.00   32           REHAB SERVICES
3212461   OT EVAL 60                        366.00      0.00   32           REHAB SERVICES
3212578   OT EVAL ADD 15                     65.00      0.00   32           REHAB SERVICES
3212180   OT EVAL BRIEF                      73.00      0.00   32           REHAB SERVICES
3212701   OT EVAL COMPREHENSIVE             383.00      0.00   32           REHAB SERVICES
3212156   OT EVAL EXTENDED                  322.00      0.00   32           REHAB SERVICES
3212560   OT EVAL INIT 30                   262.00      0.00   32           REHAB SERVICES
3212164   OT EVAL INTERMEDIATE              290.00      0.00   32           REHAB SERVICES
3212172   OT EVAL LTD                       145.00      0.00   32           REHAB SERVICES
3212735   OT EXER GP ADD 15                  60.00      0.00   32           REHAB SERVICES
3212727   OT EXER GP INIT 30                 99.00      0.00   32           REHAB SERVICES
3213378   OT EXTREMITY TEST ADD 15           65.00      0.00   32           REHAB SERVICES
3213360   OT EXTREMITY TEST INT 30          130.00      0.00   32           REHAB SERVICES
3212743   OT IONTOPHORESIS EA 15             48.00      0.00   32           REHAB SERVICES
3212677   OT IONTOPHORESIS INIT 30          100.00      0.00   32           REHAB SERVICES
3212669   OT JOINT MOB EA VISIT             139.00      0.00   32           REHAB SERVICES




                                                Page 123
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



3212552   OT MANUAL THER EA 15               112.00      0.00   32           REHAB SERVICES
3212636   OT MYOFAC/SOFT MOB 30              192.00      0.00   32           REHAB SERVICES
3211604   OT NEUROMUSC REED EA 15            165.00     53.00   32           REHAB SERVICES
3211653   OT NEUROMUSC REED INIT 30          138.00      0.00   32           REHAB SERVICES
3213352   OT ORT/PRO/ADL CK ADD 15            65.00      0.00   32           REHAB SERVICES
3213345   OT ORT/PRO/ADL CK INIT 30          130.00      0.00   32           REHAB SERVICES
3210614   OT ORTHOTIC FAB INIT 30            146.00      0.00   32           REHAB SERVICES
3210580   OT ORTHOTIC TRAIN ADD 15            71.00      0.00   32           REHAB SERVICES
3211174   OT ORTHOTIC TRAIN EA 15            173.00     53.00   32           REHAB SERVICES
3210572   OT ORTHOTIC TRAIN INIT 30          142.00      0.00   32           REHAB SERVICES
3211711   OT PARAFFIN BATH 15                 39.00      0.00   32           REHAB SERVICES
3210499   OT PROC/MOD ADD 15                  69.00      0.00   32           REHAB SERVICES
3210606   OT PROSTH TRAIN ADD 15              71.00      0.00   32           REHAB SERVICES
3210564   OT PROSTH TRAIN EA 15               73.00      0.00   32           REHAB SERVICES
3212685   OT PROSTH TRAIN INIT 30            142.00      0.00   32           REHAB SERVICES
3212487   OT RE-EVAL 15                      164.00     85.00   32           REHAB SERVICES
3211596   OT RE-EVAL 30                      291.00    114.00   32           REHAB SERVICES
3212198   OT RE-EVAL EXTENDED                322.00      0.00   32           REHAB SERVICES
3212206   OT RE-EVAL INTERMEDIATE            290.00      0.00   32           REHAB SERVICES
3212214   OT RE-EVAL LTD                     145.00      0.00   32           REHAB SERVICES
3212628   OT SOFT TISSUE MOB INT30           144.00      0.00   32           REHAB SERVICES
3211257   OT THER ACT EA 15                  179.00     58.00   32           REHAB SERVICES
3211422   OT THER ACT INIT 30                146.00      0.00   32           REHAB SERVICES
3211281   OT THER EX EA 15                   166.00     54.00   32           REHAB SERVICES
3210481   OT THER EX INIT 30                 139.00      0.00   32           REHAB SERVICES
3212602   OT THER MASSAGE EA 15               73.00      0.00   32           REHAB SERVICES
3211646   OT THER MASSAGE INIT 30            110.00      0.00   32           REHAB SERVICES
3212594   OT TREAT ADD 15                     60.00      0.00   32           REHAB SERVICES
3212586   OT TREAT INIT 30                   144.00      0.00   32           REHAB SERVICES
3213386   OT TRN BIOFD ANY MODAL 15           70.00      0.00   32           REHAB SERVICES
3213394   OT TRN BIOFD ANY MODAL 30           80.00      0.00   32           REHAB SERVICES
3213402   OT TRN BIOFD ANY MODAL 45           90.00      0.00   32           REHAB SERVICES
3213410   OT TRN BIOFD ANY MODAL 60          100.00      0.00   32           REHAB SERVICES
3210960   OT ULTRASOUND EA 15                 39.00      0.00   32           REHAB SERVICES
3210978   OT ULTRASOUND INIT 30               78.00      0.00   32           REHAB SERVICES
3211364   OT WHEELCHAIR TRAIN EA 15          122.00     40.00   32           REHAB SERVICES
3212719   OT WHIRLPOOL 15                     73.00     25.00   32           REHAB SERVICES
3211695   OT WHIRLPOOL 30                     97.00     34.00   32           REHAB SERVICES
3233129   PT ADL TRAIN EA 15                 180.00     58.00   32           REHAB SERVICES
3233103   PT ADL TRAIN INIT 30               146.00      0.00   32           REHAB SERVICES
3233483   PT AQUATC THER EA 15                78.00      0.00   32           REHAB SERVICES
3231370   PT AQUATC THER EX ADD 15            78.00      0.00   32           REHAB SERVICES
3231362   PT AQUATC THER EX INIT 30          154.00      0.00   32           REHAB SERVICES
3234093   PT DEBRID SEL<=20CM 105MN          502.15    251.07   32           REHAB SERVICES
3234119   PT DEBRID SEL<=20CM 120MN          607.60    303.80   32           REHAB SERVICES
3234101   PT DEBRID SEL>20CM 105MN           552.36    276.18   32           REHAB SERVICES
3234127   PT DEBRID SEL>20CM 120MN           668.36    334.18   32           REHAB SERVICES
3233566   PT DEBRIDE NON-SELECT 15            99.00     65.00   32           REHAB SERVICES
3232220   PT DEBRIDE NON-SELECT 30           145.00     95.00   32           REHAB SERVICES
3233574   PT DEBRIDE NON-SELECT 45           191.00    125.00   32           REHAB SERVICES
3233582   PT DEBRIDE NON-SELECT 60           243.00    155.00   32           REHAB SERVICES
3233970   PT DEBRIDE SEL<=20CM 15MN          160.00     80.00   32           REHAB SERVICES
3233996   PT DEBRIDE SEL<=20CM 30MN          193.60     96.80   32           REHAB SERVICES




                                                 Page 124
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



3234010   PT DEBRIDE SEL<=20CM 45MN          234.26    117.13   32           REHAB SERVICES
3234036   PT DEBRIDE SEL<=20CM 60MN          283.45    141.72   32           REHAB SERVICES
3234051   PT DEBRIDE SEL<=20CM 75MN          342.97    171.49   32           REHAB SERVICES
3234077   PT DEBRIDE SEL<=20CM 90MN          415.00    207.50   32           REHAB SERVICES
3233988   PT DEBRIDE SEL>20CM 15MN           176.00     88.00   32           REHAB SERVICES
3234002   PT DEBRIDE SEL>20CM 30MN           212.96    106.48   32           REHAB SERVICES
3234028   PT DEBRIDE SEL>20CM 45MN           257.68    128.84   32           REHAB SERVICES
3234044   PT DEBRIDE SEL>20CM 60MN           311.79    155.90   32           REHAB SERVICES
3234069   PT DEBRIDE SEL>20CM 75MN           377.27    188.64   32           REHAB SERVICES
3234085   PT DEBRIDE SEL>20CM 90MN           456.50    228.25   32           REHAB SERVICES
3233830   PT DEBRIDE SKIN FULL               403.00      0.00   32           REHAB SERVICES
3233848   PT DEBRIDE SKIN PARTIAL            240.00      0.00   32           REHAB SERVICES
3233855   PT DEBRIDE SKIN/TISSUE             516.00    230.00   32           REHAB SERVICES
3232915   PT E-STIM EA 15                    113.00     46.00   32           REHAB SERVICES
3231891   PT E-STIM MANUAL INIT 30           139.00      0.00   32           REHAB SERVICES
3232725   PT E-STIM SUPERVISED 15            115.00     37.00   32           REHAB SERVICES
3233558   PT E-STIM SUPERVISED 30            138.00     55.00   32           REHAB SERVICES
3233954   PT E-STIM WOUND CARE 15             97.00     37.00   32           REHAB SERVICES
3233962   PT E-STIM WOUND CARE 15             97.00     37.00   32           REHAB SERVICES
3233624   PT EVAL 15                         210.00      0.00   32           REHAB SERVICES
3233319   PT EVAL 30                         584.00    224.00   32           REHAB SERVICES
3233640   PT EVAL 45                         315.00      0.00   32           REHAB SERVICES
3233657   PT EVAL 60                         366.00      0.00   32           REHAB SERVICES
3233871   PT EVAL ADD 15                     131.00      0.00   32           REHAB SERVICES
3230091   PT EVAL BRIEF                       83.00      0.00   32           REHAB SERVICES
3231206   PT EVAL COMPREHENSIVE              383.00      0.00   32           REHAB SERVICES
3231214   PT EVAL EXTENDED                   322.00      0.00   32           REHAB SERVICES
3233863   PT EVAL INIT 30                    290.00      0.00   32           REHAB SERVICES
3231222   PT EVAL INTERMEDIATE               290.00      0.00   32           REHAB SERVICES
3231230   PT EVAL LTD                        143.00      0.00   32           REHAB SERVICES
3232170   PT EXER GP ADD 15                   56.00      0.00   32           REHAB SERVICES
3231487   PT EXER GP INIT 30                  96.00      0.00   32           REHAB SERVICES
3233061   PT FNX ACT INIT 30                 139.00      0.00   32           REHAB SERVICES
3232451   PT GAIT TRAIN EA 15                138.00     47.00   32           REHAB SERVICES
3231396   PT GAIT TRAIN INIT 30              121.00      0.00   32           REHAB SERVICES
3231909   PT IONTOPHORESIS EA 15             115.00     37.00   32           REHAB SERVICES
3231917   PT IONTOPHORESIS INIT 30           100.00      0.00   32           REHAB SERVICES
3231537   PT JOINT MOB EA VISIT              139.00      0.00   32           REHAB SERVICES
3232477   PT MANUAL THER EA 15               144.00     49.00   32           REHAB SERVICES
3231412   PT MANUAL TRACT INIT 30            126.00      0.00   32           REHAB SERVICES
3232709   PT MECH TRACT 15                   118.00      0.00   32           REHAB SERVICES
3233665   PT MECH TRACT 30                   197.00      0.00   32           REHAB SERVICES
3231511   PT MYOFAC/SOFT MOB 30              196.00      0.00   32           REHAB SERVICES
3232402   PT NEUROMUSC REED EA 15            165.00     53.00   32           REHAB SERVICES
3231347   PT NEUROMUSC REED INIT 30          138.00      0.00   32           REHAB SERVICES
3234135   PT NP WOUND TX <=50 CM 15          100.00     80.00   32           REHAB SERVICES
3234150   PT NP WOUND TX <=50 CM 30          130.00     96.00   32           REHAB SERVICES
3234176   PT NP WOUND TX <=50 CM 45          169.00    115.00   32           REHAB SERVICES
3234192   PT NP WOUND TX <=50 CM 60          220.00    138.00   32           REHAB SERVICES
3234218   PT NP WOUND TX <=50 CM 90          286.00    166.00   32           REHAB SERVICES
3234234   PT NP WOUND TX <=50CM 105          371.00    199.00   32           REHAB SERVICES
3234259   PT NP WOUND TX <=50CM 120          483.00    239.00   32           REHAB SERVICES
3234242   PT NP WOUND TX >50 CM 105          376.00    204.00   32           REHAB SERVICES




                                                 Page 125
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



3234267   PT NP WOUND TX >50 CM 120         488.00    244.00   32           REHAB SERVICES
3234143   PT NP WOUND TX >50 CM 15          105.00     85.00   32           REHAB SERVICES
3234168   PT NP WOUND TX >50 CM 30          135.00    101.00   32           REHAB SERVICES
3234184   PT NP WOUND TX >50 CM 45          174.00    120.00   32           REHAB SERVICES
3234200   PT NP WOUND TX >50 CM 60          225.00    142.00   32           REHAB SERVICES
3234226   PT NP WOUND TX >50 CM 90          291.00    171.00   32           REHAB SERVICES
3232196   PT ORT/PRO/ADL CK INIT 30         108.00      0.00   32           REHAB SERVICES
3232964   PT ORTHOTIC TRAIN EA 15           172.00     55.00   32           REHAB SERVICES
3231735   PT PARAFFIN BATH 15                85.00     30.00   32           REHAB SERVICES
3233699   PT PROC THER GP 15                 25.00      0.00   32           REHAB SERVICES
3233194   PT PROC THER GP 30                 44.00      0.00   32           REHAB SERVICES
3233707   PT PROC THER GP 45                 71.00      0.00   32           REHAB SERVICES
3230190   PT PROC THER GP 60                101.00      0.00   32           REHAB SERVICES
3233715   PT PROC THER GP 60                 97.00      0.00   32           REHAB SERVICES
3231321   PT PROC/MOD ADD 15                 69.00      0.00   32           REHAB SERVICES
3233723   PT PROSTH TRAIN ADD 15             53.00      0.00   32           REHAB SERVICES
3233434   PT PROSTH TRAIN EA 15              73.00      0.00   32           REHAB SERVICES
3231586   PT PROSTH TRAIN INIT 30           144.00      0.00   32           REHAB SERVICES
3233301   PT RE-EVAL 15                     164.00     95.00   32           REHAB SERVICES
3233749   PT RE-EVAL 30                     217.00    135.00   32           REHAB SERVICES
3233756   PT RE-EVAL 45                     270.00    175.00   32           REHAB SERVICES
3233764   PT RE-EVAL 60                     321.00      0.00   32           REHAB SERVICES
3231263   PT RE-EVAL EXTENDED               322.00      0.00   32           REHAB SERVICES
3230992   PT RE-EVAL INTERMEDIATE           290.00      0.00   32           REHAB SERVICES
3231008   PT RE-EVAL LTD                    145.00      0.00   32           REHAB SERVICES
3233897   PT SINGLE PROC ADD 15              60.00     25.00   32           REHAB SERVICES
3233889   PT SINGLE PROC INIT 30            144.00     90.00   32           REHAB SERVICES
3233145   PT SOFT TISSUE MOB INIT30         146.00      0.00   32           REHAB SERVICES
3233038   PT THER ACT EA 15                 152.00     57.00   32           REHAB SERVICES
3233772   PT THER ACT INIT 30               146.00      0.00   32           REHAB SERVICES
3232378   PT THER EX EA 15                  149.00     54.00   32           REHAB SERVICES
3231313   PT THER EX INIT 30                139.00      0.00   32           REHAB SERVICES
3232493   PT THER MASSAGE EA 15             133.00     43.00   32           REHAB SERVICES
3231438   PT THER MASSAGE INIT 30           110.00      0.00   32           REHAB SERVICES
3233913   PT TREAT COMBO ADD 15              60.00      0.00   32           REHAB SERVICES
3233905   PT TREAT COMBO INIT 30            144.00      0.00   32           REHAB SERVICES
3234275   PT TRN BIOFD ANY MODAL 15          80.00      0.00   32           REHAB SERVICES
3234283   PT TRN BIOFD ANY MODAL 30          80.00      0.00   32           REHAB SERVICES
3234291   PT TRN BIOFD ANY MODAL 45          90.00      0.00   32           REHAB SERVICES
3234309   PT TRN BIOFD ANY MODAL 60         100.00      0.00   32           REHAB SERVICES
3233368   PT ULTRASOUND EA 15                37.00      0.00   32           REHAB SERVICES
3231958   PT ULTRASOUND INIT 30              78.00      0.00   32           REHAB SERVICES
3232014   PT UNLISTED PHYS MED PROC          66.00      0.00   32           REHAB SERVICES
3232675   PT WHEELCHAIR TRAIN EA 15         122.00     40.00   32           REHAB SERVICES
3232808   PT WHIRLPOOL 15                    99.00      0.00   32           REHAB SERVICES
3233806   PT WHIRLPOOL 30                   183.00      0.00   32           REHAB SERVICES
3240025   S NSTRL E-STIM ELECTRODES          10.00      0.00   32           REHAB SERVICES
3240009   S NSTRL E-STIM ELECTRODES           8.00      0.00   32           REHAB SERVICES
3240017   S NSTRL IONTOPHORESIS ELE          17.00      0.00   32           REHAB SERVICES
3240033   S NSTRL IONTOPHORESIS PAT          21.00      0.00   32           REHAB SERVICES
3212024   S NSTRL SPLINT MCP MOB             92.00      0.00   32           REHAB SERVICES
3212057   S NSTRL SPLINT MISC                 0.00      0.00   32           REHAB SERVICES
3211992   S NSTRL SPLINT THOMAS              83.00      0.00   32           REHAB SERVICES




                                                Page 126
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



3212925   S OT EO DBL F/A EXT/FLEX        1093.00      0.00   32           REHAB SERVICES
3212065   S OT EO EL PF W/STAYS             83.00      0.00   32           REHAB SERVICES
3212909   S OT EO EL PREFAB                 52.00      0.00   32           REHAB SERVICES
3212917   S OT EO EL W/MTL JT PF           126.00      0.00   32           REHAB SERVICES
3213238   S OT FO FINGER K/B                60.00      0.00   32           REHAB SERVICES
3212016   S OT FO SAF PIN MODIFIED          54.00      0.00   32           REHAB SERVICES
3213188   S OT FO SAF PIN SPNG WIRE         48.00      0.00   32           REHAB SERVICES
3213220   S OT HFO COMPOSITE EL            105.00      0.00   32           REHAB SERVICES
3213170   S OT HFO FGR EXTN C/S             69.00      0.00   32           REHAB SERVICES
3213097   S OT HFO FLEX GLV EL FGR         115.00      0.00   32           REHAB SERVICES
3213139   S OT HFO K/B 2 SEG FLX           118.00      0.00   32           REHAB SERVICES
3213113   S OT HFO K/B BNDR PREFAB          94.00      0.00   32           REHAB SERVICES
3213121   S OT HFO K/B BNDR W/OTRG         118.00      0.00   32           REHAB SERVICES
3213212   S OT HFO RVS K/B OTRG            118.00      0.00   32           REHAB SERVICES
3212032   S OT HFO RVS K/B PREFAB           90.00      0.00   32           REHAB SERVICES
3213246   S OT HFO SPREADING HAND          100.00      0.00   32           REHAB SERVICES
3213147   S OT HFO W/O JT PREFAB            44.00      0.00   32           REHAB SERVICES
3212073   S OT SO ACRO/CLAV CNVS PF        793.00      0.00   32           REHAB SERVICES
3212958   S OT WHF 2ND MP ABDC AST          58.00      0.00   32           REHAB SERVICES
3213030   S OT WHF ADJ MP FLEX CTRL        142.00      0.00   32           REHAB SERVICES
3213048   S OT WHF ADJ MP FLEX/IP          162.00      0.00   32           REHAB SERVICES
3213196   S OT WHF DORSAL WRIST PF         107.00      0.00   32           REHAB SERVICES
3213204   S OT WHF DORSAL WRST OTRG        106.00      0.00   32           REHAB SERVICES
3213063   S OT WHF DYN HNG W/F CBL        1775.00      0.00   32           REHAB SERVICES
3213055   S OT WHF DYN HNG WRST/FGR       1443.00      0.00   32           REHAB SERVICES
3212115   S OT WHF FGR EXTN W/WRST          65.00      0.00   32           REHAB SERVICES
3212966   S OT WHF IP EXTN W/MP SP         115.00      0.00   32           REHAB SERVICES
3211950   S OT WHF LONG OPPN CUST          380.00      0.00   32           REHAB SERVICES
3212982   S OT WHF MP EXTENSION AST         94.00      0.00   32           REHAB SERVICES
3212974   S OT WHF MP EXTENSION SP          60.00      0.00   32           REHAB SERVICES
3212990   S OT WHF MP SPNG EXTN AST         99.00      0.00   32           REHAB SERVICES
3213154   S OT WHF OPHR PREFAB             119.00      0.00   32           REHAB SERVICES
3213253   S OT WHF OPHR W/KNCK             181.00      0.00   32           REHAB SERVICES
3212131   S OT WHF OPHR W/RVS              180.00      0.00   32           REHAB SERVICES
3212081   S OT WHF PALMER PREFAB            96.00      0.00   32           REHAB SERVICES
3211943   S OT WHF SHORT OPPN CUST         243.00      0.00   32           REHAB SERVICES
3213006   S OT WHF SPNG SWIVL THUMB         57.00      0.00   32           REHAB SERVICES
3213014   S OT WHF THB IP EXTN W/MP         97.00      0.00   32           REHAB SERVICES
3213162   S OT WHF THOMAS SPN               98.00      0.00   32           REHAB SERVICES
3212941   S OT WHF THUMB ABDC BAR           75.00      0.00   32           REHAB SERVICES
3212933   S OT WHF W/O JT PREFAB           219.00      0.00   32           REHAB SERVICES
3211984   S OT WHF WRST EXTN W/OTRG        142.00      0.00   32           REHAB SERVICES
3213071   S OT WHF WRST GNT THB SPC        617.00      0.00   32           REHAB SERVICES
3213022   S OT WHO CAN WRST W/DSFLX        106.00      0.00   32           REHAB SERVICES
3211976   S OT WHO COCK-UP NON MOLD         72.00      0.00   32           REHAB SERVICES
3211968   S OT WHO GAUNTLET CUST           480.00      0.00   32           REHAB SERVICES
3213105   S OT WHO WRST EXTN C-UP          100.00      0.00   32           REHAB SERVICES
3213089   S OT WO EL PREFAB                 61.00      0.00   32           REHAB SERVICES
3220738   SP COGN RETRAIN EA 15            131.00     75.00   32           REHAB SERVICES
3220787   SP EVAL 30                       164.00    100.00   32           REHAB SERVICES
3220795   SP EVAL 45                       197.00    125.00   32           REHAB SERVICES
3220803   SP EVAL 60                       230.00    150.00   32           REHAB SERVICES
3220456   SP EVAL FNX SWALL 15             197.00    125.00   32           REHAB SERVICES




                                               Page 127
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



3220464   SP EVAL FNX SWALL 30              262.00    150.00   32           REHAB SERVICES
3220472   SP EVAL FNX SWALL 45              328.00    200.00   32           REHAB SERVICES
3220480   SP EVAL FNX SWALL 60              393.00    250.00   32           REHAB SERVICES
3220753   SP EVAL LANG 30                   164.00    100.00   32           REHAB SERVICES
3220761   SP EVAL LANG 45                   197.00    125.00   32           REHAB SERVICES
3220779   SP EVAL LANG 60                   230.00    150.00   32           REHAB SERVICES
3220498   SP EVAL MTN FLUOR SWA 120         760.00      0.00   32           REHAB SERVICES
3220506   SP EVAL MTN FLUOR SWAL 15         164.00     85.00   32           REHAB SERVICES
3220514   SP EVAL MTN FLUOR SWAL 30         249.00    130.00   32           REHAB SERVICES
3220522   SP EVAL MTN FLUOR SWAL 45         335.00    175.00   32           REHAB SERVICES
3220530   SP EVAL MTN FLUOR SWAL 60         419.00    220.00   32           REHAB SERVICES
3220548   SP EVAL MTN FLUOR SWAL 75         505.00    265.00   32           REHAB SERVICES
3220555   SP EVAL MTN FLUOR SWAL 90         590.00    310.00   32           REHAB SERVICES
3220563   SP EVAL SP/LANG/COM 15            197.00    125.00   32           REHAB SERVICES
3220571   SP EVAL SP/LANG/COM 30            262.00    175.00   32           REHAB SERVICES
3220589   SP EVAL SP/LANG/COM 45            328.00    225.00   32           REHAB SERVICES
3220597   SP EVAL SP/LANG/COM 60            393.00    275.00   32           REHAB SERVICES
3220233   SP EXAM NEUROBEHAVIOR HR          492.00    287.00   32           REHAB SERVICES
3220860   SP SP/LANG THER EA 30             197.00    115.00   32           REHAB SERVICES
3220852   SP THER SP/LANG EA 60             328.00    195.00   32           REHAB SERVICES
3220811   SP THER SP/LANG GRP 15             53.00     20.00   32           REHAB SERVICES
3220829   SP THER SP/LANG GRP 30            105.00     40.00   32           REHAB SERVICES
3220837   SP THER SP/LANG GRP 45            157.00     60.00   32           REHAB SERVICES
3220845   SP THER SP/LANG GRP 60            210.00     80.00   32           REHAB SERVICES
3220605   SP TX SP/LANG/COM 15              131.00     75.00   32           REHAB SERVICES
3220613   SP TX SP/LANG/COM 30              197.00    115.00   32           REHAB SERVICES
3220621   SP TX SP/LANG/COM 45              262.00    155.00   32           REHAB SERVICES
3220639   SP TX SP/LANG/COM 60              310.00    195.00   32           REHAB SERVICES
3220647   SP TX SP/LANG/COM GP 15            53.00     20.00   32           REHAB SERVICES
3220654   SP TX SP/LANG/COM GP 30           105.00     40.00   32           REHAB SERVICES
3220662   SP TX SP/LANG/COM GP 45           157.00     60.00   32           REHAB SERVICES
3220670   SP TX SP/LANG/COM GP 60           210.00     80.00   32           REHAB SERVICES
3220688   SP TX SWALL/ORAL FNX 15           131.00     75.00   32           REHAB SERVICES
3220225   SP TX SWALL/ORAL FNX 30           197.00    115.00   32           REHAB SERVICES
3220696   SP TX SWALL/ORAL FNX 45           262.00    155.00   32           REHAB SERVICES
3220704   SP TX SWALL/ORAL FNX 60           328.00    195.00   32           REHAB SERVICES
3220878   SP UNLISTED SERVICE/PROC          419.00      0.00   32           REHAB SERVICES
3212503   TECH ASSIST                         0.00      0.00   32           REHAB SERVICES
3233822   TECH ASSIST                         0.00      0.00   32           REHAB SERVICES
3233814   TECH ASSIST                         0.00      0.00   32           REHAB SERVICES
3212495   TECH ASSIST                         0.00      0.00   32           REHAB SERVICES
3220712   TECH ASSIST                         0.00      0.00   32           REHAB SERVICES
3220720   TECH ASSIST                         0.00      0.00   32           REHAB SERVICES
95307     NEWBORN LEVEL I                  1223.00      0.00   0            ROOM & BED
92908     NEWBORN LEVEL II                 2446.00      0.00   0            ROOM & BED
85308     NEWBORN LEVEL II                 2446.00      0.00   0            ROOM & BED
75309     NEWBORN LEVEL III                3672.00      0.00   0            ROOM & BED
9019      OBSERVATION PER HOUR              112.00      0.00   0            ROOM & BED
3012      OBSERVATION PER HOUR              112.00      0.00   0            ROOM & BED
1511      OBSERVATION PER HOUR              112.00      0.00   0            ROOM & BED
1560      OBSERVATION PER HOUR              112.00      0.00   0            ROOM & BED
1743      OBSERVATION PER HOUR              112.00      0.00   0            ROOM & BED
2014      OBSERVATION PER HOUR              112.00      0.00   0            ROOM & BED




                                                Page 128
                              85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2022    OBSERVATION PER HOUR             112.00      0.00   0            ROOM & BED
2915    OBSERVATION PER HOUR             112.00      0.00   0            ROOM & BED
315     OBSERVATION PER HOUR             112.00      0.00   0            ROOM & BED
4010    OBSERVATION PER HOUR             106.00      0.00   0            ROOM & BED
5314    OBSERVATION PER HOUR             112.00      0.00   0            ROOM & BED
8011    OBSERVATION PER HOUR             112.00      0.00   0            ROOM & BED
70300   ROOM CCU                        4433.00      0.00   0            ROOM & BED
74005   ROOM ICU                        4433.00      0.00   0            ROOM & BED
73502   ROOM ICU                        4182.00      0.00   0            ROOM & BED
70409   ROOM ICU                        4182.00      0.00   0            ROOM & BED
23507   ROOM MED/SURG/GYN               2175.00      0.00   0            ROOM & BED
31732   ROOM MED/SURG/GYN               2175.00      0.00   0            ROOM & BED
42903   ROOM MED/SURG/GYN               2175.00      0.00   0            ROOM & BED
20404   ROOM MED/SURG/GYN               2175.00      0.00   0            ROOM & BED
49007   ROOM MED/SURG/GYN               2175.00      0.00   0            ROOM & BED
31500   ROOM MED/SURG/GYN               2175.00      0.00   0            ROOM & BED
20305   ROOM MED/SURG/GYN               2175.00      0.00   0            ROOM & BED
21733   ROOM MED/SURG/GYN               2175.00      0.00   0            ROOM & BED
22004   ROOM MED/SURG/GYN               2175.00      0.00   0            ROOM & BED
24000   ROOM MED/SURG/GYN               2175.00      0.00   0            ROOM & BED
33001   ROOM MED/SURG/GYN               2175.00      0.00   0            ROOM & BED
23002   ROOM MED/SURG/GYN               2175.00      0.00   0            ROOM & BED
62901   ROOM MED/SURG/GYN               2175.00      0.00   0            ROOM & BED
29009   ROOM OB/MATERNAL                2865.00      0.00   0            ROOM & BED
22905   ROOM OB/MATERNAL                2175.00      0.00   0            ROOM & BED
28001   ROOM OB/MATERNAL                2175.00      0.00   0            ROOM & BED
51730   ROOM TELEMETRY/SPEC CARE        2882.00      0.00   0            ROOM & BED
54007   ROOM TELEMETRY/SPEC CARE        2882.00      0.00   0            ROOM & BED
53504   ROOM TELEMETRY/SPEC CARE        2882.00      0.00   0            ROOM & BED
21501   ROOM TELEMETRY/SPEC CARE        2306.00      0.00   0            ROOM & BED
51508   ROOM TELEMETRY/SPEC CARE        2882.00      0.00   0            ROOM & BED
50401   ROOM TELEMETRY/SPEC CARE        2882.00      0.00   0            ROOM & BED
50302   ROOM TELEMETRY/SPEC CARE        2882.00      0.00   0            ROOM & BED
80309   ROOM TRAUMA CCU                 5542.00      0.00   0            ROOM & BED
84004   ROOM TRAUMA ICU                 5542.00      0.00   0            ROOM & BED
80408   ROOM TRAUMA ICU                 5542.00      0.00   0            ROOM & BED
83501   ROOM TRAUMA ICU                 5542.00      0.00   0            ROOM & BED
82909   ROOM TRAUMA ICU PEDIATRIC       2882.00      0.00   0            ROOM & BED
33506   ROOM TRAUMA MED/SURG/GYN        2719.00      0.00   0            ROOM & BED
30304   ROOM TRAUMA MED/SURG/GYN        2719.00      0.00   0            ROOM & BED
34009   ROOM TRAUMA MED/SURG/GYN        2719.00      0.00   0            ROOM & BED
81737   ROOM TRAUMA MED/SURG/GYN        2719.00      0.00   0            ROOM & BED
89003   ROOM TRAUMA MED/SURG/GYN        2719.00      0.00   0            ROOM & BED
82008   ROOM TRAUMA MED/SURG/GYN        2719.00      0.00   0            ROOM & BED
30403   ROOM TRAUMA MED/SURG/GYN        2719.00      0.00   0            ROOM & BED
83006   ROOM TRAUMA MED/SURG/GYN        2719.00      0.00   0            ROOM & BED
93500   ROOM TRAUMA PEDIATRIC           2882.00      0.00   0            ROOM & BED
94003   ROOM TRAUMA PEDIATRIC           2882.00      0.00   0            ROOM & BED
90407   ROOM TRAUMA PEDIATRIC           2882.00      0.00   0            ROOM & BED
90308   ROOM TRAUMA PEDIATRIC           2882.00      0.00   0            ROOM & BED
64006   ROOM TRAUMA TELEMETRY           3603.00      0.00   0            ROOM & BED
63503   ROOM TRAUMA TELEMETRY           3603.00      0.00   0            ROOM & BED
60400   ROOM TRAUMA TELEMETRY           3603.00      0.00   0            ROOM & BED




                                             Page 129
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



60301    ROOM TRAUMA TELEMETRY            3603.00      0.00   0            ROOM & BED
81505    ROOM TRAUMA TELEMETRY            3603.00      0.00   0            ROOM & BED
404103   D10W 1000ML                       181.00      0.00   4            SUPPLIES - CS
404368   D10W 250ML                        192.00      0.00   4            SUPPLIES - CS
403956   D10W 500ML                        181.00      0.00   4            SUPPLIES - CS
404293   D51/2NS 1000ML                    162.00      0.00   4            SUPPLIES - CS
404285   D51/2NS 1000ML/KCL 10             247.00      0.00   4            SUPPLIES - CS
404525   D51/2NS 1000ML/KCL 20             247.00      0.00   4            SUPPLIES - CS
404509   D51/2NS 1000ML/KCL 30             247.00      0.00   4            SUPPLIES - CS
403998   D51/2NS 1000ML/KCL 40             247.00      0.00   4            SUPPLIES - CS
404319   D51/2NS 250ML                     169.00      0.00   4            SUPPLIES - CS
404301   D51/2NS 500ML                     169.00      0.00   4            SUPPLIES - CS
404327   D51/4NS 1000ML                    162.00      0.00   4            SUPPLIES - CS
404012   D51/4NS 1000ML/KCL 10             247.00      0.00   4            SUPPLIES - CS
404186   D51/4NS 1000ML/KCL 20             247.00      0.00   4            SUPPLIES - CS
403972   D51/4NS 1000ML/KCL 30             247.00      0.00   4            SUPPLIES - CS
404004   D51/4NS 1000ML/KCL 40             247.00      0.00   4            SUPPLIES - CS
404335   D51/4NS 500ML                     169.00      0.00   4            SUPPLIES - CS
404277   D5LR 1000ML                       198.00      0.00   4            SUPPLIES - CS
404129   D5LR/KCL 20MEQ 1000ML             321.00      0.00   4            SUPPLIES - CS
404152   D5LR/KCL 40MEQ 1000ML             321.00      0.00   4            SUPPLIES - CS
404244   D5NS 1000ML                       162.00      0.00   4            SUPPLIES - CS
404020   D5NS 1000ML/KCL 20                310.00      0.00   4            SUPPLIES - CS
404137   D5NS 1000ML/KCL 40                324.00      0.00   4            SUPPLIES - CS
404079   D5NS 1000ML/KCL 40                310.00      0.00   4            SUPPLIES - CS
404442   D5NS 500ML                        169.00      0.00   4            SUPPLIES - CS
404251   D5NS 500ML                        169.00      0.00   4            SUPPLIES - CS
404343   D5W 1000ML                        186.00      0.00   4            SUPPLIES - CS
404160   D5W 1000ML/KCL 20                 247.00      0.00   4            SUPPLIES - CS
404517   D5W 1000ML/KCL 40                 247.00      0.00   4            SUPPLIES - CS
404053   D5W 250ML                         162.00      0.00   4            SUPPLIES - CS
404434   D5W 500ML                         158.00      0.00   4            SUPPLIES - CS
404095   D5W 500ML                         158.00      0.00   4            SUPPLIES - CS
404178   HEPARIN 25KU/1/2NS250             320.00      0.00   4            SUPPLIES - CS
404236   LACTATED RINGERS 1000             181.00      0.00   4            SUPPLIES - CS
409839   LIDO/DEXTROSE                      72.00      0.00   4            SUPPLIES - CS
412981   MANNITOL                          587.00      0.00   4            SUPPLIES - CS
404392   NA CL 0.45% 1000ML                186.00      0.00   4            SUPPLIES - CS
404459   NA CL 0.45% 500ML                 165.00      0.00   4            SUPPLIES - CS
404467   NA CL 0.9% 1000ML                 167.00      0.00   4            SUPPLIES - CS
404202   NA CL 0.9% 250ML                  153.00      0.00   4            SUPPLIES - CS
404350   NA CL 0.9% 500ML                  153.00      0.00   4            SUPPLIES - CS
404228   NORMOSOL R 1000ML                 320.00      0.00   4            SUPPLIES - CS
404210   NORMOSOL R/D5W 1000ML             282.00      0.00   4            SUPPLIES - CS
467381   S BRACH SOURCE GOLD 198             0.00      0.00   4            SUPPLIES - CS
467399   S BRACH SOURCE HI IRID192           0.00      0.00   4            SUPPLIES - CS
467357   S BRACH SOURCE NHDR IR192           0.00      0.00   4            SUPPLIES - CS
467365   S BRACH SOURCE PALLADM103           0.00      0.00   4            SUPPLIES - CS
467373   S BRACH SOURCE YTTRIUM 90           0.00      0.00   4            SUPPLIES - CS
406561   S IMP KNEE DURACON TIBIA         6078.00      0.00   4            SUPPLIES - CS
411298   S IMP PROSTHESIS IMPLANT            0.00      0.00   4            SUPPLIES - CS
408146   S NSTRL ADPTR TRACH TEE            31.00      0.00   4            SUPPLIES - CS
465567   S NSTRL AFO AHOC ANKL            1284.00      0.00   4            SUPPLIES - CS




                                               Page 130
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



465476   S NSTRL AFO ANKLE SPLNT           2302.00      0.00   4            SUPPLIES - CS
465492   S NSTRL AFO CSTM FIT              2248.00      0.00   4            SUPPLIES - CS
465534   S NSTRL AFO DBL UPRT              3507.00      0.00   4            SUPPLIES - CS
465518   S NSTRL AFO MOLDED RIGD           4318.00      0.00   4            SUPPLIES - CS
465484   S NSTRL AFO SNGL BR ADJ           2588.00      0.00   4            SUPPLIES - CS
465609   S NSTRL AFO SOFT INNRFC           1078.00      0.00   4            SUPPLIES - CS
465559   S NSTRL AFO TIB FX RGD            5097.00      0.00   4            SUPPLIES - CS
415612   S NSTRL ASPEN COLLAR               202.00      0.00   4            SUPPLIES - CS
408096   S NSTRL BAG BREATHING               65.00      0.00   4            SUPPLIES - CS
403733   S NSTRL BINDER, ABDOMINAL          212.00      0.00   4            SUPPLIES - CS
411314   S NSTRL BLANKET WARMER             400.00      0.00   4            SUPPLIES - CS
466474   S NSTRL BODY SOCK                  711.00      0.00   4            SUPPLIES - CS
401422   S NSTRL BOOT BUCK TRCTN            542.00      0.00   4            SUPPLIES - CS
416032   S NSTRL BRCE WRIST LH L            146.00      0.00   4            SUPPLIES - CS
416040   S NSTRL BRCE WRIST LH M            146.00      0.00   4            SUPPLIES - CS
416057   S NSTRL BRCE WRIST LH S            146.00      0.00   4            SUPPLIES - CS
416073   S NSTRL BRCE WRIST RH L            146.00      0.00   4            SUPPLIES - CS
416065   S NSTRL BRCE WRIST RH L            146.00      0.00   4            SUPPLIES - CS
416081   S NSTRL BRCE WRIST RH M            146.00      0.00   4            SUPPLIES - CS
416099   S NSTRL BRCE WRIST RH S            146.00      0.00   4            SUPPLIES - CS
416024   S NSTRL BRCE WRST LH XL            146.00      0.00   4            SUPPLIES - CS
407999   S NSTRL CAN NASAL 7FT               42.00      0.00   4            SUPPLIES - CS
400820   S NSTRL CAN NASAL ADLT              76.00      0.00   4            SUPPLIES - CS
408088   S NSTRL CAN NASAL PED               63.00      0.00   4            SUPPLIES - CS
401364   S NSTRL CAST FBGL 2"/3             175.00      0.00   4            SUPPLIES - CS
401372   S NSTRL CAST FBGL 4"/5             257.00      0.00   4            SUPPLIES - CS
409698   S NSTRL CAST LONG LOWER            838.00      0.00   4            SUPPLIES - CS
401349   S NSTRL CAST SHOE                  230.00      0.00   4            SUPPLIES - CS
465187   S NSTRL CERV CL SPN EX            3752.00      0.00   4            SUPPLIES - CS
465336   S NSTRL CERV HULO VEST           14402.00      0.00   4            SUPPLIES - CS
465328   S NSTRL CHRBCK LSO BRCE           3130.00      0.00   4            SUPPLIES - CS
408195   S NSTRL CIRC VENT IPPB             101.00      0.00   4            SUPPLIES - CS
408187   S NSTRL CIRCUIT VENT               270.00      0.00   4            SUPPLIES - CS
415604   S NSTRL COLLAR ASPEN              1269.00      0.00   4            SUPPLIES - CS
401455   S NSTRL COLLAR CERV SFT            211.00      0.00   4            SUPPLIES - CS
409987   S NSTRL COLLAR PHIL USE            117.00      0.00   4            SUPPLIES - CS
401539   S NSTRL COLOSTOMY POUCH            101.00      0.00   4            SUPPLIES - CS
401554   S NSTRL COLSTMY IRR BAG            547.00      0.00   4            SUPPLIES - CS
401521   S NSTRL COLSTMY IRR SLE            144.00      0.00   4            SUPPLIES - CS
409847   S NSTRL DIGITAL SPLINT              16.00      0.00   4            SUPPLIES - CS
467068   S NSTRL DRSG SILCON 4X7            194.00      0.00   4            SUPPLIES - CS
465179   S NSTRL FG 8 SPLNT SHLD            734.00      0.00   4            SUPPLIES - CS
465138   S NSTRL HALO MRI SYS              6484.00      0.00   4            SUPPLIES - CS
466599   S NSTRL HO ADB CNTRL              6473.00      0.00   4            SUPPLIES - CS
409730   S NSTRL IMBLR LOWER                282.00      0.00   4            SUPPLIES - CS
409862   S NSTRL IMMOBILIZER UPPER          211.00      0.00   4            SUPPLIES - CS
401299   S NSTRL KIT CPM TRCTN              793.00      0.00   4            SUPPLIES - CS
465385   S NSTRL KNEE IMBLR                 211.00      0.00   4            SUPPLIES - CS
465351   S NSTRL KO ADJ-KNEE FIT           4263.00      0.00   4            SUPPLIES - CS
465393   S NSTRL KO CUSTM MLDD             8438.00      0.00   4            SUPPLIES - CS
465369   S NSTRL KO ELSTC CNDYL            1000.00      0.00   4            SUPPLIES - CS
400978   S NSTRL LEAD TEMP                 1191.00      0.00   4            SUPPLIES - CS
465302   S NSTRL LS BDY JCKT               6716.00      0.00   4            SUPPLIES - CS




                                                Page 131
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



465310   S NSTRL LSO CORSET FIT           1325.00      0.00   4            SUPPLIES - CS
408047   S NSTRL MASK 02 7' TUBE            65.00      0.00   4            SUPPLIES - CS
408062   S NSTRL MASK AEROSOL               46.00      0.00   4            SUPPLIES - CS
408179   S NSTRL MASK IPPB                  31.00      0.00   4            SUPPLIES - CS
408211   S NSTRL MASK O2 VENTI              73.00      0.00   4            SUPPLIES - CS
408120   S NSTRL MASK TRACH                 65.00      0.00   4            SUPPLIES - CS
408237   S NSTRL NEBULIZER HAND             74.00      0.00   4            SUPPLIES - CS
408112   S NSTRL NEBULIZER KIT             181.00      0.00   4            SUPPLIES - CS
412254   S NSTRL PAD HEAT THERP            262.00      0.00   4            SUPPLIES - CS
409029   S NSTRL PAD HEAT THERP            243.00      0.00   4            SUPPLIES - CS
467076   S NSTRL PAD HEAT THPY             631.00      0.00   4            SUPPLIES - CS
406066   S NSTRL PROBE TEMP                227.00      0.00   4            SUPPLIES - CS
410381   S NSTRL RESUS ADULT               502.00      0.00   4            SUPPLIES - CS
410357   S NSTRL RESUS NEWBORN             554.00      0.00   4            SUPPLIES - CS
408245   S NSTRL SENSOR TEMP                31.00      0.00   4            SUPPLIES - CS
401406   S NSTRL SHOE POST OP              302.00      0.00   4            SUPPLIES - CS
411900   S NSTRL SHOULDER IMBLR            282.00      0.00   4            SUPPLIES - CS
413021   S NSTRL SLEEVE SEQUENT CO         506.00      0.00   4            SUPPLIES - CS
401398   S NSTRL SLING ARM                 147.00      0.00   4            SUPPLIES - CS
401448   S NSTRL SLING SWATHE              272.00      0.00   4            SUPPLIES - CS
408138   S NSTRL SPIROMTR INCNTV           167.00      0.00   4            SUPPLIES - CS
415828   S NSTRL SPLINT ANKLE              211.00      0.00   4            SUPPLIES - CS
465245   S NSTRL SPLINT COCK-UP            733.00      0.00   4            SUPPLIES - CS
410043   S NSTRL SPLINT LOWER EXTR         361.00      0.00   4            SUPPLIES - CS
410050   S NSTRL SPLINT UPPER EXTR         256.00      0.00   4            SUPPLIES - CS
401273   S NSTRL SPLINT WRIST              102.00      0.00   4            SUPPLIES - CS
401240   S NSTRL SPLINT, CLAV               93.00      0.00   4            SUPPLIES - CS
409599   S NSTRL SPLINT/HARE/TRACT         525.00      0.00   4            SUPPLIES - CS
415521   S NSTRL SPLNT GURD FNGR            36.00      0.00   4            SUPPLIES - CS
401018   S NSTRL STCKNG ANTI EMB           171.00      0.00   4            SUPPLIES - CS
414177   S NSTRL STCKNG EMBL TH            251.00      0.00   4            SUPPLIES - CS
467266   S NSTRL STRAP FETAL MONIT          12.00      0.00   4            SUPPLIES - CS
408161   S NSTRL TENT CANOPY               262.00      0.00   4            SUPPLIES - CS
465286   S NSTRL TLSO BDY JCKT            8507.00      0.00   4            SUPPLIES - CS
465294   S NSTRL TLSO BDY JCKT           10711.00      0.00   4            SUPPLIES - CS
465260   S NSTRL TLSO JEWTT HYEX          3191.00      0.00   4            SUPPLIES - CS
408021   S NSTRL TUBE LRG BORE              31.00      0.00   4            SUPPLIES - CS
465591   S NSTRL VARS/VALGS STRP           672.00      0.00   4            SUPPLIES - CS
467142   S STRL ADPT TUOHY-BORST            81.00      0.00   4            SUPPLIES - CS
414854   S STRL AEROVENT                   162.00      0.00   4            SUPPLIES - CS
414847   S STRL AQUAPAK 1000CC              91.00      0.00   4            SUPPLIES - CS
402560   S STRL BAG AUTOTRANS              976.00      0.00   4            SUPPLIES - CS
403501   S STRL BAG BILE                   183.00      0.00   4            SUPPLIES - CS
413757   S STRL BAG RESUS DISP             501.00      0.00   4            SUPPLIES - CS
415620   S STRL BARRIER SKIN GUA           108.00      0.00   4            SUPPLIES - CS
406850   S STRL BONE WAX                   155.00      0.00   4            SUPPLIES - CS
403857   S STRL BOTTLE EVAC 1L             291.00      0.00   4            SUPPLIES - CS
400788   S STRL CAN NASAL 8'                46.00      0.00   4            SUPPLIES - CS
404756   S STRL CATH 7F FEMORAL           1734.00      0.00   4            SUPPLIES - CS
404624   S STRL CATH ANGIO QUCK             94.00      0.00   4            SUPPLIES - CS
415034   S STRL CATH BARTHLN GLAND         105.00      0.00   4            SUPPLIES - CS
404657   S STRL CATH BILIARY DRAIN         531.00      0.00   4            SUPPLIES - CS
402693   S STRL CATH EXTERNAL MALE          87.00      0.00   4            SUPPLIES - CS




                                               Page 132
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



404582   S STRL CATH FEMORAL ARTRY         322.00      0.00   4            SUPPLIES - CS
402750   S STRL CATH FOLEY                 198.00      0.00   4            SUPPLIES - CS
402636   S STRL CATH FOLEY 3CC             272.00      0.00   4            SUPPLIES - CS
412700   S STRL CATH FOLEY 3CC/5CC         198.00      0.00   4            SUPPLIES - CS
402594   S STRL CATH FOLEY 3-WAY           290.00      0.00   4            SUPPLIES - CS
402669   S STRL CATH FOLEY COUDE           340.00      0.00   4            SUPPLIES - CS
465047   S STRL CATH FOLEY COUNCIL         290.00      0.00   4            SUPPLIES - CS
402602   S STRL CATH FOLLWR PHIL           283.00      0.00   4            SUPPLIES - CS
467928   S STRL CATH HEMO DL GAMBR         536.00      0.00   4            SUPPLIES - CS
410084   S STRL CATH IN & OUT              108.00      0.00   4            SUPPLIES - CS
401059   S STRL CATH INTRDUCR              496.00      0.00   4            SUPPLIES - CS
467258   S STRL CATH IUP INTRN DIS         183.00      0.00   4            SUPPLIES - CS
413344   S STRL CATH IV ALL                 93.00      0.00   4            SUPPLIES - CS
404608   S STRL CATH IV ANGIO              131.00      0.00   4            SUPPLIES - CS
404558   S STRL CATH IV ANGIO              144.00      0.00   4            SUPPLIES - CS
404574   S STRL CATH IV ANGIO               51.00      0.00   4            SUPPLIES - CS
404632   S STRL CATH IV PERIPHERAL         101.00      0.00   4            SUPPLIES - CS
400622   S STRL CATH KIT SUCTION            40.00      0.00   4            SUPPLIES - CS
404731   S STRL CATH LUMN CTR VN           690.00      0.00   4            SUPPLIES - CS
402610   S STRL CATH MALECOT               299.00      0.00   4            SUPPLIES - CS
404673   S STRL CATH NEPHROSTOMY           549.00      0.00   4            SUPPLIES - CS
404616   S STRL CATH PERIP 2-LUMEN          74.00      0.00   4            SUPPLIES - CS
403600   S STRL CATH RECTAL ROBIN          103.00      0.00   4            SUPPLIES - CS
412239   S STRL CATH ROB NEL                52.00      0.00   4            SUPPLIES - CS
404822   S STRL CATH THERMO 7F            1854.00      0.00   4            SUPPLIES - CS
404830   S STRL CATH THERMO HEPARN        1143.00      0.00   4            SUPPLIES - CS
404764   S STRL CATH UMBILCL ARTRY         257.00      0.00   4            SUPPLIES - CS
404780   S STRL CATH UMBLCL STPCCK         426.00      0.00   4            SUPPLIES - CS
415422   S STRL CATH V 4.0FR               711.00      0.00   4            SUPPLIES - CS
414110   S STRL CATH, INDWELLING           400.00      0.00   4            SUPPLIES - CS
402537   S STRL CATH, TROCAR THORA         353.00      0.00   4            SUPPLIES - CS
407858   S STRL CATHETER, COHEN UR         833.00      0.00   4            SUPPLIES - CS
415380   S STRL CATH-V 3.0 MIDLINE         711.00      0.00   4            SUPPLIES - CS
403816   S STRL CAUTERY STRL               237.00      0.00   4            SUPPLIES - CS
409854   S STRL CLAMP DISP 10MM           1327.00      0.00   4            SUPPLIES - CS
403147   S STRL CURETTER EAR DISP           76.00      0.00   4            SUPPLIES - CS
411447   S STRL CUSTOM ORTHO                 0.00      0.00   4            SUPPLIES - CS
406033   S STRL DEFIB PADS                 135.00      0.00   4            SUPPLIES - CS
406074   S STRL DEFIB PD EXT PACE          202.00      0.00   4            SUPPLIES - CS
467779   S STRL DERMABOND                  292.00      0.00   4            SUPPLIES - CS
402529   S STRL DRAIN CHEST VAC           1610.00      0.00   4            SUPPLIES - CS
400358   S STRL DRES DUDRM 4X4             120.00      0.00   4            SUPPLIES - CS
400374   S STRL DRES DUDRM 4X5             219.00      0.00   4            SUPPLIES - CS
409680   S STRL DRES GUZE IODO/PLN         154.00      0.00   4            SUPPLIES - CS
400432   S STRL DRESS VASELINE GZE          74.00      0.00   4            SUPPLIES - CS
466839   S STRL DRS SIL MEPITL 2X3          60.00      0.00   4            SUPPLIES - CS
466847   S STRL DRS SIL MEPITL 3X4          74.00      0.00   4            SUPPLIES - CS
466854   S STRL DRS SIL MEPITL 4X8         115.00      0.00   4            SUPPLIES - CS
466870   S STRL DRSG AQUACEL 2X2            40.00      0.00   4            SUPPLIES - CS
466888   S STRL DRSG AQUACEL 4X4            40.00      0.00   4            SUPPLIES - CS
466912   S STRL DRSG CARBOFLEX 3X6         233.00      0.00   4            SUPPLIES - CS
466946   S STRL DRSG CLR COMFL 2X2          39.00      0.00   4            SUPPLIES - CS
466961   S STRL DRSG CLR COMFL 3X5          51.00      0.00   4            SUPPLIES - CS




                                               Page 133
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



466953   S STRL DRSG CLR COMFL 4X4          40.00      0.00   4            SUPPLIES - CS
466979   S STRL DRSG CLR COMFL 6X6          65.00      0.00   4            SUPPLIES - CS
466987   S STRL DRSG COMFL 24"SQ            61.00      0.00   4            SUPPLIES - CS
466995   S STRL DRSG COMFL 42"SQ            83.00      0.00   4            SUPPLIES - CS
466706   S STRL DRSG CURASOL GEL            55.00      0.00   4            SUPPLIES - CS
466722   S STRL DRSG IMPREG MESALT          25.00      0.00   4            SUPPLIES - CS
466862   S STRL DRSG KALTOSTAT 3X4          63.00      0.00   4            SUPPLIES - CS
466821   S STRL DRSG MEPILEX                65.00      0.00   4            SUPPLIES - CS
466748   S STRL DRSG RIBBN MESALT           25.00      0.00   4            SUPPLIES - CS
467027   S STRL DRSG XEROFLO 1X8            39.00      0.00   4            SUPPLIES - CS
467001   S STRL DRSG XEROFLO 2X2            18.00      0.00   4            SUPPLIES - CS
467019   S STRL DRSG XEROFLO 5X9            39.00      0.00   4            SUPPLIES - CS
467290   S STRL ELECT FETAL SCALP           34.00      0.00   4            SUPPLIES - CS
467159   S STRL ESOPH/RCTL TMP DSP         178.00      0.00   4            SUPPLIES - CS
402347   S STRL EXTRACTR VACUM CUP         291.00      0.00   4            SUPPLIES - CS
408013   S STRL FILTER BACTERIA             16.00      0.00   4            SUPPLIES - CS
467134   S STRL FLOWMETER PEAK             174.00      0.00   4            SUPPLIES - CS
415406   S STRL GROSHONG 3FR PICC         1871.00      0.00   4            SUPPLIES - CS
415372   S STRL GROSHONG 4FR PICC         2401.00      0.00   4            SUPPLIES - CS
415398   S STRL GROSHONG DUL 5PICC        2401.00      0.00   4            SUPPLIES - CS
415810   S STRL GUIDEWIRE                  584.00      0.00   4            SUPPLIES - CS
400986   S STRL GUIDEWIRE DUAL             270.00      0.00   4            SUPPLIES - CS
406611   S STRL GUIDEWIRE, AMPLATZ         865.00      0.00   4            SUPPLIES - CS
414821   S STRL HEATER COLUMN              322.00      0.00   4            SUPPLIES - CS
414813   S STRL HEATER RESERVOIR           120.00      0.00   4            SUPPLIES - CS
400671   S STRL HUMIDIFIER 325ML            70.00      0.00   4            SUPPLIES - CS
409706   S STRL INTRAOSEOUS NEEDLE         380.00      0.00   4            SUPPLIES - CS
413476   S STRL IV REFLUX VALVE             63.00      0.00   4            SUPPLIES - CS
402891   S STRL KIT AMNIO PRES             662.00      0.00   4            SUPPLIES - CS
466276   S STRL KIT ANES ART-LINE          690.00      0.00   4            SUPPLIES - CS
403923   S STRL KIT ANESTH LTA II          147.00      0.00   4            SUPPLIES - CS
404798   S STRL KIT ART LINE 20G           484.00      0.00   4            SUPPLIES - CS
402768   S STRL KIT CATH SMALL              94.00      0.00   4            SUPPLIES - CS
403519   S STRL KIT GASTRIC LAVAGE         314.00      0.00   4            SUPPLIES - CS
401034   S STRL KIT INLNE TEMP INJ         567.00      0.00   4            SUPPLIES - CS
415927   S STRL KIT MICRO SAFE 3FR         106.00      0.00   4            SUPPLIES - CS
415935   S STRL KIT MICRO SAFE 4FR         106.00      0.00   4            SUPPLIES - CS
415919   S STRL KIT MICRO SAFE 5FR         106.00      0.00   4            SUPPLIES - CS
466359   S STRL KIT MLT LUMEN 9 FR        1173.00      0.00   4            SUPPLIES - CS
403782   S STRL KIT NASOSTAT               574.00      0.00   4            SUPPLIES - CS
401117   S STRL KIT PERCT SHTH             772.00      0.00   4            SUPPLIES - CS
402867   S STRL KIT PUMP BREAST            416.00      0.00   4            SUPPLIES - CS
466128   S STRL KIT SEED RECOVERY          316.00      0.00   4            SUPPLIES - CS
416156   S STRL KT TRANSDUCER BIFU         546.00      0.00   4            SUPPLIES - CS
406413   S STRL LACTATED RINGERS           275.00      0.00   4            SUPPLIES - CS
403238   S STRL LENS THRP EYE DISP         388.00      0.00   4            SUPPLIES - CS
407866   S STRL LOOP, CUTTING/ELEC        1854.00      0.00   4            SUPPLIES - CS
467647   S STRL MASTISOL                    12.00      0.00   4            SUPPLIES - CS
407940   S STRL NASAL PCK MED DISP          93.00      0.00   4            SUPPLIES - CS
404533   S STRL NDL IV BTRFLY               90.00      0.00   4            SUPPLIES - CS
404541   S STRL NDL IV BTRFLY 12"           90.00      0.00   4            SUPPLIES - CS
412114   S STRL NDO DISECTOR               499.00      0.00   4            SUPPLIES - CS
414839   S STRL NEBULIZER ADAPTOR          119.00      0.00   4            SUPPLIES - CS




                                               Page 134
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



401232   S STRL NEEDLE BIOPSY              555.00      0.00   4            SUPPLIES - CS
466102   S STRL NEEDLE BRACHYTHRPY         136.00      0.00   4            SUPPLIES - CS
467282   S STRL NEEDLE FURGESON             63.00      0.00   4            SUPPLIES - CS
405241   S STRL NEEDLE PERCUTAN 18         453.00      0.00   4            SUPPLIES - CS
404665   S STRL NEEDLE PERCUTANEUS        1018.00      0.00   4            SUPPLIES - CS
401224   S STRL NEEDLE SPINAL DISP         167.00      0.00   4            SUPPLIES - CS
407742   S STRL NEEDLE SPNE WHITKR         188.00      0.00   4            SUPPLIES - CS
406132   S STRL PAD, PATIENT GROUN         181.00      0.00   4            SUPPLIES - CS
467274   S STRL PK C-SECTION CUS          1163.00      0.00   4            SUPPLIES - CS
466581   S STRL PROBE O2 INFNT DSP         351.00      0.00   4            SUPPLIES - CS
466615   S STRL PROBE O2 PED DISP          271.00      0.00   4            SUPPLIES - CS
406017   S STRL PROBE OXIMETR DISP         120.00      0.00   4            SUPPLIES - CS
466136   S STRL RADIONUCLIDE SEEDS         181.00      0.00   4            SUPPLIES - CS
466524   S STRL RADIONUCLIDE SEEDS         181.00      0.00   4            SUPPLIES - CS
403550   S STRL RESUS NEONATL DISP        1029.00      0.00   4            SUPPLIES - CS
409631   S STRL RHINO ROCKET               440.00      0.00   4            SUPPLIES - CS
409037   S STRL SENSOR O2 PROB DIS         409.00      0.00   4            SUPPLIES - CS
401968   S STRL SET BLOOD NV Y-TYP         230.00      0.00   4            SUPPLIES - CS
401836   S STRL SET BLOOD TUBNG            265.00      0.00   4            SUPPLIES - CS
400440   S STRL SET IRR TUR 'Y             237.00      0.00   4            SUPPLIES - CS
466110   S STRL SET PROSTATE DISP         1156.00      0.00   4            SUPPLIES - CS
401109   S STRL SHEATH, INTRODUCER         547.00      0.00   4            SUPPLIES - CS
402131   S STRL SLV CATH GURD 80CM         182.00      0.00   4            SUPPLIES - CS
400556   S STRL SOL IRR NACL/H20            96.00      0.00   4            SUPPLIES - CS
400531   S STRL SOL IRR NACL/H20            61.00      0.00   4            SUPPLIES - CS
400515   S STRL SOL IRR NACL/H20            63.00      0.00   4            SUPPLIES - CS
400499   S STRL SOL IRR NACL/H20            90.00      0.00   4            SUPPLIES - CS
400523   S STRL SOL IRR SORB/MANN          237.00      0.00   4            SUPPLIES - CS
413799   S STRL SOL IRR, NACL/H20          344.00      0.00   4            SUPPLIES - CS
404400   S STRL SOL IV 1L STOCK SO         245.00      0.00   4            SUPPLIES - CS
404145   S STRL SOL, .9NACL WO MEQ         321.00      0.00   4            SUPPLIES - CS
404194   S STRL SOL, D5.9NACL 250          169.00      0.00   4            SUPPLIES - CS
404483   S STRL SOL, D5W PARTIAL F         229.00      0.00   4            SUPPLIES - CS
404269   S STRL SOL, DR LACT RINGE         189.00      0.00   4            SUPPLIES - CS
408765   S STRL SOL, IV 1L, ALL            211.00      0.00   4            SUPPLIES - CS
408880   S STRL SOL, IV 500CC, ALL         178.00      0.00   4            SUPPLIES - CS
404087   S STRL SOL, LMD 10% & NAC        1420.00      0.00   4            SUPPLIES - CS
404475   S STRL SOL, NACL .9%PARTI         229.00      0.00   4            SUPPLIES - CS
401760   S STRL SOLUSET                     79.00      0.00   4            SUPPLIES - CS
405100   S STRL STAPLE EXTRC SKIN          119.00      0.00   4            SUPPLIES - CS
401471   S STRL STAPLE SIGNET SKIN         290.00      0.00   4            SUPPLIES - CS
412825   S STRL STERILE SUPPLIES             0.00      0.00   4            SUPPLIES - CS
413245   S STRL SUTURE CARDIOVAS           209.00      0.00   4            SUPPLIES - CS
413260   S STRL SUTURE CUTICULAR           142.00      0.00   4            SUPPLIES - CS
465039   S STRL SUTURE DERMABOND           196.00      0.00   4            SUPPLIES - CS
413211   S STRL SUTURE GI POP OFF          290.00      0.00   4            SUPPLIES - CS
413203   S STRL SUTURE GI SINGLE            90.00      0.00   4            SUPPLIES - CS
413187   S STRL SUTURE GORTEX CV           366.00      0.00   4            SUPPLIES - CS
413195   S STRL SUTURE MAXON               472.00      0.00   4            SUPPLIES - CS
413179   S STRL SUTURE ORTHO               106.00      0.00   4            SUPPLIES - CS
413161   S STRL SUTURE PLASTIC-ALL         257.00      0.00   4            SUPPLIES - CS
406918   S STRL SUTURE, GC MULTI P         215.00      0.00   4            SUPPLIES - CS
406892   S STRL SUTURE, GEN. TAPER         101.00      0.00   4            SUPPLIES - CS




                                               Page 135
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



406900    S STRL SUTURE, PLASTIC            257.00      0.00   4            SUPPLIES - CS
406868    S STRL SUTURE, SUPRAMID            93.00      0.00   4            SUPPLIES - CS
410019    S STRL SYRINGE EAR & ULCE          55.00      0.00   4            SUPPLIES - CS
414722    S STRL SYS SPPLMNTL NUTR          525.00      0.00   4            SUPPLIES - CS
402511    S STRL TRACH SUCTN CLSD           433.00      0.00   4            SUPPLIES - CS
400697    S STRL TRACH TUBE LWP             978.00      0.00   4            SUPPLIES - CS
408450    S STRL TRANSDUCER 3T              546.00      0.00   4            SUPPLIES - CS
413898    S STRL TRANSDUCR PRES DSP         555.00      0.00   4            SUPPLIES - CS
467241    S STRL TRAY ANES PUDENTL          403.00      0.00   4            SUPPLIES - CS
403915    S STRL TRAY ANESTH DISP           484.00      0.00   4            SUPPLIES - CS
403097    S STRL TRAY BIOPSY DISP           406.00      0.00   4            SUPPLIES - CS
402719    S STRL TRAY CATH FOLEY            115.00      0.00   4            SUPPLIES - CS
465104    S STRL TRAY EPIDURAL              314.00      0.00   4            SUPPLIES - CS
403881    S STRL TRAY EPIDURAL DISP         631.00      0.00   4            SUPPLIES - CS
402842    S STRL TRAY FOLEY W/BAG           287.00      0.00   4            SUPPLIES - CS
403113    S STRL TRAY LUMBAR DISP           409.00      0.00   4            SUPPLIES - CS
404806    S STRL TRAY MAHURKR DL L         1551.00      0.00   4            SUPPLIES - CS
404723    S STRL TRAY MYELOGRM DISP        1321.00      0.00   4            SUPPLIES - CS
403899    S STRL TRAY SPINAL DISP           416.00      0.00   4            SUPPLIES - CS
403105    S STRL TRAY THORA DISP            588.00      0.00   4            SUPPLIES - CS
409102    S STRL TRAY THORC VNT DIS        3407.00      0.00   4            SUPPLIES - CS
402727    S STRL TRAY URETHRAL              122.00      0.00   4            SUPPLIES - CS
402586    S STRL TRAY URNE MTR FOLY         400.00      0.00   4            SUPPLIES - CS
400895    S STRL TUBE FEED DOBHOFF          555.00      0.00   4            SUPPLIES - CS
400929    S STRL TUBE FEED KEOFEED          344.00      0.00   4            SUPPLIES - CS
400846    S STRL TUBE INFANT FED             93.00      0.00   4            SUPPLIES - CS
415232    S STRL TUBE JEJUNAL FEED          888.00      0.00   4            SUPPLIES - CS
400747    S STRL TUBE TRACH IN CAN          120.00      0.00   4            SUPPLIES - CS
407726    S STRL TUBE, BRONCHO-ENDO        1537.00      0.00   4            SUPPLIES - CS
402651    S STRL URINARY BAG                156.00      0.00   4            SUPPLIES - CS
402685    S STRL URINARY BAG LEG            117.00      0.00   4            SUPPLIES - CS
414151    S STRL URINARY BAG LG DRN         117.00      0.00   4            SUPPLIES - CS
402578    S STRL URINARY DRAIN UNIT         291.00      0.00   4            SUPPLIES - CS
402701    S STRL URINE METER W/BAG          275.00      0.00   4            SUPPLIES - CS
402834    S STRL UROSTOMY BAG               110.00      0.00   4            SUPPLIES - CS
465088    S STRL VALVE SPEAK (VENT)         709.00      0.00   4            SUPPLIES - CS
465096    S STRL VALVE SPEAK(TRACH)         709.00      0.00   4            SUPPLIES - CS
404699    S STRL VESSEL DILATOR             171.00      0.00   4            SUPPLIES - CS
466896    S STRL WOUND CLEANSER             103.00      0.00   4            SUPPLIES - CS
467936    S STRL WOUND VAC CANNISTR         140.00      0.00   4            SUPPLIES - CS
467910    S STRL WOUND VAC DRSG             149.00      0.00   4            SUPPLIES - CS
2610145   CANDELA LITHOTRIPSER BILA           0.00      0.00   26           SURGICAL SERVICES - OP
2610798   CPLX GENRL ANES ADD 15M           247.00      0.00   26           SURGICAL SERVICES - OP
2610780   CPLX GENRL ANES FIRST 30M         792.00      0.00   26           SURGICAL SERVICES - OP
2610616   CPLX PACU ADD 15M                 147.00      0.00   26           SURGICAL SERVICES - OP
2610608   CPLX PACU FIRST 30M               590.00      0.00   26           SURGICAL SERVICES - OP
2610566   CX CASE OR                        590.00      0.00   26           SURGICAL SERVICES - OP
2610574   CX CASE PREOP                       0.00      0.00   26           SURGICAL SERVICES - OP
2630176   CYST/URETSCP/PYLSCP LITHO        2375.00      0.00   26           SURGICAL SERVICES - OP
2610699   INJ EPID CERV THOR               1029.00      0.00   26           SURGICAL SERVICES - OP
2610707   INJ EPIDL L/S                    1029.00      0.00   26           SURGICAL SERVICES - OP
2610731   INJ FACET L/S 1 LVL               122.00      0.00   26           SURGICAL SERVICES - OP
2610749   INJ NRV BLK C SPINE               122.00      0.00   26           SURGICAL SERVICES - OP




                                                Page 136
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2610756   INJ NRV BLK LUMB THOR            122.00      0.00   26           SURGICAL SERVICES - OP
2610723   INJ NRV INTCOSTL MULT            122.00      0.00   26           SURGICAL SERVICES - OP
2610715   INJ NRV INTCOSTL SNGL            122.00      0.00   26           SURGICAL SERVICES - OP
2651768   LITHO ESWL BILAT               17209.00      0.00   26           SURGICAL SERVICES - OP
2651750   LITHO ESWL UNILAT               9178.00      0.00   26           SURGICAL SERVICES - OP
2610814   MAC/REG ADD 15M                  111.00      0.00   26           SURGICAL SERVICES - OP
2610806   MAC/REG FIRST 30M                439.00      0.00   26           SURGICAL SERVICES - OP
2651016   S STRL DRESSING GAUZE IMP          0.00      0.00   26           SURGICAL SERVICES - OP
2650349   S STRL TRAP SPEC BRONCH           12.00      0.00   26           SURGICAL SERVICES - OP
2610822   SEDATION < 2 HRS                 660.00      0.00   26           SURGICAL SERVICES - OP
2610830   SEDATION 2 HRS - 4 HRS           660.00      0.00   26           SURGICAL SERVICES - OP
2610848   SEDATION 4 HRS - 6 HRS           660.00      0.00   26           SURGICAL SERVICES - OP
2610855   SEDATION 6 HRS - 8 HRS           660.00      0.00   26           SURGICAL SERVICES - OP
2610863   SEDATION 8 HRS - 10 HRS          660.00      0.00   26           SURGICAL SERVICES - OP
2610772   STND GENRL ANES ADD 15M          165.00      0.00   26           SURGICAL SERVICES - OP
2610764   STND GENRL ANES FIRST 30M        528.00      0.00   26           SURGICAL SERVICES - OP
2610590   STND PACU LVL 1 ADD 15M          298.00      0.00   26           SURGICAL SERVICES - OP
2610582   STND PACU LVL 1 FIRST 30M        719.00      0.00   26           SURGICAL SERVICES - OP
2610632   STND PACU LVL 2 ADD 15M           99.00      0.00   26           SURGICAL SERVICES - OP
2610624   STND PACU LVL 2 FIRST 30M        393.00      0.00   26           SURGICAL SERVICES - OP
2610491   SURG LVL 3 ADD 15M               394.00      0.00   26           SURGICAL SERVICES - OP
2610517   SURG LVL 4 ADD 15M              1816.00      0.00   26           SURGICAL SERVICES - OP
2610509   SURG LVL 4 FIRST 30M            6057.00      0.00   26           SURGICAL SERVICES - OP
2610533   SURG LVL 5 ADD 15M              1843.00      0.00   26           SURGICAL SERVICES - OP
2610525   SURG LVL 5 FIRST 30M            6149.00      0.00   26           SURGICAL SERVICES - OP
2610558   SURG LVL COSM ADD 15M            747.00      0.00   26           SURGICAL SERVICES - OP
2610541   SURG LVL COSM FIRST 30M         2388.00      0.00   26           SURGICAL SERVICES - OP
2610871   US NDL PLACE                     736.00      0.00   26           SURGICAL SERVICES - OP
2610129   YAG LASER ROOM, EACH 1/4           0.00      0.00   26           SURGICAL SERVICES - OP
2375145   AD EVAL ABR                      834.00      0.00   23           SURGICAL SUPPLIES
2369601   CHNG GT TUBE                     143.00      0.00   23           SURGICAL SUPPLIES
2375152   EEG DURING SURGERY              2263.00      0.00   23           SURGICAL SUPPLIES
2375210   ELCTRDE STIM BRAIN 1ST HR       1012.00      0.00   23           SURGICAL SUPPLIES
2375202   EMG FOUR LIMBS                  1310.00      0.00   23           SURGICAL SUPPLIES
2375244   EMG HEAD OR NECK BIL            1787.00      0.00   23           SURGICAL SUPPLIES
2375236   EMG HEAD OR NECK UNI            1787.00      0.00   23           SURGICAL SUPPLIES
2375178   EMG ONE LIMB                     864.00      0.00   23           SURGICAL SUPPLIES
2375194   EMG THREE LIMBS                 1162.00      0.00   23           SURGICAL SUPPLIES
2375186   EMG TWO LIMBS                   1131.00      0.00   23           SURGICAL SUPPLIES
2375103   H REFLX TEST GSTR/SOL UNI        893.00      0.00   23           SURGICAL SUPPLIES
2367472   LACTATED RINGERS 1000             47.00      0.00   23           SURGICAL SUPPLIES
2367498   LACTATED RINGERS 3000             16.00      0.00   23           SURGICAL SUPPLIES
2367407   NA CL IRRIG 1000ML                16.00      0.00   23           SURGICAL SUPPLIES
2367399   NA CL IRRIG 1500ML                17.00      0.00   23           SURGICAL SUPPLIES
2367456   NA CL IRRIG 3000ML                46.00      0.00   23           SURGICAL SUPPLIES
2367480   NA CL IRRIG 500ML                 13.00      0.00   23           SURGICAL SUPPLIES
2375228   NEURMSC JUNCTION TEST EA         893.00      0.00   23           SURGICAL SUPPLIES
2375160   NRV MOTOR CONDUCT STDY EA        893.00      0.00   23           SURGICAL SUPPLIES
2375020   NRV TEST IOP EA HOUR            5240.00      0.00   23           SURGICAL SUPPLIES
2375004   NRV TEST IOP EA HOUR            1667.00      0.00   23           SURGICAL SUPPLIES
2375012   NRV TEST IOP EA HOUR            2858.00      0.00   23           SURGICAL SUPPLIES
2375038   NRV TEST IOP EA HOUR            7623.00      0.00   23           SURGICAL SUPPLIES
2355659   S BRACH SOURCE IODINE 125        145.00      0.00   23           SURGICAL SUPPLIES




                                               Page 137
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2352664   S IMP SCREW, CANNTED WIT          589.00      0.00   23           SURGICAL SUPPLIES
2354322   S IMP SCREW, MALLEOLAR            230.00      0.00   23           SURGICAL SUPPLIES
2391159   S IMP #13 HIP STEM              11099.00      0.00   23           SURGICAL SUPPLIES
2391167   S IMP #13 IMAL SLEEVE            6585.00      0.00   23           SURGICAL SUPPLIES
2320794   S IMP #14 PROX SLEEVE            6585.00      0.00   23           SURGICAL SUPPLIES
2391175   S IMP #3 FEMORAL                 6462.00      0.00   23           SURGICAL SUPPLIES
2391183   S IMP #3 FEMORAL                 8899.00      0.00   23           SURGICAL SUPPLIES
2320802   S IMP #3 TIBIAL INSERT           2831.00      0.00   23           SURGICAL SUPPLIES
2391191   S IMP #3 TIBIAL INSERT           2585.00      0.00   23           SURGICAL SUPPLIES
2320810   S IMP #4 FEM COMP RT             5825.00      0.00   23           SURGICAL SUPPLIES
2391209   S IMP #4 FEMORAL                 7307.00      0.00   23           SURGICAL SUPPLIES
2391217   S IMP #4 FEMORAL                 6563.00      0.00   23           SURGICAL SUPPLIES
2391225   S IMP #4 FEMORAL                 8899.00      0.00   23           SURGICAL SUPPLIES
2391233   S IMP #4 HIP STEM                4996.00      0.00   23           SURGICAL SUPPLIES
2391241   S IMP #4 TIBIAL INSERT           3446.00      0.00   23           SURGICAL SUPPLIES
2391266   S IMP #5 FEMORAL                 7162.00      0.00   23           SURGICAL SUPPLIES
2391258   S IMP #5 FEMORAL                 8899.00      0.00   23           SURGICAL SUPPLIES
2320828   S IMP #5 HIP STEM                9173.00      0.00   23           SURGICAL SUPPLIES
2391274   S IMP #5 PATELLAR                2575.00      0.00   23           SURGICAL SUPPLIES
2391282   S IMP #7 FEMORAL                 7163.00      0.00   23           SURGICAL SUPPLIES
2391290   S IMP #7 PATELLA DOME            2575.00      0.00   23           SURGICAL SUPPLIES
2391308   S IMP #8 HIP STEM                5133.00      0.00   23           SURGICAL SUPPLIES
2320836   S IMP 10 TIBIAL INSERT           2463.00      0.00   23           SURGICAL SUPPLIES
2391316   S IMP 10MM TIB INSERT            3446.00      0.00   23           SURGICAL SUPPLIES
2320844   S IMP 11 DISTAL CENT              633.00      0.00   23           SURGICAL SUPPLIES
2391324   S IMP 12MM ACET INSERT           5420.00      0.00   23           SURGICAL SUPPLIES
2391332   S IMP 13MM CENTRAL                954.00      0.00   23           SURGICAL SUPPLIES
2391340   S IMP 13MM TIBIAL INSERT         3354.00      0.00   23           SURGICAL SUPPLIES
2391357   S IMP 16MM ORBITAL               3060.00      0.00   23           SURGICAL SUPPLIES
2320851   S IMP 2 HOLE SIDEPLATE           1370.00      0.00   23           SURGICAL SUPPLIES
2320869   S IMP 26 FEM HEAD                2503.00      0.00   23           SURGICAL SUPPLIES
2391365   S IMP 28MM C-TAPER               3673.00      0.00   23           SURGICAL SUPPLIES
2391373   S IMP 28MM FEM HEAD              2388.00      0.00   23           SURGICAL SUPPLIES
2391381   S IMP 28MM FEM HEAD              3149.00      0.00   23           SURGICAL SUPPLIES
2391399   S IMP 3 HOLE BARREL              1345.00      0.00   23           SURGICAL SUPPLIES
2320877   S IMP 32 FEM HEAD                3148.00      0.00   23           SURGICAL SUPPLIES
2391415   S IMP 32MM FEM HEAD              2867.00      0.00   23           SURGICAL SUPPLIES
2391407   S IMP 32MM FEM HEAD              3855.00      0.00   23           SURGICAL SUPPLIES
2391423   S IMP 32MM HEAD V40              3002.00      0.00   23           SURGICAL SUPPLIES
2320885   S IMP 36 FEM HEAD                4389.00      0.00   23           SURGICAL SUPPLIES
2391431   S IMP 36MM FEM HEAD              4374.00      0.00   23           SURGICAL SUPPLIES
2391449   S IMP 4 HOLE SIDE 145            1317.00      0.00   23           SURGICAL SUPPLIES
2320893   S IMP 4 SLEEVE                    962.00      0.00   23           SURGICAL SUPPLIES
2391456   S IMP 47MM HEAD                  1681.00      0.00   23           SURGICAL SUPPLIES
2391464   S IMP 48MM HUM HEAD              6047.00      0.00   23           SURGICAL SUPPLIES
2391472   S IMP 5.5 CROSSLINK              4328.00      0.00   23           SURGICAL SUPPLIES
2391480   S IMP 50MM ACET SHELL            5283.00      0.00   23           SURGICAL SUPPLIES
2391498   S IMP 54MM ACET SHELL            5952.00      0.00   23           SURGICAL SUPPLIES
2391506   S IMP 54MM HEAD                  3582.00      0.00   23           SURGICAL SUPPLIES
2320901   S IMP 56 ACETAB SHELL            5952.00      0.00   23           SURGICAL SUPPLIES
2320919   S IMP 63 FEM COMP RT             6563.00      0.00   23           SURGICAL SUPPLIES
2391142   S IMP 80MM LAG                   1156.00      0.00   23           SURGICAL SUPPLIES
2391514   S IMP 8MM TIB INSERT             3287.00      0.00   23           SURGICAL SUPPLIES




                                                Page 138
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2320927   S IMP 9 TIBIAL INSERT            3712.00      0.00   23           SURGICAL SUPPLIES
2350965   S IMP ACUMED, POLARIUS RO        1883.00      0.00   23           SURGICAL SUPPLIES
2350981   S IMP ACUMED, SCREW CANC          447.00      0.00   23           SURGICAL SUPPLIES
2350973   S IMP ACUMED, SCREW CANC          447.00      0.00   23           SURGICAL SUPPLIES
2351013   S IMP ACUMED, SCREW CORT          447.00      0.00   23           SURGICAL SUPPLIES
2370559   S IMP ALLGRAFT ALL SIZES         3967.00      0.00   23           SURGICAL SUPPLIES
2374767   S IMP ALLOGRAFT DBX PUTTY        4525.00      0.00   23           SURGICAL SUPPLIES
2340008   S IMP ALLOGRAFT IMPL             1174.00      0.00   23           SURGICAL SUPPLIES
2374296   S IMP ALLOGRAFT PUTTY DBX        2969.00      0.00   23           SURGICAL SUPPLIES
2370922   S IMP ALTA CAP LOCKING           1553.00      0.00   23           SURGICAL SUPPLIES
2391076   S IMP ANCHOR 6.5MM               1406.00      0.00   23           SURGICAL SUPPLIES
2360857   S IMP ANCHOR TRANSVAGINAL        1253.00      0.00   23           SURGICAL SUPPLIES
2348316   S IMP ANCHOR, AME 3.5 90-         761.00      0.00   23           SURGICAL SUPPLIES
2348308   S IMP ANCHOR, AME 4.5 90-         761.00      0.00   23           SURGICAL SUPPLIES
2348217   S IMP ANCHOR, CORKSCREW 3         843.00      0.00   23           SURGICAL SUPPLIES
2348183   S IMP ANCHOR, CORKSCREW 5        1187.00      0.00   23           SURGICAL SUPPLIES
2348191   S IMP ANCHOR, CORKSCREW 5         843.00      0.00   23           SURGICAL SUPPLIES
2348209   S IMP ANCHOR, CORKSCREW 6         919.00      0.00   23           SURGICAL SUPPLIES
2348241   S IMP ANCHOR, FASTAK AR-1         457.00      0.00   23           SURGICAL SUPPLIES
2348225   S IMP ANCHOR, FASTAK AR-1         919.00      0.00   23           SURGICAL SUPPLIES
2343150   S IMP ANCHOR, INSERTER IN         670.00      0.00   23           SURGICAL SUPPLIES
2348258   S IMP ANCHOR, MAINSTAY 2.         579.00      0.00   23           SURGICAL SUPPLIES
2348282   S IMP ANCHOR, MAINSTAY 3.         579.00      0.00   23           SURGICAL SUPPLIES
2348266   S IMP ANCHOR, MAINSTAY 4.         608.00      0.00   23           SURGICAL SUPPLIES
2348274   S IMP ANCHOR, MAINSTAY 4.         494.00      0.00   23           SURGICAL SUPPLIES
2349439   S IMP ANCHOR, OGDEN ANCHO         761.00      0.00   23           SURGICAL SUPPLIES
2348290   S IMP ANCHOR, PANALOCK 3.         658.00      0.00   23           SURGICAL SUPPLIES
2347912   S IMP ANCHOR, QUICK ANCHO         940.00      0.00   23           SURGICAL SUPPLIES
2349421   S IMP ANCHOR, QUICK ANCHO         914.00      0.00   23           SURGICAL SUPPLIES
2348324   S IMP ANCHOR, QUICK ANCHO         964.00      0.00   23           SURGICAL SUPPLIES
2352169   S IMP ANCHOR, SUPER QUICK         773.00      0.00   23           SURGICAL SUPPLIES
2348340   S IMP ANCHOR, SURETAC II          967.00      0.00   23           SURGICAL SUPPLIES
2348373   S IMP ANCHOR, SURETAC II          490.00      0.00   23           SURGICAL SUPPLIES
2348233   S IMP ANCHOR, SUTURE FAST         634.00      0.00   23           SURGICAL SUPPLIES
2348332   S IMP ANCHOR, SUTURE STAT         566.00      0.00   23           SURGICAL SUPPLIES
2347763   S IMP ANCHOR, SUTURE, ART         894.00      0.00   23           SURGICAL SUPPLIES
2347771   S IMP ANCHOR, SUTURE, SRG         967.00      0.00   23           SURGICAL SUPPLIES
2347805   S IMP ANCHOR, TISSUE TAK          860.00      0.00   23           SURGICAL SUPPLIES
2347789   S IMP ANCHOR, TISSUE TAK         1105.00      0.00   23           SURGICAL SUPPLIES
2347797   S IMP ANCHOR, TISSUE TAK         1371.00      0.00   23           SURGICAL SUPPLIES
2343135   S IMP ANCHOR, TRANSVAGINA        1189.00      0.00   23           SURGICAL SUPPLIES
2343143   S IMP ANCHOR, TRANSVAGINA         912.00      0.00   23           SURGICAL SUPPLIES
2360865   S IMP ANCHOR,PANALOCK #2          978.00      0.00   23           SURGICAL SUPPLIES
2358604   S IMP ANCHOR,QUICK ANC            775.00      0.00   23           SURGICAL SUPPLIES
2358786   S IMP ANCHOR,QUICKANCH            853.00      0.00   23           SURGICAL SUPPLIES
2358661   S IMP ANCHOR,SNAP-PAK             752.00      0.00   23           SURGICAL SUPPLIES
2358679   S IMP ANCHOR,SNAP-PAK             742.00      0.00   23           SURGICAL SUPPLIES
2344398   S IMP AQUAFLOW DEVICE            1590.00      0.00   23           SURGICAL SUPPLIES
2370393   S IMP ASNIS NAIL/CREWS           1626.00      0.00   23           SURGICAL SUPPLIES
2371847   S IMP BAR TRANSVERSE 6.0-         969.00      0.00   23           SURGICAL SUPPLIES
2391654   S IMP BLADE 105MM                2124.00      0.00   23           SURGICAL SUPPLIES
2391522   S IMP BLADE 95MM                 2124.00      0.00   23           SURGICAL SUPPLIES
2390748   S IMP BOLT 100MM                 2124.00      0.00   23           SURGICAL SUPPLIES




                                                Page 139
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2390755   S IMP BOLT 110MM                2124.00      0.00   23           SURGICAL SUPPLIES
2351203   S IMP BOLT, LOCKING 3.9 X        369.00      0.00   23           SURGICAL SUPPLIES
2351195   S IMP BOLT, LOCKING 3.9 X        369.00      0.00   23           SURGICAL SUPPLIES
2351187   S IMP BOLT, LOCKING 3.9 X        369.00      0.00   23           SURGICAL SUPPLIES
2349017   S IMP BONE GRAFT, ILIA          1287.00      0.00   23           SURGICAL SUPPLIES
2348555   S IMP BONE MATRIX, GRAFTO        613.00      0.00   23           SURGICAL SUPPLIES
2391530   S IMP BONE PLUG                  835.00      0.00   23           SURGICAL SUPPLIES
2349298   S IMP BONE PLUGS SM-7MM:M        143.00      0.00   23           SURGICAL SUPPLIES
2370310   S IMP CABLE & SLEEVE DAEL       3534.00      0.00   23           SURGICAL SUPPLIES
2373025   S IMP CABLE 1.0 W/CRIMP S       1490.00      0.00   23           SURGICAL SUPPLIES
2373249   S IMP CABLE 1M W/CRIMP DO       1887.00      0.00   23           SURGICAL SUPPLIES
2391084   S IMP CAGE EXPAND              20950.00      0.00   23           SURGICAL SUPPLIES
2374536   S IMP CALCIUM BONE FILLER       3515.00      0.00   23           SURGICAL SUPPLIES
2391563   S IMP CAP END 0MM                708.00      0.00   23           SURGICAL SUPPLIES
2391548   S IMP CAP END 1500               922.00      0.00   23           SURGICAL SUPPLIES
2391555   S IMP CAP END 15MM NAILS         816.00      0.00   23           SURGICAL SUPPLIES
2391589   S IMP CAP FIXATOR 5.0MM           40.00      0.00   23           SURGICAL SUPPLIES
2391571   S IMP CAP FIXATOR 6MM             40.00      0.00   23           SURGICAL SUPPLIES
2372704   S IMP CAP LOCK CLIC X 3-D       1381.00      0.00   23           SURGICAL SUPPLIES
2376572   S IMP CATH CODMAN NEURO V       1992.00      0.00   23           SURGICAL SUPPLIES
2374239   S IMP CATH INTRATHECAL ME       2809.00      0.00   23           SURGICAL SUPPLIES
2375848   S IMP CATH VENTRICULAR SH        628.00      0.00   23           SURGICAL SUPPLIES
2367209   S IMP CATH, PERMCATH 36CM       1126.00      0.00   23           SURGICAL SUPPLIES
2367217   S IMP CATH, PERMCATH 40CM        901.00      0.00   23           SURGICAL SUPPLIES
2370351   S IMP CEMENT SYSTEM             6266.00      0.00   23           SURGICAL SUPPLIES
2371102   S IMP CEMENT SYSTEM KNEE        8279.00      0.00   23           SURGICAL SUPPLIES
2391605   S IMP CHAN NEUROSTIM           38412.00      0.00   23           SURGICAL SUPPLIES
2373553   S IMP CLAMP TITA W/POST N       3108.00      0.00   23           SURGICAL SUPPLIES
2379923   S IMP CLAMP UNIVERSAL           2395.00      0.00   23           SURGICAL SUPPLIES
2371342   S IMP CLIP ANEURISM             1001.00      0.00   23           SURGICAL SUPPLIES
2371672   S IMP COLLAR 6.0/TRAN-CON        625.00      0.00   23           SURGICAL SUPPLIES
2390110   S IMP COMPONENT TIBIAL TR       6219.00      0.00   23           SURGICAL SUPPLIES
2320356   S IMP CONNE ANGLED               322.00      0.00   23           SURGICAL SUPPLIES
2373306   S IMP CONNECTOR PARALLEL        2042.00      0.00   23           SURGICAL SUPPLIES
2372167   S IMP COVER, BURR HOLE 12       1108.00      0.00   23           SURGICAL SUPPLIES
2340834   S IMP DISC, SHAH DISC 8.5        226.00      0.00   23           SURGICAL SUPPLIES
2391597   S IMP DOU CAB W/CRIMP           1861.00      0.00   23           SURGICAL SUPPLIES
2377158   S IMP DRAIN POUCH DRAINAB         47.00      0.00   23           SURGICAL SUPPLIES
2371003   S IMP DURACON FEMORAL COM      16390.00      0.00   23           SURGICAL SUPPLIES
2370989   S IMP DURACON TIBIAL BASE      13936.00      0.00   23           SURGICAL SUPPLIES
2369031   S IMP ELE PICES COMPACT L       3108.00      0.00   23           SURGICAL SUPPLIES
2369049   S IMP ELE PICES QUAD LEAD       3108.00      0.00   23           SURGICAL SUPPLIES
2342392   S IMP ELECT, MED. SINGLE        2025.00      0.00   23           SURGICAL SUPPLIES
2342400   S IMP ELECT, MED. SYNERGY      23187.00      0.00   23           SURGICAL SUPPLIES
2342418   S IMP ELECT, PLUG SYNERGY        381.00      0.00   23           SURGICAL SUPPLIES
2367654   S IMP ENDO DISSECT, 5MM W        628.00      0.00   23           SURGICAL SUPPLIES
2353704   S IMP EXPANDER, TISSUE SI       2058.00      0.00   23           SURGICAL SUPPLIES
2353720   S IMP EXPANDER, TISSUE, C       2151.00      0.00   23           SURGICAL SUPPLIES
2353712   S IMP EXPANDER, TISSUE, M       2362.00      0.00   23           SURGICAL SUPPLIES
2343440   S IMP EYE PROSTHESIS             210.00      0.00   23           SURGICAL SUPPLIES
2343085   S IMP FALOPE-RING, TUBAL         164.00      0.00   23           SURGICAL SUPPLIES
2390334   S IMP FEMORAL COMPONENT C       8899.00      0.00   23           SURGICAL SUPPLIES
2391639   S IMP FEMORAL HEAD V40          2388.00      0.00   23           SURGICAL SUPPLIES




                                               Page 140
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2391613   S IMP FEMORAL MED                6901.00      0.00   23           SURGICAL SUPPLIES
2391621   S IMP FEMORAL MED/LG             8387.00      0.00   23           SURGICAL SUPPLIES
2357325   S IMP FILTER GREENFIELD          2211.00      0.00   23           SURGICAL SUPPLIES
2379238   S IMP FLO SEAL                   1072.00      0.00   23           SURGICAL SUPPLIES
2373884   S IMP GEL, IMP 350CC             4328.00      0.00   23           SURGICAL SUPPLIES
2341089   S IMP GRADT, SCLERA, EYE         1636.00      0.00   23           SURGICAL SUPPLIES
2320711   S IMP GRAFT 10 BONE              5056.00      0.00   23           SURGICAL SUPPLIES
2391100   S IMP GRAFT 10 X 20              6144.00      0.00   23           SURGICAL SUPPLIES
2320729   S IMP GRAFT 11 FRA               9825.00      0.00   23           SURGICAL SUPPLIES
2320786   S IMP GRAFT 13 SPACER            9825.00      0.00   23           SURGICAL SUPPLIES
2391118   S IMP GRAFT 14 X 30CM            2371.00      0.00   23           SURGICAL SUPPLIES
2320737   S IMP GRAFT 14 X 7 VASC          3196.00      0.00   23           SURGICAL SUPPLIES
2320745   S IMP GRAFT 16 X 8 VASC          3078.00      0.00   23           SURGICAL SUPPLIES
2374338   S IMP GRAFT 18 X 9MM HEMA        3079.00      0.00   23           SURGICAL SUPPLIES
2320752   S IMP GRAFT 6 SPACER             4243.00      0.00   23           SURGICAL SUPPLIES
2379733   S IMP GRAFT 6MM X 40CM GO        1816.00      0.00   23           SURGICAL SUPPLIES
2320778   S IMP GRAFT 8 SPACER             4243.00      0.00   23           SURGICAL SUPPLIES
2320760   S IMP GRAFT 8 X 50 VASC          3551.00      0.00   23           SURGICAL SUPPLIES
2391126   S IMP GRAFT CERVICAL 8L          4425.00      0.00   23           SURGICAL SUPPLIES
2391134   S IMP GRAFT DURAL 1 X 3          1416.00      0.00   23           SURGICAL SUPPLIES
2376549   S IMP GRAFT DURAL MATRIX         1699.00      0.00   23           SURGICAL SUPPLIES
2377133   S IMP GRAFT DURAL MATRIX         2795.00      0.00   23           SURGICAL SUPPLIES
2357333   S IMP GRAFT GORTEX               1472.00      0.00   23           SURGICAL SUPPLIES
2357341   S IMP GRAFT GORTEX                518.00      0.00   23           SURGICAL SUPPLIES
2357358   S IMP GRAFT GORTEX               1437.00      0.00   23           SURGICAL SUPPLIES
2357366   S IMP GRAFT GORTEX               1472.00      0.00   23           SURGICAL SUPPLIES
2357382   S IMP GRAFT GORTEX                860.00      0.00   23           SURGICAL SUPPLIES
2357291   S IMP GRAFT GORTEX                817.00      0.00   23           SURGICAL SUPPLIES
2357374   S IMP GRAFT GORTEX                542.00      0.00   23           SURGICAL SUPPLIES
2357309   S IMP GRAFT GORTEX               1126.00      0.00   23           SURGICAL SUPPLIES
2357283   S IMP GRAFT GORTEX               1304.00      0.00   23           SURGICAL SUPPLIES
2357259   S IMP GRAFT GORTEX               1406.00      0.00   23           SURGICAL SUPPLIES
2357242   S IMP GRAFT GORTEX               1534.00      0.00   23           SURGICAL SUPPLIES
2357234   S IMP GRAFT GORTEX                101.00      0.00   23           SURGICAL SUPPLIES
2357317   S IMP GRAFT GORTEX                745.00      0.00   23           SURGICAL SUPPLIES
2377125   S IMP GRAFT INFUSE BONE G       15674.00      0.00   23           SURGICAL SUPPLIES
2374874   S IMP GRAFT INVASIVE INJE        5117.00      0.00   23           SURGICAL SUPPLIES
2379808   S IMP GRAFT MASTERGRAFT 1        2265.00      0.00   23           SURGICAL SUPPLIES
2343093   S IMP GRAFT, ACELLULAR AL        1902.00      0.00   23           SURGICAL SUPPLIES
2340875   S IMP GRAFT, ACELLULAR TI        1790.00      0.00   23           SURGICAL SUPPLIES
2352078   S IMP GRAFT, ALLODERM ACE         670.00      0.00   23           SURGICAL SUPPLIES
2352052   S IMP GRAFT, ALLOGRAFT 11        1917.00      0.00   23           SURGICAL SUPPLIES
2352037   S IMP GRAFT, ALLOGRAFT 13        1917.00      0.00   23           SURGICAL SUPPLIES
2352045   S IMP GRAFT, ALLOGRAFT 14        1960.00      0.00   23           SURGICAL SUPPLIES
2348175   S IMP GRAFT, ALLOGRAFT AT        3743.00      0.00   23           SURGICAL SUPPLIES
2354561   S IMP GRAFT, APLIGRAF SKI        1785.00      0.00   23           SURGICAL SUPPLIES
2352003   S IMP GRAFT, AUTOLOGOUS C       23383.00      0.00   23           SURGICAL SUPPLIES
2347896   S IMP GRAFT, BONE                3647.00      0.00   23           SURGICAL SUPPLIES
2351070   S IMP GRAFT, CANCELLOUS B         745.00      0.00   23           SURGICAL SUPPLIES
2352011   S IMP GRAFT, COLLOGRAFT S        1699.00      0.00   23           SURGICAL SUPPLIES
2343069   S IMP GRAFT, DURADERM 2 X         954.00      0.00   23           SURGICAL SUPPLIES
2343077   S IMP GRAFT, DURADERM 2 X         954.00      0.00   23           SURGICAL SUPPLIES
2343101   S IMP GRAFT, FASCIA LATA         1534.00      0.00   23           SURGICAL SUPPLIES




                                                Page 141
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2357424   S IMP GRAFT, GORTEX              599.00      0.00   23           SURGICAL SUPPLIES
2357416   S IMP GRAFT, GORTEX             1345.00      0.00   23           SURGICAL SUPPLIES
2357432   S IMP GRAFT, GORTEX             2438.00      0.00   23           SURGICAL SUPPLIES
2357457   S IMP GRAFT, GORTEX             1660.00      0.00   23           SURGICAL SUPPLIES
2357465   S IMP GRAFT, GORTEX             2133.00      0.00   23           SURGICAL SUPPLIES
2357440   S IMP GRAFT, GORTEX             2284.00      0.00   23           SURGICAL SUPPLIES
2352128   S IMP GRAFT, INTERPORE 5B        957.00      0.00   23           SURGICAL SUPPLIES
2352110   S IMP GRAFT, INTERPORE-GR       1275.00      0.00   23           SURGICAL SUPPLIES
2352136   S IMP GRAFT, INTERPORE-SM        954.00      0.00   23           SURGICAL SUPPLIES
2340099   S IMP GRAFT, PUTTY 10CC 7       1299.00      0.00   23           SURGICAL SUPPLIES
2355022   S IMP GRAFT, PUTTY ALLOMA        940.00      0.00   23           SURGICAL SUPPLIES
2355030   S IMP GRAFT, PUTTY ALLOMA       1113.00      0.00   23           SURGICAL SUPPLIES
2340107   S IMP GRAFT, PUTTY DYNAGR       1673.00      0.00   23           SURGICAL SUPPLIES
2340917   S IMP GRAFT, SCLERA, EYE         496.00      0.00   23           SURGICAL SUPPLIES
2341071   S IMP GRAFT, SCLERA, EYE         338.00      0.00   23           SURGICAL SUPPLIES
2356939   S IMP GRAFT,ACELLULAR COL       1352.00      0.00   23           SURGICAL SUPPLIES
2357408   S IMP GRAFT,ARTEGRAFT COL       1517.00      0.00   23           SURGICAL SUPPLIES
2357390   S IMP GRAFT,ARTEGRAFT COL       1364.00      0.00   23           SURGICAL SUPPLIES
2356806   S IMP GRAFT,REPLIFORM 2X1       1113.00      0.00   23           SURGICAL SUPPLIES
2356814   S IMP GRAFT,REPLIFORM 2X7       1739.00      0.00   23           SURGICAL SUPPLIES
2374833   S IMP GREENFIELD VCF SYST       4810.00      0.00   23           SURGICAL SUPPLIES
2370377   S IMP GUIDE PINS                 358.00      0.00   23           SURGICAL SUPPLIES
2375806   S IMP GUIDEWIRE MEDIUM $         396.00      0.00   23           SURGICAL SUPPLIES
2370385   S IMP HAGIE PINS                 425.00      0.00   23           SURGICAL SUPPLIES
2370898   S IMP HEAD COMPONENT FEMO       4842.00      0.00   23           SURGICAL SUPPLIES
2373462   S IMP HEAD FOR CLICK X SC       2621.00      0.00   23           SURGICAL SUPPLIES
2370914   S IMP HIP BIPOLAR CENTRAX       7353.00      0.00   23           SURGICAL SUPPLIES
2371037   S IMP HIP DISTAL CENTRALI       1008.00      0.00   23           SURGICAL SUPPLIES
2370906   S IMP HIP FIXATION SYSTEM       7285.00      0.00   23           SURGICAL SUPPLIES
2391662   S IMP HIP STEM #7               8356.00      0.00   23           SURGICAL SUPPLIES
2371045   S IMP HIP TOTAL                19050.00      0.00   23           SURGICAL SUPPLIES
2373132   S IMP HOOK TITA LAMI THOR       1752.00      0.00   23           SURGICAL SUPPLIES
2373173   S IMP HOOK TITA PEDICLE L       1822.00      0.00   23           SURGICAL SUPPLIES
2373140   S IMP HOOK TITA PEDICLE R       1752.00      0.00   23           SURGICAL SUPPLIES
2373199   S IMP HOOK TITA TRANSV PR       1822.00      0.00   23           SURGICAL SUPPLIES
2373181   S IMP HOOK TITA TRANSV PR       1822.00      0.00   23           SURGICAL SUPPLIES
2372597   S IMP HOOK, DERMA HOOK           545.00      0.00   23           SURGICAL SUPPLIES
2391712   S IMP IMAL SLEEVE               6585.00      0.00   23           SURGICAL SUPPLIES
2376762   S IMP IMPANT INSERT TIBIA       3477.00      0.00   23           SURGICAL SUPPLIES
2340081   S IMP IMPL BONESOURCE 419       1655.00      0.00   23           SURGICAL SUPPLIES
2342681   S IMP IMPL, ADCON L ADHES       2025.00      0.00   23           SURGICAL SUPPLIES
2347755   S IMP IMPL, BONE GROWTH S       8025.00      0.00   23           SURGICAL SUPPLIES
2341097   S IMP IMPL, CHIN LG. ANAT        422.00      0.00   23           SURGICAL SUPPLIES
2341105   S IMP IMPL, CHIN MED. ANA        639.00      0.00   23           SURGICAL SUPPLIES
2341113   S IMP IMPL, CHIN SM ANATO        639.00      0.00   23           SURGICAL SUPPLIES
2354520   S IMP IMPL, DOW CORNING S        990.00      0.00   23           SURGICAL SUPPLIES
2345403   S IMP IMPL, EYE EAGLE PLU        110.00      0.00   23           SURGICAL SUPPLIES
2345411   S IMP IMPL, EYE GOLD EYEL        757.00      0.00   23           SURGICAL SUPPLIES
2341121   S IMP IMPL, MALAR SHELL T        919.00      0.00   23           SURGICAL SUPPLIES
2354033   S IMP IMPL, MAMM 27-16344       1496.00      0.00   23           SURGICAL SUPPLIES
2353936   S IMP IMPL, MAMM 350-1450       1403.00      0.00   23           SURGICAL SUPPLIES
2354009   S IMP IMPL, MAMM 350-1460       1029.00      0.00   23           SURGICAL SUPPLIES
2353779   S IMP IMPL, MAMM 350-1470       1403.00      0.00   23           SURGICAL SUPPLIES




                                               Page 142
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2353993   S IMP IMPL, MAMM 350-1480         1029.00      0.00   23           SURGICAL SUPPLIES
2353910   S IMP IMPL, MAMM 350-1640         1287.00      0.00   23           SURGICAL SUPPLIES
2353928   S IMP IMPL, MAMM 350-1660         1029.00      0.00   23           SURGICAL SUPPLIES
2353688   S IMP IMPL, MAMM 350-1670         1287.00      0.00   23           SURGICAL SUPPLIES
2353738   S IMP IMPL, MAMM 350-7200         1496.00      0.00   23           SURGICAL SUPPLIES
2353894   S IMP IMPL, MAMM 350-7350         1496.00      0.00   23           SURGICAL SUPPLIES
2353746   S IMP IMPL, MAMM 350-7450         1496.00      0.00   23           SURGICAL SUPPLIES
2353761   S IMP IMPL, MAMM 354-1757         1590.00      0.00   23           SURGICAL SUPPLIES
2353837   S IMP IMPL, MAMM 354-2007         1636.00      0.00   23           SURGICAL SUPPLIES
2353753   S IMP IMPL, MAMM 354-2507         1590.00      0.00   23           SURGICAL SUPPLIES
2353969   S IMP IMPL, MAMM 354-2514         2223.00      0.00   23           SURGICAL SUPPLIES
2353803   S IMP IMPL, MAMM 354-2625         1090.00      0.00   23           SURGICAL SUPPLIES
2353795   S IMP IMPL, MAMM 354-2670         1124.00      0.00   23           SURGICAL SUPPLIES
2353811   S IMP IMPL, MAMM 354-2757         1636.00      0.00   23           SURGICAL SUPPLIES
2353951   S IMP IMPL, MAMM 354-3007         1754.00      0.00   23           SURGICAL SUPPLIES
2353845   S IMP IMPL, MAMM 354-4325         1573.00      0.00   23           SURGICAL SUPPLIES
2353852   S IMP IMPL, MAMM 354-4350         1573.00      0.00   23           SURGICAL SUPPLIES
2353886   S IMP IMPL, MAMM 354-4507         1590.00      0.00   23           SURGICAL SUPPLIES
2353860   S IMP IMPL, MAMM 354-5000         3401.00      0.00   23           SURGICAL SUPPLIES
2353829   S IMP IMPL, MAMM 354-5007         1636.00      0.00   23           SURGICAL SUPPLIES
2353878   S IMP IMPL, MAMM 354-6000         3401.00      0.00   23           SURGICAL SUPPLIES
2353787   S IMP IMPL, MAMM 354-6007         1590.00      0.00   23           SURGICAL SUPPLIES
2353944   S IMP IMPL, MAMM 354-7000         4458.00      0.00   23           SURGICAL SUPPLIES
2354025   S IMP IMPL, MAMM 354-7007         1590.00      0.00   23           SURGICAL SUPPLIES
2354017   S IMP IMPL, MAMM 357-4507         1496.00      0.00   23           SURGICAL SUPPLIES
2353977   S IMP IMPL, MAMM CONTOUR          1520.00      0.00   23           SURGICAL SUPPLIES
2353985   S IMP IMPL, MAMM CONTOUR          2151.00      0.00   23           SURGICAL SUPPLIES
2353654   S IMP IMPL, MAMM EXPANDER         2058.00      0.00   23           SURGICAL SUPPLIES
2353647   S IMP IMPL, MAMM EXPANDER         3743.00      0.00   23           SURGICAL SUPPLIES
2353639   S IMP IMPL, MAMM EXPANDER         3743.00      0.00   23           SURGICAL SUPPLIES
2353902   S IMP IMPL, MAMM, STYLE 6         1287.00      0.00   23           SURGICAL SUPPLIES
2341139   S IMP IMPL, MAND LAT LT            533.00      0.00   23           SURGICAL SUPPLIES
2341147   S IMP IMPL, MAND LAT RT            533.00      0.00   23           SURGICAL SUPPLIES
2354652   S IMP IMPL, METATARSAL LA         2775.00      0.00   23           SURGICAL SUPPLIES
2341170   S IMP IMPL, MOON-LIPPY N0          552.00      0.00   23           SURGICAL SUPPLIES
2345429   S IMP IMPL, OCULAR 20MM S          173.00      0.00   23           SURGICAL SUPPLIES
2345437   S IMP IMPL, OCULAR 22MM S          173.00      0.00   23           SURGICAL SUPPLIES
2341055   S IMP IMPL, OSSICULAR AUS          776.00      0.00   23           SURGICAL SUPPLIES
2341238   S IMP IMPL, OSSICULAR WIE         1780.00      0.00   23           SURGICAL SUPPLIES
2354660   S IMP IMPL, PHANLAGEAL, S         2379.00      0.00   23           SURGICAL SUPPLIES
2342806   S IMP IMPL, PROCEED                483.00      0.00   23           SURGICAL SUPPLIES
2342814   S IMP IMPL, TISSELL 2ML            752.00      0.00   23           SURGICAL SUPPLIES
2354876   S IMP IMPL, TOE STA-PEG A         1207.00      0.00   23           SURGICAL SUPPLIES
2354959   S IMP IMPL, TOE SWANSON F         1780.00      0.00   23           SURGICAL SUPPLIES
2354942   S IMP IMPL, TOE SWANSON F         1688.00      0.00   23           SURGICAL SUPPLIES
2354694   S IMP IMPL, TOE, SGARLATO         1279.00      0.00   23           SURGICAL SUPPLIES
2354678   S IMP IMPL, TOE, SGARLATO         1279.00      0.00   23           SURGICAL SUPPLIES
2354686   S IMP IMPL, TOE, SGARLATO         1279.00      0.00   23           SURGICAL SUPPLIES
2354595   S IMP IMPL, TOE, SM METAT         2775.00      0.00   23           SURGICAL SUPPLIES
2354603   S IMP IMPL, TOE, SM PHALA         2775.00      0.00   23           SURGICAL SUPPLIES
2354579   S IMP IMPL, TOE, SUTTER H         1412.00      0.00   23           SURGICAL SUPPLIES
2354587   S IMP IMPL, TOE, SUTTER H         1412.00      0.00   23           SURGICAL SUPPLIES
2354777   S IMP IMPL, TOE, SUTTER H         1456.00      0.00   23           SURGICAL SUPPLIES




                                                 Page 143
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2354611   S IMP IMPL, TOE, SUTTER H         1412.00      0.00   23           SURGICAL SUPPLIES
2354793   S IMP IMPL, TOE, SUTTER H         1412.00      0.00   23           SURGICAL SUPPLIES
2354645   S IMP IMPL, TOE, SUTTER S         1510.00      0.00   23           SURGICAL SUPPLIES
2354637   S IMP IMPL, TOE, SUTTER S         1510.00      0.00   23           SURGICAL SUPPLIES
2352094   S IMP IMPL, TRANSFIX               558.00      0.00   23           SURGICAL SUPPLIES
2343127   S IMP IMPL, TVT DEVICE 81         1249.00      0.00   23           SURGICAL SUPPLIES
2356996   S IMP IMPL,CONTIGEN BARD          1642.00      0.00   23           SURGICAL SUPPLIES
2356830   S IMP IMPL,CUFF S.T. AMS          3231.00      0.00   23           SURGICAL SUPPLIES
2356822   S IMP IMPL,CUFF S.T.AMS 7         2244.00      0.00   23           SURGICAL SUPPLIES
2357002   S IMP IMPL,DURASPHERE 030          729.00      0.00   23           SURGICAL SUPPLIES
2356780   S IMP IMPL,ENRO PROSTECES         3928.00      0.00   23           SURGICAL SUPPLIES
2356798   S IMP IMPL,PENILE 15CM WI         7248.00      0.00   23           SURGICAL SUPPLIES
2356988   S IMP IMPL,PENILE ALPHA 1         7137.00      0.00   23           SURGICAL SUPPLIES
2356863   S IMP IMPL,PENILE ALPHA 1         6865.00      0.00   23           SURGICAL SUPPLIES
2356954   S IMP IMPL,PENILE AMS 21C         7248.00      0.00   23           SURGICAL SUPPLIES
2356772   S IMP IMPL,PENILE AMS DYN         4320.00      0.00   23           SURGICAL SUPPLIES
2356764   S IMP IMPL,PENILE AMS MAL         3760.00      0.00   23           SURGICAL SUPPLIES
2356921   S IMP IMPL,PENILE RESERVO         2319.00      0.00   23           SURGICAL SUPPLIES
2356947   S IMP IMPL,PENILE RESERVO         1440.00      0.00   23           SURGICAL SUPPLIES
2356962   S IMP IMPL,PENILE RESERVO         2319.00      0.00   23           SURGICAL SUPPLIES
2356848   S IMP IMPL,PRESS REG BALL         2381.00      0.00   23           SURGICAL SUPPLIES
2356855   S IMP IMPL,PUMP SPHINCTER         3401.00      0.00   23           SURGICAL SUPPLIES
2355055   S IMP IMPL,TOE,PRO OSTEON         2383.00      0.00   23           SURGICAL SUPPLIES
2341154   S IMP IMPL. MORETZ PEG-TO          879.00      0.00   23           SURGICAL SUPPLIES
2390219   S IMP IMPLANT #11 FEMORAL         7163.00      0.00   23           SURGICAL SUPPLIES
2390284   S IMP IMPLANT #2 HIP STEM         8357.00      0.00   23           SURGICAL SUPPLIES
2390268   S IMP IMPLANT #3 HIP STEM         7481.00      0.00   23           SURGICAL SUPPLIES
2390326   S IMP IMPLANT #4 FEMORAL          8899.00      0.00   23           SURGICAL SUPPLIES
2379089   S IMP IMPLANT 0MM UNIVERS          908.00      0.00   23           SURGICAL SUPPLIES
2378677   S IMP IMPLANT 10MM DISTAL          707.00      0.00   23           SURGICAL SUPPLIES
2374866   S IMP IMPLANT 10MM HIP ST         4996.00      0.00   23           SURGICAL SUPPLIES
2375293   S IMP IMPLANT 10MM TIBIAL         5764.00      0.00   23           SURGICAL SUPPLIES
2374718   S IMP IMPLANT 11 X 360MM          4015.00      0.00   23           SURGICAL SUPPLIES
2378636   S IMP IMPLANT 12MM DISTAL          681.00      0.00   23           SURGICAL SUPPLIES
2378214   S IMP IMPLANT 12MM DISTAL          554.00      0.00   23           SURGICAL SUPPLIES
2378297   S IMP IMPLANT 13MM DISTAL          601.00      0.00   23           SURGICAL SUPPLIES
2378305   S IMP IMPLANT 13MM HIP CE          601.00      0.00   23           SURGICAL SUPPLIES
2374577   S IMP IMPLANT 26MM UNIVER         3583.00      0.00   23           SURGICAL SUPPLIES
2374379   S IMP IMPLANT 28MM ACETAB         3258.00      0.00   23           SURGICAL SUPPLIES
2374395   S IMP IMPLANT 28MM ACETAB         3258.00      0.00   23           SURGICAL SUPPLIES
2374304   S IMP IMPLANT 28MM C-TAPE         3002.00      0.00   23           SURGICAL SUPPLIES
2374288   S IMP IMPLANT 28MM FEMORA         2869.00      0.00   23           SURGICAL SUPPLIES
2379931   S IMP IMPLANT 28MM V40 HE         2402.00      0.00   23           SURGICAL SUPPLIES
2376457   S IMP IMPLANT 3.5 TI ROD          1412.00      0.00   23           SURGICAL SUPPLIES
2375970   S IMP IMPLANT 3.5 TI ROD           678.00      0.00   23           SURGICAL SUPPLIES
2374601   S IMP IMPLANT 32MM C-TAPE         3674.00      0.00   23           SURGICAL SUPPLIES
2379717   S IMP IMPLANT 38MM HEAD U         1682.00      0.00   23           SURGICAL SUPPLIES
2379774   S IMP IMPLANT 40MM HEAD C         2099.00      0.00   23           SURGICAL SUPPLIES
2374387   S IMP IMPLANT 46MM ACETAB         3258.00      0.00   23           SURGICAL SUPPLIES
2374908   S IMP IMPLANT 46MM ACETAB         5284.00      0.00   23           SURGICAL SUPPLIES
2374650   S IMP IMPLANT 47MM UNIVER         3935.00      0.00   23           SURGICAL SUPPLIES
2374569   S IMP IMPLANT 48MM UNIVER         3583.00      0.00   23           SURGICAL SUPPLIES
2379279   S IMP IMPLANT 4MM SLEEVE          1106.00      0.00   23           SURGICAL SUPPLIES




                                                 Page 144
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CHARGE BILLING DESCRIPTION              SEQ 999 SEQ 100 DEPARTMENT          DEPARTMENT DESCRIPTION
CODE                                    AMOUNT AMOUNT CODE



2374882   S IMP IMPLANT 52MM ACETAB        5284.00      0.00   23           SURGICAL SUPPLIES
2378792   S IMP IMPLANT 5MM END CAP         704.00      0.00   23           SURGICAL SUPPLIES
2379659   S IMP IMPLANT 6 HOLE PLAT        1507.00      0.00   23           SURGICAL SUPPLIES
2379220   S IMP IMPLANT 6.0 X 75MM         1062.00      0.00   23           SURGICAL SUPPLIES
2374916   S IMP IMPLANT 67 45 TIBIA        5360.00      0.00   23           SURGICAL SUPPLIES
2374486   S IMP IMPLANT 8MM TIBIAL         3446.00      0.00   23           SURGICAL SUPPLIES
2374775   S IMP IMPLANT ACETABULAR         4538.00      0.00   23           SURGICAL SUPPLIES
2374361   S IMP IMPLANT ACETABULAR         3258.00      0.00   23           SURGICAL SUPPLIES
2390136   S IMP IMPLANT ACETABULAR         5612.00      0.00   23           SURGICAL SUPPLIES
2390078   S IMP IMPLANT ACETABULAR         5952.00      0.00   23           SURGICAL SUPPLIES
2376895   S IMP IMPLANT ACETABULAR         5284.00      0.00   23           SURGICAL SUPPLIES
2374791   S IMP IMPLANT ACETABULAR         4369.00      0.00   23           SURGICAL SUPPLIES
2376754   S IMP IMPLANT ACETABULAR         3258.00      0.00   23           SURGICAL SUPPLIES
2390128   S IMP IMPLANT ACETABULAR         5612.00      0.00   23           SURGICAL SUPPLIES
2390094   S IMP IMPLANT ACETABULAR         5952.00      0.00   23           SURGICAL SUPPLIES
2374890   S IMP IMPLANT ACETABULAR         5284.00      0.00   23           SURGICAL SUPPLIES
2390144   S IMP IMPLANT ACETABULAR         7294.00      0.00   23           SURGICAL SUPPLIES
2390086   S IMP IMPLANT ACETABULAR         5952.00      0.00   23           SURGICAL SUPPLIES
2377000   S IMP IMPLANT ALUMINA INS        6760.00      0.00   23           SURGICAL SUPPLIES
2374940   S IMP IMPLANT BASEPLATE T        5518.00      0.00   23           SURGICAL SUPPLIES
2375871   S IMP IMPLANT BONE PLUG M         627.00      0.00   23           SURGICAL SUPPLIES
2378669   S IMP IMPLANT CEMENT SPAC         707.00      0.00   23           SURGICAL SUPPLIES
2375913   S IMP IMPLANT COLLAR              675.00      0.00   23           SURGICAL SUPPLIES
2375756   S IMP IMPLANT COMPRESSION         248.00      0.00   23           SURGICAL SUPPLIES
2376648   S IMP IMPLANT C-TAPER HEA        2388.00      0.00   23           SURGICAL SUPPLIES
2376655   S IMP IMPLANT C-TAPER HEA        2388.00      0.00   23           SURGICAL SUPPLIES
2379899   S IMP IMPLANT C-TAPER HEA        2389.00      0.00   23           SURGICAL SUPPLIES
2378651   S IMP IMPLANT DISTAL CENT         681.00      0.00   23           SURGICAL SUPPLIES
2378255   S IMP IMPLANT DISTAL CENT         629.00      0.00   23           SURGICAL SUPPLIES
2375921   S IMP IMPLANT DISTAL CENT         680.00      0.00   23           SURGICAL SUPPLIES
2378289   S IMP IMPLANT DISTAL STEM         601.00      0.00   23           SURGICAL SUPPLIES
2376556   S IMP IMPLANT EAR FLEX H/        1846.00      0.00   23           SURGICAL SUPPLIES
2376028   S IMP IMPLANT END CAP $           704.00      0.00   23           SURGICAL SUPPLIES
2378800   S IMP IMPLANT END CAP T2          704.00      0.00   23           SURGICAL SUPPLIES
2378537   S IMP IMPLANT END CAP T2          667.00      0.00   23           SURGICAL SUPPLIES
2374221   S IMP IMPLANT EXTERNAL FI        2791.00      0.00   23           SURGICAL SUPPLIES
2390151   S IMP IMPLANT FEMORAL #5         6563.00      0.00   23           SURGICAL SUPPLIES
2390201   S IMP IMPLANT FEMORAL COM        7163.00      0.00   23           SURGICAL SUPPLIES
2390300   S IMP IMPLANT FEMORAL COM        8387.00      0.00   23           SURGICAL SUPPLIES
2390169   S IMP IMPLANT FEMORAL COM        6642.00      0.00   23           SURGICAL SUPPLIES
2390177   S IMP IMPLANT FEMORAL COM        6901.00      0.00   23           SURGICAL SUPPLIES
2390193   S IMP IMPLANT FEMORAL COM        7163.00      0.00   23           SURGICAL SUPPLIES
2390235   S IMP IMPLANT FEMORAL COM        7307.00      0.00   23           SURGICAL SUPPLIES
2377026   S IMP IMPLANT FEMORAL COM        6900.00      0.00   23           SURGICAL SUPPLIES
2390250   S IMP IMPLANT FEMORAL COM        7307.00      0.00   23           SURGICAL SUPPLIES
2376986   S IMP IMPLANT FEMORAL COM        6563.00      0.00   23           SURGICAL SUPPLIES
2390292   S IMP IMPLANT FEMORAL COM        8387.00      0.00   23           SURGICAL SUPPLIES
2390185   S IMP IMPLANT FEMORAL COM        6953.00      0.00   23           SURGICAL SUPPLIES
2377075   S IMP IMPLANT FEMORAL COM        8386.00      0.00   23           SURGICAL SUPPLIES
2377067   S IMP IMPLANT FEMORAL COM        8386.00      0.00   23           SURGICAL SUPPLIES
2390243   S IMP IMPLANT FEMORAL COM        7307.00      0.00   23           SURGICAL SUPPLIES
2378206   S IMP IMPLANT FEMORAL END         546.00      0.00   23           SURGICAL SUPPLIES
2374320   S IMP IMPLANT FEMORAL HEA        3002.00      0.00   23           SURGICAL SUPPLIES




                                                Page 145
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2376689   S IMP IMPLANT FEMORAL HEA        2388.00      0.00   23           SURGICAL SUPPLIES
2374346   S IMP IMPLANT FEMORAL HEA        3105.00      0.00   23           SURGICAL SUPPLIES
2374353   S IMP IMPLANT FEMORAL HEA        3105.00      0.00   23           SURGICAL SUPPLIES
2374841   S IMP IMPLANT FEMORAL HEA        4854.00      0.00   23           SURGICAL SUPPLIES
2376671   S IMP IMPLANT FEMORAL HEA        2388.00      0.00   23           SURGICAL SUPPLIES
2374270   S IMP IMPLANT FEMORAL HEA        2869.00      0.00   23           SURGICAL SUPPLIES
2379949   S IMP IMPLANT FEMORAL HEA        2440.00      0.00   23           SURGICAL SUPPLIES
2376663   S IMP IMPLANT FEMORAL HEA        2388.00      0.00   23           SURGICAL SUPPLIES
2379907   S IMP IMPLANT FEMORAL HEA        2389.00      0.00   23           SURGICAL SUPPLIES
2374742   S IMP IMPLANT FEMORAL NAI        4015.00      0.00   23           SURGICAL SUPPLIES
2376853   S IMP IMPLANT FEMORAL NAI        4215.00      0.00   23           SURGICAL SUPPLIES
2374635   S IMP IMPLANT FEMORAL NAI        3833.00      0.00   23           SURGICAL SUPPLIES
2390318   S IMP IMPLANT FEMORAL RIG        8538.00      0.00   23           SURGICAL SUPPLIES
2377091   S IMP IMPLANT FEMORAL STE       11098.00      0.00   23           SURGICAL SUPPLIES
2379915   S IMP IMPLANT HEAD V40 28        2389.00      0.00   23           SURGICAL SUPPLIES
2376887   S IMP IMPLANT HEAD V40 32        5132.00      0.00   23           SURGICAL SUPPLIES
2374858   S IMP IMPLANT HIP STEM #1        4996.00      0.00   23           SURGICAL SUPPLIES
2377059   S IMP IMPLANT HIP STEM #1        8357.00      0.00   23           SURGICAL SUPPLIES
2376903   S IMP IMPLANT HIP STEM #2        5332.00      0.00   23           SURGICAL SUPPLIES
2377117   S IMP IMPLANT HIP STEM #3       12008.00      0.00   23           SURGICAL SUPPLIES
2376911   S IMP IMPLANT HIP STEM #3        5332.00      0.00   23           SURGICAL SUPPLIES
2377042   S IMP IMPLANT HIP STEM #4        8357.00      0.00   23           SURGICAL SUPPLIES
2376994   S IMP IMPLANT HIP STEM #4        6707.00      0.00   23           SURGICAL SUPPLIES
2377109   S IMP IMPLANT HIP STEM #4       12008.00      0.00   23           SURGICAL SUPPLIES
2374684   S IMP IMPLANT HIP STEM #5        3938.00      0.00   23           SURGICAL SUPPLIES
2376879   S IMP IMPLANT HIP STEM 13        5132.00      0.00   23           SURGICAL SUPPLIES
2390359   S IMP IMPLANT HIP STEM 6X       12123.00      0.00   23           SURGICAL SUPPLIES
2377034   S IMP IMPLANT HIP STEM CE        8357.00      0.00   23           SURGICAL SUPPLIES
2390342   S IMP IMPLANT HIP STEM HO       12009.00      0.00   23           SURGICAL SUPPLIES
2379451   S IMP IMPLANT HOLE ELIMAN        1224.00      0.00   23           SURGICAL SUPPLIES
2374924   S IMP IMPLANT HUMERAL HEA        5440.00      0.00   23           SURGICAL SUPPLIES
2390276   S IMP IMPLANT HUMERAL STE        8214.00      0.00   23           SURGICAL SUPPLIES
2375335   S IMP IMPLANT INSERT 28MM        5845.00      0.00   23           SURGICAL SUPPLIES
2374809   S IMP IMPLANT INSERT 32MM        4435.00      0.00   23           SURGICAL SUPPLIES
2376564   S IMP IMPLANT LAG SCREW 9        1883.00      0.00   23           SURGICAL SUPPLIES
2379758   S IMP IMPLANT LAMINA HOOK        1944.00      0.00   23           SURGICAL SUPPLIES
2379766   S IMP IMPLANT LAMINA HOOK        1944.00      0.00   23           SURGICAL SUPPLIES
2376176   S IMP IMPLANT LEIBINGER B         901.00      0.00   23           SURGICAL SUPPLIES
2376846   S IMP IMPLANT LOW PROFILE        4056.00      0.00   23           SURGICAL SUPPLIES
2374189   S IMP IMPLANT MAMMARY 350        2605.00      0.00   23           SURGICAL SUPPLIES
2374197   S IMP IMPLANT MAMMARY 350        2605.00      0.00   23           SURGICAL SUPPLIES
2390102   S IMP IMPLANT NAIL 11 X 3        5987.00      0.00   23           SURGICAL SUPPLIES
2374817   S IMP IMPLANT NAIL 12 X 3        4551.00      0.00   23           SURGICAL SUPPLIES
2374734   S IMP IMPLANT NAIL 13 X 3        4015.00      0.00   23           SURGICAL SUPPLIES
2374593   S IMP IMPLANT NAIL TIBIAL        3651.00      0.00   23           SURGICAL SUPPLIES
2374700   S IMP IMPLANT NAIL TIBIAL        4015.00      0.00   23           SURGICAL SUPPLIES
2376838   S IMP IMPLANT NAIL TIBIAL        4015.00      0.00   23           SURGICAL SUPPLIES
2375798   S IMP IMPLANT NUT 11MM            345.00      0.00   23           SURGICAL SUPPLIES
2376481   S IMP IMPLANT OMEGA KEYLE        1385.00      0.00   23           SURGICAL SUPPLIES
2390227   S IMP IMPLANT ORTHOBIOLOG        7291.00      0.00   23           SURGICAL SUPPLIES
2379956   S IMP IMPLANT PATELLA            2571.00      0.00   23           SURGICAL SUPPLIES
2376713   S IMP IMPLANT PATELLA 11M        2835.00      0.00   23           SURGICAL SUPPLIES
2376697   S IMP IMPLANT PATELLA 3-P        2570.00      0.00   23           SURGICAL SUPPLIES




                                                Page 146
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2374254   S IMP IMPLANT PATELLA 9MM         2836.00      0.00   23           SURGICAL SUPPLIES
2374171   S IMP IMPLANT PATELLA ALL         2590.00      0.00   23           SURGICAL SUPPLIES
2390045   S IMP IMPLANT PATELLA DOM         2576.00      0.00   23           SURGICAL SUPPLIES
2379964   S IMP IMPLANT PATELLA DOM         2571.00      0.00   23           SURGICAL SUPPLIES
2376721   S IMP IMPLANT PATELLA S 1         2835.00      0.00   23           SURGICAL SUPPLIES
2379980   S IMP IMPLANT PATELLA STA         2576.00      0.00   23           SURGICAL SUPPLIES
2376705   S IMP IMPLANT PATELLAR CO         2575.00      0.00   23           SURGICAL SUPPLIES
2378222   S IMP IMPLANT PIN SCHANZ           556.00      0.00   23           SURGICAL SUPPLIES
2378164   S IMP IMPLANT PIN SCHANZ           479.00      0.00   23           SURGICAL SUPPLIES
2376184   S IMP IMPLANT PLATE LEIBI          901.00      0.00   23           SURGICAL SUPPLIES
2376473   S IMP IMPLANT PLATE OMEGA         1385.00      0.00   23           SURGICAL SUPPLIES
2377018   S IMP IMPLANT PLIF SPACER         6851.00      0.00   23           SURGICAL SUPPLIES
2376739   S IMP IMPLANT PRESS FIT S         3072.00      0.00   23           SURGICAL SUPPLIES
2376978   S IMP IMPLANT PROXIMAL SL         6586.00      0.00   23           SURGICAL SUPPLIES
2379832   S IMP IMPLANT RADIANCE IN         2376.00      0.00   23           SURGICAL SUPPLIES
2375947   S IMP IMPLANT ROD 50MM $           703.00      0.00   23           SURGICAL SUPPLIES
2379600   S IMP IMPLANT SHEET MEDPO         1365.00      0.00   23           SURGICAL SUPPLIES
2376440   S IMP IMPLANT SIDEPLATE 1         1395.00      0.00   23           SURGICAL SUPPLIES
2378644   S IMP IMPLANT SPACER CEME          681.00      0.00   23           SURGICAL SUPPLIES
2376432   S IMP IMPLANT STD BARREL          1395.00      0.00   23           SURGICAL SUPPLIES
2376424   S IMP IMPLANT STD SIDEPLA         1395.00      0.00   23           SURGICAL SUPPLIES
2378529   S IMP IMPLANT STEM CENTRA          661.00      0.00   23           SURGICAL SUPPLIES
2378511   S IMP IMPLANT STEM CENTRA          661.00      0.00   23           SURGICAL SUPPLIES
2369114   S IMP IMPLANT SUBTALAR 8M         2078.00      0.00   23           SURGICAL SUPPLIES
2369130   S IMP IMPLANT SUBTALAR M          2078.00      0.00   23           SURGICAL SUPPLIES
2390367   S IMP IMPLANT SYNCHROMED         30009.00      0.00   23           SURGICAL SUPPLIES
2376820   S IMP IMPLANT T2 TIBIAL N         4015.00      0.00   23           SURGICAL SUPPLIES
2376531   S IMP IMPLANT TI TRANSCON         1694.00      0.00   23           SURGICAL SUPPLIES
2376523   S IMP IMPLANT TI TRANSCON         1694.00      0.00   23           SURGICAL SUPPLIES
2374932   S IMP IMPLANT TIBIAL BASE         5518.00      0.00   23           SURGICAL SUPPLIES
2376937   S IMP IMPLANT TIBIAL BASE         5517.00      0.00   23           SURGICAL SUPPLIES
2374957   S IMP IMPLANT TIBIAL BASE         5518.00      0.00   23           SURGICAL SUPPLIES
2376952   S IMP IMPLANT TIBIAL BASE         5517.00      0.00   23           SURGICAL SUPPLIES
2376929   S IMP IMPLANT TIBIAL BASE         5517.00      0.00   23           SURGICAL SUPPLIES
2376945   S IMP IMPLANT TIBIAL BASE         5517.00      0.00   23           SURGICAL SUPPLIES
2374585   S IMP IMPLANT TIBIAL BEAR         3630.00      0.00   23           SURGICAL SUPPLIES
2376770   S IMP IMPLANT TIBIAL INSE         3477.00      0.00   23           SURGICAL SUPPLIES
2374494   S IMP IMPLANT TIBIAL INSE         3478.00      0.00   23           SURGICAL SUPPLIES
2374403   S IMP IMPLANT TIBIAL INSE         3287.00      0.00   23           SURGICAL SUPPLIES
2374510   S IMP IMPLANT TIBIAL INSE         3478.00      0.00   23           SURGICAL SUPPLIES
2374502   S IMP IMPLANT TIBIAL INSE         3478.00      0.00   23           SURGICAL SUPPLIES
2374437   S IMP IMPLANT TIBIAL INSE         3330.00      0.00   23           SURGICAL SUPPLIES
2390052   S IMP IMPLANT TIBIAL KEEL         5865.00      0.00   23           SURGICAL SUPPLIES
2374726   S IMP IMPLANT TIBIAL NAIL         4015.00      0.00   23           SURGICAL SUPPLIES
2374478   S IMP IMPLANT TIBIAL NAIL         3425.00      0.00   23           SURGICAL SUPPLIES
2374692   S IMP IMPLANT TIBIAL NAIL         4015.00      0.00   23           SURGICAL SUPPLIES
2374981   S IMP IMPLANT TIBIAL TRAY         5524.00      0.00   23           SURGICAL SUPPLIES
2374999   S IMP IMPLANT TIBIAL TRAY         5524.00      0.00   23           SURGICAL SUPPLIES
2377083   S IMP IMPLANT TIBIAL TRAY         8596.00      0.00   23           SURGICAL SUPPLIES
2374973   S IMP IMPLANT TIBIAL TRAY         5524.00      0.00   23           SURGICAL SUPPLIES
2390060   S IMP IMPLANT TIBIAL TRAY         5865.00      0.00   23           SURGICAL SUPPLIES
2374965   S IMP IMPLANT TIBIAL TRAY         5524.00      0.00   23           SURGICAL SUPPLIES
2376960   S IMP IMPLANT TIBIAL TRAY         5523.00      0.00   23           SURGICAL SUPPLIES




                                                 Page 147
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2374619   S IMP IMPLANT TRANSCONNEC        3765.00      0.00   23           SURGICAL SUPPLIES
2375962   S IMP IMPLANT UNIVERSAL D         706.00      0.00   23           SURGICAL SUPPLIES
2374544   S IMP IMPLANT UNIVERSAL H        3583.00      0.00   23           SURGICAL SUPPLIES
2374676   S IMP IMPLANT UNIVERSAL H        3935.00      0.00   23           SURGICAL SUPPLIES
2376804   S IMP IMPLANT UNIVERSAL H        3934.00      0.00   23           SURGICAL SUPPLIES
2374668   S IMP IMPLANT UNIVERSAL H        3935.00      0.00   23           SURGICAL SUPPLIES
2374551   S IMP IMPLANT UNIVERSAL H        3583.00      0.00   23           SURGICAL SUPPLIES
2376796   S IMP IMPLANT UNIVERSAL H        3934.00      0.00   23           SURGICAL SUPPLIES
2376788   S IMP IMPLANT UNIVERSAL H        3934.00      0.00   23           SURGICAL SUPPLIES
2375954   S IMP IMPLANT UNIVERSAL S         706.00      0.00   23           SURGICAL SUPPLIES
2374312   S IMP IMPLANT V40 L FIT H        3002.00      0.00   23           SURGICAL SUPPLIES
2378263   S IMP IMPLANT WASHER SPIK         638.00      0.00   23           SURGICAL SUPPLIES
2378545   S IMP IMPLANT WASHER THRE         673.00      0.00   23           SURGICAL SUPPLIES
2379691   S IMP IMPLANT ZIMMER BIPO        1588.00      0.00   23           SURGICAL SUPPLIES
2379816   S IMP IMPLANT ZIMMER BIPO        2546.00      0.00   23           SURGICAL SUPPLIES
2369247   S IMP IMPLANT, BONE PRO O        1885.00      0.00   23           SURGICAL SUPPLIES
2373868   S IMP IMPLANT, CMF HEX-FI        4220.00      0.00   23           SURGICAL SUPPLIES
2373850   S IMP IMPLANT, CMF HEX-FI        4220.00      0.00   23           SURGICAL SUPPLIES
2373819   S IMP IMPLANT, CMF SQU-FI        3879.00      0.00   23           SURGICAL SUPPLIES
2373835   S IMP IMPLANT, CMF SQU-FI        3879.00      0.00   23           SURGICAL SUPPLIES
2373827   S IMP IMPLANT, CMF SQU-FI        3879.00      0.00   23           SURGICAL SUPPLIES
2369213   S IMP IMPLANT, MAMMARY           1855.00      0.00   23           SURGICAL SUPPLIES
2373454   S IMP IMPLANT, TOE LTIP30        2546.00      0.00   23           SURGICAL SUPPLIES
2371011   S IMP INSERT ACETABULAR          5125.00      0.00   23           SURGICAL SUPPLIES
2379188   S IMP IOL ALCON MA60AC 24        1007.00      0.00   23           SURGICAL SUPPLIES
2343457   S IMP JARDON 22MM                 138.00      0.00   23           SURGICAL SUPPLIES
2320943   S IMP KIT CRANIOPLASTY           2656.00      0.00   23           SURGICAL SUPPLIES
2391761   S IMP KIT RESOR BEAD             2540.00      0.00   23           SURGICAL SUPPLIES
2351732   S IMP KIT, BONE MULCH            1636.00      0.00   23           SURGICAL SUPPLIES
2356905   S IMP KIT,ACESSORY FOR           1842.00      0.00   23           SURGICAL SUPPLIES
2356913   S IMP KIT,ASSEMBLY PEN           1145.00      0.00   23           SURGICAL SUPPLIES
2370997   S IMP KNEE DRACON TIBIAL         6078.00      0.00   23           SURGICAL SUPPLIES
2358646   S IMP KUGEL HERNIA PATCH          815.00      0.00   23           SURGICAL SUPPLIES
2358653   S IMP KUGEL HERNIA PATCH          979.00      0.00   23           SURGICAL SUPPLIES
2391779   S IMP K-WIRE 1.25 X 150MM          78.00      0.00   23           SURGICAL SUPPLIES
2391787   S IMP K-WIRE 1.25MM                92.00      0.00   23           SURGICAL SUPPLIES
2391795   S IMP K-WIRE 1.5 X 5MM            765.00      0.00   23           SURGICAL SUPPLIES
2391092   S IMP LEAD PISCES QUAD           2809.00      0.00   23           SURGICAL SUPPLIES
2375376   S IMP LEIBINGER CROSS FIT          67.00      0.00   23           SURGICAL SUPPLIES
2391670   S IMP LG NAIL 11X320X135         4829.00      0.00   23           SURGICAL SUPPLIES
2342699   S IMP MARLEX MESH                  94.00      0.00   23           SURGICAL SUPPLIES
2342756   S IMP MARLEX MESH, 1" X 4         388.00      0.00   23           SURGICAL SUPPLIES
2342749   S IMP MARLEX MESH, 10" X          940.00      0.00   23           SURGICAL SUPPLIES
2342707   S IMP MARLEX MESH, 2" X 1         518.00      0.00   23           SURGICAL SUPPLIES
2340891   S IMP MCGEE LOOP PISTON,          258.00      0.00   23           SURGICAL SUPPLIES
2340883   S IMP MCGEE LOOP PISTON,          258.00      0.00   23           SURGICAL SUPPLIES
2340909   S IMP MCGEE LOOP PISTON,          258.00      0.00   23           SURGICAL SUPPLIES
2340867   S IMP MCGEE LOOP PISTON,          258.00      0.00   23           SURGICAL SUPPLIES
2340859   S IMP MCGEE LOOP PISTON,          330.00      0.00   23           SURGICAL SUPPLIES
2320935   S IMP MED FEM COMP RT            7355.00      0.00   23           SURGICAL SUPPLIES
2369205   S IMP MENISCAL DART ARTHR        1269.00      0.00   23           SURGICAL SUPPLIES
2351047   S IMP MENISCAL, DART A           1021.00      0.00   23           SURGICAL SUPPLIES
2351062   S IMP MENISCAL, DART A           1021.00      0.00   23           SURGICAL SUPPLIES




                                                Page 148
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2351054   S IMP MENISCAL, DART A            1021.00      0.00   23           SURGICAL SUPPLIES
2351039   S IMP MENISCAL, DART C             211.00      0.00   23           SURGICAL SUPPLIES
2351716   S IMP MENISCUS ARROW,              562.00      0.00   23           SURGICAL SUPPLIES
2351690   S IMP MENISCUS ARROW,              562.00      0.00   23           SURGICAL SUPPLIES
2351708   S IMP MENISCUS ARROW,              562.00      0.00   23           SURGICAL SUPPLIES
2351724   S IMP MENISCUS ARROW,              562.00      0.00   23           SURGICAL SUPPLIES
2377851   S IMP MESH 3 X 6 PROLENE           314.00      0.00   23           SURGICAL SUPPLIES
2391803   S IMP MESH 6 X 6.010              1462.00      0.00   23           SURGICAL SUPPLIES
2320976   S IMP MESH 60 X 60 X 1            1905.00      0.00   23           SURGICAL SUPPLIES
2391811   S IMP MESH 8 X 12CM SM            2672.00      0.00   23           SURGICAL SUPPLIES
2369197   S IMP MESH MARLES PERFIX           660.00      0.00   23           SURGICAL SUPPLIES
2391829   S IMP MESH MED OVAL               3824.00      0.00   23           SURGICAL SUPPLIES
2320984   S IMP MESH PATCH LG               4399.00      0.00   23           SURGICAL SUPPLIES
2376861   S IMP MESH SURGISIS GOLD          4449.00      0.00   23           SURGICAL SUPPLIES
2342962   S IMP MESH, A SOR A LE SE          639.00      0.00   23           SURGICAL SUPPLIES
2342830   S IMP MESH, ATRIUM 3 X 7.          436.00      0.00   23           SURGICAL SUPPLIES
2342723   S IMP MESH, BARD 1 X 4 01          204.00      0.00   23           SURGICAL SUPPLIES
2342715   S IMP MESH, BARD 10 X 14           781.00      0.00   23           SURGICAL SUPPLIES
2343044   S IMP MESH, BARD 2 X 4 01          476.00      0.00   23           SURGICAL SUPPLIES
2343051   S IMP MESH, BARD 3 X 6 01          505.00      0.00   23           SURGICAL SUPPLIES
2342764   S IMP MESH, BARD 3 X 6 01         1066.00      0.00   23           SURGICAL SUPPLIES
2342848   S IMP MESH, BARD 3DMAX, L          569.00      0.00   23           SURGICAL SUPPLIES
2342855   S IMP MESH, BARD 3DMAX, R          569.00      0.00   23           SURGICAL SUPPLIES
2342863   S IMP MESH, BARD 4 X 8 01         1492.00      0.00   23           SURGICAL SUPPLIES
2342871   S IMP MESH, BARD 6 X 6 01          337.00      0.00   23           SURGICAL SUPPLIES
2342889   S IMP MESH, BARD 6 X 8 01         1269.00      0.00   23           SURGICAL SUPPLIES
2342772   S IMP MESH, COMPOSIX 8 X          1871.00      0.00   23           SURGICAL SUPPLIES
2342905   S IMP MESH, DUALMESH ANTI         1560.00      0.00   23           SURGICAL SUPPLIES
2342939   S IMP MESH, DUALMESH ANTI         1282.00      0.00   23           SURGICAL SUPPLIES
2342921   S IMP MESH, DUALMESH ANTI         1937.00      0.00   23           SURGICAL SUPPLIES
2342913   S IMP MESH, DUALMESH ANTI         2918.00      0.00   23           SURGICAL SUPPLIES
2369171   S IMP MESH, DUALMESH ANTI         1560.00      0.00   23           SURGICAL SUPPLIES
2342731   S IMP MESH, MARLEX 2 X 12          345.00      0.00   23           SURGICAL SUPPLIES
2342970   S IMP MESH, MARLEX KEYHOL          553.00      0.00   23           SURGICAL SUPPLIES
2343002   S IMP MESH, MARLEX PERFIX          678.00      0.00   23           SURGICAL SUPPLIES
2342988   S IMP MESH, MARLEX PERFIX          660.00      0.00   23           SURGICAL SUPPLIES
2342954   S IMP MESH, MARLEX PERFIX          660.00      0.00   23           SURGICAL SUPPLIES
2342996   S IMP MESH, MARLEX PERFIX          660.00      0.00   23           SURGICAL SUPPLIES
2343010   S IMP MESH, ORIGIN 3 X 6/          356.00      0.00   23           SURGICAL SUPPLIES
2342780   S IMP MESH, PROLENE 6" X           272.00      0.00   23           SURGICAL SUPPLIES
2342798   S IMP MESH, PROLENE MED.           812.00      0.00   23           SURGICAL SUPPLIES
2342897   S IMP MESH, SCREEN, 1.3,          2505.00      0.00   23           SURGICAL SUPPLIES
2369189   S IMP MESH, SURGIPRO               382.00      0.00   23           SURGICAL SUPPLIES
2343028   S IMP MESH, SURGIPRO 14"X          382.00      0.00   23           SURGICAL SUPPLIES
2343036   S IMP MESH, SURGIPRO 3*5"          211.00      0.00   23           SURGICAL SUPPLIES
2374429   S IMP NAIL 10 X 32CM TIBI         3328.00      0.00   23           SURGICAL SUPPLIES
2374445   S IMP NAIL 10 X 34CM TIBI         3425.00      0.00   23           SURGICAL SUPPLIES
2391837   S IMP NAIL 10 X 380MM FEM         4215.00      0.00   23           SURGICAL SUPPLIES
2374627   S IMP NAIL 10 X 420MM T2          3833.00      0.00   23           SURGICAL SUPPLIES
2391647   S IMP NAIL 10MM X 130             5137.00      0.00   23           SURGICAL SUPPLIES
2391845   S IMP NAIL 11 X 330MM TIB         3651.00      0.00   23           SURGICAL SUPPLIES
2391852   S IMP NAIL 11 X 340MM FEM         4215.00      0.00   23           SURGICAL SUPPLIES
2374460   S IMP NAIL 11 X 34MM TIBI         3425.00      0.00   23           SURGICAL SUPPLIES




                                                 Page 149
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2391860   S IMP NAIL 11 X 380MM FEM         4015.00      0.00   23           SURGICAL SUPPLIES
2374247   S IMP NAIL 11 X 38CM FEMO         2809.00      0.00   23           SURGICAL SUPPLIES
2391886   S IMP NAIL 11 X 400MM             5987.00      0.00   23           SURGICAL SUPPLIES
2391878   S IMP NAIL 11 X 400MM FEM         3833.00      0.00   23           SURGICAL SUPPLIES
2391894   S IMP NAIL 11 X 420MM FEM         4215.00      0.00   23           SURGICAL SUPPLIES
2320992   S IMP NAIL 12 X 380 FEM           4579.00      0.00   23           SURGICAL SUPPLIES
2374411   S IMP NAIL 12 X 38CM FEMO         3293.00      0.00   23           SURGICAL SUPPLIES
2321008   S IMP NAIL 12 X 40 FEM            3293.00      0.00   23           SURGICAL SUPPLIES
2374759   S IMP NAIL 12 X 400MM FEM         4216.00      0.00   23           SURGICAL SUPPLIES
2391902   S IMP NAIL 12 X 420MM FEM         4773.00      0.00   23           SURGICAL SUPPLIES
2391910   S IMP NAIL 13 X 400MM FEM         4773.00      0.00   23           SURGICAL SUPPLIES
2391928   S IMP NAIL 13 X 42CM FEM          3200.00      0.00   23           SURGICAL SUPPLIES
2392124   S IMP NAIL 7.5MMX225MM            6710.00      0.00   23           SURGICAL SUPPLIES
2392132   S IMP NAIL 7.5MMX240MM            8755.00      0.00   23           SURGICAL SUPPLIES
2391936   S IMP NAIL 9 X 315MM TIB          4551.00      0.00   23           SURGICAL SUPPLIES
2391944   S IMP NAIL 9 X 330MM TIB          3651.00      0.00   23           SURGICAL SUPPLIES
2391951   S IMP NAIL 9 X 345MM TIB          4551.00      0.00   23           SURGICAL SUPPLIES
2391969   S IMP NAIL 9 X 34CM TIB           3328.00      0.00   23           SURGICAL SUPPLIES
2374825   S IMP NAIL 9 X 380MM FEMO         4773.00      0.00   23           SURGICAL SUPPLIES
2392140   S IMP NAIL 9MMX240MM              6439.00      0.00   23           SURGICAL SUPPLIES
2392157   S IMP NAIL 9MMX255MM              6439.00      0.00   23           SURGICAL SUPPLIES
2391977   S IMP NAIL FEM 10X340MM           3736.00      0.00   23           SURGICAL SUPPLIES
2391985   S IMP NAIL FEM 10X380MM           3736.00      0.00   23           SURGICAL SUPPLIES
2373892   S IMP NAIL RETRO 9MMX14CM         4400.00      0.00   23           SURGICAL SUPPLIES
2373900   S IMP NAIL RETRO 9MMX16CM         4400.00      0.00   23           SURGICAL SUPPLIES
2373918   S IMP NAIL RETRO 9MMX18CM         4400.00      0.00   23           SURGICAL SUPPLIES
2376812   S IMP NAIL T2 TIBIAL 9 X          4015.00      0.00   23           SURGICAL SUPPLIES
2392173   S IMP NAIL TIB 11X345MM           3840.00      0.00   23           SURGICAL SUPPLIES
2392181   S IMP NAIL TIB 11X360MM           3840.00      0.00   23           SURGICAL SUPPLIES
2374452   S IMP NAIL TIBIAL NAIL 9          3425.00      0.00   23           SURGICAL SUPPLIES
2392199   S IMP NAIL TROC                   5137.00      0.00   23           SURGICAL SUPPLIES
2392165   S IMP NAIL TROC                   5137.00      0.00   23           SURGICAL SUPPLIES
2391993   S IMP NAIL TROC 10X235MM          4426.00      0.00   23           SURGICAL SUPPLIES
2392009   S IMP NAIL TROC 10X300MM          5274.00      0.00   23           SURGICAL SUPPLIES
2392017   S IMP NAIL TROC 10X320MM          5274.00      0.00   23           SURGICAL SUPPLIES
2392025   S IMP NAIL TROC 10X400MM          5274.00      0.00   23           SURGICAL SUPPLIES
2392033   S IMP NAIL TROC 10X420MM          5274.00      0.00   23           SURGICAL SUPPLIES
2392041   S IMP NAIL TROC 11X340MM          5274.00      0.00   23           SURGICAL SUPPLIES
2392058   S IMP NAIL TROC 11X360MM          5274.00      0.00   23           SURGICAL SUPPLIES
2392066   S IMP NAIL TROC 12X360MM          5274.00      0.00   23           SURGICAL SUPPLIES
2392074   S IMP NAIL TROC 12X380MM          5274.00      0.00   23           SURGICAL SUPPLIES
2392082   S IMP NAIL TROC 12X400MM          5274.00      0.00   23           SURGICAL SUPPLIES
2392090   S IMP NAIL TROC 12X420MM          5274.00      0.00   23           SURGICAL SUPPLIES
2392108   S IMP NAIL TROC 12X440MM          5274.00      0.00   23           SURGICAL SUPPLIES
2392116   S IMP NAIL TROC 12X460MM          5274.00      0.00   23           SURGICAL SUPPLIES
2391688   S IMP NAIL TROCH                  4310.00      0.00   23           SURGICAL SUPPLIES
2340131   S IMP PALTE, LEIB 54-0515          400.00      0.00   23           SURGICAL SUPPLIES
2340156   S IMP PALTE, LEIB 54-0628          415.00      0.00   23           SURGICAL SUPPLIES
2370500   S IMP PATELLA COMP PLASTI         5633.00      0.00   23           SURGICAL SUPPLIES
2379972   S IMP PATELLA OVAL DOME 3         2571.00      0.00   23           SURGICAL SUPPLIES
2392272   S IMP PIN 1.8X18MM                 356.00      0.00   23           SURGICAL SUPPLIES
2377778   S IMP PIN 2.8 X 230MM THR          260.00      0.00   23           SURGICAL SUPPLIES
2392207   S IMP PIN 2.8 X 450MM              425.00      0.00   23           SURGICAL SUPPLIES




                                                 Page 150
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2321024   S IMP PIN 4 X 120                  558.00      0.00   23           SURGICAL SUPPLIES
2392215   S IMP PIN 4.5MMX180MM              631.00      0.00   23           SURGICAL SUPPLIES
2392223   S IMP PIN 5 X 120MM                565.00      0.00   23           SURGICAL SUPPLIES
2392249   S IMP PIN 5 X 150MM                574.00      0.00   23           SURGICAL SUPPLIES
2392231   S IMP PIN 5 X 150MM                625.00      0.00   23           SURGICAL SUPPLIES
2392256   S IMP PIN 5 X 180MM                625.00      0.00   23           SURGICAL SUPPLIES
2392280   S IMP PIN 5 X 225MM                631.00      0.00   23           SURGICAL SUPPLIES
2392264   S IMP PIN 5 X 250MM                717.00      0.00   23           SURGICAL SUPPLIES
2392298   S IMP PIN DISTRA 14MM              601.00      0.00   23           SURGICAL SUPPLIES
2370401   S IMP PIN K WIRES                  156.00      0.00   23           SURGICAL SUPPLIES
2392306   S IMP PIN K-WIRE 1.6MM              78.00      0.00   23           SURGICAL SUPPLIES
2375822   S IMP PIN K-WIRE 1.6MM $           591.00      0.00   23           SURGICAL SUPPLIES
2377208   S IMP PIN K-WIRE 2.0 X 15           78.00      0.00   23           SURGICAL SUPPLIES
2392322   S IMP PIN STEIN 4.5MM              631.00      0.00   23           SURGICAL SUPPLIES
2392314   S IMP PIN STEIN 5.0MM              631.00      0.00   23           SURGICAL SUPPLIES
2370419   S IMP PIN STEINMAN                 146.00      0.00   23           SURGICAL SUPPLIES
2392330   S IMP PIN STNMN 4.5MM              631.00      0.00   23           SURGICAL SUPPLIES
2392348   S IMP PIN STNMN 5MM                631.00      0.00   23           SURGICAL SUPPLIES
2392355   S IMP PIN STNMN 5MM                631.00      0.00   23           SURGICAL SUPPLIES
2392363   S IMP PIN STNMN 5MM                631.00      0.00   23           SURGICAL SUPPLIES
2375731   S IMP PIN THREADED TIP GU          232.00      0.00   23           SURGICAL SUPPLIES
2390763   S IMP PIN TO ROD CONN             2411.00      0.00   23           SURGICAL SUPPLIES
2351237   S IMP PIN, ORTHOSORB A             537.00      0.00   23           SURGICAL SUPPLIES
2351252   S IMP PIN, ORTHO-SORB,             476.00      0.00   23           SURGICAL SUPPLIES
2370609   S IMP PIN/SCREW ORTHO FIX         1403.00      0.00   23           SURGICAL SUPPLIES
2340842   S IMP PISTON, MCGEE, MOD           258.00      0.00   23           SURGICAL SUPPLIES
2343465   S IMP P-K FLAT HEADED PED          173.00      0.00   23           SURGICAL SUPPLIES
2343473   S IMP P-K THREADED SLEVE           417.00      0.00   23           SURGICAL SUPPLIES
2370971   S IMP PLASTE COMPRESSION          3267.00      0.00   23           SURGICAL SUPPLIES
2393411   S IMP PLATE                       2528.00      0.00   23           SURGICAL SUPPLIES
2393155   S IMP PLATE 1.0MM 6-H              903.00      0.00   23           SURGICAL SUPPLIES
2393536   S IMP PLATE 1.3MM 3X4-H            922.00      0.00   23           SURGICAL SUPPLIES
2392371   S IMP PLATE 1.5MM CONDO           1260.00      0.00   23           SURGICAL SUPPLIES
2393163   S IMP PLATE 1.5MM LFT             1030.00      0.00   23           SURGICAL SUPPLIES
2393171   S IMP PLATE 1.5MM RT              1030.00      0.00   23           SURGICAL SUPPLIES
2392405   S IMP PLATE 1/3 TUB 3-H            327.00      0.00   23           SURGICAL SUPPLIES
2392397   S IMP PLATE 1/3 TUB 3-H            716.00      0.00   23           SURGICAL SUPPLIES
2392413   S IMP PLATE 1/3 TUB 4-H            778.00      0.00   23           SURGICAL SUPPLIES
2392389   S IMP PLATE 1/3 TUB 9-H            834.00      0.00   23           SURGICAL SUPPLIES
2371649   S IMP PLATE 1/3 TUBULAR 1          442.00      0.00   23           SURGICAL SUPPLIES
2371573   S IMP PLATE 1/3 TUBULAR 2          202.00      0.00   23           SURGICAL SUPPLIES
2371581   S IMP PLATE 1/3 TUBULAR 3          255.00      0.00   23           SURGICAL SUPPLIES
2371631   S IMP PLATE 1/3 TUBULAR 4          140.00      0.00   23           SURGICAL SUPPLIES
2371599   S IMP PLATE 1/3 TUBULAR 5          274.00      0.00   23           SURGICAL SUPPLIES
2378909   S IMP PLATE 1/3 TUBULAR 5          778.00      0.00   23           SURGICAL SUPPLIES
2378917   S IMP PLATE 1/3 TUBULAR 6          778.00      0.00   23           SURGICAL SUPPLIES
2371607   S IMP PLATE 1/3 TUBULAR 6          193.00      0.00   23           SURGICAL SUPPLIES
2371615   S IMP PLATE 1/3 TUBULAR 7          420.00      0.00   23           SURGICAL SUPPLIES
2371623   S IMP PLATE 1/3 TUBULAR 8          420.00      0.00   23           SURGICAL SUPPLIES
2321032   S IMP PLATE 10 HOLE               4336.00      0.00   23           SURGICAL SUPPLIES
2378958   S IMP PLATE 10 HOLE 3.5 L          835.00      0.00   23           SURGICAL SUPPLIES
2392694   S IMP PLATE 10-H                  1900.00      0.00   23           SURGICAL SUPPLIES
2392439   S IMP PLATE 10-H MED              4334.00      0.00   23           SURGICAL SUPPLIES




                                                 Page 151
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2392447   S IMP PLATE 10-H TIB              3258.00      0.00   23           SURGICAL SUPPLIES
2392421   S IMP PLATE 10-H TIB              4443.00      0.00   23           SURGICAL SUPPLIES
2392470   S IMP PLATE 12 H                  4409.00      0.00   23           SURGICAL SUPPLIES
2392462   S IMP PLATE 12 H                  1074.00      0.00   23           SURGICAL SUPPLIES
2392496   S IMP PLATE 12 H                  4264.00      0.00   23           SURGICAL SUPPLIES
2392488   S IMP PLATE 12 H                  4492.00      0.00   23           SURGICAL SUPPLIES
2392454   S IMP PLATE 12 HOLE                866.00      0.00   23           SURGICAL SUPPLIES
2379626   S IMP PLATE 12 HOLE 3.5 L         1473.00      0.00   23           SURGICAL SUPPLIES
2379048   S IMP PLATE 12 HOLE NARRO          885.00      0.00   23           SURGICAL SUPPLIES
2392702   S IMP PLATE 12-H                  4648.00      0.00   23           SURGICAL SUPPLIES
2321040   S IMP PLATE 12MM MESH             2402.00      0.00   23           SURGICAL SUPPLIES
2392504   S IMP PLATE 13 H                  4749.00      0.00   23           SURGICAL SUPPLIES
2392512   S IMP PLATE 13 H                  4749.00      0.00   23           SURGICAL SUPPLIES
2393114   S IMP PLATE 135 DEG 2-H           1740.00      0.00   23           SURGICAL SUPPLIES
2393106   S IMP PLATE 135 DEG 2-H           1739.00      0.00   23           SURGICAL SUPPLIES
2393098   S IMP PLATE 135 DEG 2-H           1739.00      0.00   23           SURGICAL SUPPLIES
2393122   S IMP PLATE 135 DEG 3-H           1740.00      0.00   23           SURGICAL SUPPLIES
2391720   S IMP PLATE 135/3 HOLE            1694.00      0.00   23           SURGICAL SUPPLIES
2392520   S IMP PLATE 14 H                  4543.00      0.00   23           SURGICAL SUPPLIES
2392538   S IMP PLATE 14 H                  4947.00      0.00   23           SURGICAL SUPPLIES
2392546   S IMP PLATE 14 H                  4482.00      0.00   23           SURGICAL SUPPLIES
2393130   S IMP PLATE 140 4-H               1739.00      0.00   23           SURGICAL SUPPLIES
2393148   S IMP PLATE 145 DEG 6-H           1739.00      0.00   23           SURGICAL SUPPLIES
2392728   S IMP PLATE 14-H                  4307.00      0.00   23           SURGICAL SUPPLIES
2392710   S IMP PLATE 14-H                  4307.00      0.00   23           SURGICAL SUPPLIES
2392744   S IMP PLATE 16-H                  2655.00      0.00   23           SURGICAL SUPPLIES
2392736   S IMP PLATE 16-H                  3102.00      0.00   23           SURGICAL SUPPLIES
2379790   S IMP PLATE 2 HOLE PLATE          2245.00      0.00   23           SURGICAL SUPPLIES
2379527   S IMP PLATE 2 HOLE SIDEPL         1395.00      0.00   23           SURGICAL SUPPLIES
2392553   S IMP PLATE 2 X 2 H                758.00      0.00   23           SURGICAL SUPPLIES
2392579   S IMP PLATE 2.0MM Y               1125.00      0.00   23           SURGICAL SUPPLIES
2393031   S IMP PLATE 20 HOLE               1405.00      0.00   23           SURGICAL SUPPLIES
2392587   S IMP PLATE 24 H                  4204.00      0.00   23           SURGICAL SUPPLIES
2393189   S IMP PLATE 2MM 2X3-H              935.00      0.00   23           SURGICAL SUPPLIES
2392603   S IMP PLATE 3 H "T"               1521.00      0.00   23           SURGICAL SUPPLIES
2392595   S IMP PLATE 3 H T                 1345.00      0.00   23           SURGICAL SUPPLIES
2321057   S IMP PLATE 3 HOLE                1410.00      0.00   23           SURGICAL SUPPLIES
2379501   S IMP PLATE 3 HOLE "T" PL         1346.00      0.00   23           SURGICAL SUPPLIES
2392611   S IMP PLATE 3 X 2 H L              798.00      0.00   23           SURGICAL SUPPLIES
2393668   S IMP PLATE 3.5MM 10-H            2036.00      0.00   23           SURGICAL SUPPLIES
2393676   S IMP PLATE 3.5MM 11-H            2138.00      0.00   23           SURGICAL SUPPLIES
2393684   S IMP PLATE 3.5MM 12-H            2216.00      0.00   23           SURGICAL SUPPLIES
2393692   S IMP PLATE 3.5MM 9-H             2011.00      0.00   23           SURGICAL SUPPLIES
2393437   S IMP PLATE 3.5X137 10-H          1331.00      0.00   23           SURGICAL SUPPLIES
2393445   S IMP PLATE 3.5X150 11-H          1385.00      0.00   23           SURGICAL SUPPLIES
2393452   S IMP PLATE 3.5X98 7-H            1409.00      0.00   23           SURGICAL SUPPLIES
2393544   S IMP PLATE 3X3-H LFT              922.00      0.00   23           SURGICAL SUPPLIES
2392645   S IMP PLATE 4 H                   6032.00      0.00   23           SURGICAL SUPPLIES
2392660   S IMP PLATE 4 H                   1193.00      0.00   23           SURGICAL SUPPLIES
2392678   S IMP PLATE 4 H                    344.00      0.00   23           SURGICAL SUPPLIES
2392652   S IMP PLATE 4 H T                 1454.00      0.00   23           SURGICAL SUPPLIES
2321123   S IMP PLATE 4 HOLE                 809.00      0.00   23           SURGICAL SUPPLIES
2321073   S IMP PLATE 4 HOLE                1163.00      0.00   23           SURGICAL SUPPLIES




                                                 Page 152
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2321115   S IMP PLATE 4 HOLE                 809.00      0.00   23           SURGICAL SUPPLIES
2321107   S IMP PLATE 4 HOLE                 809.00      0.00   23           SURGICAL SUPPLIES
2321099   S IMP PLATE 4 HOLE                 809.00      0.00   23           SURGICAL SUPPLIES
2321065   S IMP PLATE 4 HOLE                 809.00      0.00   23           SURGICAL SUPPLIES
2321081   S IMP PLATE 4 HOLE                 809.00      0.00   23           SURGICAL SUPPLIES
2374213   S IMP PLATE 4 HOLE                2687.00      0.00   23           SURGICAL SUPPLIES
2392629   S IMP PLATE 4 HOLE                1810.00      0.00   23           SURGICAL SUPPLIES
2392637   S IMP PLATE 4 HOLE                1009.00      0.00   23           SURGICAL SUPPLIES
2379493   S IMP PLATE 4 HOLE MAXILL         1322.00      0.00   23           SURGICAL SUPPLIES
2379519   S IMP PLATE 4 HOLE MODULA         1352.00      0.00   23           SURGICAL SUPPLIES
2392686   S IMP PLATE 4 X 2 H SQ            1329.00      0.00   23           SURGICAL SUPPLIES
2392751   S IMP PLATE 4.5MM 6-H             1482.00      0.00   23           SURGICAL SUPPLIES
2392769   S IMP PLATE 4.5MM 6-H             1381.00      0.00   23           SURGICAL SUPPLIES
2392785   S IMP PLATE 4.5MM 9-H             1754.00      0.00   23           SURGICAL SUPPLIES
2392777   S IMP PLATE 4.5MM 9-H             2070.00      0.00   23           SURGICAL SUPPLIES
2393320   S IMP PLATE 4.5MMX10-H             884.00      0.00   23           SURGICAL SUPPLIES
2393247   S IMP PLATE 4.5MMX10-H            1125.00      0.00   23           SURGICAL SUPPLIES
2393254   S IMP PLATE 4.5MMX11-H            1149.00      0.00   23           SURGICAL SUPPLIES
2393338   S IMP PLATE 4.5MMX11-H             884.00      0.00   23           SURGICAL SUPPLIES
2393262   S IMP PLATE 4.5MMX12-H            1118.00      0.00   23           SURGICAL SUPPLIES
2393270   S IMP PLATE 4.5MMX14-H            1118.00      0.00   23           SURGICAL SUPPLIES
2393346   S IMP PLATE 4.5MMX5-H              638.00      0.00   23           SURGICAL SUPPLIES
2393288   S IMP PLATE 4.5MMX6-H              903.00      0.00   23           SURGICAL SUPPLIES
2393353   S IMP PLATE 4.5MMX6-H              723.00      0.00   23           SURGICAL SUPPLIES
2393296   S IMP PLATE 4.5MMX7-H              903.00      0.00   23           SURGICAL SUPPLIES
2393361   S IMP PLATE 4.5MMX7-H              723.00      0.00   23           SURGICAL SUPPLIES
2393304   S IMP PLATE 4.5MMX8-H             1125.00      0.00   23           SURGICAL SUPPLIES
2393312   S IMP PLATE 4.5MMX9-H             1125.00      0.00   23           SURGICAL SUPPLIES
2393379   S IMP PLATE 4.5MMX9-H              723.00      0.00   23           SURGICAL SUPPLIES
2393072   S IMP PLATE 4H 2.0MM              1030.00      0.00   23           SURGICAL SUPPLIES
2393213   S IMP PLATE 4-H LFT TIB           1304.00      0.00   23           SURGICAL SUPPLIES
2393221   S IMP PLATE 4-H RT TIB            1304.00      0.00   23           SURGICAL SUPPLIES
2393700   S IMP PLATE 4-HHEAD 3-H           1345.00      0.00   23           SURGICAL SUPPLIES
2392819   S IMP PLATE 5 H                   4498.00      0.00   23           SURGICAL SUPPLIES
2393080   S IMP PLATE 5 H 94MM              1739.00      0.00   23           SURGICAL SUPPLIES
2393387   S IMP PLATE 5 H X 156MM           3942.00      0.00   23           SURGICAL SUPPLIES
2392827   S IMP PLATE 5 HOLE                 358.00      0.00   23           SURGICAL SUPPLIES
2379592   S IMP PLATE 5 HOLE 135 DE         1317.00      0.00   23           SURGICAL SUPPLIES
2392793   S IMP PLATE 5 HOLE 3.5            1628.00      0.00   23           SURGICAL SUPPLIES
2392801   S IMP PLATE 5 HOLE 3.5            1270.00      0.00   23           SURGICAL SUPPLIES
2379139   S IMP PLATE 5 X 4 HOLES L          940.00      0.00   23           SURGICAL SUPPLIES
2392850   S IMP PLATE 6 H                   4346.00      0.00   23           SURGICAL SUPPLIES
2392843   S IMP PLATE 6 H                   1458.00      0.00   23           SURGICAL SUPPLIES
2392876   S IMP PLATE 6 H                   4252.00      0.00   23           SURGICAL SUPPLIES
2392835   S IMP PLATE 6 H                    853.00      0.00   23           SURGICAL SUPPLIES
2392868   S IMP PLATE 6 H "Y"                855.00      0.00   23           SURGICAL SUPPLIES
2392561   S IMP PLATE 6 HO                  1351.00      0.00   23           SURGICAL SUPPLIES
2321131   S IMP PLATE 6 HOLE                 942.00      0.00   23           SURGICAL SUPPLIES
2321149   S IMP PLATE 6 HOLE                1079.00      0.00   23           SURGICAL SUPPLIES
2379576   S IMP PLATE 6 HOLE 2.4MM          1515.00      0.00   23           SURGICAL SUPPLIES
2379725   S IMP PLATE 6 HOLE LCP            1803.00      0.00   23           SURGICAL SUPPLIES
2379212   S IMP PLATE 6 HOLE MINI           1030.00      0.00   23           SURGICAL SUPPLIES
2374205   S IMP PLATE 6 HOLE PERIAR         2673.00      0.00   23           SURGICAL SUPPLIES




                                                 Page 153
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2392892   S IMP PLATE 7 H                  1654.00      0.00   23           SURGICAL SUPPLIES
2392900   S IMP PLATE 7 HOLE               1125.00      0.00   23           SURGICAL SUPPLIES
2393056   S IMP PLATE 7 HOLE               1211.00      0.00   23           SURGICAL SUPPLIES
2392884   S IMP PLATE 7 HOLE               1976.00      0.00   23           SURGICAL SUPPLIES
2378933   S IMP PLATE 7 HOLE 1/3 TU         835.00      0.00   23           SURGICAL SUPPLIES
2392975   S IMP PLATE 8 H                  4488.00      0.00   23           SURGICAL SUPPLIES
2392983   S IMP PLATE 8 H                  1320.00      0.00   23           SURGICAL SUPPLIES
2392959   S IMP PLATE 8 H                  3473.00      0.00   23           SURGICAL SUPPLIES
2392942   S IMP PLATE 8 H                  2058.00      0.00   23           SURGICAL SUPPLIES
2392934   S IMP PLATE 8 H                  1320.00      0.00   23           SURGICAL SUPPLIES
2392926   S IMP PLATE 8 HOLE                703.00      0.00   23           SURGICAL SUPPLIES
2392918   S IMP PLATE 8 HOLE               1739.00      0.00   23           SURGICAL SUPPLIES
2392967   S IMP PLATE 8 HOLE               4789.00      0.00   23           SURGICAL SUPPLIES
2378941   S IMP PLATE 8 HOLE 1/3 L          835.00      0.00   23           SURGICAL SUPPLIES
2379550   S IMP PLATE 8 HOLE 3.5 LC        1480.00      0.00   23           SURGICAL SUPPLIES
2379204   S IMP PLATE 8 HOLE MODULA        1030.00      0.00   23           SURGICAL SUPPLIES
2392991   S IMP PLATE 8 HOLES              4789.00      0.00   23           SURGICAL SUPPLIES
2393064   S IMP PLATE 8-HS                 1381.00      0.00   23           SURGICAL SUPPLIES
2393007   S IMP PLATE 9 HOLE               3942.00      0.00   23           SURGICAL SUPPLIES
2393023   S IMP PLATE 9 HOLE               3942.00      0.00   23           SURGICAL SUPPLIES
2393015   S IMP PLATE 9 HOLE               3942.00      0.00   23           SURGICAL SUPPLIES
2379584   S IMP PLATE 9 HOLE 3.5 LC        1538.00      0.00   23           SURGICAL SUPPLIES
2379303   S IMP PLATE 9 HOLE MODULA        1125.00      0.00   23           SURGICAL SUPPLIES
2393619   S IMP PLATE ADLT 85MM            1978.00      0.00   23           SURGICAL SUPPLIES
2393429   S IMP PLATE CAL                  2528.00      0.00   23           SURGICAL SUPPLIES
2393049   S IMP PLATE CAL                  1730.00      0.00   23           SURGICAL SUPPLIES
2371094   S IMP PLATE DHS                  3043.00      0.00   23           SURGICAL SUPPLIES
2393197   S IMP PLATE L 2MM 3X4-H           985.00      0.00   23           SURGICAL SUPPLIES
2393205   S IMP PLATE L 2MM 4X6-H          1093.00      0.00   23           SURGICAL SUPPLIES
2371326   S IMP PLATE LARGE ASIF           1476.00      0.00   23           SURGICAL SUPPLIES
2370286   S IMP PLATE LARGE ASIF BU        1922.00      0.00   23           SURGICAL SUPPLIES
2375830   S IMP PLATE LEIBINGER 2 H         607.00      0.00   23           SURGICAL SUPPLIES
2376242   S IMP PLATE LEIBINGER I-S         940.00      0.00   23           SURGICAL SUPPLIES
2393403   S IMP PLATE L-MINI OBL            319.00      0.00   23           SURGICAL SUPPLIES
2393395   S IMP PLATE L-MINI OBL            319.00      0.00   23           SURGICAL SUPPLIES
2376259   S IMP PLATE L-SHAPE BAR 1         947.00      0.00   23           SURGICAL SUPPLIES
2393460   S IMP PLATE L-SM OBL              319.00      0.00   23           SURGICAL SUPPLIES
2393478   S IMP PLATE L-SM OBL              319.00      0.00   23           SURGICAL SUPPLIES
2321156   S IMP PLATE MESH 100X100         5833.00      0.00   23           SURGICAL SUPPLIES
2370468   S IMP PLATE MIN ASIF              370.00      0.00   23           SURGICAL SUPPLIES
2393601   S IMP PLATE ORBI 9H               922.00      0.00   23           SURGICAL SUPPLIES
2375988   S IMP PLATE OSTEOMED 15MM         678.00      0.00   23           SURGICAL SUPPLIES
2375996   S IMP PLATE OSTEOMED 22MM         678.00      0.00   23           SURGICAL SUPPLIES
2375939   S IMP PLATE OSTEOMED DOUB         689.00      0.00   23           SURGICAL SUPPLIES
2376747   S IMP PLATE PROXIMAL TIBI        3132.00      0.00   23           SURGICAL SUPPLIES
2393551   S IMP PLATE RT 3-H               1531.00      0.00   23           SURGICAL SUPPLIES
2393569   S IMP PLATE RT 4-H               1356.00      0.00   23           SURGICAL SUPPLIES
2393577   S IMP PLATE RT 5-H               1405.00      0.00   23           SURGICAL SUPPLIES
2393585   S IMP PLATE RT 7-H               1526.00      0.00   23           SURGICAL SUPPLIES
2393593   S IMP PLATE RT 8-H               1603.00      0.00   23           SURGICAL SUPPLIES
2376325   S IMP PLATE SKULL FLAP 6         1000.00      0.00   23           SURGICAL SUPPLIES
2393239   S IMP PLATE SM 14HOL             1415.00      0.00   23           SURGICAL SUPPLIES
2371664   S IMP PLATE STR 2 HOLE 1.         624.00      0.00   23           SURGICAL SUPPLIES




                                                Page 154
                                      85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2371656   S IMP PLATE STR 4 HOLE 1.              466.00      0.00   23           SURGICAL SUPPLIES
2393726   S IMP PLATE STUB 6H                    363.00      0.00   23           SURGICAL SUPPLIES
2379782   S IMP PLATE SYNTH 14 HOLE             2178.00      0.00   23           SURGICAL SUPPLIES
2393759   S IMP PLATE T 1.5MM 3-H                985.00      0.00   23           SURGICAL SUPPLIES
2393767   S IMP PLATE T 1.5MM 4-H               1030.00      0.00   23           SURGICAL SUPPLIES
2393742   S IMP PLATE T 3X4-H                    922.00      0.00   23           SURGICAL SUPPLIES
2393783   S IMP PLATE T 4 SHAFT                 1356.00      0.00   23           SURGICAL SUPPLIES
2393775   S IMP PLATE T 4H 84                   1055.00      0.00   23           SURGICAL SUPPLIES
2393791   S IMP PLATE T 5 SHAFT                 1405.00      0.00   23           SURGICAL SUPPLIES
2393809   S IMP PLATE T 6 SHAFT                 1458.00      0.00   23           SURGICAL SUPPLIES
2393817   S IMP PLATE T 7 SHAFT                 1526.00      0.00   23           SURGICAL SUPPLIES
2393825   S IMP PLATE T 8 SHAFT                 1603.00      0.00   23           SURGICAL SUPPLIES
2393833   S IMP PLATE T RT 3-H4-H               1398.00      0.00   23           SURGICAL SUPPLIES
2393841   S IMP PLATE T RT 3-H5-H               1537.00      0.00   23           SURGICAL SUPPLIES
2393858   S IMP PLATE T RT 3-H6-H               1507.00      0.00   23           SURGICAL SUPPLIES
2393866   S IMP PLATE T RT 3-H7-H               1875.00      0.00   23           SURGICAL SUPPLIES
2393874   S IMP PLATE T RT 3-H8-H               2167.00      0.00   23           SURGICAL SUPPLIES
2393882   S IMP PLATE T RT 4-H5-H               1537.00      0.00   23           SURGICAL SUPPLIES
2393890   S IMP PLATE T RT 4-H7-H               1875.00      0.00   23           SURGICAL SUPPLIES
2393908   S IMP PLATE T RT 4-H8-H               2167.00      0.00   23           SURGICAL SUPPLIES
2393916   S IMP PLATE T TIB 6-H                 1147.00      0.00   23           SURGICAL SUPPLIES
2393924   S IMP PLATE T TIB 8-H                 1342.00      0.00   23           SURGICAL SUPPLIES
2393932   S IMP PLATE TI 2.4 STR                1124.00      0.00   23           SURGICAL SUPPLIES
2393940   S IMP PLATE TI 2.4 STR                1158.00      0.00   23           SURGICAL SUPPLIES
2393494   S IMP PLATE TIB 10-H LFT              4653.00      0.00   23           SURGICAL SUPPLIES
2393502   S IMP PLATE TIB 12-H LFT              4699.00      0.00   23           SURGICAL SUPPLIES
2393973   S IMP PLATE TIB 13-H LFT              4749.00      0.00   23           SURGICAL SUPPLIES
2393981   S IMP PLATE TIB 13-H RT               4749.00      0.00   23           SURGICAL SUPPLIES
2393627   S IMP PLATE TIB 4.5MM 4               4465.00      0.00   23           SURGICAL SUPPLIES
2393957   S IMP PLATE TIB 4-H                   4465.00      0.00   23           SURGICAL SUPPLIES
2393999   S IMP PLATE TIB 5-H LFT               4749.00      0.00   23           SURGICAL SUPPLIES
2394005   S IMP PLATE TIB 5-H RT                4749.00      0.00   23           SURGICAL SUPPLIES
2393510   S IMP PLATE TIB 6-H LFT               4563.00      0.00   23           SURGICAL SUPPLIES
2393528   S IMP PLATE TIB 6-H RT                4563.00      0.00   23           SURGICAL SUPPLIES
2393965   S IMP PLATE TIB 8-H                   4570.00      0.00   23           SURGICAL SUPPLIES
2393486   S IMP PLATE TIB 8HOLE RT              2026.00      0.00   23           SURGICAL SUPPLIES
2394021   S IMP PLATE TIB 9 H                   4749.00      0.00   23           SURGICAL SUPPLIES
2394013   S IMP PLATE TIBIAL                    4757.00      0.00   23           SURGICAL SUPPLIES
2394039   S IMP PLATE T-MIN 2-H                  319.00      0.00   23           SURGICAL SUPPLIES
2394047   S IMP PLATE T-SM 3-H                   319.00      0.00   23           SURGICAL SUPPLIES
2394054   S IMP PLATE TUB 3-H 23M                340.00      0.00   23           SURGICAL SUPPLIES
2393635   S IMP PLATE TUB 4H 33MM                365.00      0.00   23           SURGICAL SUPPLIES
2393643   S IMP PLATE TUB 5H 41MM                387.00      0.00   23           SURGICAL SUPPLIES
2393650   S IMP PLATE TUB 6H 49MM                427.00      0.00   23           SURGICAL SUPPLIES
2393734   S IMP PLATE TUB 7H                     391.00      0.00   23           SURGICAL SUPPLIES
2394062   S IMP PLATE TUB 7-H 55M                447.00      0.00   23           SURGICAL SUPPLIES
2394070   S IMP PLATE TUB 8-H 63MM               478.00      0.00   23           SURGICAL SUPPLIES
2394088   S IMP PLATE WRIST FUSION              3037.00      0.00   23           SURGICAL SUPPLIES
2394096   S IMP PLATE X 1.0MM TI 5-              866.00      0.00   23           SURGICAL SUPPLIES
2394104   S IMP PLATE X 2.0MM TI 4-              903.00      0.00   23           SURGICAL SUPPLIES
2394112   S IMP PLATE Y 1.3MM TI 1X              872.00      0.00   23           SURGICAL SUPPLIES
2394120   S IMP PLATE Y 1.5MM                    985.00      0.00   23           SURGICAL SUPPLIES
2372076   S IMP PLATE, "X" 1.5MMX4              1025.00      0.00   23           SURGICAL SUPPLIES




                                                     Page 155
                                      85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2352243   S IMP PLATE, 1/3 TUB 4H                153.00      0.00   23           SURGICAL SUPPLIES
2352250   S IMP PLATE, 1/3 TUB 5H                171.00      0.00   23           SURGICAL SUPPLIES
2352268   S IMP PLATE, 1/3 TUB 6H                158.00      0.00   23           SURGICAL SUPPLIES
2373215   S IMP PLATE, ADAPTION 100             1849.00      0.00   23           SURGICAL SUPPLIES
2373058   S IMP PLATE, ADAPTION 193             1538.00      0.00   23           SURGICAL SUPPLIES
2372605   S IMP PLATE, ADAPTION 90X             1297.00      0.00   23           SURGICAL SUPPLIES
2373165   S IMP PLATE, ADAPTION 95X             1817.00      0.00   23           SURGICAL SUPPLIES
2352342   S IMP PLATE, AN SM 3H 245              293.00      0.00   23           SURGICAL SUPPLIES
2373595   S IMP PLATE, ANG 4X11HO 2             3153.00      0.00   23           SURGICAL SUPPLIES
2373603   S IMP PLATE, ANG 4X11HO 2             3153.00      0.00   23           SURGICAL SUPPLIES
2373686   S IMP PLATE, ANG 4X14HO 2             3279.00      0.00   23           SURGICAL SUPPLIES
2373694   S IMP PLATE, ANG 4X14HO 2             3279.00      0.00   23           SURGICAL SUPPLIES
2373512   S IMP PLATE, ANG 4X8HO 2.             2910.00      0.00   23           SURGICAL SUPPLIES
2373504   S IMP PLATE, ANG 4X8HO 2.             2910.00      0.00   23           SURGICAL SUPPLIES
2373090   S IMP PLATE, ANGLED 6HO 2             1701.00      0.00   23           SURGICAL SUPPLIES
2373280   S IMP PLATE, ANGLED 6HO 2             1998.00      0.00   23           SURGICAL SUPPLIES
2352276   S IMP PLATE, AO, 3 HOLE                263.00      0.00   23           SURGICAL SUPPLIES
2352284   S IMP PLATE, AO, 4 HOLE                330.00      0.00   23           SURGICAL SUPPLIES
2352300   S IMP PLATE, BONE 7-HOLE,              349.00      0.00   23           SURGICAL SUPPLIES
2373363   S IMP PLATE, BUTTR 158M,              2202.00      0.00   23           SURGICAL SUPPLIES
2373272   S IMP PLATE, BUTTR 158M,              1993.00      0.00   23           SURGICAL SUPPLIES
2373447   S IMP PLATE, BUTTR 190M,              2482.00      0.00   23           SURGICAL SUPPLIES
2373314   S IMP PLATE, BUTTR 190M,              2063.00      0.00   23           SURGICAL SUPPLIES
2373157   S IMP PLATE, C SYMPHSIS 4             1817.00      0.00   23           SURGICAL SUPPLIES
2351286   S IMP PLATE, CALCANEAL 70             1010.00      0.00   23           SURGICAL SUPPLIES
2373934   S IMP PLATE, CERVI TITA 2             4627.00      0.00   23           SURGICAL SUPPLIES
2373652   S IMP PLATE, CERVI TITA 2             3247.00      0.00   23           SURGICAL SUPPLIES
2373660   S IMP PLATE, CERVI TITA 2             3261.00      0.00   23           SURGICAL SUPPLIES
2373959   S IMP PLATE, CERVI TITA 2             4627.00      0.00   23           SURGICAL SUPPLIES
2373579   S IMP PLATE, CERVI TITA 2             3121.00      0.00   23           SURGICAL SUPPLIES
2373942   S IMP PLATE, CERVI TITA 2             4627.00      0.00   23           SURGICAL SUPPLIES
2373520   S IMP PLATE, CERVI TITA 2             3098.00      0.00   23           SURGICAL SUPPLIES
2373926   S IMP PLATE, CERVI TITA 2             4627.00      0.00   23           SURGICAL SUPPLIES
2373561   S IMP PLATE, CERVI TITA 2             3121.00      0.00   23           SURGICAL SUPPLIES
2373975   S IMP PLATE, CERVI TITA 3             4627.00      0.00   23           SURGICAL SUPPLIES
2373678   S IMP PLATE, CERVI TITA 3             3270.00      0.00   23           SURGICAL SUPPLIES
2373967   S IMP PLATE, CERVI TITA 3             4627.00      0.00   23           SURGICAL SUPPLIES
2373629   S IMP PLATE, CERVI TITA 3             3243.00      0.00   23           SURGICAL SUPPLIES
2373983   S IMP PLATE, CERVI TITA 3             4627.00      0.00   23           SURGICAL SUPPLIES
2373587   S IMP PLATE, CERVI TITA 3             3121.00      0.00   23           SURGICAL SUPPLIES
2373991   S IMP PLATE, CERVI TITA 3             4545.00      0.00   23           SURGICAL SUPPLIES
2373546   S IMP PLATE, CERVI TITA 3             3098.00      0.00   23           SURGICAL SUPPLIES
2373538   S IMP PLATE, CERVI TITA 3             3098.00      0.00   23           SURGICAL SUPPLIES
2373611   S IMP PLATE, CERVI TITA 3             3243.00      0.00   23           SURGICAL SUPPLIES
2373744   S IMP PLATE, CERVI TITA 4             3402.00      0.00   23           SURGICAL SUPPLIES
2374031   S IMP PLATE, CERVI TITA 4             4545.00      0.00   23           SURGICAL SUPPLIES
2374023   S IMP PLATE, CERVI TITA 4             4545.00      0.00   23           SURGICAL SUPPLIES
2373793   S IMP PLATE, CERVI TITA 4             3566.00      0.00   23           SURGICAL SUPPLIES
2374015   S IMP PLATE, CERVI TITA 4             4545.00      0.00   23           SURGICAL SUPPLIES
2373769   S IMP PLATE, CERVI TITA 4             3414.00      0.00   23           SURGICAL SUPPLIES
2373637   S IMP PLATE, CERVI TITA 4             3243.00      0.00   23           SURGICAL SUPPLIES
2373751   S IMP PLATE, CERVI TITA 4             3402.00      0.00   23           SURGICAL SUPPLIES
2374007   S IMP PLATE, CERVI TITA 4             4545.00      0.00   23           SURGICAL SUPPLIES




                                                     Page 156
                                      85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2373736   S IMP PLATE, CERVI TITA 5             3363.00      0.00   23           SURGICAL SUPPLIES
2374072   S IMP PLATE, CERVI TITA 5             4948.00      0.00   23           SURGICAL SUPPLIES
2374064   S IMP PLATE, CERVI TITA 5             4948.00      0.00   23           SURGICAL SUPPLIES
2374056   S IMP PLATE, CERVI TITA 5             4545.00      0.00   23           SURGICAL SUPPLIES
2373702   S IMP PLATE, CERVI TITA 5             3363.00      0.00   23           SURGICAL SUPPLIES
2374049   S IMP PLATE, CERVI TITA 5             4545.00      0.00   23           SURGICAL SUPPLIES
2373710   S IMP PLATE, CERVI TITA 5             3363.00      0.00   23           SURGICAL SUPPLIES
2373728   S IMP PLATE, CERVI TITA 5             3363.00      0.00   23           SURGICAL SUPPLIES
2373785   S IMP PLATE, CERVI TITA 5             3552.00      0.00   23           SURGICAL SUPPLIES
2373645   S IMP PLATE, CERVI TITA 5             3243.00      0.00   23           SURGICAL SUPPLIES
2374114   S IMP PLATE, CERVI TITA 6             4948.00      0.00   23           SURGICAL SUPPLIES
2374080   S IMP PLATE, CERVI TITA 6             4948.00      0.00   23           SURGICAL SUPPLIES
2374098   S IMP PLATE, CERVI TITA 6             4948.00      0.00   23           SURGICAL SUPPLIES
2373777   S IMP PLATE, CERVI TITA 6             3538.00      0.00   23           SURGICAL SUPPLIES
2374106   S IMP PLATE, CERVI TITA 6             4948.00      0.00   23           SURGICAL SUPPLIES
2374122   S IMP PLATE, CERVI TITA 7             4948.00      0.00   23           SURGICAL SUPPLIES
2374148   S IMP PLATE, CERVI TITA 7             4948.00      0.00   23           SURGICAL SUPPLIES
2374130   S IMP PLATE, CERVI TITA 7             4948.00      0.00   23           SURGICAL SUPPLIES
2372134   S IMP PLATE, CERVICAL 25,             1073.00      0.00   23           SURGICAL SUPPLIES
2372290   S IMP PLATE, CERVICAL 41,             1164.00      0.00   23           SURGICAL SUPPLIES
2373470   S IMP PLATE, CRANI CROSS-             2653.00      0.00   23           SURGICAL SUPPLIES
2372878   S IMP PLATE, CURVED 4HO 2             1509.00      0.00   23           SURGICAL SUPPLIES
2373108   S IMP PLATE, CURVED 6HO 2             1701.00      0.00   23           SURGICAL SUPPLIES
2350189   S IMP PLATE, DCS 6 HOLE               1585.00      0.00   23           SURGICAL SUPPLIES
2371912   S IMP PLATE, DOU Y 1HO AR              990.00      0.00   23           SURGICAL SUPPLIES
2373496   S IMP PLATE, DOU Y 6HO 2M             1654.00      0.00   23           SURGICAL SUPPLIES
2373488   S IMP PLATE, DOU Y 6HO 2M             1654.00      0.00   23           SURGICAL SUPPLIES
2371862   S IMP PLATE, H 5HO SIDEX1              976.00      0.00   23           SURGICAL SUPPLIES
2371920   S IMP PLATE, H 5HO SIDEX1              990.00      0.00   23           SURGICAL SUPPLIES
2352102   S IMP PLATE, INTERMEDICS              1685.00      0.00   23           SURGICAL SUPPLIES
2371946   S IMP PLATE, L 2 BASX3HO               990.00      0.00   23           SURGICAL SUPPLIES
2371979   S IMP PLATE, L 2 BASX3HO              1003.00      0.00   23           SURGICAL SUPPLIES
2371938   S IMP PLATE, L 2HO BASX3               990.00      0.00   23           SURGICAL SUPPLIES
2371805   S IMP PLATE, L 2HO BASX3               942.00      0.00   23           SURGICAL SUPPLIES
2373439   S IMP PLATE, L 2X2HO 2.0              1308.00      0.00   23           SURGICAL SUPPLIES
2373397   S IMP PLATE, L 2X2HO 2.0              1308.00      0.00   23           SURGICAL SUPPLIES
2373405   S IMP PLATE, L 2X2HO 2.0              1308.00      0.00   23           SURGICAL SUPPLIES
2373413   S IMP PLATE, L 2X2HO 2.0              1308.00      0.00   23           SURGICAL SUPPLIES
2373421   S IMP PLATE, L 2X2HO 2.0              1308.00      0.00   23           SURGICAL SUPPLIES
2371896   S IMP PLATE, L 3HO BASX4               983.00      0.00   23           SURGICAL SUPPLIES
2371888   S IMP PLATE, L 3HO BASX4               983.00      0.00   23           SURGICAL SUPPLIES
2372118   S IMP PLATE, L 3HOBASX4HO             1053.00      0.00   23           SURGICAL SUPPLIES
2372126   S IMP PLATE, L 3HOBASX4HO             1053.00      0.00   23           SURGICAL SUPPLIES
2372142   S IMP PLATE, L 4HO BASX6-             1094.00      0.00   23           SURGICAL SUPPLIES
2372159   S IMP PLATE, L 4HO BASX6-             1094.00      0.00   23           SURGICAL SUPPLIES
2371789   S IMP PLATE, L 4X5HO SHAF              934.00      0.00   23           SURGICAL SUPPLIES
2371771   S IMP PLATE, L 4X5HO SHAF              934.00      0.00   23           SURGICAL SUPPLIES
2352318   S IMP PLATE, LARGE FRAG 4              112.00      0.00   23           SURGICAL SUPPLIES
2349835   S IMP PLATE, LATERAL FIBU             1437.00      0.00   23           SURGICAL SUPPLIES
2352326   S IMP PLATE, LEIB 54-0510              273.00      0.00   23           SURGICAL SUPPLIES
2340149   S IMP PLATE, LEIB 54-0517              564.00      0.00   23           SURGICAL SUPPLIES
2350635   S IMP PLATE, LG ASIF BD/D              449.00      0.00   23           SURGICAL SUPPLIES
2350643   S IMP PLATE, LG BUTT 4HOL              431.00      0.00   23           SURGICAL SUPPLIES




                                                     Page 157
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2349744   S IMP PLATE, LT DORSA RAD         1636.00      0.00   23           SURGICAL SUPPLIES
2350536   S IMP PLATE, MINI ASIF QU          103.00      0.00   23           SURGICAL SUPPLIES
2350650   S IMP PLATE, MINI ASIF QU          126.00      0.00   23           SURGICAL SUPPLIES
2350668   S IMP PLATE, MINI ASIF ST          134.00      0.00   23           SURGICAL SUPPLIES
2350676   S IMP PLATE, MINI ASIF ST          206.00      0.00   23           SURGICAL SUPPLIES
2371722   S IMP PLATE, ORBI 4HO 1.7          716.00      0.00   23           SURGICAL SUPPLIES
2372365   S IMP PLATE, ORBIT RIM 49         1175.00      0.00   23           SURGICAL SUPPLIES
2371730   S IMP PLATE, ORBITA 6HOLE          735.00      0.00   23           SURGICAL SUPPLIES
2373371   S IMP PLATE, ORBITAL MED.         2317.00      0.00   23           SURGICAL SUPPLIES
2372092   S IMP PLATE, ORBITAL RIM          1038.00      0.00   23           SURGICAL SUPPLIES
2371904   S IMP PLATE, ORBITAL RIM           983.00      0.00   23           SURGICAL SUPPLIES
2351302   S IMP PLATE, OSTEOMED L 2          394.00      0.00   23           SURGICAL SUPPLIES
2351310   S IMP PLATE, OSTEOMED L 2          394.00      0.00   23           SURGICAL SUPPLIES
2369254   S IMP PLATE, RECON 3.5 HL          710.00      0.00   23           SURGICAL SUPPLIES
2351328   S IMP PLATE, RECON 3.5M 7          573.00      0.00   23           SURGICAL SUPPLIES
2351278   S IMP PLATE, SHORT BEND W         1684.00      0.00   23           SURGICAL SUPPLIES
2350551   S IMP PLATE, SM FRAG ASIF          152.00      0.00   23           SURGICAL SUPPLIES
2350569   S IMP PLATE, SM FRAG ASIF          152.00      0.00   23           SURGICAL SUPPLIES
2350627   S IMP PLATE, SM FRAG ASIF          292.00      0.00   23           SURGICAL SUPPLIES
2350544   S IMP PLATE, SM FRAG ASIF          488.00      0.00   23           SURGICAL SUPPLIES
2350577   S IMP PLATE, SM FRAG ASIF          152.00      0.00   23           SURGICAL SUPPLIES
2350585   S IMP PLATE, SM FRAG ASIF          145.00      0.00   23           SURGICAL SUPPLIES
2350593   S IMP PLATE, SM FRAG ASIF          233.00      0.00   23           SURGICAL SUPPLIES
2351336   S IMP PLATE, SM FRAG ASIF          121.00      0.00   23           SURGICAL SUPPLIES
2350619   S IMP PLATE, SM FRAG ASIF          330.00      0.00   23           SURGICAL SUPPLIES
2351294   S IMP PLATE, SM FRAG L SH           99.00      0.00   23           SURGICAL SUPPLIES
2351344   S IMP PLATE, SM FRAG T 3           194.00      0.00   23           SURGICAL SUPPLIES
2350601   S IMP PLATE, SM PERIARTIC          400.00      0.00   23           SURGICAL SUPPLIES
2372431   S IMP PLATE, SQU 3X2HOLE          1213.00      0.00   23           SURGICAL SUPPLIES
2372886   S IMP PLATE, SQU 4X2 HO 1         1516.00      0.00   23           SURGICAL SUPPLIES
2372845   S IMP PLATE, SQUARE 2X2HO         1409.00      0.00   23           SURGICAL SUPPLIES
2373355   S IMP PLATE, STR 14HOLE 2         2185.00      0.00   23           SURGICAL SUPPLIES
2373322   S IMP PLATE, STR 16 HO 2.         1106.00      0.00   23           SURGICAL SUPPLIES
2372373   S IMP PLATE, STR 16HOLE 1         1179.00      0.00   23           SURGICAL SUPPLIES
2373074   S IMP PLATE, STR 24HOLE 1         1556.00      0.00   23           SURGICAL SUPPLIES
2372860   S IMP PLATE, STR 4HO 2.0           689.00      0.00   23           SURGICAL SUPPLIES
2372852   S IMP PLATE, STR 4HO 2.0           683.00      0.00   23           SURGICAL SUPPLIES
2372324   S IMP PLATE, STR 4HO 2.3S         1238.00      0.00   23           SURGICAL SUPPLIES
2372894   S IMP PLATE, STR 4HOLE 2.         1516.00      0.00   23           SURGICAL SUPPLIES
2372589   S IMP PLATE, STR 4HOLE 2.         1284.00      0.00   23           SURGICAL SUPPLIES
2372902   S IMP PLATE, STR 4HOLE 2.          742.00      0.00   23           SURGICAL SUPPLIES
2372175   S IMP PLATE, STR 4HOLE 35         1117.00      0.00   23           SURGICAL SUPPLIES
2372308   S IMP PLATE, STR 4HOLE 40         1225.00      0.00   23           SURGICAL SUPPLIES
2373017   S IMP PLATE, STR 6 HOLE 2          778.00      0.00   23           SURGICAL SUPPLIES
2373116   S IMP PLATE, STR 6HO 2.3M         1717.00      0.00   23           SURGICAL SUPPLIES
2373223   S IMP PLATE, STR 6HO 2.3M         1857.00      0.00   23           SURGICAL SUPPLIES
2373041   S IMP PLATE, STR 6HOLE 2.         1515.00      0.00   23           SURGICAL SUPPLIES
2373033   S IMP PLATE, STR 6HOLE 50         1505.00      0.00   23           SURGICAL SUPPLIES
2371714   S IMP PLATE, STR 8 HOLE 1          657.00      0.00   23           SURGICAL SUPPLIES
2371698   S IMP PLATE, STR 8 HOLE 1          651.00      0.00   23           SURGICAL SUPPLIES
2371763   S IMP PLATE, STR 8HOLE 1.          766.00      0.00   23           SURGICAL SUPPLIES
2372951   S IMP PLATE, STR 8HOLE 60         1571.00      0.00   23           SURGICAL SUPPLIES
2373298   S IMP PLATE, STR BRI MX 1         2019.00      0.00   23           SURGICAL SUPPLIES




                                                 Page 158
                                85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2373389   S IMP PLATE, STR BRI MX 1       2383.00      0.00   23           SURGICAL SUPPLIES
2373348   S IMP PLATE, STR BRI MX 1       2122.00      0.00   23           SURGICAL SUPPLIES
2373256   S IMP PLATE, STR BRI MX 8       1925.00      0.00   23           SURGICAL SUPPLIES
2373231   S IMP PLATE, STRA 16HO 12       1879.00      0.00   23           SURGICAL SUPPLIES
2372985   S IMP PLATE, STRAIGHT 8HO       1634.00      0.00   23           SURGICAL SUPPLIES
2373066   S IMP PLATE, STRUT 30X16H       1544.00      0.00   23           SURGICAL SUPPLIES
2373124   S IMP PLATE, STRUT 42MX22       1731.00      0.00   23           SURGICAL SUPPLIES
2355063   S IMP PLATE, SYNTHES            1773.00      0.00   23           SURGICAL SUPPLIES
2351625   S IMP PLATE, SYNTHES COND        533.00      0.00   23           SURGICAL SUPPLIES
2352292   S IMP PLATE, SYNTHES, 241        521.00      0.00   23           SURGICAL SUPPLIES
2371813   S IMP PLATE, T 5HOX5HO SH        942.00      0.00   23           SURGICAL SUPPLIES
2371953   S IMP PLATE, T 5HOX7HO SH        990.00      0.00   23           SURGICAL SUPPLIES
2349967   S IMP PLATE, T, 5 HOLE           339.00      0.00   23           SURGICAL SUPPLIES
2372084   S IMP PLATE, Y 1HO ARMX3H       1025.00      0.00   23           SURGICAL SUPPLIES
2371854   S IMP PLATE, Y 1HO ARMX3H        969.00      0.00   23           SURGICAL SUPPLIES
2371961   S IMP PLATE, Y 2 ARMX4HO         997.00      0.00   23           SURGICAL SUPPLIES
2371821   S IMP PLATE, Y 2X5HOLES S        962.00      0.00   23           SURGICAL SUPPLIES
2371839   S IMP PLATE, Y 3X7HOLES S        962.00      0.00   23           SURGICAL SUPPLIES
2373082   S IMP PLATE, Y 87MM             1689.00      0.00   23           SURGICAL SUPPLIES
2371797   S IMP PLATE, ZYGOMATIC 22        934.00      0.00   23           SURGICAL SUPPLIES
2371870   S IMP PLATE, ZYGOMATIC 27        976.00      0.00   23           SURGICAL SUPPLIES
2372100   S IMP PLATE, ZYGOMATIC 32       1046.00      0.00   23           SURGICAL SUPPLIES
2347102   S IMP PLATE,LIEB.ORIBITAL       1727.00      0.00   23           SURGICAL SUPPLIES
2391696   S IMP PLIF SPACER 13MM          6852.00      0.00   23           SURGICAL SUPPLIES
2391704   S IMP PLIF SPACER 15MM          6852.00      0.00   23           SURGICAL SUPPLIES
2378495   S IMP PLUG BONE SMALL            627.00      0.00   23           SURGICAL SUPPLIES
2375889   S IMP PLUG LARGE BONE $          627.00      0.00   23           SURGICAL SUPPLIES
2357275   S IMP PORTACATH,PERITONEA       1865.00      0.00   23           SURGICAL SUPPLIES
2378487   S IMP POUCH MESH SYNCHROM        618.00      0.00   23           SURGICAL SUPPLIES
2390821   S IMP PROGR SYNERGY             4629.00      0.00   23           SURGICAL SUPPLIES
2375251   S IMP PROSTHESIS IMPLANT           0.00      0.00   23           SURGICAL SUPPLIES
2341196   S IMP PROSTHESIS, EAR WEH       1330.00      0.00   23           SURGICAL SUPPLIES
2354546   S IMP PROSTHESIS, SGARLET       1084.00      0.00   23           SURGICAL SUPPLIES
2356897   S IMP PROSTHESIS,PENILE         3799.00      0.00   23           SURGICAL SUPPLIES
2356889   S IMP PROSTHESIS,PENILE         4174.00      0.00   23           SURGICAL SUPPLIES
2357101   S IMP PROSTHESIS,PENILE,        8044.00      0.00   23           SURGICAL SUPPLIES
2357028   S IMP PROSTHESIS,PENILE,        3590.00      0.00   23           SURGICAL SUPPLIES
2357051   S IMP PROSTHESIS,PENILE,        1391.00      0.00   23           SURGICAL SUPPLIES
2357044   S IMP PROSTHESIS,PENILE,        7365.00      0.00   23           SURGICAL SUPPLIES
2357010   S IMP PROSTHESIS,PENILE,        4310.00      0.00   23           SURGICAL SUPPLIES
2357085   S IMP PROSTHESIS,SPHINCT        4807.00      0.00   23           SURGICAL SUPPLIES
2370518   S IMP PROXIMAL SPACER            952.00      0.00   23           SURGICAL SUPPLIES
2369163   S IMP PUMP SYCHROMED           20842.00      0.00   23           SURGICAL SUPPLIES
2394138   S IMP PUTTY 1CC DBX             1033.00      0.00   23           SURGICAL SUPPLIES
2355667   S IMP RADIONUCLIDE,SEEDS         145.00      0.00   23           SURGICAL SUPPLIES
2394146   S IMP RING LOKG AXIS             689.00      0.00   23           SURGICAL SUPPLIES
2321198   S IMP ROD 6.0 X 350 TI          1299.00      0.00   23           SURGICAL SUPPLIES
2379485   S IMP ROD 6.0 X 400MM HAR       1299.00      0.00   23           SURGICAL SUPPLIES
2379618   S IMP ROD 8 X 8MM ROD TO        1385.00      0.00   23           SURGICAL SUPPLIES
2321206   S IMP ROD 8.0 X 220              796.00      0.00   23           SURGICAL SUPPLIES
2372720   S IMP ROD CURV SOF TITA 6       1381.00      0.00   23           SURGICAL SUPPLIES
2372712   S IMP ROD CURV SOF TITA 6       1381.00      0.00   23           SURGICAL SUPPLIES
2372738   S IMP ROD CURV SOFTTITA 6       1381.00      0.00   23           SURGICAL SUPPLIES




                                               Page 159
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2379477   S IMP ROD HARD TITA 6.0 X         1299.00      0.00   23           SURGICAL SUPPLIES
2372357   S IMP ROD HARD TITA 6.0MM         1239.00      0.00   23           SURGICAL SUPPLIES
2372340   S IMP ROD HARD TITA 6.0MM         1239.00      0.00   23           SURGICAL SUPPLIES
2372282   S IMP ROD HARD TITA 6.0MM         1157.00      0.00   23           SURGICAL SUPPLIES
2372548   S IMP ROD HARD TITA 6.0MM         1228.00      0.00   23           SURGICAL SUPPLIES
2372449   S IMP ROD HARD TITA 6.0MM         1213.00      0.00   23           SURGICAL SUPPLIES
2370963   S IMP ROD INTERMEDULLARY          6118.00      0.00   23           SURGICAL SUPPLIES
2372456   S IMP ROD SOFT TITA 6.0MM         1213.00      0.00   23           SURGICAL SUPPLIES
2372464   S IMP ROD SOFT TITA 6.0MM         1213.00      0.00   23           SURGICAL SUPPLIES
2371755   S IMP ROD SOFT TITA 6.0X1          749.00      0.00   23           SURGICAL SUPPLIES
2371680   S IMP ROD SOFT TITA 6.0X5          633.00      0.00   23           SURGICAL SUPPLIES
2371748   S IMP ROD SOFT TITA 6.0X5          735.00      0.00   23           SURGICAL SUPPLIES
2371706   S IMP ROD SOFT TITA 6.0X5          657.00      0.00   23           SURGICAL SUPPLIES
2340818   S IMP SCLERAL GRAFT                538.00      0.00   23           SURGICAL SUPPLIES
2377190   S IMP SCREW 1.2 X 4MM CRO           67.00      0.00   23           SURGICAL SUPPLIES
2377885   S IMP SCREW 1.5 X 10MM             319.00      0.00   23           SURGICAL SUPPLIES
2394161   S IMP SCREW 1.5 X 11MM             311.00      0.00   23           SURGICAL SUPPLIES
2377844   S IMP SCREW 1.5 X 12MM CO          311.00      0.00   23           SURGICAL SUPPLIES
2394179   S IMP SCREW 1.5 X 13MM             311.00      0.00   23           SURGICAL SUPPLIES
2394187   S IMP SCREW 1.5 X 14MM             311.00      0.00   23           SURGICAL SUPPLIES
2394195   S IMP SCREW 1.5 X 16MM             319.00      0.00   23           SURGICAL SUPPLIES
2394203   S IMP SCREW 1.5 X 18MM             319.00      0.00   23           SURGICAL SUPPLIES
2394211   S IMP SCREW 1.5 X 20MM             331.00      0.00   23           SURGICAL SUPPLIES
2394229   S IMP SCREW 1.5 X 22M              331.00      0.00   23           SURGICAL SUPPLIES
2394237   S IMP SCREW 1.5 X 24MM             319.00      0.00   23           SURGICAL SUPPLIES
2394245   S IMP SCREW 1.5 X 8MM              331.00      0.00   23           SURGICAL SUPPLIES
2377877   S IMP SCREW 1.5 X 8MM              319.00      0.00   23           SURGICAL SUPPLIES
2394252   S IMP SCREW 1.5 X 9MM              331.00      0.00   23           SURGICAL SUPPLIES
2375772   S IMP SCREW 1.6 X 6MM OST          286.00      0.00   23           SURGICAL SUPPLIES
2321214   S IMP SCREW 1.8                   1419.00      0.00   23           SURGICAL SUPPLIES
2378230   S IMP SCREW 100/30 ORTHOF          616.00      0.00   23           SURGICAL SUPPLIES
2379436   S IMP SCREW 110MM LAG STA         1193.00      0.00   23           SURGICAL SUPPLIES
2321222   S IMP SCREW 115 LAG               1109.00      0.00   23           SURGICAL SUPPLIES
2394260   S IMP SCREW 120MM LAG             1109.00      0.00   23           SURGICAL SUPPLIES
2394278   S IMP SCREW 14MM                   696.00      0.00   23           SURGICAL SUPPLIES
2377943   S IMP SCREW 2 X 16MM CORT          352.00      0.00   23           SURGICAL SUPPLIES
2377968   S IMP SCREW 2 X 22MM CORT          352.00      0.00   23           SURGICAL SUPPLIES
2394302   S IMP SCREW 2.0 X 10MM             366.00      0.00   23           SURGICAL SUPPLIES
2394294   S IMP SCREW 2.0 X 11MM             366.00      0.00   23           SURGICAL SUPPLIES
2394310   S IMP SCREW 2.0 X 12MM             366.00      0.00   23           SURGICAL SUPPLIES
2394328   S IMP SCREW 2.0 X 13MM             405.00      0.00   23           SURGICAL SUPPLIES
2394336   S IMP SCREW 2.0 X 14MM             352.00      0.00   23           SURGICAL SUPPLIES
2377950   S IMP SCREW 2.0 X 18MM CO          352.00      0.00   23           SURGICAL SUPPLIES
2394344   S IMP SCREW 2.0 X 20MM             352.00      0.00   23           SURGICAL SUPPLIES
2394351   S IMP SCREW 2.0 X 24MM             366.00      0.00   23           SURGICAL SUPPLIES
2394286   S IMP SCREW 2.0 X 26MM             352.00      0.00   23           SURGICAL SUPPLIES
2394369   S IMP SCREW 2.0 X 28MM             352.00      0.00   23           SURGICAL SUPPLIES
2394377   S IMP SCREW 2.0 X 30MM             352.00      0.00   23           SURGICAL SUPPLIES
2394385   S IMP SCREW 2.0 X 32MM             352.00      0.00   23           SURGICAL SUPPLIES
2321230   S IMP SCREW 2.0 X 4                339.00      0.00   23           SURGICAL SUPPLIES
2321248   S IMP SCREW 2.0 X 6                339.00      0.00   23           SURGICAL SUPPLIES
2394393   S IMP SCREW 2.0 X 6MM              352.00      0.00   23           SURGICAL SUPPLIES
2394401   S IMP SCREW 2.0 X 7MM              352.00      0.00   23           SURGICAL SUPPLIES




                                                 Page 160
                                        85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2321255   S IMP SCREW   2.0 X 8                    339.00      0.00   23           SURGICAL SUPPLIES
2394419   S IMP SCREW   2.0 X 8MM                  352.00      0.00   23           SURGICAL SUPPLIES
2394427   S IMP SCREW   2.0 X 9MM                  352.00      0.00   23           SURGICAL SUPPLIES
2394435   S IMP SCREW   2.4 X 10MM                 465.00      0.00   23           SURGICAL SUPPLIES
2394443   S IMP SCREW   2.4 X 12MM                 465.00      0.00   23           SURGICAL SUPPLIES
2378057   S IMP SCREW   2.4 X 14MM CO              447.00      0.00   23           SURGICAL SUPPLIES
2394450   S IMP SCREW   2.4 X 16MM                 436.00      0.00   23           SURGICAL SUPPLIES
2378099   S IMP SCREW   2.4 X 18MM CO              447.00      0.00   23           SURGICAL SUPPLIES
2378073   S IMP SCREW   2.4 X 20MM                 447.00      0.00   23           SURGICAL SUPPLIES
2378081   S IMP SCREW   2.4 X 22MM CO              447.00      0.00   23           SURGICAL SUPPLIES
2378065   S IMP SCREW   2.4 X 24MM                 447.00      0.00   23           SURGICAL SUPPLIES
2378107   S IMP SCREW   2.4 X 28MM                 447.00      0.00   23           SURGICAL SUPPLIES
2321263   S IMP SCREW   2.4 X 6                    364.00      0.00   23           SURGICAL SUPPLIES
2394468   S IMP SCREW   2.4 X 8MM                  465.00      0.00   23           SURGICAL SUPPLIES
2394476   S IMP SCREW   2.4 X 9MM                  465.00      0.00   23           SURGICAL SUPPLIES
2394484   S IMP SCREW   2.4X13MM                   465.00      0.00   23           SURGICAL SUPPLIES
2394492   S IMP SCREW   2.4X16MM                   465.00      0.00   23           SURGICAL SUPPLIES
2378040   S IMP SCREW   2.5 X 12MM MF              447.00      0.00   23           SURGICAL SUPPLIES
2321271   S IMP SCREW   2.7 X 10                   128.00      0.00   23           SURGICAL SUPPLIES
2394500   S IMP SCREW   2.7 X 14MM                 345.00      0.00   23           SURGICAL SUPPLIES
2377448   S IMP SCREW   2.7 X 14MM CO              157.00      0.00   23           SURGICAL SUPPLIES
2394518   S IMP SCREW   2.7 X 16MM                 163.00      0.00   23           SURGICAL SUPPLIES
2377901   S IMP SCREW   2.7 X 16MM CO              333.00      0.00   23           SURGICAL SUPPLIES
2377893   S IMP SCREW   2.7 X 18MM CO              333.00      0.00   23           SURGICAL SUPPLIES
2377810   S IMP SCREW   2.7 X 22MM CO              280.00      0.00   23           SURGICAL SUPPLIES
2394526   S IMP SCREW   2.7 X 26MM                 157.00      0.00   23           SURGICAL SUPPLIES
2377802   S IMP SCREW   2.7 X 26MM CO              280.00      0.00   23           SURGICAL SUPPLIES
2394534   S IMP SCREW   2.7 X 28MM                 151.00      0.00   23           SURGICAL SUPPLIES
2394542   S IMP SCREW   2.7 X 30MM                 157.00      0.00   23           SURGICAL SUPPLIES
2394559   S IMP SCREW   2.7 X 32MM                 130.00      0.00   23           SURGICAL SUPPLIES
2394567   S IMP SCREW   2.7 X 34MM                 163.00      0.00   23           SURGICAL SUPPLIES
2394575   S IMP SCREW   2.7 X 36MM                 151.00      0.00   23           SURGICAL SUPPLIES
2394583   S IMP SCREW   2.7 X 38MM                 151.00      0.00   23           SURGICAL SUPPLIES
2394591   S IMP SCREW   2.7 X 40MM                 163.00      0.00   23           SURGICAL SUPPLIES
2377273   S IMP SCREW   2.7 X 40MM                 118.00      0.00   23           SURGICAL SUPPLIES
2394609   S IMP SCREW   2.7 X 45MM                 151.00      0.00   23           SURGICAL SUPPLIES
2394617   S IMP SCREW   2.7 X 50MM                 163.00      0.00   23           SURGICAL SUPPLIES
2394625   S IMP SCREW   2.7 X 55MM                 163.00      0.00   23           SURGICAL SUPPLIES
2394633   S IMP SCREW   2.7X24MM                   157.00      0.00   23           SURGICAL SUPPLIES
2379642   S IMP SCREW   24MM MINI FIX             1482.00      0.00   23           SURGICAL SUPPLIES
2379634   S IMP SCREW   26MM MINI FIX             1482.00      0.00   23           SURGICAL SUPPLIES
2379162   S IMP SCREW   3.0 X 16MM CA              955.00      0.00   23           SURGICAL SUPPLIES
2321289   S IMP SCREW   3.0 X 18                   954.00      0.00   23           SURGICAL SUPPLIES
2379121   S IMP SCREW   3.0 X 30MM CA              921.00      0.00   23           SURGICAL SUPPLIES
2379113   S IMP SCREW   3.0 X 32MM CA              921.00      0.00   23           SURGICAL SUPPLIES
2379105   S IMP SCREW   3.0 X 38MM CA              921.00      0.00   23           SURGICAL SUPPLIES
2394641   S IMP SCREW   3.2 X 22MM                 435.00      0.00   23           SURGICAL SUPPLIES
2394658   S IMP SCREW   3.5 X 10MM                 628.00      0.00   23           SURGICAL SUPPLIES
2394666   S IMP SCREW   3.5 X 12MM                 585.00      0.00   23           SURGICAL SUPPLIES
2377455   S IMP SCREW   3.5 X 12MM CO              157.00      0.00   23           SURGICAL SUPPLIES
2378131   S IMP SCREW   3.5 X 12MM CO              448.00      0.00   23           SURGICAL SUPPLIES
2375467   S IMP SCREW   3.5 X 14MM CO              118.00      0.00   23           SURGICAL SUPPLIES
2377422   S IMP SCREW   3.5 X 14MM CO              157.00      0.00   23           SURGICAL SUPPLIES




                                                       Page 161
                                        85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2378149   S IMP SCREW   3.5 X 14MM CO              448.00      0.00   23           SURGICAL SUPPLIES
2378321   S IMP SCREW   3.5 X 14MM LO              605.00      0.00   23           SURGICAL SUPPLIES
2378156   S IMP SCREW   3.5 X 16MM CO              448.00      0.00   23           SURGICAL SUPPLIES
2375475   S IMP SCREW   3.5 X 16MM CO              118.00      0.00   23           SURGICAL SUPPLIES
2378339   S IMP SCREW   3.5 X 16MM LO              605.00      0.00   23           SURGICAL SUPPLIES
2377430   S IMP SCREW   3.5 X 18MM CO              157.00      0.00   23           SURGICAL SUPPLIES
2378115   S IMP SCREW   3.5 X 18MM CO              448.00      0.00   23           SURGICAL SUPPLIES
2378347   S IMP SCREW   3.5 X 18MM LO              605.00      0.00   23           SURGICAL SUPPLIES
2394674   S IMP SCREW   3.5 X 20MM                 594.00      0.00   23           SURGICAL SUPPLIES
2377240   S IMP SCREW   3.5 X 20MM CO              118.00      0.00   23           SURGICAL SUPPLIES
2375525   S IMP SCREW   3.5 X 20MM CO              151.00      0.00   23           SURGICAL SUPPLIES
2378354   S IMP SCREW   3.5 X 20MM LO              605.00      0.00   23           SURGICAL SUPPLIES
2394682   S IMP SCREW   3.5 X 22MM                 118.00      0.00   23           SURGICAL SUPPLIES
2378362   S IMP SCREW   3.5 X 22MM LO              605.00      0.00   23           SURGICAL SUPPLIES
2394716   S IMP SCREW   3.5 X 24MM                 628.00      0.00   23           SURGICAL SUPPLIES
2394690   S IMP SCREW   3.5 X 24MM                 128.00      0.00   23           SURGICAL SUPPLIES
2394708   S IMP SCREW   3.5 X 24MM                 594.00      0.00   23           SURGICAL SUPPLIES
2378123   S IMP SCREW   3.5 X 25MM CO              448.00      0.00   23           SURGICAL SUPPLIES
2377265   S IMP SCREW   3.5 X 26MM CO              118.00      0.00   23           SURGICAL SUPPLIES
2378370   S IMP SCREW   3.5 X 26MM LO              605.00      0.00   23           SURGICAL SUPPLIES
2377364   S IMP SCREW   3.5 X 26MM SH              143.00      0.00   23           SURGICAL SUPPLIES
2394732   S IMP SCREW   3.5 X 28MM                 594.00      0.00   23           SURGICAL SUPPLIES
2394724   S IMP SCREW   3.5 X 28MM                1072.00      0.00   23           SURGICAL SUPPLIES
2377232   S IMP SCREW   3.5 X 28MM CO              118.00      0.00   23           SURGICAL SUPPLIES
2378388   S IMP SCREW   3.5 X 28MM LO              605.00      0.00   23           SURGICAL SUPPLIES
2394740   S IMP SCREW   3.5 X 30MM                 126.00      0.00   23           SURGICAL SUPPLIES
2377257   S IMP SCREW   3.5 X 30MM CO              118.00      0.00   23           SURGICAL SUPPLIES
2378396   S IMP SCREW   3.5 X 30MM LO              605.00      0.00   23           SURGICAL SUPPLIES
2377299   S IMP SCREW   3.5 X 32 CORT              124.00      0.00   23           SURGICAL SUPPLIES
2377653   S IMP SCREW   3.5 X 32MM CO              197.00      0.00   23           SURGICAL SUPPLIES
2378404   S IMP SCREW   3.5 X 32MM LO              605.00      0.00   23           SURGICAL SUPPLIES
2377372   S IMP SCREW   3.5 X 32MM SH              143.00      0.00   23           SURGICAL SUPPLIES
2377612   S IMP SCREW   3.5 X 34MM CO              197.00      0.00   23           SURGICAL SUPPLIES
2378412   S IMP SCREW   3.5 X 34MM LO              605.00      0.00   23           SURGICAL SUPPLIES
2394757   S IMP SCREW   3.5 X 35MM                 133.00      0.00   23           SURGICAL SUPPLIES
2375590   S IMP SCREW   3.5 X 36MM CO              151.00      0.00   23           SURGICAL SUPPLIES
2378420   S IMP SCREW   3.5 X 36MM LO              605.00      0.00   23           SURGICAL SUPPLIES
2394765   S IMP SCREW   3.5 X 38MM                 594.00      0.00   23           SURGICAL SUPPLIES
2378438   S IMP SCREW   3.5 X 38MM LO              605.00      0.00   23           SURGICAL SUPPLIES
2394781   S IMP SCREW   3.5 X 40MM                 594.00      0.00   23           SURGICAL SUPPLIES
2394773   S IMP SCREW   3.5 X 40MM                 118.00      0.00   23           SURGICAL SUPPLIES
2378446   S IMP SCREW   3.5 X 40MM LO              605.00      0.00   23           SURGICAL SUPPLIES
2377646   S IMP SCREW   3.5 X 42MM CO              197.00      0.00   23           SURGICAL SUPPLIES
2378453   S IMP SCREW   3.5 X 45MM LO              605.00      0.00   23           SURGICAL SUPPLIES
2321297   S IMP SCREW   3.5 X 46                   278.00      0.00   23           SURGICAL SUPPLIES
2375632   S IMP SCREW   3.5 X 50MM CO              151.00      0.00   23           SURGICAL SUPPLIES
2378461   S IMP SCREW   3.5 X 50MM LO              605.00      0.00   23           SURGICAL SUPPLIES
2394799   S IMP SCREW   3.5 X 55MM                 128.00      0.00   23           SURGICAL SUPPLIES
2394807   S IMP SCREW   3.5 X 55MM                 180.00      0.00   23           SURGICAL SUPPLIES
2394815   S IMP SCREW   3.5 X 55MM                 634.00      0.00   23           SURGICAL SUPPLIES
2377604   S IMP SCREW   3.5 X 55MM CO              197.00      0.00   23           SURGICAL SUPPLIES
2394823   S IMP SCREW   3.5 X 60MM                 180.00      0.00   23           SURGICAL SUPPLIES
2378479   S IMP SCREW   3.5 X 60MM LO              605.00      0.00   23           SURGICAL SUPPLIES




                                                       Page 162
                                        85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2394831   S IMP SCREW   3.5 X 65MM                 128.00      0.00   23           SURGICAL SUPPLIES
2377463   S IMP SCREW   3.5 X 65MM CO              157.00      0.00   23           SURGICAL SUPPLIES
2377620   S IMP SCREW   3.5 X 70MM CO              197.00      0.00   23           SURGICAL SUPPLIES
2377414   S IMP SCREW   3.5 X 70MM CO              152.00      0.00   23           SURGICAL SUPPLIES
2394849   S IMP SCREW   3.5 X 75MM                 151.00      0.00   23           SURGICAL SUPPLIES
2394856   S IMP SCREW   3.5 X 80MM                 151.00      0.00   23           SURGICAL SUPPLIES
2377638   S IMP SCREW   3.5 X 80MM CO              197.00      0.00   23           SURGICAL SUPPLIES
2394864   S IMP SCREW   3.5 X 85MM                 180.00      0.00   23           SURGICAL SUPPLIES
2394872   S IMP SCREW   3.5 X 90MM                 163.00      0.00   23           SURGICAL SUPPLIES
2321396   S IMP SCREW   3MM                       1036.00      0.00   23           SURGICAL SUPPLIES
2321305   S IMP SCREW   4 X 13                    1691.00      0.00   23           SURGICAL SUPPLIES
2321313   S IMP SCREW   4 X 14                    1691.00      0.00   23           SURGICAL SUPPLIES
2394880   S IMP SCREW   4.0 12MM                   929.00      0.00   23           SURGICAL SUPPLIES
2394898   S IMP SCREW   4.0 14MM                   929.00      0.00   23           SURGICAL SUPPLIES
2394914   S IMP SCREW   4.0 16MM                   929.00      0.00   23           SURGICAL SUPPLIES
2394906   S IMP SCREW   4.0 16MM                   929.00      0.00   23           SURGICAL SUPPLIES
2394930   S IMP SCREW   4.0 18MM                   929.00      0.00   23           SURGICAL SUPPLIES
2394922   S IMP SCREW   4.0 18MM                   929.00      0.00   23           SURGICAL SUPPLIES
2394948   S IMP SCREW   4.0 20MM                   929.00      0.00   23           SURGICAL SUPPLIES
2394955   S IMP SCREW   4.0 22MM                   929.00      0.00   23           SURGICAL SUPPLIES
2394963   S IMP SCREW   4.0 24MM                   929.00      0.00   23           SURGICAL SUPPLIES
2377935   S IMP SCREW   4.0 X 16MM CA              351.00      0.00   23           SURGICAL SUPPLIES
2377927   S IMP SCREW   4.0 X 18MM CA              351.00      0.00   23           SURGICAL SUPPLIES
2377307   S IMP SCREW   4.0 X 18MM CA              134.00      0.00   23           SURGICAL SUPPLIES
2377315   S IMP SCREW   4.0 X 22MM CA              134.00      0.00   23           SURGICAL SUPPLIES
2377331   S IMP SCREW   4.0 X 26MM CA              134.00      0.00   23           SURGICAL SUPPLIES
2378628   S IMP SCREW   4.0 X 26MM LO              675.00      0.00   23           SURGICAL SUPPLIES
2377323   S IMP SCREW   4.0 X 30MM CA              134.00      0.00   23           SURGICAL SUPPLIES
2378610   S IMP SCREW   4.0 X 34MM LO              675.00      0.00   23           SURGICAL SUPPLIES
2377349   S IMP SCREW   4.0 X 40MM CA              134.00      0.00   23           SURGICAL SUPPLIES
2379071   S IMP SCREW   4.0 X 40MM CA              908.00      0.00   23           SURGICAL SUPPLIES
2379063   S IMP SCREW   4.0 X 44MM CA              908.00      0.00   23           SURGICAL SUPPLIES
2375491   S IMP SCREW   4.0 X 45MM PA              128.00      0.00   23           SURGICAL SUPPLIES
2378974   S IMP SCREW   4.0 X 48MM CA              862.00      0.00   23           SURGICAL SUPPLIES
2377281   S IMP SCREW   4.0 X 50MM CA              124.00      0.00   23           SURGICAL SUPPLIES
2378883   S IMP SCREW   4.0 X 55MM CA              767.00      0.00   23           SURGICAL SUPPLIES
2377356   S IMP SCREW   4.0 X 60MM CA              134.00      0.00   23           SURGICAL SUPPLIES
2378768   S IMP SCREW   4.0 X 80MM EX              683.00      0.00   23           SURGICAL SUPPLIES
2379535   S IMP SCREW   4.35 X 14MM C             1405.00      0.00   23           SURGICAL SUPPLIES
2375459   S IMP SCREW   4.5 X 14MM CO              113.00      0.00   23           SURGICAL SUPPLIES
2375442   S IMP SCREW   4.5 X 14MM CO              113.00      0.00   23           SURGICAL SUPPLIES
2377224   S IMP SCREW   4.5 X 14MM CO              113.00      0.00   23           SURGICAL SUPPLIES
2375434   S IMP SCREW   4.5 X 18MM CO              113.00      0.00   23           SURGICAL SUPPLIES
2375426   S IMP SCREW   4.5 X 22MM CO              113.00      0.00   23           SURGICAL SUPPLIES
2377547   S IMP SCREW   4.5 X 28MM CO              160.00      0.00   23           SURGICAL SUPPLIES
2321321   S IMP SCREW   4.5 X 30                  5036.00      0.00   23           SURGICAL SUPPLIES
2377471   S IMP SCREW   4.5 X 30MM CO              160.00      0.00   23           SURGICAL SUPPLIES
2377505   S IMP SCREW   4.5 X 32MM CO              160.00      0.00   23           SURGICAL SUPPLIES
2377679   S IMP SCREW   4.5 X 34MM CO              187.00      0.00   23           SURGICAL SUPPLIES
2377513   S IMP SCREW   4.5 X 34MM CO              160.00      0.00   23           SURGICAL SUPPLIES
2377687   S IMP SCREW   4.5 X 36MM CO              187.00      0.00   23           SURGICAL SUPPLIES
2377539   S IMP SCREW   4.5 X 40MM CO              160.00      0.00   23           SURGICAL SUPPLIES
2379147   S IMP SCREW   4.5 X 42MM CA              955.00      0.00   23           SURGICAL SUPPLIES




                                                       Page 163
                                        85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2377497   S IMP SCREW   4.5 X 44MM CO              160.00      0.00   23           SURGICAL SUPPLIES
2379154   S IMP SCREW   4.5 X 46MM CA              955.00      0.00   23           SURGICAL SUPPLIES
2377695   S IMP SCREW   4.5 X 46MM CO              187.00      0.00   23           SURGICAL SUPPLIES
2377380   S IMP SCREW   4.5 X 46MM CO              148.00      0.00   23           SURGICAL SUPPLIES
2377554   S IMP SCREW   4.5 X 48MM CO              160.00      0.00   23           SURGICAL SUPPLIES
2377521   S IMP SCREW   4.5 X 50MM CO              160.00      0.00   23           SURGICAL SUPPLIES
2377489   S IMP SCREW   4.5 X 54MM CO              160.00      0.00   23           SURGICAL SUPPLIES
2321339   S IMP SCREW   4.5 X 56                   122.00      0.00   23           SURGICAL SUPPLIES
2377570   S IMP SCREW   4.5 X 56MM CO              160.00      0.00   23           SURGICAL SUPPLIES
2321347   S IMP SCREW   4.5 X 58                   122.00      0.00   23           SURGICAL SUPPLIES
2377398   S IMP SCREW   4.5 X 58MM CO              148.00      0.00   23           SURGICAL SUPPLIES
2377588   S IMP SCREW   4.5 X 64MM CO              160.00      0.00   23           SURGICAL SUPPLIES
2377406   S IMP SCREW   4.5 X 70MM CO              148.00      0.00   23           SURGICAL SUPPLIES
2377703   S IMP SCREW   4.5 X 72MM CO              220.00      0.00   23           SURGICAL SUPPLIES
2376150   S IMP SCREW   4.9 X 40MM LO              796.00      0.00   23           SURGICAL SUPPLIES
2321354   S IMP SCREW   5.0 X 30                   940.00      0.00   23           SURGICAL SUPPLIES
2378719   S IMP SCREW   5.0 X 30MM LO              710.00      0.00   23           SURGICAL SUPPLIES
2378818   S IMP SCREW   5.0 X 35MM LO              704.00      0.00   23           SURGICAL SUPPLIES
2378727   S IMP SCREW   5.0 X 36MM LO              710.00      0.00   23           SURGICAL SUPPLIES
2379014   S IMP SCREW   5.0 X 40MM LO              875.00      0.00   23           SURGICAL SUPPLIES
2378735   S IMP SCREW   5.0 X 40MM LO              710.00      0.00   23           SURGICAL SUPPLIES
2379022   S IMP SCREW   5.0 X 65MM CA              875.00      0.00   23           SURGICAL SUPPLIES
2378990   S IMP SCREW   5.0 X 70MM CA              875.00      0.00   23           SURGICAL SUPPLIES
2378925   S IMP SCREW   5.0 X 70MM CA              797.00      0.00   23           SURGICAL SUPPLIES
2379006   S IMP SCREW   5.0 X 75MM CA              875.00      0.00   23           SURGICAL SUPPLIES
2379030   S IMP SCREW   5.0 X 80MM LO              875.00      0.00   23           SURGICAL SUPPLIES
2379253   S IMP SCREW   5.5 X 105MM               1085.00      0.00   23           SURGICAL SUPPLIES
2379402   S IMP SCREW   5.5 X 110MM C             1172.00      0.00   23           SURGICAL SUPPLIES
2379246   S IMP SCREW   5.5 X 95MM                1085.00      0.00   23           SURGICAL SUPPLIES
2321362   S IMP SCREW   6.0 X 30                  2378.00      0.00   23           SURGICAL SUPPLIES
2379840   S IMP SCREW   6.0 X 35MM SI             2378.00      0.00   23           SURGICAL SUPPLIES
2379857   S IMP SCREW   6.0 X 40MM SI             2378.00      0.00   23           SURGICAL SUPPLIES
2379865   S IMP SCREW   6.0 X 60MM SI             2378.00      0.00   23           SURGICAL SUPPLIES
2379055   S IMP SCREW   6.0 X 85MM LO              905.00      0.00   23           SURGICAL SUPPLIES
2374155   S IMP SCREW   6.2 X 55MM PE             2583.00      0.00   23           SURGICAL SUPPLIES
2374163   S IMP SCREW   6.2 X 60MM PE             2583.00      0.00   23           SURGICAL SUPPLIES
2378685   S IMP SCREW   6.28 X 40MM C              707.00      0.00   23           SURGICAL SUPPLIES
2378693   S IMP SCREW   6.28 X 45MM C              707.00      0.00   23           SURGICAL SUPPLIES
2378701   S IMP SCREW   6.28 X 50MM C              707.00      0.00   23           SURGICAL SUPPLIES
2378552   S IMP SCREW   6.5 X 16MM BO              675.00      0.00   23           SURGICAL SUPPLIES
2378859   S IMP SCREW   6.5 X 20MM CA              757.00      0.00   23           SURGICAL SUPPLIES
2378503   S IMP SCREW   6.5 X 20MM CA              643.00      0.00   23           SURGICAL SUPPLIES
2378560   S IMP SCREW   6.5 X 20MM CA              675.00      0.00   23           SURGICAL SUPPLIES
2378867   S IMP SCREW   6.5 X 25MM CA              757.00      0.00   23           SURGICAL SUPPLIES
2378578   S IMP SCREW   6.5 X 30MM CA              675.00      0.00   23           SURGICAL SUPPLIES
2378594   S IMP SCREW   6.5 X 35MM BO              675.00      0.00   23           SURGICAL SUPPLIES
2378875   S IMP SCREW   6.5 X 35MM CA              757.00      0.00   23           SURGICAL SUPPLIES
2377729   S IMP SCREW   6.5 X 75MM CA              227.00      0.00   23           SURGICAL SUPPLIES
2377737   S IMP SCREW   6.5 X 80MM CA              227.00      0.00   23           SURGICAL SUPPLIES
2377760   S IMP SCREW   6.5 X 85MM CA              252.00      0.00   23           SURGICAL SUPPLIES
2379873   S IMP SCREW   7.0 X 55MM SI             2378.00      0.00   23           SURGICAL SUPPLIES
2379881   S IMP SCREW   7.0 X 60MM SI             2378.00      0.00   23           SURGICAL SUPPLIES
2379410   S IMP SCREW   7.3 X 115MM C             1188.00      0.00   23           SURGICAL SUPPLIES




                                                       Page 164
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2379428   S IMP SCREW   7.3 X 120MM C       1188.00      0.00   23           SURGICAL SUPPLIES
2379444   S IMP SCREW   7.3 X 75MM LO       1218.00      0.00   23           SURGICAL SUPPLIES
2379345   S IMP SCREW   7.3 X 85MM CA       1138.00      0.00   23           SURGICAL SUPPLIES
2379352   S IMP SCREW   7.3 X 90MM CA       1138.00      0.00   23           SURGICAL SUPPLIES
2379394   S IMP SCREW   9 X 35MM DELT       1163.00      0.00   23           SURGICAL SUPPLIES
2370294   S IMP SCREW   ACET OSTEO           992.00      0.00   23           SURGICAL SUPPLIES
2370427   S IMP SCREW   ALL                  338.00      0.00   23           SURGICAL SUPPLIES
2378602   S IMP SCREW   BONE 6.5 X 24        675.00      0.00   23           SURGICAL SUPPLIES
2378586   S IMP SCREW   BONE HOWMEDIC        675.00      0.00   23           SURGICAL SUPPLIES
2375509   S IMP SCREW   CANCELLOUS 4.        130.00      0.00   23           SURGICAL SUPPLIES
2377711   S IMP SCREW   CANCELLOUS TH        227.00      0.00   23           SURGICAL SUPPLIES
2370534   S IMP SCREW   CANNULATED          1254.00      0.00   23           SURGICAL SUPPLIES
2375277   S IMP SCREW   CANNULATED BI       1163.00      0.00   23           SURGICAL SUPPLIES
2375780   S IMP SCREW   COMPRESSION 3        310.00      0.00   23           SURGICAL SUPPLIES
2378784   S IMP SCREW   COMPRESSION T        704.00      0.00   23           SURGICAL SUPPLIES
2376036   S IMP SCREW   COMPRESSION T        704.00      0.00   23           SURGICAL SUPPLIES
2371060   S IMP SCREW   CORTEX               219.00      0.00   23           SURGICAL SUPPLIES
2376317   S IMP SCREW   CORTEX TITANI        992.00      0.00   23           SURGICAL SUPPLIES
2376309   S IMP SCREW   CORTEX TITANI        992.00      0.00   23           SURGICAL SUPPLIES
2375574   S IMP SCREW   CORTICAL 3.5         151.00      0.00   23           SURGICAL SUPPLIES
2375517   S IMP SCREW   CORTICAL 3.5         151.00      0.00   23           SURGICAL SUPPLIES
2375624   S IMP SCREW   CORTICAL 3.5         151.00      0.00   23           SURGICAL SUPPLIES
2375640   S IMP SCREW   CORTICAL 3.5         151.00      0.00   23           SURGICAL SUPPLIES
2375558   S IMP SCREW   CORTICAL 3.5         151.00      0.00   23           SURGICAL SUPPLIES
2375541   S IMP SCREW   CORTICAL 3.5         151.00      0.00   23           SURGICAL SUPPLIES
2375616   S IMP SCREW   CORTICAL 3.5         151.00      0.00   23           SURGICAL SUPPLIES
2375582   S IMP SCREW   CORTICAL 3.5         151.00      0.00   23           SURGICAL SUPPLIES
2375608   S IMP SCREW   CORTICAL 3.5         151.00      0.00   23           SURGICAL SUPPLIES
2375483   S IMP SCREW   CORTICAL 3.5         118.00      0.00   23           SURGICAL SUPPLIES
2375533   S IMP SCREW   CORTICAL 3.5         151.00      0.00   23           SURGICAL SUPPLIES
2375566   S IMP SCREW   CORTICAL 3.5         151.00      0.00   23           SURGICAL SUPPLIES
2375723   S IMP SCREW   CORTICAL 4.5         186.00      0.00   23           SURGICAL SUPPLIES
2375665   S IMP SCREW   CORTICAL 4.5         153.00      0.00   23           SURGICAL SUPPLIES
2375657   S IMP SCREW   CORTICAL 4.5         153.00      0.00   23           SURGICAL SUPPLIES
2375681   S IMP SCREW   CORTICAL OMEG        186.00      0.00   23           SURGICAL SUPPLIES
2375699   S IMP SCREW   CORTICAL OMEG        186.00      0.00   23           SURGICAL SUPPLIES
2375707   S IMP SCREW   CORTICAL OMEG        186.00      0.00   23           SURGICAL SUPPLIES
2375715   S IMP SCREW   CORTICAL OMEG        186.00      0.00   23           SURGICAL SUPPLIES
2376010   S IMP SCREW   CROSS 6.28 X         704.00      0.00   23           SURGICAL SUPPLIES
2371078   S IMP SCREW   DHS LAG             2021.00      0.00   23           SURGICAL SUPPLIES
2371086   S IMP SCREW   DHS/DCS COMPR        299.00      0.00   23           SURGICAL SUPPLIES
2379543   S IMP SCREW   GAMMA LAG 12        1448.00      0.00   23           SURGICAL SUPPLIES
2370930   S IMP SCREW   INTERMEDULLAR       1544.00      0.00   23           SURGICAL SUPPLIES
2321370   S IMP SCREW   LAG 70MM            1312.00      0.00   23           SURGICAL SUPPLIES
2376465   S IMP SCREW   LAG GAMMA 100       1448.00      0.00   23           SURGICAL SUPPLIES
2376390   S IMP SCREW   LAG SCREW 100       1327.00      0.00   23           SURGICAL SUPPLIES
2376275   S IMP SCREW   LAG SCREW 105        961.00      0.00   23           SURGICAL SUPPLIES
2370955   S IMP SCREW   LBG COMPRESS        1870.00      0.00   23           SURGICAL SUPPLIES
2376069   S IMP SCREW   LOCKING 5 X 4        704.00      0.00   23           SURGICAL SUPPLIES
2376077   S IMP SCREW   LOCKING 5 X 5        704.00      0.00   23           SURGICAL SUPPLIES
2376093   S IMP SCREW   LOCKING 5 X 6        704.00      0.00   23           SURGICAL SUPPLIES
2378826   S IMP SCREW   LOCKING 5.0 X        704.00      0.00   23           SURGICAL SUPPLIES
2376051   S IMP SCREW   LOCKING 5X40M        704.00      0.00   23           SURGICAL SUPPLIES




                                                 Page 165
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2376101   S IMP SCREW LOCKING T2 65         704.00      0.00   23           SURGICAL SUPPLIES
2375749   S IMP SCREW LOCKING TITAN         243.00      0.00   23           SURGICAL SUPPLIES
2375673   S IMP SCREW OMEGA PLUS CO         186.00      0.00   23           SURGICAL SUPPLIES
2370948   S IMP SCREW REG BONE              243.00      0.00   23           SURGICAL SUPPLIES
2377562   S IMP SCREW SELF TAPPING          160.00      0.00   23           SURGICAL SUPPLIES
2376002   S IMP SCREW SET SCREW 27M         704.00      0.00   23           SURGICAL SUPPLIES
2376606   S IMP SCREW SIDE OPENING         2402.00      0.00   23           SURGICAL SUPPLIES
2376598   S IMP SCREW SIDE OPENING         2402.00      0.00   23           SURGICAL SUPPLIES
2376614   S IMP SCREW SIDE OPENING         2402.00      0.00   23           SURGICAL SUPPLIES
2379261   S IMP SCREW STANDARD LAG         1106.00      0.00   23           SURGICAL SUPPLIES
2379287   S IMP SCREW STANDARD LAG         1109.00      0.00   23           SURGICAL SUPPLIES
2376366   S IMP SCREW STANDARD LAG         1196.00      0.00   23           SURGICAL SUPPLIES
2376374   S IMP SCREW STANDARD LAG         1196.00      0.00   23           SURGICAL SUPPLIES
2376267   S IMP SCREW STANDARD LAG          961.00      0.00   23           SURGICAL SUPPLIES
2376358   S IMP SCREW SUPER LAG SCR        1196.00      0.00   23           SURGICAL SUPPLIES
2376168   S IMP SCREW SYNTHES TI LO         822.00      0.00   23           SURGICAL SUPPLIES
2376044   S IMP SCREW T2 30MM HOWME         704.00      0.00   23           SURGICAL SUPPLIES
2376085   S IMP SCREW T2 55MM HOWME         704.00      0.00   23           SURGICAL SUPPLIES
2376127   S IMP SCREW T2 75MM LOCKI         704.00      0.00   23           SURGICAL SUPPLIES
2376119   S IMP SCREW T2 LOCKING 70         704.00      0.00   23           SURGICAL SUPPLIES
2376416   S IMP SCREW TITANIUM 4.5         1351.00      0.00   23           SURGICAL SUPPLIES
2397396   S IMP SCREW, 3MMX15MM             955.00      0.00   23           SURGICAL SUPPLIES
2397586   S IMP SCREW, 3MMX20MM             955.00      0.00   23           SURGICAL SUPPLIES
2397594   S IMP SCREW, 3MMX22MM             954.00      0.00   23           SURGICAL SUPPLIES
2397602   S IMP SCREW, 3MMX26MM             955.00      0.00   23           SURGICAL SUPPLIES
2397610   S IMP SCREW, 4MMX10MM             929.00      0.00   23           SURGICAL SUPPLIES
2397628   S IMP SCREW, 4MMX30MM             929.00      0.00   23           SURGICAL SUPPLIES
2396844   S IMP SCREW, 60MM                 227.00      0.00   23           SURGICAL SUPPLIES
2396851   S IMP SCREW, 65MM                 227.00      0.00   23           SURGICAL SUPPLIES
2396901   S IMP SCREW, 2.0MMX4MM            352.00      0.00   23           SURGICAL SUPPLIES
2397263   S IMP SCREW, 4.0MMX28MM           133.00      0.00   23           SURGICAL SUPPLIES
2397271   S IMP SCREW, 4.0MMX50MM           133.00      0.00   23           SURGICAL SUPPLIES
2397289   S IMP SCREW, 4.0MMX55MM           133.00      0.00   23           SURGICAL SUPPLIES
2397297   S IMP SCREW, 4.0MMX60MM           133.00      0.00   23           SURGICAL SUPPLIES
2397255   S IMP SCREW, 4.0X30MM             135.00      0.00   23           SURGICAL SUPPLIES
2396919   S IMP SCREW, 4.5 X 18MM           160.00      0.00   23           SURGICAL SUPPLIES
2396927   S IMP SCREW, 4.5 X 60MM           160.00      0.00   23           SURGICAL SUPPLIES
2397404   S IMP SCREW, 4.5MMX20MM           954.00      0.00   23           SURGICAL SUPPLIES
2397412   S IMP SCREW, 4.5MMX22MM           954.00      0.00   23           SURGICAL SUPPLIES
2397420   S IMP SCREW, 4.5MMX24MM           954.00      0.00   23           SURGICAL SUPPLIES
2397438   S IMP SCREW, 4.5MMX26MM           954.00      0.00   23           SURGICAL SUPPLIES
2397446   S IMP SCREW, 4.5MMX28MM           954.00      0.00   23           SURGICAL SUPPLIES
2397453   S IMP SCREW, 4.5MMX30MM           954.00      0.00   23           SURGICAL SUPPLIES
2397461   S IMP SCREW, 4.5MMX32MM           954.00      0.00   23           SURGICAL SUPPLIES
2397479   S IMP SCREW, 4.5MMX34MM           954.00      0.00   23           SURGICAL SUPPLIES
2397487   S IMP SCREW, 4.5MMX36MM           954.00      0.00   23           SURGICAL SUPPLIES
2397495   S IMP SCREW, 4.5MMX38MM           954.00      0.00   23           SURGICAL SUPPLIES
2397503   S IMP SCREW, 4.5MMX40MM           954.00      0.00   23           SURGICAL SUPPLIES
2397511   S IMP SCREW, 4.5MMX44MM           954.00      0.00   23           SURGICAL SUPPLIES
2397529   S IMP SCREW, 4.5MMX48MM           954.00      0.00   23           SURGICAL SUPPLIES
2397537   S IMP SCREW, 4.5MMX50MM           954.00      0.00   23           SURGICAL SUPPLIES
2397545   S IMP SCREW, 4.5MMX52MM           954.00      0.00   23           SURGICAL SUPPLIES
2397552   S IMP SCREW, 4.5MMX54MM           954.00      0.00   23           SURGICAL SUPPLIES




                                                Page 166
                                      85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2397875   S IMP SCREW,   4.5MMX56MM              954.00      0.00   23           SURGICAL SUPPLIES
2397883   S IMP SCREW,   4.5MMX60MM              954.00      0.00   23           SURGICAL SUPPLIES
2397891   S IMP SCREW,   4.5MMX64MM              954.00      0.00   23           SURGICAL SUPPLIES
2397560   S IMP SCREW,   4.5MMX68MM              954.00      0.00   23           SURGICAL SUPPLIES
2396935   S IMP SCREW,   4.5X22MM                160.00      0.00   23           SURGICAL SUPPLIES
2397578   S IMP SCREW,   4.5X72MM                954.00      0.00   23           SURGICAL SUPPLIES
2396836   S IMP SCREW,   50MM                    227.00      0.00   23           SURGICAL SUPPLIES
2397636   S IMP SCREW,   6.5MMX110M              251.00      0.00   23           SURGICAL SUPPLIES
2397644   S IMP SCREW,   6.5MMX55MM              227.00      0.00   23           SURGICAL SUPPLIES
2397222   S IMP SCREW,   6.5X25MM                240.00      0.00   23           SURGICAL SUPPLIES
2397230   S IMP SCREW,   6.5X30MM                240.00      0.00   23           SURGICAL SUPPLIES
2397248   S IMP SCREW,   6.5X35MM                240.00      0.00   23           SURGICAL SUPPLIES
2397651   S IMP SCREW,   7.0MMX70MM             1142.00      0.00   23           SURGICAL SUPPLIES
2396869   S IMP SCREW,   70MM                    227.00      0.00   23           SURGICAL SUPPLIES
2396877   S IMP SCREW,   75MM                    227.00      0.00   23           SURGICAL SUPPLIES
2396885   S IMP SCREW,   80MM                    251.00      0.00   23           SURGICAL SUPPLIES
2396893   S IMP SCREW,   85MM                    251.00      0.00   23           SURGICAL SUPPLIES
2398105   S IMP SCREW,   1.0X6MM                 443.00      0.00   23           SURGICAL SUPPLIES
2397974   S IMP SCREW,   1.3X3MM                 417.00      0.00   23           SURGICAL SUPPLIES
2397982   S IMP SCREW,   1.3X6MM                 417.00      0.00   23           SURGICAL SUPPLIES
2398113   S IMP SCREW,   1.5MMX11MM              155.00      0.00   23           SURGICAL SUPPLIES
2398121   S IMP SCREW,   1.5MMX12MM              155.00      0.00   23           SURGICAL SUPPLIES
2398139   S IMP SCREW,   1.5MMX14MM              155.00      0.00   23           SURGICAL SUPPLIES
2398147   S IMP SCREW,   1.5MMX6MM               155.00      0.00   23           SURGICAL SUPPLIES
2398154   S IMP SCREW,   1.5MMX7MM               155.00      0.00   23           SURGICAL SUPPLIES
2398162   S IMP SCREW,   1.5MMX9MM               155.00      0.00   23           SURGICAL SUPPLIES
2398170   S IMP SCREW,   1.5X10MM                155.00      0.00   23           SURGICAL SUPPLIES
2398188   S IMP SCREW,   1.5X16MM                155.00      0.00   23           SURGICAL SUPPLIES
2398196   S IMP SCREW,   1.5X8MM                 155.00      0.00   23           SURGICAL SUPPLIES
2398204   S IMP SCREW,   2.0MMX10MM              157.00      0.00   23           SURGICAL SUPPLIES
2398212   S IMP SCREW,   2.0MMX16MM              157.00      0.00   23           SURGICAL SUPPLIES
2398220   S IMP SCREW,   2.0MMX8MM               157.00      0.00   23           SURGICAL SUPPLIES
2398238   S IMP SCREW,   2.0X20MM                157.00      0.00   23           SURGICAL SUPPLIES
2398246   S IMP SCREW,   2.0X6MM                 157.00      0.00   23           SURGICAL SUPPLIES
2398253   S IMP SCREW,   2.4 X 6MM               447.00      0.00   23           SURGICAL SUPPLIES
2398261   S IMP SCREW,   2.4MMX11MM              447.00      0.00   23           SURGICAL SUPPLIES
2398279   S IMP SCREW,   2.7MMX32MM              157.00      0.00   23           SURGICAL SUPPLIES
2398287   S IMP SCREW,   2.7MMX44MM              157.00      0.00   23           SURGICAL SUPPLIES
2398295   S IMP SCREW,   2.7X6MM                 157.00      0.00   23           SURGICAL SUPPLIES
2398303   S IMP SCREW,   2.7X8MM                 157.00      0.00   23           SURGICAL SUPPLIES
2397909   S IMP SCREW,   3.0 X 40MM              954.00      0.00   23           SURGICAL SUPPLIES
2397917   S IMP SCREW,   3.0MMX29MM              954.00      0.00   23           SURGICAL SUPPLIES
2397925   S IMP SCREW,   3.0X38MM                954.00      0.00   23           SURGICAL SUPPLIES
2398311   S IMP SCREW,   3.5MMX34MM              122.00      0.00   23           SURGICAL SUPPLIES
2398329   S IMP SCREW,   3.5MMX36MM              122.00      0.00   23           SURGICAL SUPPLIES
2398337   S IMP SCREW,   3.5MMX42MM              157.00      0.00   23           SURGICAL SUPPLIES
2398345   S IMP SCREW,   3.5MMX44MM              157.00      0.00   23           SURGICAL SUPPLIES
2398352   S IMP SCREW,   3.5MMX46MM              157.00      0.00   23           SURGICAL SUPPLIES
2398360   S IMP SCREW,   3.5MMX48MM              157.00      0.00   23           SURGICAL SUPPLIES
2320091   S IMP SCREW,   3.5MMX50MM              776.00      0.00   23           SURGICAL SUPPLIES
2398378   S IMP SCREW,   3.5MMX50MM              122.00      0.00   23           SURGICAL SUPPLIES
2398386   S IMP SCREW,   3.5X45MM                122.00      0.00   23           SURGICAL SUPPLIES
2397990   S IMP SCREW,   3.5X60MM                189.00      0.00   23           SURGICAL SUPPLIES




                                                     Page 167
                                   85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2398006   S IMP SCREW,   4.0MMX12MM          1531.00      0.00   23           SURGICAL SUPPLIES
2398014   S IMP SCREW,   4.0MMX14MM          1531.00      0.00   23           SURGICAL SUPPLIES
2398022   S IMP SCREW,   4.0MMX16MM          1531.00      0.00   23           SURGICAL SUPPLIES
2396968   S IMP SCREW,   4.0X10MM             133.00      0.00   23           SURGICAL SUPPLIES
2396950   S IMP SCREW,   4.0X10MM             133.00      0.00   23           SURGICAL SUPPLIES
2396976   S IMP SCREW,   4.0X12MM             133.00      0.00   23           SURGICAL SUPPLIES
2396984   S IMP SCREW,   4.0X12MM             133.00      0.00   23           SURGICAL SUPPLIES
2397305   S IMP SCREW,   4.0X12MM            1531.00      0.00   23           SURGICAL SUPPLIES
2397313   S IMP SCREW,   4.0X14MM            1531.00      0.00   23           SURGICAL SUPPLIES
2396992   S IMP SCREW,   4.0X14MM             133.00      0.00   23           SURGICAL SUPPLIES
2397008   S IMP SCREW,   4.0X16MM             133.00      0.00   23           SURGICAL SUPPLIES
2397321   S IMP SCREW,   4.0X16MM            1531.00      0.00   23           SURGICAL SUPPLIES
2397016   S IMP SCREW,   4.0X18MM             133.00      0.00   23           SURGICAL SUPPLIES
2397024   S IMP SCREW,   4.0X20MM             133.00      0.00   23           SURGICAL SUPPLIES
2397339   S IMP SCREW,   4.0X20MM             929.00      0.00   23           SURGICAL SUPPLIES
2397032   S IMP SCREW,   4.0X24MM             133.00      0.00   23           SURGICAL SUPPLIES
2397040   S IMP SCREW,   4.0X26MM             133.00      0.00   23           SURGICAL SUPPLIES
2397057   S IMP SCREW,   4.0X28MM             133.00      0.00   23           SURGICAL SUPPLIES
2397065   S IMP SCREW,   4.0X32MM             133.00      0.00   23           SURGICAL SUPPLIES
2397073   S IMP SCREW,   4.0X45MM             133.00      0.00   23           SURGICAL SUPPLIES
2398394   S IMP SCREW,   4.5                  118.00      0.00   23           SURGICAL SUPPLIES
2398402   S IMP SCREW,   4.5MMX66MM           160.00      0.00   23           SURGICAL SUPPLIES
2398410   S IMP SCREW,   4.5MMX76MM           242.00      0.00   23           SURGICAL SUPPLIES
2398428   S IMP SCREW,   4.5MMX80MM           242.00      0.00   23           SURGICAL SUPPLIES
2398436   S IMP SCREW,   4.5MMX85MM           242.00      0.00   23           SURGICAL SUPPLIES
2398444   S IMP SCREW,   4.5MMX90MM           242.00      0.00   23           SURGICAL SUPPLIES
2397081   S IMP SCREW,   4.5X12MM SD         1467.00      0.00   23           SURGICAL SUPPLIES
2397099   S IMP SCREW,   4.5X14MM SD         1467.00      0.00   23           SURGICAL SUPPLIES
2397107   S IMP SCREW,   4.5X16MM SD         1467.00      0.00   23           SURGICAL SUPPLIES
2320299   S IMP SCREW,   5.0 X 150M           730.00      0.00   23           SURGICAL SUPPLIES
2397115   S IMP SCREW,   6.5 45X16MM          227.00      0.00   23           SURGICAL SUPPLIES
2397123   S IMP SCREW,   6.5 45X32MM          227.00      0.00   23           SURGICAL SUPPLIES
2397131   S IMP SCREW,   6.5 65X16MM          227.00      0.00   23           SURGICAL SUPPLIES
2397156   S IMP SCREW,   6.5MM                227.00      0.00   23           SURGICAL SUPPLIES
2397149   S IMP SCREW,   6.5MM                227.00      0.00   23           SURGICAL SUPPLIES
2397164   S IMP SCREW,   6.5MMX100MM          251.00      0.00   23           SURGICAL SUPPLIES
2397172   S IMP SCREW,   6.5MMX105MM          251.00      0.00   23           SURGICAL SUPPLIES
2397669   S IMP SCREW,   6.5MMX105MM          251.00      0.00   23           SURGICAL SUPPLIES
2397677   S IMP SCREW,   6.5MMX110MM          251.00      0.00   23           SURGICAL SUPPLIES
2397685   S IMP SCREW,   6.5MMX25MM           227.00      0.00   23           SURGICAL SUPPLIES
2397180   S IMP SCREW,   6.5MMX30MM           227.00      0.00   23           SURGICAL SUPPLIES
2397693   S IMP SCREW,   6.5MMX30MM           227.00      0.00   23           SURGICAL SUPPLIES
2396943   S IMP SCREW,   6.5MMX35MM           227.00      0.00   23           SURGICAL SUPPLIES
2397701   S IMP SCREW,   6.5MMX40MM           227.00      0.00   23           SURGICAL SUPPLIES
2397719   S IMP SCREW,   6.5MMX40MM           227.00      0.00   23           SURGICAL SUPPLIES
2397727   S IMP SCREW,   6.5MMX50MM           227.00      0.00   23           SURGICAL SUPPLIES
2397735   S IMP SCREW,   6.5MMX55MM           227.00      0.00   23           SURGICAL SUPPLIES
2397198   S IMP SCREW,   6.5MMX60MM           227.00      0.00   23           SURGICAL SUPPLIES
2397743   S IMP SCREW,   6.5MMX85MM           251.00      0.00   23           SURGICAL SUPPLIES
2397206   S IMP SCREW,   6.5MMX90MM           251.00      0.00   23           SURGICAL SUPPLIES
2397214   S IMP SCREW,   6.5MMX95MM           251.00      0.00   23           SURGICAL SUPPLIES
2397750   S IMP SCREW,   6.5MMX95MM           251.00      0.00   23           SURGICAL SUPPLIES
2397933   S IMP SCREW,   7.3MM X 135         1142.00      0.00   23           SURGICAL SUPPLIES




                                                  Page 168
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2397941   S IMP SCREW, 7.3MM X 140         1142.00      0.00   23           SURGICAL SUPPLIES
2397768   S IMP SCREW, 7.3MMX100MM         1142.00      0.00   23           SURGICAL SUPPLIES
2397776   S IMP SCREW, 7.3MMX105MM         1142.00      0.00   23           SURGICAL SUPPLIES
2397784   S IMP SCREW, 7.3MMX110MM         1142.00      0.00   23           SURGICAL SUPPLIES
2397792   S IMP SCREW, 7.3MMX115MM         1142.00      0.00   23           SURGICAL SUPPLIES
2397800   S IMP SCREW, 7.3MMX120MM         1142.00      0.00   23           SURGICAL SUPPLIES
2397818   S IMP SCREW, 7.3MMX125MM         1142.00      0.00   23           SURGICAL SUPPLIES
2397826   S IMP SCREW, 7.3MMX130MM         1142.00      0.00   23           SURGICAL SUPPLIES
2397834   S IMP SCREW, 7.3MMX55MM          1142.00      0.00   23           SURGICAL SUPPLIES
2397842   S IMP SCREW, 7.3MMX60MM          1142.00      0.00   23           SURGICAL SUPPLIES
2397859   S IMP SCREW, 7.3MMX75MM          1142.00      0.00   23           SURGICAL SUPPLIES
2397867   S IMP SCREW, 7.3MMX80MM          1142.00      0.00   23           SURGICAL SUPPLIES
2397347   S IMP SCREW, 7.3X32X135M         1142.00      0.00   23           SURGICAL SUPPLIES
2397354   S IMP SCREW, 7.3X32X140M         1142.00      0.00   23           SURGICAL SUPPLIES
2397362   S IMP SCREW, 7.3X32X145M         1142.00      0.00   23           SURGICAL SUPPLIES
2397370   S IMP SCREW, 7.3X32X150M         1142.00      0.00   23           SURGICAL SUPPLIES
2398519   S IMP SCREW, LRG 4.5MMX7          193.00      0.00   23           SURGICAL SUPPLIES
2398527   S IMP SCREW, TAP 2.0X54M          587.00      0.00   23           SURGICAL SUPPLIES
2398535   S IMP SCREW, TAP 4.5 125          645.00      0.00   23           SURGICAL SUPPLIES
2398543   S IMP SCREW, TI 1.0X2MM           443.00      0.00   23           SURGICAL SUPPLIES
2398550   S IMP SCREW, TI 1.0X3MM           443.00      0.00   23           SURGICAL SUPPLIES
2398568   S IMP SCREW, TI 1.0X4MM           443.00      0.00   23           SURGICAL SUPPLIES
2398576   S IMP SCREW, TI 1.5MM X           319.00      0.00   23           SURGICAL SUPPLIES
2398584   S IMP SCREW, TI 1.5X6MM           319.00      0.00   23           SURGICAL SUPPLIES
2398592   S IMP SCREW, TI 2.4MM X           447.00      0.00   23           SURGICAL SUPPLIES
2398600   S IMP SCREW, TI 2.4X14MM          447.00      0.00   23           SURGICAL SUPPLIES
2398618   S IMP SCREW, TI 2.4X26MM          447.00      0.00   23           SURGICAL SUPPLIES
2398626   S IMP SCREW, TI 2.4X30MM          447.00      0.00   23           SURGICAL SUPPLIES
2398634   S IMP SCREW, TI 2.4X32MM          447.00      0.00   23           SURGICAL SUPPLIES
2398642   S IMP SCREW, TI 2.4X34MM          447.00      0.00   23           SURGICAL SUPPLIES
2398659   S IMP SCREW, TI 2.4X8MM           447.00      0.00   23           SURGICAL SUPPLIES
2398667   S IMP SCREW, TI 3.5 X 18          122.00      0.00   23           SURGICAL SUPPLIES
2398030   S IMP SCREW, TI 4.5X44MM          193.00      0.00   23           SURGICAL SUPPLIES
2398048   S IMP SCREW, TI 4.5X46MM          193.00      0.00   23           SURGICAL SUPPLIES
2398055   S IMP SCREW, TI 4.5X48MM          193.00      0.00   23           SURGICAL SUPPLIES
2398063   S IMP SCREW, TI 4.5X50MM          193.00      0.00   23           SURGICAL SUPPLIES
2398071   S IMP SCREW, TI 4.5X52MM          193.00      0.00   23           SURGICAL SUPPLIES
2398089   S IMP SCREW, TI 4.5X54MM          193.00      0.00   23           SURGICAL SUPPLIES
2398097   S IMP SCREW, TI 4.5X56MM          193.00      0.00   23           SURGICAL SUPPLIES
2398675   S IMP SCREW, TITAN 2.7 X          319.00      0.00   23           SURGICAL SUPPLIES
2398683   S IMP SCREW, TITAN 3.5MM          122.00      0.00   23           SURGICAL SUPPLIES
2398709   S IMP SCREW, TITAN 3.5MM          122.00      0.00   23           SURGICAL SUPPLIES
2398691   S IMP SCREW, TITAN 3.5MM          122.00      0.00   23           SURGICAL SUPPLIES
2394971   S IMP SCREW, 4.0 24MM             929.00      0.00   23           SURGICAL SUPPLIES
2394989   S IMP SCREW, 4.0 26MM             929.00      0.00   23           SURGICAL SUPPLIES
2394997   S IMP SCREW, 4.0 28MM             929.00      0.00   23           SURGICAL SUPPLIES
2395002   S IMP SCREW, 4.0 32MM             929.00      0.00   23           SURGICAL SUPPLIES
2395028   S IMP SCREW, 4.0 34MM             929.00      0.00   23           SURGICAL SUPPLIES
2395010   S IMP SCREW, 4.0 34MM             929.00      0.00   23           SURGICAL SUPPLIES
2395036   S IMP SCREW, 4.0 36MM             929.00      0.00   23           SURGICAL SUPPLIES
2395044   S IMP SCREW, 4.0 38MM             929.00      0.00   23           SURGICAL SUPPLIES
2395051   S IMP SCREW, 4.0 40MM             929.00      0.00   23           SURGICAL SUPPLIES
2395069   S IMP SCREW, 4.0 42MM             929.00      0.00   23           SURGICAL SUPPLIES




                                                Page 169
                                     85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2395077   S IMP SCREW, 4.0 44MM                 929.00      0.00   23           SURGICAL SUPPLIES
2395085   S IMP SCREW, 4.0 50MM                 929.00      0.00   23           SURGICAL SUPPLIES
2395093   S IMP SCREW, 4.0 X 12MM              1117.00      0.00   23           SURGICAL SUPPLIES
2395101   S IMP SCREW, 4.0 X 16 MM              678.00      0.00   23           SURGICAL SUPPLIES
2395119   S IMP SCREW, 4.0 X 16MM              1537.00      0.00   23           SURGICAL SUPPLIES
2395127   S IMP SCREW, 4.0 X 17MM              1537.00      0.00   23           SURGICAL SUPPLIES
2395135   S IMP SCREW, 4.0 X 20MM               122.00      0.00   23           SURGICAL SUPPLIES
2395143   S IMP SCREW, 4.0 X 22 MM              678.00      0.00   23           SURGICAL SUPPLIES
2395150   S IMP SCREW, 4.0 X 22MM               966.00      0.00   23           SURGICAL SUPPLIES
2395168   S IMP SCREW, 4.0 X 26                 699.00      0.00   23           SURGICAL SUPPLIES
2395176   S IMP SCREW, 4.0 X 26MM               966.00      0.00   23           SURGICAL SUPPLIES
2395184   S IMP SCREW, 4.0 X 28MM               966.00      0.00   23           SURGICAL SUPPLIES
2395192   S IMP SCREW, 4.0 X 30MM               699.00      0.00   23           SURGICAL SUPPLIES
2395200   S IMP SCREW, 4.0 X 30MM               133.00      0.00   23           SURGICAL SUPPLIES
2395218   S IMP SCREW, 4.0 X 30MM               931.00      0.00   23           SURGICAL SUPPLIES
2395226   S IMP SCREW, 4.0 X 30MM               678.00      0.00   23           SURGICAL SUPPLIES
2395234   S IMP SCREW, 4.0 X 32MM               931.00      0.00   23           SURGICAL SUPPLIES
2395242   S IMP SCREW, 4.0 X 36MM               966.00      0.00   23           SURGICAL SUPPLIES
2395259   S IMP SCREW, 4.0 X 38MM               678.00      0.00   23           SURGICAL SUPPLIES
2395267   S IMP SCREW, 4.0 X 40MM               138.00      0.00   23           SURGICAL SUPPLIES
2395275   S IMP SCREW, 4.0 X 42MM               908.00      0.00   23           SURGICAL SUPPLIES
2395283   S IMP SCREW, 4.0 X 42MM               674.00      0.00   23           SURGICAL SUPPLIES
2395291   S IMP SCREW, 4.0 X 46MM               908.00      0.00   23           SURGICAL SUPPLIES
2395309   S IMP SCREW, 4.0 X 46MM               966.00      0.00   23           SURGICAL SUPPLIES
2395317   S IMP SCREW, 4.0 X 46MM               674.00      0.00   23           SURGICAL SUPPLIES
2395325   S IMP SCREW, 4.0 X 48MM               966.00      0.00   23           SURGICAL SUPPLIES
2395333   S IMP SCREW, 4.0 X 50MM               966.00      0.00   23           SURGICAL SUPPLIES
2395341   S IMP SCREW, 4.2 X 30MM              2472.00      0.00   23           SURGICAL SUPPLIES
2395358   S IMP SCREW, 4.35                    1211.00      0.00   23           SURGICAL SUPPLIES
2395366   S IMP SCREW, 4.35 X 12MM             1299.00      0.00   23           SURGICAL SUPPLIES
2395374   S IMP SCREW, 4.35 X 16MM             1461.00      0.00   23           SURGICAL SUPPLIES
2395382   S IMP SCREW, 4.5 LG 24MM              118.00      0.00   23           SURGICAL SUPPLIES
2395390   S IMP SCREW, 4.5 LG 26MM              118.00      0.00   23           SURGICAL SUPPLIES
2395408   S IMP SCREW, 4.5 LG 28MM              118.00      0.00   23           SURGICAL SUPPLIES
2395416   S IMP SCREW, 4.5 LG 36MM              118.00      0.00   23           SURGICAL SUPPLIES
2395424   S IMP SCREW, 4.5 LG 42MM              118.00      0.00   23           SURGICAL SUPPLIES
2351666   S IMP SCREW, 4.5 TITANIU               53.00      0.00   23           SURGICAL SUPPLIES
2395432   S IMP SCREW, 4.5 X 12MM              1299.00      0.00   23           SURGICAL SUPPLIES
2395440   S IMP SCREW, 4.5 X 14MM              1403.00      0.00   23           SURGICAL SUPPLIES
2395457   S IMP SCREW, 4.5 X 14MM               211.00      0.00   23           SURGICAL SUPPLIES
2395465   S IMP SCREW, 4.5 X 20MM               166.00      0.00   23           SURGICAL SUPPLIES
2395473   S IMP SCREW, 4.5 X 24MM               151.00      0.00   23           SURGICAL SUPPLIES
2395481   S IMP SCREW, 4.5 X 26MM               151.00      0.00   23           SURGICAL SUPPLIES
2395507   S IMP SCREW, 4.5 X 32MM               156.00      0.00   23           SURGICAL SUPPLIES
2395499   S IMP SCREW, 4.5 X 32MM               133.00      0.00   23           SURGICAL SUPPLIES
2320307   S IMP SCREW, 4.5 X 36MM               156.00      0.00   23           SURGICAL SUPPLIES
2395523   S IMP SCREW, 4.5 X 38MM               156.00      0.00   23           SURGICAL SUPPLIES
2395531   S IMP SCREW, 4.5 X 40MM               133.00      0.00   23           SURGICAL SUPPLIES
2395549   S IMP SCREW, 4.5 X 42MM               147.00      0.00   23           SURGICAL SUPPLIES
2395556   S IMP SCREW, 4.5 X 46MM               122.00      0.00   23           SURGICAL SUPPLIES
2395564   S IMP SCREW, 4.5 X 50MM               225.00      0.00   23           SURGICAL SUPPLIES
2395572   S IMP SCREW, 4.5 X 62MM               160.00      0.00   23           SURGICAL SUPPLIES
2395580   S IMP SCREW, 4.5 X 68MM               993.00      0.00   23           SURGICAL SUPPLIES




                                                    Page 170
                                     85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2395598   S IMP SCREW, 5 X 65MM                 829.00      0.00   23           SURGICAL SUPPLIES
2395606   S IMP SCREW, 5 X 75MM                 829.00      0.00   23           SURGICAL SUPPLIES
2395614   S IMP SCREW, 5 X 85MM                 829.00      0.00   23           SURGICAL SUPPLIES
2395622   S IMP SCREW, 5.0 X 200MM              730.00      0.00   23           SURGICAL SUPPLIES
2395630   S IMP SCREW, 5.0 X 150MM              901.00      0.00   23           SURGICAL SUPPLIES
2395648   S IMP SCREW, 5.0 X 18MM               881.00      0.00   23           SURGICAL SUPPLIES
2395655   S IMP SCREW, 5.0 X 200MM              579.00      0.00   23           SURGICAL SUPPLIES
2395663   S IMP SCREW, 5.0 X 26MM               881.00      0.00   23           SURGICAL SUPPLIES
2395671   S IMP SCREW, 5.0 X 32MM               320.00      0.00   23           SURGICAL SUPPLIES
2395689   S IMP SCREW, 5.0 X 34MM              1492.00      0.00   23           SURGICAL SUPPLIES
2395697   S IMP SCREW, 5.0 X 35MM               940.00      0.00   23           SURGICAL SUPPLIES
2395705   S IMP SCREW, 5.0 X 38MM               691.00      0.00   23           SURGICAL SUPPLIES
2395713   S IMP SCREW, 5.0 X 40MM               881.00      0.00   23           SURGICAL SUPPLIES
2395721   S IMP SCREW, 5.0 X 45MM               940.00      0.00   23           SURGICAL SUPPLIES
2395739   S IMP SCREW, 5.0 X 46MM              1492.00      0.00   23           SURGICAL SUPPLIES
2395770   S IMP SCREW, 5.0 X 50MM               954.00      0.00   23           SURGICAL SUPPLIES
2395762   S IMP SCREW, 5.0 X 50MM               709.00      0.00   23           SURGICAL SUPPLIES
2395754   S IMP SCREW, 5.0 X 50MM               940.00      0.00   23           SURGICAL SUPPLIES
2395747   S IMP SCREW, 5.0 X 50MM               940.00      0.00   23           SURGICAL SUPPLIES
2395812   S IMP SCREW, 5.0 X 55MM               881.00      0.00   23           SURGICAL SUPPLIES
2395804   S IMP SCREW, 5.0 X 55MM               709.00      0.00   23           SURGICAL SUPPLIES
2395796   S IMP SCREW, 5.0 X 55MM               703.00      0.00   23           SURGICAL SUPPLIES
2395788   S IMP SCREW, 5.0 X 55MM               874.00      0.00   23           SURGICAL SUPPLIES
2395820   S IMP SCREW, 5.0 X 60MM               940.00      0.00   23           SURGICAL SUPPLIES
2395838   S IMP SCREW, 5.0 X 65MM               881.00      0.00   23           SURGICAL SUPPLIES
2395846   S IMP SCREW, 5.0 X 75MM               881.00      0.00   23           SURGICAL SUPPLIES
2395853   S IMP SCREW, 5.0 X 80MM               709.00      0.00   23           SURGICAL SUPPLIES
2395887   S IMP SCREW, 5.0 X 85MM               881.00      0.00   23           SURGICAL SUPPLIES
2395879   S IMP SCREW, 5.0 X 85MM               667.00      0.00   23           SURGICAL SUPPLIES
2395861   S IMP SCREW, 5.0 X 85MM               874.00      0.00   23           SURGICAL SUPPLIES
2395903   S IMP SCREW, 5.0 X 90MM               875.00      0.00   23           SURGICAL SUPPLIES
2395895   S IMP SCREW, 5.0 X 90MM               709.00      0.00   23           SURGICAL SUPPLIES
2395911   S IMP SCREW, 5.0X28MM                 691.00      0.00   23           SURGICAL SUPPLIES
2395929   S IMP SCREW, 5.0X42MM                 691.00      0.00   23           SURGICAL SUPPLIES
2395986   S IMP SCREW, 6.5 100MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2395978   S IMP SCREW, 6.5 100MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2395994   S IMP SCREW, 6.5 105MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2396000   S IMP SCREW, 6.5 105MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2396018   S IMP SCREW, 6.5 110MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2396034   S IMP SCREW, 6.5 115MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2396026   S IMP SCREW, 6.5 115MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2396042   S IMP SCREW, 6.5 120MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2396059   S IMP SCREW, 6.5 120MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2396067   S IMP SCREW, 6.5 125MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2396075   S IMP SCREW, 6.5 125MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2396083   S IMP SCREW, 6.5 130MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2396091   S IMP SCREW, 6.5 130MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2396109   S IMP SCREW, 6.5 135MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2396117   S IMP SCREW, 6.5 140MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2396125   S IMP SCREW, 6.5 140MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2396141   S IMP SCREW, 6.5 145MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2396133   S IMP SCREW, 6.5 145MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2396166   S IMP SCREW, 6.5 150MM/              1142.00      0.00   23           SURGICAL SUPPLIES




                                                    Page 171
                                     85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2396158   S IMP SCREW, 6.5 150MM/              1142.00      0.00   23           SURGICAL SUPPLIES
2396174   S IMP SCREW, 6.5 30MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2395945   S IMP SCREW, 6.5 35MM                 227.00      0.00   23           SURGICAL SUPPLIES
2396182   S IMP SCREW, 6.5 35MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2396190   S IMP SCREW, 6.5 40MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2396208   S IMP SCREW, 6.5 45MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2395952   S IMP SCREW, 6.5 50MM                 227.00      0.00   23           SURGICAL SUPPLIES
2396224   S IMP SCREW, 6.5 50MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2396216   S IMP SCREW, 6.5 50MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2396232   S IMP SCREW, 6.5 55MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2396240   S IMP SCREW, 6.5 55MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2396257   S IMP SCREW, 6.5 60MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2396265   S IMP SCREW, 6.5 60MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2396273   S IMP SCREW, 6.5 65MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2396281   S IMP SCREW, 6.5 70MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2396299   S IMP SCREW, 6.5 75MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2396307   S IMP SCREW, 6.5 75MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2395960   S IMP SCREW, 6.5 80MM                 227.00      0.00   23           SURGICAL SUPPLIES
2396323   S IMP SCREW, 6.5 80MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2396315   S IMP SCREW, 6.5 80MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2396331   S IMP SCREW, 6.5 85MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2396349   S IMP SCREW, 6.5 90MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2396356   S IMP SCREW, 6.5 90MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2396364   S IMP SCREW, 6.5 95MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2396372   S IMP SCREW, 6.5 95MM/               1142.00      0.00   23           SURGICAL SUPPLIES
2395937   S IMP SCREW, 6.5 110MM                251.00      0.00   23           SURGICAL SUPPLIES
2396380   S IMP SCREW, 6.5 X 110MM             1188.00      0.00   23           SURGICAL SUPPLIES
2396398   S IMP SCREW, 6.5 X 12MM               643.00      0.00   23           SURGICAL SUPPLIES
2396406   S IMP SCREW, 6.5 X 30MM               790.00      0.00   23           SURGICAL SUPPLIES
2396414   S IMP SCREW, 6.5 X 35MM               790.00      0.00   23           SURGICAL SUPPLIES
2396422   S IMP SCREW, 6.5 X 45MM               790.00      0.00   23           SURGICAL SUPPLIES
2396430   S IMP SCREW, 6.5 X 45MM              1188.00      0.00   23           SURGICAL SUPPLIES
2396448   S IMP SCREW, 6.5 X 60MM               227.00      0.00   23           SURGICAL SUPPLIES
2396455   S IMP SCREW, 6.5 X 65MM              1142.00      0.00   23           SURGICAL SUPPLIES
2396463   S IMP SCREW, 6.5 X 70MM               209.00      0.00   23           SURGICAL SUPPLIES
2396471   S IMP SCREW, 6.5 X 70MM               227.00      0.00   23           SURGICAL SUPPLIES
2396489   S IMP SCREW, 6.5 X 70MM              1142.00      0.00   23           SURGICAL SUPPLIES
2396497   S IMP SCREW, 6.5 X 75MM               227.00      0.00   23           SURGICAL SUPPLIES
2396505   S IMP SCREW, 6.5 X 85MM              1142.00      0.00   23           SURGICAL SUPPLIES
2396513   S IMP SCREW, 6.5 X 90MM               251.00      0.00   23           SURGICAL SUPPLIES
2396521   S IMP SCREW, 6X1.3MM                  417.00      0.00   23           SURGICAL SUPPLIES
2396539   S IMP SCREW, 7.0 X 32MM               888.00      0.00   23           SURGICAL SUPPLIES
2396547   S IMP SCREW, 7.0 X 40MM              2402.00      0.00   23           SURGICAL SUPPLIES
2396554   S IMP SCREW, 7.0 X 50MM              2308.00      0.00   23           SURGICAL SUPPLIES
2396612   S IMP SCREW, 7.3 100MM               1142.00      0.00   23           SURGICAL SUPPLIES
2396562   S IMP SCREW, 7.3 100MM               1142.00      0.00   23           SURGICAL SUPPLIES
2396620   S IMP SCREW, 7.3 105MM               1142.00      0.00   23           SURGICAL SUPPLIES
2396570   S IMP SCREW, 7.3 110MM               1142.00      0.00   23           SURGICAL SUPPLIES
2396638   S IMP SCREW, 7.3 150MM               1142.00      0.00   23           SURGICAL SUPPLIES
2396588   S IMP SCREW, 7.3 50MM                1142.00      0.00   23           SURGICAL SUPPLIES
2396646   S IMP SCREW, 7.3 80MM                1142.00      0.00   23           SURGICAL SUPPLIES
2396653   S IMP SCREW, 7.3 90MM                1142.00      0.00   23           SURGICAL SUPPLIES
2396596   S IMP SCREW, 7.3 90MM                1142.00      0.00   23           SURGICAL SUPPLIES




                                                    Page 172
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2396661   S IMP SCREW, 7.3 95MM            1142.00      0.00   23           SURGICAL SUPPLIES
2396604   S IMP SCREW, 7.3 95MM            1142.00      0.00   23           SURGICAL SUPPLIES
2396679   S IMP SCREW, 7.3 X 115MM         1142.00      0.00   23           SURGICAL SUPPLIES
2396687   S IMP SCREW, 7.3 X 120MM         1142.00      0.00   23           SURGICAL SUPPLIES
2396695   S IMP SCREW, 7.3 X 125MM         1142.00      0.00   23           SURGICAL SUPPLIES
2396703   S IMP SCREW, 7.3 X 35MM          1142.00      0.00   23           SURGICAL SUPPLIES
2396711   S IMP SCREW, 7.3 X 40MM          1142.00      0.00   23           SURGICAL SUPPLIES
2396729   S IMP SCREW, 7.3 X 50MM          1142.00      0.00   23           SURGICAL SUPPLIES
2396737   S IMP SCREW, 7.3 X 55MM          1142.00      0.00   23           SURGICAL SUPPLIES
2396745   S IMP SCREW, 7.3 X 65MM          1302.00      0.00   23           SURGICAL SUPPLIES
2396752   S IMP SCREW, 7.3 X 70MM          1302.00      0.00   23           SURGICAL SUPPLIES
2396760   S IMP SCREW, 7.3 X 75MM          1142.00      0.00   23           SURGICAL SUPPLIES
2396786   S IMP SCREW, 7.3 X 85MM          1157.00      0.00   23           SURGICAL SUPPLIES
2396778   S IMP SCREW, 7.3 X 85MM          1218.00      0.00   23           SURGICAL SUPPLIES
2396794   S IMP SCREW, 7.3 X 90MM          1218.00      0.00   23           SURGICAL SUPPLIES
2396802   S IMP SCREW, 7.3MM 105MM         1142.00      0.00   23           SURGICAL SUPPLIES
2396810   S IMP SCREW, 7.3MM 145X1         1142.00      0.00   23           SURGICAL SUPPLIES
2396828   S IMP SCREW, 7.3MM 45X32         1140.00      0.00   23           SURGICAL SUPPLIES
2351351   S IMP SCREW, ACUTRAK FIX         1199.00      0.00   23           SURGICAL SUPPLIES
2352508   S IMP SCREW, ARTHREX 7 X         1431.00      0.00   23           SURGICAL SUPPLIES
2352516   S IMP SCREW, ARTHREX ORT          946.00      0.00   23           SURGICAL SUPPLIES
2351591   S IMP SCREW, ARTHROTEK 2          594.00      0.00   23           SURGICAL SUPPLIES
2351609   S IMP SCREW, ARTHROTEK 4          447.00      0.00   23           SURGICAL SUPPLIES
2350023   S IMP SCREW, ASNIS CANNT          508.00      0.00   23           SURGICAL SUPPLIES
2350031   S IMP SCREW, ASNIS CANNT          573.00      0.00   23           SURGICAL SUPPLIES
2350049   S IMP SCREW, ASNIS CANNT          573.00      0.00   23           SURGICAL SUPPLIES
2350056   S IMP SCREW, ASNIS CANNT          520.00      0.00   23           SURGICAL SUPPLIES
2350064   S IMP SCREW, ASNIS CANNT          682.00      0.00   23           SURGICAL SUPPLIES
2350072   S IMP SCREW, ASNIS CANNT          682.00      0.00   23           SURGICAL SUPPLIES
2351534   S IMP SCREW, BIOMET 4.5           414.00      0.00   23           SURGICAL SUPPLIES
2351526   S IMP SCREW, BIOMET 4.5M          414.00      0.00   23           SURGICAL SUPPLIES
2353332   S IMP SCREW, BOLD 1110-1          592.00      0.00   23           SURGICAL SUPPLIES
2351518   S IMP SCREW, BONE, ACUTR         1472.00      0.00   23           SURGICAL SUPPLIES
2353522   S IMP SCREW, CANC P/T 4.           46.00      0.00   23           SURGICAL SUPPLIES
2353464   S IMP SCREW, CANC P/T 4.           46.00      0.00   23           SURGICAL SUPPLIES
2353472   S IMP SCREW, CANC P/T 4.           46.00      0.00   23           SURGICAL SUPPLIES
2353480   S IMP SCREW, CANC P/T 4.           46.00      0.00   23           SURGICAL SUPPLIES
2353498   S IMP SCREW, CANC P/T 4.           46.00      0.00   23           SURGICAL SUPPLIES
2353456   S IMP SCREW, CANC P/T 4.           46.00      0.00   23           SURGICAL SUPPLIES
2353530   S IMP SCREW, CANC P/T 4.           46.00      0.00   23           SURGICAL SUPPLIES
2353506   S IMP SCREW, CANC P/T 4.           46.00      0.00   23           SURGICAL SUPPLIES
2353514   S IMP SCREW, CANC P/T 4.           46.00      0.00   23           SURGICAL SUPPLIES
2350510   S IMP SCREW, CANC, 6.5MM           87.00      0.00   23           SURGICAL SUPPLIES
2350353   S IMP SCREW, CANC, 6.5MM           46.00      0.00   23           SURGICAL SUPPLIES
2350361   S IMP SCREW, CANC, 6.5MM           83.00      0.00   23           SURGICAL SUPPLIES
2350502   S IMP SCREW, CANC, 6.5MM           83.00      0.00   23           SURGICAL SUPPLIES
2349892   S IMP SCREW, CANCELLOUS           160.00      0.00   23           SURGICAL SUPPLIES
2349942   S IMP SCREW, CANCELLOUS            99.00      0.00   23           SURGICAL SUPPLIES
2352987   S IMP SCREW, CANCELLOUS            93.00      0.00   23           SURGICAL SUPPLIES
2353233   S IMP SCREW, CANCELLOUS           447.00      0.00   23           SURGICAL SUPPLIES
2352490   S IMP SCREW, CANCELLOUS           348.00      0.00   23           SURGICAL SUPPLIES
2354298   S IMP SCREW, CANCELLOUS           112.00      0.00   23           SURGICAL SUPPLIES
2352912   S IMP SCREW, CANCELLOUS           112.00      0.00   23           SURGICAL SUPPLIES




                                                Page 173
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2354504   S IMP SCREW, CANCELLOUS,          112.00      0.00   23           SURGICAL SUPPLIES
2354488   S IMP SCREW, CANCELLOUS,          112.00      0.00   23           SURGICAL SUPPLIES
2354462   S IMP SCREW, CANCELLOUS,          112.00      0.00   23           SURGICAL SUPPLIES
2354447   S IMP SCREW, CANCELLOUS,          112.00      0.00   23           SURGICAL SUPPLIES
2354496   S IMP SCREW, CANCELLOUS,          112.00      0.00   23           SURGICAL SUPPLIES
2354454   S IMP SCREW, CANCELLOUS,          112.00      0.00   23           SURGICAL SUPPLIES
2352938   S IMP SCREW, CANCELLOUS,           46.00      0.00   23           SURGICAL SUPPLIES
2352946   S IMP SCREW, CANCELLOUS,           46.00      0.00   23           SURGICAL SUPPLIES
2354470   S IMP SCREW, CANCELLOUS,          112.00      0.00   23           SURGICAL SUPPLIES
2352953   S IMP SCREW, CANCELLOUS,           46.00      0.00   23           SURGICAL SUPPLIES
2352920   S IMP SCREW, CANCELLOUS,          112.00      0.00   23           SURGICAL SUPPLIES
2350221   S IMP SCREW, CANC-FULL T           83.00      0.00   23           SURGICAL SUPPLIES
2350239   S IMP SCREW, CANC-FULL T           83.00      0.00   23           SURGICAL SUPPLIES
2350205   S IMP SCREW, CANC-FULL T           46.00      0.00   23           SURGICAL SUPPLIES
2350213   S IMP SCREW, CANC-FULL T          434.00      0.00   23           SURGICAL SUPPLIES
2350247   S IMP SCREW, CANC-SHRT T           83.00      0.00   23           SURGICAL SUPPLIES
2352961   S IMP SCREW, CANNTED 2.3          615.00      0.00   23           SURGICAL SUPPLIES
2352979   S IMP SCREW, CANNTED 2.3          615.00      0.00   23           SURGICAL SUPPLIES
2352896   S IMP SCREW, CANNTED 3.5          397.00      0.00   23           SURGICAL SUPPLIES
2352839   S IMP SCREW, CANNTED BIO          691.00      0.00   23           SURGICAL SUPPLIES
2352797   S IMP SCREW, CANNTED BIO          691.00      0.00   23           SURGICAL SUPPLIES
2352805   S IMP SCREW, CANNTED BIO          691.00      0.00   23           SURGICAL SUPPLIES
2352813   S IMP SCREW, CANNTED BIO          691.00      0.00   23           SURGICAL SUPPLIES
2352821   S IMP SCREW, CANNTED BIO          691.00      0.00   23           SURGICAL SUPPLIES
2352847   S IMP SCREW, CANNTED BIO          691.00      0.00   23           SURGICAL SUPPLIES
2352854   S IMP SCREW, CANNTED BIO          757.00      0.00   23           SURGICAL SUPPLIES
2352730   S IMP SCREW, CANNTED INT          534.00      0.00   23           SURGICAL SUPPLIES
2352714   S IMP SCREW, CANNTED INT          534.00      0.00   23           SURGICAL SUPPLIES
2352698   S IMP SCREW, CANNTED INT          534.00      0.00   23           SURGICAL SUPPLIES
2352672   S IMP SCREW, CANNTED INT          534.00      0.00   23           SURGICAL SUPPLIES
2352656   S IMP SCREW, CANNTED INT          534.00      0.00   23           SURGICAL SUPPLIES
2352649   S IMP SCREW, CANNTED INT          534.00      0.00   23           SURGICAL SUPPLIES
2353001   S IMP SCREW, CANNTED INT          534.00      0.00   23           SURGICAL SUPPLIES
2352722   S IMP SCREW, CANNTED INT          534.00      0.00   23           SURGICAL SUPPLIES
2352904   S IMP SCREW, CANNTED INT          515.00      0.00   23           SURGICAL SUPPLIES
2352706   S IMP SCREW, CANNTED INT          534.00      0.00   23           SURGICAL SUPPLIES
2352888   S IMP SCREW, CANNTED INT          515.00      0.00   23           SURGICAL SUPPLIES
2352870   S IMP SCREW, CANNTED INT          515.00      0.00   23           SURGICAL SUPPLIES
2352995   S IMP SCREW, CANNTED MAG          539.00      0.00   23           SURGICAL SUPPLIES
2352615   S IMP SCREW, CANNTED MAG          431.00      0.00   23           SURGICAL SUPPLIES
2352581   S IMP SCREW, CANNTED MAG          539.00      0.00   23           SURGICAL SUPPLIES
2352599   S IMP SCREW, CANNTED MAG          539.00      0.00   23           SURGICAL SUPPLIES
2352623   S IMP SCREW, CANNTED MAG          442.00      0.00   23           SURGICAL SUPPLIES
2352862   S IMP SCREW, CANNTED MAG          539.00      0.00   23           SURGICAL SUPPLIES
2352573   S IMP SCREW, CANNTED MAG          539.00      0.00   23           SURGICAL SUPPLIES
2352680   S IMP SCREW, CANNTED MAG          539.00      0.00   23           SURGICAL SUPPLIES
2352607   S IMP SCREW, CANNTED MAG          348.00      0.00   23           SURGICAL SUPPLIES
2352763   S IMP SCREW, CANNTED WIT          589.00      0.00   23           SURGICAL SUPPLIES
2352771   S IMP SCREW, CANNTED WIT          589.00      0.00   23           SURGICAL SUPPLIES
2352789   S IMP SCREW, CANNTED WIT          471.00      0.00   23           SURGICAL SUPPLIES
2352755   S IMP SCREW, CANNTED WIT          589.00      0.00   23           SURGICAL SUPPLIES
2352631   S IMP SCREW, CANNTED WIT          589.00      0.00   23           SURGICAL SUPPLIES
2352748   S IMP SCREW, CANNTED WIT          589.00      0.00   23           SURGICAL SUPPLIES




                                                Page 174
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2353134   S IMP SCREW, CANNTED WIT           589.00      0.00   23           SURGICAL SUPPLIES
2350908   S IMP SCREW, CANU 3.5 FU            46.00      0.00   23           SURGICAL SUPPLIES
2350916   S IMP SCREW, CANU 3.5 FU            46.00      0.00   23           SURGICAL SUPPLIES
2350890   S IMP SCREW, CANU 3.5 FU            46.00      0.00   23           SURGICAL SUPPLIES
2350932   S IMP SCREW, CANU 3.5 FU           348.00      0.00   23           SURGICAL SUPPLIES
2350924   S IMP SCREW, CANU 3.5 FU           397.00      0.00   23           SURGICAL SUPPLIES
2350882   S IMP SCREW, CANU 3.5 TH           128.00      0.00   23           SURGICAL SUPPLIES
2398717   S IMP SCREW, CORT FIXATIO          822.00      0.00   23           SURGICAL SUPPLIES
2350445   S IMP SCREW, CORTES, 4.5           293.00      0.00   23           SURGICAL SUPPLIES
2350296   S IMP SCREW, CORTEX 2.0M            55.00      0.00   23           SURGICAL SUPPLIES
2354306   S IMP SCREW, CORTEX OR C           428.00      0.00   23           SURGICAL SUPPLIES
2372316   S IMP SCREW, CORTEX TITA           562.00      0.00   23           SURGICAL SUPPLIES
2372415   S IMP SCREW, CORTEX TITA           583.00      0.00   23           SURGICAL SUPPLIES
2372423   S IMP SCREW, CORTEX TITA           583.00      0.00   23           SURGICAL SUPPLIES
2372407   S IMP SCREW, CORTEX TITA           583.00      0.00   23           SURGICAL SUPPLIES
2372209   S IMP SCREW, CORTEX TITA1          527.00      0.00   23           SURGICAL SUPPLIES
2372191   S IMP SCREW, CORTEX TITA1          527.00      0.00   23           SURGICAL SUPPLIES
2372977   S IMP SCREW, CORTEX TITA1          763.00      0.00   23           SURGICAL SUPPLIES
2372969   S IMP SCREW, CORTEX TITA1          763.00      0.00   23           SURGICAL SUPPLIES
2372993   S IMP SCREW, CORTEX TITA1          751.00      0.00   23           SURGICAL SUPPLIES
2373009   S IMP SCREW, CORTEX TITA1          764.00      0.00   23           SURGICAL SUPPLIES
2350270   S IMP SCREW, CORTEX, 1.5            43.00      0.00   23           SURGICAL SUPPLIES
2350262   S IMP SCREW, CORTEX, 1.5            37.00      0.00   23           SURGICAL SUPPLIES
2354272   S IMP SCREW, CORTEX, 1.5           155.00      0.00   23           SURGICAL SUPPLIES
2351385   S IMP SCREW, CORTEX, 1.5            56.00      0.00   23           SURGICAL SUPPLIES
2351393   S IMP SCREW, CORTEX, 1.5            63.00      0.00   23           SURGICAL SUPPLIES
2350288   S IMP SCREW, CORTEX, 2.0            55.00      0.00   23           SURGICAL SUPPLIES
2354280   S IMP SCREW, CORTEX, 2.0            54.00      0.00   23           SURGICAL SUPPLIES
2351427   S IMP SCREW, CORTEX, 2.0            52.00      0.00   23           SURGICAL SUPPLIES
2351435   S IMP SCREW, CORTEX, 2.0            54.00      0.00   23           SURGICAL SUPPLIES
2351443   S IMP SCREW, CORTEX, 2.0            55.00      0.00   23           SURGICAL SUPPLIES
2351492   S IMP SCREW, CORTEX, 2.0            43.00      0.00   23           SURGICAL SUPPLIES
2351500   S IMP SCREW, CORTEX, 2.0            43.00      0.00   23           SURGICAL SUPPLIES
2351419   S IMP SCREW, CORTEX, 2.0            54.00      0.00   23           SURGICAL SUPPLIES
2351401   S IMP SCREW, CORTEX, 2.0            55.00      0.00   23           SURGICAL SUPPLIES
2350320   S IMP SCREW, CORTEX, 2.7            90.00      0.00   23           SURGICAL SUPPLIES
2350338   S IMP SCREW, CORTEX, 2.7            53.00      0.00   23           SURGICAL SUPPLIES
2350304   S IMP SCREW, CORTEX, 2.7            35.00      0.00   23           SURGICAL SUPPLIES
2350346   S IMP SCREW, CORTEX, 2.7            53.00      0.00   23           SURGICAL SUPPLIES
2351484   S IMP SCREW, CORTEX, 2.7            52.00      0.00   23           SURGICAL SUPPLIES
2351476   S IMP SCREW, CORTEX, 2.7            52.00      0.00   23           SURGICAL SUPPLIES
2351468   S IMP SCREW, CORTEX, 2.7            52.00      0.00   23           SURGICAL SUPPLIES
2351450   S IMP SCREW, CORTEX, 2.7            51.00      0.00   23           SURGICAL SUPPLIES
2350452   S IMP SCREW, CORTEX, 4.5            51.00      0.00   23           SURGICAL SUPPLIES
2350486   S IMP SCREW, CORTEX, 4.5           112.00      0.00   23           SURGICAL SUPPLIES
2350460   S IMP SCREW, CORTEX, 4.5            37.00      0.00   23           SURGICAL SUPPLIES
2350437   S IMP SCREW, CORTEX, 4.5            90.00      0.00   23           SURGICAL SUPPLIES
2350429   S IMP SCREW, CORTEX, 4.5           112.00      0.00   23           SURGICAL SUPPLIES
2350411   S IMP SCREW, CORTEX, 4.5            44.00      0.00   23           SURGICAL SUPPLIES
2350403   S IMP SCREW, CORTEX, 4.5            44.00      0.00   23           SURGICAL SUPPLIES
2350395   S IMP SCREW, CORTEX, 4.5            44.00      0.00   23           SURGICAL SUPPLIES
2350387   S IMP SCREW, CORTEX, 4.5            44.00      0.00   23           SURGICAL SUPPLIES
2350478   S IMP SCREW, CORTEX, 4.5           293.00      0.00   23           SURGICAL SUPPLIES




                                                 Page 175
                                     85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2350379   S IMP SCREW, CORTEX, 4.5              112.00      0.00   23           SURGICAL SUPPLIES
2354215   S IMP SCREW, CORTEX, 4.5              112.00      0.00   23           SURGICAL SUPPLIES
2350007   S IMP SCREW, CORTEX-FN 3               55.00      0.00   23           SURGICAL SUPPLIES
2350528   S IMP SCREW, CORTEX-FN 3               48.00      0.00   23           SURGICAL SUPPLIES
2350163   S IMP SCREW, CORTEX-FN 3               55.00      0.00   23           SURGICAL SUPPLIES
2350015   S IMP SCREW, CORTEX-FN 3              112.00      0.00   23           SURGICAL SUPPLIES
2349991   S IMP SCREW, CORTEX-FN 3               55.00      0.00   23           SURGICAL SUPPLIES
2349959   S IMP SCREW, CORTEX-FN 3               53.00      0.00   23           SURGICAL SUPPLIES
2349983   S IMP SCREW, CORTEX-FN 3               48.00      0.00   23           SURGICAL SUPPLIES
2350122   S IMP SCREW, CORTEX-FN 3               48.00      0.00   23           SURGICAL SUPPLIES
2349975   S IMP SCREW, CORTEX-FN 3               48.00      0.00   23           SURGICAL SUPPLIES
2354199   S IMP SCREW, CORTEX-FN 3               55.00      0.00   23           SURGICAL SUPPLIES
2354181   S IMP SCREW, CORTEX-FN 3               55.00      0.00   23           SURGICAL SUPPLIES
2354207   S IMP SCREW, CORTEX-FN 3               55.00      0.00   23           SURGICAL SUPPLIES
2354512   S IMP SCREW, CORTEX-FN 3               55.00      0.00   23           SURGICAL SUPPLIES
2349843   S IMP SCREW, CORTICAL 3.              116.00      0.00   23           SURGICAL SUPPLIES
2349868   S IMP SCREW, CORTICAL 3.              116.00      0.00   23           SURGICAL SUPPLIES
2349876   S IMP SCREW, CORTICAL 3.              116.00      0.00   23           SURGICAL SUPPLIES
2349884   S IMP SCREW, CORTICAL 3.              116.00      0.00   23           SURGICAL SUPPLIES
2349850   S IMP SCREW, CORTICAL 3.              116.00      0.00   23           SURGICAL SUPPLIES
2353431   S IMP SCREW, CORTICAL 3.               35.00      0.00   23           SURGICAL SUPPLIES
2353019   S IMP SCREW, CORTICAL 3.              263.00      0.00   23           SURGICAL SUPPLIES
2353027   S IMP SCREW, CORTICAL 3.              263.00      0.00   23           SURGICAL SUPPLIES
2352532   S IMP SCREW, CORTICAL 3.              263.00      0.00   23           SURGICAL SUPPLIES
2352540   S IMP SCREW, CORTICAL 3.              263.00      0.00   23           SURGICAL SUPPLIES
2353340   S IMP SCREW, CORTICAL 3.              263.00      0.00   23           SURGICAL SUPPLIES
2353357   S IMP SCREW, CORTICAL 3.              263.00      0.00   23           SURGICAL SUPPLIES
2353365   S IMP SCREW, CORTICAL 3.              263.00      0.00   23           SURGICAL SUPPLIES
2353373   S IMP SCREW, CORTICAL 3.               35.00      0.00   23           SURGICAL SUPPLIES
2353381   S IMP SCREW, CORTICAL 3.              263.00      0.00   23           SURGICAL SUPPLIES
2353449   S IMP SCREW, CORTICAL 3.               35.00      0.00   23           SURGICAL SUPPLIES
2353407   S IMP SCREW, CORTICAL 3.              211.00      0.00   23           SURGICAL SUPPLIES
2353118   S IMP SCREW, CORTICAL 3.              263.00      0.00   23           SURGICAL SUPPLIES
2353415   S IMP SCREW, CORTICAL 3.               35.00      0.00   23           SURGICAL SUPPLIES
2353423   S IMP SCREW, CORTICAL 3.               35.00      0.00   23           SURGICAL SUPPLIES
2353217   S IMP SCREW, CORTICAL 3.              263.00      0.00   23           SURGICAL SUPPLIES
2353399   S IMP SCREW, CORTICAL 3.              263.00      0.00   23           SURGICAL SUPPLIES
2351617   S IMP SCREW, CORTICAL 30              224.00      0.00   23           SURGICAL SUPPLIES
2350783   S IMP SCREW, CORTICAL 4.              143.00      0.00   23           SURGICAL SUPPLIES
2350775   S IMP SCREW, CORTICAL 4.               47.00      0.00   23           SURGICAL SUPPLIES
2350791   S IMP SCREW, CORTICAL 4.              115.00      0.00   23           SURGICAL SUPPLIES
2353084   S IMP SCREW, CORTICAL 4.              263.00      0.00   23           SURGICAL SUPPLIES
2353035   S IMP SCREW, CORTICAL 4.              174.00      0.00   23           SURGICAL SUPPLIES
2353050   S IMP SCREW, CORTICAL 4.              263.00      0.00   23           SURGICAL SUPPLIES
2353068   S IMP SCREW, CORTICAL 4.              263.00      0.00   23           SURGICAL SUPPLIES
2353076   S IMP SCREW, CORTICAL 4.              263.00      0.00   23           SURGICAL SUPPLIES
2353092   S IMP SCREW, CORTICAL 4.              263.00      0.00   23           SURGICAL SUPPLIES
2352524   S IMP SCREW, CORTICAL 4.              263.00      0.00   23           SURGICAL SUPPLIES
2353043   S IMP SCREW, CORTICAL 4.              263.00      0.00   23           SURGICAL SUPPLIES
2353100   S IMP SCREW, CORTICAL 4.              263.00      0.00   23           SURGICAL SUPPLIES
2351542   S IMP SCREW, CORTICAL 50              411.00      0.00   23           SURGICAL SUPPLIES
2353225   S IMP SCREW, CORTICAL PO              447.00      0.00   23           SURGICAL SUPPLIES
2352565   S IMP SCREW, CORTICAL RE              663.00      0.00   23           SURGICAL SUPPLIES




                                                    Page 176
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2352557   S IMP SCREW, CORTICAL RE           663.00      0.00   23           SURGICAL SUPPLIES
2350833   S IMP SCREW, CORTICAL, 4           115.00      0.00   23           SURGICAL SUPPLIES
2350809   S IMP SCREW, CORTICAL, 4           115.00      0.00   23           SURGICAL SUPPLIES
2350817   S IMP SCREW, CORTICAL, 4           142.00      0.00   23           SURGICAL SUPPLIES
2350825   S IMP SCREW, CORTICAL, 4           115.00      0.00   23           SURGICAL SUPPLIES
2398725   S IMP SCREW, CRANIAL 4X1.          417.00      0.00   23           SURGICAL SUPPLIES
2398733   S IMP SCREW, CRANIAL 5X1.          417.00      0.00   23           SURGICAL SUPPLIES
2372555   S IMP SCREW, CROSS-PIN 1.          610.00      0.00   23           SURGICAL SUPPLIES
2372563   S IMP SCREW, CROSS-PIN 1.          610.00      0.00   23           SURGICAL SUPPLIES
2372571   S IMP SCREW, CROSS-PIN 1.          610.00      0.00   23           SURGICAL SUPPLIES
2398741   S IMP SCREW, CTRSINK 4.5M          998.00      0.00   23           SURGICAL SUPPLIES
2399921   S IMP SCREW, ED 3.0X30MM           954.00      0.00   23           SURGICAL SUPPLIES
2372910   S IMP SCREW, EMER 1.4X3MM          751.00      0.00   23           SURGICAL SUPPLIES
2372928   S IMP SCREW, EMER 1.4X5MM          751.00      0.00   23           SURGICAL SUPPLIES
2372936   S IMP SCREW, EMER 1.4X7MM          751.00      0.00   23           SURGICAL SUPPLIES
2372944   S IMP SCREW, EMER 1.4X9MM          751.00      0.00   23           SURGICAL SUPPLIES
2372332   S IMP SCREW, EMER 1.9X4MM          564.00      0.00   23           SURGICAL SUPPLIES
2372217   S IMP SCREW, EMER 1.9X5MM          528.00      0.00   23           SURGICAL SUPPLIES
2372753   S IMP SCREW, EMER HE FIT           669.00      0.00   23           SURGICAL SUPPLIES
2372761   S IMP SCREW, EMER HEXFIT           669.00      0.00   23           SURGICAL SUPPLIES
2372746   S IMP SCREW, EMER HEXFIT           669.00      0.00   23           SURGICAL SUPPLIES
2398758   S IMP SCREW, EMER MF 1.7X          437.00      0.00   23           SURGICAL SUPPLIES
2372399   S IMP SCREW, EMER SQU 2.3          579.00      0.00   23           SURGICAL SUPPLIES
2372381   S IMP SCREW, EMER SQU 2.3          579.00      0.00   23           SURGICAL SUPPLIES
2398766   S IMP SCREW, EMER T1 2.4X          336.00      0.00   23           SURGICAL SUPPLIES
2398774   S IMP SCREW, EMER TI 1.2X          458.00      0.00   23           SURGICAL SUPPLIES
2398782   S IMP SCREW, EMER TI 1.2X          458.00      0.00   23           SURGICAL SUPPLIES
2398808   S IMP SCREW, EMER TI 1.2X          458.00      0.00   23           SURGICAL SUPPLIES
2398790   S IMP SCREW, EMER TI 1.2X          458.00      0.00   23           SURGICAL SUPPLIES
2398816   S IMP SCREW, EMER TI 1.2X          458.00      0.00   23           SURGICAL SUPPLIES
2398832   S IMP SCREW, EMER TI 1.7X          437.00      0.00   23           SURGICAL SUPPLIES
2398857   S IMP SCREW, EMER TI 1.7X          437.00      0.00   23           SURGICAL SUPPLIES
2398824   S IMP SCREW, EMER TI 1.7X          437.00      0.00   23           SURGICAL SUPPLIES
2398840   S IMP SCREW, EMER TI 1.7X          437.00      0.00   23           SURGICAL SUPPLIES
2398865   S IMP SCREW, EMER TI 1.7X          437.00      0.00   23           SURGICAL SUPPLIES
2398915   S IMP SCREW, EMER TI 2.0X          339.00      0.00   23           SURGICAL SUPPLIES
2398907   S IMP SCREW, EMER TI 2.0X          339.00      0.00   23           SURGICAL SUPPLIES
2398899   S IMP SCREW, EMER TI 2.0X          339.00      0.00   23           SURGICAL SUPPLIES
2398881   S IMP SCREW, EMER TI 2.0X          339.00      0.00   23           SURGICAL SUPPLIES
2398873   S IMP SCREW, EMER TI 2.0X          339.00      0.00   23           SURGICAL SUPPLIES
2398956   S IMP SCREW, EMER TI 2.4X          336.00      0.00   23           SURGICAL SUPPLIES
2398998   S IMP SCREW, EMER TI 2.4X          336.00      0.00   23           SURGICAL SUPPLIES
2398972   S IMP SCREW, EMER TI 2.4X          336.00      0.00   23           SURGICAL SUPPLIES
2398949   S IMP SCREW, EMER TI 2.4X          336.00      0.00   23           SURGICAL SUPPLIES
2398964   S IMP SCREW, EMER TI 2.4X          336.00      0.00   23           SURGICAL SUPPLIES
2398980   S IMP SCREW, EMER TI 2.4X          336.00      0.00   23           SURGICAL SUPPLIES
2398931   S IMP SCREW, EMER TI 2.4X          336.00      0.00   23           SURGICAL SUPPLIES
2398923   S IMP SCREW, EMER TI 2.4X          336.00      0.00   23           SURGICAL SUPPLIES
2399020   S IMP SCREW, EMER TI 2.7X          482.00      0.00   23           SURGICAL SUPPLIES
2399046   S IMP SCREW, EMER TI 2.7X          481.00      0.00   23           SURGICAL SUPPLIES
2399012   S IMP SCREW, EMER TI 2.7X          482.00      0.00   23           SURGICAL SUPPLIES
2399038   S IMP SCREW, EMER TI 2.7X          482.00      0.00   23           SURGICAL SUPPLIES
2399004   S IMP SCREW, EMER TI 2.7X          482.00      0.00   23           SURGICAL SUPPLIES




                                                 Page 177
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2341204   S IMP SCREW, ENDOBROW BI           298.00      0.00   23           SURGICAL SUPPLIES
2372787   S IMP SCREW, FACIAL 1.2X1          674.00      0.00   23           SURGICAL SUPPLIES
2372779   S IMP SCREW, FACIAL 1.2X1          674.00      0.00   23           SURGICAL SUPPLIES
2372795   S IMP SCREW, FACIAL 1.2X3          674.00      0.00   23           SURGICAL SUPPLIES
2372803   S IMP SCREW, FACIAL 1.2X4          674.00      0.00   23           SURGICAL SUPPLIES
2372811   S IMP SCREW, FACIAL 1.2X5          674.00      0.00   23           SURGICAL SUPPLIES
2372829   S IMP SCREW, FACIAL 1.2X6          674.00      0.00   23           SURGICAL SUPPLIES
2372837   S IMP SCREW, FACIAL 1.2X8          674.00      0.00   23           SURGICAL SUPPLIES
2372613   S IMP SCREW, HEX FIT 2.7X          652.00      0.00   23           SURGICAL SUPPLIES
2372621   S IMP SCREW, HEX FIT 2.7X          652.00      0.00   23           SURGICAL SUPPLIES
2372647   S IMP SCREW, HEX FIT 2.7X          652.00      0.00   23           SURGICAL SUPPLIES
2372696   S IMP SCREW, HEX FIT 2.7X          652.00      0.00   23           SURGICAL SUPPLIES
2372654   S IMP SCREW, HEX FIT 2.7X          652.00      0.00   23           SURGICAL SUPPLIES
2372662   S IMP SCREW, HEX FIT 2.7X          652.00      0.00   23           SURGICAL SUPPLIES
2372670   S IMP SCREW, HEX FIT 2.7X          652.00      0.00   23           SURGICAL SUPPLIES
2372688   S IMP SCREW, HEX FIT 2.7X          652.00      0.00   23           SURGICAL SUPPLIES
2372639   S IMP SCREW, HEX FIT 2.7X          652.00      0.00   23           SURGICAL SUPPLIES
2372506   S IMP SCREW, HEX-FIT 2.3X          590.00      0.00   23           SURGICAL SUPPLIES
2372530   S IMP SCREW, HEX-FIT 2.3X          590.00      0.00   23           SURGICAL SUPPLIES
2372514   S IMP SCREW, HEX-FIT 2.3X          590.00      0.00   23           SURGICAL SUPPLIES
2372498   S IMP SCREW, HEX-FIT 2.3X          590.00      0.00   23           SURGICAL SUPPLIES
2372480   S IMP SCREW, HEX-FIT 2.3X          590.00      0.00   23           SURGICAL SUPPLIES
2372472   S IMP SCREW, HEX-FIT 2.3X          590.00      0.00   23           SURGICAL SUPPLIES
2372522   S IMP SCREW, HEX-FIT 2.3X          590.00      0.00   23           SURGICAL SUPPLIES
2399095   S IMP SCREW, LAG 12.7MM X         1363.00      0.00   23           SURGICAL SUPPLIES
2399087   S IMP SCREW, LAG 12.7MM X         1363.00      0.00   23           SURGICAL SUPPLIES
2399079   S IMP SCREW, LAG 12.7MM X         1363.00      0.00   23           SURGICAL SUPPLIES
2399053   S IMP SCREW, LAG 12.7MM X         1363.00      0.00   23           SURGICAL SUPPLIES
2399061   S IMP SCREW, LAG 12.7MM X         1363.00      0.00   23           SURGICAL SUPPLIES
2399103   S IMP SCREW, LAG 12.7MMX1         1363.00      0.00   23           SURGICAL SUPPLIES
2399111   S IMP SCREW, LAG 12.7MMX1         1363.00      0.00   23           SURGICAL SUPPLIES
2399129   S IMP SCREW, LAG 14MMX110         1462.00      0.00   23           SURGICAL SUPPLIES
2340164   S IMP SCREW, LEIB 1.2 3            175.00      0.00   23           SURGICAL SUPPLIES
2340172   S IMP SCREW, LEIB 1.7 X            160.00      0.00   23           SURGICAL SUPPLIES
2340180   S IMP SCREW, LEIB 1.7 X            160.00      0.00   23           SURGICAL SUPPLIES
2352433   S IMP SCREW, LEIB 1.7 X            175.00      0.00   23           SURGICAL SUPPLIES
2340206   S IMP SCREW, LEIB 2.0 X            154.00      0.00   23           SURGICAL SUPPLIES
2340198   S IMP SCREW, LEIB 2.0 X            147.00      0.00   23           SURGICAL SUPPLIES
2340214   S IMP SCREW, LEIB 2.0 X            154.00      0.00   23           SURGICAL SUPPLIES
2353175   S IMP SCREW, LOCKING 4.5           238.00      0.00   23           SURGICAL SUPPLIES
2353167   S IMP SCREW, LOCKING 4.5           238.00      0.00   23           SURGICAL SUPPLIES
2353142   S IMP SCREW, LOCKING 4.5           238.00      0.00   23           SURGICAL SUPPLIES
2353159   S IMP SCREW, LOCKING 4.5           238.00      0.00   23           SURGICAL SUPPLIES
2353183   S IMP SCREW, LOCKING 5.0           453.00      0.00   23           SURGICAL SUPPLIES
2399137   S IMP SCREW, LOCKINT TI S          821.00      0.00   23           SURGICAL SUPPLIES
2399236   S IMP SCREW, LOKG 3.5MM/           709.00      0.00   23           SURGICAL SUPPLIES
2399244   S IMP SCREW, LOKG 3.5X90           709.00      0.00   23           SURGICAL SUPPLIES
2399251   S IMP SCREW, LOKG 5MM/14           709.00      0.00   23           SURGICAL SUPPLIES
2399269   S IMP SCREW, LOKG 5MM/16           709.00      0.00   23           SURGICAL SUPPLIES
2399277   S IMP SCREW, LOKG 5MM/18           709.00      0.00   23           SURGICAL SUPPLIES
2399285   S IMP SCREW, LOKG 5MM/20           709.00      0.00   23           SURGICAL SUPPLIES
2399293   S IMP SCREW, LOKG 5MM/22           709.00      0.00   23           SURGICAL SUPPLIES
2399301   S IMP SCREW, LOKG 5MM/24           709.00      0.00   23           SURGICAL SUPPLIES




                                                 Page 178
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2399319   S IMP SCREW, LOKG 5MM/26          709.00      0.00   23           SURGICAL SUPPLIES
2399327   S IMP SCREW, LOKG 5MM/44          709.00      0.00   23           SURGICAL SUPPLIES
2399145   S IMP SCREW, LOKG 3.5             594.00      0.00   23           SURGICAL SUPPLIES
2399152   S IMP SCREW, LOKG 3.5             594.00      0.00   23           SURGICAL SUPPLIES
2399160   S IMP SCREW, LOKG 3.5             594.00      0.00   23           SURGICAL SUPPLIES
2399178   S IMP SCREW, LOKG 3.5 36M         594.00      0.00   23           SURGICAL SUPPLIES
2399186   S IMP SCREW, LOKG 4MM/18M         672.00      0.00   23           SURGICAL SUPPLIES
2399194   S IMP SCREW, LOKG 4MM/22M         672.00      0.00   23           SURGICAL SUPPLIES
2399202   S IMP SCREW, LOKG 4MMX14M         672.00      0.00   23           SURGICAL SUPPLIES
2399210   S IMP SCREW, LOKG 4MMX50          696.00      0.00   23           SURGICAL SUPPLIES
2399228   S IMP SCREW, LOKG 80MM X         1252.00      0.00   23           SURGICAL SUPPLIES
2399335   S IMP SCREW, LOKG SLF-TAP         594.00      0.00   23           SURGICAL SUPPLIES
2399376   S IMP SCREW, LOKG TI 5MMX         847.00      0.00   23           SURGICAL SUPPLIES
2399384   S IMP SCREW, LOKG TI 5MMX         847.00      0.00   23           SURGICAL SUPPLIES
2399368   S IMP SCREW, LOKG TI 5MMX         847.00      0.00   23           SURGICAL SUPPLIES
2399350   S IMP SCREW, LOKG TI 5MMX         847.00      0.00   23           SURGICAL SUPPLIES
2399343   S IMP SCREW, LOKG TI 5MMX         847.00      0.00   23           SURGICAL SUPPLIES
2398451   S IMP SCREW, LRG 4.5MMX24         133.00      0.00   23           SURGICAL SUPPLIES
2398469   S IMP SCREW, LRG 4.5MMX28         133.00      0.00   23           SURGICAL SUPPLIES
2398477   S IMP SCREW, LRG 4.5MMX30         133.00      0.00   23           SURGICAL SUPPLIES
2398485   S IMP SCREW, LRG 4.5MMX42         193.00      0.00   23           SURGICAL SUPPLIES
2398493   S IMP SCREW, LRG 4.5MMX42         821.00      0.00   23           SURGICAL SUPPLIES
2398501   S IMP SCREW, LRG 4.5MMX60         193.00      0.00   23           SURGICAL SUPPLIES
2399459   S IMP SCREW, MALLEOLAR 4.         216.00      0.00   23           SURGICAL SUPPLIES
2399418   S IMP SCREW, MALLEOLAR 4.         216.00      0.00   23           SURGICAL SUPPLIES
2399400   S IMP SCREW, MALLEOLAR 4.         216.00      0.00   23           SURGICAL SUPPLIES
2399392   S IMP SCREW, MALLEOLAR 4.         216.00      0.00   23           SURGICAL SUPPLIES
2399426   S IMP SCREW, MALLEOLAR 4.         216.00      0.00   23           SURGICAL SUPPLIES
2399434   S IMP SCREW, MALLEOLAR 4.         216.00      0.00   23           SURGICAL SUPPLIES
2399442   S IMP SCREW, MALLEOLAR 4.         216.00      0.00   23           SURGICAL SUPPLIES
2399467   S IMP SCREW, MALLEOLAR 4.         216.00      0.00   23           SURGICAL SUPPLIES
2350494   S IMP SCREW, MALLEOLAR/4           92.00      0.00   23           SURGICAL SUPPLIES
2350171   S IMP SCREW, MALLEOLAR/5           92.00      0.00   23           SURGICAL SUPPLIES
2353209   S IMP SCREW, MENISCUS AR          562.00      0.00   23           SURGICAL SUPPLIES
2353191   S IMP SCREW, MENISCUS AR          562.00      0.00   23           SURGICAL SUPPLIES
2399475   S IMP SCREW, MF 2.0X6MM           352.00      0.00   23           SURGICAL SUPPLIES
2399483   S IMP SCREW, MINI 1.5MMX          306.00      0.00   23           SURGICAL SUPPLIES
2399509   S IMP SCREW, MINI 2.7MMX          319.00      0.00   23           SURGICAL SUPPLIES
2399491   S IMP SCREW, MINI 2.7MMX          319.00      0.00   23           SURGICAL SUPPLIES
2399517   S IMP SCREW, MINI 2.7MMX          319.00      0.00   23           SURGICAL SUPPLIES
2399533   S IMP SCREW, ORTHO S CAN         1142.00      0.00   23           SURGICAL SUPPLIES
2399558   S IMP SCREW, ORTHO S CAN         1142.00      0.00   23           SURGICAL SUPPLIES
2399525   S IMP SCREW, ORTHO S CAN         1142.00      0.00   23           SURGICAL SUPPLIES
2399541   S IMP SCREW, ORTHO S CAN         1142.00      0.00   23           SURGICAL SUPPLIES
2399608   S IMP SCREW, ORTHO S CAN         1142.00      0.00   23           SURGICAL SUPPLIES
2399590   S IMP SCREW, ORTHO S CAN         1142.00      0.00   23           SURGICAL SUPPLIES
2399582   S IMP SCREW, ORTHO S CAN         1142.00      0.00   23           SURGICAL SUPPLIES
2399574   S IMP SCREW, ORTHO S CAN         1142.00      0.00   23           SURGICAL SUPPLIES
2399566   S IMP SCREW, ORTHO S CAN         1142.00      0.00   23           SURGICAL SUPPLIES
2350197   S IMP SCREW, ORTHOFIX, C          342.00      0.00   23           SURGICAL SUPPLIES
2351369   S IMP SCREW, ORTHOFIX, C          342.00      0.00   23           SURGICAL SUPPLIES
2351377   S IMP SCREW, ORTHOFIX, C          342.00      0.00   23           SURGICAL SUPPLIES
2351559   S IMP SCREW, OSTEOMED 2           171.00      0.00   23           SURGICAL SUPPLIES




                                                Page 179
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2399632   S IMP SCREW, PEDICLE TI 6         2582.00      0.00   23           SURGICAL SUPPLIES
2399624   S IMP SCREW, PEDICLE TI 6         2582.00      0.00   23           SURGICAL SUPPLIES
2399616   S IMP SCREW, PEDICLE TI 6         2582.00      0.00   23           SURGICAL SUPPLIES
2399665   S IMP SCREW, PEDICLE TI 7         2582.00      0.00   23           SURGICAL SUPPLIES
2399657   S IMP SCREW, PEDICLE TI 7         2582.00      0.00   23           SURGICAL SUPPLIES
2399640   S IMP SCREW, PEDICLE TI 7         2582.00      0.00   23           SURGICAL SUPPLIES
2399673   S IMP SCREW, PEDICLE TI 7         2582.00      0.00   23           SURGICAL SUPPLIES
2399681   S IMP SCREW, PEDICLE TI 8         2582.00      0.00   23           SURGICAL SUPPLIES
2399715   S IMP SCREW, PEDICLE TI 8         2582.00      0.00   23           SURGICAL SUPPLIES
2399699   S IMP SCREW, PEDICLE TI 8         2582.00      0.00   23           SURGICAL SUPPLIES
2399707   S IMP SCREW, PEDICLE TI 8         2582.00      0.00   23           SURGICAL SUPPLIES
2399723   S IMP SCREW, SCHANZ TITAN          866.00      0.00   23           SURGICAL SUPPLIES
2353282   S IMP SCREW, SELF TAPPIN           199.00      0.00   23           SURGICAL SUPPLIES
2353274   S IMP SCREW, SELF TAPPIN           199.00      0.00   23           SURGICAL SUPPLIES
2353266   S IMP SCREW, SELF TAPPIN           156.00      0.00   23           SURGICAL SUPPLIES
2353258   S IMP SCREW, SELF TAPPIN           156.00      0.00   23           SURGICAL SUPPLIES
2353241   S IMP SCREW, SELF TAPPIN           156.00      0.00   23           SURGICAL SUPPLIES
2399731   S IMP SCREW, SELF TAPPING          156.00      0.00   23           SURGICAL SUPPLIES
2399749   S IMP SCREW, SHAFT 3.5 X           143.00      0.00   23           SURGICAL SUPPLIES
2399772   S IMP SCREW, SHAFT 3.5MM           143.00      0.00   23           SURGICAL SUPPLIES
2399756   S IMP SCREW, SHAFT 3.5MM           143.00      0.00   23           SURGICAL SUPPLIES
2399764   S IMP SCREW, SHAFT 3.5MM           143.00      0.00   23           SURGICAL SUPPLIES
2399780   S IMP SCREW, SHAFT 3.5MM           143.00      0.00   23           SURGICAL SUPPLIES
2399806   S IMP SCREW, SHAFT 3.5MMX          143.00      0.00   23           SURGICAL SUPPLIES
2399848   S IMP SCREW, SHAFT 3.5MMX          143.00      0.00   23           SURGICAL SUPPLIES
2399814   S IMP SCREW, SHAFT 3.5MMX          143.00      0.00   23           SURGICAL SUPPLIES
2399822   S IMP SCREW, SHAFT 3.5MMX          143.00      0.00   23           SURGICAL SUPPLIES
2399798   S IMP SCREW, SHAFT 3.5MMX          143.00      0.00   23           SURGICAL SUPPLIES
2399830   S IMP SCREW, SHAFT 3.5MMX          143.00      0.00   23           SURGICAL SUPPLIES
2399855   S IMP SCREW, SHZ 4MM/2.5M          675.00      0.00   23           SURGICAL SUPPLIES
2373264   S IMP SCREW, SIDE OPEN 5.         1983.00      0.00   23           SURGICAL SUPPLIES
2373207   S IMP SCREW, SIDE OPEN 5X         1828.00      0.00   23           SURGICAL SUPPLIES
2373330   S IMP SCREW, SIDE OPEN 5X         2122.00      0.00   23           SURGICAL SUPPLIES
2399863   S IMP SCREW, SIDE-OPEN TI         2378.00      0.00   23           SURGICAL SUPPLIES
2399871   S IMP SCREW, SPNL TI SHZ          1217.00      0.00   23           SURGICAL SUPPLIES
2399889   S IMP SCREW, SPNL TI SO 7         2378.00      0.00   23           SURGICAL SUPPLIES
2372225   S IMP SCREW, SQUARE 1.7X1          528.00      0.00   23           SURGICAL SUPPLIES
2372027   S IMP SCREW, SQUARE 2.0X1          462.00      0.00   23           SURGICAL SUPPLIES
2371987   S IMP SCREW, SQUARE 2.0X1          462.00      0.00   23           SURGICAL SUPPLIES
2372019   S IMP SCREW, SQUARE 2.0X1          462.00      0.00   23           SURGICAL SUPPLIES
2372001   S IMP SCREW, SQUARE 2.0X1          462.00      0.00   23           SURGICAL SUPPLIES
2371995   S IMP SCREW, SQUARE 2.0X1          462.00      0.00   23           SURGICAL SUPPLIES
2372035   S IMP SCREW, SQUARE 2.0X4          462.00      0.00   23           SURGICAL SUPPLIES
2372043   S IMP SCREW, SQUARE 2.0X5          462.00      0.00   23           SURGICAL SUPPLIES
2372050   S IMP SCREW, SQUARE 2.0X6          462.00      0.00   23           SURGICAL SUPPLIES
2372068   S IMP SCREW, SQUARE 2.0X8          462.00      0.00   23           SURGICAL SUPPLIES
2372233   S IMP SCREW, SQUARE FIT 1          528.00      0.00   23           SURGICAL SUPPLIES
2372241   S IMP SCREW, SQUARE FIT 1          528.00      0.00   23           SURGICAL SUPPLIES
2372258   S IMP SCREW, SQUARE FIT 1          528.00      0.00   23           SURGICAL SUPPLIES
2372266   S IMP SCREW, SQUARE FIT 1          528.00      0.00   23           SURGICAL SUPPLIES
2372274   S IMP SCREW, SQUARE FIT 1          528.00      0.00   23           SURGICAL SUPPLIES
2353589   S IMP SCREW, STAY FUSE M           465.00      0.00   23           SURGICAL SUPPLIES
2353597   S IMP SCREW, STAY FUSE M           465.00      0.00   23           SURGICAL SUPPLIES




                                                 Page 180
                                  85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2353571   S IMP SCREW, STAY FUSE P           465.00      0.00   23           SURGICAL SUPPLIES
2353308   S IMP SCREW, SYNTHES 12,           217.00      0.00   23           SURGICAL SUPPLIES
2353316   S IMP SCREW, SYNTHES 16,            80.00      0.00   23           SURGICAL SUPPLIES
2353290   S IMP SCREW, SYNTHES, 1.           280.00      0.00   23           SURGICAL SUPPLIES
2399905   S IMP SCREW, TAP EXPAN HE         1345.00      0.00   23           SURGICAL SUPPLIES
2399897   S IMP SCREW, TAP EXPAN HE         1345.00      0.00   23           SURGICAL SUPPLIES
2399913   S IMP SCREW, TEMPO FIX 3.          435.00      0.00   23           SURGICAL SUPPLIES
2351575   S IMP SCREW, TENSIONING            409.00      0.00   23           SURGICAL SUPPLIES
2351567   S IMP SCREW, TENSIONING            409.00      0.00   23           SURGICAL SUPPLIES
2399939   S IMP SCREW, TI 1.3X5MM            417.00      0.00   23           SURGICAL SUPPLIES
2399947   S IMP SCREW, TI 1.3X8MM            417.00      0.00   23           SURGICAL SUPPLIES
2399954   S IMP SCREW, TI 2.4X12MM           447.00      0.00   23           SURGICAL SUPPLIES
2399962   S IMP SCREW, TI 6.2X40MM          2582.00      0.00   23           SURGICAL SUPPLIES
2399970   S IMP SCREW, TI 6.2X50MM          2582.00      0.00   23           SURGICAL SUPPLIES
2399996   S IMP SCREW, TI SELF TAP           319.00      0.00   23           SURGICAL SUPPLIES
2399988   S IMP SCREW, TI SELF TAP           319.00      0.00   23           SURGICAL SUPPLIES
2320059   S IMP SCREW, TI SELF TAP           352.00      0.00   23           SURGICAL SUPPLIES
2320042   S IMP SCREW, TI SELF TAP           352.00      0.00   23           SURGICAL SUPPLIES
2320067   S IMP SCREW, TI SELF TAP           352.00      0.00   23           SURGICAL SUPPLIES
2320034   S IMP SCREW, TI SELF TAP           352.00      0.00   23           SURGICAL SUPPLIES
2320026   S IMP SCREW, TI SELF TAP           319.00      0.00   23           SURGICAL SUPPLIES
2351583   S IMP SCREW, TICANNTED 4           474.00      0.00   23           SURGICAL SUPPLIES
2320083   S IMP SCREW, TNSN TI 4MMX          860.00      0.00   23           SURGICAL SUPPLIES
2320075   S IMP SCREW, TNSN TI 4MMX          860.00      0.00   23           SURGICAL SUPPLIES
2353324   S IMP SCREW, TRANS-FIX I          1508.00      0.00   23           SURGICAL SUPPLIES
2397958   S IMP SCREW,5MM/25MM               903.00      0.00   23           SURGICAL SUPPLIES
2397388   S IMP SCREW,7.3MM/70MM            1124.00      0.00   23           SURGICAL SUPPLIES
2397966   S IMP SCREW,7.3MMX60MM            1252.00      0.00   23           SURGICAL SUPPLIES
2355097   S IMP SCREW,CANCELLOUS 4           112.00      0.00   23           SURGICAL SUPPLIES
2355147   S IMP SCREW,CANCELLOUS 4            46.00      0.00   23           SURGICAL SUPPLIES
2355121   S IMP SCREW,CANCELLOUS 4           112.00      0.00   23           SURGICAL SUPPLIES
2355113   S IMP SCREW,CANCELLOUS 4           112.00      0.00   23           SURGICAL SUPPLIES
2355071   S IMP SCREW,CANCELLOUS 4           112.00      0.00   23           SURGICAL SUPPLIES
2355139   S IMP SCREW,CANCELLOUS 4            46.00      0.00   23           SURGICAL SUPPLIES
2355105   S IMP SCREW,CANCELLOUS 4           112.00      0.00   23           SURGICAL SUPPLIES
2355089   S IMP SCREW,CANCELLOUS 4           112.00      0.00   23           SURGICAL SUPPLIES
2355170   S IMP SCREW,CANCELLOUS 6            76.00      0.00   23           SURGICAL SUPPLIES
2355188   S IMP SCREW,CANCELLOUS 6            99.00      0.00   23           SURGICAL SUPPLIES
2355162   S IMP SCREW,CANCELLOUS 6           107.00      0.00   23           SURGICAL SUPPLIES
2355154   S IMP SCREW,CANCELLOUS 6           275.00      0.00   23           SURGICAL SUPPLIES
2355212   S IMP SCREW,CORTICAL 4.0           263.00      0.00   23           SURGICAL SUPPLIES
2355196   S IMP SCREW,CORTICAL 4.0           263.00      0.00   23           SURGICAL SUPPLIES
2355204   S IMP SCREW,CORTICAL 4.0           263.00      0.00   23           SURGICAL SUPPLIES
2370302   S IMP SCREWS DISTRACTION          1138.00      0.00   23           SURGICAL SUPPLIES
2374783   S IMP SET GUNTHER TULIP V         4298.00      0.00   23           SURGICAL SUPPLIES
2378891   S IMP SET SCREW VERTEX             770.00      0.00   23           SURGICAL SUPPLIES
2320109   S IMP SET, 1.6MM BEADED C         1836.00      0.00   23           SURGICAL SUPPLIES
2371029   S IMP SHELL ACETABULAR            9646.00      0.00   23           SURGICAL SUPPLIES
2369148   S IMP SHIP TOE IMPLANT             854.00      0.00   23           SURGICAL SUPPLIES
2371268   S IMP SHUNT CATH VALVES           4428.00      0.00   23           SURGICAL SUPPLIES
2376515   S IMP SHUNT FLUSHING VALV         1516.00      0.00   23           SURGICAL SUPPLIES
2374643   S IMP SHUNT MULTIPURPOSE          3840.00      0.00   23           SURGICAL SUPPLIES
2378834   S IMP SHUNT PERITONEAL CA          730.00      0.00   23           SURGICAL SUPPLIES




                                                 Page 181
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2320125   S IMP SHUNT, FLUSHING VAL        1512.00      0.00   23           SURGICAL SUPPLIES
2376580   S IMP SLEEVE CABLE GRIP 1        2186.00      0.00   23           SURGICAL SUPPLIES
2340925   S IMP STAPES, MCGEE SS PI          80.00      0.00   23           SURGICAL SUPPLIES
2341212   S IMP STAPES, STORZ ROBIN          81.00      0.00   23           SURGICAL SUPPLIES
2370567   S IMP STAPLES BONE ALL           1033.00      0.00   23           SURGICAL SUPPLIES
2317154   S IMP STENT BILIARY COTTO           0.00      0.00   23           SURGICAL SUPPLIES
2312775   S IMP STENT BILIARY COTTO         277.00      0.00   23           SURGICAL SUPPLIES
2377794   S IMP STENT COTTON LEUNG          278.00      0.00   23           SURGICAL SUPPLIES
2376143   S IMP STENT GEENEN PANCRE         763.00      0.00   23           SURGICAL SUPPLIES
2357168   S IMP STENT URETERAL              552.00      0.00   23           SURGICAL SUPPLIES
2357119   S IMP STENT URETERAL              443.00      0.00   23           SURGICAL SUPPLIES
2357135   S IMP STENT URETERAL              537.00      0.00   23           SURGICAL SUPPLIES
2357218   S IMP STENT URETERAL              515.00      0.00   23           SURGICAL SUPPLIES
2357150   S IMP STENT URETERAL              456.00      0.00   23           SURGICAL SUPPLIES
2357176   S IMP STENT URETERAL              644.00      0.00   23           SURGICAL SUPPLIES
2357184   S IMP STENT URETERAL              537.00      0.00   23           SURGICAL SUPPLIES
2357192   S IMP STENT URETERAL              537.00      0.00   23           SURGICAL SUPPLIES
2357200   S IMP STENT URETERAL              537.00      0.00   23           SURGICAL SUPPLIES
2357127   S IMP STENT URETERAL             2107.00      0.00   23           SURGICAL SUPPLIES
2357143   S IMP STENT URETERAL              894.00      0.00   23           SURGICAL SUPPLIES
2356558   S IMP STENT, URETERAL             443.00      0.00   23           SURGICAL SUPPLIES
2356566   S IMP STENT, URETERAL             443.00      0.00   23           SURGICAL SUPPLIES
2356608   S IMP STENT, URETERAL             443.00      0.00   23           SURGICAL SUPPLIES
2356541   S IMP STENT, URETERAL             443.00      0.00   23           SURGICAL SUPPLIES
2356533   S IMP STENT, URETERAL             443.00      0.00   23           SURGICAL SUPPLIES
2356525   S IMP STENT, URETERAL             443.00      0.00   23           SURGICAL SUPPLIES
2356517   S IMP STENT, URETERAL             443.00      0.00   23           SURGICAL SUPPLIES
2356509   S IMP STENT, URETERAL             293.00      0.00   23           SURGICAL SUPPLIES
2356574   S IMP STENT, URETERAL             443.00      0.00   23           SURGICAL SUPPLIES
2356590   S IMP STENT, URETERAL             443.00      0.00   23           SURGICAL SUPPLIES
2356582   S IMP STENT, URETERAL             443.00      0.00   23           SURGICAL SUPPLIES
2356632   S IMP STENT, URETERAL             716.00      0.00   23           SURGICAL SUPPLIES
2356616   S IMP STENT,INFUSUR INJEC         728.00      0.00   23           SURGICAL SUPPLIES
2356624   S IMP STENT,INFUSUR INJEC         728.00      0.00   23           SURGICAL SUPPLIES
2356657   S IMP STENT,URETERAL              575.00      0.00   23           SURGICAL SUPPLIES
2356681   S IMP STENT,URETERAL              537.00      0.00   23           SURGICAL SUPPLIES
2356673   S IMP STENT,URETERAL              537.00      0.00   23           SURGICAL SUPPLIES
2356699   S IMP STENT,URETERAL              537.00      0.00   23           SURGICAL SUPPLIES
2356665   S IMP STENT,URETERAL              537.00      0.00   23           SURGICAL SUPPLIES
2356640   S IMP STENT,URETERAL              716.00      0.00   23           SURGICAL SUPPLIES
2354538   S IMP SUTTER IMPL, LTIP          1084.00      0.00   23           SURGICAL SUPPLIES
2320133   S IMP SWVR CRUCIFORM 1.5M        2390.00      0.00   23           SURGICAL SUPPLIES
2320141   S IMP SWVR CRUCIFORM SLV         1497.00      0.00   23           SURGICAL SUPPLIES
2320158   S IMP SWVR CRUCIFORM W/SL        3403.00      0.00   23           SURGICAL SUPPLIES
2320166   S IMP SWVR EXPAN HEAD 4.0        1438.00      0.00   23           SURGICAL SUPPLIES
2320174   S IMP SWVR HEXAGONAL 3.9M        1176.00      0.00   23           SURGICAL SUPPLIES
2391738   S IMP SYNC PUMP                 30009.00      0.00   23           SURGICAL SUPPLIES
2375285   S IMP T2 25MM LOCKING $           667.00      0.00   23           SURGICAL SUPPLIES
2356756   S IMP TESTICULAR PROSTHE          895.00      0.00   23           SURGICAL SUPPLIES
2356871   S IMP TESTICULAR PROSTHE         9833.00      0.00   23           SURGICAL SUPPLIES
2391746   S IMP TIS EXPA                   4955.00      0.00   23           SURGICAL SUPPLIES
2340826   S IMP TORP, TOTAL OSSICUL        1238.00      0.00   23           SURGICAL SUPPLIES
2373801   S IMP TRANCONN/6.0 ROD 24        3840.00      0.00   23           SURGICAL SUPPLIES




                                                Page 182
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2373876   S IMP TRANCONN/6.0 ROD 31        4299.00      0.00   23           SURGICAL SUPPLIES
2373843   S IMP TRANCONN/6.0 ROD 35        4135.00      0.00   23           SURGICAL SUPPLIES
2372183   S IMP TRANS CONN CLAMP BO        1143.00      0.00   23           SURGICAL SUPPLIES
2320182   S IMP TROCHANTERIC FIXATI        5137.00      0.00   23           SURGICAL SUPPLIES
2353662   S IMP UNOKM NANN 350-1690        1287.00      0.00   23           SURGICAL SUPPLIES
2357226   S IMP VESSICA,SUTURE A           2301.00      0.00   23           SURGICAL SUPPLIES
2369023   S IMP VNS GENERATOR             19801.00      0.00   23           SURGICAL SUPPLIES
2354108   S IMP VNS LEAD                   8775.00      0.00   23           SURGICAL SUPPLIES
2391753   S IMP WASHER 7MM                  173.00      0.00   23           SURGICAL SUPPLIES
2320190   S IMP WASHER, 10MM                196.00      0.00   23           SURGICAL SUPPLIES
2320208   S IMP WASHER, 6.5MM               164.00      0.00   23           SURGICAL SUPPLIES
2351641   S IMP WASHER, ARTHROTE           1291.00      0.00   23           SURGICAL SUPPLIES
2351658   S IMP WASHER, ASNIS               185.00      0.00   23           SURGICAL SUPPLIES
2350254   S IMP WASHER, CANC SCR             44.00      0.00   23           SURGICAL SUPPLIES
2320216   S IMP WASHER, LG SCREW 13         179.00      0.00   23           SURGICAL SUPPLIES
2320224   S IMP WASHER, SPIKED 13.5         637.00      0.00   23           SURGICAL SUPPLIES
2320232   S IMP WASHER, SPIKED 8.0X         642.00      0.00   23           SURGICAL SUPPLIES
2370252   S IMP WASHERS                     234.00      0.00   23           SURGICAL SUPPLIES
2375855   S IMP WIRE K-WIRE 450MM $         618.00      0.00   23           SURGICAL SUPPLIES
2320240   S IMP WIRE, 2.0MMN                229.00      0.00   23           SURGICAL SUPPLIES
2320257   S IMP WIRE, KIRSCHNER 1.6          89.00      0.00   23           SURGICAL SUPPLIES
2320265   S IMP WIRE, KIRSCHNER 2.0         816.00      0.00   23           SURGICAL SUPPLIES
2320273   S IMP WIRE, KIRSCHNER SPA         251.00      0.00   23           SURGICAL SUPPLIES
2320281   S IMP, CAP EXTFIX 11MM TU         118.00      0.00   23           SURGICAL SUPPLIES
2350312   S IMPSCREW, CORTEX, 2.7            90.00      0.00   23           SURGICAL SUPPLIES
2346518   S IOL IOL, ALCON MC60CM 9        1025.00      0.00   23           SURGICAL SUPPLIES
2347243   S IOL IOL, ALCON SA60AT 1        1025.00      0.00   23           SURGICAL SUPPLIES
2347227   S IOL IOL, ALCON SA60AT 1        1025.00      0.00   23           SURGICAL SUPPLIES
2347250   S IOL IOL, ALCON SA60AT 1        1025.00      0.00   23           SURGICAL SUPPLIES
2347219   S IOL IOL, ALCON SA60AT 1        1025.00      0.00   23           SURGICAL SUPPLIES
2347201   S IOL IOL, ALCON SA60AT 1        1025.00      0.00   23           SURGICAL SUPPLIES
2347235   S IOL IOL, ALCON SA60AT 1        1025.00      0.00   23           SURGICAL SUPPLIES
2347193   S IOL IOL, ALCON SA60AT 1        1025.00      0.00   23           SURGICAL SUPPLIES
2347185   S IOL IOL, ALCON SA60AT 1        1025.00      0.00   23           SURGICAL SUPPLIES
2347268   S IOL IOL, ALCON SA60AT 1        1025.00      0.00   23           SURGICAL SUPPLIES
2347292   S IOL IOL, ALCON SA60AT 2        1025.00      0.00   23           SURGICAL SUPPLIES
2347284   S IOL IOL, ALCON SA60AT 2        1025.00      0.00   23           SURGICAL SUPPLIES
2347300   S IOL IOL, ALCON SA60AT 2        1025.00      0.00   23           SURGICAL SUPPLIES
2347318   S IOL IOL, ALCON SA60AT 2        1025.00      0.00   23           SURGICAL SUPPLIES
2347326   S IOL IOL, ALCON SA60AT 2        1025.00      0.00   23           SURGICAL SUPPLIES
2347342   S IOL IOL, ALCON SA60AT 2        1025.00      0.00   23           SURGICAL SUPPLIES
2347276   S IOL IOL, ALCON SA60AT 2        1025.00      0.00   23           SURGICAL SUPPLIES
2347359   S IOL IOL, ALCON SA60AT 2        1025.00      0.00   23           SURGICAL SUPPLIES
2347334   S IOL IOL, ALCON SA60AT 2        1025.00      0.00   23           SURGICAL SUPPLIES
2344406   S IOL IOL, ALLERGAN AR4          1025.00      0.00   23           SURGICAL SUPPLIES
2344588   S IOL IOL, ALLERGAN AR40,        1025.00      0.00   23           SURGICAL SUPPLIES
2344620   S IOL IOL, ALLERGAN AR40,        1025.00      0.00   23           SURGICAL SUPPLIES
2344612   S IOL IOL, ALLERGAN AR40,        1025.00      0.00   23           SURGICAL SUPPLIES
2344604   S IOL IOL, ALLERGAN AR40,        1025.00      0.00   23           SURGICAL SUPPLIES
2344596   S IOL IOL, ALLERGAN AR40,        1025.00      0.00   23           SURGICAL SUPPLIES
2344497   S IOL IOL, ALLERGAN AR40,        1025.00      0.00   23           SURGICAL SUPPLIES
2344463   S IOL IOL, ALLERGAN AR40,        1025.00      0.00   23           SURGICAL SUPPLIES
2344471   S IOL IOL, ALLERGAN AR40,        1025.00      0.00   23           SURGICAL SUPPLIES




                                                Page 183
                                      85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2344489   S IOL IOL, ALLERGAN AR40,             1025.00      0.00   23           SURGICAL SUPPLIES
2344448   S IOL IOL, ALLERGAN AR40,             1025.00      0.00   23           SURGICAL SUPPLIES
2344430   S IOL IOL, ALLERGAN AR40,             1025.00      0.00   23           SURGICAL SUPPLIES
2344422   S IOL IOL, ALLERGAN AR40,             1025.00      0.00   23           SURGICAL SUPPLIES
2344455   S IOL IOL, ALLERGAN AR40,             1025.00      0.00   23           SURGICAL SUPPLIES
2344414   S IOL IOL, ALLERGAN AR40,             1025.00      0.00   23           SURGICAL SUPPLIES
2344505   S IOL IOL, ALLERGAN AR40,             1025.00      0.00   23           SURGICAL SUPPLIES
2344513   S IOL IOL, ALLERGAN AR40,             1025.00      0.00   23           SURGICAL SUPPLIES
2344521   S IOL IOL, ALLERGAN AR40,             1025.00      0.00   23           SURGICAL SUPPLIES
2344539   S IOL IOL, ALLERGAN AR40,             1025.00      0.00   23           SURGICAL SUPPLIES
2344547   S IOL IOL, ALLERGAN AR40,             1025.00      0.00   23           SURGICAL SUPPLIES
2344554   S IOL IOL, ALLERGAN AR40,             1025.00      0.00   23           SURGICAL SUPPLIES
2344562   S IOL IOL, ALLERGAN AR40,             1025.00      0.00   23           SURGICAL SUPPLIES
2344570   S IOL IOL, ALLERGAN AR40,             1025.00      0.00   23           SURGICAL SUPPLIES
2347086   S IOL IOL, ALLERGAN OC11N             1025.00      0.00   23           SURGICAL SUPPLIES
2347094   S IOL IOL, ALLERGAN PC11N             1025.00      0.00   23           SURGICAL SUPPLIES
2347078   S IOL IOL, ALLERGAN PC11N             1025.00      0.00   23           SURGICAL SUPPLIES
2347151   S IOL IOL, ALLERGAN SA40N             1025.00      0.00   23           SURGICAL SUPPLIES
2347169   S IOL IOL, ALLERGAN SA40N             1025.00      0.00   23           SURGICAL SUPPLIES
2347177   S IOL IOL, ALLERGAN SA40N             1025.00      0.00   23           SURGICAL SUPPLIES
2347128   S IOL IOL, ALLERGAN, A140             1025.00      0.00   23           SURGICAL SUPPLIES
2347110   S IOL IOL, ALLERGAN, S130             1025.00      0.00   23           SURGICAL SUPPLIES
2347367   S IOL IOL, ALLERGAN, SI30             1025.00      0.00   23           SURGICAL SUPPLIES
2347482   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347508   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347631   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347623   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347615   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347607   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347599   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347581   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347573   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347565   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347557   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347540   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347532   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347466   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347516   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347490   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347474   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347458   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347441   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347433   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347425   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347417   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347409   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347391   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347383   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347375   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2347524   S IOL IOL, ALLERGAN, SI40             1025.00      0.00   23           SURGICAL SUPPLIES
2344638   S IOL IOL, CHIRON C11UB 2             1025.00      0.00   23           SURGICAL SUPPLIES
2346419   S IOL IOL, CILCO MA60AC,              1025.00      0.00   23           SURGICAL SUPPLIES
2345460   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES




                                                     Page 184
                                      85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2345684   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345445   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345692   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345452   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345676   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345650   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345635   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345619   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345593   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345577   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345510   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345551   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345536   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345478   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345528   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345486   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345494   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345502   S IOL IOL, CILCO LX10BD 1             1025.00      0.00   23           SURGICAL SUPPLIES
2345767   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345775   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345783   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345700   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345817   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345734   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345825   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345833   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345841   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345858   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345791   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345544   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345759   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345585   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345742   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345601   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345718   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345726   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345569   S IOL IOL, CILCO LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345627   S IOL IOL, CILCO LX10BD 3             1025.00      0.00   23           SURGICAL SUPPLIES
2345643   S IOL IOL, CILCO LX10BD 9             1025.00      0.00   23           SURGICAL SUPPLIES
2345668   S IOL IOL, CILCO LX10BD 9             1025.00      0.00   23           SURGICAL SUPPLIES
2346450   S IOL IOL, CILCO MA60BM 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346468   S IOL IOL, CILCO MA60BM 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346476   S IOL IOL, CILCO MA60BM 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346484   S IOL IOL, CILCO MA60BM 2             1025.00      0.00   23           SURGICAL SUPPLIES
2346492   S IOL IOL, CILCO MA60BM 2             1025.00      0.00   23           SURGICAL SUPPLIES
2346500   S IOL IOL, CILCO MA60BM 2             1025.00      0.00   23           SURGICAL SUPPLIES
2346179   S IOL IOL, CILCO, CA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2345148   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345221   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345296   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345288   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345270   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345262   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES




                                                     Page 185
                                      85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2345239   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345205   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345197   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345189   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345171   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345213   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345155   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345023   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345130   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345122   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345114   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345106   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345098   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345080   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345072   S IOL IOL, CILCO, CR5BUO,              456.00      0.00   23           SURGICAL SUPPLIES
2345064   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345056   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345049   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345163   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345247   S IOL IOL, CILCO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345320   S IOL IOL, CILCO, CZ70BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345312   S IOL IOL, CILCO, CZ70BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345338   S IOL IOL, CILCO, CZ70BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345346   S IOL IOL, CILCO, CZ70BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345353   S IOL IOL, CILCO, CZ70BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345361   S IOL IOL, CILCO, CZ70BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345379   S IOL IOL, CILCO, CZ70BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345387   S IOL IOL, CILCO, CZ70BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345395   S IOL IOL, CILCO, CZ70BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345304   S IOL IOL, CILCO, CZ70BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346138   S IOL IOL, CILCO, LK90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345882   S IOL IOL, CILCO, LX90BD              1025.00      0.00   23           SURGICAL SUPPLIES
2346096   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346047   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346054   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346062   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346070   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346088   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346104   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346112   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346120   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346039   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346153   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346005   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346146   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345908   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345866   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346021   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345890   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346013   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345916   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345924   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345932   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES




                                                     Page 186
                                      85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2345957   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345965   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345973   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345981   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345999   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345940   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2345874   S IOL IOL, CILCO, LX90BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346393   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346310   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346328   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346336   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346344   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346351   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346369   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346377   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346385   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346401   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346187   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346302   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346161   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346286   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346278   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346260   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346252   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346245   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346237   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346229   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346211   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346195   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346203   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346294   S IOL IOL, CILCO, MA30BA,             1025.00      0.00   23           SURGICAL SUPPLIES
2346435   S IOL IOL, CILCO, MA60BD              1025.00      0.00   23           SURGICAL SUPPLIES
2346443   S IOL IOL, CILCO, MA60BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346427   S IOL IOL, CILCO, MA60BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346740   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346807   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346583   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346799   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346815   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346781   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346773   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346765   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346757   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346724   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346708   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346690   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346682   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346666   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346641   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346609   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346567   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346732   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346625   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES




                                                     Page 187
                                      85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2346716   S IOL IOL, CILCO, MT4U, 1             1025.00      0.00   23           SURGICAL SUPPLIES
2346658   S IOL IOL, CILCO, MT4U, 2             1025.00      0.00   23           SURGICAL SUPPLIES
2346856   S IOL IOL, CILCO, MT4U, 2             1025.00      0.00   23           SURGICAL SUPPLIES
2346823   S IOL IOL, CILCO, MT4U, 2             1025.00      0.00   23           SURGICAL SUPPLIES
2346849   S IOL IOL, CILCO, MT4U, 2             1025.00      0.00   23           SURGICAL SUPPLIES
2346831   S IOL IOL, CILCO, MT4U, 2             1025.00      0.00   23           SURGICAL SUPPLIES
2346534   S IOL IOL, CILCO, MT4U, 2             1025.00      0.00   23           SURGICAL SUPPLIES
2346559   S IOL IOL, CILCO, MT4U, 2             1025.00      0.00   23           SURGICAL SUPPLIES
2346575   S IOL IOL, CILCO, MT4U, 2             1025.00      0.00   23           SURGICAL SUPPLIES
2346591   S IOL IOL, CILCO, MT4U, 2             1025.00      0.00   23           SURGICAL SUPPLIES
2346617   S IOL IOL, CILCO, MT4U, 2             1025.00      0.00   23           SURGICAL SUPPLIES
2346633   S IOL IOL, CILCO, MT4U, 2             1025.00      0.00   23           SURGICAL SUPPLIES
2346674   S IOL IOL, CILCO, MT4U, 3             1025.00      0.00   23           SURGICAL SUPPLIES
2346526   S IOL IOL, CILCO, MT4U, 8             1025.00      0.00   23           SURGICAL SUPPLIES
2346542   S IOL IOL, CILCO, MT4U, 9             1025.00      0.00   23           SURGICAL SUPPLIES
2346864   S IOL IOL, CILCO, MTA3UO,             1025.00      0.00   23           SURGICAL SUPPLIES
2346906   S IOL IOL, CILCO, MTA4UO,             1025.00      0.00   23           SURGICAL SUPPLIES
2346914   S IOL IOL, CILCO, MTA4UO,             1025.00      0.00   23           SURGICAL SUPPLIES
2346898   S IOL IOL, CILCO, MTA4UO,             1025.00      0.00   23           SURGICAL SUPPLIES
2346880   S IOL IOL, CILCO, MTA4UO,             1025.00      0.00   23           SURGICAL SUPPLIES
2346872   S IOL IOL, CILCO, MTA4UO,             1025.00      0.00   23           SURGICAL SUPPLIES
2346922   S IOL IOL, CILCO, MZ60BD              1025.00      0.00   23           SURGICAL SUPPLIES
2346997   S IOL IOL, CILCO, MZ60BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346930   S IOL IOL, CILCO, MZ60BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346948   S IOL IOL, CILCO, MZ60BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346955   S IOL IOL, CILCO, MZ60BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346963   S IOL IOL, CILCO, MZ60BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346989   S IOL IOL, CILCO, MZ60BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2347003   S IOL IOL, CILCO, MZ60BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2347029   S IOL IOL, CILCO, MZ60BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2347052   S IOL IOL, CILCO, MZ60BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2347011   S IOL IOL, CILCO, MZ60BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2346971   S IOL IOL, CILCO, MZ60BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2347045   S IOL IOL, CILCO, MZ60BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2347037   S IOL IOL, CILCO, MZ60BD,             1025.00      0.00   23           SURGICAL SUPPLIES
2347060   S IOL IOL, CILCO, MZ60CD,             1025.00      0.00   23           SURGICAL SUPPLIES
2347144   S IOL IOL, CILCO, SA30AL              1025.00      0.00   23           SURGICAL SUPPLIES
2347136   S IOL IOL, CILCO, SA30AL              1025.00      0.00   23           SURGICAL SUPPLIES
2345254   S IOL IOL, CILCO. CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345031   S IOL IOL, CILDO, CR5BUO,             1025.00      0.00   23           SURGICAL SUPPLIES
2345809   S IOL IOL, COLCI LX10BD 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344216   S IOL IOL, SATRR AQ2010 1             1025.00      0.00   23           SURGICAL SUPPLIES
2344323   S IOL IOL, STAAR AQ2010               1025.00      0.00   23           SURGICAL SUPPLIES
2343549   S IOL IOL, STAAR, AA4203              1025.00      0.00   23           SURGICAL SUPPLIES
2343721   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343739   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343747   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343754   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343762   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343770   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343788   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343481   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343713   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES




                                                     Page 188
                                      85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2343804   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343796   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343663   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343689   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343697   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343705   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343671   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343655   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343648   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343630   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343622   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343614   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343606   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343598   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343580   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343515   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343572   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343507   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343499   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343523   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343531   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343556   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343564   S IOL IOL, STAAR, AA4203,             1025.00      0.00   23           SURGICAL SUPPLIES
2343812   S IOL IOL, STAAR, AA4207              1025.00      0.00   23           SURGICAL SUPPLIES
2344158   S IOL IOL, STAAR, AQ1016              1025.00      0.00   23           SURGICAL SUPPLIES
2343887   S IOL IOL, STARR AA4207 1             1025.00      0.00   23           SURGICAL SUPPLIES
2343937   S IOL IOL, STARR AA4207 1             1025.00      0.00   23           SURGICAL SUPPLIES
2343903   S IOL IOL, STARR AA4207 1             1025.00      0.00   23           SURGICAL SUPPLIES
2343853   S IOL IOL, STARR AA4207 1             1025.00      0.00   23           SURGICAL SUPPLIES
2343861   S IOL IOL, STARR AA4207 1             1025.00      0.00   23           SURGICAL SUPPLIES
2343945   S IOL IOL, STARR AA4207 1             1025.00      0.00   23           SURGICAL SUPPLIES
2343895   S IOL IOL, STARR AA4207 1             1025.00      0.00   23           SURGICAL SUPPLIES
2343846   S IOL IOL, STARR AA4207 1             1025.00      0.00   23           SURGICAL SUPPLIES
2343929   S IOL IOL, STARR AA4207 1             1025.00      0.00   23           SURGICAL SUPPLIES
2343838   S IOL IOL, STARR AA4207 1             1025.00      0.00   23           SURGICAL SUPPLIES
2343879   S IOL IOL, STARR AA4207 1             1025.00      0.00   23           SURGICAL SUPPLIES
2343911   S IOL IOL, STARR AA4207 1             1025.00      0.00   23           SURGICAL SUPPLIES
2344117   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES
2343952   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES
2343960   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344034   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344091   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344083   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344075   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344125   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344109   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES
2343978   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344018   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344026   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES
2343994   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344059   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES
2343986   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344067   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES




                                                     Page 189
                                      85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2344042   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344000   S IOL IOL, STARR AA4207 2             1025.00      0.00   23           SURGICAL SUPPLIES
2343820   S IOL IOL, STARR AA4207 3             1025.00      0.00   23           SURGICAL SUPPLIES
2344133   S IOL IOL, STARR AQ1016,              1025.00      0.00   23           SURGICAL SUPPLIES
2344331   S IOL IOL, STARR AQ2010               1025.00      0.00   23           SURGICAL SUPPLIES
2344356   S IOL IOL, STARR AQ2010               1025.00      0.00   23           SURGICAL SUPPLIES
2344349   S IOL IOL, STARR AQ2010               1025.00      0.00   23           SURGICAL SUPPLIES
2344380   S IOL IOL, STARR AQ2010               1025.00      0.00   23           SURGICAL SUPPLIES
2344174   S IOL IOL, STARR AQ2010 1             1025.00      0.00   23           SURGICAL SUPPLIES
2344208   S IOL IOL, STARR AQ2010 1             1025.00      0.00   23           SURGICAL SUPPLIES
2344166   S IOL IOL, STARR AQ2010 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344257   S IOL IOL, STARR AQ2010,              1025.00      0.00   23           SURGICAL SUPPLIES
2344182   S IOL IOL, STARR AQ2010,              1025.00      0.00   23           SURGICAL SUPPLIES
2344646   S IOL IOL, STARR CC4203 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344653   S IOL IOL, STARR CC4203 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344661   S IOL IOL, STARR CC4203 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344679   S IOL IOL, STARR CC4203 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344687   S IOL IOL, STARR CC4203 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344695   S IOL IOL, STARR CC4203 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344711   S IOL IOL, STARR CC4203 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344737   S IOL IOL, STARR CC4203 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344703   S IOL IOL, STARR CC4203 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344729   S IOL IOL, STARR CC4203 3             1025.00      0.00   23           SURGICAL SUPPLIES
2344810   S IOL IOL, STARR CC4204 1             1025.00      0.00   23           SURGICAL SUPPLIES
2344828   S IOL IOL, STARR CC4204 1             1025.00      0.00   23           SURGICAL SUPPLIES
2344794   S IOL IOL, STARR CC4204 1             1025.00      0.00   23           SURGICAL SUPPLIES
2344869   S IOL IOL, STARR CC4204 1             1025.00      0.00   23           SURGICAL SUPPLIES
2344851   S IOL IOL, STARR CC4204 1             1025.00      0.00   23           SURGICAL SUPPLIES
2344836   S IOL IOL, STARR CC4204 1             1025.00      0.00   23           SURGICAL SUPPLIES
2344802   S IOL IOL, STARR CC4204 1             1025.00      0.00   23           SURGICAL SUPPLIES
2344752   S IOL IOL, STARR CC4204 1             1025.00      0.00   23           SURGICAL SUPPLIES
2344745   S IOL IOL, STARR CC4204 1             1025.00      0.00   23           SURGICAL SUPPLIES
2344844   S IOL IOL, STARR CC4204 1             1025.00      0.00   23           SURGICAL SUPPLIES
2344992   S IOL IOL, STARR CC4204 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344984   S IOL IOL, STARR CC4204 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344877   S IOL IOL, STARR CC4204 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345007   S IOL IOL, STARR CC4204 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344935   S IOL IOL, STARR CC4204 2             1025.00      0.00   23           SURGICAL SUPPLIES
2345015   S IOL IOL, STARR CC4204 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344976   S IOL IOL, STARR CC4204 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344968   S IOL IOL, STARR CC4204 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344950   S IOL IOL, STARR CC4204 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344943   S IOL IOL, STARR CC4204 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344927   S IOL IOL, STARR CC4204 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344919   S IOL IOL, STARR CC4204 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344901   S IOL IOL, STARR CC4204 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344885   S IOL IOL, STARR CC4204 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344778   S IOL IOL, STARR CC4204 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344760   S IOL IOL, STARR CC4204 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344893   S IOL IOL, STARR CC4204 2             1025.00      0.00   23           SURGICAL SUPPLIES
2344786   S IOL IOL, STARR CC4204 3             1025.00      0.00   23           SURGICAL SUPPLIES
2344141   S IOL IOL, STARR, AQ1016,             1025.00      0.00   23           SURGICAL SUPPLIES
2344299   S IOL IOL, STARR, AQ201               1025.00      0.00   23           SURGICAL SUPPLIES




                                                     Page 190
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2344372   S IOL IOL, STARR, AQ201          1025.00      0.00   23           SURGICAL SUPPLIES
2344364   S IOL IOL, STARR, AQ201          1025.00      0.00   23           SURGICAL SUPPLIES
2344315   S IOL IOL, STARR, AQ201          1025.00      0.00   23           SURGICAL SUPPLIES
2344307   S IOL IOL, STARR, AQ201          1025.00      0.00   23           SURGICAL SUPPLIES
2344281   S IOL IOL, STARR, AQ201          1025.00      0.00   23           SURGICAL SUPPLIES
2344240   S IOL IOL, STARR, AQ2010         1025.00      0.00   23           SURGICAL SUPPLIES
2344273   S IOL IOL, STARR, AQ2010         1025.00      0.00   23           SURGICAL SUPPLIES
2344190   S IOL IOL, STARR, AQ2010         1025.00      0.00   23           SURGICAL SUPPLIES
2344224   S IOL IOL, STARR, AQ2010         1025.00      0.00   23           SURGICAL SUPPLIES
2344232   S IOL IOL, STARR, AQ2010         1025.00      0.00   23           SURGICAL SUPPLIES
2344265   S IOL IOL, STARR, AQ2010         1025.00      0.00   23           SURGICAL SUPPLIES
2390375   S IOL LENS                       1025.00      0.00   23           SURGICAL SUPPLIES
2320968   S LD PCR LEAD BIPOLAR            3173.00      0.00   23           SURGICAL SUPPLIES
2321016   S LD PCR PACING CABLES            231.00      0.00   23           SURGICAL SUPPLIES
2348985   S NSTRL ARTHREX, FOAM IN          211.00      0.00   23           SURGICAL SUPPLIES
2371136   S NSTRL BAG PRESSURE              217.00      0.00   23           SURGICAL SUPPLIES
2342004   S NSTRL BAIR HUGGER BLANE         145.00      0.00   23           SURGICAL SUPPLIES
2341998   S NSTRL BAIR HUGGER, BLA          117.00      0.00   23           SURGICAL SUPPLIES
2377166   S NSTRL CAP PROTECTIVE             40.00      0.00   23           SURGICAL SUPPLIES
2370443   S NSTRL CAST LOWER EXTREM         769.00      0.00   23           SURGICAL SUPPLIES
2370435   S NSTRL CAST UPPER EXTREM         478.00      0.00   23           SURGICAL SUPPLIES
2348670   S NSTRL CAST, LONG ARM C          272.00      0.00   23           SURGICAL SUPPLIES
2348712   S NSTRL CAST, LONG LEG A          272.00      0.00   23           SURGICAL SUPPLIES
2349702   S NSTRL CAST, SHOE, LARG           54.00      0.00   23           SURGICAL SUPPLIES
2349694   S NSTRL CAST, SHOE, MEDI           51.00      0.00   23           SURGICAL SUPPLIES
2349686   S NSTRL CAST, SHOE, SM             48.00      0.00   23           SURGICAL SUPPLIES
2348688   S NSTRL CAST, SHORT ARM           196.00      0.00   23           SURGICAL SUPPLIES
2348696   S NSTRL CAST, SHORT ARM           138.00      0.00   23           SURGICAL SUPPLIES
2348738   S NSTRL CAST, SHORT LEG           196.00      0.00   23           SURGICAL SUPPLIES
2348746   S NSTRL CAST, SHORT LEG           138.00      0.00   23           SURGICAL SUPPLIES
2370781   S NSTRL CILLAR PHILIADEL          510.00      0.00   23           SURGICAL SUPPLIES
2390631   S NSTRL COLLAR ASPEN               31.00      0.00   23           SURGICAL SUPPLIES
2370799   S NSTRL COLLAR CERVICAL H         611.00      0.00   23           SURGICAL SUPPLIES
2371227   S NSTRL COLLAR CERVICAL H         611.00      0.00   23           SURGICAL SUPPLIES
2370625   S NSTRL COLOSTOMY CLAMP            92.00      0.00   23           SURGICAL SUPPLIES
2370617   S NSTRL COLOSTOMY POUCH           100.00      0.00   23           SURGICAL SUPPLIES
2377786   S NSTRL CONTAINER KCI VAC         272.00      0.00   23           SURGICAL SUPPLIES
2330025   S NSTRL CRY/CUF, ANKLE W          448.00      0.00   23           SURGICAL SUPPLIES
2330033   S NSTRL CRY/CUF, ELB W/C          448.00      0.00   23           SURGICAL SUPPLIES
2330041   S NSTRL CRY/CUF,HND/WRST          448.00      0.00   23           SURGICAL SUPPLIES
2330058   S NSTRL CRY/CUF,KNEE LG           448.00      0.00   23           SURGICAL SUPPLIES
2330009   S NSTRL CRY/CUF,KNEE MED          448.00      0.00   23           SURGICAL SUPPLIES
2330066   S NSTRL CRY/CUF,SHLD W/C          505.00      0.00   23           SURGICAL SUPPLIES
2340628   S NSTRL EAR PROTECTOR, E           85.00      0.00   23           SURGICAL SUPPLIES
2341410   S NSTRL FILTER, BACTERIA           11.00      0.00   23           SURGICAL SUPPLIES
2348977   S NSTRL FILTER, VERSA LI          767.00      0.00   23           SURGICAL SUPPLIES
2370195   S NSTRL HELMET SYSTEM              52.00      0.00   23           SURGICAL SUPPLIES
2320018   S NSTRL HSE, SEQ COMP, T          317.00      0.00   23           SURGICAL SUPPLIES
2320000   S NSTRL HSO, TED THIGH L           56.00      0.00   23           SURGICAL SUPPLIES
2349108   S NSTRL IMMO, KNEE, LARG           92.00      0.00   23           SURGICAL SUPPLIES
2348563   S NSTRL IMMOB, DON JOY 1          555.00      0.00   23           SURGICAL SUPPLIES
2349116   S NSTRL IMMOB, KNEE, MED           91.00      0.00   23           SURGICAL SUPPLIES
2349124   S NSTRL IMMOB, KNEE, SM            88.00      0.00   23           SURGICAL SUPPLIES




                                                Page 191
                                 85004b2e-e1ba-478d-b34c-3af0e97eeea9.XLS




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



2349132   S NSTRL IMMOB, KNEE, X-L           93.00      0.00   23           SURGICAL SUPPLIES
2347953   S NSTRL IMMOB, SHOULDER,           66.00      0.00   23           SURGICAL SUPPLIES
2347979   S NSTRL IMMOB, SHOULDER,           69.00      0.00   23           SURGICAL SUPPLIES
2347961   S NSTRL IMMOB, SHOULDER,           69.00      0.00   23           SURGICAL SUPPLIES
2347672   S NSTRL IMMOB, SHOULDER,           62.00      0.00   23           SURGICAL SUPPLIES
2354421   S NSTRL KIT, EDINTRAK NE          499.00      0.00   23           SURGICAL SUPPLIES
2349348   S NSTRL KIT, SHOULDER SU          280.00      0.00   23           SURGICAL SUPPLIES
2354983   S NSTRL K-WIRE .045, UNS           36.00      0.00   23           SURGICAL SUPPLIES
2354991   S NSTRL K-WIRE .062, UNS           35.00      0.00   23           SURGICAL SUPPLIES
2340669   S NSTRL LASER, ANGLED DE         1124.00      0.00   23           SURGICAL SUPPLIES
2340677   S NSTRL LASER, FIBER BAR          817.00      0.00   23           SURGICAL SUPPLIES
2341303   S NSTRL PAD, K-THERMIA 2          108.00      0.00   23           SURGICAL SUPPLIES
2354157   S NSTRL POST-OP SHOE (ZI           47.00      0.00   23           SURGICAL SUPPLIES
2370773   S NSTRL RESUSCITATOR/AMBU         493.00      0.00   23           SURGICAL SUPPLIES
2349736   S NSTRL ROLL, PLASTER F-          166.00      0.00   23           SURGICAL SUPPLIES
2349728   S NSTRL ROLL, PLASTER F-          127.00      0.00   23           SURGICAL SUPPLIES
2349710   S NSTRL ROLL, PLASTER F-           88.00      0.00   23           SURGICAL SUPPLIES
2349678   S NSTRL ROLL, PLASTER F-           71.00      0.00   23           SURGICAL SUPPLIES
2340560   S NSTRL S NSTRL BAND, UN           79.00      0.00   23           SURGICAL SUPPLIES
2343275   S NSTRL SHIELD, EYE, MET            8.00      0.00   23           SURGICAL SUPPLIES
2354330   S NSTRL SHOE, CAST, MEDI           51.00      0.00   23           SURGICAL SUPPLIES
2354371   S NSTRL SHOE, POST-OP WO           65.00      0.00   23           SURGICAL SUPPLIES
2354355   S NSTRL SHOE, POST-OP, M           65.00      0.00   23           SURGICAL SUPPLIES
2354363   S NSTRL SHOE, POST-OP, M           65.00      0.00   23           SURGICAL SUPPLIES
2354348   S NSTRL SHOE, POST-OP, M           65.00      0.00   23           SURGICAL SUPPLIES
2354389   S NSTRL SHOE, POST-OP, W           65.00      0.00   23           SURGICAL SUPPLIES
2354397   S NSTRL SHOE, POST-OP, W           65.00      0.00   23           SURGICAL SUPPLIES
2349355   S NSTRL SKIN-TRAC, MEDIU           39.00      0.00   23           SURGICAL SUPPLIES
2370526   S NSTRL SPLINT ARM/LEG            854.00      0.00   23           SURGICAL SUPPLIES
2370583   S NSTRL SPLINT FIBERGLASS        1310.00      0.00   23           SURGICAL SUPPLIES
2370344   S NSTRL SPLINT KNEE UNIVE         467.00      0.00   23           SURGICAL SUPPLIES
2349454   S NSTRL SPLINT ROLL, PLA           88.00      0.00   23           SURGICAL SUPPLIES
2370336   S NSTRL SPLINT WRIST              238.00      0.00   23           SURGICAL SUPPLIES
2347656   S NSTRL SPLINT, ALUMAFOA         2620.00      0.00   23           SURGICAL SUPPLIES
2347680   S NSTRL SPLINT, FINGER             30.00      0.00   23           SURGICAL SUPPLIES
2348092   S NSTRL SPLINT, FINGER 3           28.00      0.00   23           SURGICAL SUPPLIES
2348100   S NSTRL SPLINT, FINGER 4           28.00      0.00   23           SURGICAL SUPPLIES
2347664   S NSTRL SPLINT, KNEE              299.00      0.00   23           SURGICAL SUPPLIES
2349496   S NSTRL SPLINT, ORTHO-GL            3.00      0.00   23           SURGICAL SUPPLIES
2349504   S NSTRL SPLINT, ORTHO-GL            5.00      0.00   23           SURGICAL SUPPLIES
2349488   S NSTRL SPLINT, ORTHO-GL            3.00      0.00   23           SURGICAL SUPPLIES
2349462   S NSTRL SPLINT, SHORT AR          158.00      0.00   23           SURGICAL SUPPLIES
2349447   S NSTRL SPLINT, WRIST             165.00      0.00   23           SURGICAL SUPPLIES
2349629   S NSTRL SPLNT ORTHO-GLAS          194.00      0.00   23           SURGICAL SUPPLIES
2354405   S NSTRL SPLNT, "PRO-MOTI         1115.00      0.00   23           SURGICAL SUPPLIES
2340776   S NSTRL SPLNT, NAS, BYRO           81.00      0.00   23           SURGICAL SUPPLIES
2340784   S NSTRL SPLNT, NAS, BYRO           99.00      0.00   23           SURGICAL SUPPLIES
2340792   S NSTRL SPLNT, NAS, BY