Section: File Summary
Hospital Name	Prices Posted And Effective	File Disclaimer	Payer Disclaimer	Gross Charge	Discounted Cash Price	Inpatient De-identified Negotiated Charge	Inpatient Payer Specific Charge	Outpatient De-identified Negotiated Charge	Outpatient Payer Specific Charge
MemorialCare Orange Coast Medical Center	8/1/2022 12:00:00 AM	The information contained in this file is intended for informational purposes only and does not represent any obligation or agreement.	In the absence of payment rates by plan type (HMO vs PPO), unless otherwise noted, please assume all plans are contracted under the same payer specific negotiated charge.	This section presents the standard gross charge for items And services.	This section presents information regarding discounted cash pricing for those patients who decide to pay without insurance coverage.	This section presents the de-identified minimum and maximum charge for items, services, and service packages that occur in the inpatient setting.	This section presents the payer specific negotiated charge for items, services, and service packages that occur in the inpatient setting.	This section presents the de-identified minimum and maximum charge for items, services, and service packages that occur in the outpatient setting.	This section presents the payer specific negotiated charge for items, services, and service packages that occur in the outpatient setting.

Section: Gross Charges
Itemcode	Description	CDM Revenue Code	CDM HCPCS	Item Price	Fee Schedule Price
HC25000001	ED LEVEL I-BRIEF	450	99281	569.00	N/A
HC25000019	ED LEVEL II - LIMITED	450	99282	1,145.00	N/A
HC25000027	ED LEVEL III - INTERMEDIATE	450	99283	1,883.00	N/A
HC25000035	ED LEVEL IV - EXTENDED	450	99284	3,042.00	N/A
HC25000043	ED LEVEL V - COMPREHENSIVE	450	99285	4,146.00	N/A
HC25000050	ED LEVEL VI - CRITICAL	450	99291	5,656.00	N/A
HC25000068	CRITICAL CARE EA ADDL 30 MIN	450	99292	2,479.00	N/A
HC89500300	CALL BACK FEE HRLY(2HR MIN)-AA	309	99027	280.00	504.00
HC89500532	CALL BACK FEE HRLY-SB	309	99027	380.00	380.00
HC11200177	DESENSITIZATION RAPID EA HR	924	95180	1,027.00	N/A
HC11500006	EST PT LVL1-BRIEF	510	99211	172.00	N/A
HC11500014	EST PT LVL2-PROB FOCUS	510	99212	210.00	N/A
HC11500022	EST PT LVL3-EXPANDED	510	99213	237.00	N/A
HC11500030	EST PT LVL4-DETAILED	510	99214	284.00	N/A
HC11500048	EST PT LVL5-COMPREHENSIVE	510	99215	349.00	N/A
HC11500063	NEW PT LVL2-PROB FOCUS	510	99202	219.00	N/A
HC11500071	NEW PT LVL3-EXPANDED	510	99203	386.00	N/A
HC11500089	NEW PT LVL4-DETAILED	510	99204	462.00	N/A
HC11500097	NEW PT LVL5-COMPREHENSIVE	510	99205	566.00	N/A
HC11500469	LACTATION E&M BRIEF EST'D L:I	761	99211	193.00	N/A
HC11500477	LACTATION E&M LIMITD NEW L:II	761	99202	219.00	N/A
HC11500485	LACTATION E&M INTRMD NEW L:III	761	99203	259.00	N/A
HC11500493	LACTATION E&M EXT'D EST'D L:IV	761	99214	323.00	N/A
HC11500501	LACTATION E&M COMPRHNS EST'D L:V	761	99215	379.00	N/A
HC11500527	LACTATION E&M LIMITD EST' L:II	761	99212	206.00	N/A
HC11500535	LACTATION E&M INTRMD EST'L:III	761	99213	226.00	N/A
HC11500543	LACTATION E&M EXT'D NEW L:IV	761	99204	309.00	N/A
HC11500550	LACTATION E&M COMPRHNS NEW:V	761	99205	351.00	N/A
HC11500576	AM/PACU EVAL LO/MOD-III	761	99213	497.00	N/A
HC11500659	WC NEW E&M ASSESS MINOR LVL 2	761	99202	276.00	N/A
HC11500667	WC NEW E&M ASSESS INTRMED LVL3	761	99203	446.00	N/A
HC11500675	WC NEW E&M ASSESS EXTENDED L:4	761	99204	544.00	N/A
HC11500683	WC NEW E&M ASSESS COMPREHN L:5	761	99205	624.00	N/A
HC11500691	WC ESTB E&M  BRIEF LVL1	761	99211	202.00	N/A
HC11500709	WC ESTB E&M  MINOR LVL 2	761	99212	276.00	N/A
HC11500717	WC ESTB E&M  INTERMEDIATE LVL3	761	99213	442.00	N/A
HC11500725	WC ESTB E&M  EXTENDED LVL 4	761	99214	487.00	N/A
HC11500733	WC ESTB E&M  COMPREHENSIVE L:5	761	99215	544.00	N/A
HC11500766	AM/PACU EVAL BRIEF-I	761	99211	219.00	N/A
HC11500774	AM/PACU EVAL MINOR-II	761	99212	363.00	N/A
HC11500782	AM/PACU EVAL MOD/HI-IV	761	99214	622.00	N/A
HC11500790	AM/PACU EVAL COMPLX-V	761	99215	829.00	N/A
HC11500816	PEDS ESTAB PT ASSES BRIEF(5')	761	99211	175.00	N/A
HC11500824	PEDS ESTAB PT ASSESS LTD(10')	761	99212	262.00	N/A
HC11500832	PEDS ESTAB PT ASSESS MOD(15')	761	99213	359.00	N/A
HC11500840	PEDS ESTAB PT ASSESS EXT(25')	761	99214	394.00	N/A
HC11500857	PEDS ESTAB PT ASSESS COMP(40')	761	99215	619.00	N/A
HC11500865	WM EXAM EST' PT EVAL LO/MODIII	761	99213	295.00	N/A
HC11500873	WM EXAM EST' PT EVAL MOD/HI IV	761	99214	424.00	N/A
HC11500881	INFANT EXAM 20 MIN	761	99212	224.00	N/A
HC11500899	HOSPITAL OUTPATIENT CLINIC VISIT (FACILITY FEE)	510	99213	238.00	N/A
HC11500907	WM EXAM EST' PT EVAL  BRIEF LVL1	761	99211	154.00	N/A
HC11500915	WM EXAM EST' PT EVAL  MINOR LVL 2	761	99212	203.00	N/A
HC11500923	WM EXAM EST' PT EVAL  COMPLEX L 5	761	99215	461.00	N/A
HC11500949	WM EXAM NEW PT EVAL  MINOR LVL 2	761	99202	226.00	N/A
HC11500956	WM EXAM NEW PT EVAL MOD LVL3	761	99203	341.00	N/A
HC11500964	WM EXAM NEW PT EVAL  HIGH L 4	761	99204	443.00	N/A
HC11500972	WM EXAM NEW PT EVAL  COMPLEX L 5	761	99205	483.00	N/A
HC11501046	WC PROLONGED E&M SERVICE ADDL 15MIN+	761	99417	100.00	N/A
HC12200150	INF CNTR-NEW PT EVAL LOW/MOD	510	99202	289.00	N/A
HC12200168	INF CNTR-NEW PT EVAL MODERATE	510	99203	358.00	N/A
HC12200176	INF CNTR-NEW PT EVAL HI/MOD	510	99204	467.00	N/A
HC12200184	INF CNTR-NEW PT EVAL COMPLEX	510	99205	630.00	N/A
HC12200192	INF CNTR-ESTBD PT EVAL MINOR	510	99212	303.00	N/A
HC12200200	INF CNTR-ESTB'D PT EVAL MOD/HI	510	99214	465.00	N/A
HC12200218	INF CNTR-ESTBL'D PT EVAL BRIEF	510	99211	207.00	N/A
HC12200226	INF CNTR-ESTBLD PT EVAL LOWMOD	510	99213	354.00	N/A
HC12200234	INF CNTR-ESTBL'D PT EVAL-CMPLX	510	99215	609.00	N/A
HC13500012	GENETIC CNSL RISK REDCTN 15MIN	510	99401	139.00	N/A
HC13500020	GENETIC CNSL RISK REDCTN 30MIN	510	99402	278.00	N/A
HC13500038	GENETIC CNSL RISK REDCTN 45MIN	510	99403	365.00	N/A
HC13500046	GENETIC CNSL RISK REDCTN 60MIN	510	99404	431.00	N/A
HC14500045	PREGNANCY DIAB MGT 15MIN	942	99211	158.00	N/A
HC14500052	PREGNANCY DIAB MGT 30MIN	942	99212	247.00	N/A
HC14500060	PREGNANCY DIAB MGT 1HR	942	99213	335.00	N/A
HC14500078	SS-NUTRIT-POST PARTUM EA 15MIN	942	99212	202.00	N/A
HC14500086	PREGNANCY DIAB MGT 2HR	942	99214	382.00	N/A
HC22000012	OST NEW PT EVAL LVL2-(20MIN)	761	99202	227.00	N/A
HC22000020	OST NEW PT EVAL LVL3-(30MIN)	761	99203	364.00	N/A
HC22000038	OST NEW PT EVAL LVL4- (45MIN)	761	99204	540.00	N/A
HC22000046	OST NEW PT EVAL LVL5-(60MIN)	761	99205	793.00	N/A
HC22000053	OST EST PT EVAL LVL1-(5MIN)	761	99211	210.00	N/A
HC22000061	OST EST PT EVAL LVL2-(10MIN)	761	99212	252.00	N/A
HC22000079	OST EST PT EVAL LVL 3-(15MIN)	761	99213	397.00	N/A
HC22000087	OST EST PT EVAL LVL4-(25MIN)	761	99214	440.00	N/A
HC22000095	OST EST PT EVAL LVL5-(40 MIN)	761	99215	642.00	N/A
HC25005968	NEW PT LVL2-PROB FOCUS	510	99202	272.00	N/A
HC25005976	NEW PT LVL3-EXPANDED	510	99203	371.00	N/A
HC25005984	NEW PT LVL4-DETAILED	510	99204	444.00	N/A
HC25005992	NEW PT LVL5-COMPREHENSIVE	510	99205	575.00	N/A
HC25006008	EST PT LVL1-BRIEF	510	99211	183.00	N/A
HC25006016	EST PT LVL2-PROB FOCUS	510	99212	235.00	N/A
HC25006024	EST PT LVL3-EXPANDED	510	99213	314.00	N/A
HC25006032	EST PT LVL4-DETAILED	510	99214	381.00	N/A
HC25006040	EST PT LVL5-COMPREHENSIVE	510	99215	444.00	N/A
HC25006206	POSTPARTUM CARE	450	59430	1,325.00	N/A
HC26000117	POSTPARTUM CARE	720	59430	2,058.00	N/A
HC26000158	L&D EVAL LEVEL I - BRIEF	720	99211	496.00	N/A
HC26000166	L&D EVAL LEVEL II - LIMITED	720	99212	988.00	N/A
HC26000174	L&D EVAL LEVEL III - INTERMED	720	99213	1,322.00	N/A
HC26000182	L&D EVAL LEVEL IV - EXTENDED	720	99214	1,470.00	N/A
HC26000190	L&D EVAL LEVEL V - COMPREHENSV	720	99215	2,033.00	N/A
HC27001932	BIOFEEDBACK PERINEAL MSCLS W/EMG&/MNMTRY F2F 1ST 15MIN	917	90912	219.00	N/A
HC27001940	BIOFEEDBACK PERINEAL MSCLS W/EMG&/MNMTRY F2F ADD'L 15MIN+	917	90913	150.00	N/A
HC28000016	CR REHAB CARDIAC IP SESSION PHASE I	943	93798	585.00	N/A
HC28000024	CR REHAB CARDIAC W/ ECG SESSION (II)	943	93798	585.00	N/A
HC28000032	CR REHAB CARDIAC W/O ECG SESSION (II)	943	93797	500.00	N/A
HC28000040	CR EST PT EVAL LVL1-(5MIN)	510	99211	184.00	N/A
HC28000057	CR EST PT EVAL LVL2-(10MIN)	510	99212	229.00	N/A
HC28000065	CR EST PT EVAL LVL3-(15MIN)	510	99213	350.00	N/A
HC28000073	CR EST PT EVAL LVL4-(25MIN)	510	99214	443.00	N/A
HC28000081	CR EST PT EVAL LVL5-(40 MIN)	510	99215	554.00	N/A
HC28000107	CR NEW PT EVAL LVL2-(20MIN)	510	99202	277.00	N/A
HC28000115	CR NEW PT EVAL LVL3-(30MIN)	510	99203	370.00	N/A
HC28000123	CR NEW PT EVAL LVL4- (45MIN)	510	99204	486.00	N/A
HC28000131	CR NEW PT EVAL LVL5-(60MIN)	510	99205	657.00	N/A
HC28000222	CR REHAB PAD PERIPHERAL PER SESSION	943	93668	289.00	N/A
HC29000338	TONOMETRY	519	92100	186.00	N/A
HC29000502	E&M PREVENTIVE NEW 18-39 Y/O	770	99385	428.00	N/A
HC29000510	E&M PREVENTIVE NEW 40-64 Y/O	770	99386	428.00	N/A
HC29000544	FBI EVAL RESPIRATOR QUESTIONNR	510	99401	50.00	N/A
HC29000551	PREVENTATIVE MED COUNSELING 15MIN	770	99401	135.00	N/A
HC29000569	PREVENTATIVE MED COUNSELING 30MIN	770	99402	274.00	N/A
HC29000577	PREVENTATIVE MED COUNSELING 45MIN	770	99403	414.00	N/A
HC29000585	PREVENTATIVE MED COUNSELING 60MIN	770	99404	563.00	N/A
HC29000601	AWV ANNUAL WELLNESS PLAN; INITIAL	770	G0438	365.00	N/A
HC29000619	AWV ANNUAL WELLNESS PLAN; SUBSEQUENT	770	G0439	298.00	N/A
HC29000627	IPPE EXAM INITIAL PREVENTIVE	770	G0402	265.00	N/A
HC29000635	COUNSEL ASSESS CA LUNG SCREEN LDCT	770	G0296	241.00	N/A
HC29000643	ADMIN/INTERP RISK ASSESS INSTR PT-FOCUS	770	96160	159.00	N/A
HC29000650	ADMIN/INTERP RISK ASSESS INSTR CAREGIVER FCS	770	96161	159.00	N/A
HC31000128	PT CASE CONF & RPT 1-30 MIN	420	99366	271.00	N/A
HC31000136	PT-TEAM CONF W/MD >30MIN(NO PT)	420	99367	271.00	N/A
HC31000185	PT-DEVEL TEST PER STANDARD INSTRUMENT(SCREENING)	420	96110	431.00	N/A
HC31000607	PT-TEAM CONF W/NONMD>30MIN(NO PT)	420	99368	261.00	N/A
HC31001191	PT-TEAM CONF W/PT &3D 30MINOR>	420	G0175	289.00	N/A
HC31001704	REPOSITIONING CANALITH/DAY	420	95992	420.00	N/A
HC31002116	PT-DEVEL TEST ADMIN ASSESS COG INSTR; 1ST HR	420	96112	489.00	N/A
HC31002132	PT-DEVEL TEST ADMIN ASSESS COG INSTR;  EA ADD 30MIN+	420	96113	210.00	N/A
HC31010176	PT-BIOFEEDBACK PERINEAL MSCLS W/EMG&/MNMTRY F2F 1ST 15MIN	420	90912	218.00	N/A
HC31010184	PT-BIOFEEDBACK PERINEAL MSCLS W/EMG&/MNMTRY F2F ADD'L 15MIN+	420	90913	149.00	N/A
HC31090145	PT-ONLINE ASSESS & MANAGMNT EST PT 5-10MIN	420	98970	105.00	N/A
HC31090152	PT-ONLINE ASSESS & MANAGMNT EST PT 11-20MIN	420	98971	157.00	N/A
HC31090160	PT-ONLINE ASSESS & MANAGMNT EST PT 21+MIN	420	98972	209.00	N/A
HC32000036	OT-CASE CONFERENCE 30MIN	430	99366	271.00	N/A
HC32001323	OT-TEAM CONF W/MD >30MIN(NO PT)	430	99367	271.00	N/A
HC32001331	OT-TEAM CONF W/NONMD>30MIN(NO PT)	430	99368	261.00	N/A
HC32001414	OT-TEAM CONF W/PT &3D 30MINOR>	430	G0175	289.00	N/A
HC32001471	OT-DEVEL TEST PER STANDARD INSTRUMENT(SCREENING)	430	96110	248.00	N/A
HC32001513	OT-INTERDISCIPLINARY TEAM W/MD	430	99367	271.00	N/A
HC32001919	OT - RANGE OF MOTION MEASUREMENTS	430	95852	138.00	N/A
HC32003352	OT-DEVEL TEST ADMIN ASSESS COG INSTR; 1ST HR	430	96112	489.00	N/A
HC32003360	OT-DEVEL TEST ADMIN ASSESS COG INSTR;  EA ADD 30MIN+	430	96113	210.00	N/A
HC32010324	OT-ONLINE ASSESS & MANAGMNT EST PT 5-10MIN	430	98970	105.00	N/A
HC32010332	OT-ONLINE ASSESS & MANAGMNT EST PT 11-20MIN	430	98971	157.00	N/A
HC32010340	OT-ONLINE ASSESS & MANAGMNT EST PT 21+MIN	430	98972	209.00	N/A
HC33000001	SP-ASSESS APHASIA/REPT EA HR/M	440	96105	447.00	N/A
HC33000449	ST-TEAM CONF W/PT&/FAM30MINOR>	440	99366	271.00	N/A
HC33000654	ST-TEAM CONF W/MD >30MIN(NO PT)	440	99367	253.00	N/A
HC33000670	ST-TEAM CONF W/NONMD>30MIN(NO PT	440	99368	253.00	N/A
HC33000829	ST-TEAM CONF W/PT &3D 30MINOR>	440	G0175	289.00	N/A
HC33000837	ST-TEAM CONF W/MD>30MIN(NO PT)	440	99367	271.00	N/A
HC33010190	ST-ONLINE ASSESS & MANAGMNT EST PT 5-10MIN	440	98970	105.00	N/A
HC33010208	ST-ONLINE ASSESS & MANAGMNT EST PT 11-20MIN	440	98971	157.00	N/A
HC33010216	ST-ONLINE ASSESS & MANAGMNT EST PT 21+MIN	440	98972	209.00	N/A
HC35000017	REC- EVALUATION 15MIN	941	99212	213.00	N/A
HC35000025	REC- EVALUATION 30MIN	941	99213	437.00	N/A
HC35000033	REC- EVALUATION 45MIN	941	99214	632.00	N/A
HC35000041	REC- EVALUATION 60MIN	941	99215	802.00	N/A
HC35000181	REC-TEAM CONF W/PT&/FAM 30MIN	941	99366	251.00	N/A
HC35000199	REC-TEAM CONF W/MD >30MIN(NO PT)	941	99367	260.00	N/A
HC35000207	REC-TEAM CONF W/NONMD>30MIN(NO PT	941	99368	238.00	N/A
HC35000215	REC-TEAM CONF W/PT &3D 30MINOR>	941	G0175	272.00	N/A
HC35500149	MT-BEHAVIOR ASSESS/RE-ASSESS	941	96156	251.00	N/A
HC35500156	MT-BEHAVIOR TX INDIV 1ST 30 MIN	941	96158	251.00	N/A
HC35500164	MT-BEHAVIOR TX INDIV ADDL 15 MIN	941	96159	124.00	N/A
HC35500172	MT-BEHAVIOR TX GROUP 1ST 30 MIN	941	96164	88.00	N/A
HC35500180	MT-BEHAVIOR TX GROUP ADDL 15 MIN	915	96165	42.00	N/A
HC35500198	MT-BEHAVIOR TX FAMW/PT 1ST 30MIN	916	96167	110.00	N/A
HC35500206	MT-BEHAVIOR TX FAMW/PT ADD 15MIN	916	96168	55.00	N/A
HC35500214	MT-BEHAV TX FAM W/O PT 1ST 30MIN	916	96170	110.00	N/A
HC35500222	MT-BEHAV TX FAM W/O PT ADD 15	916	96171	55.00	N/A
HC36000008	ADMIN SURFACTANT THRU TUBE	410	94610	559.00	N/A
HC36000693	RT-TEAM CONF W/MD >30MIN(NO PT)	410	99367	160.00	N/A
HC36001071	ATTENDANCE AT DELIVERY	410	99464	635.00	N/A
HC36500007	SMOKING CESSATION 3-10 MIN	942	99406	90.00	N/A
HC36500015	SMOKING CESSATION > 10 MIN	942	99407	125.00	N/A
HC36500056	PR-PULM REHAB PER HR PER SESS'N	948	G0424	N/A	N/A
HC36800274	PHYSIOLOGIC DATA COLLECTION	920	99091	84.00	N/A
HC37000304	MNT RE ASSESS INDIV EA 15MIN   2ND REF (DX)	942	G0270	130.00	N/A
HC37000312	MNT THERAPY GROUP EA 30 MIN      2ND REF(DX)	942	G0271	100.00	N/A
HC38000170	USE OF CAST ROOM	700	99213	370.00	N/A
HC39000005	PSYCH DX EVAL EXAM (NO MED SVCS)	911	90791	544.00	N/A
HC39000013	PSYCH TX W/PATIENT 30MIN	914	90832	452.00	N/A
HC39000039	PSYCH TX W/PATIENT 45MIN	914	90834	610.00	N/A
HC39000112	PSYCH FAMILY GROUP THERAPY	915	90849	303.00	N/A
HC39000120	PSYCH GRP TX(NOT MULTI FAMILY)60MIN/COMM	915	90853	284.00	N/A
HC39000153	PSY MED RECORD REVIEW	919	90885	239.00	N/A
HC39000161	PSY FAMILY CONFERENCE	919	90887	235.00	N/A
HC39000179	PSY PREPARE REPORT 1 HOUR	919	90889	367.00	N/A
HC39000187	PSY PREPARE REPORT 2 HOURS	919	90889	581.00	N/A
HC39000237	PSY TM CONF W/MD 30/+MIN(NO PT)	900	99367	258.00	N/A
HC39000245	PSY TM CONFW/NONMD 30/+MIN(NO PT	900	99368	233.00	N/A
HC39000252	PSY TM CONF W/PT&/FAM 60MIN	900	99366	374.00	N/A
HC39000260	PSYCH FAMILY TX W/PT 50MIN	914	90847	687.00	N/A
HC39000278	PSYCH FAMILY TX W/O PT 50 MIN	914	90846	571.00	N/A
HC39000286	PSYCH TX W/PATIENT 60MIN	914	90837	709.00	N/A
HC39000302	PSY TEAM CONF W/PT&/FAM 30MIN	900	99366	273.00	N/A
HC39000310	PSYCH GRP TX(NOT MULTI FAMILY)90MIN	915	90853	362.00	N/A
HC39000518	PSY-TEAM CONF W/PT &3D 30MINOR>	914	G0175	243.00	N/A
HC39000609	PSYCH CASE CONF 30MIN	914	99367	231.00	N/A
HC39000617	PSYCH CASE CONF 60MIN	914	99367	323.00	N/A
HC39000724	PSY PREPARE REPORT	919	90889	367.00	N/A
HC39000914	PSYCH TX FOR CRISIS 1ST 60MINS/COMM	914	90839	889.00	N/A
HC39000922	PSYCH TX FOR CRISIS EA ADD 30MINS+/COMM	914	90840	389.00	N/A
HC39000930	INTERACTIVE COMPLEXITY+	914	90785	218.00	N/A
HC39000948	PSY TX W/PATIENT 30MIN W/E&M+	914	90833	384.00	N/A
HC39000955	PSY TX W/PATIENT 45MIN W/E&M+	914	90836	604.00	N/A
HC39000963	PSY TX W/PATIENT 60MIN W/E&M+	914	90838	694.00	N/A
HC39000989	PSYCH DIAG EVAL W/ MED SERVICE	900	90792	607.00	N/A
HC39000997	PSYCH PSYCHOANALYSIS	914	90845	309.00	N/A
HC39001003	PHARMACOLOGIC MGMT W/PSYTX+	900	90863	129.00	N/A
HC39001011	PSYCH NARCOSYNTHESIS	914	90865	381.00	N/A
HC39001052	PSYCH THERAPY W/BIOFEEDBACK 30 MIN	900	90875	345.00	N/A
HC39001060	PSYCH THERAPY W/BIOFEEDBACK 45 MIN	900	90876	419.00	N/A
HC39001078	PSYCH HYPNOTHERAPY	900	90880	450.00	N/A
HC39001367	PSY-DEVEL TEST ADMIN ASSESS COG INSTR; 1ST HR	900	96112	489.00	N/A
HC39001375	PSY-DEVEL TEST ADMIN ASSESS COG INSTR;  EA ADD 30MIN+	900	96113	210.00	N/A
HC39001383	PSY-ASSESS APHASIA W/REPORT PER HOUR	900	96105	447.00	N/A
HC39001417	PSY-DEVEL TEST PER STANDARD INSTRUMENT(SCREENING)	918	96110	232.00	N/A
HC39001524	PSY-BEHAVIOR ASSESS/RE-ASSESS	914	96156	258.00	N/A
HC39001532	PSY-BEHAVIOR TX INDIV 1ST 30 MIN	914	96158	258.00	N/A
HC39001540	PSY-BEHAVIOR TX INDIV ADDL 15 MIN	914	96159	127.00	N/A
HC39001557	PSY-BEHAVIOR TX GROUP 1ST 30 MIN	915	96164	88.00	N/A
HC39001565	PSY-BEHAVIOR TX GROUP ADDL 15 MIN	915	96165	42.00	N/A
HC39001573	PSY-BEHAVIOR TX FAMW/PT 1ST 30MIN	916	96167	110.00	N/A
HC39001581	PSY-BEHAVIOR TX FAMW/PT ADD 15MIN	916	96168	55.00	N/A
HC39001599	PSY-BEHAV TX FAM W/O PT 1ST 30MIN	510	96170	110.00	N/A
HC39001607	PSY-BEHAV TX FAM W/O PT ADD 15	510	96171	55.00	N/A
HC41500026	CALORIC VESTIB BITHERM 4 IRRIG W/REC	471	92537	1,187.00	N/A
HC41500661	CALORIC VESTIB BITHERM 2 IRRIG W/REC	471	92538	738.00	N/A
HC42000554	WCH NEW PT LVL2-PROB FOCUS	510	99202	202.00	N/A
HC42000562	WCH NEW PT LVL3-EXPANDED	510	99203	347.00	N/A
HC42000570	WCH NEW PT LVL4-DETAILED	510	99204	415.00	N/A
HC42000588	WCH NEW PT LVL5-COMPREHEN	510	99205	507.00	N/A
HC42000596	WCH EST PT LVL1-BRIEF	510	99211	152.00	N/A
HC42000604	WCH EST PT LVL2-PROB FOCUS	510	99212	195.00	N/A
HC42000612	WCH EST PT LVL3-EXPANDED	510	99213	223.00	N/A
HC42000620	WCH EST PT LVL4-DETAILED	510	99214	266.00	N/A
HC42000638	WCH EST PT LVL5-COMPREHEN	510	99215	312.00	N/A
HC42000877	INTERROGATE CV PHYS MONITOR REMOTE 30 DAYS	480	G2066	183.00	N/A
HC44700532	INTRACARDIAC ECHO +	481	93662	7,525.00	N/A
HC44701175	TILT TABLE EVALUATION	480	93660	3,785.00	N/A
HC47200753	RAD ONC E&M LEVEL I BRIEF	761	99211	214.00	N/A
HC47200761	RAD ONC E&M LEVEL II LIMITED	761	99212	280.00	N/A
HC47200779	RAD ONC E&M LEVEL III INTERMED	761	99213	523.00	N/A
HC47200787	RAD ONC E&M LEVEL IV EXTENDED	761	99214	563.00	N/A
HC47200795	RAD ONC E&M LEVEL V COMPREHNSV	761	99215	710.00	N/A
HC51000289	HOSP OP CAST ROOM VISIT (FACILITY FEE)	510	99213	210.00	N/A
HC51000396	HOSPITAL OUTPATIENT CLINIC VISIT (FACILITY FEE)	510	99213	210.00	N/A
HC51003432	SMOKING CESSATION 3-10 MIN	510	99406	54.00	N/A
HC51003440	SMOKING CESSATION > 10 MIN	510	99407	94.00	N/A
HC51003457	CA SCREEN-EXAM PELVIC/BREAST	510	G0101	146.00	N/A
HC51003929	BIOFEEDBACK PERINEAL MSCLS W/EMG&/MNMTRY F2F 1ST 15MIN	510	90912	140.00	N/A
HC51003937	BIOFEEDBACK PERINEAL MSCLS W/EMG&/MNMTRY F2F ADD'L 15MIN+	510	90913	54.00	N/A
HC51010569	IMMUNTX NOT INCL EXTRACT 1 INJ	510	95115	65.00	N/A
HC51010577	IMMUNTX NOT INCL EXTRCT 2/+ INJ	510	95117	70.00	N/A
HC51010585	IMMUNOTHERAPY ONE INJECTION /COMM	510	95120	88.00	N/A
HC51010593	IMMUNOTHERAPY 2/> INJECTIONS /COMM	510	95125	129.00	N/A
HC51010601	IMMNTX 1 STING INSECT /COMM	510	95130	83.00	N/A
HC51010619	IMMNTX 2 STING INSECTS /COMM	510	95131	123.00	N/A
HC51010627	IMMNTX 3 STING INSECTS /COMM	510	95132	157.00	N/A
HC51010635	IMMNTX 4 STING INSECTS /COMM	510	95133	190.00	N/A
HC51010643	IMMNTX 5 STING INSECTS /COMM	510	95134	222.00	N/A
HC51010650	IMMUNTX PREP-PROV AG SNGL DOSE VL	510	95144	75.00	N/A
HC51010668	IMMUNTX PREP-PROV AG1STING BUG VNM	510	95145	52.00	N/A
HC51010676	IMMUNTX PREP-PROV AG2STING BUG VNM	510	95146	145.00	N/A
HC51010684	IMMUNTX PREP-PROV AG3STING BUG VNM	510	95147	144.00	N/A
HC51010692	IMMUNTX PREP-PROV AG4STING BUG VNM	510	95148	144.00	N/A
HC51010700	IMMUNTX PREP-PROV AG5STING BUG VNM	510	95149	144.00	N/A
HC51010718	IMMUNTX PREP-PROV 1/+ANTIGNS	510	95165	138.00	N/A
HC51010726	IMMUNTX PREP-PROV 1/+AG BUG/ARTHPD	510	95170	138.00	N/A
HC51010734	DESENSITIZATION RAPID EA HR	510	95180	390.00	N/A
HC51010809	MICROSCOPY BINOCULAR EAR	510	92504	106.00	N/A
HC51020238	RN-DEVEL TEST PER STANDARD INSTRUMENT(SCREENING)	510	96110	209.00	N/A
HC51020279	OPSC NP EST PT LVL I; BRIEF	510	99211	210.00	N/A
HC51020287	OPSC NP EST PT LVL II; LIMITED	510	99212	235.00	N/A
HC51020295	OPSC NP EST PT LVL III;INTERMED	510	99213	275.00	N/A
HC51020303	OPSC NP EST PT LVL IV;EXTENDED	510	99214	325.00	N/A
HC51020311	OPSC NP EST PT LVL V; COMPLEX	510	99215	400.00	N/A
HC51020337	OPSC NP NEW PT LVL II; LIMITED	510	99202	215.00	N/A
HC51020345	OPSC NP NEW PT LVL III;INTERMED	510	99203	325.00	N/A
HC51020352	OPSC NP NEW PT LVL IV;EXTENDED	510	99204	400.00	N/A
HC51020360	OPSC NP NEW PT LVL V; COMPLEX	510	99205	500.00	N/A
HC51040129	MNT RE ASSESS INDIV EA 15MIN    2ND REF (DX)	942	G0270	82.00	N/A
HC51040137	MNT THERAPY GROUP EA 30 MIN     2ND REF(DX)	942	G0271	50.00	N/A
HC51060168	PT-DEVEL TEST PER STANDARD INSTRUMENT(SCREENING)	420	96110	266.00	N/A
HC51060184	OT-DEVEL TEST PER STANDARD INSTRUMENT(SCREENING)	430	96110	235.00	N/A
HC51060770	OT-DEVEL TEST ADMIN ASSESS COG INSTR; 1ST HR	430	96112	369.00	N/A
HC51060788	OT-DEVEL TEST ADMIN ASSESS COG INSTR;  EA ADD 30MIN+	430	96113	151.00	N/A
HC51060796	PT-DEVEL TEST ADMIN ASSESS COG INSTR; 1ST HR	420	96112	369.00	N/A
HC51060804	PT-DEVEL TEST ADMIN ASSESS COG INSTR;  EA ADD 30MIN+	420	96113	151.00	N/A
HC51061976	COLLECT INTERP PHYSIOLOGIC DATA PT TRANSMIT	510	99091	25.00	N/A
HC51070001	PSYCH DX EVAL EXAM (NO MED SVCS)	510	90791	346.00	N/A
HC51070019	PSY MED RECORD REVIEW	510	90885	171.00	N/A
HC51070027	PSY FAMILY CONFERENCE 30 MIN	510	90887	140.00	N/A
HC51070035	PSY PREPARE REPORT 1 HOUR	510	90889	280.00	N/A
HC51070134	PSY TM CONFW/NONMD 30/+MIN(NO PT)/M	510	99368	128.00	N/A
HC51070282	PSY-DEVEL TEST PER STANDARD INSTRUMENT(SCREENING)	510	96110	182.00	N/A
HC51070290	PSYCH TX FOR CRISIS 1ST 60MINS/COMM	510	90839	428.00	N/A
HC51070308	PSYCH TX FOR CRISIS EA ADD 30MINS+	510	90840	218.00	N/A
HC51070316	PSYCH GRP TX(NOT MULTI FAMILY)60MIN	915	90853	175.00	N/A
HC51070324	PSYCH GRP TX(NOT MULTI FAMILY)90MIN	915	90853	207.00	N/A
HC51070332	INTERACTIVE COMPLEXITY+	914	90785	168.00	N/A
HC51070340	PSY FAMILY CONFERENCE 60MIN	510	90887	258.00	N/A
HC51070357	PSYCH TX W/PATIENT 30MIN	914	90832	344.00	N/A
HC51070365	PSY TX W/PATIENT 30MIN W/E&M+	914	90833	298.00	N/A
HC51070373	PSYCH TX W/PATIENT 45MIN	914	90834	474.00	N/A
HC51070381	PSY TX W/PATIENT 45MIN W/E&M+	914	90836	460.00	N/A
HC51070399	PSYCH TX W/PATIENT 60MIN	914	90837	546.00	N/A
HC51070407	PSY TX W/PATIENT 60MIN W/E&M+	914	90838	540.00	N/A
HC51070415	PSYCH PSYCHOANALYSIS	914	90845	240.00	N/A
HC51070423	PSYCH FAMILY TX W/O PT 50 MIN	914	90846	444.00	N/A
HC51070431	PSYCH FAMILY TX W/PT 50MIN	914	90847	533.00	N/A
HC51070449	PSYCH FAMILY GROUP THERAPY	915	90849	236.00	N/A
HC51070456	PSYCH NARCOSYNTHESIS	914	90865	306.00	N/A
HC51070464	PSYCH HYPNOTHERAPY	900	90880	350.00	N/A
HC51070514	PSY TM CONF W/PT&/FAM 60MIN	900	99366	286.00	N/A
HC51070522	PSY TM CONF W/MD 30/+MIN(?PT)	900	99367	197.00	N/A
HC51070530	PSY-TEAM CONF W/PT &3D 30MINOR>	914	G0175	192.00	N/A
HC51070662	PSY-DEVEL TEST ADMIN ASSESS COG INSTR; 1ST HR	510	96112	369.00	N/A
HC51070670	PSY-DEVEL TEST ADMIN ASSESS COG INSTR;  EA ADD 30MIN+	510	96113	151.00	N/A
HC51070688	PSY-ASSESS APHASIA W/REPORT PER HOUR	510	96105	260.00	N/A
HC51070738	PSY-BEHAVIOR ASSESS/RE-ASSESS	510	96156	198.00	N/A
HC51070746	PSY-BEHAVIOR TX INDIV 1ST 30 MIN	510	96158	198.00	N/A
HC51070753	PSY-BEHAVIOR TX INDIV ADDL 15 MIN	510	96159	94.00	N/A
HC51070761	PSY-BEHAVIOR TX GROUP 1ST 30 MIN	510	96164	70.00	N/A
HC51070779	PSY-BEHAVIOR TX GROUP ADDL 15 MIN	510	96165	32.00	N/A
HC51070787	PSY-BEHAVIOR TX FAMW/PT 1ST 30MIN	510	96167	87.00	N/A
HC51070795	PSY-BEHAVIOR TX FAMW/PT ADD 15MIN	510	96168	42.00	N/A
HC51070803	PSY-BEHAV TX FAM W/O PT 1ST 30MIN	510	96170	87.00	N/A
HC51070811	PSY-BEHAV TX FAM W/O PT ADD 15	510	96171	44.00	N/A
HC83000448	AUTO DONOR EVAL(STATISTICAL)	300	99241	N/A	N/A
HC83000455	THERAPEUTIC PHLB EVAL(STATIST)	300	99241	N/A	N/A
HC83001073	APHERESIS THER EVAL-IP(PROF ST)	300	99252	N/A	N/A
HC83504316	PATHOLOGY CONSULT - WD	310	99245	340.00	340.00
HC43000108	DUCTOGRAM/GALACTOGRAM SINGLE	320	77053	1,321.00	N/A
HC43000116	DUCTOGRAM/GALACTOGRAM MULTI	320	77054	1,509.00	N/A
HC43000561	DUCTOGRAM MULTI DUCT(S) LT	320	77054	1,509.00	N/A
HC43000579	DUCTOGRAM MULTI DUCT(S) RT	320	77054	1,509.00	N/A
HC43000686	DUCTOGRAM SINGLE LT	320	77053	1,321.00	N/A
HC43000694	DUCTOGRAM SINGLE RT	320	77053	1,321.00	N/A
HC43001031	TOMO BRST DX 3-D; UNILAT LT+	401	77061	87.00	N/A
HC43001049	TOMO BRST DX 3-D; UNILAT RT+	401	77061	87.00	N/A
HC43001056	TOMO BRST DX 3-D; BILAT+	401	77062	109.00	N/A
HC43001064	TOMO BRST SCREEN 3-D BILAT+	403	77063	109.00	N/A
HC43001080	MAMMO SCREEN W/CAD BILAT	403	77067	1,147.00	N/A
HC43001098	MAMMO SCREEN W/IMP W/CAD BIL	403	77067	1,252.00	N/A
HC43001106	MAMMO SCREENING W/CAD LEFT	403	77067	745.00	N/A
HC43001114	MAMMO SCREENING W/CAD RIGHT	403	77067	745.00	N/A
HC43001122	MAMMO DX W/CAD BILAT	401	77066	1,231.00	N/A
HC43001130	MAMMO DX LTD/FOCUS EXM W/CAD BIL	401	77066	905.00	N/A
HC43001148	MAMMO DX W/SPC VWS W/CAD BIL	401	77066	1,286.00	N/A
HC43001155	MAMMO DX LTD/FOCUS EXM UNILT W/CAD LT	401	77065	734.00	N/A
HC43001163	MAMMO DX LTD/FOCUS EXM UNILT W/CAD RT	401	77065	734.00	N/A
HC43001171	MAMMO DX UNILAT W/CAD LT	401	77065	905.00	N/A
HC43001189	MAMMO DX UNILAT W/CAD RT	401	77065	905.00	N/A
HC43001197	MAMMO DX W/SPC VWS UNILT W/CAD LT	401	77065	995.00	N/A
HC43001205	MAMMO DX W/SPC VWS UNILT W/CAD RT	401	77065	995.00	N/A
HC44000362	CHEST 2 VIEWS	324	71046	777.00	N/A
HC44000388	CHEST 2 VWS W/APICAL LORDOTIC (3VIEWS)	324	71047	878.00	N/A
HC44000396	CHEST 2 VWS W/OBLIQUES (4VIEWS)	324	71048	923.00	N/A
HC44000404	CHEST 4/> VIEWS	324	71048	1,079.00	N/A
HC44000412	CHEST SINGLE VIEW	324	71045	609.00	N/A
HC44002608	XR EXAM SURGICAL SPECIMEN	320	76098	1,006.00	N/A
HC44003051	CHEST 3 VIEWS	324	71047	878.00	N/A
HC44901056	CT BREAST 3D RENDER UNILAT W/O CONTRAST	352	0633T	2,610.00	N/A
HC44901064	CT BREAST 3D RENDER UNILAT W/CONTRAST	352	0634T	2,775.00	N/A
HC44901072	CT BREAST 3D RENDER UNILAT W&W/O CONTRAST	352	0635T	3,250.00	N/A
HC44901080	CT BREAST 3D RENDER BILAT W/O CONTRAST	352	0636T	4,000.00	N/A
HC44901098	CT BREAST 3D RENDER BILAT W/CONTRAST	352	0637T	4,250.00	N/A
HC44901106	CT BREAST 3D RENDER UNILAT W&W/O CONTRAST	352	0638T	4,555.00	N/A
HC82202227	RADIOLOGIC EXAM-SURG SPEC (ST)	312	76098	N/A	N/A
HC44900132	CT C-SPINE W&W/O  CONTRAST	352	72127	7,279.00	N/A
HC44900140	CT C-SPINE W/ CONTRAST	352	72126	6,705.00	N/A
HC44900157	CT C-SPINE W/O CONTRAST	352	72125	6,252.00	N/A
HC44900207	CT HEAD W&W/O CONTRAST	351	70470	5,987.00	N/A
HC44900215	CT HEAD W/CONTRAST	351	70460	5,537.00	N/A
HC44900223	CT HEAD W/O CONTRAST	351	70450	5,146.00	N/A
HC44900363	CT MAXILLO FACIAL W&W/O CONT	351	70488	5,368.00	N/A
HC44900371	CT MAXILLO FACIAL W/ CONTRAST	351	70487	4,902.00	N/A
HC44900389	CT MAXILLO FACIAL W/O CONTRAST	351	70486	4,268.00	N/A
HC44900405	CT NECK SOFT TISSUE W&W/O CONT	351	70492	5,968.00	N/A
HC44900413	CT NECK SOFT TISSUE W/ CONT	351	70491	5,138.00	N/A
HC44900421	CT NECK SOFT TISSUE W/O CONT	351	70490	4,689.00	N/A
HC44900439	CT ORBIT/SELLA/EAR W&W/O CONT	351	70482	6,197.00	N/A
HC44900447	CT ORBIT/SELLA/EAR W/ CONTRAST	351	70481	5,713.00	N/A
HC44900454	CT ORBIT/SELLA/EAR W/O CONTRAS	351	70480	5,126.00	N/A
HC44900652	CTA HEAD	351	70496	6,427.00	N/A
HC44900694	CTA NECK	351	70498	6,302.00	N/A
HC44500700	CTA ABD AORTA/ILIOFEM RUNOFF	352	75635	8,967.00	N/A
HC44900009	CT ABDOMEN W&W/O CONTRAST	352	74170	6,522.00	N/A
HC44900017	CT ABDOMEN W/ CONTRAST	352	74160	5,519.00	N/A
HC44900025	CT ABDOMEN W/O CONTRAST	352	74150	4,814.00	N/A
HC44900033	CT ABDOMEN W/O CONTRAST LTD	352	74150	3,301.00	N/A
HC44900066	CT BONE DENSITY STDY AXIAL SKL	352	77078	1,478.00	N/A
HC44900074	CT CHEST DX HI RESOLUTION W/ CNTRST	352	71260	5,416.00	N/A
HC44900082	CT CHEST DX HI RESOLUTION W/O CNTRST	352	71250	4,921.00	N/A
HC44900090	CT CHEST/LUNG LOW DOSE SCREENING	352	71271	2,384.00	N/A
HC44900108	CT CHEST DX W&W/O CONTRAST	352	71270	6,306.00	N/A
HC44900116	CT CHEST DX W/ CONTRAST	352	71260	5,249.00	N/A
HC44900124	CT CHEST DX W/O CONTRAST	352	71250	4,819.00	N/A
HC44900165	CT GUIDE NEEDLE PLACEMENT	350	77012	4,378.00	N/A
HC44900173	CT GUIDE STEREOTACTIC LOC	350	77011	9,262.00	N/A
HC44900181	CT GUIDANCE ABLATION PARENCHYMAL TISSUE	350	77013	4,137.00	N/A
HC44900231	CT LOW EXT W&W/O CONT BILAT	352	73702	9,449.00	N/A
HC44900249	CT LOW EXT W&W/O CONTRAST LT	352	73702	5,568.00	N/A
HC44900256	CT LOW EXT W&W/O CONTRAST RT	352	73702	5,568.00	N/A
HC44900264	CT LOW EXT W/CONTRAST BILAT	352	73701	9,068.00	N/A
HC44900272	CT LOW EXT W/CONTRAST LT	352	73701	4,864.00	N/A
HC44900280	CT LOW EXT W/CONTRAST RT	352	73701	4,864.00	N/A
HC44900298	CT LOW EXT W/O CONTRAST BILAT	352	73700	7,735.00	N/A
HC44900306	CT LOW EXT W/O CONTRAST LT	352	73700	4,444.00	N/A
HC44900314	CT LOW EXT W/O CONTRAST RT	352	73700	4,444.00	N/A
HC44900322	CT L-SPINE W&W/O  CONTRAST	352	72133	7,329.00	N/A
HC44900330	CT L-SPINE W/ CONTRAST	352	72132	6,406.00	N/A
HC44900348	CT L-SPINE W/O CONTRAST	352	72131	5,794.00	N/A
HC44900355	CT LTD OR LOCALIZED F/U STUDY	350	76380	2,397.00	N/A
HC44900397	M: CT MISC STUDY	350	76497	N/A	N/A
HC44900462	CT PELVIS W&W/O CONTRAST	352	72194	6,270.00	N/A
HC44900470	CT PELVIS W/ CONTRAST	352	72193	5,542.00	N/A
HC44900488	CT PELVIS W/O CONTRAST	352	72192	5,031.00	N/A
HC44900496	CT PELVIS W/O CONTRAST LTD	352	72192	3,388.00	N/A
HC44900504	CT T-SPINE W&W/O  CONTRAST	352	72130	7,490.00	N/A
HC44900512	CT T-SPINE W/ CONTRAST	352	72129	6,528.00	N/A
HC44900520	CT T-SPINE W/O CONTRAST	352	72128	5,821.00	N/A
HC44900538	CT UPPER EXT W&W/O CONT BILAT	352	73202	9,534.00	N/A
HC44900546	CT UPPER EXT W&W/O CONTRAST LT	352	73202	5,794.00	N/A
HC44900553	CT UPPER EXT W&W/O CONTRAST RT	352	73202	5,794.00	N/A
HC44900561	CT UPPER EXT W/CONTRAST BILAT	352	73201	8,718.00	N/A
HC44900579	CT UPPER EXT W/CONTRAST LT	352	73201	4,932.00	N/A
HC44900587	CT UPPER EXT W/CONTRAST RT	352	73201	4,932.00	N/A
HC44900595	CT UPPER EXT W/O CONTRAST BIL	352	73200	8,692.00	N/A
HC44900603	CT UPPER EXT W/O CONTRAST LT	352	73200	4,542.00	N/A
HC44900611	CT UPPER EXT W/O CONTRAST RT	352	73200	4,542.00	N/A
HC44900629	CT WHOLE BODY SCREEN	350	76497	1,365.00	N/A
HC44900637	CTA ABDOMEN	352	74175	6,951.00	N/A
HC44900645	CTA CHEST	352	71275	6,720.00	N/A
HC44900660	CTA LOW EXT BILAT	352	73706	11,947.00	N/A
HC44900678	CTA LOW EXT LT	352	73706	6,318.00	N/A
HC44900686	CTA LOW EXT RT	352	73706	6,318.00	N/A
HC44900702	CTA PELVIS	352	72191	6,786.00	N/A
HC44900710	CTA UPPER EXT W/CONTRAST-BILAT	352	73206	12,419.00	N/A
HC44900728	CTA UPPER EXT W/CONTRAST-LT	352	73206	6,536.00	N/A
HC44900736	CTA UPPER EXT W/CONTRAST-RT	352	73206	6,536.00	N/A
HC44900744	CT HEART W/CORO CALC W/O CON	350	75571	1,470.00	N/A
HC44900827	CT COLONOGRAPHY SCREEN VIRTUAL W&WO CONTRAST	350	74263	1,840.00	N/A
HC44900835	CT COLONOGRAPHY DX VIRTUAL W/O CONTRAST	350	74261	3,547.00	N/A
HC44900926	CT COLONOGRAPHY DX VIRTUAL W/ CONTRAST	350	74262	4,293.00	N/A
HC44900934	CT HEART EVAL W/ 3D IMAGE	350	75572	3,679.00	N/A
HC44900942	CT HEART CONGEN EVAL /3D IMAGE	350	75573	4,456.00	N/A
HC44900959	CCTA HEART EVAL W/3D IMAGE	350	75574	6,722.00	N/A
HC44900975	CT ABDOMEN & PELVIS W/O CONTRAST	352	74176	7,162.00	N/A
HC44900983	CT ABDOMEN & PELVIS W/CONTRAST	352	74177	8,402.00	N/A
HC44900991	CT ABD & PELVIS W/O&W CONTRAST	352	74178	9,445.00	N/A
HC44901007	CT ABD & PELVIS W/O CONST LTD	352	74176	4,276.00	N/A
HC44901023	CTA ABDOMEN+PELVIS	352	74174	10,508.00	N/A
HC44901031	CT CEREBRAL PERF ANALYSIS	350	0042T	5,983.00	N/A
HC47200118	CT RAD THER PLANNING	350	77014	3,345.00	N/A
HC47200852	CT GUIDANCE SRS LOCALIZATION	350	77011	8,864.00	N/A
HC42000083	ECHO CONGENITAL COMPLETE	483	93303	3,922.00	N/A
HC42000091	ECHO CONGENITAL LTD OR F/U	483	93304	2,191.00	N/A
HC42000125	ECHO 2D CMPLT W/SPEC&CLR DOPLR	483	93306	5,031.00	N/A
HC42000133	ECHO 2D CMPLT W/O SPEC&CLR DOP	483	93307	2,949.00	N/A
HC42000141	ECHO 2D LMTD W/O SPEC&CLR /DOP	483	93308	1,909.00	N/A
HC42000158	ECHO 2D DOP SPEC&CLR W/CON	483	C8929	4,939.00	N/A
HC42000166	ECHO DOPPLER COMPLETE	483	93320	1,770.00	N/A
HC42000174	ECHO DOPPLER F/U OR LTD*	483	93321	1,252.00	N/A
HC42000182	ECHO DOPPLER COLOR FLOW	483	93325	1,573.00	N/A
HC42000232	ECHO 2D STRESS PHARMOCOLOGIC	483	93350	3,992.00	N/A
HC42000240	ECHO 2D STRESS TRDMLW/EKG W/CON	483	C8928	4,225.00	N/A
HC42000257	ECHO 2D STRESS TREADMILL	483	93350	3,922.00	N/A
HC42000505	TEE COMPLETE	483	93312	4,743.00	N/A
HC42000513	TEE CONGENITAL COMPLETE	483	93315	4,464.00	N/A
HC42000521	TEE MONITORING COMPLETE	483	93318	3,960.00	N/A
HC42000703	ECHO CONGENITAL CMPLT W/ORWO FOL CONTR	483	C8921	3,759.00	N/A
HC42000711	ECHO CNGNTL LTD OR F/U W/WO CONTR	483	C8922	2,724.00	N/A
HC42000729	ECHO 2D CMPLT W/O SPC&DOP W/WO CONTR	483	C8923	3,138.00	N/A
HC42000737	ECHO 2D LMTD W/O SPEC&DOP W/WO CONTR	483	C8924	2,483.00	N/A
HC42000745	TEE COMPLETE W/WO CONTRAST	483	C8925	4,993.00	N/A
HC42000752	TEE CONGENITAL COMPLT W/WO CONTR	483	C8926	4,144.00	N/A
HC42000760	TEE MONITORING COMPLT W/WO CONTR	483	C8927	4,283.00	N/A
HC42000778	ECHO 2D RX STRESS;CONT EKG W/WO CONTR	483	C8930	4,968.00	N/A
HC42000786	ECHO 2D RX STRESS; CONT EKG	483	93351	4,783.00	N/A
HC42000836	MYOCARDIAL STRAIN QUANT ASSESS +	480	93356	1,074.00	N/A
HC44200186	US DUPLEX CAROTID COMP BILAT	921	93880	2,528.00	N/A
HC44200194	US DUPLEX CAROTID UNILAT LT	921	93882	1,674.00	N/A
HC44200202	US DUPLEX CAROTID UNILAT RT	921	93882	1,674.00	N/A
HC44200210	US DUPLEX CAROTID LTD	921	93882	1,405.00	N/A
HC44200608	TRANSCRANIAL DOPPLER STUDY COMP	921	93886	2,757.00	N/A
HC44200616	TRANSCRANIAL DOPPLER STUDY LTD	921	93888	1,708.00	N/A
HC44700557	INTRAVASC DOPPLER INIT VESSEL+	481	93571	4,950.00	N/A
HC44700565	INTRAVASC DOPPLER ADDL VESSEL+	481	93572	2,972.00	N/A
HC44700607	IVUS/OCT CORONARY VESS/GRAFT INIT	481	92978	7,730.00	N/A
HC44700615	IVUS/OCT CORONARY VES/GRFT EA ADL+	481	92979	4,518.00	N/A
HC51061588	ECHO CONGENITAL COMPLETE	510	93303	1,575.00	N/A
HC51061596	ECHO CONGENITAL LTD OR F/U	510	93304	1,274.00	N/A
HC51061604	ECHO 2D CMPLT W/SPEC&CLR DOPLR	510	93306	1,450.00	N/A
HC51061612	ECHO DOPPLER COMPLETE+	510	93320	450.00	N/A
HC51061620	ECHO DOPPLER F/U OR LTD+	510	93321	425.00	N/A
HC51061638	ECHO DOPPLER COLOR FLOW+	510	93325	400.00	N/A
HC51061653	ECHO 2D CMPLT W/O SPEC&CLR DOP	483	93307	600.00	N/A
HC51061661	ECHO 2D LMTD W/O SPEC&CLR /DOP	483	93308	475.00	N/A
HC51061679	MYOCARDIAL STRAIN QUANT ASSESS+	483	93356	200.00	N/A
HC42000190	ECHO FETAL CARDIOVASCULAR	483	76825	3,132.00	N/A
HC42000208	ECHO FETAL DOPPLER COMPLETE	483	76827	1,265.00	N/A
HC42000216	ECHO FETAL DOPPLER F/U OR REP	483	76828	1,053.00	N/A
HC42000224	ECHO FETAL F/U OR REPEAT	483	76826	1,689.00	N/A
HC42000810	TEE GUIDE TRANSCATH INTVNTN INCL US	483	93355	4,614.00	N/A
HC43000371	US GUIDE FNA	402	76942	1,930.00	N/A
HC43000710	US GUIDE BREAST CORE BIOPSY LT	402	76942	1,812.00	N/A
HC43000728	US GUIDE BREAST CORE BIOPSY RT	402	76942	1,811.00	N/A
HC43000736	US GUIDE CYST ASPIRATION LT	402	76942	1,900.00	N/A
HC43000744	US GUIDE CYST ASPIRATION RT	402	76942	1,900.00	N/A
HC43000975	US BREAST; COMPLETE LT	402	76641	967.00	N/A
HC43000983	US BREAST; COMPLETE RT	402	76641	967.00	N/A
HC43000991	US BREAST; COMPLETE BILATERAL	402	76641	1,783.00	N/A
HC43001007	US BREAST; LIMITED LT	402	76642	724.00	N/A
HC43001015	US BREAST; LIMITED RT	402	76642	724.00	N/A
HC43001023	US BREAST; LIMITED BILATERAL	402	76642	1,424.00	N/A
HC43001221	QT SCAN BREAST	409	76999	137.00	N/A
HC44200004	US ABDOMEN	402	76700	2,460.00	N/A
HC44200012	US ABDOMEN LTD	402	76705	1,765.00	N/A
HC44200020	US GUIDANCE ABLATION PARENCHYMAL TISSUE	402	76940	1,715.00	N/A
HC44200095	US CHEST	402	76604	1,539.00	N/A
HC44200103	US DUPLEX ABD/PEL FLOW COMP	921	93975	3,204.00	N/A
HC44200111	US DUPLEX ABD/PEL FLOW LTD	921	93976	1,919.00	N/A
HC44200129	US DUPLEX AORTA,IVC,ILIAC COMP	921	93978	2,388.00	N/A
HC44200137	US DUPLEX AORTA,IVC,ILIAC UNI/LTD	921	93979	1,833.00	N/A
HC44200145	US DUPLEX ART LOW EXT COMP BIL	921	93925	3,500.00	N/A
HC44200152	US DUPLEX ART LOW EXT UNILAT/LTD	921	93926	1,931.00	N/A
HC44200160	US DUPLEX ART UP EXT COMP BIL	921	93930	2,902.00	N/A
HC44200178	US DUPLEX ART UP EXT UNILAT/LTD	921	93931	1,900.00	N/A
HC44200236	US DUPLEX PENILE VESSEL COMP	921	93980	2,253.00	N/A
HC44200244	US DUPLEX PENILE VESSEL F/U OR LTD	921	93981	1,750.00	N/A
HC44200251	US DUPLEX VEIN EXT COMP BILAT	921	93970	3,058.00	N/A
HC44200269	US DUPLEX VEIN EXT UNILAT/LTD	921	93971	2,159.00	N/A
HC44200285	US FETAL BIO PROFILE W/NST	402	76818	1,748.00	N/A
HC44200293	US FETAL BIO PROF W/O NST(INTL)	402	76819	1,539.00	N/A
HC44200301	US GUIDANCE INTRAOPERATIVE	402	76998	2,724.00	N/A
HC44200327	US GUIDE VASC ACCESS	402	76937	1,425.00	N/A
HC44200335	US HEAD	402	76506	2,017.00	N/A
HC44200343	US HEAD/NECK SOFT TISSUE	402	76536	1,830.00	N/A
HC44200350	US HYSTEROSONOGRAPHY	402	76831	1,806.00	N/A
HC44200368	US INFANT HIPS(DYNAMIC)	402	76885	1,880.00	N/A
HC44200376	US INFANT HIPS LTD/STATIC	402	76886	1,467.00	N/A
HC44200384	US KIDNEY TRANSPLANT W/DOPLER	402	76776	2,073.00	N/A
HC44200392	US OB >1ST TRI/1ST GEST	402	76805	2,309.00	N/A
HC44200400	US OB >1ST TRI ADD'L GEST+	402	76810	1,680.00	N/A
HC44200418	US OB 1ST TRI/1ST GEST	402	76801	1,967.00	N/A
HC44200426	US OB 1ST TRI ADD'L GEST +	402	76802	1,099.00	N/A
HC44200434	US OB FOLLOW UP(RE-EVAL)	402	76816	1,175.00	N/A
HC44200442	US OB FOLLOW UP EA ADD'L FETUS+	402	76816	1,182.00	N/A
HC44200459	US OB LIMITED FETUS(S)	402	76815	1,254.00	N/A
HC44200467	US OB NUCHAL MEAS, 1ST GEST	402	76813	1,410.00	N/A
HC44200475	US OB NUCHAL MEAS EA ADL GEST+	402	76814	1,247.00	N/A
HC44200483	US OB TRANSVAGINAL	402	76817	1,607.00	N/A
HC44200491	US OPHTH B-SCAN	402	76512	1,273.00	N/A
HC44200525	US PELVIC(NON OB)	402	76856	2,030.00	N/A
HC44200533	US PELVIC(NON OB)LTD OR F/U	402	76857	1,420.00	N/A
HC44200541	US RETROPERITONEAL COMPLETE	402	76770	2,160.00	N/A
HC44200558	US RETROPERITONEAL LTD	402	76775	1,485.00	N/A
HC44200566	US SCROTUM	402	76870	1,930.00	N/A
HC44200574	US SPINAL CANAL & CONTENT	402	76800	1,716.00	N/A
HC44200624	US TRANSRECT PROSTATE VOL STDY	402	76873	1,949.00	N/A
HC44200632	US TRANSRECTAL	402	76872	1,676.00	N/A
HC44200640	US TRANSVAGINAL(NON OB)	402	76830	1,887.00	N/A
HC44200673	US GUIDANCE AMNIOCENTESIS	402	76946	1,398.00	N/A
HC44200699	US AAA SCREENING	402	76706	1,015.00	N/A
HC44200707	US GUIDE PLCMNT NEEDLE LOC	402	76942	1,949.00	N/A
HC44200749	US GUIDE FNA LT	402	76942	1,949.00	N/A
HC44200756	US GUIDE FNA RT	402	76942	1,949.00	N/A
HC44200764	US GUIDE PLCMNT LT	402	76942	1,949.00	N/A
HC44200772	US GUIDE PLCMNT RT	402	76942	1,949.00	N/A
HC44200780	US GUIDE PLCMNT NEEDLE LOC LT	402	76942	1,949.00	N/A
HC44200798	US GUIDE PLCMNT NEEDLE LOC RT	402	76942	1,949.00	N/A
HC44200806	US EXTREMITY NON VASC CMPLT-RT	402	76881	1,625.00	N/A
HC44200814	US EXTREMITY NON VASC CMPLT-LT	402	76881	1,625.00	N/A
HC44200822	US EXTREMITY NON VASC LTD-RT	402	76882	840.00	N/A
HC44200830	US EXTREMITY NON VASC LTD- LT	402	76882	840.00	N/A
HC44200897	US FETAL BPP W/O NST(EA ADD'L)+	402	76819	1,427.00	N/A
HC44200921	US CHEST LTD	402	76604	820.00	N/A
HC44200939	US HEAD/NECK SOFT TISSUE LTD	402	76536	788.00	N/A
HC44200962	US ELASTOGRAPHY	402	76981	827.00	N/A
HC44200970	US ELASTOGRAPHY 1ST LESION	402	76982	761.00	N/A
HC44200988	US ELASTOGRAPHY ADDTL LESION	402	76983	496.00	N/A
HC44200996	US OB EVAL PLUS FETAL ANATOMIC DETAIL 1ST GEST	402	76811	2,775.00	N/A
HC44201002	US OB EVA PLUS FETAL ANATOMIC DETAIL EA ADL GEST+	402	76812	1,875.00	N/A
HC44504462	IVUS VESSEL INIT'L NONCORON W/EXAM+	402	37252	5,933.00	N/A
HC44504470	IVUS VESSEL ADD'L NONCORON W/EXAM++	402	37253	4,843.00	N/A
HC47200720	US GUIDE RAD ELEMENT APP	402	76965	3,373.00	N/A
HC51002376	US PELVIC(NON OB)LTD OR F/U	402	76857	223.00	N/A
HC51002509	US SCROTUM W/DOPPLER	402	76870	323.00	N/A
HC51002517	US TRANSRECTAL	402	76872	323.00	N/A
HC51002525	US GUIDE PLCMNT NEEDLE /BX	402	76942	376.00	N/A
HC51002533	US TRANSVAGINAL(NON OB)	402	76830	329.00	N/A
HC51002541	US ABDOMEN	402	76700	338.00	N/A
HC51061109	US RETROPERITONEAL COMPLETE	510	76770	560.00	N/A
HC51061695	ECHO FETAL CARDIOVASCULAR 2D	483	76825	850.00	N/A
HC51061703	ECHO FETAL CARDIO 2D F/U OR REPEAT	483	76826	625.00	N/A
HC51061711	ECHO FETAL DOPPLER COMPLETE	483	76827	350.00	N/A
HC51061729	ECHO FETAL DOPPLER F/U OR REPEAT	483	76828	300.00	N/A
HC45400058	MR BRAIN W&W/O CONTRAST	611	70553	9,643.00	N/A
HC45400066	MR BRAIN W/CONTRAST	611	70552	6,651.00	N/A
HC45400074	MR BRAIN W/O CONTRAST	611	70551	5,767.00	N/A
HC45400116	MR C-SPINE W&W/O CONTRAST	612	72156	9,816.00	N/A
HC45400124	MR C-SPINE W/CONTRAST	612	72142	6,453.00	N/A
HC45400132	MR C-SPINE W/O CONTRAST	612	72141	5,617.00	N/A
HC45400371	MR ORBIT/FACE&OR NECK W&WO CON	611	70543	10,015.00	N/A
HC45400389	MR ORBIT/FACE&OR NECK W/CONTR	611	70542	6,514.00	N/A
HC45400397	MR ORBIT/FACE&OR NECK W/O CONT	611	70540	5,514.00	N/A
HC45400686	MRA HEAD W&W/O CONTRAST	611	70546	8,528.00	N/A
HC45400694	MRA HEAD W/CONTRAST	611	70545	6,058.00	N/A
HC45400702	MRA HEAD W/O CONTRAST	611	70544	5,403.00	N/A
HC45400710	MRA NECK W&W/O CONTRAST	611	70549	8,748.00	N/A
HC45400728	MRA NECK W/ CONTRAST	611	70548	6,740.00	N/A
HC45400736	MRA NECK W/O CONTRAST	611	70547	5,403.00	N/A
HC45400009	MR ABDOMEN W&W/O CONTRAST	610	74183	11,292.00	N/A
HC45400017	MR ABDOMEN W/ CONTRAST	610	74182	8,140.00	N/A
HC45400025	MR ABDOMEN W/O CONTRAST	610	74181	7,075.00	N/A
HC45400033	MR ABDOMEN(MRCP)W/O CONTRAST	610	74181	7,075.00	N/A
HC45400041	MR BONE MARROW BLOOD SUPPLY	610	77084	6,736.00	N/A
HC45400082	MR CHEST W&W/O CONTRAST	610	71552	12,053.00	N/A
HC45400090	MR CHEST W/CONTRAST	610	71551	7,291.00	N/A
HC45400108	MR CHEST W/O CONTRAST	610	71550	6,400.00	N/A
HC45400140	MR IMAG GUIDE NEEDLE PLACEMENT	610	77021	4,595.00	N/A
HC45400157	MR GUIDANCE ABLATION PARENCHYMAL TISSUE	610	77022	4,668.00	N/A
HC45400165	MR LOW EXT(NON JNT)W/O CONT BIL	610	73718	12,113.00	N/A
HC45400173	MR LOW EXT(NON JNT)W/O CONT LT	610	73718	6,243.00	N/A
HC45400181	MR LOW EXT(NON JNT)W/O CONT RT	610	73718	6,243.00	N/A
HC45400199	MR LOW EXT(NON JNT)W/CONT BIL	610	73719	13,129.00	N/A
HC45400207	MR LOW EXT(NON JNT)W/CONT LT	610	73719	7,183.00	N/A
HC45400215	MR LOW EXT(NON JNT)W/CONT RT	610	73719	7,183.00	N/A
HC45400223	MR LO EXT(NON JNT)W&W/O CON BI	610	73720	18,618.00	N/A
HC45400231	MR LO EXT(NON JNT)W&W/O CON LT	610	73720	10,041.00	N/A
HC45400249	MR LO EXT(NON JNT)W&W/O CON RT	610	73720	10,041.00	N/A
HC45400256	MR LOW EXT(JNT) W/O CONT BIL	610	73721	12,566.00	N/A
HC45400264	MR LOW EXT(JNT) W/O CONT LT	610	73721	6,135.00	N/A
HC45400272	MR LOW EXT(JNT) W/O CONT RT	610	73721	6,135.00	N/A
HC45400280	MR LOW EXT(JNT)W/CONT BIL	610	73722	13,648.00	N/A
HC45400298	MR LOW EXT(JNT)W/CONT LT	610	73722	7,183.00	N/A
HC45400306	MR LOW EXT(JNT)W/CONT RT	610	73722	7,183.00	N/A
HC45400314	MR LOW EXT(JNT)W&W/O CONT BIL	610	73723	17,074.00	N/A
HC45400322	MR LOW EXT(JNT)W&W/O CONT LT	610	73723	9,858.00	N/A
HC45400330	MR LOW EXT(JNT)W&W/O CONT RT	610	73723	9,858.00	N/A
HC45400348	MR L-SPINE W&W/O CONTRAST	612	72158	12,235.00	N/A
HC45400355	MR L-SPINE W/CONTRAST	612	72149	8,365.00	N/A
HC45400363	MR L-SPINE W/O CONTRAST	612	72148	7,488.00	N/A
HC45400405	MR PELVIS W&W/O CONTRAST	610	72197	11,309.00	N/A
HC45400413	MR PELVIS W/CONTRAST	610	72196	7,348.00	N/A
HC45400421	MR PELVIS W/O CONTRAST	610	72195	6,606.00	N/A
HC45400439	MR SPECTROSCOPY	610	76390	6,501.00	N/A
HC45400462	MR TMJ(S)	610	70336	6,337.00	N/A
HC45400470	MR T-SPINE W&W/O CONTRAST	612	72157	12,146.00	N/A
HC45400488	MR T-SPINE W/CONTRAST	612	72147	8,207.00	N/A
HC45400496	MR T-SPINE W/O CONTRAST	612	72146	7,200.00	N/A
HC45400504	MR UP EXT(NON JNT) W/O CONT BIL	610	73218	12,560.00	N/A
HC45400512	MR UP EXT(NON JNT) W/O CONT LT	610	73218	6,047.00	N/A
HC45400520	MR UP EXT(NON JNT) W/O CONT RT	610	73218	6,047.00	N/A
HC45400538	MR UP EXT(NON JNT)W/CONT BIL	610	73219	13,646.00	N/A
HC45400546	MR UP EXT(NON JNT)W/CONT LT	610	73219	7,184.00	N/A
HC45400553	MR UP EXT(NON JNT)W/CONT RT	610	73219	7,184.00	N/A
HC45400561	MR UP EXT(NON JNT) W&W/O BIL	610	73220	19,391.00	N/A
HC45400579	MR UP EXT(NON JNT) W&W/O LT	610	73220	10,205.00	N/A
HC45400587	MR UP EXT(NON JNT) W&W/O RT	610	73220	10,205.00	N/A
HC45400595	MR UP EXT(JNT) W/O CONT BIL	610	73221	11,319.00	N/A
HC45400603	MR UP EXT(JNT) W/O CONT LT	610	73221	6,076.00	N/A
HC45400611	MR UP EXT(JNT) W/O CONT RT	610	73221	6,076.00	N/A
HC45400629	MR UP EXT (JNT) W/CONT BIL	610	73222	14,050.00	N/A
HC45400637	MR UP EXT (JNT) W/CONT LT	610	73222	7,393.00	N/A
HC45400645	MR UP EXT (JNT) W/CONT RT	610	73222	7,393.00	N/A
HC45400652	MRA CHEST W&W/O CONTRAST	610	C8911	8,214.00	N/A
HC45400660	MRA CHEST W/CONTRAST	610	C8909	6,447.00	N/A
HC45400678	MRA CHEST W/O CONTRAST	610	C8910	5,877.00	N/A
HC45400744	MRA PELVIS W/ CONTRAST	610	C8918	5,730.00	N/A
HC45400751	MRA PELVIS W/O & W/ CONTRAST	610	C8920	7,188.00	N/A
HC45400769	MRA PELVIS W/O CONTRAST	610	C8919	5,331.00	N/A
HC45400827	MRI CARDIAC FOR MORPH W/CON	610	75561	9,099.00	N/A
HC45400835	MRI CARDIAC MORPH W/O CONT	610	75557	6,797.00	N/A
HC45400843	MRI CARDIAC MORPH W/STRESS W/O	610	75559	8,954.00	N/A
HC45400884	MRI CARDIAC W/STRESS IMG W/CON	610	75563	11,331.00	N/A
HC45400892	MR UPPER EXT JNT W&W/O CONT RT	610	73223	10,904.00	N/A
HC45400900	MR UPPER EXT JNT W&W/O CONT LT	610	73223	10,904.00	N/A
HC45400918	MR UP EXT JNT W&W/O CONT BILAT	610	73223	20,727.00	N/A
HC45400926	MR BREAST CAD+	610	C8937	961.00	N/A
HC45401007	MR BREAST W/O CONTRAST LTD RT	610	77046	2,459.00	N/A
HC45401015	MR BREAST W/O CONTRAST LTD LT	610	77046	2,459.00	N/A
HC45401023	MR BREAST W/O CONTRAST RT	610	77046	5,459.00	N/A
HC45401031	MR BREAST W/O CONTRAST LT	610	77046	5,459.00	N/A
HC45401049	MR BREAST W/O& W/ CONTRAST RT	610	C8905	6,482.00	N/A
HC45401056	MR BREAST W/O& W/ CONTRAST LT	610	C8905	6,482.00	N/A
HC45401064	MR BREAST W/O&W CONTRAST LTD RT	610	C8905	2,801.00	N/A
HC45401072	MR BREAST W/O&W CONTRAST LTD LT	610	C8905	2,801.00	N/A
HC45401106	MR BREASTS W/O CONTRAST (BILAT)	610	77047	6,702.00	N/A
HC45401114	MR BREASTS W/O CONTRAST LTD (BILAT)	610	77047	3,804.00	N/A
HC45401122	MR BREASTS W/O&W CONTRAST (BILAT)	610	C8908	8,308.00	N/A
HC45401130	MR BREASTS W/O&W CONTRST LTD (BILAT)	610	C8908	4,261.00	N/A
HC45401171	MRA LOW EXT W/CONT RT	610	C8912	5,373.00	N/A
HC45401189	MRA LOW EXT W/CONT LT	610	C8912	5,373.00	N/A
HC45401197	MRA LOW EXT W/CONT BILAT	610	C8912	10,739.00	N/A
HC45401205	MRA LOW EXT W/O CONT RT	610	C8913	5,968.00	N/A
HC45401213	MRA LOW EXT W/O CONT  LT	610	C8913	5,949.00	N/A
HC45401221	MRA LOW EXT W/O CONT BILAT	610	C8913	9,591.00	N/A
HC45401239	MRA LOW EXT W&W/O CONT RT	610	C8914	7,353.00	N/A
HC45401247	MRA LOW EXT W&W/O CONT LT	610	C8914	7,353.00	N/A
HC45401254	MRA LOW EXT W&W/O CONT BILAT	610	C8914	12,685.00	N/A
HC45401262	MRA ABDOMEN W&W/O CONTRAST	610	C8902	7,470.00	N/A
HC45401270	MRA ABDOMEN W/CONT	610	C8900	6,284.00	N/A
HC45401288	MRA ABDOMEN W/O CONT	610	C8901	5,502.00	N/A
HC45401312	MR CARDIAC VELOCITY FLOW MAP +	610	75565	1,706.00	N/A
HC45401320	MRA SPINE W/ CONTRAST	612	C8931	8,532.00	N/A
HC45401338	MRA SPINE W/O & W/ CONTRAST	612	C8933	9,447.00	N/A
HC45401346	MRA SPINE W/O CONTRAST	612	C8932	6,812.00	N/A
HC45401387	MRA UPPER EXT W/CONT RT	610	C8934	4,968.00	N/A
HC45401395	MRA UPPER EXT W/O CONT RT	610	C8935	4,579.00	N/A
HC45401403	MRA UPPER EXT W/O&W/CONT RT	610	C8936	5,429.00	N/A
HC45401411	MRA UPPER EXT W/CONT LT	610	C8934	4,968.00	N/A
HC45401429	MRA UPPER EXT W/O CONT LT	610	C8935	4,579.00	N/A
HC45401437	MRA UPPER EXT W/O&W/CONT LT	610	C8936	5,429.00	N/A
HC45401536	MR ABDOMEN(MRCP)W&W/O CONTRAST	610	74183	11,292.00	N/A
HC45401544	MRI FETAL INCL PLACENTA PLVC IF PRF; SINGLE 1ST GESTATION	610	74712	4,875.00	N/A
HC45401551	MRI FETAL PLACENTAL PLVC IF PRF; EA ADDL+	610	74713	3,412.00	N/A
HC45401569	MR ELASTOGRAPHY	610	76391	2,795.00	N/A
HC45401577	MR BREAST W/O& W/ CONTR & CAD LT [COMM&MCAL]	610	77048	6,434.00	N/A
HC45401585	MR BREAST W/O& W/ CONTR & CAD RT [COMM&MCAL]	610	77048	6,434.00	N/A
HC45401593	MR BREASTS W/O&W CONTR & CAD (BILAT) [COMM&MCAL]	610	77049	10,045.00	N/A
HC45600103	PET BREAST CA INTL/ SURG PLAN	404	G0252	8,135.00	N/A
HC43500008	DEXA BONE DENS-APPEND SKELETAL	320	77081	831.00	N/A
HC43500016	DEXA BONE DENS-AXIAL SKELETAL	320	77080	1,115.00	N/A
HC43500024	DEXA BONE DENS-BODY $	320	77080	1,106.00	N/A
HC43500040	DEXA BONE DENS-AXIAL/APPEND COMB	320	77080	1,210.00	N/A
HC44000065	AC JOINTS BILAT	320	73050	909.00	N/A
HC44000073	ANKLE 2 VIEWS BILAT	320	73600	1,304.00	N/A
HC44000081	ANKLE 2 VIEWS LT	320	73600	728.00	N/A
HC44000099	ANKLE 2 VIEWS RT	320	73600	728.00	N/A
HC44000107	ANKLE ARTHROGRAM BILAT	322	73615	2,737.00	N/A
HC44000115	ANKLE ARTHROGRAM LT	322	73615	1,474.00	N/A
HC44000123	ANKLE ARTHROGRAM RT	322	73615	1,474.00	N/A
HC44000131	ANKLE COMP MIN 3 VWS BILAT	320	73610	1,880.00	N/A
HC44000149	ANKLE COMP MIN 3 VWS LT	320	73610	941.00	N/A
HC44000156	ANKLE COMP MIN 3 VWS RT	320	73610	941.00	N/A
HC44000214	BONE AGE STUDIES	320	77072	721.00	N/A
HC44000222	BONE LENGTH STUDIES	320	77073	2,033.00	N/A
HC44000230	BONE SURVEY COMPLETE	320	77075	2,501.00	N/A
HC44000248	BONE SURVEY INFANT	320	77076	1,552.00	N/A
HC44000255	BONE SURVEY LTD	320	77074	1,506.00	N/A
HC44000297	CALCANEUS (HEEL) BILAT	320	73650	1,159.00	N/A
HC44000305	CALCANEUS (HEEL) LT	320	73650	622.00	N/A
HC44000313	CALCANEUS (HEEL) RT	320	73650	622.00	N/A
HC44000321	CERVICAL SPINE 1 VIEW	320	72020	722.00	N/A
HC44000339	CERVICAL SPINE 2 OR 3VWS	320	72040	988.00	N/A
HC44000347	CERVICAL SPINE COMP 6/> VWS	320	72052	1,507.00	N/A
HC44000354	CERVICAL SPINE 4/5VWS	320	72050	1,420.00	N/A
HC44000503	CLAVICLE BILATERAL	320	73000	1,204.00	N/A
HC44000511	CLAVICLE LT	320	73000	673.00	N/A
HC44000529	CLAVICLE RT	320	73000	673.00	N/A
HC44000560	DISKOGRAPHY-CERVICAL/THORACIC	320	72285	5,772.00	N/A
HC44000578	DISKOGRAPHY-LUMBAR	320	72295	5,351.00	N/A
HC44000594	ELBOW 2 VWS BILAT	320	73070	1,385.00	N/A
HC44000602	ELBOW 2 VWS LT	320	73070	702.00	N/A
HC44000610	ELBOW 2 VWS RT	320	73070	702.00	N/A
HC44000651	ELBOW COMP MIN 3 VWS BILAT	320	73080	1,801.00	N/A
HC44000669	ELBOW COMP MIN 3 VWS LT	320	73080	898.00	N/A
HC44000677	ELBOW COMP MIN 3 VWS RT	320	73080	897.00	N/A
HC44000735	FACIAL BONES COMP MIN 3 VWS	320	70150	1,195.00	N/A
HC44000743	FACIAL BONES LTD < THAN 3 VWS	320	70140	765.00	N/A
HC44000768	FEMUR 2/> VIEWS BILAT	320	73552	1,951.00	N/A
HC44000776	FEMUR 2/> VIEWS LT	320	73552	1,006.00	N/A
HC44000784	FEMUR 2/> VIEWS RT	320	73552	1,006.00	N/A
HC44000792	FINGER(S) MIN 2 VWS-LT	320	73140	616.00	N/A
HC44000800	FINGER(S) MIN 2 VWS-RT	320	73140	616.00	N/A
HC44000883	FOOT 2 VIEWS BILAT	320	73620	1,441.00	N/A
HC44000891	FOOT 2 VIEWS LT	320	73620	723.00	N/A
HC44000909	FOOT 2 VIEWS RT	320	73620	723.00	N/A
HC44000917	FOOT COMP MIN 3 VWS BILAT	320	73630	1,818.00	N/A
HC44000925	FOOT COMP MIN 3 VWS LT	320	73630	910.00	N/A
HC44000933	FOOT COMP MIN 3 VWS RT	320	73630	909.00	N/A
HC44000941	FOREARM BILAT	320	73090	1,369.00	N/A
HC44000958	FOREARM LT	320	73090	745.00	N/A
HC44000966	FOREARM RT	320	73090	745.00	N/A
HC44000974	HAND 2 VIEWS BILAT	320	73120	1,342.00	N/A
HC44000982	HAND 2 VIEWS LT	320	73120	689.00	N/A
HC44000990	HAND 2 VIEWS RT	320	73120	689.00	N/A
HC44001006	HAND COMPLETE MIN 3 VWS BILAT	320	73130	1,787.00	N/A
HC44001014	HAND COMPLETE MIN 3 VWS LT	320	73130	897.00	N/A
HC44001022	HAND COMPLETE MIN 3 VWS RT	320	73130	897.00	N/A
HC44001170	HUMERUS BILAT	320	73060	1,340.00	N/A
HC44001188	HUMERUS LT	320	73060	762.00	N/A
HC44001196	HUMERUS RT	320	73060	762.00	N/A
HC44001212	INFANT LOW EXT MIN 2VWS BILAT	320	73592	1,483.00	N/A
HC44001220	INFANT LOW EXTREM MIN 2VWS LT	320	73592	793.00	N/A
HC44001238	INFANT LOW EXTREM MIN 2VWS RT	320	73592	793.00	N/A
HC44001246	INFANT UP EXTREM MIN 2VW BILAT	320	73092	1,406.00	N/A
HC44001253	INFANT UP EXTREM MIN 2VWS LT	320	73092	691.00	N/A
HC44001261	INFANT UP EXTREM MIN 2VWS RT	320	73092	691.00	N/A
HC44001279	INTERNAL AUDITORY CANAL	320	70134	565.00	N/A
HC44001352	JNT SURVEY SNGL VW 2 OR>JNTS	320	77077	1,136.00	N/A
HC44001360	KNEE 1 VIEW BILAT	320	73560	1,373.00	N/A
HC44001378	KNEE 1 VIEW LT	320	73560	740.00	N/A
HC44001386	KNEE 1 VIEW RT	320	73560	740.00	N/A
HC44001394	KNEE 2 VIEWS BILAT	320	73560	1,476.00	N/A
HC44001402	KNEE 2 VIEWS LT	320	73560	826.00	N/A
HC44001410	KNEE 2 VIEWS RT	320	73560	826.00	N/A
HC44001428	KNEE 3 VIEWS BILAT	320	73562	1,885.00	N/A
HC44001436	KNEE 3 VIEWS LT	320	73562	959.00	N/A
HC44001444	KNEE 3 VIEWS RT	320	73562	959.00	N/A
HC44001451	KNEE 4 OR MORE VWS BILAT	320	73564	2,296.00	N/A
HC44001469	KNEE 4 OR MORE VWS LT	320	73564	1,146.00	N/A
HC44001477	KNEE 4 OR MORE VWS RT	320	73564	1,146.00	N/A
HC44001485	KNEE ARTHROGRAM BILAT	322	73580	3,637.00	N/A
HC44001493	KNEE ARTHROGRAM LT	322	73580	1,918.00	N/A
HC44001501	KNEE ARTHROGRAM RT	322	73580	1,918.00	N/A
HC44001519	KNEES BILATERAL AP STANDING	320	73565	753.00	N/A
HC44001527	LUMBAR SPINE 1 VIEW	320	72020	722.00	N/A
HC44001535	LUMBAR SPINE 2 OR 3 VWS	320	72100	923.00	N/A
HC44001543	LUMBAR SPINE BEND ONLY;2/3 VWS	320	72120	1,093.00	N/A
HC44001550	LUMBAR SPINE W/BEND MIN 6 VWS	320	72114	1,622.00	N/A
HC44001568	LUMBAR SPINE SERIES MIN 4VWS	320	72110	1,416.00	N/A
HC44001576	MANDIBLE < 4 VIEWS	320	70100	709.00	N/A
HC44001584	MANDIBLE COMPLETE MIN 4 VWS	320	70110	1,145.00	N/A
HC44001592	MASTOIDS < 3 VIEWS PER SIDE	320	70120	682.00	N/A
HC44001600	MASTOIDS MIN 3 VIEWS	320	70130	986.00	N/A
HC44001659	NASAL BONES	320	70160	898.00	N/A
HC44001683	OPTIC FORAMINA	320	70190	452.00	N/A
HC44001691	ORBITS COMPLETE MIN 4 VWS	320	70200	1,068.00	N/A
HC44001709	ORTHOPANTOGRAM	320	70355	679.00	N/A
HC44001717	PELVIS 1 OR 2 VWS	320	72170	795.00	N/A
HC44001725	PELVIS COMP MIN 3 VWS	320	72190	1,004.00	N/A
HC44001774	RIBS BILAT 3 VIEWS	320	71110	1,071.00	N/A
HC44001782	RIBS BILAT MIN 4VWS W/PA CHEST	320	71111	1,233.00	N/A
HC44001790	RIBS UNILAT 2 VIEWS LT	320	71100	839.00	N/A
HC44001808	RIBS UNILAT 2 VIEWS RT	320	71100	838.00	N/A
HC44001816	RIBS UNILAT MIN 3 VWS W/PA-LT	320	71101	1,028.00	N/A
HC44001824	RIBS UNILAT MIN 3 VWS W/PA-RT	320	71101	1,028.00	N/A
HC44001832	SACRO-ILIAC JNTS 3 OR MORE VWS	320	72202	901.00	N/A
HC44001840	SACROILIAC JOINTS < 3VWS	320	72200	683.00	N/A
HC44001857	SACRUM & COCCYX MIN 2VWS	320	72220	877.00	N/A
HC44001873	SCAPULA BILATERAL	320	73010	1,257.00	N/A
HC44001881	SCAPULA LT	320	73010	713.00	N/A
HC44001899	SCAPULA RT	320	73010	713.00	N/A
HC44001915	SELLA TURCICA	320	70240	486.00	N/A
HC44001923	SHOULDER 1 VIEW BILATERAL	320	73020	1,351.00	N/A
HC44001931	SHOULDER 1 VIEW LT	320	73020	710.00	N/A
HC44001949	SHOULDER 1 VIEW RT	320	73020	710.00	N/A
HC44001980	SHOULDER COMP MIN 2VWS BILAT	320	73030	1,782.00	N/A
HC44001998	SHOULDER COMP MIN 2VWS LT	320	73030	933.00	N/A
HC44002004	SHOULDER COMP MIN 2VWS RT	320	73030	933.00	N/A
HC44002020	SINUSES COMP MIN 3 VIEWS	320	70220	1,058.00	N/A
HC44002038	SINUSES LTD <  3 VWS	320	70210	722.00	N/A
HC44002046	SKULL COMPLETE MIN 4 VWS	320	70260	1,381.00	N/A
HC44002053	SKULL LTD <4 VIEWS	320	70250	855.00	N/A
HC44002111	STERNOCLAVICULAR MIN 3 VWS	320	71130	797.00	N/A
HC44002129	STERNUM MIN 2 VIEWS	320	71120	740.00	N/A
HC44002137	STRESS VIEW, ANY JOINT	320	77071	550.00	N/A
HC44002160	TEETH SINGLE VIEW	320	70300	374.00	N/A
HC44002178	TEETH/LESS THAN FULL MOUTH	320	70310	519.00	N/A
HC44002186	THORACIC SPINE 1VIEW	320	72020	722.00	N/A
HC44002194	THORACIC SPINE 2 VIEWS	320	72070	753.00	N/A
HC44002202	THORACIC SPINE 3 VIEWS	320	72072	901.00	N/A
HC44002210	THORACIC SPINE MIN 4 VIEWS	320	72074	1,068.00	N/A
HC44002228	SPINE THORACOLUMBAR JUNCTN MIN 2 VWS	320	72080	892.00	N/A
HC44002236	TIBIA & FIBULA (LEG) 2 VWS BIL	320	73590	1,594.00	N/A
HC44002244	TIBIA & FIBULA (LEG) 2 VWS LT	320	73590	862.00	N/A
HC44002251	TIBIA & FIBULA (LEG) 2 VWS RT	320	73590	862.00	N/A
HC44002277	TMJ ARTHROGRAM BILAT	322	70332	2,044.00	N/A
HC44002285	TMJ ARTHROGRAM LT	322	70332	1,028.00	N/A
HC44002293	TMJ ARTHROGRAM RT	322	70332	1,028.00	N/A
HC44002301	TMJ BILAT	320	70330	1,009.00	N/A
HC44002319	TMJ UNILATERAL LEFT	320	70328	480.00	N/A
HC44002327	TMJ UNILATERAL RIGHT	320	70328	480.00	N/A
HC44002335	TOE (S) BILAT	320	73660	1,141.00	N/A
HC44002343	TOE (S) LT	320	73660	602.00	N/A
HC44002350	TOE (S) RT	320	73660	602.00	N/A
HC44002517	WRIST 2 VIEWS BILAT	320	73100	1,328.00	N/A
HC44002525	WRIST 2 VIEWS LT	320	73100	702.00	N/A
HC44002533	WRIST 2 VIEWS RT	320	73100	702.00	N/A
HC44002541	WRIST ARTHROGRAM BILAT	322	73115	2,981.00	N/A
HC44002558	WRIST ARTHROGRAM LT	322	73115	1,608.00	N/A
HC44002566	WRIST ARTHROGRAM RT	322	73115	1,608.00	N/A
HC44002574	WRIST COMP MIN 3 VWS BILAT	320	73110	1,782.00	N/A
HC44002582	WRIST COMP MIN 3 VWS LT	320	73110	876.00	N/A
HC44002590	WRIST COMP MIN 3 VWS RT	320	73110	876.00	N/A
HC44002707	ELBOW - COMPLETE	320	73080	898.00	N/A
HC44002715	UPPER EXTREMITY - INFANT	320	73092	691.00	N/A
HC44002723	WRIST - TWO VIEWS	320	73100	702.00	N/A
HC44002731	WRIST MIN 3 VIEWS	320	73110	876.00	N/A
HC44002749	WRIST - FOUR VIEWS	320	73110	876.00	N/A
HC44002756	FINGER(S)	320	73140	616.00	N/A
HC44002764	KNEE 1 OR 2 VIEWS	320	73560	732.00	N/A
HC44002772	KNEE 4 VIEWS	320	73564	1,146.00	N/A
HC44002780	TIBIA AND FIBULA	320	73590	862.00	N/A
HC44002798	ANKLE 2 VIEWS	320	73600	728.00	N/A
HC44002806	ANKLE MIN 3 VIEWS	320	73610	941.00	N/A
HC44002814	OS CALSIS	320	73650	622.00	N/A
HC44002871	SPINE ENTIRE SKULL-SACRUM 1 VIEW	320	72081	762.00	N/A
HC44002889	SPINE ENTIRE SKULL-SACRUM 2-3 VIEWS	320	72082	1,151.00	N/A
HC44002897	SPINE ENTIRE SKULL-SACRUM 4-5 VIEWS	320	72083	1,542.00	N/A
HC44002905	SPINE ENTIRE SKULL-SACRUM 6/> VIEWS	320	72084	1,852.00	N/A
HC44002913	HIP (W/PELVIS WHN PRFRMD) 1 VIEW LT	320	73501	784.00	N/A
HC44002921	HIP (W/PELVIS WHN PRFRMD) 1 VIEW RT	320	73501	784.00	N/A
HC44002939	HIP (W/PELVIS WHN PRFRMD) 2-3VWS LT	320	73502	1,073.00	N/A
HC44002947	HIP (W/PELVIS WHN PRFRMD) 2-3VWS RT	320	73502	1,073.00	N/A
HC44002954	HIP (W/PELVIS WHN PRFRMD) 4/>VWS LT	320	73503	1,281.00	N/A
HC44002962	HIP (W/PELVIS WHN PRFRMD) 4/>VWS RT	320	73503	1,281.00	N/A
HC44002970	HIPS BILAT2VWS(W/PELVIS WHN PRFRMD)	320	73521	1,119.00	N/A
HC44002988	HIPS BILAT3-4VWS(W/PELVIS WHN PRFRMD)	320	73522	1,153.00	N/A
HC44002996	HIPS BILAT MIN5VWS(W/PELVS WHN PRFRMD)	320	73523	1,726.00	N/A
HC44003002	FEMUR 1 VIEW LT	320	73551	544.00	N/A
HC44003010	FEMUR 1 VIEW RT	320	73551	544.00	N/A
HC51001626	X-RAY SPINE CERVICAL; 4 OR 5VWS	510	72050	390.00	N/A
HC51001634	X-RAY SPINE LUMBOSACRAL; 2 OR 3VWS	510	72100	368.00	N/A
HC51001642	X-RAY SPINE LUMBOSACRAL; MIN 4VWS	510	72110	345.00	N/A
HC51001659	X-RAY SPINE LUMBOSCARAL; BEND ONLY 2 OR 3VWS	510	72120	362.00	N/A
HC51001675	X-RAY CLAVICLE	510	73000	204.00	N/A
HC51001683	X-RAY SHOULDER; COMPLETE MIN 2 VWS	510	73030	230.00	N/A
HC51001691	X-RAY HUMERUS; MIN 2 VWS	510	73060	234.00	N/A
HC51001709	X-RAY ELBOW 2 VW	510	73070	377.00	N/A
HC51001717	X-RAY ELBOW 3+ VW	510	73080	248.00	N/A
HC51001725	X-RAY FOREARM 2 VW	510	73090	248.00	N/A
HC51001733	X-RAY WRIST 2 VW	510	73100	209.00	N/A
HC51001741	X-RAY HAND 2 VW	510	73120	206.00	N/A
HC51001758	X-RAY HAND 3+ VW	510	73130	242.00	N/A
HC51001766	X-RAY EXAM OF FINGERS MIN 2 VWS	510	73140	185.00	N/A
HC51001774	X-RAY PELVIS 1 OR 2 VWS	510	72170	206.00	N/A
HC51001816	X-RAY KNEE 3 VWS	510	73562	248.00	N/A
HC51001824	X-RAY KNEE CMPLET 4+ VWS	510	73564	251.00	N/A
HC51001832	X-RAY TIBULA + FIBULA, 2 VWS	510	73590	211.00	N/A
HC51001840	X-RAY ANKLE 2 VWS	510	73600	210.00	N/A
HC51001857	X-RAY ANKLE 3+ VWS	510	73610	223.00	N/A
HC51001865	X-RAY FOOT 3+ VWS	510	73630	218.00	N/A
HC51001873	X-RAY TOES MIN 2 VWS	510	73660	162.00	N/A
HC51001881	X-RAY BONE AGE STUDIES	510	77072	199.00	N/A
HC51001899	X-RAY BONE LENGTH STUDIES	510	77073	208.00	N/A
HC51003879	X-RAY FEMUR 1 VIEW	510	73551	195.00	N/A
HC51003887	X-RAY FEMUR MIN 2 VIEWS	510	73552	206.00	N/A
HC51061745	X-RAY SPINE 1 VIEW ANY LEVEL	510	72020	220.00	N/A
HC51061752	X-RAY SPINE CERVICAL; 2 OR 3VWS	510	72040	250.00	N/A
HC51061760	X-RAY SPINE CERVICAL; COMP 6/> VWS	510	72052	425.00	N/A
HC51061778	X-RAY SPINE THORACIC; 2 VIEWS	510	72070	325.00	N/A
HC51061786	X-RAY SPINE THORACIC; 3 VIEWS	510	72072	350.00	N/A
HC51061794	X-RAY SPINE THORACIC; MIN 4 VIEWS	510	72074	375.00	N/A
HC51061802	X-RAY SPINE THORACOLUMBAR JUNCTN MIN 2 VWS	510	72080	265.00	N/A
HC51061810	X-RAY SPINE ENTIRE SKULL-SACRUM 1 VIEW	510	72081	255.00	N/A
HC51061828	X-RAY SPINE ENTIRE SKULL-SACRUM 2-3 VIEWS	510	72082	325.00	N/A
HC51061836	X-RAY SPINE ENTIRE SKULL-SACRUM 4-5 VIEWS	510	72083	355.00	N/A
HC51061844	X-RAY SPINE ENTIRE SKULL-SACRUM 6/> VIEWS	510	72084	425.00	N/A
HC51061851	X-RAY SPINE LUMBOSACRAL; CMPLT W/BEND MIN 6 VWS	510	72114	450.00	N/A
HC51061869	X-RAY PELVIS COMPLETE MIN 3 VWS	510	72190	235.00	N/A
HC51061877	X-RAY SCAPULA	510	73010	225.00	N/A
HC51061885	X-RAY SHOULDER; 1 VW	510	73020	200.00	N/A
HC51061893	X-RAY UPPER EXTREMITY INFANT MIN 2 VWS	510	73092	240.00	N/A
HC51061901	X-RAY KNEE 1 OR 2 VWS	510	73560	210.00	N/A
HC51061919	X-RAY LOWER EXTREMITY, INFANT MIN 2 VWS	510	73592	210.00	N/A
HC51061927	X-RAY FOOT 2 VWS	510	73620	195.00	N/A
HC45200003	CARDIAC BLOOD POOL 1ST PASS+	341	78496	1,988.00	N/A
HC45200029	CSF FLOW W/ VENTRICULOGRAPHY	341	78635	3,825.00	N/A
HC45200037	NM ADRENAL IMAGING	341	78075	4,699.00	N/A
HC45200045	NM BONE MARROW LTD AREA	341	78102	2,311.00	N/A
HC45200052	NM BONE MARROW MULTI AREA	341	78103	3,078.00	N/A
HC45200060	NM BONE MARROW WHOLE BODY	341	78104	3,320.00	N/A
HC45200078	NM BONE SCAN LTD AREA	341	78300	2,994.00	N/A
HC45200086	NM BONE SCAN MULTI AREA	341	78305	3,492.00	N/A
HC45200094	NM BONE SCAN 3 PHASE	341	78315	4,450.00	N/A
HC45200110	NM BONE SCAN WHOLE BODY	341	78306	4,203.00	N/A
HC45200128	NM BRAIN IMAG 4<VWS W/VASCFLOW	341	78601	3,667.00	N/A
HC45200136	NM BRAIN IMAG MIN'4 STATC W/VF	341	78606	4,096.00	N/A
HC45200144	NM BRAIN IMAG MIN'4 STATIC VWS	341	78605	3,444.00	N/A
HC45200151	NM BRAIN IMAG VASC FLOW ONLY	341	78610	2,847.00	N/A
HC45200169	NM BRAIN IMAGING 4< STATIC VWS	341	78600	2,656.00	N/A
HC45200185	NM CARDIAC BP 1ST PASS(EF)SNGL	341	78481	3,492.00	N/A
HC45200193	NM CARDIAC BP 1ST PASS(EF)MULT	341	78483	4,282.00	N/A
HC45200201	NM CARDIAC BP IMAG GATED SNGLE	341	78472	3,624.00	N/A
HC45200219	NM CARDIAC BP IMAG GATED MULTI	341	78473	4,367.00	N/A
HC45200227	NM CARDIAC BP SPECT REST WM/EF	341	78494	3,285.00	N/A
HC45200235	NM CARDIAC SCAN	341	78466	2,653.00	N/A
HC45200243	NM CARDIAC SCAN SPECT	341	78469	3,422.00	N/A
HC45200250	NM CARDIAC SCAN W/EF 1ST PASS	341	78468	2,745.00	N/A
HC45200268	NM CARDIAC SHUNT DETECTION	341	78428	2,845.00	N/A
HC45200276	NM CISTERNOGRAM	341	78630	4,206.00	N/A
HC45200284	NM CSF LEAKAGE IMAGING	341	78650	3,685.00	N/A
HC45200292	NM ESOPHAGEAL MOTILITY	341	78258	2,461.00	N/A
HC45200300	NM GASTRIC EMPTYING	341	78264	4,046.00	N/A
HC45200318	NM GASTRIC MUCOSA IMAGING	341	78261	2,475.00	N/A
HC45200326	NM GASTRIC REFLUX STUDY	341	78262	2,781.00	N/A
HC45200334	NM GASTROINTEST PROTEIN LOSS	341	78282	2,162.00	N/A
HC45200342	NM GASTROINTESTINAL BLOOD LOSS	341	78278	4,156.00	N/A
HC45200375	NM INTRACAV RADIOAC COLLOID TX	342	79200	2,492.00	N/A
HC45200383	NM INTRAVASCULAR RAD TX	342	79445	2,630.00	N/A
HC45200391	NM KIDNEY IMAGING MORPHOLOGY	341	78700	2,580.00	N/A
HC45200409	NM KIDNEY IMAGING W/VASC FLOW	341	78701	3,084.00	N/A
HC45200417	NM KIDNEY IMAG FLOW/FUNCTION	341	78707	4,185.00	N/A
HC45200425	NM KIDNEY IMAG FLW/FUNC W/PHAR	341	78708	3,885.00	N/A
HC45200433	NM KIDNEY FLW/FUNC MULTI STUDY	341	78709	4,377.00	N/A
HC45200482	NM LIVER IMAGING STATIC ONLY	341	78201	2,691.00	N/A
HC45200490	NM LIVER IMAGING W/VASC FLOW	341	78202	2,870.00	N/A
HC45200508	NM LIVER/SPLEEN IMAGING STATIC	341	78215	3,267.00	N/A
HC45200516	NM LIVER/SPLEEN W/VASC FLOW	341	78216	3,066.00	N/A
HC45200524	PULM PERFUSION IMAGING	341	78580	3,384.00	N/A
HC45200532	NM LYMPH GLAND/NODES IMAGING	341	78195	4,391.00	N/A
HC45200540	NM MECKEL'S/BOWEL IMAGING	341	78290	3,872.00	N/A
HC45200631	M: NM NUCLEAR MED MISC PROC	341	78999	N/A	N/A
HC45200649	NM PARATHYROID PLANAR IMAG+SUBTR	341	78070	3,045.00	N/A
HC45200656	NM PERITON VEN SHUNT PATENCY	341	78291	2,795.00	N/A
HC45200664	NM PLASMA VOL MULTI SAMPLE	341	78111	2,333.00	N/A
HC45200714	RADIOPHARM' TX; IV ADMIN	342	79101	2,314.00	N/A
HC45200722	NM RADIONUCLIDE VOIDING CYSTO	341	78740	2,943.00	N/A
HC45200730	NM RED CELL SURVIVAL	341	78130	2,843.00	N/A
HC45200748	NM RED CELL VOL SNGL SAMPLE	341	78120	2,457.00	N/A
HC45200755	NM SALIVARY GLAND W/SER IMAG	341	78231	2,549.00	N/A
HC45200797	NM SHUNT EVALUATION	341	78645	3,225.00	N/A
HC45200805	NM SPLEEN SCAN IMAGING ONLY	341	78185	2,306.00	N/A
HC45200813	NM TESTICULAR IMAGING W/FLOW	341	78761	2,819.00	N/A
HC45200839	NM THYROID CA METS BODY SCAN	341	78018	4,384.00	N/A
HC45200896	NM THYROID CA METS LTD AREA	341	78015	2,893.00	N/A
HC45200904	THYROID METS IMAG W/ADD STUDIES	341	78016	3,738.00	N/A
HC45200912	NM THYROID METS UPTAKE (+)	341	78020	1,476.00	N/A
HC45200961	NM TUMOR LOCALIZE PLNR SGL AREA 1 DAY	341	78800	2,757.00	N/A
HC45200979	NM TUMOR LOCALIZE PLNR 2+AREAS 1+DAYS//1AREA 2+ DAYS	341	78801	3,437.00	N/A
HC45200987	NM TUMOR LOCALIZE PLNR WHOLE BODY 1 DAY	341	78802	5,040.00	N/A
HC45200995	NM TUMOR LOCALIZE SPECT SNGL AREA 1 DAY	341	78803	5,297.00	N/A
HC45201001	NM VASCULAR BLOOD FLOW	341	78445	2,541.00	N/A
HC45201019	NM VENOGRAM(THROMBOS)UNILAT LT	341	78457	2,269.00	N/A
HC45201027	NM VENOGRAM(THROMBOS)UNILAT RT	341	78457	2,269.00	N/A
HC45201035	NM VENOGRAM(THROMBOSIS)BILAT	341	78458	3,685.00	N/A
HC45201043	NM VENOUS THROMBOSIS PEPTIDE	341	78456	3,486.00	N/A
HC45201068	NM TUMOR LOCALIZE PLNR WHOLE BODY 2+ DAYS	341	78804	7,769.00	N/A
HC45201175	RADIOPHARM' TX; ORAL ADMIN	342	79005	3,086.00	N/A
HC45201209	MIBI SPECT SNG STUDY W/WM & EF	341	78451	6,273.00	N/A
HC45201217	MIBI SPECT MULTI STUDY W/WM&EF	341	78452	8,597.00	N/A
HC45201225	MIBI PLANAR SNG STUDY W/WM &EF	341	78453	5,483.00	N/A
HC45201233	MIBI PLANAR MULT STUDY W/WM&EF	341	78454	6,547.00	N/A
HC45201241	PULM VENTILATION IMAGING	341	78579	2,662.00	N/A
HC45201258	PULM VENTILATION & PERF IMAG	341	78582	4,538.00	N/A
HC45201266	QUANT DIFF PULM PERF	341	78597	2,663.00	N/A
HC45201274	QUANT DIFF PULM PERF& VENT	341	78598	4,320.00	N/A
HC45201282	HEPATOBILIARY SYSTEM IMAGING	341	78226	3,933.00	N/A
HC45201290	HEPATOBIL SYS IMAGW/RX(&QUANT)	341	78227	4,863.00	N/A
HC45201308	NM THYROID UPTAKE (PROBE) ONLY SNGL/MULT QNT MSRMT	341	78012	2,025.00	N/A
HC45201316	NM THYROID SCAN IMAGE ONLY [W/VASC FLOW IF PERF]	341	78013	2,638.00	N/A
HC45201324	NM THYROID SCAN & UPTAKE SNG/MULT MSRMT [W/VASC FLOW IF PERF]	341	78014	3,083.00	N/A
HC45201332	NM PARATHYRD SCN W/SPECT W-W/O SUBTR	341	78071	4,196.00	N/A
HC45201340	NM PARATHYRD SCN W/SPECT & CT	341	78072	4,448.00	N/A
HC45201357	NM GASTRIC EMPTYING SMALL BOWEL	341	78265	3,301.00	N/A
HC45201365	NM GASTRIC EMPTY SML BWL&COLON>1DAY	341	78266	4,334.00	N/A
HC45201373	NM TUMOR LOCALIZE SPECT CT  SNGL AREA 1 DAY	341	78830	6,143.00	N/A
HC45201381	NM TUMOR LOCALIZE SPECT 2+ AREAS 1 DAY//SNGL AREA 2+DAYS	341	78831	7,678.00	N/A
HC45201399	NM TUMOR LOCALIZE SPECT CT  2+ AREAS 1 DAY//SNGL AREA 2+DAYS	341	78832	8,907.00	N/A
HC45201407	NM RADIOPHARM QUANTIFICATION MSRMNT SINGLE AREA+	341	78835	338.00	N/A
HC45600004	PET ASSESS MYOCARD VIABILITY	404	78459	10,013.00	N/A
HC45600012	PET BRAIN METABOLIC EVAL	404	78608	12,145.00	N/A
HC45600020	PET LIMITED AREA	404	78811	10,181.00	N/A
HC45600038	PET SKULL BASE TO MID-THIGH	404	78812	11,916.00	N/A
HC45600046	PET WHOLE BODY TUMOR IMAGING	404	78813	12,325.00	N/A
HC45600053	PET  W/CT LIMITED AREA	404	78814	11,926.00	N/A
HC45600061	PET W/CT SKULL BASE-MID THIGH	404	78815	15,256.00	N/A
HC45600079	PET W/CT WHOLE BODY	404	78816	16,042.00	N/A
HC47200803	RADIOPHARM' TX; IV ADMIN	333	79101	2,279.00	N/A
HC44000024	ABDOMEN 2 VIEWS	320	74019	872.00	N/A
HC44000032	ABDOMEN W/DECUB &/OR ERECT (3/>VIEWS)	320	74021	1,057.00	N/A
HC44000040	XR ABDOMEN COMPLETE (2/> IMAGES) W/CXR	320	74022	1,251.00	N/A
HC44000057	ABDOMEN SINGLE VIEW	320	74018	607.00	N/A
HC44000198	XR COLON SINGLE CONTRAST INC SCOUT,DELAYED	320	74270	1,809.00	N/A
HC44000206	XR COLON DOUBLE CONTRAST INC SCOUT,DELAYED	320	74280	2,241.00	N/A
HC44000438	CHOLANGIOGRAM INTRAOPERATIVE	320	74300	1,649.00	N/A
HC44000446	CHOLANGIOGRAM INTRAOP ADDL SET	320	74301	546.00	N/A
HC44000487	CHOLECYSTOGRAM ORAL (GB)	320	74290	960.00	N/A
HC44000537	CONSULT OUTSIDE FILM (ST)	320	76140	N/A	N/A
HC44000545	CYSTOGRAM	320	74430	1,345.00	N/A
HC44000552	DACRYOCYSTOGRAPHY	320	70170	834.00	N/A
HC44000693	XR ESOPHAGUS W/SNGLE CONSTRST INC SCOUT&DELAYS	320	74220	1,251.00	N/A
HC44000701	EYE FOR FOREIGN BODY BILAT	320	70030	891.00	N/A
HC44000719	EYE FOR FOREIGN BODY LT	320	70030	452.00	N/A
HC44000727	EYE FOR FOREIGN BODY RT	320	70030	452.00	N/A
HC44000750	FB CHILD NOSE-RECTUM EXAM	320	76010	623.00	N/A
HC44000818	FISTULA/SINUS ABSCESS STUDY	320	76080	1,724.00	N/A
HC44001204	HYSTEROSALPINGOGRAM	320	74740	1,674.00	N/A
HC44001287	INTRALUMINAL DILATION O/STRICT	320	74360	1,671.00	N/A
HC44001303	XR INTRO GI TUBE IMAGING S&I	320	74340	1,422.00	N/A
HC44001311	IVP DRIP OR BOLUS W/TOMO	320	74415	2,107.00	N/A
HC44001329	IVP INFUSION DRIP OR BOLUS	320	74410	1,755.00	N/A
HC44001337	IVP LIMITED	320	74400	1,741.00	N/A
HC44001345	IVP ROUTINE	320	74400	2,251.00	N/A
HC44001667	NECK, SOFT TISSUE	320	70360	607.00	N/A
HC44001675	NECK, SOFT TISSUE (REDUCED SVC)	320	70360	410.00	N/A
HC44001733	PERINEOGRAM	320	74775	1,136.00	N/A
HC44001741	XR PHARYNX/CERVICAL ESOPHAGUS W/CNSTRST INC SCOUT&DELAYS	320	74210	1,048.00	N/A
HC44001758	PYELOGRAM RETROGRADE	320	74420	2,034.00	N/A
HC44001766	REMOV FB ESOPHAGEAL W/BALLOON	320	74235	1,451.00	N/A
HC44001865	SALIVARY GLAND FOR CALCULUS	320	70380	481.00	N/A
HC44002012	SIALOGRAPHY	320	70390	1,088.00	N/A
HC44002061	XR SMALL BOWEL W/SINGLE CONTRAST INC SCOUT,SERIAL	320	74250	1,600.00	N/A
HC44002079	XR SMALL BOWEL W/DOUBLE CONTRAST INC SCOUT,SERIAL	320	74251	2,144.00	N/A
HC44002087	SOFT PALATE CINE (OR VIDEO)	320	70370	774.00	N/A
HC44002095	SPEECH STUDY - CINE/VIDEO	320	70371	1,096.00	N/A
HC44002152	XR SWALLOW FUNC W/CINE/VIDEO INC SCOUT&DELAYES	320	74230	1,441.00	N/A
HC44002368	TOMOGRAM BILAT	320	76102	2,359.00	N/A
HC44002376	TOMOGRAM SINGLE PLANE	320	76100	1,187.00	N/A
HC44002384	TOMOGRAM UNILAT LT	320	76101	1,539.00	N/A
HC44002392	TOMOGRAM UNILAT RT	320	76101	1,539.00	N/A
HC44002400	TRANSCERV CATH FALLOPIAN TUBES	320	74742	1,529.00	N/A
HC44002442	XR UGI W/DOUBLE CONTRAST INC SCOUT,DELAYED	320	74246	1,590.00	N/A
HC44002467	UGI W/O KUB	320	74240	1,491.00	N/A
HC44002483	URETHROCYSTOGRAM RETROGRADE	320	74450	1,393.00	N/A
HC44002491	URETHROCYSTOGRAM VOIDING	320	74455	1,607.00	N/A
HC44002509	UROGRAPHY ANTEGRADE	320	74425	1,872.00	N/A
HC44002616	XR UGI W/SNGLE CONTRAST INC SCOUT,DELAYED	320	74240	1,557.00	N/A
HC44002681	UROGRAPHY ANTEGRADE LTD LT	320	74425	1,142.00	N/A
HC44002699	UROGRAPHY ANTEGRADE LTD RT	320	74425	1,142.00	N/A
HC44002822	SWALLOW FUNC W/CINE/VIDEO	320	74230	1,441.00	N/A
HC44003036	PERITONEOGRAM S&I	320	74190	1,640.00	N/A
HC44003069	ABDOMEN 3/> VIEWS	324	74021	1,057.00	N/A
HC44003077	XR ESOPHAGUS W/DOUBLE CONSTRST INC SCOUT&DELAYS	320	74221	1,536.00	N/A
HC44003085	XR SMALL BOWEL F-THRU INC SERIAL+	320	74248	953.00	N/A
HC44500650	PERC DRAINAGE TUBE/CATH	320	75984	2,172.00	N/A
HC44500676	CINERADIOGRAPHY W/ EXAM	320	76125	625.00	N/A
HC44500684	CINERADIOGRAPHY(SEPARATE PROC)	320	76120	906.00	N/A
HC44500692	CORPORA CAVERNOSGRAPHY	320	74445	2,262.00	N/A
HC44500726	PERC DIL URETER/URETHRA S&I-LT	320	74485	2,570.00	N/A
HC44500734	PERC DIL URETER/URETHRA S&I-RT	320	74485	2,570.00	N/A
HC44500791	ERCP BILIARY DUCT SYSTEM	320	74328	2,606.00	N/A
HC44500809	ERCP BILIARY&PANCREATIC SYSTEM	320	74330	2,773.00	N/A
HC44500817	ERCP PANCREATIC DUCT SYSTEM	320	74329	1,735.00	N/A
HC44500866	GUIDE PERC DRAIN W/CATH PLCMNT	350	75989	2,637.00	N/A
HC44502060	TRANSCATH EMBOLIZATION S&I	320	75894	11,077.00	N/A
HC44502136	TRANSHEP DIL BILI W/O-W STENT	320	74363	3,256.00	N/A
HC46000212	INJ CONT-ASSESS CYST VIA CATH	320	49424	1,338.00	N/A
HC46500344	BIOPSY TRANSCATHETER RAD S&I	361	75970	6,637.00	N/A
HC51002202	X RAY URETHROCYSTOGRAM VOIDING	320	74455	559.00	N/A
HC51002228	X RAY CYSTOGRAM MIN 3 VWS	320	74430	534.00	N/A
HC51002251	X RAY UROGRAPHY ANTEGRADE R&I	320	74425	590.00	N/A
HC51002269	X RAY URETHROCYSTOGRAM RETROGRADE	361	74450	511.00	N/A
HC51003382	X-RAY ORPORA CAVERNOSGRAPHY	510	74445	550.00	N/A
HC51003390	X-RAY PERC DIL URETER/URETHRA	510	74485	1,582.00	N/A
HC51061091	X RAY PYELOGRAM RETROGRADE	320	74420	640.00	N/A
HC43001213	METABOLIC IMAGING RISK ASSESSMENT (MIRA)	409	76499	118.00	N/A
HC43500032	DEXA VERTEBRAL FX ASSESSMENT	320	77086	758.00	N/A
HC43500057	DEXA BONE DENS&VERTBRL FX ASSESS	320	77085	1,224.00	N/A
HC44000008	3D RENDER W/ INDEPNDNT WORKSTN	320	76377	2,345.00	N/A
HC44000016	3D RENDER W/O INDENDNPT WORKSTN	320	76376	1,610.00	N/A
HC44000628	ELBOW ARTHROGRAM BILAT	322	73085	2,631.00	N/A
HC44000636	ELBOW ARTHROGRAM LT	322	73085	1,396.00	N/A
HC44000644	ELBOW ARTHROGRAM RT	322	73085	1,396.00	N/A
HC44000685	ENEMA THERAPEUTIC CONTRAST/AIR	320	74283	1,875.00	N/A
HC44000826	FLUORO GUIDE NDL PLCMT	320	77002	1,691.00	N/A
HC44000834	FLUORO GUIDE SPINE INJ(NONFRMN	320	77003	1,647.00	N/A
HC44000842	FLUORO CV ACCESS CATH REPLACE/RMVL	320	77001	1,601.00	N/A
HC44000867	FLUOROSCOPY < 1HR	320	76000	1,517.00	N/A
HC44001030	HIP ARTHROGRAM BILAT	322	73525	2,965.00	N/A
HC44001048	HIP ARTHROGRAM LT	322	73525	1,619.00	N/A
HC44001055	HIP ARTHROGRAM RT	322	73525	1,619.00	N/A
HC44001618	MYELOGRAM CERVICAL	320	72240	2,730.00	N/A
HC44001626	MYELOGRAM LUMBOSACRAL	320	72265	2,835.00	N/A
HC44001634	MYELOGRAM THORACIC	320	72255	2,781.00	N/A
HC44001642	MYELOGRAM ENTIRE SPINE CANAL	320	72270	3,453.00	N/A
HC44001956	SHOULDER ARTHROGRAM BILAT	322	73040	2,877.00	N/A
HC44001964	SHOULDER ARTHROGRAM LT	322	73040	1,595.00	N/A
HC44001972	SHOULDER ARTHROGRAM RT	322	73040	1,595.00	N/A
HC44200319	US GUIDE COMP REPR PSEUDOANEUR	402	76936	2,871.00	N/A
HC44200582	TCD EMBOLI DETECT W/ IV MICROBUBBLE	921	93893	2,775.00	N/A
HC44200590	TCD EMBOLI DETECT W/O IV MICROBUBBL	921	93892	2,601.00	N/A
HC44200889	ECHO VELOCIMETRY FETAL UMBILIC	402	76820	815.00	N/A
HC44500031	ANGIO ADRENAL BILAT	323	75733	11,049.00	N/A
HC44500049	ANGIO ADRENAL LT	323	75731	6,693.00	N/A
HC44500056	ANGIO ADRENAL RT	323	75731	6,693.00	N/A
HC44500171	ANGIO EA ADD'L VESSEL +	323	75774	6,430.00	N/A
HC44500213	ANGIO EXTREMITY BILAT	323	75716	12,291.00	N/A
HC44500221	ANGIO EXTREMITY UE OR LE LT	323	75710	7,682.00	N/A
HC44500239	ANGIO EXTREMITY UE OR LE RT	323	75710	7,682.00	N/A
HC44500262	ANGIO PELVIC	323	75736	7,177.00	N/A
HC44500270	ANGIO PULMONARY BILAT	323	75743	11,680.00	N/A
HC44500288	ANGIO PULMONARY LT	323	75741	6,607.00	N/A
HC44500296	ANGIO PULMONARY RT	323	75741	6,607.00	N/A
HC44500312	ANGIO PULMONARY NON SELECT LT	323	75746	5,814.00	N/A
HC44500320	ANGIO PULMONARY NON SELECT RT	323	75746	5,814.00	N/A
HC44500379	ANGIO SPINAL SELECTIVE  LT	323	75705	8,799.00	N/A
HC44500387	ANGIO SPINAL SELECTIVE  RT	323	75705	8,799.00	N/A
HC44500395	ANGIO THRU EXISTING CATH	323	75898	3,678.00	N/A
HC44500437	ANGIO VISCERAL	323	75726	8,757.00	N/A
HC44500445	AORTOGRAM ABD W/ RUN OFF	323	75630	9,011.00	N/A
HC44500452	AORTOGRAM ABDOMINAL	323	75625	7,490.00	N/A
HC44500460	AORTOGRAM ABDOMINAL LTD	323	75625	4,690.00	N/A
HC44500478	AORTOGRAM THOR W/ SERIAL(ARCH)	323	75605	7,718.00	N/A
HC44501013	INTRALUMIN OBST VEN DEV S&I	323	75902	3,096.00	N/A
HC44501203	MECH REMOV PERICTH CEN VEN S&I	320	75901	3,274.00	N/A
HC44501468	PORTOGRAM W/ HEMODYNAMIC EVAL	320	75885	6,230.00	N/A
HC44501476	PORTOGRAM W/O HEMODYNAMIC EVAL	320	75887	4,994.00	N/A
HC44501872	SPLENOPORTOGRAM	323	75810	5,600.00	N/A
HC44502177	VENOGRAM ADRENAL BILAT	320	75842	8,783.00	N/A
HC44502185	VENOGRAM ADRENAL LT	320	75840	6,162.00	N/A
HC44502193	VENOGRAM ADRENAL RT	320	75840	6,162.00	N/A
HC44502201	VENOGRAM CAVAL INFERIOR	323	75825	6,871.00	N/A
HC44502219	VENOGRAM CAVAL SUPERIOR	323	75827	6,401.00	N/A
HC44502227	VENOGRAM EPIDURAL	320	75872	5,564.00	N/A
HC44502235	VENOGRAM EXTREMITY BILAT	323	75822	5,457.00	N/A
HC44502243	VENOGRAM EXTREMITY UNILAT LT	323	75820	3,097.00	N/A
HC44502250	VENOGRAM HEPATIC W/HEMO EVAL	320	75889	6,532.00	N/A
HC44502268	VENOGRAM HEPATIC W/O HEMO EVAL	320	75891	5,420.00	N/A
HC44502276	VENOGRAM RENAL BILAT	320	75833	9,181.00	N/A
HC44502284	VENOGRAM RENAL LT	320	75831	6,173.00	N/A
HC44502292	VENOGRAM RENAL RT	320	75831	6,173.00	N/A
HC44502300	VENOGRAM SINUS/JUGULAR	320	75860	5,623.00	N/A
HC44502359	VENOUS SAMPLING THRU CATH	323	75893	5,723.00	N/A
HC44503431	VENOGRAM EXTREMITY UNILAT RT	323	75820	3,097.00	N/A
HC44503548	SEL CATH&RENAL ANGIO1STW/S&I-L	361	36251	10,064.00	N/A
HC44503555	SEL CATH&RENAL ANGIO1STW/S&I-R	361	36251	10,064.00	N/A
HC44503563	SEL CATH&RENAL ANGIO1STW/S&I-B	361	36252	16,267.00	N/A
HC44503571	SEL CATH&RENAL ANGIO2NDW/S&I-L	361	36253	11,399.00	N/A
HC44503589	SEL CATH&RENAL ANGIO2NDW/S&I-R	361	36253	11,399.00	N/A
HC44503597	SEL CATH&RENAL ANGIO2NDW/S&I-B	361	36254	17,649.00	N/A
HC44503779	PLACE CATH THOR AORTA&ANGIO W/S&I	323	36221	10,454.00	N/A
HC44503787	SEL CATH CC/INOM &ANGIO EXCC W/S&I LT	323	36222	12,532.00	N/A
HC44503795	SEL CATH CC/INOM &ANGIO EXCC W/S&I RT	323	36222	12,532.00	N/A
HC44503803	SEL CATH CC/INOM &ANGIO IC W/S&I LT	323	36223	16,984.00	N/A
HC44503811	SEL CATH CC/INOM &ANGIO IC W/S&I RT	323	36223	16,984.00	N/A
HC44503829	SEL CATH  IC CAROTID &ANG IC W/SI LT	323	36224	20,547.00	N/A
HC44503837	SEL CATH  IC CAROTID &ANG IC W/SI RT	323	36224	20,547.00	N/A
HC44503845	SEL CATH SUBC/INOM &ANG VRT W/SI LT	323	36225	12,647.00	N/A
HC44503852	SEL CATH SUBC/INOM &ANG VRT W/SI RT	323	36225	12,647.00	N/A
HC44503860	SEL CATH VERTEBRAL &ANG VRT W/SI LT	323	36226	18,245.00	N/A
HC44503878	SEL CATH VERTEBRAL &ANG VRT W/SI RT	323	36226	18,245.00	N/A
HC44503886	SEL CATH EX CAROTID&ANG EC W/SI LT+	323	36227	8,858.00	N/A
HC44503894	SEL CATH EX CAROTID&ANG EC W/SI RT+	323	36227	8,858.00	N/A
HC44503902	SEL CATH EA IC CRTD/VERT&ANG W/SI LT+	323	36228	8,555.00	N/A
HC44503910	SEL CATH EA IC CRTD/VERT&ANG W/SI RT+	323	36228	8,555.00	N/A
HC44504017	ANGIO IL/FEM DURING HRTCATH&/CORO W/S&I	323	G0278	3,462.00	N/A
HC44504132	SEL CATH CC/INOM &ANGIO EXCC W/S&I BI	323	36222	21,570.00	N/A
HC44504140	SEL CATH CC/INOM &ANGIO IC W/S&I BI	323	36223	31,419.00	N/A
HC44504157	SEL CATH  IC CAROTID &ANG IC W/SI BI	323	36224	36,979.00	N/A
HC44504165	SEL CATH SUBC/INOM &ANG VRT W/SI BI	323	36225	22,761.00	N/A
HC44504173	SEL CATH VERTEBRAL &ANG VRT W/SI BI	323	36226	34,448.00	N/A
HC44504181	SEL CATH EX CAROTID&ANG EC W/SI BI+	323	36227	15,941.00	N/A
HC44504199	SEL CATH EA IC CRTD/VERT&ANG W/SI BI+	323	36228	15,396.00	N/A
HC44504207	XRAY TEVAR W/ LT SUBCLAV; INT'L ENDO& DIST EXTS CELIAC S&I	481	75956	7,749.00	N/A
HC44504215	XRAY TEVAR; INITIAL ENDO & DIST EXTS TO CELIAC S&I	481	75957	6,353.00	N/A
HC44504223	XRAY TEVAR; PLCMT PROX EXT PROTH S&I	481	75958	4,897.00	N/A
HC44504231	XRAY TEVAR; PLCMT OF DISTAL EXTS PROTH(S) DELAYED S&I	481	75959	4,897.00	N/A
HC44504447	REMOV CALC DUCT(S)BIL&/GB PERC(DESTRCT,S&I)+	361	47544	6,523.00	N/A
HC44504504	PERC PLCMT TISS SOFT DEV 1ST LESN	361	10035	3,770.00	N/A
HC44504512	PERC PLCMT TISS SOFT DEV ADDL LESN+	361	10036	2,304.00	N/A
HC44504686	ABLATION UTERINE FIBROID(S) TRANSCERV W US GUIDE; RF	361	0404T	10,321.00	N/A
HC44701688	FLUORO GUIDANCE UNLISTED PROCEDURE	481	76496	1,512.00	N/A
HC45600087	PET MELANOMA, NON-COV INDCTNS	404	G0219	8,082.00	N/A
HC46000030	INJ ARTHRO HIP W/ANESTH-LT	320	27095	1,778.00	N/A
HC46000048	INJ ARTHRO HIP W/ANESTH-RT	320	27095	1,778.00	N/A
HC46000063	INJ ARTHRO/CT/MRI SHOULDER-LT	320	23350	1,538.00	N/A
HC46000071	INJ ARTHRO/CT/MRI SHOULDER-RT	320	23350	1,538.00	N/A
HC46000097	INJ ARTHROGRAM ANKLE-LT	320	27648	962.00	N/A
HC46000105	INJ ARTHROGRAM ANKLE-RT	320	27648	962.00	N/A
HC46000121	INJ ARTHROGRAM ELBOW-LT	320	24220	1,495.00	N/A
HC46000139	INJ ARTHROGRAM ELBOW-RT	320	24220	1,495.00	N/A
HC46000147	INJ ARTHROGRAM TMJ	320	21116	713.00	N/A
HC46000162	INJ ARTHROGRAM WRIST-LT	320	25246	1,062.00	N/A
HC46000170	INJ ARTHROGRAM WRIST-RT	320	25246	1,062.00	N/A
HC46000238	INJ CORPORA CAVERNOSOGRAM	320	54230	1,907.00	N/A
HC46000253	INJ DISKOGRAM CS/TS EA LVL	320	62291	2,474.00	N/A
HC46000261	INJ DISKOGRAM LUMBAR EA LVL	320	62290	3,744.00	N/A
HC46000287	INJ FOR CYSTOGRAM	320	51600	1,944.00	N/A
HC46000311	INJ FOR DACRYCYSTOGRAPHY	320	68850	976.00	N/A
HC46000378	INJ FOR RETRO URETHROCYSTO	320	51610	1,771.00	N/A
HC46000386	INJ FOR SIALOGRAPHY	320	42550	1,231.00	N/A
HC46000394	INJ PROCEDURE MYELOGRAPHY, LUMBAR	320	62284	2,957.00	N/A
HC46000428	INJ PROC SPLENOPORTOGRAM	320	38200	1,559.00	N/A
HC46000469	INJECTION HIP ARTHROGRAM BIL	320	27093	2,763.00	N/A
HC46000477	INJECTION HIP ARTHROGRAM LT	361	27093	1,536.00	N/A
HC46000485	INJECTION HIP ARTHROGRAM RT	361	27093	1,536.00	N/A
HC46000501	INTRO CATH HYSTERO	320	58340	1,503.00	N/A
HC46000550	INTRO CATHETER AORTA	321	36200	7,519.00	N/A
HC46000626	INTRO NDL/CATH EXT ART UE OR LE LT	320	36140	2,708.00	N/A
HC46000634	INTRO NDL/CATH EXT ART UE OR LE RT	320	36140	2,708.00	N/A
HC46000675	INTRO OF CATH SVC OR IVC	320	36010	3,155.00	N/A
HC46000683	INJ PROC;TRACER, SENTINEL NODE	361	38792	2,218.00	N/A
HC46000709	SEL CATH AB/PEL/LOEXT1ST OR BI	321	36245	10,908.00	N/A
HC46000717	SEL CATH AB/PEL/LOEXT1ST OR LT	321	36245	6,153.00	N/A
HC46000725	SEL CATH AB/PEL/LOEXT1ST OR RT	321	36245	6,153.00	N/A
HC46000741	SEL CATH AB/PEL/LOEXT2ND OR LT	321	36246	6,831.00	N/A
HC46000758	SEL CATH AB/PEL/LOEXT2ND OR RT	321	36246	6,831.00	N/A
HC46000774	SEL CATH AB/PEL/LOEX 2ND+ORD LT	321	36248	2,079.00	N/A
HC46000782	SEL CATH AB/PEL/LOEX 2ND+ORD RT	321	36248	2,079.00	N/A
HC46000808	SEL CATH AB/PEL/LOEXT3RD OR LT	321	36247	8,082.00	N/A
HC46000816	SEL CATH AB/PEL/LOEXT3RD OR RT	321	36247	8,082.00	N/A
HC46000881	SEL CATH THOR/BRAC 1ST ORD LT	321	36215	5,544.00	N/A
HC46000899	SEL CATH THOR/BRAC 1ST ORD RT	321	36215	5,544.00	N/A
HC46000907	SEL CATH THOR/BRAC 2ND ORD LT	321	36216	6,336.00	N/A
HC46000915	SEL CATH THOR/BRAC 2ND ORD RT	321	36216	6,336.00	N/A
HC46000923	SEL CATH THOR/BRAC 3RD ORD LT	321	36217	7,794.00	N/A
HC46000931	SEL CATH THOR/BRAC 3RD ORD RT	321	36217	7,794.00	N/A
HC46000949	SEL CATH THOR/BRAC+ 2ND/3RD LT	321	36218	1,606.00	N/A
HC46000956	SEL CATH THOR/BRAC+ 2ND/3RD RT	321	36218	1,606.00	N/A
HC46001053	SEL CATH AB/PEL/LOEXT1ST OR	321	36245	6,210.00	N/A
HC46001061	SEL CATH AB/PEL/LOEXT2ND OR	321	36246	6,831.00	N/A
HC46001079	SEL CATH AB/PEL/LOEXT3RD OR	321	36247	8,082.00	N/A
HC46001087	SEL CATH AB/PEL/LOEX2ND+ORDERT	321	36248	2,079.00	N/A
HC46001095	INJ ARTHRO/CT/MRI SHOULDER-BIL	322	23350	2,700.00	N/A
HC46001103	INJ ARTHROGRAM ELBOW-SC BIL	322	24220	2,692.00	N/A
HC46001111	INJ ARTHRO HIP W/ANESTH-SC BIL	322	27095	3,204.00	N/A
HC46001137	INJ ARTHROGRAM ANKLE-SC BIL	322	27648	1,916.00	N/A
HC46001251	INJ CHOLANGIO PERC/S&I;EXIST ACCESS	361	47531	5,578.00	N/A
HC46001269	INJ CHOLANGIO PERC/S&I;NEW ACCESS	361	47532	7,940.00	N/A
HC46001277	INJ ANTEGRAD COMP(NEPH/URET'GRM,S&I)NEW ACCESS BI	361	50430	9,299.00	N/A
HC46001285	INJ ANTEGRAD COMP(NEPH/URET'GRM,S&I)NEW ACCESS LT	361	50430	5,314.00	N/A
HC46001293	INJ ANTEGRAD COMP(NEPH/URET'GRM,S&I)NEW ACCESS RT	361	50430	5,314.00	N/A
HC46001301	INJ ANTEGRAD NEPH/URET'GRM,S&I EXIST ACCESS BI	361	50431	6,088.00	N/A
HC46001319	INJ ANTEGRAD NEPH/URET'GRM,S&I EXIST ACCESS LT	361	50431	3,471.00	N/A
HC46001327	INJ ANTEGRAD NEPH/URET'GRM,S&I EXIST ACCESS RT	361	50431	3,471.00	N/A
HC46500930	INJ W/FLUOR, EVAL CV ACCESS DEVICE	361	36598	1,764.00	N/A
HC46502555	INJECT URETEROGRAPH VIA URETEROS/CATH	361	50684	1,334.00	N/A
HC46502621	INJECT URETEROGRAPH VIA ILEAL CONDUIT	361	50690	1,953.00	N/A
HC51002145	INJ FOR CYSTOGRAM	510	51600	483.00	N/A
HC51002244	INJECT URETEROGRAGH VIA URETEROS	361	50684	394.00	N/A
HC51002343	INJ RETROGRADE URETHROCYSTO	510	51610	496.00	N/A
HC51002483	X RAY FLUORO GUIDANCE	320	76000	411.00	N/A
HC51003044	INJ CORPORA CAVERNOSOGRAM	510	54230	603.00	N/A
HC51040145	3D RENDER W/ INDEPNDNT WORKSTN	320	76377	300.00	N/A
HC51060978	INJ ANTEGRAD NEPH/URET'GRM,S&I EXIST ACCESS BI	510	50431	1,576.00	N/A
HC51060986	INJ ANTEGRAD NEPH/URET'GRM,S&I EXIST ACCESS LT	510	50431	1,050.00	N/A
HC51060994	INJ ANTEGRAD NEPH/URET'GRM,S&I EXIST ACCESS RT	510	50431	1,050.00	N/A
HC51061687	3D RENDER W/O INDENDNPT WORKSTN	320	76376	200.00	N/A
HC14500136	DM HEMOGLOBIN GLYCOSYLATED(A1C	301	83036	171.00	N/A
HC29000353	OB FECES GUAIAC1-3SCR(IN DEPT)	300	82270	71.00	N/A
HC36000792	METHGB,QUANT TRANSCUTANEUS/DAY	300	88741	291.00	N/A
HC36000800	HGB,QUANT TRANSCUTANEOUS	300	88738	63.00	N/A
HC36001022	HGB,QUANT TRANSCUTANEOUS DAILY	300	88738	280.00	N/A
HC36800423	BLOOD GAS PH ONLY	301	82800	214.00	N/A
HC36800431	BLOOD GAS LTD	301	82803	556.00	N/A
HC36800449	BLOOD GAS LTD CORD	301	82803	556.00	N/A
HC36800456	BLOOD GAS W/MEASURED O2 SAT	301	82805	676.00	N/A
HC36800464	BLOOD GAS O2 SAT ONLY	301	82810	242.00	N/A
HC36800597	CARBOXYHEMOGLOBIN,QUANT	301	82375	274.00	112.75
HC36800605	CHLORIDE	301	82435	125.00	38.00
HC36800613	METHEMOGLOBIN,QUANT	300	83050	115.00	N/A
HC36800621	POTASSIUM	301	84132	139.00	42.00
HC36800639	SODIUM	301	84295	144.00	27.75
HC36800654	CALCIUM IONIZED	301	82330	261.00	91.00
HC36800662	PH FLUID	301	83986	150.00	N/A
HC36800670	HGB,QUANT TRANSCUTANEOUS	300	88738	63.00	N/A
HC36800688	METHGB,QUANT TRANSCUTANEUS/DAY	300	88741	291.00	N/A
HC36800696	HGB,QUANT TRANSCUTANEOUS DAILY	300	88738	280.00	N/A
HC51000008	OB FECES GUAIAC1-3 NEOPLSM SCR	510	82270	33.00	N/A
HC51000024	GLUCOSE BY REAGENT STRIP	510	82948	34.00	N/A
HC51000032	DM HEMOGLOBIN GLYCOSYLATED(A1C	510	83036	94.00	N/A
HC51000503	GLUCOSE SERUM QUANT (POS)	301	82947	40.00	N/A
HC81100000	PHOSPHORUS URINE	301	84105	184.00	42.00
HC81100018	PROTEIN URINE	301	84156	164.00	62.75
HC81100026	UREA NITROGEN URINE	301	84540	187.00	58.25
HC81100034	URIC ACID URINE	301	84560	174.00	48.25
HC81100042	POTASSIUM URINE	301	84133	159.00	46.75
HC81100059	SODIUM URINE	301	84300	167.00	46.75
HC81100067	OSMOLALITY URINE	301	83935	253.00	79.75
HC81100075	HDL CHOLESTEROL	301	83718	182.00	62.75
HC81100109	LDL CHOLESTEROL DIRECT	301	83721	207.00	48.50
HC81100117	GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)	301	82947	154.00	22.25
HC81100125	GLUCOSE FLUID/URINE	301	82945	203.00	36.75
HC81100133	PROTEIN FLUID	301	84157	184.00	56.75
HC81100141	URIC ACID FLUID	301	84560	174.00	48.25
HC81100174	B-TYPE NATRIURETIC PEPTIDE	301	83880	495.00	172.25
HC81100182	IRON	301	83540	182.00	33.00
HC81100208	TIBC	301	83550	189.00	46.00
HC81100216	GLUCOSE TOLERANCE 3 SPECIMENS	301	82951	325.00	65.50
HC81100224	GLUCOSE TOLERANCE EA ADDL SPEC	301	82952	118.00	22.25
HC81100240	BILIRUBIN DIRECT/CONJUGATED	301	82248	157.00	25.25
HC81100257	UREA NITROGEN CLEARANCE	301	84545	188.00	88.00
HC81100323	BILIRUBIN TOTAL	301	82247	144.00	45.75
HC81100349	ACETONE	301	82010	208.00	52.25
HC81100364	ALBUMIN; SERUM/PLASMA/WHOLE BLOOD	301	82040	154.00	36.75
HC81100398	ALK PHOSPHATASE	301	84075	174.00	42.00
HC81100406	TROPONIN	301	84484	342.00	94.00
HC81100414	AMMONIA	301	82140	409.00	104.00
HC81100422	AMYLASE	301	82150	249.00	50.00
HC81100455	LACTIC ACID	301	83605	327.00	106.25
HC81100463	BICARBONATE/CO2	301	82374	124.00	36.75
HC81100471	UREA NITROGEN	301	84520	135.00	22.25
HC81100489	CALCIUM TOTAL	301	82310	163.00	42.00
HC81100497	CALCIUM URINE QUANT TIMED SPEC	301	82340	165.00	50.00
HC81100513	CHLORIDE SERUM	301	82435	141.00	38.00
HC81100521	CHOLESTEROL	301	82465	135.00	42.00
HC81100539	CPK	301	82550	294.00	33.00
HC81100547	CREATININE	301	82565	156.00	26.25
HC81100554	CREATININE OTHER	301	82570	165.00	50.00
HC81100562	CREATININE CLEARANCE	301	82575	335.00	73.50
HC81100570	GGT	301	82977	187.00	42.00
HC81100620	SGOT(AST)	301	84450	160.00	32.00
HC81100638	SGPT(ALT)	301	84460	163.00	27.00
HC81100646	LDH	301	83615	228.00	42.00
HC81100653	LIPASE	301	83690	312.00	59.50
HC81100661	MAGNESIUM	301	83735	208.00	56.75
HC81100679	OSMOLALITY	301	83930	237.00	79.75
HC81100687	PHOSPHORUS	301	84100	164.00	38.00
HC81100695	POTASSIUM	301	84132	148.00	42.00
HC81100703	PROTEIN TOTAL	301	84155	157.00	38.75
HC81100737	SODIUM	301	84295	154.00	27.75
HC81100745	TRIGLYCERIDES	301	84478	182.00	48.25
HC81100752	URIC ACID	301	84550	153.00	27.75
HC81100760	CPK - MB	301	82553	448.00	109.00
HC81100786	FECAL FAT QUAL	301	82705	70.00	47.50
HC81100828	FETAL LUNG MATURITY L/S	301	83661	468.00	205.00
HC81100836	SPECIFIC GRAVITY FLUID	301	84315	83.00	53.00
HC81100844	PH FLUID	301	83986	160.00	45.75
HC81100851	OB FECES GUAIAC1-3 NEOPLSM SCR	301	82270	114.00	36.75
HC81100869	MYOGLOBIN	301	83874	315.00	79.50
HC81101016	ACETYLCHOLINESTERASE	301	82013	159.00	77.00
HC81101024	ALDOLASE	301	82085	188.00	83.00
HC81101032	AMINO ACIDS SNGL QUAN EA	301	82131	308.00	184.00
HC81101040	AMNIOTIC FLUID SCAN	301	82143	271.00	113.00
HC81101057	OCCULT BLOOD OTHER SOURCE	301	82271	118.00	36.75
HC81101065	CALCIUM IONIZED	301	82330	278.00	91.00
HC81101073	CERULOPLASMIN	301	82390	205.00	88.00
HC81101081	CHLORIDE URINE	301	82436	158.00	46.75
HC81101099	CHLORIDE OTHER SOURCE	301	82438	180.00	38.00
HC81101107	FETAL FIBRONECTIN	301	82731	1,154.00	326.75
HC81101115	BLOOD GAS W/MEASURED O2 SAT	301	82805	746.00	88.50
HC81101123	GLUCOSE POST DOSE	301	82950	174.00	31.00
HC81101131	G6PD	301	82955	175.00	72.00
HC81101149	APT TEST (FETAL HGB)	301	83033	145.00	50.00
HC81101156	HEMOGLOBIN GLYCATED (A1C)	301	83036	235.00	44.75
HC81101164	METHEMOBLOBIN QT	301	83050	381.00	91.00
HC81101172	HEMOGLOBIN PLASMA	301	83051	163.00	72.00
HC81101180	HOMOCYSTINE	301	83090	335.00	91.00
HC81101198	LEAD	301	83655	157.00	61.50
HC81101206	PARATHYROID HORMONE	301	83970	524.00	209.25
HC81101214	PHOSPHATIDYL GLYCEROL	301	84081	373.00	162.50
HC81101222	SODIUM FLUID	301	84302	166.00	46.75
HC81101230	TRANSFERRIN	301	84466	272.00	104.00
HC81101271	PROTEIN OTHER SOURCE	301	84157	180.00	56.75
HC81101305	GLUCOSE BY REAGENT STRIP	301	82948	112.00	22.25
HC81101313	BLOOD GASES LTD	301	82803	624.00	88.50
HC81101321	BLOOD GAS O2 SAT ONLY	301	82810	239.00	97.00
HC81101347	PARATHYROID HORMONE SUBSEQUENT	301	83970	524.00	209.25
HC81101362	CARBOXYHEMOGLOBIN	301	82375	286.00	112.75
HC81101370	BLOOD GAS PH ONLY	301	82800	228.00	45.75
HC81101388	HGB O2 AFFINITY	301	82820	242.00	95.00
HC81101396	FOAM STABILITY	301	83662	263.00	95.00
HC81101404	FLORESCENCE POLARIZATION	301	83663	275.00	98.00
HC81101412	HAPTOGLOBIN/NEPHELOMTRY	301	83010	397.00	137.75
HC81101420	PREALBUMIN	302	84134	293.00	85.00
HC81101438	NT PRO BNP NATRIURETIC PEPTIDE	301	83880	490.00	93.00
HC81101453	CORTISOL(INITIAL)	301	82533	349.00	82.50
HC81101461	CORTISOL(SUBSEQ)	301	82533	349.00	82.50
HC81101479	LIPOPROTEIN A	301	83695	174.00	28.00
HC81101487	ALBUMIN; OTHER SOURCE	301	82042	213.00	38.00
HC81101503	PROTEIN TOTAL, REFRCT	301	84160	167.00	56.75
HC81101511	ALBUMIN ISCHEMIA MODIFIED	301	82045	409.00	150.50
HC81101545	INSULIN TOTAL	301	83525	204.00	71.25
HC81101552	C-PEPTIDE	301	84681	297.00	93.25
HC81101560	BICARBONATE	301	82374	122.00	36.00
HC81101586	GLUCOSE BY DEVICE (POS)	301	82962	101.00	22.25
HC81101594	LDL CHOLEST DIRECT	301	83721	204.00	48.50
HC81101602	OB FECES GUAIC 1-3 NON NEOPLSM	301	82272	98.00	36.75
HC81101628	PROTEIN TOTAL, FLUID	301	84160	170.00	56.75
HC81101636	GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)	301	82947	154.00	22.25
HC81101685	DHEA SULFATE	301	82627	284.00	83.00
HC81101693	BILIRUBIN TRANSCUTANEOUS(POCS)	301	88720	165.00	28.00
HC81101701	CHOLESTEROL (DA)	301	82465	115.00	16.00
HC81101768	BLOOD GASES LTD  (POS)	301	82803	624.00	88.50
HC81101776	LACTIC ACID (POS)	301	83605	327.00	16.25
HC81101784	POTASSIUM (POS)	301	84132	148.00	42.00
HC81101792	SODIUM  (POS)	301	84295	154.00	27.75
HC81101800	CALCIUM IONIZED (POS)	301	82330	278.00	91.00
HC81101818	PROCALCITONIN	301	84145	369.00	73.64
HC81101826	SEX HORMONE BINDING GLOB	301	84270	277.00	90.00
HC81101842	OB FECES GUAIAC1-3 NEO SCR(DA)	301	82270	58.00	15.00
HC81101859	HEMOGLOBIN GLYCATED, A1C(DA)	301	83036	155.00	30.00
HC81101875	PREGNANCY, HCG-UR (DA)	301	84703	220.00	25.00
HC81190043	CREATININE (POS)	301	82565	152.00	26.25
HC81500258	G6-PD SCREEN	301	82960	178.00	61.50
HC81500266	HEMOSIDERIN QUAL	301	83070	128.00	53.25
HC81500712	HEMOGLOBIN ELECTROPHERESIS	301	83020	268.00	82.00
HC81500746	LAMELLAR BODY DENSITY	301	83664	293.00	81.50
HC81500779	MUCIN CLOT BODY FLUID	301	83872	195.00	36.75
HC81500795	HEMOGLOBIN -HPLC	301	83021	377.00	135.50
HC81500811	HEMOGLOBIN ELECTRO-CONFIRM	301	83020	268.00	82.00
HC81500829	HEMOGLOBIN ELECT QUANT F,S	301	83021	269.00	91.50
HC81500852	PLACENTAL ALPHA MICROGLOBULIN-1	301	84112	748.00	125.00
HC81500977	HEMOGLOBIN GLYCATED (A1C)	301	83036	219.00	N/A
HC81700049	AFP	301	82105	297.00	96.25
HC81700056	BETA-2 MICROGLOBULIN	301	82232	254.00	66.75
HC81700064	CARCINOEMBRYONIC ANTIGEN (CEA)	301	82378	416.00	96.25
HC81700072	CRYOGLOBULIN	301	82595	148.00	53.25
HC81700080	VITAMIN B12	301	82607	293.00	101.00
HC81700098	ESTRADIOL	301	82670	378.00	86.75
HC81700106	FOLIC ACID	301	82746	300.00	106.25
HC81700114	IMMUNOGLOBULIN IGE	301	82785	378.00	102.25
HC81700122	FSH	301	83001	341.00	94.25
HC81700130	LH (LUTEINIZING HORMONE)	301	83002	313.00	94.00
HC81700148	PROGESTERONE	301	84144	387.00	106.00
HC81700155	PROLACTIN	301	84146	352.00	98.50
HC81700163	PROTEIN ELECT FRACT AND QT	301	84165	339.00	97.00
HC81700171	TESTOSTERONE TOTAL	301	84403	442.00	131.00
HC81700189	T4/THYROXINE TOTAL	301	84436	180.00	33.50
HC81700197	T4 FREE	301	84439	226.00	57.75
HC81700205	TSH	301	84443	395.00	77.50
HC81700213	T3 OR T4 UPTAKE	301	84479	179.00	30.00
HC81700221	T3 TOTAL	301	84480	273.00	72.00
HC81700239	T3 FREE	301	84481	326.00	85.75
HC81700247	HCG QUANT	301	84702	371.00	69.25
HC81700254	HCG QUAL	301	84703	302.00	46.75
HC81700577	FERRITIN	301	82728	323.00	69.00
HC81700585	PSA TOTAL	301	84153	276.00	93.25
HC81700593	IMMUNOGLOBULIN IGA	301	82784	303.00	71.50
HC81700601	IMMUNOGLOBULIN IGG	301	82784	303.00	71.50
HC81700619	IMMUNOGLOBULIN IGM.	301	82784	303.00	71.50
HC81700635	ALBUMIN; URINE QUANT	301	82043	168.00	45.00
HC81700643	PSA COMPLEXED	301	84152	243.00	93.25
HC81701187	ALPHA1 ANTITRYPSIN	301	82103	290.00	15.00
HC81701195	TSH SUBSEQUENT	301	84443	384.00	77.50
HC81701211	CORTISOL, PREDOSE	301	82533	349.00	82.50
HC81701377	PSA SCREENING	301	G0103	214.00	93.25
HC81701500	PROTEIN ELECT OTHER FLUIDS	301	84166	400.00	97.00
HC81701518	CLOTEST FOR H. PYLORI	301	83009	754.00	118.50
HC81701633	KAPPA FREE LIGHT CHAINS QT	301	83883	212.00	56.00
HC81701641	LAMBDA FREE LIGHT CHAINS QT	301	83883	212.00	56.00
HC81701658	VITAMIN D, 25-HYDROXY	301	82306	421.00	129.75
HC81701716	CRYOFIBRINOGEN	301	82585	123.00	46.75
HC81701849	IGG SUBCLASS 1; EACH	301	82787	298.00	33.25
HC81701856	IGG SUBCLASS 2; EACH	301	82787	298.00	33.25
HC81701864	IGG SUBCLASS 3; EACH	301	82787	298.00	33.25
HC81701872	IGG SUBCLASS 4; EACH	301	82787	298.00	33.25
HC81701914	TISSUE TRANSGLUTAMINASE IGA	302	83516	249.00	50.75
HC81701922	TISSUE TRANSGLUTAMINASE IGG	302	83516	249.00	50.75
HC81701948	DEAMIDATED GLIADIN PEP IGA	302	83516	245.00	50.75
HC81701955	DEAMIDATED GLIADIN PEP IGG	302	83516	245.00	50.75
HC83500033	STONE ANALYSIS-AU	301	82360	27.00	26.70
HC83500041	STONE ANALYSIS-LH	301	82360	N/A	N/A
HC83500066	RECEPTOR ASSAY, ESTROGEN-PI	301	84233	28.00	28.00
HC83500074	RECEPTOR ASSAY, PROGESTERON-PI	301	84234	28.00	28.00
HC83504399	IRON ASSAY TISSUE-AU	301	83540	155.00	154.50
HC84200476	OB FECAL IMM ASSAY QUAL 1-3 DX	301	82274	218.00	80.75
HC84200484	LACTOFERRIN/LEUK, FECAL; QUAL	300	83630	267.00	99.50
HC84201037	H.PYLORI BREATH TST UREASE	301	83013	796.00	244.00
HC88600119	MONARCH SPECIAL PROCESSING	300	84999	N/A	N/A
HC88600176	RESEARCH STUDY FEE(SOCSMG)*CLB	300	84999	N/A	N/A
HC89000020	GLIADIN IGA AND IGG ABS-QD	301	83516	42.00	41.20
HC89000053	FRUCTOSAMINE-SL	301	82985	N/A	N/A
HC89000079	PH FLUID-QD	301	83986	N/A	N/A
HC89000137	PSA TOTAL-QD	301	84153	52.00	51.80
HC89000145	TESTOSTERONE FREE-QD	301	84402	25.00	25.00
HC89000152	PSA FREE-QD	301	84154	14.00	13.15
HC89000194	ESTRIOL-SL	301	82677	N/A	N/A
HC89000293	ESTRIOL URINE-SL	301	82677	N/A	N/A
HC89000327	ESTROGENS URINE-SL	301	82672	N/A	N/A
HC89000335	ARGININE VASOPRESSIN HORMON-QD	301	84588	N/A	N/A
HC89000343	A-1 ANTITRYPSIN PHENOTYPE-QD	301	82104	N/A	N/A
HC89000350	CALCIUM IONIZED-QD	301	82330	130.00	129.04
HC89000368	T-3 REVERSE-QD	301	84482	19.00	18.75
HC89000376	DHEA-QD	301	82626	13.00	12.45
HC89000384	DHEA SULFATE-QD	301	82627	12.00	11.14
HC89000392	HUMAN GROWTH HORMONE-QD	301	83003	10.00	10.00
HC89000418	ALPHA-2 MACROGLOBULIN-QD	301	83883	N/A	N/A
HC89000426	C1 INHIBITOR-QD	302	83883	N/A	N/A
HC89000459	HISTONE REACTIVE ANA-SL	301	83520	23.00	23.00
HC89000566	ANTI-HISTONE AB-AU	301	83516	11.00	12.00
HC89000582	GLUCAGON-QD	301	82943	N/A	N/A
HC89000590	SOMATOMEDIN-QD	301	84305	27.00	26.03
HC89000608	IMMUNOGLOB G INDEX(PNL)-AU	301	82784	6.00	7.00
HC89000616	ALKALINE PHOS ISOENZYMES-QD	301	84080	41.00	40.65
HC89000640	17-OH CORTICOSTEROIDS-QD	301	83491	N/A	N/A
HC89000665	COPPER-QD	301	82525	23.00	22.33
HC89000699	BETA-GLUCURONIDASE, CSF-AU	301	84311	164.00	163.44
HC89000749	HEMOGLOBIN PLASMA-QD	301	83051	14.00	13.62
HC89000756	PYRUVATE-QD	301	84210	9.00	8.91
HC89000764	SEROTONIN-QD	301	84260	17.00	17.00
HC89000798	PORPHYRINS FRACT URINE-QD	301	84120	75.00	75.00
HC89000806	OXALATE URINE-QD	301	83945	14.00	13.08
HC89000814	THYROGLOBULIN-QD	301	84432	N/A	N/A
HC89000848	ANGIOTENSIN CONVERT ENZYME-QD	301	82164	144.00	144.00
HC89000855	COMPOUND S-QD	301	82634	N/A	N/A
HC89000863	ACTH-QD	301	82024	89.00	88.98
HC89000889	PARATHYROID HORMONE TERM-QD	301	83970	181.00	181.00
HC89000897	ALDOSTERONE-QD	301	82088	N/A	N/A
HC89000905	ALDOSTERONE URINE-QD	301	82088	38.00	37.95
HC89000913	CATECHOLAMINES FRACT-QD	301	82384	N/A	N/A
HC89000921	CATECHOLAMINES TOTAL-QD	301	82383	108.00	108.00
HC89000939	OLIGOCLONAL BANDS (CSF)-SL	301	83916	22.00	21.50
HC89000947	MYELIN BASIC PROTEIN CSF-SL	301	83873	N/A	N/A
HC89000988	VITAMIN C-QD	301	82180	N/A	N/A
HC89000996	AMINOLEVULINIC ACID-QD	301	82135	N/A	N/A
HC89001002	CYANIDE-QD	301	82600	N/A	N/A
HC89001010	FECAL FAT QUANT-QD	301	82710	N/A	N/A
HC89001036	ZINC-QD	301	84630	11.00	10.69
HC89001051	CYCLIC AMP-QD	301	82030	N/A	N/A
HC89001069	CARBOXYHEMOGLOBIN-QD	301	82375	8.00	8.00
HC89001077	AMINO ACID SCREEN-QD	301	82128	68.00	67.23
HC89001093	HYDROXYPROLINE TOTAL-QD	301	83505	N/A	N/A
HC89001101	METHEMALBUMIN-QD	301	83857	N/A	N/A
HC89001119	THIOCYANATE-QD	301	84430	N/A	N/A
HC89001150	C-1 ESTERASE INHIBITOR-QD	302	83520	49.00	48.82
HC89001168	CHLORAMPHENICOL-QD	301	82415	N/A	N/A
HC89001176	CYSTINE URINE QUAL-QD	301	82615	N/A	N/A
HC89001200	LIPOPROTEIN-ASSOC PHS(PLAC)-AU	301	83698	125.00	125.00
HC89001218	CALCITONIN-QD	301	82308	21.00	20.50
HC89001226	C-PEPTIDE-QD	301	84681	37.00	36.45
HC89001234	BILE ACIDS TOTAL-QD	301	82239	N/A	N/A
HC89001242	COPPER URINE-QD	301	82525	N/A	N/A
HC89001259	THYROXINE BIND GLOBULIN-QD	301	84442	30.00	29.65
HC89001267	HISTAMINE-QD	301	83088	N/A	N/A
HC89001291	DIHYDROXYVITAMIN D 1-25-QD	301	82652	35.00	35.00
HC89001382	ACETYLCHOLINE RECEPTOR AB-QD	301	84238	61.00	60.06
HC89001408	CITRIC ACID-QD	301	82507	10.00	10.00
HC89001614	MANGANESE-QD	301	83785	N/A	N/A
HC89001622	VITAMIN B1 THIAMINE-QD	301	84425	25.00	24.23
HC89001655	ACID PHOS PROSTATIC-QD	301	84066	N/A	N/A
HC89001747	DIBUCAINE NUMBER-QD	301	82638	N/A	N/A
HC89001754	CYSTICERCOSIS AB-SL	301	84182	N/A	N/A
HC89001812	APOLIPOPROTIN A-SL	301	82172	N/A	N/A
HC89001820	FETAL FIBRONECTIN-U2	301	82731	N/A	N/A
HC89001846	FOLATE RBC-QD	301	82747	7.00	7.00
HC89001879	HOMOVANILLIC ACID-QD	301	83150	N/A	N/A
HC89001895	NITROGEN TOTAL URINE-QD	301	84999	5.00	4.22
HC89001903	METHEMOBLOBIN-QD	301	83050	N/A	N/A
HC89001945	PORPHOBILINOGEN QUANT-QD	301	84110	N/A	N/A
HC89001952	ALUMINUM-QD	301	82108	N/A	N/A
HC89001978	CHOLINESTERASE-QD	301	82480	N/A	N/A
HC89001986	AMYLASE ISOENZYME-QD	301	84999	5.00	4.22
HC89002018	VASOACTIVE INTEST PEPTIDE-QD	301	84586	25.00	24.43
HC89002026	METANEPHRINE-QD	301	83835	17.00	16.88
HC89002059	ARSENIC-QD	301	82175	63.00	62.25
HC89002067	FLUORIDE-QD	301	82735	N/A	N/A
HC89002117	CHOLINESTERASE RBC-QD	301	82482	N/A	N/A
HC89002141	ERYTHROPOIETIN-QD	301	82668	25.00	24.23
HC89002166	ETHYLENE GLYCOL-QD	301	82693	14.00	13.63
HC89002182	LEAD-QD	301	83655	38.00	37.95
HC89002190	GLOMERULAR BASEMENT MEMB AB-QD	301	83520	49.00	48.82
HC89002240	BETA-2 MICROGLOBULIN-QD	301	82232	N/A	N/A
HC89002273	CITRIC ACID URINE-QD	301	82507	N/A	N/A
HC89002299	SULFATIDE AB-SL	301	83520	N/A	N/A
HC89002372	IMMUNOGLOBULIN D-QD	301	82784	6.00	5.50
HC89002380	CPK ISO-QD	301	82552	51.00	50.15
HC89002406	BETA-HCG QUANT-QD	301	84702	96.00	95.04
HC89002521	AMINO ACIDS QUANT URINE-QD	301	82139	N/A	N/A
HC89002539	LEAD URINE-QD	301	83655	38.00	37.95
HC89002547	MYOGLOBIN URINE-QD	301	83874	16.00	15.34
HC89002562	PARATHYROID HORMONE INTACT-QD	301	83970	N/A	N/A
HC89002620	TRYPSIN-QD	301	84485	N/A	N/A
HC89002646	PHOSPHATIDYL GLYCEROL-U2	301	84081	46.00	46.00
HC89002653	CHLORIDE URINE 24HR-QD	301	82436	N/A	N/A
HC89002836	ARSENIC URINE-QD	301	82175	63.00	62.25
HC89002844	MERCURY URINE-QD	301	83825	N/A	N/A
HC89002927	ANTI-MAG-QD	301	83520	49.00	48.82
HC89002935	LIPID ASSOC SIALIC ACID-QD	301	84275	N/A	N/A
HC89002976	IGG SUBCLASS-QD	301	82787	70.00	70.00
HC89002984	5-HIAA 24HR URINE-QD	301	83497	8.00	7.13
HC89002992	VMA URINE-QD	301	84585	18.00	17.62
HC89003008	CATECHOLAMINES TOTAL URINE-QD	301	82382	14.00	13.57
HC89003016	LDH ISOENZYMES-QD	301	83625	10.00	9.76
HC89003024	CHLORIDE CSF-QD	301	82438	N/A	N/A
HC89003073	17 KETOSTEROIDS-QD	301	83586	N/A	N/A
HC89003099	HEAVY METAL(S) QUALITATIVE-QD	301	83015	37.00	37.00
HC89003156	CAROTENE-QD	301	82380	N/A	N/A
HC89003164	CERULOPLASMIN-QD	301	82390	19.00	18.90
HC89003180	GASTRIN-QD	301	82941	12.00	12.00
HC89003198	HGB ELECTROPHERESIS-QD	301	83020	19.00	18.64
HC89003222	PROTEIN ELECT FRACT&QT-QD	301	84165	13.00	12.54
HC89003230	PROTEIN ELECT FRACT&QT UR-QD	301	84166	13.00	12.54
HC89003255	TESTOSTERONE TOTAL-QD	301	84403	7.00	7.00
HC89003271	CORTISOL FREE URINE-QD	301	82530	292.00	292.00
HC89003297	PROTEIN ELECT FRACT&QT CSF-QD	301	84166	13.00	12.54
HC89003305	TRANSFERRIN-QD	301	84466	9.00	8.83
HC89003339	MERCURY-QD	301	83825	15.00	14.18
HC89003503	GM1 AUTO AB-QD	301	83520	49.00	48.82
HC89003545	ARYLSULFATASE A URINE-AU	301	84311	332.00	331.44
HC89003552	ARSENIC URINE-AU	301	82175	13.00	15.00
HC89003560	HEAVY METAL QN EA URINE;BERYLLIUM-AU	301	83018	125.00	125.00
HC89003628	NITROGEN URINE-AU	301	84999	213.00	212.80
HC89003669	ADENOSINE DEAMINASE-AU	301	84311	31.00	31.00
HC89003735	CREATININE URINE (PNL)-AU	301	82570	8.00	7.43
HC89003768	FLUORIDE URINE (PNL)-AU	301	82735	71.00	70.57
HC89003776	TRICHLOROACETIC URINE(PNL)-AU	301	83918	91.00	91.00
HC89003792	NBS PHENYLALANINE SCREEN-GE	301	84030	12.00	12.00
HC89003800	NBS TYROSINE SCREEN-GE	301	84510	11.00	11.00
HC89003818	NBS TRANSFERASE-GE	301	82776	18.00	15.95
HC89003826	NBS TSH-GE	301	84443	18.00	15.95
HC89003834	NBS HGB CHROMATOGRAPHY-GE	301	83021	18.00	15.95
HC89004048	AMYLASE ISOENZYMES -AU	301	82150	7.50	16.80
HC89004063	CARNITINE, FREE-AU	301	83789	23.00	16.00
HC89004089	FAT FECAL QUAL-AU	301	82705	14.00	7.80
HC89004097	OSTEOCALCIN-AU	301	83937	16.00	16.00
HC89004154	PHOSPHOLIPIDS - AU	301	84311	25.00	20.00
HC89004162	ANTI-GLIADIN, IGA SPEC(PNL)-PR	302	83520	23.00	22.40
HC89004170	ANTI-GLIADIN, IGG SPEC(PNL)-PR	302	83520	23.00	22.40
HC89004188	ANTI-HUMAN TIS TRNS IGA(PNL-PR	302	83520	62.00	61.20
HC89004204	IGA SER NEPHELOMETRY(PNL)-PR	302	82784	20.00	20.00
HC89004279	BETA-2 MICROGLOBULIN SR/PLS-AU	301	82232	8.00	8.00
HC89004428	CHLORAMPHENICOL CSF-MA	301	82415	124.00	123.80
HC89004493	ANTI-GLIADIN, IGA SPEC(PNL2-PR	302	83520	23.00	22.40
HC89004501	ANTI-GLIADIN, IGG SPEC(PNL2-PR	302	83520	23.00	22.40
HC89004519	ANTI-HUMAN TIS TRNSIGA(PNL2-PR	302	83520	62.00	61.20
HC89004535	IGA SER NEPHELOMETRY(PNL2)-PR	302	82784	20.00	20.00
HC89004584	COPPER, LIVER TISSUE-MA	301	82525	71.00	70.60
HC89004592	ASCA IGA (PNL)-PR	302	83520	32.00	32.00
HC89004600	ASCA IGG (PNL)-PR	302	83520	32.00	32.00
HC89004618	PANCA IGG (PNL)-PR	302	83520	32.00	32.00
HC89004626	ANTI-OMPC IGA (PNL)-PR	302	83520	32.00	32.00
HC89004634	ANTI-CBIR1 (PNL)-PR	302	83520	32.00	32.00
HC89004758	NBS BIOTINIDASE-GE	301	82261	18.00	15.94
HC89004766	NBS IMMUNO TRYPSINOGEN(IRT)-GE	301	83516	18.00	15.95
HC89004816	KAPPA LIGHT CHAINS-QD	301	83883	90.00	90.00
HC89004824	OXALATE SERUM-QD	301	83945	N/A	N/A
HC89004840	ESTRONE BY TMS-AU	301	82679	31.00	31.00
HC89004857	ESTROGENS, FRACTIONATED,TMS-AU	301	82671	25.00	20.00
HC89005045	CALCIUM IONIZED-U2	301	82330	30.00	30.00
HC89005052	CALCIUM IONIZED-AU	301	82330	9.00	9.00
HC89005060	TRIGLYCERIDES-VAP(IN GRP)-AU	301	84478	9.00	8.15
HC89005078	ULTRACENTRIFUG VAP(IN PNL)-AU	301	83701	53.00	57.85
HC89005359	PARATHYROID HORMONE RELPEP-AU	301	83519	75.00	75.00
HC89005367	SEX HORMONE BINDING GLOB2ND-AU	301	84270	12.00	12.00
HC89005375	IMMUNOGLOB IGA-AU	301	82784	16.00	16.00
HC89005383	ENDOMYSIAL AB IGA SCRN-AU	301	83516	16.00	16.00
HC89005391	B-TYPE NATRIURETIC PEPTIDE-UCI	301	83880	100.00	100.00
HC89005409	MYOGLOBIN-UCI	301	83874	39.00	39.00
HC89005417	TROPONIN-UCI	301	84484	45.00	45.00
HC89005490	MYELOPEROXIDASE AB (MPO)-AU	301	83516	13.03	14.40
HC89005508	MAGNESIUM URINE 24 HR-AU	301	83735	10.00	144.00
HC89006233	ASSAY PHENCYCLIDINE (PCP)-AU	301	83992	75.00	N/A
HC89006977	BETA HYDROXYBUTYRATE-AU	301	82010	N/A	N/A
HC89006985	ACETYLCHOLINESTERASE-AU	301	82013	16.00	16.00
HC89006993	ACETYLCHOLINESTERASE-QD	301	82013	N/A	N/A
HC89007009	ACTH-ES	301	82024	88.00	87.25
HC89007017	ACTH-AU	301	82024	18.00	18.00
HC89007025	ADRENOCORTICOTROPIC HRMN-AU	301	82024	6.00	6.00
HC89007074	ALBUMIN SERUM/PLASMA NEPHELOMETRY-AU	301	82040	12.00	22.50
HC89007082	ALBUMIN URINE -AU	301	82042	4.00	4.00
HC89007090	ALDOSTERONE-AU	301	82088	23.00	16.50
HC89007108	A-1 ANTITRYPSIN-AU	301	82103	9.00	7.50
HC89007116	A-1 ANTITRYPSIN FECES-AU	301	82103	28.00	27.90
HC89007124	A-1 ANTITRYPSIN/PHENOTYPE-AU	301	82104	16.00	7.50
HC89007132	AFP-AU	301	82105	16.00	16.00
HC89007140	AFP-GE	301	82105	11.00	11.00
HC89007157	AFP AMNIOTIC FLUID-GZ	301	82106	N/A	N/A
HC89007165	ALUMINIUM-AU	301	82108	15.00	16.00
HC89007173	AMINO ACID SINGLE QUANT-AU	301	82131	60.00	60.00
HC89007181	AMINO ACID SINGLE QUANT-QD	301	82131	130.00	129.38
HC89007199	CYSTINE QUANT URINE-AU	301	82131	60.00	60.00
HC89007207	AMINOLEVULINIC ACID-AU	301	82135	36.00	35.10
HC89007215	AMINO ACIDS QUANT-CA	301	82139	158.00	158.00
HC89007223	AMINO ACIDS QUANT URINE-CA	301	82139	158.00	158.00
HC89007231	AMINO ACIDS QUANT-AU	301	82139	90.00	90.00
HC89007249	DELTA OD 450-U2	301	82143	16.00	16.00
HC89007256	AMYLASE-QD	301	82150	73.00	72.38
HC89007264	ANGIOTENSIN CONVERT ENZYME-AU	301	82164	8.00	10.00
HC89007272	APOLIPOPROTEIN A-1 AU	301	82172	11.00	15.00
HC89007280	APOLIPOPROTEIN A1-QN	302	82172	N/A	N/A
HC89007298	ARSENIC, BLOOD-AU	301	82175	11.00	15.00
HC89007306	VITAMIN C-AU	301	82180	18.00	25.80
HC89007348	BILE ACIDS TOTAL-AU	301	82239	13.00	13.50
HC89007355	CHOLYGLYCINE BILE ACIDS-AU	301	82240	N/A	N/A
HC89007363	CADMIUM-AU	301	82300	15.00	15.00
HC89007389	STONE/CALCULI ANALYS MICRO-AU	301	82365	13.00	26.70
HC89007397	CARBOXYHEMOGLOBIN-AU	301	82375	39.00	38.57
HC89007405	CARNITINE FREE & TOTAL-AU	301	82379	30.88	31.81
HC89007413	CAROTENE-AU	301	82380	16.00	13.50
HC89007421	CATECHOLAMINES FRACT-AU	301	82384	28.00	31.80
HC89007439	CHLORAMPHENICOL-AU	301	82415	73.00	72.60
HC89007447	CHLORIDE FECAL-AU	301	82438	14.00	13.80
HC89007454	CHOLINESTERASE-AU	301	82480	14.00	13.05
HC89007462	PSEUDOCHOLINESTERASE-AU	301	82480	10.00	9.60
HC89007470	CHOLINESTERASE RBC-AU	301	82482	17.00	16.50
HC89007488	CHROMATOGRAPHY QUAL-AU	301	83789	120.00	120.00
HC89007652	DEOXYPYRIDINOLIN CROSSLINKS-AU	301	82523	42.00	42.00
HC89007660	N-TELOPEPTIDE CROSSLINK UR-AU	301	82523	22.00	28.50
HC89007678	NTX SERUM-AU	301	82523	95.00	123.07
HC89007686	PYRIDINIUM CROSSLINKS TOTAL-AU	301	82523	54.00	54.00
HC89007694	CORTISOL FREE-QN	301	82530	125.00	125.00
HC89007702	CORTISOL FREE URINE-AU	301	82530	18.00	16.50
HC89007710	CORTISOL FREE URINE-QN	301	82530	N/A	N/A
HC89007744	CREATINE-QD	301	82540	N/A	N/A
HC89007751	CPK-AU	301	82550	9.00	9.00
HC89007769	CPK ISO-AU	301	82552	9.00	9.00
HC89007777	CPK ISO-QN	301	82552	24.00	23.33
HC89007785	CRYOFIBRINOGEN-AU	301	82585	9.00	8.10
HC89007793	CRYOGLOBULIN(QUAL/SEMI QT)-AU	301	82595	8.00	7.50
HC89007801	CYANIDE-AU	301	82600	54.00	33.00
HC89007819	VIT B12 BINDING CAPACITY-AU	301	82608	22.00	16.50
HC89007827	DHEA-AU	301	82626	22.00	30.00
HC89007835	DHEA SULFATE-AU	301	82627	8.00	8.00
HC89007843	DHEA SULFATE-ES	301	82627	50.00	48.25
HC89007850	DEOXYCORTISOL 11-AU	301	82634	34.00	30.30
HC89007868	DEOXYCORTISOL 11-QD	301	82634	N/A	N/A
HC89007876	DEOXYCORTISOL 11-ES	301	82634	170.00	74.00
HC89007884	COMPOUND S SPECIFIC-ES	301	82634	N/A	N/A
HC89007892	DIBUCAINE NO +PSEUDOCHOLIN-AU	301	82638	12.00	11.10
HC89007900	DIHYDROTESTOSTERONE TANDUM SPECT-AU	301	82542	20.00	37.50
HC89007926	DIHYDROXYVITAMIN D 1-25-AU	301	82652	18.00	24.00
HC89007934	BETA GLUCURONIDASE CSF-AU	301	82657	N/A	N/A
HC89007942	ERYTHROPOIETIN-AU	301	82668	10.00	10.00
HC89007959	ESTRADIOL-ES	301	82670	68.00	68.00
HC89007967	ESTROGENS FRACTIONATED-AU	301	82671	20.00	20.00
HC89007975	ESTROGENS TOTAL-ES	301	82672	49.00	49.00
HC89007983	ESTRIOL-AU	301	82677	15.00	15.30
HC89007991	ESTRONE-QN	301	82679	N/A	N/A
HC89008007	ESTRONE-AU	301	82679	38.00	20.00
HC89008015	ETHYLENE GLYCOL-AU	301	82693	36.00	27.60
HC89008023	FECAL FAT QUANT-AU	301	82710	100.00	99.50
HC89008031	FATTY ACIDS FREE-AU	301	82725	16.00	16.00
HC89008049	FATTY ACIDS FREE-QN	301	82725	22.00	21.38
HC89008056	FLUORIDE URINE-AU	301	82735	N/A	N/A
HC89008064	FLUORIDE-AU	301	82735	108.00	108.00
HC89008098	FOLATE RBC-AU	301	82747	8.00	15.00
HC89008106	GALACTOSE-1-PHOS URIDYL TR-AU	301	82775	75.00	74.25
HC89008114	IMMUNOGLB IGA EA-AU	301	82784	6.00	6.00
HC89008122	IMMUNOGLB IGA,D,G,M EA-QD	301	82784	6.00	5.50
HC89008130	IMMUNOGLB IGA,D,G,M EA-SL	301	82784	N/A	N/A
HC89008148	IMMUNOGLOBULIN IGD-AU	301	82784	22.40	16.50
HC89008155	IGG SUBCLASS-AU	301	82787	40.00	57.60
HC89008163	GASTRIN-QN	301	82941	N/A	N/A
HC89008171	GASTRIN-AU	301	82941	15.00	13.50
HC89008189	GLUCAGON-AU	301	82943	23.00	18.00
HC89008197	GLUCAGON-QN	301	82943	N/A	N/A
HC89008213	GLUTAMINE FLUID-SL	301	82127	N/A	N/A
HC89008221	ALPHA-1 ACID GLYCOPROTEIN-AU	301	82985	63.00	62.10
HC89008239	FRUCTOSAMINE-AU	301	82985	8.00	11.40
HC89008247	FSH-ES	301	83001	29.00	28.75
HC89008254	LH(LUTEINIZ HORMONE)-ES	301	83002	33.00	32.25
HC89008262	HUMAN GROWTH HORMONE-AU	301	83003	14.00	15.00
HC89008270	HUMAN GROWTH HORMONE-ES	301	83003	35.00	34.75
HC89008288	HAPTOGLOBIN QUANT-AU	301	83010	16.00	16.00
HC89008296	HEAVY METAL QN EA;BERYLLIUM-AU	301	83018	N/A	N/A
HC89008304	HEAVY METAL QN EA;BISMUTH-AU	301	83018	N/A	N/A
HC89008312	HEAVY METAL QN EA;THALLIUM-AU	301	83018	N/A	N/A
HC89008320	HGB ELECTROPHERESIS-AU	301	83020	16.00	16.00
HC89008338	HGB CHROMATOGRAPHY-AU	301	83021	15.00	15.00
HC89008346	HEMOGLOBIN GLYCATED (A1C)-AU	301	83036	12.00	11.40
HC89008353	HEMOGLOBIN GLYCATED (A1C)-ES	301	83036	19.00	18.90
HC89008361	METHEMOBLOBIN-AU	301	83050	39.00	38.57
HC89008379	HEMOGLOBIN PLASMA-AU	301	83051	19.00	15.30
HC89008387	HEMOSIDERIN QUAL URINE-AU	301	83070	9.00	9.00
HC89008395	HEXOSAMINIDASE-AU	301	83080	152.25	232.00
HC89008403	HISTAMINE, WHOLE BLOOD-AU	301	83088	27.40	25.50
HC89008411	HOMOVANILLIC ACID-AU	301	83150	17.00	16.50
HC89008429	HVA URINE-CA	301	83150	48.00	48.00
HC89008437	17-OH CORTICOSTEROIDS-QN	301	83491	29.00	28.19
HC89008445	17-OH CORTICOSTEROIDS -AU	301	83491	45.00	44.70
HC89008452	5-HIAA URINE-AU	301	83497	20.00	16.80
HC89008460	5-HIAA URINE-CA	301	83497	42.00	42.00
HC89008478	17 OH PROGESTERONE-AU	301	83498	24.00	15.00
HC89008486	17 OH PROGESTERONE-ES	301	83498	65.00	58.00
HC89008494	17-D HYDROXYPROGESTERONE-QN	301	83498	45.00	N/A
HC89008502	HYDROXYPROLINE TOTAL-AU	301	83505	16.00	16.00
HC89008510	SERINE PROTEASE3 IGG IMMUNOASSAY-AU	301	83516	13.03	14.40
HC89008528	GLIADIN IGA AND IGG ABS-AU	301	83516	21.00	21.00
HC89008544	CARNITINE-CA	301	83519	42.00	41.30
HC89008551	CARNITINE URINE-CA	301	83519	110.00	110.00
HC89008569	ENDORPHIN-QN	301	83519	N/A	N/A
HC89008577	GLUTAMIC ACID AB-AU	301	83516	35.00	42.00
HC89008585	IGF BINDING PROTEIN-3-AU	301	82397	18.00	21.00
HC89008593	IGF BINDING PROTEIN-3-ES	301	83519	42.00	41.30
HC89008601	LEGIONELLA AG URINE-AU	301	83519	16.00	16.00
HC89008619	LEPTIN-QN	301	83519	75.00	75.00
HC89008627	MYASTHENIA GRAVIS EVAL-SL	301	83519	171.00	171.00
HC89008635	MYASTHENIA GRAVIS EVAL-AT	301	83519	N/A	N/A
HC89008643	PANCREATIC POLYPEPTIDE-AU	301	83519	87.13	93.00
HC89008650	TRYPSIN-AU	301	83519	29.00	16.00
HC89008668	TRYPSIN-QD	301	83519	45.00	44.40
HC89008676	TSH HIGH SENSITIVITY-ES	301	83519	N/A	N/A
HC89008684	TSH RECEPTOR AB-AU	301	83519	16.00	16.00
HC89008692	ADRENOGENITAL-QN	301	83520	N/A	N/A
HC89008700	ADENOVIRUS AG-FT	301	83520	N/A	N/A
HC89008718	GM1 AUTO AB-AT	301	83520	268.00	255.00
HC89008726	GM1 AUTO AB-AU	301	83520	N/A	N/A
HC89008734	PEPSINOGEN-AU	301	83520	N/A	N/A
HC89008742	TRYPTASE-AU	301	83520	41.00	123.07
HC89008759	INSULIN TOTAL-QD	301	83525	N/A	N/A
HC89008767	INSULIN TOTAL-ES	301	83525	25.00	24.50
HC89008775	IRON TOTAL URINE-AU	301	83540	175.00	168.32
HC89008783	IRON LIVER TISSUE-MA	301	83540	70.00	69.16
HC89008791	17 KETOSTEROIDS-AU	301	83586	21.00	21.00
HC89008809	17-KETOSTEROID FRACTIONAT'N-AU	301	83593	288.00	287.30
HC89008817	LDH-AU	301	83615	11.00	10.35
HC89008825	LD-AU	301	83625	11.00	10.35
HC89008833	LDH ISOENZYMES(PNL)-AU	301	83625	16.00	16.00
HC89008841	LEAD URINE-AU	301	83655	10.31	7.50
HC89008866	L/S RATIO-MA	301	83661	N/A	N/A
HC89008874	LEUCINE AMINOPEPTIDASE-AU	301	83670	27.00	27.00
HC89008882	LIPOPROTEIN ELECTROPHORESIS-AU	301	83700	46.23	51.60
HC89008890	LDL SUBCLASS-AU	301	83701	48.00	47.23
HC89008908	VLDL CHOLESTEROL-AU	301	83719	16.00	16.00
HC89008916	VLDL CHOLESTEROL-QD	301	83719	N/A	N/A
HC89008924	MANGANESE-AU	301	83785	16.03	15.00
HC89008940	BILE ACID FRACTIONATED-AU	301	83789	205.00	205.00
HC89008957	NUCLEIC ACID PCR QUANT-HP	301	83789	N/A	N/A
HC89008981	MERCURY BLOOD-AU	301	83825	9.50	10.50
HC89008999	METANEPHRINE-AU	301	83835	22.00	22.50
HC89009013	METHEMALBUMIN-AU	301	83857	N/A	N/A
HC89009047	MYELIN BASIC PROTEIN CSF-AU	301	83873	29.00	19.50
HC89009054	MYELIN BASIC PROTEIN CSF-QN	301	83873	N/A	N/A
HC89009062	ALPHA-2 MACROGLOBULIN-AU	301	83883	19.00	18.90
HC89009328	NUCLEOTIDASE-5-AU	301	83915	12.00	15.00
HC89009336	OLIGOCLONAL BANDS (CSF)-AT	301	83916	N/A	N/A
HC89009344	OLIGOCLONAL BANDS (CSF)-AU	301	83916	65.00	72.00
HC89009351	ORGANIC ACIDS TOTAL QUANT-AU	301	83918	124.00	225.00
HC89009369	ORGANIC ACIDS TOTAL QUANT-QD	301	83918	N/A	N/A
HC89009377	ORGANIC ACIDS TOTAL QUANT-MA	301	83918	N/A	N/A
HC89009385	ORGANIC ACIDS TOT QUANT UR-AU	301	83918	100.00	120.00
HC89009393	ORGANIC ACIDS TOT QUANT UR-CA	301	83918	N/A	N/A
HC89009401	ORGANIC ACIDS TOT QUANT UR-QD	301	83918	242.00	242.00
HC89009419	ORGANIC ACIDS TOT QUANT UR-MA	301	83918	N/A	N/A
HC89009427	METHYL MALONIC ACID (B12)-AU	301	83921	15.00	20.00
HC89009443	OXALATE URINE-AU	301	83945	21.00	14.40
HC89009450	PARATHYROID HORMONE INTACT-AU	301	83970	18.00	17.45
HC89009468	PARATHYROID HORMONE INTACT-ES	301	83970	N/A	N/A
HC89009476	PARATHYROID HORMONE INTACT-QN	301	83970	N/A	N/A
HC89009492	PARATHYROID HORMONE MID-QD	301	83970	N/A	N/A
HC89009500	PARATHYROID HORMONE MID-QN	301	83970	N/A	N/A
HC89009518	PARATHYROID HORMONE TERM-ES	301	83970	N/A	N/A
HC89009526	PARATHYROID HORMONE TERM-QN	301	83970	55.00	54.43
HC89009542	PHENYLALANINE SCREEN-AU	301	84030	16.00	16.00
HC89009559	ACID PHOS -TOTAL-AU	301	84060	10.00	9.30
HC89009567	ACID PHOS PROSTATIC-AU	301	84066	13.35	13.20
HC89009575	ALK PHOSPHATASE-AU	301	84075	N/A	N/A
HC89009583	ALKALINE PHOS ISOENZYMES-AU	301	84080	13.00	15.50
HC89009591	ALK PHOS ISO BONE SPECIFIC-AU	301	84080	30.00	68.82
HC89009609	PHOSPHATIDYL GLYCEROL-FE	301	84081	59.00	58.75
HC89009617	PHOSPHATIDYL GLYCEROL-MA	301	84081	N/A	N/A
HC89009625	PHOSPHATIDYL GLYCEROL-AU	301	84081	N/A	N/A
HC89009633	PHOSPHORUS URINE-AU	301	84105	16.00	16.00
HC89009641	PORPHOBILINOGEN QUANT-AU	301	84110	33.00	30.90
HC89009658	PORPHYRINS QUAL URINE-AU	301	84119	N/A	N/A
HC89009666	PORPHYRINS FRACT URINE-AU	301	84120	28.55	22.50
HC89009674	PORPHYRINS FECAL FRACT-AU	301	84126	126.00	126.00
HC89009682	17-HYDROXYPREGNENOLONE-AU	301	84143	34.00	N/A
HC89009690	PROLACTIN-ES	301	84146	47.00	47.00
HC89009708	PSA TOTAL-AU	301	84153	6.00	6.00
HC89009716	PSA FREE-AU	301	84154	6.00	6.00
HC89009724	TOT PROT REFRACTOMETRIC-AU	301	84160	8.00	7.23
HC89009732	PROTEIN ELECT FRACT&QT(PNL)-AU	301	84165	4.00	3.50
HC89009740	PROTOPORPHYRINS RBC QUANT-AU	301	84202	60.00	56.73
HC89009757	PROINSULIN-AU	301	84206	32.00	24.00
HC89009765	PROINSULIN-QD	301	84206	N/A	N/A
HC89009773	VITAMIN B6 PYRIDOXAL-AU	301	84207	9.00	10.00
HC89009781	PYRUVATE-AU	301	84210	28.00	22.50
HC89009799	QUININE-AU	301	84228	97.00	97.00
HC89009807	RENIN-AU	301	84244	13.50	13.50
HC89009815	RENIN-ES	301	84244	60.00	59.50
HC89009823	VITAMIN B-2-AU	301	84252	33.00	176.00
HC89009831	SELENIUM-AU	301	84255	13.00	16.00
HC89009849	SEROTONIN-AU	301	84260	31.00	37.50
HC89009856	SEX HORMONE BINDING GLOB-ES	301	84270	48.00	47.81
HC89009864	SEX HORMONE BINDING GLOB-AU	301	84270	8.00	8.00
HC89009872	LIPID ASSOC SIALIC ACID-AU	301	84275	19.00	18.90
HC89009880	SODIUM OTHER SOURCE-AU	301	84302	14.00	13.22
HC89009898	SOMATOMEDIN-ES	301	84305	59.00	59.00
HC89009906	SOMATOMEDIN-AU	301	84305	9.00	12.00
HC89009914	HEXOSAMINIDASE A-AU	301	84311	N/A	N/A
HC89009922	HEXOSAMINIDASE A-MA	301	84311	N/A	N/A
HC89009930	TESTOSTERONE FREE-AU	301	84402	14.00	13.50
HC89009948	TESTOSTERONE FREE-ES	301	84402	7.00	6.69
HC89009955	TESTOSTERONE TOTAL-ES	301	84403	54.00	51.00
HC89009963	TESTOSTERONE TOTAL MALE-AU	301	84403	7.00	6.00
HC89009971	VITAMIN B1 THIAMINE-AU	301	84425	16.00	17.00
HC89009989	THIOCYANATE-AU	301	84430	74.00	25.50
HC89009997	THYROGLOBULIN BY CIA-AU	301	84432	18.88	11.00
HC89010003	THYROGLOBULIN-ES	301	84432	N/A	N/A
HC89010011	T4 FREE-ES	301	84439	34.00	33.50
HC89010029	T4 FREE-AU	301	84439	30.00	30.00
HC89010037	THYROXINE BIND GLOBULIN-ES	301	84442	28.00	28.00
HC89010045	THYROXINE BIND GLOBULIN-AU	301	84442	17.00	16.50
HC89010052	THYROID STIM IMMUNOGLOB-AU	301	84445	39.15	45.00
HC89010060	TSH RECEPTOR AB-ES	301	83519	120.00	119.25
HC89010078	VITAMIN E-AU	301	84446	9.00	15.00
HC89010086	TRANSFERRIN-AU	301	84466	16.00	16.00
HC89010094	T3 FREE-AU	301	84481	N/A	N/A
HC89010102	T-3 REVERSE-AU	301	84482	14.00	14.00
HC89010110	T-3 REVERSE-ES	301	84482	47.00	46.20
HC89010136	TRYPSIN (FECES)-AU	301	84488	11.00	10.50
HC89010144	URIC ACID FLUID-AU	301	84560	16.00	16.00
HC89010151	UROBILINOGEN FECES-AU	301	84577	N/A	N/A
HC89010169	UROBILINOGEN 24H URINE-AU	301	84580	N/A	N/A
HC89010177	VANILLYLMANDELIC ACID URINE-AU	301	84585	15.00	16.80
HC89010185	VMA URINE-CA	301	84585	48.00	48.00
HC89010193	VMA URINE-AU	301	84585	16.00	16.00
HC89010201	VASOACTIVE INTEST PEPTIDE-QN	301	84586	57.00	56.38
HC89010219	VASOACTIVE INTEST PEPTIDE-AU	301	84586	29.00	28.50
HC89010227	ARGININE VASOPRESSIN HORMON-AU	301	84588	29.73	24.00
HC89010235	ARGININE VASOPRESSIN HORMON-QN	301	84588	61.00	60.26
HC89010243	VITAMIN A-AU	301	84590	9.00	10.00
HC89010250	VOLATILES-AU	301	84600	22.40	25.20
HC89010268	VOLATILES-NM	301	84600	N/A	N/A
HC89010276	XYLOSE ABSORPTION TEST-AU	301	84620	N/A	N/A
HC89010284	ZINC, SERUM -AU	301	84630	5.00	8.00
HC89010292	C PEPTIDE-ES	301	84681	50.00	50.00
HC89010300	C-PEPTIDE-AU	301	84681	N/A	N/A
HC89010318	BETA-HCG QUANT-AU	301	84702	14.00	12.90
HC89011464	ANTI-PARIETAL AB-AU	302	83516	20.00	16.00
HC89013460	AFP-GZ	301	82105	N/A	N/A
HC89013478	ANDROSTENEDIONE-AU	301	82157	24.00	34.80
HC89013486	ANDROSTENEDIONE-ES	301	82157	65.00	58.00
HC89013494	LIPOPROTEIN A-QD	301	83695	20.00	19.21
HC89013502	BETA-2 MICROGLOBULIN CSF-AU	301	82232	12.00	12.00
HC89013510	BETA-2 MICROGLOBULIN URINE-AU	301	82232	14.00	12.00
HC89013528	VITAMIN D 25 OH-AU	301	82306	10.00	10.00
HC89013536	CALCITONIN-AU	301	82308	20.00	24.00
HC89013544	CALCITONIN-ES	301	82308	54.00	53.90
HC89013551	CALCIUM URINE-AU	301	82340	N/A	N/A
HC89013577	COENZYME Q10(PNL)-AU	301	82542	65.00	62.50
HC89013585	CITRATE-AU	301	82507	13.00	13.50
HC89013593	COPPER-AU	301	82525	6.00	13.50
HC89013601	CORTISOL-ES	301	82533	43.00	38.50
HC89013619	DHEA-ES	301	82626	79.00	N/A
HC89013627	IMMUNOGLOBULIN IGE-AU	301	82785	9.00	9.00
HC89013635	IMMUNOGLOBULIN IGE(PNL)-AU	301	82785	N/A	N/A
HC89013643	FRUCTOSAMINE-QD	301	82985	5.00	4.88
HC89013650	GLIADIN AB IGA-AU	301	83516	11.00	10.50
HC89013668	NEURONAL CELL AB-AU	301	83520	75.00	74.77
HC89013676	INSULIN TOTAL-AU	301	83525	8.00	9.00
HC89013684	LIPASE-AU	301	83690	26.00	25.50
HC89013692	MYELIN BASIC PROTEIN CSF-QD	301	83873	15.00	14.02
HC89013700	MYOGLOBIN URINE-AU	301	83874	12.00	12.90
HC89013718	NEPHELOMETRY EA ANALYT(PNL)-AU	302	83883	N/A	N/A
HC89013825	OLIGOCLONAL BANDS (CSF)-QD	301	83916	277.00	277.00
HC89013833	ORGANIC ACID SNGL QUANT-AU	301	83921	N/A	N/A
HC89013841	ORGANIC ACID SNGL QUANT-CA	301	83921	N/A	N/A
HC89013858	ORGANIC ACID SNGL QUANT UR-AU	301	83921	182.00	181.90
HC89013882	ACID PHOS PROSTATIC-AU	301	84066	16.00	16.00
HC89013890	TOTAL PROTEIN(PNL)-AU	301	84155	5.00	N/A
HC89013908	TOT PROT REFRACTOM(PNL)-AU	301	84160	4.00	3.50
HC89013916	PROTEIN ELECT FRACT&QT(PNL)-AU	301	84165	5.00	8.00
HC89013924	RI ANTIBODY-AT	301	84181	340.00	N/A
HC89013932	WESTERN BLOT IMMUNE PROBE-AT	301	84182	N/A	N/A
HC89013940	ACETYLCHOLINE RECEPTOR AB-AU	301	83519	15.00	36.00
HC89013957	THYROGLOBULIN-UE	301	84432	N/A	N/A
HC89013965	T4/THYROXINE-ES	301	84436	20.00	19.75
HC89013973	THS 3RD GENERATION-AU	301	84443	16.00	16.00
HC89013981	TSH-ES	301	84443	44.53	42.00
HC89013999	T3 TOTAL-ES	301	84480	33.00	32.25
HC89014005	POTASSIUM STOOL-AU	301	84999	14.00	13.22
HC89014781	STREPTOCOCCUS PNEUMONIAE AG-AU	306	83789	54.00	54.00
HC89015101	APT TEST (FETAL HGB)-U2	301	83033	N/A	N/A
HC89015168	ALDOLASE-AU	301	82085	5.00	5.00
HC89015291	BETA HYDROXYBUTYRATE-QD	301	82010	23.00	23.00
HC89015317	ALDOLASE-QD	301	82085	11.00	11.00
HC89015325	A-1 ANTITRYPSIN-QD	301	82103	18.00	18.00
HC89015333	VITAMIN D 25 OH-QD	301	82306	195.00	195.00
HC89015341	CALCIUM URINE-QD	301	82340	16.00	16.00
HC89015358	N-TELOPEPTIDE CROSSLINK UR-QD	301	82523	29.00	29.00
HC89015366	N-TELOPEPTIDE CROSSLINK-QD	301	82523	26.00	26.00
HC89015374	ESTROGEN TOTAL-QD	301	82672	17.00	17.00
HC89015382	ESTRIOL-QD	300	82677	10.00	10.00
HC89015390	FOLIC ACID-QD	301	82746	13.00	13.00
HC89015408	IMMUNOGLOBULIN IGE-QD	301	82785	21.00	21.00
HC89015416	G6PD-QD	301	82955	7.00	7.00
HC89015424	FSH-QD	301	83001	6.00	6.00
HC89015432	LH(LUTEINIZ HORMONE)-QD	301	83002	23.00	23.00
HC89015440	HOMOCYSTINE-QD	301	83090	14.00	14.00
HC89015457	LACTIC ACID-QD	301	83605	14.00	14.00
HC89015473	NUCLEOTIDASE-5-QD	301	83915	17.00	17.00
HC89015481	ALK PHOSPHATASE-QD	301	84075	18.00	18.00
HC89015499	PROLACTIN-QD	301	84146	12.00	12.00
HC89015507	VITAMIN B6 PYRIDOXAL-QD	301	84207	23.00	23.00
HC89015515	RENIN-QD	301	84244	8.00	8.00
HC89015523	VITAMIN B-2-QD	301	84252	14.00	14.00
HC89015531	SELENIUM-QD	301	84255	11.00	11.00
HC89015549	SEX HORMONE BINDING GLOB-QD	301	84270	27.00	27.00
HC89015556	THYROID STIM IMMUNOGLOB-QD	301	84445	26.00	26.00
HC89015564	VITAMIN E-QD	301	84446	12.00	12.00
HC89015572	T3 TOTAL-QD	301	84480	11.00	11.00
HC89015580	T3 FREE-QD	301	84481	10.00	10.00
HC89015598	UREA NITROGEN URINE-QD	301	84540	22.00	22.00
HC89015606	URIC ACID FLUID-QD	301	84560	18.00	18.00
HC89015994	CARCINOEMBRYONIC ANTIGEN (CEA)-QD	301	82378	6.00	6.00
HC89016000	VITAMIN B12-QD	301	82607	14.00	14.00
HC89016018	ESTRADIOL-QD	301	82670	12.00	12.00
HC89016026	PREALBUMIN-QD	301	84134	13.00	13.00
HC89016034	PREGNENOLONE-QD	301	84140	15.00	15.00
HC89016042	PROGESTERONE-QD	301	84144	15.00	15.00
HC89016083	CARNITINE FREE & TOTAL-MA	301	82379	32.00	31.81
HC89016091	ACYLCARNITINES QUANT-MA	301	82017	48.00	47.61
HC89016109	AMINO ACIDS QUANT-MA	301	82139	137.00	136.92
HC89016117	ORGANIC ACIDS TOT QUAL-MA	301	83919	55.00	54.51
HC89016133	AFP-QD	301	82105	22.00	22.00
HC89016166	CORTISOL-QD	301	82533	9.00	9.00
HC89016174	CRYOGLOBULIN(QUAL/SEMI QT)-QD	301	82595	4.00	4.00
HC89016190	BILE ACID FRACTIONATED-QD	301	83789	2.00	1.99
HC89016281	LIPOPROTEIN ELECTROPHORESIS-QD	301	83700	125.00	125.00
HC89016299	ALBUMIN; URINE QUANT-QD	301	82043	8.00	8.00
HC89016315	REVERSE T3-QD	301	84482	2.00	1.99
HC89016398	TOTAL PROTEIN UR-AU	301	84156	5.00	5.00
HC89016406	NEPHELOMETRY EA ANALYT UR-AU	302	83883	33.00	32.70
HC89016422	PYRUVATE KINASE-AU	301	84220	39.00	39.00
HC89016539	TESTOSTERONE FREE-MALE-AU	301	84402	6.00	6.00
HC89016547	TESTOSTERONE FREE FEM/CHILD-AU	301	84402	43.00	42.90
HC89016554	FAT FECAL QUAL-U2	301	82705	N/A	N/A
HC89016562	PH FLUID FECAL-AU	301	83986	11.03	5.10
HC89016570	REDUCING SUBS FECAL-AU	301	84376	13.55	16.00
HC89016653	TRIGLYCERIDES-VAP(IN GRP)-AH	301	84478	6.00	5.50
HC89016661	ULTRACENTRIFUG VAP(IN PNL)-AH	301	83701	33.00	32.50
HC89016711	NBS TANDEM MASS SPEC MS/MS-GE	301	83789	18.00	16.00
HC89016729	NBS 17 OH PROGESTERONE-GE	301	83498	N/A	N/A
HC89016760	NBS MS/MS AMINO ACID W/PKU-GE	301	83789	21.00	20.35
HC89016778	NBS 17 OH PROGESTERONE-GE	301	83498	18.00	15.95
HC89016828	ACETYLCHOLINE RECEPTOR BLOC-QD	301	83519	N/A	N/A
HC89016836	ACETYLCHOLINE RECEPTOR MOD-QD	301	83519	N/A	N/A
HC89016844	VOLTAGE GATED CA CHANNEL AB-QD	301	83519	N/A	N/A
HC89016851	LACTIC ACID-AU	301	83605	8.00	7.20
HC89016869	CRYOGLOBULIN IGA, QUANT-AU	301	82784	8.00	7.50
HC89016877	CRYOGLOBULIN IGM, QUANT-AU	301	82784	8.00	7.50
HC89016885	CRYOGLOBULIN IGG, QUANT-AU	301	82784	8.00	7.50
HC89016992	LIPOPROTEIN A-AU	301	83695	7.00	19.50
HC89017008	CATECHOLAMINES FRACT UR-AU	301	82384	25.00	31.80
HC89017016	CHOLESTEROL ARUP-AU	301	82465	13.00	12.17
HC89017024	MITOCHONDRIAL M2 AB IGG-AU	302	83516	7.00	7.00
HC89017073	AMNIOTIC BILIRUBIN SCAN-AU	301	82143	44.00	16.00
HC89017131	IM ASSAY TISSUE TG AB-AU	301	83516	9.00	9.00
HC89017156	IA F-ACTIN ANTIBODY, IGG-AU	301	83516	6.00	16.00
HC89017206	PTH RELATED PROTEIN-AU	301	83519	N/A	N/A
HC89017214	LEPTIN ELISA-AU	301	82397	60.00	45.00
HC89017230	CERULOPLASMIN-AU	301	82390	7.00	7.00
HC89017255	AMINO ACIDS QUANT URINE-AU	301	82139	109.00	108.50
HC89017305	METHYL MALONIC ACID-QD	301	83921	55.00	54.19
HC89017321	ANTI-RIBOSOMAL AB-QD	302	83520	86.00	85.70
HC89017370	GLIADIN AB IGG-AU	302	83516	11.00	10.50
HC89017388	CHLORIDE CSF-AU	301	82438	16.00	16.00
HC89017396	TRANSGLUT'AB IGA REFLEX IFA-AU	302	83516	16.00	16.00
HC89017404	H. PYLORI BREATH (& KIT)-AU	301	83013	77.00	77.00
HC89017602	ARSENIC URINE (PNL)-AU	301	82175	13.00	26.56
HC89017610	LEAD(PNL)-AU	301	83655	7.00	3.22
HC89017628	MERCURY URINE (PNL)-AU	301	83825	11.00	3.22
HC89017636	CADMIUM(PNL)-AU	301	82300	33.00	33.00
HC89017644	COPPER(PNL)-AU	301	82525	3.00	3.00
HC89017651	ZINC, SERUM (PNL) -AU	301	84630	3.00	3.00
HC89017669	CHOLINESTERASE RBC(PNL)-AU	301	82482	14.00	13.05
HC89017677	GLOMERULAR BSMT MEM EL(PNL)-AU	301	83516	30.00	30.00
HC89017701	OLIGOCLONAL BANDS (PNL)-AU	301	83916	28.00	28.00
HC89017719	MYELIN BASIC PROTEIN(PNL)-AU	301	83873	30.00	29.10
HC89017727	IMMUNOGLOBULIN G(PNL)-AU	301	82784	9.00	8.75
HC89017735	APOLIPOPROTEIN A1(PNL)-AU	301	82172	15.00	15.00
HC89018055	TISSUE TRANSGLUTAMNS AB IGG-AU	301	83516	24.00	30.00
HC89018063	TISSUE TRANSGLUTAMNS AB IGA-AU	301	83516	6.00	6.00
HC89018071	CALCIUM FOR PTH(PNL)-QD	301	82310	170.00	170.00
HC89018121	CREATININE OTHER SRC (PNL)-QD	301	82570	98.00	98.00
HC89018139	17-KETOSTEROID FRACTIONAT'N-QD	301	83593	98.00	98.00
HC89018147	ANNEXIN AB V IGM -EC	301	83516	93.00	93.00
HC89018154	ANNEXIN AB V IGG -EC	301	83516	93.00	93.00
HC89018162	11-DEHYROTHROMBOXANE B2 UR-ES	301	84431	93.00	92.50
HC89018170	CREATININE URINE (PNL)-ES	301	82570	52.00	52.00
HC89018212	ALPHA-2 UR-AU	301	83883	19.00	18.50
HC89018253	IMMUNOGLOB IGA AR-AU	301	82784	7.00	6.00
HC89018378	TESTOSTERONE TOTL FEM/CHILD-AU	301	84403	17.00	12.00
HC89018386	KAPPA FREE LIGHT CHAINS QT-AU	301	83520	15.00	25.00
HC89018394	LAMBDA FREE LIGHT CHAINS QT-AU	301	83520	15.00	25.00
HC89018451	IMMUNOASSAY ANA QUANT (PNL)-PR	301	83520	24.00	23.05
HC89018469	CHEMILUMINESCENT ASSAY(PNL)-PR	301	82397	25.00	24.88
HC89019038	HYDROXYPROLINE TOTAL URINE -AU	301	83505	51.00	50.70
HC89019293	TSH RECEPTOR AB (TRAB)-AU	301	83520	31.00	34.50
HC89019434	FATTY ACID PROFILE, COMP -MA	301	82542	130.00	129.78
HC89019467	PROCALCITONIN (PCT) - AU	301	84145	180.00	180.00
HC89019558	GLIAD PEPTD AB IGA(PNL1155/6360)-PR	301	83520	28.00	28.00
HC89019566	GLIAD PEPTD AB IGG(PNL1155/6360)-PR	301	83520	28.00	28.00
HC89019574	ANTI-HU-TTG IGA (PNL1155/6360)-PR	301	83520	36.00	36.00
HC89019590	TOT SRM IGA NPHLMT(PNL1155/6360)-PR	301	82784	20.00	20.00
HC89019707	THYROGLOBULIN BY LC/MS/MS-AU	301	84432	60.00	69.00
HC89019731	HU AUTOANTIBODY TEST-AT	301	83516	405.00	405.00
HC89019764	ENZYME ACT-RBC(P TPMT ENZYME)-PR	301	82657	88.00	88.00
HC89019772	QUANT HPLC-6-MTG(P TPMT ENZYME)-PR	301	82542	88.00	88.00
HC89019780	QUANT HPLC 6-TGN RBC(P THIOPUR)-PR	301	82542	108.00	108.00
HC89019798	QUANT HPLC-6-MMPN RBC(P THIOPUR)-PR	301	82542	108.00	108.00
HC89019970	17 HYDROXYPREGNENOLONE -ES	301	84143	65.00	58.00
HC89020077	ASCA ELISA IGA SPECIFIC(PNL) -PR	301	83520	20.00	20.00
HC89020085	ASCA ELISA IGG SPECIF(PNL)-PR	301	83520	20.00	20.00
HC89020093	ANCA ELISA IGG SPECIF(PNL)-PR	301	83520	20.00	20.00
HC89020101	ANTI-OMPC ELISA IGA SPC(PN)-PR	301	83520	20.00	20.00
HC89020119	ANTI-CBIR1 ELISA(PNL)-PR	301	83520	20.00	20.00
HC89020127	ANTI-A4-FLE2 ELISA(PNL)-PR	301	83520	20.00	16.00
HC89020135	ANTI-FLA-X ELISA (PNL)-PR	301	83520	20.00	16.00
HC89020143	VEGF ELISA(PNL)-PR	301	83520	28.00	16.00
HC89020150	ICAM CHEMILUMINESCENT (PNL)-PR	301	82397	28.00	16.00
HC89020168	VCAM CHEMILUMINESCENT (PNL)-PR	301	82397	28.00	16.00
HC89020176	SAA CHEMILUMINESCENT (PNL)-PR	301	82397	28.00	16.00
HC89020275	LACTASE  (DISACCHARIDASE)-AU	301	82657	38.00	55.25
HC89020283	MALTASE (DISACCHARIDASE)-AU	301	82657	38.00	55.25
HC89020291	PALATINASE (DISACCHARIDASE)-AU	301	82657	38.00	56.13
HC89020309	SUCRASE (DISACCHARIDASE)-AU	301	82657	38.00	55.25
HC89020358	HEAT SHOCK PROTEIN 70-AU	301	84182	195.00	195.00
HC89020424	T3 UPTAKE-AU	301	84479	7.00	6.60
HC89020432	ZINC, WHOLE BLOOD -AU	301	84630	74.00	74.00
HC89020457	C-TELOPEPTIDE BETA-X-LINKED-AU	301	82523	40.00	84.00
HC89020465	IMMUNOGLB IGG EA -AU	301	82784	6.00	6.00
HC89020473	IMMUNOGLB IGM EA -AU	301	82784	6.00	6.00
HC89020507	CYSTATIN C, SERUM-AU	301	82610	60.00	60.00
HC89020846	HGB CHROMAT-SICKLE-AU	302	83021	9.00	9.00
HC89020895	17-D OH PROGES NEONATE STT -ES	301	83498	101.00	N/A
HC89020903	ALBUMIN; OTHER SRC: CSF -AU	301	82042	6.00	5.60
HC89020929	ANSER IFX-PR	300	84999	2,000.00	2,500.00
HC89020945	PANCREATIC ELASTERASE FEC-AU	301	83520	70.00	75.00
HC89020952	ARSENIC, FRACTIONATED-AU	301	82175	87.00	126.00
HC89021042	METANEPHRINES, PLASMA(FREE)-AU	301	83835	20.00	50.00
HC89021125	SOLUBLE IL-2R -CN	302	83520	309.00	309.00
HC89021216	MAG AUTOANTIBODY-AT	301	83520	285.00	272.50
HC89021315	HEAVY METAL QN EA;IODINE SERUM-AU	301	83018	165.00	N/A
HC89021372	PROCALCITONIN-U2	301	84145	70.00	N/A
HC89021430	PROGESTERONE QNT-HPLC MS/MS-AU	301	84144	23.00	22.50
HC89021448	MAGNESIUM RBC - AU	301	83735	54.00	N/A
HC89021554	THIOPURINE METABOL(CAT#3200)-PR	301	82542	216.00	N/A
HC89021570	PREGNENOLONE, SERUM/PLASMA-AU	301	84140	33.00	N/A
HC89021620	FETAL LUNG MATURITY L/S RATIO-AU	301	83661	117.00	N/A
HC89021638	SUGARS; SNGL QT GLYCOMARK EA SPEC -AU	301	84378	62.00	N/A
HC89021737	PHENCYCLIDINE (PCP) MEC(PNL)-AU	301	83992	131.25	N/A
HC89021778	CELIAC DX DUAL ANTIGEN SCREEN-AU	301	83516	39.00	N/A
HC89021919	DEOXYCORTICOSTERONE (DOC)-ES	301	82633	155.00	N/A
HC89022008	PROGESTERONE MASS SPECTROMETRY-ES	301	84144	54.00	N/A
HC89022131	PHENCYCLIDINE (PCP)SERUM QNT(PNL)-AU	301	83992	77.00	N/A
HC89022149	ANGIOTENSIN CONVERT ENZYME CSF -AU	301	82164	20.00	N/A
HC89022164	ANTIBODY ACETYLCHOLINE RCPTR MODULTNG -AU	301	83516	44.00	N/A
HC89022511	OROTIC ACID QUANT URINE -AU	301	83921	100.25	N/A
HC89022529	ANSER IFX SUBSEQUENT MEASUREMENTS-PR	300	84999	300.00	N/A
HC89022560	ANDROSTENEDIONE-QN	301	82157	54.00	N/A
HC89022578	CORTICOSTERONE-QN	301	82528	50.50	N/A
HC89022586	CORTISOL-QN	301	82533	21.38	N/A
HC89022594	CHROMATOGRAPHY/SPECTROMETRY QL/QN-QN	301	82542	185.00	N/A
HC89022602	DHEA-QN	301	82626	71.54	N/A
HC89022610	DEOXYCORTICOSTERONE (DOC)-QN	301	82633	215.00	N/A
HC89022628	11 DEOXYCORTISOL-QN	301	82634	60.00	N/A
HC89022636	PREGNENOLONE-QN	301	84140	117.00	N/A
HC89022644	17-HYDROXYPREGNENOLONE-QN	301	84143	64.96	N/A
HC89022651	PROGESTERONE-QN	301	84144	26.66	N/A
HC89022669	TESTOSTERONE TOTAL-QN	301	84403	35.82	N/A
HC89022735	CALPROTECTIN FECAL-AU	301	83993	95.00	N/A
HC89022776	ANSER VDZ-PR	300	84999	2,000.00	N/A
HC89022784	ANSER VDZ SUBSEQUENT MEASUREMENTS-PR	300	84999	300.00	N/A
HC89022800	CHOLESTEROL FLUID SPECTROPHTMTRY-AU	301	84311	11.00	N/A
HC89022818	SPECIFIC GRAVITY FLUID -U2	301	84315	14.00	N/A
HC89022883	AMYLASE, BODY FLUID-AU	301	82150	12.00	N/A
HC89022891	BILIRUBIN, TOTAL BODY FLUID-AU	301	82247	9.00	N/A
HC89022909	BILIRUBIN SERUM(PANEL)-AU	301	82247	44.00	N/A
HC89022917	CHLORIDE, BODY FLUID-AU	301	82438	10.00	N/A
HC89022925	CREATININE, BODY FLUID-AU	301	82570	9.00	N/A
HC89022933	LIPASE, BODY FLUID-AU	301	83690	10.00	N/A
HC89022941	SODIUM, BODY FLUID-AU	301	84302	10.00	N/A
HC89022958	NET ABSORBANCE, BILIRUBIN CSF(PANEL)-AU	301	84311	32.00	N/A
HC89022966	NET ABSORBANCE, OXYHEMOGLOBIN, CSF(PANEL)-AU	301	84311	32.00	N/A
HC89022974	TRIGLYCERIDES, BODY FLUID-AU	301	84478	10.00	N/A
HC89022982	UREA NITROGEN, BODY FLUID-AU	301	84520	9.00	N/A
HC89022990	POTASSIUM, BODY FLUID-AU	301	84999	11.00	N/A
HC89023006	CARCINOEMBRYONIC ANTIGEN (CEA) BODY FLUID-AU	301	82378	17.40	N/A
HC89023014	ACTH-QN	301	82024	112.00	N/A
HC89023022	DHEA SULFATE-QN	301	82627	24.00	N/A
HC89023030	RENIN-QN	301	84244	35.00	N/A
HC89023121	ELECTRO FRAC AND QUANT URINE-AU	301	84166	16.00	N/A
HC89023139	KAPPA FREE LIGHT CHAINS QT URINE-AU	301	83520	37.00	N/A
HC89023147	LAMBDA FREE LIGHT CHAINS QT URINE-AU	301	83520	37.00	N/A
HC89023154	ENZYME ACTIVITY NONRAD; DISACCHARIDASE-AU	301	82657	80.00	N/A
HC89023162	ENZYME ACTIVITY LYSOSOME-JU	301	82657	800.00	N/A
HC89023196	ESTRADIOL-QN	301	82670	60.00	N/A
HC89023204	ALDOSTERONE-QN	301	82088	81.50	N/A
HC89023212	LAMELLAR BODY DENSITY FETAL LUNG-U2	301	83664	45.00	N/A
HC89023238	LAMBDA FREE LIGHT CHAINS QT URINE(IFE)-AU	301	83520	14.00	N/A
HC89023246	KAPPA FREE LIGHT CHAINS QT URINE(IFE)-AU	301	83520	14.00	N/A
HC89023261	TOTAL PROTEIN URINE (IFE)-AU	301	84156	10.00	N/A
HC89023311	INTERLEUKIN 6-AU	301	83520	65.00	N/A
HC89023329	B-TYPE NATRIURETIC PEPTIDE-AU	301	83880	60.00	N/A
HC89023360	HEMOGLOBIN GLYCATED (A1C)-U2	301	83036	25.00	N/A
HC89023444	HISTAMINE, URINE-AU	302	83088	25.00	N/A
HC89091276	ALBUMIN; OTHER SRC - AU	301	82042	6.00	5.60
HC89091367	ANTI-MULLERIAN HORMONE-AU	302	83520	63.00	98.00
HC81100091	ACETAMINOPHEN/TYLENOL; 1-2	301	80143	400.00	92.00
HC81100299	CARBAMAZEPINE  TOTAL	301	80161	409.00	98.00
HC81100380	ALCOHOL; 1-2	301	80320	374.00	85.00
HC81100729	SALICYLATES; 1-2	301	80179	314.00	56.75
HC81100968	CAFFEINE	301	80155	405.00	107.75
HC81100976	METHOTREXATE	301	80204	536.00	117.00
HC81101925	DRUG TEST PRESUMP DIRECT OBSERV/ DOS	301	80305	236.00	13.00
HC81101933	DRUG TEST PRESUMP DIR OPT INSTRMNT ASS'T/ DOS	301	80306	285.00	17.00
HC81101941	DRUG TEST PRESUMPTIVE CHEM ANALYZERS/ DOS	301	80307	597.00	62.00
HC81101958	DRUG TST DEFNTV 1-7RX CLSS W/METBLTS/DAY	301	G0480	749.00	172.00
HC81101966	DRUG TST DEFNTV 8-14RX CLSS W/METBLTS/DAY	301	G0481	901.00	235.00
HC81101974	DRUG TST DEFNTV15-21RX CLSS W/METBLTS/DAY	301	G0482	1,076.00	298.00
HC81101982	DRUG TST DEFNTV 22/>RX CLSS W/METBLTS/DAY	301	G0483	1,254.00	370.00
HC89001341	METHAQUALONE DEF 1-7CLS-AU	301	80368	148.00	148.00
HC89001853	AMIODARONE-QD	301	80151	60.00	60.00
HC89002000	DESIPRAMINE; 1-2-AU	301	80335	17.00	16.50
HC89002034	CYCLOSPORINE-U2	301	80158	45.00	45.00
HC89002042	METHOTREXATE-QD	301	80204	60.00	60.00
HC89002596	CAFFEINE-U2	300	80155	26.00	26.00
HC89002794	GABAPENTIN (SERUM)-QD	301	80171	60.00	60.00
HC89003586	EPHEDRINE; 1-2 URINE-AU	301	80324	115.00	115.00
HC89003610	MEPERIDINE ANLG; 1-2 URINE-AU	301	80361	103.00	103.00
HC89003651	FLECAINIDE-QD	301	80181	60.00	60.00
HC89004055	CLOMIPRAMINE; 1-2-AU	301	80335	16.00	16.00
HC89005797	LAMOTRIGINE-QD	301	80175	60.00	60.00
HC89005805	CYCLOSPORINE-QD	301	80158	N/A	N/A
HC89005821	AMIODARONE-AU	301	80151	18.38	19.50
HC89005920	DRUG SCREEN NONFORENSIC SRM^DOS-AU	301	80307	39.00	88.35
HC89005961	DRUGS OF ABUSE TEST-DTI 7A-AU	301	80307	27.00	24.80
HC89006159	DS AMPHETAMINE 1-2-AU	301	80324	31.00	N/A
HC89006167	FLUPHENAZINE; 1-3-AU	301	80342	18.00	17.50
HC89006191	METHADONE &METABOLITE QUANT URINE-AU	301	80358	36.00	39.00
HC89006217	DS OPIATES SGL METHD^DOS-AU	301	80307	N/A	N/A
HC89006258	CANNABINOIDS, NATURAL(THC)-AU	301	80349	20.00	N/A
HC89006290	AMITRIPTYLINE (ANTIDEPR)1 OR 2-AU	301	80335	24.00	12.00
HC89006308	ALPRAZOLAM (BENZODZEPNS) 1-12-AU	301	80346	40.00	39.60
HC89006332	BENZODIAZEPINES; 1-12-AU	301	80346	31.00	43.60
HC89006381	CLONAZEPAM; 1-12-AU	301	80346	29.00	28.80
HC89006399	DIAZEPAM; 1-12-AU	301	80346	30.00	29.70
HC89006415	LIBRIUM; 1-12-AU	301	80346	21.00	20.70
HC89006423	LORAZEPAM; 1-12-AU	301	80346	34.00	16.00
HC89006431	CLORAZEPATE; 1-12-AU	301	80346	N/A	N/A
HC89006456	CYCLOSPORIN A-U2	301	80158	N/A	N/A
HC89006464	CYCLOSPORINE -CA	301	80158	N/A	N/A
HC89006472	CYCLOSPORINE-AU	301	80158	22.00	16.00
HC89006498	DOXEPIN; 1-2 SRM/PLSM-AU	301	80335	27.00	26.40
HC89006522	IMIPRAMINE; 1-2-AU	301	80335	6.00	17.50
HC89006548	NORTRIPTYLINE; 1-2-AU	301	80335	17.03	14.40
HC89006662	CLOZAPINE-AU	301	80159	24.00	18.00
HC89006688	DIPHENHYDRAMINE SERUM/PLASMA-AU	301	80375	90.00	90.00
HC89006720	FLECAINIDE-AU	301	80181	28.65	19.50
HC89006738	GABAPENTIN (SERUM)-AU	301	80171	19.00	16.00
HC89006746	IBUPROFEN; 1-2-AU	301	80329	16.00	16.00
HC89006761	LAMOTRIGINE-AU	301	80175	10.00	15.00
HC89006803	METHOTREXATE-QN	301	80204	N/A	N/A
HC89006811	METHOTREXATE-AU	301	80204	16.00	16.00
HC89006845	OXCARBAZEPINE METABOLITE-AU	301	80183	20.00	24.80
HC89006852	OXCARBAZEPINE METABOLITE-QD	301	80183	60.00	60.00
HC89006878	PROTRIPTYLINE; 1-2-AU	301	80335	18.00	17.50
HC89006928	TRAZODONE; 1-2-AU	301	80338	20.00	19.50
HC89006936	TRIMIPRAMINE-AU	301	80375	113.00	113.00
HC89007314	BARBITURATES QUANTITATIVE EA SPEC-U2	301	80345	42.00	42.00
HC89007322	BUTALBITAL/FLORINAL-AU	301	80345	16.00	15.60
HC89007330	PENTOBARBITAL-AU	301	80345	16.00	16.00
HC89007637	DIURETIC SCREEN, URINE - AU	301	80377	126.00	125.59
HC89007645	TRIMIPRAMINE & METAB QUANT-AU	301	80335	N/A	N/A
HC89008965	MEPROBAMATE; 1-2-AU	301	80369	18.00	17.50
HC89009005	METHADONE &METABOLITE QUANT SERUM-AU	301	80358	73.00	72.62
HC89009039	METHSUXIMIDE; 1-3-AU	301	80339	16.00	16.00
HC89009070	ASSAY NICOTINE-AU	301	80323	68.00	67.71
HC89009435	MEPERIDINE ANLG; 1-2 SRM/PLSM-AU	301	80361	83.00	82.50
HC89013437	FLUOXETINE; 1-2-AU	301	80332	32.00	16.00
HC89013866	CHLORPROMAZINE; 1-3-AU	301	80342	65.00	59.10
HC89015077	NORTRIPTYLINE(PNL); 3-5-AU	301	80336	12.00	12.00
HC89015093	MYCOPHENOLIC ACID-AU	301	80180	24.00	20.00
HC89015267	PENTOBARBITAL-U2	301	80345	42.00	42.00
HC89015309	ALCOHOL; 1-2 (URINE)-QD	301	80320	17.00	17.00
HC89015465	ASSAY NICOTINE-QD	300	80323	11.00	11.00
HC89016901	NORDIAZEPAM; 1-12-AU	301	80346	21.00	20.70
HC89017123	CYCLOSPORINE-U4	301	80158	75.00	75.00
HC89017222	METHOTREXATE-U2	301	80204	55.00	55.00
HC89019756	OXYCODONE CONFIRM URINE -AU	301	80365	10.00	39.00
HC89020481	BENZODIAZEPINES ;13 OR > URINE-AU	301	80347	43.00	39.00
HC89021489	DS BARBITURATES CONFIRM-AU	301	80345	59.00	N/A
HC89021497	DS COCAINE CONF-AU	301	80353	34.25	N/A
HC89021505	DRUG SCREEN NONFORENSIC URN^DOS-AU	301	80307	39.00	N/A
HC89021596	DRUG SCRN, TOF PRESUMP-AU	301	80307	78.00	N/A
HC89021604	DS BENZODIAZEPINES DETECT/PRESUMP-AU	301	80307	17.00	N/A
HC89021612	DRUGS OF ABUSE SCR STIM AMINES,URINE-AU	301	80307	17.00	N/A
HC89021646	DRUGS OF ABUSE SCRN MEC W-RFLX CONF(PNL)-AU	301	80307	30.00	N/A
HC89021653	AMPHETAMINES;1 OR 2 MEC(CONF PNL)-AU	301	80324	47.50	N/A
HC89021661	BARBITURATES MEC(PNL)-AU	301	80345	135.50	N/A
HC89021679	BENZODIAZEPINES; 1-12 MEC(PNL)-AU	301	80346	128.75	N/A
HC89021687	CANNABINOIDS, NATURAL MEC(PNL)-AU	301	80349	50.00	N/A
HC89021695	COCAINE MEC(PNL)-AU	301	80353	98.88	N/A
HC89021703	METHADONE MEC(PNL)-AU	301	80358	98.38	N/A
HC89021711	OPIATES, 1 OR MORE MEC(PNL)-AU	301	80361	32.50	N/A
HC89021729	BUPRENORPHINE MEC(PNL)-AU	301	80348	79.00	N/A
HC89021745	AMPHETAMINES(MDA,MDEA,MDMA)MEC(CONF PNL)-AU	301	80359	47.50	N/A
HC89021752	OXYCODONE MEC(PNL)-AU	301	80365	32.50	N/A
HC89021760	OPIATES CNFRM/QNT 1/> URINE -AU	301	80361	10.00	N/A
HC89021968	ANTIDEPRSSNTS TRICYCL =6/> QUANT UR -AU	301	80337	36.75	N/A
HC89021984	LEVETIRACETAM (KEPPRA) -AU	301	80177	33.00	N/A
HC89022024	DRUG SCRN 9 SERUM W-RFLX CONF(PNL)-AU	301	80307	51.00	N/A
HC89022032	AMPHETAMINES;1 OR 2 SERUM QNT(PNL)-AU	301	80324	30.00	N/A
HC89022040	BARBITURATES SERUM QNTS(PNL)-AU	301	80345	76.00	N/A
HC89022057	BENZODIAZEPINES 1-12 SERUM QNTS(PNL)-AU	301	80346	35.00	N/A
HC89022065	BUPRENORPHINE&METABLTS SERUM QNTS(PNL)-AU	301	80348	58.63	N/A
HC89022073	CANNABINOIDS NATURAL SERUM QNT(PNL)-AU	301	80349	54.00	N/A
HC89022081	COCAINE SERUM QNT(PNL)-AU	301	80353	48.63	N/A
HC89022099	METHADONE&METABOLITE SERUM QNT(PNL)-AU	301	80358	61.13	N/A
HC89022107	METHAMPHETAMINES(MDA,MDEA,MDMA)SERUM QNTS(PNL)-AU	301	80359	33.00	N/A
HC89022115	OPIATES 1 OR MORE SERUM QNT(PNL) -AU	301	80361	28.00	N/A
HC89022123	OXYCODONE SERUM QNT(PNL) -AU	301	80365	28.00	N/A
HC89022156	CAFFEINE SERUM/PLASMA - AU	301	80155	40.25	N/A
HC89022826	ALCOHOL; 1-2 (URINE)-U2	301	80320	23.00	N/A
HC89023188	VORICONAZOLE ANTIFNGL-AU	301	80285	53.00	N/A
HC89023352	DIGITOXIN QUANTITATIVE-AU	301	80375	89.00	N/A
HC36800647	HEMOGLOBIN	305	85018	94.00	10.25
HC51000495	HEMOGLOBIN (POS - EG:HEMACUE)	305	85018	24.00	N/A
HC51001907	CBC WITH AUTOMATED DIFF	305	85025	78.00	32.50
HC51001915	WBC MANUAL DIFF	305	85007	33.00	N/A
HC51001923	RETICULOCYTE MANUAL	305	85044	45.00	45.00
HC51001931	CBC W/O DIFF	305	85027	62.00	29.75
HC51061646	RETICULOCYTE - AUTO	305	85045	44.00	42.00
HC81500027	PLATELET COUNT- AUTO	305	85049	163.00	36.75
HC81500035	RETICULOCYTE - AUTO	305	85045	130.00	42.00
HC81500043	SED RATE NON-AUTO	305	85651	128.00	46.00
HC81500068	CBC WITH AUTOMATED DIFF	305	85025	252.00	32.50
HC81500076	PROTHROMBIN TIME	305	85610	159.00	17.75
HC81500084	PTT (APTT)	305	85730	243.00	33.50
HC81500092	BLEEDING TIME	305	85002	180.00	62.75
HC81500100	D-DIMER QT ULTRA-SENS OR STD	305	85379	335.00	99.25
HC81500118	ACTIVATED COAG TIME	305	85347	174.00	43.00
HC81500126	D-DIMER QUAL OR SEMI-QT	305	85378	263.00	106.00
HC81500134	FIBRINOGEN	305	85384	270.00	56.75
HC81500159	CBC W/O DIFF	305	85027	180.00	29.75
HC81500167	WBC MANUAL DIFF	305	85007	147.00	30.00
HC81500175	PLATELET AGG EPINEPHRINE	305	85576	339.00	109.00
HC81500183	PLATELET AGG EA AGENT	305	85576	346.00	109.00
HC81500225	CELL COUNT CORD BLOOD	305	85027	160.00	29.75
HC81500233	BLOOD COUNT/WBC (EOS)	305	85032	162.00	45.75
HC81500241	FACTOR 8 INHIB/TITR	305	85335	360.00	223.75
HC81500274	WBC AUTO DIFF	305	85004	84.00	29.00
HC81500282	BUFFY COAT	305	85009	160.00	112.75
HC81500290	HEMATOCRIT	305	85014	98.00	10.25
HC81500308	HEMOGLOBIN	305	85018	101.00	10.25
HC81500316	MANUAL CELL COUNT RED/LEUK/PLT	305	85032	155.00	81.50
HC81500324	RETICULOCYTE MANUAL	305	85044	132.00	45.00
HC81500332	BONE MARROW SMEAR INTERP	305	85097	673.00	770.00
HC81500340	FACTOR II PT SPECIFIC	305	85210	382.00	140.75
HC81500357	FACTOR V LABILE	305	85220	428.00	140.75
HC81500365	FACTOR VII STABLE	305	85230	414.00	140.75
HC81500373	FACTOR VIII RELATED AG	305	85244	477.00	126.75
HC81500381	FACTOR VIII VW	305	85245	500.00	201.75
HC81500399	FACTOR VIII VW MULTI	305	85247	377.00	285.00
HC81500407	FACTOR X	305	85260	422.00	140.75
HC81500415	FACTOR XI PTA	305	85270	423.00	140.75
HC81500423	FACTOR XII	305	85280	439.00	140.75
HC81500431	ANTITHROMBIN III	305	85300	386.00	128.00
HC81500449	ANTITHROMBIN III AG	305	85301	249.00	118.00
HC81500456	INHIB PROTEIN C AG	305	85302	258.00	118.00
HC81500464	INHIB PROTEIN C ACTIVITY	305	85303	392.00	148.50
HC81500472	INHIB PROTEIN S TOTAL	305	85305	283.00	222.75
HC81500480	ACTIVATED PROT C RESISTANCE	305	85307	347.00	135.00
HC81500498	FACTOR INHIBITOR TEST	305	85335	472.00	223.75
HC81500506	COAG TIME OTHER METHODS	305	85348	161.00	38.00
HC81500514	D-DIMER ULTRA SENSITIVE	305	85380	293.00	94.00
HC81500522	HEINZ BODIES DIRECT	305	85441	116.00	58.25
HC81500530	KLEIHAUER-BETKE	305	85460	332.00	126.00
HC81500548	HEMOLYSIN ACID	305	85475	184.00	64.25
HC81500555	HEPARIN ASSAY	305	85520	350.00	126.00
HC81500563	LEUKOCYTE ALK PHOS W/ COUNT	305	85540	210.00	86.00
HC81500571	OSMOTIC FRAGILITY UNINCUBATED	305	85555	169.00	125.00
HC81500589	OSMOTIC FRAG INCUBATED	305	85557	288.00	124.75
HC81500597	PT SUBS PLASMA FRACTIONS EA	305	85611	213.00	71.50
HC81500605	SICKLE CELL SCREEN	305	85660	150.00	42.00
HC81500613	THROMBIN TIME	305	85670	181.00	62.75
HC81500621	APTT SUBS PLASMA FRACTIONS EA	305	85732	259.00	84.53
HC81500639	BLOOD SMEAR SCAN	305	85008	73.00	17.50
HC81500670	FACTOR IX ASSAY	305	85250	457.00	140.75
HC81500688	FACTOR VIII ASSAY	305	85240	414.00	140.75
HC81500696	FACTOR XIII ASSAY	305	85290	306.00	195.00
HC81500704	FIBRIN SPLIT PRODUCTS	305	85362	272.00	82.75
HC81500720	PROTAMINE SULFATE/PARACOAG	305	85366	252.00	76.50
HC81500738	FACTOR XIII SCREEN	305	85291	188.00	57.00
HC81500753	HEPARIN NEUTRALIZATION	305	85525	217.00	93.00
HC81500761	SED RATE AUTOMATED	305	85652	100.00	26.75
HC81500787	BLOOD COUNT LEUKOCYTE(WBC)AUTO	305	85048	88.00	38.00
HC81500803	HEMATOCRIT SPUN	305	85013	117.00	30.75
HC81500837	PLATELET AGG PLAVIX RESISTANCE	305	85576	298.00	109.00
HC81500860	HEMATOCRIT (POS)	305	85014	98.00	10.25
HC81500878	PROTHROMBIN TIME (POS)	305	85610	144.00	17.75
HC81500886	RETICULOCYTE MULTI PARAMETERS	305	85046	164.00	52.00
HC81500894	RETICULATED PLATELET ASSAY	305	85055	313.00	110.40
HC81500902	HEPARIN PROTAMINE TOLERANCE	305	85530	159.00	95.00
HC81500910	INHIB CLOT PROTEIN S FREE (FUNC)	305	85306	447.00	200.00
HC82200486	BONE MARROW SMEAR INTERP	305	85097	710.00	770.00
HC83000265	ROSETTE TEST,FETAL HGB	305	85461	180.00	84.00
HC83500090	BONE MARROW SMEAR INTERP-IM	305	85097	N/A	N/A
HC84200245	WBC IN FECES	300	89055	132.00	59.00
HC85100469	WBC MANUAL DIFF	305	85007	29.00	N/A
HC85100477	CBC WITH AUTOMATED DIFF	305	85025	69.00	N/A
HC85100485	CBC W/O DIFF	305	85027	55.00	N/A
HC85100493	RETICULOCYTE MANUAL	305	85044	41.00	N/A
HC85100501	RETICULOCYTE - AUTO	305	85045	40.00	N/A
HC89001127	VISCOSITY-QD	305	85810	12.00	11.54
HC89002208	FACTOR XII-U2	305	85280	N/A	N/A
HC89002216	FACTOR X-U2	305	85260	N/A	N/A
HC89002224	FACTOR V LABILE-U2	305	85220	N/A	N/A
HC89002315	EUGLOBULIN CLOT LYSIS-QD	305	85360	N/A	N/A
HC89002323	FACTOR VII STABLE-U2	305	85230	N/A	N/A
HC89002331	FACTOR VIII ASSAY-U2	305	85240	N/A	N/A
HC89002349	FACTOR IX ASSAY-U2	305	85250	N/A	N/A
HC89002398	PLATELET AGG EA AGENT-U2	305	85576	N/A	N/A
HC89002604	KLEIHAUER BETKE-U2	305	85460	N/A	N/A
HC89002745	ACTIVATED PROT C RESISTANCE-QD	301	85307	N/A	N/A
HC89002851	PLASMINOGEN ACTIVITY-QD	305	85421	N/A	N/A
HC89003057	FACTOR INHIBITOR TEST-U2	301	85335	N/A	N/A
HC89003396	FACTOR XI-U2	305	85270	N/A	N/A
HC89003404	FACTOR XIII ASSAY-U2	305	85290	N/A	N/A
HC89003412	FACTOR VIII VW AG-U2	305	85246	N/A	N/A
HC89003420	FACTOR VIII RELATED AG-U2	305	85244	N/A	N/A
HC89003438	FACTOR VIII VW-U2	305	85245	N/A	N/A
HC89004022	HEPARIN ANTI-XA -AU	305	85520	85.00	110.00
HC89004121	FIBRINOGEN ANTIGEN-AU	305	85385	39.00	39.00
HC89004139	ACTIVATED PROT C RESISTANCE-AU	305	85307	21.00	21.30
HC89004147	HEXA P'LIPID NEUTRALIZATION-AU	305	85597	75.00	75.00
HC89004485	THROMBIN TIME-AU	305	85670	15.00	14.70
HC89004865	DRVVT RUSS VIPER VENOM 1:1MIX RFX-AU	305	85613	13.00	11.10
HC89004873	DRVVT RUSS VIPER VNM CONFIRM RFX-AU	305	85613	23.00	23.40
HC89004881	PTT-D CORR RFX- AU	305	85732	11.00	10.80
HC89004899	PLAT NEUT RFX - AU	305	85597	39.00	38.70
HC89005342	FIBRINOGEN ANTIGEN-EC	305	85385	130.00	130.00
HC89005870	FACTOR VIII VW MULTI-AU	305	85247	33.10	62.98
HC89010615	FACTOR VIII VW-AU	305	85245	26.00	33.00
HC89010623	FACTOR VIII VW AG-AU	305	85246	24.00	25.50
HC89010631	ANTITHROMBIN III-AU	305	85300	22.78	25.50
HC89010649	ANTITHROMBIN III AG-AU	305	85301	21.18	23.70
HC89010656	INHIB PROTEIN C AG-AU	301	85302	N/A	N/A
HC89010664	INHIB PROTEIN C ACTIVITY-AU	301	85303	24.00	24.00
HC89010672	INHIB PROTEIN S TOTAL-AU	301	85305	15.00	15.00
HC89010680	INHIB PROTEIN S FREE (FUNC)-AU	301	85306	16.00	16.00
HC89010698	EUGLOBULIN CLOT LYSIS-AU	305	85360	N/A	N/A
HC89010706	PLASMINOGEN ACTIVATOR INH-1-AU	305	85415	54.00	54.00
HC89010714	PLASMINOGEN-AU	305	85420	22.00	21.30
HC89010722	LEUKOCYTE ALKALINE PHOS-AU	305	85540	60.00	60.00
HC89010730	MURAMIDASE-AU	305	85549	16.50	13.80
HC89010748	MURAMIDASE-MA	305	85549	N/A	N/A
HC89010755	OSMOTIC FRAGILITY UNINCUBAT-AU	305	85555	72.73	75.00
HC89010763	PLATELET NEUT-AU	305	85597	42.00	42.00
HC89010771	PROTHROMBIN -AU	305	85610	10.00	9.70
HC89010789	DRVVT RUSS VIPER VENOM-AU	305	85613	14.00	8.60
HC89010797	PARTIAL THROMBOPLASTIN-AU	305	85730	11.00	10.80
HC89010805	PTT 1:1 MIX-AU	305	85732	N/A	N/A
HC89010813	VISCOSITY-AU	305	85810	11.00	10.50
HC89014013	KLEIHAUER BETKE-AU	305	85460	124.00	123.12
HC89015614	FACTOR VIII ASSAY-QD	305	85240	20.00	20.00
HC89015622	FACTOR VIII VW AG-QD	305	85246	20.00	20.00
HC89015630	ANTITHROMBIN III-QD	305	85300	19.00	19.00
HC89015648	ANTITHROMBIN III AG-QD	305	85301	22.00	22.00
HC89015655	INHIB PROTEIN C ACTIVITY-QD	301	85303	27.00	27.00
HC89015663	INHIB PROTEIN S FREE (FUNC)-QD	301	85306	30.00	30.00
HC89015671	FIBRINOGEN-QD	305	85384	13.00	13.00
HC89015689	LEUKOCYTE ALKALINE PHOS-QD	305	85540	26.00	26.00
HC89016216	FIBRIN SPLIT PRODUCTS-QD	305	85362	4.00	4.00
HC89016745	FACTOR VIII ASSAY-AU	305	85240	20.00	19.50
HC89017099	THROMBIN TIME 1:1 MIX-AU	305	85670	17.00	16.50
HC89017107	REPTILASE TIME-AU	305	85635	28.00	27.60
HC89017115	REPTILASE TIME 1:1 MIX-AU	305	85635	30.00	29.10
HC89017438	HEXAGONL PHOSLPD NEUTLZ RFX-AU	305	85597	75.00	75.00
HC89017446	PTT HEPARIN NEUTRALZ RFX - AU	305	85525	39.00	38.70
HC89017453	REPTILASE TIME RFX- AU	305	85635	28.00	27.60
HC89017461	THROMBIN TIME RFX - AU	305	85670	15.00	14.70
HC89018089	VON WILLEBRAND FACT 2N BIND-EC	305	85246	172.00	172.00
HC89018204	FACTOR VIII ASSAY -EC	305	85240	125.00	125.00
HC89018220	FACTOR VIII VW AG-EC	305	85246	81.00	81.00
HC89018238	FACTOR VIII INHIBITOR-EC	305	85335	40.00	40.00
HC89018246	PLATELET NEUT-EC	305	85597	112.00	111.60
HC89018287	FACTOR VIII BETHESDA TITER(PNL) -EC	305	85335	102.00	101.60
HC89018295	FACTOR IX ASSAY -EC	305	85250	163.00	162.75
HC89018303	FACTOR IX BETHESDA TITER(PNL) -EC	305	85335	130.00	129.50
HC89018311	FACTOR V ASSAY -EC	305	85220	163.00	162.75
HC89018329	FACTOR VII ASSAY-EC	305	85230	145.00	144.50
HC89018337	FACTOR X ASSAY -EC	305	85260	163.00	162.75
HC89018345	FACTOR XI ASSAY -EC	305	85270	163.00	162.75
HC89018352	FACTOR XII ASSAY -EC	305	85280	163.00	162.75
HC89018360	FACTOR XIII ASSAY -EC	305	85290	163.00	162.75
HC89018956	HEINZ BODIES DIRECT-AU	305	85441	42.00	54.96
HC89018964	HEINZ BODIES INDUCED-AU	305	85445	77.00	89.04
HC89019269	FACTOR VIII VW FACTOR AG-OS	305	85246	90.00	90.00
HC89019277	FACTOR VIII INHIBITOR-OS	305	85335	90.00	90.00
HC89021158	FACTOR VIII INHIBITOR TEST(PNL) -EC	305	85240	122.00	121.60
HC89021166	FACTOR IX INHIBITOR TEST(PNL) -EC	305	85250	150.00	149.50
HC89021174	FACTOR VIII ACTIVITY -EC	305	85240	163.00	162.75
HC89021976	FACTOR XIII ASSAY -AU	305	85290	125.00	N/A
HC89023220	FIBRINOLYSIS COAG ADAMTS-13-AU	305	85397	113.50	N/A
HC89023394	FACTOR INHIBITOR ADAMTS13-AU	305	85335	175.00	N/A
HC89500953	HEMOGLOBIN SICKLE TESTING-SB	305	85660	46.00	N/A
HC29000296	TB TEST (PPD) PROCEDURE	761	86580	134.00	N/A
HC51002095	TB TEST (PPD) PROCEDURE	510	86580	85.00	N/A
HC81101248	C-REACTIVE PROTEIN	302	86140	142.00	41.00
HC81101255	C-REACTIVE PROTEIN HI SENS	302	86141	179.00	65.75
HC81101289	C3 COMPLEMENT	302	86160	273.00	94.25
HC81101297	C4 COMPLEMENT	302	86160	273.00	94.25
HC81101834	HEPATITIS C VIRUS (DA)	302	86803	191.00	40.00
HC81700007	MONOSPOT TEST	302	86308	161.00	79.75
HC81700015	RHEUMATOID FACTOR QUAL	302	86430	132.00	42.50
HC81700023	FTA ABSORPTION	302	86780	198.00	70.00
HC81700031	RHEUMATOID FACTOR QUANT	302	86431	132.00	44.50
HC81700262	ANTI-NUCLEAR AB EIA	302	86038	182.00	87.25
HC81700270	CARDIOLIPIN AB EA IG CLASS	302	86147	261.00	71.25
HC81700288	COMPLEMENT TOT HEMOLYTIC CH50	302	86162	290.00	144.00
HC81700296	DNA DOUBLE STRAND AB IGG EIA	302	86225	160.00	46.00
HC81700304	EXTRCTBL NUCLEAR AG AB TO ECH	302	86235	217.00	94.50
HC81700312	CA 27-29	302	86300	284.00	68.50
HC81700320	CA 19-9	302	86301	262.00	76.00
HC81700338	CA 125	302	86304	269.00	105.50
HC81700346	HETEROPHILE AB TITER	302	86309	114.00	67.00
HC81700353	IMMUNOFIXATION ELECTROPHORESIS	302	86334	269.00	152.25
HC81700361	CD3 ABSOLUTE COUNT	302	86359	426.00	140.46
HC81700379	CD4 AND CD8 COUNT WITH RATIO	302	86360	459.00	209.04
HC81700387	RPR/VDRL SPINAL FLUID/QUAL.	302	86592	120.00	53.25
HC81700395	RPR/VDRL QUAL	302	86592	120.00	21.50
HC81700403	RPR/VDRL QUANT	302	86593	140.00	53.25
HC81700411	HELICOBACTER PYLORI IGG AB	302	86677	217.00	130.75
HC81700429	HIV-1 & HIV-2 AB SNGL ASSAY	302	86703	211.00	69.50
HC81700437	HEPATITIS B CORE AB, TOT	302	86704	206.00	84.75
HC81700445	HEPATITIS B CORE AB IGM	302	86705	207.00	85.00
HC81700452	HEPATITIS B SURFACE AB	302	86706	198.00	82.28
HC81700460	HEPATITIS A ANTIBODY	302	86708	210.00	97.25
HC81700478	RUBELLA SCREEN	302	86317	150.00	94.50
HC81700486	RUBEOLA AB IGG	302	86765	225.00	82.50
HC81700494	VARICELLA AB	302	86787	198.00	79.75
HC81700502	THYROGLOBULIN AB	302	86800	193.00	80.75
HC81700510	HEPATITIS C AB	302	86803	208.00	87.00
HC81700528	HLA B27	302	86812	264.00	140.00
HC81700650	ANA TITER	302	86039	183.00	86.38
HC81700668	ASO TITER	302	86060	118.00	30.25
HC81700676	ASO SCREEN	302	86063	103.00	43.00
HC81700684	ANTI SMOOTH MUSC/RNP AB	302	86235	214.00	94.25
HC81700692	SJORGEN SYNDROME AB SSA EIA	302	86235	217.00	94.50
HC81700700	SJORGEN SYNDROME AB SSB EIA	302	86235	217.00	94.25
HC81700718	SMITH ANTIBODY EIA	302	86235	217.00	94.25
HC81700726	ANTI-DNA (DS)	302	86256	155.00	66.25
HC81700734	CENTROMERE AB	302	86256	155.00	66.25
HC81700742	CRYPTOCUCCUS AG - SERUM	302	86256	198.00	66.25
HC81700759	MYOCARDIAL AB	301	86256	155.00	66.25
HC81700767	IMMUNOFIX ELECTPH URINE	302	86325	256.00	113.50
HC81700775	THYROID PEROXIDASE AB BY EIA	302	86376	183.00	54.00
HC81701112	IMMUNOELECTROPHERESIS-SRM	302	86320	269.00	125.00
HC81701120	PARTICLE AGGLUT TITER EACH AB	302	86406	207.00	120.00
HC81701138	HEP A ANTIBODY IGM	302	86709	202.00	91.00
HC81701161	HTLV I & II	302	86687	161.00	62.00
HC81701179	HIV 1 AB	302	86701	198.00	100.00
HC81701393	MUMPS AB IGG	302	86735	159.00	60.25
HC81701450	B CELL TOTAL COUNT	302	86355	344.00	191.00
HC81701468	NK CELL TOTAL COUNT	302	86357	365.00	191.00
HC81701484	SCLERODERMA SCL-70 AB, IGG	302	86235	217.00	94.25
HC81701492	IMMUNOFIX ELECT OTHER FLUIDS	302	86335	318.00	155.50
HC81701609	RUBELLA AB IGG	302	86762	177.00	94.50
HC81701617	SYPHILIS TOTAL IGG&IGM	302	86592	121.00	53.25
HC81701724	EBV AB TO VIRAL CAPSID AG, IGG	302	86665	244.00	100.00
HC81701732	EBV AB TO VIRAL CAPSID AG, IGM	302	86665	244.00	100.00
HC81701740	EBV AB TO NUCLEAR AG, IGG	302	86664	188.00	87.75
HC81701757	EBV AB TO EARLY (D) AG, IGG	302	86663	180.00	75.25
HC81701799	T CELL ABSOLUTE CD4 COUNT	302	86361	316.00	110.50
HC81701807	HERPES I/II AB IGG	302	86694	189.00	57.75
HC81701815	HERPES I/II AB IGM	302	86694	189.00	57.75
HC81701823	HSV TYPE 1 AB, IGG	302	86695	162.00	54.50
HC81701831	HSV TYPE 2 AB, IGG	302	86696	228.00	80.00
HC81701880	CA 15-3	302	86300	284.00	68.50
HC81701898	HIV TYPE 1 OR 2ANTIBODY(RAPID)	302	86703	209.00	56.75
HC81701906	ALLERGEN IGE CRUDE EXTRACT, EACH	302	86003	47.00	21.50
HC81701930	CYCLIC CITRULLINATED PEPTIDE	302	86200	159.00	70.75
HC81701971	HEPATITIS C AB SCREENING	302	86803	196.00	75.00
HC81702003	TREPONEMA PALLIDUM AB, IGG	302	86780	155.00	70.00
HC81702011	ALLERGEN IGE SPECFC RECOMB QNT/SEMI QNT EA	302	86008	145.00	20.00
HC81702201	HIV 2 ANTIBODY	302	86702	195.00	150.00
HC83000273	CMV IGM	302	86645	219.00	73.63
HC83000802	COLD AGGLUTININS TITER	302	86157	136.00	53.75
HC83001057	CMV AB NEGATIVE BLOOD	302	86318	138.00	40.00
HC83001065	BB PATH; INVEST TRANFUSION REACTION	310	86078	478.00	175.00
HC83001230	BB PATH; DIFFICULT CROSSMATCH IRREG AB	310	86077	269.00	45.00
HC84200344	CRYPTOCOCCUS AG EA CSF	306	86406	234.00	151.50
HC84200351	PARTICLE AGGLUTINATION EA AB	306	86403	200.00	110.00
HC84200468	OB FECAL IMM  ASSAY 1-3 CA SCR	301	G0328	126.00	80.75
HC84200583	CRYPTCOCCUS AB QNT BLOOD	306	86256	207.00	66.25
HC84201052	PARTICLE AGGLUTIN EA AB(PNL)	306	86403	195.00	110.00
HC89000012	ENDOMYSIAL FA AB SCRN-QD	302	86255	24.00	24.00
HC89000038	HLA TYPING-U2	302	86813	225.00	225.00
HC89000046	EBV CAPSID AG AB (PNL)-FT	302	86665	70.00	69.75
HC89000061	TOXOPLASMA AB IGG(PNL)-AU	302	86317	11.35	10.37
HC89000095	JO 1 ENA AB-QD	302	86235	14.00	14.00
HC89000103	HERPES 2 IGM AB (PNL)-FT	302	86696	70.00	69.75
HC89000111	ADENOVIRUS AB (PNL)-FT	302	86603	70.00	69.75
HC89000129	EBV NUCLEAR AG AB (PNL)-FT	302	86664	70.00	69.75
HC89000160	HERPES 1&2 IGM AB (PNL)-FT	302	86694	70.00	69.75
HC89000178	HERPES 1 IGM AB (PNL)-FT	302	86695	70.00	69.75
HC89000202	INFLUENZA B SEROLOGY-QD	302	86710	34.00	33.50
HC89000210	ADENOVIRUS AB-QD	302	86603	16.00	16.00
HC89000228	HERPES IGM SCREEN-QD	302	86694	20.00	20.00
HC89000236	INFLUENZA A SEROLOGY-QD	302	86710	23.00	23.00
HC89000244	MUMPS AB-QD	302	86735	11.00	11.00
HC89000269	HERPES SIMPLEX I AB-QD	302	86695	22.00	22.00
HC89000277	MEASLES (RUBEOLA)-SL	302	86765	N/A	N/A
HC89000434	C1Q COMPLEMENT-QD	302	86160	17.00	17.00
HC89000442	IMMUNE COMPLEXES RAJI CELL-QD	302	86332	29.00	29.00
HC89000467	TEICHOIC ACID AB (ID)-QD	302	86329	24.00	24.00
HC89000475	TULAREMIA AB-QD	302	86668	15.00	15.00
HC89000483	Q FEVER AB-QD	302	86638	13.00	13.00
HC89000509	F-ACTIN (SM) AB, IGG, RFLX-AU	302	86256	8.00	8.00
HC89000525	COXSACKIE A AB-SL	302	86658	28.00	27.65
HC89000533	COXSACKIE B AB (PNL)-SL	302	86658	101.00	100.80
HC89000558	DENGUE FEVER AB-SL	302	86790	73.00	72.85
HC89000574	ANTI-DNASE B-AU	302	86215	7.00	10.50
HC89000624	COCCIDIOIDES AB-QD	302	86635	11.00	11.00
HC89000632	LEGIONNELLA SCREEN-QD	302	86713	21.00	21.00
HC89000657	PROTOZOA AB OTHER-QD	302	86753	20.00	20.00
HC89000707	HISTOPLASMA AB-QD	302	86698	17.00	17.00
HC89000731	MYCOPLASMA PNEUMONIAE AB-QD	302	86738	27.00	27.00
HC89000830	ANTI CENTROMERE-QD	302	86038	18.00	18.00
HC89001028	RAST-INDIVIDUAL-QD	302	86003	9.00	9.00
HC89001044	TOXOPLASMA AB IGM(PNL)-AU	302	86778	10.00	10.50
HC89001135	ASPERGILLUS AB-QD	302	86606	17.00	17.00
HC89001143	TOXOPLASMA AB IGG(PNL)-AU	302	86317	11.35	10.50
HC89001309	BLASTOMYCES AB-QD	302	86612	17.00	17.00
HC89001325	ANTI-DNASE B-QD	302	86215	15.00	15.00
HC89001390	STRIATED MUSCLE FA AB SCRN-QD	302	86255	29.00	29.00
HC89001416	TRICHINELLA AB-QD	302	86784	17.00	17.00
HC89001473	ECHOVIRUS AB-QD	302	86658	15.00	15.00
HC89001499	CRYPTOCOCCUS AB-QD	302	86641	18.00	18.00
HC89001507	LEPTOSPIRA AB-QD	302	86720	16.00	16.00
HC89001515	PARAINFLUENZA AB-QD	302	86790	19.00	19.00
HC89001523	POLIOVIRUS-QD	302	86658	13.00	13.00
HC89001572	MYOCARDIAL FA AB SCRN-QD	302	86255	24.00	24.00
HC89001580	RETICULIN FA AB SCRN-QD	302	86255	23.00	23.00
HC89001630	ANTI-HISTONE AB-QD	302	86235	18.00	18.00
HC89001671	YERSINIA AB-QD	302	86793	14.00	14.00
HC89001788	ANTI-DNA ANTIBODIES (SS)-SL	302	86226	N/A	N/A
HC89001796	INSULIN AB-QD	302	86337	13.00	13.00
HC89001937	PARIETAL FA AB SCRN-QD	302	86255	22.00	22.00
HC89002075	PLATELET ASSOCIATED IGG-QD	302	86023	68.00	67.25
HC89002091	HTLV-I AB-SL	302	86687	N/A	N/A
HC89002125	CANDIDA AB-QD	302	86628	13.00	13.00
HC89002133	EPIDERMAL FA AB SCRN-QD	302	86255	23.00	23.00
HC89002158	HTLV-II AB-SL	302	86688	N/A	N/A
HC89002257	LYME DISEASE AB-QD	302	86618	18.00	18.00
HC89002265	CHLAMYDIA AB IGM-QD	302	86632	19.00	19.00
HC89002281	C2 COMPLEMENT-QD	302	86160	16.00	16.00
HC89002307	HEPATITIS DELTA AB-QD	302	86692	21.00	21.00
HC89002356	PLATELET ANTIBODIES-QD	302	86022	140.00	139.50
HC89002364	INTRINSIC FACTOR AB-QD	302	86340	22.00	22.00
HC89002505	HEPARIN-INDUCED PLATELET AB-QD	302	86022	88.00	87.25
HC89002570	ANTI-DNA ANTIBODIES (DS)-QD	302	86225	27.00	27.00
HC89002612	ANA TITER-QD	302	86039	12.00	12.00
HC89002661	PARVOVIRUS AB-QD	302	86747	16.00	16.00
HC89002679	RUBELLA IGM AB-QD	302	86762	17.00	17.00
HC89002687	WEST NILE VIR AB IGG/IGM(SERM)ELISA-AU	302	86790	14.00	16.50
HC89002760	ALLERGEN(PNL 2)-AU	302	86003	5.00	4.50
HC89002802	HU FA AB SCRN-QD	302	86255	16.00	16.00
HC89002810	YO FA AB SCRN-QD	302	86255	16.00	16.00
HC89002869	ANTI NEUT CYTOPLASMIC AB-QD	302	86021	66.00	65.47
HC89002893	COCCIDIOIDES AB CSF-QD	302	86635	22.00	22.00
HC89002901	ANA FLUID-QD	302	86038	321.00	320.05
HC89002919	RHEUMATOID FACTOR-SL	302	86431	8.00	7.70
HC89002950	SMOOTH MUSCLE FA AB SCRN-QD	302	86255	27.00	27.00
HC89002968	MITOCHONDRIAL FA AB SCRN-QD	302	86255	27.00	27.00
HC89003107	THYROGLOBULIN AB-QD	302	86800	19.00	19.00
HC89003115	ANTI MICROSOMAL THYROID-QD	302	86376	26.00	26.00
HC89003123	C3 COMPLEMENT-QD	302	86160	16.00	16.00
HC89003131	C4 COMPLEMENT-QD	302	86160	16.00	16.00
HC89003149	CA 15-3-QD	302	86300	10.00	10.00
HC89003172	CMV AB IGG-QD	302	86644	13.00	13.00
HC89003206	IMMUNO ELECT-QD	302	86334	15.00	15.00
HC89003214	IMMUNO ELECT URINE-QD	302	86325	21.00	21.00
HC89003248	RUBELLA AB-QD	302	86762	13.00	13.00
HC89003263	VDRL CSF-QD	302	86592	11.00	11.00
HC89003289	IMMUNO ELECT CSF-QD	302	86335	19.00	19.00
HC89003321	HEPATITIS BE AB-QD	302	86707	18.00	18.00
HC89003347	SCL 70 ENA AB-QD	302	86235	16.00	16.00
HC89003354	ENCEPHALITIS CALIF AB-QD	302	86651	24.00	24.00
HC89003362	ENCEPHALITIS EASTERN AB-QD	302	86652	26.00	26.00
HC89003370	ENCEPHALITIS ST LOUIS AB-QD	302	86653	27.00	27.00
HC89003388	ENCEPHALITIS WESTERN AB-QD	302	86654	26.00	26.00
HC89003446	EBV AB TO EARLY AG-QD	302	86663	21.00	21.00
HC89003453	EBV AB TO NUCLEAR AG-QD	302	86664	23.00	23.00
HC89003461	EBV AB-VIRAL CAPSID AG-QD	302	86665	25.00	25.00
HC89003479	TOXOPLASMA AB-QD	302	86777	16.00	16.00
HC89003487	TOXOPLASMA AB IGM-QD	302	86778	20.00	20.00
HC89003511	MUMPS IGM-AU	301	86735	13.00	9.00
HC89003644	RSV AB-AU	302	86756	12.00	11.16
HC89003677	CHLAMYDIA AB-QD	302	86631	12.00	12.00
HC89003685	CHLAMYDIA AB-QD	302	86631	N/A	N/A
HC89003743	HERPES TYPE I IGM-QD	302	86695	N/A	N/A
HC89003750	HERPES TYPE I IGM-QD	302	86695	N/A	N/A
HC89003784	WEST NILE VIRUS AB, IGM-QD	302	86788	N/A	N/A
HC89003842	CMV AB IGM-QD	302	86645	13.00	13.00
HC89003859	HERPES SIMPLEX II AB-QD	302	86696	23.00	23.00
HC89004030	NEUTROPHIL-ASSOC ANTIBODIES -AU	302	86021	71.43	69.00
HC89004105	ENTAMOEBA HISTOLYTICA AB - AU	302	86753	16.00	16.00
HC89004113	ADRENAL AB - AU	302	86255	46.00	45.90
HC89004352	BETA 2 GLYCOPROTEIN, IGG- AU	302	86146	10.00	19.50
HC89004360	BETA 2 GLYCOPROTEIN, IGM- AU	302	86146	10.00	19.50
HC89004394	ADENOVIRUS AB, IGG-AU	302	86603	11.00	10.50
HC89004402	ADENOVIRUS AB, IGM-AU	302	86603	11.00	10.50
HC89004410	HTLV I/II AB, WESTERN BLOT-AU	302	86689	79.43	78.00
HC89004436	CHAGAS AB-AU	302	86753	16.00	16.00
HC89004444	ENCEPHALITIS CALIF AB (PNL)-AU	302	86651	19.00	18.37
HC89004451	ENCEPHALITIS EASTRN AB(PNL)-AU	302	86652	19.00	18.37
HC89004469	ENCEPHALITIS STLOUIS AB(PNL-AU	302	86653	19.00	18.38
HC89004477	ENCEPHALITIS WESTRN AB(PNL)-AU	302	86654	19.00	18.38
HC89004667	STREPTOCOCCUS PNEUM AG-FT	302	86403	75.00	74.70
HC89004675	ANTI-RO SS-A (PNL2)-RD	302	86235	21.00	20.75
HC89004683	ANTI-SM AB (PNL2)-RD	302	86235	24.00	24.00
HC89004691	ANTI-RNP AB (PNL2)-RD	302	86235	24.00	24.00
HC89004709	ANTI-LA (SS-B) (PNL)-RD	302	86235	24.00	24.00
HC89004717	ANTI-SCL-70 AB (PNL2)-RD	302	86235	24.00	24.00
HC89004725	ANTI-CHROMATIN AB (PNL2)-RD	302	86235	24.00	24.00
HC89004733	ANTI MICROSOMAL THYROI(PNL2-RD	302	86376	25.00	25.00
HC89004741	ANTI-CARDIOLIPIN AB (PNL2)-RD	302	86147	40.00	40.00
HC89004832	STREPTOLYSIN O AB (ASO)-AU	302	86060	10.00	9.90
HC89004949	HISTOPLASMA AB CF (PNL)-AU	302	86698	11.03	10.50
HC89004972	CRYPTOCOCCUS AB (SERUM)-FT	302	86641	76.00	75.60
HC89004980	STREPTOCOCCUS GROUP B AG -AU	302	86403	20.00	19.15
HC89004998	H INFULENZA AG -AU	302	86403	20.00	19.15
HC89005003	S PNEUMONIA AG -AU	302	86403	20.00	19.15
HC89005011	N MENINGITIOIS GROUP C/W -AU	302	86403	20.00	19.15
HC89005029	N MENINGITIOIS GROUP A/Y -AU	302	86403	20.00	19.15
HC89005037	GROUP B/E COLI K1 AG -AU	302	86403	20.00	19.15
HC89005110	B BURGDORFERI C6 PEP RFLX-FT	302	86618	93.00	92.70
HC89005128	B BURGDORFERI IGG WB -FT	302	86617	89.00	88.20
HC89005136	B BURGDORFERI IGM WB -FT	302	86617	89.00	88.20
HC89005144	HSV I IGG INDEX&INTERP -FT	302	86695	63.00	63.00
HC89005151	HSV 2 IGG INDEX&INTERP -FT	302	86696	63.00	63.00
HC89005169	HSV I/2 IGM INDEX&INTERP- FT	302	86694	63.00	63.00
HC89005177	HSV I IGM, IFA - FT	302	86695	45.00	44.10
HC89005185	HSV 2 IGM, IFA  -FT	302	86696	45.00	44.10
HC89005201	ADENOVIRUS AB (SERUM) -FT	302	86603	62.00	61.20
HC89005243	HERPESVIRUS 6 AB IGG- FT	302	86790	81.00	81.00
HC89005250	HERPESVIRUS 6 AB IGM -FT	302	86790	81.00	81.00
HC89005284	BORDETELLA PERTUS PT IGG-FT	302	86615	41.00	40.50
HC89005292	BORDETELLA PERTUS PT IGA-FT	302	86615	41.00	40.50
HC89005300	BORDETELLA PERTUS FHA IGG-FT	302	86615	41.00	40.50
HC89005318	BORDETELLA PERTUS FHA IGA-FT	302	86615	41.00	40.50
HC89005334	HEPARIN-INDUCED PLATELET AB-EC	302	86022	210.00	210.00
HC89005482	INFLUENZA A&B ABS, IGG/IGM-AU	302	86710	10.35	32.40
HC89005524	ECHOVIRUS 4 AB-FT	302	86658	26.00	25.38
HC89005532	ECHOVIRUS 7 AB-FT	302	86658	26.00	25.38
HC89005540	ECHOVIRUS 9 AB-FT	302	86658	26.00	25.38
HC89005557	ECHOVIRUS 11 AB-FT	302	86658	26.00	25.38
HC89005565	ECHOVIRUS 30 AB-FT	302	86658	26.00	25.38
HC89005573	COXSACKIE B1 AB-FT	302	86658	22.00	21.45
HC89005581	COXSACKIE B2 AB-FT	302	86658	22.00	21.45
HC89005599	COXSACKIE B3 AB-FT	302	86658	22.00	21.45
HC89005607	COXSACKIE B4 AB-FT	302	86658	22.00	21.45
HC89005615	COXSACKIE B5 AB-FT	302	86658	22.00	21.45
HC89005623	COXSACKIE B6 AB-FT	302	86658	22.00	21.45
HC89005631	INFLUENZA A ANTIBODY-FT	302	86710	63.00	63.00
HC89005649	INFLUENZA B ANTIBODY-FT	302	86710	63.00	63.00
HC89005656	C PNEUMONIAE IGG ANTIBODY-FT	302	86631	90.00	90.00
HC89005664	C PNEUMONIAE IGA ANTIBODY-FT	302	86631	90.00	90.00
HC89005672	C PNEUMONIAE IGM ANTIBODY-FT	302	86632	90.00	90.00
HC89005698	STREPTOCOCCUS GRP B ANTIGEN-FT	302	86403	81.00	80.34
HC89005706	H. INFLUENZA TYPE B ANTIGEN-FT	302	86403	84.00	83.34
HC89005714	S. PNEUMONIAE ANTIGEN-FT	302	86403	84.00	83.34
HC89005722	N. MENINGITIDIS GRP C/W135-FT	302	86403	84.00	83.34
HC89005730	N. MENINGITIDIS GRP A/Y-FT	302	86403	84.00	83.34
HC89005789	WEST NILE VIRUS AB EA-QD	302	86789	24.00	24.00
HC89010821	FEBRILE AGGLUTININS-FT	302	86000	16.00	16.00
HC89010839	PROTEUS OX19 AGGLUT-AU	302	86000	N/A	N/A
HC89010847	PROTEUS OX19 AGGLUT-QD	302	86000	N/A	N/A
HC89010854	PROTEUS OX2 AGGLUT-AU	302	86000	N/A	N/A
HC89010862	PROTEUS OX2 AGGLUT-QD	302	86000	N/A	N/A
HC89010870	PROTEUS OXK AGGLUT-AU	302	86000	N/A	N/A
HC89010888	PROTEUS OXK AGGLUT-QD	302	86000	N/A	N/A
HC89010896	WEIL FELIX AGGLUT-AU	302	86000	N/A	N/A
HC89010904	ALLERGEN-INDIVIDUAL-AU	302	86003	6.00	4.50
HC89010912	PLATELET ANTIBODIES-AU	302	86022	100.00	56.00
HC89010920	PLATELET ASSOCIATED ABS-AU	302	86023	28.78	33.00
HC89010938	ANTI-CARDIOLIPIN AB-UT	302	86147	N/A	N/A
HC89010946	ANTI-CARDIOLIPIN AB-RD	302	86147	13.00	13.00
HC89010953	ANTI-CARDIOLIPIN AB-AU	302	86147	16.00	16.00
HC89010961	C1 INHIBITOR-AU	302	86160	13.00	14.10
HC89010979	C1Q COMPLEMENT-QN	302	86160	22.00	21.38
HC89010987	C2 COMPLEMENT-AU	302	86160	32.00	36.00
HC89010995	C5 COMPLEMENT-AU	302	86160	28.38	36.00
HC89011001	C3 COMPLEMENT (PNL)-RD	302	86160	13.00	13.00
HC89011019	C4 COMPLEMENT (PNL)-RD	302	86160	13.00	13.00
HC89011027	C-1 ESTERASE INHIBITOR FUNCTIONAL-AU	302	86161	20.00	27.30
HC89011035	COMPLEMENT TOTAL HEMOLYTIC-AU	302	86162	15.00	7.00
HC89011043	ECHOVIRUS(PNL)-AU	302	86171	N/A	N/A
HC89011050	NEISSERIA GONORRHOEAE AB-AU	302	86609	57.00	56.78
HC89011068	HISTOPLASMOSIS CF-FT	302	86171	N/A	N/A
HC89011076	HISTOPLASMOSIS CF-AU	302	86171	N/A	N/A
HC89011084	LCM TITER BY CF-AU	302	86171	N/A	N/A
HC89011092	LCM TITER BY CF-SL	302	86171	N/A	N/A
HC89011100	MELIOIDOSIS AB-AU	302	86171	N/A	N/A
HC89011126	ANTI-DNA ANTIBODIES (DS)-AU	302	86225	16.00	16.00
HC89011134	ANTI-DNA ANTIBODIES (DS)-RD	302	86225	13.00	13.00
HC89011159	ANALYZER1000/LUPUS PNL-SL	302	86235	N/A	N/A
HC89011167	ANTI JO 1-SL	302	86235	N/A	N/A
HC89011175	ANTI JO 1-SL-AU	302	86235	N/A	N/A
HC89011183	ANTI-CCP AB (PNL)-RD	302	86235	32.00	31.25
HC89011191	ANTI-CHROMATIN AB (PNL)-RD	302	86235	13.00	13.00
HC89011209	ANTI-LA (SS-B) (PNL2)-RD	302	86235	13.00	13.00
HC89011217	ANTI-RNP AB (PNL)-RD	302	86235	13.00	13.00
HC89011225	RNP ENA AB-QD	302	86235	13.00	13.00
HC89011233	ANTI-RO SS-A (PNL)-RD	302	86235	32.00	31.25
HC89011241	ANTI-SCL-70 AB (PNL)-RD	302	86235	13.00	13.00
HC89011258	ANTI-SM AB (PNL)-RD	302	86235	13.00	13.00
HC89011266	SM ENA AB-QD	302	86235	12.00	12.00
HC89011274	ANTI-SSA AB-AU	302	86235	16.00	16.00
HC89011282	ANTI-SSB AB-AU	302	86235	16.00	16.00
HC89011290	CYTOPLASMIC NEUTRO AB-AU	302	86235	N/A	N/A
HC89011308	JO 1 AB-AU	302	86235	20.00	24.00
HC89011316	NEUTROPHIL CYTOPLAS IFA AB-FT	302	86235	N/A	N/A
HC89011324	NEUTROPHIL CYTOPLAS IFA AB-AU	302	86235	16.00	16.00
HC89011332	NEUTROPHIL GRANULOCYTE AB-FT	302	86235	N/A	N/A
HC89011340	RNP AB IGG-AU	302	86235	16.00	16.00
HC89011357	RNP REFLEX (PNL)-AU	302	86235	16.00	16.00
HC89011365	SCL-70 REFLEX (PNL)-AU	302	86235	16.00	16.00
HC89011373	SCLERODERMA SCL-70 AB IGG-AU	302	86235	16.00	16.00
HC89011381	SMITH (ENA) AD IGG-AU	302	86235	16.00	16.00
HC89011399	SMITH REFLEX (PNL)-AU	302	86235	16.00	16.00
HC89011407	SSA REFLEX (PNL)-AU	302	86235	16.00	16.00
HC89011415	SSA ENA AB-QD	302	86235	13.00	13.00
HC89011423	SSB REFLEX (PNL)-AU	302	86235	16.00	16.00
HC89011431	SSB ENA AB-QD	302	86235	13.00	13.00
HC89011449	ANTI SMOOTH MUSCLE AB-AU	302	86255	16.00	16.00
HC89011456	ANTI-NEUTROPHIL CYTOPLSMC SCRN IGG-AU	302	86255	12.00	15.00
HC89011472	ENDOMYSIAL AB IGA TITER-AU	302	86256	17.00	40.20
HC89011480	GLOMERULAR BSMT MEM IF-AU	302	86255	50.00	60.00
HC89011498	ANTI-ANDREN CORTEX AB TITER-AU	302	86256	N/A	N/A
HC89011506	ANTI-CENTROM AB TITER(PNL)-RD	302	86256	13.00	13.00
HC89011514	ANTI-RETICULIN AB TITER-AU	302	86255	84.00	51.70
HC89011522	ANTI-STRIAT MUSCLE AB IGG SCREEN-AU	302	86255	12.00	16.50
HC89011548	MYELIN AB SCRP-AT	302	86256	N/A	N/A
HC89011555	RIBOSOMAL P PROTEIN AB-AU	302	86235	17.00	14.00
HC89011563	TYPHUS FEVER AB-AU	302	86256	N/A	N/A
HC89011571	DIPHTHERIA AB TITER-AU	302	86280	22.00	21.70
HC89011589	ECHINOCOCCUS AB IHA-FT	302	86280	N/A	N/A
HC89011597	HETEROPHILE AB SCREEN-AU	302	86308	9.00	9.00
HC89011605	HETEROPHILE AB TITER-AU	302	86309	N/A	N/A
HC89011613	CANCER AG 15-3-AU	302	86300	10.00	10.00
HC89011621	CHROMOGRANIN A-AU	302	86316	35.00	45.90
HC89011639	NEURON SPECIFIC ENOLASE-AU	302	86316	32.00	36.00
HC89011647	GLOMERULAR BASEMENT MEMB AB-QN	302	86317	N/A	N/A
HC89011654	GLOMERULAR BASEMENT MEMB AB-AU	302	86317	47.00	46.66
HC89011662	CATSCRATCH FEVER-AU	302	86317	N/A	N/A
HC89011670	CYSTICERCOSIS ELISA-FT	302	86317	N/A	N/A
HC89011688	DIPHTHERIA AB-AU	302	86317	16.16	10.50
HC89011696	HBV SURFACE AB QUANT-SL	302	86317	16.00	15.75
HC89011704	PNEUMOCOCCAL AB(PNL)-AU	302	86317	13.00	12.60
HC89011712	TETANUS/ELISA-FT	302	86317	N/A	N/A
HC89011720	TOXOCARA CANIS/ELISA-FT	302	86317	110.00	109.80
HC89011738	IMMUNO ELECT-AU	302	86320	N/A	N/A
HC89011746	IMMUNO ELECT CSF-AT	302	86325	19.00	18.90
HC89011753	PM 1 AB-AU	302	86325	N/A	N/A
HC89011761	SCL-70-AU	302	86325	N/A	N/A
HC89011779	IMMUNODIF(PNL)-AU	302	86329	N/A	N/A
HC89011787	TEICHOIC ACID AB (ID)-AU	302	86329	25.00	16.00
HC89011795	TEICHOIC ACID AB (ID)-FT	302	86329	84.00	84.00
HC89011803	LYSOZYME MURAMIDASE (GID)-AU	302	86331	16.00	16.00
HC89011811	TEICHOIC ACID AB (GID)-AU	302	86331	N/A	N/A
HC89011829	CIQ BINDING ASSAY-AU	302	86332	18.00	18.00
HC89011837	IMMUNE COMPLEX C1Q BIND-AU	302	86332	147.00	152.52
HC89011845	IMMUNE COMPLEXES RAJI CELL-AU	302	86332	148.00	147.60
HC89011852	IMMUNOFIX ELECTROPHORESIS-AU	302	86334	15.00	44.86
HC89011860	IMMUNOFIX ELECTROPHOR(PNL)-AU	302	86334	10.00	9.93
HC89011878	INSULIN AB-ES	302	86337	N/A	N/A
HC89011886	INSULIN AB-AU	302	86337	35.00	39.00
HC89011894	INTRINSIC FACTOR AB-AU	302	86340	20.00	16.50
HC89011902	ISLET AB-AU	302	86341	20.00	24.30
HC89011910	LYMPHOCYTE MITOGENS-SL	302	86353	N/A	N/A
HC89011928	LYMPH T-CELL TOT CNT (PNL)-AU	302	86359	23.00	22.47
HC89011936	LYMPH ABS CD4/CD8 CNT(PNL)-AU	302	86360	23.00	22.48
HC89011944	ANTI MICROSOMAL THYROID-ES	302	86376	32.00	31.50
HC89011951	ANTI MICROSOMAL THYROI(PNL)-RD	302	86376	13.00	13.00
HC89011969	ANTI MICROSOMAL THYROID-AU	302	86376	14.00	9.00
HC89011977	COXSACKIE NEUT B VIRUS-AU	302	86382	N/A	N/A
HC89011985	ECHOVIRUS-AU	302	86382	N/A	N/A
HC89011993	POLIO VIRUS-AU	302	86382	N/A	N/A
HC89012009	BACTERIAL AG SCREEN - CSF-FT	302	86403	167.00	166.86
HC89012017	CANDIDA AB-FT	302	86403	16.00	16.00
HC89012025	SPOROTRICHOSIS AB-FT	302	86403	75.00	74.70
HC89012033	STREPTOZYME AB-AU	302	86403	9.00	9.00
HC89012041	RHEUMATOID FACTOR-AU	302	86431	9.00	9.00
HC89012058	RHEUMATOID FACTOR-RD	302	86431	44.00	44.00
HC89012066	VDRL CSF-AU	302	86592	6.00	6.00
HC89012074	VDRL TITER QUANT-AU	302	86593	16.00	16.00
HC89012082	ADENOVIRUS AB-AU	302	86603	21.00	21.00
HC89012090	ADENOVIRUS AB-SL	302	86603	N/A	N/A
HC89012108	ASPERGILLUS AB BY CF-AU	302	86606	11.03	12.00
HC89012116	BARTONELLA AB-AU	302	86611	11.35	11.10
HC89012124	BLASTOMYCES AB-AU	302	86612	12.35	12.00
HC89012132	BLASTOMYCES AB-SL	302	86612	N/A	N/A
HC89012140	LYME DISEASE AB CONFIRM-AU	302	86617	16.00	16.00
HC89012157	LYME DISEASE AB-AU	302	86618	8.00	9.00
HC89012165	BRUCELLA AB-FT	302	86622	N/A	N/A
HC89012173	BRUCELLA AB-AU	302	86622	12.38	8.40
HC89012181	CANDIDA AB-FT	302	86628	16.00	16.00
HC89012199	CHLAMYDIA AB (PNL)-AU	302	86631	8.00	9.00
HC89012207	CHLAMYDIA AB IGM (PNL)-AU	302	86632	8.00	9.00
HC89012215	COCCIDIOIDES AB SERUM -AU	302	86635	10.25	10.50
HC89012223	Q FEVER AB-AU	302	86638	15.00	36.00
HC89012231	Q FEVER AB-FT	302	86638	N/A	N/A
HC89012249	CRYPTOCOCCUS AB-AU	302	86641	75.00	74.43
HC89012256	CRYPTOCOCCUS AB-FT	302	86641	76.00	75.60
HC89012264	CMV AB IGG-AU	302	86644	8.00	10.50
HC89012272	CMV AB IGM-AU	302	86645	8.00	11.10
HC89012280	CMV AB IGM(PNL)-FT	302	86645	70.00	69.75
HC89012298	DIPHTHERIA/ELISA AB-FT	302	86648	N/A	N/A
HC89012306	ENCEPHALITIS CALIF AB IGG-AU	302	86651	19.00	18.60
HC89012314	ENCEPHALITIS CALIF AB-FT	302	86651	N/A	N/A
HC89012322	ENCEPHALITIS EASTERN AB IGG-AU	302	86652	19.00	18.60
HC89012330	ENCEPHALITIS EASTERN AB-FT	302	86652	N/A	N/A
HC89012348	ENCEPHALITIS ST LOUIS AB-FT	302	86653	N/A	N/A
HC89012355	ENCEPHALITIS ST LOUIS AB IGG-AU	302	86653	19.00	18.60
HC89012363	ENCEPHALITIS WESTERN AB-FT	302	86654	N/A	N/A
HC89012371	ENCEPHALITIS WESTERN AB IGG-AU	302	86654	19.00	18.60
HC89012389	COXSACKIE A AB (PNL)-FT	302	86658	22.00	21.55
HC89012397	COXSACKIE A AB (PNL)-AU	302	86658	23.00	16.00
HC89012405	COXSACKIE A9 AB-AU	302	86658	23.00	23.70
HC89012413	COXSACKIE B AB-AU	302	86658	116.00	115.20
HC89012421	COXSACKIE B AB (PNL)-AU	302	86658	16.00	19.20
HC89012439	ECHOVIRUS AB (PNL)- AU	302	86658	90.00	90.00
HC89012447	POLIOVIRUS AB (PNL)-AU	302	86658	39.00	99.00
HC89012454	EBV AB TO EARLY AG (PNL)-AU	302	86663	8.00	5.50
HC89012462	EBV AB TO EARLY AG-AU	302	86663	10.00	9.60
HC89012470	EBV AB TO NUCLEAR AG (PNL)-AU	302	86664	8.00	5.50
HC89012488	EBV AB TO NUCLEAR AG-AU	302	86664	N/A	N/A
HC89012496	EBV AB-VIRAL CAPSID AG(PNL)-AU	302	86665	8.00	11.10
HC89012504	EBV AB-VIRAL CAPSID AG-AU	302	86665	16.00	16.00
HC89012512	HELICOBACTER PYLOR AB (PNL)-AU	302	86677	9.00	9.00
HC89012520	HELICOBACTER PYLORI AB-AU	302	86677	8.00	8.00
HC89012538	CYSTICERCOSIS AB-AU	302	86682	19.00	18.60
HC89012546	CYSTICERCOSIS AB-FT	302	86682	109.00	108.90
HC89012553	ECHINOCOCCUS AB-AU	302	86682	15.00	19.50
HC89012561	SCHISTOSOMA AB-AU	302	86682	90.00	62.96
HC89012579	SCHISTOSOMA AB-FT	302	86682	114.00	114.00
HC89012587	TOXOCARA AB ELISA -AU	302	86682	108.00	24.00
HC89012595	HEMOPHILUS INFLUENZA AB-FT	302	86684	125.00	124.20
HC89012603	HTLV-I AB-AU	302	86687	16.00	16.00
HC89012611	HEPATITIS DELTA AB-AU	302	86692	14.23	7.50
HC89012629	HERPES I&II SIMPLE AB (PNL)-AU	302	86694	15.00	12.00
HC89012637	HERPES SIMPLEX I&II AB-AU	302	86694	13.00	12.00
HC89012645	HERPES SMPLX I GLYC AB(PNL)-AU	302	86695	6.00	6.00
HC89012652	HERPES SIMPLEX I GLYCO AB-AU	302	86695	14.00	12.00
HC89012660	HERPES SIMPL II GLYCO (PNL)-AU	302	86696	6.00	6.00
HC89012678	HERPES SIMPLEX II GLYCO AB-AU	302	86696	14.00	12.00
HC89012686	HISTOPLASMA AB (PNL)-AU	302	86698	10.70	8.95
HC89012694	HISTOPLASMA AB-AU	302	86698	11.03	10.50
HC89012702	HIV-2 AB-AU	302	86702	73.00	72.90
HC89012710	HIV 1&2 AB-AU	302	86703	16.00	16.00
HC89012728	HEPATITIS BE AB-AU	302	86707	17.00	13.80
HC89012736	HEPATITIS A AB IGM-AU	302	86709	N/A	N/A
HC89012744	LEGIONELLA AB-AU	302	86713	12.03	11.10
HC89012751	LEISHMANIASIS AB -AU	302	86717	39.00	38.40
HC89012769	LEPTOSPIRA AB-AU	302	86720	29.00	28.50
HC89012777	LEPTOSPIRA AB-FT	302	86720	87.00	86.40
HC89012785	MUMPS AB-AU	302	86735	10.00	16.00
HC89012793	MYCOPLASMA PNEUMONIAE AB-AU	302	86738	7.00	7.00
HC89012801	PARVOVIRUS B19 AB-AU	302	86747	15.00	16.50
HC89012819	PARVOVIRUS B19 AB (PNL)-AU	302	86747	14.19	16.50
HC89012827	RSV AB-FT	302	86756	N/A	N/A
HC89012835	RICKETTSIA AB PANEL-AU	302	86757	32.00	31.20
HC89012843	ROCKY MT  SPOTTED FEVER AB-AU	302	86757	12.50	31.20
HC89012850	TYPHUS FEVER ANTIBODY-AU	302	86757	15.00	15.60
HC89012868	RUBELLA IGM AB-AU	302	86762	9.00	9.00
HC89012876	MEASLES (RUBEOLA) AB (CSF)-AU	302	86765	N/A	N/A
HC89012884	TETANUS AB-AU	302	86317	13.00	10.50
HC89012892	TORCH TOXOPLASM AB IGG(PNL)-AU	302	86777	10.00	10.00
HC89012900	TORCH TOXOPLASM AB IGM(PNL)-AU	302	86778	10.00	10.87
HC89012918	TOXOPLASMA AB IGM-AU	302	86778	10.00	10.50
HC89012926	TREPONEMA PALLIDUM AB-AU	302	86780	13.00	15.60
HC89012934	TRICHINELLA AB-AU	302	86784	45.00	44.40
HC89012942	VARICELLA AB (PNL)-AU	302	86787	8.00	7.50
HC89012959	VARICELLA ZOSTER IGG-AU	302	86787	8.00	7.50
HC89012967	VARICELLA ZOSTER (PNL)-AU	302	86787	7.50	16.00
HC89012975	VARICELLA-ZOSTER IGM-AU	302	86787	8.00	7.50
HC89012983	DENGUE FEVER AB-FT	302	86790	94.00	93.60
HC89012991	DENGUE FEVER AB-AU	302	86790	19.03	19.05
HC89013007	PARAINFLUENZA AB-FT	302	86790	N/A	N/A
HC89013015	THYROGLOBULIN AB-AU	302	86800	8.00	9.00
HC89013023	HEPATITIS C AB CONFIRM(DS)-U2	302	86803	N/A	N/A
HC89013031	HEPATITIS C AB CONFIRM-AU	302	86804	77.00	76.58
HC89013049	HLA-A AND B PHENOTYPE-AU	302	86813	180.00	180.00
HC89013056	HLA DR MULT AG-AU	302	86817	N/A	N/A
HC89014021	ALLERGEN-AU	302	86003	7.00	6.60
HC89014039	ALLERGEN(PNL)-AU	302	86003	5.00	4.50
HC89014047	ANA-RD	302	86038	32.00	31.25
HC89014054	ANA-AU	302	86038	16.00	16.00
HC89014062	ANA TITER (PNL)-RD	302	86039	13.00	13.00
HC89014070	ANA TITER REFLEX (PNL)-AU	302	86039	14.00	13.50
HC89014096	C6 COMPLEMENT-QN	302	86160	N/A	N/A
HC89014104	C7 COMPLEMENT-QN	302	86160	N/A	N/A
HC89014112	ANTIBODY PM-1 AB-AU	302	86235	71.00	70.86
HC89014120	RIBOSOMAL P PROTEIN AB-AU	302	86235	N/A	N/A
HC89014146	FLUORESCNT AB NON INF SREEN-U9	302	86255	N/A	N/A
HC89014153	FLUORESCNT AB NON INF SREEN-AU	302	86255	N/A	N/A
HC89014161	LYSOSOMAL SCREEN-CA	302	86255	368.00	368.00
HC89014179	FLUORESCNT AB NON INF SREEN-CA	302	86255	N/A	N/A
HC89014187	FLUORESCNT AB TITER EA AB-AU	302	86256	N/A	N/A
HC89014195	FLUORESCNT AB TITER EA AB-FT	302	86256	N/A	N/A
HC89014203	FLUORESCNT AB TITER EA AB-SL	302	86256	70.00	70.00
HC89014211	ANTI-SMOOTH MUSCLE TITER AB-AU	302	86256	34.00	40.20
HC89014229	IMMUNO ELEC GEL DIF EA(PNL)-AU	302	86331	6.00	5.70
HC89014237	HYPERSENSITIVITY PNEUMO I (PNL)-AU	302	86331	6.00	5.70
HC89014245	IMMUNOFIX ELECTROPH UR(PNL)-AU	302	86334	N/A	N/A
HC89014252	RHEUMATOID FACT IGM (PNL)-RD	302	86431	32.00	31.25
HC89014260	COCCIDIOIDES AB CSF(PNL) -AU	302	86635	11.00	10.50
HC89014278	CMV AB IGG (PNL)-FT	302	86644	70.00	69.75
HC89014286	COXSACKIE A AB-QD	302	86658	17.00	17.00
HC89014294	COXSACKIE B AB-QD	302	86658	17.00	17.00
HC89014302	ECHOVIRUS AB CSF-AU	302	86658	N/A	N/A
HC89014310	TULAREMIA AB-AU	302	86668	20.00	58.50
HC89014328	FUNGUS AB OTHER-FT	302	86671	N/A	N/A
HC89014336	GIARDIA AB IFA-AU	302	86674	71.00	70.70
HC89014344	HTLV-II AB-AU	302	86688	N/A	N/A
HC89014369	HEPATITIS B CORE AB-U2	302	86704	N/A	N/A
HC89014377	INFLUENZA A SEROLOGY-AU	302	86710	11.00	8.10
HC89014385	INFLUENZA B SEROLOGY-AU	302	86710	11.00	8.10
HC89014393	LCM AB-AU	302	86727	19.95	15.60
HC89014401	CHAGAS AB (PNL)-AU	302	86753	19.00	18.60
HC89014419	PROTOZOA AB OTHER-AU	302	86753	11.35	12.00
HC89014443	MEASLES (RUBEOLA)(PNL) IGM-AU	302	86765	13.70	10.20
HC89014450	MEASLES (RUBEOLA)(PNL) IGG-AU	302	86765	9.00	8.00
HC89014468	TOXOPLASMA AB IGG-AU	302	86777	16.00	16.00
HC89014476	FLUORESCENT TREPONMAL ABCSF-AU	302	86780	11.00	10.50
HC89014484	VARICELLA AB (PNL)-FT	302	86787	70.00	69.75
HC89014492	YERSINIA AB IGA BY IMMUNOBLOT-ARUP	302	86793	41.75	37.51
HC89014500	THYROGLOBULIN AB-ES	302	86800	32.00	31.50
HC89014518	HLA DR AG-AU	302	86816	N/A	N/A
HC89014526	HLA DR MULT AG-U9	302	86817	338.00	337.50
HC89014534	HLA MIXED LYMPH CULTURE-U9	302	86821	N/A	N/A
HC89015085	CYCLIC CITRU PEPTIDE AB-AU	301	86200	14.00	14.00
HC89015119	LYMPH ABS CD4/CD8 CNT-U2	302	86360	N/A	N/A
HC89015127	NK CELL TOTAL COUNT-U2	302	86357	N/A	N/A
HC89015135	B CELL TOTAL COUNT-U2	302	86355	N/A	N/A
HC89015143	LYMPH T-CELL TOT CNT (PNL)-AU	302	86359	N/A	N/A
HC89015150	FEBRILE AGGLUTININS-AU	302	86000	95.00	94.89
HC89015697	ASO TITER-QD	302	86060	12.00	12.00
HC89015705	ANTI-DNA ANTIBODIES (SS)-QD	302	86226	27.00	27.00
HC89015713	CA 19-9-QD	302	86301	10.00	10.00
HC89015721	CA 125-QD	302	86304	9.00	9.00
HC89015739	IMMUNOFIXATION ELECT(URINE)-QD	302	86334	30.00	30.00
HC89015747	LYMPH ABS CD4/CD8 CNT(PNL)-QD	302	86360	29.00	29.00
HC89015754	RHEUMATOID FACTOR-QD	302	86431	20.00	20.00
HC89015762	RPR/VDRL QUAL-QD	302	86592	16.00	16.00
HC89015770	BARTONELLA AB-QD	302	86611	16.00	16.00
HC89015788	HELICOBACTER PYLORI AB-QD	302	86677	25.00	25.00
HC89015796	HEPATITIS B CORE AB-QD	302	86704	22.00	22.00
HC89015804	HEPATITIS B CORE AB IGM-QD	302	86705	26.00	26.00
HC89015812	HEPATITIS A ANTIBODY -QD	302	86708	29.00	29.00
HC89015820	HEPATITIS A AB IGM-QD	302	86709	21.00	21.00
HC89015838	ROCKY MT  SPOTTED FEVER AB-QD	302	86757	29.00	29.00
HC89015846	RUBEOLA AB IGG-QD	302	86765	17.00	17.00
HC89015853	SALMONELLA AB-QD	302	86768	16.00	16.00
HC89015861	VARICELLA ZOSTER IGG-QD	302	86787	23.00	23.00
HC89015879	VARICELLA-ZOSTER IGM-QD	302	86787	23.00	23.00
HC89015887	DENGUE FEVER AB-QD	302	86790	18.00	18.00
HC89015895	HLA B27-QD	302	86812	10.00	10.00
HC89015960	HIV 1 AB-QD	302	86701	11.00	11.00
HC89015978	HIV AB WESTERN BLOT-QD	302	86689	29.00	29.00
HC89015986	INHIBIN A-QD	302	86336	12.00	12.00
HC89016059	CANDIDA AB - AU	302	86628	13.00	12.60
HC89016158	COMPLEMENT TOTAL HEMOLYTIC-QD	302	86162	16.00	16.00
HC89016208	BRUCELLA AB-QD	302	86622	20.00	20.00
HC89016232	GIARDIA AB IFA-QD	302	86674	2.00	1.99
HC89016240	HLA-A AND B PHENOTYPE-QD	302	86813	23.00	23.00
HC89016257	HEPATITIS B SURFACE AB-QD	302	86706	18.00	18.00
HC89016265	HEPATITIS C AB CONFIRM(DS)-QD	302	86803	8.00	8.00
HC89016273	HIV 1&2 AB-QD	302	86703	25.00	24.26
HC89016323	ANTI JO 1-SL-QD	302	86235	21.00	21.00
HC89016331	RICKETTSIA AB PANEL-QD	302	86757	120.00	120.00
HC89016349	HELICOBACTER PYLORI AG-QD	302	86677	29.00	29.00
HC89016646	IMMUNO ELECT URINE-AU	302	86335	37.00	41.00
HC89016695	HEPATITIS B SURFACE AB-QD	302	86706	52.00	51.50
HC89016737	WEST NILE VIRUS AB EA-LB	300	86788	20.00	20.00
HC89016794	NORCARDIA AB-QD	302	86744	N/A	N/A
HC89016802	ANTI MICROSOMAL LIVR-KIDNEY-QD	302	86376	N/A	N/A
HC89016810	IMMUNO ELECT OTHER FLUIDS-QD	302	86335	N/A	N/A
HC89016893	HTVL I/II W/ABS RFX TO WB-AU	302	86790	12.35	12.00
HC89017040	HEPARIN AB DETECTION-AU	300	86022	30.00	50.00
HC89017081	PHOSPHATIDYLSERINE ANTIBODY-AU	305	86148	59.00	58.50
HC89017149	ALLERGEN SPECIFIC IGE, EACH-IB	302	86003	419.00	418.53
HC89017198	ASCA AB, IGG/IGA - AU	302	86671	N/A	N/A
HC89017248	RUBELLA AB IGG - AU	302	86317	9.00	16.00
HC89017263	C3 COMPLEMENT-AU	302	86160	6.00	6.00
HC89017271	C4 COMPLEMENT-AU	302	86160	6.00	6.00
HC89017289	CMV AB IGG(PNL-2)-AU	302	86644	8.00	10.50
HC89017313	NEISSERIA GONORRHOEAE AB-QD	302	86609	43.00	42.50
HC89017339	FUNGUS AB OTHER-QD	302	86671	84.00	84.00
HC89017347	LYME AB IGG & IGM BY WB-AU	302	86617	42.00	42.00
HC89017354	LYME AB, IGM BY WB -AU	302	86617	15.00	21.00
HC89017362	LYME AB, IGG BY WB-AU	302	86617	15.00	21.00
HC89017487	HERPESVIRUS 6 (HHV-6)AB IGG-AU	302	86790	100.00	18.30
HC89017495	MYCOPLASMA PNEUMONA AB(PNL)-AU	302	86738	7.00	7.00
HC89017503	ANTI-CARDIOLIPIN IGG/GM(PNL-AU	302	86147	8.00	8.00
HC89017537	COCCIDIOIDES FUNGAL AB PAN (PNL)-AU	302	86635	9.00	9.20
HC89017545	BLASTOMYCES AB(PNL)-AU	302	86612	13.70	9.20
HC89017552	CMV AB IGM(PNL)-AU	302	86645	8.00	11.10
HC89017560	RUBELLA IGM AB(PNL)-AU	302	86762	9.00	9.00
HC89017578	HSV AB IGG(PNL)-AU	302	86694	13.00	11.63
HC89017586	CMV AB IGG (PNL)-AU	302	86644	8.00	11.00
HC89017594	RUBELLA AB IGG(PNL)-AU	302	86317	9.00	9.00
HC89017743	ANTI-DNA AB (DS)(PNL)-AU	302	86225	16.00	16.00
HC89017750	ANTI MICROSOMAL THYROID(PNL-AU	302	86376	16.00	16.00
HC89017768	PARAINFLUENZA AB(PNL)-AU	302	86790	13.00	12.60
HC89017800	ASPERGILLUS AB(PNL)-AU	302	86606	19.00	18.85
HC89017818	ANTI-RO SS-A (PNL)-RD	302	86235	31.00	31.00
HC89018097	WEST NILE VIR AB,IGM, CSF-AU	302	86788	18.00	16.50
HC89018105	ANTI-NEUTROPHIL CYTOPLSM IGG TITR-AU	302	86256	40.00	40.20
HC89018261	HIV-2 AB CONFIRM IMMUNOBLOT-AU	301	86689	103.00	102.52
HC89018279	SEROTONIN RELEASE ASSAY- QN	302	86022	260.00	260.00
HC89018402	QUANTIFERON-TB GOLD-AU	302	86480	40.00	50.00
HC89018436	PNH RBC CD59-AU	302	86356	37.50	97.50
HC89018444	PNH RBC GLYCOPHORIN-AU	302	86356	37.50	97.50
HC89018477	C-REACTIVE PROTEIN(PNL)-PR	302	86140	8.00	7.28
HC89018972	BORDETELLA PERTUS FHA IGA-AU	302	86615	15.00	18.00
HC89018980	BORDETELLA PERTUS FHA IGG-AU	302	86615	15.00	18.00
HC89018998	BORDETELLA PERTUS IMMUNOBLOT IGA-AU	302	86615	31.00	31.50
HC89019004	BORDETELLA PERTUS IMMUNOBLOT IGG-AU	302	86615	31.00	31.50
HC89019244	WEST NILE VIRUS IGG AB-AU	302	86789	17.00	16.50
HC89019285	NEUTROPHIL OXIDATIVE BURST-AU	302	86352	160.00	200.00
HC89019301	PM/SCL-100 AB, IGG-AU	301	86235	73.00	72.10
HC89019541	ANTIBODY IGG MUMPS VIRUS -AU	302	86735	9.00	9.00
HC89019749	PLATELET AB IDENTIFY-AU	302	86022	160.00	160.00
HC89019863	AH50-ALTERNATE PATHWAY-SL	302	86162	92.00	91.13
HC89019889	HLA AB DETECTION-AU	301	86828	330.00	330.00
HC89020184	C-REACTIVE PROTEIN(PNL2)-PR	301	86140	22.40	24.00
HC89020820	HELICOBACTER PYLORI IGM - AU	302	86677	8.00	8.00
HC89020838	BLASTOMYCES AB IMM -AU	302	86612	14.00	13.20
HC89020853	NEISSERIA GONORRHOEAE CF-AU	302	86171	57.00	56.78
HC89020861	SIN NOMBRE VIRUS IGG-AU	302	86790	50.00	50.00
HC89020879	SIN NOMBRE VIRUS IGM-AU	302	86790	52.00	51.80
HC89020887	WEST NILE VIRUS ELISA(PNL) -AU	302	86789	16.92	17.40
HC89020960	ECHOVIRUS AB TYPE 6-AU	302	86658	25.40	18.00
HC89020978	ECHOVIRUS AB TYPE 7-AU	302	86658	25.40	18.00
HC89020986	ECHOVIRUS AB TYPE 9-AU	302	86658	25.40	18.00
HC89020994	ECHOVIRUS AB TYPE 11-AU	302	86658	25.40	18.00
HC89021000	ECHOVIRUS AB TYPE 30-AU	302	86658	25.40	18.00
HC89021059	ASPERGILLUS AB (PNL2)-AU	302	86606	6.00	5.70
HC89021067	PEANUT ALLERGEN F13 (PNL)-AU	302	86003	50.00	50.00
HC89021075	PEANUT COMP ANTGNC EPI ARA H1(PNL)-AU	302	86003	50.00	50.00
HC89021083	PEANUT COMP ANTGNC EPI ARA H2(PNL)-AU	302	86003	50.00	50.00
HC89021091	PEANUT COMP ANTGNC EPI ARA H3(PNL)-AU	302	86003	50.00	50.00
HC89021109	PEANUT COMP ANTGNC EPI ARA H4(PNL)-AU	302	86003	50.00	50.00
HC89021117	PEANUT COMP ANTGNC EPI ARA H5(PNL)-AU	302	86003	50.00	50.00
HC89021133	NK FUNCTION ASSAY(PNL) -CN	302	86352	430.00	429.66
HC89021141	NK CELLS TOTAL COUNT(PNL) -CN	302	86357	129.00	128.34
HC89021190	ALLERGEN IGE-EA(IMMUNOCAP ISAC)-PD	302	86003	3.00	2.50
HC89021224	LCM AB, IGM-AU	302	86727	18.00	18.00
HC89021257	ENCEPHALITIS CALIF AB IGM-AU	302	86651	45.00	44.40
HC89021265	ENCEPHALITIS EASTERN AB IGM-AU	302	86652	45.00	44.40
HC89021273	ENCEPHALITIS ST LOUIS AB IGM-AU	302	86653	45.00	44.40
HC89021281	ENCEPHALITIS WESTERN AB IGM-AU	302	86654	45.00	44.40
HC89021414	HIV 1 AB -AU	302	86701	37.50	41.01
HC89021422	HIV 2 AB -AU	302	86702	37.50	61.51
HC89021877	ZIKA VIRUS IGM AB CAPTURE-AU	302	86790	85.00	N/A
HC89022016	BETA 2 GLYCOPROTEIN, IGA- AU	302	86146	10.00	N/A
HC89022412	ANTI-STRIAT MUSCLE AB IGG TITER -AU	302	86256	49.00	N/A
HC89023097	ANTI-DNA ANTIBODIES SNGL STRND-QI	302	86226	130.00	N/A
HC89023253	IMMUNO ELECT URINE (IFE)-AU	301	86335	48.95	N/A
HC89023378	ANTIBODY SARS-COV-2 COVID-19 QUAL CIA-AU	302	86769	27.50	N/A
HC89023386	ANTIBODY SARS-COV-2 COVID-19 ELISA-AU	302	86769	40.00	N/A
HC89023428	ASPERGILLUS AB BY ID-AU	302	86606	11.28	N/A
HC89023451	HSV TYPE 1 &/OR 2AB IGM PNL)-AU	302	86694	9.50	N/A
HC89023469	YERSINIA AB IGG BY IMMUNOBLOT-AU	302	86793	40.50	N/A
HC89023477	HSV TYPE 1 &/OR 2AB IGG PNL)-AU	302	86694	13.00	N/A
HC89023493	ISLET AUTOANTIBODY ANTIGEN-2-AU	302	86341	65.00	N/A
HC89023501	ISLET AB ZINC TRANSPORTER 8-AU	302	86341	205.00	N/A
HC89091391	STRONGYLOIDES AB IGG -AU	302	86682	20.00	N/A
HC89091409	CHIKUNGUNYA AB IGG -AU	302	86790	43.50	N/A
HC89091417	CHIKUNGUNYA AB IGM -AU	302	86790	43.50	N/A
HC89091425	SEROTONIN RELEASE ASSAY -AU	301	86022	135.00	N/A
HC89091516	HLA TYPING MULTI ANTIGEN A/B/C-U9	302	86813	N/A	N/A
HC89500680	PLATELET ANTIBODY ID -SB	302	86022	195.00	150.00
HC89500706	CMV IGM / UNIT-SB	302	86645	40.00	40.00
HC89500748	HLA TYPING A,B OR C -SB	302	86813	265.00	265.00
HC89500839	CMV IGM / UNIT-HC	302	86645	40.00	40.00
HC51000487	STREP A ANTIGN SCRN(DIRECT OBS)	300	87880	88.00	N/A
HC81101727	INFLUENZA A BY PCR	306	87798	449.00	150.75
HC81101735	INFLUENZA B BY PCR	306	87798	449.00	201.25
HC81500191	THIN SMEAR, BLOOD PARASITES	300	87207	188.00	63.50
HC81500209	THICK SMEAR, BLOOD PARASITES	300	87015	132.00	38.75
HC81700536	HEPATITIS B SURFACE AG	306	87340	220.00	65.25
HC81700544	C TRACHOMATIS BY DNA PROBE	306	87490	270.00	75.00
HC81700551	N-GONORRHEA BY DNA PROBE	306	87590	254.00	101.75
HC81700783	HEPATITIS B SURFACE AG CONFIRM	302	87341	191.00	67.00
HC81700791	HEPATITIS C QT BY DNA OR RNA	302	87522	552.00	143.50
HC81700809	HIV-1 RNA, QUANT	302	87536	978.00	375.00
HC81701237	HPV HI RISK(16,18,31,33,35,39,45,51,52,56,58,59,68)	306	87624	350.00	162.00
HC81701278	HCV RNA OR DNA AMP PROBE TECH	302	87521	474.00	251.00
HC81701385	HEPATITIS B DNA ULTRA QNT PCR	306	87517	545.00	217.75
HC81701526	STREPTOCCUS GROUP B, PCR	306	87653	453.00	147.25
HC81701534	C TRACHOMATIS BY DNA AMP PROBE	306	87491	383.00	147.25
HC81701542	N-GONORRHEA BY DNA AMP PROBE	306	87591	350.00	100.50
HC81701559	MULTI ORGANIZ DNA BY AMP PROBE	306	87801	798.00	294.50
HC81701625	ENTEROVIRUS RNA RT PCR	306	87498	418.00	215.00
HC81701690	S AUREUS BY PCR	300	87640	423.00	148.25
HC81701708	MRSA BY PCR	300	87641	503.00	148.25
HC81701781	GENOTYPE DNA/RNA HEPATITIS C	306	87902	2,899.00	775.00
HC81701963	HIV TYPE 1 ANTIGEN (RAPID)	300	87390	271.00	38.00
HC81701997	HIV-1 AG W/ HIV-1 & HIV-2 ABS, SINGLE RESULT	302	87389	309.00	75.00
HC83505156	HUMAN PAPILLOMAVIRUS HI/LO- PI	302	87624	48.00	47.70
HC84200005	CULTURE CATH TIP	306	87070	359.00	94.50
HC84200013	CULTURE ANAEROBIC	306	87075	416.00	73.00
HC84200021	CULTURE BLOOD	306	87040	486.00	74.75
HC84200039	CULTURE FUNGUS OTHER SOURCE	306	87102	366.00	99.75
HC84200047	GRAM STAIN	306	87205	152.00	48.25
HC84200054	CULTURE DECUBITUS	306	87070	359.00	94.50
HC84200062	URINE ISOLATE, PRESUMP ID, EA	306	87088	254.00	41.25
HC84200070	STREP A ANTIGN SCRN(DIRECT OBS)	306	87880	167.00	42.00
HC84200088	CULTURE, BACTERIAL-OTHR SOURCE	306	87070	360.00	57.00
HC84200096	KOH PREP	306	87220	145.00	38.75
HC84200104	CULTURE THROAT	306	87070	359.00	43.00
HC84200112	WET MOUNT	306	87210	187.00	38.75
HC84200120	CULTURE CSF	306	87070	359.00	94.50
HC84200138	PINWORM PREP	306	87172	105.00	39.50
HC84200146	CULTURE STOOL	306	87045	374.00	64.75
HC84200153	KIRBY BAUER SENSITIVITY	306	87184	213.00	51.00
HC84200161	MIC SENSITIVITY	306	87186	317.00	46.25
HC84200179	CLOSTRIDIUM DIFFICILE TOXIN	306	87230	265.00	100.00
HC84200187	CULTURE SCREEN	306	87070	359.00	33.50
HC84200195	CULTURE MRSA	306	87081	232.00	42.00
HC84200203	CULTURE VRE	306	87081	232.00	48.25
HC84200211	CULTURE MRSA & VRE	306	87081	232.00	41.85
HC84200229	CULTURE NASAL	306	87070	359.00	94.50
HC84200237	CULTURE GC	306	87081	232.00	48.25
HC84200252	SPECIAL STAIN	306	87207	196.00	63.50
HC84200260	BACTERIAL ANTIGENS EIA	306	87449	188.00	81.00
HC84200278	AEROBIC ID EA ISOLATE	306	87077	225.00	41.25
HC84200286	ANAEROBIC ID EA ISOLATE	306	87076	257.00	41.25
HC84200294	YEAST ID EA ORG	306	87106	233.00	52.25
HC84200302	CULTURE FUNGUS BLOOD	306	87103	386.00	90.50
HC84200310	CULTURE TYPE AGGLUTINATION EA	306	87147	131.00	24.22
HC84200328	MIC ANTIBIOTIC GRADIENT STRIP	306	87181	107.00	21.00
HC84200336	ENZYME DET BETA LACTAMASE	306	87185	92.00	19.25
HC84200369	CULTURE URINE QUANTITATIVE	306	87086	349.00	37.25
HC84200377	TISSUE PROCESS GRINDING	306	87176	142.00	30.00
HC84200385	CULTURE STOOL ADDL PATH	306	87046	260.00	30.00
HC84200393	SPUTUM EVALUATION STAIN	306	87205	152.00	48.25
HC84200401	CULT QT AEROBIC OTHER SOURCE	306	87071	351.00	131.00
HC84200419	CRYPTOCOCCUS NEOFORMANS AG	306	87327	214.00	58.00
HC84200427	INFLUENZA ANTIGEN DIRECT OPT	306	87804	171.00	57.00
HC84200435	TRICHROME STAIN CMPLX OVA/PARA	300	87209	261.00	91.25
HC84200492	ENTAMOEBA HISTO AG(DISPAR)	306	87336	137.00	33.00
HC84200500	CULTURE GROUP B STREPTOCOCCUS	306	87081	232.00	48.25
HC84200518	HUMAN METAPNEUMOVIRUS (HMPV)	306	87299	211.00	55.50
HC84200526	E. COLI SHIGA-LIKE TOXIN ASSAY	306	87427	155.00	43.00
HC84200534	TRICHOMONAS RAPID TEST	306	87808	161.00	43.00
HC84200542	SHIGELLA TOXIN BY IMMUNOASSAY	306	87899	127.00	43.00
HC84200559	SHIGELLA TOXIN BY IMM	306	87899	127.00	43.00
HC84200567	CONCENTRATION AFB/TB/MYCOBACTERIA	306	87015	133.00	67.00
HC84200575	M: CULTURE MISC	306	87070	359.00	57.00
HC84200591	CULTURE SPUTUM QUANT	306	87071	351.00	131.00
HC84200609	STREP PNEUMONIAE URINE AG	306	87449	253.00	95.00
HC84200617	LEGIONELLA AG URINE	306	87449	251.00	115.25
HC84200625	SPECIAL STAIN THICK	306	87015	132.00	38.75
HC84200633	CULTURE RESPIRATORY	306	87070	359.00	94.50
HC84200641	CULTURE WOUND	306	87070	358.00	100.00
HC84200658	CULTURE PERTUSSIS	306	87081	232.00	41.85
HC84200666	CULTURE FUNGUS HAIR/SKIN/NAIL	306	87101	238.00	96.50
HC84200674	MOLD ID EA ORG	306	87107	192.00	52.25
HC84200682	CULTURE MYCOPLASMA ANY SOURCE	306	87109	309.00	78.00
HC84200690	CULTURE CHLAMYDIA  ANY SOURCE	306	87110	391.00	156.75
HC84200708	CULTURE ACID FAST	306	87116	395.00	100.75
HC84200716	CULTURE MYCOBACTERIAL ID	306	87118	295.00	63.72
HC84200724	AFB ID BY PROBE	306	87149	315.00	66.50
HC84200732	ARTHROPOD ID	306	87168	107.00	21.50
HC84200740	PARASITE ID	306	87169	111.00	21.50
HC84200757	OVA/PARASITE-CONC PREP W/SMEAR	306	87177	171.00	45.00
HC84200765	SMEAR CELL TYPE	306	87205	152.00	48.25
HC84200773	AFB STAIN DIRECT	306	87206	182.00	53.25
HC84200799	ADDITIONAL VIRUS TEST	306	87253	262.00	71.25
HC84200807	VIRAL ID (SHELL VIAL)	306	87254	275.00	99.25
HC84200815	ADENOVIRUS FA ANTIGEN	306	87260	203.00	102.75
HC84200823	PERTUSSIS FA ANTIGEN	306	87265	203.00	49.00
HC84200831	CHLAMYDIA FA ANTIGEN	306	87270	248.00	96.25
HC84200849	HSV 2 FA ANTIGEN	306	87273	204.00	49.50
HC84200856	HSV 1 FA ANTIGEN	306	87274	204.00	49.50
HC84200864	INFLUENZA B FA ANTIGEN	306	87275	252.00	102.75
HC84200872	INFLUENZA A FA ANTIGEN	306	87276	252.00	102.75
HC84200880	PARAINFLUENZA EA TYPE	306	87279	202.00	102.75
HC84200898	RESPIRATORY SYNCTAL VIRUS AG	306	87280	198.00	49.50
HC84200906	VARICELLA ZOSTER FA ANTIGEN	306	87290	220.00	49.50
HC84200914	C DIFFICILE AG, EIA	306	87324	344.00	128.25
HC84200922	GIARDIA	306	87329	167.00	79.45
HC84200930	HELICOBACTER PYLORI	306	87339	203.00	74.00
HC84200948	INFLUENZA A OR B EIA EACH	306	87400	235.00	40.50
HC84200955	RESPIRATORY SYNCTAL VIRUS EIA	306	87420	283.00	75.75
HC84200963	ROTAVIRUS ASSAY EIA/ANTIGEN	306	87425	266.00	81.25
HC84201029	CULTURE WHIRLPOOL	306	87070	359.00	43.00
HC84201045	BETA STREP SCREEN(QUAL)	306	87430	210.00	40.50
HC84201060	CRYPTOSPORIDIUM	306	87328	167.00	45.00
HC84201078	ENTAMOEBA HISTOL AG	306	87337	137.00	28.00
HC84201102	CLOTEST FOR H. PYLORI	306	87077	276.00	41.25
HC84201110	C DIFFICILE AG EIA	306	87449	193.00	71.00
HC84201128	CULTURE MRSA; STATISTIC SCREEN	306	87081	N/A	33.50
HC84201136	CULTURE TYPE AGGL EA;ST SCREEN	306	87081	N/A	23.50
HC84201144	CULTURE THROAT-SCREENING	306	87081	232.00	48.25
HC84201151	INFLUENZA H1N1 BY PCR	306	87503	304.00	87.75
HC84201169	INFLUENZA A&B BY PCR (RVP PNL)	306	87502	975.00	362.00
HC84201177	GRAM STAIN (MHL)	306	87205	152.00	48.25
HC84201185	C DIFFICILE TOXIN GENE PCR	306	87493	440.00	150.75
HC84201193	C DIFFICILE TOXIN	306	87324	350.00	105.00
HC84201219	INFLUENZA A BY PCR	306	87798	449.00	201.25
HC84201227	INFLUENZA B BY PCR	306	87798	449.00	201.25
HC84201284	CULTURE CRE	306	87081	232.00	48.25
HC84201292	RESP VIRUS 12-25 TRGTS(RVP PNL)	306	87633	3,640.00	1,500.00
HC84201318	B. PERTUSSIS BY PCR (RVP PNL)	306	87798	457.00	149.50
HC84201326	C. PNEUMONIAE BY PCR (RVP PNL)	306	87486	439.00	149.50
HC84201334	M. PNEUMONIAE BY PCR (RVP PNL)	306	87581	432.00	149.50
HC84201342	INFLUENZA A OR B EIA EACH (POS)	306	87400	235.00	19.25
HC84201359	RESPIRATORY SYNCTAL VIRUS EIA (POS)	306	87420	283.00	75.75
HC84201367	CULTURE CARBAPENEM RESIST ENTER	306	87081	232.00	48.25
HC84201375	CULTURE BLOOD TRANS REACT-MHL	306	87040	486.00	74.75
HC84201383	CULTURE CIPROFLOXACIN RESIST SCRN	306	87081	232.00	48.25
HC84201391	M TUBERCULOSIS DNA AMP PROBE	306	87556	414.00	143.75
HC84201409	IADNA-DNA/RNA PROBE TQ 12-25 GI PCR	306	87507	3,347.00	1,500.00
HC84201417	CULT DNA/RNA AMP PCR GRAM NEG ISO	306	87150	389.00	191.00
HC84201425	CULT DNA/RNA AMP PCR GRAM POS ISO	306	87150	389.00	220.00
HC84201433	CULT DNA/RNA AMP PCR YEAST ISO	306	87150	389.00	220.00
HC84201441	CULT DNA/RNA AMP PCR RESISTANT GENE	306	87150	389.00	220.00
HC84201458	DNA/RNA CMV PCR(PNL)	306	87496	401.00	150.00
HC84201466	DNA/RNA HERPES SIMPLEX I PCR(PNL)	306	87529	354.00	75.00
HC84201474	DNA/RNA HERPES SIMPLEX II PCR(PNL)	306	87529	354.00	75.00
HC84201482	DNA/RNA HERPES VIRUS-6 PCR(PNL)	306	87532	354.00	75.00
HC84201490	DNA/RNA S PNEUMONIAE GROUP B PCR(PNL)	306	87653	398.00	150.00
HC84201508	DNA/RNA E COLI K1 PCR(PNL)	306	87798	386.00	150.00
HC84201516	DNA/RNA INFLUENZAE H PCR(PNL)	306	87798	386.00	150.00
HC84201524	DNA/RNA L MONOCYTOGENES PCR(PNL)	306	87798	386.00	150.00
HC84201532	DNA/RNA N MENINGITIDIS PCR(PNL)	306	87798	386.00	150.00
HC84201540	DNA/RNA S AGALACTIAE PCR(PNL)	306	87798	386.00	150.00
HC84201557	DNA/RNA ENTEROVIRUS PCR(PNL)	306	87798	395.00	150.00
HC84201565	DNA/RNA HUMAN PARECHOVIRUS PCR(PNL)	306	87798	395.00	150.00
HC84201573	DNA/RNA VARICELLA ZOSTER PCR(PNL)	306	87798	386.00	150.00
HC84201581	DNA/RNA C NEOFORMANS/GATTII PCR(PNL)	306	87798	386.00	150.00
HC84201599	DNA/RNA STREP A AMP PROBE(XPERT XPRESS)	306	87651	385.00	150.00
HC84201607	C TRACHOMATIS BY DNA AMP PROBE	306	87491	426.00	155.00
HC84201615	N-GONORRHEA BY DNA AMP PROBE	306	87591	350.00	75.00
HC84201623	MULTI ORGANIZ DNA BY AMP PROBE	306	87801	798.00	200.00
HC84201631	DNA/RNA MENINGITIS/ENCEPHALITIS PCR	306	87483	3,177.00	418.00
HC84201649	DNA/RNA ACINETOBACTER CALCOACETICUS-BAUMANNII CMPLX(PNL)	306	87798	356.00	150.00
HC84201656	DNA/RNA ENTEROBACTER CLOACAE CMPLX (PNL)	306	87798	356.00	150.00
HC84201664	DNA/RNA KLEBSIELLA AEROGENES (PNL)	306	87798	356.00	150.00
HC84201672	DNA/RNA KLEBSIELLA OXYTOCA (PNL)	306	87798	356.00	150.00
HC84201680	DNA/RNA KLEBSIELLA PNEUMONIAE GROUP (PNL)	306	87798	356.00	150.00
HC84201698	DNA/RNA MORAXELLA CATARRHALIS (PNL)	306	87798	356.00	150.00
HC84201706	DNA/RNA PROTEUS SPP (PNL)	306	87798	356.00	150.00
HC84201714	DNA/RNA PSEUDOMONAS AERUGINOSA (PNL)	306	87798	356.00	150.00
HC84201722	DNA/RNA SERRATIA MARCESCENS (PNL)	306	87798	356.00	150.00
HC84201730	DNA/RNA STAPHYLOCOCCUS AUREUS (PNL)	306	87798	356.00	150.00
HC84201748	DNA/RNA STREPTOCOCCUS AGALACTIAE (PNL)	306	87798	356.00	150.00
HC84201755	DNA/RNA STREPTOCOCCUS PNEUMONIAE (PNL)	306	87798	356.00	150.00
HC84201763	DNA/RNA STREPTOCOCCUS PYOGENES (PNL)	306	87798	356.00	150.00
HC84201771	DNA/RNA CHLAMYDIA PNEUMONIAE (PNL)	306	87486	223.00	125.00
HC84201789	DNA/RNA LEGIONELLA PNEUMOPHILA (PNL)	306	87541	238.00	75.00
HC84201797	DNA/RNA MYCOPLASMA PNEUMONIAE (PNL)	306	87581	216.00	75.00
HC84201805	RESP VIRUS 6-11 TARGETS (PNL)	306	87632	1,230.00	327.00
HC84201813	RESP VIRUS 3-5 TARGETS	306	87631	630.00	215.00
HC84201821	SARS-COV-2 COVID-19 AMP QUAL PCR	306	87635	426.00	110.00
HC84201854	STREPTOCCUS GROUP B, PCR	306	87653	449.00	N/A
HC84201862	S AUREUS BY PCR	300	87640	419.00	N/A
HC84201870	MRSA BY PCR	300	87641	503.00	N/A
HC89000186	CULTURE AFB DIR STAIN(PNL)-FT	306	87206	13.00	12.75
HC89000251	CONCENTRATION INF AGTS(PNL)-FT	306	87015	15.00	15.00
HC89000285	ANAEROBIC ID PRESUM(PNL)-FT	306	87185	39.00	38.48
HC89000301	ANAEROBIC SUSC(PNL)-FT	306	87186	39.00	38.48
HC89000491	LEGIONELLA AG DFA-U2	306	87278	16.00	16.00
HC89000541	EPSTEIN BARR VIR DNA PCR-AU	306	87798	65.00	75.00
HC89000970	CULTURE BORD PERTUSSIS(PNL)-U2	306	87070	35.00	35.00
HC89001440	CULTURE CHLAMYDIA-U2	306	87110	N/A	N/A
HC89001481	CRYPTOCOCCUS AG-QD	306	87449	18.00	18.00
HC89001531	CULTURE VIRUS-U2	306	87252	N/A	N/A
HC89001549	CULTURE LEPTOSPIRA-U2	306	87077	N/A	N/A
HC89001556	CULTURE MYCOPLASMA-U2	306	87109	N/A	N/A
HC89001564	CULTURE LEGIONNELLA-U2	306	87081	N/A	N/A
HC89001598	ROTAVIRUS AG-QD	306	87425	15.00	15.00
HC89001606	CULTURE HERPES-U2	306	87252	N/A	N/A
HC89002463	HEPATISIS C RNA BY PCR-SL	306	87522	N/A	N/A
HC89002471	HEPATITIS C GENOTYPE PCR-SL	306	87902	N/A	N/A
HC89002489	HIV-1 RNA QUANT BY PCR-SL	306	87536	N/A	N/A
HC89002497	HSV PCR QUANT-SL	306	87530	N/A	N/A
HC89002513	HEPATITIS B DNA BY PCR-SL	306	87517	N/A	N/A
HC89002554	LEGIONELLA AG URINE-QD	306	87449	22.00	22.00
HC89003313	HEPATITIS BE AG-QD	306	87350	18.00	18.00
HC89003529	ENTEROVIRUS BY PCR/BLOOD-AU	306	87498	110.00	110.00
HC89003909	CULTURE BORDETELLA-U2	306	87081	35.00	35.00
HC89003917	B.PARAPERTUSSIS/PERT DFA-U2	306	87265	13.00	13.00
HC89004345	CRYPTOSPORIDIUM ANTIGEN-AU	306	87328	16.00	16.00
HC89004378	ADENOVIRUS AG-AU	301	87301	19.00	10.50
HC89004774	CULTURE FUNG'HAIR/SKIN/NAIL-FT	306	87101	N/A	N/A
HC89004782	CULTURE FUNGUS OTHER SRC-FT	306	87102	N/A	N/A
HC89004790	CULTURE FUNGUS BLOOD-FT	306	87103	N/A	N/A
HC89004808	MTB COMPLEX DNA, PCR-FT	306	87556	269.00	268.20
HC89004956	PARVOVIRUS B19 BY PCR -AU	306	87798	75.00	75.00
HC89004964	ASPERGILLUS ANTIGEN-AU	302	87305	50.00	84.00
HC89005086	INFECT AGNT-VARIC ZSTR PCR-FT	306	87798	269.00	268.20
HC89005094	PARVOVIRUS B19 DNA QUAL PCR-FT	306	87798	269.00	268.20
HC89005193	INFCT AGNT ADENO DNA  PCR-FT	306	87799	315.00	314.10
HC89005219	INFCT AGNT ADENO DNA(RFX QT-FT	306	87798	269.00	268.20
HC89005227	HERPES VIRUS-6 DNA QUANT -FT	306	87533	314.00	314.00
HC89005235	HERPESVIRUS 6 QUAL(RFX QNT)-FT	306	87532	269.00	268.20
HC89005268	HSV 1 QUANT PCR- FT	306	87530	158.00	157.05
HC89005276	HSV 2 QUANT PCR- FT	306	87530	158.00	157.05
HC89005425	CULTURE MYCOPLASMA-FT	306	87109	99.00	99.00
HC89005433	CULTURE CHLAMYDIA-FT	306	87110	100.00	100.00
HC89005441	CULTURE - CHLAMYDIA STAIN-FT	306	87140	30.00	29.60
HC89005458	CHLAMYDIA PNEUMONIAE BY PCR-AU	306	87486	180.00	179.18
HC89005466	EPSTEIN-BARR VIRUS QNT PCR-AU	306	87799	75.00	100.00
HC89005474	BARTONELLA DNA QNT BY PCR-AU	306	87471	194.00	244.86
HC89005516	ASPERGILLUS ANTIGEN-FT	302	87305	217.00	217.00
HC89005680	PARVOVIRUS B19 DNA QNT PCR-FT	306	87799	269.00	268.20
HC89005847	SPECIMEN CONCENTRATION-U2	306	87015	9.00	9.00
HC89005854	VIRUS TEST ADDITIONAL-U2	306	87253	N/A	N/A
HC89005862	VIRAL ID(SHELL VIAL)-U2	306	87254	N/A	N/A
HC89013064	ANAEROBIC ID PRESUMPTIVE-FT	306	87075	N/A	N/A
HC89013072	CULTURE CLOSTRIDUIM FECAL-AU	306	87075	N/A	N/A
HC89013080	ANAEROBIC BACTERIAL ID-FT	306	87076	93.00	92.22
HC89013098	CULTURE LEGIONELLA-AU	306	87081	39.00	39.60
HC89013106	CULTURE STOOL-AU	306	87045	N/A	N/A
HC89013114	CULTURE MYCOPLASMA-AU	306	87109	39.00	39.00
HC89013122	CULTURE CHLAMYDIA-AU	306	87110	73.00	72.90
HC89013130	CULTURE AFB OTHER(PNL)-FT	306	87116	27.00	26.60
HC89013148	SCHLICTER TEST-AU	306	87197	N/A	N/A
HC89013155	CLOSTRIDIUM DIFFICILE TOXIN-AU	306	87230	28.05	N/A
HC89013163	VIRAL ISOLATE CONFIRM-U2	306	87250	150.00	150.00
HC89013171	GIARDIA AG-AU	306	87329	16.00	16.00
HC89013189	HELICOBACTER PYLORI AG-AU	306	87338	40.00	16.00
HC89013197	HEPATITIS B SURFACE AG (DS)-U2	306	87340	N/A	N/A
HC89013205	HEPATITIS BE AG-AU	306	87350	16.00	12.30
HC89013213	HEPATITIS DELTA AG-AU	306	87380	125.00	125.00
HC89013221	CHLAMYDIA DNA PROBE (PNL)-AU	306	87490	N/A	N/A
HC89013239	CHLAMYDIA DNA PROBE-AU	306	87490	11.00	10.80
HC89013247	CHLAMYDIA TRACHOMATIS AMP-AU	306	87491	15.00	27.00
HC89013254	CYTOMEGALOVIRUS DNA QNT PCR-AU	306	87497	55.00	55.00
HC89013262	HEPATITIS B DNA BY PCR-AU	306	87517	82.00	82.00
HC89013270	HEPATITIS C PCR QUAL-AU	306	87521	66.00	66.00
HC89013288	HEPATISIS C RNA BY PCR-AU	306	87522	82.00	95.00
HC89013296	HSV BY PCR-AU	306	87529	55.00	55.00
HC89013304	HIV-1 DNA PCR QUAL-AU	306	87535	114.00	243.86
HC89013312	HIV-1 RNA QUANT BY PCR-AU	306	87536	75.00	75.00
HC89013320	HIV-1 ULTRA RNA QUANT PCR-AU	306	87536	100.00	100.00
HC89013338	GC DNA PROBE (PNL)-AU	306	87590	N/A	N/A
HC89013346	GC DNA PROBE-AU	306	87590	11.00	10.80
HC89013353	N-GONORRHEA DNA AMP PROBE-AU	306	87591	15.00	27.00
HC89013361	HPV LO RISK TYPES(6,11,42,43,44)-AU	306	87623	47.00	46.56
HC89013379	HPV HI RISK(16,18,31,33,35,39,45,51,52,56,58,59,68)-AU	306	87624	47.00	46.56
HC89013387	RESP VIRAL EACH ORG (PNL)-AU	306	87798	N/A	N/A
HC89013395	AMPLIFIED PROBE TECH-AU	306	87801	16.00	16.00
HC89013403	HIV-1 GENOTYPING-AU	306	87901	275.00	325.00
HC89014542	UREA PLASMA/MYCOPLASMA-AU	306	87109	36.00	16.00
HC89014559	ANAEROBIC SUSCEPTIBILITY-FT	306	87186	N/A	N/A
HC89014567	AFB MIC AVIUM(PNL)-AU	306	87186	N/A	N/A
HC89014575	AFB MIC OTHER-AU	306	87186	N/A	N/A
HC89014583	AFB MIC RAPID GROW-AU	306	87186	N/A	N/A
HC89014591	AFB MIC PRIMARY(PNL)-AU	306	87190	62.00	62.00
HC89014609	AFB MIC SECONDARY(PNL)-AU	306	87188	N/A	N/A
HC89014617	FUNGUS ID-FT	306	87220	53.00	52.79
HC89014625	CULTURE VIRUS - AU	306	87252	27.00	26.70
HC89014633	CULTURE RAPID CYTOMEGALOVIRUS-AU	306	87254	73.00	65.40
HC89014641	VIRUS TEST ADDITIONAL-U2	306	87253	N/A	N/A
HC89014658	CRYPTOCOCCUS NEOFORMANS AG-AU	306	87327	21.00	20.40
HC89014674	LEGIONELLA AG DFA-AU	306	87278	37.00	37.20
HC89014682	LEGIONELLA AG URINE-AU	306	87449	15.00	16.00
HC89014690	HEPATITIS B DNA BY PCR-QD	306	87517	25.00	25.00
HC89014708	HEPATITIS C RNA BY PCR-QD	306	87522	25.00	25.00
HC89014716	HSV BY PCR(CSF)-AU	306	87529	55.00	55.00
HC89014724	HSV PCR QUANT-QD	306	87529	13.00	13.00
HC89014732	HIV-1 RNA QUANT BY PCR-QD	306	87536	25.00	25.00
HC89014740	B PERTUSSIS PCR(PNL)-AU	306	87798	45.00	47.43
HC89014757	B PARAPERTUSSIS PCR-AU	306	87798	45.00	47.43
HC89014765	ENTEROVIRUS BY PCR -AU	306	87498	110.00	110.00
HC89014773	VAGINAL PATHOGEN DNA PROBE-AU	306	87800	66.00	65.41
HC89014807	HEPATITIS C GENOTYPE PCR-AU	306	87902	80.00	245.00
HC89014815	HEPATITIS C GENOTYPE PCR-QD	306	87902	27.00	27.00
HC89014823	LIMULUS LYSSATE ASSAY-AU	306	87999	90.00	89.87
HC89015903	ANAEROBIC SUSCEPTIBILITY-QD	306	87186	27.00	27.00
HC89015911	ACIDFAST BACILL STAIN (OTH)-QD	306	87206	32.00	32.00
HC89015929	CULTURE VIRUS-QD	306	87252	16.00	16.00
HC89015937	B. PARAPERTUSSIS/PERT DFA-QD	306	87265	29.00	29.00
HC89015945	HEPATITIS B SURFACE AG (DS)-QD	306	87340	30.00	30.00
HC89015952	LEGIONELLA AG URINE-QD	306	87449	22.00	22.00
HC89016075	HSV 1-2 BY PCR-FT	306	87801	165.00	164.80
HC89016125	HEPATITIS C PCR QUAL-QD	306	87521	54.00	54.00
HC89016141	VIRAL ID (SHELL VIAL)-QD	306	87254	19.00	19.00
HC89016182	CULTURE STOOL ADDL PATH-QD	306	87046	16.00	16.00
HC89016307	PARASITE IDENTIFICATION(O&P)QD	306	87177	2.00	1.99
HC89016356	CULTURE FUNGUS BLOOD-QD	306	87103	8.00	8.00
HC89016364	CULTURE TYPE AGGLUTIN EA-QD	306	87147	12.00	12.00
HC89016588	ENTEROVIRUS BY PCR-FT	306	87498	165.00	164.80
HC89016604	VIRUS ID(SHELL VIAL)-AU	306	87254	N/A	N/A
HC89016612	HIV-1 GENOTYPING-QD	306	87901	N/A	N/A
HC89016620	CULTURE - CHLAMYDIA STAIN-AU	306	87140	23.00	22.50
HC89016687	ACID FAST PARASITES-AU	306	87206	16.00	16.00
HC89016943	HIV GENE SEQ-VI	306	87901	495.00	494.98
HC89016950	HIV PHENOTYP P'SENS GT(PNL)-VI	306	87903	705.00	705.00
HC89016968	HIV GENOTYPE P'SENS GT(PNL)-VI	306	87901	195.00	195.00
HC89016976	HIV PHENOTYP EACH ADDL(PNL)-VI	306	87904	40.00	40.00
HC89016984	HIV PHENOTYPE 1ST 1-10(PNL)-VI	306	87903	755.00	755.00
HC89017032	GC/CHL DNA PROBE-AU	306	87800	22.00	21.60
HC89017057	AEROBIC BACTERIAL ID-FT	306	87077	58.00	57.13
HC89017065	CHLAMYDIA FA ANTIGEN-AU	302	87270	28.00	27.60
HC89017172	HISTOPLASMA AG-AU	306	87385	60.00	110.00
HC89017297	HIV-1 P24 AG - FT	306	87390	180.00	180.00
HC89017412	PARASITE IDENTIFICATION(O&P)AU	306	87177	31.00	30.50
HC89017420	TRICHROME STAIN CMPLX(O&P)-AU	306	87209	31.00	30.50
HC89017479	FUNGUS SUSCEPTIBILITY-FT	306	87186	249.00	248.15
HC89017511	HSV 2 AG(PNL)-AU	306	87273	25.00	24.75
HC89017529	HSV 1 AG(PNL)-AU	306	87274	25.00	24.75
HC89017776	CULTURE CMV(PNL)-AU	306	87252	33.00	32.70
HC89017784	CULTURE CMV VIR SHELL(PNL)-AU	306	87254	33.00	32.70
HC89017792	CULTURE CHLAMYDIA(PNL)-AU	306	87110	23.00	22.50
HC89019012	ASPERGILLUS ANTIGEN-MV	302	87305	95.00	95.00
HC89019202	HPV TYPES 16&18(45) ONLY-AU	306	87625	67.00	42.75
HC89019236	VARICELLA ZOSTER QNT-FT	306	87799	314.00	314.00
HC89019251	PARECHOVIRUS RNA, RT-PCR-FT	306	87798	269.00	268.20
HC89019442	FUNGITELL ASSAY-BD	306	87449	162.00	128.00
HC89019459	FUNGITELL ASSAY, DILUTION-BD	306	87449	110.00	84.00
HC89019475	CONCENTRATION;MICROSPORIDIA-AU	306	87015	12.00	6.60
HC89019483	SPECIAL STAIN;MICROSPORIDIA-AU	306	87207	10.00	6.00
HC89019525	HIV GENO DRUG SPECIFIC SUS-VI	306	87900	90.00	90.00
HC89019533	FUNGITELL (1,3)BETA D-GLUC-AU	306	87449	70.00	165.00
HC89019871	ENTAMOEBA ANTIGEN EIA -AU	302	87337	22.23	18.00
HC89019996	B PERTUSSIS PCR - AU	306	87798	46.00	45.90
HC89020002	B PARAPERTUSSIS PCR - AU	306	87798	46.00	45.90
HC89020390	C.TRACHOMATIS DNA AMP PROBE-PI	302	87491	39.00	39.00
HC89020408	N.GONORRHEA DNA AMP PROBE-PI	302	87591	39.00	39.00
HC89021018	CANDIDA SPECIES DNA-AU	306	87480	22.00	21.10
HC89021026	GARDNERELLA VAGINALIS DNA-AU	306	87510	21.00	21.00
HC89021034	TRICHOMONAS VAGINALIS DNA-AU	306	87660	21.00	21.10
HC89021232	HSV 6 (HHV6)(A&B), QNT PCR-AU	306	87533	150.00	N/A
HC89021331	BORDETELLA PERTUSSIS CULTURE-AU	306	87081	39.00	N/A
HC89021349	PAN-ASPERGILLUS-VC	306	87798	132.00	N/A
HC89021356	A FUMIGATUS-VC	306	87798	132.00	N/A
HC89021364	A TERREUS-VC	306	87798	131.00	N/A
HC89021455	CONCENTRATION AGNT INF SPECIMEN -AU	306	87015	35.00	35.00
HC89021463	SUSCEPTIBILITY ANTIMICROB MIC -AU	306	87186	90.00	89.40
HC89021513	AFB MTB DNA, PCR-AU	306	87556	195.00	N/A
HC89021562	CYTOMEGALOVIRUS DNA QUAL PCR-AU	306	87496	98.00	N/A
HC89021885	ZIKA VIRUS BY PCR, BLOOD-AU	306	87798	150.00	N/A
HC89021950	PNEUMOCYSTIS JIROVECII DFA-AU	306	87299	37.00	N/A
HC89022172	HSV1&HSV2 SUBTYPES BY PCR -AU	306	87529	170.00	N/A
HC89022438	CULTURE VIRUS NON-RESPIRATORY-AU	306	87252	49.00	N/A
HC89022446	CULTURE VIRUS RESPIRATORY-AU	306	87252	73.00	N/A
HC89022453	CULTURE VIRUS ID DEFIN/ADDL+-AU	306	87253	45.00	N/A
HC89022461	CULTURE PRESUMPTIVE ID HSV(PNL)-AU	306	87252	16.00	N/A
HC89022479	CULTURE ID DEFIN/ADDL HSV(PNL)+-AU	306	87253	13.00	N/A
HC89022487	DFA W/REFLEX CULT VARICELLA ZV-AU	306	87290	77.00	N/A
HC89022495	CULTURE PRESUMP ID VARICELLA ZV(PNL)-AU	306	87252	42.00	N/A
HC89022503	CULTURE ID W/IMMUNOFLUOR' VZV(PNL)-AU	306	87254	31.00	N/A
HC89023279	HIV-1 DNA/RNA QUANT BY NAAT-AU	306	87536	93.50	N/A
HC89023287	SARS-COV-2 RNA QUAL RT-PCR-QN	302	87635	100.00	N/A
HC89023295	SARS-COV-2 RNA QUAL RT-PCR-AU	302	87635	95.00	N/A
HC89023436	B. PERTUSSIS & PARAPERTUSSIS PCR-AU	306	87798	70.00	N/A
HC89023519	HEPATITIS B DNA/RNA QUANT BY NAAT-AU	306	87517	99.00	N/A
HC81500951	FACTOR V LEIDEN BY PCR	301	81241	514.00	N/A
HC81500969	FACTOR 2 MUTATION BY PCR	301	81240	491.00	N/A
HC81701765	FACTOR V LEIDEN BY PCR	301	81241	539.00	249.00
HC81701773	FACTOR 2 MUTATION BY PCR	301	81240	515.00	249.00
HC83505636	BRAF MUTATION ANALYSIS-NG	310	81210	170.00	N/A
HC83505644	KRAS MUT ANALSYS VARIANTS EXONS 2-NG	310	81275	500.00	N/A
HC83505651	KRAS MUT ANALYSIS EXON 4-NG	310	81276	369.00	N/A
HC83505669	NRAS MUT ANALYSIS EXONS 2&3-NG	310	81311	580.00	N/A
HC83505677	NRAS MUT ANALYSIS EXON 4-NG	310	81403	340.00	N/A
HC83505826	EGFR GENE COM VARIANTS-NG	310	81235	360.00	N/A
HC89019897	FRAGILE X (FMR1) DIAGNOSTIC-AU	301	81244	460.00	325.00
HC89019905	CYTOGENOMIC SNP MICROARRAY -AU	300	81229	995.00	1,245.00
HC89019913	HEMOCHROMATOSIS MUTATION-AU	301	81256	89.00	100.00
HC89019939	MTHFR MUTATION DETECTION-AU	301	81291	60.00	60.00
HC89019947	PROTHROMBIN(F2) G20210A MUT-AU	301	81240	75.00	75.00
HC89019954	FACTOR V LEIDEN PCR-AU	301	81241	72.00	72.00
HC89019988	FHL2 PRF1 GENE MUTATION-CN	309	81479	3,984.00	2,346.00
HC89020010	FRAGILE X SCREEN REFLEX-AU	300	81243	95.00	130.00
HC89020036	TPMT GENETICS (3300)-PR	301	81401	316.00	316.00
HC89020044	HLA-DQA1(PNL 6260/6360)-PR	301	81382	260.00	260.00
HC89020051	HLA-DQB1(PNL 6260/6360)-PR	301	81382	260.00	260.00
HC89020069	LACTO TYPE (LCT)(CAT #6100-2013) -PR	301	81400	236.80	236.80
HC89020218	ATG16L1 SNP (RS2241880)(PL)-PR	301	81479	14.40	47.00
HC89020226	ECM1 SNP (RS3737240)(PNL)-PR	301	81479	14.40	47.00
HC89020234	NKX2-3 SNP (RS10883365)(PL)-PR	301	81479	14.40	47.00
HC89020242	STAT3 SNP (RS744166)(PNL)-PR	301	81479	14.40	47.00
HC89020259	MAJOR BREAKPOINT (BCR/ABL1)-AU	309	81206	75.00	75.00
HC89020267	MINOR BREAKPOINT (BCR/ABL1)-AU	309	81207	75.00	75.00
HC89020317	HLA-A GENOTYPE-AU	309	81380	325.00	325.00
HC89020325	HLA-B GENOTYPE-AU	309	81380	325.00	325.00
HC89020333	CYTOGENOMIC SNP MICROARRAY-FETAL-AU	300	81229	1,570.00	1,950.00
HC89020341	CONNEXIN 26 (GJB2) SEQUENCING-AU	300	81252	520.00	520.00
HC89020366	EGFR GENE COM VARIANTS-AU	301	81235	443.00	443.00
HC89020374	MOLECULAR PATH PROC LVL 4-AU	301	81403	164.00	164.00
HC89020382	KRAS GENE ANALYSIS-AU	301	81275	164.00	164.00
HC89020499	T-CELL RECEPTOR EXCISION CIRCLES-GE	301	81479	1.00	0.01
HC89020937	SPINAL MUSCULAR ATROPHY-QN	301	81401	695.00	695.00
HC89021182	PCA3 PROSTATE CA BIOMARKER-AU	310	81313	305.00	305.00
HC89021208	CYSTIC FIBROSIS RFLX TO SEQ-AU	310	81223	868.00	1,200.00
HC89021786	CYSTIC FIBROSIS 165 VARIANTS-AU	301	81220	155.00	N/A
HC89022685	HLA CLASS I TYPING LOW RES COMPLETE-U9	310	81372	350.00	N/A
HC89022693	HLA CLASS II TYPING LOW RES HLA-DRB1/3/4/5&-DQB1-U9	310	81375	220.00	N/A
HC89022701	HLA CLASS I TYPING HIGH RES EACH LOCUS-U9	310	81380	350.00	N/A
HC89022719	HLA CLASS II TYPING HIGH RES EACH LOCUS-U9	310	81382	300.00	N/A
HC89022743	HLA CLASS II TYPING INTERMED RES 1 LOCUS-U9	309	81376	130.00	N/A
HC89022792	TARGETED GENOME PNL SEQ 51/>GENES-AU	310	81455	1,900.00	N/A
HC89023063	ANAL' GENE TPMT COMMON VARIANT-AU	310	81335	76.00	N/A
HC89023071	ANAL' GENE NUDT15 COMMON VARIANT-AU	310	81306	124.00	N/A
HC89023410	TARGETED GENOME PNL SEQ 5-50 GENES PANCREASEQ-SS	309	81445	750.00	N/A
HC89091342	FAM ADENOM POLYPOSIS DEL/DUP-AU	310	81203	320.00	320.00
HC89091359	FAM ADENOM POLYPOSIS SEQ-AU	310	81201	1,000.00	1,000.00
HC89091375	HLA-B*5701-ABACAVIR SENS EA-AU	310	81381	100.00	160.00
HC89500946	RBC AG PROFILE-MOLECULAR LEVEL 4-SB	301	81403	575.00	N/A
HC81100083	LIPID PANEL	301	80061	387.00	67.25
HC81100273	COMP METABOLIC PANEL	301	80053	594.00	65.00
HC81100281	RENAL FUNCTION PANEL	301	80069	405.00	49.50
HC81100372	HEPATIC FUNCTION PANEL	301	80076	409.00	36.25
HC81100430	ELECTROLYTE PANEL	301	80051	292.00	35.75
HC81100448	BASIC METABOLIC PANEL/TOTAL CA	301	80048	490.00	38.50
HC81100877	ACUTE HEPATITIS PANEL	301	80074	787.00	313.50
HC81101354	LIPID PANEL SUBSEQUENT	301	80061	374.00	67.25
HC81101446	BASIC METABOLIC PANEL/ION'D CA	301	80047	394.00	38.50
HC81101867	LIPID PANEL (DA)	301	80061	277.00	35.00
HC81101891	BASIC METABOLIC PAN/ION'D CA (POS)	301	80047	369.00	38.50
HC81101917	GENERAL HEALTH PANEL     (CHAMPUS)	300	80050	1,086.00	205.00
HC11501020	COLLECTION SPECIMEN SARS-COV-2	300	C9803	145.00	N/A
HC47201215	COLLECTION SPECIMEN SARS-COV-2	300	C9803	145.00	N/A
HC51001600	HANDLING & SENDOUT TO REF' LAB	510	99000	22.00	N/A
HC51004034	COLLCTN SPUTM AEROSL TECH, SEP PROC	410	89220	292.00	N/A
HC51061232	COLLECTION SPECIMEN SARS-COV-2	300	C9803	77.00	N/A
HC51061950	MONITOR AMB GLUCOSE ASSESS 72+ HRS	510	95249	200.00	N/A
HC81100158	VANCOMYCIN INIT	301	80202	454.00	124.00
HC81100166	VANCOMYCIN SUBS	301	80202	445.00	124.00
HC81100190	LITHIUM	301	80178	262.00	47.25
HC81100265	VALPROIC ACID; TOTAL	301	80164	508.00	96.25
HC81100307	PHENYTOIN TOTAL	301	80185	455.00	75.25
HC81100315	PHENOBARBITOL	301	80184	439.00	112.75
HC81100356	THEOPHYLINE	301	80198	396.00	91.00
HC81100505	DIGOXIN; TOTAL	301	80162	423.00	75.25
HC81100588	GENTAMICIN SUBS	301	80170	515.00	106.25
HC81100596	GENTAMICIN INIT	301	80170	537.00	106.25
HC81100604	TOBRAMYCIN SUBS	301	80200	484.00	193.00
HC81100612	TOBRAMYCIN INIT	301	80200	504.00	124.00
HC81100711	QUINIDINE	301	80194	246.00	89.00
HC81100778	PROCAINAMIDE W/NAPA	301	80192	274.00	80.00
HC81100810	FAT STAIN URINE/FECES/SECRETNS	301	89125	118.00	21.75
HC81100893	AMIKACIN INIT	301	80150	356.00	106.25
HC81100901	AMIKACIN  SUBS	301	80150	356.00	106.25
HC81100919	ETHOSUXIMIDE	301	80168	324.00	87.00
HC81100927	LIDOCAINE	301	80176	327.00	81.00
HC81100935	PHENYTOIN FREE	301	80186	520.00	106.25
HC81100943	PRIMIDONE	301	80188	261.00	135.00
HC81100950	PROCAINAMIDE	301	80190	302.00	80.00
HC81100984	NORPACE/DISOPYRAM	301	80299	334.00	117.00
HC81101263	SWEAT COLLECT IONTOPHORESIS	301	89230	808.00	119.00
HC81101750	ACTH STIMULATION PANEL	301	80400	763.00	340.00
HC81500001	CELL COUNT FLUID W/ DIFF	300	89051	280.00	48.25
HC81500019	NASAL SMEAR FOR EOS	300	89190	145.00	59.00
HC81500050	CRYSTALS FLUID	300	89060	217.00	63.50
HC81500142	CELL COUNT FLUID W/O DIFF	300	89050	231.00	45.00
HC82200544	MOLECULAR CYTO DNA PROBE	310	88271	783.00	95.00
HC82200551	INTERPHASE IN-SITU HYBRI 25-99	310	88274	1,159.00	252.00
HC82202201	CRYSTALS FLUID	300	89060	213.00	63.50
HC82202649	MISC PATHOLOGY-SOF(CLIENT BILL	302	89240	107.00	13.80
HC82204710	HANDLING AND/OR CONVEYANCE TO REF LAB(AP)	310	99001	94.00	25.00
HC83000976	HANDLING AND/OR CONVEYANCE TO REF LAB(BB)	300	99001	94.00	38.00
HC83500058	UROVYSION FISH BLADDER CA-US	311	88299	N/A	N/A
HC83500181	CHROMO LYMPHOCYTE TISSUE-GZ	310	88230	N/A	N/A
HC83500199	CHROMO ANALYSIS, TISSUE -GZ	310	88233	350.00	350.00
HC83500207	CHROMO  TISSUE CULT-GZ	310	88237	N/A	N/A
HC83500215	CHROMO  TISSUE CULT-HP	310	88237	N/A	N/A
HC83500223	CHROMO  TISSUE CULT-GZ	310	88237	N/A	N/A
HC83500249	CHROM ANAL BM TISSUE CULT-GZ	310	88237	N/A	N/A
HC83500256	CHROMO  TISSUE BLOOD-US	310	88237	175.00	175.00
HC83500264	CHROMO  TISSUE BLOOD-HP	310	88237	N/A	N/A
HC83500272	CHROMO  TISSUE BLOOD-IM	310	88237	175.00	175.00
HC83500280	CHROMO SOLID TUMOR-GZ	310	88239	N/A	N/A
HC83500298	CHROMOSOME BRKG ANAL 50-102-GZ	310	88248	N/A	N/A
HC83500306	CHROMO TISSUE COUNT-HP	310	88261	N/A	N/A
HC83500314	CHROMO TISSUE COUNT-GZ	310	88261	N/A	N/A
HC83500322	BM: CHROMOSOME ANALYSIS-GZ	310	88262	200.00	200.00
HC83500330	KARYOTYPING,COUNT,BANDING-GZ	310	88262	N/A	N/A
HC83500348	15-20 CELLS, 2 KARYO,BAND-GZ	310	88262	100.00	100.00
HC83500355	15-20 CELLS,2 KARYO,BAND-IM	310	88262	N/A	N/A
HC83500363	CHROMO CT 15-20 W/BANDING-HP	310	88262	N/A	N/A
HC83500371	CHROMO CT 15-20 W/BANDING-IM	310	88262	N/A	N/A
HC83500389	CHROMO CT 15-20 W/BANDING-US	310	88262	180.00	180.00
HC83500397	CHROM ANAL TISSUE COUNT-US	310	88262	175.00	175.00
HC83500405	CHROM ANAL TISSUE COUNT-GZ	310	88262	100.00	100.00
HC83500413	15 CELLS, 1 KARYO, BAND -GZ	310	88267	N/A	N/A
HC83500421	CHROMO AMNIOTIC FLD CT 17-GZ	310	88267	399.00	398.25
HC83500439	CHROMO ANAL AMNIO FLD 6-14-GZ	310	88269	N/A	N/A
HC83500447	MOLECUL CYTO DNA PROBE FISH-HP	310	88271	N/A	N/A
HC83500454	MOLECUL CYTO DNA PROBE FISH-IM	310	88271	N/A	N/A
HC83500462	MOLECUL CYTO DNA PROBE FISH-US	310	88271	65.00	65.00
HC83500470	MOLECUL CYTO DNA PROBE FISH-GZ	310	88271	490.00	490.00
HC83500488	INTERPHASE FISH HYBRI 25-99-HP	310	88274	N/A	N/A
HC83500496	INTERPHASE FISH HYBRI 25-99-IM	310	88274	N/A	N/A
HC83500504	INTERPHASE FISH HYBRI 25-99-US	310	88274	N/A	N/A
HC83500512	INTERPHASE FISH HYBRI 25-99-GZ	310	88274	N/A	N/A
HC83500520	INTERPHS FISH HYBRI 100-300-HP	310	88275	N/A	N/A
HC83500538	INTERPHS FISH HYBRI 100-300-IM	310	88275	N/A	N/A
HC83500546	INTERPHS FISH HYBRI 100-300-US	310	88275	65.00	65.00
HC83500553	KARYOTYPING,ADD EA-HP	310	88280	N/A	N/A
HC83500561	KARYOTYPING,ADD EA-IM	310	88280	49.00	48.99
HC83500587	CHROM ANAL ADDL CELL CT-GZ	310	88285	N/A	N/A
HC83500595	CHROM ANAL ADDL CELL CT-HP	310	88285	N/A	N/A
HC83500603	CHROM ANAL ADDL CELL CT-IM	310	88285	N/A	N/A
HC83500611	CHROM ANAL ADDL CELL CT-US	310	88285	N/A	N/A
HC83500629	CHROM ANAL ADDL HI RESOLUTION -GZ	310	88289	149.00	148.50
HC83503946	HANDLING AND/OR SHIPPING	300	99001	85.00	25.00
HC83503995	CHROM ANAL AMNIO/CHORIONIC-GZ	310	88235	N/A	N/A
HC83504001	CHROMO SOLID TUMOR-HP	310	88239	N/A	N/A
HC83504019	CHROM ANAL 45 CELLS-GZ	310	88263	360.00	359.10
HC83504027	KARYOTYPING,ADD EA-GZ	310	88280	68.00	67.50
HC83504035	CHROM ANAL ADD SPEC BAND-GZ	310	88283	135.00	135.00
HC83504407	CHROMO LYMPHOCYTE TISSUE-GC	310	88230	N/A	N/A
HC83504415	MOLECUL CYTO DNA PROBE FISH-GC	310	88271	N/A	N/A
HC83504423	CHROM ANAL ADD SPEC BAND-GC	310	88283	N/A	N/A
HC83504431	CHROM ANAL ADDL CELL CT-GC	310	88285	N/A	N/A
HC83504563	HANDLING SPEC COURIER-CS	300	99001	85.00	85.00
HC83505883	CHROM TISSUE CULT BONE MARROW-NG	311	88237	150.00	N/A
HC83505891	CHROM ANAL 20-25 CELLS BONE MARROW-NG	311	88264	200.00	N/A
HC84200989	FAT STAIN FECES QUAL	300	89125	121.00	29.00
HC84200997	MEAT FIBERS, FECES	300	89160	94.00	45.00
HC84201003	SEMEN ANALYSIS COMPLETE	300	89320	334.00	99.25
HC84201011	SEMEN ANALYSIS POST	300	89321	207.00	61.00
HC84201201	CHARCOT-LEYDEN CRYSTALS	306	89060	272.00	31.75
HC84201839	RESP BACTERIA/VIRAL 22 TRGT SARS-COV-2 QUAL RT-PCR(PNL RP2.1)	306	0202U	2,288.00	500.00
HC84201847	SARS-COV-2/FLU/RSV RNA QUAL PCR	306	0241U	741.00	220.00
HC84600063	PAP SMEAR SCREEN (MCR)	311	P3000	79.00	30.00
HC84600097	PAP THIN LAYER PREP MAN&RE SCN	311	G0143	251.00	64.00
HC88600093	HANDLING AND/OR CONVEYANCE TO REF LAB(TRIAGE)	309	99001	85.00	27.75
HC88600101	NBS HANDLE COLLECTION CARD-GE	309	99001	1.00	1.00
HC88600200	AP TRANSPORT CHARGE	309	99001	68.00	34.00
HC88600226	SPECIAL COURIER       85	300	99001	108.00	85.00
HC88600234	SPECIAL COURIER       25	300	99001	32.00	25.00
HC88600242	SPECIAL COURIER       40	300	99001	51.00	40.00
HC88600267	SPECIAL COURIER       30	300	99001	38.00	30.00
HC88600275	SPECIAL COURIER      110	300	99001	139.00	110.00
HC88600283	SPECIAL COURIER-MISC	300	99001	N/A	N/A
HC88600317	HANDLING & SHIPPING-BD	309	99001	76.00	60.00
HC89000517	SPERM ANTIBODIES-AU	300	89325	48.00	48.25
HC89000681	DIGITOXIN-QD	301	80299	60.00	60.00
HC89000715	CHLORPROPAMIDE-AU	301	80299	84.00	84.00
HC89000772	CIMETIDINE/TAGAMET-AU	301	80299	100.00	100.00
HC89000780	DYPHYLLINE-AU	301	80299	94.00	94.00
HC89000871	ENCAINIDE-AU	301	80299	422.00	422.00
HC89001085	FLUOROCYTOSINE-QD	301	80299	60.00	60.00
HC89001184	INDERAL-QD	301	80299	60.00	60.00
HC89001275	IODINE-QD	301	80299	60.00	60.00
HC89001333	LOXAPINE & METABOLITE-AU	301	80299	222.00	222.00
HC89001366	DARVON-QD	301	80299	60.00	60.00
HC89001432	METHOCARBAMOL-AU	301	80299	98.00	98.00
HC89001457	METHYPRYLON-AU	301	80299	95.00	95.00
HC89001648	PHENSUXIMIDE-AU	301	80299	112.00	112.00
HC89001739	SPERM AB (PNL)-AU	300	89325	33.00	32.16
HC89001762	THIOTHIXENE-QD	301	80299	60.00	60.00
HC89001770	ETHOSUXIMIDE-QD	301	80168	N/A	N/A
HC89001861	CODEINE URINE-QD	301	80299	60.00	60.00
HC89001887	SULFONAMIDES-QD	301	80299	60.00	60.00
HC89001911	TOCAINIDE-QD	301	80299	60.00	60.00
HC89001994	TACROLIMUS-U2	301	80197	40.00	N/A
HC89002232	MEXILETINE-QD	301	80299	60.00	60.00
HC89002588	TOPIRAMATE-QD	301	80201	38.00	37.35
HC89002828	DISOPYRAMIDE-QD	301	80299	60.00	60.00
HC89002877	AMIKACIN INITIAL-QD	301	80150	N/A	N/A
HC89002885	AMIKACIN SUBSEQUENT-QD	301	80150	71.00	70.36
HC89002943	CIMETIDINE/TAGAMET-QD	301	80299	60.00	60.00
HC89003032	PROPAFENONE-QD	301	80299	60.00	60.00
HC89003040	HALOPERIDOL-QD	301	80173	N/A	N/A
HC89003065	QUINIDINE-U2	301	80194	N/A	N/A
HC89003081	PRIMIDONE-U2	301	80188	35.00	35.00
HC89003537	ACETAZOLAMIDE URINE-AU	301	80299	91.00	91.00
HC89003578	DIPHENHYDRAMINE URINE-AU	301	80299	90.00	90.00
HC89003594	HYDROXYZINE URINE-AU	301	80299	113.00	113.00
HC89003636	TISSUE CULTURE-HP	311	88237	N/A	N/A
HC89003701	PHENMETRAZINE URINE-AU	301	80299	125.00	125.00
HC89003719	PHENYLPROPANOLAMINE URINE-AU	301	80299	97.00	97.00
HC89003867	PROCAINAMIDE W/NAPA-U2	301	80192	25.00	25.00
HC89003891	LIDOCAINE-U2	301	80176	38.00	38.00
HC89003933	CHROMO ANALYSIS TISSUE-GC	310	88233	N/A	N/A
HC89003941	CHROMO ANALYSIS AMINIO FLD-GC	311	88235	N/A	N/A
HC89003958	CHROM ANALYSIS BONE MARROW-GC	310	88237	517.00	517.00
HC89003966	5 CELLS, 1 KARYO BANDING-GC	311	88261	N/A	N/A
HC89003974	15-20 CELLS, 2 KARYO BAND-GC	311	88262	N/A	N/A
HC89003982	15 CELLS, 1 KARYO BAND-GC	311	88267	N/A	N/A
HC89003990	KARYOTYPING,ADD EA-GC	311	88280	192.00	192.00
HC89004006	CHROM ANAL ADDL CELL CT-GC	311	88285	N/A	N/A
HC89004014	TISSUE CULTURE BM, BLOOD-IM	311	88237	N/A	N/A
HC89004071	TOPIRAMATE-AU	301	80201	26.00	16.00
HC89004261	AMIKACIN - RANDOM-U2	301	80150	35.00	35.00
HC89004287	MEAT FIBERS, FECES-AU	300	89160	16.00	16.00
HC89004386	PROCAINAMIDE W/NAPA-AU	301	80192	16.00	16.00
HC89005102	VORICONAZOLE ANTIFNGL-FT	301	80299	178.00	178.00
HC89005748	CHROM LYMPHOCYTE TISSUE-GC	310	88230	N/A	N/A
HC89005755	MOLECUL CYTO DNA PROBE FISH-GC	310	88271	N/A	N/A
HC89005763	INTERPHASE FISH HYBRI 10-30-GC	310	88273	N/A	N/A
HC89005813	TACROLIMUS-QD	301	80197	35.00	34.63
HC89005839	PHENOBARBITAL-U2	301	80184	30.00	30.00
HC89006175	HALOPERIDOL-AU	301	80173	29.00	16.00
HC89006274	AMIKACIN PEAK OR TROUGH-U2	301	80150	35.00	35.00
HC89006506	ETHOSUXIMIDE-AU	301	80168	12.00	12.00
HC89006530	LIDOCAINE-AU	301	80176	16.00	16.00
HC89006555	PHENOBARBITAL LEVEL-AU	301	80184	11.35	8.00
HC89006563	PHENYTOIN FREE(PNL)-AU	301	80186	32.76	12.75
HC89006571	PRIMIDONE-AU	301	80188	5.35	8.00
HC89006589	NAPA-U2	301	80190	25.00	25.00
HC89006597	QUINIDINE-AU	301	80194	15.00	15.00
HC89006613	TACROLIMUS-AU	301	80197	15.00	15.00
HC89006621	TOBRAMYCIN INITIAL-U2	301	80200	38.00	37.80
HC89006639	TOBRAMYCIN SUBSEQUENT-U2	301	80200	N/A	N/A
HC89006647	ANTIMICROB LEVEL-FT	301	80299	N/A	N/A
HC89006654	BROMIDES-AU	301	80299	32.00	31.20
HC89006670	DIGITOXIN-AU	301	80299	22.70	22.80
HC89006696	DISOPYRAMIDE-AU	301	80299	20.00	19.50
HC89006704	EPHEDRINE-AU	301	80299	N/A	N/A
HC89006712	ETHOTOIN-AU	301	80299	N/A	N/A
HC89006753	ISONIAZID-NM	301	80299	90.00	90.00
HC89006779	LEVODOPA-AU	301	80299	N/A	N/A
HC89006787	MAPROTILINE/LUDIOMIL-QN	301	80299	N/A	N/A
HC89006829	MEXILETINE-AU	301	80299	29.00	28.50
HC89006837	NAPROXEN-AU	301	80299	106.00	106.00
HC89006860	PROPOXYPHENE-AU	301	80299	N/A	N/A
HC89006886	SIROLIMUS(RAPAMUNE)-AU	301	80299	30.00	62.00
HC89006894	SULFONAMIDES - AU	301	80299	N/A	N/A
HC89006902	THIOTHIXENE-AU	301	80299	N/A	N/A
HC89006944	TRIMIPRAMINE-QN	301	80299	N/A	N/A
HC89006951	VERAPAMIL-MA	301	80299	N/A	N/A
HC89006969	WARFARIN-AU	301	80299	62.00	62.00
HC89013411	AMOXAPINE/HPLC-AU	301	80299	N/A	N/A
HC89013429	COGENTIN/BENZTROPINE-SL	301	80299	N/A	N/A
HC89013445	NEURONTIN-AU	301	80299	N/A	N/A
HC89013452	VERAPAMIL-AU	301	80299	73.00	72.69
HC89014872	CHROM ANAL BLOOD TISSU CULT-GZ	311	88230	228.00	185.00
HC89014880	SPECIMEN PREP BLOOD-GZ	311	88230	N/A	N/A
HC89014898	CHROM ANAL-TISSUE-TISSU CUL-GZ	310	88233	252.00	185.00
HC89014906	CHROM ANAL AF TISSUE CULT-GZ	311	88235	78.00	78.00
HC89014914	CHROM ANAL-POC TISSUE CULT-GZ	311	88235	N/A	N/A
HC89014922	CHROM ANALYSIS BONE MARROW-GZ	311	88237	110.00	110.00
HC89014930	CHROM ANAL CRD BD TISS/CULT-GZ	311	88239	N/A	N/A
HC89014948	CHROMOSOME BRKG ANAL 50-102-GZ	311	88248	N/A	N/A
HC89014955	CHROM ANAL BM COUNT-US	311	88262	N/A	N/A
HC89014963	15-20 CELLS, 2 KARYO,BAND-GZ	311	88262	223.00	200.00
HC89014971	BM: CHROMOSOME ANALYSIS-GZ	311	88262	N/A	N/A
HC89014989	CHROMO AMNIOTIC FLD CT 17-GZ	311	88267	N/A	N/A
HC89014997	CHROM ANAL AF COUNTING-GZ	311	88267	250.00	250.00
HC89015002	CHROMO ANAL AMNIO FLD 6-14-GZ	311	88269	N/A	N/A
HC89015010	KARYOTYPING,ADD EA-GZ	311	88280	20.00	20.00
HC89015028	KARYOTYPING,ADD EA-GZ	311	88280	N/A	N/A
HC89015036	CHROM ANAL ADDL CELL CT-GZ	311	88285	N/A	N/A
HC89015044	CHROM ANAL ADDL HI RESOLUT-GZ	311	88289	N/A	N/A
HC89015069	FAT STAIN URINE-AU	300	89125	N/A	N/A
HC89015242	INDERAL - AU	301	80299	19.00	18.90
HC89015259	CODEINE URINE - U2	301	80299	71.00	70.47
HC89015283	PRIMIDONE-QD	301	80188	12.00	12.00
HC89016521	PHENYTOIN TOTAL(PNL)-AU	301	80185	N/A	12.75
HC89017164	PROPAFENONE-AU	301	80299	16.00	16.00
HC89018592	CHROM ANAL TISSUE CULT, BM-AU	310	88237	163.00	214.82
HC89018600	CHROM ANAL 20-25 CELLS, BM-AU	310	88264	163.00	211.24
HC89018626	CHROM ANAL TISS CULT, BLD-AU	310	88230	148.80	198.70
HC89018634	CHROM ANAL 15-20 CELLS, BLD-AU	310	88262	161.20	212.59
HC89018659	CHROM ANAL TISSUE CULT, AF-AU	310	88235	183.00	241.24
HC89018667	CHROM COUNT 6-12 CELLS, AF-AU	311	88269	207.00	272.44
HC89018675	CHROM ADD KARYOTYPE, AF-AU	310	88280	42.00	41.14
HC89018691	MOLECUL CYTO DNA PROBE FISH-AU	310	88271	85.40	69.13
HC89018709	INTERPHS FISH HYBRI 100-300-AU	310	88275	181.48	129.61
HC89018832	CHROM ANAL 15-20 CELLS, POC-AU	310	88262	211.50	267.83
HC89018840	CHROM ANAL TISSUE POC-AU	310	88233	238.50	302.40
HC89020416	THEOPHYLLINE-U2	301	80198	36.00	36.00
HC89020515	ISONIAZID -AU	301	80299	102.00	101.40
HC89021323	EOSINOPHIL SPUTUM-AU	305	89190	8.00	N/A
HC89023402	RESP DNA/RNA SARS-COV-2/COVID-19 AMP PROBE-ET	302	U0003	65.00	N/A
HC89500458	SAMPLE TRANSPORT-SB	300	99001	75.00	75.00
HC89501043	RBC DNA GENOTYPE 16 GROUPS 51 AG-SB	301	0246U	500.00	N/A
HC81500217	LEUKEMIA CELLS, SPINAL FL	311	88108	339.00	184.00
HC81700569	FLOW CYT MKR TC ADD+ KAPPA	311	88185	249.00	104.00
HC81700817	ABSOLUTE T4/CELL MRKR ADD+	311	88185	249.00	104.00
HC81700825	CALLA/ACUTE LYMPH LEUK AG MKR+	311	88185	249.00	565.00
HC81700833	FLOW CYT MKR TC ADD+ CD23	311	88185	249.00	104.00
HC81700858	FLOW CYT MKR TC ADD + CD38	311	88185	249.00	104.00
HC81700866	FLOW CYTO MKR TC ADD + CALLA	311	88185	249.00	104.00
HC81700874	FLOW CYTO CELL MKR TC ADD+	311	88185	249.00	104.00
HC81700882	FLW CYT MKR CD11 TC ADD+	311	88185	249.00	104.00
HC81700890	FLW CYT MKR CD14 TC ADD+	311	88185	249.00	104.00
HC81700908	FLW CYT MKR CD19 TC ADD+	311	88185	249.00	104.00
HC81700916	FLW CYT MKR CD2 TC ADD +	311	88185	249.00	104.00
HC81700924	FLW CYT MKR CD20 TC ADD+	311	88185	249.00	104.00
HC81700932	FLW CYT MKR CD24 TC ADD+	311	88185	249.00	104.00
HC81700940	FLW CYT MKR CD3 (LEU-4)TC ADD+	311	88185	249.00	104.00
HC81700957	FLW CYT MKR CD30 (KI-1)TC ADD+	311	88185	249.00	104.00
HC81700965	FLW CYT MKR CD33 TC ADD+	311	88185	249.00	104.00
HC81700973	FLW CYT MKR CD34 (HPCA-1)ADD+	311	88185	249.00	104.00
HC81700981	FLOW CYT MKR TC CD45	311	88184	483.00	342.00
HC81700999	FLW CYT MKR CD5 TC ADD+	311	88185	249.00	104.00
HC81701005	FLW CYT MKR CD56 TC ADD+	311	88185	249.00	104.00
HC81701013	FLW CYT MKR CD7 TC ADD+	311	88185	249.00	104.00
HC81701021	FLW CYT MKR CD8 TC ADD+	311	88185	249.00	104.00
HC81701039	FLW CYT MKR IGA TC ADD+	311	88185	249.00	104.00
HC81701047	FLW CYT MKR IGG TC ADD+	311	88185	249.00	104.00
HC81701054	FLW CYT MKR IGM TC ADD+	311	88185	249.00	104.00
HC81701062	FLW CYT MKR CD11B TC ADD+	311	88185	249.00	104.00
HC81701070	FLW CYT MKR LAMBDA TC ADD+	311	88185	249.00	104.00
HC81701088	FLW CYT MKR VS. CD13 TC ADD+	311	88185	249.00	104.00
HC81701096	FLW CYT MKR, CDI TC ADD+	311	88185	249.00	104.00
HC81701104	TDT TEST IFA 1ST STAIN	310	88346	454.00	247.50
HC81701401	FLOW CYT MKR TC ADD+	311	88185	249.00	104.00
HC81701419	FLOW CYT MKR (TDT) TC ADD+	311	88185	249.00	104.00
HC81701476	MORPH STDY ISH MNL PER SPEC INTL SNGL PROBE	310	88368	1,053.00	406.50
HC81701666	FLOW CYT TC; 1ST MARKER	311	88184	483.00	342.00
HC81701989	FLW CYT MKR CD10/CA TC ADD+	311	88185	249.00	104.00
HC81702029	FLW CYT MKR CD117 TC ADD+	311	88185	249.00	104.00
HC81702037	FLW CYT MKR CD103 TC ADD+	311	88185	249.00	104.00
HC81702045	FLW CYT MKR CD11C TC ADD+	311	88185	249.00	104.00
HC81702052	FLW CYT MKR CD138 TC ADD+	311	88185	249.00	104.00
HC81702060	FLW CYT MKR CD16 TC ADD+	311	88185	249.00	104.00
HC81702078	FLW CYT MKR CD22 TC ADD+	311	88185	247.00	104.00
HC81702086	FLW CYT MKR CD235A TC ADD+	311	88185	249.00	104.00
HC81702094	FLW CYT MKR CD25 TC ADD+	311	88185	249.00	104.00
HC81702102	FLW CYT MKR CD4 TC ADD+	311	88185	249.00	104.00
HC81702110	FLW CYT MKR CD41 TC ADD+	311	88185	249.00	104.00
HC81702128	FLW CYT MKR CD57 TC ADD+	311	88185	249.00	104.00
HC81702136	FLW CYT MKR CD61 TC ADD+	311	88185	249.00	104.00
HC81702144	FLW CYT MKR CD64 TC ADD+	311	88185	249.00	104.00
HC81702151	FLW CYT MKR CD79A TC ADD+	311	88185	249.00	104.00
HC81702169	FLW CYT MKR MPO TC ADD+	311	88185	249.00	104.00
HC81702177	FLW CYT MKR TCRAB TC ADD+	311	88185	249.00	104.00
HC81702185	FLW CYT MKR TCRGD TC ADD+	311	88185	249.00	104.00
HC81702193	FLW CYT MKR HLA-DR TC ADD+	311	88185	249.00	104.00
HC82200007	AMYLOID (CONGO RED)/GRP II+	312	88313	371.00	106.50
HC82200015	ELASTIC STAIN/GRP II+	312	88313	371.00	106.50
HC82200023	GIEMSA STAIN/GRP I W/INT&RPT+	312	88312	428.00	144.00
HC82200031	IRON STAIN/GRP II+	312	88313	371.00	106.50
HC82200049	ACID FAST STN/GR I W/INT&RPT+	312	88312	428.00	144.00
HC82200056	BROWN BREEN GRM STN/GR I W/I&R+	312	88312	428.00	50.00
HC82200064	MUCIN MUCICARMINE STN/GRP II+	312	88313	371.00	106.50
HC82200072	OIL RED O STAIN/GRP II+	312	88313	371.00	107.75
HC82200080	PAS STAIN/GROUP I W/ INT&RPT+	312	88312	428.00	144.00
HC82200098	PTAH STAIN/GRP II+	312	88313	371.00	70.50
HC82200106	TRICHROME STAIN/GRP II+	312	88313	371.00	106.50
HC82200114	SILVER METHENMN ST/GR I W/I&R+	312	88312	428.00	121.00
HC82200122	RETICULUM STAIN/GRP II+	312	88313	371.00	106.50
HC82200130	ALCIAN BLUE STAIN/ GR I W/I&R+	312	88312	428.00	140.00
HC82200148	AMYLOID (CRYST VIOLET)/GRP II+	312	88313	371.00	106.50
HC82200155	STEINER STN/GR I W/I&R+	312	88312	428.00	144.00
HC82200163	GENTA STAIN/GROUP I W/INT&RPT+	312	88312	428.00	144.00
HC82200171	IHC/IP PER SPEC INITIAL AB STAIN S100	312	88342	464.00	193.00
HC82200189	IHC/IP PER SPEC INITIAL AB STAIN HMB-45	312	88342	464.00	193.00
HC82200197	IHC/IP PER SPEC INITIAL AB STAIN CEA	312	88342	464.00	193.00
HC82200205	IHC/IP PER SPEC INITIAL AB STAIN PSA	312	88342	464.00	193.00
HC82200213	IHC/IP PER SPEC INITIAL AB STAIN LCA/CD45	312	88342	464.00	193.00
HC82200221	IHC/IP PER SPEC INITIAL AB STAIN CHROMOGRNIN	312	88342	464.00	193.00
HC82200239	IHC/IP PER SPEC INITIAL AB STAIN VIMENTIN	312	88342	464.00	193.00
HC82200247	IHC/IP PER SPEC INITIAL AB STAIN AFP	312	88342	464.00	193.00
HC82200254	IHC/IP PER SPEC INITIAL AB STAIN FACTOR 8	312	88342	464.00	193.00
HC82200262	IHC/IP PER SPEC INITIAL AB STAIN GFAP	312	88342	464.00	193.00
HC82200270	IHC/IP PER SPEC INITIAL AB STAIN HCG	312	88342	464.00	193.00
HC82200288	IHC/IP PER SPEC INITIAL AB STAIN EPITH	312	88342	464.00	193.00
HC82200296	IHC/IP PER SPEC INITIAL AB STAIN LEU-22/CD 43	312	88342	464.00	193.00
HC82200304	IHC/IP PER SPEC INITIAL AB STAIN KERATIN	312	88342	464.00	193.00
HC82200312	IHC/IP PER SPEC INITIAL AB STAIN SYNAPTOPH	312	88342	464.00	193.00
HC82200338	TISSUE EXAM G&M LEVEL 6	312	88309	1,044.00	526.25
HC82200346	DECALCIFICATION+	312	88311	123.00	49.00
HC82200353	TISSUE FROZEN SECTION	312	88331	451.00	301.50
HC82200361	CONSULT DURING SURGERY	312	88329	310.00	102.25
HC82200379	TISSUE GROSS EXAM ONLY LEVEL 1	312	88300	207.00	60.00
HC82200387	TISSUE EXAM G&M LEVEL 2	312	88302	314.00	95.75
HC82200395	TISSUE EXAM G&M LEVEL 3	312	88304	395.00	120.00
HC82200403	TISSUE EXAM G&M LEVEL 4	312	88305	611.00	217.75
HC82200411	TISSUE EXAM G&M LEVEL 5	312	88307	884.00	296.00
HC82200429	ANATOMIC CONSULT:SLIDE REVIEW	312	88321	336.00	242.00
HC82200437	IHC/IP PER SPEC INITIAL AB STAIN -OP	312	88342	464.00	83.00
HC82200445	SPECIAL STN GRP I W/I&R   * OP	312	88312	428.00	40.00
HC82200452	ANATOMIC CONSULT:REVIEW/PREP	312	88323	435.00	272.25
HC82200460	ANATOMIC CONSULT:COMP.REVIEW	312	88325	495.00	279.50
HC82200494	IRON STAIN/B.M. SMEARS+	312	88313	371.00	96.75
HC82200502	TISSUE FROZEN SECTION ADDIT'L	312	88332	216.00	150.75
HC82200510	TISSUE EXAM - LAB REPORT - OP	310	88399	356.00	325.00
HC82200528	IHC/IP PER SPEC INITIAL AB STAIN	312	88342	464.00	193.00
HC82200536	MORPH STDY ISH PER SPEC INTL SNGL PROBE	312	88365	668.00	165.00
HC82200569	SPECIAL STAIN GRP I W/INT&RPT+	312	88312	428.00	144.00
HC82200577	SPECIAL STAIN GROUP II+	312	88313	371.00	106.50
HC82200601	TISSUE EXAM LVL 5 (PQRI)	312	88307	884.00	396.00
HC82200619	TISSUE EXAM LVL 6 (PQRI)	312	88309	1,044.00	526.25
HC82200627	TISSUE EXAM LEVEL 6 ADD'L	312	88309	1,044.00	408.50
HC82200635	TISSUE FRZN SECTION REDUCED	312	88331	362.00	241.00
HC82200643	TISSUE EXAM LEVEL 2 ADD'L	312	88302	314.00	77.50
HC82200650	TISSUE EXAM LEVEL 3 ADD'L	312	88304	395.00	100.75
HC82200668	TISSUE EXAM LEVEL 4 SKIN	312	88305	611.00	125.25
HC82200676	TISSUE EXAM LEVEL 4 SPECIAL	312	88305	611.00	217.75
HC82200684	TISSUE EXAM LEVEL 5 ADD'L	312	88307	884.00	308.50
HC82200692	CONSULT PATH SURGICAL GROSS	312	88329	310.00	102.25
HC82200718	TISSUE EXAM G&M SLIDE PREP-MHL	312	88305	611.00	217.75
HC82200726	INTRAOP CNSLT CYT PRP-DIST ADL	311	88334	308.00	92.50
HC82200734	INTRAOP CNSLT CYT PRP-DIST SRV	311	88333	670.00	500.00
HC82200742	INTRAOP CNSLT CYTOPREP, ADL	311	88334	308.00	120.00
HC82200759	INTRAOP CNSLT CYT PREP INT'L	311	88333	670.00	500.00
HC82200924	TISSUE EX G&M LVL 2  DIST SVC	312	88302	314.00	95.75
HC82200932	TISSUE EX G&M  LVL 3  DIST SVC	312	88304	395.00	120.00
HC82200940	TISSUE EX G&M LVL 4  DIST SVC	312	88305	611.00	217.75
HC82200957	TISSUE EX G&M LVL 5  DIST SVC	312	88307	884.00	296.00
HC82200965	TISSUE EX G&M LVL 6 DIST SVC	312	88309	1,044.00	543.50
HC82200973	DIETERLE MODF STN/GR I W/I&R+	312	88312	428.00	50.00
HC82200981	GRAMS STAIN-AP/GR I W/INT&RPT+	312	88312	428.00	144.00
HC82200999	GROCOTT SILVER STN/GR I W/I&R+	312	88312	428.00	144.00
HC82201005	WADES MOD FITE STN/GR I W/I&R+	312	88312	428.00	144.00
HC82201013	WARTHIN-STARRY STN/GR I W/I&R+	312	88312	428.00	144.00
HC82201021	ZIEHL NEELSON STN/GR I W/I&R+	312	88312	428.00	85.00
HC82201039	ALCIAN BLUE NO DIGEST'N/GRPII+	312	88313	377.00	106.50
HC82201047	ALCIAN BLUE STN W/DIG/GRP II+	312	88313	371.00	106.50
HC82201054	AMYLOID ST BENNHOLDS/GRP II+	312	88313	371.00	106.50
HC82201062	BONE MAR IRON STN/GRP II+	312	88313	371.00	106.50
HC82201070	F-M ARGENTAFFIN STAIN/GRP II+	312	88313	371.00	106.50
HC82201088	F-M MELANIN STN BLEACH/GRPII+	312	88313	371.00	106.50
HC82201096	GIEMSA STAIN MAST CELL/GRP II+	312	88313	371.00	106.50
HC82201104	GRIMELIUS ARGYROPHL STN GRPII+	312	88313	371.00	106.50
HC82201112	HALLS BILE STAIN/GRP II+	312	88313	371.00	106.50
HC82201120	JONES SILVER STAIN/GRP II+	312	88313	371.00	106.50
HC82201138	KOSSA CALCIUM STAIN/GRP II+	312	88313	371.00	106.50
HC82201146	LUXOL FAST BLUE STAIN GRP II+	312	88313	371.00	106.50
HC82201153	MASSON TRICHROME STAIN/GRP II+	312	88313	371.00	106.50
HC82201161	MAY GRUNWALD GIEMS STN GRP II+	312	88313	371.00	106.50
HC82201179	MELANIN BLEACHING/GRP II+	312	88313	371.00	106.50
HC82201187	METHYL GREEN PYRON STN/GRP II+	312	88313	371.00	106.50
HC82201195	MYELIN STAIN GRP II+	312	88313	371.00	106.50
HC82201203	PAS STAIN W/DIGESTION GRP II+	312	88313	371.00	106.50
HC82201211	PAS STAIN/GRP II+	312	88313	371.00	106.50
HC82201229	PERLS PRUSSIAN BLU STN GRP II+	312	88313	371.00	70.50
HC82201237	SNOOKS RETICULIN STAIN GRP II+	312	88313	371.00	60.00
HC82201245	SUDA BLACK B STN/GRP II+	312	88313	371.00	106.50
HC82201252	TOLUID BLU MAST CL STN/GRP II+	312	88313	371.00	106.50
HC82201260	VERHOFF ELASTI TIS STN/GRP II+	312	88313	371.00	106.50
HC82201278	HISTOCHM STAIN,FROZ TIS BLK	312	88314	304.00	107.75
HC82201286	HISTCHM ST ALK PTASE,FRZ TIS	312	88319	719.00	500.00
HC82201294	HISTCHM ST ATPSE PH4.3,FR TS	312	88319	719.00	500.00
HC82201302	HISTCHM ST ATPSE PH4.6,FR TS	312	88319	719.00	500.00
HC82201310	HISTCHM ST ATPSE PH9.4,FR TS	312	88319	719.00	500.00
HC82201328	HISTCHM ST GOM TRICHRM,FR TS	312	88313	368.00	107.75
HC82201336	HISTCHM ST MYPHSPHRYLS,FR TS	312	88319	719.00	500.00
HC82201344	HISTCHM ST NADH-TR,FROZ TISS	312	88319	719.00	500.00
HC82201351	HISTCHM ST ACID PTASE,FRO TS	312	88314	304.00	107.75
HC82201369	HISTCHM ST ACRIDINE OR,FR TS	312	88314	304.00	107.75
HC82201377	HISTCHM ST AZURE-II MB,FR TS	312	88314	304.00	107.75
HC82201385	HISTCHM ST CYTCHRM OXDS,FR TS	312	88319	719.00	500.00
HC82201393	HISTCHM ST MAD, FROZ TIS BLK	312	88314	304.00	107.75
HC82201401	HISTCHM ST MYPHSPHFRC1,FRO TS	312	88314	304.00	107.75
HC82201419	HISTCHM ST MYPHSPHFRC2,FRO TS	312	88314	304.00	107.75
HC82201427	HISTCHM ST NNSPC ESTERS,FR TS	312	88314	304.00	107.75
HC82201435	HISTOCHM STN SDH, FRZ TIS BLK	312	88319	719.00	500.00
HC82201443	HISTOCHM STN OS-PPD,FROZ TIS	312	88314	304.00	107.75
HC82201450	PAS W/DIGESTON,FROZ TIS BLK	312	88313	368.00	107.75
HC82201468	OIL RED O STAIN,FROZ TIS BLK	312	88314	304.00	98.00
HC82201476	HISTOCHEM DETERMINATIVE,GRIII	312	88319	719.00	500.00
HC82201484	PEROXIDASE STAIN, GRP III	312	88319	719.00	500.00
HC82201492	ACID PTASE STAIN, GRP III	312	88319	719.00	500.00
HC82201500	N-CHLORO EST STAIN, GRP III	312	88319	719.00	500.00
HC82201518	ALPHA NAPBUT STAIN, GRP III	312	88319	719.00	500.00
HC82201526	IHC/IP PER SPEC INITIAL AB STAIN DYSTROPH(C-TERMINUS)	312	88342	464.00	193.00
HC82201534	IHC/IP PER SPEC INITIAL AB STAIN DYSTROPH(N-TERMINUS)	312	88342	464.00	193.00
HC82201542	IHC/IP PER SPEC INITIAL AB STAIN DYSTROPH(ROD DOMAIN)	312	88342	464.00	193.00
HC82201559	IHC/IP PER SPEC INITIAL AB STAIN IHC/IP STAIN ACTH	312	88342	464.00	193.00
HC82201567	IHC/IP PER SPEC INITIAL AB STAIN BRST2	312	88342	464.00	193.00
HC82201575	IHC/IP PER SPEC INITIAL AB STAIN CALCITONIN	312	88342	464.00	193.00
HC82201583	IHC/IP PER SPEC INITIAL AB STAIN CD-34	312	88342	464.00	193.00
HC82201591	IHC/IP PER SPEC INITIAL AB STAIN DESMIN	312	88342	464.00	193.00
HC82201609	IHC/IP PER SPEC INITIAL AB STAIN ESTROGN RECEPT	312	88342	464.00	193.00
HC82201617	IHC/IP PER SPEC INITIAL AB STAIN GASTRIN	312	88342	464.00	193.00
HC82201625	IHC/IP PER SPEC INITIAL AB STAIN GLUCAGON	312	88342	464.00	193.00
HC82201633	IHC/IP PER SPEC INITIAL AB STAIN HERPES POLY	312	88342	464.00	193.00
HC82201641	IHC/IP PER SPEC INITIAL AB STAIN INSULIN	312	88342	464.00	193.00
HC82201658	IHC/IP PER SPEC INITIAL AB STAIN KAPPA	312	88342	464.00	193.00
HC82201666	IHC/IP PER SPEC INITIAL AB STAIN KI-1	312	88342	464.00	193.00
HC82201674	IHC/IP PER SPEC INITIAL AB STAIN KP1	312	88342	464.00	193.00
HC82201682	IHC/IP PER SPEC INITIAL AB STAIN L26/CD 20	312	88342	464.00	193.00
HC82201690	IHC/IP PER SPEC INITIAL AB STAIN LAMBDA	312	88342	464.00	193.00
HC82201708	IHC/IP PER SPEC INITIAL AB STAIN LN1	312	88342	464.00	193.00
HC82201716	IHC/IP PER SPEC INITIAL AB STAIN LN2	312	88342	464.00	193.00
HC82201724	IHC/IP PER SPEC INITIAL AB STAIN MT1	312	88342	464.00	193.00
HC82201732	IHC/IP PER SPEC INITIAL AB STAIN MUSCLE	312	88342	464.00	193.00
HC82201740	IHC/IP PER SPEC INITIAL AB STAIN MYGLOBIN	312	88342	464.00	193.00
HC82201757	IHC/IP PER SPEC INITIAL AB STAIN NEUROFILAMENT	312	88342	464.00	193.00
HC82201765	IHC/IP PER SPEC INITIAL AB STAIN NSE	312	88342	464.00	193.00
HC82201773	IHC/IP PER SPEC INITIAL AB STAIN PROGEST RECEPT	312	88342	464.00	193.00
HC82201781	IHC/IP PER SPEC INITIAL AB STAIN SMOOTH MUSC	312	88342	464.00	193.00
HC82201799	IHC/IP PER SPEC INITIAL AB STAIN SOMATOSATIN	312	88342	464.00	193.00
HC82201807	IHC/IP PER SPEC INITIAL AB STAIN T4/CD 4	312	88342	464.00	193.00
HC82201815	IHC/IP PER SPEC INITIAL AB STAIN THYROGLOBULIN	312	88342	464.00	193.00
HC82201823	IHC/IP PER SPEC INITIAL AB STAIN UCHL1	312	88342	464.00	193.00
HC82201831	IHC/IP PER SPEC INITIAL AB STAIN ACTH	312	88342	464.00	193.00
HC82201849	IHC/IP PER SPEC INITIAL AB STAIN ANTI-BCL-2	312	88342	464.00	193.00
HC82201856	IHC/IP PER SPEC INITIAL AB STAIN CD3	312	88342	464.00	193.00
HC82201864	IHC/IP PER SPEC INITIAL AB STAIN CD-68	312	88342	464.00	193.00
HC82201872	IHC/IP PER SPEC INITIAL AB STAIN CYCLIN D1	312	88342	464.00	193.00
HC82201880	IHC/IP PER SPEC INITIAL AB STAIN CYTO KERATIN-20	312	88342	464.00	193.00
HC82201898	IHC/IP PER SPEC INITIAL AB STAIN CYTO KERATIN-7	312	88342	464.00	193.00
HC82201906	IHC/IP PER SPEC INITIAL AB STAIN EWINGS SARCOMA	312	88342	464.00	193.00
HC82201914	IHC/IP PER SPEC INITIAL AB STAIN FACTOR 13-A	312	88342	464.00	193.00
HC82201922	IHC/IP PER SPEC INITIAL AB STAIN GROWTH HORMONE STN	312	88342	464.00	193.00
HC82201930	IHC/IP PER SPEC INITIAL AB STAIN KERATIN 903	312	88342	464.00	193.00
HC82201955	IHC/IP PER SPEC INITIAL AB STAIN KI-67	312	88342	464.00	193.00
HC82201963	IHC/IP PER SPEC INITIAL AB STAIN LEU MI (CD15)	312	88342	464.00	193.00
HC82201989	IHC/IP PER SPEC INITIAL AB STAIN MYELOPEROXIDASE	312	88342	464.00	193.00
HC82201997	IHC/IP PER SPEC INITIAL AB STAIN P-53	312	88342	464.00	193.00
HC82202003	IHC/IP PER SPEC INITIAL AB STAIN PLAP	312	88342	464.00	193.00
HC82202011	IHC/IP PER SPEC INITIAL AB STAIN PROLACTIN	312	88342	464.00	193.00
HC82202029	IHC/IP PER SPEC INITIAL AB STAIN SMMHC	312	88342	464.00	193.00
HC82202037	IHC/IP PER SPEC INITIAL AB STAIN TERM DEOZY	312	88342	464.00	193.00
HC82202052	IHC/IP PER SPEC INITIAL AB STAIN HER-2-NEU	312	88342	464.00	193.00
HC82202060	IHC/IP PER SPEC INITIAL AB STAIN UBIQUITIN STAIN	312	88342	464.00	193.00
HC82202078	IF STUDY DIRECT 1ST STAIN	312	88346	440.00	93.00
HC82202169	ELECTRON MICROSCOPY	312	88348	2,811.00	907.50
HC82202177	MORPHOMETRIC STUDY SKEL MUSC	312	88355	792.00	574.75
HC82202185	MORPHOMETRIC STUDY NERVE	312	88356	670.00	458.00
HC82202193	NERVE TEASING	312	88362	1,344.00	423.50
HC82202243	TISSUE GROSS EXAM LV1-DIST SVC	312	88300	207.00	60.00
HC82202250	TISSUE EXAM G&M LEVEL 4-REDUCE	312	88305	611.00	217.75
HC82202268	DECALCIFICATION DIST SVC	312	88311	123.00	49.00
HC82202276	CONSULT DURING SURG DIST SVC	312	88329	310.00	102.25
HC82202284	TISSUE FROZEN SECTION DIST SVC	312	88331	451.00	301.50
HC82202292	TISSUE FROZ SECT AD'L DIST SVC	312	88332	216.00	150.75
HC82202300	ELECTRON MICROSCOPY REDUCE SVC	312	88348	2,096.00	405.00
HC82202334	M: MISC SURGICAL PATH PROC	310	88399	N/A	N/A
HC82202367	BM CELL BLOCK & INTERP	312	88305	611.00	217.75
HC82202375	MORPH STDY TMR IHC CAT ER PER SPEC EA ADDL AB	312	88361	827.00	386.00
HC82202383	MORPH STDY TMR IHC CAT PR PER SPEC EA ADDL AB	312	88361	827.00	386.00
HC82202391	MORPH STDY TMR IHC CAT KI67 PER SPEC EA ADDL AB	312	88361	827.00	386.00
HC82202409	MORPH STDY TMR IHC CAT HER2 PER SPEC EA ADDL AB	312	88361	827.00	386.00
HC82202417	MORPH STDY TMR IHC CAT EGFR PER SPEC EA ADDL AB	312	88361	827.00	428.50
HC82202425	MORPH STDY TMR IHC CAT NOS PER SPEC EA ADDL AB	312	88361	827.00	386.00
HC82202433	MORPH STDY TMR IHC CAT PER SPEC EA ADDL AB	312	88361	827.00	428.50
HC82202441	MORPH STDY ISH CAT QNT/SPEC INTL SNGL PROBE HER2	310	88367	1,357.00	567.50
HC82202458	MORPH STDY ISH CAT QNT/SPEC INTL SNGL PROBE CEP17	310	88367	1,357.00	567.50
HC82202466	MORPH STUDY MAN ISH QNT 9P21	310	88368	1,042.00	607.00
HC82202474	MORPH STUDY MAN ISH QNT CEP 3	310	88368	1,042.00	607.00
HC82202482	MORPH STUDY MAN ISH QNT CEP 7	310	88368	1,042.00	607.00
HC82202490	MORPH STUDY MAN ISH QNT CEP17	310	88368	1,042.00	607.00
HC82202508	MORPH STUDY MAN ISH QNT HER2	310	88368	1,042.00	513.25
HC82202540	TISSUE GROSS EXAM ONLY LVL1*OP	312	88300	207.00	30.00
HC82202557	TISSUE EXAM G&M LEVEL 2 *OP	312	88302	314.00	50.00
HC82202565	TISSUE EXAM G&M LEVEL 3 *OP	312	88304	395.00	58.00
HC82202573	TISSUE EXAM G&M LEVEL 4 *OP	312	88305	611.00	95.00
HC82202581	TISSUE EXAM G&M LEVEL 5 *OP	312	88307	884.00	110.00
HC82202599	DECALCIFICATION+ *OP	312	88311	123.00	21.00
HC82202607	SPECIAL STAIN GROUP I+	312	88312	428.00	40.00
HC82202615	SPECIAL STAIN GROUP II+ *OP	312	88313	371.00	60.00
HC82202623	ANATOMIC CONSULT:SLIDE REVW*OP	312	88321	336.00	30.00
HC82202672	H & E BLOCK (CLIENT)	312	88399	79.00	10.00
HC82202680	H & E BLOCK ADDITIONAL(CLIENT)	312	88399	79.00	10.00
HC82202698	LEVEL/RECUTS (CLIENT)	312	88399	79.00	6.00
HC82202706	BM BIOPSY PROCESSING & INTERP	312	88305	611.00	217.75
HC82202714	BM BIOPSY PROC & INT 2ND SITE	312	88305	611.00	217.75
HC82202722	BM CELL BLOCK & INTER-2ND SITE	312	88305	611.00	217.75
HC82202730	TISSUE EXAM G&M LVL 2(TC ONLY)	312	88302	314.00	68.70
HC82202748	TISSUE EXAM G&M LVL 3(TC ONLY)	312	88304	395.00	68.70
HC82202755	TISSUE EXAM G&M LVL 4(TC ONLY)	312	88305	611.00	120.00
HC82202763	TISSUE EXAM G&M LVL 5(TC ONLY)	312	88307	884.00	169.00
HC82202771	TISSUE EXAM G&M LVL 6(TC ONLY)	312	88309	1,044.00	227.00
HC82202789	ADDL UNSTAINED SLIDE/PROC BLK	310	88399	79.00	3.00
HC82202797	ADDITIONAL UNSTAINED SLIDES	310	88399	84.00	2.50
HC82202805	PROCESS, EMBED & 2 H&E'S	310	88399	11.00	10.00
HC82202813	PREP SURG TISSUE NON-MICRO STUDIES+	312	88388	189.00	108.00
HC82202862	PROSTATE NEEDLE BX ANY METHD	312	G0416	2,851.00	2,280.00
HC82202912	IMMUNOCYTOCHEMICAL STAIN	310	88399	149.00	26.00
HC82202920	PROCESS, EMBED & 1 UNSTN SLIDE	310	88399	82.00	8.00
HC82202938	PROCESS & EMBED ONLY	310	88399	82.00	6.00
HC82202946	H&E FROM BLOCK	310	88399	148.00	4.00
HC82202953	IHC/IP PER SPEC INITIAL AB STAIN BASAL CELL COCKTAIL	312	88342	464.00	193.00
HC82202961	IHC/IP PER SPEC INITIAL AB STAIN BCL-6	312	88342	464.00	193.00
HC82202979	IHC/IP PER SPEC INITIAL AB STAIN CALRETIN	312	88342	464.00	193.00
HC82202987	IHC/IP PER SPEC INITIAL AB STAIN CAM5-2	312	88342	464.00	193.00
HC82202995	IHC/IP PER SPEC INITIAL AB STAIN CD1A	312	88342	464.00	193.00
HC82203001	IHC/IP PER SPEC INITIAL AB STAIN CD4	312	88342	464.00	193.00
HC82203019	IHC/IP PER SPEC INITIAL AB STAIN CD5	312	88342	464.00	193.00
HC82203027	IHC/IP PER SPEC INITIAL AB STAIN CD7	312	88342	464.00	193.00
HC82203035	IHC/IP PER SPEC INITIAL AB STAIN CD8	312	88342	464.00	193.00
HC82203043	IHC/IP PER SPEC INITIAL AB STAIN CD10	312	88342	464.00	193.00
HC82203050	IHC/IP PER SPEC INITIAL AB STAIN CD21	312	88342	464.00	193.00
HC82203068	IHC/IP PER SPEC INITIAL AB STAIN CD23	312	88342	464.00	193.00
HC82203076	IHC/IP PER SPEC INITIAL AB STAIN CD31	312	88342	464.00	193.00
HC82203084	IHC/IP PER SPEC INITIAL AB STAIN CD56	312	88342	464.00	193.00
HC82203092	IHC/IP PER SPEC INITIAL AB STAIN CD117	312	88342	464.00	193.00
HC82203100	IHC/IP PER SPEC INITIAL AB STAIN CD138	312	88342	464.00	193.00
HC82203118	IHC/IP PER SPEC INITIAL AB STAIN CDX-2	312	88342	464.00	193.00
HC82203126	IHC/IP PER SPEC INITIAL AB STAIN CEA MONOCLONAL	312	88342	464.00	193.00
HC82203134	IHC/IP PER SPEC INITIAL AB STAIN CK-5/6	312	88342	464.00	193.00
HC82203142	IHC/IP PER SPEC INITIAL AB STAIN CK-19	312	88342	464.00	193.00
HC82203159	IHC/IP PER SPEC INITIAL AB STAIN CMV	312	88342	464.00	193.00
HC82203167	IHC/IP PER SPEC INITIAL AB STAIN E-CADHERIN	312	88342	464.00	193.00
HC82203175	IHC/IP PER SPEC INITIAL AB STAIN EMA (MC5)(LIVER)	312	88342	464.00	193.00
HC82203183	IHC/IP PER SPEC INITIAL AB STAIN HEPPAR	312	88342	464.00	193.00
HC82203191	IHC/IP PER SPEC INITIAL AB STAIN IGD	312	88342	464.00	193.00
HC82203209	IHC/IP PER SPEC INITIAL AB STAIN INHIBIN	312	88342	464.00	193.00
HC82203217	IHC/IP PER SPEC INITIAL AB STAIN INI-1	312	88342	464.00	193.00
HC82203225	IHC/IP PER SPEC INITIAL AB STAIN KERATIN (AE1/AE1) LN	312	88342	464.00	193.00
HC82203233	IHC/IP PER SPEC INITIAL AB STAIN KERATIN HMWK	312	88342	464.00	193.00
HC82203241	IHC/IP PER SPEC INITIAL AB STAIN MELAN-A	312	88342	464.00	193.00
HC82203258	IHC/IP PER SPEC INITIAL AB STAIN MUM-1	312	88342	464.00	193.00
HC82203266	IHC/IP PER SPEC INITIAL AB STAIN MYOGENIN	312	88342	464.00	193.00
HC82203274	IHC/IP PER SPEC INITIAL AB STAIN P16	312	88342	464.00	193.00
HC82203282	IHC/IP PER SPEC INITIAL AB STAIN P63	312	88342	464.00	193.00
HC82203290	IHC/IP PER SPEC INITIAL AB STAIN PGP 9.5	312	88342	464.00	193.00
HC82203308	IHC/IP PER SPEC INITIAL AB STAIN TH	312	88342	464.00	193.00
HC82203316	IHC/IP PER SPEC INITIAL AB STAIN TTF-1	312	88342	464.00	193.00
HC82203324	IHC/IP PER SPEC INITIAL AB STAIN WT-1	312	88342	464.00	193.00
HC82203332	IHC/IP PER SPEC INITIAL AB STAIN EGFR	312	88342	464.00	193.00
HC82203340	IHC/IP PER SPEC EA ADD AB STAIN+ S100	312	88341	404.00	183.00
HC82203357	IHC/IP PER SPEC EA ADD AB STAIN+ HMB-45	312	88341	404.00	183.00
HC82203365	IHC/IP PER SPEC EA ADD AB STAIN+ CEA	312	88341	404.00	183.00
HC82203373	IHC/IP PER SPEC EA ADD AB STAIN+ PSA	312	88341	404.00	183.00
HC82203381	IHC/IP PER SPEC EA ADD AB STAIN+ LCA AP	312	88341	404.00	183.00
HC82203399	IHC/IP PER SPEC EA ADD AB STAIN+ CHROMOGRAN	312	88341	404.00	183.00
HC82203407	IHC/IP PER SPEC EA ADD AB STAIN+ VIMENTIN	312	88341	404.00	183.00
HC82203415	IHC/IP PER SPEC EA ADD AB STAIN+ AFP	312	88341	404.00	183.00
HC82203423	IHC/IP PER SPEC EA ADD AB STAIN+ FCTR 8 AG	312	88341	404.00	183.00
HC82203431	IHC/IP PER SPEC EA ADD AB STAIN+ GFAP	312	88341	404.00	183.00
HC82203449	IHC/IP PER SPEC EA ADD AB STAIN+ HCG	312	88341	404.00	183.00
HC82203456	IHC/IP PER SPEC EA ADD AB STAIN+ EPI MEMBR	312	88341	404.00	183.00
HC82203464	IHC/IP PER SPEC EA ADD AB STAIN+ LEU-22	312	88341	404.00	183.00
HC82203472	IHC/IP PER SPEC EA ADD AB STAIN+ KERATIN	312	88341	404.00	183.00
HC82203480	IHC/IP PER SPEC EA ADD AB STAIN+ SYNAPTOP	312	88341	404.00	183.00
HC82203498	IHC/IP PER SPEC EA ADD AB STAIN+ CYTOCHM	312	88341	404.00	183.00
HC82203506	IP/IHC AB BC COCKTAIL PER SPEC; EA MULTIPLEX	312	88344	551.00	193.00
HC82203514	IHC/IP PER SPEC EA ADD AB STAIN+ BCL-6	312	88341	404.00	183.00
HC82203522	IHC/IP PER SPEC EA ADD AB STAIN+ CAM5-2	312	88341	404.00	183.00
HC82203530	IHC/IP PER SPEC EA ADD AB STAIN+ CD-1A	312	88341	404.00	183.00
HC82203548	IHC/IP PER SPEC EA ADD AB STAIN+ CD-21	312	88341	404.00	183.00
HC82203555	IHC/IP PER SPEC EA ADD AB STAIN+ CD-23	312	88341	404.00	183.00
HC82203563	IHC/IP PER SPEC EA ADD AB STAIN+ CD-31	312	88341	404.00	183.00
HC82203571	IHC/IP PER SPEC EA ADD AB STAIN+ CD-138	312	88341	404.00	183.00
HC82203589	IHC/IP PER SPEC EA ADD AB STAIN+ CDX-28	312	88341	404.00	183.00
HC82203597	IHC/IP PER SPEC EA ADD AB STAIN+ CEA MONOCLON	312	88341	404.00	183.00
HC82203605	IHC/IP PER SPEC EA ADD AB STAIN+ CK-5/6	312	88341	404.00	183.00
HC82203613	IHC/IP PER SPEC EA ADD AB STAIN+ CK-19	312	88341	404.00	183.00
HC82203621	IHC/IP PER SPEC EA ADD AB STAIN+ E-CADHERIN	312	88341	404.00	183.00
HC82203639	IHC/IP PER SPEC EA ADD AB STAIN+ EMA (MC5)(LIVER)	312	88341	404.00	183.00
HC82203647	IHC/IP PER SPEC EA ADD AB STAIN+ HEPPAR	312	88341	404.00	183.00
HC82203654	IHC/IP PER SPEC EA ADD AB STAIN+ IGD	312	88341	404.00	183.00
HC82203662	IHC/IP PER SPEC EA ADD AB STAIN+ INHIBIN	312	88341	404.00	183.00
HC82203670	IHC/IP PER SPEC EA ADD AB STAIN+ INI-1	312	88341	404.00	183.00
HC82203688	IHC/IP PER SPEC EA ADD AB STAIN+ KERATIN (AE1/AE3) LN	312	88341	404.00	183.00
HC82203696	IHC/IP PER SPEC EA ADD AB STAIN+ KERATIN HMWK	312	88341	404.00	183.00
HC82203704	IHC/IP PER SPEC EA ADD AB STAIN+ MUM-1	312	88341	404.00	183.00
HC82203712	IHC/IP PER SPEC EA ADD AB STAIN+ MYOGENIN	312	88341	404.00	183.00
HC82203720	IHC/IP PER SPEC EA ADD AB STAIN+ P63	312	88341	404.00	183.00
HC82203738	IHC/IP PER SPEC EA ADD AB STAIN+ PGP 9.5	312	88341	404.00	183.00
HC82203746	IHC/IP PER SPEC EA ADD AB STAIN+ TH	312	88341	404.00	183.00
HC82203753	IHC/IP PER SPEC EA ADD AB STAIN+ WT-1	312	88341	404.00	183.00
HC82203761	IHC/IP PER SPEC EA ADD AB STAIN+ DYSTROPH (C-TERM)	312	88341	404.00	183.00
HC82203779	IHC/IP PER SPEC EA ADD AB STAIN+ DYSTROPH (N-TERM)	312	88341	404.00	183.00
HC82203787	IHC/IP PER SPEC EA ADD AB STAIN+ DYSTROPH (ROD DOMAIN)	312	88341	404.00	183.00
HC82203795	IHC/IP PER SPEC EA ADD AB STAIN+ ACTH	312	88341	404.00	183.00
HC82203803	IHC/IP PER SPEC EA ADD AB STAIN+ MONOCLNL BREAST	312	88341	404.00	183.00
HC82203811	IHC/IP PER SPEC EA ADD AB STAIN+ CALCITON	312	88341	404.00	183.00
HC82203829	IHC/IP PER SPEC EA ADD AB STAIN+ HPCA-1	312	88341	404.00	183.00
HC82203837	IHC/IP PER SPEC EA ADD AB STAIN+ DESMIN	312	88341	404.00	183.00
HC82203845	IHC/IP PER SPEC EA ADD AB STAIN+ ESTR RCPT	312	88341	404.00	183.00
HC82203852	IHC/IP PER SPEC EA ADD AB STAIN+ GASTRIN	312	88341	404.00	183.00
HC82203860	IHC/IP PER SPEC EA ADD AB STAIN+ GLUCAGON	312	88341	404.00	183.00
HC82203878	IHC/IP PER SPEC EA ADD AB STAIN+ HERPES POLYV	312	88341	404.00	183.00
HC82203886	IHC/IP PER SPEC EA ADD AB STAIN+ INSULIN	312	88341	404.00	183.00
HC82203894	IHC/IP PER SPEC EA ADD AB STAIN+ KAPPA	312	88341	404.00	183.00
HC82203902	IHC/IP PER SPEC EA ADD AB STAIN+ KI-1	312	88341	404.00	183.00
HC82203910	IHC/IP PER SPEC EA ADD AB STAIN+ KP-1	312	88341	404.00	183.00
HC82203928	IHC/IP PER SPEC EA ADD AB STAIN+ L26 AB	312	88341	404.00	183.00
HC82203936	IHC/IP PER SPEC EA ADD AB STAIN+ LAMBDA	312	88341	404.00	183.00
HC82203944	IHC/IP PER SPEC EA ADD AB STAIN+ LN 1	312	88341	404.00	183.00
HC82203951	IHC/IP PER SPEC EA ADD AB STAIN+ LN 2	312	88341	404.00	183.00
HC82203969	IHC/IP PER SPEC EA ADD AB STAIN+ MT-1	312	88341	404.00	183.00
HC82203977	IHC/IP PER SPEC EA ADD AB STAIN+ MUSCLE	312	88341	404.00	183.00
HC82203985	IHC/IP PER SPEC EA ADD AB STAIN+ MYOGLOBIN	312	88341	404.00	183.00
HC82203993	IHC/IP PER SPEC EA ADD AB STAIN+ NEURFLMNT	312	88341	404.00	183.00
HC82204009	IHC/IP PER SPEC EA ADD AB STAIN+ NSE	312	88341	404.00	183.00
HC82204017	IHC/IP PER SPEC EA ADD AB STAIN+ PROGEST REC	312	88341	404.00	183.00
HC82204025	IHC/IP PER SPEC EA ADD AB STAIN+ SMOOTH MUSC	312	88341	404.00	183.00
HC82204033	IHC/IP PER SPEC EA ADD AB STAIN+ SOMATOSTN	312	88341	404.00	183.00
HC82204041	IHC/IP PER SPEC EA ADD AB STAIN+ T4	312	88341	404.00	183.00
HC82204058	IHC/IP PER SPEC EA ADD AB STAIN+ THYROGLOBLN	312	88341	404.00	183.00
HC82204066	IHC/IP PER SPEC EA ADD AB STAIN+ UCHL 1	312	88341	404.00	183.00
HC82204082	IHC/IP PER SPEC EA ADD AB STAIN+ ANTI-BCL-2	312	88341	404.00	183.00
HC82204090	IHC/IP PER SPEC EA ADD AB STAIN+ ANTI-CD3/HRP	312	88341	404.00	183.00
HC82204108	IHC/IP PER SPEC EA ADD AB STAIN+ CD-68	312	88341	404.00	183.00
HC82204116	IHC/IP PER SPEC EA ADD AB STAIN+ CYCLIN D1	312	88341	404.00	183.00
HC82204124	IHC/IP PER SPEC EA ADD AB STAIN+ CYTOKERATIN-20	312	88341	404.00	183.00
HC82204132	IHC/IP PER SPEC EA ADD AB STAIN+ CYTOKERATIN-7	312	88341	404.00	183.00
HC82204140	IHC/IP PER SPEC EA ADD AB STAIN+ EWINGS SARCOMA	312	88341	404.00	183.00
HC82204157	IHC/IP PER SPEC EA ADD AB STAIN+ FACTOR 13-A	312	88341	404.00	183.00
HC82204165	IHC/IP PER SPEC EA ADD AB STAIN+ GROWTH HORM	312	88341	404.00	183.00
HC82204173	IHC/IP PER SPEC EA ADD AB STAIN+ KERATIN 903	312	88341	404.00	183.00
HC82204199	IHC/IP PER SPEC EA ADD AB STAIN+ KI-67	312	88341	404.00	183.00
HC82204207	IHC/IP PER SPEC EA ADD AB STAIN+ LEU M1 (CD15)	312	88341	404.00	183.00
HC82204215	IHC/IP PER SPEC EA ADD AB STAIN+ MT-1	312	88341	404.00	183.00
HC82204223	IHC/IP PER SPEC EA ADD AB STAIN+ MYELOPEROXIDASE	312	88341	404.00	183.00
HC82204231	IHC/IP PER SPEC EA ADD AB STAIN+ P-53	312	88341	404.00	183.00
HC82204249	IHC/IP PER SPEC EA ADD AB STAIN+ PLAP	312	88341	404.00	183.00
HC82204256	IHC/IP PER SPEC EA ADD AB STAIN+ PROLACTIN	312	88341	404.00	183.00
HC82204264	IHC/IP PER SPEC EA ADD AB STAIN+ SMMHC	312	88341	404.00	183.00
HC82204272	IHC/IP PER SPEC EA ADD AB STAIN+ TERM DEOXZYTRANS	312	88341	404.00	183.00
HC82204280	IHC/IP PER SPEC EA ADD AB STAIN+ UCHL-1	312	88341	404.00	183.00
HC82204298	IHC/IP PER SPEC EA ADD AB STAIN+ HER-2-NEU	312	88341	404.00	183.00
HC82204306	IHC/IP PER SPEC EA ADD AB STAIN+ UBIQUITIN	312	88341	404.00	183.00
HC82204314	IHC/IP PER SPEC EA ADD AB STAIN+ CALRETININ	312	88341	404.00	183.00
HC82204322	IHC/IP PER SPEC EA ADD AB STAIN+ CD4	312	88341	404.00	183.00
HC82204330	IHC/IP PER SPEC EA ADD AB STAIN+ CD5	312	88341	404.00	183.00
HC82204348	IHC/IP PER SPEC EA ADD AB STAIN+ CD7	312	88341	404.00	183.00
HC82204355	IHC/IP PER SPEC EA ADD AB STAIN+ CD8	312	88341	404.00	183.00
HC82204363	IHC/IP PER SPEC EA ADD AB STAIN+ CD10	312	88341	404.00	183.00
HC82204371	IHC/IP PER SPEC EA ADD AB STAIN+ CD56	312	88341	404.00	183.00
HC82204389	IHC/IP PER SPEC EA ADD AB STAIN+ CD117	312	88341	404.00	183.00
HC82204397	IHC/IP PER SPEC EA ADD AB STAIN+ CMV	312	88341	404.00	183.00
HC82204405	IHC/IP PER SPEC EA ADD AB STAIN+ EGFR	312	88341	404.00	183.00
HC82204413	IHC/IP PER SPEC EA ADD AB STAIN+ MELAN-A	312	88341	404.00	183.00
HC82204421	IHC/IP PER SPEC EA ADD AB STAIN+ P16	312	88341	404.00	183.00
HC82204439	IHC/IP PER SPEC EA ADD AB STAIN+ TTF-1	312	88341	404.00	183.00
HC82204447	IHC/IP PER SPEC INITIAL AB STAIN CD-79A	312	88342	464.00	193.00
HC82204454	IHC/IP PER SPEC EA ADD AB STAIN+ CD-79A	312	88341	404.00	183.00
HC82204462	IHC/IP PER SPEC EA ADD AB STAIN+ PROS ACID PHOS	312	88341	404.00	183.00
HC82204470	IP/IHC PER SPEC INITIAL AB STAIN PROSTATIC ACID PHOS	312	88342	464.00	193.00
HC82204538	IHC/IP PER SPEC INITIAL AB STAIN SOX10	312	88342	464.00	193.00
HC82204546	IHC/IP PER SPEC EA ADD AB STAIN+ SOX10	312	88341	404.00	183.00
HC82204553	IHC/IP PER SPEC INITIAL AB STAIN PAX8	312	88342	464.00	193.00
HC82204561	IHC/IP PER SPEC EA ADD AB STAIN+ PAX8	312	88341	404.00	183.00
HC82204579	IHC/IP PER SPEC INITIAL AB STAIN GATA-3	312	88342	464.00	193.00
HC82204587	IHC/IP PER SPEC EA ADD AB STAIN+ GATA-3	312	88341	404.00	183.00
HC82204595	IHC/IP PER SPEC INITIAL AB STAIN C-MYC	312	88342	464.00	193.00
HC82204603	IHC/IP PER SPEC EA ADD AB STAIN+ C-MYC	312	88341	404.00	183.00
HC82204611	IP/IHC PER SPEC INITIAL AB STAIN H PYLORI	312	88342	464.00	193.00
HC82204629	IHC/IP PER SPEC EA ADD AB STAIN+ H PYLORI	312	88341	404.00	183.00
HC82204637	IHC/IP PER SPEC INITIAL AB STAIN HSV-1	312	88342	464.00	193.00
HC82204645	IHC/IP PER SPEC EA ADD AB STAIN+ HSV-1	312	88341	404.00	183.00
HC82204652	IHC/IP PER SPEC INITIAL AB STAIN HSV-2	312	88342	464.00	193.00
HC82204660	IHC/IP PER SPEC EA ADD AB STAIN+ HSV-2	312	88341	404.00	183.00
HC82204678	IHC/IP PER SPEC INITIAL AB STAIN MLH-1	312	88342	464.00	193.00
HC82204686	IHC/IP PER SPEC EA ADD AB STAIN+ MSH-2	312	88341	404.00	183.00
HC82204694	IHC/IP PER SPEC EA ADD AB STAIN+ MSH-6	312	88341	404.00	183.00
HC82204702	IHC/IP PER SPEC EA ADD AB STAIN+ PMS2	312	88341	404.00	183.00
HC83500140	SEX ID BARR BODIES-GZ	311	88130	N/A	N/A
HC83500157	PAP SMEAR PATH INTERP+ -PI	311	88141	30.00	30.00
HC83500678	TISSUE EXAM G&M LEVEL 4-SU	312	88305	268.00	268.00
HC83500686	TISSUE EXAM G&M LEVEL 4-CS	312	88305	157.15	222.23
HC83500694	TISSUE EXAM G&M LEVEL 4-HP	312	88305	N/A	N/A
HC83500702	TISSUE EXAM G&M LEVEL 4-US	312	88305	N/A	N/A
HC83500710	TISSUE EXAM G&M LEVEL 4 PRO-US	312	88305	N/A	N/A
HC83500736	TISSUE EXAM G&M LEVEL 5-US	312	88307	N/A	N/A
HC83500744	TISSUE EXAM LVL 6 DIST SVC-US	312	88309	N/A	N/A
HC83500751	SPECIAL STAIN GRP I W/ I&R+-U2	312	88312	N/A	N/A
HC83500769	SPECIAL STAIN GRP I W/ I&R+-IM	312	88312	N/A	N/A
HC83500777	SPECIAL STAIN GRP I W/ I&R+-US	312	88312	N/A	N/A
HC83500785	SPECIAL STAIN GRP I W/ I&R+-MA	312	88312	152.00	151.10
HC83500793	ACID FAST STN/GRP I W/I&R+-IM	312	88312	N/A	N/A
HC83500801	ACID FAST STN/GRP I W/I&R+-US	312	88312	N/A	N/A
HC83500819	ACID FAST STN/GRP I W/I&R+-U2	312	88312	N/A	N/A
HC83500827	ALCIAN BLUE STN/GR I W/I&R+-IM	312	88312	N/A	N/A
HC83500835	ALCIAN BLUE STN/GR I W/I&R+-US	312	88312	N/A	N/A
HC83500843	ALCIAN BLUE STN/GR I W/I&R+-U2	312	88312	N/A	N/A
HC83500850	BRWN BRN GRM ST/GR I W/I&R+-IM	312	88312	N/A	N/A
HC83500868	BRWN BRN GRM ST/GR I W/I&R+-US	312	88312	N/A	N/A
HC83500876	BRWN BRN GRM ST/GR I W/I&R+-U2	312	88312	N/A	N/A
HC83500884	DIETERL MOD STN/GR I W/I&R+-IM	312	88312	N/A	N/A
HC83500892	DIETERL MOD STN/GR I W/I&R+-US	312	88312	N/A	N/A
HC83500900	DIETERL MOD STN/GR I W/I&R+-U2	312	88312	N/A	N/A
HC83500918	GENTA STAIN/GROUP I W/I&R+-IM	312	88312	N/A	N/A
HC83500926	GENTA STAIN/GROUP I W/I&R+-US	312	88312	N/A	N/A
HC83500934	GENTA STAIN/GROUP I W/I&R+-U2	312	88312	N/A	N/A
HC83500942	GIEMSA STN/GR I W/I&R+-IM	312	88312	N/A	N/A
HC83500959	GIEMSA STN/GR I W/I&R+-US	312	88312	N/A	N/A
HC83500967	GIEMSA STN/GR I W/I&R+-U2	312	88312	N/A	N/A
HC83500975	GRAMS STAIN-AP/GR I W/I&R+-IM	312	88312	N/A	N/A
HC83500983	GRAMS STAIN-AP/GR I W/I&R+-US	312	88312	N/A	N/A
HC83500991	GRAMS STAIN-AP/GR I W/I&R+-U2	312	88312	N/A	N/A
HC83501007	GROCOT SILVR ST/GR I W/I&R+-IM	312	88312	N/A	N/A
HC83501015	GROCOT SILVR ST/GR I W/I&R+-US	312	88312	N/A	N/A
HC83501023	GROCOT SILVR ST/GR I W/I&R+-U2	312	88312	N/A	N/A
HC83501031	PAS STAIN/GRP I W/ INT&RPT+-IM	312	88312	N/A	N/A
HC83501049	PAS STAIN/GRP I W/ INT&RPT+-US	312	88312	N/A	N/A
HC83501056	PAS STAIN/GRP I W/ INT&RPT+-U2	312	88312	N/A	N/A
HC83501064	SILVR METHNM ST/GR I W/I&R+-IM	312	88312	N/A	N/A
HC83501072	SILVR METHNM ST/GR I W/I&R+-US	312	88312	N/A	N/A
HC83501080	SILVR METHNM ST/GR I W/I&R+-U2	312	88312	N/A	N/A
HC83501098	STEINER STN/GR I W/I&R+-IM	312	88312	N/A	N/A
HC83501106	STEINER STN/GR I W/I&R+-US	312	88312	N/A	N/A
HC83501114	STEINER STN/GR I W/I&R+-U2	312	88312	N/A	N/A
HC83501122	WADES MOD FT ST/GR I W/I&R+-IM	312	88312	N/A	N/A
HC83501130	WADES MOD FT ST/GR I W/I&R+-US	312	88312	N/A	N/A
HC83501148	WADES MOD FT ST/GR I W/I&R+-U2	312	88312	N/A	N/A
HC83501155	WARTHN-STARRY ST/GR I W/I&R+-IM	312	88312	N/A	N/A
HC83501163	WARTHN-STARRY ST/GR I W/I&R+-US	312	88312	N/A	N/A
HC83501171	WARTHN-STARRY ST/GR I W/I&R+-U2	312	88312	N/A	N/A
HC83501189	ZIEHL NEELSON STN/GR I W/I&R+-IM	312	88312	N/A	N/A
HC83501197	ZIEHL NEELSON STN/GR I W/I&R+-US	312	88312	N/A	N/A
HC83501205	ZIEHL NEELSON STN/GR I W/I&R+-U2	312	88312	N/A	N/A
HC83501213	SPECIAL STAIN GROUP II+-IM	312	88313	N/A	N/A
HC83501221	SPECIAL STAIN GROUP II+-US	312	88313	N/A	N/A
HC83501239	SPECIAL STAIN GROUP II+-U2	312	88313	N/A	N/A
HC83501247	ALCIAN BLUE NO DIGES/GRPII+-IM	312	88313	N/A	N/A
HC83501254	ALCIAN BLUE NO DIGES/GRPII+-US	312	88313	N/A	N/A
HC83501262	ALCIAN BLUE NO DIGES/GRPII+-U2	312	88313	N/A	N/A
HC83501270	ALCIAN BLUE W/DIGES/GRP II+-IM	312	88313	N/A	N/A
HC83501288	ALCIAN BLUE W/DIGES/GRP II+-US	312	88313	N/A	N/A
HC83501296	ALCIAN BLUE W/DIGES/GRP II+-U2	312	88313	N/A	N/A
HC83501304	AMYLOID (CONGO RED)/GRP II+-IM	312	88313	N/A	N/A
HC83501312	AMYLOID (CONGO RED)/GRP II+-US	312	88313	N/A	N/A
HC83501320	AMYLOID (CONGO RED)/GRP II+-U2	312	88313	N/A	N/A
HC83501338	AMYLOID (VIOLET)/GRP II+-IM	312	88313	N/A	N/A
HC83501346	AMYLOID (VIOLET)/GRP II+-US	312	88313	N/A	N/A
HC83501353	AMYLOID (VIOLET)/GRP II+-U2	312	88313	N/A	N/A
HC83501361	AMYLOID STN BENHOLD/GRP II+-IM	312	88313	N/A	N/A
HC83501379	AMYLOID STN BENHOLD/GRP II+-US	312	88313	N/A	N/A
HC83501387	AMYLOID STN BENHOLD/GRP II+-U2	312	88313	N/A	N/A
HC83501395	BONE MAR IRON STN/GRP II+-IM	312	88313	N/A	N/A
HC83501403	BONE MAR IRON STN/GRP II+-US	312	88313	N/A	N/A
HC83501411	BONE MAR IRON STN/GRP II+-U2	312	88313	N/A	N/A
HC83501429	ELASTIC STAIN/GRP II+-IM	312	88313	N/A	N/A
HC83501437	ELASTIC STAIN/GRP II+-US	312	88313	N/A	N/A
HC83501445	ELASTIC STAIN/GRP II+-U2	312	88313	N/A	N/A
HC83501452	F-M ARGENTAFFIN STN/GRP II+-IM	312	88313	N/A	N/A
HC83501460	F-M ARGENTAFFIN STN/GRP II+-US	312	88313	N/A	N/A
HC83501478	F-M ARGENTAFFIN STN/GRP II+-U2	312	88313	N/A	N/A
HC83501486	F-M MELAN STN BLEACH/GRPII+-IM	312	88313	N/A	N/A
HC83501494	F-M MELAN STN BLEACH/GRPII+-US	312	88313	N/A	N/A
HC83501502	F-M MELAN STN BLEACH/GRPII+-U2	312	88313	N/A	N/A
HC83501510	GIEMSA STN MAST CEL/GRP II+-IM	312	88313	N/A	N/A
HC83501528	GIEMSA STN MAST CEL/GRP II+-US	312	88313	N/A	N/A
HC83501536	GIEMSA STN MAST CEL/GRP II+-U2	312	88313	N/A	N/A
HC83501544	GRIMELIUS ARGYRO STN GRPII+-IM	312	88313	N/A	N/A
HC83501551	GRIMELIUS ARGYRO STN GRPII+-US	312	88313	N/A	N/A
HC83501569	GRIMELIUS ARGYRO STN GRPII+-U2	312	88313	N/A	N/A
HC83501577	HALLS BILE STAIN/GRP II+-IM	312	88313	N/A	N/A
HC83501585	HALLS BILE STAIN/GRP II+-US	312	88313	N/A	N/A
HC83501593	HALLS BILE STAIN/GRP II+-U2	312	88313	N/A	N/A
HC83501601	IRON STAIN/GRP II+-IM	312	88313	N/A	N/A
HC83501619	IRON STAIN/GRP II+-US	312	88313	N/A	N/A
HC83501627	IRON STAIN/GRP II+-U2	312	88313	N/A	N/A
HC83501635	IRON STAIN/B.M. SMEARS+-IM	312	88313	N/A	N/A
HC83501643	IRON STAIN/B.M. SMEARS+-US	312	88313	N/A	N/A
HC83501650	IRON STAIN/B.M. SMEARS+-U2	312	88313	N/A	N/A
HC83501668	JONES SILVER STAIN/GRP II+-IM	312	88313	N/A	N/A
HC83501676	JONES SILVER STAIN/GRP II+-US	312	88313	N/A	N/A
HC83501684	JONES SILVER STAIN/GRP II+-U2	312	88313	N/A	N/A
HC83501692	KOSSA CALCIUM STAIN/GRP II+-IM	312	88313	N/A	N/A
HC83501700	KOSSA CALCIUM STAIN/GRP II+-US	312	88313	N/A	N/A
HC83501718	KOSSA CALCIUM STAIN/GRP II+-U2	312	88313	N/A	N/A
HC83501726	LUXOL FAST BLUE STN GRP II+-IM	312	88313	N/A	N/A
HC83501734	LUXOL FAST BLUE STN GRP II+-US	312	88313	N/A	N/A
HC83501742	LUXOL FAST BLUE STN GRP II+-U2	312	88313	N/A	N/A
HC83501759	MASSON TRICHROM STN/GRP II+-IM	312	88313	N/A	N/A
HC83501767	MASSON TRICHROM STN/GRP II+-US	312	88313	N/A	N/A
HC83501775	MASSON TRICHROM STN/GRP II+-U2	312	88313	N/A	N/A
HC83501783	MAY GRUN GIEMSA STN GRP II+-IM	312	88313	N/A	N/A
HC83501791	MAY GRUN GIEMSA STN GRP II+-US	312	88313	N/A	N/A
HC83501809	MAY GRUN GIEMSA STN GRP II+-U2	312	88313	N/A	N/A
HC83501817	MELANIN BLEACHING/GRP II+-IM	312	88313	N/A	N/A
HC83501825	MELANIN BLEACHING/GRP II+-US	312	88313	N/A	N/A
HC83501833	MELANIN BLEACHING/GRP II+-U2	312	88313	N/A	N/A
HC83501841	METHYL GREEN PY STN/GRP II+-IM	312	88313	N/A	N/A
HC83501858	METHYL GREEN PYSTN/GRP II+-US	312	88313	N/A	N/A
HC83501866	METHYL GREEN PY STN/GRP II+-U2	312	88313	N/A	N/A
HC83501874	MUCIN MUCICARM STN/GRP II+-IM	312	88313	N/A	N/A
HC83501882	MUCIN MUCICARM STN/GRP II+-US	312	88313	N/A	N/A
HC83501890	MUCIN MUCICARM STN/GRP II+-U2	312	88313	N/A	N/A
HC83501908	MYELIN STAIN GRP II+-IM	312	88313	N/A	N/A
HC83501916	MYELIN STAIN GRP II+-US	312	88313	N/A	N/A
HC83501924	OIL RED O STAIN/GRP II+-IM	312	88313	N/A	N/A
HC83501932	OIL RED O STAIN/GRP II+-U2	312	88313	N/A	N/A
HC83501940	PAS STAIN W/DIGEST GRP II+-IM	312	88313	N/A	N/A
HC83501957	PAS STAIN W/DIGEST GRP II+-U2	312	88313	N/A	N/A
HC83501965	PAS STAIN/GRP II+-IM	312	88313	N/A	N/A
HC83501973	PAS STAIN/GRP II+-US	312	88313	N/A	N/A
HC83501981	PERLS PRUSS BLU STN GRP II+-IM	312	88313	N/A	N/A
HC83501999	PERLS PRUSS BLU STN GRP II+-US	312	88313	N/A	N/A
HC83502005	PTAH STAIN/GRP II+-IM	312	88313	N/A	N/A
HC83502013	PTAH STAIN/GRP II+-US	312	88313	N/A	N/A
HC83502021	RETICULUM STAIN/GRP II+-IM	312	88313	N/A	N/A
HC83502039	RETICULUM STAIN/GRP II+-US	312	88313	N/A	N/A
HC83502047	SPECIAL STAIN GROUP II+-SU	312	88313	N/A	N/A
HC83502054	SPECIAL STAIN GROUP II+-IM	312	88313	N/A	N/A
HC83502062	SPECIAL STAIN GROUP II+-US	312	88313	N/A	N/A
HC83502096	PAS W/DIGESTON -IM	312	88314	N/A	N/A
HC83502104	PAS W/DIGESTON -US	312	88314	N/A	N/A
HC83502112	PAS W/DIGESTON -U2	312	88314	N/A	N/A
HC83502120	OIL RED O STAIN -IM	312	88314	N/A	N/A
HC83502138	OIL RED O STAIN -US	312	88314	N/A	N/A
HC83502153	HISTOCHEMISTRY DETERMINATIV-HP	312	88319	N/A	N/A
HC83502211	ANATOMIC CONSULT; SLIDE REV-IM	312	88321	N/A	N/A
HC83502229	ANATOMIC CONSULT; SLIDE REV-US	312	88321	N/A	N/A
HC83502245	ANATOMIC CONSULT; SLIDE REV-DR	312	88321	N/A	N/A
HC83502252	ANATOMIC CONSULT; SLIDE REV-JH	312	88321	225.00	225.00
HC83502278	ANATOMIC CONSULT; REV/PREP-IM	312	88323	N/A	N/A
HC83502286	ANATMIC CONSULT; REV/PREP-US	312	88323	N/A	N/A
HC83502294	ANATOMIC CONSULT; COMP. REV-HP	310	88325	N/A	N/A
HC83502328	ANATOMIC CONSULT; COMP. REV-IM	310	88325	N/A	N/A
HC83502344	IHC/IP PER SPEC INITIAL AB STAIN (PNL 6&7)-HP	312	88342	59.00	58.33
HC83502351	IHC/IP PER SPEC INITIAL AB STAIN -IM	312	88342	40.00	40.00
HC83502369	IHC/IP PER SPEC INITIAL AB STAIN -US	312	88342	180.00	180.00
HC83502385	IHC/IP PER SPEC INITIAL AB STAIN -MA	312	88342	193.70	104.00
HC83502393	IHC/IP PER SPEC INITIAL AB STAIN DYSTRPH C-TERMINS -IM	312	88342	N/A	N/A
HC83502401	IHC/IP PER SPEC INITIAL AB STAIN DYSTRPH C-TERMINS -US	312	88342	N/A	N/A
HC83502419	IHC/IP PER SPEC INITIAL AB STAIN DYSTRPH N-TERMINS -IM	312	88342	N/A	N/A
HC83502427	IHC/IP PER SPEC INITIAL AB STAIN DYSTRPH N-TERMINS -US	312	88342	N/A	N/A
HC83502435	IHC/IP PER SPEC INITIAL AB STAIN DYSTRPH ROD DOMAN -IM	312	88342	N/A	N/A
HC83502443	IHC/IP PER SPEC INITIAL AB STAIN DYSTRPH ROD DOMAN -US	312	88342	N/A	N/A
HC83502450	IHC/IP PER SPEC INITIAL AB STAIN IHC/IP STAIN ACTH -IM	312	88342	N/A	N/A
HC83502468	IHC/IP PER SPEC INITIAL AB STAIN IHC/IP STAIN ACTH -US	312	88342	N/A	N/A
HC83502476	IHC/IP PER SPEC INITIAL AB STAIN AFP -IM	312	88342	N/A	N/A
HC83502484	IHC/IP PER SPEC INITIAL AB STAIN AFP -US	312	88342	N/A	N/A
HC83502492	IHC/IP PER SPEC INITIAL AB STAIN BRST2 -IM	312	88342	N/A	N/A
HC83502500	IHC/IP PER SPEC INITIAL AB STAIN BRST2 -US	312	88342	N/A	N/A
HC83502518	IHC/IP PER SPEC INITIAL AB STAIN CALCITONIN -IM	312	88342	N/A	N/A
HC83502526	IHC/IP PER SPEC INITIAL AB STAIN CALCITONIN -US	312	88342	N/A	N/A
HC83502534	IHC/IP PER SPEC INITIAL AB STAIN CD-34 -IM	312	88342	N/A	N/A
HC83502542	IHC/IP PER SPEC INITIAL AB STAIN CD-34 -US	312	88342	N/A	N/A
HC83502559	IHC/IP PER SPEC INITIAL AB STAIN CEA -IM	312	88342	N/A	N/A
HC83502567	IHC/IP PER SPEC INITIAL AB STAIN CEA -US	312	88342	N/A	N/A
HC83502575	IHC/IP PER SPEC INITIAL AB STAIN CHROMOGRNIN -IM	312	88342	N/A	N/A
HC83502583	IHC/IP PER SPEC INITIAL AB STAIN CHROMOGRNIN -US	312	88342	N/A	N/A
HC83502591	IHC/IP PER SPEC INITIAL AB STAIN DESMIN -IM	312	88342	N/A	N/A
HC83502609	IHC/IP PER SPEC INITIAL AB STAIN DESMIN -US	312	88342	N/A	N/A
HC83502617	IHC/IP PER SPEC INITIAL AB STAIN EPITH -IM	312	88342	N/A	N/A
HC83502625	IHC/IP PER SPEC INITIAL AB STAIN EPITH -US	312	88342	N/A	N/A
HC83502633	IHC/IP PER SPEC INITIAL AB STAIN ESTROGN RECPT -IM	312	88342	N/A	N/A
HC83502641	IHC/IP PER SPEC INITIAL AB STAIN ESTROGN RECPT -US	312	88342	N/A	N/A
HC83502658	IHC/IP PER SPEC INITIAL AB STAIN FACTOR 8 -IM	312	88342	N/A	N/A
HC83502666	IHC/IP PER SPEC INITIAL AB STAIN FACTOR 8 -US	312	88342	N/A	N/A
HC83502674	IHC/IP PER SPEC INITIAL AB STAIN GASTRIN -IM	312	88342	N/A	N/A
HC83502682	IHC/IP PER SPEC INITIAL AB STAIN GASTRIN -US	312	88342	N/A	N/A
HC83502690	IHC/IP PER SPEC INITIAL AB STAIN GF -IM	312	88342	N/A	N/A
HC83502708	IHC/IP PER SPEC INITIAL AB STAIN GF -US	312	88342	N/A	N/A
HC83502716	IHC/IP PER SPEC INITIAL AB STAIN GLUCAGON -IM	312	88342	N/A	N/A
HC83502724	IHC/IP PER SPEC INITIAL AB STAIN GLUCAGON -US	312	88342	N/A	N/A
HC83502732	IHC/IP PER SPEC INITIAL AB STAIN HCG -IM	312	88342	N/A	N/A
HC83502740	IHC/IP PER SPEC INITIAL AB STAIN HCG -US	312	88342	N/A	N/A
HC83502757	IHC/IP PER SPEC INITIAL AB STAIN HERPES POLY -IM	312	88342	N/A	N/A
HC83502765	IHC/IP PER SPEC INITIAL AB STAIN HERPES POLY -US	312	88342	N/A	N/A
HC83502773	IHC/IP PER SPEC INITIAL AB STAIN HMB-45 -IM	312	88342	N/A	N/A
HC83502781	IHC/IP PER SPEC INITIAL AB STAIN HMB-45 -US	312	88342	N/A	N/A
HC83502799	IHC/IP PER SPEC INITIAL AB STAIN INSULIN -IM	312	88342	N/A	N/A
HC83502807	IHC/IP PER SPEC INITIAL AB STAIN INSULIN -US	312	88342	N/A	N/A
HC83502815	IHC/IP PER SPEC INITIAL AB STAIN KAPPA -IM	312	88342	N/A	N/A
HC83502823	IHC/IP PER SPEC INITIAL AB STAIN KAPPA -US	312	88342	N/A	N/A
HC83502856	IHC/IP PER SPEC INITIAL AB STAIN KI-1 -IM	312	88342	N/A	N/A
HC83502864	IHC/IP PER SPEC INITIAL AB STAIN KI-1 -US	312	88342	N/A	N/A
HC83502872	IHC/IP PER SPEC INITIAL AB STAIN KP1 -IM	312	88342	N/A	N/A
HC83502880	IHC/IP PER SPEC INITIAL AB STAIN KP1 -US	312	88342	N/A	N/A
HC83502898	IHC/IP PER SPEC INITIAL AB STAIN L26 -IM	312	88342	N/A	N/A
HC83502906	IHC/IP PER SPEC INITIAL AB STAIN L26 -US	312	88342	N/A	N/A
HC83502914	IHC/IP PER SPEC INITIAL AB STAIN LAMBDA -IM	312	88342	N/A	N/A
HC83502922	IHC/IP PER SPEC INITIAL AB STAIN LAMBDA -US	312	88342	N/A	N/A
HC83502930	IHC/IP PER SPEC INITIAL AB STAIN LCA -IM	312	88342	N/A	N/A
HC83502948	IHC/IP PER SPEC INITIAL AB STAIN LCA -US	312	88342	N/A	N/A
HC83502955	IHC/IP PER SPEC INITIAL AB STAIN LEU-22 -IM	312	88342	N/A	N/A
HC83502963	IHC/IP PER SPEC INITIAL AB STAIN LEU-22 -US	312	88342	N/A	N/A
HC83502971	IHC/IP PER SPEC INITIAL AB STAIN LN1 -IM	312	88342	N/A	N/A
HC83502989	IHC/IP PER SPEC INITIAL AB STAIN LN1 -US	312	88342	N/A	N/A
HC83502997	IHC/IP PER SPEC INITIAL AB STAIN LN2 -IM	312	88342	N/A	N/A
HC83503003	IHC/IP PER SPEC INITIAL AB STAIN LN2 -US	312	88342	N/A	N/A
HC83503037	IHC/IP PER SPEC INITIAL AB STAIN MUSCLE -IM	312	88342	N/A	N/A
HC83503045	IHC/IP PER SPEC INITIAL AB STAIN MUSCLE -US	312	88342	N/A	N/A
HC83503052	IHC/IP PER SPEC INITIAL AB STAIN MYGLOBIN -IM	312	88342	N/A	N/A
HC83503060	IHC/IP PER SPEC INITIAL AB STAIN MYGLOBIN -US	312	88342	N/A	N/A
HC83503078	IHC/IP PER SPEC INITIAL AB STAIN NEUROFILAMENT -IM	312	88342	N/A	N/A
HC83503086	IHC/IP PER SPEC INITIAL AB STAIN NEUROFILAMENT -US	312	88342	N/A	N/A
HC83503094	IHC/IP PER SPEC INITIAL AB STAIN NSE -IM	312	88342	N/A	N/A
HC83503102	IHC/IP PER SPEC INITIAL AB STAIN NSE -US	312	88342	N/A	N/A
HC83503110	IHC/IP PER SPEC INITIAL AB STAIN PROGEST RECPT -IM	312	88342	N/A	N/A
HC83503128	IHC/IP PER SPEC INITIAL AB STAIN PROGEST RECPT -US	312	88342	N/A	N/A
HC83503136	IHC/IP PER SPEC INITIAL AB STAIN PSA -IM	312	88342	N/A	N/A
HC83503144	IHC/IP PER SPEC INITIAL AB STAIN PSA -US	312	88342	N/A	N/A
HC83503151	IHC/IP PER SPEC INITIAL AB STAIN S100 -IM	312	88342	N/A	N/A
HC83503169	IHC/IP PER SPEC INITIAL AB STAIN S100 -US	312	88342	N/A	N/A
HC83503177	IHC/IP PER SPEC INITIAL AB STAIN SMOOTH MUSC -IM	312	88342	N/A	N/A
HC83503185	IHC/IP PER SPEC INITIAL AB STAIN SMOOTH MUSC -US	312	88342	N/A	N/A
HC83503193	IHC/IP PER SPEC INITIAL AB STAIN SOMATOSATIN -IM	312	88342	N/A	N/A
HC83503201	IHC/IP PER SPEC INITIAL AB STAIN SOMATOSATIN -US	312	88342	N/A	N/A
HC83503219	IHC/IP PER SPEC INITIAL AB STAIN T4 -IM	312	88342	N/A	N/A
HC83503227	IHC/IP PER SPEC INITIAL AB STAIN T4 -US	312	88342	N/A	N/A
HC83503235	IHC/IP PER SPEC INITIAL AB STAIN THYROGLOBULIN -IM	312	88342	N/A	N/A
HC83503243	IHC/IP PER SPEC INITIAL AB STAIN THYROGLOBULIN -US	312	88342	N/A	N/A
HC83503276	IHC/IP PER SPEC INITIAL AB STAIN VIMENTIN -IM	312	88342	N/A	N/A
HC83503284	IHC/IP PER SPEC INITIAL AB STAIN VIMENTIN -US	312	88342	N/A	N/A
HC83503292	IHC/IP PER SPEC INITIAL AB STAIN SYNAPTOPH PER SPEC INITIAL AB STAIN  -IM	312	88342	N/A	N/A
HC83503300	IHC/IP PER SPEC INITIAL AB STAIN SYNAPTOPH PER SPEC INITIAL AB STAIN  -US	312	88342	N/A	N/A
HC83503318	IHC/IP PER SPEC INITIAL AB STAIN ACTH PIT PNL -IM	312	88342	N/A	N/A
HC83503326	IHC/IP PER SPEC INITIAL AB STAIN ACTH PIT PNL -US	312	88342	N/A	N/A
HC83503334	IHC/IP PER SPEC INITIAL AB STAIN ANTI-BCL-2 -IM	312	88342	N/A	N/A
HC83503342	IHC/IP PER SPEC INITIAL AB STAIN ANTI-BCL-2 -US	312	88342	N/A	N/A
HC83503359	IHC/IP PER SPEC INITIAL AB STAIN ANTI-CD3/HRP -IM	312	88342	N/A	N/A
HC83503367	IHC/IP PER SPEC INITIAL AB STAIN ANTI-CD3/HRP -US	312	88342	N/A	N/A
HC83503375	IHC/IP PER SPEC INITIAL AB STAIN CD-68 -IM	312	88342	N/A	N/A
HC83503383	IHC/IP PER SPEC INITIAL AB STAIN CD-68 -US	312	88342	N/A	N/A
HC83503391	IHC/IP PER SPEC INITIAL AB STAIN CYCLIN D1 -IM	312	88342	N/A	N/A
HC83503409	IHC/IP PER SPEC INITIAL AB STAIN CYCLIN D1 -US	312	88342	N/A	N/A
HC83503417	IHC/IP PER SPEC INITIAL AB STAIN CYTO KERATIN-20 -IM	312	88342	N/A	N/A
HC83503425	IHC/IP PER SPEC INITIAL AB STAIN CYTO KERATIN-20 -US	312	88342	N/A	N/A
HC83503433	IHC/IP PER SPEC INITIAL AB STAIN CYTO KERATIN-7 -IM	312	88342	N/A	N/A
HC83503441	IHC/IP PER SPEC INITIAL AB STAIN CYTO KERATIN-7 -US	312	88342	N/A	N/A
HC83503458	IHC/IP PER SPEC INITIAL AB STAIN EWINGS SARCOMA -IM	312	88342	N/A	N/A
HC83503466	IHC/IP PER SPEC INITIAL AB STAIN EWINGS SARCOMA -US	312	88342	N/A	N/A
HC83503474	IHC/IP PER SPEC INITIAL AB STAIN FACTOR 13-A -IM	312	88342	N/A	N/A
HC83503482	IHC/IP PER SPEC INITIAL AB STAIN FACTOR 13-A -US	312	88342	N/A	N/A
HC83503490	IHC/IP PER SPEC INITIAL AB STAIN GH STAIN -IM	312	88342	N/A	N/A
HC83503508	IHC/IP PER SPEC INITIAL AB STAIN GH STAIN -US	312	88342	N/A	N/A
HC83503516	IHC/IP PER SPEC INITIAL AB STAIN KERATIN 903 -IM	312	88342	N/A	N/A
HC83503524	IHC/IP PER SPEC INITIAL AB STAIN KERATIN 903 -US	312	88342	N/A	N/A
HC83503557	IHC/IP PER SPEC INITIAL AB STAIN KI-67 -IM	312	88342	N/A	N/A
HC83503565	IHC/IP PER SPEC INITIAL AB STAIN KI-67 -US	312	88342	N/A	N/A
HC83503573	IHC/IP PER SPEC INITIAL AB STAIN LEU MI (CD15) -IM	312	88342	N/A	N/A
HC83503581	IHC/IP PER SPEC INITIAL AB STAIN LEU MI (CD15) -US	312	88342	N/A	N/A
HC83503615	IHC/IP PER SPEC INITIAL AB STAIN MYELOPEROXIDASE -IM	312	88342	N/A	N/A
HC83503623	IHC/IP PER SPEC INITIAL AB STAIN MYELOPEROXIDASE -US	312	88342	N/A	N/A
HC83503631	IHC/IP PER SPEC INITIAL AB STAIN P-53 -IM	312	88342	N/A	N/A
HC83503649	IHC/IP PER SPEC INITIAL AB STAIN P-53 -US	312	88342	N/A	N/A
HC83503656	IHC/IP PER SPEC INITIAL AB STAIN PLAP -IM	312	88342	40.00	40.00
HC83503664	IHC/IP PER SPEC INITIAL AB STAIN PLAP -US	312	88342	50.00	50.00
HC83503672	IHC/IP PER SPEC INITIAL AB STAIN PROLACTIN -IM	312	88342	40.00	40.00
HC83503680	IHC/IP PER SPEC INITIAL AB STAIN PROLACTIN -US	312	88342	50.00	50.00
HC83503698	IHC/IP PER SPEC INITIAL AB STAIN SEND OUT -IM	312	88342	N/A	N/A
HC83503706	IHC/IP PER SPEC INITIAL AB STAIN SEND OUT -US	312	88342	50.00	50.00
HC83503714	IHC/IP PER SPEC INITIAL AB STAIN SMMHC -IM	312	88342	89.00	88.56
HC83503722	IHC/IP PER SPEC INITIAL AB STAIN SMMHC -US	312	88342	50.00	50.00
HC83503730	IHC/IP PER SPEC INITIAL AB STAIN TERM DEOZY -IM	312	88342	89.00	88.56
HC83503748	IHC/IP PER SPEC INITIAL AB STAIN TERM DEOZY -US	312	88342	50.00	50.00
HC83503771	IHC/IP PER SPEC INITIAL AB STAIN HER-2-NEU -IM	312	88342	124.00	124.00
HC83503789	IHC/IP PER SPEC INITIAL AB STAIN HER-2-NEU -US	312	88342	154.00	154.00
HC83503797	IHC/IP PER SPEC INITIAL AB STAIN UBIQUITIN STAIN -IM	312	88342	40.00	40.00
HC83503805	IHC/IP PER SPEC INITIAL AB STAIN UBIQUITIN STAIN -US	312	88342	50.00	50.00
HC83503813	IF STUDY DIRECT 1ST STAIN-CS	312	88346	55.00	54.90
HC83503821	IF STUDY DIRECT PROF 1ST STAIN-CS	312	88346	207.00	206.82
HC83503847	ELECTRON MICROSCOPY-CS	312	88348	771.13	484.46
HC83503854	ELECTRON MICROSCOPY PROF-CS	312	88348	303.00	302.80
HC83503862	MORPHOMETRIC STDY SKEL MUSC-AT	312	88355	N/A	N/A
HC83503870	MORPHOMETRIC STDY NERVE-AT	312	88356	N/A	N/A
HC83503904	MORPHOM STDY TUMOR IHC-US	312	88361	N/A	N/A
HC83503912	MORPHOM STDY TUMOR IHC PROF-US	312	88361	N/A	N/A
HC83503920	TISSUE IN-SITU HYBRI INTER-US	312	88365	250.00	250.00
HC83503961	HISTOCHEMISTRY DETERMINATIV-ON	312	88319	N/A	N/A
HC83503979	ANATMIC CONSULT; REV/PREP-ON	312	88323	N/A	N/A
HC83504043	TISSUE EXAM G&M LEVEL 4PROF-CS	312	88305	116.00	115.38
HC83504050	TISSUE EXAM G&M LEVEL 5-CS	312	88307	365.00	364.50
HC83504076	IF STUDY INDIRECT 1ST STAIN-CS	310	88346	352.34	243.00
HC83504084	MORPHOMETRIC STUDY TUMOR-PI	312	88358	50.00	50.00
HC83504092	TISSUE IN-SITU HYBRI INTER-IM	312	88365	621.00	621.00
HC83504324	ANATOMIC CONSULT; SLIDE REV-MA	312	88321	259.00	258.50
HC83504340	ANATOMIC CONSULT; COMP. REV-DR	310	88325	N/A	N/A
HC83504357	ANATOMIC CONSULT; COMP. REV-JH	310	88325	N/A	N/A
HC83504365	ANATOMIC CONSULT; COMP. REV-JO	310	88325	N/A	N/A
HC83504373	ANATOMIC CONSULT; COMP. REV-BR	310	88325	N/A	N/A
HC83504381	IHC/IP PER SPEC INITIAL AB STAIN ANTI-BCL-2 -BR	312	88342	100.00	88.56
HC83504449	ANATOMIC CONSULT; COMP. REV-CS	310	88325	1,283.00	1,282.50
HC83504456	IHC/IP PER SPEC INITIAL AB STAIN -EM	312	88342	80.00	80.00
HC83504464	TISSUE IN-SITU HYBRI INTER-GC	312	88365	N/A	N/A
HC83504589	FLOW CYT MKR TC 1ST-U2	311	88184	N/A	N/A
HC83504597	FLOW CYT MKR TC ADD+-U2	311	88185	N/A	N/A
HC83504688	FLOW CYT MKR TC 1ST-HP	311	88184	N/A	N/A
HC83504696	FLOW CYT MKR TC ADD+-HP	311	88185	N/A	N/A
HC83504746	FLOW CYT MKR TC ADD+-US	311	88185	14.00	14.00
HC83504779	IHC/IP PER SPEC INITIAL AB STAIN (PNL X 4)-HP	312	88342	88.00	87.50
HC83504787	IHC/IP PER SPEC INITIAL AB STAIN (PNL X 5)-HP	312	88342	70.00	70.00
HC83504795	MORPH STDY CAT ISH QNT HER2-NG	310	88367	231.00	230.53
HC83504803	MORPH STDY CAT ISH QNT/SPEC INTL SNGL PROBE CEP17-NG	310	88367	231.00	230.53
HC83504811	MORPH STDY MAN ISH QNTCEP17-NG	310	88368	201.00	200.92
HC83504829	MORPH STDY MAN ISH QNT HER2-NG	310	88368	201.00	200.92
HC83504837	IHC MLH1 QNT-NG	310	88360	45.00	58.50
HC83504845	IHC EGFR QNT-NG	310	88360	45.00	58.50
HC83504852	IHC MSH2 QNT-NG	310	88360	45.00	58.50
HC83504860	IP/IHC PER SPEC INITIAL AB STAIN -NG	312	88342	45.00	40.00
HC83504910	MORPH STDY CAT ISH/SPEC INTL SNGL PROBE HER2-NG	310	88367	241.00	240.18
HC83504928	MORPH STUDY MAN ISH HER2-NG	310	88368	169.00	168.90
HC83505099	TISSUE IN-SITU HYBRI INITIAL -NG	312	88365	80.00	75.01
HC83505248	IHC/IP PER SPEC EA ADD AB STAIN+ -PI	312	88341	28.00	28.00
HC83505255	IHC/IP PER SPEC EA ADD AB STAIN+ -NG	312	88341	45.00	N/A
HC83505263	IF, EACH ADD'L SINGLE AB STAIN-CS	312	88350	51.00	N/A
HC83505339	CONSULTATION PATH; REF SLIDE REV-BR	310	88321	300.00	N/A
HC83505347	IHC/IP PER SPEC EA ADD AB STAIN+ -BR	310	88341	N/A	N/A
HC83505412	FLOW CYT MKR TC 1ST (PNL) -NG	311	88184	76.00	N/A
HC83505420	FLOW CYT MKR TC EACH ADD+ -NG	311	88185	13.00	N/A
HC83505461	SPECIAL STAIN GROUP I -NG	312	88312	57.00	N/A
HC83505479	SPECIAL STAIN GROUP II -NG	312	88313	50.00	N/A
HC83505487	STAIN IMMUNOHISTOCHEMICAL QUANT -NG	312	88360	45.00	N/A
HC83505495	SPECIAL STAIN GROUP II+-CS	312	88313	70.10	N/A
HC83505503	ANATOMIC CONSULT; SLIDE REV-CS	312	88321	140.00	N/A
HC83505511	IHC/IP PER SPEC EA ADD AB STAIN+ -CS	312	88341	40.00	N/A
HC83505529	IP/IHC PER SPEC INITIAL AB STAIN -CS	312	88342	317.34	N/A
HC83505537	ANATOMIC CONSULT; COMPLEX REV-UX	312	88321	272.00	N/A
HC83505602	IP/IHC PER SPEC INITIAL AB STAIN -CA	312	88342	148.00	N/A
HC83505610	IHC/IP PER SPEC EA ADD AB STAIN+ -CA	312	88341	148.00	N/A
HC83505685	PD-L1 IHC QNT-NG	310	88360	150.00	N/A
HC83505693	IHC/IP PER SPEC EA ADD AB STAIN+ MSH-6-NG	310	88341	45.00	N/A
HC83505701	IHC/IP PER SPEC EA ADD AB STAIN+ PMS2-NG	310	88341	45.00	N/A
HC83505719	IHC/IP PER SPEC INITIAL AB STAIN MLH-1-NG	310	88342	45.00	N/A
HC83505727	IHC/IP PER SPEC EA ADD AB STAIN+ MSH-2-NG	310	88341	45.00	N/A
HC83505735	EXAM GROSS&MICRO INTERM LVL IV(PANEL)-U2	314	88305	80.00	N/A
HC83505743	SPECIAL STAIN GROUP II(PANEL)-U2	314	88313	50.00	N/A
HC83505750	HISTCHM ST FROZ TIS BLK EA ADD(PANEL)+-U2	314	88314	44.00	N/A
HC83505768	SPECIAL STAIN GRP III ENZYMES(PANEL)-U2	314	88319	69.00	N/A
HC83505800	ANATOMIC CONSULT; SLIDE REV-BC	312	88321	125.00	N/A
HC83505834	IHC/IP PER SPEC INITIAL AB STAIN - AP	312	88342	40.00	N/A
HC83505842	IHC/IP PER SPEC EA ADD AB STAIN+ - AP	312	88341	40.00	N/A
HC83505875	MORPH STDY CAT FISH EA MULTI PROBE HER2-NG	312	88374	270.00	N/A
HC83505909	SPECIAL STAIN GROUP I -AP	312	88312	25.00	N/A
HC83505917	SPECIAL STAIN GROUP II -AP	312	88313	40.00	N/A
HC83505925	TISSUE IN-SITU HYBRI INITIAL -AP	312	88365	135.00	N/A
HC83505933	TISSUE IN-SITU HYBRI EA ADDL -AP	312	88364	135.00	N/A
HC83505941	IHC/IP PER SPEC EA ADD AB STAIN+ -MA	312	88341	193.70	N/A
HC83505982	MORPH STDY TMR IHC-AP	312	88361	150.00	N/A
HC83505990	TISSUE IN-SITU HYBRID SGL PROBE EA ADDL-NG	312	88364	80.00	N/A
HC83506006	FLOW CYT MKR CD4/CD8 BAL 1ST (PNL)-NG	311	88184	91.00	N/A
HC83506014	FLOW CYT MKR CD4/CD8 BAL EA ADD+ (PNL)-NG	311	88185	13.00	N/A
HC84200971	TRICHROME STAIN	310	88313	364.00	106.50
HC84600006	CYTOLOGY FLD/BRSH/WASH-DIST SV	311	88104	244.00	146.25
HC84600014	CYTOLOGY FLUID/BRUSH/WASH	311	88104	244.00	146.25
HC84600022	CYTOLOGY FILTER ONLY	311	88106	198.00	143.00
HC84600048	CYTOLOGY CONCENTRATE TECHNIQUE	311	88108	342.00	184.00
HC84600055	CYTOPATH SELECT CELL ENHANCE	311	88112	540.00	266.25
HC84600071	PAP SMEAR PATH INTERP+	311	88141	149.00	49.50
HC84600089	PAP THIN LAYER PREP MANL SCRN	311	88142	195.00	85.00
HC84600105	PAP SLIDES MANUAL SCREEN	311	88150	113.00	50.00
HC84600113	PAP SLIDES MAN& RE-SCREEN	311	88153	120.00	50.00
HC84600121	PAP DEFIN HORMONAL EVAL+	311	88155	85.00	35.00
HC84600139	PAP BETHESDA MANUAL SCREEN	311	88164	115.00	52.75
HC84600147	PAP BETHESDA MAN & RE-SCREEN	311	88165	131.00	52.75
HC84600154	CYTOLOGY SMEAR NON GYN S&I	311	88160	288.00	119.00
HC84600162	CYTOLOGY PREP NON GYN S&I	311	88161	295.00	150.25
HC84600170	CYTOLOGY EXTENDED STUDY>5SLIDE	311	88162	285.00	126.00
HC84600188	CYTP DX EVAL FNA 1ST EVAL EA SITE	311	88172	362.00	180.50
HC84600196	FNA INTERPRETATION/REPORT	311	88173	466.00	300.00
HC84600204	CYTO SMEAR NON GYN S&I-DIS SVC	311	88160	288.00	109.00
HC84600212	CYTO PREP NON GYN S&I-DIST SVC	311	88161	295.00	150.25
HC84600220	CYTP DX EVAL FNA EA ADDL SAME SITE	311	88177	256.00	100.00
HC84600238	FNA INTERPR/REPORT-DIST SVC	311	88173	466.00	300.00
HC84600253	CELL BLOCK (TISSUE EXAM LVL 4)	312	88305	611.00	217.75
HC84600261	CELL BLOCK (TISSUE EX)DIST SVC	312	88305	611.00	217.75
HC84600287	MORPH STDY IHC QT MANUAL PER SPEC EA AB	312	88360	609.00	236.00
HC84600295	CYTO FLUID/BRUSH/WASH DIST SRV	311	88104	244.00	146.25
HC84600303	CYTO CONC TECHNIQUE DIST SRV	311	88108	341.00	164.00
HC84600311	MORPH STDY IHC/HER-2/NEU PER SPEC EA AB	312	88360	609.00	236.00
HC84600329	MORPH STDY IHC/ESTROG RCPTR PER SPEC EA AB	312	88360	609.00	236.00
HC84600337	MORPH STDY IHC/PROG RCPTR PER SPEC EA AB	312	88360	609.00	239.00
HC84600345	CYTO SEL CELL ENHANCE DIST SRV	311	88112	541.00	266.25
HC84600485	COPPER STAIN/GRP II+	312	88313	371.00	106.50
HC84600493	COLLOIDAL IRON STAIN/GRP II+	312	88313	371.00	106.50
HC84600527	CYTOLOGY FLUID/BRUSH/WASH *OP	311	88104	244.00	60.00
HC84600535	CYTOLOGY CONC TECHNIQUE *OP	311	88108	342.00	100.00
HC84600543	CYTOPATH SELECT CELL ENHANC*OP	311	88112	541.00	70.00
HC84600550	FNA INTERPRETATION/REPORT *OP	311	88173	285.00	70.00
HC84600568	EXM/SELEC ARCHVL TISS MOL ANAL	312	88363	243.00	174.75
HC84600576	PAP THIN LAYER  MNL SCRN DX	311	88142	195.00	85.00
HC89001929	FLOW CYTO EA BLOOD(T-PNL)-U2	311	88184	N/A	N/A
HC89002109	FLOW CYTO EA BLOOD(T&B PNL)-U2	311	88184	N/A	N/A
HC89003925	FLOW CYTOMETRY EA BLOOD-U2	311	88182	N/A	N/A
HC89004196	ANTI-ENDOMY IGA AB IFA1ST STAIN(PNL)-PR	310	88346	106.00	106.00
HC89004527	ANTI-ENDOMY IGA AB IFA1ST STAIN(PNL2-PR	310	88346	106.00	106.00
HC89004642	NSNAII IGG 1ST STAIN(PNL)-PR	310	88346	98.00	98.00
HC89004659	NSNAII IGG DNASE 1ST STAIN(PNL)-PR	310	88346	98.00	98.00
HC89014831	BUCCAL SMEAR-IG-GZ	311	88130	N/A	N/A
HC89014849	FLOW CYT MKR TC 1ST-HP	311	88184	N/A	N/A
HC89014856	FLOW CYT MKR TC 1ST-IM	311	88184	N/A	N/A
HC89014864	FLOW CYT MKR TC 1ST-US	311	88184	N/A	N/A
HC89015192	FLOW CYT MKR TC 1ST-U2	311	88184	N/A	N/A
HC89015200	FLOW CYT MKR TC ADD+-U2	311	88185	N/A	N/A
HC89015218	FLOW CYT MKR TC ADD+-HP	311	88185	N/A	N/A
HC89015226	FLOW CYT MKR TC ADD+-IM	311	88185	N/A	N/A
HC89015234	FLOW CYT MKR TC ADD+-US	311	88185	N/A	N/A
HC89016067	FLOW CYT MKR 1ST-QD	311	88184	N/A	N/A
HC89016224	FLOW CYT MKR TC ADD+-QD	311	88185	2.00	1.99
HC89016372	ELECTRON MICROSCOPY-QD	310	88348	2.00	1.99
HC89016430	FLOW CYT MKR TC 1ST-AU	311	88184	18.00	17.25
HC89016448	FLOW CYT MKR TC ADD+-AU	311	88185	18.00	17.25
HC89016927	ANATOMIC CONSULT; CMPLX REV-CE	312	88321	275.00	275.00
HC89016935	ANATOMIC CONSULT; CMPLX REV-JH	312	88321	250.00	250.00
HC89017883	MICRODISSECTION, MANUAL-NG	310	88381	258.00	257.11
HC89017909	TUMOR IMMUNOHISTOCHEM/MANL-NG	310	88360	133.00	132.67
HC89018188	FLOW CYT MKR TC 1ST-ES	311	88184	90.00	90.00
HC89018196	FLOW CYT MKR TC ADD+-ES	311	88185	53.00	52.50
HC89018485	IMMUNOFLUOR' STUDY EA AB1ST STAIN(PNL)-PR	310	88346	51.00	50.89
HC89018535	MICRODISSECTION; MANUAL-AU	310	88381	5.00	5.00
HC89019400	HLA AB DETECT 1ST MARKERS-AU	311	88184	96.00	96.00
HC89019418	HLA AB DETECT MARKERS ADD+-AU	311	88185	20.00	20.00
HC89019582	ANTI-EMA IGA AB IFA 1ST STAIN(PNL1155/6360)-PR	312	88346	120.00	120.00
HC89020192	PANCA INDIRECT IGG 1ST STAIN(PN)-PR	310	88346	120.00	72.00
HC89020200	DNASE INDIRECT IGG ADDL STAIN(PNL)-PR	310	88350	120.00	72.00
HC89022339	FLOW CYTOMETRY 1ST MRKR{W-INT/87}-CC	311	88184	123.00	N/A
HC89022347	FLOW CYTOMETRY 1ST MRKR{W-INT/88}-CC	311	88184	148.00	N/A
HC89022354	FLOW CYTOMETRY 1ST MRKR{W-INT/89}-CC	311	88184	188.00	N/A
HC89022362	FLOW CYTOMETRY MARKERS ADD+-CC	311	88185	24.00	N/A
HC89022370	FLOW CYT LEUK/LYMPH 1ST MRKR{W-INT/87}-AU	311	88184	79.00	N/A
HC89022388	FLOW CYT LEUK/LYMPH 1ST MRKR{W-INT/88}-AU	311	88184	99.00	N/A
HC89022396	FLOW CYT LEUK/LYMPH 1ST MRKR{W-INT/89}-AU	311	88184	114.00	N/A
HC89022404	FLOW CYT LEUK/LYMPH MRKRS ADD+-AU	311	88185	15.00	N/A
HC36000719	CAPILLARY/HEEL/FINGER STICK	300	36416	52.00	18.00
HC36001006	VENIPUNCTURE ROUTINE	300	36415	52.00	N/A
HC36800787	CAPILLARY/HEEL/FINGER STICK	300	36416	52.00	N/A
HC51001592	VENIPUNCTURE ROUTINE	300	36415	16.00	N/A
HC51004091	CAPILLARY/HEEL/FINGER STICK	300	36416	17.00	N/A
HC88600010	CAPILLARY/HEEL/FINGER STICK	300	36416	58.00	18.25
HC88600028	NEWBORN SCREEN DRAW FEE (GE)	300	36416	8.00	6.00
HC88600044	VENIPUNCTURE ROUTINE (BY UNIT)	300	36415	58.00	18.00
HC88600077	VENIPUNCTURE ROUTINE	300	36415	58.00	18.25
HC88600291	VENIPUNCTURE ROUTINE AFP PROGRAM	300	36415	8.00	6.00
HC88600309	VENIPUNCTURE ROUTINE SPECIAL CLIENT	300	36415	32.00	25.00
HC38420014	COLLECT AUTOLOGUS BLD INL' 2 HR	481	86891	2,191.00	N/A
HC38420022	COLLECT AUTO'BLOOD ADD'L UNIT	481	86891	1,203.00	N/A
HC83000000	PLATELETS CONCENTRATE EA UNIT	390	P9019	454.00	130.00
HC83000018	RBC'S EA UNIT	390	P9021	789.00	401.00
HC83000026	WHOLE BLOOD EA UNIT	390	P9010	877.00	510.00
HC83000034	RBC'S WASHED EA UNIT	390	P9022	1,120.00	635.00
HC83000042	RBC'S LEUKOREDUCE EA UNIT	390	P9016	952.00	416.00
HC83000059	RBC'S DEGLYCEROLIZED EA UNIT	390	P9039	1,485.00	834.00
HC83000067	PLATELET LR APHER/PHER EA UNIT	390	P9035	2,137.00	906.00
HC83000075	CRYOPRECIPITATE EA UNIT	390	P9012	313.00	109.00
HC83000083	FRESH FROZEN PLASMA EA UNIT	390	P9017	409.00	107.00
HC83000091	RBC ANTIGENS OTHER THAN ABO/RH	300	86905	308.00	342.00
HC83000109	X-MATCH I-SPIN TECH EA UNIT	302	86920	426.00	175.00
HC83000125	RBC ANTIBODY SCREEN	300	86850	282.00	58.25
HC83000133	RBC ANTIBODY ID EACH TECH	302	86870	532.00	42.25
HC83000141	BLOOD TYPE SEROLOGIC; ABO	300	86900	171.00	131.00
HC83000158	BLOOD TYPE SEROLOGIC; RH(D)	300	86901	170.00	40.00
HC83000166	COMBS  DIRECT(EA)	302	86880	182.00	69.75
HC83000174	RBC ANTIBODY ELUTION	302	86860	416.00	111.50
HC83000182	X-MATCH AHG TECH EA UNIT	302	86922	422.00	175.00
HC83000190	X-MATCH INCUB TECH EA UNIT	302	86921	387.00	175.00
HC83000216	FFP THAWING EA UNIT	300	86927	342.00	175.00
HC83000224	SPLITTING BLD/BLD PROD EA UNIT	302	86985	323.00	175.00
HC83000281	COMBS  INDIR TITER EA ANTISER	302	86886	369.00	175.00
HC83000299	AUTOL/DD BLD/COMPON PROC/STOR	300	86890	1,253.00	175.00
HC83000315	RH PHENOTYPE	300	86906	165.00	64.00
HC83000323	FREEZING BLOOD EA UNIT	300	86930	397.00	342.00
HC83000331	THAWING BLOOD EA UNIT	300	86931	315.00	342.00
HC83000349	FREEZING & THAW BLD EA UNIT	300	86932	354.00	185.00
HC83000356	IRRADIATION EA UNIT	300	86945	310.00	71.50
HC83000364	POOLING PLAT OR OTHER BLD PROD	300	86965	292.00	175.00
HC83000372	RBC PRETREAT W/DRUG/CHEM	302	86970	163.00	8.25
HC83000380	RBC PRETREAT W/ENZYMES	302	86971	321.00	342.00
HC83000398	SERUM PRETREATMNT W/INHIB EA	302	86977	245.00	175.00
HC83000406	SERUM PRETREATMNT/ABSORPTION	302	86978	244.00	101.00
HC83000414	HOLD CLOT (ST)	309	86999	N/A	N/A
HC83000463	RBC LEUKOREDUC/CMV NEG EA	390	P9051	607.00	377.00
HC83000471	RBC LR/CMV NEG DIVIDED UNIT	390	P9051	621.00	292.00
HC83000489	PLATELETS LEUKO RED EA UNIT	390	P9031	450.00	250.00
HC83000497	PLATELETS IRRAD EA UNIT	390	P9032	598.00	390.00
HC83000505	PLATELETS LR IRRAD EA UNIT	390	P9033	581.00	375.00
HC83000513	PLATELET PHERESIS EA UNIT	390	P9034	2,160.00	806.00
HC83000521	PLATELET HLA LR APHER/PHER	390	P9052	2,843.00	945.00
HC83000539	PLATELET LR CMV NEG APHER/PHER	390	P9055	1,683.00	1,167.00
HC83000547	PLATELET PHERESIS IRRD EA UNIT	390	P9036	2,154.00	886.00
HC83000554	PLATELETPHER LR IRRAD EA UNIT	390	P9037	2,743.00	1,355.00
HC83000562	PLATELETPHER LR/CMV-/IRRAD/U	390	P9053	2,439.00	1,828.00
HC83000570	RBC IRRADIATED EA UNIT	390	P9038	866.00	629.00
HC83000588	BLOOD LR FROZ/DEGLY/WASH'D	390	P9054	1,047.00	365.00
HC83000596	WHOLE BLOOD LEUKO RED/IRRAD EA UNIT	390	P9056	894.00	644.00
HC83000604	RBC/FRZ/DEGLYC/WSHD/LR/IRRAD	390	P9057	1,350.00	1,011.00
HC83000612	RBC'S LR/CMV-NEG/IRRAD/UNIT	390	P9058	1,155.00	290.00
HC83000620	PLASMA CRYO REDUCED EA UNIT-OS	390	P9044	411.00	105.00
HC83000794	COOMBS INDIRECT QUAL EA	302	86885	267.00	175.00
HC83000810	ALIQUOT RED CELLS	390	P9011	594.00	245.00
HC83000828	ALIQUOT PLATELETS	390	P9011	594.00	380.00
HC83000844	CRYOPRECIPITATE POOLED 5 UNITS	390	P9012	622.00	500.00
HC83000919	BLOOD TYPE SERO; PER AG/ANTIGEN DONOR	302	86902	301.00	342.00
HC83000927	RBC'S LUK RED EA UNIT AUTOL~BB	390	P9016	949.00	627.00
HC83000935	RBC'S LUK RED EA UNIT DIREC~BB	390	P9016	949.00	627.00
HC83000943	RBC'S LUK RED'IRR EAUNIT DD~BB	390	P9056	894.00	768.00
HC83000984	RBC'S EA UNIT -SB	390	P9021	789.00	278.75
HC83000992	RBC'S LEUKO REDUCED EA UNIT-SB	390	P9016	953.00	286.25
HC83001008	PLATELET LR PHER EA UNIT -SB	390	P9035	2,088.00	556.25
HC83001016	CRYOPRECIPITATE EA UNIT -SB	390	P9012	313.00	94.00
HC83001024	CRYOPRECIP 5 UNITS POOLED -SB	390	P9012	639.00	427.50
HC83001032	RBC'S WASHED EA UNIT -SB	390	P9022	1,120.00	397.50
HC83001040	RBC'S EA UNIT (AUTOLOGOUS)-SB	390	P9021	789.00	400.00
HC83001123	CRYOPRECIPITATE 4 UNITS POOLED-SB	390	P9012	559.00	150.00
HC83001131	ALIQUOT PLASMA	390	P9011	559.00	234.00
HC83001149	RBC'S LEUKO RED IRRAD EACH UNIT	390	P9040	1,186.00	575.00
HC83001156	PLASMA FRZN COLL 8-24 HRS EA UNIT	390	P9059	388.00	255.00
HC83001172	CRYOPRECIPITATE EA UNIT	390	P9012	313.00	130.00
HC83001180	RBC'S LEUKO REDUCED EA UNIT	390	P9016	945.00	335.00
HC83001198	RBC'S EA UNIT	390	P9021	789.00	305.00
HC83001206	PLATELET LR PHER EA UNIT	390	P9035	2,088.00	650.00
HC83001214	RBC DEGLYCEROLIZED EA UNIT	390	P9039	1,485.00	147.00
HC83001222	X-MATCH ELECTRONIC TECH EA UNIT	302	86923	452.00	175.00
HC83001248	PLATELET PHERESIS PATHOGEN REDUCED EA UNIT	390	P9073	1,963.00	700.00
HC83001255	PATHOGEN(S) TEST PLATELETS	310	P9100	94.00	42.00
HC83001263	PLASMA CONVALESCENT (COVID-AB)	390	P9060	0.01	N/A
HC83001271	PLASMA CONVALESCENT (COVID-AB) -SB	390	P9060	719.00	N/A
HC83001289	ALIQUOT PLASMA CONVALESCENT	390	P9011	559.00	N/A
HC83500116	CHEMOSENSITIVITY ASSAY-ON	300	86999	N/A	N/A
HC83500124	CHEMOSENSITIVITY ASSAY-WD	300	86999	880.00	880.00
HC89000004	BLOOD TYPE SERO; ABO FRANCSLLA AGLTNS-AU	302	86900	95.00	94.89
HC89017180	HEMOLYSIN SCREEN-AU	302	86941	N/A	N/A
HC89500128	BLOOD TYPING AG SCREEN(PT)-AA	300	86904	60.00	98.00
HC89500193	RBC PRETREAT W/DRUG/CHEM-AA	302	86970	45.00	80.00
HC89500326	AUTO/DD BLD/COMP PROC/STOR-UCI	300	86890	773.00	773.00
HC89500417	RBC ANTIBODY ID EA TECH-SB	302	86870	85.00	71.00
HC89500425	RBC PRETREAT W/DRUG/CHEM-SB	302	86970	75.00	88.75
HC89500433	SERUM PRETREATMNT/ABSORP-SB	302	86978	70.00	57.00
HC89500441	RBC ANTIBODY ELUTION-SB	302	86860	100.00	81.00
HC89500482	RBC ANTIBODY SCRN EA TECH-SB	302	86850	50.00	38.00
HC89500490	BLOOD TYPE SEROLOGIC; ABO-SB	300	86900	20.00	16.00
HC89500508	BLOOD TYPE SEROLOGIC; RH(D)-SB	300	86901	20.00	16.00
HC89500516	BLOOD TYPE SERO; PER AG/ANTIGEN DNR-SB	300	86902	80.00	61.00
HC89500557	COOMBS DIRECT(EA)-SB	302	86886	17.00	15.00
HC89500565	RH PHENOTYPE (CCEE)-SB	300	86906	62.00	52.00
HC89500573	RBC AG OTHER THAN ABO/RH-SB	300	86905	33.00	29.00
HC89500581	COOMBS INDIR TITER EA -SB	302	86886	90.00	63.00
HC89500599	BLOOD TYPING AG SCREEN(PT)-SB	300	86904	62.00	50.00
HC89500607	SERUM PRETREATMNT W INHIB-SB	300	86977	65.00	45.00
HC89500698	FREEZING BLOOD EA UNIT-SB	300	86930	294.00	294.00
HC89500714	IRRADIATION EA UNIT-SB	300	86945	40.00	40.00
HC89500722	FREEZING BLOOD EA UNIT AUTO-SB	300	86930	155.00	155.00
HC89500862	IRRADIATION EA UNIT-HC	300	86945	35.00	35.00
HC89500961	ANTIGLOBULIN DIRECT TEST COOMBS; EACH ANTISERUM-SB	302	86880	15.00	N/A
HC89500979	ANTIGLOBULIN INDIRECT TEST COOMBS; QUAL EA REAGENT RC-SB	302	86885	20.00	N/A
HC89500987	FFP THAWING; EA UNIT-SB	302	86927	12.00	N/A
HC89500995	RBC PRETX AB DETECT, ID, COMPAT; INCUB EZYM, EACH-SB	302	86971	75.00	N/A
HC89501027	RARE DONOR SEARCH-SB	302	86999	178.00	N/A
HC89501035	HISTORICAL ANTIGEN FEE-SB	302	86999	46.00	N/A
HC51000016	URINALYSIS NON-AUTO W/O MICRO	510	81002	27.00	N/A
HC51001964	HCG QUAL URINE (POS)	307	81025	55.00	21.00
HC51002210	URINALYSIS DIP STICK NONAUTO W/SCOPE	300	81000	15.00	N/A
HC51003408	URINALYSIS AUTO W/O MICRO	510	81003	28.00	N/A
HC81100331	VOL MEASURE TIMED COLLECTION	307	81050	58.00	27.00
HC81100794	URINALYSIS AUTO W/ MICROSCOPY	307	81001	170.00	24.25
HC81100802	URINALYSIS AUTO W/O MICRO	307	81003	102.00	21.50
HC81100992	URINALYSIS NON-AUTO W/O MICRO	307	81002	110.00	22.25
HC81101008	UA QUAL/SEMIQUAN	307	81005	98.00	39.50
HC81101495	URINALYSIS MICROSCOPIC ONLY	307	81015	107.00	39.50
HC81101578	UA DIPSTICK (DIRECT ACCESS)	301	81003	85.00	25.00
HC81500928	URINALYSIS AUTO W/ MICROSCOPY	307	81001	163.00	N/A
HC81500936	URINALYSIS AUTO W/O MICRO	307	81003	98.00	N/A
HC81500944	URINALYSIS NON-AUTO W/O MICRO	307	81002	105.00	N/A
HC81700627	HCG QUAL URINE	301	81025	192.00	43.18
HC89000087	REDUCING SUBSTANCES-U2	301	81002	N/A	N/A
HC89000400	UA QUAL/SEMI QUAN MELANIN-AU	301	81005	9.00	9.00
HC25001413	TRAUMA ACTVTN I CMPREN	682	G0390	31,030.00	N/A
HC25001421	TRAUMA ACTVTN II INTRM	682	G0390	18,411.00	N/A
HC25001439	TRAUMA ACTVTN III LMTD	682	G0390	12,667.00	N/A
HC25002676	TRAUMA ACT' I W/O CC SERVICE	682		27,186.00	N/A
HC25002684	TRAUMA ACT' II W/O CC SERVICE	682		14,918.00	N/A
HC25002692	TRAUMA ACT' III W/O CC SERVICE	682		11,501.00	N/A
HC11500998	TELEHEALTH ORIGINATING SITE FACILITY FEE	780	Q3014	57.00	N/A
HC11501038	SERVICE PHASE I CLINICAL TRIAL	510	S9988	N/A	N/A
HC12200317	IV INFUSION MONOCLONAL ABX BAMLANIVIMAB/XXXX	771	M0239	1,045.00	N/A
HC12200325	IV INFUSE/SC MONOCLONAL CASIRIVIMAB/IMDEVIMAB (REGENERON)	771	M0243	1,700.00	N/A
HC14500094	DIABETIC SELF MGMT TRN GRP 30M	942	G0109	202.00	N/A
HC14500102	DIABETIC SELF MGMT TRNG EA 30M	942	G0108	297.00	N/A
HC28000008	CR REHAB PHASE III MONTHLYNTH	943	S9472	82.00	N/A
HC32001786	OT-DYSPHAGIA SCREENING/IP	430	V5364	125.00	N/A
HC33000787	ST-DYSPHAGIA SCREENING/IP	440	V5364	126.00	N/A
HC33000795	ST-LANGUAGE SCREENING/IP	440	V5363	126.00	N/A
HC33000803	ST-SPEECH SCREENING/IP	440	V5362	126.00	N/A
HC37000296	DAILY MNGMT BREAST MILK PROC/STORE/DIST	940	T2101	829.00	N/A
HC39000740	SW TEACH/COUNSEL INDIVIDUAL -COMM	914	S9445	80.00	N/A
HC39000765	PSYCH TEACH/COUNSEL INDIVIDUAL -COMM	914	S9445	117.00	N/A
HC39000799	PSYCH GROUP TEACH/COUNS SESSION	915	S9446	94.00	N/A
HC39000807	SW TEACH/COUNSEL GROUP SESSION - COMM/CCS	915	S9446	84.00	N/A
HC39001029	TMS INITIAL MAP THRES DEL MGMT SESS	900	90867	746.00	N/A
HC39001037	TMS SUBSEQ DELIV MGMNT SESS	900	90868	895.00	N/A
HC39001045	TMS REDETERMINATION THRES DELV MGNT	900	90869	820.00	N/A
HC39001102	PHP OT SKILLS PER SESSION 45 M/>	430	G0129	341.00	N/A
HC39001110	PSYCH THERAPY ACT MUS/ART SESS45M/>	904	G0176	510.00	N/A
HC39001128	PSYCH EDUCATION TRNG SESS 45M/>	915	G0177	435.00	N/A
HC39001151	PHP MENTAL HEALTH TX<24HR	900	H0035	2,378.00	N/A
HC39001169	PARTIAL HOSPITALIZATION SERV	909	S0201	2,285.00	N/A
HC39001177	INTENSIVE OUTPT PSYCHIA PER DIEM	905	S9480	1,160.00	N/A
HC44089894	CDSM EVICORE	329	G1001	0.01	N/A
HC44089902	CDSM MEDCURRENT	329	G1002	0.01	N/A
HC44089910	CDSM MEDICALIS	329	G1003	0.01	N/A
HC44089928	CDSM NATIONAL DECISION SUPPORT COMPANY (NDSC)	329	G1004	0.01	N/A
HC44089951	CDSM AIM SPECIALTY HEALTH	329	G1007	0.01	N/A
HC44089969	CDSM CRANBERRY PEAK	329	G1008	0.01	N/A
HC44089977	CDSM SAGE HEALTH MANAGEMENT SOL	329	G1009	0.01	N/A
HC44089985	CDSM STANSON	329	G1010	0.01	N/A
HC44089993	CDSM QUALIFIED NOS	329	G1011	0.01	N/A
HC47201181	TELEHEALTH ORIGINATING SITE FACILITY FEE	780	Q3014	58.00	N/A
HC51002137	RD COUNSELING NUTRITION VISIT/C	510	S9470	159.00	N/A
HC51003481	SCREENING MISUSE ANNUAL ETOH	510	G0442	136.00	N/A
HC51003499	SCREENING MISUSE BEHAVIORAL ETOH	510	G0443	137.00	N/A
HC51003507	SCREENING DEPRESSION ANNUAL	510	G0444	60.00	N/A
HC51010361	REFILL MAINT IMPLNT PMP/RESV WANAL'	515	95990	445.00	N/A
HC51010379	REFILL MAINT IMPL PMP/RESV WANAL'MD	515	95991	536.00	N/A
HC51061208	TELEHEALTH ORIGINATING SITE FACILITY FEE	780	Q3014	57.00	N/A
HC51061414	IV INFUSION MONOCLONAL ABX BAMLANIVIMAB/XXXX	771	M0239	523.00	N/A
HC51061422	IV INFUSE/SC MONOCLONAL CASIRIVIMAB/IMDEVIMAB (REGENERON)	771	M0243	850.00	N/A
HC51061968	GROUP HEALTH EDUCATION	510	99078	25.00	N/A
HC51061984	REMOTE MONITOR PHYSIOLOGIC PARAM INITIAL SET UP	510	99453	250.00	N/A
HC51061992	REMOTE MONITOR PHYSIOL PARAM INTL SUPPLY DEVICE EA 30DAY	510	99454	125.00	N/A
HC51070720	PSYCH TEACH/COUNSEL GROUP SESSION - COMM/CCS	510	S9446	72.00	N/A
HC83000638	GRANULOCYT PHERESIS EA UNIT-OS	390	P9050	4,803.00	2,725.00
HC89022727	NBS TESTS PANEL NEWBORN METABLC SCRNING-GE	301	S3620	176.25	N/A
HC25001264	MOD CS BY MD  ADD'L 15 MIN	450	99153	222.00	N/A
HC25001298	CS DIFF MD ADD'L 15 MIN	450	99157	222.00	N/A
HC25001553	MOD CS SAME PHYS/QHP<5YR INIT'L 15MIN	372	99151	264.00	N/A
HC25001561	MOD CS SAME PHYS/QHP 5/>YR INIT'L 15MIN	372	99152	266.00	N/A
HC25001579	MOD CS DIFF PHYS/QHP <5 YR INIT'L 15MIN	372	99155	281.00	N/A
HC25001587	MOD CS DIFF PHYS/QHP 5/>YR INIT'L 15MIN	372	99156	286.00	N/A
HC77400026	MOD CS BY MD  ADD'L 15 MIN	372	99153	248.00	N/A
HC77400059	CS DIFF MD ADD'L 15 MIN	372	99157	271.00	N/A
HC77400216	MOD CS GI ENDO SVCS>5YRS INIT'L 15MIN	372	G0500	275.00	N/A
HC77400224	MOD CS SAME PHYS/QHP <5 YR INIT'L 15MIN	372	99151	301.00	N/A
HC77400232	MOD CS SAME PHYS/QHP 5/>YR INIT'L 15MIN	372	99152	286.00	N/A
HC77400240	MOD CS DIFF PHYS/QHP <5 YR INIT'L 15MIN	372	99155	327.00	N/A
HC77400257	MOD CS DIFF PHYS/QHP 5/>YR INIT'L 15MIN	372	99156	315.00	N/A
HC25000092	CPR	410	92950	2,090.00	N/A
HC25000209	INSERT/REPLAC TEMP PACER; SNGL	450	33210	7,431.00	N/A
HC25001025	PERICARDIOCENTESIS INCL IMAGING	450	33016	1,470.00	N/A
HC25001041	THROMBOLYSIS CORONARY IV INFUSION	450	92977	1,777.00	N/A
HC25005653	THROMBOLYSIS CEREBRAL IV INFUSION	450	37195	1,521.00	N/A
HC38420030	IABP SERV/SUPPORT PER HR	481	92970	144.00	N/A
HC38420048	LVAD/RVAD SERVICE/HR	481	92970	364.00	N/A
HC38420055	PERFUSION CARDIOASSIST INL' 2HR	481	92970	7,609.00	N/A
HC38420063	PERFUSION CARDIO' EA ADDL .5HR	481	92970	1,353.00	N/A
HC38420071	PERFUSION CARDIOASSIST DC'D PROC	481	92970	2,376.00	N/A
HC38420089	ECMO INITIATION VENO-VENOUS	489	33946	13,370.00	N/A
HC38420097	ECMO INITIATION VENO-ARTERIAL	489	33947	14,774.00	N/A
HC38420105	ECMO DAILY MNGMT EA DAY VENO-VENO	489	33948	10,540.00	N/A
HC38420113	ECMO DAILY MNGMT EA DAY VENO-ART	489	33949	10,251.00	N/A
HC38420121	ECMO REPSN PERIF A&/V PERC W/FLUOR=5Y	489	33957	7,822.00	N/A
HC38420139	ECMO REPSN OPEN A&/V PERC W/FLUOR=5Y	489	33959	9,961.00	N/A
HC38420147	ECMO INSERT PERIPH CANNULA PERC W/FLUORO	489	33952	18,161.00	N/A
HC38420154	ECMO/ECLS INSERT PERIPH CANNULA PERC BIRTH-AGE 5	489	33951	18,161.00	N/A
HC38420162	ECMO/ECLS INSERT PERIPH CANNULA OPEN BIRTH-AGE 5	489	33953	20,300.00	N/A
HC38420170	ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN	489	33954	20,300.00	N/A
HC38420188	ECMO/ECLS INSJ OF CENTRAL CANNULA BIRTH-5 YRS	489	33955	35,653.00	N/A
HC38420196	ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER	489	33956	35,653.00	N/A
HC38420204	ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER	489	33958	7,822.00	N/A
HC38420212	ECMO/ECLS REPOS PERPH CANNULA OPEN 6 YRS & OLDER	489	33962	9,961.00	N/A
HC38420238	ECMO/ECLS ECLS REPOS CENTRAL CNULA 6YRS & OLDER	489	33964	21,169.00	N/A
HC38420246	ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS	489	33965	7,822.00	N/A
HC38420253	ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER	489	33966	10,028.00	N/A
HC38420261	ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS	489	33969	11,632.00	N/A
HC38420279	ECMO/ECLS REMOVAL PRPH CANNULA OPEN 6 YRS & OLDER	489	33984	12,167.00	N/A
HC38420287	ECMO/ECLS REMOVAL OF CENTRAL CANNULA BIRTH-5 YRS	489	33985	22,039.00	N/A
HC38420295	ECMO/ECLS REMOVAL OF CENTRAL CANNULA 6 YRS & OLDER	489	33986	22,284.00	N/A
HC38420303	ARTERY EXPOS/GRAFT ARTERY PERFUSION ECMO/ECLS	489	33987	9,003.00	N/A
HC38420311	INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS	489	33988	33,425.00	N/A
HC38420329	REMOVAL LEFT HEART VENT BY THORACIC INCIS ECMO/ECLS	489	33989	21,169.00	N/A
HC42000794	PROGRAM/EVAL S-ICD SNGL LEAD	480	93260	449.00	N/A
HC42000802	INTERROGATION S-ICD	480	93261	449.00	N/A
HC44500908	INJ PERC EXT PSEUDOANEUR BILAT	361	36002	4,281.00	N/A
HC44500916	INJ PERC EXT PSEUDOANEUR LT	361	36002	2,376.00	N/A
HC44500924	INJ PERC EXT PSEUDOANEUR RT	361	36002	2,376.00	N/A
HC44501211	MISC VASCULAR SURGICAL PROC	361	37799	8,312.00	N/A
HC44501484	TLA AORTA W/S&I:INITIAL	323	37246	17,171.00	N/A
HC44501898	THROMBEC VC/ILIAC FEMPOP INCSN	361	34421	11,052.00	N/A
HC44502029	THROMBOLYSIS CEREBRAL/IV  RT	361	37195	1,593.00	N/A
HC44502037	THROMBOLYSIS CEREBRAL/IV LT	361	37195	1,593.00	N/A
HC44502714	REVASC ILIAC W/TLA INITL VES-RT	323	37220	20,857.00	N/A
HC44502722	REVASC ILIAC W/TLA INITL VES-LT	323	37220	20,857.00	N/A
HC44502730	REVASC ILIAC W/TLA INITL VES-BI	323	37220	37,553.00	N/A
HC44502748	REVASC ILIAC W/TLA & STENT-RT	323	37221	28,204.00	N/A
HC44502755	REVASC ILIAC W/TLA & STENT-LT	323	37221	28,204.00	N/A
HC44502763	REVASC ILIAC W/TLA & STENT-BI	323	37221	51,695.00	N/A
HC44502771	REVASC ILIAC EA+VES W/TLA-RT	323	37222	18,011.00	N/A
HC44502789	REVASC ILIAC EA+VES W/TLA-LT	323	37222	18,011.00	N/A
HC44502797	REVASC ILIAC EA+VES W/TLA-BI	323	37222	32,595.00	N/A
HC44502805	REVAS ILIAC EA+VES W/TLA&STENT-R	323	37223	23,234.00	N/A
HC44502813	REVAS ILIAC EA+VES W/TLA&STENT-L	323	37223	23,234.00	N/A
HC44502821	REVAS ILIAC EA+VES W/TLA&STENT-B	323	37223	44,628.00	N/A
HC44502839	REVASC FEM POP W/TLA-RT	323	37224	20,725.00	N/A
HC44502847	REVASC FEM POP W/TLA-LT	323	37224	20,725.00	N/A
HC44502854	REVASC FEM POP W/TLA-BI	323	37224	37,304.00	N/A
HC44502862	REVASC FEM POP W/TLA&ATHER-RT	323	37225	34,539.00	N/A
HC44502870	REVASC FEM POP W/TLA&ATHER-LT	323	37225	34,539.00	N/A
HC44502888	REVASC FEM POP W/TLA&ATHER-BI	323	37225	62,171.00	N/A
HC44502896	REVASC FEM POP W/TLA&STENT-RT	323	37226	32,652.00	N/A
HC44502904	REVASC FEM POP W/TLA&STENT-LT	323	37226	32,652.00	N/A
HC44502912	REVASC FEM POP W/TLA&STENT-BI	323	37226	58,772.00	N/A
HC44502920	REVAS FEMPOP TLA&STENT&ATHER-R	323	37227	47,934.00	N/A
HC44502938	REVAS FEMPOP TLA&STENT&ATHER-L	323	37227	47,934.00	N/A
HC44502946	REVAS FEMPOP TLA&STENT&ATHER-B	323	37227	86,277.00	N/A
HC44502953	REVAS TIB/PERO W/TLA 1ST VES-RT	323	37228	19,566.00	N/A
HC44502961	REVAS TIB/PERO W/TLA 1ST VES-LT	323	37228	19,566.00	N/A
HC44502979	REVAS TIB/PERO W/TLA 1ST VES-BI	323	37228	35,219.00	N/A
HC44502987	REVAS TIB/PERO W/TLA & ATHER-RT	323	37229	31,061.00	N/A
HC44502995	REVAS TIB/PERO W/TLA & ATHER-LT	323	37229	31,061.00	N/A
HC44503001	REVAS TIB/PERO W/TLA & ATHER-BI	323	37229	56,025.00	N/A
HC44503019	REVAS TIB/PERO W/TLA&STENT-RT	323	37230	30,953.00	N/A
HC44503027	REVAS TIB/PERO W/TLA&STENT-LT	323	37230	30,953.00	N/A
HC44503035	REVAS TIB/PERO W/TLA&STENT-BI	323	37230	56,134.00	N/A
HC44503043	REVAS TIB/PERO TLA&STNT&ATHR-R	323	37231	36,633.00	N/A
HC44503050	REVAS TIB/PERO TLA&STNT&ATHR-L	323	37231	36,633.00	N/A
HC44503068	REVAS TIB/PERO TLA&STNT&ATHR-B	323	37231	69,612.00	N/A
HC44503076	REVASC TIB/PERO EA+VES W/TLA-R	323	37232	17,071.00	N/A
HC44503084	REVASC TIB/PERO EA+VES W/TLA-L	323	37232	17,071.00	N/A
HC44503092	REVASC TIB/PERO EA+VES W/TLA-B	323	37232	31,795.00	N/A
HC44503100	REVASC TIB/PERO EA+VES W/TLA-R	323	37233	22,646.00	N/A
HC44503118	REVASC TIB/PERO EA+VES W/TLA-L	323	37233	22,646.00	N/A
HC44503126	REVASC TIB/PERO EA+VES W/TLA-B	323	37233	43,022.00	N/A
HC44503134	REVAS TIB/PER EA+V TLA&STENT-R	323	37234	24,577.00	N/A
HC44503142	REVAS TIB/PER EA+V TLA&STENT-L	323	37234	24,577.00	N/A
HC44503159	REVAS TIB/PER EA+V TLA&STENT-B	323	37234	46,692.00	N/A
HC44503167	REVAS TIB/PER EA+TLA&ATH&STN-R	323	37235	28,241.00	N/A
HC44503175	REVAS TIB/PER EA+TLA&ATH&STN-L	323	37235	28,241.00	N/A
HC44503183	REVAS TIB/PER EA+TLA&ATH&STN-B	323	37235	53,641.00	N/A
HC44503613	REPOS IVC FILTER/S&I/IMG GUIDE	361	37192	12,654.00	N/A
HC44503621	REMOV IVC FILTER/S&I/IMG GUIDE	361	37193	12,890.00	N/A
HC44503639	LIGATION INFERIOR VENA CAVA	361	37619	21,072.00	N/A
HC44503928	PLCMNT DEV ENDOVAS OCCLUD ART ILIAC+	360	34808	6,966.00	N/A
HC44503936	PLCMNT GRAFT FEM-FEM-AAA REP+	360	34813	18,965.00	N/A
HC44504066	REVAS OTHR PERIPH1ST ART W/STNT W-S&I	361	37236	29,198.00	N/A
HC44504074	REVAS OTHR PERIPH +ART W/STNT W-S&I	361	37237	13,977.00	N/A
HC44504082	REVAS OTHR PERIPH1ST VEIN W/STNT W-S&I	361	37238	24,936.00	N/A
HC44504090	REVAS OTHR PERIPH +VEIN W/STNT W-S&I	361	37239	12,900.00	N/A
HC44504710	ACCESS DIALYSIS CIRCUIT EVAL->VENA CAVA WS&I	361	36901	8,514.00	N/A
HC44504728	ACCESS DIALYSIS CIRCUIT EVAL->VENA CAVA WS&I; PDS PTA	361	36902	13,569.00	N/A
HC44504736	ACCESS DIALYSIS CIRCUIT EVAL->VENA CAVA WS&I: PDS PTA,STENT(S)	361	36903	19,997.00	N/A
HC44504744	THROMBECT &/THROMBOLYSIS DIALYSIS CIRC WS&I,PHARM INJ	361	36904	21,071.00	N/A
HC44504751	THROMBECT &/THROMBOLYSIS DIALYSIS CIRC WS&I,PHARM INJ;&PTA OF PDS	361	36905	27,749.00	N/A
HC44504769	THROMBECT &/THROMBOLYSIS DIALYSIS CIRC WS&I,PHARM INJ; &PTA,STENT(S)OF PDS	361	36906	32,641.00	N/A
HC44504777	PTA CDS VIA DIALYSIS CIRCUIT WS&I +	361	36907	8,838.00	N/A
HC44504785	PLACEMENT STENT(S)CDS VIA DIALYSIS CIRCUIT WS&I, PTA+	361	36908	11,385.00	N/A
HC44504793	EMBOLIZATION DIALYSIS CIRCUIT VEIN(S)WS&I+	361	36909	10,809.00	N/A
HC44504801	TRANSLUMINAL BALO ANGIOP ARTERY W/S&I:INTL LEFT	361	37246	16,824.00	N/A
HC44504819	TRANSLUMINAL BALO ANGIOP ARTERY W/S&I:INTL RIGHT	361	37246	16,824.00	N/A
HC44504827	TRANSLUMINAL BALO ANGIOP ARTERY W/S&I:INTL BILAT	361	37246	31,964.00	N/A
HC44504835	TRANSLUMINAL BALO ANGIOP ARTERY W/S&I:ADDL + LT	361	37247	11,294.00	N/A
HC44504843	TRANSLUMINAL BALO ANGIOP ARTERY W/S&I:ADDL + RT	361	37247	11,294.00	N/A
HC44504850	TRANSLUMINAL BALO ANGIOP ARTERY W/S&I:ADDL + BILAT	361	37247	20,512.00	N/A
HC44504868	TRANSLUMINAL BALO ANGIOP VEIN W/S&I:INTL LEFT	361	37248	15,336.00	N/A
HC44504876	TRANSLUMINAL BALO ANGIOP VEIN W/S&I:INTL RIGHT	361	37248	15,336.00	N/A
HC44504884	TRANSLUMINAL BALO ANGIOP VEIN W/S&I:INTL BILAT	361	37248	27,597.00	N/A
HC44504892	TRANSLUMINAL BALO ANGIOP VEIN W/S&I:ADDL + LT	361	37249	9,297.00	N/A
HC44504900	TRANSLUMINAL BALO ANGIOP VEIN W/S&I:ADDL + RT	361	37249	9,297.00	N/A
HC44504918	TRANSLUMINAL BALO ANGIOP VEIN W/S&I:ADDL + BILAT	361	37249	16,749.00	N/A
HC44700011	BUNDLE OF HIS RECORDING	481	93600	7,498.00	N/A
HC44700029	CARDIOVERSION INTERNAL	481	92961	4,553.00	N/A
HC44700037	CATH ABLAT AV NODE HEART BLOCK	481	93650	22,349.00	N/A
HC44700177	ENDOMYOCARDIAL BIOPSY	481	93505	5,563.00	N/A
HC44700227	ESOPHAG REC ATRIAL ELECTROGRAM	481	93615	4,938.00	N/A
HC44700235	ESOPHAGEAL RECORDING W/PACING	481	93616	5,397.00	N/A
HC44700243	IMPLANT CARDIAC RHYTHM MONITOR SQ & PROGRAMMING	481	33285	13,605.00	N/A
HC44700250	INDUCTION OF ARRHYTHMIA	481	93618	5,692.00	N/A
HC44700334	INSERT ARTERIAL LINE LT	481	36620	1,046.00	N/A
HC44700342	INSERT ARTERIAL LINE RT	481	36620	1,046.00	N/A
HC44700359	INSERT LV LEAD AT INIT IMPLNT+	481	33225	22,338.00	N/A
HC44700367	INSERT PACER ATRIAL SNGL CHAMB	481	33206	23,692.00	N/A
HC44700375	INSERT PACER VENT SNGL CHAMBER	481	33207	25,329.00	N/A
HC44700383	INSERT PACER DUAL CHAMBER	481	33208	30,209.00	N/A
HC44700391	INSERT SWAN-GANZ CATHETER	481	93503	3,777.00	N/A
HC44700409	INSERT/EXTRAC/RET/REPOS D TV LEADS	481	33217	19,492.00	N/A
HC44700417	INSERT/EXTRAC/RET/REPOS S TV LEAD	481	33216	15,386.00	N/A
HC44700425	INSERT/REPLAC TEMP PACER	481	33210	12,775.00	N/A
HC44700433	INSERT/REPLC SYSTM T-ICD DUAL W/LDS	481	33249	41,010.00	N/A
HC44700441	INSERT/REPLC SYSTM T-ICD SNGL W/LD	481	33249	38,223.00	N/A
HC44700458	INSERTION OF IABP PERCUTANEOUS	481	33967	10,786.00	N/A
HC44700466	INSRT PACER ONLY;W/EXIST SNGL LEAD	481	33212	15,785.00	N/A
HC44700474	INSRT PACER ONLY;W/EXIST DUAL LEAD	481	33213	18,042.00	N/A
HC44700482	INSRT/REPL TEMP DUAL PACER	481	33211	13,104.00	N/A
HC44700490	INSRT ICD W/EXISTNG SNGL LEAD	481	33240	27,568.00	N/A
HC44700508	INSRT/RPLC DUAL ICD GENERATOR	481	33240	27,568.00	N/A
HC44700516	INTRA-ATRIAL PACING	481	93610	8,017.00	N/A
HC44700524	INTRA-ATRIAL RECORDING	481	93602	7,480.00	N/A
HC44700540	INTRACARDIAC EP 3D MAPPING+	481	93613	12,665.00	N/A
HC44700573	INTRAVENTRICULAR PACING	481	93612	8,329.00	N/A
HC44700623	LIGATION /BANDING A/V FISTULA	481	37607	11,466.00	N/A
HC44700664	MAP TACHYCARDIA SITES NON 3D+	481	93609	11,029.00	N/A
HC44700680	PERC BALLOON VALVPLSTY AORTIC	481	92986	32,748.00	N/A
HC44700698	PERC BALLOON VALVPLSTY MITRAL	481	92987	36,748.00	N/A
HC44700706	PERC BALLOON VALVPLSTY PULM	481	92990	31,309.00	N/A
HC44700714	PERC CLOSURE OF ASD W/IMPLANT	481	93580	32,193.00	N/A
HC44700789	PERC TRANSLUM COR THROMBECTMY+	481	92973	11,019.00	N/A
HC44700797	PERICARDIOCENTESIS INCL IMAGING	361	33016	4,547.00	N/A
HC44700813	PLACEMENT COIL  SEPTUM	481	33647	31,073.00	N/A
HC44700896	PROG STIM/PACING POST MEDS+	481	93623	9,212.00	N/A
HC44700904	PTA PULMONARY ARTERY SNGL	481	92997	21,656.00	N/A
HC44700912	PTA PULMONARY ARTERY EA ADDL+	481	92998	8,962.00	N/A
HC44700987	REMVL PERM PACER PULSE GN ONLY	481	33233	11,367.00	N/A
HC44700995	REMOVAL ICD GENERATOR ONLY	481	33241	10,024.00	N/A
HC44701001	REMOV ICD LEADS EXTRACTN TRANSVENOS	481	33244	12,200.00	N/A
HC44701019	REMOVE CARDIAC RHYTHM MONITOR SQ	481	33286	5,259.00	N/A
HC44701027	REMOVE SINGLE LEAD	481	33234	10,306.00	N/A
HC44701035	REMOVE DUAL LEAD	481	33235	12,641.00	N/A
HC44701043	REPAIR LEAD TV SNGL PACER/ICD	481	33218	12,434.00	N/A
HC44701050	REPAIR LEADS TV DUAL PACER/ICD	481	33220	13,213.00	N/A
HC44701068	REPOS PREV PLCD LV SYSTEM ELEC	481	33226	15,144.00	N/A
HC44701076	REPOSITION PACER/ICD LEAD RT HRT	481	33215	12,282.00	N/A
HC44701084	RELOCATE SKIN POCKET ICD	481	33223	12,351.00	N/A
HC44701092	RELOCATE SKIN POCKET PACEMAKER	481	33222	11,854.00	N/A
HC44701100	RIGHT HEART CATH; MSRMT, CO	481	93451	16,470.00	N/A
HC44701126	RT VENTRICULAR RECORDING	481	93603	6,893.00	N/A
HC44701159	THROMBOLYSIS INTRACORONARY INF WANGIO	481	92975	4,014.00	N/A
HC44701167	THROMBOLYSIS CORONARY IV INFUSION	481	92977	3,047.00	N/A
HC44701183	UPGRADE PACER  SNGL-DUAL	481	33214	25,265.00	N/A
HC44701191	UPGRADE W/ ADD LV LEAD	481	33224	27,563.00	N/A
HC44701324	LEFT HEART CATH; LT VENT,W/S&I	481	93452	23,796.00	N/A
HC44701332	RT & LT HEART CATH;LT VENT S&I	481	93453	27,648.00	N/A
HC44701340	PLCMT CORONARY CATH(ANGIO/S&I)	481	93454	21,858.00	N/A
HC44701357	PLCMT CORON CATH;BYPASS GRAFTS	481	93455	23,463.00	N/A
HC44701365	PLCMT CORON CATH;RT HRT CATH	481	93456	27,060.00	N/A
HC44701373	PLCMT CORON CATH;GRAFTS&RT HRT	481	93457	29,383.00	N/A
HC44701381	PLCMT CORON CATH;LT HRT CATH	481	93458	29,207.00	N/A
HC44701399	PLCMT CORON CATH;LT HRT&GRAFTS	481	93459	35,925.00	N/A
HC44701407	PLCMT CORON CATH;R&L HRT CATH	481	93460	34,702.00	N/A
HC44701415	PLCMT CORON CATH;R&L HRT&GRFT	481	93461	37,953.00	N/A
HC44701423	PUNCTURE TRANSEPTL (LT HC) +	481	93462	8,919.00	N/A
HC44701431	INJ PRO CATH;CORON CONGNTL HRT	481	93563	7,773.00	N/A
HC44701449	INJ PRO CATH;AORTOCORON GRAFTS	481	93564	7,227.00	N/A
HC44701456	INJ PRO CATH; LT VENT / ATRIUM	481	93565	6,131.00	N/A
HC44701464	INJ PRO CATH; RT VENT / ATRIUM	481	93566	5,966.00	N/A
HC44701472	INJ PRO CATH; SUPRAVALVULAR	481	93567	6,143.00	N/A
HC44701480	INJ PRO CATH; PULM ANGIO	481	93568	6,374.00	N/A
HC44701548	INCISE FEMEROL; DELIVERY EVS PROTH	360	34812	13,890.00	N/A
HC44701563	ADMIN RX;MULT MSRMNTS PRE/PST+	481	93463	1,180.00	N/A
HC44701571	INSRT PACER ONLY;EXST MULTI LD	481	33221	19,044.00	N/A
HC44701589	REMV&REPL PACER SINGL LEAD SYS	481	33227	23,701.00	N/A
HC44701597	REMV&REPL PACER DUAL LEAD SYS	481	33228	26,258.00	N/A
HC44701605	REMV&REPL PACER MULTI LEAD SYS	481	33229	28,505.00	N/A
HC44701613	INSRT ICD W/EXSTNG DUAL LEAD	481	33230	29,299.00	N/A
HC44701621	INSRT ICD W/EXSTNG MULTI LEADS	481	33231	33,685.00	N/A
HC44701639	REMV&REPLC SYSTM ICD LEAD SINGL	481	33262	26,661.00	N/A
HC44701647	REMV&REPLC SYSTM ICD LEAD DUAL	481	33263	29,333.00	N/A
HC44701654	REMV&REPLC SYSTM ICD LEAD MULTI	481	33264	33,273.00	N/A
HC44701662	PERC CLOSURE OF VSD W/IMPLANT	481	93581	39,995.00	N/A
HC44701670	INSERT IMPLANTED MONITOR DEVIC	481	33999	7,289.00	N/A
HC44701712	PERC COR ANGIOPLST; SNGL CA/BRCH-LM	481	92920	25,758.00	N/A
HC44701720	PERC COR ANGIOPLST; SNGL CA/BRCH-LD	481	92920	25,758.00	N/A
HC44701738	PERC COR ANGIOPLST; SNGL CA/BRCH-LC	481	92920	25,758.00	N/A
HC44701746	PERC COR ANGIOPLST; SNGL CA/BRCH-RC	481	92920	25,758.00	N/A
HC44701753	PERC COR ANGIOPLST; SNGL CA/BRCH-RI	481	92920	25,758.00	N/A
HC44701761	PERC COR ANGIOPLST; ADDL CA/BRCH-LM+	481	92921	16,361.00	N/A
HC44701779	PERC COR ANGIOPLST; ADDL CA/BRCH-LD+	481	92921	16,361.00	N/A
HC44701787	PERC COR ANGIOPLST; ADDL CA/BRCH-LC+	481	92921	16,361.00	N/A
HC44701795	PERC COR ANGIOPLST; ADDL CA/BRCH-RC+	481	92921	16,361.00	N/A
HC44701803	PERC COR ANGIOPLST; ADDL CA/BRCH-RI+	481	92921	16,361.00	N/A
HC44701811	PERC COR ANGIOP/ATHRECT; SNGL CA/BR-LM	481	92924	32,087.00	N/A
HC44701829	PERC COR ANGIOP/ATHRECT; SNGL CA/BR-LD	481	92924	32,087.00	N/A
HC44701837	PERC COR ANGIOP/ATHRECT; SNGL CA/BR-LC	481	92924	32,087.00	N/A
HC44701845	PERC COR ANGIOP/ATHRECT; SNGL CA/BR-RC	481	92924	32,087.00	N/A
HC44701852	PERC COR ANGIOP/ATHRECT; SNGL CA/BR-RI	481	92924	32,087.00	N/A
HC44701860	PERC COR ANGIOP/ATHRECT; ADDL CA/BR-LM+	481	92925	19,429.00	N/A
HC44701878	PERC COR ANGIOP/ATHRECT; ADDL CA/BR-LD+	481	92925	19,429.00	N/A
HC44701886	PERC COR ANGIOP/ATHRECT; ADDL CA/BR-LC+	481	92925	19,429.00	N/A
HC44701894	PERC COR ANGIOP/ATHRECT; ADDL CA/BR-RC+	481	92925	19,429.00	N/A
HC44701902	PERC COR ANGIOP/ATHRECT; ADDL CA/BR-RI+	481	92925	19,429.00	N/A
HC44701910	PERC COR STENT(S)/ANGIOP; SNGL CA/BR-LM	481	92928	29,709.00	N/A
HC44701928	PERC COR STENT(S)/ANGIOP; SNGL CA/BR-LD	481	92928	29,709.00	N/A
HC44701936	PERC COR STENT(S)/ANGIOP; SNGL CA/BR-LC	481	92928	29,709.00	N/A
HC44701944	PERC COR STENT(S)/ANGIOP; SNGL CA/BR-RC	481	92928	29,709.00	N/A
HC44701951	PERC COR STENT(S)/ANGIOP; SNGL CA/BR-RI	481	92928	29,709.00	N/A
HC44701969	PERC COR STENT(S)/ANGIOP; ADDL CA/BR-LM+	481	92929	18,533.00	N/A
HC44701977	PERC COR STENT(S)/ANGIOP; ADDL CA/BR-LD+	481	92929	18,533.00	N/A
HC44701985	PERC COR STENT(S)/ANGIOP; ADDL CA/BR-LC+	481	92929	18,513.00	N/A
HC44701993	PERC COR STENT(S)/ANGIOP; ADDL CA/BR-RC+	481	92929	18,533.00	N/A
HC44702009	PERC COR STENT(S)/ANGIOP; ADDL CA/BR-RI+	481	92929	18,533.00	N/A
HC44702017	PERC COR ATHR+STENT/ANGIOP; SNGL-LM	481	92933	35,272.00	N/A
HC44702025	PERC COR ATHR+STENT/ANGIOP; SNGL-LD	481	92933	35,272.00	N/A
HC44702033	PERC COR ATHR+STENT/ANGIOP; SNGL-LC	481	92933	35,272.00	N/A
HC44702041	PERC COR ATHR+STENT/ANGIOP; SNGL-RC	481	92933	35,272.00	N/A
HC44702058	PERC COR ATHR+STENT/ANGIOP; SNGL-RI	481	92933	35,272.00	N/A
HC44702066	PERC COR ATHR+STENT/ANGIOP; ADDL-LM+	481	92934	20,733.00	N/A
HC44702074	PERC COR ATHR+STENT/ANGIOP; ADDL-LD+	481	92934	20,733.00	N/A
HC44702082	PERC COR ATHR+STENT/ANGIOP; ADDL-LC+	481	92934	20,733.00	N/A
HC44702090	PERC COR ATHR+STENT/ANGIOP; ADDL-RC+	481	92934	20,733.00	N/A
HC44702108	PERC COR ATHR+STENT/ANGIOP; ADDL-RI+	481	92934	20,733.00	N/A
HC44702116	PERC CABG REVAS ATHR/STENT/ANG; SNGL-LM	481	92937	30,573.00	N/A
HC44702124	PERC CABG REVAS ATHR/STENT/ANG; SNGL-LD	481	92937	30,573.00	N/A
HC44702132	PERC CABG REVAS ATHR/STENT/ANG; SNGL-LC	481	92937	30,573.00	N/A
HC44702140	PERC CABG REVAS ATHR/STENT/ANG; SNGL-RC	481	92937	30,573.00	N/A
HC44702157	PERC CABG REVAS ATHR/STENT/ANG; SNGL-RI	481	92937	18,150.00	N/A
HC44702165	PERC CABG REVAS ATHR/STENT/ANG; ADDL-LM+	481	92938	18,495.00	N/A
HC44702173	PERC CABG REVAS ATHR/STENT/ANG; ADDL-LD+	481	92938	18,495.00	N/A
HC44702181	PERC CABG REVAS ATHR/STENT/ANG; ADDL-LC+	481	92938	18,495.00	N/A
HC44702199	PERC CABG REVAS ATHR/STENT/ANG; ADDL-RC+	481	92938	18,495.00	N/A
HC44702207	PERC CABG REVAS ATHR/STENT/ANG; ADDL-RI+	481	92938	18,495.00	N/A
HC44702215	PERC COR AMI REVAS ATHR/STNT/ANG;SNGL-LM	481	92941	34,953.00	N/A
HC44702223	PERC COR AMI REVAS ATHR/STNT/ANG;SNGL-LD	481	92941	34,953.00	N/A
HC44702231	PERC COR AMI REVAS ATHR/STNT/ANG;SNGL-LC	481	92941	34,953.00	N/A
HC44702249	PERC COR AMI REVAS ATHR/STNT/ANG;SNGL-RC	481	92941	34,953.00	N/A
HC44702256	PERC COR AMI REVAS ATHR/STNT/ANG;SNGL-RI	481	92941	34,953.00	N/A
HC44702264	PERC COR CHRON REVAS ATHR/STNT/A;SNGL-LM	481	92943	35,617.00	N/A
HC44702272	PERC COR CHRON REVAS ATHR/STNT/A;SNGL-LD	481	92943	35,617.00	N/A
HC44702280	PERC COR CHRON REVAS ATHR/STNT/A;SNGL-LC	481	92943	35,617.00	N/A
HC44702298	PERC COR CHRON REVAS ATHR/STNT/A;SNGL-RC	481	92943	35,617.00	N/A
HC44702306	PERC COR CHRON REVAS ATHR/STNT/A;SNGL-RI	481	92943	35,617.00	N/A
HC44702314	PERC COR CHRON REVAS ATHR/STNT/A;ADDL-LM+	481	92944	20,957.00	N/A
HC44702322	PERC COR CHRON REVAS ATHR/STNT/A;ADDL-LD+	481	92944	20,957.00	N/A
HC44702330	PERC COR CHRON REVAS ATHR/STNT/A;ADDL-LC+	481	92944	20,957.00	N/A
HC44702348	PERC COR CHRON REVAS ATHR/STNT/A;ADDL-RC+	481	92944	20,957.00	N/A
HC44702355	PERC COR CHRON REVAS ATHR/STNT/A;ADDL-RI+	481	92944	20,957.00	N/A
HC44702363	PERC COR DES STENT(S)/ANGIOP; SNGL-LM	481	92928	29,744.00	N/A
HC44702371	PERC COR DES STENT(S)/ANGIOP; SNGL-LD	481	92928	29,744.00	N/A
HC44702389	PERC COR DES STENT(S)/ANGIOP; SNGL-LC	481	92928	29,744.00	N/A
HC44702397	PERC COR DES STENT(S)/ANGIOP; SNGL-RC	481	92928	29,744.00	N/A
HC44702405	PERC COR DES STENT(S)/ANGIOP; SNGL-RI	481	92928	29,744.00	N/A
HC44702413	PERC COR DES STENT(S)/ANGIOP; ADDL-LM+	481	92929	18,533.00	N/A
HC44702421	PERC COR DES STENT(S)/ANGIOP; ADDL-LD+	481	92929	18,533.00	N/A
HC44702439	PERC COR DES STENT(S)/ANGIOP; ADDL-LC+	481	92929	18,533.00	N/A
HC44702447	PERC COR DES STENT(S)/ANGIOP; ADDL-RC+	481	92929	18,533.00	N/A
HC44702454	PERC COR DES STENT(S)/ANGIOP; ADDL-RI+	481	92929	18,533.00	N/A
HC44702462	PERC COR ATHR+STENT(DES)ANGIOP; SNGL-LM	481	92933	35,272.00	N/A
HC44702470	PERC COR ATHR+STENT(DES)ANGIOP; SNGL-LD	481	92933	35,272.00	N/A
HC44702488	PERC COR ATHR+STENT(DES)ANGIOP; SNGL-LC	481	92933	35,272.00	N/A
HC44702496	PERC COR ATHR+STENT(DES)ANGIOP; SNGL-RC	481	92933	35,272.00	N/A
HC44702504	PERC COR ATHR+STENT(DES)ANGIOP; SNGL-RI	481	92933	35,272.00	N/A
HC44702512	PERC COR ATHR+STENT(DES)ANGIOP; ADDL-LM+	481	92934	20,733.00	N/A
HC44702520	PERC COR ATHR+STENT(DES)ANGIOP; ADDL-LD+	481	92934	20,733.00	N/A
HC44702538	PERC COR ATHR+STENT(DES)ANGIOP; ADDL-LC+	481	92934	20,733.00	N/A
HC44702546	PERC COR ATHR+STENT(DES)ANGIOP; ADDL-RC+	481	92934	20,733.00	N/A
HC44702553	PERC COR ATHR+STENT(DES)ANGIOP; ADDL-RI+	481	92934	20,733.00	N/A
HC44702561	PERC CABG REVAS ATHR/DES/ANGIOP; SNGL-LM	481	92937	30,573.00	N/A
HC44702579	PERC CABG REVAS ATHR/DES/ANGIOP; SNGL-LD	481	92937	30,573.00	N/A
HC44702587	PERC CABG REVAS ATHR/DES/ANGIOP; SNGL-LC	481	92937	30,573.00	N/A
HC44702595	PERC CABG REVAS ATHR/DES/ANGIOP; SNGL-RC	481	92937	30,573.00	N/A
HC44702603	PERC CABG REVAS ATHR/DES/ANGIOP; SNGL-RI	481	92937	30,573.00	N/A
HC44702611	PERC CABG REVAS ATHR/DES/ANGPL; ADDL-LM+	481	92938	18,495.00	N/A
HC44702629	PERC CABG REVAS ATHR/DES/ANGPL; ADDL-LD+	481	92938	18,495.00	N/A
HC44702637	PERC CABG REVAS ATHR/DES/ANGPL; ADDL-LC+	481	92938	18,495.00	N/A
HC44702645	PERC CABG REVAS ATHR/DES/ANGPL; ADDL-RC+	481	92938	18,495.00	N/A
HC44702652	PERC CABG REVAS ATHR/DES/ANGPL; ADDL-RI+	481	92938	18,495.00	N/A
HC44702660	PERC COR AMI REVAS ATHR/DES/ANGP;SNGL-LM	481	92941	34,953.00	N/A
HC44702678	PERC COR AMI REVAS ATHR/DES/ANGP;SNGL-LD	481	92941	34,953.00	N/A
HC44702686	PERC COR AMI REVAS ATHR/DES/ANGP;SNGL-LC	481	92941	34,953.00	N/A
HC44702694	PERC COR AMI REVAS ATHR/DES/ANGP;SNGL-RC	481	92941	34,953.00	N/A
HC44702702	PERC COR AMI REVAS ATHR/DES/ANGP;SNGL-RI	481	92941	34,953.00	N/A
HC44702710	PERC COR CHRONC REVAS ATHR/DES/A;SNGL-LM	481	92943	35,617.00	N/A
HC44702728	PERC COR CHRONC REVAS ATHR/DES/A;SNGL-LD	481	92943	35,617.00	N/A
HC44702736	PERC COR CHRONC REVAS ATHR/DES/A;SNGL-LC	481	92943	35,617.00	N/A
HC44702744	PERC COR CHRONC REVAS ATHR/DES/A;SNGL-RC	481	92943	35,617.00	N/A
HC44702751	PERC COR CHRONC REVAS ATHR/DES/A;SNGL-RI	481	92943	35,617.00	N/A
HC44702769	PERC COR CHRON REVAS ATHR/DES/A;ADDL-LM+	481	92944	20,957.00	N/A
HC44702777	PERC COR CHRON REVAS ATHR/DES/A;ADDL-LD+	481	92944	20,957.00	N/A
HC44702785	PERC COR CHRON REVAS ATHR/DES/A;ADDL-LC+	481	92944	20,957.00	N/A
HC44702793	PERC COR CHRON REVAS ATHR/DES/A;ADDL-RC+	481	92944	20,957.00	N/A
HC44702801	PERC COR CHRON REVAS ATHR/DES/A;ADDL-RI+	481	92944	20,957.00	N/A
HC44702819	COMP EP EVAL W/INDUC&ABLAT 3D MAP TX SVT	481	93653	45,000.00	N/A
HC44702827	COMP EP EVAL W/INDUC&ABLAT 3D MAP TX VT	481	93654	54,000.00	N/A
HC44702835	COMP EP EVAL W/INDUC&ABLAT 3D MAP ECHO S&I PVI AFIB	481	93656	63,000.00	N/A
HC44702843	ABLAT NON1 DEG INCL RPT DX INDUC ARRHM+	481	93655	12,106.00	N/A
HC44702850	ABLAT ADD'L ATRIUM A FIB POST PVI+	481	93657	12,178.00	N/A
HC44702868	REPAIR VISC AORTA FEVAR;1 PROSTH	360	34841	46,036.00	N/A
HC44702876	REPAIR VISC AORTA FEVAR; 2 PROSTH	360	34842	47,308.00	N/A
HC44702884	REPAIR VISC AORTA FEVAR; 3 PROSTH	360	34843	48,578.00	N/A
HC44702892	REPAIR VISC AORTA FEVAR; 4+PROSTH	360	34844	50,269.00	N/A
HC44702900	REPAIR VISC AORTA FEVAR(PROX&DIS);1 PROSTH	360	34845	55,633.00	N/A
HC44702918	REPAIR VISC AORTA FEVAR(PROX&DIST);2 PROSTH	360	34846	56,076.00	N/A
HC44702926	REPAIR VISC AORTA FEVAR(PROX&DIST);3 PROSTH	360	34847	57,983.00	N/A
HC44702934	REPAIR VISC AORTA FEVAR(PROX&DIST);4 PROSTH	360	34848	59,319.00	N/A
HC44702942	INSERT PERC VAD INC S&I ARTERIAL ONLY; LEFT HEART	361	33990	15,042.00	N/A
HC44702959	REM PERC VAD DEVICE-SEP SETTING ARTERIAL/AV; LEFT HEART	361	33992	7,911.00	N/A
HC44702967	REPOSIT PERC VAD DEVICE INC S&I; LEFT OR RIGHT HEART DEVICE	361	33993	6,908.00	N/A
HC44702975	INSERT/REPLC SYSTM ICD PERM&SUBQ LD	481	33270	32,944.00	N/A
HC44702991	REMV&REPLC SUBQ ICD GEN ONLY	481	33262	26,661.00	N/A
HC44703007	TAVR/TAVI W/ PROSTH; PERC FEM ARTERY	481	33361	41,521.00	N/A
HC44703015	TAVR/TAVI W/ PROSTH; OPEN FEM ARTERY	481	33362	50,918.00	N/A
HC44703023	TAVR/TAVI W/ PROSTH; OPEN AXILLARLY ARTERY	481	33363	46,077.00	N/A
HC44703031	TAVR/TAVI W/ PROSTH; OPEN ILIAC ARTERY	481	33364	48,365.00	N/A
HC44703049	TAVR/TAVI W/ PROSTH; TRANSAORTIC EXP (STERNO)	481	33365	53,738.00	N/A
HC44703056	TAVR/TAVI W/ PROSTH; TRANSAPICAL EXP (LT THORAC)	481	33366	60,781.00	N/A
HC44703064	TAVR/TAVI; BYPASS PERC PERIPH A&V(FEM)+	481	33367	21,872.00	N/A
HC44703072	TAVR/TAVI; BYPASS OPEN PERIPH A&V(F/I/A)+	481	33368	26,100.00	N/A
HC44703080	TAVR/TAVI; BYPASS OPEN CENTRAL A&V(AORTA,RA,PA)+	481	33369	27,318.00	N/A
HC44703098	PERC CLOSURE OF PDA TRANSCATH	481	93582	28,883.00	N/A
HC44703106	TEVAR W/ LT SUBCLAV; INITIAL ENDO& DIST EXTS CELIAC	360	33880	59,717.00	N/A
HC44703114	TEVAR; INITIAL ENDO & DIST EXTS TO CELIAC	360	33881	54,400.00	N/A
HC44703122	TEVAR; PLCMT PROX EXT PROTH; INITIAL	360	33883	40,604.00	N/A
HC44703130	TEVAR; PLCMT PROX EXT PROTH; EACH ADD'L+	360	33884	16,803.00	N/A
HC44703148	TEVAR; PLCMT OF DISTAL EXTS PROTH(S) DELAYED	360	33886	35,512.00	N/A
HC44703155	OPEN ILIAC FOR ENDOGRAFT OR OCCLUSION, UNI	360	34820	21,313.00	N/A
HC44703163	OPEN REPAIR INFRARENAL AAA; FAILED ENDOGRAFT; TUBE PRO	360	34830	59,811.00	N/A
HC44703171	OPEN REPAIR INFRARENAL AAA; FAILED ENDOGRAFT; AORTO-BI-ILIAC PRO	360	34831	60,322.00	N/A
HC44703189	OPEN REPAIR INFRARENAL AAA; FAILED ENDOGRAFT; AORTO-BIFEM PRO	360	34832	60,322.00	N/A
HC44703197	OPEN ILIAC FOR ILIAC OR AORTIC ENDOGRAFT, UNI	360	34833	25,833.00	N/A
HC44703205	OPEN BRACHIAL FOR ILIAC OR AORTIC ENDOGRAFT, UNI	360	34834	10,875.00	N/A
HC44703221	PERC LT ATRIAL APPEND CLOSURE (LARIAT)	360	33999	43,411.00	N/A
HC44703239	RIGHT HEART CATH; W/SENSOR PULM ARTERY W/S&I	481	33289	13,293.00	N/A
HC44703247	INSERT ELECTRODE DEFIBRILLATOR SUBQ	481	33271	19,635.00	N/A
HC44703254	REMOVE ELECTRODE DEFIBRILLATOR SUBQ	481	33272	8,397.00	N/A
HC44703262	REPOSIT ELECTRODE DEFIBRILLATOR SUBQ	481	33273	10,902.00	N/A
HC44703270	PPVI PERC TRANSCATH PV IMPLANT W/STENTING	481	33477	38,891.00	N/A
HC44703288	INSERT/REPLACE TRANSCATH PACER LEADLESS RV	481	33274	16,002.00	N/A
HC44703304	EV REPAIR INFRARENAL AORTA DEPLOY GRAFT A-A NON-RUPT	360	34701	31,230.00	N/A
HC44703312	EV REPAIR INFRARENAL AORTA DEPLOY GRAFT A-A ~RUPT	360	34702	42,427.00	N/A
HC44703320	EV REPAIR INFRARENAL AORTA&/ILIAC GRFT AORT-UNIILIAC NONRUPT	360	34703	36,435.00	N/A
HC44703338	EV REPAIR INFRARENAL AORTA&/ILIAC GRFT AORTO-UNI-ILIAC ~RUPT	360	34704	54,321.00	N/A
HC44703346	EV REPAIR INFRARENAL AORTA&/ILIAC GRFT AORT-BI-ILIAC NONRUPT	360	34705	38,727.00	N/A
HC44703353	EV REPAIR INFRARENAL AORTA&/ILIAC GRAFT AORTO-BI-ILIAC ~RUPT	360	34706	54,805.00	N/A
HC44703361	EV REPAIR ILIAC GRFT ILIO-ILIAC AORTC BI DIST UNILAT NONRUPT	360	34707	28,005.00	N/A
HC44703379	EV REPAIR ILIAC GRFT ILIO-ILIAC AORTIC BI DIST UNILAT ~RUPT	360	34708	41,057.00	N/A
HC44703387	PLACMNT EXTNSN PROTH ILIAC ART/PROX RENAL EV PER VESSEL TX+	360	34709	6,251.00	N/A
HC44703395	PLACMNT DELAY DISTL/PROX EXTSN INFRARENL AA ILIAC:INT'L VSSL	360	34710	21,528.00	N/A
HC44703403	PLACMNT DELAY DISTL/PRX EXTSN INFRARENL AA ILIAC:ADD'L VSSL+	360	34711	5,725.00	N/A
HC44703411	TRANSCATH DELIVERY ENHANCED FIXATION DEVICE	360	34712	23,281.00	N/A
HC44703429	PERCUT ACCESS & CLOSE FEMORAL ARTERY DELIVERY GRAFT+	360	34713	3,233.00	N/A
HC44703437	OPEN FEMORAL ART CONDUIT DELIVER EV PROTH / BYPASS UNILATL+	360	34714	6,956.00	N/A
HC44703445	OPEN AXILLARY/SUBCLAV ART EXPOSE DELIVER EV PROTH UNILATL+	360	34715	7,301.00	N/A
HC44703452	OPEN AXILL/SUBCLV ART CONDUIT DELIVER PROTH /BYPASS UNILAT+	360	34716	10,242.00	N/A
HC44703460	REPAIR AORTA ASCENDING ENDOVSC STENT GRAFT	361	37799	58,720.00	N/A
HC44703478	PERC CLOSURE LAA (WATCHMAN)	360	33340	25,046.00	N/A
HC44703486	PERICARDIAL DRAIN 6+YR W/O ANOMOLY INCL FLUORO &/US	361	33017	4,584.00	N/A
HC44703494	PERICARDIAL DRAIN 0-5YR W/ANOMOLY INCL FLUORO &/US	361	33018	5,227.00	N/A
HC44703502	PERICARDIAL DRAIN W/CATH & CT GUIDANCE	361	33019	4,245.00	N/A
HC44703510	INTRAPRCDRL CORONARY FFR ANGIO W/3D MAP+	481	0523T	6,615.00	N/A
HC44703528	REVASCULARIZATION LITHOTRIPSY INTRAVASC	480	C9764	23,513.00	N/A
HC44703536	REVASCULARIZATION LITHOTRIPSY INTRAVASC W/STENT	480	C9765	28,215.00	N/A
HC44703544	REVASCULARIZATION LITHOTRIPSY INTRAVASC & ATHERECT	480	C9766	29,156.00	N/A
HC44703551	REVASCULARIZATION LITHOTRIPSY INTRAVASC W/STENT & ATHERECT	480	C9767	35,739.00	N/A
HC44703569	EV REPAIR AORTOILIAC DEPLOY GRAFT ILIAC CATH UNILAT RUPT/NON-RUPT+	360	34717	10,481.00	N/A
HC44703577	EV REPAIR NON-AORTOILIAC DEPLOY GRAFT ILIAC CATH UNILAT NON-RUPT	360	34718	29,080.00	N/A
HC44703585	TMVR MITRACLIP INITIAL PROTH	481	33418	42,323.00	N/A
HC44703593	TMVR MITRACLIP ADD'L PROTH+	481	33419	9,450.00	N/A
HC44703601	TRANSCATH ATRIAL SEPT(TAS)CONGENTL INCLED ALL IMAG(RASHKIND)	361	33741	37,620.00	N/A
HC44703619	TRANSCATH INTRACARD SHUNT(TIS) STENT ICF CONGENTL INCLUDE IMAGI; 1ST SHUNT (FONTANE)	361	33745	47,025.00	N/A
HC44703627	TRANSCATH INTRACARD SHUNT(TIS) STENT CONGENTL INCLUDE IMAGE; EA ADDL+	361	33746	22,080.00	N/A
HC44703635	INSERT VAD PERCUT INC S&I VENOUS ONLY RIGHT	361	33995	15,042.00	N/A
HC44703643	REMOVE VAD PERCUT VENOUS RIGHT	361	33997	6,685.00	N/A
HC44703700	PERC TRANSCATH INTRATRIAL SEPTAL SHUNT	481	C9758	35,505.00	N/A
HC44703718	PERC REPAIR TRNSCTH TRICUSPID VALVE 1ST PROSTHESIS	481	0569T	40,500.00	N/A
HC44703726	PERC REPAIR TRNSCTH TRICUSPID VALVE ADDL PROSTHESIS+	481	0570T	9,000.00	N/A
HC44703734	INSERT PERC VAD INC S&I TRANSSEPTL PUNC; LEFT HEART	489	33991	19,699.00	N/A
HC45201415	NM MYOCARDIAL SYMPATHETIC INNERV IMAGE	341	0331T	2,713.00	N/A
HC46000436	INJ VENOGRAM EXTREMITY- BILAT	320	36005	3,105.00	N/A
HC46000444	INJ VENOGRAM EXTREMITY-LT	320	36005	1,665.00	N/A
HC46000451	INJ VENOGRAM EXTREMITY-RT	320	36005	1,665.00	N/A
HC46000543	INTRO CATH RT HEART/PUL ART	321	36013	3,134.00	N/A
HC46000576	INTRO NDL/INTRACATH VEIN LT	320	36000	458.00	N/A
HC46000584	INTRO NDL/INTRACATH VEIN RT	320	36000	458.00	N/A
HC46000691	PERC PORTAL VEIN CATH	323	36481	3,170.00	N/A
HC46000824	SEL CATH PULMONARY ART BILAT	321	36014	5,363.00	N/A
HC46000832	SEL CATH PULMONARY ART LT	321	36014	3,213.00	N/A
HC46000840	SEL CATH PULMONARY ART RT	321	36014	3,213.00	N/A
HC46000857	SEL CATH SEGMNT PULM ART BILAT	321	36015	6,053.00	N/A
HC46000865	SEL CATH SEGMNT PULM ART LT	321	36015	3,054.00	N/A
HC46000873	SEL CATH SEGMNT PULM ART RT	321	36015	3,054.00	N/A
HC46000964	SEL VENOUS CATH 1ST ORD BI	321	36011	5,706.00	N/A
HC46000972	SEL VENOUS CATH 1ST ORD LT	321	36011	3,369.00	N/A
HC46000980	SEL VENOUS CATH 1ST ORD RT	321	36011	3,369.00	N/A
HC46000998	SEL VENOUS CATH 2ND+ORDR LT	321	36012	4,026.00	N/A
HC46001004	SEL VENOUS CATH 2ND+ORDR RT	321	36012	4,026.00	N/A
HC46001020	INTRO NDL/INTRACATH VEIN BI	320	36000	912.00	N/A
HC46001038	INTRO NDL/INTRACATH VEIN	320	36000	458.00	N/A
HC46001046	INJ PERC EXT PSEUDOANEUR	320	36002	2,258.00	N/A
HC46501508	REPLC PICC LINE W/O SQ PORT/PUMP &W/O IMAGING	361	37799	4,665.00	N/A
HC46502878	REVASC LITHOTRIP TIBIA/PERONEAL ENDOVASC	361	C9772	21,632.00	N/A
HC46502886	REVASC LITHOTRIP TIBIA/PERONEAL ENDOVASC W/STENT	361	C9773	22,572.00	N/A
HC46502894	REVASC LITHOTRIP ARTHERECTOMY TIBIA/PERONEAL ENDOVASC	361	C9774	23,043.00	N/A
HC46502902	REVASC LITHOTRIP ARTHERECTOMY TIBIA/PERONEAL ENDOVASC W/STENT	361	C9775	23,984.00	N/A
HC46502910	PERC AV FISTULA TISSUE W/MAGNETIC AV CATH	361	G2171	23,984.00	N/A
HC44200228	US DUPLEX HEMODIALYSIS ACCESS	921	93990	1,852.00	N/A
HC44200947	US MAPPING VESSEL HEMODIALYSIS; COMPLT BILAT	402	93985	1,778.00	N/A
HC44200954	US MAPPING VESSEL HEMODIALYSIS; COMPLT UNILAT	402	93986	1,435.00	N/A
HC73000002	DIALYSIS CAPD W/SNGL EVAL(IP)	803	90945	2,907.00	N/A
HC73000044	DIALYSIS CCPD W/SNGL EVAL(IP)	804	90945	3,032.00	N/A
HC73000085	DIALYSIS CRRT W/SNGL EVAL(IP)	881	90945	4,104.00	N/A
HC73000127	HEMODIALYSIS W/SNGL EVAL(IP)	801	90935	3,076.00	N/A
HC73000168	HEMOPERFUSION	880	90997	2,794.00	N/A
HC73000200	HEMODIALYSIS CANCEL-MED NEC	800	90935	1,406.00	N/A
HC73000234	DIALYSIS CRRT CANCEL-MED NEC	881	90945	2,011.00	N/A
HC73000242	DIALYSIS CAPD CANCEL-MED NEC	803	90945	1,399.00	N/A
HC73000259	DIALYSIS CCPD CANCEL-MED NEC	804	90945	1,443.00	N/A
HC73000267	DIALYSIS CVVH (CONT VENOVENOUS) QD	809	90947	4,221.00	N/A
HC25005323	PROCTOSIGMOIDOSCOPY RIGID W/REMOVE FB	450	45307	1,611.00	N/A
HC25005331	SIGMOIDOSCOPY FLEX W/REMOVE FB	450	45332	1,484.00	N/A
HC27000173	COLONOSCOPY DX (INCL COLLECTION)	750	45378	4,642.00	N/A
HC27000181	COLONOSCOPY DIAGNOSTIC DC'D	750	45378	1,528.00	N/A
HC27000207	COLONOSCOPY STOMA W/BIOPSY	750	44389	4,415.00	N/A
HC27000215	COLONOSCOPY STOMA W/BLEED CONT	750	44391	4,672.00	N/A
HC27000223	COLONOSCOPY STOMA W/FRN BDY(S)REMOV	750	44390	4,207.00	N/A
HC27000231	COLONOSCOPY STOMA W/HOT BIOPSY	750	44392	4,408.00	N/A
HC27000249	COLONOSCOPY STOMA W/SNARE TECH	750	44394	4,534.00	N/A
HC27000256	COLONOSCOPY THRU STOMA INCL COLLECTN	750	44388	4,174.00	N/A
HC27000272	COLONOSCOPY W/BIOPSY	750	45380	4,745.00	N/A
HC27000280	COLONOSCOPY W/BLEED CONTROL	750	45382	4,822.00	N/A
HC27000298	COLONOSCOPY W/DILATION/BALLOON	750	45386	5,021.00	N/A
HC27000306	COLONOSCOPY W/FB(S) REMOVAL	750	45379	4,812.00	N/A
HC27000314	COLONOSCOPY W/HOT BIOPSY	750	45384	4,329.00	N/A
HC27000322	COLONOSCOPY W/INJ SUBMUCOSAL	750	45381	4,463.00	N/A
HC27000330	COLONOSCOPY W/SNARE TECH	750	45385	4,580.00	N/A
HC27001072	SIGMOIDOSCOPY DX DISCONT PROC	750	45330	1,018.00	N/A
HC27001080	SIGMOIDOSCOPY FLEX BLEED CONT	750	45334	5,158.00	N/A
HC27001098	SIGMOIDOSCOPY FL W/DECOMP&PLAC TUBE	750	45337	4,070.00	N/A
HC27001106	SIGMOIDOSCOPY FLEX DIAGNOSTIC	750	45330	3,812.00	N/A
HC27001114	SIGMOIDOSCOPY FLEX INJ SUBMCSL	750	45335	4,169.00	N/A
HC27001130	SIGMOIDOSCOPY FLEX W/BIOPSY	750	45331	4,094.00	N/A
HC27001148	SIGMOIDSCPY FLEX W/DILAT 1+/>STRICT	750	45340	4,714.00	N/A
HC27001155	SIGMOIDOSCOPY FLEX W/FB(S) REMOV	750	45332	4,456.00	N/A
HC27001163	SIGMOIDOSCOPY FLEX W/HOT BX	750	45333	4,215.00	N/A
HC27001171	SIGMOIDOSCOPY FLEX W/SNARE	750	45338	4,424.00	N/A
HC27001221	SIGMOIDOSCOPY FLEX SCRN (Q48MO)	750	G0104	2,699.00	N/A
HC27001239	COLONOS' SCREEN HI RISK (Q48MO)	750	G0105	3,873.00	N/A
HC27001619	COLONOSCOPY STOMA W/ABLAT LESN GUIDEWIRE	750	44401	4,619.00	N/A
HC27001627	COLONOSCOPY STOMA W/PLCMNT STENT	750	44402	4,824.00	N/A
HC27001635	COLONOSCOPY STOMA W/RESECT MUCOSL	750	44403	4,778.00	N/A
HC27001643	COLONOSCOPY STOMA W/INJ SUBMUCOSL	750	44404	4,164.00	N/A
HC27001650	COLONOSCOPY STOMA W/DILATN BALLOON	750	44405	4,347.00	N/A
HC27001668	COLONOSCOPY STOMA W/EXAM US COLON	750	44406	4,335.00	N/A
HC27001676	COLONOSCOPY STOMA W/EUS FNA/BX COLON	750	44407	4,421.00	N/A
HC27001684	COLONOSCOPY STOMA W/DECOMP&PLACE TUBE	750	44408	4,211.00	N/A
HC27001692	SIGMOIDSCPY FL W/ABLAT LESN(S)GUIDEWIRE	750	45346	4,785.00	N/A
HC27001700	SIGMOIDOSCOPY FLEX  W/PLACE STENT	750	45347	4,925.00	N/A
HC27001718	SIGMOIDOSCOPY FLEX  W/RESECT MUCOSL	750	45349	5,111.00	N/A
HC27001726	SIGMOIDOSCOPY FLEX  W/LIGATION BAND	750	45350	4,760.00	N/A
HC27001734	COLONOSCOPY FLEX ABLAT TUMR/POLYP/LESN GUIDEWIRE	750	45388	5,066.00	N/A
HC27001742	COLONOSCOPY FLEX W/PLACE STENT	750	45389	5,395.00	N/A
HC27001759	COLONOSCOPY FLEX W/RESECTN MUCOSL	750	45390	4,776.00	N/A
HC27001767	COLONOSCOPY FLEX W/DECOMP&PLACE TUBE	750	45393	4,861.00	N/A
HC27001775	COLONOSCOPY FLEX  W/LIGATION BAND	750	45398	4,427.00	N/A
HC27001841	SIGMOIDOSCOPY FLEX W/EUS&FNA/BX	750	45342	4,993.00	N/A
HC27001858	COLONOSCOPY FLEX W/EUS FNA/BX	750	45392	4,545.00	N/A
HC27001866	COLONOSCOPY FLEX W/EUS	750	45391	4,662.00	N/A
HC27001874	SIGMOIDOSCOPY FLEX W/EUS	750	45341	4,830.00	N/A
HC27002377	COLONOS' SCREEN NOT HI RISK (Q120MO)	750	G0121	3,878.00	N/A
HC25000928	ANOSCOPY DIAGNOSTIC	450	46600	601.00	N/A
HC25005166	LARYNGOSCOPY W/REMOVE FB	450	31511	445.00	N/A
HC25005356	ANOSCOPY W/REMOVE FB	450	46608	1,134.00	N/A
HC25005828	LARYNGOSCOPY DIAGNOSTIC	450	31575	540.00	N/A
HC27000025	ANOSCOPY DX (INCL COLLECTION)	750	46600	1,184.00	N/A
HC27000033	ANOSCOPY W/ABLATION	750	46615	5,777.00	N/A
HC27000041	ANOSCOPY W/BIOPSY	750	46606	3,980.00	N/A
HC27000058	ANOSCOPY W/BLEED CONTROL	750	46614	3,061.00	N/A
HC27000066	ANOSCOPY W/DILATION	750	46604	3,877.00	N/A
HC27000074	ANOSCOPY W/FB REMOVAL	750	46608	3,435.00	N/A
HC27000082	ANOSCOPY W/HOT BIOPSY	750	46610	4,969.00	N/A
HC27000090	ANOSCOPY W/SNARE SINGLE REMVL	750	46611	3,745.00	N/A
HC27000108	ANOSCOPY W/SNARE MULTI REMVL	750	46612	5,560.00	N/A
HC27000546	ENDO SM INTST POUCH(KOCK)DX INCL COLLECT	750	44385	4,342.00	N/A
HC27000553	ENDO SM INTEST POUCH (KOCK) W/BX(S)	750	44386	5,266.00	N/A
HC27000561	ENTEROSCPY (NOT ILEUM)INCL COLLECTN	750	44360	5,521.00	N/A
HC27000579	ENTEROSCOPY TO ILEUM	750	44376	5,556.00	N/A
HC27000587	ENTEROSCOPY TO ILEUM W/BIOPSY	750	44377	5,558.00	N/A
HC27000595	ENTEROSCOPY W/ PERC JEJUN TUBE	750	44372	5,770.00	N/A
HC27000603	ENTEROSCOPY W/ABLATION	750	44369	6,196.00	N/A
HC27000611	ENTEROSCOPY W/BIOPSY	750	44361	5,650.00	N/A
HC27000629	ENTEROSCOPY W/BLEED CONTROL	750	44366	6,194.00	N/A
HC27000637	ENTEROSCOPY W/CONVRT PEG>JEJUN	750	44373	5,420.00	N/A
HC27000645	ENTEROSCOPY W/FRN BDY(S) REMOVAL	750	44363	5,268.00	N/A
HC27000652	ENTEROSCOPY W/HOT BIOPSY	750	44365	4,841.00	N/A
HC27000660	ENTEROSCOPY W/REMOV BY SNARE	750	44364	5,122.00	N/A
HC27000678	ENTEROSCOPY(ILEUM) W/BLEED CON	750	44378	5,764.00	N/A
HC27000983	GI TRACT CAPSULE ENDO IMAG ESOPHAGUS ONLY	750	91111	6,810.00	N/A
HC27000991	GI TRACT CAPSULE ENDO IMAG ESOPH THRU ILEUM	750	91110	7,963.00	N/A
HC27001023	ILEOSCOPY THRU STOMA INCL COLLECTN	750	44380	5,210.00	N/A
HC27001031	ILEOSCOPY THRU STOMA W/BIOPSY(S)	750	44382	5,488.00	N/A
HC27001288	ENDO PANCREATOSCOPY DUCT(S) +	750	43273	5,247.00	N/A
HC27001593	ILEOSCOPY THRU STOMA DILATN BALLOON	750	44381	5,494.00	N/A
HC27001601	ILEOSCOPY STOMA W/STENT(W/DILATE)	750	44384	6,150.00	N/A
HC33000746	ST-NASOPHARYNGOSCOPY	440	92511	1,485.00	N/A
HC33001173	LARYNGOSC W/STROBOSCOPY	440	31579	1,253.00	N/A
HC36000818	BRONCHOSCOPY THRU ESTAB TRACH	410	31615	4,125.00	N/A
HC36000826	BRONCH DIAGNOSTIC	410	31622	5,423.00	N/A
HC36000834	BRONCH W/NDL ASP BX(S);INITIAL	410	31629	6,359.00	N/A
HC36000842	BRONCH W/NDL ASP BX; EA ADD'L+	410	31633	2,988.00	N/A
HC36000859	BRONCHOSCOPY W/FB REMOVAL	410	31635	5,832.00	N/A
HC36000867	BRONCH DIAG W/BRUSHING	410	31623	5,707.00	N/A
HC36000875	BRONCH W/DESTRUCT TUMOR/STEN	410	31641	8,788.00	N/A
HC36000883	BRONCH DIAG W/LAVAGE	410	31624	5,754.00	N/A
HC36000891	BRONCH THERAPEUTIC INIT (PER DOS)	410	31645	4,586.00	N/A
HC36000909	BRONCH THERAPEUTIC SUBSEQ (PER DOS)	410	31646	4,543.00	N/A
HC36000917	BRONCH W/BRONCHIAL/ENDO BX(S)	410	31625	5,719.00	N/A
HC36000925	BRONCH W/LUNG BX;SINGLE LOBE	410	31628	5,824.00	N/A
HC36000933	BRONCH W/LUNG BX; EA ADD'L+	410	31632	3,018.00	N/A
HC36000941	BRONCH DIAGNOSTIC DC'D PROC	410	31622	2,045.00	N/A
HC36000958	BRONCH THERAPEUTIC DC'D PROC	410	31645	2,061.00	N/A
HC36001121	BRONCH W/EBUS SAMPLING 1/2 NODES	410	31652	8,718.00	N/A
HC36001139	BRONCH W/EBUS SAMPLING 3/> NODES	410	31653	9,356.00	N/A
HC36001147	TRANSENDOSCOPIC EBUS DURING BRONCH DX OR TX FOR PERIPH NODE(S)+	410	31654	2,609.00	N/A
HC36001162	BRONCHOSCOPY FIDUCIAL PLMT SGL/MULTI	410	31626	6,075.00	N/A
HC36001188	BRONCH W/COMPTR-ASST IMAGE-GUIDE NAVIGATE+	410	31627	2,003.00	N/A
HC36800001	BRONCHOSCOPY THRU ESTAB TRACH	410	31615	4,125.00	N/A
HC36800019	BRONCH W/BRONCHIAL/ENDO BX(S)	410	31625	5,719.00	N/A
HC36800027	BRONCH DIAG W/BRUSHING	410	31623	5,707.00	N/A
HC36800035	BRONCH DIAG W/LAVAGE	410	31624	5,754.00	N/A
HC36800043	BRONCHOSCOPY DIAGNOSTIC	410	31622	5,432.00	N/A
HC36800050	BRONCH DIAGNOSTIC DC'D PROC	410	31622	2,045.00	N/A
HC36800068	BRONCH W/LUNG BX; SINGLE LOBE	410	31628	5,824.00	N/A
HC36800076	BRONCH W/NDL ASP BX(S) INITIAL	410	31629	6,359.00	N/A
HC36800084	BRONCH THERAPEUTIC DC'D PROC	410	31645	2,061.00	N/A
HC36800092	BRONCH THERAPEUTIC INIT (PER DOS)	410	31645	4,585.00	N/A
HC36800100	BRONCH THERAPEUTIC SUBSEQ (PER DOS)	410	31646	4,543.00	N/A
HC36800118	BRONCH W/DESTRUCT TUMOR/STEN	410	31641	8,788.00	N/A
HC36800480	BRONCH W/LUNG BX; EACH ADD'L+	410	31632	3,018.00	N/A
HC36800498	BRONCH W/NDL ASP BX(S) EA ADDL+	410	31633	2,988.00	N/A
HC36800506	BRONCHOSCOPY W/FB REMOVAL	410	31635	5,833.00	N/A
HC36800514	BRONCH THERAPEUTIC DC'D PROC	361	31645	2,061.00	N/A
HC36800829	BRONCH W/EBUS SAMPLING 1/2 NODES	460	31652	8,718.00	N/A
HC36800837	BRONCH W/EBUS SAMPLING 3/> NODES	460	31653	9,224.00	N/A
HC36800845	TRANSENDOSCOPIC EBUS DURING BRONCH DX OR TX FOR PERIPH NODE(S)+	460	31654	2,609.00	N/A
HC36800878	BRONCHOSCOPY FIDUCIAL PLMT SGL/MULTI	410	31626	6,075.00	N/A
HC36800894	BRONCH W/COMPTR-ASST IMAGE-GUIDE NAVIGATE+	410	31627	2,003.00	N/A
HC44500668	CHOLANGIOGRAM W/STONE REMVL	361	47554	8,923.00	N/A
HC44500759	ENDO BILI W/DILAT W/ STENT	320	47556	7,572.00	N/A
HC44500767	ENDO BILI W/DILAT W/O STENT	320	47555	6,850.00	N/A
HC44504439	BX(S) BILTREE PERC SNGL/MULTI(IMG,S&I)+	361	47543	5,269.00	N/A
HC44701217	INSTILL FIBRIN CT INIT' DAY RT	320	32561	2,350.00	N/A
HC44701225	INSTILL FIBRIN CT SUB' DAY RT	320	32562	2,082.00	N/A
HC44701233	INSTILL FIBRIN CT INIT' DAY LT	320	32561	2,350.00	N/A
HC44701241	INSTILL FIBRIN CT SUB' DAY LT	320	32562	2,082.00	N/A
HC46502522	LARYNGOSCOPY DIAGNOSTIC	361	31575	1,115.00	N/A
HC51002780	INJECT ENDOSCOPIC MATERIAL IMPLANT	510	51715	3,064.00	N/A
HC51002814	CYSTOURETHROSCOPY(SEPARATE PROC)	510	52000	2,080.00	N/A
HC51002822	CYSTOURETHROSCOPY W/CATH URETERAL	510	52005	2,282.00	N/A
HC51002830	CYSTOURETHROSCOPY W/BX(S)	510	52204	2,391.00	N/A
HC51002848	CYSTOURETHROSCOPY W/DIL BLADDER	510	52265	2,451.00	N/A
HC51002855	CYSTOURETHROSCOPY W/DIL STRIC URETH	510	52281	2,418.00	N/A
HC51002863	CYSTOSCOPY W/REMV STENT/FB/CALC SIMPL	510	52310	2,408.00	N/A
HC51002871	CYSTOSCOPY W/REM STNT/FB/CALC COMPLIC	510	52315	2,717.00	N/A
HC51002889	CYSTOSCOPY W/INSERT STENT URETER INDW	510	52332	2,962.00	N/A
HC51002897	CYSTOURETHRSCPY W/TX URETER STRICT	510	52341	2,777.00	N/A
HC51002905	CYSTOURETHRSCPY&/PYELOSCPY FLEX DX	510	52351	2,782.00	N/A
HC51002913	CYSTOURETHRSCPY&/PYELOSCPY W/BX&/FULG	510	52354	3,863.00	N/A
HC51003242	COLPOSCOPY CERVIX&ADJACENT VAGINA	510	57452	423.00	N/A
HC51003259	COLPOSCPY CERV&ADJ VAG W/CERV BX(S)&ECC	510	57454	747.00	N/A
HC51003267	COLPOSCPY CERV&ADJ VAG W/CERV BX(S)	510	57455	671.00	N/A
HC51003275	COLPOSCPY CERV&ADJ VAG W/ECC	510	57456	625.00	N/A
HC51003283	COLPOSCPY CERV W/BX(S)LOOP ELECTRD	510	57460	3,260.00	N/A
HC51003291	COLPOSCPY CERV W/CONIZ LOOP ELECTRD	510	57461	3,537.00	N/A
HC51003622	ANOSCOPY DX (INCL COLLECTION)	510	46600	416.00	N/A
HC51003630	ANOSCOPY W/DILATION	510	46604	1,706.00	N/A
HC51003648	ANOSCOPY W/BIOPSY	510	46606	1,705.00	N/A
HC51003655	ANOSCOPY W/FB REMOVAL	510	46608	1,305.00	N/A
HC51010445	NASOPHARYNGOSCOPY	510	92511	457.00	N/A
HC51010767	ENDOSCOPY NASAL DX UNI/BILAT	510	31231	350.00	N/A
HC51010775	LARYNGOSCOPY DIAGNOSTIC	510	31575	425.00	N/A
HC51061166	ST-LARYNGOSC W/STROBOSCOPY	440	31579	664.00	N/A
HC27000355	EGD COMPLETE DX W/ BRUSH/SPEC ~FO	750	43235	4,556.00	N/A
HC27000363	EGD DIAGNOSTIC DISCONTINUED PROC	750	43235	1,347.00	N/A
HC27000397	EGD W/BALLOON DILATION <30MM  ~FO	750	43249	5,247.00	N/A
HC27000405	EGD W/BANDING  ESOPH/GASTRIC ~FO	750	43244	5,314.00	N/A
HC27000413	EGD W/BIOPSY(S) ~FO	750	43239	4,526.00	N/A
HC27000421	EGD W/CONTOL BLEED ~FO	750	43255	5,390.00	N/A
HC27000439	EGD W/DIL OVER GUIDEWIRE ~FO	750	43248	5,073.00	N/A
HC27000447	EGD W/DILATION GASTRIC OUTLET ~FO	750	43245	5,307.00	N/A
HC27000454	EGD W/FOREIGN BODY(S) REMOVAL ~FO	750	43247	5,238.00	N/A
HC27000462	EGD W/TUMR/LES REMOV HOT BX~FO	750	43250	4,629.00	N/A
HC27000470	EGD W/INJ SUBMUCOSAL ~FO	750	43236	4,941.00	N/A
HC27000488	EGD W/PEG PLACEMENT ~FO	750	43246	5,459.00	N/A
HC27000496	EGD W/SCLEROTHERAPY ~FO	750	43243	5,054.00	N/A
HC27000512	EGD W/TRANSENDO TUBE/CATH PLC ~FO	750	43241	4,466.00	N/A
HC27000520	EGD W/TRANS DRAIN/STENT CYST(EUS) ~FO	750	43240	6,451.00	N/A
HC27000538	EGD W/TUMR/LES REMOV W/SNARE~FO	750	43251	4,551.00	N/A
HC27000686	ERCP DIAGNOSTIC (W/SPEC)	750	43260	7,047.00	N/A
HC27000694	ERCP DIAGNOSTIC DC'D PROC	750	43260	3,860.00	N/A
HC27000728	ERCP W/BIOPSY	750	43261	7,124.00	N/A
HC27000744	ERCP W/LITHOTRIPSY	750	43265	7,627.00	N/A
HC27000751	ERCP W/PRES MEAS SPHINC(ODDI)	750	43263	7,290.00	N/A
HC27000777	ERCP W/SPHINCTER/PAPILLOTOMY	750	43262	7,290.00	N/A
HC27000793	ERCP W/STONE(S) REMOVAL	750	43264	7,328.00	N/A
HC27000926	ESOPHSCPY DX- BRUSH/WASH ~FO	750	43200	4,061.00	N/A
HC27001320	ERCP W/STENT REMV&XCH BILI/PANC DUCT	750	43276	9,447.00	N/A
HC27001338	ERCP W/STENT PLACE BILI/PANC DUCT EA	750	43274	8,711.00	N/A
HC27001346	ERCP W/ABLAT TUMR/POLYP/LESN GUIDEWIRE	750	43278	7,736.00	N/A
HC27001353	ERCP W/BALLN DIL BILI/PANC DUCT/AMP EA	750	43277	7,413.00	N/A
HC27001361	ERCP W/STENT/FB REMOV BILI/PANC DUCT	750	43275	7,300.00	N/A
HC27001379	EGD W/RESECT SUBMUCOSAL ~FO	750	43254	5,054.00	N/A
HC27001387	ESOPHSCPY W/DILAT ESOPH RETROGR ~FO	750	43213	5,649.00	N/A
HC27001395	ESOPHSCPY W/RESECT MUCOSAL ~FO	750	43211	4,782.00	N/A
HC27001403	EGD W/ABLAT TUMR/POLYP/LESN(DIL&GIDEWR)~FO	750	43270	5,706.00	N/A
HC27001411	EGD HEAT ESO SPHINC/GASTRIC CARDIA~FO	750	43257	6,895.00	N/A
HC27001429	EGD W/DIL BALLN =30MM (FLUORO) ~FO	750	43233	4,924.00	N/A
HC27001437	EGD W/STENT (DIL&GUIDEWIRE)	750	43266	7,001.00	N/A
HC27001445	EGD W/EUS ESOPH/STOMCH/DUOD ~FO	750	43237	5,512.00	N/A
HC27001452	ESOPHSCPY W/ABLAT TUMR/LESN(S(DILATE)~FO	750	43229	7,400.00	N/A
HC27001460	ESOPHSCPY W/BALLN DIL=30MM (W-FLUOR) ~FO	750	43214	5,254.00	N/A
HC27001478	ESOPHSCPY W/STENT (DIL PRE-POST) ~FO	750	43212	7,380.00	N/A
HC27001486	ESOPHSCPY W/CONTROL BLEED  ~FO	750	43227	4,892.00	N/A
HC27001494	ESOPHSCPY W/TUMR/LES REMOV W/SNARE  ~FO	750	43217	5,010.00	N/A
HC27001502	ESOPHSCPY W/BAND VARICES ~FO	750	43205	5,426.00	N/A
HC27001510	ESOPHSCPY W/FRN BDY(S)REMOVAL ~FO	750	43215	4,891.00	N/A
HC27001528	ESOPHSCPY W/INJ SCLERO VARICES ~FO	750	43204	4,525.00	N/A
HC27001536	ESOPHSCPY W/LES(S) REMOV HOT BX ~FO	750	43216	6,266.00	N/A
HC27001544	ESOPHSCPY W/OPTICAL ENDOMICRO ~FO	750	43206	5,976.00	N/A
HC27001551	ESOPHSCPY W/DIL OVER GUIDEWIRE ~FO	750	43226	5,193.00	N/A
HC27001569	ESOPHSCPY W/BALLOON DILATION <30MM ~FO	750	43220	5,013.00	N/A
HC27001577	ESOPHSCPY W/BIOPSY(S) ~FO	750	43202	4,490.00	N/A
HC27001585	ESOPHSCPY W/INJ SUBMUCOSAL ~FO	750	43201	5,791.00	N/A
HC27001791	ESOPHSCPY DX- BRSH/WSH~FO DISCONT'D	750	43200	1,503.00	N/A
HC27001809	ESOPHSCPY W/EUS FNA/BX ~FO	750	43232	5,204.00	N/A
HC27001817	EGD W/EUS FNA/BX ESOPH/STOMCH/DUOD~FO	750	43238	5,840.00	N/A
HC27001825	EGD W/EUS FNA/BX ESOPH->DUOD/SURG ALT STOMCH JEJUN~FO	750	43242	5,413.00	N/A
HC27001833	EGD W/EUS ESOPH->DUOD/SURG ALT STOMCH JEJUN ~FO	750	43259	6,031.00	N/A
HC27001890	EGD PARTIAL/COMPL EG FUNDOPLASTY	750	43210	15,554.00	N/A
HC25005463	REMOVE FB EXTRNL EYE; CONJUNCT SUPERF LT	450	65205	334.00	N/A
HC25005471	REMOVE FB EXTRNL EYE; CONJUNCT SUPERF RT	450	65205	334.00	N/A
HC25005489	REMOVE FB EXTRNL EYE; CONJUNCT SUPERF BIL	450	65205	600.00	N/A
HC25005497	REMOVE FB EXTRNL EYE; CONJUNCT EMBEDD LT	450	65210	710.00	N/A
HC25005505	REMOVE FB EXTRNL EYE; CONJUNCT EMBEDD RT	450	65210	710.00	N/A
HC25005513	REMOVE FB EXTRNL EYE; CONJUNCT EMBEDD BIL	450	65210	1,417.00	N/A
HC25005521	REMOVE FB EXTRNL EYE; CORNEAL NO SLITLAMP LT	450	65220	700.00	N/A
HC25005539	REMOVE FB EXTRNL EYE; CORNEAL NO SLITLAMP RT	450	65220	700.00	N/A
HC25005547	REMOVE FB EXTRNL EYE; CORNEAL NO SLITLAMP BIL	450	65220	1,334.00	N/A
HC25005554	REMOVE FB EXTRNL EYE; CORNEAL W/SLITLAMP LT	450	65222	376.00	N/A
HC25005562	REMOVE FB EXTRNL EYE; CORNEAL W/SLITLAMP RT	450	65222	376.00	N/A
HC25005570	REMOVE FB EXTRNL EYE; CORNL W/SLITLAMP BIL	450	65222	676.00	N/A
HC25005927	PARACENTESIS EYE W/REMOVAL AQUEOUS BIL	450	65800	3,336.00	N/A
HC25005935	PARACENTESIS EYE W/REMOVAL AQUEOUS LT	450	65800	1,876.00	N/A
HC25005943	PARACENTESIS EYE W/REMOVAL AQUEOUS RT	450	65800	1,876.00	N/A
HC29000460	SCREENING VISION	519	99172	96.00	N/A
HC12200002	IV INFUSION THERAPY 1ST HOUR	260	96365	1,075.00	N/A
HC12200010	IV INFUSION THERAPY EA ADDL HR	260	96366	542.00	N/A
HC12200028	IV INF HYDRATION INITIAL HR	260	96360	886.00	N/A
HC12200036	IV INF HYDRATION EA ADD'L HR	260	96361	446.00	N/A
HC12200044	IV INF THER CONCURRENT/ ENCNTR	260	96368	373.00	N/A
HC12200051	IV INF THER SEQ/NEW RX 1ST HR	260	96367	574.00	N/A
HC12200069	IV PUSH SINGLE/INIT'L INJ	260	96374	622.00	N/A
HC12200077	IVP SINGLE/EA NEW RX ADD'L INJ	260	96375	458.00	N/A
HC12200085	IVP SINGLE/REPEAT RX ADD'L INJ	260	96376	266.00	N/A
HC12200093	IM OR SQ INJECTION THERAPEUTIC	260	96372	266.00	N/A
HC12200267	SC INFUSION THERAPY INITIAL UP TO 1HR	260	96369	1,614.00	N/A
HC12200275	SC INFUSION THERAPY EA ADDL HOUR	260	96370	881.00	N/A
HC12200283	SC INFUSION THERAPY; ADD'L SET UP NEW SITE	260	96371	441.00	N/A
HC12200291	APPLY ON-BODY INJECTOR FOR TIMED SQ INJ	260	96377	316.00	N/A
HC12200333	IV INFUSION MONOCLONAL ABX BAMLANIVIMAB/ETESEVIMAB	771	M0245	1,700.00	N/A
HC12200341	IV INFUSE/SC MONOCLONAL CASIRIVIMAB/IMDEVIMAB (REGENERON) REPEAT	771	M0240	1,460.00	N/A
HC12200382	IV INFUSE MONOCLONAL TOCILIZUMAB >2YEARS INITIAL	771	M0249	1,460.00	N/A
HC12200390	IV INFUSE MONOCLONAL TOCILIZUMAB >2YEARS DOSE 2ND	771	M0250	1,460.00	N/A
HC12600003	IMMUNIZATION ADMIN SINGLE	771	90471	201.00	N/A
HC12600011	IMMUNIZATION ADMIN ADD'L	771	90472	170.00	N/A
HC12600029	ADMIN VACCINE INFLUENZA	771	G0008	184.00	N/A
HC12600037	ADMIN VACCINE PNEUMOCOCCAL	771	G0009	184.00	N/A
HC12600052	ADMIN VACCINE HEPATITIS B	771	G0010	184.00	N/A
HC12600060	ADMIN VACCINE COVID-19 PFIZER-BIONTECH INITIAL DOSE	771	0001A	131.00	N/A
HC12600078	ADMIN VACCINE COVID-19 PFIZER-BIONTECH 2ND DOSE	771	0002A	128.00	N/A
HC12600086	ADMIN VACCINE COVID-19 MODERNA INITIAL DOSE	771	0011A	128.00	N/A
HC12600094	ADMIN VACCINE COVID-19 MODERNA 2ND DOSE	771	0012A	128.00	N/A
HC25001405	ADMIN VACCINE HEPATITIS B	450	G0010	111.00	N/A
HC51000131	IMMUNIZATION ADMIN SINGLE	771	90471	110.00	N/A
HC51000149	IMMUNIZATION ADMIN ADD'L	771	90472	46.00	N/A
HC51000206	IM OR SQ INJECTION THERAPEUTIC	260	96372	114.00	N/A
HC51000214	IV PUSH SINGLE/INIT'L INJ	260	96374	257.00	N/A
HC51000222	IV INFUSION THERAPY 1ST HOUR	260	96365	363.00	N/A
HC51000230	IV INFUSION THERAPY EA ADDL HR	260	96366	108.00	N/A
HC51000248	IV INF THER SEQ/NEW RX 1ST HR	260	96367	175.00	N/A
HC51000255	IV INF THER CONCURRENT/ ENCNTR	260	96368	96.00	N/A
HC51000263	IVP SINGLE/EA NEW RX ADD'L INJ	260	96375	119.00	N/A
HC51000271	IVP SINGLE/REPEAT RX ADD'L INJ	260	96376	67.00	N/A
HC51000404	IV INF HYDRATION INITIAL HR	260	96360	287.00	N/A
HC51000412	IV INF HYDRATION EA ADD'L HR	260	96361	87.00	N/A
HC51020378	ADMINISTRATION OF VACCINE INFLUENZA	771	G0008	90.00	N/A
HC51020386	ADMINISTRATION OF VACCINE PNEUMOCOCCAL	771	G0009	90.00	N/A
HC51020394	SC INFUSION THERAPY INITIAL UP TO 1HR	260	96369	534.00	N/A
HC51020402	SC INFUSION THERAPY EA ADDL HOUR	260	96370	400.00	N/A
HC51020410	SC INFUSION THERAPY; ADD'L SET UP NEW SITE	260	96371	232.00	N/A
HC51061372	ADMIN VACCINE COVID-19 PFIZER-BIONTECH INITIAL DOSE	771	0001A	90.00	N/A
HC51061380	ADMIN VACCINE COVID-19 PFIZER-BIONTECH 2ND DOSE	771	0002A	90.00	N/A
HC51061398	ADMIN VACCINE COVID-19 MODERNA INITIAL DOSE	771	0011A	90.00	N/A
HC51061406	ADMIN VACCINE COVID-19 MODERNA 2ND DOSE	771	0012A	90.00	N/A
HC51061737	IV INFUSION MONOCLONAL ABX BAMLANIVIMAB/ETESEVIMAB	771	M0245	850.00	N/A
HC51062057	IV INFUSE/SC MONOCLONAL CASIRIVIMAB/IMDEVIMAB (REGENERON) REPEAT	771	M0240	730.00	N/A
HC83000422	INJECTION IM (RHOGAM)	940	96372	330.00	45.00
HC12800090	TRANSFUSION EXCHANGE BLOOD NOT NEWBORN	391	36455	2,915.00	N/A
HC21000542	PREP SITE TRUNK/EXT<100SQCM	361	15002	3,198.00	N/A
HC21000559	PREP TRUNK/EXT EA ADDL 100SQCM	361	15003	2,644.00	N/A
HC21000567	PREP SITE/SCR F/N/HF/G<100SQCM	361	15004	2,775.00	N/A
HC21000575	PREP SITE F/N/HF/G EA +100SQCM	361	15005	2,426.00	N/A
HC21000773	APPY SKIN SUB T,A,L 1ST 25SQ~HC	361	15271	2,972.00	N/A
HC21000781	APPY SKIN SUB T,A,L EA +25SQ~HC	361	15272	1,932.00	N/A
HC21000799	APPY SKIN SUB T,A,L 1ST 100SQ~HC	361	15273	4,486.00	N/A
HC21000807	APPY SKIN SUB T,A,L EA+ 100SQ~HC	361	15274	2,505.00	N/A
HC21000815	APPY SKIN SUB HEAD/HND/FT 1ST25SQ~HC	361	15275	2,920.00	N/A
HC21000823	APPY SKIN SUB HEAD/HND/FT EA+25SQ~HC	361	15276	1,648.00	N/A
HC21000831	APPY SKIN SUB HED/HND/FT 1ST100SQ~HC	361	15277	4,253.00	N/A
HC21000849	APPY SKIN SUB HED/HND/FT EA+100SQ~HC	361	15278	2,524.00	N/A
HC23000557	INJ CERVICAL PLEXUS BLOCK	361	64999	1,925.00	N/A
HC23001084	INJ/INF NEUROLYTIC AGNT SUBARACH	361	62280	3,326.00	N/A
HC23001100	INJ/INF NEUROLYTIC LUMB/SACRAL	361	62282	3,844.00	N/A
HC23001118	PERC IMPLANT'N NEUROSTIM ELEC	361	63650	13,594.00	N/A
HC23001126	REMOVE EPIDURAL/INTRATH CATH	361	62355	4,530.00	N/A
HC23001134	DESTR C/T FAC JOINT SNGL W/IMG-B	361	64633	10,883.00	N/A
HC23001142	DESTR C/T FAC JOINT +LVL W/IMG-B	361	64634	8,447.00	N/A
HC23001159	DESTR L/S FAC JOINT SNGL W/IMG-B	361	64635	10,337.00	N/A
HC23001167	DESTR L/S FAC JOINT ADDL W/IMG-B	361	64636	9,533.00	N/A
HC23001225	DESTR C/T FAC JOINT SINGL W/IMG-L	361	64633	5,726.00	N/A
HC23001233	DESTR C/T FAC JOINT SNGL W/IMG-R	361	64633	5,726.00	N/A
HC23001241	DESTR C/T FAC JOINT +LVL W/IMG-L	361	64634	4,448.00	N/A
HC23001258	DESTR C/T FAC JOINT +LVL W/IMG-R	361	64634	4,448.00	N/A
HC23001266	DESTR L/S FAC JOINT SINGL W/IMG-L	361	64635	6,162.00	N/A
HC23001274	DESTR L/S FAC JOINT SNGL W/IMG-R	361	64635	6,162.00	N/A
HC23001282	DESTR L/S FAC JOINT ADDL W/IMG-L	361	64636	5,014.00	N/A
HC23001290	DESTR L/S FAC JOINT ADDL W/IMG-R	361	64636	5,014.00	N/A
HC23001399	INJ CER/THR F/IMAGE 3RD+&LVLRT RT	361	64492	1,713.00	N/A
HC23001407	INJ CER/THR F/IMAGE 3RD+&LVLLT LT	361	64492	1,713.00	N/A
HC23001415	INJ CER/THR F/IMAGE 3RD+&LVLBI	361	64492	3,259.00	N/A
HC23001589	INJ CERVICAL PLEXUS BLOCK RT	361	64999	1,925.00	N/A
HC23001597	INJ CERVICAL PLEXUS BLOCK LT	361	64999	1,925.00	N/A
HC23001605	INJ CERVICAL PLEXUS BLOCK BIL	361	64999	3,788.00	N/A
HC23001704	EXAM CSF PUMP (MISC PROC)	361	64999	1,356.00	N/A
HC25000100	CRICOTHYROIDOSTOMY	450	31605	1,324.00	N/A
HC25000225	TRACHEOSTOMY	450	31603	1,931.00	N/A
HC25000597	EMERGENCY DELIVERY VAGINAL	450	59409	3,989.00	N/A
HC25000639	PARACENTESIS ABD W/O IMAGING	450	49082	1,439.00	N/A
HC25000985	INTUBATION	450	31500	1,193.00	N/A
HC25001512	PARACENTESIS ABD W/ IMAGING	450	49083	1,770.00	N/A
HC25005737	CLOSED TX HIP FX W/MANIP BIL	450	27222	1,748.00	N/A
HC25005745	CLOSED TX HIP FX W/MANIP LT	450	27222	1,043.00	N/A
HC25005752	CLOSED TX HIP FX W/MANIP RT	450	27222	1,043.00	N/A
HC25006164	TRANSABDOMINAL AMNIOINFUSION	450	59070	1,705.00	N/A
HC25006180	BREECH VERSION EXTERNAL MANIP	450	59412	2,921.00	N/A
HC26000026	BREECH VERSION EXTERNAL MANIP	720	59412	4,421.00	N/A
HC26000042	DELIVERY VAGINAL	720	59409	8,054.00	N/A
HC26000059	DELIVERY VAGINAL TWINS	720	59409	13,908.00	N/A
HC26000125	TRANSABDOMINAL AMNIOINFUSION	720	59070	2,561.00	N/A
HC27001189	M: UNLISTED PROCEDURE, ESOPH	750	43499	2,343.00	N/A
HC27001197	M: UNLISTED PROCEDURE, STOMACH	750	43999	N/A	N/A
HC27001783	M: UNLISTED PROCEDURE, COLON	750	45399	4,651.00	N/A
HC27001882	CHEMODENERVATION ANAL MUSCLE	750	46505	4,317.00	N/A
HC36000222	INTUBATION	410	31500	2,202.00	N/A
HC41500059	DBS CORTICAL MAP EA ADDL' HRS	740	95962	1,147.00	N/A
HC41500067	DBS CORTICAL MAP INITIAL HR	740	95961	2,068.00	N/A
HC43000009	ABLATION CRYO BREAST FIBROADENOMA EA W/US	361	19105	7,058.00	N/A
HC43001072	BREAST PROCEDURE UNSPECIFIED	361	19499	6,994.00	N/A
HC44500544	PERC DILATATION INTRACRANIAL VASOSPASM EA ADD VES DIFF TERRITORY+	361	61642	30,678.00	N/A
HC44500551	PERC DILATATION INTRACRANIAL VASOSPASM EA ADD VES SAME TERRITORY+	361	61641	10,953.00	N/A
HC44500601	CAROTID STENT W/EMBOL PROT LT	481	37215	32,047.00	N/A
HC44500619	CAROTID STENT W/EMBOL PROT RT	481	37215	32,047.00	N/A
HC44500882	INJ ART OCCLUS AVM SPINAL	361	62294	4,288.00	N/A
HC44500890	INJ CHEMONUCLEOLYSIS	361	62292	6,047.00	N/A
HC44501237	OCCL BALLOON TEMP HEAD/NECK	320	61623	19,517.00	N/A
HC44501450	PLACEMT OF CHOLEDOCHAL STENT	361	47801	9,045.00	N/A
HC44501583	PTA INTRACRANIAL	361	61630	32,805.00	N/A
HC44501799	REMOVE NEPHROSTOMY TUBE BIL	320	50389	6,924.00	N/A
HC44501807	REMOVE NEPHROSTOMY TUBE LT	320	50389	3,728.00	N/A
HC44501815	REMOVE NEPHROSTOMY TUBE RT	320	50389	3,728.00	N/A
HC44501880	STENT PLAC INTRACRANIAL	361	61635	32,942.00	N/A
HC44501906	THROMBECTOMY MECH PRIM ART LT(NONCOR/CRNL)	361	37184	14,916.00	N/A
HC44501914	THROMBECTOMY MECH PRIM ART RT(NONCOR/CRNL)	361	37184	14,916.00	N/A
HC44501922	THROMBECT MECH PRIM ART ADD LT(NONCOR/CRNL)+	361	37185	10,950.00	N/A
HC44501930	THROMBECT MECH PRIM ART ADD RT(NONCOR/CRNL)+	361	37185	10,950.00	N/A
HC44501948	THROMBECTOMY ART 2ND LT(NONCOR/CRNL)	361	37186	10,261.00	N/A
HC44501955	THROMBECTOMY ART 2ND RT(NONCOR/CRNL)	361	37186	10,261.00	N/A
HC44501989	THROMBECTOMY VENOUS LT	361	37187	13,490.00	N/A
HC44501997	THROMBECTOMY VENOUS RT	361	37187	13,490.00	N/A
HC44502003	THROMBECTOMY VEIN REPEAT LT	361	37188	10,969.00	N/A
HC44502011	THROMBECTOMY VEIN REPEAT RT	361	37188	10,969.00	N/A
HC44502045	TRANSCATH EMBOLIZ PERC-CNS	361	61624	29,478.00	N/A
HC44502052	TRANSCATH EMBOLIZ PERC-NON CNS	361	61626	28,952.00	N/A
HC44502318	ENDOVENOUS ABLAT LASER WS&I; INITIAL VEIN	361	36478	11,843.00	N/A
HC44502334	ENDOVENOUS ABLAT LASER WS&I; ADDL VEIN+	361	36479	7,343.00	N/A
HC44502524	PERC DILATATION INTRACRANIAL VASSOSPASM INITIAL VESSEL -LT	361	61640	17,893.00	N/A
HC44502532	PERC DILATATION INTRACRANIAL VASSOSPASM INITIAL VESSEL -RT	361	61640	17,893.00	N/A
HC44502698	CAROTID STENT W/O EMBO PROT LT	481	37216	32,047.00	N/A
HC44502706	CAROTID STENT W/O EMBO PROT RT	481	37216	32,047.00	N/A
HC44503514	ENDOVENOUS ABLAT RADIO FREQ WS&I; INITIAL VEIN	361	36475	12,886.00	N/A
HC44503530	ENDOVENOUS ABLAT RADIO FREQ WS&I; ADDL VEIN+	361	36476	7,631.00	N/A
HC44503605	PLCMNT IVC FILTER /S&I/IMAGE	361	37191	19,029.00	N/A
HC44503712	INJ SCLEROTHERAPY LYMPHOCELE	320	38999	3,182.00	N/A
HC44503720	THROMBOLYSIS ART OTHER NONCOR/CRNL+S&I1ST DAY	323	37211	13,453.00	N/A
HC44503738	THROMBOLYSIS VEN NONCOR+S&I1ST DAY	323	37212	11,922.00	N/A
HC44503746	THROMBOLYSIS NONCOR+S&I SUB DAY	323	37213	11,924.00	N/A
HC44503753	THROMBOLYSIS NONCOR END OF TX	323	37214	12,770.00	N/A
HC44503761	TRANSCATH RETRIEVAL PERC FB W/S&I	323	37197	12,872.00	N/A
HC44504025	EMBOLIZE VENOUS (ANY MALFORMTN)W/S&I	361	37241	33,158.00	N/A
HC44504033	EMBOLIZE ARTERIAL(ANY MALFORMTN)W/S&I	361	37242	39,138.00	N/A
HC44504041	EMBOLIZE TUMOR/ORGAN/INFARCT W/S&I	361	37243	44,726.00	N/A
HC44504058	EMBOLIZE VES HEMORRG/LYMPH EXTRAVW/S&I	361	37244	44,423.00	N/A
HC44504124	ABLAT PULM TUMOR(S) PERC UNILAT W/IMG GUID; CRYO	361	32994	17,757.00	N/A
HC44504249	VERTEBROPLASTY 1BODY/GUIDE;CERVICOTHORACIC	320	22510	11,127.00	N/A
HC44504256	VERTEBROPLASTY 1BODY/GUIDE;LUMBOSACRAL	320	22511	11,272.00	N/A
HC44504264	VERTEBROPLASTY1BODY/GUIDE; EA ADD'L VBODY	320	22512	9,861.00	N/A
HC44504272	VERTEBRAL AUGMNT 1BODY W/GUIDE;THORACIC	320	22513	20,793.00	N/A
HC44504280	VERTEBRAL AUGMNT 1BODY W/GUIDE;LUMBAR	320	22514	21,923.00	N/A
HC44504298	VERTEBRAL AUGMNT 1BODY W/GUIDE;EA ADD'L L	320	22515	15,191.00	N/A
HC44504322	ABLATION LIVER TUMOR(S) PERC; CRYO	361	47383	19,155.00	N/A
HC44504363	PLCMT STNT BIL PERC EA(CHOLANG,BLN DIL,S&I)NEW ACC	361	47539	11,722.00	N/A
HC44504371	PLCMT STNT BIL PERC EA&CATH(CHOLANG,BLN DIL,S&I)NEW ACC	361	47540	13,690.00	N/A
HC44504389	CONVRT CATH DRN BIL EXT->INT-EXT PERC(CHOLANG,S&I)	361	47535	8,711.00	N/A
HC44504397	EXCHNG CATH DRN BIL EXT->INT-EXT PERC(CHOLANG,S&I)	361	47536	7,576.00	N/A
HC44504405	REMOVE CATH DRN BIL PERC(CHOLANG,S&I)	361	47537	4,576.00	N/A
HC44504413	PLCMT ACC BILTREE->SB4ENDO PERC(CHOLANG,S&I) NEW ACC	361	47541	8,992.00	N/A
HC44504421	DILATE DUCT(S)BIL /AMPULLA PERC(IMG,S&I);EA+	361	47542	4,983.00	N/A
HC44504488	ENDOVASC INFUS CRANIAL(NON-THROMB)INIT'L TRRT	361	61650	15,051.00	N/A
HC44504496	ENDOVASC INFUS CRANIAL(NON-THROMB)ADD TRRT+	361	61651	6,197.00	N/A
HC44504611	THROMBECT MECH PERC&/THROMBOLYSIS INF CRANI BI	361	61645	46,678.00	N/A
HC44504629	THROMBECT MECH PERC&/THROMBOLYSIS INF CRANI LT	361	61645	25,563.00	N/A
HC44504637	THROMBECT MECH PERC&/THROMBOLYSIS INF CRANI RT	361	61645	25,563.00	N/A
HC44504645	EMBOLIZATION/OCCLUSION URETERAL  LT	361	50705	6,127.00	N/A
HC44504652	EMBOLIZATION/OCCLUSION URETERAL  RT	361	50705	6,127.00	N/A
HC44504660	DILAT BALLOON STRICTURE URETERAL  LT	361	50706	5,785.00	N/A
HC44504678	DILAT BALLOON STRICTURE URETERAL  RT	361	50706	5,785.00	N/A
HC44504694	ENDOVENOUS ABLAT MECHANOCHEM WS&I; INITIAL VEIN	361	36473	8,505.00	N/A
HC44504702	ENDOVENOUS ABLAT MECHANOCHEM WS&I; ADDL VEIN+	361	36474	4,095.00	N/A
HC45401601	MRI GUIDED US STEREOTACT ABLAT INTRACRAN LESION	361	0398T	44,550.00	N/A
HC46000220	INJ CONTRAST-ASSESS PV SHUNT	361	49427	1,041.00	N/A
HC46001012	VENOUS CATH ORGAN BLD SIMPLE	320	36500	2,346.00	N/A
HC46500005	ABLATION LIVER TUMOR(S) PERC; RF	361	47382	13,908.00	N/A
HC46500054	ASP PERC SPINAL CORD CYST	361	62268	2,294.00	N/A
HC46500294	BIOPSY NEEDLE PANCREAS	361	48102	4,804.00	N/A
HC46500351	BIOPSY TRANSCATHETER	361	37200	8,633.00	N/A
HC46500393	BX DEEP PELV/HIP-SC BIL	361	27041	9,269.00	N/A
HC46500401	BX DEEP PELV/HIP-SC LT	361	27041	5,151.00	N/A
HC46500419	BX DEEP PELV/HIP-SC RT	361	27041	5,151.00	N/A
HC46500526	BX PLEURA NDL-LT	361	32400	2,801.00	N/A
HC46500534	BX PLEURA NDL-RT	361	32400	2,801.00	N/A
HC46500864	EXCHANGE EXISTING DRAIN CATH	361	49423	4,138.00	N/A
HC46500898	FIX G/COLON TUBE W/ DEVICE W/FLUORO	361	49460	3,231.00	N/A
HC46501060	INSERT PERITONEAL CATH TUNNELED FOR DIALYSIS; OPEN	361	49421	11,054.00	N/A
HC46501227	PARACENTESIS ABD W/O IMAGING GUIDE	361	49082	3,384.00	N/A
HC46501235	PERITONEAL LAVAGE W-W/O IMAG GUIDE	361	49084	4,162.00	N/A
HC46501920	ADJUST GASTRIC BAND VIA PORT	361	43999	3,045.00	N/A
HC46501953	PERC CHOLECYSTOSTOMY WCATH/S&I	361	47490	9,577.00	N/A
HC46502068	BIOPSY PLEURA NEEDLE	361	32400	2,801.00	N/A
HC46502092	PARACENTESIS ABD W/IMAGING GUIDE	361	49083	4,756.00	N/A
HC46502100	DRAIN CYSTS OVA UNI/BIL ABD APPR	361	58805	9,787.00	N/A
HC46502142	PERC BX BREAST W/LOC DEV SG 1ST LESN	361	19081	6,217.00	N/A
HC46502159	PERC BX BREAST W/LOC DEV SG ADDL LESN+	361	19082	3,399.00	N/A
HC46502167	PERC BX BREAST W/LOC DEV US 1ST LESN	361	19083	5,815.00	N/A
HC46502175	PERC BX BREAST W/LOC DEV US ADDL LESN+	361	19084	3,765.00	N/A
HC46502183	PERC BX BREAST W/LOC DEV MR 1ST LESN	361	19085	7,455.00	N/A
HC46502191	PERC BX BREAST W/LOC DEV MR ADDL LESN+	361	19086	5,597.00	N/A
HC46502209	PERC PLC BRST LOC DEV MAMMO 1ST LESN	361	19281	4,370.00	N/A
HC46502217	PERC PLC BRST LOC DEV MAMMO ADDL LESN+	361	19282	3,650.00	N/A
HC46502225	PERC PLC BRST LOC DEV SG 1ST LESN	361	19283	4,558.00	N/A
HC46502233	PERC PLC BRST LOC DEV SG ADDL LESN+	361	19284	3,024.00	N/A
HC46502241	PERC PLC BRST LOC DEV US 1ST LESN	361	19285	3,878.00	N/A
HC46502258	PERC PLC BRST LOC DEV US ADDL LESN+	361	19286	3,085.00	N/A
HC46502266	PERC PLC BRST LOC DEV MR 1ST LESN	361	19287	6,061.00	N/A
HC46502274	PERC PLC BRST LOC DEV MR ADDL LESN+	361	19288	4,444.00	N/A
HC46502290	PERC DRAIN CATH W/IMAG; VISCERAL	361	49405	6,336.00	N/A
HC46502308	PERC DRAIN CATH W/IMAG; PERITONEAL/RETROPERIT	361	49406	6,640.00	N/A
HC46502316	PERC DRAIN W/IMAG; PERIT/RETROPERIT TRANSVAG/RECTAL	361	49407	5,964.00	N/A
HC46502324	TENOTOMY SHOULDER AREA, SNGL TENDON	361	23405	8,573.00	N/A
HC46502332	TENOTOMY SHOULDER AREA, MULT TENDNS	361	23406	10,219.00	N/A
HC46502340	TENOTOMY ELBOW, LATERAL OR MEDIAL	361	24357	9,848.00	N/A
HC46502407	PLCMT NEPHROSTOMY CATHETER,(NEPH/URET'GRM,S&I) BI	361	50432	12,159.00	N/A
HC46502415	PLCMT NEPHROSTOMY CATHETER,(NEPH/URET'GRM,S&I) LT	361	50432	6,950.00	N/A
HC46502423	PLCMT NEPHROSTOMY CATHETER,(NEPH/URET'GRM,S&I) RT	361	50432	6,950.00	N/A
HC46502431	PLCMT CATH NEPHURET PERC(NEPH/URET'GRM,S&I)NEW ACC BI	361	50433	14,362.00	N/A
HC46502449	PLCMT CATH NEPHURET PERC(NEPH/URET'GRM,S&I)NEW ACC LT	361	50433	8,208.00	N/A
HC46502456	PLCMT CATH NEPHURET PERC(NEPH/URET'GRM,S&I)NEW ACC RT	361	50433	8,208.00	N/A
HC46502464	CONVERT NEPH CATH -> NEPH'URET PERC(NEPH/URET'GRM,S&I)EXST BI	361	50434	12,168.00	N/A
HC46502472	CONVERT NEPH CATH->NEPH'URET PERC(NEPH/URET'GRM,S&I)EXST LT	361	50434	6,405.00	N/A
HC46502480	CONVERT NEPH CATH->NEPH'URET PERC(NEPH/URET'GRM,S&I)EXST RT	361	50434	6,405.00	N/A
HC46502829	INSERT/DRILL SUBDUR/VENTRIC CATH	361	61107	6,724.00	N/A
HC46502928	ABLATION PERC CRYO UPPER EXTREMITY NERVE INCLD IMAG	361	0440T	6,050.00	N/A
HC46502936	ABLATION PERC CRYO LOWER EXTREMITY NERVE INCLDE IMAG	361	0441T	6,050.00	N/A
HC47200100	ABLAT PULM TUMOR(S) PERC UNILAT  W/IMG GUID; RF	350	32998	13,000.00	N/A
HC47200324	PLC BRACHY CATH W/PART MAST BIL	333	19298	23,724.00	N/A
HC47200332	PLC BRACHY CATH W/PART MAST LT	333	19298	11,913.00	N/A
HC47200340	PLC BRACHY CATH W/PART MAST RT	333	19298	11,913.00	N/A
HC47200357	PLC MAMMOSITE AFTER DOS BIL	333	19296	23,197.00	N/A
HC47200365	PLC MAMMOSITE AFTER DOS LT	333	19296	12,770.00	N/A
HC47200373	PLC MAMMOSITE AFTER DOS RT	333	19296	12,770.00	N/A
HC47200381	PLC MAMMOSITE ON DOS BIL	333	19297	20,435.00	N/A
HC47200399	PLC MAMMOSITE ON DOS LT	333	19297	10,326.00	N/A
HC47200407	PLC MAMMOSITE ON DOS RT	333	19297	10,326.00	N/A
HC47200415	PLCMNT INTERSTIT DEV PROSTATE	361	55876	5,159.00	N/A
HC47201173	TRANSPERINEAL PLCMNT BIODEGRADABLE MATERIAL	361	55874	14,299.00	N/A
HC51001337	CLOSED TX OF THIGH FX	510	27501	750.00	N/A
HC51002285	MEATOTOMY (INFANT)	361	53025	482.00	N/A
HC51002699	PARACENTESIS ABD W/O IMAGING GUIDE	510	49082	1,043.00	N/A
HC51002707	PARACENTESIS ABD W/IMAGING GUIDE	510	49083	1,223.00	N/A
HC51002715	REMOVE NEPHROSTOMY TUBE	510	50389	1,056.00	N/A
HC51002731	CYSTOSTOMY(I&D BLADDER)W/W-OUT DRAIN	510	51040	2,344.00	N/A
HC51003085	VASECTOMY BILAT/UNILAT(SEP PROCEDURE)	510	55250	3,249.00	N/A
HC51010353	ANAL' IMPLNTD PUMP W/PROG MD SKILL	510	62370	390.00	N/A
HC51010791	EAR WICK (UNLISTED PROCEDURE)	510	69399	114.00	N/A
HC51061000	REMOVE NEPHROSTOMY TUBE BIL	510	50389	1,630.00	N/A
HC51061018	REMOVE NEPHROSTOMY TUBE LT	510	50389	1,035.00	N/A
HC51061026	REMOVE NEPHROSTOMY TUBE RT	510	50389	1,035.00	N/A
HC51061034	CONVERT NEPH CATH->NEPH'URET PERC(NEPH/URET'GRM,S&I)EXST BI	510	50434	3,676.00	N/A
HC51061042	CONVERT NEPH CATH->NEPH'URET PERC(NEPH/URET'GRM,S&I)EXST LT	510	50434	2,626.00	N/A
HC51061059	CONVERT NEPH CATH->NEPH'URET PERC(NEPH/URET'GRM,S&I)EXST RT	510	50434	2,626.00	N/A
HC51061141	OSTEOTOMY TIBIA	510	27705	10,635.00	N/A
HC73000226	PERITONITIS TREATMENT	803	49084	3,726.00	N/A
HC12200135	BLOOD DRAW IMP'T VENOUS DEVICE	300	36591	478.00	N/A
HC12200242	DRAW BLOOD VEN PICC/PERIPH CATH	300	36592	490.00	N/A
HC12200259	INITIATE PROLONG THERA INFUSION VIA PUMP	260	C8957	1,804.00	N/A
HC12800009	PHLEBOTOMY THERAPEUTIC	940	99195	869.00	N/A
HC12800017	THER APHER W/EXTRACORP IMMUNO/ADSORP/FILTRATION	940	36516	10,074.00	N/A
HC12800025	THER APHERESIS PLASMA CX/DC'D	940	36514	2,648.00	N/A
HC12800041	THERAPEUTIC APHERESIS PLASMA	940	36514	7,405.00	N/A
HC12800058	THERAPEUTIC APHERESIS PLATELET	940	36513	7,190.00	N/A
HC12800066	THERAPEUTIC APHERESIS RBC'S	940	36512	7,320.00	N/A
HC12800074	THERAPEUTIC APHERESIS WBC'S	940	36511	5,678.00	N/A
HC12800082	TRANSFUSION BLOOD &/OR COMPNTS	391	36430	2,859.00	N/A
HC21000005	ABRASION; EA ADDL LESION 4OR<	361	15787	583.00	N/A
HC21000013	ABRASION; SNGL LESION	361	15786	610.00	N/A
HC21000153	ASPIRATION OF ABCESS/CYST	361	10160	2,100.00	N/A
HC21000161	ASPIRATION OF ABCESS/CYST-ADDL	361	10160	1,771.00	N/A
HC21000179	AVULSION OF NAIL, SIMPLE:1	361	11730	752.00	N/A
HC21000187	AVULSION OF NAIL, EA ADDL'	361	11732	498.00	N/A
HC21000195	BX BONE OPEN; SUPERFICIAL	361	20240	9,534.00	N/A
HC21000203	CAUTERIZE W/CHEM; GRAN TISSUE	361	17250	1,127.00	N/A
HC21000211	DEBRID SKIN EXT EA ADDL 10%BSA	361	11001	888.00	N/A
HC21000229	DEBRID/REMVL OPEN FX SKIN/SBQ	361	11010	2,565.00	N/A
HC21000237	DEBRID/REMVL OPEN FX MUSCLE	361	11011	2,580.00	N/A
HC21000245	DEBRID/REMVL OPEN FX &BONE	361	11012	4,950.00	N/A
HC21000252	DEBRIDE OF NAILS: 1-5	361	11720	508.00	N/A
HC21000260	DEBRIDE OF NAILS: 6 OR >	361	11721	590.00	N/A
HC21000278	DEBRIDE P-THICK BURN SM<5%BSA	361	16020	1,148.00	N/A
HC21000286	DEBRIDE P-THICK BURN 5-10% BSA	361	16025	1,478.00	N/A
HC21000294	DEBRIDE P-THICK BURN LG>10%BSA	361	16030	1,661.00	N/A
HC21000302	DEBRIDE SKIN EXT UP TO 10% BSA	361	11000	1,982.00	N/A
HC21000336	DEBRID SKIN&SUBQ UP TO 20 SQCM	361	11042	2,878.00	N/A
HC21000344	DBRD SKIN MUSCL UP TO 20 SQCM	361	11043	3,431.00	N/A
HC21000351	DBRD SKIN MUSL/BONE TO 20SQCM	361	11044	6,008.00	N/A
HC21000369	DESTRUCT PREMALG LESION 1ST	361	17000	495.00	N/A
HC21000377	DESTRUCT PREMALG LESIONS 2-14	361	17003	226.00	N/A
HC21000385	I&D HEMATOMA OR FLUID COLL	361	10140	5,335.00	N/A
HC21000393	ESCHAROTOMY; FULL THICK BURN	361	16035	2,276.00	N/A
HC21000401	EXCISION OF NAIL/MATRIX PERM	361	11750	1,812.00	N/A
HC21000450	GRAFTING SNGL/MULT UP TO 2CM	361	15050	3,823.00	N/A
HC21000468	I&D ABSCESS SIMPLE SNGL	361	10060	1,779.00	N/A
HC21000476	I&D ABSCESS COMPLICATED MULT	361	10061	2,301.00	N/A
HC21000484	I&D POLINIDAL CYST: SIMPLE	361	10080	1,382.00	N/A
HC21000492	I&D POST OP WOUND INF COMP'	361	10180	6,641.00	N/A
HC21000500	I&D POLINIDAL CYST: COMPLICATE	361	10081	3,292.00	N/A
HC21000518	PAIRING BENIGN LESION: 1	361	11055	449.00	N/A
HC21000526	PAIRING BENIGN LESIONS: 2-4	361	11056	667.00	N/A
HC21000534	PAIRING BENIGN LESIONS: >4	361	11057	949.00	N/A
HC21000583	TRIM NONDYSTROPHIC NAILS	361	11719	422.00	N/A
HC21000591	DEBRIDE OPN WND 1ST 20SQCM OR<	361	97597	1,488.00	N/A
HC21000609	DEBRID OPN WOUND EA ADD 20CM/<	361	97598	935.00	N/A
HC21000617	WOUND NON-SEL DEBRID PER SESSN	361	97602	867.00	N/A
HC21000625	WOUND VAC W/ DME <50 SQ CM PER SESSION	361	97605	836.00	N/A
HC21000633	WOUND VAC W/ DME >50 SQ CM PER SESSION	361	97606	1,039.00	N/A
HC21000666	REMOV IMPACTD EAR WAX(INSTRUMENT) BI           (NO MOD50)	361	69210	565.00	N/A
HC21000674	APPLY MULTILAY COMPRS BK RT	361	29581	841.00	N/A
HC21000682	APPLY MULTILAY COMPRS BK LT	361	29581	841.00	N/A
HC21000690	APPLY MULTILAY COMPRS BK BIL	361	29581	1,734.00	N/A
HC21000708	DBRD SKIN&SUBQ EA ADD 20SQCM/<	361	11045	2,202.00	N/A
HC21000716	DBRD SKN MUSCL EA ADD 20SQCM/<	361	11046	2,414.00	N/A
HC21000724	DBRD SKN MUSL/BON EA ADD20CM/<	361	11047	5,031.00	N/A
HC21000732	LAC REPAIR TO 2.5 CM(SMALL)	361	12001	752.00	N/A
HC21000740	LAC REPAIR 2.6-7 5CM	361	12002	811.00	N/A
HC21000757	LAC REPAIR 7.6-12 5CM(MEDIUM)	361	12004	1,027.00	N/A
HC21000765	COMPARTM'L PRESSURE MEASURM'NT	361	20950	1,659.00	N/A
HC21000914	APPLY MULTILAY COMPRS UPREX B	361	29584	1,703.00	N/A
HC21000922	APPLY MULTILAY COMPRS UPREX LT	361	29584	854.00	N/A
HC21000930	APPLY MULTILAY COMPRS UPREX RT	361	29584	854.00	N/A
HC21000948	APPY SKIN SUB T,A,L 1ST 25SQ~LC	361	C5271	3,281.00	N/A
HC21000955	APPY SKIN SUB T,A,L EA +25SQ~LC	361	C5272	2,272.00	N/A
HC21000963	APPY SKIN SUB T,A,L 1ST 100SQ~LC	361	C5273	5,799.00	N/A
HC21000971	APPY SKIN SUB T,A,L EA+ 100SQ~LC	361	C5274	3,239.00	N/A
HC21000989	APPY SKIN SUB HEAD/HND/FT 1ST25SQ~LC	361	C5275	3,395.00	N/A
HC21000997	APPY SKIN SUB HEAD/HND/FT EA+25SQ~LC	361	C5276	1,994.00	N/A
HC21001003	APPY SKIN SUB HED/HND/FT 1ST100SQ~LC	361	C5277	4,838.00	N/A
HC21001011	APPY SKIN SUB HED/HND/FT EA+100SQ~LC	361	C5278	3,112.00	N/A
HC21001029	REMOV IMPACTD EAR WAX(INSTRUMENT) LT	361	69210	281.00	N/A
HC21001037	REMOV IMPACTD EAR WAX(INSTRUMENT) RT	361	69210	281.00	N/A
HC21001045	REMOV IMPACTD EAR WAX IRRIG/LAVG BI	361	69209	401.00	N/A
HC21001052	REMOV IMPACTD EAR WAX IRRIG/LAVG LT	361	69209	220.00	N/A
HC21001060	REMOV IMPACTD EAR WAX IRRIG/LAVG RT	361	69209	220.00	N/A
HC21001078	WOUND VAC TX W/ DISP ASST/INSTR <50SQ CM SESSION	761	97607	1,287.00	N/A
HC21001086	WOUND VAC TX W/ DISP ASST/INSTR >50SQ CM SESSION	761	97608	1,457.00	N/A
HC23000003	ANALYSIS IMPLANTED PUMP W/PROG	361	62368	1,592.00	N/A
HC23000029	ASP & INJ GANGLION CYST	361	20612	1,161.00	N/A
HC23000037	ASP/INJ JOINT SM W/O UTZ GUIDE-BILAT	361	20600	2,151.00	N/A
HC23000045	ASP/INJ JOINT SM W/O UTZ GUIDE-LT	361	20600	1,141.00	N/A
HC23000052	ASP/INJ JOINT SM W/O UTZ GUIDE-RT	361	20600	1,118.00	N/A
HC23000060	ASP/INJ JOINT MED W/O UTZ GUIDE-BILAT	361	20605	3,194.00	N/A
HC23000078	ASP/INJ JOINT MED W/O UTZ GUIDE-LT	361	20605	1,491.00	N/A
HC23000086	ASP/INJ JOINT MED W/O UTZ GUIDE-RT	361	20605	1,492.00	N/A
HC23000094	ASP/INJ JOINT LRG W/O UTZ GUIDE-BILAT	361	20610	3,649.00	N/A
HC23000102	ASP/INJ JOINT LRG W/O UTZ GUIDE-LT	361	20610	2,085.00	N/A
HC23000110	ASP/INJ JOINT LRG W/O UTZ GUIDE-RT	361	20610	2,085.00	N/A
HC23000250	DESTRUCT OTHER PERIPH SNGL BI	361	64640	8,840.00	N/A
HC23000268	DESTRUCT OTHER PERIPH SNGL LT	361	64640	4,419.00	N/A
HC23000276	DESTRUCT OTHER PERIPH SNGL RT	361	64640	4,419.00	N/A
HC23000292	DESTRUCT CELIAC PLEXUS	361	64680	4,834.00	N/A
HC23000300	DESTRUCT INTERCOSTAL NERVE	361	64620	4,321.00	N/A
HC23000318	EPIDUROLYSIS PROCEDURE	361	62264	4,996.00	N/A
HC23000326	IMPLNT/REV/REPOS TUN EPI CATH	361	62350	12,610.00	N/A
HC23000334	INJ ANES/STEROID NERVE OCCIPITAL GREAT	361	64405	1,338.00	N/A
HC23000367	INJ ANES/STEROID NERVE AXILLARY BIL	361	64417	2,719.00	N/A
HC23000375	INJ ANES/STEROID NERVE AXILLARY LT	361	64417	1,565.00	N/A
HC23000383	INJ ANES/STEROID NERVE AXILLARY RT	361	64417	1,565.00	N/A
HC23000391	INJ ANES/STEROID BRACHIAL PLEXUS	361	64415	2,051.00	N/A
HC23000425	INJ ANES/STEROID NERVE SCIATIC BIL	361	64445	4,138.00	N/A
HC23000433	INJ ANES/STEROID NERVE SCIATIC LT	361	64445	2,253.00	N/A
HC23000441	INJ ANES/STEROID NERVE SCIATIC RT	361	64445	2,253.00	N/A
HC23000458	INJ ANES/STEROID NERVE SUPRASCAP BI	361	64418	3,075.00	N/A
HC23000466	INJ ANES/STEROID NERVE SUPRASCAP LT	361	64418	1,639.00	N/A
HC23000474	INJ ANES/STEROID NERVE SUPRASCAP RT	361	64418	1,639.00	N/A
HC23000482	INJ ANES/STEROID NERVE VAGUS	361	64408	1,864.00	N/A
HC23000516	INJ CELIAC PLEXUS	361	64530	4,677.00	N/A
HC23000649	INJ ANES/STEROID NERVE FEMORAL BIL	361	64447	3,357.00	N/A
HC23000656	INJ ANES/STEROID NERVE FEMORAL LT	361	64447	1,703.00	N/A
HC23000664	INJ ANES/STEROID NERVE FEMORAL RT	361	64447	1,703.00	N/A
HC23000672	INJ FORAMN EPI C/T INTLW/S&I-BI	361	64479	9,256.00	N/A
HC23000680	INJ FORAMN EPI C/T INTL W/S&I-L	361	64479	5,830.00	N/A
HC23000698	INJ FORAMN EPI C/T INTL W/S&I-R	361	64479	5,830.00	N/A
HC23000706	INJ FORAMN EPI C/T ADD+W/S&I-BI	361	64480	5,737.00	N/A
HC23000714	INJ FORAMN EPI C/T ADD+ W/S&I-L	361	64480	3,632.00	N/A
HC23000722	INJ FORAMN EPI C/T ADD+ W/S&I-R	361	64480	3,632.00	N/A
HC23000730	INJ FORAMN EPI LMBR INTLW/S&I-B	361	64483	9,830.00	N/A
HC23000748	INJ FORAMN EPI LMBR INTLW/S&I-L	361	64483	5,903.00	N/A
HC23000755	INJ FORAMN EPI LMBR INTLW/S&I-R	361	64483	5,903.00	N/A
HC23000763	INJ FORAMN EPI LMBR ADD+S&I-BI	361	64484	6,989.00	N/A
HC23000771	INJ FORAMN EPI LMBR ADDLWS&I+L	361	64484	3,732.00	N/A
HC23000789	INJ FORAMN EPI LMBR ADDLWS&I+R	361	64484	3,732.00	N/A
HC23000797	INJ ANES/STEROID ILIOINGNL/ILIOHYPOGAS NERVE	361	64425	1,647.00	N/A
HC23000821	INJ ANES/STEROID NERVE INTERCOSTAL SINGL	361	64420	3,318.00	N/A
HC23000839	INJ ANES/STEROID INTERCOSTAL ADDL EA	361	64421	4,642.00	N/A
HC23000904	INJ ANES/STEROID NERVE/BRNCH PERIPH BIL	361	64450	3,643.00	N/A
HC23000912	INJ ANES/STEROID NERVE/BRNCH PERIPH LT	361	64450	2,023.00	N/A
HC23000920	INJ ANES/STEROID NERVE/BRNCH PERIPH RT	361	64450	2,023.00	N/A
HC23000938	INJ PARAVERT SYMPATH NERVE	361	64520	4,216.00	N/A
HC23000946	INJ ANES/STEROID NERVE PUDENDAL BIL	361	64430	5,445.00	N/A
HC23000953	INJ ANES/STEROID NERVE PUDENDAL LT	361	64430	2,866.00	N/A
HC23000961	INJ ANES/STEROID NERVE PUDENDAL RT	361	64430	2,866.00	N/A
HC23000979	INJ DX/THER CERVICAL/THORACIC W/O IMAG	361	62320	4,576.00	N/A
HC23000987	INJ DX/THER LUMBAR/SACRAL W/O IMAG	361	62322	4,350.00	N/A
HC23000995	INJ STELLATE GANGLION	361	64510	4,826.00	N/A
HC23001001	INJ SUPERIOR HYPOGASTRIC PLEXS	361	64517	6,130.00	N/A
HC23001019	INJ(S);SNGL TNDON ORIGN/INSERT	361	20551	1,157.00	N/A
HC23001027	INJ(S);SINGLE TENDON/SHEATH	361	20550	1,120.00	N/A
HC23001035	INJ ANES/STEROID NERVE TRIGEML BRNCH EA	361	64400	1,136.00	N/A
HC23001043	INJ(S);TRIGGER POINT 1-2MUSCLES	361	20552	1,506.00	N/A
HC23001050	INJ(S);TRIGGER POINT 3/>MUSCLES	361	20553	1,626.00	N/A
HC23001068	INJ W/CATH PLCMT EPI CERV/THOR W/O IMAG	361	62324	4,320.00	N/A
HC23001076	INJ W/CATH PLCMT EPI LUMBAR W/O IMAG	361	62326	4,574.00	N/A
HC23001092	INJ/INF NEUROLYTIC CERV/THOR	361	62281	4,694.00	N/A
HC23001175	INJ S-I JOINT ANESTH W/IMAG LT	361	G0260	3,770.00	N/A
HC23001183	INJ S-I JOINT ANESTH W/IMAG RT	361	G0260	3,770.00	N/A
HC23001308	INJ S-I JOINT ANESTH W/IMAG BI	361	G0260	6,917.00	N/A
HC23001332	INJ CER/THOR F/IMAGE SNG LVLRT	361	64490	5,605.00	N/A
HC23001340	INJ CER/THOR F/IMAGE SNG LVLLT	361	64490	5,605.00	N/A
HC23001357	INJ CER/THOR F/IMAGE SNG LVLBI	361	64490	10,713.00	N/A
HC23001365	INJ CER/THOR F/IMAGE 2ND LVLRT	361	64491	2,675.00	N/A
HC23001373	INJ CER/THOR F/IMAGE 2ND LVLLT	361	64491	2,675.00	N/A
HC23001381	INJ CER/THOR F/IMAGE 2ND LVLBI	361	64491	4,950.00	N/A
HC23001423	INJ  L/S F W/IMAGE 1ST LVL RT	361	64493	5,971.00	N/A
HC23001431	INJ  L/S F W/IMAGE 1ST LVL LT	361	64493	5,971.00	N/A
HC23001449	INJ  L/S F W/IMAGE 1ST LVL BIL	361	64493	11,939.00	N/A
HC23001456	INJ  L/S F W/IMAGE 2ND LVL RT	361	64494	2,724.00	N/A
HC23001464	INJ  L/S F W/IMAGE 2ND LVL LT	361	64494	2,724.00	N/A
HC23001472	INJ  L/S F W/IMAGE 2ND LVL BIL	361	64494	5,594.00	N/A
HC23001480	INJ  L/S F /IMAGE 3RD+& LVL RT	361	64495	2,651.00	N/A
HC23001498	INJ  L/S F /IMAGE 3RD+& LVL LT	361	64495	2,651.00	N/A
HC23001506	INJ  L/S F /IMAGE 3RD+& LVL BI	361	64495	5,107.00	N/A
HC23001514	INJ ANES/STEROID NERVE TRIGEML BRNCH EA RT	361	64400	1,136.00	N/A
HC23001522	INJ ANES/STEROID NERVE TRIGEML BRNCH EA LT	361	64400	1,136.00	N/A
HC23001530	INJ ANES/STEROID NERVE TRIGEML BRNCH EA BI	361	64400	2,263.00	N/A
HC23001555	INJ ANES/STEROID NERVE OCCIPITL GREAT RT	361	64405	1,338.00	N/A
HC23001563	INJ ANES/STEROID NERVE OCCIPITL GREAT LT	361	64405	1,338.00	N/A
HC23001571	INJ ANES/STEROID NERVE OCCIPITL GREAT BI	361	64405	2,697.00	N/A
HC23001613	INJ ANES/STEROID BRACHIAL PLEXUS RT	361	64415	2,051.00	N/A
HC23001621	INJ ANES/STEROID BRACHIAL PLEXUS LT	361	64415	2,051.00	N/A
HC23001639	INJ ANES/STEROID BRACHIAL PLEXUS BI	361	64415	4,090.00	N/A
HC23001647	INJ ANES/STEROID INTERCOSTAL ADDL EA RT	361	64421	4,162.00	N/A
HC23001654	INJ ANES/STEROID INTERCOSTAL ADDL EA LT	361	64421	4,162.00	N/A
HC23001662	INJ ANES/STEROID INTERCOSTAL ADDL EA BI	361	64421	7,376.00	N/A
HC23001670	INJ ANES/STEROID ILIOINGNL/ILIOHYPOGAS RT	361	64425	1,647.00	N/A
HC23001688	INJ ANES/STEROID ILIOINGNL/ILIOHYPOGAS LT	361	64425	1,647.00	N/A
HC23001696	INJ ANES/STEROID ILIOINGNL/ILIOHYPOGAS BI	361	64425	3,228.00	N/A
HC23001712	N BLOCK INJ PLANTAR DIGIT (MOTONS) BIL	361	64455	2,595.00	N/A
HC23001720	N BLOCK INJ PLANTAR DIGIT (MOTONS) LT	361	64455	1,412.00	N/A
HC23001738	N BLOCK INJ PLANTAR DIGIT (MOTONS) RT	361	64455	1,412.00	N/A
HC23001746	ASP/INJ JOINT SM W/UTZ GUIDE-BILAT	361	20604	3,897.00	N/A
HC23001753	ASP/INJ JOINT SM W/UTZ GUIDE-LT	361	20604	2,995.00	N/A
HC23001761	ASP/INJ JOINT SM W/UTZ GUIDE-RT	361	20604	2,995.00	N/A
HC23001779	ASP/INJ JOINT MED W/UTZ GUIDE-BILAT	361	20606	6,440.00	N/A
HC23001787	ASP/INJ JOINT MED W/UTZ GUIDE-LT	361	20606	3,493.00	N/A
HC23001795	ASP/INJ JOINT MED W/UTZ GUIDE-RT	361	20606	3,493.00	N/A
HC23001803	ASP/INJ JOINT LRG W/UTZ GUIDE-BILAT	361	20611	6,633.00	N/A
HC23001811	ASP/INJ JOINT LRG W/UTZ GUIDE-LT	361	20611	3,687.00	N/A
HC23001829	ASP/INJ JOINT LRG W/UTZ GUIDE-RT	361	20611	3,687.00	N/A
HC23001837	INJ DX/THER CERVICAL/THORACIC W/IMAG	361	62321	6,538.00	N/A
HC23001845	INJ SINGLE LUMBAR/SACRAL W/IMAG	361	62323	4,822.00	N/A
HC23001852	INJ W/CATH PLCMT EPI CERV/THOR W/IMAG	361	62325	5,148.00	N/A
HC23001860	INJ W/CATH PLCMT EPI LUMBAR W/IMAG	361	62327	4,920.00	N/A
HC23001878	INJ ANES/STEROID NERVE SI JOINT INNRV W/IMAGE	361	64451	1,876.00	N/A
HC23001886	INJ ANES/STEROID NERVE SI JOINT INNRV W/IMAGE BI	361	64451	3,086.00	N/A
HC23001894	INJ ANES/STEROID NERVE SI JOINT INNRV W/IMAGE LT	361	64451	1,876.00	N/A
HC23001902	INJ ANES/STEROID NERVE SI JOINT INNRV W/IMAGE RT	361	64451	1,876.00	N/A
HC23001910	INJ ANES/STEROID NERVE GENICULAR IMAGE GUIDE	361	64454	2,104.00	N/A
HC23001928	INJ ANES/STEROID NERVE GENICULAR IMAGE GUIDE BI	361	64454	3,285.00	N/A
HC23001936	INJ ANES/STEROID NERVE GENICULAR IMAGE GUIDE LT	361	64454	2,104.00	N/A
HC23001944	INJ ANES/STEROID NERVE GENICULAR IMAGE GUIDE RT	361	64454	2,104.00	N/A
HC23001951	DESTR NERVE GENICULAR W/NEUROLYT AGNT W/IMAGE	361	64624	3,772.00	N/A
HC23001969	DESTR NERVE GENICULAR W/NEUROLYT AGNT W/IMAGE BI	361	64624	5,657.00	N/A
HC23001977	DESTR NERVE GENICULAR W/NEUROLYT AGNT W/IMAGE LT	361	64624	3,772.00	N/A
HC23001985	DESTR NERVE GENICULAR W/NEUROLYT AGNT W/IMAGE RT	361	64624	3,772.00	N/A
HC23001993	ABLATE RF NERVE SACROILIAC JT INNRV W/IMAGE	361	64625	5,043.00	N/A
HC23002009	ABLATE RF NERVE SACROILIAC JT INNRV W/IMAGE BIL	361	64625	7,670.00	N/A
HC23002017	ABLATE RF NERVE SACROILIAC JT INNRV W/IMAGE LT	361	64625	5,043.00	N/A
HC23002025	ABLATE RF NERVE SACROILIAC JT INNRV W/IMAGE RT	361	64625	5,043.00	N/A
HC24000010	HBO TX EA 1/2 HR BASIC/M	940	G0277	1,190.00	N/A
HC24000093	HBO TX EA 1/2 HR COMPLEX/M	940	G0277	1,644.00	N/A
HC24000101	HBO TX EA 1/2 HR INTERMEDIAT/M	940	G0277	1,386.00	N/A
HC25000084	ASPIRATION OF BLADDER TROCAR	450	51101	1,579.00	N/A
HC25000118	REMOV IMPACTD EAR WAX(INSTRUMENT) BI           (NO MOD50)	450	69210	359.00	N/A
HC25000134	EVACUATE SUBUNGUAL HEMATOMA	450	11740	578.00	N/A
HC25000142	EXCISE NAIL FOLD INGROWN	450	11765	686.00	N/A
HC25000159	FB REMOVAL EAR	450	69200	378.00	N/A
HC25000167	FB REMOVAL NASAL	450	30300	574.00	N/A
HC25000175	FB REMOVAL SQ SIMPLE	450	10120	1,911.00	N/A
HC25000183	FB REMOVAL SQ COMPLEX	450	10121	3,613.00	N/A
HC25000191	INSERT NEEDLE INTRAOSSEOUS INF	450	36680	1,369.00	N/A
HC25000217	REPAIR NAIL BED	450	11760	1,243.00	N/A
HC25000233	BURNS LOCAL TREATMENT LG 36%	450	16030	818.00	N/A
HC25000241	BURNS LOCAL TREATMENT MED 18%	450	16025	665.00	N/A
HC25000258	BURNS LOCAL TREATMENT SM 9%	450	16020	511.00	N/A
HC25000506	REMOVAL/BIVALVE CAST ARM OR LEG	450	29705	559.00	N/A
HC25000514	SPLINT FINGER STATIC	450	29130	515.00	N/A
HC25000522	SPLINT LONG ARM	450	29105	665.00	N/A
HC25000530	SPLINT LONG LEG	450	29505	713.00	N/A
HC25000548	SPLINT SHORT ARM	450	29125	553.00	N/A
HC25000555	SPLINT SHORT LEG	450	29515	581.00	N/A
HC25000563	WINDOW CAST	450	29730	431.00	N/A
HC25000571	BLADDER IRRIGATION SIMPLE	450	51700	710.00	N/A
HC25000605	GASTRIC INTUB ASP THER' LAVAGE	450	43753	792.00	N/A
HC25000654	LUMBAR PUNCTURE DX [NOT W/ CT OR FLUORO]	450	62270	1,484.00	N/A
HC25000746	ASPIRATION OF ABCESS/CYST	450	10160	1,111.00	N/A
HC25000761	AVULSION OF NAIL, SIMPLE:1	450	11730	616.00	N/A
HC25000779	AVULSION OF NAIL, EA ADDL'	450	11732	352.00	N/A
HC25000837	ASP/INJ SMALL JOINT-BILAT	450	20600	1,062.00	N/A
HC25000845	ASP/INJ SMALL JOINT-LT	450	20600	646.00	N/A
HC25000852	ASP/INJ SMALL JOINT-RT	450	20600	646.00	N/A
HC25000860	ASP/INJ MED JOINT-BILAT	450	20605	1,336.00	N/A
HC25000878	ASP/INJ MED JOINT-LT	450	20605	721.00	N/A
HC25000886	ASP/INJ MED JOINT-RT	450	20605	721.00	N/A
HC25000894	ASP/INJ LARGE JOINT-BILAT	450	20610	1,759.00	N/A
HC25000902	ASP/INJ LARGE JOINT-LT	450	20610	946.00	N/A
HC25000910	ASP/INJ LARGE JOINT-RT	450	20610	946.00	N/A
HC25000936	CHANGE GT TUBE W/O IMAGE/ENDO	450	43762	1,471.00	N/A
HC25000944	I&D PERIANAL ABSCESS	450	46050	2,803.00	N/A
HC25000951	INCISION EXTERNAL HEMORRHOID	450	46083	1,427.00	N/A
HC25000969	INHALATION TREATMENT INITIAL	412	94640	449.00	N/A
HC25000977	INHALATION TX SUBSQ SAME DAY	412	94640	437.00	N/A
HC25001017	CARDIOVERSION EXTERNAL	450	92960	2,336.00	N/A
HC25001058	ASP BLADDER W/INSERT SUPRAPUB	450	51102	3,559.00	N/A
HC25001066	BLOOD PATCH (INJ EPIDURAL)	450	62273	2,328.00	N/A
HC25001074	INSERT CT(OPEN) W/DRAIN SYSTEM BIL	450	32551	4,143.00	N/A
HC25001082	INSERT CT(OPEN) W/DRAIN SYSTEM LT	450	32551	1,804.00	N/A
HC25001090	INSERT CT(OPEN) W/DRAIN SYSTEM RT	450	32551	1,803.00	N/A
HC25001108	INSERT PICC <5 YR AGE W/O IMAGING	450	36568	2,477.00	N/A
HC25001116	INSERT PICC >5 YR AGE W/O IMAGING	450	36569	4,254.00	N/A
HC25001124	INSRT BLADDER CATH-NON INDWELL	450	51701	491.00	N/A
HC25001132	INSRT BLADDER CATH-TEMP FOLEY	450	51702	556.00	N/A
HC25001140	INSRT BLADDER CATH-TEMP-COMPLX	450	51703	687.00	N/A
HC25001157	PLCMNT CENTRAL VEN CATH<5 YR	450	36555	4,389.00	N/A
HC25001165	PLCMNT CENTRAL VEN CATH>5 YR	450	36556	4,616.00	N/A
HC25001173	THORACENTESIS ASP W/O IMG GUID-BIL	450	32554	2,891.00	N/A
HC25001181	THORACENTESIS ASP W/O IMG GUID-LT	450	32554	1,606.00	N/A
HC25001199	THORACENTESIS ASP W/O IMG GUID-RT	450	32554	1,606.00	N/A
HC25001207	THORACENTESIS W/TUBE W/O IMAG BI	450	32556	2,863.00	N/A
HC25001215	THORACENTESIS W/TUBE W/O IMAG LT	450	32556	1,592.00	N/A
HC25001223	THORACENTESIS W/TUBE W/O IMAG RT	450	32556	1,592.00	N/A
HC25001322	BURNS 1ST DEGREE INITIAL TX	450	16000	810.00	N/A
HC25001348	DEBRIDE OPN WND 1ST 20SQCM OR<	450	97597	951.00	N/A
HC25001355	DEBRID OPN WOUND EA ADD 20CM/<	450	97598	665.00	N/A
HC25001389	INJ(S);TRIGGER POINT 1-2MUSCLES	450	20552	807.00	N/A
HC25001496	REMOV IMPACTD EAR WAX(INSTRUMENT) LT	450	69210	202.00	N/A
HC25001504	REMOV IMPACTD EAR WAX(INSTRUMENT) RT	450	69210	202.00	N/A
HC25001520	REMOV IMPACTD EAR WAX IRRIG/LAVG BI	450	69209	399.00	N/A
HC25001538	REMOV IMPACTD EAR WAX IRRIG/LAVG LT	450	69209	226.00	N/A
HC25001546	REMOV IMPACTD EAR WAX IRRIG/LAVG RT	450	69209	226.00	N/A
HC25002759	INSERT PICC >5 YR AGE W/ IMAGING	450	36573	4,594.00	N/A
HC25002809	I&D ABSCESS; SIMPLE/SINGLE	450	10060	653.00	N/A
HC25002817	I&D ABSCESS; COMPLICATED/MULT	450	10061	1,192.00	N/A
HC25002825	I&D POLINIDAL CYST; SIMPLE	450	10080	1,263.00	N/A
HC25002833	I&D POLINIDAL CYST; COMPLICATED	450	10081	1,932.00	N/A
HC25002841	I&D HEMATOMA/SEROMA/FLUID COLLECTION	450	10140	2,502.00	N/A
HC25002858	DEBRIDE ECZEM/INFCT SKIN UP TO 10% BSA	450	11000	1,261.00	N/A
HC25002866	DEBRIDE/REMOVL OPEN FX SKIN/SBQ	450	11010	1,796.00	N/A
HC25002874	DEBRIDE/REMOVL OPEN FX&/DISLOC SQ T/M/BONE	450	11012	3,493.00	N/A
HC25002882	DEBRIDE SKIN SUBQ; FIRST 20SQCM OR LESS	450	11042	1,126.00	N/A
HC25002890	DEBRIDE SKIN MUSCLE; FIRST 20SQCM OR LESS	450	11043	1,159.00	N/A
HC25002908	DEBRIDE SKIN MUSL/BONE; FIRST 20SQCM OR LESS	450	11044	2,930.00	N/A
HC25002916	EXCISION OF NAIL/MATRIX PERM	450	11750	1,153.00	N/A
HC25002924	LAC REPAIR SIMPLE S/N/AX/GEN/T/EXT 2.5CM OR LESS	450	12001	536.00	N/A
HC25002932	LAC REPAIR SIMPLE S/N/A/GEN/T/EXT 2.6-7.5CM	450	12002	550.00	N/A
HC25002940	LAC REPAIR SIMPLE S/N/A/GEN/T/EXT 7.6-12.5CM	450	12004	673.00	N/A
HC25002957	LAC REPAIR SIMPLE S/N/A/GEN/T/EXT 12.6-20.0CM	450	12005	799.00	N/A
HC25002965	LAC REPAIR SIMPLE S/N/A/GEN/T/EXT 20.1-30.0CM	450	12006	834.00	N/A
HC25002973	LAC REPAIR SIMPLE S/N/A/GEN/T/EXT >30.0CM	450	12007	876.00	N/A
HC25002981	LAC REPAIR SIMPLE F/E/E/N/L/M TO 2.5 CM	450	12011	565.00	N/A
HC25002999	LAC REPAIR SIMPLE F/E/E/N/L/M 2.6-5.0 CM	450	12013	582.00	N/A
HC25003005	LAC REPAIR SIMPLE F/E/E/N/L/M 5.1-7.5 CM	450	12014	691.00	N/A
HC25003013	LAC REPAIR SIMPLE F/E/E/N/L/M 7.6-12.5 CM	450	12015	734.00	N/A
HC25003021	LAC REPAIR SIMPLE F/E/E/N/L/M 12.6-20.0 CM	450	12016	851.00	N/A
HC25003039	LAC REPAIR SIMPLE F/E/E/N/L/M 20.1-30.0 CM	450	12017	1,051.00	N/A
HC25003047	LAC REPAIR SIMPLE F/E/E/N/L/M >30.0 CM	450	12018	1,096.00	N/A
HC25003054	CLOSURE SUPERFCL WOUND DEHISC SIMPLE	450	12020	1,162.00	N/A
HC25003062	CLOSURE SUPERFCL WOUND DEHISC W/PACKING	450	12021	1,324.00	N/A
HC25003070	LAC REPAIR INTMD S/A/T/EXT 2.5 CM/<	450	12031	1,078.00	N/A
HC25003088	LAC REPAIR INTMD S/A/T/EXT 2.6-7.5CM	450	12032	1,146.00	N/A
HC25003096	LAC REPAIR INTMD S/A/T/EXT 7.6-12.5CM	450	12034	1,263.00	N/A
HC25003104	LAC REPAIR INTMD S/A/T/EXT 12.6-20CM	450	12035	1,272.00	N/A
HC25003112	LAC REPAIR INTMD S/A/T/EXT 20.1-30CM	450	12036	1,302.00	N/A
HC25003120	LAC REPAIR INTMD S/A/T/EXT >30.0CM	450	12037	3,336.00	N/A
HC25003138	LAC REPAIR INTMD N/H/F/GEN 2.5CM/<	450	12041	1,053.00	N/A
HC25003146	LAC REPAIR INTMD N/H/F/GEN 2.6-7.5	450	12042	1,229.00	N/A
HC25003153	LAC REPAIR INTMD N/H/F/GEN 7.6-12.5	450	12044	1,293.00	N/A
HC25003161	LAC REPAIR INTMD N/H/F/GEN 12.6-20	450	12045	1,334.00	N/A
HC25003179	LAC REPAIR INTMD N/H/F/GEN 20.1-30	450	12046	1,502.00	N/A
HC25003187	LAC REPAIR INTMD N/H/F/GEN >30.0CM	450	12047	2,668.00	N/A
HC25003195	LAC REPAIR INTMD F/E/E/N/L&/MM 2.5CM/<	450	12051	1,095.00	N/A
HC25003203	LAC REPAIR INTMD F/E/E/N/L/MM 2.6-5.0CM	450	12052	1,254.00	N/A
HC25003211	LAC REPAIR INTMD F/E/E/N/L/MM 5.1-7.5CM	450	12053	1,334.00	N/A
HC25003229	LAC REPAIR INTMD F/E/E/N/L/MM 7.6-12.5CM	450	12054	1,432.00	N/A
HC25003237	LAC REPAIR INTMD F/E/E/N/L/MM 12.6-20CM	450	12055	1,515.00	N/A
HC25003245	LAC REPAIR INTMD F/E/E/N/L/MM 20.1-30.0CM	450	12056	1,683.00	N/A
HC25003252	LAC REPAIR INTMD F/E/E/N/L/MM  >30.0CM	450	12057	1,924.00	N/A
HC25003260	LAC REPAIR CMPLX TRUNK 1.1-2.5 CM	450	13100	1,312.00	N/A
HC25003278	LAC REPAIR CMPLX TRUNK 2.6-7.5 CM	450	13101	1,355.00	N/A
HC25003286	LAC REPAIR CMPLX S/A/L 1.1-2.5 CM	450	13120	1,334.00	N/A
HC25003294	LAC REPAIR CMPLX S/A/L 2.6-7.5 CM	450	13121	1,472.00	N/A
HC25003302	LAC REPAIR CMPLX S/A/L ADDL 5 CM/>	450	13122	471.00	N/A
HC25003310	LAC REPAIR CMPLX F/C/C/M/N/AX/G/H/F 1.1-2.5CM	450	13131	1,263.00	N/A
HC25003328	LAC REPAIR CMPLX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM	450	13132	1,348.00	N/A
HC25003336	LAC REPAIR CMPLX E/N/E/L 1.1-2.5 CM	450	13151	1,323.00	N/A
HC25003344	LAC REPAIR CMPLX E/N/E/L 2.6-7.5 CM	450	13152	1,432.00	N/A
HC25003351	REMOVE FB MUSCLE/TENDON SHEATH SIMPLE	450	20520	2,101.00	N/A
HC25003369	REMOVE FB MUSCLE/TNDON SHEATH DEEP/COMP	450	20525	2,622.00	N/A
HC25003377	INJ(S);SGL TNDN SHEATH/LIGMNT/APONEUR LT	450	20550	585.00	N/A
HC25003385	INJ(S);SGL TNDN SHEATH/LIGMNT/APONEUR RT	450	20550	585.00	N/A
HC25003393	INJ(S);SGL TNDN SHEATH/LIGMNT/APONEUR-BIL	450	20550	1,051.00	N/A
HC25003401	ASP & INJ GANGLION CYST(S)	450	20612	581.00	N/A
HC25003419	CLOSED TX NOSE FX W/O STABILIZATION	450	21315	2,348.00	N/A
HC25003427	CLOSED TX NOSE FX W/ STABILIZATION	450	21320	2,505.00	N/A
HC25003435	CLOSED TX TMJ DISLOCATION 1ST/SBSQ	450	21480	523.00	N/A
HC25003443	CLOSED TX CLAVICLE FX-BIL	450	23500	751.00	N/A
HC25003450	CLOSED TX CLAVICLE FX LT	450	23500	625.00	N/A
HC25003468	CLOSED TX CLAVICLE FX RT	450	23500	625.00	N/A
HC25003476	CLOSED TX CLAVICLE FX W/MANIP-BIL	450	23505	2,529.00	N/A
HC25003484	CLOSED TX CLAVICLE FX W/MANIP LT	450	23505	1,263.00	N/A
HC25003492	CLOSED TX CLAVICLE FX W/MANIP RT	450	23505	1,263.00	N/A
HC25003500	CLOSED TX STERNOCLVCLE DISLOC W/MAN-BIL	450	23525	1,008.00	N/A
HC25003518	CLOSED TX STRENOCLVCLE DISLOC W/MAN LT	450	23525	686.00	N/A
HC25003526	CLOSED TX STERNOCLVCLE DISLOC W/MAN RT	450	23525	686.00	N/A
HC25003534	CLOSED TX HUMRL FX W/MAN W/WO SKLTL TRAC-BIL	450	23605	2,902.00	N/A
HC25003542	CLOSED TX HUMRL FX W/MAN W/WO SKLTL TRAC LT	450	23605	1,450.00	N/A
HC25003559	CLOSED TX HUMRL FX W/MAN W/WO SKLTL TRAC RT	450	23605	1,450.00	N/A
HC25003567	CLOSED TX SHOULDR DSLC W/MAN W/O ANES-BIL	450	23650	1,317.00	N/A
HC25003575	CLOSED TX SHOULDR DSLC W/MAN W/O ANES LT	450	23650	766.00	N/A
HC25003583	CLOSED TX SHOULDR DSLC W/MAN W/O ANES RT	450	23650	766.00	N/A
HC25003591	REMOVE FB UPPER ARM/ELBOW SQ-BIL	450	24200	4,383.00	N/A
HC25003609	REMOVE FB UPPER ARM/ELBOW SQ LT	450	24200	1,566.00	N/A
HC25003617	REMOVE FB UPPER ARM/ELBOW SQ RT	450	24200	1,566.00	N/A
HC25003625	REMOVE FB UPPER ARM/ELBOW DEEP-BIL	450	24201	5,159.00	N/A
HC25003633	REMOVE FB UPPER ARM/ELBOW DEEP LT	450	24201	3,039.00	N/A
HC25003641	REMOVE FB UPPER ARM/ELBOW DEEP RT	450	24201	3,039.00	N/A
HC25003658	CLOSED TX ELBOW DISLOC W/O ANES LT	450	24600	709.00	N/A
HC25003666	CLOSED TX ELBOW DISLOC W/O ANES RT	450	24600	709.00	N/A
HC25003674	CLOSED TX ELBOW DISLOC W/O ANES-BIL	450	24600	1,263.00	N/A
HC25003682	CLOSED TX ELBOW DISLOCATION LT	450	24640	567.00	N/A
HC25003690	CLOSED TX ELBOW DISLOCATION RT	450	24640	567.00	N/A
HC25003708	CLOSED TX ELBOW DISLOCATION-BIL	450	24640	1,021.00	N/A
HC25003716	REMOVE FB FOREARM DEEP-BIL	450	25248	4,603.00	N/A
HC25003724	REMOVE FB FOREARM DEEP LT	450	25248	2,849.00	N/A
HC25003732	REMOVE FB FOREARM DEEP RT	450	25248	2,849.00	N/A
HC25003740	CLOSED TX RADIAL SHAFT FX W/MANIP-BIL	450	25505	4,789.00	N/A
HC25003757	CLOSED TX RADIAL SHAFT FX W/MANIP LT	450	25505	2,793.00	N/A
HC25003765	CLOSED TX RADIAL SHAFT FX W/MANIP RT	450	25505	2,793.00	N/A
HC25003773	CLOSED TX ULNA SHAFT FX W/MANIP LT	450	25535	833.00	N/A
HC25003781	CLOSED TX ULNA SHAFT FX W/MANIP RT	450	25535	833.00	N/A
HC25003799	CLOSED TX ULNA SHAFT FX W/MANIP-BIL	450	25535	1,287.00	N/A
HC25003807	CLOSED TX RAD&ULN SHAFT FX W/MAN-BIL	450	25565	4,989.00	N/A
HC25003815	CLOSED TX RAD&ULN SHAFT FX W/MAN LT	450	25565	2,835.00	N/A
HC25003823	CLOSED TX RAD&ULN SHAFT FX W/MAN RT	450	25565	2,835.00	N/A
HC25003831	CLOSED TX RAD/EPHYSL SEP&ULN FX NO M LT	450	25600	692.00	N/A
HC25003849	CLOSED TX RAD/EPHYSL SEP&ULN FX NO M RT	450	25600	692.00	N/A
HC25003856	CLOSED TX RAD/EPHYSL SEP&ULN FX NO M-BIL	450	25600	1,044.00	N/A
HC25003864	CLOSED TX RAD/EPHYSL SEP&ULN FX W/MAN-BIL	450	25605	5,315.00	N/A
HC25003872	CLOSED TX RAD/EPHYSL SEP&ULN FX W/MAN LT	450	25605	3,099.00	N/A
HC25003880	CLOSED TX RAD/EPHYSL SEP&ULN FX W/MAN RT	450	25605	3,099.00	N/A
HC25003898	CLOSED TX CARPAL SCAPHOID FX W/MAN-BIL	450	25624	4,948.00	N/A
HC25003906	CLOSED TX CARPAL SCAPHOID FX W/MAN LT	450	25624	2,862.00	N/A
HC25003914	CLOSED TX CARPAL SCAPHOID FX W/MAN RT	450	25624	2,862.00	N/A
HC25003922	CLOSED TX CARPAL BONE FX W/M EA BONE LT	450	25635	2,879.00	N/A
HC25003930	CLOSED TX CARPAL BONE FX W/M EA BONE RT	450	25635	2,879.00	N/A
HC25003948	CLOSED TX CARPAL BONE FX W/M EA BONE-BIL	450	25635	4,891.00	N/A
HC25003955	CLOSED TX WRIST DSLOC 1/> BONES W/MAN LT	450	25660	814.00	N/A
HC25003963	CLOSED TX WRIST DSLOC 1/> BONES W/MAN RT	450	25660	814.00	N/A
HC25003971	CLOSED TX WRIST DSLOC 1/> BONES W/MAN-BIL	450	25660	1,243.00	N/A
HC25003989	CLOSED TX DISTL RADIOULNAR DISLOC W/M LT	450	25675	814.00	N/A
HC25003997	CLOSED TX DISTL RADIOULNAR DISLOC W/M RT	450	25675	814.00	N/A
HC25004003	CLOSED TX DISTL RADIOULNAR DISLOC W/M-BIL	450	25675	1,202.00	N/A
HC25004011	DRAIN ABSCESS FINGER SIMPLE	450	26010	720.00	N/A
HC25004029	DRAIN ABSCESS FINGER COMPLEX	450	26011	1,668.00	N/A
HC25004037	CLOSED TX METACARPAL FX W/MAN EA	450	26605	629.00	N/A
HC25004045	CLOSED TX THUMB DISLOC W/MANIP LT	450	26641	578.00	N/A
HC25004052	CLOSED TX THUMB DISLOC W/MANIP RT	450	26641	578.00	N/A
HC25004060	CLOSED TX THUMB DISLOC W/MANIP BIL	450	26641	1,009.00	N/A
HC25004078	CLOSED TX THUMB FX DISLOC W/MAN(BENNETT)LT	450	26645	2,739.00	N/A
HC25004086	CLOSED TX THUMB FX DISLOC W/MAN(BENNETT)RT	450	26645	2,739.00	N/A
HC25004094	CLOSED TX THUMB FX DISLOC W/MAN(BENNETT)BIL	450	26645	5,009.00	N/A
HC25004102	CLOSED TX FINGER JNT DISLOC W/MAN SINGLE	450	26670	695.00	N/A
HC25004110	CLOSED TX KNUCLE DISLOC W/MANIP EA	450	26700	646.00	N/A
HC25004128	CLOSED TX FINGER/THUMB SHAFT FX NO MANIP EA	450	26720	692.00	N/A
HC25004136	CLOSED TX FINGER/THUMB SHAFT FX W/MANIP EA	450	26725	651.00	N/A
HC25004144	CLOSED TX ARTICULAR FX W/MANIP EA	450	26742	2,486.00	N/A
HC25004151	CLOSED TX FINGER/THUMB DISTAL FX NO MANIP EA	450	26750	679.00	N/A
HC25004169	CLOSED TX FINGER/THUMB DISTAL FX W/MANIP EA	450	26755	687.00	N/A
HC25004177	CLOSED TX FINGER JNT DISLOC	450	26770	675.00	N/A
HC25004185	CLOSED TX HIP DISLOC TRAUMIC LT	450	27250	692.00	N/A
HC25004193	CLOSED TX HIP DISLOC TRAUMIC RT	450	27250	692.00	N/A
HC25004201	CLOSED TX HIP DISLOC TRAUMIC BIL	450	27250	1,221.00	N/A
HC25004219	CLOSED TX HIP DISLOC POST ARTHROPLASTY LT	450	27265	838.00	N/A
HC25004227	CLOSED TX HIP DISLOC POST ARTHROPLASTY RT	450	27265	838.00	N/A
HC25004235	CLOSED TX HIP DISLOC POST ARTHROPLASTY BIL	450	27265	1,507.00	N/A
HC25004243	I&D ABSCESS/BURSA/HEMATOMA THIGH/KNEE DEEP LT	450	27301	3,592.00	N/A
HC25004250	I&D ABSCESS/BURSA/HEMATOMA THIGH/KNEE DEEP RT	450	27301	3,592.00	N/A
HC25004268	I&D ABSCESS/BURSA/HEMATOMA THIGH/KNEE DEEP BIL	450	27301	6,466.00	N/A
HC25004276	REMOVE FB DEEP THIGH/KNEE AREA LT	450	27372	3,493.00	N/A
HC25004284	REMOVE FB DEEP THIGH/KNEE AREA RT	450	27372	3,493.00	N/A
HC25004292	REMOVE FB DEEP THIGH/KNEE AREA BIL	450	27372	6,286.00	N/A
HC25004300	CLOSED TX KNEE DISLOC; NO ANESTH LT	450	27550	830.00	N/A
HC25004318	CLOSED TX KNEE DISLOC; NO ANESTH RT	450	27550	830.00	N/A
HC25004326	CLOSED TX KNEE DISLOC; NO ANESTH BIL	450	27550	1,507.00	N/A
HC25004334	CLOSED TX PATELLAR DISLOC; NO ANESTH LT	450	27560	692.00	N/A
HC25004342	CLOSED TX PATELLAR DISLOC; NO ANESTH RT	450	27560	692.00	N/A
HC25004359	CLOSED TX PATELLAR DISLOC; NO ANESTH BIL	450	27560	1,302.00	N/A
HC25004367	I&D ABSCESS/HEMATOMA LEG/ANKLE DEEP LT	450	27603	3,297.00	N/A
HC25004375	I&D ABSCESS/HEMATOMA LEG/ANKLE DEEP RT	450	27603	3,297.00	N/A
HC25004383	I&D ABSCESS/HEMATOMA LEG/ANKLE DEEP BIL	450	27603	5,942.00	N/A
HC25004391	CLOSED TX TIBIAL SHAFT FX W/MANIP W/W-O FIBFX/TRAC LT	450	27752	3,039.00	N/A
HC25004409	CLOSED TX TIBIAL SHAFT FX W/MANIP W/W-O FIBFX/TRAC RT	450	27752	3,039.00	N/A
HC25004417	CLOSED TX TIBIAL SHAFT FX W/MANIP W/W-O FIBFX/TRAC BIL	450	27752	5,642.00	N/A
HC25004425	CLOSED TX MEDIAL MALLEO(ANKLE)FX W/MANIP W/W-O TRAC LT	450	27762	3,025.00	N/A
HC25004433	CLOSED TX MEDIAL MALLEO(ANKLE)FX W/MANIP W/W-O TRAC RT	450	27762	3,025.00	N/A
HC25004441	CLOSED TX MEDIAL MALLEO(ANKLE)FX W/MANIP W/W-O TRAC BIL	450	27762	5,588.00	N/A
HC25004458	CLOSED TX PROX FIBULA/SHAFT FX; W/MANIP LT	450	27781	2,851.00	N/A
HC25004466	CLOSED TX PROX FIBULA/SHAFT FX; W/MANIP RT	450	27781	2,851.00	N/A
HC25004474	CLOSED TX PROX FIBULA/SHAFT FX; W/MANIP BIL	450	27781	5,109.00	N/A
HC25004482	CLOSED TX BIMALLEOLA ANKLE FX; W/MANIP LT	450	27810	3,061.00	N/A
HC25004490	CLOSED TX BIMALLEOLA ANKLE FX; W/MANIP RT	450	27810	3,061.00	N/A
HC25004508	CLOSED TX BIMALLEOLA ANKLE FX; W/MANIP BIL	450	27810	5,372.00	N/A
HC25004516	CLOSED TX PROX TIBIOFIBULAR JNT DISLOC; NO ANES LT	450	27830	692.00	N/A
HC25004524	CLOSED TX PROX TIBIOFIBULAR JNT DISLOC; NO ANES RT	450	27830	692.00	N/A
HC25004532	CLOSED TX PROX TIBIOFIBULAR JNT DISLOC; NO ANES BIL	450	27830	1,269.00	N/A
HC25004540	CLOSED TX ANKLE DISLOC; NO ANES LT	450	27840	751.00	N/A
HC25004557	CLOSED TX ANKLE DISLOC; NO ANES RT	450	27840	751.00	N/A
HC25004565	CLOSED TX ANKLE DISLOC; NO ANES BIL	450	27840	1,334.00	N/A
HC25004573	REMOVE FB FOOT; SUBC LT	450	28190	1,280.00	N/A
HC25004581	REMOVE FB FOOT; SUBC RT	450	28190	1,280.00	N/A
HC25004599	REMOVE FB FOOT; SUBC BIL	450	28190	2,478.00	N/A
HC25004607	REMOVE FB FOOT; DEEP LT	450	28192	2,478.00	N/A
HC25004615	REMOVE FB FOOT; DEEP RT	450	28192	2,478.00	N/A
HC25004623	REMOVE FB FOOT; DEEP BIL	450	28192	5,946.00	N/A
HC25004631	CLOSED TX TARSAL FX; W/MANIPLTN EA	450	28455	2,424.00	N/A
HC25004649	CLOSED TX METATARSAL FX; NO MANIPULTN EA	450	28470	692.00	N/A
HC25004656	CLOSED TX METATARSAL FX; W/MANIPULTN EA	450	28475	652.00	N/A
HC25004664	CLOSED TX BIG TOE FX; NO MANIPULTN LT	450	28490	643.00	N/A
HC25004672	CLOSED TX BIG TOE FX; NO MANIPULTN RT	450	28490	643.00	N/A
HC25004680	CLOSED TX BIG TOE FX; NO MANIPULTN BIL	450	28490	1,157.00	N/A
HC25004698	CLOSED TX BIG TOE FX; W/MANIPULTN LT	450	28495	676.00	N/A
HC25004706	CLOSED TX BIG TOE FX; W/MANIPULTN RT	450	28495	676.00	N/A
HC25004714	CLOSED TX BIG TOE FX; W/MANIPULTN BIL	450	28495	1,271.00	N/A
HC25004722	CLOSED TX PHALANX(TOE) FX; NO MANIPULTN	450	28510	635.00	N/A
HC25004730	CLOSED TX PHALANX(TOE) FX; W/MANIPULTN EA	450	28515	685.00	N/A
HC25004748	CLOSED TX SESAMOID FX LT	450	28530	643.00	N/A
HC25004755	CLOSED TX SESAMOID FX RT	450	28530	643.00	N/A
HC25004763	CLOSED TX SESAMOID FX BILAT	450	28530	1,151.00	N/A
HC25004771	CLOSED TX TARSAL DISLOC; NO ANES LT	450	28540	700.00	N/A
HC25004789	CLOSED TX TARSAL DISLOC; NO ANES RT	450	28540	700.00	N/A
HC25004797	CLOSED TX TARSAL DISLOC; NO ANES BIL	450	28540	1,302.00	N/A
HC25004805	CLOSED TX TALOTARSAL JNT DISLOC; NO ANES LT	450	28570	710.00	N/A
HC25004813	CLOSED TX TALOTARSAL JNT DISLOC; NO ANES RT	450	28570	710.00	N/A
HC25004821	CLOSED TX TALOTARSAL JNT DISLOC; NO ANES BIL	450	28570	966.00	N/A
HC25004839	CLOSED TX TARSOMETATARSAL JNT DISLOC; NO ANES LT	450	28600	710.00	N/A
HC25004847	CLOSED TX METATARSOPHALAN JNT DISLOC; NO ANES LT	450	28630	659.00	N/A
HC25004854	CLOSED TX INTERPHALANGEAL JNT DISLOC; NO ANES LT	450	28660	651.00	N/A
HC25004862	APPLY CAST; SHOULDER TO HAND (LONG ARM) LT	450	29065	767.00	N/A
HC25004870	APPLY CAST; SHOULDER TO HAND (LONG ARM) RT	450	29065	767.00	N/A
HC25004888	APPLY CAST; SHOULDER TO HAND (LONG ARM) BILAT	450	29065	1,369.00	N/A
HC25004896	APPLY CAST; ELBOW TO FINGER (SHORT ARM) LT	450	29075	692.00	N/A
HC25004904	APPLY CAST; ELBOW TO FINGER (SHORT ARM) RT	450	29075	692.00	N/A
HC25004912	APPLY CAST; ELBOW TO FINGER (SHORT ARM) BILAT	450	29075	1,302.00	N/A
HC25004920	APPLY CAST HAND & LWR FOREARM (GAUNTLET) LT	450	29085	367.00	N/A
HC25004938	APPLY CAST HAND & LWR FOREARM (GAUNTLET) RT	450	29085	367.00	N/A
HC25004946	APPLY CAST HAND & LWR FOREARM (GAUNTLET) BIL	450	29085	660.00	N/A
HC25004953	STRAPPING; SHOULDER LT	450	29240	312.00	N/A
HC25004961	STRAPPING; SHOULDER RT	450	29240	312.00	N/A
HC25004979	STRAPPING; SHOULDER BILATERAL	450	29240	560.00	N/A
HC25004987	APPLY CAST LONG LEG LT	450	29345	785.00	N/A
HC25004995	APPLY CAST LONG LEG RT	450	29345	785.00	N/A
HC25005000	APPLY CAST LONG LEG BILATERAL	450	29345	1,422.00	N/A
HC25005018	APPLY CAST SHORT LEG LT	450	29405	710.00	N/A
HC25005026	APPLY CAST SHORT LEG RT	450	29405	710.00	N/A
HC25005034	APPLY CAST SHORT LEG BILATERAL	450	29405	1,402.00	N/A
HC25005042	ADDING WALKER HEEL PREV CAST LT	450	29440	414.00	N/A
HC25005059	ADDING WALKER HEEL PREV CAST RT	450	29440	414.00	N/A
HC25005067	ADDING WALKER HEEL PREV CAST BILAT	450	29440	744.00	N/A
HC25005075	STRAPPING; ANKLE AND/OR FOOT LT	450	29540	332.00	N/A
HC25005083	STRAPPING; ANKLE AND/OR FOOT RT	450	29540	332.00	N/A
HC25005091	STRAPPING; ANKLE AND/OR FOOT BILAT	450	29540	494.00	N/A
HC25005109	REMOVE/BIVALVING; GAUNTLET,BOOT OR BODY CAST	450	29700	605.00	N/A
HC25005117	WEDGING CAST EXCEPT CLUBFOOT	450	29740	620.00	N/A
HC25005125	CONTROL NASAL HEMORRHAGE,ANTERIOR,SIMPLE ANY TX	450	30901	341.00	N/A
HC25005133	CONTROL NASAL HEMORRHAGE,ANTERIOR,COMPLEX ANY TX	450	30903	341.00	N/A
HC25005141	CONTROL NASAL HEMORRHAGE,POSTERIOR W/PACKS+/OR CAUTRY INT'L	450	30905	427.00	N/A
HC25005158	CHANGE TRACH TUBE PRIOR ESTAB FISTULA TRACT	450	31502	607.00	N/A
HC25005174	DRAIN ABSCESS LYMPH NODE/LYMPHADENITIS; SIMPLE	450	38300	1,835.00	N/A
HC25005182	REPAIR LIP FULL THICK; VERMILION ONLY	450	40650	1,334.00	N/A
HC25005190	REPAIR LIP FULL THICK; TO HALF VERTICAL HT	450	40652	1,489.00	N/A
HC25005208	REPAIR LIP FULL THICK; OVER 1/2 VERTICAL HT/COMPLEX	450	40654	2,857.00	N/A
HC25005216	DRAIN ABSCESS/LESION MOUTH; SIMPLE	450	40800	1,458.00	N/A
HC25005224	REMOVE FB VESTIBULE MOUTH; SIMPLE	450	40804	1,502.00	N/A
HC25005232	LAC REPAIR MOUTH; 2.5 CM OR LESS	450	40830	667.00	N/A
HC25005240	LAC REPAIR MOUTH; >2.5 CM/COMPLEX	450	40831	1,169.00	N/A
HC25005257	DRAIN LESION DENTOALVEOLAR (GUM)	450	41800	417.00	N/A
HC25005265	I&D ABSCESS PERITONSILLAR LT	450	42700	644.00	N/A
HC25005273	I&D ABSCESS PERITONSILLAR RT	450	42700	644.00	N/A
HC25005281	I&D ABSCESS PERITONSILLAR BILAT	450	42700	876.00	N/A
HC25005299	REMOVE FB PHARYNX	450	42809	1,169.00	N/A
HC25005307	REPOSIT NASO/ORO GASTRIC FEED TUBE THRU DUODENUM	450	43761	874.00	N/A
HC25005315	I&D ABSCESS SUBMUCSL RECTUM	450	45005	2,024.00	N/A
HC25005349	HEMORRHOIDECTOMY/BANDING	450	46221	1,716.00	N/A
HC25005364	US MEASUR POST-VOID RES&/BLDR CAP NO IMG	450	51798	209.00	N/A
HC25005372	DRAIN ABSCESS WALL SCROTAL	450	55100	2,260.00	N/A
HC25005380	I&D ABSCESS VULVA/PERINEUM	450	56405	744.00	N/A
HC25005398	I&D ABSCESS BARTHOLIN'S GLAND	450	56420	579.00	N/A
HC25005406	INJ ANES/STEROID NERVE TRIGEML BRNCH EA LT	450	64400	625.00	N/A
HC25005414	INJ ANES/STEROID NERVE TRIGEML BRNCH EA RT	450	64400	625.00	N/A
HC25005422	INJ ANES/STEROID NERVE TRIGEML BRNCH EA BI	450	64400	1,033.00	N/A
HC25005430	IINJ ANES/STEROID NERVE/BRNCH PERIPH LT	450	64450	1,169.00	N/A
HC25005448	INJ ANES/STEROID NERVE/BRNCH PERIPH RT	450	64450	1,169.00	N/A
HC25005455	INJ ANES/STEROID NERVE/BRNCH PERIPH BIL	450	64450	2,502.00	N/A
HC25005588	DRAIN EXTERNAL EAR LESION SIMPLE LT	450	69000	1,000.00	N/A
HC25005596	DRAIN EXTERNAL EAR LESION SIMPLE RT	450	69000	1,000.00	N/A
HC25005604	DRAIN EXTERNAL EAR LESION SIMPLE BIL	450	69000	1,835.00	N/A
HC25005612	DRAIN EXTERNAL EAR LESION COMPLEX RT	450	69005	1,835.00	N/A
HC25005620	DRAIN EXTERNAL EAR LESION COMPLEX LT	450	69005	1,835.00	N/A
HC25005638	DRAIN EXTERNAL EAR LESION COMPLEX BIL	450	69005	3,336.00	N/A
HC25005646	PACING TRANSCUTANEOUS TEMPORARY	450	92953	1,064.00	N/A
HC25005661	REMOV SKIN TAGS UP TO&INCL 15 LESIONS	450	11200	823.00	N/A
HC25005679	ASP/INJ JOINT/BURSA MAJOR W/US-BIL	450	20611	1,359.00	N/A
HC25005687	ASP/INJ JOINT/BURSA MAJOR W/US-LT	450	20611	905.00	N/A
HC25005695	ASP/INJ JOINT/BURSA MAJOR W/US-RT	450	20611	905.00	N/A
HC25005703	AMPUTATE FINGER/THUMB SGL W/CLOSURE	450	26951	4,363.00	N/A
HC25005711	AMPUTATE FINGER/THUMB SGL W/CLOSURE LT	450	26951	2,914.00	N/A
HC25005729	AMPUTATE FINGER/THUMB SGL W/CLOSURE RT	450	26951	2,914.00	N/A
HC25005760	CLOSED TX FIBULA DISTAL FX W/MANIP BIL	450	27788	1,506.00	N/A
HC25005778	CLOSED TX FIBULA DISTAL FX W/MANIP LT	450	27788	846.00	N/A
HC25005786	CLOSED TX FIBULA DISTAL FX W/MANIP RT	450	27788	846.00	N/A
HC25005794	CLOSED TX ANKLE FX W/MANIP BIL	450	27818	1,668.00	N/A
HC25005802	CLOSED TX ANKLE FX W/MANIP LT	450	27818	894.00	N/A
HC25005810	CLOSED TX ANKLE FX W/MANIP RT	450	27818	894.00	N/A
HC25005836	ASPIRATION W/ CATHETER; NASOTRACHEAL	450	31720	207.00	N/A
HC25005844	REMOVE CATH CV TUNNELED W/O PORT/PUMP	450	36589	1,443.00	N/A
HC25005851	DECLOT IVAD W/THROMBOLYTIC	450	36593	673.00	N/A
HC25005869	I&D ABSCESS RECTAL	450	46040	2,145.00	N/A
HC25005877	CHANGE CYSTOSTOMY TUBE; SIMPLE	450	51705	685.00	N/A
HC25005885	LYSIS & STRETCHING ADHESIONS PREPUTIAL	450	54450	625.00	N/A
HC25005893	INJ ANES/STEROID NERVE OCCIPITL GREAT BI	450	64405	800.00	N/A
HC25005901	INJ ANES/STEROID NERVE OCCIPITL GREAT LT	450	64405	542.00	N/A
HC25005919	INJ ANES/STEROID NERVE OCCIPITL GREAT RT	450	64405	542.00	N/A
HC25006057	CLOSED TX TARSOMETATARSAL JNT DISLOC; NO ANES RT	450	28600	645.00	N/A
HC25006065	CLOSED TX TARSOMETATARSAL JNT DISLOC; NO ANES BIL	450	28600	966.00	N/A
HC25006073	CLOSED TX METATARSOPHALAN JNT DISLOC; NO ANES RT	450	28630	599.00	N/A
HC25006081	CLOSED TX METATARSOPHALAN JNT DISLOC; NO ANES BIL	450	28630	966.00	N/A
HC25006099	CLOSED TX INTERPHALANGEAL JNT DISLOC; NO ANES RT	450	28660	592.00	N/A
HC25006107	CLOSED TX INTERPHALANGEAL JNT DISLOC; NO ANES BIL	450	28660	966.00	N/A
HC25006115	AMNIOCENTESIS	450	59000	2,475.00	N/A
HC25006123	AMNIOCENTESIS FLUID REDUCTION	450	59001	1,953.00	N/A
HC25006131	FETAL CONTRACT/NIPPLE STIM	450	59020	935.00	N/A
HC25006149	FETAL CONTRACTION STRESS TEST	450	59020	963.00	N/A
HC25006156	FETAL NON-STRESS TEST	450	59025	715.00	N/A
HC25006172	INSERTION CERVICAL DILATOR	450	59200	963.00	N/A
HC25006198	DELIVERY OF PLACENTA	450	59414	2,750.00	N/A
HC26000000	AMNIOCENTESIS	720	59000	3,718.00	N/A
HC26000018	AMNIOCENTESIS FLUID REDUCTION	720	59001	4,497.00	N/A
HC26000034	DELIVERY OF PLACENTA	720	59414	4,657.00	N/A
HC26000075	FETAL CONTRACT/NIPPLE STIM	720	59020	1,435.00	N/A
HC26000083	FETAL CONTRACTION STRESS TEST	720	59020	1,435.00	N/A
HC26000091	FETAL NON-STRESS TEST	720	59025	1,148.00	N/A
HC26000109	INSERTION CERVICAL DILATOR	720	59200	1,477.00	N/A
HC27000017	ANORECTAL WALL BX,ANAL APPROAC	750	45100	7,720.00	N/A
HC27000157	CHANGE GT TUBE W/O IMAGE/ENDO	750	43762	2,266.00	N/A
HC27000801	ESOPH DILATION OVER GUIDE WIRE	750	43453	5,656.00	N/A
HC27000819	ESOPH DILATION UNGUIDED	750	43450	4,822.00	N/A
HC27000843	ESOPH RFLUX PH STDY-LNG DISCTD	750	91034	1,386.00	N/A
HC27000850	ESOPH RFLUX W/PH ELECTR DISCTD	750	91035	1,404.00	N/A
HC27000868	ESOPHAG REFLUX W/NASAL ELEC>1H	750	91038	5,111.00	N/A
HC27000892	ESOPH GASTROESOPH REFLUX PH STDY-LONG	750	91034	4,201.00	N/A
HC27000900	ESOPHAGEAL REFLUX W/NASAL ELEC	750	91037	3,161.00	N/A
HC27000918	ESOPHAGEAL REFLUX W/PH ELECTR	750	91035	6,565.00	N/A
HC27000959	GASTRIC INTUB ASP THER' LAVAGE	750	43753	1,061.00	N/A
HC27001007	HEMORRHOIDECTOMY/BANDING	750	46221	3,936.00	N/A
HC27001056	INJ SCLEROTHERAPY HEMORRHOIDS	750	46500	3,693.00	N/A
HC27001064	REPOSIT GASTRO FEED TUBE(PEG)	750	43761	4,121.00	N/A
HC27001254	GASTRIC INTUB ASP DX;SNGL SPEC	750	43754	1,257.00	N/A
HC27001262	GASTRIC INTUB ASP DX;MULT SPEC	750	43755	1,532.00	N/A
HC27001957	ESOPHAGUS BALLOON DISTENTION PROVOC STUDY	750	91040	4,153.00	N/A
HC27001965	ESOPHAG REFLUX W/NASAL ELEC>1H DISCON'D	750	91038	1,403.00	N/A
HC28000156	EXTERNAL COUNTERPULSATION/TX	480	G0166	1,328.00	N/A
HC31000011	PT-APPLICATION CAST SHORT LEG	420	29405	840.00	N/A
HC31000029	PT-APPLIC CAST SHORT LEG WALK	420	29425	890.00	N/A
HC31000037	PT-APPLIC SPLINT SHORT LEG	420	29515	679.00	N/A
HC31000045	PT-APPLICATION SPLINT LONG LEG	420	29505	851.00	N/A
HC31000656	PT-DEBRIDE OPN WND 1ST 20SQCM OR<	420	97597	977.00	N/A
HC31000771	PT-WOUND NON-SEL DEB 15MIN/MW	420	97602	222.00	N/A
HC31000789	PT-WOUND NON-SEL DEB 30MIN/CMW	420	97602	421.00	N/A
HC31000797	PT-WOUND NON-SEL DEB 45MIN/MW	420	97602	629.00	N/A
HC31000805	PT-WOUND NON-SEL DEB 60MIN/MW	420	97602	817.00	N/A
HC31000813	PT-WOUND VAC 15MIN<50 SQ CM/M	420	97605	211.00	N/A
HC31000821	PT-WOUND VAC 30MIN<50 SQ CM/CM	420	97605	384.00	N/A
HC31000839	PT-WOUND VAC 45MIN<50 SQ CM/M	420	97605	433.00	N/A
HC31000847	PT-WOUND VAC 60MIN<50 SQ CM/M	420	97605	565.00	N/A
HC31000854	PT-WOUND VAC 15MIN>50 SQ CM/M	420	97606	226.00	N/A
HC31000862	PT-WOUND VAC 30MIN>50 SQ CM/CM	420	97606	407.00	N/A
HC31000870	PT-WOUND VAC 45MIN>50 SQ CM/M	420	97606	520.00	N/A
HC31000888	PT-WOUND VAC 60>50 SQ CM/M	420	97606	695.00	N/A
HC31001266	PT-ELEC STIM/TENS/MCW	420	G0283	304.00	N/A
HC31001357	PT-DBRD OPN WND EA+20SQCM OR <	420	97598	855.00	N/A
HC31001571	PT-ELEC STIM/WOUND CARE/M	420	G0281	303.00	N/A
HC31001712	PT-REMOVE/BIVAL CAST SHRT LIMB	420	29700	607.00	N/A
HC31001720	PT-REMOVE/BIVAL CAST FULL LIMB	420	29705	660.00	N/A
HC31001795	PT-APPLICATION CAST LONG LEG	420	29345	1,010.00	N/A
HC31001803	PT-APPLICATIN CAST LEG CLBFOOT	420	29450	744.00	N/A
HC31001928	PT-WINDOWING CAST	420	29730	470.00	N/A
HC31001977	PT - STRAPPING; ELBOW OR WRIST	420	29260	405.00	N/A
HC31001985	PT - STRAPPING; HAND OR FINGER	420	29280	406.00	N/A
HC31001993	PT - STRAPPING; HIP	420	29520	432.00	N/A
HC31002009	PT - STRAPPING; KNEE	420	29530	494.00	N/A
HC31002017	PT - STRAPPING; ANKLE AND/OR FOOT	420	29540	433.00	N/A
HC31002033	PT - STRAPPING; SHOULDER	420	29240	410.00	N/A
HC31002140	PT-APPLIC CAST SHORT LEG WALK BILAT	420	29425	1,605.00	N/A
HC31002157	PT-APPLIC CAST LONG LEG BILAT	420	29345	1,587.00	N/A
HC32000598	OT-DEBRIDE OPN WND 1ST 20SQCM OR<	430	97597	977.00	N/A
HC32000713	OT-WOUND NON-SEL DEB 15MIN/MW	430	97602	222.00	N/A
HC32000721	OT-WOUND NON-SEL DEB 30MIN/CMW	430	97602	421.00	N/A
HC32000739	OT-WOUND NON-SEL DEB 45MIN/MW	430	97602	629.00	N/A
HC32000747	OT-WOUND NON-SEL DEB 60MIN/MW	430	97602	817.00	N/A
HC32000754	OT-WOUND VAC 15MIN<50 SQ CM/M	430	97605	211.00	N/A
HC32000762	OT-WOUND VAC 30MIN<50 SQ CM/CM	430	97605	373.00	N/A
HC32000770	OT-WOUND VAC 45MIN<50 SQ CM/M	430	97605	433.00	N/A
HC32000788	OT-WOUND VAC 60MIN<50 SQ CM/M	430	97605	565.00	N/A
HC32000796	OT-WOUND VAC 15MIN>50 SQ CM/M	430	97606	226.00	N/A
HC32000804	OT-WOUND VAC 30MIN>50 SQ CM/CM	430	97606	407.00	N/A
HC32000812	OT-WOUND VAC 45MIN>50 SQ CM/M	430	97606	520.00	N/A
HC32000820	OT-WOUND VAC 60>50 SQ CM/M	430	97606	695.00	N/A
HC32001182	OT-ELEC STIM/TENS/MCW	430	G0283	304.00	N/A
HC32001265	OT-DBRD OPN WND EA+20SQCM OR <	430	97598	855.00	N/A
HC32001497	OT-REMOVE/BIVAL CAST SHRT LIMB	430	29700	607.00	N/A
HC32001505	OT-REMOVE/BIVAL CAST FULL LIMB	430	29705	660.00	N/A
HC32001604	OT-APPLICATION CAST LONG ARM	430	29065	772.00	N/A
HC32001612	OT-APPLICATION CAST SHORT ARM	430	29075	701.00	N/A
HC32001620	OT-APPLICATION CAST GAUNTLET	430	29085	622.00	N/A
HC32001638	OT-APPLICATION CAST FINGER	430	29086	424.00	N/A
HC32001646	OT-APPLICATION SPLINT LONG ARM	430	29105	734.00	N/A
HC32001653	OT-APPLICATION SPLINT SHORTARM	430	29125	676.00	N/A
HC32001661	OT-APPLIC'SPLINT FINGER STATIC	430	29130	547.00	N/A
HC32001679	OT-APPLY SPLINT FINGER DYNAMIC	430	29131	598.00	N/A
HC32001687	OT-WINDOWING CAST	430	29730	470.00	N/A
HC32001695	OT-APP SPLINT SHORTARM;DYNAMIC	430	29126	704.00	N/A
HC32001877	OT - STRAPPING; SHOULDER	430	29240	410.00	N/A
HC32001885	OT - STRAPPING; ELBOW OR WRIST	430	29260	405.00	N/A
HC32001893	OT - STRAPPING; HAND OR FINGER	430	29280	406.00	N/A
HC33000498	STP-ELEC STIM/TENS/MCW	440	G0283	304.00	N/A
HC36000032	AEROSOL-HHN TREATMENT INIT	412	94640	532.00	N/A
HC36000040	AEROSOL-HHN TX SUBSQ SAME DAY	412	94640	490.00	N/A
HC36000057	AEROSOL-IPPB TREATMENT INIT	412	94640	532.00	N/A
HC36000065	AEROSOL-IPPB TX SUBSQ SAME DAY	412	94640	490.00	N/A
HC36000073	AEROSOL-MDI TREATMENT INIT	412	94640	532.00	N/A
HC36000081	AEROSOL-MDI TX SUBSQ SAME DAY	412	94640	490.00	N/A
HC36000099	AEROSOL-PENTAMADINE	412	94642	561.00	N/A
HC36000107	AEROSOL-TREATMENT INITIAL	412	94640	532.00	N/A
HC36000115	AEROSOL-TX SUBSQ SAME DAY	412	94640	490.00	N/A
HC36000131	MANIP CHEST WALL INIT DEMO/EVAL	410	94667	660.00	N/A
HC36000149	MANIP CHEST(INFANT) INIT DEMO/EVAL	410	94667	660.00	N/A
HC36000156	MANIP CHEST WALL SUBSEQUENT	410	94668	543.00	N/A
HC36000164	MANIP CHEST (INFANT) SUBSEQ	410	94668	543.00	N/A
HC36000172	DEMO&/OR EVAL OF INH TX	410	94664	629.00	N/A
HC36000206	INHALATION W/GAS TX INITIAL	412	94640	532.00	N/A
HC36000214	INHAL W/GAS TX SUBSQ SAME DAY	412	94640	490.00	N/A
HC36000230	SPUTUM INDUCTION INIT TX	412	94640	532.00	N/A
HC36000248	SPUTUM INDUC TX SUBSQ SAME DAY	412	94640	490.00	N/A
HC36000255	TRACH TUBE CHANGE	410	31502	1,946.00	N/A
HC36000727	ARTERIAL PUNCTURE	300	36600	432.00	N/A
HC36000735	IPV TREATMENT INITIAL	412	94640	588.00	N/A
HC36000743	IPV TREATMENT SUBSQ SAME DAY	412	94640	549.00	N/A
HC36000966	RT INHALATION TREATMENT	410	94640	532.00	N/A
HC36000974	RT INHALATION TREATMENT SUBSQ	410	94640	484.00	N/A
HC36001089	ASPIRATION W/ CATHETER; NASOTRACHEAL	410	31720	352.00	N/A
HC36001097	OSCILLATE CHEST WALL MECH EA SESSION	410	94669	637.00	N/A
HC36001170	PERC BX CORE LUNG/MEDIASTINUM W/ IMAG IF OCCURS	410	32408	5,500.00	N/A
HC36500023	PR-THERAPEUTIC STRENGTH/ENDURNC 15MIN	410	G0237	N/A	N/A
HC36500031	PR-THER INC RESP FUNC 15MIN	410	G0238	N/A	N/A
HC36500049	PR-THERAPEUTIC RESP FUNCTION GROUP [ 15MIN]	410	G0239	N/A	N/A
HC36800530	RT THER MUSC STRENGTH 15MIN/MW	410	G0237	230.00	N/A
HC36800548	RT THER INC RESP FUNC 15MIN/MW	410	G0238	252.00	N/A
HC36800555	RT RESP THER GRP 15 MIN/MW	410	G0239	92.00	N/A
HC36800563	RT RESP THER GRP 30 MIN/MW	410	G0239	173.00	N/A
HC36800571	RT RESP THER GRP 45 MIN/MW	410	G0239	257.00	N/A
HC36800589	RT RESP THER GRP 60 MIN/MW	410	G0239	339.00	N/A
HC36800795	ARTERIAL PUNCTURE	300	36600	432.00	N/A
HC36800886	PERC BX CORE LUNG/MEDIASTINUM W/ IMAG IF OCCURS	410	32408	5,500.00	N/A
HC37000015	MNT REASSESMENT EA 15 MIN	942	97803	158.00	N/A
HC37000023	MNT THERAPY GROUP EA 30 MIN         1ST REF	942	97804	156.00	N/A
HC37000031	MNT INITIAL ASSESS INDIV EA 15MIN   1ST REF	942	97802	180.00	N/A
HC37000049	MNT REASSESS EA INDIV 15MIN            1ST REF	942	97803	158.00	N/A
HC38000006	APPLIC CAST LEG CLUBFOOT	510	29450	609.00	N/A
HC38000014	APPLICATION CAST FINGER	510	29086	398.00	N/A
HC38000022	APPLY CAST SHORT ARM	510	29075	699.00	N/A
HC38000030	APPLY CAST LONG ARM	510	29065	781.00	N/A
HC38000048	APPLY CAST SHORT LEG	510	29405	789.00	N/A
HC38000055	APPLY CAST SHORT LEG WALKING	510	29425	884.00	N/A
HC38000063	APPLY CAST LONG LEG	510	29345	873.00	N/A
HC38000071	APPLY CAST RIGID TOTAL LEG	510	29445	1,184.00	N/A
HC38000089	APPLICATION CAST GAUNTLET	510	29085	494.00	N/A
HC38000097	APPLY CMPRSSN BOOT/WRAP(UNNA)	510	29580	674.00	N/A
HC38000105	REMV/BIVALVE FULL CAST ARM/LEG	700	29705	688.00	N/A
HC38000113	REMV/BIVALVE SHRT CAST ARM/LEG	700	29700	591.00	N/A
HC38000121	APPLY SPLINT FINGER STATIC	700	29130	293.00	N/A
HC38000139	APPLY SPLINT LONG ARM	700	29105	816.00	N/A
HC38000147	APPLY SPLINT LONG LEG	700	29505	875.00	N/A
HC38000154	APPLY SPLINT SHORT ARM	700	29125	655.00	N/A
HC38000162	APPLY SPLINT SHORT LEG	700	29515	701.00	N/A
HC38000188	WINDOW CAST	700	29730	550.00	N/A
HC38000196	APPLY CMPRSSN BOOT/WRAP(UNNA)R	510	29580	674.00	N/A
HC38000204	APPLY CMPRSSN BOOT/WRAP(UNNA)L	510	29580	674.00	N/A
HC38000212	APPLY CMPRSSN BOOT/WRAP(UNNA)BI	510	29580	1,264.00	N/A
HC38000238	APPLY BODY CAST;SHOULDER-HIPS	700	29035	830.00	N/A
HC38000246	APPLY BODY CAST;SHOLD-HIP-HEAD	700	29040	896.00	N/A
HC38000253	APPLY BODY CAST;SHOLD/HIP/1THI	700	29044	978.00	N/A
HC38000261	APPLY BODY CAST; FULL ADULT	700	29046	1,344.00	N/A
HC38000279	APPLY BODY CAST; FULL CHILD	700	29046	1,304.00	N/A
HC38000287	APPLY CAST SPICA SHOULDER	700	29055	817.00	N/A
HC38000295	APPLY SPICA  HIP ONE LEG	700	29305	983.00	N/A
HC38000303	APPLY SPICA HIP1 1/2 OR 2 LEGS	700	29325	1,176.00	N/A
HC38000311	APPLY LONG LEG CAST/WALKER	700	29355	945.00	N/A
HC38000329	APPLY LONG LEG CAST BRACE	700	29358	629.00	N/A
HC38000337	APPLY CYLINDER CAST(THI-ANKLE)	700	29365	746.00	N/A
HC38000345	APPLY CAST PATELR TENDN BEARNG	700	29435	784.00	N/A
HC38000352	ADDING WALKER HEEL  PREV CAST	700	29440	424.00	N/A
HC38000360	APPLY STRAPPNG KNEE(ROBRTJONES	700	29530	494.00	N/A
HC38000378	REM/BIVALV SPICA SHOULDER/HIP	700	29710	781.00	N/A
HC38000386	REPAIR SPICA BODY CAST	700	29720	788.00	N/A
HC38000394	WEDGING CAST EXCEPT CLUBFOOT	700	29740	541.00	N/A
HC38000402	WEDGING CAST CLUBFOOT	700	29750	555.00	N/A
HC38000428	APPLY CAST RISSER JACKET BODY; ONLY	700	29010	1,058.00	N/A
HC38000436	APPLY CAST RISSER JACKET BODY; WITH HEAD	700	29015	1,135.00	N/A
HC38420006	REMOVAL IABP DEVICE; PERC	481	33968	1,744.00	N/A
HC39001136	PSYCH GROUP THER (NOT FAM)45-50MIN	915	G0410	307.00	N/A
HC39001144	PSYCH GROUP INTERACTIVE 45-50M	915	G0411	297.00	N/A
HC39001409	PSY-ASSESS BEHAVIOR W/SCORE & DOCD/STAND INSTRUMENT	900	96127	168.00	N/A
HC41500182	ELECTROCORTICOGRAM IN SURGERY	740	95829	2,409.00	N/A
HC41500190	EMG 1 EXTREMITY	922	95860	1,050.00	N/A
HC41500208	EMG 2 EXTREMITY	922	95861	1,542.00	N/A
HC41500216	EMG 3 EXTREMITY	922	95863	1,922.00	N/A
HC41500224	EMG 4 EXTREMITY	922	95864	2,336.00	N/A
HC41500232	EMG FACIAL BILAT	922	95868	1,432.00	N/A
HC41500240	EMG FACIAL UNILAT LT	922	95867	820.00	N/A
HC41500257	EMG FACIAL UNILAT RT	922	95867	820.00	N/A
HC41500539	EMG FACIAL UNILAT	922	95867	820.00	N/A
HC41500737	EMG THORACIC PARASPINAL(NO T1/T12)	922	95869	667.00	N/A
HC41500745	EMG LMTD EXTRM 1 (NOT PARASP/CRANIAL/SPHINC)	922	95870	500.00	N/A
HC42000059	CARDIOVERSION EXTERNAL	480	92960	4,503.00	N/A
HC43000041	BREAST BX CORE W/O GUIDE-LT	361	19100	2,187.00	N/A
HC43000058	BREAST BX CORE W/O GUIDE-RT	361	19100	2,187.00	N/A
HC43000066	BREAST BX CORE W/O GUIDE-BI	361	19100	3,681.00	N/A
HC43000140	MAMMO DUCTO/GALACTO INJ-BI	361	19030	3,393.00	N/A
HC43000157	MAMMO DUCTO/GALACTO INJ-LT	361	19030	1,778.00	N/A
HC43000165	MAMMO DUCTO/GALACTO INJ-RT	361	19030	1,778.00	N/A
HC43000322	PUNC CYST ASP BREAST ADD'L	361	19001	1,657.00	N/A
HC43000546	PUNCTURE ASP CYST BREAST-RT	361	19000	2,263.00	N/A
HC43000553	PUNC ASP CYST BREAST EA ADD+RT	361	19001	1,657.00	N/A
HC43000611	PUNC ASP CYST BREAST EA ADD+LT	361	19001	1,657.00	N/A
HC43000629	PUNCTURE ASP CYST BREAST-LT	361	19000	2,263.00	N/A
HC43000819	INCISION BREAST LESION-RT	361	19020	3,912.00	N/A
HC43000827	INCISION BREAST LESION-LT	361	19020	3,912.00	N/A
HC44001295	INTRODUCE TUBE GASTROINTESTINAL LONG	361	44500	1,965.00	N/A
HC44002830	MYELOGRAPHY INJ W/S&I; CERVICAL	320	62302	6,802.00	N/A
HC44002848	MYELOGRAPHY INJ W/S&I; THORACIC	320	62303	6,951.00	N/A
HC44002855	MYELOGRAPHY INJ W/S&I; LUMBOSAC	320	62304	7,087.00	N/A
HC44002863	MYELOGRAPHY INJ W/S&I; =/>2SPINALREGIONS	320	62305	7,828.00	N/A
HC44200665	AMNIOCENTESIS	402	59000	3,754.00	N/A
HC44500007	ABLATION RENAL TUMOR(S) PERC; RF	350	50592	15,343.00	N/A
HC44500015	ABLATION RENAL TUMOR(S) PERC; RF LT	350	50592	15,343.00	N/A
HC44500023	ABLATION RENAL TUMOR(S) PERC; RF RT	350	50592	15,343.00	N/A
HC44500486	ASP/DECOMP PERC DISKECTOMY	361	62287	12,455.00	N/A
HC44500932	INJ SCLEROTHERAPY MULT VEINS-LT	361	36471	1,834.00	N/A
HC44500940	INJ SCLEROTHERAPY MULT VEINS-RT	361	36471	1,834.00	N/A
HC44500957	INJ SCLEROTHERAPY SNGL VEIN-LT	361	36470	1,576.00	N/A
HC44500965	INJ SCLEROTHERAPY SNGL VEIN-RT	361	36470	1,576.00	N/A
HC44501005	INSERTION-TIPS	323	37182	39,312.00	N/A
HC44501229	PLACE TUBE NASO/ORO-GASTRIC BY MD W/FLUORO	361	43752	1,820.00	N/A
HC44501435	PHLEBCT VEIN/EXT 10-20 STAB-LT	361	37765	10,415.00	N/A
HC44501443	PHLEBCT VEIN/EXT 10-20 STAB-RT	361	37765	10,415.00	N/A
HC44501732	REM & REPLAC EXT URET CATH(IMG,S&I) BI	361	50387	12,140.00	N/A
HC44501740	REM & REPLAC EXT URET CATH(IMG,S&I) LT	361	50387	6,391.00	N/A
HC44501757	REM & REPLAC EXT URET CATH(IMG,S&I) RT	361	50387	6,391.00	N/A
HC44501765	REM & REPLAC URETERAL STENT BI	361	50382	17,004.00	N/A
HC44501773	REM & REPLAC URETERAL STENT LT	361	50382	8,948.00	N/A
HC44501781	REM & REPLAC URETERAL STENT RT	361	50382	8,948.00	N/A
HC44501823	REMOVE URETERAL STENT BIL	320	50384	15,587.00	N/A
HC44501831	REMOVE URETERAL STENT LT	320	50384	8,204.00	N/A
HC44501849	REMOVE URETERAL STENT RT	320	50384	8,204.00	N/A
HC44501864	REVISION-TIPS	323	37183	33,893.00	N/A
HC44502607	REMOVAL PLEURAL CATH W/CUFF RT	320	32552	3,490.00	N/A
HC44502615	REMOVAL PLEURAL CATH W/CUFF LT	320	32552	3,490.00	N/A
HC44502623	INSERT PLEURAL CATH TUNNELD RT	320	32550	10,909.00	N/A
HC44502631	INSERT PLEURAL CATH TUNNELD LT	320	32550	10,909.00	N/A
HC44502649	REPOSIT NASO/ORO GFT THRU DUOD	320	43761	3,817.00	N/A
HC44503191	ATHER' TRLUML RENAL ART&S&I-RT	323	0234T	19,761.00	N/A
HC44503209	ATHER' TRLUML RENAL ART&S&I-LT	323	0234T	19,761.00	N/A
HC44503217	ATHER' TRLUML RENAL ART&S&I-BI	323	0234T	36,504.00	N/A
HC44503225	ATHER' TRLUML VISERCL EA & S&I	323	0235T	12,001.00	N/A
HC44503233	ATHER' TRLUML ABD AORTA W/S&I	323	0236T	19,539.00	N/A
HC44503241	ATHER'TRLUML BRACH EAVES W/S&I-R	323	0237T	19,923.00	N/A
HC44503258	ATHER'TRLUML BRACH EAVES W/S&I-L	323	0237T	19,923.00	N/A
HC44503266	ATHER'TRLUML BRACH EAVES W/S&I-B	323	0237T	36,881.00	N/A
HC44503274	ATHER'TRLUML ILIAC EAVES W/S&I-R	323	0238T	23,275.00	N/A
HC44503282	ATHER'TRLUML ILIAC EAVES W/S&I-L	323	0238T	23,275.00	N/A
HC44503290	ATHER'TRLUML ILIAC EAVES W/S&I-B	323	0238T	42,394.00	N/A
HC44503449	DECLOTTING VASC ACCES/CATH LT	361	36593	2,056.00	N/A
HC44503456	DECLOTTING VASC ACCES/CATH RT	361	36593	2,056.00	N/A
HC44503464	DECLOT IVAD BY THROMBOLYTIC LT	361	36593	2,099.00	N/A
HC44503472	DECLOT IVAD BY THROMBOLYTIC RT	361	36593	2,099.00	N/A
HC44503480	PHLEBCT VEIN/EXT >20 STAB-RT	361	37766	13,402.00	N/A
HC44503498	PHLEBCT VEIN/EXT >20 STAB-LT	361	37766	13,402.00	N/A
HC44503662	VERT/THOR CAROTID STENT 1ST LT	361	0075T	33,493.00	N/A
HC44503670	VERT/THOR CAROTID STENT 1ST RT	361	0075T	33,493.00	N/A
HC44503688	VERT/THOR CAROTID STENT+LT	361	0076T	6,778.00	N/A
HC44503696	VERT/THOR CAROTID STENT+RT	361	0076T	6,778.00	N/A
HC44503704	DEST SUPERIOR HYPOGASTR PLEXUS	361	64681	4,059.00	N/A
HC44504108	PERC TRNSCTH RENAL SYMP DENRV W/IMG UNILAT	361	0338T	10,048.00	N/A
HC44504116	PERC TRNSCTH RENAL SYMP DENRV W/IMG BI	361	0339T	14,652.00	N/A
HC44504306	PERC SACRAL AUGMT UNILAT W/ GUIDANCE&BX	320	0200T	10,372.00	N/A
HC44504314	PERC SACRAL AUGMT BILAT W/ GUIDANCE&BX	320	0201T	10,372.00	N/A
HC44504330	PLCMT CATH BIL DRN PERC(CHOLANG,S&I)EXTRNL	361	47533	11,525.00	N/A
HC44504348	PLCMT CATH BIL DRN PERC(CHOLANG,S&I)INT/EXT	361	47534	12,793.00	N/A
HC44504355	PLCMT STNT BIL PERC EA(CHOLANG,BLN DIL,S&I)EXIST ACC	361	47538	14,560.00	N/A
HC44504454	SCLEROTX FLUID (CYST) PERC(IMAG,S&I)	361	49185	4,122.00	N/A
HC44504520	PLCMT URET STENT PERC(NEPH/URET'GRM,S&I)PRE-EXIST BI	361	50693	17,925.00	N/A
HC44504538	PLCMT URET STENT PERC(NEPH/URET'GRM,S&I)PRE-EXIST LT	361	50693	9,958.00	N/A
HC44504546	PLCMT URET STENT PERC(NEPH/URET'GRM,S&I)PRE-EXIST RT	361	50693	9,958.00	N/A
HC44504553	PLCMT URET STENT PERC(NEPH/URET'GRM,S&I)NEW ACCES BI	361	50694	24,580.00	N/A
HC44504561	PLCMT URET STENT PERC(NEPH/URET'GRM,S&I)NEW ACCES LT	361	50694	12,935.00	N/A
HC44504579	PLCMT URET STENT PERC(NEPH/URET'GRM,S&I)NEW ACCES RT	361	50694	12,935.00	N/A
HC44504587	PLCMT URET STENT PERC(NEPH/URET'GRM,S&I) NEW ACCES SEP CATH BI	361	50695	22,548.00	N/A
HC44504595	PLCMT URET STENT PERC(NEPH/URET'GRM,S&I) NEW ACCES SEP CATH LT	361	50695	14,798.00	N/A
HC44504603	PLCMT URET STENT PERC(NEPH/URET'GRM,S&I) NEW ACCES SEP CATH RT	361	50695	14,798.00	N/A
HC44701316	PERC IMPLANT NEURO ELEC; PERIP	481	64555	17,297.00	N/A
HC44900041	ABLATE BONE TUMOR(S) PERQ W/CT;RF	350	20982	15,586.00	N/A
HC44901049	ABLATE BONE TUMOR(S) PERQ W/CT;CRYO	350	20983	15,569.00	N/A
HC46000014	INJ AIR/CONTRAST PERITONEAL CAVITY	320	49400	3,756.00	N/A
HC46000246	INJ SINUS TRACT; DIAGNOSTIC (SINOGRAM)	320	20501	2,666.00	N/A
HC46000402	INJ OF GT/COLON TUBE; PATENCY W/IMAG	320	49465	2,280.00	N/A
HC46000493	INTRO CATH FALLOPIAN TUBE	320	58345	6,127.00	N/A
HC46001244	INJECTION SINUS TRACT; THERAPEUTIC	361	20500	3,266.00	N/A
HC46001335	INJ CONTRAST KNEE ARTHRO/CT/MRI	361	27369	1,525.00	N/A
HC46500047	ASP BLADDER W/INSERT SUPRAPUB	361	51102	8,358.00	N/A
HC46500062	ASP&INJ BONE CYST	361	20615	2,348.00	N/A
HC46500070	ASP/INJ HYDROCELE	361	55000	2,203.00	N/A
HC46500088	ASP/INJ RENAL CYST/PELVIS BI	361	50390	8,431.00	N/A
HC46500096	ASP/INJ RENAL CYST/PELVIS LT	361	50390	4,442.00	N/A
HC46500104	ASP/INJ RENAL CYST/PELVIS RT	361	50390	4,442.00	N/A
HC46500112	ASP/INJ THYROID CYST	361	60300	2,508.00	N/A
HC46500120	BONE MARROW DX; ASPIRATION(S) ONLY	361	38220	3,353.00	N/A
HC46500146	BX BONE TROCAR/NEEDLE; DEEP	361	20225	6,965.00	N/A
HC46500211	BX BONE TROC/NEEDLE; SUPERFICIAL	361	20220	4,716.00	N/A
HC46500245	BIOPSY LIVER(NEEDLE/PERCUTAN)	361	47000	5,945.00	N/A
HC46500252	BIOPSY MUSCLE PERC NEEDLE	361	20206	4,495.00	N/A
HC46500286	BIOPSY NEEDLE ABD/RETROMASS	361	49180	4,670.00	N/A
HC46500302	BIOPSY NEEDLE RENAL-BILAT	361	50200	10,966.00	N/A
HC46500310	BIOPSY NEEDLE RENAL-LT	361	50200	5,716.00	N/A
HC46500328	BIOPSY NEEDLE RENAL-RT	361	50200	5,716.00	N/A
HC46500336	BIOPSY NEEDLE SALIVARY GLAND	361	42400	2,671.00	N/A
HC46500369	BX VERTEBRAL BODY; OPEN THORACIC	361	20250	9,809.00	N/A
HC46500385	BLOOD PATCH (INJ EPIDURAL)	361	62273	4,625.00	N/A
HC46500450	BX LYMPH NODE(S)-SUPERFCL-BIL	361	38505	8,210.00	N/A
HC46500468	BX LYMPH NODE(S)-SUPERFCL-LT	361	38505	4,321.00	N/A
HC46500476	BX LYMPH NODE(S)-SUPERFCL-RT	361	38505	4,321.00	N/A
HC46500542	BX PROSTATE NDL/PUNCH SGL/MULT	361	55700	5,637.00	N/A
HC46500559	BX SFT TISS PELV/HIP-BIL	361	27040	8,101.00	N/A
HC46500567	BX SFT TISS PELV/HIP-LT	361	27040	4,721.00	N/A
HC46500575	BX SFT TISS PELV/HIP-RT	361	27040	4,721.00	N/A
HC46500609	BX THYROID NEEDLE CORE	361	60100	3,217.00	N/A
HC46500617	CHANGE CYSTOSTOMY TUBE; SIMPLE	361	51705	1,712.00	N/A
HC46500625	CHANGE CYSTOSTOMY; COMPLICATED	361	51710	3,291.00	N/A
HC46500674	CHANGE PERC GT TO GJ TUBE W/FLUORO	361	49446	6,950.00	N/A
HC46500690	CHANGE URETEROSTOMY TUBE LT	361	50688	5,693.00	N/A
HC46500708	CHANGE URETEROSTOMY TUBE RT	361	50688	5,693.00	N/A
HC46500716	CIRCUMCISION PROCEDURE	361	54150	3,632.00	N/A
HC46500732	CT ASP&INJ BONE CYST-LT	361	20615	2,348.00	N/A
HC46500740	CT ASP&INJ BONE CYST-RT	361	20615	2,348.00	N/A
HC46500757	CYSTOGRAM COMPLEX	361	51726	2,291.00	N/A
HC46500765	DECLOTTING IVAD W/THROMBOLYTIC	361	36593	2,149.00	N/A
HC46500773	DEST CUTANEOUS VASCULAR LESION	361	17106	1,282.00	N/A
HC46500906	FNA ASP BX W/O GUIDE; FIRST LESION	361	10021	1,355.00	N/A
HC46500914	FNA ASP BX W/O GUIDE; EACH ADD'L LESION	361	10004	1,219.00	N/A
HC46500948	INS PICC LINE W/PORT<5YR	361	36570	10,613.00	N/A
HC46500955	INS PICC LINE W/PORT>5YR	361	36571	10,613.00	N/A
HC46500963	INS TUN VEN ACS DEV 2 SITES	361	36565	11,541.00	N/A
HC46500971	INS TUN VEN ACS DEV W/PORT<5YR	361	36560	13,917.00	N/A
HC46500989	INS TUN CV ACCESS DEV W/PORT 5YRS+	361	36561	13,776.00	N/A
HC46500997	INS TUN VEN ACS DEV W/SQ PUMP	361	36563	12,633.00	N/A
HC46501003	INS TUN VEN CATH W/O PORT<5	361	36557	10,655.00	N/A
HC46501011	INS TUN CV ACS CATH W/O PORT 5YRS+	361	36558	10,549.00	N/A
HC46501029	INS VEN ACS DEV 2SITES W/PORT	361	36566	13,881.00	N/A
HC46501037	INSERT CT(OPEN) W/DRAIN SYSTEM BIL	361	32551	6,550.00	N/A
HC46501045	INSERT CT(OPEN) W/DRAIN SYSTEM LT	361	32551	3,339.00	N/A
HC46501052	INSERT CT(OPEN) W/DRAIN SYSTEM RT	361	32551	3,339.00	N/A
HC46501078	INSERT PERITONEAL CATH TUNNELED W/IMAGING	361	49418	12,523.00	N/A
HC46501086	INSERT PERITONEAL CATH TUNNELED W/PORT	361	49419	14,733.00	N/A
HC46501094	INSERT PICC <5 YR AGE W/O IMAGING	361	36568	6,201.00	N/A
HC46501102	INSERT PICC >5 YR AGE W/O IMAGING	361	36569	5,493.00	N/A
HC46501110	INSRT BLADDER CATH-NON INDWELL	361	51701	536.00	N/A
HC46501128	INSRT BLADDER CATH-TEMP FOLEY	361	51702	600.00	N/A
HC46501136	INSRT BLADDER CATH-TEMP-COMPLX	361	51703	758.00	N/A
HC46501169	LUMBAR PUNCTURE DX [NOT W/ CT OR FLUORO ]	361	62270	3,523.00	N/A
HC46501177	PUNCTURE SPINAL TX DRAIN CSF [NOT W/FLUORO/CT]	361	62272	3,526.00	N/A
HC46501185	MANOMETRIC STDY VIA NEPHRO BI	361	50396	3,899.00	N/A
HC46501193	MANOMETRIC STDY VIA NEPHRO LT	361	50396	2,048.00	N/A
HC46501201	MANOMETRIC STDY VIA NEPHRO RT	361	50396	2,048.00	N/A
HC46501219	MECH REMOV PERICATH OBSTR MAT CV	361	36595	8,733.00	N/A
HC46501250	PERC PLACEMENT CEC TUBE W/FLUORO	361	49442	7,474.00	N/A
HC46501268	PERC PLACEMENT DU/J TUBE W/FLUORO	361	49441	8,177.00	N/A
HC46501276	PERC PLCMNT GT TUBE W/FLUORO	361	49440	7,841.00	N/A
HC46501284	PLCMNT CENTRAL VEN CATH<5 YR	361	36555	5,346.00	N/A
HC46501292	INS NO TUN CV ACCESS CATH 5YRS+	361	36556	5,670.00	N/A
HC46501334	PUNC SHUNT/RES FOR ASP/INJ	361	61070	3,641.00	N/A
HC46501342	PUNCTURE CISTERN/LAT CERVICAL C1-C2 W/O INJ	361	61050	4,789.00	N/A
HC46501359	PUNCTURE CISTERN/LAT CERVICAL C1-C2 W/INJ	361	61055	5,161.00	N/A
HC46501367	REMOV TUNNELED CV ACS CATH W/O PORT/PUMP	361	36589	5,793.00	N/A
HC46501375	REMOVE PERITONEAL CATH TUNNELED	361	49422	9,972.00	N/A
HC46501383	REMVL INTRALUMIN OBST VEN DEV	361	36596	3,931.00	N/A
HC46501391	REMVL TUN CV ACS DEVICE W/ SQ PORT	361	36590	7,010.00	N/A
HC46501409	REPAIR CV ACCESS CATH	361	36575	3,782.00	N/A
HC46501417	REPAIR CV ACCESS CATH W/PORT	361	36576	6,764.00	N/A
HC46501425	REPLACE PERC DU/J TUBE W/FLUORO	361	49451	4,981.00	N/A
HC46501433	REPLACE PERC G-J TUBE W/FLUORO	361	49452	4,972.00	N/A
HC46501441	REPLACE PERC GT/CEC TUBE W/FLUORO	361	49450	4,845.00	N/A
HC46501458	REPLC CATH ONLY CV ACESS W/PORT	361	36578	9,484.00	N/A
HC46501466	REPLC TUNNELED CV ACS DEVICE W/O PORT/PUMP	361	36581	8,897.00	N/A
HC46501474	REPLC TUNNELED CV ACS DEVICE W/PORT	361	36582	12,008.00	N/A
HC46501482	REPLC TUNNELED CV ACS DEV W/PUMP	361	36583	12,917.00	N/A
HC46501490	REPLC NON-TUN CV ACS CATH W/O PORT/PUMP	361	36580	6,154.00	N/A
HC46501516	REPLC PICC LINE W/ SQ PORT	361	36585	10,621.00	N/A
HC46501524	REPOSITION CV CATH UNDER FLUORO	361	36597	3,943.00	N/A
HC46501540	THORACENTESIS ASP W/ IMG GUID-BILAT	361	32555	9,754.00	N/A
HC46501557	THORACENTESIS ASP W/ IMG GUID-LT	361	32555	5,134.00	N/A
HC46501565	THORACENTESIS ASP W/ IMG GUID-RT	361	32555	5,134.00	N/A
HC46501573	THORACENTESIS W/TUBE W/ IMAG BI	361	32557	10,315.00	N/A
HC46501581	THORACENTESIS W/TUBE W/ IMAG LT	361	32557	5,425.00	N/A
HC46501599	THORACENTESIS W/TUBE W/ IMAG RT	361	32557	5,425.00	N/A
HC46501615	URO-EMG	361	51784	1,048.00	N/A
HC46501623	UROFLOWMETRY COMPLEX	361	51741	876.00	N/A
HC46501631	UROFLOWMETRY SIMPLE	361	51736	655.00	N/A
HC46501706	BX/RMVL LYMPH NODE(S)-OPEN BI	361	38510	13,136.00	N/A
HC46501714	BX/RMVL LYMPH NODE(S)-OPEN LT	361	38510	6,912.00	N/A
HC46501722	BX/RMVL LYMPH NODE(S)-OPEN RT	361	38510	6,912.00	N/A
HC46501730	BX NECK/THORAX SOFT TISSUE-SC	361	21550	5,935.00	N/A
HC46501748	BX LYMPH NODE(S)SUPERFICIAL-SC	361	38505	4,321.00	N/A
HC46501755	BX LYMPH NODE(S) DEEP CERVICAL	361	38510	6,912.00	N/A
HC46501763	BIOPSY NEEDLE RENAL	361	50200	5,716.00	N/A
HC46501771	ASP/INJ RENAL CYST/PELVIS	361	50390	4,442.00	N/A
HC46501789	THORACENTESIS ASP W/O IMAG GUIDE	361	32554	3,997.00	N/A
HC46501797	INSERT CT(OPEN) W/DRAIN SYSTEM	361	32551	3,380.00	N/A
HC46501813	BX LYMPH NODE(S)SUPERFICIAL*DS	361	38505	4,321.00	N/A
HC46501821	BX NECK/THORAX SOFT TISSUE*DS	361	21550	5,935.00	N/A
HC46501912	BX LYMPH NODE(S) DEEP CERV-*DS	361	38510	6,912.00	N/A
HC46501938	PERC ASP INTERDISCAL DX	361	62267	2,489.00	N/A
HC46501961	BONE MARROW DX; ASPIRATION(S) ONLY LT	361	38220	3,353.00	N/A
HC46501979	BONE MARROW DX; ASPIRATION(S) ONLY RT	361	38220	3,353.00	N/A
HC46501987	BONE MARROW DX; BIOPSY(SIES) ONLY	361	38221	3,619.00	N/A
HC46501995	BONE MARROW DX; BIOPSY(SIES) ONLY LT	361	38221	3,619.00	N/A
HC46502001	BONE MARROW DX; BIOPSY(SIES) ONLY RT	361	38221	3,619.00	N/A
HC46502035	BX SOFT TISS THIGH/KNEE;SUP BI	361	27323	4,497.00	N/A
HC46502043	BX SOFT TISS THIGH/KNEE;SUP LT	361	27323	2,530.00	N/A
HC46502050	BX SOFT TISS THIGH/KNEE;SUP RT	361	27323	2,530.00	N/A
HC46502084	BX PROSTATE STEREO/TEMPLAT W/IMG	361	55706	5,966.00	N/A
HC46502118	ABLAT RENAL TUMOR(S) PERC CRYO	361	50593	24,232.00	N/A
HC46502126	ABLATION RENAL TUMOR(S) PERC; CRYO LT	361	50593	24,232.00	N/A
HC46502134	ABLATION RENAL TUMOR(S) PERC; CRYO RT	361	50593	24,232.00	N/A
HC46502282	PERC DRAIN CATH W/IMAG; SOFT TISSUE	361	10030	4,523.00	N/A
HC46502357	TENOTOMY THIGH SINGLE TENDON	361	27306	8,221.00	N/A
HC46502365	TENOTOMY THIGH MULTIPLE TENDONS	361	27307	11,454.00	N/A
HC46502373	TENOTOMY ACHILLES TENDON *DS	361	27605	9,166.00	N/A
HC46502381	FASCIOTOMY, FOOT AND/OR TOE	361	28008	10,350.00	N/A
HC46502399	DIVSN PLANTR FASCIA&MUSCLE(STEINDLER STRIP)	361	28250	9,522.00	N/A
HC46502498	EXCHANGE TUBE NEPHRO(NEPH/URET'GRM,S&I) BI	361	50435	11,945.00	N/A
HC46502506	EXCHANGE TUBE NEPHRO(NEPH/URET'GRM,S&I) LT	361	50435	6,925.00	N/A
HC46502514	EXCHANGE TUBE NEPHRO(NEPH/URET'GRM,S&I) RT	361	50435	6,925.00	N/A
HC46502530	TENOTOMY  PERC, TOE; SINGLE TENDON	361	28010	5,980.00	N/A
HC46502548	TENOTOMY  PERC, TOE; MULTIPLE TENDONS	361	28011	7,801.00	N/A
HC46502563	BONE MARROW DX; BIOPSY(IES) & ASPIRATION(S)	361	38222	5,056.00	N/A
HC46502571	BONE MARROW DX; BIOPSY(IES) & ASPIRATION(S) RT	361	38222	5,056.00	N/A
HC46502589	BONE MARROW DX; BIOPSY(IES) & ASPIRATION(S) LT	361	38222	5,056.00	N/A
HC46502597	BONE MARROW DX; BIOPSY(IES) & ASPIRATION(S) BILAT	361	38222	8,194.00	N/A
HC46502605	INSERT MIDLINE CATH <3 YR AGE	361	36406	2,251.00	N/A
HC46502613	INSERT MIDLINE CATH >3 YR AGE	361	36410	4,097.00	N/A
HC46502639	FNA ASP BX W/US; FIRST LESION	361	10005	2,669.00	N/A
HC46502647	FNA ASP BX W/US; EACH ADD'L LESION	361	10006	1,820.00	N/A
HC46502654	FNA ASP BX W/FLUORO; FIRST LESION	361	10007	2,957.00	N/A
HC46502662	FNA ASP BX W/FLUORO; EACH ADD'L LESION	361	10008	1,946.00	N/A
HC46502670	FNA ASP BX W/CT; FIRST LESION	361	10009	3,457.00	N/A
HC46502688	FNA ASP BX W/CT; EACH ADD'L LESION	361	10010	2,527.00	N/A
HC46502696	FNA ASP BX W/MR; FIRST LESION	361	10011	3,790.00	N/A
HC46502704	FNA ASP BX W/MR; EACH ADD'L LESION	361	10012	2,865.00	N/A
HC46502712	BIOPSY TANGENTIAL SKIN; SINGLE INITIAL LESION	361	11102	1,044.00	N/A
HC46502720	BIOPSY TANGENTIAL SKIN; EACH SEP ADD'L LESION	361	11103	710.00	N/A
HC46502738	BIOPSY PUNCH SKIN; SINGLE INITIAL LESION	361	11104	1,226.00	N/A
HC46502746	BIOPSY PUNCH SKIN; EACH SEP ADD'L LESION	361	11105	843.00	N/A
HC46502753	BIOPSY INCISIONAL SKIN; SINGLE INITIAL LESION	361	11106	1,371.00	N/A
HC46502761	BIOPSY INCISIONAL SKIN; EACH SEP ADD'L LESION	361	11107	1,003.00	N/A
HC46502803	INSERT PICC>5 YR AGE W/IMAGING	361	36573	7,021.00	N/A
HC46502811	REPLC PICC LINE W/O SQ PORT/PUMP W/IMAGING	361	36584	6,507.00	N/A
HC46502837	LUMBAR PUNCTR DX WITH FLUORO/CT [NOT W/MRI OR US]	361	62328	3,760.00	N/A
HC46502845	PUNCTURE SPINAL TX CSF WITH FLUORO/CT[NOT W/MRI OR US]	361	62329	4,262.00	N/A
HC46502852	NEUROENDOSCOPY PLACE CATH/DRAIN INTRACRANIAL	361	62160	5,058.00	N/A
HC46502860	PERC BX CORE LUNG/MEDIASTINUM W/ IMAG IF OCCURS	361	32408	5,748.00	N/A
HC47200860	PLACE DEVICE/MARKER OTHER SITES(NON-PROST)	333	C9728	5,478.00	N/A
HC47200886	REMOVAL OF FIXATION DEVICE	361	20665	1,034.00	N/A
HC51000040	REPAIR CENTRAL VENOUS CATH	510	36575	941.00	N/A
HC51000057	DECLOT IVAD W/THROMBOLYTIC	510	36593	389.00	N/A
HC51000065	INSRT BLADDER CATH-NON INDWELL	510	51701	272.00	N/A
HC51000073	INSRT BLADDER CATH-TEMP FOLEY	510	51702	320.00	N/A
HC51000081	INSRT BLADDER CATH-TEMP-COMPLX	510	51703	425.00	N/A
HC51000099	CYSTOGRAM COMPLEX	510	51726	707.00	N/A
HC51000107	CYSTOMETROGRAM W/VOID PRESSURE	510	51728	1,050.00	N/A
HC51000115	URO-EMG	510	51784	386.00	N/A
HC51000123	VOIDING PRESSURE STUDIES+	510	51797	224.00	N/A
HC51000198	DEMO&/OR EVAL OF INH TX	510	94664	143.00	N/A
HC51000438	REPAIR CENTRAL VEN CATH(TECH/HOSP)	361	36575	775.00	N/A
HC51000446	REPAIR CENTRAL VEN CATH W/PORT	361	36576	952.00	N/A
HC51000453	REMOV IMPL VEN CATH DEVICE	361	36589	938.00	N/A
HC51000461	BLOOD DRAW IMP'T VENOUS DEVICE	300	36591	145.00	N/A
HC51000479	DECLOT IVAD W/THROMBOLYTC(TECH/HOSP)	361	36593	389.00	N/A
HC51000552	INSERT PICC <5 YR AGE W/O IMAGING	361	36568	1,202.00	N/A
HC51000560	INSERT PICC >5 YR AGE W/O IMAGING	361	36569	1,196.00	N/A
HC51000578	CHANGE GT TUBE W/O IMAGE/ENDO	750	43762	307.00	N/A
HC51001170	CLOSED TX CLAVICLE FX	510	23500	449.00	N/A
HC51001188	CLOSED TX HUMERUS NECK FX NO MANIP	510	23600	668.00	N/A
HC51001196	CLOSED TX HUMERUS SHAFT FX NO MANIP	510	24500	839.00	N/A
HC51001204	CLOSED TX HUMERL SUPRA/TRANS CON FX	510	24530	944.00	N/A
HC51001212	CLOSED TX HUMRL CON FX MED/LAT NO M	510	24576	988.00	N/A
HC51001220	CLOSED TX ELBOW DISLOCATION	510	24640	550.00	N/A
HC51001238	CLOSED TX RADIAL HED/NEK FX NO MANP	510	24650	696.00	N/A
HC51001246	CLOSED TX ULNAR FX	510	24670	734.00	N/A
HC51001253	CLOSED TX RADIAL SHAFT FX NO MANIP	510	25500	688.00	N/A
HC51001261	CLOSED TX RADIUS&ULNA SHAFT FX NO M	510	25560	694.00	N/A
HC51001279	CLOSED TX FX RAD/ULN DISTAL FX NO M	510	25600	754.00	N/A
HC51001287	CLOSED TX METACARPAL FX NO MANIP	510	26600	646.00	N/A
HC51001295	CLOSED TX FINGER SHAFT FX,EA,NO MAN	510	26720	364.00	N/A
HC51001303	CLOSED TX FINGER DISTAL FX,EA,NO M	510	26750	399.00	N/A
HC51001311	CLOSED TX PELVIC RING FX W/O MANIPULATION	510	27197	998.00	N/A
HC51001329	CLOSED TX OF FEMUR FX	510	27500	750.00	N/A
HC51001345	CLOSED TX MIDFOOT FX, EACH	510	28450	672.00	N/A
HC51001352	CLOSED TX KNEECAP FX	510	27520	822.00	N/A
HC51001360	CLOSED TX KNEE FX(S)	510	27538	2,112.00	N/A
HC51001378	CLOSED TX TIBIA FX	510	27750	861.00	N/A
HC51001386	CLOSED TX FIBULA FX	510	27780	606.00	N/A
HC51001394	CLOSED TX ANKLE FX	510	27760	823.00	N/A
HC51001402	CLOSED TX LAT MALLEO ANKL FX NO MAN	510	27786	809.00	N/A
HC51001410	CLOSED TX BIMALLEO ANKLE FX NO MAN	510	27808	999.00	N/A
HC51001428	CLOSED TX METATARSAL FX	510	28470	646.00	N/A
HC51001436	CLOSED TX BIG TOE FX	510	28490	302.00	N/A
HC51001444	CLOSED TX TOE FX	510	28510	277.00	N/A
HC51001469	APPLY CAST LONG ARM	700	29065	421.00	N/A
HC51001477	APPLY CAST SHORT ARM	700	29075	312.00	N/A
HC51001485	APPLY CAST LONG LEG	700	29345	452.00	N/A
HC51001493	APPLY LONG LEG CAST/WALKER	700	29355	497.00	N/A
HC51001501	APPLY CYLINDER CAST(THI-ANKLE)	700	29365	418.00	N/A
HC51001519	APPLY CAST PATELR TENDN BEARNG	700	29435	430.00	N/A
HC51001527	APPLY CAST SHORT LEG	700	29405	433.00	N/A
HC51001535	APPLY CAST SHORT LEG WALKING	700	29425	453.00	N/A
HC51001543	APPLIC CAST LEG CLUBFOOT	700	29450	298.00	N/A
HC51001550	APPLY SPLINT LONG ARM	700	29105	375.00	N/A
HC51001568	APPLY SPLINT SHORT ARM	700	29125	311.00	N/A
HC51001576	APPLY SPLINT LONG LEG	700	29505	404.00	N/A
HC51001584	APPLY SPLINT SHORT LEG	700	29515	334.00	N/A
HC51001956	DRAW BLOOD VEN PICC/PERIPH CATH	300	36592	142.00	N/A
HC51001972	US MEASUR POST-VD RES&/BLDR CAP NO IMG	510	51798	144.00	N/A
HC51001980	INSERT DRUG DELIVERY IMPLANT	510	11981	266.00	N/A
HC51001998	REMOVE DRUG DELIVERY IMPLANT	510	11982	302.00	N/A
HC51002061	REMOVE/INSERT DRUG DELIVERY IMPLANT	510	11983	486.00	N/A
HC51002079	REMOV IMPACTD EAR WAX(INSTRUMENT) LT	510	69210	87.00	N/A
HC51002087	REMOV IMPACTD EAR WAX(INSTRUMENT) RT	510	69210	87.00	N/A
HC51002103	MNT INITIAL ASSESSMENT INDIV EA 15MIN  1ST REF	510	97802	88.00	N/A
HC51002111	MNT REASSESSMENT EA INDIV 15MIN       1ST REF	510	97803	86.00	N/A
HC51002129	MNT THERAPY 2>/GROUP EA 30 MIN      1ST REF	942	97804	52.00	N/A
HC51002152	CYSTOGRAM SIMPLE	510	51725	398.00	N/A
HC51002160	CYSTOGRAM W/ URETH PRFL STDY	510	51727	881.00	N/A
HC51002178	CYSTOMETROGRAM W/VOID PRSSR& URTH PRFL	510	51729	1,182.00	N/A
HC51002186	UROFLOWMETRY SIMPLE	510	51736	212.00	N/A
HC51002194	UROFLOWMETRY COMPLEX	510	51741	245.00	N/A
HC51002236	ASP/INJ RENAL CYST/PELVIS	361	50390	1,055.00	N/A
HC51002277	MEATOTOMY (NON-INFANT)	361	53020	531.00	N/A
HC51002293	CIRCUMCISION W/DEVICE RING/BLOCK	361	54150	554.00	N/A
HC51002301	LYSIS & STRETCHING ADHESIONS PREPUTIAL	361	54450	292.00	N/A
HC51002319	LYSIS OF LABIAL ADHESIONS	361	56441	816.00	N/A
HC51002327	CIRCUMCISION INFANT<28D EXCISE NO DEVICE	361	54160	665.00	N/A
HC51002335	CIRCUMCISION INFANT >28D EXCISE NO DEVICE	361	54161	791.00	N/A
HC51002350	EXCISION GLAND BULBOURETHRAL	361	53250	932.00	N/A
HC51002368	EXCISN/FULGURATN POLYP(S) URETHRAL	361	53260	1,469.00	N/A
HC51002384	EXCISE LESION <0.5CM HND-FT-SC-NCK-GN	510	11420	315.00	N/A
HC51002392	EXCISE LESION 0.6-1CM HND-FT-SC-NCK-GN	510	11421	588.00	N/A
HC51002400	EXCISE LESION 1.1-2CM HND-FT-SC-NCK-GN	510	11422	686.00	N/A
HC51002418	EXCISE LESION 2.1-3CM HND-FT-SC-NCK-GN	510	11423	804.00	N/A
HC51002426	EXCISE LESION 3.1-4CM HND-FT-SC-NCK-GN	510	11424	959.00	N/A
HC51002434	CHANGE CYSTOSTOMY TUBE; SIMPLE	510	51705	470.00	N/A
HC51002442	CHANGE CYSTOSTOMY; COMPLICATED	510	51710	849.00	N/A
HC51002475	PERC NEUROSTIMULATION TIBIAL  SINGLE TX	510	64566	516.00	N/A
HC51002558	REMOV IMPACTD EAR WAX IRRIG/LAVG BI	510	69209	217.00	N/A
HC51002566	REMOV IMPACTD EAR WAX IRRIG/LAVG LT	510	69209	125.00	N/A
HC51002574	REMOV IMPACTD EAR WAX IRRIG/LAVG RT	510	69209	125.00	N/A
HC51002590	FNA ASP BX W/O GUIDE; FIRST LESION	510	10021	578.00	N/A
HC51002608	IMPLANT PELLET(S) HORMONE SUBQ	510	11980	252.00	N/A
HC51002616	CAUTERIZE W/CHEM; GRAN TISSUE	510	17250	323.00	N/A
HC51002624	PUNCTURE ASP CYST BREAST	510	19000	1,475.00	N/A
HC51002632	THORACENTESIS ASP W/O IMG GUID	510	32554	1,016.00	N/A
HC51002640	THORACENTESIS ASP W/ IMG GUID	510	32555	1,143.00	N/A
HC51002657	I&D ABSCESS RECTAL	510	46040	1,791.00	N/A
HC51002665	REMOVE HEMORRHOID INT&EXT GROUPS 2+	510	46260	4,228.00	N/A
HC51002673	REPAIR FISTULA ANAL W/GLUE	510	46706	3,668.00	N/A
HC51002681	REPAIR FISTULA ANAL W/PLUG	510	46707	4,256.00	N/A
HC51002723	MANOMETRIC STDY VIA NEPHRO	510	50396	845.00	N/A
HC51002749	ASPIRATION OF BLADDER BY NEEDLE	510	51100	1,040.00	N/A
HC51002756	ASPIRATION OF BLADDER TROCAR	510	51101	1,676.00	N/A
HC51002764	ASP BLADDER W/INSERT SUPRAPUB	510	51102	2,242.00	N/A
HC51002772	BLADDER IRRIGATION SIMPLE	510	51700	421.00	N/A
HC51002806	STUDY REFLEX BLADDER URINARY	510	51792	157.00	N/A
HC51002921	DILAT STRICTURE URETHRAL MALE INT'L	510	53600	538.00	N/A
HC51002939	DILAT STRICTURE URETHRAL MALE SUBSQ	510	53601	254.00	N/A
HC51002947	DILAT STRICTR URETHRL FLFRM MALE INT'L	510	53620	1,287.00	N/A
HC51002954	DILAT STRICTR URETHRL FLFRM MALE SUBSQ	510	53621	543.00	N/A
HC51002962	DILATION URETHRAL FEMALE INITIAL	510	53660	326.00	N/A
HC51002970	DILATION URETHRAL FEMALE SUBSEQUENT	510	53661	217.00	N/A
HC51002988	INSERT STENT URETHRAL PROSTATIC TEMP	510	53855	2,228.00	N/A
HC51002996	DESTROY LESION(S) PENILE SIMPLE/CHEM	510	54050	408.00	N/A
HC51003036	BIOPSY PENIS(SEPARATE PROC)	510	54100	1,902.00	N/A
HC51003051	INJECT RX CORPORA CAVERNOSA	510	54235	625.00	N/A
HC51003069	ASP/INJ HYDROCELE	510	55000	1,005.00	N/A
HC51003077	DRAIN ABSCESS WALL SCROTAL	510	55100	1,956.00	N/A
HC51003093	BX PROSTATE NDL/PUNCH SGL/MULT	510	55700	2,663.00	N/A
HC51003101	DESTROY LESION(S) VULVA SIMPLE	510	56501	2,777.00	N/A
HC51003119	DESTROY LESION(S) VULVA EXTENSIVE	510	56515	3,863.00	N/A
HC51003127	BX VULVA	510	56605	487.00	N/A
HC51003135	BX VULVA EACH ADDITIONAL+	510	56606	279.00	N/A
HC51003143	COLPOSCOPY VULVA	510	56820	375.00	N/A
HC51003150	COLPOSCOPY VULVA W/BX(S)	510	56821	531.00	N/A
HC51003168	DESTROY LESION(S) VAGINAL SIMPLE	510	57061	2,826.00	N/A
HC51003176	DESTROY LESION(S) VAGINAL EXTENSIVE	510	57065	3,537.00	N/A
HC51003184	BX VAGINA SIMPLE	510	57100	1,226.00	N/A
HC51003192	BX VAGINA EXTENSIVE INCL CYSTS	510	57105	2,887.00	N/A
HC51003200	IRRIG &/APPLY OINTMENT VAGINAL	510	57150	253.00	N/A
HC51003218	FIT&INSERT PESSARY/INTRAVAG SPPRT DEV	510	57160	341.00	N/A
HC51003226	COLPOSCOPY VAGINA W/CERVIX IF PRESENT	510	57420	657.00	N/A
HC51003234	COLPOSCOPY VAG W/BX(S)VAGINA/CERVIX	510	57421	1,622.00	N/A
HC51003309	BX(S)CERVIX / EXCISE LESION(SEP PROC)	510	57500	1,366.00	N/A
HC51003317	CURETTAGE ENDOCERVICAL (ECC)	510	57505	1,732.00	N/A
HC51003325	CRYOCAUTERY CERVIX	510	57511	709.00	N/A
HC51003333	ABLATION LASER CERVIX	510	57513	3,001.00	N/A
HC51003341	CONIZATION CERVIX LOOP ELECTRD	510	57522	3,863.00	N/A
HC51003358	DILAT CANAL CERV INSTRMNT(SEP PROC)	510	57800	2,487.00	N/A
HC51003366	BX(S)/SAMPL ENDOMETRIAL(SEP PROC)	510	58100	391.00	N/A
HC51003374	BX(S)/SAMPL ENDOMETRIAL W/COLPOSCPY+	510	58110	264.00	N/A
HC51003515	OBTAIN/PREP/CONVEY SCREEN PAP SMEAR	510	Q0091	39.00	N/A
HC51003663	HEMORRHOIDECTOMY/BANDING	510	46221	1,305.00	N/A
HC51003671	INJ SCLEROTHERAPY HEMORRHOIDS	510	46500	1,305.00	N/A
HC51003788	LYSIS ADHESIONS POST-CIRCUMCISION	361	54162	1,413.00	N/A
HC51003796	EXCISE LESION <0.5CM TRNK/ARMS/LEGS	510	11400	331.00	N/A
HC51003804	EXCISE LESION 0.6-1CM TRNK/ARMS/LEGS	510	11401	504.00	N/A
HC51003812	REMOV SKIN TAGS UP TO&INCL 15 LESIONS	510	11200	220.00	N/A
HC51003820	I&D ABSCESS SIMPLE SNGL	510	10060	301.00	N/A
HC51003838	I&D ABSCESS COMPLICATED MULT	510	10061	565.00	N/A
HC51003846	I&D HEMATOMA OR FLUID COLL	510	10140	653.00	N/A
HC51003853	REPAIR CIRCUMCISION INCOMPLETE	510	54163	2,260.00	N/A
HC51003861	FRENULOTOMY PENIS	510	54164	2,119.00	N/A
HC51003895	BONE MARROW DX; BIOPSY(IES) & ASPIRATION(S)	361	38222	1,950.00	N/A
HC51003903	FNA ASP BX W/O GUIDE; EACH ADD'L LESION	361	10004	406.00	N/A
HC51004042	INHALATION TREATMENT INITIAL	510	94640	225.00	N/A
HC51004109	ARTERIAL PUNCTURE	300	36600	138.00	N/A
HC51004117	TRACH TUBE CHANGE	410	31502	450.00	N/A
HC51004158	REMOV IMPACTD EAR WAX(INSTRUMENT) BI           (NO MOD50)	510	69210	146.00	N/A
HC51010056	DESTROY MUSCLE(S) FACIAL NERVE BI	361	64612	998.00	N/A
HC51010064	DESTROY MUSCLE(S) FACIAL NERVE LT	361	64612	625.00	N/A
HC51010072	DESTROY MUSCLE(S) FACIAL NERVE RT	361	64612	625.00	N/A
HC51010148	DESTRUCT OTHER PERIPH NERV/BRNCH BI	361	64640	1,865.00	N/A
HC51010155	DESTRUCT OTHER PERIPH NERV/BRNCH LT	361	64640	955.00	N/A
HC51010163	DESTRUCT OTHER PERIPH NERV/BRNCH RT	361	64640	955.00	N/A
HC51010171	ASP/INJ SMALL JNT-SC BILAT	361	20600	453.00	N/A
HC51010189	ASP/INJ SMALL JNT-SC LT	361	20600	259.00	N/A
HC51010197	ASP/INJ SMALL JNT-SC RT	361	20600	259.00	N/A
HC51010205	ASP/INJ MED JOINT-BILAT	361	20605	481.00	N/A
HC51010213	ASP/INJ MED JOINT-LT	361	20605	276.00	N/A
HC51010221	ASP/INJ MED JOINT-RT	361	20605	276.00	N/A
HC51010239	ASP/INJ LARGE JOINT-BILAT	361	20610	494.00	N/A
HC51010247	ASP/INJ LARGE JOINT-LT	361	20610	309.00	N/A
HC51010254	ASP/INJ LARGE JOINT-RT	361	20610	309.00	N/A
HC51010262	INJ(S);SINGLE TENDON/SHEATH BI	361	20550	545.00	N/A
HC51010270	INJ(S);SINGLE TENDON/SHEATH RT	361	20550	340.00	N/A
HC51010288	INJ(S);SINGLE TENDON/SHEATH LT	361	20550	340.00	N/A
HC51010296	INJ(S);SNGL TNDON ORIGN/INSER	361	20551	389.00	N/A
HC51010304	INJ(S);TRIGGER POINT 1-2MUSCLS	361	20552	376.00	N/A
HC51010312	INJ(S);TRIGGER POINT 3/>MUSCLS	361	20553	406.00	N/A
HC51010320	BACLOPHEN PUMP TRIAL PROCEDURE	361	62326	1,068.00	N/A
HC51010338	ANAL' IMPLANTED PUMP NO PROG/REFILL	361	62367	347.00	N/A
HC51010346	ANALYSIS IMPLANTED PUMP W/PROG	510	62368	446.00	N/A
HC51010387	EMG 1 EXTREMITY	922	95860	423.00	N/A
HC51010395	EMG 2 EXTREMITY	922	95861	640.00	N/A
HC51010403	EMG 3 EXTREMITY	922	95863	720.00	N/A
HC51010411	EMG 4 EXTREMITY	922	95864	1,061.00	N/A
HC51010429	EMG THORACIC PARASPINAL(NO T1/T12)	922	95869	223.00	N/A
HC51010437	EMG LTD NOT PARASP/CRANIAL/SPHINC	922	95870	150.00	N/A
HC51010783	DEBRIDE MASTOIDECT CAVITY COMPLEX	510	69222	919.00	N/A
HC51010833	BONE MARROW DX; ASPIRATION(S) ONLY	510	38220	1,221.00	N/A
HC51010841	BONE MARROW DX; BIOPSY(SIES) ONLY	510	38221	1,542.00	N/A
HC51010858	THORACENTESIS W/TUBE W/O IMAG	510	32556	1,323.00	N/A
HC51010866	THORACENTESIS W/TUBE W/IMAGING	510	32557	1,413.00	N/A
HC51010874	LUMBAR PUNCTURE DX [NOT W/ CT OR FLUORO ]	510	62270	742.00	N/A
HC51010882	PUNCTURE SPINAL TX DRAIN CSF [NOT W/FLUORO/CT]	510	62272	794.00	N/A
HC51010940	INSERT DEVICE INTRAUTERINE IUD	514	58300	600.00	N/A
HC51010957	REMOVAL DEVICE INTRAUTERINE IUD	514	58301	500.00	N/A
HC51010973	PUNC SHUNT/RES FOR ASP/INJ	510	61070	1,326.00	N/A
HC51060556	DESTROY MUSCLE(S) NECK NO LARYNX BI	361	64616	1,305.00	N/A
HC51060564	DESTROY MUSCLE(S) NECK NO LARYNX LT	361	64616	686.00	N/A
HC51060572	DESTROY MUSCLE(S) NECK NO LARYNX RT	361	64616	686.00	N/A
HC51060580	DESTROY MUSCLE(S) LARYNX BI	361	64617	1,500.00	N/A
HC51060598	DESTROY MUSCLE(S) LARYNX LT	361	64617	1,000.00	N/A
HC51060606	DESTROY MUSCLE(S) LARYNX RT	361	64617	1,000.00	N/A
HC51060614	DESTROY MUSCLE(S) 1-4 1ST EXTREMITY	361	64642	1,181.00	N/A
HC51060622	DESTROY MUSCLE(S) 1-4 EA ADD EXTREM	361	64643	900.00	N/A
HC51060630	DESTROY MUSCLE(S) 5/+ 1ST EXTREMITY	361	64644	1,181.00	N/A
HC51060648	DESTROY MUSCLE(S) 5/+ EA ADD EXTREM	361	64645	900.00	N/A
HC51060655	DESTROY MUSCLE(S) TRUNK 1-5	361	64646	1,181.00	N/A
HC51060663	DESTROY MUSCLE(S) TRUNK RT 6/+	361	64647	900.00	N/A
HC51061067	EXCHANGE TUBE NEPHRO(NEPH/URET'GRM,S&I) BI	510	50435	3,676.00	N/A
HC51061075	EXCHANGE TUBE NEPHRO(NEPH/URET'GRM,S&I) LT	510	50435	2,626.00	N/A
HC51061083	EXCHANGE TUBE NEPHRO(NEPH/URET'GRM,S&I) RT	510	50435	2,626.00	N/A
HC51061117	CLOSED TX RAD/EPHYSL SEP&ULN FX W/MAN	510	25605	2,496.00	N/A
HC51061125	CLOSED TX CARPAL SCAPHOID FX W/O MAN	510	25622	624.00	N/A
HC51061133	CLOSED TX FINGER/THUMB SHAFT FX W/MANIP EA	510	26725	684.00	N/A
HC51061513	REMOVE IMPLANT SUPERFICIAL	510	20670	1,640.00	N/A
HC51061521	CLOSED TREATMENT TIBIAL FRACTURE PROXIMAL W/O MANIP	510	27530	365.00	N/A
HC51061539	ASP & INJ GANGLION CYST	510	20612	457.00	N/A
HC51061547	CLOSED TREATMENT ULNAR SHAFT FRACTURE W/O MANIP	510	25530	364.00	N/A
HC51061554	STRAPPING; HAND OR FINGER	510	29280	135.00	N/A
HC51070704	PSY-ASSESS BEHAVIOR W/SCORE & DOCD/STAND INSTRUMENT	510	96127	109.00	N/A
HC73000184	DIALYSIS URGENT/NON-ROUTINE ESRD (OP)	820	G0257	4,998.00	N/A
HC73000275	DIALYSIS URGENT ESRD(OP)CANCEL	820	G0257	2,040.00	N/A
HC79200002	MUSCLE TEST, ONE LIMB	922	95860	800.00	N/A
HC79200010	MUSCLE TEST, TWO LIMBS	922	95861	1,225.00	N/A
HC79200028	MUSCLE TEST, THREE LIMBS	922	95863	1,438.00	N/A
HC79200036	MUSCLE TEST, FOUR LIMBS	922	95864	1,851.00	N/A
HC82200320	BONE MARROW DX; ASP(S) ONLY	361	38220	3,387.00	1,651.00
HC82200791	BONE MARROW DX; ASP(S) ONLY RT	361	38220	3,387.00	1,651.00
HC82200809	BONE MARROW DX; ASP(S) ONLY LT	361	38220	3,387.00	1,651.00
HC82200817	BONE MARROW DX; BX(S) ONLY RT	361	38221	3,655.00	1,651.00
HC82200825	BONE MARROW DX; BX(S) ONLY LT	361	38221	3,655.00	1,651.00
HC82200841	AUTOPSY MACERATED FETUS	310	88016	N/A	N/A
HC82200858	AUTOPSY GROSS & MICRO W/O CNS	310	88020	N/A	N/A
HC82200866	AUTOPSY GROSS & MICRO W/BRAIN	310	88025	N/A	N/A
HC82200874	AUTOPSY GROSS & MICRO W/CNS	310	88027	N/A	N/A
HC82200882	AUTOPSY G&M INFANT W/BRAIN	310	88028	N/A	N/A
HC82200890	AUTOPSY G&M STILL/NB W/BRAIN	310	88029	N/A	N/A
HC82200908	AUTOPSY LIMITED/REGIONL G&/ORM	310	88036	N/A	N/A
HC82200916	AUTOPSY FORENSIC	310	88040	N/A	N/A
HC82202219	FNA ASP BX W/O GUIDE; EACH ADD'L LESION	361	10004	1,219.00	193.50
HC82202235	AUTOPSY GROSS INFANT W/BRAIN	310	88014	N/A	N/A
HC82202524	FNA ASP BX W/O GUIDE; FIRST LESION	361	10021	1,355.00	375.00
HC82202532	BONE MARROW DX; BX(S) ONLY	361	38221	3,655.00	1,651.00
HC82204488	BONE MARROW DX; BX(S) & ASP(S) RT	361	38222	5,056.00	2,782.00
HC82204496	BONE MARROW DX; BX(S) & ASP(S) LT	361	38222	5,056.00	2,782.00
HC82204504	BONE MARROW DX; BX(S) & ASP(S) BILAT	361	38222	8,194.00	4,173.00
HC82204512	BONE MARROW DX; ASP(S) ONLY BILAT	361	38220	4,609.00	2,477.00
HC82204520	BONE MARROW DX; BX(S) ONLY BILAT	361	38221	5,858.00	2,477.00
HC83000430	THERAPEUTIC PHLEBOTOMY	940	99195	871.00	132.00
HC83000737	THERAPEUTIC APHERESIS WBC'S	940	36511	5,817.00	1,600.00
HC83000745	THERAPEUTIC APHERESIS RBC'S	940	36512	7,355.00	1,600.00
HC83000752	THERAPEUTIC APHERESIS PLATELET	940	36513	7,225.00	800.00
HC83000760	THERAPEUTIC APHERESIS PLASMA	940	36514	7,423.00	1,600.00
HC83000786	THER APHER W/EXTRACORP IMMUNO/ADSORP/FILTRATION	940	36516	10,140.00	3,500.00
HC83000836	THER APHERESIS PLASMA CX/ABORT	940	36514	2,660.00	1,600.00
HC88600002	ARTERIAL PUNCTURE	300	36600	390.00	131.00
HC88600051	VENIPUNCTURE BY PHYSICIAN OR QHC <3YRS	410	36406	67.00	18.00
HC88600069	VENIPUNCTURE CUTDOWN <1	361	36420	585.00	131.00
HC12200101	IVAD IRRIGATION	940	96523	403.00	N/A
HC12200119	REFILL/MAINTENANCE PORT PUMP	940	96521	1,167.00	N/A
HC12200127	REFILL&MAINT'N IMPLANT PUMP	940	96522	861.00	N/A
HC12400008	CHEMO ADMIN IV INITIAL HR	335	96413	1,961.00	N/A
HC12400016	CHEMO ADMIN IV ADD'L HR	335	96415	933.00	N/A
HC12400024	CHEMO INF SEQ/NEW RX 1ST HR	335	96417	975.00	N/A
HC12400032	CHEMO ADMIN IVP SNGL/INIT'LINJ	335	96409	1,336.00	N/A
HC12400040	CHEMO ADMIN IVP SNGL/ADD'L INJ	335	96411	1,028.00	N/A
HC12400057	INITIATE PROLONG CHEMO INFUSION VIA PUMP	335	96416	1,992.00	N/A
HC12400065	CHEMO ADMIN CNS W/SPINAL PUNCTURE	331	96450	2,006.00	N/A
HC12400073	CHEMO HORMON ANTINEOPL SQ/IM	331	96402	853.00	N/A
HC12400081	CHEMO NONHRMNL ANTINEOPL SQ/IM	331	96401	965.00	N/A
HC12400099	ADMIN CHEMO INTRA ARTERIAL INJ	335	96420	1,507.00	N/A
HC12400107	INTRAPERITONEAL CHEMO THERAPY	335	96446	1,774.00	N/A
HC12400115	INITIATE PROLONG CHEMO INFUSION PORTBL PUMP &F/U VISIT	335	G0498	2,175.00	N/A
HC12400123	CHEMO ADMIN PLEURAL CAV W/THORACENTESIS	331	96440	2,536.00	N/A
HC12400131	CHEMO INJECT(S) SUBARACHNOID/INTRAVENT VIA RESEVOIR	331	96542	1,758.00	N/A
HC12400149	CHEMO ADMIN INTRA ARTERIAL INFUSION UP TO 1 HR	335	96422	1,343.00	N/A
HC12400156	CHEMO ADMIN INTRA ARTERIAL INF EA ADDL HR+	335	96423	388.00	N/A
HC43001239	ABLATION CRYO BREAST MALIG TUMOR(S) &IMAG UNILAT	361	0581T	13,000.00	N/A
HC47200134	HYPERTHERMIA EXTERNAL SUPERFCL	333	77600	3,182.00	N/A
HC47200142	HYPERTHERMIA EXTERNAL DEEP	333	77605	4,358.00	N/A
HC47200159	HYPERTHERMIA PROBE 1-5 APPS	333	77610	5,651.00	N/A
HC47200167	HYPERTHERMIA PROBE 6+ APPS	333	77615	6,927.00	N/A
HC47200175	HYPERTHERMIA INTRACAVITARY	333	77620	3,033.00	N/A
HC47200902	PLCMNT INTERSTIT DEV THORACIC	350	32553	5,146.00	N/A
HC47200910	PLCMNT INTERSTIT DEV ABD/PELV	350	49411	6,017.00	N/A
HC47201140	HDR ELECTRONIC BRACHYTHERAPY SKIN SURFACE	333	0394T	1,131.00	N/A
HC47201157	HDR ELECTRONIC BRACHYTHERAPY INTERSTIT/INTRACAV	333	0395T	3,963.00	N/A
HC51000420	IVAD IRRIGATION	940	96523	116.00	N/A
HC51000511	CHEMO ADMIN IVP SNGL/INIT'LINJ	335	96409	493.00	N/A
HC51000529	CHEMO ADMIN IVP SNGL/ADD'L INJ	335	96411	480.00	N/A
HC51000537	CHEMO NONHRMNL ANTINEOPL SQ/IM	331	96401	223.00	N/A
HC51000545	CHEMO HORMON ANTINEOPL SQ/IM	331	96402	164.00	N/A
HC51001451	REFILL&MAINT'N IMPLANT PUMP	940	96522	356.00	N/A
HC51002798	INSTILL BLADDER CHEMO	510	51720	525.00	N/A
HC51010890	CHEMO ADMIN CNS W/SPINAL PUNCTURE	331	96450	770.00	N/A
HC51010908	CHEMO ADMIN PLEURAL CAV W/THORACENTESIS	331	96440	1,087.00	N/A
HC51010916	INTRAPERITONEAL CHEMO THERAPY	335	96446	664.00	N/A
HC51010932	CHEMO INJECT(S) SUBARACHNOID/INTRAVENT VIA RESEVOIR	331	96542	530.00	N/A
HC44003093	EVAL MED PHYSICS DOSE RADIATION EXPOSE W/REPORT	320	76145	444.00	N/A
HC45201167	RADIOLABEL MONONCLON ANTIBODY	342	79403	3,045.00	N/A
HC47200001	BASIC DOSIMETRY CALCULATION	333	77300	1,789.00	N/A
HC47200084	BRACHYTX INSERT HEYMAN CAPSULE	333	58346	5,260.00	N/A
HC47200092	BRACHYTX INSERT UTERINE TANDEM	333	57155	6,253.00	N/A
HC47200126	HANDLING/LOADING RAD SOURCE	333	77790	1,636.00	N/A
HC47200183	IMRT TX PLAN	333	77301	18,388.00	N/A
HC47200209	INTRACAVITARY TREATMT SIMPLE	333	77761	2,233.00	N/A
HC47200217	INTRACAVITARY TREATMT INTERMED	333	77762	3,822.00	N/A
HC47200225	INTRACAVITARY TREATMT COMPLEX	333	77763	4,461.00	N/A
HC47200258	INTERSTITIAL RADIATION, COMPLEX	333	77778	6,884.00	N/A
HC47200290	M: MISC RAD TX PROC PLANNING	333	77299	N/A	N/A
HC47200308	PHYSICS CONSULT CONTINUOUS	333	77336	1,847.00	N/A
HC47200316	PHYSICS CONSULT SPECIAL	333	77370	2,222.00	N/A
HC47200423	RADIATION TX SUPRFCL OR/ORTH PER DAY	333	77401	1,213.00	N/A
HC47200456	RAD TREATMENT DELVR, = 1MEV;SIMPLE	333	77402	1,705.00	N/A
HC47200498	RAD TREATMENT DELVR, = 1MEV;INTRMED	333	77407	2,137.00	N/A
HC47200530	RAD TREATMENT DELVR, = 1MEV;CMPLX	333	77412	2,827.00	N/A
HC47200555	M: MISC RADIATION THERAPY	333	77399	N/A	N/A
HC47200563	RADIOELEMENT INFUSION	333	77750	1,184.00	N/A
HC47200571	SPECIAL DOSIMETRY	333	77331	1,507.00	N/A
HC47200589	SPECIAL TELETHERAPY PORT PLAN	333	77321	3,411.00	N/A
HC47200597	SPECIAL RAD TX;IRRAD,ENDO,CONE	333	77470	6,021.00	N/A
HC47200613	APPLY LOW DOSE RADIONUCLIDE SOURCE	333	77789	1,294.00	N/A
HC47200621	THERAPEUTIC RAD PORT IMAGES	333	77417	1,074.00	N/A
HC47200639	TRANSCATH PLCMNT RAD DEL DEVIC	333	92974	7,380.00	N/A
HC47200647	TREATMENT DEVICES SIMPLE	333	77332	1,521.00	N/A
HC47200654	TREATMENT DEVICES INTERMEDIATE	333	77333	2,347.00	N/A
HC47200662	TREATMENT DEVICES COMPLEX	333	77334	3,619.00	N/A
HC47200670	TREATMENT SIMULATION SIMPLE	333	77280	2,468.00	N/A
HC47200688	TREATMENT SIMULATION INTERMED	333	77285	3,254.00	N/A
HC47200696	TREATMENT SIMULATION COMPLEX	333	77290	4,559.00	N/A
HC47200704	RADIOTHERAPY PLAN 3D W/VOL HISTOGRAM	333	77295	15,782.00	N/A
HC47200738	M: UNLISTED BRACHY PROCEDURE	333	77799	N/A	N/A
HC47200746	M: UNLISTED THERAPEUTIC PROC	333	77499	N/A	N/A
HC47200811	SRS LINR ACCL TX 1 SESSN,CMPLT(CRANIAL)	333	77372	34,488.00	N/A
HC47200829	SRS LINR ACCL FX 1-5 SESSNS,CMPLT	333	77373	24,572.00	N/A
HC47200837	SRS ROBOTIC TX 1 SESSN, CMPLT(CRANIAL)	333	77372	34,488.00	N/A
HC47200845	SRS ROBOTIC FX EA 1-5 SESS,CMPLT	333	77373	24,828.00	N/A
HC47200894	STEREOTACTIC BODY RAD THER	333	77435	4,229.00	N/A
HC47200977	TREATMENT DEVICES MLC FOR IMRT	333	77338	5,018.00	N/A
HC47200993	DELIV TX XRAY INTRAOP SNGL SESSION	333	77424	4,681.00	N/A
HC47201009	DELIV TX ELCTRN INTRAOP SNGL SESS	333	77425	4,713.00	N/A
HC47201017	MANAGE RAD TREATMENT INTRAOP	333	77469	2,049.00	N/A
HC47201033	TELETX ISODOSE W/ DOSIMETRY;SIMPLE	333	77306	3,010.00	N/A
HC47201041	TELETX ISODOSE W/DOSIMETRY;COMPLEX	333	77307	5,218.00	N/A
HC47201058	BRACHYTX ISODOSE W/DOSIMETRY; SIMPL	333	77316	3,497.00	N/A
HC47201066	BRACHYTX ISODOSE W/DOSIMETRY;INTRM	333	77317	4,615.00	N/A
HC47201074	BRACHYTX ISODOSE W/DOSIMETRY;CMPLX	333	77318	6,843.00	N/A
HC47201082	IMRT TX DELIVERY,GUIDE&TRACK SIMPLE	333	77385	7,651.00	N/A
HC47201090	IMRT TX DELIVERY, GUIDE&TRACK CMPLX	333	77386	10,284.00	N/A
HC47201108	GUIDANCE RADIAJ TX DLVR (TRACKING)	333	77387	2,903.00	N/A
HC47201116	HDR RADIONUCLIDE INTRSTTL/INTRVIT BRACH 1 CHANNEL	333	77770	8,992.00	N/A
HC47201124	HDR RADIONUCLIDE INTRSTTL/INTRVIT BRACH 2-12 CHANN	333	77771	12,105.00	N/A
HC47201132	HDR RADIONUCLIDE INTRSTTL/INTRVIT BRACH 12+ CHANN	333	77772	14,730.00	N/A
HC47201165	BRACHYTX INSERT VAG RAD AFTRLOAD DEVICE	333	57156	2,910.00	N/A
HC29000312	TREADMILL STRESS TEST	519	93017	1,676.00	N/A
HC29000320	STEP TEST	519	93799	235.00	N/A
HC41500109	EEG AWAKE AND DROWSY	740	95816	2,193.00	N/A
HC41500117	EEG CEREBRAL SILENCE	740	95824	3,019.00	N/A
HC41500125	EEG INTRAOP NON-INTRACRANIAL	740	95955	1,317.00	N/A
HC41500133	EEG MONITORING 61-119MINUTES	740	95813	3,046.00	N/A
HC41500141	EEG MONITORING 41-60MINUTES	740	95812	1,950.00	N/A
HC41500166	EEG ROUTINE(AWAKE&ASLEEP)	740	95819	2,730.00	N/A
HC41500174	EEG SLEEP(ONLY)	740	95822	2,595.00	N/A
HC41500471	WADA TEST	740	95958	3,258.00	N/A
HC41500679	EEG ANALYSIS DIGITAL	740	95957	643.00	N/A
HC41500703	EEG PHARMACOLOGICAL/PHYSICAL ACTIVATION	740	95954	4,034.00	N/A
HC41500760	EEG SETUP W/VIDEO REC CONT MIN8 CHNNL	740	95700	1,068.00	N/A
HC41500778	EEG W/O VID UNMONITOR 2-12 HR	740	95705	889.00	N/A
HC41500786	EEG W/O VID MONITOR INTERMIT 2-12HR	740	95706	1,931.00	N/A
HC41500794	EEG W/O VID MONITOR CONT 2-12HR	740	95707	2,986.00	N/A
HC41500802	EEG W/O VID UNMONITOR EA 12-26HR	740	95708	1,989.00	N/A
HC41500810	EEG W/O VID MONITOR INTERMT EA 12-26HR	740	95709	2,547.00	N/A
HC41500828	EEG W/O VID MONITOR CONT EA 12-26HR	740	95710	3,560.00	N/A
HC41500836	EEG W/VIDEO UNMONITOR 2-12 HR	740	95711	1,844.00	N/A
HC41500844	EEG W/VIDEO MONITOR INTERMT 2-12 HR	740	95712	4,072.00	N/A
HC41500851	EEG W/VIDEO MONITOR CONT 2-12 HR	740	95713	3,975.00	N/A
HC41500869	EEG W/VIDEO UNMONITOR EA 12-26 HR	740	95714	2,774.00	N/A
HC41500877	EEG W/VIDEO MONITOR INTERMT EA 12-26HR	740	95715	4,486.00	N/A
HC41500885	EEG W/VIDEO MONITOR CONT EA 12-26HR	740	95716	7,069.00	N/A
HC42000018	ECG EXT PT ACTV EVENT MONITOR ATTEND 24HRS-30DAYS;HOOK&RECORD	731	93270	1,214.00	N/A
HC42000042	BIOIMPEDENCE THORACIC	480	93701	701.00	N/A
HC42000067	CV STRESS TEST TREADMILL	482	93017	2,340.00	N/A
HC42000075	CV STRESS TEST PHARMACOLOGIC	482	93017	2,490.00	N/A
HC42000109	ECG ROUTINE 12+ LEADS	730	93005	635.00	N/A
HC42000117	ECG ROUTINE 15 LEADS	730	93005	668.00	N/A
HC42000281	ERGONOVINE PROVOCATION TEST	482	93024	1,095.00	N/A
HC42000315	ECG EXT HOLTER W/CONNECT UP TO 48HRS; RECORD	731	93225	1,372.00	N/A
HC42000331	ECG EXT HOLTER UP TO 48HRS; SCANNING ANYS & REPORT	731	93226	1,791.00	N/A
HC42000398	PROGRAM/EVAL T-ICD SNGL LEAD	480	93282	432.00	N/A
HC42000406	PROGRAM/EVAL T-ICD DUAL LEAD	480	93283	512.00	N/A
HC42000414	PROGRAM/EVAL T-ICD MULTI LEAD	480	93284	590.00	N/A
HC42000430	PROGRAM EVAL CARDIAC RHYTHM MON SQ	480	93285	383.00	N/A
HC42000448	PROGRAM EVAL PACEMAKER SINGLE LEAD/LEADLESS	480	93279	366.00	N/A
HC42000455	PROGRAM/EVAL PACEMKR DUAL LEAD	480	93280	457.00	N/A
HC42000463	PROGRAM/EVAL PACEMKR MULT LEAD	480	93281	506.00	N/A
HC42000489	RHYTHM STRIP 1-3 LEADS	730	93041	358.00	N/A
HC42000497	SIGNAL AVERAGE ECG	730	93278	865.00	N/A
HC42000646	ECG EXT PT ACTV EVENT MONITOR ATTEND 24HRS-30DAYS; TRANSMIT/ANYS	731	93271	2,851.00	N/A
HC42000828	ECG EXT TELEM MCT>24HRS-30DAYS TECH ATTEND TIME;CONNECT&TRANS	731	93229	2,939.00	N/A
HC42000885	ECG EXT HOLTER W/CONNECT>48HRS-7DAYS; RECORDING	731	93242	1,020.00	N/A
HC42000893	ECG EXT HOLTER >48HRS-7DAYS; SCANNING ANYS W/REPORT	731	93243	1,199.00	N/A
HC42000901	ECG EXT HOLTER W/CONNECT >7DAYS-15DAYS; RECORDING	731	93246	1,228.00	N/A
HC42000919	ECG EXT HOLTER >7DAYS-15DAYS; SCANNING ANYS W/REPORT	731	93247	1,803.00	N/A
HC42000927	CTA CORONARY FFR DATA PREP&TRANSMIT	481	0502T	725.00	N/A
HC42000935	CTA CORO FFR ANLYSIS FLUID DYNAMICS&HYPEREMIA MAX SIM W/DATA MODEL	481	0503T	4,000.00	N/A
HC44700136	COMP EP EVAL W/O IND ARRHYTH	481	93619	19,047.00	N/A
HC44700144	COMP EP EVAL W/ INDUC ARRHYTHM	481	93620	24,524.00	N/A
HC44700151	COMP EP EVAL W/LT ATRIAL PACE+	481	93621	12,394.00	N/A
HC44700169	COMP EP EVAL W/LT VENT PACE+	481	93622	10,637.00	N/A
HC44700193	EP EVAL ICD LEADS/GEN AT IMPLA	481	93641	6,836.00	N/A
HC44700201	EP EVAL T-ICD W/PROGRAMMING	481	93642	7,167.00	N/A
HC44700219	EP FOLLOW UP POST THERAPY	481	93624	10,343.00	N/A
HC44701555	PHYSIOLOGIC EXERCISE STUDY+	481	93464	1,551.00	N/A
HC44702983	EVAL EP ICD/LEAD SUBQ	481	93644	5,816.00	N/A
HC51000164	ECG ROUTINE 12+ LEADS	730	93005	116.00	N/A
HC51001618	ECG ROUTINE 12+ LEADS; TRACING ONLY	730	93005	116.00	N/A
HC51001949	ECG EXT HOLTER W/CONNECT UP TO 48HRS; RECORD	731	93225	232.00	N/A
HC51061158	ECG ROUTINE 15 LEADS	730	93005	130.00	N/A
HC51061430	ECG EXT HOLTER UP TO 48HRS; SCANNING ANYS & REPORT	731	93226	232.00	N/A
HC51061448	ECG EXT TELEM MCT>24HRS-30DAYS TECH ATTEND TIME;CONNECT&TRANS	731	93229	350.00	N/A
HC51061455	ECG EXT HOLTER W/CONNECT>48HRS-7DAYS; RECORDING	731	93242	125.00	N/A
HC51061463	ECG EXT HOLTER >48HRS-7DAYS; SCANNING ANYS W/REPORT	731	93243	165.00	N/A
HC51061471	ECG EXT HOLTER W/CONNECT >7DAYS-15DAYS; RECORDING	731	93246	165.00	N/A
HC51061489	ECG EXT HOLTER >7DAYS-15DAYS; SCANNING ANYS W/REPORT	731	93247	240.00	N/A
HC51061497	ECG EXT PT ACTV EVENT MONITOR ATTEND 24HRS-30DAYS;HOOK&RECORD	731	93270	130.00	N/A
HC51061505	ECG EXT PT ACTV EVENT MONITOR ATTEND 24HRS-30DAYS; TRANSMIT/ANYS	731	93271	235.00	N/A
HC51062008	SELF MEASURE BP PT EDUCATION/TRAINING	510	99473	75.00	N/A
HC13500061	GENETIC COUNSELING EA 30MIN/P	510	96040	362.00	N/A
HC21000658	WOUND ULTRASOUND PER DAY	361	97610	711.00	N/A
HC27000009	ANORECTAL MANOMETRY	750	91122	4,035.00	N/A
HC27000140	BREATH HYDROGEN TEST	761	91065	1,451.00	N/A
HC27000835	ESOPH MOTILITY/MANO' DISCONT'D	750	91010	1,303.00	N/A
HC27000884	ESOPH MOTILTY/MANO STDY/I&R;2D	750	91010	4,203.00	N/A
HC27001247	ESOPH MOTILTY STDY/STIM/PERF2D	750	91013	2,400.00	N/A
HC27001296	ANORECTAL MANOMETRY DISCON'D	750	91122	1,046.00	N/A
HC27001908	INSTILL FECAL MICROBIOTA (FMT)	750	G0455	3,448.00	N/A
HC27001924	GI TRACT CAPSULE PATENCY STUDY	750	91299	537.00	N/A
HC29000304	AUDIOMETRY	519	92552	255.00	N/A
HC29000346	PLETHYSMOGRAPHY	519	94726	487.00	N/A
HC29000494	SCREENING PURE TONE HEARING AIR	510	92551	145.00	N/A
HC31000151	PT-COMPUT DYNAMIC POSTURE SOT 6 CONDITIONS	420	92548	895.00	N/A
HC31010168	PT-COMPUT DYNAMIC POSTURE SOT 6 CNDTNS; &MCT&ADT	420	92549	1,101.00	N/A
HC32000051	OT-COMPUT DYNAMIC POSTURE SOT 6 CONDITIONS	430	92548	895.00	N/A
HC32010217	OT-COMPUT DYNAMIC POSTURE SOT 6 CNDTNS; &MCT&ADT	430	92549	1,101.00	N/A
HC33000209	SP-LARYNGEAL FUNCTION STUDIES	444	92520	532.00	N/A
HC33000753	ST-SCREEN PURE TONE, AIR ONLY	471	92551	147.00	N/A
HC33000779	ST-LARYNGEAL FUNCTION STUDIES	444	92520	532.00	N/A
HC34000000	AUD-PURE TONE AUDIO AIR ONLY	471	92552	277.00	N/A
HC34000018	AUD-PURE TONE AUDIO AIR&BONE	471	92553	451.00	N/A
HC34000026	AUD-AUDIOMETRY THRESHOLD	471	92555	204.00	N/A
HC34000034	AUD-AUDIO THRESHOLD W/RECOG	471	92556	333.00	N/A
HC34000042	AUD-COMPREHENSV AUDIOMETRY/MCW	471	92557	731.00	N/A
HC34000059	AUD-TYMPANOMETRY/MCW	471	92567	320.00	N/A
HC34000067	AUD-ACOUSTIC REFLEX TEST/MWC	471	92568	255.00	N/A
HC34000083	AUD-VISUAL REINFORCE AUDIO(VRA)	471	92579	394.00	N/A
HC34000091	AUD-CONDITIONING PLAY AUDIO	471	92582	409.00	N/A
HC34000133	AUD-OTOACOUSTIC EVOKED RESP LTD	471	92587	521.00	N/A
HC34000141	AUD-EV OTOACOUSTIC EMM COMP/MW	471	92588	732.00	N/A
HC34000158	AUD-HEARING AID EXAM MONAURAL	471	92590	365.00	N/A
HC34000166	AUD-HEARING AID EXAM&SEL BI/MCW	471	92591	505.00	N/A
HC36000016	AEROSOL-CONTINUOUS TX FIRST HR	412	94644	705.00	N/A
HC36000024	AEROSOL-CONTINUOUS TX EA AD'HR	412	94645	631.00	N/A
HC36000651	PLETHYSMOGRAPHY LUNG VOL	410	94726	1,073.00	N/A
HC36000669	GAS DILUT/WASHOUT LUNG VOL	410	94727	908.00	N/A
HC36000677	AIRWAY RESISTANCE OSCILLOMETRY	410	94728	1,049.00	N/A
HC36000685	DIFFUSING CAPACITY+	410	94729	962.00	N/A
HC36000784	PULSE OX NOCTURNAL STUDY	410	94762	1,342.00	N/A
HC36000982	HTN ASSESSMENT W/ NITRIC OXIDE	460	94799	836.00	N/A
HC36001055	SPIROMETRY W/MEASUREMNTS& REC	460	94010	864.00	N/A
HC36001063	SPIROMETRY W/PRE&POST BRONCHO	460	94060	1,604.00	N/A
HC36001113	BREATHING RESPONSE HYPOXIA CURVE	410	94450	586.00	N/A
HC36800126	TEST BRONCHIAL INHAL CHALLENGE W/HISTAMINE	460	95070	1,518.00	N/A
HC36800134	BRONCHIAL PROVOCATION EVAL	460	94070	2,266.00	N/A
HC36800175	EXHALED NITRIC OXIDE MEASRMNT	460	95012	688.00	N/A
HC36800183	FLOW VOLUME LOOP	460	94375	728.00	N/A
HC36800209	HIGH ALTITUDE SIM' TEST- HAST	460	94452	1,592.00	N/A
HC36800217	HIGH ALTD SIM TEST W/O2TI-HAST	460	94453	1,708.00	N/A
HC36800225	HTN ASSESSMENT W/ NITRIC OXIDE	460	94799	842.00	N/A
HC36800233	M V V (MAX VOL VENT)	460	94200	539.00	N/A
HC36800258	O2 UPTAKE COMPLETE	460	94681	1,581.00	N/A
HC36800266	O2 UPTAKE CO2 OUTPUT @REST IND	460	94690	1,071.00	N/A
HC36800290	PNEUMOGRAM 12-24HR REC INFANT	460	94772	2,003.00	N/A
HC36800324	TEST EXERC CARIOPULM INCL VENT,CO2,O2,EKG	460	94621	3,822.00	N/A
HC36800357	PULSE OX NOCTURNAL STUDY	460	94762	1,340.00	N/A
HC36800365	PULSE OX NOCTURNAL STUDY DC'D	460	94762	559.00	N/A
HC36800381	SPIROMETRY W/MEASUREMNTS& REC	460	94010	864.00	N/A
HC36800399	SPIROMETRY W/PRE&POST BRONCHO	460	94060	1,604.00	N/A
HC36800415	VITAL CAPACITY	410	94150	534.00	N/A
HC36800704	PLETHYSMOGRAPHY LUNG VOL	460	94726	1,083.00	N/A
HC36800712	GAS DILUT/WASHOUT LUNG VOL	460	94727	908.00	N/A
HC36800720	AIRWAY RESISTANCE OSCILLOMETRY	460	94728	1,049.00	N/A
HC36800738	DIFFUSING CAPACITY+	460	94729	968.00	N/A
HC36800753	SPIROMETRY INFANT-2Y/O	460	94011	642.00	N/A
HC36800761	SPIROMETRY INF PRE&POST RX ADM	460	94012	1,099.00	N/A
HC36800779	PFT/LUNG VOL INFANT-2Y/O	460	94013	1,212.00	N/A
HC36800811	BREATHING RESPONSE HYPOXIA CURVE	460	94450	586.00	N/A
HC36800852	TEST EXERC BRONCHOSPASM INCL SPIR&POX W/O ECG	460	94619	1,757.00	N/A
HC36800860	TEST STRESS PULMON INCL HR,POX,O2 TIT	460	94618	977.00	N/A
HC39000203	NEUROPSYCH STATUS EXAM/HR	918	96116	724.00	N/A
HC39001235	NEUROBEHAVIORAL STATUS EXAM CLIN ASSESS INTERP & REPORT;  EA ADDL HR+	918	96121	483.00	N/A
HC39001243	PSYCH TESTING EVAL INTEGR INTERPRET CLIN DES TX; 1ST HOUR	918	96130	522.00	N/A
HC39001250	PSYCH TESTING EVAL INTEGR INTERPRET CLIN DES TX; EA ADDL HR+	918	96131	532.00	N/A
HC39001268	NEUROPSYCH TESTING EVAL INTRG INTERP CLIN DES TX FEEDBACK; 1ST HOUR	918	96132	522.00	N/A
HC39001276	NEUROPSYCH TEST EVAL INTRG INTERP  CLIN DES FEEDBACK; EA ADDL HR+	918	96133	513.00	N/A
HC39001284	PSYCH/NEUROPSYCH TEST ADMIN & SCORING, 2 OR > TESTS; 1ST 30 MIN	918	96136	230.00	N/A
HC39001292	PSYCH/NEUROPSYCH TEST ADMIN & SCORING, 2 OR > TESTS;  EA ADDL 30MIN+	918	96137	198.00	N/A
HC39001300	PSYCH/NEUROPSYCH TEST ADMIN SNGLE AUTO INSTRU VIA ELECTRONIC AUTO RESULT ON	918	96146	159.00	N/A
HC39001318	BEHAVIOR ID ASSESS ADMIN BY QHCP PT/GUARD EA 15MIN	918	97151	118.00	N/A
HC39001326	BEHAVIOR ADAPT TX ADMN QHCP EA 15MIN	918	97155	118.00	N/A
HC39001334	BEHAVIOR ADAPT TX FAMILY GUIDNC QHCP W GUARDIANS EA 15MIN	918	97156	118.00	N/A
HC39001342	BEHAVIOR ADAPT MULT FAM TX GDN W/O PT; EA 15MIN	918	97157	118.00	N/A
HC39001359	BEHAVIOR ADAPT TX GROUP BY QHCP; EA 15MIN	918	97158	118.00	N/A
HC41000127	HOME SLEEP STUDY/T II MIN' 7CH	920	G0398	1,260.00	N/A
HC41000128	HOME SLEEP STUDY/T III MIN'4CH	920	G0399	1,021.00	N/A
HC41000129	HOME SLEEP STUDY/T IV MIN' 3CH	920	G0400	870.00	N/A
HC41500034	CENTRAL MOTOR EVOKED LOW LIMBS	922	95929	2,257.00	N/A
HC41500042	CENTRAL MOTOR EVOKED UP LIMBS	922	95928	2,339.00	N/A
HC41500356	NEUROMUSC REPEAT STIM EA NERVE	922	95937	1,038.00	N/A
HC41500364	NYSTAGMUS MIN 4POSITIONS W/REC	471	92542	584.00	N/A
HC41500372	NYSTAGMUS OPTOKINETIC BIDIRECT	471	92544	522.00	N/A
HC41500380	NYSTAGMUS SPONT GAZE/FIX	471	92541	539.00	N/A
HC41500398	OSCILLAT TRACKING TEST W/REC	471	92545	501.00	N/A
HC41500406	SINUSOIDAL VERT ROTATION(VORT)	471	92546	1,375.00	N/A
HC41500414	SOMATOSENSORY HEAD/TRUNK	922	95927	2,508.00	N/A
HC41500422	SOMATOSENSORY LOWER LIMBS	922	95926	2,671.00	N/A
HC41500430	SOMATOSENSORY UPPER LIMBS	922	95925	2,800.00	N/A
HC41500448	USE OF VERTICAL ELECTRODES	471	92547	578.00	N/A
HC41500455	VASOMOTOR ADRENERGIC INNERV	920	95922	1,004.00	N/A
HC41500463	VISUAL EVOKED RESP CNS/FLASH	922	95930	2,066.00	N/A
HC41500489	EMG 1 EXTREM W/PARASPINAL LTD+	922	95885	803.00	N/A
HC41500497	EMG EA EXTRM /PRSPNL;CMPL 5MUS+	922	95886	812.00	N/A
HC41500505	EMG NON-EXTREM (FACIAL) MUSC +	922	95887	718.00	N/A
HC41500513	SOMATOSENSORY UPPER& LWR LIMBS	922	95938	4,267.00	N/A
HC41500521	CENTRAL MOTOR EVOK UP& LWR LIMBS	922	95939	4,784.00	N/A
HC41500554	VESTIBULAR COMPREHENSIVE EVAL	471	92540	1,561.00	N/A
HC41500562	STUDIES NERVE CONDUCTN 1-2 STUDIES	922	95907	974.00	N/A
HC41500570	STUDIES NERVE CONDUCTN 3-4 STUDIES	922	95908	1,428.00	N/A
HC41500588	STUDIES NERVE CONDUCTN 5-6 STUDIES	922	95909	1,686.00	N/A
HC41500596	STUDIES NERVE CONDUCTN 7-8 STUDIES	922	95910	1,964.00	N/A
HC41500604	STUDIES NERVE CONDUCTN 9-10 STUDIES	922	95911	2,243.00	N/A
HC41500612	STUDIES NERVE CONDUCTN11-12 STUDIES	922	95912	2,401.00	N/A
HC41500620	STUDIES NERVE CONDUCTN 13/> STUDIES	922	95913	2,724.00	N/A
HC41500638	MONITOR NEURO INTRAOP CONT ATTEND 1:1 EA 15MIN+	920	95940	243.00	N/A
HC41500646	MONITOR NEURO INTRAOP CONT REMOTE >1 PT PER HR	920	95941	395.00	N/A
HC41500653	MONITOR NEURO INTRAOP CONT REMOTE PER PT 15MIN+	920	G0453	209.00	N/A
HC41500711	EMG LARYNX	922	95865	1,089.00	N/A
HC41500729	EMG HEMIDIAPHRAGM	922	95866	1,111.00	N/A
HC41500752	ORBICULARIS OCULI (BLINK) REFLEX	922	95933	537.00	N/A
HC41500893	VESTIBULAR EVOKD MYOGN POTENTL-VEMP;CERVICAL (CVEMP)	471	92517	687.00	N/A
HC41500901	VESTIBULR EVOKD MYOGN POTENTL-VEMP;OCULAR (OVEMP)	471	92518	687.00	N/A
HC41500919	VESTIBULR EVOKD MYOGN POTENTL-VEMP; CVEMP & OVEMP	471	92519	1,057.00	N/A
HC42000026	AMB BP MONITOR 24HR+ RECORD ONLY	480	93786	813.00	N/A
HC42000034	AMB BP MONITOR 24HR+ ANALYSIS W/RPT; SCANNING	480	93788	814.00	N/A
HC42000299	EVAL PCMKR TRANSTELEPH ^90D	480	93293	432.00	N/A
HC42000349	INTERROGATE REMOTE ^90 D; SGL/DUAL/MULTI/LEADLESS/DEFIB	480	93296	478.00	N/A
HC42000356	INTERROGATION T-ICD	480	93289	578.00	N/A
HC42000364	INTERROGATE  IMP' CVPHYS MONITOR 1 OR MORE DATA	480	93290	449.00	N/A
HC42000372	INTERROGATE SQ CARDIAC RHYTHM MONITOR	480	93291	403.00	N/A
HC42000380	INTERROGATE  PACEMAKER SGL/DUAL/MULTI/LEADLESS	480	93288	504.00	N/A
HC42000422	PROGRAM/EVAL T-ICD PRE/POST PROC	480	93287	445.00	N/A
HC42000471	PROGRAM EVAL PERI-OP PACEMAKER SGL/DUAL/MULTI/LEADLESS	480	93286	410.00	N/A
HC44200038	US ART NONINVAS REST/STRES LEA	921	93924	2,051.00	N/A
HC44200046	ART STDY BILAT U/L 1-2 LVL LTD	921	93922	1,480.00	N/A
HC44200053	ART STDY BILAT U/L 3/> LVL CMP	921	93923	2,284.00	N/A
HC44200848	ART STDY SNG U/L 1-2 LVL LTD-R	921	93922	1,022.00	N/A
HC44200855	ART STDY SNG U/L 1-2 LVL LTD-L	921	93922	1,022.00	N/A
HC44200863	ART STDY SNG U/L 3/> LVL CMP-R	921	93922	1,480.00	N/A
HC44200871	ART STDY SNG U/L 3/> LVL CMP-L	921	93922	1,480.00	N/A
HC44200913	TCD ICA VASOREACTIVITY STUDY	921	93890	3,086.00	N/A
HC44700185	EP EVAL ICD LEADS AT IMPLANT	481	93640	7,528.00	N/A
HC45600095	PET ANY SITE, NOS	404	G0235	8,770.00	N/A
HC47201025	MOTION RESPIRATORY MGNT SIMULATION+	333	77293	4,177.00	N/A
HC51000156	BREATH HYDROGEN TEST	510	91065	255.00	N/A
HC51000172	SPIROMETRY W/MEASUREMNTS& REC	510	94010	247.00	N/A
HC51000180	SPIROMETRY W/PRE&POST BRONCHO	510	94060	467.00	N/A
HC51002582	ANALYZ COMPLX NRSTM SPNL CD/PERIPH W/PROG	471	95972	379.00	N/A
HC51003424	ANORECTAL MANOMETRY	510	91122	700.00	N/A
HC51004059	AEROSOL-CONTINUOUS TX FIRST HR	510	94644	152.00	N/A
HC51004067	AEROSOL-CONTINUOUS TX EA AD'HR	510	94645	88.00	N/A
HC51004125	DIFFUSING CAPACITY+ /M	510	94729	220.00	N/A
HC51004133	ANALYZ NRSTM NO REPROGRAMMING	510	95970	268.00	N/A
HC51010452	TESTS PERCUTANEOUS ALLERGY	510	95004	555.00	N/A
HC51010460	MEASURE NO2 EXHALED	510	95012	81.00	N/A
HC51010478	TEST ALLERGY PERQ&INTRAQ VENOM	510	95017	65.00	N/A
HC51010486	TEST ALLERGY PERQ&INTRAQ RX/BIOLOGIC	510	95018	75.00	N/A
HC51010494	TEST ALLERGY INTRAQ RX/BIOLOGIC	510	95024	100.00	N/A
HC51010502	TEST ALLERGY INTRAQ AIRBORNE	510	95027	65.00	N/A
HC51010510	TEST ALLERGY INTRAQ DELAYED RXN	510	95028	75.00	N/A
HC51010528	TEST ALLERGY PATCH	510	95044	555.00	N/A
HC51010536	TEST ALLERGY PATCH PHOTO	510	95052	60.00	N/A
HC51010544	TEST CHALLENGE INGEST 1ST120MIN	510	95076	555.00	N/A
HC51010551	TEST CHALLENGE INGEST ADD 60MIN	510	95079	241.00	N/A
HC51060812	PSYCH/NEUROPSYCH TEST ADMIN SNGLE AUTO INSTRU VIA ELECTRONIC AUTO RESULT ON	510	96146	80.00	N/A
HC51061190	ST-LARYNGEAL FUNCTION STUDIES	440	92520	307.00	N/A
HC51061935	SPIROMETRY PT INITIATED 30DAY; EDUCATION TRANSMIT INTERPRETATION	510	94014	525.00	N/A
HC51061943	SPIROMETRY PT INITIATED 30DAY; HOOKUP RECORD TREND RECALIBRATION	510	94015	500.00	N/A
HC51062024	SELF MANAGEMENT EDUC & TRAINING INDIV 30MIN (PRIVAT INSAUTHREQ)	510	98960	150.00	N/A
HC51062032	SELF MANAGEMENT EDUC & TRAINING 2-4PTS 30MIN (PRIVAT INSAUTHREQ)	510	98961	100.00	N/A
HC51062040	SELF MANAGEMENT EDUC & TRAINING 5-8PTS 30MIN (PRIVAT INSAUTHREQ)	510	98962	75.00	N/A
HC51070068	NEUROPSYCH STATUS EXAM/HR	510	96116	487.00	N/A
HC51070548	NEUROBEHAVIORAL STATUS EXAM CLIN ASSESS INTERP & REPORT;  EA ADDL HR+	510	96121	265.00	N/A
HC51070555	PSYCH TESTING EVAL INTEGR INTERPRET CLIN DES TX; 1ST HOUR	510	96130	400.00	N/A
HC51070563	PSYCH TESTING EVAL INTEGR INTERPRET CLIN DES TX; EA ADDL HR+	510	96131	286.00	N/A
HC51070571	NEUROPSYCH TESTING EVAL INTRG INTERP CLIN DES TX FEEDBACK; 1ST HOUR	510	96132	400.00	N/A
HC51070589	NEUROPSYCH TEST EVAL INTRG INTERP  CLIN DES FEEDBACK; EA ADDL HR+	510	96133	260.00	N/A
HC51070597	PSYCH/NEUROPSYCH TEST ADMIN & SCORING, 2 OR > TESTS; 1ST 30 MIN	510	96136	199.00	N/A
HC51070605	PSYCH/NEUROPSYCH TEST ADMIN & SCORING, 2 OR > TESTS;  EA ADDL 30MIN+	510	96137	90.00	N/A
HC51070613	BEHAVIOR ID ASSESS ADMIN BY QHCP PT/GUARD EA 15MIN	510	97151	82.00	N/A
HC51070621	BEHAVIOR ADAPT TX ADMN QHCP EA 15MIN	510	97155	82.00	N/A
HC51070639	BEHAVIOR ADAPT TX FAMILY GUIDNC QHCP W GUARDIANS EA 15MIN	510	97156	82.00	N/A
HC51070647	BEHAVIOR ADAPT MULT FAM TX GDN W/O PT; EA 15MIN	510	97157	82.00	N/A
HC51070654	BEHAVIOR ADAPT TX GROUP BY QHCP; EA 15MIN	510	97158	82.00	N/A
HC51070829	TEST STRESS PULMON INCL HR,POX,O2 TIT (6MIN WALK)	510	94618	350.00	N/A
HC51070837	TEST EXERC BRONCHOSPSM INCL SPIR & POX W/O ECG	510	94619	300.00	N/A
HC41000001	SLEEP STUDY - MSLT/MWT	740	95805	5,250.00	N/A
HC41000019	SLEEP STUDY ATTENDED	920	95807	4,750.00	N/A
HC41000027	SLEEP STUDY ATTENDED DISCNT'D	920	95807	1,706.00	N/A
HC41000035	POLYSOMNOGRAPHY 4+ STAGES 6&> ATTD	740	95810	7,075.00	N/A
HC41000043	POLYSOMNOGRAPHY 4+ STG 6&> REDCD SVC	740	95810	3,206.00	N/A
HC41000050	POLYSOMNOGRAPHY CPAP/BIPAP 6&> ATTD	740	95811	7,125.00	N/A
HC41000068	POLYSMNGRPH 4+STG6&> ATTD DISCONT'	740	95810	1,769.00	N/A
HC41000076	POLYSMN CPAP/BIPAP6&>ATTD REDCD SVC	740	95811	3,835.00	N/A
HC41000084	POLYSMNGRPH 4+STGS <6 Y/O ATTD	740	95782	7,250.00	N/A
HC41000092	POLYSMNGRPH 4+STG<6Y/O ATTD RDC SVC	740	95782	3,738.00	N/A
HC41000100	POLYSMNGRPH 4+STGS <6 DISCONT	740	95782	1,669.00	N/A
HC41000118	POLYSMNGRPH CPAP/BIPAP <6Y/O ATTD	740	95783	7,500.00	N/A
HC41000126	POLYSMN CPAP/BIPAP<6 ATTD REDCD SVC	740	95783	3,290.00	N/A
HC31000003	PT-SELF/HOME MGMT/ADL 15MIN/M	420	97535	238.00	N/A
HC31000052	PT-AQUATIC THERAPY 15MIN/M	420	97113	247.00	N/A
HC31000060	PT-AQUATIC GRP 30MIN/MCW	423	97150	117.00	N/A
HC31000078	PT-AQUATIC GRP 45MIN/M	423	97150	228.00	N/A
HC31000086	PT-AQUATIC GRP 60MIN/M	423	97150	401.00	N/A
HC31000102	PT-ASSESS ASSIST TECH 15MIN/CM	420	97755	173.00	N/A
HC31000144	PT-COMMTY WK/REINTEGRT 15M/M	420	97537	233.00	N/A
HC31000169	PT-CONTRAST BATH 15MIN/MW	420	97034	145.00	N/A
HC31000193	PT-ELEC STIM/TENS ATTD15MIN/MW	420	97032	202.00	N/A
HC31000201	PT-THER ACTIVITIES 15MIN/M	420	97530	246.00	N/A
HC31000219	PT-PHYS PERFORM TEST 15 MIN/M	424	97750	203.00	N/A
HC31000227	PT-GAIT TRAINING 15MIN/M	420	97116	240.00	N/A
HC31000284	PT-HOT/COLD PACKS /CMW	420	97010	132.00	N/A
HC31000292	PT-HUBBARD TANK 15MIN/M	420	97036	236.00	N/A
HC31000300	PT-INFRARED/CMW	420	97026	166.00	N/A
HC31000318	PT-EVAL LOW COMPLEXITY <20MF2F 15MIN	424	97161	299.00	N/A
HC31000326	PT-EVAL LOW COMPLEXITY 20MF2F 30MIN	424	97161	488.00	N/A
HC31000334	PT-EVAL MOD COMPLEXITY 30MF2F 45MIN	424	97162	705.00	N/A
HC31000342	PT-EVAL HIGH COMPLEXITY 45MF2F 60MIN	424	97163	893.00	N/A
HC31000359	PT-EVAL HIGH COMPLEXITY 45MF2F 75MIN	424	97163	1,104.00	N/A
HC31000367	PT-EVAL HIGH COMPLEXITY 45MF2F 90MIN	424	97163	1,241.00	N/A
HC31000375	PT-IONTOPHORESIS 15MIN/MW	420	97033	223.00	N/A
HC31000383	PT-MANUAL THERAPY 15MIN/M	420	97140	236.00	N/A
HC31000391	PT-MASSAGE 15MIN/M	420	97124	208.00	N/A
HC31000409	PT-NEUROMUSC RE-ED 15MIN/M	420	97112	235.00	N/A
HC31000417	PT-ORTHOTIC/PROSTH MGMT/TRAIN SUBSQ 15MIN/CMW	420	97763	228.00	N/A
HC31000425	PT-ORTHOTIC MGMT & TRNG INITIAL ENC 15MIN/M	420	97760	270.00	N/A
HC31000433	PT-PARAFFIN BATH /CMW	420	97018	160.00	N/A
HC31000441	PT-PROSTHETIC MGMT & TRNG INITIAL ENC 15MIN/M	420	97761	214.00	N/A
HC31000458	PT-RE-EVAL EST POC  15MIN	424	97164	276.00	N/A
HC31000466	PT-RE-EVAL EST POC  30MIN	424	97164	465.00	N/A
HC31000474	PT-RE-EVAL EST POC  45MIN	424	97164	667.00	N/A
HC31000482	PT-RE-EVAL EST POC  60MIN	424	97164	797.00	N/A
HC31000615	PT-THER EXER 15MIN/M	420	97110	241.00	N/A
HC31000623	PT-TRACTION/MECHANICAL/CMW	420	97012	204.00	N/A
HC31000631	PT-ULTRASOUND 15MIN/MW	420	97035	190.00	N/A
HC31000722	PT-WHEELCHAIR MGT 15MIN/M	420	97542	218.00	N/A
HC31000730	PT-APPLY WHIRLPOOL MODALITY	420	97022	332.00	N/A
HC31000748	PT-APPLY WHIRLPOOL MODALITY	420	97022	332.00	N/A
HC31000755	PT-WORK HARDENING INIT 2HR/CMW	420	97545	711.00	N/A
HC31000763	PT-WORK HARDENING ADD 1HR/CMW+	420	97546	387.00	N/A
HC31001365	PT-RE-EVAL EST POC  75MIN	424	97164	958.00	N/A
HC31001373	PT-RE-EVAL EST POC  90MIN	424	97164	1,158.00	N/A
HC31001472	PT-THER PROC GRP 30MIN/MWC	423	97150	201.00	N/A
HC31001480	PT-THER PROC GRP 45MIN/MC	423	97150	251.00	N/A
HC31001498	PT-THER PROC GRP 60MIN/MC	423	97150	407.00	N/A
HC31001514	PT-APPLY VASOPNEUMATIC DEV/MW	420	97016	168.00	N/A
HC31001753	PT-EVAL LOCOMOTOR /W	420	97799	756.00	N/A
HC31001779	PT-THER PROC GRP 15MIN/M	423	97150	95.00	N/A
HC31001787	PT-EVAL HIGH COMPLEXITY 45MIF2F 120MIN	424	97163	1,435.00	N/A
HC31001811	PT-THER PROC GRP 90MIN/MC	423	97150	425.00	N/A
HC31001829	PT-THER PROC GRP 120MIN/MC	423	97150	440.00	N/A
HC31001837	PT-EVAL HIGH COMPLEXITY 45MIF2F 150MIN	424	97163	2,068.00	N/A
HC31001845	PT-EVAL HIGH COMPLEXITY 45MIF2F 180MIN	424	97163	2,482.00	N/A
HC31001886	PT-WHEELCHAIR ASSESS 15 MIN/M	424	97750	203.00	N/A
HC31001894	PT-EVAL LOCOMOTOR TRAINING	420	97799	318.00	N/A
HC31001902	LOCOMOTOR TRAINING	420	97799	311.00	N/A
HC31001910	LOCOMOTOR TRAINING/W	420	97799	756.00	N/A
HC31002058	PT-EVAL MOD COMPLEXITY 30MF2F 30MIN	424	97162	504.00	N/A
HC31002066	PT-EVAL MOD COMPLEXITY 30MF2F 60MIN	424	97162	837.00	N/A
HC31002074	PT-EVAL MOD COMPLEXITY 30MF2F 90MIN	424	97162	1,144.00	N/A
HC31002082	PT-EVAL HIGH COMPLEXITY 45MF2F 30MIN	424	97163	549.00	N/A
HC31002090	PT-EVAL HIGH COMPLEXITY 45MF2F 45MIN	424	97163	750.00	N/A
HC31002108	PT-EVAL LOW COMPLEXITY 20MF2F 45MIN	424	97161	621.00	N/A
HC31010002	PT-SELF/HOME MGMT/ADL 15MIN	420	97535	233.00	N/A
HC31010010	PT-NEUROMUSC RE-ED 15MIN	420	97112	231.00	N/A
HC31010028	PT-EVAL MOD COMPLEXITY 30M F2F [15MIN]	424	97162	239.00	N/A
HC31010036	PT-GAIT TRAINING 15MIN	420	97116	233.00	N/A
HC31010044	PT-THER ACTIVITIES 15MIN	420	97530	233.00	N/A
HC31010051	PT-THER EXER 15MIN	420	97110	235.00	N/A
HC31010069	PT-EVAL LOW COMPLEXITY 20MIN F2F [15MIN]	424	97161	233.00	N/A
HC31010077	PT-EVAL HIGH COMPLEXITY 45M F2F [15MIN]	424	97163	240.00	N/A
HC31010085	PT-RE-EVAL EST POC  [15MIN]	424	97164	223.00	N/A
HC31010093	PT-THER PROC GROUP [15MIN]	423	97150	89.00	N/A
HC31010101	PT-ELEC STIM/TENS ATTD 15MIN	420	97032	199.00	N/A
HC31010119	PT-WHEELCHAIR MGT 15MIN	420	97542	215.00	N/A
HC31010127	PT-COMMTY WK/REINTEGRT 15MIN	420	97537	224.00	N/A
HC31010135	PT-ORTHOTIC MGMT & TRNG INITIAL ENC 15MIN	420	97760	270.00	N/A
HC31010143	PT-MANUAL THERAPY 15MIN	420	97140	226.00	N/A
HC31010150	PT-ORTHOTIC/PROSTH MGMT/TRAIN SUBSQ 15MIN	420	97763	218.00	N/A
HC31010218	PT-AQUATIC THERAPY 15MIN	420	97113	239.00	N/A
HC31010234	PT-PROSTHETIC MGMT & TRNG INITIAL ENC 15MIN	420	97761	213.00	N/A
HC31010275	PT-IONTOPHORESIS 15MIN	420	97033	209.00	N/A
HC31010283	PT-ULTRASOUND 15MIN	420	97035	182.00	N/A
HC31010291	PT-PHYS PERFORM TEST 15 MIN	424	97750	203.00	N/A
HC32000002	OT-ADL 15MIN	430	97535	238.00	N/A
HC32000028	OT-ASSESS ASSIST TECH 15MIN/CM	430	97755	173.00	N/A
HC32000044	OT-COMMTY WK/REINTEGRAT 15M/M	430	97537	233.00	N/A
HC32000069	OT-CONTRAST BATH 15MIN/MW	430	97034	145.00	N/A
HC32000101	OT-ELEC STIM/TENS ATTD15MIN/MW	430	97032	202.00	N/A
HC32000135	OT-FUNCTIONAL ACTIVITY 15MIN	430	97530	247.00	N/A
HC32000143	OT-PHYS PERFORM TEST 15 MIN/MW	430	97750	203.00	N/A
HC32000150	OT-GAIT TRAINING 15MIN/M	430	97116	240.00	N/A
HC32000218	OT-HOT/COLD PACKS /CMW	430	97010	132.00	N/A
HC32000226	OT-HUBBARD TANK 15MIN/M	430	97036	236.00	N/A
HC32000234	OT-INFRARED/CMW	430	97026	166.00	N/A
HC32000242	OT-EVAL LOW COMPLEXITY <20MF2F 15MIN	434	97165	277.00	N/A
HC32000259	OT-EVAL LOW COMPLEXITY 20MF2F 30MIN	434	97165	503.00	N/A
HC32000267	OT-EVAL MOD COMPLEXITY 30MF2F 45MIN	434	97166	693.00	N/A
HC32000275	OT-EVAL HIGH COMPLEXITY 45MF2F 60MIN	434	97167	912.00	N/A
HC32000283	OT-EVAL HIGH COMPLEXITY 45MF2F 75MIN	434	97167	1,083.00	N/A
HC32000291	OT-EVAL HIGH COMPLEXITY 45MF2F 90MIN	434	97167	1,241.00	N/A
HC32000309	OT-IONTOPHORESIS 15MIN/MW	430	97033	223.00	N/A
HC32000317	OT-MANUAL THERAPY 15MIN/M	430	97140	236.00	N/A
HC32000325	OT-MASSAGE 15MIN/M	430	97124	208.00	N/A
HC32000333	OT-NEUROMUSC RE-ED 15MIN/M	430	97112	235.00	N/A
HC32000341	OT-ORTHOTIC/PROSTH MGMT/TRAIN SUBSQ 15MIN/M	430	97763	228.00	N/A
HC32000358	OT-ORTHOTIC MGMT & TRNG INITIAL ENC 15MIN/M	430	97760	270.00	N/A
HC32000366	OT-PARAFFIN BATH /CMW	430	97018	159.00	N/A
HC32000374	OT-PROSTHETIC MGMT & TRNG INITIAL ENC 15MIN/M	430	97761	214.00	N/A
HC32000382	OT-RE-EVAL EST POC  15MIN	434	97168	279.00	N/A
HC32000390	OT-RE-EVAL EST POC  30MIN	434	97168	484.00	N/A
HC32000408	OT-RE-EVAL EST POC  45MIN	434	97168	700.00	N/A
HC32000416	OT-RE-EVAL EST POC  60MIN	434	97168	930.00	N/A
HC32000424	OT-SENSRY INTEGRT TECH 15MIN	430	97533	204.00	N/A
HC32000549	OT-THER EXER 15MIN/M	430	97110	241.00	N/A
HC32000556	OT-THER PROC GRP  ADD 15MIN/CW	430	97150	98.00	N/A
HC32000564	OT-TRACTION/MECHANICAL/CMW	430	97012	204.00	N/A
HC32000572	OT-ULTRASOUND 15MIN/MW	430	97035	190.00	N/A
HC32000663	OT-WHEELCHAIR MGT 15MIN	430	97542	217.00	N/A
HC32000671	OT-WHIRLPOOL-EXTREMITY/CMW	430	97022	332.00	N/A
HC32000697	OT-WORK HARDENING INIT 2HR/CMW	430	97545	711.00	N/A
HC32000705	OT-WORK HARDENING ADD 1HR/CMW+	430	97546	387.00	N/A
HC32001273	OT-RE-EVAL EST POC  75MIN	434	97168	1,043.00	N/A
HC32001281	OT-RE-EVAL EST POC  90MIN	434	97168	1,233.00	N/A
HC32001299	OT-THER PROC GRP 1ST 30MIN/MW	430	97150	193.00	N/A
HC32001307	OT-THER PROC GRP 45MIN/MC	430	97150	233.00	N/A
HC32001315	OT-THER PROC GRP 60MIN/MC	430	97150	389.00	N/A
HC32001356	OT-THER PROC GRP 30MIN/CMW	430	97150	193.00	N/A
HC32001364	OT-THER PROC GRP 45MIN/M	430	97150	241.00	N/A
HC32001372	OT-THER PROC GRP 60MIN/M	430	97150	389.00	N/A
HC32001521	OT-THER PROC GRP 90MIN/MC	433	97150	431.00	N/A
HC32001539	OT-THER PROC GRP 120MIN/MC	433	97150	409.00	N/A
HC32001570	OT-EVAL DRIVING REHAB/W	434	97799	1,822.00	N/A
HC32001588	OT-DRIVING TRAINING 60MIN/W	430	97799	351.00	N/A
HC32001703	OT-AQUATIC THERAPY 15MIN/M	430	97113	246.00	N/A
HC32001711	OT-EVAL HIGH COMPLEXITY 45MF2F 120MIN	434	97167	1,383.00	N/A
HC32001737	OT-EVAL HIGH COMPLEXITY 45MF2F 150MIN	434	97167	1,658.00	N/A
HC32001745	OT-EVAL HIGH COMPLEXITY 45MF2F 180MIN	434	97167	1,974.00	N/A
HC32003295	OT-EVAL LOW COMPLEXITY 20MF2F 45MIN	434	97165	619.00	N/A
HC32003303	OT-EVAL MOD COMPLEXITY 30MF2F 30MIN	434	97166	514.00	N/A
HC32003311	OT-EVAL MOD COMPLEXITY 30MF2F 60MIN	434	97166	840.00	N/A
HC32003329	OT-EVAL MOD COMPLEXITY 30MF2F 90MIN	434	97166	1,147.00	N/A
HC32003337	OT-EVAL HIGH COMPLEXITY 45MF2F 30MIN	434	97167	549.00	N/A
HC32003345	OT-EVAL HIGH COMPLEXITY 45MF2F 45MIN	434	97167	750.00	N/A
HC32010019	OT-SELF/HOME MGMT/ADL 15MIN	430	97535	233.00	N/A
HC32010035	OT-NEUROMUSC RE-ED 15MIN	430	97112	231.00	N/A
HC32010043	OT-FUNCTIONAL ACTIVITY 15MIN	430	97530	233.00	N/A
HC32010050	OT-THER EXER 15MIN	430	97110	234.00	N/A
HC32010076	OT-EVAL LOW COMPLEXITY 30MIN F2F [15MIN]	434	97165	235.00	N/A
HC32010084	OT-EVAL MOD COMPLEXITY 45MIN F2F [15MIN]	434	97166	241.00	N/A
HC32010092	OT-EVAL HIGH COMPLEXITY 60MIN [15MIN]	434	97167	242.00	N/A
HC32010100	OT-RE-EVAL EST POC  [15MIN]	434	97168	225.00	N/A
HC32010126	OT-THER PROC GROUP [15MIN]	433	97150	89.00	N/A
HC32010134	OT-ELEC STIM/TENS ATTD 15MIN	430	97032	199.00	N/A
HC32010142	OT-WHEELCHAIR MGT 15MIN	430	97542	215.00	N/A
HC32010159	OT-ORTHOTIC MGMT & TRNG INITIAL ENC 15MIN	430	97760	270.00	N/A
HC32010167	OT-MANUAL THERAPY 15MIN	430	97140	225.00	N/A
HC32010175	OT-COMMTY WK/REINTEGRAT 15MIN	430	97537	224.00	N/A
HC32010183	OT-ORTHOTIC/PROSTH MGMT/TRAIN SUBSQ 15MIN	430	97763	218.00	N/A
HC32010191	OT-DEV COGNITIVE SKILLS INITL 15MIN	430	97129	224.00	N/A
HC32010209	OT-DEV COGNITIVE SKILLS ADDL 15MIN	430	97130	216.00	N/A
HC32010241	OT-SENSORY INTEGRT TECH 15MIN	430	97533	209.00	N/A
HC32010258	OT-AQUATIC THERAPY 15MIN	430	97113	239.00	N/A
HC32010274	OT-PROSTHETIC MGMT & TRNG INITIAL ENC 15MIN	430	97761	213.00	N/A
HC32010316	OT-ULTRASOUND 15MIN	430	97035	182.00	N/A
HC33000118	SP-ASSESS ASSIST TECH 15MIN/CM	444	97755	177.00	N/A
HC33010117	ST-DEV COGNITIVE SKILLS INITL 15MIN	440	97129	224.00	N/A
HC33010125	ST-DEV COGNITIVE SKILLS ADDL 15MIN	440	97130	216.00	N/A
HC35000074	REC' THER' TX ADD'L 15 MIN	941	97530	238.00	N/A
HC35000157	REC-SENSRY INTEGRT TECH 15MIN	941	97533	202.00	N/A
HC35000165	REC-SELF/HOME MGMT/ADL 15MIN	941	97535	214.00	N/A
HC35000173	REC-COMMTY WK/REINTEGRAT 15M	941	97537	226.00	N/A
HC35000223	REC' THER' TX 1-30 MIN	941	97110	341.00	N/A
HC35000249	REC-DEV COGNITIVE SKILLS INITL 15MIN	941	97129	216.00	N/A
HC35000256	REC-DEV COGNITIVE SKILLS ADDL 15MIN	941	97130	212.00	N/A
HC35500040	MT-FUNCTIONAL ACTIVITY 15 MIN	941	97530	200.00	N/A
HC35500065	MT-SENSORY INTEGRATION 15 MIN	941	97533	185.00	N/A
HC35500230	MT-DEV COGNITIVE SKILLS INITL 15MIN	941	97129	179.00	N/A
HC35500248	MT-DEV COGNITIVE SKILLS ADDL 15MIN	941	97130	172.00	N/A
HC38000410	APPLY TRACTN MECHANCL 1+ AREAS	700	97012	198.00	N/A
HC51060143	PT-EVAL MOD COMPLEXITY 30MF2F 45MIN	424	97162	315.00	N/A
HC51060192	OT-EVAL MOD COMPLEXITY 30MF2F 45MIN	434	97166	307.00	N/A
HC51060697	PT-EVAL LOW COMPLEXITY 20MF2F 30MIN	424	97161	272.00	N/A
HC51060705	PT-EVAL HIGH COMPLEXITY 45MF2F 60MIN	424	97163	382.00	N/A
HC51060713	OT-EVAL LOW COMPLEXITY 20MF2F 30MIN	434	97165	278.00	N/A
HC51060721	OT-EVAL HIGH COMPLEXITY 45MF2F 60MIN	434	97167	382.00	N/A
HC51060754	PT-THER EXER 15MIN/M	420	97110	67.00	N/A
HC51060929	OT-ORTHOTIC MGMT & TRNG INITIAL ENC 15MIN/M	430	97760	164.00	N/A
HC51060937	OT-PROSTHETIC MGMT & TRNG INITIAL ENC 15MIN/M	430	97761	159.00	N/A
HC51060945	OT-ORTHOTIC/PROSTH MGMT/TRAIN SUBSQ 15MIN/M	430	97763	169.00	N/A
HC32000119	OT-EVAL SWALLOW CINE/FLUORO 60MIN	434	92611	1,204.00	N/A
HC32000127	OT-EVAL SWALLOW CINE/FLUORO 90MIN	434	92611	1,588.00	N/A
HC32000432	OT-SWALLOWING EVAL 30MIN	434	92610	747.00	N/A
HC32000440	OT-SWALLOWING EVAL 45MIN	434	92610	945.00	N/A
HC32000457	OT-SWALLOWING EVAL 60MIN	434	92610	1,215.00	N/A
HC32000465	OT-DYSPHAGIA EVAL 75 MIN/MC	434	92610	1,295.00	N/A
HC32000473	OT-SWALLOWING EVAL 90MIN	434	92610	1,400.00	N/A
HC32000481	OT-SWALLOWING EVAL 120MIN	434	92610	1,554.00	N/A
HC32000499	OT-SWALLOWING THERAPY  15 MIN	430	92526	321.00	N/A
HC32000507	OT-SWALLOWING THERAPY  30 MIN	430	92526	484.00	N/A
HC32000515	OT-SWALLOWING THERAPY  45 MIN	430	92526	725.00	N/A
HC32000523	OT-SWALLOWING THERAPY  60 MIN	430	92526	936.00	N/A
HC32000531	OT-SWALLOWING THERAPY  90 MIN	430	92526	1,195.00	N/A
HC32001760	OT-DYSPHAGIA/SWALLOW TX 75MIN/M	430	92526	900.00	N/A
HC32001794	OT-ENDOSCOPIC EVAL SWALLOW	434	92612	1,338.00	N/A
HC32001802	OT-ENDOSCOPIC EVAL LARYNGEAL	434	92614	1,053.00	N/A
HC32001810	OT-ENDOSCOP EVAL SWALLOW/LARYN	434	92616	1,103.00	N/A
HC32001828	OT-SWALLOWING EVAL 15MIN	434	92610	442.00	N/A
HC32001836	OT-EVAL SWALLOW CINE/FLUORO 30MIN	434	92611	729.00	N/A
HC32001844	OT-EVAL SWALLOW CINE/FLUORO 45MIN	434	92611	954.00	N/A
HC32010027	OT-SWALLOWING THERAPY  [15MIN]	430	92526	226.00	N/A
HC32010068	OT-SWALLOWING EVAL [15MIN]	434	92610	228.00	N/A
HC32010118	OT-EVAL SWALLOW CINE/FLUORO [15MIN]	434	92611	249.00	N/A
HC32010357	OT-EVAL SWALLOW CINE/FLUORO 120MIN	434	92611	1,913.00	N/A
HC32010365	OT-EVAL SWALLOW CINE/FLUORO 150MIN	434	92611	2,250.00	N/A
HC32010373	OT-EVAL SWALLOW CINE/FLUORO 180MIN	434	92611	2,588.00	N/A
HC33000134	ST-ENDOSCOP EVAL SWALLOW/LARYN	444	92616	1,103.00	N/A
HC33000142	ST-ENDOSCOPIC EVAL LARYNGEAL	444	92614	1,053.00	N/A
HC33000159	ST-ENDOSCOPIC EVAL SWALLOW	444	92612	1,338.00	N/A
HC33000167	ST-EVAL RX SP GEN DEVC; 1ST HR	444	92607	1,186.00	N/A
HC33000175	ST-EVAL RX SP GEN DEV ADD30MIN	444	92608	507.00	N/A
HC33000183	ST-EVAL SWALLOW CINE/FLUORO 60MIN	444	92611	1,204.00	N/A
HC33000191	ST-EVAL SWALLOW CINE/FLUORO 90MIN	444	92611	1,588.00	N/A
HC33000217	ST-SPEECH THERAPY 30 MIN/MCW	440	92507	474.00	N/A
HC33000225	ST-SPEECH THERAPY 45 MIN/MW	440	92507	603.00	N/A
HC33000233	ST-SPEECH THERAPY 60 MIN/MCW	440	92507	806.00	N/A
HC33000241	ST-SPEECH THERAPY 75 MIN/MW	440	92507	857.00	N/A
HC33000258	ST-SPEECH THERAPY 90 MIN/MW	440	92507	1,007.00	N/A
HC33000266	ST-SPEECH THERAPY 120MIN/MW	440	92507	1,207.00	N/A
HC33000274	ST-SPEECH THERAPY GRP 30MIN/MCW	443	92508	205.00	N/A
HC33000282	ST-SPEECH THERAPY GRP 45MIN/MCW	443	92508	307.00	N/A
HC33000290	ST-SPEECH THERAPY GRP 60MIN/MCW	443	92508	378.00	N/A
HC33000308	ST-SPEECH THERAPY GRP120MIN/MCW	443	92508	568.00	N/A
HC33000316	ST-SWALLOWING EVAL 30MIN	444	92610	753.00	N/A
HC33000324	ST-SWALLOWING EVAL 45MIN	444	92610	954.00	N/A
HC33000332	ST-SWALLOWING EVAL 60MIN	444	92610	1,210.00	N/A
HC33000340	ST-SWALLOWING EVAL 75MIN	444	92610	1,275.00	N/A
HC33000357	ST-SWALLOWING EVAL 90MIN	444	92610	1,385.00	N/A
HC33000365	ST-SWALLOWING EVAL 120MIN	444	92610	1,498.00	N/A
HC33000373	ST-SWALLOWING EVAL 180MIN	444	92610	1,816.00	N/A
HC33000381	ST-SWALLOWING THERAPY  15 MIN	440	92526	321.00	N/A
HC33000399	ST-SWALLOWING THERAPY  30 MIN	440	92526	485.00	N/A
HC33000407	ST-SWALLOWING THERAPY  45 MIN	440	92526	691.00	N/A
HC33000415	ST-SWALLOWING THERAPY  60 MIN	440	92526	827.00	N/A
HC33000423	ST-SWALLOWING THERAPY 75 MIN	440	92526	927.00	N/A
HC33000431	ST-SWALLOWING THERAPY 90 MIN	440	92526	1,171.00	N/A
HC33000456	ST-THER NON-SP GEN DEV W/PROG	440	92606	803.00	N/A
HC33000464	ST-THER SP GEN DEV W/PROG	440	92609	937.00	N/A
HC33000548	ST-SPEECH THERAPY 15 MIN/MW	440	92507	243.00	N/A
HC33000555	ST-SWALLOWING EVAL 15MIN	444	92610	439.00	N/A
HC33000563	ST-EVAL SWALLOW CINE/FLUORO 30M	444	92611	729.00	N/A
HC33000571	ST-EVAL SWALLOW CINE/FLUORO 45M	444	92611	954.00	N/A
HC33000597	ST-SPEECH THERAPY GRP 90MIN/MCW	443	92508	446.00	N/A
HC33000688	ST-SPEECH THERAPY GRP 15MIN/MW	443	92508	119.00	N/A
HC33000696	ST-EVAL LANGUAGE CMPNT 60MIN	444	92521	604.00	N/A
HC33000704	ST-EVAL LANGUAGE CMPNT 90MIN	444	92521	806.00	N/A
HC33000712	ST-EVAL LANGUAGE CMPT 120MIN	444	92521	886.00	N/A
HC33000720	ST-EVAL LANGUAGE CMPT 180MIN	444	92521	1,075.00	N/A
HC33000761	ST-EVAL NONSPEECH DEVICE RX:1ST HR	444	92605	837.00	N/A
HC33000811	ST-EVAL NONSP'CH DEV RX:ADD30MIN	444	92618	515.00	N/A
HC33000845	ST-EVAL SPEECH CMPNT 60MIN	444	92522	598.00	N/A
HC33000852	ST-EVAL SPEECH CMPNT 90MIN	444	92522	854.00	N/A
HC33000860	ST-EVAL SPEECH CMPNT 120MIN	444	92522	1,060.00	N/A
HC33000902	ST EVAL SPEECH FLUENCY 30MIN/M	444	92521	258.00	N/A
HC33000910	ST EVAL SPEECH FLUENCY 45MIN/M	444	92521	378.00	N/A
HC33000928	ST EVAL SPEECH FLUENCY 60MIN/M	444	92521	485.00	N/A
HC33000936	ST EVAL SPEECH FLUENCY 90MIN/M	444	92521	663.00	N/A
HC33000944	ST EVAL SPEECH FLUENCY 120MIN/M	444	92521	711.00	N/A
HC33000969	ST EVAL SOUND PRODUCTION 30MIN/M	444	92522	216.00	N/A
HC33000977	ST EVAL SOUND PRODUCTION 45MIN/M	444	92522	330.00	N/A
HC33000985	ST EVAL SOUND PRODUCTION 60MIN/M	444	92522	413.00	N/A
HC33000993	ST EVAL SOUND PRODUCTION 90MIN/M	444	92522	582.00	N/A
HC33001009	ST EVAL SOUND PRODUCTION 120MIN/M	444	92522	646.00	N/A
HC33001017	ST EVAL SOUND PRODUCTION 180MIN/M	444	92522	809.00	N/A
HC33001025	ST EVAL SOUND W/LANG COMP&EXPRESS 30MIN/M	444	92523	423.00	N/A
HC33001041	ST EVAL SOUND W/LANG COMP&EXPRESS 60MIN/M	444	92523	677.00	N/A
HC33001058	ST EVAL SOUND W/LANG COMP&EXPRESS 90MIN/M	444	92523	904.00	N/A
HC33001066	ST EVAL SOUND W/LANG COMP&EXPRESS 120MIN/M	444	92523	992.00	N/A
HC33001074	ST EVAL SOUND W/LANG COMP&EXPRESS 180MIN/M	444	92523	1,171.00	N/A
HC33001082	ST EVAL BEHAVRAL QUAL VOICE 30MIN/M	444	92524	262.00	N/A
HC33001090	ST EVAL BEHAVRAL QUAL VOICE 45MIN/M	444	92524	384.00	N/A
HC33001108	ST EVAL BEHAVRAL QUAL VOICE 60MIN/M	444	92524	477.00	N/A
HC33001124	ST EVAL BEHAVRAL QUAL VOICE 120MIN/M	444	92524	729.00	N/A
HC33001132	ST EVAL BEHAVRAL QUAL VOICE 180MIN/M	444	92524	923.00	N/A
HC33001140	ST EVAL SPEECH FLUENCY 180MIN/M	444	92521	854.00	N/A
HC33001157	ST EVAL SOUND W/LANG COMP&EXPRESS 45MIN/M	444	92523	558.00	N/A
HC33001165	ST EVAL BEHAVRAL QUAL VOICE 90MIN/M	444	92524	643.00	N/A
HC33001215	ST-TEST COGNITIVE PERFORMANCE STDRD PER HOUR	440	96125	478.00	N/A
HC33010018	ST-SWALLOWING THERAPY  [15MIN]	440	92526	226.00	N/A
HC33010026	ST-SWALLOWING EVAL [15MIN]	444	92610	228.00	N/A
HC33010034	ST-EVAL SWALLOW CINE/FLUORO [15MIN]	444	92611	249.00	N/A
HC33010042	ST-SPEECH THERAPY [15MIN]	440	92507	197.00	N/A
HC33010059	ST EVAL SOUND W/LANG COMP&EXPRESS [15MIN]	444	92523	160.00	N/A
HC33010067	ST EVAL SOUND PRODUCTION [15MIN]	444	92522	107.00	N/A
HC33010075	ST EVAL SPEECH FLUENCY [15MIN]	444	92521	134.00	N/A
HC33010083	ST EVAL BEHAVRAL QUAL VOICE [15MIN]	444	92524	122.00	N/A
HC33010174	ST-SPEECH THERAPY GROUP [15MIN]	443	92508	89.00	N/A
HC33010224	ST-EVAL SWALLOW CINE/FLUORO 120MIN	444	92611	1,913.00	N/A
HC33010232	ST-EVAL SWALLOW CINE/FLUORO 150MIN	444	92611	2,250.00	N/A
HC33010240	ST-EVAL SWALLOW CINE/FLUORO 180MIN	444	92611	2,588.00	N/A
HC34000109	AUD-INFANT HEARING SCREEN AEP BBS AUTO INITIAL OP	471	92650	614.00	N/A
HC34000117	AUD-INFANT HEARING SCREEN AEP BBS AUTO REPEAT OP	471	92650	525.00	N/A
HC34000125	AUD-AUDITORY EVOKED AEP BBS HEARING DETERM W/I&R	471	92651	608.00	N/A
HC34000190	AUD-INFANT HEARING SCREEN AEP BBS AUTO INITIAL IP	471	92650	711.00	N/A
HC34000208	AUD-AUDITORY EVOKED AEP THRESHOLD EST MULT FREQ W/I&R	471	92652	635.00	N/A
HC34000216	AUD-AUDITORY EVOKED AEP NEURODIAGNOSTIC W/I&R	471	92653	541.00	N/A
HC39001391	PSY-TEST COGNITIVE PERFORMANCE STDRD PER HOUR	900	96125	497.00	N/A
HC41500000	AUDITORY EVOKED AEP BBS HEARING DETERM W/I&R	471	92651	1,930.00	N/A
HC41500018	AUDITORY EVOKED AEP BBS HEARING DETERM W/I&R	471	92651	1,079.00	N/A
HC41500281	INFANT HEARING SCREEN AEP BBS AUTO INITIAL IP	471	92650	1,021.00	N/A
HC41500299	INFANT HEARING SCREEN AEP BBS AUTO INITIAL OP	471	92650	712.00	N/A
HC41500307	INFANT HEARING SCREEN AEP BBS AUTO REPEAT OP	471	92650	732.00	N/A
HC41500547	AUDITORY EVOKED AEP BBS HEARING DETERM W/I&R	471	92651	1,930.00	N/A
HC41500927	AUDITORY EVOKED AEP THRESHOLD EST MULT FREQ W/I&R	471	92652	1,412.00	N/A
HC41500935	AUDITORY EVOKED AEP NEURODIAGNOSTIC W/I&R	471	92653	1,412.00	N/A
HC51060200	OT-DYSPHAGIA/SWALLOW TX/M	430	92526	234.00	N/A
HC51060515	ST EVAL SPEECH FLUENCY/M	444	92521	205.00	N/A
HC51060523	ST EVAL SOUND PRODUCTION/M	444	92522	161.00	N/A
HC51060531	ST EVAL SOUND PROD W/LANG COMP&EXPRESS/C	444	92523	258.00	N/A
HC51060549	ST EVAL BEHAVRAL QUAL VOICE &RESONANCE/M	444	92524	175.00	N/A
HC51060671	ST-SWALLOWING EVAL	444	92610	203.00	N/A
HC51060689	OT-SWALLOWING EVAL	434	92610	203.00	N/A
HC51060739	ST-SPEECH THERAPY 60 MIN	440	92507	147.00	N/A
HC51061174	ST-ENDOSCOPIC EVAL SWALLOW	440	92612	324.00	N/A
HC51061182	ST-ENDOSCOP EVAL SWALLOW/LARYN	440	92616	349.00	N/A
HC51070696	PSY-TEST COGNITIVE PERFORMANCE STDRD PER HOUR	510	96125	277.00	N/A
HC36000123	CPAP/BIPAP DAILY MGMT	410	94660	4,299.00	N/A
HC36000263	VENT DAY INITIAL-ADULT	410	94002	5,981.00	N/A
HC36000271	VENT DAY INITIAL-INFANT	410	94002	5,981.00	N/A
HC36000289	VENT DAY INIT-JET VENT	410	94002	6,011.00	N/A
HC36000297	VENT DAY INIT-OSCIL&/OR HI FRQ	410	94002	5,981.00	N/A
HC36000305	VENT DAY SUBSEQUENT-ADULT	410	94003	5,459.00	N/A
HC36000313	VENT DAY SUBSEQUENT-INFANT	410	94003	5,459.00	N/A
HC36000321	VENT DAY SUBSQ-JET VENT	410	94003	5,551.00	N/A
HC36000339	VENT DAY SUBSQ-OSCIL&/OR HI FR	410	94003	5,459.00	N/A
HC12200309	EXTENDED RECOVERY PER HOUR	710		217.00	N/A
HC13300009	LACTATION CONSULT IP 30 MIN (ST)	761		N/A	N/A
HC13500053	GENETIC COUNSEL 15MIN  CMRCL/C	510		207.00	N/A
HC14500110	DM PHONE CONSULT OP 15MIN (ST)	942		N/A	N/A
HC14500128	DM INPT CONSULT 30 MIN (STAT)	942		N/A	N/A
HC24000028	HBO FIRST 15MIN BASIC/C	413		492.00	N/A
HC24000036	HBO EA SUBSEQUNT 15MIN BASIC/C	413		489.00	N/A
HC24000119	HBO EA SUBSEQNT 15MIN INTERM/C	413		539.00	N/A
HC24000127	HBO EA SUBSEQUNT 15MIN CMPLX/C	413		678.00	N/A
HC24000135	HBO FIRST 15MIN COMPLEX/C	413		678.00	N/A
HC24000143	HBO FIRST 15MIN INTERMEDIATE/C	413		538.00	N/A
HC25000076	LEFT W/O BEING SEEN BY MD (QA)	450		N/A	N/A
HC25000266	I&D HEMATOMA	450		623.00	N/A
HC25000274	LAC REPAIR TO 2.5 CM(SMALL)	450		344.00	N/A
HC25000282	LAC REPAIR 20.1-30CM(LARGE)	450		661.00	N/A
HC25000290	LAC REPAIR 12.6-20CM	450		574.00	N/A
HC25000308	LAC REPAIR 2.6-7 5CM	450		435.00	N/A
HC25000316	LAC REPAIR 7.6-12 5CM(MEDIUM)	450		513.00	N/A
HC25000324	THORACOTOMY	450		3,854.00	N/A
HC25000332	ANOSCOPY W/PROCEDURE	450		423.00	N/A
HC25000357	EXPLORE WOUND	450		1,256.00	N/A
HC25000365	FB REMOVAL EYE	450		1,035.00	N/A
HC25000373	I&D ABSCESS	450		742.00	N/A
HC25000399	LAC REPAIR 30.0+CM	450		812.00	N/A
HC25000407	NASAL EPISTAXIS	450		718.00	N/A
HC25000415	LARYNGOSCOPY FIBEROPTIC DX	450		883.00	N/A
HC25000423	LARYNGOSCOPY FIBEROP W/FB REM	450		1,198.00	N/A
HC25000431	MANIPULATION MAJOR JOINT	450		1,102.00	N/A
HC25000449	MANIPULATION MINOR JOINT	450		947.00	N/A
HC25000456	FRACTURE TX FINGER/TOE	450		821.00	N/A
HC25000464	FRACTURE TX  LONG BONE	450		1,072.00	N/A
HC25000472	FRACTURE TX  RIBS	450		617.00	N/A
HC25000480	FRACTURE TX  NASAL	450		431.00	N/A
HC25001330	M: ED MISC PROCEDURE	450		1,159.00	N/A
HC25001363	EKG EMERGENCY (STATISTICAL)	450		N/A	N/A
HC25001371	NO CHARGE (STATISTICAL)	450		N/A	N/A
HC25001397	I&D POSTOP WOUND	450		593.00	N/A
HC25002700	TRAUMA ACT' I W/O P-H ALERT	459		20,969.00	N/A
HC25002718	TRAUMA ACT' II W/O P-H ALERT	459		10,787.00	N/A
HC25002726	TRAUMA ACT' III W/O P-H ALERT	459		7,921.00	N/A
HC27001205	M:GI LAB MISC PROCEDURE	750		1,342.00	N/A
HC27001213	NURSE ASSIST EA HR (STATISTIC)	750		N/A	N/A
HC31000094	PT-AQUATIC GRP ADDL 15 MIN/CW	423		94.00	N/A
HC31000904	PT-INITIAL EVAL ADDL 15MIN/CW	424		216.00	N/A
HC31000912	PT-RE-EVAL ADDL 15MIN/CW	420		196.00	N/A
HC31000920	PT-ELEC STIM/TENS ATTD30MIN/CW	420		354.00	N/A
HC31000938	PT-ELEC STIM/TENS ATT ADD15/CW	420		177.00	N/A
HC31000946	PT-IONTOPHORESIS 30MIN/CW	420		310.00	N/A
HC31000953	PT-IONTOPHORESIS ADDL 15MIN/CW	420		155.00	N/A
HC31000961	PT-ULTRASOUND 30MIN/CW	420		288.00	N/A
HC31000979	PT-ULTRASOUND  ADD 15MIN/CW	420		132.00	N/A
HC31000987	PT-THER EXER 30MIN/CW	420		389.00	N/A
HC31000995	PT-PHYS MED TX ANY ADDL 15MIN/CW	420		183.00	N/A
HC31001001	PT-NEUROMUSC RE-ED 30MIN/CW	420		316.00	N/A
HC31001019	PT-NEUROMUSC RE-ED ADD15MIN/CW	420		158.00	N/A
HC31001027	PT-GAIT TRAINING 30MIN/CW	420		318.00	N/A
HC31001035	PT-GAIT TRAINING ADD 15MIN/CW	420		175.00	N/A
HC31001043	PT-MASSAGE 30MIN/CW	420		303.00	N/A
HC31001050	PT-MASSAGE  ADD 15MIN/CW	420		152.00	N/A
HC31001068	PT-MANUAL THERAPY 30 MIN/CW	420		303.00	N/A
HC31001076	PT-MANUAL THERAPY ADD 15MIN/CW	420		152.00	N/A
HC31001084	PT-MANUAL THER MYOFASC REL/W	420		213.00	N/A
HC31001092	PT-MANUAL THER S0FT TIS MOB/W	420		213.00	N/A
HC31001100	PT-MANUAL THER JOINT MOB/W	420		207.00	N/A
HC31001118	PT-ORTHOTIC FIT/TRNG 30MIN/CW	420		318.00	N/A
HC31001126	PT-ORTHOTIC FIT/TRNG ADD15M/CW	420		159.00	N/A
HC31001134	PT-PROSTHETIC TRNG 30MIN/CW	420		298.00	N/A
HC31001142	PT-PROSTHETIC TRNG ADD15MIN/CW	420		148.00	N/A
HC31001159	PT-FUNC ACTIVITY 30MIN/CW	420		354.00	N/A
HC31001167	PT-FUNC ACTIVITY ADDL 15MIN/CW	420		177.00	N/A
HC31001175	PT-ADL 30MIN/CW	420		347.00	N/A
HC31001183	PT-ADL ADD 15MIN/CW	420		177.00	N/A
HC31001209	PT CASE CONF & RPT ADD'L 15MIN	420		80.00	N/A
HC31001217	PT-CASE CONF 15MIN(STAT)/M	420		N/A	N/A
HC31001274	PT-STATUS REVIEW 15MIN(STAT)	420		N/A	N/A
HC31001316	PT-HUBBARD TANK 30MIN/CW	420		318.00	N/A
HC31001324	PT-HUBBARD TANK ADD15MIN/CW	420		157.00	N/A
HC31001340	PT-SCREENING/IPA 15MIN(ST)	420		N/A	N/A
HC31001431	PT-TEST/MEASUREMENT 1ST30MIN/C	424		357.00	N/A
HC31001449	PT-TEST/MEASUREMENT ADD15MIN/C	424		183.00	N/A
HC31001456	PT-PROC+MODALITY.COMBO 30MIN/C	420		338.00	N/A
HC31001464	PT-PROC+MOD.COMBO ADD 15MIN/C	420		164.00	N/A
HC31001522	PT-PHYS PERFORM TEST INL'30M/W	420		317.00	N/A
HC31001530	PT-PHYS PERFORM TEST ADD'15M/W	420		166.00	N/A
HC31001548	PT-INDIV PROC W/COMPUT EQUIP/W	420		374.00	N/A
HC31001555	PT-THER PROC GRP ADD 15MIN/CW	423		88.00	N/A
HC31001563	PT-GROUP EDUCATION MIN 1HR/W	420		237.00	N/A
HC31001589	PT-CONTRAST BATH 30MIN/CW	420		310.00	N/A
HC31001597	PT-CONTRAST BATH AD15MIN/CW	420		132.00	N/A
HC31001605	PT-COMMTY WK/REINTEGRAT 30M/CW	420		318.00	N/A
HC31001613	PT-COMMTY WK/REINT ADD15MIN/CW	420		147.00	N/A
HC31001621	PT-WHEELCHAIR MGT 30MIN/C	420		341.00	N/A
HC31001639	PT-WHEELCHAIR MGT ADD 15MIN/C	420		171.00	N/A
HC31001647	PT-WOUND NON-SEL DEB ADD15M/C	420		164.00	N/A
HC31001654	PT-WD SEL DEBRID<20CM 15MIN+/C	420		191.00	N/A
HC31001662	PT-WD SEL DEBRID>20CM 15MIN+/C	420		191.00	N/A
HC31001670	PT-WOUND VAC 15MIN<50 SQ+/C	420		162.00	N/A
HC31001688	PT-WOUND VAC 15MIN>50 SQ+/C	420		175.00	N/A
HC31001761	PT-CASE CONF 30MIN/C	420		285.00	N/A
HC31001852	CAST ROOM USE	515		282.00	N/A
HC31001860	PT-AQUATIC THERAPY 30MIN/CW	420		394.00	N/A
HC31001878	PT-AQUATIC THERAPY ADD15MIN/CW	420		196.00	N/A
HC31001936	TRANSITIONAL REHAB 1/2 DAY (QA)	931		1.00	N/A
HC31001944	TRANSITIONAL REHAB FULL DAY (QA)	932		1.00	N/A
HC32000838	OT-INITIAL EVAL ADD 15MIN/CW	434		211.00	N/A
HC32000846	OT-RE-EVAL ADDL 15MIN/CW	434		186.00	N/A
HC32000853	OT-ELEC STIM/TENS ATTD30MIN/CW	430		318.00	N/A
HC32000861	OT-ELEC STIM/TENS ATT ADD15/CW	430		178.00	N/A
HC32000879	OT-IONTOPHORESIS 30MIN/CW	430		318.00	N/A
HC32000887	OT-IONTOPHORESIS  ADDL 15/CW	430		164.00	N/A
HC32000895	OT-ULTRASOUND 30MIN/CW	430		303.00	N/A
HC32000903	OT-ULTRASOUND  ADD 15MIN/CW	430		157.00	N/A
HC32000911	OT-THER EXER 30MIN/CW	430		386.00	N/A
HC32000929	OT-TREATMENT ADD 15 MIN/CW	430		196.00	N/A
HC32000937	OT-NEUROMUSC RE-ED 30MIN/CW	430		365.00	N/A
HC32000945	OT-NEUROMUSC RE-ED ADD15MIN/CW	430		183.00	N/A
HC32000952	OT-MASSAGE 30MIN/CW	430		303.00	N/A
HC32000960	OT-MASSAGE ADDL 15MIN/CW	430		159.00	N/A
HC32000978	OT-MANUAL THERAPY 30 MIN/CW	430		330.00	N/A
HC32000986	OT-MANUAL THERAPY ADDL 15MIN/CW	430		169.00	N/A
HC32000994	OT-MANUAL THER MYOFASC REL/W	430		229.00	N/A
HC32001000	OT-MANUAL THER S0FT TIS MOB/W	430		237.00	N/A
HC32001018	OT-MANUAL THER JOINT MOB/W	430		229.00	N/A
HC32001026	OT-ORTHOTIC FIT/TRNG 30MIN/CW	430		355.00	N/A
HC32001034	OT-ORTHOTIC FIT/TRNG ADD15M/CW	430		178.00	N/A
HC32001042	OT-PROSTHETIC TRNG 30MIN/CW	430		322.00	N/A
HC32001059	OT-PROSTHETIC TRNG ADD15MIN/CW	430		166.00	N/A
HC32001067	OT-FUNC ACTIVITY 30MIN/CW	430		354.00	N/A
HC32001075	OT-FUNC ACTIVITY ADDL 15MIN/CW	430		177.00	N/A
HC32001083	OT-DEV COGNITIVE SKLL 30MIN/CW	430		340.00	N/A
HC32001091	OT-DEV COGNITIV SKLL ADD15M/CW	430		194.00	N/A
HC32001109	OT-ADL 30MIN/CW	430		312.00	N/A
HC32001117	OT-ADL ADD 15MIN/CW	430		157.00	N/A
HC32001125	OT-WHEELCHAIR MGT 30MIN/C	430		349.00	N/A
HC32001133	OT-WHEELCHAIR MGT ADD15MIN/C	430		173.00	N/A
HC32001190	OT-CASE CONF 15MIN (STAT)	430		N/A	N/A
HC32001208	OT-STATUS REVIEW 15MIN(STAT)	430		N/A	N/A
HC32001216	OT-SENSRY INTEGR TECH 30MIN/CW	430		336.00	N/A
HC32001224	OT-SENSRY INTEGR TECH ADD15/CW	430		172.00	N/A
HC32001232	OT-GAIT TRAINING 30MIN/CW	430		354.00	N/A
HC32001240	OT-GAIT TRAINING ADD 15MIN/CW	430		177.00	N/A
HC32001349	OT-CONTRAST BATH 30MIN/CW	430		247.00	N/A
HC32001380	OT-TRTMNT(ANY) INIT'L 30MIN	430		355.00	N/A
HC32001398	OT-CASE/TEAM CONF ADD15 MIN/C	430		98.00	N/A
HC32001422	OT-COMMTY WK/REINTEGRAT 30M/CW	430		213.00	N/A
HC32001430	OT-COMMTY WK/REINT ADD15MIN/CW	430		308.00	N/A
HC32001448	OT-WD SEL DEBRID<20CM 15MIN+/C	430		192.00	N/A
HC32001455	OT-WOUND VAC 15MIN<50 SQ CM+/C	430		171.00	N/A
HC32001463	OT-WOUND VAC 15MIN>50 SQ CM+/C	430		182.00	N/A
HC32001752	OT-ASSISTV TECH ASSESS' 30MN/C	430		293.00	N/A
HC33000472	ST-CASE CONFERENCE 30MIN/C	440		242.00	N/A
HC33000480	ST-CASE CONF  ADD 15MIN/C	440		108.00	N/A
HC33000605	ST-SCREENING/IPA 15MIN (ST)	440		N/A	N/A
HC33001207	ST-DEV COGNITIVE SKILL 30MIN/CW	440		327.00	N/A
HC36000354	TRANSPORT EXTERNAL LBM ASSIST RT ACCOMP(STATISTICAL)	410		N/A	N/A
HC36001154	TRANSPORT EXTERNAL MILLER ASSIST RT ACCOMP(STATISTICAL)	410		N/A	N/A
HC37000056	IP VISIT (STATISTIC) EA 15 MIN	942		N/A	N/A
HC37000064	NUTRIT TEAM CONF(ST)EA 15 MIN	942		N/A	N/A
HC37000072	MNT INIT ASSESS EA 15MIN-IP(ST	942		N/A	N/A
HC37000080	MNT RE-ASSESS EA 15MIN-IP(ST)	942		N/A	N/A
HC37000098	NUTRITION EDUCATION 15MIN (ST)	942		N/A	N/A
HC37000106	NUTRITION SCREENING 15MIN (ST)	942		N/A	N/A
HC37000205	OP VISIT/REVIEW 15 MIN (ST)	942		N/A	N/A
HC39000732	SW ASSESS/INTERVEN PER 30MIN/MCL	914		105.00	N/A
HC39000757	PSYCH ASSESS/INTERVEN EA30MIN/MCL	914		139.00	N/A
HC39000773	PSYCH TEAM CONF PRTCPNT PER 15MIN	914		36.00	N/A
HC39000781	SW TEAM CONF PRTCPNT PER 15MIN	914		53.00	N/A
HC39001193	PHP - LESS INTENSIVE (IOP) (3) SERVICE TYPE	912		1.00	N/A
HC39001201	PHP - INTENSIVE SERVICE (=4) SERVICE TYPE	913		1.00	N/A
HC44900843	CT BODY SCAN LTD ABD/PELVIS	350		728.00	N/A
HC44900850	CT BODY SCAN LTD ABD/CHEST	350		728.00	N/A
HC44900868	CT BODY SCAN LTD ABD/CHEST/PEL	350		994.00	N/A
HC44900876	CT BODY SCAN ABD/CHEST/PEL/HRT	350		1,259.00	N/A
HC44900884	CT BODY SCAN NK/CH/ABD/PEL/HRT	350		1,524.00	N/A
HC44900892	CT BODY SCAN NK/CH/ABD/PEL	350		1,325.00	N/A
HC44900900	CT PRIVATE CONSULT W/RAD	350		66.00	N/A
HC44900918	CT BODY SCAN HRT/LUNG/SC	350		728.00	N/A
HC46501946	M: MISC PROCEDURE	361		1,157.00	N/A
HC51060051	PT-TEST&MEASUREMENT 1ST30MIN/C	424		192.00	N/A
HC51060069	PT-TEST/MEASUREMENT ADD15MIN/C	424		93.00	N/A
HC51060077	PT-TEAM CASE CONFERENCE EA 15MIN/C	420		45.00	N/A
HC51060085	OT-EVAL+REPORT INITIAL 30 MIN/C	434		200.00	N/A
HC51060093	OT-EVAL+REPORT EA ADD 15 MIN/C	434		89.00	N/A
HC51060101	OT-TEAM CASE CONFERENCE EA 15MIN/C	430		48.00	N/A
HC51060119	ST-LANGUAGE EVALUATION/C	440		350.00	N/A
HC51060127	ST-SPEECH EVALUATION/C	440		350.00	N/A
HC51060135	ST-TEAM CASE CONF  EA 15MIN/C	440		45.00	N/A
HC51060465	PT CONSULT TELEPHONE PER 15MIN	510		45.00	N/A
HC51060473	OT CONSULT TELEPHONE PER 15MIN	510		48.00	N/A
HC51060499	PT EVAL/TX/PROG RPT	424		112.00	N/A
HC51060747	PT-THER EXER 30MIN/C	420		88.00	N/A
HC51060762	PT-PROC+MOD.COMBO ADD 15MIN/C	420		60.00	N/A
HC51060952	OT-ORTHOTIC FIT/TRNG 30MIN/C	430		245.00	N/A
HC51060960	OT-ORTHOTIC FIT/TRNG ADD15M/C	430		119.00	N/A
HC51062016	NO SHOW OPSC	510		N/A	N/A
HC51099999	NO CHARGE OPSC	510		N/A	N/A
HC74200007	OR TIME INITIAL HR LEVEL 1	360		9,939.00	N/A
HC74200015	OR TIME INITIAL HR LEVEL 2	360		12,067.00	N/A
HC74200023	OR TIME INITIAL HR LEVEL 3	360		14,356.00	N/A
HC74200031	OR TIME INITIAL HR LEVEL 4	360		16,668.00	N/A
HC74200049	OR TIME INITIAL HR LEVEL 5	360		18,362.00	N/A
HC74200056	OR TIME INITIAL HR LEVEL 6	360		20,875.00	N/A
HC74200064	OR TIME ADD'L 15MIN LEVEL 1	360		2,486.00	N/A
HC74200072	OR TIME ADD'L 15MIN LEVEL 2	360		3,016.00	N/A
HC74200080	OR TIME ADD'L 15MIN LEVEL 3	360		3,590.00	N/A
HC74200098	OR TIME ADD'L 15MIN LEVEL 4	360		4,167.00	N/A
HC74200106	OR TIME ADD'L 15MIN LEVEL 5	360		4,591.00	N/A
HC74200114	OR TIME ADD'L 15MIN LEVEL 6	360		5,219.00	N/A
HC74200122	OR TIME INIT'L HR CASE CX LEVEL 1	360		4,654.00	N/A
HC74200130	OR TIME INIT'L HR CASE CX LEVEL 2	360		5,976.00	N/A
HC74200148	OR TIME INIT'L HR CASE CX LEVEL 3	360		6,958.00	N/A
HC74200155	OR TIME INIT'L HR CASE CX LEVEL 4	360		7,714.00	N/A
HC74200163	OR TIME INIT'L HR CASE CX LEVEL 5	360		8,606.00	N/A
HC74200171	OR TIME INIT'L HR CASE CX LEVEL 6	360		9,484.00	N/A
HC74200189	BEDSIDE/OTHER SURGICAL INITIAL HR 1	369		4,919.00	N/A
HC74200197	BEDSIDE/OTHER SURGICAL INITIAL HR 2	369		6,272.00	N/A
HC74200205	BEDSIDE/OTHER SURGICAL INITIAL HR 3	369		7,198.00	N/A
HC74200213	BEDSIDE/OTHER SURGICAL INITIAL HR 4	369		8,672.00	N/A
HC74200221	BEDSIDE/OTHER SURGICAL INITIAL HR 5	369		9,370.00	N/A
HC74200239	BEDSIDE/OTHER SURGICAL INITIAL HR 6	369		10,065.00	N/A
HC74200247	BEDSIDE/OTHER SURGICAL ADD'L 15MIN 1	369		1,201.00	N/A
HC74200254	BEDSIDE/OTHER SURGICAL ADD'L 15MIN 2	369		1,559.00	N/A
HC74200262	BEDSIDE/OTHER SURGICAL ADD'L 15MIN 3	369		1,860.00	N/A
HC74200270	BEDSIDE/OTHER SURGICAL ADD'L 15MIN 4	369		2,157.00	N/A
HC74200288	BEDSIDE/OTHER SURGICAL ADD'L 15MIN 5	369		2,330.00	N/A
HC74200296	BEDSIDE/OTHER SURGICAL ADD'L 15MIN 6	369		2,504.00	N/A
HC74200304	BEDSIDE/OTHER SURGICAL CANCEL LVL 1	369		2,381.00	N/A
HC74200312	BEDSIDE/OTHER SURGICAL CANCEL LVL 2	369		3,090.00	N/A
HC74200320	BEDSIDE/OTHER SURGICAL CANCEL LVL 3	369		3,684.00	N/A
HC74200338	BEDSIDE/OTHER SURGICAL CANCEL LVL 4	369		4,272.00	N/A
HC74200346	BEDSIDE/OTHER SURGICAL CANCEL LVL 5	369		4,617.00	N/A
HC74200353	BEDSIDE/OTHER SURGICAL CANCEL LVL 6	369		4,959.00	N/A
HC74200361	OR TIME ADD'L 15MIN CASE CX LEVEL 1	360		1,158.00	N/A
HC74200379	OR TIME ADD'L 15MIN CASE CX LEVEL 2	360		1,487.00	N/A
HC74200387	OR TIME ADD'L 15MIN CASE CX LEVEL 3	360		1,731.00	N/A
HC74200395	OR TIME ADD'L 15MIN CASE CX LEVEL 4	360		1,919.00	N/A
HC74200403	OR TIME ADD'L 15MIN CASE CX LEVEL 5	360		2,141.00	N/A
HC74200411	OR TIME ADD'L 15MIN CASE CX LEVEL 6	360		2,370.00	N/A
HC77400067	ANESTHESIA INITIAL HR	370		2,901.00	N/A
HC77400075	ANESTHESIA ADD'L 15MIN	370		729.00	N/A
HC77400083	BEDSIDE/OTHER ANESTH' ADD'L 15MIN	379		354.00	N/A
HC77400091	BEDSIDE/OTHER ANESTH' INITIAL HR	379		1,412.00	N/A
HC77400109	ANESTHESIA MAC INITIAL HOUR	370		1,251.00	N/A
HC77400117	ANESTHESIA MAC EACH ADD 15 MIN	370		313.00	N/A
HC77400125	ANESTHESIA REGIONAL INITIAL HOUR	370		1,000.00	N/A
HC77400133	ANESTHESIA REGIONAL ADD 15 MIN	370		252.00	N/A
HC77400141	ANESTHESIA INIT'L HR CASE CX	370		2,046.00	N/A
HC77400158	ANESTHESIA EPIDURAL EA ADD 15MIN	370		279.00	N/A
HC77400166	ANESTHESIA EPIDURAL INITIAL HR	370		1,113.00	N/A
HC77400174	ANESTHESIA SPINAL EA ADD 15MIN	370		252.00	N/A
HC77400182	ANESTHESIA SPINAL INITIAL HR	370		1,003.00	N/A
HC77400190	ANESTHESIA LOCAL EA ADD 15MIN	370		214.00	N/A
HC77400208	ANESTHESIA LOCAL INITIAL HR	370		849.00	N/A
HC77400265	BEDSIDE/OTHER ANESTH' INIT'L HR CASE CX	379		711.00	N/A
HC77400273	ANESTHESIA ADD'L 15MIN CASE CX	370		512.00	N/A
HC77400281	BEDSIDE/OTHER ANESTH' ADD'L 15MIN CASE CX	379		177.00	N/A
HC78600004	PACU I 1ST HOUR (INITIAL)	710		2,483.00	N/A
HC78600012	PACU I 15MIN (SUBSEQUENT)	710		622.00	N/A
HC78600046	PACU II 15MIN (SUBSEQUENT)	710		382.00	N/A
HC78600053	PACU II 1ST HOUR (INITIAL)	710		1,527.00	N/A
HC79200044	SURGERY MINOR 1ST 30 MIN	361		3,061.00	N/A
HC79200051	SURGERY MINOR ADD'L 15 MIN	361		1,563.00	N/A
HC88600325	FBI COLLECTION SPECIMEN URINE	510		63.00	50.00
HC26000141	FETAL MONITORING (STATISTICAL)	720		N/A	N/A
HC11500980	CRC CONFIRM NO CHARGES - RELEASE	115		N/A	N/A
HC91000066	R&B DETOXIFICATION	126		4,914.00	N/A
HC91000123	R&B ONCOLOGY	127		6,525.00	N/A
HC91000163	R&B ISOLATION/PRECAUTIONARY	164		6,000.00	N/A
HC91000243	R&B TELEMETRY CARE	129		8,755.00	N/A
HC91000331	R&B STANDARD	121		5,250.00	N/A
HC91200131	R&B STANDARD-WOMEN	121		5,250.00	N/A
HC91200241	R&B L&D PP OBSTETRICS CARE	122		8,125.00	N/A
HC91400094	R&B PEDIATRIC ACUTE	123		7,800.00	N/A
HC91500125	R&B HOSPICE	125		4,500.00	N/A
HC91600029	R&B REHABILITATION	128		4,950.00	N/A
HC91800055	R&B PSYCHIATRIC	124		4,996.00	N/A
HC91200133	R&B NURSERY LEVEL EOL	170		1,050.00	N/A
HC91200134	R&B NEWBORN CARE	170		3,328.00	N/A
HC91200135	R&B NEWBORN CARE-BOARDER	171		5,033.00	N/A
HC91200136	R&B NICU-NURSERY LEVEL II	172		15,125.00	N/A
HC91200137	R&B NICU-NURSERY LEVEL III	173		17,600.00	N/A
HC91200138	R&B NICU-NURSERY LEVEL IV	174		20,213.00	N/A
HC91000044	R&B STEP DOWN/DOU INTERMD ICU	206		9,425.00	N/A
HC91000204	R&B INTENSIVE CARE	200		12,880.00	N/A
HC91000208	R&B TRAUMA ICU	208		15,225.00	N/A
HC91000404	R&B ICU - INTENSIVE PPE ISOLATION	209		13,935.00	N/A
HC91200242	R&B HIGH RISK PERINATAL	206		8,950.00	N/A
HC91200404	R&B IICU - INTENSIVE PPE ISOLATION	209		13,935.00	N/A
HC91400095	R&B PEDS STEPDOWN/DOU	206		10,975.00	N/A
HC91400096	R&B PEDIATRIC INTENSIVE CARE	203		14,750.00	N/A
HC91400496	R&B ICU PEDS - INTENSIVE PPE ISOLATION	209		15,521.00	N/A
HC11200000	OBSERVATION PER HOUR	762	G0378	225.00	N/A
HC11200004	OBSERVATION PER HOUR - ICU	762	G0378	536.00	N/A
HC11200011	ASSESS-DIRECT OBSERV ADMIT	762	G0379	650.00	N/A
HC11200023	OBSERVATION PER HOUR - ONCOLOGY	762	G0378	275.00	N/A
HC11200031	OBSERVATION PER HOUR - MED/SURG	762	G0378	226.00	N/A
HC11200037	OBSERVATION PER HOUR - NICU	762	G0378	496.00	N/A
HC11200041	OBSERVATION PER HOUR - OB	762	G0378	350.00	N/A
HC11200043	OBSERVATION PER HOUR - TELEMETRY	762	G0378	363.00	N/A
HC11200094	OBSERVATION PER HOUR - PEDS ACUTE	762	G0378	325.00	N/A
HC11200095	OBSERVATION PER HOUR - PEDS DOU	762	G0378	460.00	N/A
HC11200096	OBSERVATION PER HOUR - PEDS ICU	762	G0378	614.00	N/A
HC11200131	OBSERVATION PER HOUR -PACU	762	G0378	314.00	N/A
HC11200143	OBSERVATION PER HOUR - ED	762	G0378	340.00	N/A
HC29000106	HEPATITIS A (ADULT) VACC INJ	636	90632	389.00	N/A
HC29000114	HEPATITIS A(PED/ADOLS) VAC INJ	636	90633	178.00	N/A
HC29000122	HEP A-HEP B VACC INJ	636	90636	470.00	N/A
HC29000130	INFLUENZA VACC TRIVAL PF INJ	636	90656	105.00	N/A
HC29000148	RABIES-HDCV VACC INJ	636	90676	1,054.00	N/A
HC29000155	RABIES-PCEC VACC INJ	636	90675	982.00	N/A
HC29000163	TYPHOID (VICPS) VACC INJ	636	90691	298.00	N/A
HC29000171	MEASLES MUMPS RUBELLA VACC INJ	636	90707	301.00	N/A
HC29000189	POLIO INACTIVATED(IPV) VAC INJ	636	90713	150.00	N/A
HC29000197	TET/DIPHT/PERT(TDAP)>7 VAC INJ	636	90715	219.00	N/A
HC29000205	YELLOW FEVER, LIVE, VACC SQ	636	90717	362.00	N/A
HC29000221	PNEUMOCOCCAL VACC INJ	636	90732	210.00	N/A
HC29000239	MENINGOCOCCAL CONJ VACC INJ	636	90734	611.00	N/A
HC29000247	MENINGOCOCCAL POLYSAC VAC INJ	636	90733	624.00	N/A
HC29000262	JAPANESE ENCEPHAL' IXIARO INJ	636	90738	1,150.00	N/A
HC29000270	HEPATITIS B PED/ADOL VACC INJ	636	90744	145.00	N/A
HC29000288	HEPATITIS B ADULT PF VACC INJ	636	90746	356.00	N/A
HC29000478	ZOSTER VACC SC	636	90736	225.00	N/A
HC29000486	VARICELLA VACC INJ	636	90716	327.00	N/A
HC29000593	TETANUS DIPTHERIA VACCINE	636	90714	131.00	N/A
HC29000668	INFLUENZA VACC QUAD PF INJ	636	90686	44.00	N/A
HC29000676	HIB PRP-T VACC 1 OF 4 DOSES IM	636	90648	90.00	N/A
HC29070091	PNEUMOCOCCAL VACC 13 VAL IM	636	90670	366.00	N/A
HC36000636	DRUG - DETAILED CODING - RESP	636		N/A	N/A
HC36000636_06469300202	NONCDM CHARGE RECORD PHARMACY	250	J3490	15,757.94	N/A
HC36000701	NITRIC OXIDE PER DIEM/ 12 HRS	636	J3490	4,353.00	N/A
HC36001014	NITRIC OXIDE, PER HOUR	636	J3490	688.00	N/A
HC62208301	INK/DYE                           B	250		50.00	N/A
HC62803374	M: APLIGRAF PER SQ CM	636	Q4101	N/A	N/A
HC62803382	M: INTEGRA DRSG BMWD PER SQ CM	636	Q4104	11,474.35	N/A
HC62803390	M: GRAFTJACKET PER SQ CM	636	Q4107	11,183.25	N/A
HC62803416	M: ALLODERM  PER SQ CM	636	Q4116	787.51	N/A
HC62803424	M: FLEX HD ALLOPATCH PER SQ CM	636	Q4128	236.93	N/A
HC62804125	M: DERMAGRAFT PER SQ CM	636	Q4106	551.45	N/A
HC62804554	M: OASIS WOUND PER SQ CM	636	Q4102	N/A	N/A
HC62806146	M: MESHED BILAYER WOUND MATRIX CM2	636	C9363	17,549.55	N/A
HC62807367	M: EPIFIX PER SQ CM	636	Q4186	9,408.75	N/A
HC62807383	M: NEOX1K/RT /CLARIX 1K CORD PER SQ CM	636	Q4148	9,237.31	N/A
HC62807474	M: OASIS TRI-LAYER WND MATRIX PER SQ CM	636	Q4124	N/A	N/A
HC62807482	M: ALLOWRAP DS/DRY PER SQ CM	636	Q4150	16,872.38	N/A
HC62807847	M: AMNIOTIC MEMBRANE SKIN SUB NOS	636	Q4100	921.02	N/A
HC62808126	M: PRIMATRIX PER SQ CM	636	Q4110	593.56	N/A
HC62808241	M:  AMNIOEXCEL	636	Q4137	N/A	N/A
HC62808258	M:  EPICORD PER SQ CM	636	Q4187	N/A	N/A
HC62808266	M:  PURAPLY PER SQ CM	636	Q4195	0.01	N/A
HC62808274	M:  PURAPLY AM PER SQ CM	636	Q4196	N/A	N/A
HC62808282	M:  PURAPLY XT PER SQ CM	636	Q4197	N/A	N/A
HC62808472	M:INTEGRA DERMAL REGEN TEMP/OMNIGRFT PER SQ CM	636	Q4105	N/A	N/A
HC62808480	M:INTEGRA MATRIX PER SQ CM	636	Q4108	25,584.00	N/A
HC62808498	M:MEMODERM DERMASPAN, TRANZGRAFT OR INTEGUPLY PER SQ	636	Q4126	N/A	N/A
HC62808506	M:CYTAL WOUND (MATRISTEM BURN) PER SQ CM	636	Q4166	N/A	N/A
HC65000250	MEDICATION-GENERAL	250		15.04	N/A
HC65000250_00000412400	NONCDM CHARGE RECORD PHARMACY	250		31.46	N/A
HC65000250_00002323560	NONCDM CHARGE RECORD PHARMACY	250		45.90	N/A
HC65000250_00002324030	NONCDM CHARGE RECORD PHARMACY	250		52.04	N/A
HC65000250_00002327030	NONCDM CHARGE RECORD PHARMACY	250		52.37	N/A
HC65000250_00002446234	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00002446330	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00002512130	NONCDM CHARGE RECORD PHARMACY	250		91.80	N/A
HC65000250_00002512377	NONCDM CHARGE RECORD PHARMACY	250		91.80	N/A
HC65000250_00003089321	NONCDM CHARGE RECORD PHARMACY	250		49.17	N/A
HC65000250_00003089331	NONCDM CHARGE RECORD PHARMACY	250		48.65	N/A
HC65000250_00003089421	NONCDM CHARGE RECORD PHARMACY	250		49.67	N/A
HC65000250_00003089431	NONCDM CHARGE RECORD PHARMACY	250		48.32	N/A
HC65000250_00003161112	NONCDM CHARGE RECORD PHARMACY	250		205.87	N/A
HC65000250_00003362412	NONCDM CHARGE RECORD PHARMACY	250		146.33	N/A
HC65000250_00003633517	NONCDM CHARGE RECORD PHARMACY	250		4.54	N/A
HC65000250_00004003822	NONCDM CHARGE RECORD PHARMACY	250		530.41	N/A
HC65000250_00004003909	NONCDM CHARGE RECORD PHARMACY	250	Z7610	437.80	N/A
HC65000250_00004080085	NONCDM CHARGE RECORD PHARMACY	250		91.13	N/A
HC65000250_00005417758	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00005417990	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_00005434462	NONCDM CHARGE RECORD PHARMACY	250		0.58	N/A
HC65000250_00005445160	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00005445174	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00006003220	NONCDM CHARGE RECORD PHARMACY	250		27.92	N/A
HC65000250_00006007131	NONCDM CHARGE RECORD PHARMACY	250		20.70	N/A
HC65000250_00006011228	NONCDM CHARGE RECORD PHARMACY	250		97.08	N/A
HC65000250_00006011231	NONCDM CHARGE RECORD PHARMACY	250		94.68	N/A
HC65000250_00006011254	NONCDM CHARGE RECORD PHARMACY	250		97.39	N/A
HC65000250_00006022128	NONCDM CHARGE RECORD PHARMACY	250		95.36	N/A
HC65000250_00006022131	NONCDM CHARGE RECORD PHARMACY	250		94.24	N/A
HC65000250_00006022761	NONCDM CHARGE RECORD PHARMACY	250		162.65	N/A
HC65000250_00006026718	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00006027728	NONCDM CHARGE RECORD PHARMACY	250		97.54	N/A
HC65000250_00006027754	NONCDM CHARGE RECORD PHARMACY	250		97.08	N/A
HC65000250_00006360361	NONCDM CHARGE RECORD PHARMACY	250		41.33	N/A
HC65000250_00006911754	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00007337013	NONCDM CHARGE RECORD PHARMACY	250		55.06	N/A
HC65000250_00008104005	NONCDM CHARGE RECORD PHARMACY	250		95.35	N/A
HC65000250_00008121030	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00008121101	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00008121130	NONCDM CHARGE RECORD PHARMACY	250		10.64	N/A
HC65000250_00009001201	NONCDM CHARGE RECORD PHARMACY	250		5.84	N/A
HC65000250_00009003101	NONCDM CHARGE RECORD PHARMACY	250		10.01	N/A
HC65000250_00009031508	NONCDM CHARGE RECORD PHARMACY	250		51.71	N/A
HC65000250_00009032301	NONCDM CHARGE RECORD PHARMACY	250		168.05	N/A
HC65000250_00009034201	NONCDM CHARGE RECORD PHARMACY	250		250.61	N/A
HC65000250_00009035301	NONCDM CHARGE RECORD PHARMACY	250		249.89	N/A
HC65000250_00009039605	NONCDM CHARGE RECORD PHARMACY	250		80.69	N/A
HC65000250_00009043601	NONCDM CHARGE RECORD PHARMACY	250		9.64	N/A
HC65000250_00009076004	NONCDM CHARGE RECORD PHARMACY	250		15.57	N/A
HC65000250_00009513601	NONCDM CHARGE RECORD PHARMACY	250	Z7610	53.75	N/A
HC65000250_00009766304	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00023040350	NONCDM CHARGE RECORD PHARMACY	250		1.54	N/A
HC65000250_00023040370	NONCDM CHARGE RECORD PHARMACY	250		1.48	N/A
HC65000250_00023050601	NONCDM CHARGE RECORD PHARMACY	250		1.72	N/A
HC65000250_00023050650	NONCDM CHARGE RECORD PHARMACY	250		1.58	N/A
HC65000250_00023079815	NONCDM CHARGE RECORD PHARMACY	250		47.34	N/A
HC65000250_00023455430	NONCDM CHARGE RECORD PHARMACY	250		1.94	N/A
HC65000250_00023585318	NONCDM CHARGE RECORD PHARMACY	250		22.50	N/A
HC65000250_00023599060	NONCDM CHARGE RECORD PHARMACY	250		61.62	N/A
HC65000250_00023611001	NONCDM CHARGE RECORD PHARMACY	250		21.62	N/A
HC65000250_00023611201	NONCDM CHARGE RECORD PHARMACY	250		43.80	N/A
HC65000250_00023614730	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00023615108	NONCDM CHARGE RECORD PHARMACY	250		179.28	N/A
HC65000250_00023916330	NONCDM CHARGE RECORD PHARMACY	250		61.50	N/A
HC65000250_00023916360	NONCDM CHARGE RECORD PHARMACY	250		60.60	N/A
HC65000250_00024135202	NONCDM CHARGE RECORD PHARMACY	250		21.33	N/A
HC65000250_00024135301	NONCDM CHARGE RECORD PHARMACY	250		18.99	N/A
HC65000250_00024159601	NONCDM CHARGE RECORD PHARMACY	250	Z7610	11.20	N/A
HC65000250_00024414210	NONCDM CHARGE RECORD PHARMACY	250		64.77	N/A
HC65000250_00024414260	NONCDM CHARGE RECORD PHARMACY	250		59.81	N/A
HC65000250_00024542131	NONCDM CHARGE RECORD PHARMACY	250		115.48	N/A
HC65000250_00025145134	NONCDM CHARGE RECORD PHARMACY	250		5.13	N/A
HC65000250_00025146131	NONCDM CHARGE RECORD PHARMACY	250		33.11	N/A
HC65000250_00025146160	NONCDM CHARGE RECORD PHARMACY	250		31.62	N/A
HC65000250_00025152034	NONCDM CHARGE RECORD PHARMACY	250		50.37	N/A
HC65000250_00025152534	NONCDM CHARGE RECORD PHARMACY	250		82.69	N/A
HC65000250_00032120370	NONCDM CHARGE RECORD PHARMACY	250		8.99	N/A
HC65000250_00032120601	NONCDM CHARGE RECORD PHARMACY	250		10.58	N/A
HC65000250_00032121201	NONCDM CHARGE RECORD PHARMACY	250		20.90	N/A
HC65000250_00032121207	NONCDM CHARGE RECORD PHARMACY	250		20.82	N/A
HC65000250_00032122401	NONCDM CHARGE RECORD PHARMACY	250		39.58	N/A
HC65000250_00032122407	NONCDM CHARGE RECORD PHARMACY	250		40.39	N/A
HC65000250_00036314178	NONCDM CHARGE RECORD PHARMACY	250		4.00	N/A
HC65000250_00037006603	NONCDM CHARGE RECORD PHARMACY	250	Z7610	17,830.80	N/A
HC65000250_00037067896	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00039022310	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00039413012	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.34	N/A
HC65000250_00046110081	NONCDM CHARGE RECORD PHARMACY	250		37.19	N/A
HC65000250_00046110181	NONCDM CHARGE RECORD PHARMACY	250		37.19	N/A
HC65000250_00046110281	NONCDM CHARGE RECORD PHARMACY	250		36.36	N/A
HC65000250_00046110481	NONCDM CHARGE RECORD PHARMACY	250		35.42	N/A
HC65000250_00046110511	NONCDM CHARGE RECORD PHARMACY	250		45.63	N/A
HC65000250_00049234045	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00049316044	NONCDM CHARGE RECORD PHARMACY	250		323.18	N/A
HC65000250_00049318030	NONCDM CHARGE RECORD PHARMACY	250		22.03	N/A
HC65000250_00049345019	NONCDM CHARGE RECORD PHARMACY	250	Z7610	81.01	N/A
HC65000250_00049491030	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00051842530	NONCDM CHARGE RECORD PHARMACY	250		124.62	N/A
HC65000250_00054000725	NONCDM CHARGE RECORD PHARMACY	250		5.68	N/A
HC65000250_00054001020	NONCDM CHARGE RECORD PHARMACY	250		3.44	N/A
HC65000250_00054001021	NONCDM CHARGE RECORD PHARMACY	250		3.44	N/A
HC65000250_00054001025	NONCDM CHARGE RECORD PHARMACY	250		3.44	N/A
HC65000250_00054001120	NONCDM CHARGE RECORD PHARMACY	250		4.59	N/A
HC65000250_00054001121	NONCDM CHARGE RECORD PHARMACY	250		5.63	N/A
HC65000250_00054004421	NONCDM CHARGE RECORD PHARMACY	250		2.14	N/A
HC65000250_00054004641	NONCDM CHARGE RECORD PHARMACY	250		216.00	N/A
HC65000250_00054005746	NONCDM CHARGE RECORD PHARMACY	250		14.01	N/A
HC65000250_00054007928	NONCDM CHARGE RECORD PHARMACY	250		4.52	N/A
HC65000250_00054008013	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00054008826	NONCDM CHARGE RECORD PHARMACY	250		3.41	N/A
HC65000250_00054011125	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00054019959	NONCDM CHARGE RECORD PHARMACY	250		47.92	N/A
HC65000250_00054023524	NONCDM CHARGE RECORD PHARMACY	250		4.55	N/A
HC65000250_00054023749	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00054023755	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_00054023763	NONCDM CHARGE RECORD PHARMACY	250		2.13	N/A
HC65000250_00054026424	NONCDM CHARGE RECORD PHARMACY	250		1.80	N/A
HC65000250_00054029225	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00054033425	NONCDM CHARGE RECORD PHARMACY	250		15.50	N/A
HC65000250_00054037951	NONCDM CHARGE RECORD PHARMACY	250		540.00	N/A
HC65000250_00054039063	NONCDM CHARGE RECORD PHARMACY	250		4.89	N/A
HC65000250_00054039168	NONCDM CHARGE RECORD PHARMACY	250		3.14	N/A
HC65000250_00054039925	NONCDM CHARGE RECORD PHARMACY	250		0.00	N/A
HC65000250_00054040013	NONCDM CHARGE RECORD PHARMACY	250		4.78	N/A
HC65000250_00054040022	NONCDM CHARGE RECORD PHARMACY	250		6.05	N/A
HC65000250_00054040444	NONCDM CHARGE RECORD PHARMACY	250		3.59	N/A
HC65000250_00054042523	NONCDM CHARGE RECORD PHARMACY	250	Z7610	18.43	N/A
HC65000250_00054051744	NONCDM CHARGE RECORD PHARMACY	250		3.30	N/A
HC65000250_00054051750	NONCDM CHARGE RECORD PHARMACY	250		3.44	N/A
HC65000250_00054052625	NONCDM CHARGE RECORD PHARMACY	250		7.20	N/A
HC65000250_00054056150	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.01	N/A
HC65000250_00054060313	NONCDM CHARGE RECORD PHARMACY	250		5.85	N/A
HC65000250_00054252625	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00054311763	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00054312041	NONCDM CHARGE RECORD PHARMACY	250		33.54	N/A
HC65000250_00054319446	NONCDM CHARGE RECORD PHARMACY	250		56.02	N/A
HC65000250_00054327099	NONCDM CHARGE RECORD PHARMACY	250		1.52	N/A
HC65000250_00054329446	NONCDM CHARGE RECORD PHARMACY	250		0.85	N/A
HC65000250_00054329450	NONCDM CHARGE RECORD PHARMACY	250		1.05	N/A
HC65000250_00054350049	NONCDM CHARGE RECORD PHARMACY	250	Z7610	66.00	N/A
HC65000250_00054350547	NONCDM CHARGE RECORD PHARMACY	250		183.32	N/A
HC65000250_00054355563	NONCDM CHARGE RECORD PHARMACY	250		3.85	N/A
HC65000250_00054356710	NONCDM CHARGE RECORD PHARMACY	250		5.76	N/A
HC65000250_00054372763	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_00054430129	NONCDM CHARGE RECORD PHARMACY	250		1.27	N/A
HC65000250_00054458111	NONCDM CHARGE RECORD PHARMACY	250		17.98	N/A
HC65000250_00054458127	NONCDM CHARGE RECORD PHARMACY	250		11.41	N/A
HC65000250_00054814622	NONCDM CHARGE RECORD PHARMACY	250		15.94	N/A
HC65000250_00054829725	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00054829925	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00054830125	NONCDM CHARGE RECORD PHARMACY	250		2.26	N/A
HC65000250_00054849619	NONCDM CHARGE RECORD PHARMACY	250		9.45	N/A
HC65000250_00054852625	NONCDM CHARGE RECORD PHARMACY	250		0.92	N/A
HC65000250_00054852725	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00054852825	NONCDM CHARGE RECORD PHARMACY	250		1.23	N/A
HC65000250_00054855324	NONCDM CHARGE RECORD PHARMACY	250		1.85	N/A
HC65000250_00054855424	NONCDM CHARGE RECORD PHARMACY	250	S0109	1.95	N/A
HC65000250_00056016970	NONCDM CHARGE RECORD PHARMACY	250		6.43	N/A
HC65000250_00065002315	NONCDM CHARGE RECORD PHARMACY	250		169.14	N/A
HC65000250_00065008515	NONCDM CHARGE RECORD PHARMACY	250		45.09	N/A
HC65000250_00065030355	NONCDM CHARGE RECORD PHARMACY	250		287.01	N/A
HC65000250_00065035902	NONCDM CHARGE RECORD PHARMACY	250		168.70	N/A
HC65000250_00065035905	NONCDM CHARGE RECORD PHARMACY	250		297.71	N/A
HC65000250_00065039602	NONCDM CHARGE RECORD PHARMACY	250		88.98	N/A
HC65000250_00065041130	NONCDM CHARGE RECORD PHARMACY	250		85.45	N/A
HC65000250_00065047401	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00065053001	NONCDM CHARGE RECORD PHARMACY	250		106.77	N/A
HC65000250_00065065605	NONCDM CHARGE RECORD PHARMACY	250		707.31	N/A
HC65000250_00065074114	NONCDM CHARGE RECORD PHARMACY	250		55.67	N/A
HC65000250_00065079515	NONCDM CHARGE RECORD PHARMACY	250		63.64	N/A
HC65000250_00065079550	NONCDM CHARGE RECORD PHARMACY	250		85.45	N/A
HC65000250_00065080050	NONCDM CHARGE RECORD PHARMACY	250		471.05	N/A
HC65000250_00065401105	NONCDM CHARGE RECORD PHARMACY	250		58.50	N/A
HC65000250_00067200091	NONCDM CHARGE RECORD PHARMACY	250		0.87	N/A
HC65000250_00067434509	NONCDM CHARGE RECORD PHARMACY	250		79.43	N/A
HC65000250_00067815201	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00067815202	NONCDM CHARGE RECORD PHARMACY	250		48.00	N/A
HC65000250_00067815204	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00069012201	NONCDM CHARGE RECORD PHARMACY	250		11.69	N/A
HC65000250_00069097193	NONCDM CHARGE RECORD PHARMACY	250		25.19	N/A
HC65000250_00069097195	NONCDM CHARGE RECORD PHARMACY	250		70.09	N/A
HC65000250_00069306030	NONCDM CHARGE RECORD PHARMACY	250		12.75	N/A
HC65000250_00069420030	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.05	N/A
HC65000250_00069582043	NONCDM CHARGE RECORD PHARMACY	250		62.67	N/A
HC65000250_00071000740	NONCDM CHARGE RECORD PHARMACY	250		10.95	N/A
HC65000250_00071015640	NONCDM CHARGE RECORD PHARMACY	250		100.88	N/A
HC65000250_00071015823	NONCDM CHARGE RECORD PHARMACY	250		96.11	N/A
HC65000250_00071036924	NONCDM CHARGE RECORD PHARMACY	250		8.61	N/A
HC65000250_00071036940	NONCDM CHARGE RECORD PHARMACY	250		9.13	N/A
HC65000250_00071041813	NONCDM CHARGE RECORD PHARMACY	250		7.78	N/A
HC65000250_00071101268	NONCDM CHARGE RECORD PHARMACY	250		50.32	N/A
HC65000250_00071101341	NONCDM CHARGE RECORD PHARMACY	250		55.84	N/A
HC65000250_00071101441	NONCDM CHARGE RECORD PHARMACY	250		55.77	N/A
HC65000250_00071101541	NONCDM CHARGE RECORD PHARMACY	250		55.92	N/A
HC65000250_00071221420	NONCDM CHARGE RECORD PHARMACY	250		17.18	N/A
HC65000250_00071374066	NONCDM CHARGE RECORD PHARMACY	250		7.39	N/A
HC65000250_00074333330	NONCDM CHARGE RECORD PHARMACY	250		51.43	N/A
HC65000250_00074339930	NONCDM CHARGE RECORD PHARMACY	250		51.43	N/A
HC65000250_00074372790	NONCDM CHARGE RECORD PHARMACY	250		7.99	N/A
HC65000250_00074431730	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00074434190	NONCDM CHARGE RECORD PHARMACY	250		7.20	N/A
HC65000250_00074455211	NONCDM CHARGE RECORD PHARMACY	250		8.03	N/A
HC65000250_00074518211	NONCDM CHARGE RECORD PHARMACY	250		7.81	N/A
HC65000250_00074518290	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00074621213	NONCDM CHARGE RECORD PHARMACY	250		7.11	N/A
HC65000250_00074659490	NONCDM CHARGE RECORD PHARMACY	250		8.09	N/A
HC65000250_00074662411	NONCDM CHARGE RECORD PHARMACY	250		7.97	N/A
HC65000250_00074706811	NONCDM CHARGE RECORD PHARMACY	250		8.01	N/A
HC65000250_00074706890	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00074706990	NONCDM CHARGE RECORD PHARMACY	250		8.01	N/A
HC65000250_00074712611	NONCDM CHARGE RECORD PHARMACY	250		35.33	N/A
HC65000250_00074736201	NONCDM CHARGE RECORD PHARMACY	250		18.66	N/A
HC65000250_00074929690	NONCDM CHARGE RECORD PHARMACY	250		7.95	N/A
HC65000250_00078012706	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00078034642	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00078035834	NONCDM CHARGE RECORD PHARMACY	250		47.12	N/A
HC65000250_00078035934	NONCDM CHARGE RECORD PHARMACY	250		50.68	N/A
HC65000250_00078036034	NONCDM CHARGE RECORD PHARMACY	250		64.10	N/A
HC65000250_00078038666	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00078040805	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00078040905	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00078042315	NONCDM CHARGE RECORD PHARMACY	250		39.42	N/A
HC65000250_00078050115	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00078050215	NONCDM CHARGE RECORD PHARMACY	250		137.16	N/A
HC65000250_00078050883	NONCDM CHARGE RECORD PHARMACY	250		37.03	N/A
HC65000250_00078050905	NONCDM CHARGE RECORD PHARMACY	250		15.20	N/A
HC65000250_00078051005	NONCDM CHARGE RECORD PHARMACY	250		8.14	N/A
HC65000250_00078065920	NONCDM CHARGE RECORD PHARMACY	250		56.62	N/A
HC65000250_00078069620	NONCDM CHARGE RECORD PHARMACY	250		54.79	N/A
HC65000250_00078077720	NONCDM CHARGE RECORD PHARMACY	250		57.18	N/A
HC65000250_00081073088	NONCDM CHARGE RECORD PHARMACY	250		20.36	N/A
HC65000250_00081079888	NONCDM CHARGE RECORD PHARMACY	250		23.60	N/A
HC65000250_00087040203	NONCDM CHARGE RECORD PHARMACY	250		1.09	N/A
HC65000250_00087040303	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_00087040501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00087086644	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2.37	N/A
HC65000250_00088117112	NONCDM CHARGE RECORD PHARMACY	250		1.53	N/A
HC65000250_00088210224	NONCDM CHARGE RECORD PHARMACY	250		0.00	N/A
HC65000250_00088216130	NONCDM CHARGE RECORD PHARMACY	250		259.16	N/A
HC65000250_00093005101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00093005301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00093005401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00093005405	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_00093013501	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00093019901	NONCDM CHARGE RECORD PHARMACY	250		1.87	N/A
HC65000250_00093026215	NONCDM CHARGE RECORD PHARMACY	250		218.61	N/A
HC65000250_00093026230	NONCDM CHARGE RECORD PHARMACY	250		413.08	N/A
HC65000250_00093031101	NONCDM CHARGE RECORD PHARMACY	250		2.07	N/A
HC65000250_00093031401	NONCDM CHARGE RECORD PHARMACY	250		6.47	N/A
HC65000250_00093031801	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00093031805	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00093031901	NONCDM CHARGE RECORD PHARMACY	250		1.41	N/A
HC65000250_00093031905	NONCDM CHARGE RECORD PHARMACY	250		1.39	N/A
HC65000250_00093032001	NONCDM CHARGE RECORD PHARMACY	250		1.75	N/A
HC65000250_00093032101	NONCDM CHARGE RECORD PHARMACY	250		2.60	N/A
HC65000250_00093075201	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00093075210	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00093077801	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3.16	N/A
HC65000250_00093078701	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_00093081001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00093081101	NONCDM CHARGE RECORD PHARMACY	250		1.60	N/A
HC65000250_00093081201	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00093083201	NONCDM CHARGE RECORD PHARMACY	250		0.95	N/A
HC65000250_00093117701	NONCDM CHARGE RECORD PHARMACY	250		6.11	N/A
HC65000250_00093171801	NONCDM CHARGE RECORD PHARMACY	250		2.03	N/A
HC65000250_00093172001	NONCDM CHARGE RECORD PHARMACY	250		2.18	N/A
HC65000250_00093172301	NONCDM CHARGE RECORD PHARMACY	250		2.10	N/A
HC65000250_00093206406	NONCDM CHARGE RECORD PHARMACY	250		2.27	N/A
HC65000250_00093206506	NONCDM CHARGE RECORD PHARMACY	250		1.91	N/A
HC65000250_00093214062	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.01	N/A
HC65000250_00093220301	NONCDM CHARGE RECORD PHARMACY	250		1.02	N/A
HC65000250_00093220305	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00093220310	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00093220401	NONCDM CHARGE RECORD PHARMACY	250		1.02	N/A
HC65000250_00093220405	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00093221001	NONCDM CHARGE RECORD PHARMACY	250		1.62	N/A
HC65000250_00093221005	NONCDM CHARGE RECORD PHARMACY	250		1.42	N/A
HC65000250_00093227434	NONCDM CHARGE RECORD PHARMACY	250		8.47	N/A
HC65000250_00093227534	NONCDM CHARGE RECORD PHARMACY	250		9.48	N/A
HC65000250_00093274865	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00093300256	NONCDM CHARGE RECORD PHARMACY	250		33.95	N/A
HC65000250_00093300993	NONCDM CHARGE RECORD PHARMACY	250		71.73	N/A
HC65000250_00093310701	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_00093310905	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_00093312301	NONCDM CHARGE RECORD PHARMACY	250		3.76	N/A
HC65000250_00093312701	NONCDM CHARGE RECORD PHARMACY	250		11.96	N/A
HC65000250_00093312901	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00093314501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00093314701	NONCDM CHARGE RECORD PHARMACY	250		1.31	N/A
HC65000250_00093316006	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00093317431	NONCDM CHARGE RECORD PHARMACY	250		215.88	N/A
HC65000250_00093321201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00093342201	NONCDM CHARGE RECORD PHARMACY	250		0.95	N/A
HC65000250_00093365528	NONCDM CHARGE RECORD PHARMACY	250		119.15	N/A
HC65000250_00093406901	NONCDM CHARGE RECORD PHARMACY	250		7.86	N/A
HC65000250_00093412773	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2.58	N/A
HC65000250_00093412774	NONCDM CHARGE RECORD PHARMACY	250		1.88	N/A
HC65000250_00093414656	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00093415573	NONCDM CHARGE RECORD PHARMACY	250		0.78	N/A
HC65000250_00093417773	NONCDM CHARGE RECORD PHARMACY	250		4.15	N/A
HC65000250_00093524565	NONCDM CHARGE RECORD PHARMACY	250		10.63	N/A
HC65000250_00093535301	NONCDM CHARGE RECORD PHARMACY	250		0.00	N/A
HC65000250_00093535401	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00093540189	NONCDM CHARGE RECORD PHARMACY	250		9.92	N/A
HC65000250_00093545462	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00093551798	NONCDM CHARGE RECORD PHARMACY	250		5.29	N/A
HC65000250_00093557156	NONCDM CHARGE RECORD PHARMACY	250		39.69	N/A
HC65000250_00093576801	NONCDM CHARGE RECORD PHARMACY	250		1.39	N/A
HC65000250_00093577001	NONCDM CHARGE RECORD PHARMACY	250		2.09	N/A
HC65000250_00093596101	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.01	N/A
HC65000250_00093611816	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2.12	N/A
HC65000250_00093645056	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00093681573	NONCDM CHARGE RECORD PHARMACY	250		46.25	N/A
HC65000250_00093681673	NONCDM CHARGE RECORD PHARMACY	250		53.55	N/A
HC65000250_00093703098	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00093716501	NONCDM CHARGE RECORD PHARMACY	250		7.22	N/A
HC65000250_00093720198	NONCDM CHARGE RECORD PHARMACY	250		2.93	N/A
HC65000250_00093729056	NONCDM CHARGE RECORD PHARMACY	250		23.20	N/A
HC65000250_00093729501	NONCDM CHARGE RECORD PHARMACY	250		0.93	N/A
HC65000250_00093729505	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00093729601	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00093733506	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00093738001	NONCDM CHARGE RECORD PHARMACY	250		1.93	N/A
HC65000250_00093738201	NONCDM CHARGE RECORD PHARMACY	250		2.10	N/A
HC65000250_00093738598	NONCDM CHARGE RECORD PHARMACY	250		1.72	N/A
HC65000250_00093738756	NONCDM CHARGE RECORD PHARMACY	250		130.68	N/A
HC65000250_00093760756	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00093761356	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00093762056	NONCDM CHARGE RECORD PHARMACY	250		2.20	N/A
HC65000250_00093775698	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00093786565	NONCDM CHARGE RECORD PHARMACY	250		73.11	N/A
HC65000250_00093811856	NONCDM CHARGE RECORD PHARMACY	250		9.65	N/A
HC65000250_00093811956	NONCDM CHARGE RECORD PHARMACY	250		19.34	N/A
HC65000250_00093820401	NONCDM CHARGE RECORD PHARMACY	250		3.61	N/A
HC65000250_00093834301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00093834401	NONCDM CHARGE RECORD PHARMACY	250		1.56	N/A
HC65000250_00093834498	NONCDM CHARGE RECORD PHARMACY	250		1.27	N/A
HC65000250_00093873901	NONCDM CHARGE RECORD PHARMACY	250		7.76	N/A
HC65000250_00093874001	NONCDM CHARGE RECORD PHARMACY	250		9.44	N/A
HC65000250_00093894301	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_00093914701	NONCDM CHARGE RECORD PHARMACY	250		1.87	N/A
HC65000250_00096073204	NONCDM CHARGE RECORD PHARMACY	250		73.44	N/A
HC65000250_00115146860	NONCDM CHARGE RECORD PHARMACY	250		34.34	N/A
HC65000250_00115148701	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00115164501	NONCDM CHARGE RECORD PHARMACY	250		8.16	N/A
HC65000250_00115180101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00115180201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00115351101	NONCDM CHARGE RECORD PHARMACY	250		6.12	N/A
HC65000250_00115423301	NONCDM CHARGE RECORD PHARMACY	250		22.42	N/A
HC65000250_00115441101	NONCDM CHARGE RECORD PHARMACY	250		4.86	N/A
HC65000250_00115551110	NONCDM CHARGE RECORD PHARMACY	250		1.62	N/A
HC65000250_00115552210	NONCDM CHARGE RECORD PHARMACY	250		3.40	N/A
HC65000250_00115681108	NONCDM CHARGE RECORD PHARMACY	250		2.50	N/A
HC65000250_00115703301	NONCDM CHARGE RECORD PHARMACY	250		3.55	N/A
HC65000250_00116200116	NONCDM CHARGE RECORD PHARMACY	250		0.12	N/A
HC65000250_00121048900	NONCDM CHARGE RECORD PHARMACY	250		20.41	N/A
HC65000250_00121050400	NONCDM CHARGE RECORD PHARMACY	250		9.88	N/A
HC65000250_00121052710	NONCDM CHARGE RECORD PHARMACY	250		17.32	N/A
HC65000250_00121053005	NONCDM CHARGE RECORD PHARMACY	250		21.15	N/A
HC65000250_00121054410	NONCDM CHARGE RECORD PHARMACY	250		3.68	N/A
HC65000250_00121057616	NONCDM CHARGE RECORD PHARMACY	250		1.58	N/A
HC65000250_00121057708	NONCDM CHARGE RECORD PHARMACY	250		15.00	N/A
HC65000250_00121057716	NONCDM CHARGE RECORD PHARMACY	250		21.96	N/A
HC65000250_00121059500	NONCDM CHARGE RECORD PHARMACY	250		19.79	N/A
HC65000250_00121059516	NONCDM CHARGE RECORD PHARMACY	250		1.89	N/A
HC65000250_00121059530	NONCDM CHARGE RECORD PHARMACY	250		10.80	N/A
HC65000250_00121063800	NONCDM CHARGE RECORD PHARMACY	250		13.10	N/A
HC65000250_00121064610	NONCDM CHARGE RECORD PHARMACY	250	Z7610	12.84	N/A
HC65000250_00121064616	NONCDM CHARGE RECORD PHARMACY	250		2.47	N/A
HC65000250_00121064908	NONCDM CHARGE RECORD PHARMACY	250	Z7610	237.00	N/A
HC65000250_00121065700	NONCDM CHARGE RECORD PHARMACY	250		10.79	N/A
HC65000250_00121067616	NONCDM CHARGE RECORD PHARMACY	250		8.16	N/A
HC65000250_00121067816	NONCDM CHARGE RECORD PHARMACY	250		31.57	N/A
HC65000250_00121072104	NONCDM CHARGE RECORD PHARMACY	250	Z7610	33.42	N/A
HC65000250_00121074700	NONCDM CHARGE RECORD PHARMACY	250		49.04	N/A
HC65000250_00121074730	NONCDM CHARGE RECORD PHARMACY	250		62.22	N/A
HC65000250_00121074740	NONCDM CHARGE RECORD PHARMACY	250		53.36	N/A
HC65000250_00121075908	NONCDM CHARGE RECORD PHARMACY	250		6.43	N/A
HC65000250_00121079916	NONCDM CHARGE RECORD PHARMACY	250		5.95	N/A
HC65000250_00121081002	NONCDM CHARGE RECORD PHARMACY	250	Z7610	72.00	N/A
HC65000250_00121086802	NONCDM CHARGE RECORD PHARMACY	250		71.39	N/A
HC65000250_00121087316	NONCDM CHARGE RECORD PHARMACY	250		28.53	N/A
HC65000250_00121090494	NONCDM CHARGE RECORD PHARMACY	250		8.14	N/A
HC65000250_00121090594	NONCDM CHARGE RECORD PHARMACY	250		22.98	N/A
HC65000250_00121091400	NONCDM CHARGE RECORD PHARMACY	250		6.13	N/A
HC65000250_00121091700	NONCDM CHARGE RECORD PHARMACY	250		7.88	N/A
HC65000250_00121091840	NONCDM CHARGE RECORD PHARMACY	250		6.72	N/A
HC65000250_00121097800	NONCDM CHARGE RECORD PHARMACY	250		16.42	N/A
HC65000250_00121100800	NONCDM CHARGE RECORD PHARMACY	250		8.78	N/A
HC65000250_00121115400	NONCDM CHARGE RECORD PHARMACY	250		4.22	N/A
HC65000250_00121115440	NONCDM CHARGE RECORD PHARMACY	250		7.05	N/A
HC65000250_00121119000	NONCDM CHARGE RECORD PHARMACY	250		21.30	N/A
HC65000250_00121127600	NONCDM CHARGE RECORD PHARMACY	250		13.81	N/A
HC65000250_00121131400	NONCDM CHARGE RECORD PHARMACY	250		10.80	N/A
HC65000250_00121146515	NONCDM CHARGE RECORD PHARMACY	250	Z7610	4.20	N/A
HC65000250_00121148800	NONCDM CHARGE RECORD PHARMACY	250		4.08	N/A
HC65000250_00121154440	NONCDM CHARGE RECORD PHARMACY	250		62.33	N/A
HC65000250_00121155000	NONCDM CHARGE RECORD PHARMACY	250		3.84	N/A
HC65000250_00121157610	NONCDM CHARGE RECORD PHARMACY	250		10.46	N/A
HC65000250_00121168016	NONCDM CHARGE RECORD PHARMACY	250		12.67	N/A
HC65000250_00121174400	NONCDM CHARGE RECORD PHARMACY	250		3.15	N/A
HC65000250_00121174410	NONCDM CHARGE RECORD PHARMACY	250		3.30	N/A
HC65000250_00121176030	NONCDM CHARGE RECORD PHARMACY	250	Z7610	18.00	N/A
HC65000250_00121176130	NONCDM CHARGE RECORD PHARMACY	250		15.99	N/A
HC65000250_00121176230	NONCDM CHARGE RECORD PHARMACY	250		13.25	N/A
HC65000250_00121177500	NONCDM CHARGE RECORD PHARMACY	250		3.86	N/A
HC65000250_00121178100	NONCDM CHARGE RECORD PHARMACY	250		14.12	N/A
HC65000250_00121182800	NONCDM CHARGE RECORD PHARMACY	250		9.42	N/A
HC65000250_00121183605	NONCDM CHARGE RECORD PHARMACY	250		5.08	N/A
HC65000250_00121197100	NONCDM CHARGE RECORD PHARMACY	250		12.47	N/A
HC65000250_00121457706	NONCDM CHARGE RECORD PHARMACY	250	Z7610	15.00	N/A
HC65000250_00121457730	NONCDM CHARGE RECORD PHARMACY	250	Z7610	18.00	N/A
HC65000250_00121467500	NONCDM CHARGE RECORD PHARMACY	250		3.24	N/A
HC65000250_00121467540	NONCDM CHARGE RECORD PHARMACY	250		3.72	N/A
HC65000250_00121476605	NONCDM CHARGE RECORD PHARMACY	250		15.36	N/A
HC65000250_00121477240	NONCDM CHARGE RECORD PHARMACY	250		44.29	N/A
HC65000250_00121477440	NONCDM CHARGE RECORD PHARMACY	250		4.06	N/A
HC65000250_00121477640	NONCDM CHARGE RECORD PHARMACY	250		16.29	N/A
HC65000250_00121479940	NONCDM CHARGE RECORD PHARMACY	250		34.50	N/A
HC65000250_00121479950	NONCDM CHARGE RECORD PHARMACY	250	Z7610	10.31	N/A
HC65000250_00131247735	NONCDM CHARGE RECORD PHARMACY	250		59.32	N/A
HC65000250_00131247760	NONCDM CHARGE RECORD PHARMACY	250		64.48	N/A
HC65000250_00131247860	NONCDM CHARGE RECORD PHARMACY	250		100.71	N/A
HC65000250_00131541072	NONCDM CHARGE RECORD PHARMACY	250		859.79	N/A
HC65000250_00132007912	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00132007924	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00132008112	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_00132019012	NONCDM CHARGE RECORD PHARMACY	250		27.32	N/A
HC65000250_00132020140	NONCDM CHARGE RECORD PHARMACY	250		5.50	N/A
HC65000250_00132020220	NONCDM CHARGE RECORD PHARMACY	250		6.95	N/A
HC65000250_00132030140	NONCDM CHARGE RECORD PHARMACY	250		10.13	N/A
HC65000250_00132070336	NONCDM CHARGE RECORD PHARMACY	250	Z7610	12.43	N/A
HC65000250_00135011814	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00135020001	NONCDM CHARGE RECORD PHARMACY	250		85.93	N/A
HC65000250_00140000501	NONCDM CHARGE RECORD PHARMACY	250		31.53	N/A
HC65000250_00143117101	NONCDM CHARGE RECORD PHARMACY	250		6.08	N/A
HC65000250_00143117201	NONCDM CHARGE RECORD PHARMACY	250		5.73	N/A
HC65000250_00143126301	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00143176901	NONCDM CHARGE RECORD PHARMACY	250		3.17	N/A
HC65000250_00143177101	NONCDM CHARGE RECORD PHARMACY	250		3.47	N/A
HC65000250_00143211205	NONCDM CHARGE RECORD PHARMACY	250		7.20	N/A
HC65000250_00143923210	NONCDM CHARGE RECORD PHARMACY	250		108.11	N/A
HC65000250_00143923410	NONCDM CHARGE RECORD PHARMACY	250		28.67	N/A
HC65000250_00143925010	NONCDM CHARGE RECORD PHARMACY	250		18.39	N/A
HC65000250_00143931010	NONCDM CHARGE RECORD PHARMACY	250		16.80	N/A
HC65000250_00143931810	NONCDM CHARGE RECORD PHARMACY	250		132.42	N/A
HC65000250_00143950610	NONCDM CHARGE RECORD PHARMACY	250		36.83	N/A
HC65000250_00143950710	NONCDM CHARGE RECORD PHARMACY	250		40.32	N/A
HC65000250_00143950910	NONCDM CHARGE RECORD PHARMACY	250		12.90	N/A
HC65000250_00143958625	NONCDM CHARGE RECORD PHARMACY	250		21.46	N/A
HC65000250_00143963710	NONCDM CHARGE RECORD PHARMACY	250		16.75	N/A
HC65000250_00143966010	NONCDM CHARGE RECORD PHARMACY	250		15.29	N/A
HC65000250_00143968125	NONCDM CHARGE RECORD PHARMACY	250		66.90	N/A
HC65000250_00143968225	NONCDM CHARGE RECORD PHARMACY	250		47.13	N/A
HC65000250_00143968410	NONCDM CHARGE RECORD PHARMACY	250		25.48	N/A
HC65000250_00143978410	NONCDM CHARGE RECORD PHARMACY	250		20.41	N/A
HC65000250_00143978510	NONCDM CHARGE RECORD PHARMACY	250		106.13	N/A
HC65000250_00143978610	NONCDM CHARGE RECORD PHARMACY	250		49.54	N/A
HC65000250_00143978710	NONCDM CHARGE RECORD PHARMACY	250		17.10	N/A
HC65000250_00143987325	NONCDM CHARGE RECORD PHARMACY	250		16.05	N/A
HC65000250_00143988701	NONCDM CHARGE RECORD PHARMACY	250		2.48	N/A
HC65000250_00143988901	NONCDM CHARGE RECORD PHARMACY	250		0.26	N/A
HC65000250_00143988980	NONCDM CHARGE RECORD PHARMACY	250		0.20	N/A
HC65000250_00168000415	NONCDM CHARGE RECORD PHARMACY	250		27.90	N/A
HC65000250_00168000580	NONCDM CHARGE RECORD PHARMACY	250		55.68	N/A
HC65000250_00168000615	NONCDM CHARGE RECORD PHARMACY	250	Z7610	27.90	N/A
HC65000250_00168000680	NONCDM CHARGE RECORD PHARMACY	250		69.60	N/A
HC65000250_00168000715	NONCDM CHARGE RECORD PHARMACY	250		83.97	N/A
HC65000250_00168002031	NONCDM CHARGE RECORD PHARMACY	250		36.06	N/A
HC65000250_00168003501	NONCDM CHARGE RECORD PHARMACY	250		15.99	N/A
HC65000250_00168005415	NONCDM CHARGE RECORD PHARMACY	250		83.97	N/A
HC65000250_00168008031	NONCDM CHARGE RECORD PHARMACY	250		19.80	N/A
HC65000250_00168014630	NONCDM CHARGE RECORD PHARMACY	250		19.73	N/A
HC65000250_00168016230	NONCDM CHARGE RECORD PHARMACY	250		865.80	N/A
HC65000250_00168035755	NONCDM CHARGE RECORD PHARMACY	250		49.59	N/A
HC65000250_00172208360	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00172392560	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00172392660	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00172409660	NONCDM CHARGE RECORD PHARMACY	250		1.79	N/A
HC65000250_00172524160	NONCDM CHARGE RECORD PHARMACY	250		5.00	N/A
HC65000250_00172541046	NONCDM CHARGE RECORD PHARMACY	250	Z7610	4.00	N/A
HC65000250_00172541160	NONCDM CHARGE RECORD PHARMACY	250		6.00	N/A
HC65000250_00172541360	NONCDM CHARGE RECORD PHARMACY	250		8.00	N/A
HC65000250_00172572860	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00172572870	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00172572880	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_00173054700	NONCDM CHARGE RECORD PHARMACY	250		351.95	N/A
HC65000250_00173063302	NONCDM CHARGE RECORD PHARMACY	250		78.93	N/A
HC65000250_00173066200	NONCDM CHARGE RECORD PHARMACY	250		48.79	N/A
HC65000250_00173067502	NONCDM CHARGE RECORD PHARMACY	250		41.20	N/A
HC65000250_00173068220	NONCDM CHARGE RECORD PHARMACY	250		299.62	N/A
HC65000250_00173068221	NONCDM CHARGE RECORD PHARMACY	250		128.54	N/A
HC65000250_00173068224	NONCDM CHARGE RECORD PHARMACY	250		93.34	N/A
HC65000250_00173071215	NONCDM CHARGE RECORD PHARMACY	250		39.63	N/A
HC65000250_00173085702	NONCDM CHARGE RECORD PHARMACY	250		84.60	N/A
HC65000250_00173085910	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00173085914	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00173088408	NONCDM CHARGE RECORD PHARMACY	250		15.04	N/A
HC65000250_00178030103	NONCDM CHARGE RECORD PHARMACY	250		10.80	N/A
HC65000250_00185001001	NONCDM CHARGE RECORD PHARMACY	250		2.46	N/A
HC65000250_00185003451	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3.67	N/A
HC65000250_00185005501	NONCDM CHARGE RECORD PHARMACY	250		11.37	N/A
HC65000250_00185007201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00185007401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00185012201	NONCDM CHARGE RECORD PHARMACY	250		15.53	N/A
HC65000250_00185015701	NONCDM CHARGE RECORD PHARMACY	250		3.60	N/A
HC65000250_00185022360	NONCDM CHARGE RECORD PHARMACY	250		3.60	N/A
HC65000250_00185041560	NONCDM CHARGE RECORD PHARMACY	250		2.70	N/A
HC65000250_00185061501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00185064901	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00185067401	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_00185079901	NONCDM CHARGE RECORD PHARMACY	250		34.26	N/A
HC65000250_00185085301	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00185094098	NONCDM CHARGE RECORD PHARMACY	250		12.31	N/A
HC65000250_00185536830	NONCDM CHARGE RECORD PHARMACY	250		20.83	N/A
HC65000250_00186077660	NONCDM CHARGE RECORD PHARMACY	250		39.62	N/A
HC65000250_00186077739	NONCDM CHARGE RECORD PHARMACY	250		39.67	N/A
HC65000250_00186108805	NONCDM CHARGE RECORD PHARMACY	250		7.18	N/A
HC65000250_00187073090	NONCDM CHARGE RECORD PHARMACY	250		293.97	N/A
HC65000250_00223176001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00225038280	NONCDM CHARGE RECORD PHARMACY	250		12.00	N/A
HC65000250_00225052547	NONCDM CHARGE RECORD PHARMACY	250		15.40	N/A
HC65000250_00225080047	NONCDM CHARGE RECORD PHARMACY	250		17.65	N/A
HC65000250_00225080547	NONCDM CHARGE RECORD PHARMACY	250		16.20	N/A
HC65000250_00225081047	NONCDM CHARGE RECORD PHARMACY	250		19.61	N/A
HC65000250_00228202710	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00228202750	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00228207610	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00228207650	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_00228212710	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_00228212750	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00228212810	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00228212910	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00228234810	NONCDM CHARGE RECORD PHARMACY	250		4.50	N/A
HC65000250_00228249710	NONCDM CHARGE RECORD PHARMACY	250		5.13	N/A
HC65000250_00228253010	NONCDM CHARGE RECORD PHARMACY	250		11.05	N/A
HC65000250_00228253810	NONCDM CHARGE RECORD PHARMACY	250		1.40	N/A
HC65000250_00228253910	NONCDM CHARGE RECORD PHARMACY	250		1.61	N/A
HC65000250_00228253950	NONCDM CHARGE RECORD PHARMACY	250		1.52	N/A
HC65000250_00228254010	NONCDM CHARGE RECORD PHARMACY	250		0.94	N/A
HC65000250_00228254050	NONCDM CHARGE RECORD PHARMACY	250		1.72	N/A
HC65000250_00228255106	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00228257111	NONCDM CHARGE RECORD PHARMACY	250		2.52	N/A
HC65000250_00228259711	NONCDM CHARGE RECORD PHARMACY	250		1.91	N/A
HC65000250_00228262011	NONCDM CHARGE RECORD PHARMACY	250		3.05	N/A
HC65000250_00228263111	NONCDM CHARGE RECORD PHARMACY	250		2.93	N/A
HC65000250_00228277811	NONCDM CHARGE RECORD PHARMACY	250		10.09	N/A
HC65000250_00228277911	NONCDM CHARGE RECORD PHARMACY	250		11.78	N/A
HC65000250_00228278011	NONCDM CHARGE RECORD PHARMACY	250		14.62	N/A
HC65000250_00228282011	NONCDM CHARGE RECORD PHARMACY	250		1.65	N/A
HC65000250_00228299611	NONCDM CHARGE RECORD PHARMACY	250		3.00	N/A
HC65000250_00228299650	NONCDM CHARGE RECORD PHARMACY	250		3.09	N/A
HC65000250_00228300311	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00228315603	NONCDM CHARGE RECORD PHARMACY	250	J0571	14.91	N/A
HC65000250_00234057517	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00245001201	NONCDM CHARGE RECORD PHARMACY	250		9.56	N/A
HC65000250_00245003642	NONCDM CHARGE RECORD PHARMACY	250	Z7610	12.30	N/A
HC65000250_00245007011	NONCDM CHARGE RECORD PHARMACY	250		6.05	N/A
HC65000250_00245010801	NONCDM CHARGE RECORD PHARMACY	250		3.61	N/A
HC65000250_00245014401	NONCDM CHARGE RECORD PHARMACY	250		37.56	N/A
HC65000250_00245014501	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00245014701	NONCDM CHARGE RECORD PHARMACY	250		5.31	N/A
HC65000250_00245021111	NONCDM CHARGE RECORD PHARMACY	250		3.15	N/A
HC65000250_00245021201	NONCDM CHARGE RECORD PHARMACY	250		16.79	N/A
HC65000250_00245021211	NONCDM CHARGE RECORD PHARMACY	250		4.43	N/A
HC65000250_00245021311	NONCDM CHARGE RECORD PHARMACY	250		8.27	N/A
HC65000250_00245053660	NONCDM CHARGE RECORD PHARMACY	250		12.30	N/A
HC65000250_00245531701	NONCDM CHARGE RECORD PHARMACY	250		2.94	N/A
HC65000250_00245531901	NONCDM CHARGE RECORD PHARMACY	250		3.18	N/A
HC65000250_00245531915	NONCDM CHARGE RECORD PHARMACY	250		2.99	N/A
HC65000250_00245532630	NONCDM CHARGE RECORD PHARMACY	250		7.56	N/A
HC65000250_00254100752	NONCDM CHARGE RECORD PHARMACY	250		215.87	N/A
HC65000250_00254101196	NONCDM CHARGE RECORD PHARMACY	250		21.15	N/A
HC65000250_00254102047	NONCDM CHARGE RECORD PHARMACY	250	Z7610	42.63	N/A
HC65000250_00254200801	NONCDM CHARGE RECORD PHARMACY	250		33.54	N/A
HC65000250_00254203080	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.01	N/A
HC65000250_00254302802	NONCDM CHARGE RECORD PHARMACY	250		29.76	N/A
HC65000250_00254302902	NONCDM CHARGE RECORD PHARMACY	250		29.69	N/A
HC65000250_00264317311	NONCDM CHARGE RECORD PHARMACY	250		115.38	N/A
HC65000250_00264553532	NONCDM CHARGE RECORD PHARMACY	250		16.92	N/A
HC65000250_00264752000	NONCDM CHARGE RECORD PHARMACY	250	J3490	1.80	N/A
HC65000250_00264752020	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00281032608	NONCDM CHARGE RECORD PHARMACY	250		12.92	N/A
HC65000250_00281032630	NONCDM CHARGE RECORD PHARMACY	250		202.58	N/A
HC65000250_00283061026	NONCDM CHARGE RECORD PHARMACY	250		62.94	N/A
HC65000250_00283067902	NONCDM CHARGE RECORD PHARMACY	250		174.66	N/A
HC65000250_00299391742	NONCDM CHARGE RECORD PHARMACY	250	Z7610	22.95	N/A
HC65000250_00299391808	NONCDM CHARGE RECORD PHARMACY	250	Z7610	34.13	N/A
HC65000250_00299391816	NONCDM CHARGE RECORD PHARMACY	250		56.76	N/A
HC65000250_00310009530	NONCDM CHARGE RECORD PHARMACY	250		73.90	N/A
HC65000250_00310075590	NONCDM CHARGE RECORD PHARMACY	250		53.97	N/A
HC65000250_00310110530	NONCDM CHARGE RECORD PHARMACY	250		166.11	N/A
HC65000250_00310111030	NONCDM CHARGE RECORD PHARMACY	250		137.68	N/A
HC65000250_00310111039	NONCDM CHARGE RECORD PHARMACY	250		138.40	N/A
HC65000250_00310135030	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00310196930	NONCDM CHARGE RECORD PHARMACY	250		71.08	N/A
HC65000250_00310197039	NONCDM CHARGE RECORD PHARMACY	250		71.08	N/A
HC65000250_00310620530	NONCDM CHARGE RECORD PHARMACY	250		105.12	N/A
HC65000250_00310621030	NONCDM CHARGE RECORD PHARMACY	250		105.50	N/A
HC65000250_00338002302	NONCDM CHARGE RECORD PHARMACY	250		2.36	N/A
HC65000250_00338004902	NONCDM CHARGE RECORD PHARMACY	250		3.90	N/A
HC65000250_00338004904	NONCDM CHARGE RECORD PHARMACY	250	J7030	1.20	N/A
HC65000250_00338004931	NONCDM CHARGE RECORD PHARMACY	250		12.22	N/A
HC65000250_00338051909	NONCDM CHARGE RECORD PHARMACY	250		225.76	N/A
HC65000250_00338051913	NONCDM CHARGE RECORD PHARMACY	250		38.60	N/A
HC65000250_00338051958	NONCDM CHARGE RECORD PHARMACY	250		139.63	N/A
HC65000250_00338081909	NONCDM CHARGE RECORD PHARMACY	250		49.66	N/A
HC65000250_00338104702	NONCDM CHARGE RECORD PHARMACY	250		4.34	N/A
HC65000250_00338104902	NONCDM CHARGE RECORD PHARMACY	250		113.14	N/A
HC65000250_00338105548	NONCDM CHARGE RECORD PHARMACY	250		12.75	N/A
HC65000250_00338519741	NONCDM CHARGE RECORD PHARMACY	250		29.00	N/A
HC65000250_00338954124	NONCDM CHARGE RECORD PHARMACY	250		6.00	N/A
HC65000250_00363014940	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_00363070008	NONCDM CHARGE RECORD PHARMACY	250		1.66	N/A
HC65000250_00378001801	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00378001805	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00378003210	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00378005301	NONCDM CHARGE RECORD PHARMACY	250		2.14	N/A
HC65000250_00378007001	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.00	N/A
HC65000250_00378014491	NONCDM CHARGE RECORD PHARMACY	250		2.29	N/A
HC65000250_00378018201	NONCDM CHARGE RECORD PHARMACY	250		1.71	N/A
HC65000250_00378020810	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00378021601	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00378022101	NONCDM CHARGE RECORD PHARMACY	250		8.17	N/A
HC65000250_00378022201	NONCDM CHARGE RECORD PHARMACY	250		5.80	N/A
HC65000250_00378023110	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00378027101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00378031701	NONCDM CHARGE RECORD PHARMACY	250		2.22	N/A
HC65000250_00378032701	NONCDM CHARGE RECORD PHARMACY	250		4.91	N/A
HC65000250_00378035101	NONCDM CHARGE RECORD PHARMACY	250		1.56	N/A
HC65000250_00378037201	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.12	N/A
HC65000250_00378075101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00378086001	NONCDM CHARGE RECORD PHARMACY	250		13.09	N/A
HC65000250_00378087199	NONCDM CHARGE RECORD PHARMACY	250		160.75	N/A
HC65000250_00378087299	NONCDM CHARGE RECORD PHARMACY	250		267.68	N/A
HC65000250_00378102005	NONCDM CHARGE RECORD PHARMACY	250	Z7610	10.46	N/A
HC65000250_00378108693	NONCDM CHARGE RECORD PHARMACY	250		16.29	N/A
HC65000250_00378113401	NONCDM CHARGE RECORD PHARMACY	250		10.87	N/A
HC65000250_00378161001	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_00378162001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00378170001	NONCDM CHARGE RECORD PHARMACY	250		16.21	N/A
HC65000250_00378180077	NONCDM CHARGE RECORD PHARMACY	250		2.17	N/A
HC65000250_00378180377	NONCDM CHARGE RECORD PHARMACY	250		2.50	N/A
HC65000250_00378180577	NONCDM CHARGE RECORD PHARMACY	250		2.74	N/A
HC65000250_00378180777	NONCDM CHARGE RECORD PHARMACY	250		2.79	N/A
HC65000250_00378180977	NONCDM CHARGE RECORD PHARMACY	250		2.82	N/A
HC65000250_00378181177	NONCDM CHARGE RECORD PHARMACY	250		3.25	N/A
HC65000250_00378181377	NONCDM CHARGE RECORD PHARMACY	250		3.29	N/A
HC65000250_00378181577	NONCDM CHARGE RECORD PHARMACY	250		3.40	N/A
HC65000250_00378181777	NONCDM CHARGE RECORD PHARMACY	250		4.03	N/A
HC65000250_00378181977	NONCDM CHARGE RECORD PHARMACY	250		4.04	N/A
HC65000250_00378182377	NONCDM CHARGE RECORD PHARMACY	250		3.34	N/A
HC65000250_00378190101	NONCDM CHARGE RECORD PHARMACY	250		4.87	N/A
HC65000250_00378190201	NONCDM CHARGE RECORD PHARMACY	250		9.79	N/A
HC65000250_00378190301	NONCDM CHARGE RECORD PHARMACY	250		19.59	N/A
HC65000250_00378300701	NONCDM CHARGE RECORD PHARMACY	250		6.08	N/A
HC65000250_00378306577	NONCDM CHARGE RECORD PHARMACY	250		2.14	N/A
HC65000250_00378306677	NONCDM CHARGE RECORD PHARMACY	250		3.91	N/A
HC65000250_00378312501	NONCDM CHARGE RECORD PHARMACY	250		3.65	N/A
HC65000250_00378334999	NONCDM CHARGE RECORD PHARMACY	250		111.39	N/A
HC65000250_00378335099	NONCDM CHARGE RECORD PHARMACY	250		111.39	N/A
HC65000250_00378335299	NONCDM CHARGE RECORD PHARMACY	250		111.39	N/A
HC65000250_00378363201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00378363401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00378363501	NONCDM CHARGE RECORD PHARMACY	250		1.22	N/A
HC65000250_00378410591	NONCDM CHARGE RECORD PHARMACY	250		48.22	N/A
HC65000250_00378414591	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00378415101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00378427193	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00378454301	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00378464026	NONCDM CHARGE RECORD PHARMACY	250		54.50	N/A
HC65000250_00378464226	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00378501301	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00378518693	NONCDM CHARGE RECORD PHARMACY	250		6.00	N/A
HC65000250_00378528001	NONCDM CHARGE RECORD PHARMACY	250		1.94	N/A
HC65000250_00378561578	NONCDM CHARGE RECORD PHARMACY	250		2.88	N/A
HC65000250_00378563059	NONCDM CHARGE RECORD PHARMACY	250		6.41	N/A
HC65000250_00378580793	NONCDM CHARGE RECORD PHARMACY	250		1.60	N/A
HC65000250_00378606001	NONCDM CHARGE RECORD PHARMACY	250		15.23	N/A
HC65000250_00378609001	NONCDM CHARGE RECORD PHARMACY	250		17.40	N/A
HC65000250_00378641001	NONCDM CHARGE RECORD PHARMACY	250		8.87	N/A
HC65000250_00378647044	NONCDM CHARGE RECORD PHARMACY	250		110.28	N/A
HC65000250_00378647099	NONCDM CHARGE RECORD PHARMACY	250		110.47	N/A
HC65000250_00378668910	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00378698188	NONCDM CHARGE RECORD PHARMACY	250		54.93	N/A
HC65000250_00378698288	NONCDM CHARGE RECORD PHARMACY	250		54.08	N/A
HC65000250_00378699789	NONCDM CHARGE RECORD PHARMACY	250		4.50	N/A
HC65000250_00378728053	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00378728353	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00378728853	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00378730053	NONCDM CHARGE RECORD PHARMACY	250		3.67	N/A
HC65000250_00378740178	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00378802077	NONCDM CHARGE RECORD PHARMACY	250		23.99	N/A
HC65000250_00378804321	NONCDM CHARGE RECORD PHARMACY	250		24.61	N/A
HC65000250_00378876693	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00378876793	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00378905593	NONCDM CHARGE RECORD PHARMACY	250		49.32	N/A
HC65000250_00378907093	NONCDM CHARGE RECORD PHARMACY	250		34.03	N/A
HC65000250_00378907193	NONCDM CHARGE RECORD PHARMACY	250		34.03	N/A
HC65000250_00378910293	NONCDM CHARGE RECORD PHARMACY	250		3.64	N/A
HC65000250_00378910493	NONCDM CHARGE RECORD PHARMACY	250		4.20	N/A
HC65000250_00378911293	NONCDM CHARGE RECORD PHARMACY	250		4.90	N/A
HC65000250_00378911693	NONCDM CHARGE RECORD PHARMACY	250		6.22	N/A
HC65000250_00378911998	NONCDM CHARGE RECORD PHARMACY	250		97.45	N/A
HC65000250_00378912198	NONCDM CHARGE RECORD PHARMACY	250		42.78	N/A
HC65000250_00378912298	NONCDM CHARGE RECORD PHARMACY	250	Z7610	76.00	N/A
HC65000250_00386000802	NONCDM CHARGE RECORD PHARMACY	250		13.55	N/A
HC65000250_00386000803	NONCDM CHARGE RECORD PHARMACY	250		12.51	N/A
HC65000250_00386000804	NONCDM CHARGE RECORD PHARMACY	250		44.59	N/A
HC65000250_00395266216	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00406012362	NONCDM CHARGE RECORD PHARMACY	250		2.57	N/A
HC65000250_00406012462	NONCDM CHARGE RECORD PHARMACY	250		2.90	N/A
HC65000250_00406012562	NONCDM CHARGE RECORD PHARMACY	250		2.95	N/A
HC65000250_00406048462	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00406048501	NONCDM CHARGE RECORD PHARMACY	250		1.73	N/A
HC65000250_00406051223	NONCDM CHARGE RECORD PHARMACY	250		2.46	N/A
HC65000250_00406051262	NONCDM CHARGE RECORD PHARMACY	250		2.45	N/A
HC65000250_00406052262	NONCDM CHARGE RECORD PHARMACY	250		9.54	N/A
HC65000250_00406052301	NONCDM CHARGE RECORD PHARMACY	250		2.96	N/A
HC65000250_00406052362	NONCDM CHARGE RECORD PHARMACY	250		11.32	N/A
HC65000250_00406055262	NONCDM CHARGE RECORD PHARMACY	250		2.70	N/A
HC65000250_00406114601	NONCDM CHARGE RECORD PHARMACY	250		5.52	N/A
HC65000250_00406324301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00406575562	NONCDM CHARGE RECORD PHARMACY	250		1.74	N/A
HC65000250_00406577162	NONCDM CHARGE RECORD PHARMACY	250		1.91	N/A
HC65000250_00406831562	NONCDM CHARGE RECORD PHARMACY	250		5.03	N/A
HC65000250_00406833062	NONCDM CHARGE RECORD PHARMACY	250		9.53	N/A
HC65000250_00406838062	NONCDM CHARGE RECORD PHARMACY	250		18.60	N/A
HC65000250_00406851562	NONCDM CHARGE RECORD PHARMACY	250		5.94	N/A
HC65000250_00406900076	NONCDM CHARGE RECORD PHARMACY	250		165.35	N/A
HC65000250_00406901276	NONCDM CHARGE RECORD PHARMACY	250		97.45	N/A
HC65000250_00406902576	NONCDM CHARGE RECORD PHARMACY	250		42.78	N/A
HC65000250_00406905076	NONCDM CHARGE RECORD PHARMACY	250		76.00	N/A
HC65000250_00406996001	NONCDM CHARGE RECORD PHARMACY	250		18.87	N/A
HC65000250_00406996101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00409110901	NONCDM CHARGE RECORD PHARMACY	250		37.95	N/A
HC65000250_00409114102	NONCDM CHARGE RECORD PHARMACY	250		2.97	N/A
HC65000250_00409114402	NONCDM CHARGE RECORD PHARMACY	250		191.78	N/A
HC65000250_00409114405	NONCDM CHARGE RECORD PHARMACY	250		193.09	N/A
HC65000250_00409114410	NONCDM CHARGE RECORD PHARMACY	250		173.64	N/A
HC65000250_00409115901	NONCDM CHARGE RECORD PHARMACY	250		10.02	N/A
HC65000250_00409115902	NONCDM CHARGE RECORD PHARMACY	250		10.52	N/A
HC65000250_00409115910	NONCDM CHARGE RECORD PHARMACY	250		8.46	N/A
HC65000250_00409116001	NONCDM CHARGE RECORD PHARMACY	250		15.72	N/A
HC65000250_00409116201	NONCDM CHARGE RECORD PHARMACY	250		11.38	N/A
HC65000250_00409116202	NONCDM CHARGE RECORD PHARMACY	250		10.95	N/A
HC65000250_00409116301	NONCDM CHARGE RECORD PHARMACY	250		14.01	N/A
HC65000250_00409116501	NONCDM CHARGE RECORD PHARMACY	250		12.04	N/A
HC65000250_00409116502	NONCDM CHARGE RECORD PHARMACY	250		18.92	N/A
HC65000250_00409120901	NONCDM CHARGE RECORD PHARMACY	250		29.26	N/A
HC65000250_00409148202	NONCDM CHARGE RECORD PHARMACY	250		37.50	N/A
HC65000250_00409155910	NONCDM CHARGE RECORD PHARMACY	250		19.94	N/A
HC65000250_00409155930	NONCDM CHARGE RECORD PHARMACY	250		5.15	N/A
HC65000250_00409156010	NONCDM CHARGE RECORD PHARMACY	250		23.19	N/A
HC65000250_00409156029	NONCDM CHARGE RECORD PHARMACY	250		21.34	N/A
HC65000250_00409158229	NONCDM CHARGE RECORD PHARMACY	250		13.31	N/A
HC65000250_00409163110	NONCDM CHARGE RECORD PHARMACY	250		41.60	N/A
HC65000250_00409163201	NONCDM CHARGE RECORD PHARMACY	250		41.73	N/A
HC65000250_00409163401	NONCDM CHARGE RECORD PHARMACY	250		174.74	N/A
HC65000250_00409174630	NONCDM CHARGE RECORD PHARMACY	250		27.87	N/A
HC65000250_00409174910	NONCDM CHARGE RECORD PHARMACY	250		23.62	N/A
HC65000250_00409174929	NONCDM CHARGE RECORD PHARMACY	250		13.26	N/A
HC65000250_00409176102	NONCDM CHARGE RECORD PHARMACY	250		26.21	N/A
HC65000250_00409177510	NONCDM CHARGE RECORD PHARMACY	250		66.75	N/A
HC65000250_00409177805	NONCDM CHARGE RECORD PHARMACY	250		6.43	N/A
HC65000250_00409196607	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00409205105	NONCDM CHARGE RECORD PHARMACY	250		9.70	N/A
HC65000250_00409212288	NONCDM CHARGE RECORD PHARMACY	250		17.22	N/A
HC65000250_00409263405	NONCDM CHARGE RECORD PHARMACY	250		4.20	N/A
HC65000250_00409317701	NONCDM CHARGE RECORD PHARMACY	250		5.84	N/A
HC65000250_00409317801	NONCDM CHARGE RECORD PHARMACY	250		9.44	N/A
HC65000250_00409317802	NONCDM CHARGE RECORD PHARMACY	250		26.44	N/A
HC65000250_00409317803	NONCDM CHARGE RECORD PHARMACY	250		21.63	N/A
HC65000250_00409317816	NONCDM CHARGE RECORD PHARMACY	250		14.45	N/A
HC65000250_00409318101	NONCDM CHARGE RECORD PHARMACY	250		49.80	N/A
HC65000250_00409318201	NONCDM CHARGE RECORD PHARMACY	250		16.28	N/A
HC65000250_00409318301	NONCDM CHARGE RECORD PHARMACY	250		7.01	N/A
HC65000250_00409329451	NONCDM CHARGE RECORD PHARMACY	250		17.99	N/A
HC65000250_00409329905	NONCDM CHARGE RECORD PHARMACY	250		18.51	N/A
HC65000250_00409329906	NONCDM CHARGE RECORD PHARMACY	250		22.50	N/A
HC65000250_00409329926	NONCDM CHARGE RECORD PHARMACY	250		2.18	N/A
HC65000250_00409330803	NONCDM CHARGE RECORD PHARMACY	250		9.90	N/A
HC65000250_00409337504	NONCDM CHARGE RECORD PHARMACY	250		152.43	N/A
HC65000250_00409361301	NONCDM CHARGE RECORD PHARMACY	250		14.04	N/A
HC65000250_00409371401	NONCDM CHARGE RECORD PHARMACY	250		132.00	N/A
HC65000250_00409401101	NONCDM CHARGE RECORD PHARMACY	250		106.02	N/A
HC65000250_00409409001	NONCDM CHARGE RECORD PHARMACY	250		3.77	N/A
HC65000250_00409434673	NONCDM CHARGE RECORD PHARMACY	250		39.20	N/A
HC65000250_00409469801	NONCDM CHARGE RECORD PHARMACY	250		32.47	N/A
HC65000250_00409488710	NONCDM CHARGE RECORD PHARMACY	250		2.53	N/A
HC65000250_00409488720	NONCDM CHARGE RECORD PHARMACY	250		7.49	N/A
HC65000250_00409488750	NONCDM CHARGE RECORD PHARMACY	250		1.84	N/A
HC65000250_00409488799	NONCDM CHARGE RECORD PHARMACY	250		1.93	N/A
HC65000250_00409488810	NONCDM CHARGE RECORD PHARMACY	250		2.50	N/A
HC65000250_00409488812	NONCDM CHARGE RECORD PHARMACY	250		9.02	N/A
HC65000250_00409488820	NONCDM CHARGE RECORD PHARMACY	250		1.42	N/A
HC65000250_00409488850	NONCDM CHARGE RECORD PHARMACY	250		4.02	N/A
HC65000250_00409490034	NONCDM CHARGE RECORD PHARMACY	250		84.30	N/A
HC65000250_00409490234	NONCDM CHARGE RECORD PHARMACY	250		51.78	N/A
HC65000250_00409492834	NONCDM CHARGE RECORD PHARMACY	250		56.36	N/A
HC65000250_00409553414	NONCDM CHARGE RECORD PHARMACY	250		85.71	N/A
HC65000250_00409553434	NONCDM CHARGE RECORD PHARMACY	250		64.86	N/A
HC65000250_00409650901	NONCDM CHARGE RECORD PHARMACY	250		21.45	N/A
HC65000250_00409662502	NONCDM CHARGE RECORD PHARMACY	250		43.84	N/A
HC65000250_00409662514	NONCDM CHARGE RECORD PHARMACY	250		23.77	N/A
HC65000250_00409662525	NONCDM CHARGE RECORD PHARMACY	250		54.84	N/A
HC65000250_00409662535	NONCDM CHARGE RECORD PHARMACY	250		6.11	N/A
HC65000250_00409663714	NONCDM CHARGE RECORD PHARMACY	250		67.94	N/A
HC65000250_00409663734	NONCDM CHARGE RECORD PHARMACY	250		64.58	N/A
HC65000250_00409664802	NONCDM CHARGE RECORD PHARMACY	250		18.99	N/A
HC65000250_00409669501	NONCDM CHARGE RECORD PHARMACY	250		32.45	N/A
HC65000250_00409669502	NONCDM CHARGE RECORD PHARMACY	250		38.40	N/A
HC65000250_00409729501	NONCDM CHARGE RECORD PHARMACY	250		30.73	N/A
HC65000250_00409729973	NONCDM CHARGE RECORD PHARMACY	250		15.02	N/A
HC65000250_00409739172	NONCDM CHARGE RECORD PHARMACY	250		46.55	N/A
HC65000250_00409751716	NONCDM CHARGE RECORD PHARMACY	250		53.56	N/A
HC65000250_00409781124	NONCDM CHARGE RECORD PHARMACY	250		10.77	N/A
HC65000250_00409793009	NONCDM CHARGE RECORD PHARMACY	250		4.10	N/A
HC65000250_00409798108	NONCDM CHARGE RECORD PHARMACY	250		92.59	N/A
HC65000250_00409798303	NONCDM CHARGE RECORD PHARMACY	250	J7040	3.30	N/A
HC65000250_00409798309	NONCDM CHARGE RECORD PHARMACY	250	J7030	1.50	N/A
HC65000250_00409798413	NONCDM CHARGE RECORD PHARMACY	250		14.70	N/A
HC65000250_00409806201	NONCDM CHARGE RECORD PHARMACY	250		102.06	N/A
HC65000250_00409818301	NONCDM CHARGE RECORD PHARMACY	250		13.61	N/A
HC65000250_00409904201	NONCDM CHARGE RECORD PHARMACY	250		41.90	N/A
HC65000250_00409904217	NONCDM CHARGE RECORD PHARMACY	250		11.45	N/A
HC65000250_00409904501	NONCDM CHARGE RECORD PHARMACY	250		14.84	N/A
HC65000250_00409955805	NONCDM CHARGE RECORD PHARMACY	250		15.30	N/A
HC65000250_00409955810	NONCDM CHARGE RECORD PHARMACY	250		42.52	N/A
HC65000250_00409955849	NONCDM CHARGE RECORD PHARMACY	250		15.72	N/A
HC65000250_00409955850	NONCDM CHARGE RECORD PHARMACY	250		42.12	N/A
HC65000250_00414200007	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00414200040	NONCDM CHARGE RECORD PHARMACY	250		3.96	N/A
HC65000250_00430000531	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.01	N/A
HC65000250_00440806701	NONCDM CHARGE RECORD PHARMACY	250	Z7610	19.98	N/A
HC65000250_00456045801	NONCDM CHARGE RECORD PHARMACY	250		4.75	N/A
HC65000250_00456045901	NONCDM CHARGE RECORD PHARMACY	250		5.41	N/A
HC65000250_00456114030	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00456120104	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00456120130	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00456120204	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.01	N/A
HC65000250_00456120230	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00456140230	NONCDM CHARGE RECORD PHARMACY	250		30.90	N/A
HC65000250_00456140263	NONCDM CHARGE RECORD PHARMACY	250		32.18	N/A
HC65000250_00456140530	NONCDM CHARGE RECORD PHARMACY	250		30.98	N/A
HC65000250_00456140563	NONCDM CHARGE RECORD PHARMACY	250		31.76	N/A
HC65000250_00456140590	NONCDM CHARGE RECORD PHARMACY	250		31.23	N/A
HC65000250_00456141030	NONCDM CHARGE RECORD PHARMACY	250		30.61	N/A
HC65000250_00456141090	NONCDM CHARGE RECORD PHARMACY	250		30.83	N/A
HC65000250_00456202001	NONCDM CHARGE RECORD PHARMACY	250		78.17	N/A
HC65000250_00456228030	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00456320560	NONCDM CHARGE RECORD PHARMACY	250		44.48	N/A
HC65000250_00456320563	NONCDM CHARGE RECORD PHARMACY	250		44.46	N/A
HC65000250_00469012599	NONCDM CHARGE RECORD PHARMACY	250		99.32	N/A
HC65000250_00469260130	NONCDM CHARGE RECORD PHARMACY	250		4.51	N/A
HC65000250_00469260230	NONCDM CHARGE RECORD PHARMACY	250		61.31	N/A
HC65000250_00472016615	NONCDM CHARGE RECORD PHARMACY	250		83.97	N/A
HC65000250_00472016630	NONCDM CHARGE RECORD PHARMACY	250		126.00	N/A
HC65000250_00472017934	NONCDM CHARGE RECORD PHARMACY	250		10.98	N/A
HC65000250_00472033730	NONCDM CHARGE RECORD PHARMACY	250		39.06	N/A
HC65000250_00472034356	NONCDM CHARGE RECORD PHARMACY	250		7.90	N/A
HC65000250_00472040015	NONCDM CHARGE RECORD PHARMACY	250		461.75	N/A
HC65000250_00472073041	NONCDM CHARGE RECORD PHARMACY	250		29.19	N/A
HC65000250_00472073556	NONCDM CHARGE RECORD PHARMACY	250		14.28	N/A
HC65000250_00472120006	NONCDM CHARGE RECORD PHARMACY	250	Z7610	4.20	N/A
HC65000250_00472173803	NONCDM CHARGE RECORD PHARMACY	250		87.62	N/A
HC65000250_00472191530	NONCDM CHARGE RECORD PHARMACY	250		26.49	N/A
HC65000250_00486112501	NONCDM CHARGE RECORD PHARMACY	250		4.05	N/A
HC65000250_00487020101	NONCDM CHARGE RECORD PHARMACY	250		2.99	N/A
HC65000250_00487278401	NONCDM CHARGE RECORD PHARMACY	250		5.11	N/A
HC65000250_00487590199	NONCDM CHARGE RECORD PHARMACY	250		7.04	N/A
HC65000250_00487900360	NONCDM CHARGE RECORD PHARMACY	250		1.99	N/A
HC65000250_00487900760	NONCDM CHARGE RECORD PHARMACY	250		1.99	N/A
HC65000250_00487930103	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00487950101	NONCDM CHARGE RECORD PHARMACY	250		1.19	N/A
HC65000250_00487950125	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00487960101	NONCDM CHARGE RECORD PHARMACY	250		47.74	N/A
HC65000250_00487970101	NONCDM CHARGE RECORD PHARMACY	250		56.26	N/A
HC65000250_00487980101	NONCDM CHARGE RECORD PHARMACY	250		1.26	N/A
HC65000250_00487980130	NONCDM CHARGE RECORD PHARMACY	250		1.11	N/A
HC65000250_00487980160	NONCDM CHARGE RECORD PHARMACY	250		1.11	N/A
HC65000250_00487990130	NONCDM CHARGE RECORD PHARMACY	250		2.30	N/A
HC65000250_00487990401	NONCDM CHARGE RECORD PHARMACY	250		7.97	N/A
HC65000250_00496088206	NONCDM CHARGE RECORD PHARMACY	250		34.61	N/A
HC65000250_00501379805	NONCDM CHARGE RECORD PHARMACY	250		21.02	N/A
HC65000250_00517037505	NONCDM CHARGE RECORD PHARMACY	250		1,087.02	N/A
HC65000250_00517037510	NONCDM CHARGE RECORD PHARMACY	250		43.20	N/A
HC65000250_00517078110	NONCDM CHARGE RECORD PHARMACY	250		60.00	N/A
HC65000250_00517460125	NONCDM CHARGE RECORD PHARMACY	250		78.00	N/A
HC65000250_00517481025	NONCDM CHARGE RECORD PHARMACY	250		41.99	N/A
HC65000250_00517671010	NONCDM CHARGE RECORD PHARMACY	250		129.88	N/A
HC65000250_00517750425	NONCDM CHARGE RECORD PHARMACY	250		47.97	N/A
HC65000250_00517760425	NONCDM CHARGE RECORD PHARMACY	250		50.61	N/A
HC65000250_00517912025	NONCDM CHARGE RECORD PHARMACY	250		42.42	N/A
HC65000250_00517919125	NONCDM CHARGE RECORD PHARMACY	250		53.06	N/A
HC65000250_00527058601	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_00527105001	NONCDM CHARGE RECORD PHARMACY	250		6.00	N/A
HC65000250_00527128201	NONCDM CHARGE RECORD PHARMACY	250		1.65	N/A
HC65000250_00527131301	NONCDM CHARGE RECORD PHARMACY	250		3.30	N/A
HC65000250_00527131501	NONCDM CHARGE RECORD PHARMACY	250		8.01	N/A
HC65000250_00527131801	NONCDM CHARGE RECORD PHARMACY	250		26.12	N/A
HC65000250_00527132601	NONCDM CHARGE RECORD PHARMACY	250		7.50	N/A
HC65000250_00527139501	NONCDM CHARGE RECORD PHARMACY	250		0.87	N/A
HC65000250_00527143501	NONCDM CHARGE RECORD PHARMACY	250		9.00	N/A
HC65000250_00527169801	NONCDM CHARGE RECORD PHARMACY	250		7.16	N/A
HC65000250_00527179001	NONCDM CHARGE RECORD PHARMACY	250		28.98	N/A
HC65000250_00527185943	NONCDM CHARGE RECORD PHARMACY	250		361.82	N/A
HC65000250_00527193106	NONCDM CHARGE RECORD PHARMACY	250		5.63	N/A
HC65000250_00527221537	NONCDM CHARGE RECORD PHARMACY	250		8.86	N/A
HC65000250_00527221637	NONCDM CHARGE RECORD PHARMACY	250		10.21	N/A
HC65000250_00527328146	NONCDM CHARGE RECORD PHARMACY	250		1.95	N/A
HC65000250_00527328246	NONCDM CHARGE RECORD PHARMACY	250		2.15	N/A
HC65000250_00527411637	NONCDM CHARGE RECORD PHARMACY	250		2.03	N/A
HC65000250_00527411737	NONCDM CHARGE RECORD PHARMACY	250		2.25	N/A
HC65000250_00527512162	NONCDM CHARGE RECORD PHARMACY	250		65.88	N/A
HC65000250_00536104610	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_00536104815	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00536106410	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00536106501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00536114397	NONCDM CHARGE RECORD PHARMACY	250		34.20	N/A
HC65000250_00536116134	NONCDM CHARGE RECORD PHARMACY	250		3.16	N/A
HC65000250_00536116137	NONCDM CHARGE RECORD PHARMACY	250		3.04	N/A
HC65000250_00536117201	NONCDM CHARGE RECORD PHARMACY	250		0.96	N/A
HC65000250_00536117801	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_00536118297	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00536118612	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00536120215	NONCDM CHARGE RECORD PHARMACY	250		7.36	N/A
HC65000250_00536121195	NONCDM CHARGE RECORD PHARMACY	250	Z7610	29.40	N/A
HC65000250_00536121277	NONCDM CHARGE RECORD PHARMACY	250		18.76	N/A
HC65000250_00536122858	NONCDM CHARGE RECORD PHARMACY	250		14.87	N/A
HC65000250_00536123201	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00536123441	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_00536124701	NONCDM CHARGE RECORD PHARMACY	250		1.02	N/A
HC65000250_00536127180	NONCDM CHARGE RECORD PHARMACY	250		9.03	N/A
HC65000250_00536127211	NONCDM CHARGE RECORD PHARMACY	250		7.39	N/A
HC65000250_00536129434	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00536129801	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00536130375	NONCDM CHARGE RECORD PHARMACY	250		11.36	N/A
HC65000250_00536130485	NONCDM CHARGE RECORD PHARMACY	250		1.45	N/A
HC65000250_00536132701	NONCDM CHARGE RECORD PHARMACY	250		0.86	N/A
HC65000250_00536136223	NONCDM CHARGE RECORD PHARMACY	250		1.16	N/A
HC65000250_00536245001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00536252525	NONCDM CHARGE RECORD PHARMACY	250		41.76	N/A
HC65000250_00536322301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00536344238	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00536348107	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00536407401	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00536408501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00536430608	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00536440601	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_00536478701	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00536509008	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00536570028	NONCDM CHARGE RECORD PHARMACY	250		12.42	N/A
HC65000250_00536589488	NONCDM CHARGE RECORD PHARMACY	250		10.20	N/A
HC65000250_00536589588	NONCDM CHARGE RECORD PHARMACY	250		10.23	N/A
HC65000250_00536589688	NONCDM CHARGE RECORD PHARMACY	250		10.21	N/A
HC65000250_00536730001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00536741551	NONCDM CHARGE RECORD PHARMACY	250		4.76	N/A
HC65000250_00536781710	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00538800927	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00555003302	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00555007102	NONCDM CHARGE RECORD PHARMACY	250		1.49	N/A
HC65000250_00555009596	NONCDM CHARGE RECORD PHARMACY	250		7.48	N/A
HC65000250_00555015802	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_00555015902	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00555015904	NONCDM CHARGE RECORD PHARMACY	250		1.04	N/A
HC65000250_00555021110	NONCDM CHARGE RECORD PHARMACY	250		11.12	N/A
HC65000250_00555048402	NONCDM CHARGE RECORD PHARMACY	250		7.20	N/A
HC65000250_00555079002	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.01	N/A
HC65000250_00555087202	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00555087302	NONCDM CHARGE RECORD PHARMACY	250		1.27	N/A
HC65000250_00555088202	NONCDM CHARGE RECORD PHARMACY	250		7.07	N/A
HC65000250_00555088602	NONCDM CHARGE RECORD PHARMACY	250		1.69	N/A
HC65000250_00555097102	NONCDM CHARGE RECORD PHARMACY	250		5.20	N/A
HC65000250_00555097202	NONCDM CHARGE RECORD PHARMACY	250		5.20	N/A
HC65000250_00555097302	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.01	N/A
HC65000250_00555099702	NONCDM CHARGE RECORD PHARMACY	250		3.29	N/A
HC65000250_00555901658	NONCDM CHARGE RECORD PHARMACY	250		4.66	N/A
HC65000250_00573287193	NONCDM CHARGE RECORD PHARMACY	250		35.28	N/A
HC65000250_00573287194	NONCDM CHARGE RECORD PHARMACY	250		61.22	N/A
HC65000250_00573288320	NONCDM CHARGE RECORD PHARMACY	250		2.94	N/A
HC65000250_00574006716	NONCDM CHARGE RECORD PHARMACY	250		14.19	N/A
HC65000250_00574006924	NONCDM CHARGE RECORD PHARMACY	250		12.98	N/A
HC65000250_00574006930	NONCDM CHARGE RECORD PHARMACY	250		17.77	N/A
HC65000250_00574006945	NONCDM CHARGE RECORD PHARMACY	250		1.63	N/A
HC65000250_00574007030	NONCDM CHARGE RECORD PHARMACY	250		11.85	N/A
HC65000250_00574010770	NONCDM CHARGE RECORD PHARMACY	250		7.72	N/A
HC65000250_00574010777	NONCDM CHARGE RECORD PHARMACY	250	Z7610	6.86	N/A
HC65000250_00574011302	NONCDM CHARGE RECORD PHARMACY	250		2.53	N/A
HC65000250_00574012004	NONCDM CHARGE RECORD PHARMACY	250		95.90	N/A
HC65000250_00574012008	NONCDM CHARGE RECORD PHARMACY	250		97.51	N/A
HC65000250_00574012074	NONCDM CHARGE RECORD PHARMACY	250	Z7610	88.06	N/A
HC65000250_00574012104	NONCDM CHARGE RECORD PHARMACY	250		79.92	N/A
HC65000250_00574012174	NONCDM CHARGE RECORD PHARMACY	250		87.19	N/A
HC65000250_00574024001	NONCDM CHARGE RECORD PHARMACY	250		3.24	N/A
HC65000250_00574024101	NONCDM CHARGE RECORD PHARMACY	250		3.24	N/A
HC65000250_00574029201	NONCDM CHARGE RECORD PHARMACY	250		1.31	N/A
HC65000250_00574030316	NONCDM CHARGE RECORD PHARMACY	250		1.14	N/A
HC65000250_00574030416	NONCDM CHARGE RECORD PHARMACY	250		1.14	N/A
HC65000250_00574052004	NONCDM CHARGE RECORD PHARMACY	250	Z7610	159.84	N/A
HC65000250_00574052074	NONCDM CHARGE RECORD PHARMACY	250		79.92	N/A
HC65000250_00574200202	NONCDM CHARGE RECORD PHARMACY	250		65.58	N/A
HC65000250_00574200815	NONCDM CHARGE RECORD PHARMACY	250		116.37	N/A
HC65000250_00574402450	NONCDM CHARGE RECORD PHARMACY	250		43.28	N/A
HC65000250_00574402535	NONCDM CHARGE RECORD PHARMACY	250		35.11	N/A
HC65000250_00574703412	NONCDM CHARGE RECORD PHARMACY	250		6.97	N/A
HC65000250_00574703612	NONCDM CHARGE RECORD PHARMACY	250		7.24	N/A
HC65000250_00574704004	NONCDM CHARGE RECORD PHARMACY	250		160.57	N/A
HC65000250_00574704012	NONCDM CHARGE RECORD PHARMACY	250		160.57	N/A
HC65000250_00574704512	NONCDM CHARGE RECORD PHARMACY	250		131.35	N/A
HC65000250_00574705012	NONCDM CHARGE RECORD PHARMACY	250		2.12	N/A
HC65000250_00574705050	NONCDM CHARGE RECORD PHARMACY	250		1.59	N/A
HC65000250_00574722612	NONCDM CHARGE RECORD PHARMACY	250		52.28	N/A
HC65000250_00574985510	NONCDM CHARGE RECORD PHARMACY	250		13.35	N/A
HC65000250_00575620030	NONCDM CHARGE RECORD PHARMACY	250	Z7610	72.82	N/A
HC65000250_00591024001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00591024101	NONCDM CHARGE RECORD PHARMACY	250		0.94	N/A
HC65000250_00591034301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00591040401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00591040701	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00591040801	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00591044401	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.22	N/A
HC65000250_00591058201	NONCDM CHARGE RECORD PHARMACY	250		2.31	N/A
HC65000250_00591060505	NONCDM CHARGE RECORD PHARMACY	250		2.33	N/A
HC65000250_00591060601	NONCDM CHARGE RECORD PHARMACY	250		3.49	N/A
HC65000250_00591079401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00591079601	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00591079605	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00591084501	NONCDM CHARGE RECORD PHARMACY	250		3.44	N/A
HC65000250_00591207072	NONCDM CHARGE RECORD PHARMACY	250		42.51	N/A
HC65000250_00591234101	NONCDM CHARGE RECORD PHARMACY	250		12.04	N/A
HC65000250_00591246401	NONCDM CHARGE RECORD PHARMACY	250		22.84	N/A
HC65000250_00591256230	NONCDM CHARGE RECORD PHARMACY	250		4.90	N/A
HC65000250_00591267930	NONCDM CHARGE RECORD PHARMACY	250		28.02	N/A
HC65000250_00591272901	NONCDM CHARGE RECORD PHARMACY	250		3.13	N/A
HC65000250_00591288201	NONCDM CHARGE RECORD PHARMACY	250	Z7610	9.14	N/A
HC65000250_00591292754	NONCDM CHARGE RECORD PHARMACY	250		328.52	N/A
HC65000250_00591298135	NONCDM CHARGE RECORD PHARMACY	250	Z7610	80.16	N/A
HC65000250_00591299239	NONCDM CHARGE RECORD PHARMACY	250	Z7610	58.49	N/A
HC65000250_00591299801	NONCDM CHARGE RECORD PHARMACY	250		12.88	N/A
HC65000250_00591304101	NONCDM CHARGE RECORD PHARMACY	250		19.62	N/A
HC65000250_00591315901	NONCDM CHARGE RECORD PHARMACY	250		30.65	N/A
HC65000250_00591321630	NONCDM CHARGE RECORD PHARMACY	250		72.92	N/A
HC65000250_00591322001	NONCDM CHARGE RECORD PHARMACY	250		5.60	N/A
HC65000250_00591333130	NONCDM CHARGE RECORD PHARMACY	250		7.83	N/A
HC65000250_00591336901	NONCDM CHARGE RECORD PHARMACY	250		4.01	N/A
HC65000250_00591352530	NONCDM CHARGE RECORD PHARMACY	250		32.70	N/A
HC65000250_00591354060	NONCDM CHARGE RECORD PHARMACY	250		2.00	N/A
HC65000250_00591354160	NONCDM CHARGE RECORD PHARMACY	250		1.99	N/A
HC65000250_00591363560	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00591401201	NONCDM CHARGE RECORD PHARMACY	250		2.40	N/A
HC65000250_00591530701	NONCDM CHARGE RECORD PHARMACY	250		2.28	N/A
HC65000250_00591533501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00591555601	NONCDM CHARGE RECORD PHARMACY	250		2.30	N/A
HC65000250_00591565801	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_00597003134	NONCDM CHARGE RECORD PHARMACY	250		426.06	N/A
HC65000250_00597003234	NONCDM CHARGE RECORD PHARMACY	250		704.87	N/A
HC65000250_00597004037	NONCDM CHARGE RECORD PHARMACY	250		43.15	N/A
HC65000250_00597004724	NONCDM CHARGE RECORD PHARMACY	250	Z7610	10.32	N/A
HC65000250_00597005216	NONCDM CHARGE RECORD PHARMACY	250		1.78	N/A
HC65000250_00597005801	NONCDM CHARGE RECORD PHARMACY	250		53.08	N/A
HC65000250_00597014030	NONCDM CHARGE RECORD PHARMACY	250		51.89	N/A
HC65000250_00597014090	NONCDM CHARGE RECORD PHARMACY	250		94.73	N/A
HC65000250_00597015207	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.01	N/A
HC65000250_00597015307	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00597015330	NONCDM CHARGE RECORD PHARMACY	250		105.29	N/A
HC65000250_00597018461	NONCDM CHARGE RECORD PHARMACY	250		38.33	N/A
HC65000250_00597019090	NONCDM CHARGE RECORD PHARMACY	250		42.13	N/A
HC65000250_00597035556	NONCDM CHARGE RECORD PHARMACY	250		46.85	N/A
HC65000250_00597036082	NONCDM CHARGE RECORD PHARMACY	250		46.89	N/A
HC65000250_00603020922	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00603038046	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.84	N/A
HC65000250_00603107505	NONCDM CHARGE RECORD PHARMACY	250		4.85	N/A
HC65000250_00603116158	NONCDM CHARGE RECORD PHARMACY	250		10.01	N/A
HC65000250_00603139364	NONCDM CHARGE RECORD PHARMACY	250		35.28	N/A
HC65000250_00603154258	NONCDM CHARGE RECORD PHARMACY	250		15.89	N/A
HC65000250_00603155416	NONCDM CHARGE RECORD PHARMACY	250		43.27	N/A
HC65000250_00603156705	NONCDM CHARGE RECORD PHARMACY	250		5.03	N/A
HC65000250_00603158658	NONCDM CHARGE RECORD PHARMACY	250		2.18	N/A
HC65000250_00603188016	NONCDM CHARGE RECORD PHARMACY	250		44.93	N/A
HC65000250_00603221321	NONCDM CHARGE RECORD PHARMACY	250		1.72	N/A
HC65000250_00603240621	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00603243921	NONCDM CHARGE RECORD PHARMACY	250		1.22	N/A
HC65000250_00603254421	NONCDM CHARGE RECORD PHARMACY	250		6.74	N/A
HC65000250_00603411021	NONCDM CHARGE RECORD PHARMACY	250		1.26	N/A
HC65000250_00603497521	NONCDM CHARGE RECORD PHARMACY	250		2.92	N/A
HC65000250_00603506021	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00603544821	NONCDM CHARGE RECORD PHARMACY	250		1.40	N/A
HC65000250_00603548221	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00603548321	NONCDM CHARGE RECORD PHARMACY	250		1.02	N/A
HC65000250_00603548421	NONCDM CHARGE RECORD PHARMACY	250		1.52	N/A
HC65000250_00603616121	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00641600810	NONCDM CHARGE RECORD PHARMACY	250	J3490	16.49	N/A
HC65000250_00641602225	NONCDM CHARGE RECORD PHARMACY	250		5.37	N/A
HC65000250_00641614725	NONCDM CHARGE RECORD PHARMACY	250		5.62	N/A
HC65000250_00703115303	NONCDM CHARGE RECORD PHARMACY	250		151.70	N/A
HC65000250_00703291403	NONCDM CHARGE RECORD PHARMACY	250		36.91	N/A
HC65000250_00703950303	NONCDM CHARGE RECORD PHARMACY	250		37.62	N/A
HC65000250_00703951403	NONCDM CHARGE RECORD PHARMACY	250		90.23	N/A
HC65000250_00703952601	NONCDM CHARGE RECORD PHARMACY	250		225.72	N/A
HC65000250_00713013512	NONCDM CHARGE RECORD PHARMACY	250		52.28	N/A
HC65000250_00713016450	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3.14	N/A
HC65000250_00713028031	NONCDM CHARGE RECORD PHARMACY	250		13.28	N/A
HC65000250_00713050301	NONCDM CHARGE RECORD PHARMACY	250		68.99	N/A
HC65000250_00713050312	NONCDM CHARGE RECORD PHARMACY	250		68.99	N/A
HC65000250_00713050324	NONCDM CHARGE RECORD PHARMACY	250		75.69	N/A
HC65000250_00713052612	NONCDM CHARGE RECORD PHARMACY	250		50.34	N/A
HC65000250_00713067815	NONCDM CHARGE RECORD PHARMACY	250		77.94	N/A
HC65000250_00761019520	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00761055520	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00766784508	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2.30	N/A
HC65000250_00781105301	NONCDM CHARGE RECORD PHARMACY	250		3.25	N/A
HC65000250_00781106101	NONCDM CHARGE RECORD PHARMACY	250		0.96	N/A
HC65000250_00781106401	NONCDM CHARGE RECORD PHARMACY	250		4.33	N/A
HC65000250_00781107701	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00781107801	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00781107810	NONCDM CHARGE RECORD PHARMACY	250		0.96	N/A
HC65000250_00781107901	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00781139201	NONCDM CHARGE RECORD PHARMACY	250		2.21	N/A
HC65000250_00781139601	NONCDM CHARGE RECORD PHARMACY	250		4.91	N/A
HC65000250_00781145201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00781145301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00781148601	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00781148801	NONCDM CHARGE RECORD PHARMACY	250		3.43	N/A
HC65000250_00781150701	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00781155601	NONCDM CHARGE RECORD PHARMACY	250		5.15	N/A
HC65000250_00781163501	NONCDM CHARGE RECORD PHARMACY	250		4.73	N/A
HC65000250_00781169501	NONCDM CHARGE RECORD PHARMACY	250		5.68	N/A
HC65000250_00781176401	NONCDM CHARGE RECORD PHARMACY	250		2.06	N/A
HC65000250_00781194339	NONCDM CHARGE RECORD PHARMACY	250		36.82	N/A
HC65000250_00781194382	NONCDM CHARGE RECORD PHARMACY	250		36.83	N/A
HC65000250_00781196601	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00781204801	NONCDM CHARGE RECORD PHARMACY	250		9.69	N/A
HC65000250_00781205201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00781207401	NONCDM CHARGE RECORD PHARMACY	250		1.27	N/A
HC65000250_00781208102	NONCDM CHARGE RECORD PHARMACY	250		3.77	N/A
HC65000250_00781216760	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3.50	N/A
HC65000250_00781282210	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00781286810	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.39	N/A
HC65000250_00781304095	NONCDM CHARGE RECORD PHARMACY	250	J3490	184.31	N/A
HC65000250_00781312595	NONCDM CHARGE RECORD PHARMACY	250		135.95	N/A
HC65000250_00781322092	NONCDM CHARGE RECORD PHARMACY	250		37.83	N/A
HC65000250_00781322095	NONCDM CHARGE RECORD PHARMACY	250		13.57	N/A
HC65000250_00781375595	NONCDM CHARGE RECORD PHARMACY	250		118.02	N/A
HC65000250_00781382996	NONCDM CHARGE RECORD PHARMACY	250		13.20	N/A
HC65000250_00781406215	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00781506801	NONCDM CHARGE RECORD PHARMACY	250		1.65	N/A
HC65000250_00781507701	NONCDM CHARGE RECORD PHARMACY	250		1.50	N/A
HC65000250_00781523864	NONCDM CHARGE RECORD PHARMACY	250		3.83	N/A
HC65000250_00781523964	NONCDM CHARGE RECORD PHARMACY	250	Z7610	6.91	N/A
HC65000250_00781531801	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00781532531	NONCDM CHARGE RECORD PHARMACY	250		30.09	N/A
HC65000250_00781557801	NONCDM CHARGE RECORD PHARMACY	250		18.96	N/A
HC65000250_00781572001	NONCDM CHARGE RECORD PHARMACY	250		3.00	N/A
HC65000250_00781591601	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.00	N/A
HC65000250_00781599401	NONCDM CHARGE RECORD PHARMACY	250		19.62	N/A
HC65000250_00781602346	NONCDM CHARGE RECORD PHARMACY	250	Z7610	47.64	N/A
HC65000250_00781603946	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.74	N/A
HC65000250_00781613957	NONCDM CHARGE RECORD PHARMACY	250		10.20	N/A
HC65000250_00781714483	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00781751587	NONCDM CHARGE RECORD PHARMACY	250		46.93	N/A
HC65000250_00781801601	NONCDM CHARGE RECORD PHARMACY	250		5.50	N/A
HC65000250_00799000102	NONCDM CHARGE RECORD PHARMACY	250		23.86	N/A
HC65000250_00799000104	NONCDM CHARGE RECORD PHARMACY	250		29.66	N/A
HC65000250_00832003800	NONCDM CHARGE RECORD PHARMACY	250		1.02	N/A
HC65000250_00832003801	NONCDM CHARGE RECORD PHARMACY	250		3.20	N/A
HC65000250_00832030100	NONCDM CHARGE RECORD PHARMACY	250		22.68	N/A
HC65000250_00832046515	NONCDM CHARGE RECORD PHARMACY	250		65.43	N/A
HC65000250_00832051101	NONCDM CHARGE RECORD PHARMACY	250		2.54	N/A
HC65000250_00832051201	NONCDM CHARGE RECORD PHARMACY	250		5.00	N/A
HC65000250_00832059011	NONCDM CHARGE RECORD PHARMACY	250		2.95	N/A
HC65000250_00832121100	NONCDM CHARGE RECORD PHARMACY	250		1.92	N/A
HC65000250_00832121101	NONCDM CHARGE RECORD PHARMACY	250		1.81	N/A
HC65000250_00832121200	NONCDM CHARGE RECORD PHARMACY	250		2.28	N/A
HC65000250_00832121201	NONCDM CHARGE RECORD PHARMACY	250		2.28	N/A
HC65000250_00832121301	NONCDM CHARGE RECORD PHARMACY	250		2.33	N/A
HC65000250_00832121400	NONCDM CHARGE RECORD PHARMACY	250		2.39	N/A
HC65000250_00832121401	NONCDM CHARGE RECORD PHARMACY	250		2.38	N/A
HC65000250_00832121500	NONCDM CHARGE RECORD PHARMACY	250		2.39	N/A
HC65000250_00832121501	NONCDM CHARGE RECORD PHARMACY	250		2.40	N/A
HC65000250_00832121600	NONCDM CHARGE RECORD PHARMACY	250		2.42	N/A
HC65000250_00832121601	NONCDM CHARGE RECORD PHARMACY	250		2.44	N/A
HC65000250_00832121700	NONCDM CHARGE RECORD PHARMACY	250		3.37	N/A
HC65000250_00832121701	NONCDM CHARGE RECORD PHARMACY	250		3.31	N/A
HC65000250_00832121800	NONCDM CHARGE RECORD PHARMACY	250		3.47	N/A
HC65000250_00832121801	NONCDM CHARGE RECORD PHARMACY	250		3.46	N/A
HC65000250_00832121901	NONCDM CHARGE RECORD PHARMACY	250		3.66	N/A
HC65000250_00832152011	NONCDM CHARGE RECORD PHARMACY	250		2.22	N/A
HC65000250_00832532411	NONCDM CHARGE RECORD PHARMACY	250		2.84	N/A
HC65000250_00832532511	NONCDM CHARGE RECORD PHARMACY	250		1.66	N/A
HC65000250_00832712301	NONCDM CHARGE RECORD PHARMACY	250		1.32	N/A
HC65000250_00832712401	NONCDM CHARGE RECORD PHARMACY	250		1.75	N/A
HC65000250_00832712411	NONCDM CHARGE RECORD PHARMACY	250		1.95	N/A
HC65000250_00869016638	NONCDM CHARGE RECORD PHARMACY	250		7.10	N/A
HC65000250_00869060243	NONCDM CHARGE RECORD PHARMACY	250		5.45	N/A
HC65000250_00869066738	NONCDM CHARGE RECORD PHARMACY	250		7.10	N/A
HC65000250_00904000514	NONCDM CHARGE RECORD PHARMACY	250		1.50	N/A
HC65000250_00904001261	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904020161	NONCDM CHARGE RECORD PHARMACY	250		2.59	N/A
HC65000250_00904020261	NONCDM CHARGE RECORD PHARMACY	250		4.40	N/A
HC65000250_00904026252	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904027460	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904043004	NONCDM CHARGE RECORD PHARMACY	250		19.19	N/A
HC65000250_00904043006	NONCDM CHARGE RECORD PHARMACY	250		12.85	N/A
HC65000250_00904052060	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904052360	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904052361	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904052372	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904052380	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904053060	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904053061	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904053961	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904053980	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904064360	NONCDM CHARGE RECORD PHARMACY	250		1.78	N/A
HC65000250_00904078816	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_00904110231	NONCDM CHARGE RECORD PHARMACY	250		9.02	N/A
HC65000250_00904110309	NONCDM CHARGE RECORD PHARMACY	250		12.74	N/A
HC65000250_00904131546	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904145361	NONCDM CHARGE RECORD PHARMACY	250		2.39	N/A
HC65000250_00904188260	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904188261	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904188361	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904188372	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904188392	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904198261	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_00904201360	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904205661	NONCDM CHARGE RECORD PHARMACY	250		0.96	N/A
HC65000250_00904208560	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904227260	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904250091	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904252820	NONCDM CHARGE RECORD PHARMACY	250		26.90	N/A
HC65000250_00904253321	NONCDM CHARGE RECORD PHARMACY	250		8.50	N/A
HC65000250_00904264113	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904264172	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904272561	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904292061	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904292461	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904319760	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904357161	NONCDM CHARGE RECORD PHARMACY	250		1.22	N/A
HC65000250_00904385461	NONCDM CHARGE RECORD PHARMACY	250		3.07	N/A
HC65000250_00904386575	NONCDM CHARGE RECORD PHARMACY	250		4.72	N/A
HC65000250_00904404073	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904404360	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904434270	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904501546	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904504260	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904504561	NONCDM CHARGE RECORD PHARMACY	250		8.48	N/A
HC65000250_00904504661	NONCDM CHARGE RECORD PHARMACY	250		3.07	N/A
HC65000250_00904505359	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904506260	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904506860	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904512559	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_00904513559	NONCDM CHARGE RECORD PHARMACY	250		0.94	N/A
HC65000250_00904528261	NONCDM CHARGE RECORD PHARMACY	250		6.64	N/A
HC65000250_00904530660	NONCDM CHARGE RECORD PHARMACY	250		0.94	N/A
HC65000250_00904530661	NONCDM CHARGE RECORD PHARMACY	250		0.92	N/A
HC65000250_00904530680	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904530780	NONCDM CHARGE RECORD PHARMACY	250		0.71	N/A
HC65000250_00904530909	NONCDM CHARGE RECORD PHARMACY	250		6.08	N/A
HC65000250_00904531360	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904533260	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904535431	NONCDM CHARGE RECORD PHARMACY	250		10.68	N/A
HC65000250_00904536560	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904544561	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904544861	NONCDM CHARGE RECORD PHARMACY	250		1.58	N/A
HC65000250_00904546052	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904546072	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904546080	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904546092	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904548652	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904548689	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_00904549213	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904549261	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904549280	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904549546	NONCDM CHARGE RECORD PHARMACY	250		2.58	N/A
HC65000250_00904550261	NONCDM CHARGE RECORD PHARMACY	250		2.82	N/A
HC65000250_00904552261	NONCDM CHARGE RECORD PHARMACY	250		5.09	N/A
HC65000250_00904552361	NONCDM CHARGE RECORD PHARMACY	250		4.87	N/A
HC65000250_00904552461	NONCDM CHARGE RECORD PHARMACY	250		5.10	N/A
HC65000250_00904560961	NONCDM CHARGE RECORD PHARMACY	250		2.77	N/A
HC65000250_00904561061	NONCDM CHARGE RECORD PHARMACY	250		3.01	N/A
HC65000250_00904561161	NONCDM CHARGE RECORD PHARMACY	250		4.28	N/A
HC65000250_00904561646	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904564361	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904565661	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904565761	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904567661	NONCDM CHARGE RECORD PHARMACY	250		4.75	N/A
HC65000250_00904567761	NONCDM CHARGE RECORD PHARMACY	250		1.50	N/A
HC65000250_00904572514	NONCDM CHARGE RECORD PHARMACY	250		2.64	N/A
HC65000250_00904578461	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904578561	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904578961	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904579061	NONCDM CHARGE RECORD PHARMACY	250		2.36	N/A
HC65000250_00904582360	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904582460	NONCDM CHARGE RECORD PHARMACY	250		0.96	N/A
HC65000250_00904582493	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904585361	NONCDM CHARGE RECORD PHARMACY	250		0.96	N/A
HC65000250_00904585461	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904585560	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904585561	NONCDM CHARGE RECORD PHARMACY	250		0.93	N/A
HC65000250_00904585961	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904586061	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904588061	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904589161	NONCDM CHARGE RECORD PHARMACY	250		2.35	N/A
HC65000250_00904589261	NONCDM CHARGE RECORD PHARMACY	250		3.35	N/A
HC65000250_00904589361	NONCDM CHARGE RECORD PHARMACY	250		4.15	N/A
HC65000250_00904589430	NONCDM CHARGE RECORD PHARMACY	250		11.04	N/A
HC65000250_00904592161	NONCDM CHARGE RECORD PHARMACY	250		8.07	N/A
HC65000250_00904592261	NONCDM CHARGE RECORD PHARMACY	250		8.05	N/A
HC65000250_00904592861	NONCDM CHARGE RECORD PHARMACY	250		1.89	N/A
HC65000250_00904592961	NONCDM CHARGE RECORD PHARMACY	250		2.66	N/A
HC65000250_00904593061	NONCDM CHARGE RECORD PHARMACY	250		2.27	N/A
HC65000250_00904595961	NONCDM CHARGE RECORD PHARMACY	250		1.86	N/A
HC65000250_00904598426	NONCDM CHARGE RECORD PHARMACY	250		23.05	N/A
HC65000250_00904600761	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904600861	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904601946	NONCDM CHARGE RECORD PHARMACY	250		1.73	N/A
HC65000250_00904605161	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904605261	NONCDM CHARGE RECORD PHARMACY	250		1.29	N/A
HC65000250_00904605361	NONCDM CHARGE RECORD PHARMACY	250		1.70	N/A
HC65000250_00904606861	NONCDM CHARGE RECORD PHARMACY	250		4.50	N/A
HC65000250_00904608261	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904608361	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904608461	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904608561	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904617261	NONCDM CHARGE RECORD PHARMACY	250		5.13	N/A
HC65000250_00904617861	NONCDM CHARGE RECORD PHARMACY	250		4.82	N/A
HC65000250_00904622161	NONCDM CHARGE RECORD PHARMACY	250		10.08	N/A
HC65000250_00904623761	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904623861	NONCDM CHARGE RECORD PHARMACY	250		1.48	N/A
HC65000250_00904625549	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904626908	NONCDM CHARGE RECORD PHARMACY	250		28.95	N/A
HC65000250_00904626945	NONCDM CHARGE RECORD PHARMACY	250		16.15	N/A
HC65000250_00904627008	NONCDM CHARGE RECORD PHARMACY	250		28.95	N/A
HC65000250_00904628361	NONCDM CHARGE RECORD PHARMACY	250		2.07	N/A
HC65000250_00904629061	NONCDM CHARGE RECORD PHARMACY	250		1.47	N/A
HC65000250_00904629161	NONCDM CHARGE RECORD PHARMACY	250		1.98	N/A
HC65000250_00904629261	NONCDM CHARGE RECORD PHARMACY	250		1.90	N/A
HC65000250_00904629304	NONCDM CHARGE RECORD PHARMACY	250		2.56	N/A
HC65000250_00904629461	NONCDM CHARGE RECORD PHARMACY	250		1.40	N/A
HC65000250_00904630061	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904630161	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904630261	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904630361	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904630521	NONCDM CHARGE RECORD PHARMACY	250		10.62	N/A
HC65000250_00904632078	NONCDM CHARGE RECORD PHARMACY	250		6.38	N/A
HC65000250_00904632206	NONCDM CHARGE RECORD PHARMACY	250		3.34	N/A
HC65000250_00904632261	NONCDM CHARGE RECORD PHARMACY	250		5.22	N/A
HC65000250_00904632361	NONCDM CHARGE RECORD PHARMACY	250		6.29	N/A
HC65000250_00904632946	NONCDM CHARGE RECORD PHARMACY	250		1.41	N/A
HC65000250_00904632951	NONCDM CHARGE RECORD PHARMACY	250		1.31	N/A
HC65000250_00904635161	NONCDM CHARGE RECORD PHARMACY	250		1.34	N/A
HC65000250_00904635261	NONCDM CHARGE RECORD PHARMACY	250		1.47	N/A
HC65000250_00904635361	NONCDM CHARGE RECORD PHARMACY	250		2.63	N/A
HC65000250_00904635761	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904635861	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904635961	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904636061	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904636345	NONCDM CHARGE RECORD PHARMACY	250		9.13	N/A
HC65000250_00904636361	NONCDM CHARGE RECORD PHARMACY	250		7.77	N/A
HC65000250_00904636445	NONCDM CHARGE RECORD PHARMACY	250		15.13	N/A
HC65000250_00904636461	NONCDM CHARGE RECORD PHARMACY	250		12.26	N/A
HC65000250_00904636961	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904637061	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904637161	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904637361	NONCDM CHARGE RECORD PHARMACY	250		2.94	N/A
HC65000250_00904637461	NONCDM CHARGE RECORD PHARMACY	250		3.40	N/A
HC65000250_00904637761	NONCDM CHARGE RECORD PHARMACY	250		2.11	N/A
HC65000250_00904639061	NONCDM CHARGE RECORD PHARMACY	250		4.05	N/A
HC65000250_00904639161	NONCDM CHARGE RECORD PHARMACY	250		3.48	N/A
HC65000250_00904640161	NONCDM CHARGE RECORD PHARMACY	250		2.57	N/A
HC65000250_00904640180	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904640761	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904641292	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904641861	NONCDM CHARGE RECORD PHARMACY	250		3.16	N/A
HC65000250_00904642281	NONCDM CHARGE RECORD PHARMACY	250		8.35	N/A
HC65000250_00904642661	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904642761	NONCDM CHARGE RECORD PHARMACY	250		1.73	N/A
HC65000250_00904643604	NONCDM CHARGE RECORD PHARMACY	250		21.02	N/A
HC65000250_00904643761	NONCDM CHARGE RECORD PHARMACY	250		1.78	N/A
HC65000250_00904643861	NONCDM CHARGE RECORD PHARMACY	250		7.01	N/A
HC65000250_00904643961	NONCDM CHARGE RECORD PHARMACY	250		8.28	N/A
HC65000250_00904644061	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904644161	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_00904644261	NONCDM CHARGE RECORD PHARMACY	250		1.03	N/A
HC65000250_00904644961	NONCDM CHARGE RECORD PHARMACY	250		2.28	N/A
HC65000250_00904645061	NONCDM CHARGE RECORD PHARMACY	250		2.48	N/A
HC65000250_00904645204	NONCDM CHARGE RECORD PHARMACY	250		8.87	N/A
HC65000250_00904645261	NONCDM CHARGE RECORD PHARMACY	250		9.62	N/A
HC65000250_00904645361	NONCDM CHARGE RECORD PHARMACY	250		8.56	N/A
HC65000250_00904645561	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904645760	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904645780	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904646161	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904646861	NONCDM CHARGE RECORD PHARMACY	250		3.06	N/A
HC65000250_00904646961	NONCDM CHARGE RECORD PHARMACY	250		3.10	N/A
HC65000250_00904647061	NONCDM CHARGE RECORD PHARMACY	250		3.51	N/A
HC65000250_00904647561	NONCDM CHARGE RECORD PHARMACY	250		2.17	N/A
HC65000250_00904647661	NONCDM CHARGE RECORD PHARMACY	250		4.00	N/A
HC65000250_00904648838	NONCDM CHARGE RECORD PHARMACY	250		24.59	N/A
HC65000250_00904650161	NONCDM CHARGE RECORD PHARMACY	250		12.22	N/A
HC65000250_00904650261	NONCDM CHARGE RECORD PHARMACY	250		7.24	N/A
HC65000250_00904650361	NONCDM CHARGE RECORD PHARMACY	250		11.96	N/A
HC65000250_00904650506	NONCDM CHARGE RECORD PHARMACY	250		2.43	N/A
HC65000250_00904650561	NONCDM CHARGE RECORD PHARMACY	250		2.58	N/A
HC65000250_00904651106	NONCDM CHARGE RECORD PHARMACY	250	Z7610	50.21	N/A
HC65000250_00904651661	NONCDM CHARGE RECORD PHARMACY	250		1.94	N/A
HC65000250_00904651761	NONCDM CHARGE RECORD PHARMACY	250		2.71	N/A
HC65000250_00904651961	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904652261	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904653061	NONCDM CHARGE RECORD PHARMACY	250		1.47	N/A
HC65000250_00904655061	NONCDM CHARGE RECORD PHARMACY	250		1.39	N/A
HC65000250_00904655761	NONCDM CHARGE RECORD PHARMACY	250		6.86	N/A
HC65000250_00904655861	NONCDM CHARGE RECORD PHARMACY	250		7.50	N/A
HC65000250_00904656460	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904656461	NONCDM CHARGE RECORD PHARMACY	250		2.96	N/A
HC65000250_00904657006	NONCDM CHARGE RECORD PHARMACY	250		16.79	N/A
HC65000250_00904657061	NONCDM CHARGE RECORD PHARMACY	250		13.68	N/A
HC65000250_00904657161	NONCDM CHARGE RECORD PHARMACY	250		1.97	N/A
HC65000250_00904657261	NONCDM CHARGE RECORD PHARMACY	250		3.97	N/A
HC65000250_00904657561	NONCDM CHARGE RECORD PHARMACY	250		2.27	N/A
HC65000250_00904658304	NONCDM CHARGE RECORD PHARMACY	250		46.19	N/A
HC65000250_00904658561	NONCDM CHARGE RECORD PHARMACY	250		3.48	N/A
HC65000250_00904658661	NONCDM CHARGE RECORD PHARMACY	250		3.56	N/A
HC65000250_00904659204	NONCDM CHARGE RECORD PHARMACY	250		67.77	N/A
HC65000250_00904659304	NONCDM CHARGE RECORD PHARMACY	250		70.89	N/A
HC65000250_00904659604	NONCDM CHARGE RECORD PHARMACY	250		48.58	N/A
HC65000250_00904661761	NONCDM CHARGE RECORD PHARMACY	250		1.49	N/A
HC65000250_00904661861	NONCDM CHARGE RECORD PHARMACY	250		1.99	N/A
HC65000250_00904661961	NONCDM CHARGE RECORD PHARMACY	250		3.68	N/A
HC65000250_00904662061	NONCDM CHARGE RECORD PHARMACY	250		4.31	N/A
HC65000250_00904662735	NONCDM CHARGE RECORD PHARMACY	250		8.11	N/A
HC65000250_00904663061	NONCDM CHARGE RECORD PHARMACY	250		10.76	N/A
HC65000250_00904663561	NONCDM CHARGE RECORD PHARMACY	250		7.25	N/A
HC65000250_00904663661	NONCDM CHARGE RECORD PHARMACY	250		9.83	N/A
HC65000250_00904663761	NONCDM CHARGE RECORD PHARMACY	250		1.99	N/A
HC65000250_00904663861	NONCDM CHARGE RECORD PHARMACY	250		1.73	N/A
HC65000250_00904664061	NONCDM CHARGE RECORD PHARMACY	250		2.75	N/A
HC65000250_00904666361	NONCDM CHARGE RECORD PHARMACY	250		19.89	N/A
HC65000250_00904666404	NONCDM CHARGE RECORD PHARMACY	250		66.05	N/A
HC65000250_00904666561	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904666661	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904666761	NONCDM CHARGE RECORD PHARMACY	250		1.23	N/A
HC65000250_00904667104	NONCDM CHARGE RECORD PHARMACY	250		3.93	N/A
HC65000250_00904667106	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5.03	N/A
HC65000250_00904668961	NONCDM CHARGE RECORD PHARMACY	250		0.94	N/A
HC65000250_00904669161	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904669661	NONCDM CHARGE RECORD PHARMACY	250		17.44	N/A
HC65000250_00904670461	NONCDM CHARGE RECORD PHARMACY	250		1.54	N/A
HC65000250_00904670506	NONCDM CHARGE RECORD PHARMACY	250		2.59	N/A
HC65000250_00904670806	NONCDM CHARGE RECORD PHARMACY	250		7.56	N/A
HC65000250_00904671146	NONCDM CHARGE RECORD PHARMACY	250		1.85	N/A
HC65000250_00904671741	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904671761	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904671839	NONCDM CHARGE RECORD PHARMACY	250		5.34	N/A
HC65000250_00904672040	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904672080	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904672580	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904673059	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904673061	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_00904673870	NONCDM CHARGE RECORD PHARMACY	250	Z7610	19.44	N/A
HC65000250_00904674172	NONCDM CHARGE RECORD PHARMACY	250		12.44	N/A
HC65000250_00904674561	NONCDM CHARGE RECORD PHARMACY	250		28.31	N/A
HC65000250_00904674604	NONCDM CHARGE RECORD PHARMACY	250		57.85	N/A
HC65000250_00904674759	NONCDM CHARGE RECORD PHARMACY	250		0.58	N/A
HC65000250_00904674780	NONCDM CHARGE RECORD PHARMACY	250		0.93	N/A
HC65000250_00904674817	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904674860	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904674880	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904675180	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904675514	NONCDM CHARGE RECORD PHARMACY	250		1.34	N/A
HC65000250_00904676130	NONCDM CHARGE RECORD PHARMACY	250		9.36	N/A
HC65000250_00904677361	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_00904677861	NONCDM CHARGE RECORD PHARMACY	250		6.01	N/A
HC65000250_00904678061	NONCDM CHARGE RECORD PHARMACY	250		7.38	N/A
HC65000250_00904678261	NONCDM CHARGE RECORD PHARMACY	250		4.54	N/A
HC65000250_00904678480	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904678744	NONCDM CHARGE RECORD PHARMACY	250		10.43	N/A
HC65000250_00904679104	NONCDM CHARGE RECORD PHARMACY	250		55.94	N/A
HC65000250_00904679480	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904679489	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_00904679761	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904679861	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904679961	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904680061	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904680806	NONCDM CHARGE RECORD PHARMACY	250		1.99	N/A
HC65000250_00904680861	NONCDM CHARGE RECORD PHARMACY	250		1.97	N/A
HC65000250_00904680940	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_00904681861	NONCDM CHARGE RECORD PHARMACY	250		4.88	N/A
HC65000250_00904681907	NONCDM CHARGE RECORD PHARMACY	250		6.44	N/A
HC65000250_00904682076	NONCDM CHARGE RECORD PHARMACY	250		19.91	N/A
HC65000250_00904682104	NONCDM CHARGE RECORD PHARMACY	250		26.66	N/A
HC65000250_00904682461	NONCDM CHARGE RECORD PHARMACY	250		2.15	N/A
HC65000250_00904682561	NONCDM CHARGE RECORD PHARMACY	250		2.56	N/A
HC65000250_00904683006	NONCDM CHARGE RECORD PHARMACY	250		4.05	N/A
HC65000250_00904685261	NONCDM CHARGE RECORD PHARMACY	250		1.38	N/A
HC65000250_00904686190	NONCDM CHARGE RECORD PHARMACY	250		1.95	N/A
HC65000250_00904686861	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904686961	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904687045	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_00904688406	NONCDM CHARGE RECORD PHARMACY	250		11.74	N/A
HC65000250_00904689361	NONCDM CHARGE RECORD PHARMACY	250		31.53	N/A
HC65000250_00904690706	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904691761	NONCDM CHARGE RECORD PHARMACY	250		1.34	N/A
HC65000250_00904692661	NONCDM CHARGE RECORD PHARMACY	250		2.39	N/A
HC65000250_00904693061	NONCDM CHARGE RECORD PHARMACY	250		4.96	N/A
HC65000250_00904693176	NONCDM CHARGE RECORD PHARMACY	250		8.55	N/A
HC65000250_00904693181	NONCDM CHARGE RECORD PHARMACY	250		9.24	N/A
HC65000250_00904693806	NONCDM CHARGE RECORD PHARMACY	250		10.63	N/A
HC65000250_00904696661	NONCDM CHARGE RECORD PHARMACY	250		1.97	N/A
HC65000250_00904698072	NONCDM CHARGE RECORD PHARMACY	250		11.88	N/A
HC65000250_00904698520	NONCDM CHARGE RECORD PHARMACY	250		2.14	N/A
HC65000250_00904698861	NONCDM CHARGE RECORD PHARMACY	250		3.10	N/A
HC65000250_00904699061	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904699104	NONCDM CHARGE RECORD PHARMACY	250		7.92	N/A
HC65000250_00904699261	NONCDM CHARGE RECORD PHARMACY	250		4.52	N/A
HC65000250_00904699361	NONCDM CHARGE RECORD PHARMACY	250		1.78	N/A
HC65000250_00904699860	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904699880	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904699960	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904699980	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904700061	NONCDM CHARGE RECORD PHARMACY	250		4.74	N/A
HC65000250_00904700161	NONCDM CHARGE RECORD PHARMACY	250		5.04	N/A
HC65000250_00904700635	NONCDM CHARGE RECORD PHARMACY	250		17.93	N/A
HC65000250_00904700761	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904700861	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904702404	NONCDM CHARGE RECORD PHARMACY	250		138.99	N/A
HC65000250_00904704304	NONCDM CHARGE RECORD PHARMACY	250		8.74	N/A
HC65000250_00904704361	NONCDM CHARGE RECORD PHARMACY	250		9.45	N/A
HC65000250_00904704461	NONCDM CHARGE RECORD PHARMACY	250		8.62	N/A
HC65000250_00904704561	NONCDM CHARGE RECORD PHARMACY	250		8.62	N/A
HC65000250_00904704606	NONCDM CHARGE RECORD PHARMACY	250		7.66	N/A
HC65000250_00904704661	NONCDM CHARGE RECORD PHARMACY	250		8.33	N/A
HC65000250_00904704861	NONCDM CHARGE RECORD PHARMACY	250		3.50	N/A
HC65000250_00904705761	NONCDM CHARGE RECORD PHARMACY	250		1.56	N/A
HC65000250_00904709361	NONCDM CHARGE RECORD PHARMACY	250		1.70	N/A
HC65000250_00904709461	NONCDM CHARGE RECORD PHARMACY	250		5.87	N/A
HC65000250_00904709561	NONCDM CHARGE RECORD PHARMACY	250		7.88	N/A
HC65000250_00904711061	NONCDM CHARGE RECORD PHARMACY	250		2.67	N/A
HC65000250_00904711161	NONCDM CHARGE RECORD PHARMACY	250		5.21	N/A
HC65000250_00904711561	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_00904712004	NONCDM CHARGE RECORD PHARMACY	250		34.18	N/A
HC65000250_00904712461	NONCDM CHARGE RECORD PHARMACY	250		1.34	N/A
HC65000250_00904712661	NONCDM CHARGE RECORD PHARMACY	250		3.93	N/A
HC65000250_00904714461	NONCDM CHARGE RECORD PHARMACY	250		28.35	N/A
HC65000250_00904716261	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904759060	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904759080	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904759161	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904759180	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904772524	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904782236	NONCDM CHARGE RECORD PHARMACY	250		7.40	N/A
HC65000250_00904791259	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00904791461	NONCDM CHARGE RECORD PHARMACY	250		0.95	N/A
HC65000250_00904880567	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_00942064104	NONCDM CHARGE RECORD PHARMACY	250		42.00	N/A
HC65000250_00955104190	NONCDM CHARGE RECORD PHARMACY	250		2.30	N/A
HC65000250_00955104818	NONCDM CHARGE RECORD PHARMACY	250		36.00	N/A
HC65000250_00955105290	NONCDM CHARGE RECORD PHARMACY	250		56.74	N/A
HC65000250_00955173730	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_00990793002	NONCDM CHARGE RECORD PHARMACY	250		2.40	N/A
HC65000250_00990793003	NONCDM CHARGE RECORD PHARMACY	250	J3490	12.32	N/A
HC65000250_00990793009	NONCDM CHARGE RECORD PHARMACY	250		2.45	N/A
HC65000250_00990797408	NONCDM CHARGE RECORD PHARMACY	250		72.00	N/A
HC65000250_00990798302	NONCDM CHARGE RECORD PHARMACY	250		6.71	N/A
HC65000250_00990798303	NONCDM CHARGE RECORD PHARMACY	250	J7040	3.48	N/A
HC65000250_00990798309	NONCDM CHARGE RECORD PHARMACY	250	J7030	1.79	N/A
HC65000250_00990798361	NONCDM CHARGE RECORD PHARMACY	250		10.50	N/A
HC65000250_00990798413	NONCDM CHARGE RECORD PHARMACY	250		28.91	N/A
HC65000250_00990798423	NONCDM CHARGE RECORD PHARMACY	250		7.15	N/A
HC65000250_00990798436	NONCDM CHARGE RECORD PHARMACY	250	Z7610	8.70	N/A
HC65000250_00990798437	NONCDM CHARGE RECORD PHARMACY	250		5.70	N/A
HC65000250_00998001615	NONCDM CHARGE RECORD PHARMACY	250		213.91	N/A
HC65000250_00998020415	NONCDM CHARGE RECORD PHARMACY	250		533.29	N/A
HC65000250_00998040815	NONCDM CHARGE RECORD PHARMACY	250		156.83	N/A
HC65000250_00998063006	NONCDM CHARGE RECORD PHARMACY	250		386.76	N/A
HC65000250_01000670012	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01000670021	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01000670022	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01000670028	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01000670031	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01000670033	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_01000670038	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01000670043	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01000670127	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01000673013	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_01000673021	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01000673027	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01000673035	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01000673051	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01001955303	NONCDM CHARGE RECORD PHARMACY	250		126.67	N/A
HC65000250_01001955304	NONCDM CHARGE RECORD PHARMACY	250		121.31	N/A
HC65000250_01011902090	NONCDM CHARGE RECORD PHARMACY	250		28.98	N/A
HC65000250_01011902239	NONCDM CHARGE RECORD PHARMACY	250		40.93	N/A
HC65000250_01013511101	NONCDM CHARGE RECORD PHARMACY	250		0.96	N/A
HC65000250_01013562001	NONCDM CHARGE RECORD PHARMACY	250		3.82	N/A
HC65000250_01013562101	NONCDM CHARGE RECORD PHARMACY	250		7.00	N/A
HC65000250_01013563801	NONCDM CHARGE RECORD PHARMACY	250		1.42	N/A
HC65000250_01013565201	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_01013566901	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01013568962	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_01014717003	NONCDM CHARGE RECORD PHARMACY	250	Z7610	44.53	N/A
HC65000250_01022302013	NONCDM CHARGE RECORD PHARMACY	250		347.16	N/A
HC65000250_01022302014	NONCDM CHARGE RECORD PHARMACY	250		315.12	N/A
HC65000250_01031028313	NONCDM CHARGE RECORD PHARMACY	250		24.23	N/A
HC65000250_01035609004	NONCDM CHARGE RECORD PHARMACY	250		32.54	N/A
HC65000250_01035610110	NONCDM CHARGE RECORD PHARMACY	250		33.86	N/A
HC65000250_01037010103	NONCDM CHARGE RECORD PHARMACY	250		5.00	N/A
HC65000250_01037074501	NONCDM CHARGE RECORD PHARMACY	250		1.74	N/A
HC65000250_01037082911	NONCDM CHARGE RECORD PHARMACY	250		4.78	N/A
HC65000250_01037083111	NONCDM CHARGE RECORD PHARMACY	250		8.18	N/A
HC65000250_01048101118	NONCDM CHARGE RECORD PHARMACY	250		62.33	N/A
HC65000250_01053903697	NONCDM CHARGE RECORD PHARMACY	250		2.70	N/A
HC65000250_01057210101	NONCDM CHARGE RECORD PHARMACY	250		72.00	N/A
HC65000250_01070200301	NONCDM CHARGE RECORD PHARMACY	250		1.02	N/A
HC65000250_01070201001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01070201301	NONCDM CHARGE RECORD PHARMACY	250		4.33	N/A
HC65000250_01070203645	NONCDM CHARGE RECORD PHARMACY	250		13.59	N/A
HC65000250_01070216901	NONCDM CHARGE RECORD PHARMACY	250		2.67	N/A
HC65000250_01070220101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01070223701	NONCDM CHARGE RECORD PHARMACY	250		4.74	N/A
HC65000250_01070225301	NONCDM CHARGE RECORD PHARMACY	250		1.29	N/A
HC65000250_01070227703	NONCDM CHARGE RECORD PHARMACY	250		4.00	N/A
HC65000250_01093904633	NONCDM CHARGE RECORD PHARMACY	250	Z7610	6.34	N/A
HC65000250_01093913944	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01093914233	NONCDM CHARGE RECORD PHARMACY	250		25.60	N/A
HC65000250_01093914344	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01093914833	NONCDM CHARGE RECORD PHARMACY	250		10.36	N/A
HC65000250_01093915633	NONCDM CHARGE RECORD PHARMACY	250		48.25	N/A
HC65000250_01093916733	NONCDM CHARGE RECORD PHARMACY	250		7.29	N/A
HC65000250_01093919844	NONCDM CHARGE RECORD PHARMACY	250		14.14	N/A
HC65000250_01093920444	NONCDM CHARGE RECORD PHARMACY	250	Z7610	42.12	N/A
HC65000250_01093933233	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01093933733	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01093940233	NONCDM CHARGE RECORD PHARMACY	250		8.82	N/A
HC65000250_01093941433	NONCDM CHARGE RECORD PHARMACY	250		10.41	N/A
HC65000250_01093945944	NONCDM CHARGE RECORD PHARMACY	250		11.68	N/A
HC65000250_01093946833	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01093950233	NONCDM CHARGE RECORD PHARMACY	250		3.12	N/A
HC65000250_01093956433	NONCDM CHARGE RECORD PHARMACY	250		14.48	N/A
HC65000250_01093956833	NONCDM CHARGE RECORD PHARMACY	250		10.24	N/A
HC65000250_01093960244	NONCDM CHARGE RECORD PHARMACY	250		19.44	N/A
HC65000250_01093962144	NONCDM CHARGE RECORD PHARMACY	250		11.61	N/A
HC65000250_01093969133	NONCDM CHARGE RECORD PHARMACY	250		1.36	N/A
HC65000250_01093971244	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01093972744	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01093973944	NONCDM CHARGE RECORD PHARMACY	250		34.34	N/A
HC65000250_01093974444	NONCDM CHARGE RECORD PHARMACY	250		1.47	N/A
HC65000250_01093977544	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01093979444	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01093983044	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2.90	N/A
HC65000250_01093985244	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01093986544	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01093987244	NONCDM CHARGE RECORD PHARMACY	250		10.90	N/A
HC65000250_01093990033	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01093991144	NONCDM CHARGE RECORD PHARMACY	250		2.25	N/A
HC65000250_01093995368	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01152300962	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3.14	N/A
HC65000250_01152311591	NONCDM CHARGE RECORD PHARMACY	250		33.84	N/A
HC65000250_01152311676	NONCDM CHARGE RECORD PHARMACY	250	Z7610	24.95	N/A
HC65000250_01152372683	NONCDM CHARGE RECORD PHARMACY	250		6.26	N/A
HC65000250_01152372688	NONCDM CHARGE RECORD PHARMACY	250		9.04	N/A
HC65000250_01153416503	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01170100216	NONCDM CHARGE RECORD PHARMACY	250		24.48	N/A
HC65000250_01170105033	NONCDM CHARGE RECORD PHARMACY	250		35.11	N/A
HC65000250_01184505651	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01184512295	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01184579601	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_01191705014	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01216510003	NONCDM CHARGE RECORD PHARMACY	250		1.44	N/A
HC65000250_01249612083	NONCDM CHARGE RECORD PHARMACY	250		53.88	N/A
HC65000250_01254720436	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_01254723813	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01287000011	NONCDM CHARGE RECORD PHARMACY	250		3.70	N/A
HC65000250_01287000012	NONCDM CHARGE RECORD PHARMACY	250		3.38	N/A
HC65000250_01310701401	NONCDM CHARGE RECORD PHARMACY	250		1.32	N/A
HC65000250_01310703105	NONCDM CHARGE RECORD PHARMACY	250		1.59	N/A
HC65000250_01310703134	NONCDM CHARGE RECORD PHARMACY	250		1.77	N/A
HC65000250_01310704501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01310707001	NONCDM CHARGE RECORD PHARMACY	250		2.24	N/A
HC65000250_01310708305	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_01310715430	NONCDM CHARGE RECORD PHARMACY	250		1.37	N/A
HC65000250_01351710716	NONCDM CHARGE RECORD PHARMACY	250		8.88	N/A
HC65000250_01351711201	NONCDM CHARGE RECORD PHARMACY	250		4.02	N/A
HC65000250_01351711301	NONCDM CHARGE RECORD PHARMACY	250		5.68	N/A
HC65000250_01366800801	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01366800901	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_01366801001	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_01366801005	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01366808630	NONCDM CHARGE RECORD PHARMACY	250		14.01	N/A
HC65000250_01366810230	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01366810390	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01366810401	NONCDM CHARGE RECORD PHARMACY	250		2.41	N/A
HC65000250_01366810501	NONCDM CHARGE RECORD PHARMACY	250		4.19	N/A
HC65000250_01366813201	NONCDM CHARGE RECORD PHARMACY	250		2.28	N/A
HC65000250_01366815672	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5.02	N/A
HC65000250_01366820230	NONCDM CHARGE RECORD PHARMACY	250		19.66	N/A
HC65000250_01366821730	NONCDM CHARGE RECORD PHARMACY	250		8.64	N/A
HC65000250_01366821830	NONCDM CHARGE RECORD PHARMACY	250		8.92	N/A
HC65000250_01366827101	NONCDM CHARGE RECORD PHARMACY	250		3.16	N/A
HC65000250_01381151690	NONCDM CHARGE RECORD PHARMACY	250		2.66	N/A
HC65000250_01392550530	NONCDM CHARGE RECORD PHARMACY	250		14.51	N/A
HC65000250_01625253901	NONCDM CHARGE RECORD PHARMACY	250		5.92	N/A
HC65000250_01650008619	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01650008806	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01657120106	NONCDM CHARGE RECORD PHARMACY	250		1.70	N/A
HC65000250_01657120210	NONCDM CHARGE RECORD PHARMACY	250		1.47	N/A
HC65000250_01657120310	NONCDM CHARGE RECORD PHARMACY	250		6.38	N/A
HC65000250_01657133016	NONCDM CHARGE RECORD PHARMACY	250	Z7610	6.25	N/A
HC65000250_01657140110	NONCDM CHARGE RECORD PHARMACY	250		1.40	N/A
HC65000250_01657160096	NONCDM CHARGE RECORD PHARMACY	250	Z7610	32.04	N/A
HC65000250_01657165710	NONCDM CHARGE RECORD PHARMACY	250		12.87	N/A
HC65000250_01657165906	NONCDM CHARGE RECORD PHARMACY	250		10.05	N/A
HC65000250_01657169901	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671400701	NONCDM CHARGE RECORD PHARMACY	250		4.22	N/A
HC65000250_01671401401	NONCDM CHARGE RECORD PHARMACY	250		5.44	N/A
HC65000250_01671403502	NONCDM CHARGE RECORD PHARMACY	250		2.18	N/A
HC65000250_01671403901	NONCDM CHARGE RECORD PHARMACY	250		34.90	N/A
HC65000250_01671404110	NONCDM CHARGE RECORD PHARMACY	250		1.18	N/A
HC65000250_01671404112	NONCDM CHARGE RECORD PHARMACY	250		1.28	N/A
HC65000250_01671404210	NONCDM CHARGE RECORD PHARMACY	250		2.32	N/A
HC65000250_01671404211	NONCDM CHARGE RECORD PHARMACY	250		2.03	N/A
HC65000250_01671404701	NONCDM CHARGE RECORD PHARMACY	250		16.34	N/A
HC65000250_01671404801	NONCDM CHARGE RECORD PHARMACY	250		23.41	N/A
HC65000250_01671405001	NONCDM CHARGE RECORD PHARMACY	250		47.39	N/A
HC65000250_01671405901	NONCDM CHARGE RECORD PHARMACY	250		24.69	N/A
HC65000250_01671407104	NONCDM CHARGE RECORD PHARMACY	250		1.08	N/A
HC65000250_01671407106	NONCDM CHARGE RECORD PHARMACY	250		1.40	N/A
HC65000250_01671407204	NONCDM CHARGE RECORD PHARMACY	250		1.89	N/A
HC65000250_01671407801	NONCDM CHARGE RECORD PHARMACY	250		71.40	N/A
HC65000250_01671408110	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671408210	NONCDM CHARGE RECORD PHARMACY	250		1.02	N/A
HC65000250_01671408310	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671408501	NONCDM CHARGE RECORD PHARMACY	250		2.11	N/A
HC65000250_01671409701	NONCDM CHARGE RECORD PHARMACY	250		4.57	N/A
HC65000250_01671410102	NONCDM CHARGE RECORD PHARMACY	250		1.02	N/A
HC65000250_01671410105	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671411502	NONCDM CHARGE RECORD PHARMACY	250		62.99	N/A
HC65000250_01671411602	NONCDM CHARGE RECORD PHARMACY	250		61.15	N/A
HC65000250_01671411702	NONCDM CHARGE RECORD PHARMACY	250		61.16	N/A
HC65000250_01671414201	NONCDM CHARGE RECORD PHARMACY	250		6.97	N/A
HC65000250_01671414301	NONCDM CHARGE RECORD PHARMACY	250		6.99	N/A
HC65000250_01671423401	NONCDM CHARGE RECORD PHARMACY	250		1.20	N/A
HC65000250_01671429302	NONCDM CHARGE RECORD PHARMACY	250	Z7610	4.22	N/A
HC65000250_01671429303	NONCDM CHARGE RECORD PHARMACY	250		1.17	N/A
HC65000250_01671429401	NONCDM CHARGE RECORD PHARMACY	250		11.14	N/A
HC65000250_01671429801	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671429903	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_01671429904	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671433201	NONCDM CHARGE RECORD PHARMACY	250		1.75	N/A
HC65000250_01671435101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671435201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671435401	NONCDM CHARGE RECORD PHARMACY	250		1.48	N/A
HC65000250_01671435501	NONCDM CHARGE RECORD PHARMACY	250		2.17	N/A
HC65000250_01671435502	NONCDM CHARGE RECORD PHARMACY	250		2.17	N/A
HC65000250_01671435801	NONCDM CHARGE RECORD PHARMACY	250		2.63	N/A
HC65000250_01671436504	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_01671439101	NONCDM CHARGE RECORD PHARMACY	250		9.25	N/A
HC65000250_01671439102	NONCDM CHARGE RECORD PHARMACY	250		8.96	N/A
HC65000250_01671439301	NONCDM CHARGE RECORD PHARMACY	250		23.44	N/A
HC65000250_01671439401	NONCDM CHARGE RECORD PHARMACY	250		32.34	N/A
HC65000250_01671439501	NONCDM CHARGE RECORD PHARMACY	250		40.60	N/A
HC65000250_01671443901	NONCDM CHARGE RECORD PHARMACY	250		9.83	N/A
HC65000250_01671444301	NONCDM CHARGE RECORD PHARMACY	250		2.94	N/A
HC65000250_01671444401	NONCDM CHARGE RECORD PHARMACY	250		3.06	N/A
HC65000250_01671444601	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671444701	NONCDM CHARGE RECORD PHARMACY	250		1.73	N/A
HC65000250_01671444801	NONCDM CHARGE RECORD PHARMACY	250		3.35	N/A
HC65000250_01671445201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671445301	NONCDM CHARGE RECORD PHARMACY	250		2.22	N/A
HC65000250_01671445401	NONCDM CHARGE RECORD PHARMACY	250		1.71	N/A
HC65000250_01671445501	NONCDM CHARGE RECORD PHARMACY	250		3.95	N/A
HC65000250_01671447601	NONCDM CHARGE RECORD PHARMACY	250		28.48	N/A
HC65000250_01671447701	NONCDM CHARGE RECORD PHARMACY	250		8.47	N/A
HC65000250_01671447801	NONCDM CHARGE RECORD PHARMACY	250		8.84	N/A
HC65000250_01671447802	NONCDM CHARGE RECORD PHARMACY	250		8.85	N/A
HC65000250_01671448202	NONCDM CHARGE RECORD PHARMACY	250		1.43	N/A
HC65000250_01671448301	NONCDM CHARGE RECORD PHARMACY	250	Z7610	37.26	N/A
HC65000250_01671448401	NONCDM CHARGE RECORD PHARMACY	250		4.73	N/A
HC65000250_01671449401	NONCDM CHARGE RECORD PHARMACY	250		6.51	N/A
HC65000250_01671449601	NONCDM CHARGE RECORD PHARMACY	250		131.49	N/A
HC65000250_01671450101	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_01671450302	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671450501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671451001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671457101	NONCDM CHARGE RECORD PHARMACY	250		4.24	N/A
HC65000250_01671460102	NONCDM CHARGE RECORD PHARMACY	250	Z7610	21.89	N/A
HC65000250_01671461201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671461204	NONCDM CHARGE RECORD PHARMACY	250		1.02	N/A
HC65000250_01671461205	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_01671461206	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671461301	NONCDM CHARGE RECORD PHARMACY	250		1.05	N/A
HC65000250_01671461304	NONCDM CHARGE RECORD PHARMACY	250		1.02	N/A
HC65000250_01671461305	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671461306	NONCDM CHARGE RECORD PHARMACY	250		0.93	N/A
HC65000250_01671461601	NONCDM CHARGE RECORD PHARMACY	250	Z7610	16.25	N/A
HC65000250_01671462101	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_01671463101	NONCDM CHARGE RECORD PHARMACY	250		2.00	N/A
HC65000250_01671463301	NONCDM CHARGE RECORD PHARMACY	250		6.75	N/A
HC65000250_01671463302	NONCDM CHARGE RECORD PHARMACY	250		6.72	N/A
HC65000250_01671465102	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671465501	NONCDM CHARGE RECORD PHARMACY	250		2.12	N/A
HC65000250_01671465601	NONCDM CHARGE RECORD PHARMACY	250		1.69	N/A
HC65000250_01671465701	NONCDM CHARGE RECORD PHARMACY	250		2.42	N/A
HC65000250_01671465801	NONCDM CHARGE RECORD PHARMACY	250		2.15	N/A
HC65000250_01671466101	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_01671466102	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671466201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671466202	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_01671466301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671466302	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671467102	NONCDM CHARGE RECORD PHARMACY	250		20.42	N/A
HC65000250_01671468101	NONCDM CHARGE RECORD PHARMACY	250		1.02	N/A
HC65000250_01671468102	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_01671468201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671468202	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671468301	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_01671468302	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671468303	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671468401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671468402	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671468403	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671469101	NONCDM CHARGE RECORD PHARMACY	250		6.64	N/A
HC65000250_01671469102	NONCDM CHARGE RECORD PHARMACY	250	Z7610	7.30	N/A
HC65000250_01671469401	NONCDM CHARGE RECORD PHARMACY	250		4.66	N/A
HC65000250_01671469601	NONCDM CHARGE RECORD PHARMACY	250		39.25	N/A
HC65000250_01671469801	NONCDM CHARGE RECORD PHARMACY	250		4.51	N/A
HC65000250_01671469803	NONCDM CHARGE RECORD PHARMACY	250		4.43	N/A
HC65000250_01671470101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671470701	NONCDM CHARGE RECORD PHARMACY	250		1.78	N/A
HC65000250_01671471801	NONCDM CHARGE RECORD PHARMACY	250		88.58	N/A
HC65000250_01671472002	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671472102	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671473001	NONCDM CHARGE RECORD PHARMACY	250		429.03	N/A
HC65000250_01671473201	NONCDM CHARGE RECORD PHARMACY	250		6.17	N/A
HC65000250_01671473301	NONCDM CHARGE RECORD PHARMACY	250		10.08	N/A
HC65000250_01671474302	NONCDM CHARGE RECORD PHARMACY	250	Z7610	28.13	N/A
HC65000250_01671475201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671475301	NONCDM CHARGE RECORD PHARMACY	250		7.53	N/A
HC65000250_01671476501	NONCDM CHARGE RECORD PHARMACY	250		92.56	N/A
HC65000250_01671476601	NONCDM CHARGE RECORD PHARMACY	250		198.96	N/A
HC65000250_01671476901	NONCDM CHARGE RECORD PHARMACY	250		103.84	N/A
HC65000250_01671477001	NONCDM CHARGE RECORD PHARMACY	250		82.09	N/A
HC65000250_01671477101	NONCDM CHARGE RECORD PHARMACY	250		81.77	N/A
HC65000250_01671478201	NONCDM CHARGE RECORD PHARMACY	250		392.67	N/A
HC65000250_01671478202	NONCDM CHARGE RECORD PHARMACY	250	Z7610	636.30	N/A
HC65000250_01671478301	NONCDM CHARGE RECORD PHARMACY	250		35.71	N/A
HC65000250_01671478401	NONCDM CHARGE RECORD PHARMACY	250		35.09	N/A
HC65000250_01671478501	NONCDM CHARGE RECORD PHARMACY	250		23.48	N/A
HC65000250_01671478601	NONCDM CHARGE RECORD PHARMACY	250		6.92	N/A
HC65000250_01671479501	NONCDM CHARGE RECORD PHARMACY	250		1.60	N/A
HC65000250_01671479502	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.27	N/A
HC65000250_01671479601	NONCDM CHARGE RECORD PHARMACY	250		10.63	N/A
HC65000250_01671479701	NONCDM CHARGE RECORD PHARMACY	250		10.63	N/A
HC65000250_01671479901	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_01671480001	NONCDM CHARGE RECORD PHARMACY	250		5.44	N/A
HC65000250_01671480401	NONCDM CHARGE RECORD PHARMACY	250		4.16	N/A
HC65000250_01671481302	NONCDM CHARGE RECORD PHARMACY	250		1.90	N/A
HC65000250_01671481401	NONCDM CHARGE RECORD PHARMACY	250		12.44	N/A
HC65000250_01671481601	NONCDM CHARGE RECORD PHARMACY	250		4.24	N/A
HC65000250_01671481602	NONCDM CHARGE RECORD PHARMACY	250		4.23	N/A
HC65000250_01671481701	NONCDM CHARGE RECORD PHARMACY	250		53.99	N/A
HC65000250_01671481901	NONCDM CHARGE RECORD PHARMACY	250		57.38	N/A
HC65000250_01671482001	NONCDM CHARGE RECORD PHARMACY	250		14.18	N/A
HC65000250_01671482101	NONCDM CHARGE RECORD PHARMACY	250		1.93	N/A
HC65000250_01671482901	NONCDM CHARGE RECORD PHARMACY	250		18.80	N/A
HC65000250_01671483001	NONCDM CHARGE RECORD PHARMACY	250		30.07	N/A
HC65000250_01671483101	NONCDM CHARGE RECORD PHARMACY	250		5.09	N/A
HC65000250_01671483201	NONCDM CHARGE RECORD PHARMACY	250		5.10	N/A
HC65000250_01671483801	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5.94	N/A
HC65000250_01671484001	NONCDM CHARGE RECORD PHARMACY	250		32.21	N/A
HC65000250_01671484101	NONCDM CHARGE RECORD PHARMACY	250		32.77	N/A
HC65000250_01671484201	NONCDM CHARGE RECORD PHARMACY	250		33.46	N/A
HC65000250_01671484301	NONCDM CHARGE RECORD PHARMACY	250		16.72	N/A
HC65000250_01671484402	NONCDM CHARGE RECORD PHARMACY	250		1.59	N/A
HC65000250_01671485201	NONCDM CHARGE RECORD PHARMACY	250		3.92	N/A
HC65000250_01671485202	NONCDM CHARGE RECORD PHARMACY	250		3.12	N/A
HC65000250_01671485301	NONCDM CHARGE RECORD PHARMACY	250		3.92	N/A
HC65000250_01671486001	NONCDM CHARGE RECORD PHARMACY	250		102.69	N/A
HC65000250_01671487402	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671487501	NONCDM CHARGE RECORD PHARMACY	250		1.66	N/A
HC65000250_01671487502	NONCDM CHARGE RECORD PHARMACY	250		1.81	N/A
HC65000250_01671487602	NONCDM CHARGE RECORD PHARMACY	250		1.33	N/A
HC65000250_01671487603	NONCDM CHARGE RECORD PHARMACY	250		1.71	N/A
HC65000250_01671488301	NONCDM CHARGE RECORD PHARMACY	250		5.50	N/A
HC65000250_01671488701	NONCDM CHARGE RECORD PHARMACY	250		22.77	N/A
HC65000250_01671489401	NONCDM CHARGE RECORD PHARMACY	250		1.34	N/A
HC65000250_01671489601	NONCDM CHARGE RECORD PHARMACY	250		2.32	N/A
HC65000250_01671489802	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01671490001	NONCDM CHARGE RECORD PHARMACY	250		133.56	N/A
HC65000250_01671494801	NONCDM CHARGE RECORD PHARMACY	250		2.35	N/A
HC65000250_01671496401	NONCDM CHARGE RECORD PHARMACY	250		29.68	N/A
HC65000250_01671497601	NONCDM CHARGE RECORD PHARMACY	250		253.80	N/A
HC65000250_01671498801	NONCDM CHARGE RECORD PHARMACY	250		1.22	N/A
HC65000250_01671498901	NONCDM CHARGE RECORD PHARMACY	250		1.21	N/A
HC65000250_01671499001	NONCDM CHARGE RECORD PHARMACY	250		1.02	N/A
HC65000250_01672900201	NONCDM CHARGE RECORD PHARMACY	250		1.03	N/A
HC65000250_01672903001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01672903510	NONCDM CHARGE RECORD PHARMACY	250		3.00	N/A
HC65000250_01672907901	NONCDM CHARGE RECORD PHARMACY	250		7.59	N/A
HC65000250_01672909015	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01672913600	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01672913616	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_01672913700	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01672914201	NONCDM CHARGE RECORD PHARMACY	250		0.00	N/A
HC65000250_01672916901	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_01672917001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01672917101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01672917301	NONCDM CHARGE RECORD PHARMACY	250		2.54	N/A
HC65000250_01672917501	NONCDM CHARGE RECORD PHARMACY	250		5.06	N/A
HC65000250_01672918201	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_01672918301	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_01672918317	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01672918401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01672918929	NONCDM CHARGE RECORD PHARMACY	250		5.30	N/A
HC65000250_01672920201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01672927801	NONCDM CHARGE RECORD PHARMACY	250		1.88	N/A
HC65000250_01672927901	NONCDM CHARGE RECORD PHARMACY	250		2.64	N/A
HC65000250_01672928001	NONCDM CHARGE RECORD PHARMACY	250		9.39	N/A
HC65000250_01672929310	NONCDM CHARGE RECORD PHARMACY	250		8.39	N/A
HC65000250_01672932015	NONCDM CHARGE RECORD PHARMACY	250		1.20	N/A
HC65000250_01672932115	NONCDM CHARGE RECORD PHARMACY	250		1.46	N/A
HC65000250_01672937010	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_01672941401	NONCDM CHARGE RECORD PHARMACY	250		2.12	N/A
HC65000250_01672943315	NONCDM CHARGE RECORD PHARMACY	250		1.76	N/A
HC65000250_01672944010	NONCDM CHARGE RECORD PHARMACY	250		13.32	N/A
HC65000250_01672944015	NONCDM CHARGE RECORD PHARMACY	250		47.21	N/A
HC65000250_01672944310	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01672944715	NONCDM CHARGE RECORD PHARMACY	250		1.72	N/A
HC65000250_01672944815	NONCDM CHARGE RECORD PHARMACY	250		2.00	N/A
HC65000250_01672944915	NONCDM CHARGE RECORD PHARMACY	250		2.15	N/A
HC65000250_01672945015	NONCDM CHARGE RECORD PHARMACY	250		2.20	N/A
HC65000250_01672945115	NONCDM CHARGE RECORD PHARMACY	250		2.16	N/A
HC65000250_01672945215	NONCDM CHARGE RECORD PHARMACY	250		2.55	N/A
HC65000250_01672945315	NONCDM CHARGE RECORD PHARMACY	250		2.69	N/A
HC65000250_01672945415	NONCDM CHARGE RECORD PHARMACY	250		2.59	N/A
HC65000250_01678414012	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01686424001	NONCDM CHARGE RECORD PHARMACY	250		4.24	N/A
HC65000250_01686468001	NONCDM CHARGE RECORD PHARMACY	250		29.02	N/A
HC65000250_01686468002	NONCDM CHARGE RECORD PHARMACY	250		27.22	N/A
HC65000250_01686468003	NONCDM CHARGE RECORD PHARMACY	250		31.54	N/A
HC65000250_01723861015	NONCDM CHARGE RECORD PHARMACY	250		38.97	N/A
HC65000250_01723890011	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_01723890030	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01747806012	NONCDM CHARGE RECORD PHARMACY	250		30.15	N/A
HC65000250_01747806235	NONCDM CHARGE RECORD PHARMACY	250		25.94	N/A
HC65000250_01747806412	NONCDM CHARGE RECORD PHARMACY	250		38.97	N/A
HC65000250_01747807031	NONCDM CHARGE RECORD PHARMACY	250		49.03	N/A
HC65000250_01747810002	NONCDM CHARGE RECORD PHARMACY	250	Z7610	70.92	N/A
HC65000250_01747810012	NONCDM CHARGE RECORD PHARMACY	250	Z7610	167.76	N/A
HC65000250_01747810212	NONCDM CHARGE RECORD PHARMACY	250		50.49	N/A
HC65000250_01747817130	NONCDM CHARGE RECORD PHARMACY	250	Z7610	40.99	N/A
HC65000250_01747817324	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_01747820102	NONCDM CHARGE RECORD PHARMACY	250		176.55	N/A
HC65000250_01747820115	NONCDM CHARGE RECORD PHARMACY	250	Z7610	48.77	N/A
HC65000250_01747820605	NONCDM CHARGE RECORD PHARMACY	250		236.19	N/A
HC65000250_01747821502	NONCDM CHARGE RECORD PHARMACY	250		225.47	N/A
HC65000250_01747821505	NONCDM CHARGE RECORD PHARMACY	250		307.92	N/A
HC65000250_01747822412	NONCDM CHARGE RECORD PHARMACY	250		527.49	N/A
HC65000250_01747828435	NONCDM CHARGE RECORD PHARMACY	250		176.08	N/A
HC65000250_01747828810	NONCDM CHARGE RECORD PHARMACY	250		38.20	N/A
HC65000250_01747829010	NONCDM CHARGE RECORD PHARMACY	250		69.90	N/A
HC65000250_01747829111	NONCDM CHARGE RECORD PHARMACY	250		119.65	N/A
HC65000250_01747840303	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01747840401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_01747850305	NONCDM CHARGE RECORD PHARMACY	250		2,680.53	N/A
HC65000250_01747860430	NONCDM CHARGE RECORD PHARMACY	250		16.56	N/A
HC65000250_01747862235	NONCDM CHARGE RECORD PHARMACY	250		59.69	N/A
HC65000250_01747862312	NONCDM CHARGE RECORD PHARMACY	250		58.63	N/A
HC65000250_01747871110	NONCDM CHARGE RECORD PHARMACY	250	Z7610	14.55	N/A
HC65000250_01747871130	NONCDM CHARGE RECORD PHARMACY	250		548.27	N/A
HC65000250_01747871131	NONCDM CHARGE RECORD PHARMACY	250		40.92	N/A
HC65000250_01747871310	NONCDM CHARGE RECORD PHARMACY	250		100.50	N/A
HC65000250_01747871410	NONCDM CHARGE RECORD PHARMACY	250		47.36	N/A
HC65000250_01747871510	NONCDM CHARGE RECORD PHARMACY	250		78.40	N/A
HC65000250_01747871610	NONCDM CHARGE RECORD PHARMACY	250		405.00	N/A
HC65000250_01747871710	NONCDM CHARGE RECORD PHARMACY	250		54.06	N/A
HC65000250_01747876106	NONCDM CHARGE RECORD PHARMACY	250		10.13	N/A
HC65000250_01747876206	NONCDM CHARGE RECORD PHARMACY	250		21.10	N/A
HC65000250_01747876610	NONCDM CHARGE RECORD PHARMACY	250		3.60	N/A
HC65000250_01785600795	NONCDM CHARGE RECORD PHARMACY	250		9.99	N/A
HC65000250_01785603122	NONCDM CHARGE RECORD PHARMACY	250		8.33	N/A
HC65000250_01785609624	NONCDM CHARGE RECORD PHARMACY	250		6.66	N/A
HC65000250_01785680405	NONCDM CHARGE RECORD PHARMACY	250		14.89	N/A
HC65000250_02045187121	NONCDM CHARGE RECORD PHARMACY	250		11.99	N/A
HC65000250_02055500301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02055502500	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02055503300	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02055503600	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02055503601	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02159934562	NONCDM CHARGE RECORD PHARMACY	250		2.83	N/A
HC65000250_02315500210	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02315501105	NONCDM CHARGE RECORD PHARMACY	250		1.13	N/A
HC65000250_02315502601	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02315510201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02315510210	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_02315510301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02315510401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02315510405	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02315510410	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02315511801	NONCDM CHARGE RECORD PHARMACY	250		5.81	N/A
HC65000250_02315516641	NONCDM CHARGE RECORD PHARMACY	250		58.20	N/A
HC65000250_02315517801	NONCDM CHARGE RECORD PHARMACY	250		2.46	N/A
HC65000250_02315519101	NONCDM CHARGE RECORD PHARMACY	250		3.24	N/A
HC65000250_02315519201	NONCDM CHARGE RECORD PHARMACY	250		4.28	N/A
HC65000250_02315519401	NONCDM CHARGE RECORD PHARMACY	250		2.31	N/A
HC65000250_02315519501	NONCDM CHARGE RECORD PHARMACY	250		10.60	N/A
HC65000250_02315551230	NONCDM CHARGE RECORD PHARMACY	250		46.50	N/A
HC65000250_02315551901	NONCDM CHARGE RECORD PHARMACY	250		1.27	N/A
HC65000250_02315553102	NONCDM CHARGE RECORD PHARMACY	250		1.54	N/A
HC65000250_02315560601	NONCDM CHARGE RECORD PHARMACY	250		2.60	N/A
HC65000250_02315560701	NONCDM CHARGE RECORD PHARMACY	250		4.67	N/A
HC65000250_02315562102	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2.53	N/A
HC65000250_02315566301	NONCDM CHARGE RECORD PHARMACY	250		2.53	N/A
HC65000250_02315572301	NONCDM CHARGE RECORD PHARMACY	250		1.73	N/A
HC65000250_02315572401	NONCDM CHARGE RECORD PHARMACY	250		2.45	N/A
HC65000250_02315572501	NONCDM CHARGE RECORD PHARMACY	250		3.27	N/A
HC65000250_02315573001	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_02315574703	NONCDM CHARGE RECORD PHARMACY	250		20.89	N/A
HC65000250_02315576601	NONCDM CHARGE RECORD PHARMACY	250		11.40	N/A
HC65000250_02318514505	NONCDM CHARGE RECORD PHARMACY	250		10.50	N/A
HC65000250_02420827715	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_02420831334	NONCDM CHARGE RECORD PHARMACY	250		40.93	N/A
HC65000250_02420831510	NONCDM CHARGE RECORD PHARMACY	250		32.93	N/A
HC65000250_02420839915	NONCDM CHARGE RECORD PHARMACY	250		175.18	N/A
HC65000250_02420841105	NONCDM CHARGE RECORD PHARMACY	250		86.63	N/A
HC65000250_02420841110	NONCDM CHARGE RECORD PHARMACY	250		163.50	N/A
HC65000250_02420848510	NONCDM CHARGE RECORD PHARMACY	250		203.94	N/A
HC65000250_02420853920	NONCDM CHARGE RECORD PHARMACY	250		643.86	N/A
HC65000250_02420855555	NONCDM CHARGE RECORD PHARMACY	250		121.61	N/A
HC65000250_02420873006	NONCDM CHARGE RECORD PHARMACY	250		123.61	N/A
HC65000250_02420873501	NONCDM CHARGE RECORD PHARMACY	250		69.98	N/A
HC65000250_02420878055	NONCDM CHARGE RECORD PHARMACY	250	Z7610	273.42	N/A
HC65000250_02420883060	NONCDM CHARGE RECORD PHARMACY	250		62.63	N/A
HC65000250_02420891019	NONCDM CHARGE RECORD PHARMACY	250		59.15	N/A
HC65000250_02420891055	NONCDM CHARGE RECORD PHARMACY	250		91.20	N/A
HC65000250_02433812203	NONCDM CHARGE RECORD PHARMACY	250		24.16	N/A
HC65000250_02433812213	NONCDM CHARGE RECORD PHARMACY	250		6.51	N/A
HC65000250_02433812403	NONCDM CHARGE RECORD PHARMACY	250		53.06	N/A
HC65000250_02433813213	NONCDM CHARGE RECORD PHARMACY	250		28.23	N/A
HC65000250_02433813402	NONCDM CHARGE RECORD PHARMACY	250		35.70	N/A
HC65000250_02435770106	NONCDM CHARGE RECORD PHARMACY	250		29.71	N/A
HC65000250_02435770115	NONCDM CHARGE RECORD PHARMACY	250		96.03	N/A
HC65000250_02438511165	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02438511878	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02451005010	NONCDM CHARGE RECORD PHARMACY	250		45.58	N/A
HC65000250_02465826060	NONCDM CHARGE RECORD PHARMACY	250	Z7610	12.04	N/A
HC65000250_02465875090	NONCDM CHARGE RECORD PHARMACY	250		7.80	N/A
HC65000250_02468985501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02501021515	NONCDM CHARGE RECORD PHARMACY	250		146.66	N/A
HC65000250_02502113182	NONCDM CHARGE RECORD PHARMACY	250		13.63	N/A
HC65000250_02502113910	NONCDM CHARGE RECORD PHARMACY	250		67.50	N/A
HC65000250_02502131202	NONCDM CHARGE RECORD PHARMACY	250	J3490	174.50	N/A
HC65000250_02502131604	NONCDM CHARGE RECORD PHARMACY	250		57.51	N/A
HC65000250_02502160203	NONCDM CHARGE RECORD PHARMACY	250		13.60	N/A
HC65000250_02502165905	NONCDM CHARGE RECORD PHARMACY	250		37.98	N/A
HC65000250_02502166205	NONCDM CHARGE RECORD PHARMACY	250		17.58	N/A
HC65000250_02502167376	NONCDM CHARGE RECORD PHARMACY	250		35.25	N/A
HC65000250_02502167377	NONCDM CHARGE RECORD PHARMACY	250		38.08	N/A
HC65000250_02502181230	NONCDM CHARGE RECORD PHARMACY	250	Z7610	29.91	N/A
HC65000250_02660800118	NONCDM CHARGE RECORD PHARMACY	250		9.59	N/A
HC65000250_02660800154	NONCDM CHARGE RECORD PHARMACY	250		8.34	N/A
HC65000250_02660800156	NONCDM CHARGE RECORD PHARMACY	250		10.35	N/A
HC65000250_02660801210	NONCDM CHARGE RECORD PHARMACY	250		19.81	N/A
HC65000250_02660802125	NONCDM CHARGE RECORD PHARMACY	250		21.03	N/A
HC65000250_02724100106	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02724100306	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_02724104910	NONCDM CHARGE RECORD PHARMACY	250		5.40	N/A
HC65000250_02724106303	NONCDM CHARGE RECORD PHARMACY	250		45.00	N/A
HC65000250_02724113436	NONCDM CHARGE RECORD PHARMACY	250		9.00	N/A
HC65000250_02724116001	NONCDM CHARGE RECORD PHARMACY	250		4.80	N/A
HC65000250_02724116101	NONCDM CHARGE RECORD PHARMACY	250		5.10	N/A
HC65000250_02724119990	NONCDM CHARGE RECORD PHARMACY	250		6.67	N/A
HC65000250_02743705057	NONCDM CHARGE RECORD PHARMACY	250		373.50	N/A
HC65000250_02743720603	NONCDM CHARGE RECORD PHARMACY	250		108.89	N/A
HC65000250_02780806502	NONCDM CHARGE RECORD PHARMACY	250		3.43	N/A
HC65000250_02780808201	NONCDM CHARGE RECORD PHARMACY	250		2.30	N/A
HC65000250_02780808601	NONCDM CHARGE RECORD PHARMACY	250		14.88	N/A
HC65000250_02780808602	NONCDM CHARGE RECORD PHARMACY	250		14.46	N/A
HC65000250_02780815601	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02780815701	NONCDM CHARGE RECORD PHARMACY	250		1.04	N/A
HC65000250_02780820601	NONCDM CHARGE RECORD PHARMACY	250		7.00	N/A
HC65000250_02903300101	NONCDM CHARGE RECORD PHARMACY	250		7.32	N/A
HC65000250_02903300301	NONCDM CHARGE RECORD PHARMACY	250		1.74	N/A
HC65000250_02903300305	NONCDM CHARGE RECORD PHARMACY	250		1.66	N/A
HC65000250_02903302602	NONCDM CHARGE RECORD PHARMACY	250		4.21	N/A
HC65000250_02903303001	NONCDM CHARGE RECORD PHARMACY	250		7.50	N/A
HC65000250_02930012601	NONCDM CHARGE RECORD PHARMACY	250		4.97	N/A
HC65000250_02930012613	NONCDM CHARGE RECORD PHARMACY	250		5.52	N/A
HC65000250_02930012713	NONCDM CHARGE RECORD PHARMACY	250		5.52	N/A
HC65000250_02930012810	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02930013501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02930013505	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02930013601	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02930013701	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02930013801	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02930017116	NONCDM CHARGE RECORD PHARMACY	250		1.94	N/A
HC65000250_02930022701	NONCDM CHARGE RECORD PHARMACY	250		3.06	N/A
HC65000250_02930039810	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_02930041101	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_03076813430	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_03172210330	NONCDM CHARGE RECORD PHARMACY	250		11.04	N/A
HC65000250_03172250560	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_03172253712	NONCDM CHARGE RECORD PHARMACY	250		1.97	N/A
HC65000250_03172254201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_03172256224	NONCDM CHARGE RECORD PHARMACY	250		94.14	N/A
HC65000250_03172256560	NONCDM CHARGE RECORD PHARMACY	250		7.50	N/A
HC65000250_03172258630	NONCDM CHARGE RECORD PHARMACY	250		7.64	N/A
HC65000250_03172270010	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_03172270090	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_03172270110	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_03172270130	NONCDM CHARGE RECORD PHARMACY	250		1.05	N/A
HC65000250_03172270190	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_03172270210	NONCDM CHARGE RECORD PHARMACY	250		1.54	N/A
HC65000250_03172270230	NONCDM CHARGE RECORD PHARMACY	250		1.57	N/A
HC65000250_03172270290	NONCDM CHARGE RECORD PHARMACY	250		1.60	N/A
HC65000250_03172272150	NONCDM CHARGE RECORD PHARMACY	250		2.02	N/A
HC65000250_03172272320	NONCDM CHARGE RECORD PHARMACY	250		4.35	N/A
HC65000250_03172272690	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_03172273030	NONCDM CHARGE RECORD PHARMACY	250		2.19	N/A
HC65000250_03172273090	NONCDM CHARGE RECORD PHARMACY	250		2.22	N/A
HC65000250_03172277701	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_03172282030	NONCDM CHARGE RECORD PHARMACY	250		3.43	N/A
HC65000250_03172283330	NONCDM CHARGE RECORD PHARMACY	250		19.33	N/A
HC65000250_03172294901	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_03334204807	NONCDM CHARGE RECORD PHARMACY	250		1.60	N/A
HC65000250_03334205407	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_03334205410	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_03334205510	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_03334205607	NONCDM CHARGE RECORD PHARMACY	250		0.92	N/A
HC65000250_03334205610	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_03334206207	NONCDM CHARGE RECORD PHARMACY	250		3.08	N/A
HC65000250_03334206310	NONCDM CHARGE RECORD PHARMACY	250		2.04	N/A
HC65000250_03334206410	NONCDM CHARGE RECORD PHARMACY	250		2.49	N/A
HC65000250_03334206510	NONCDM CHARGE RECORD PHARMACY	250		3.12	N/A
HC65000250_03334208407	NONCDM CHARGE RECORD PHARMACY	250		17.36	N/A
HC65000250_03334208909	NONCDM CHARGE RECORD PHARMACY	250		2.00	N/A
HC65000250_03334209009	NONCDM CHARGE RECORD PHARMACY	250		2.09	N/A
HC65000250_03334209809	NONCDM CHARGE RECORD PHARMACY	250		2.50	N/A
HC65000250_03334211407	NONCDM CHARGE RECORD PHARMACY	250		7.60	N/A
HC65000250_03334211507	NONCDM CHARGE RECORD PHARMACY	250		8.00	N/A
HC65000250_03334211607	NONCDM CHARGE RECORD PHARMACY	250		6.20	N/A
HC65000250_03334212307	NONCDM CHARGE RECORD PHARMACY	250		13.00	N/A
HC65000250_03334225666	NONCDM CHARGE RECORD PHARMACY	250		44.40	N/A
HC65000250_03504600431	NONCDM CHARGE RECORD PHARMACY	250		1.26	N/A
HC65000250_03557342880	NONCDM CHARGE RECORD PHARMACY	250		2.25	N/A
HC65000250_03600000124	NONCDM CHARGE RECORD PHARMACY	250	J3490	30.00	N/A
HC65000250_03600003310	NONCDM CHARGE RECORD PHARMACY	250		8.87	N/A
HC65000250_03600009210	NONCDM CHARGE RECORD PHARMACY	250		26.80	N/A
HC65000250_03600016210	NONCDM CHARGE RECORD PHARMACY	250		59.78	N/A
HC65000250_03665226769	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_03700002304	NONCDM CHARGE RECORD PHARMACY	250		2.20	N/A
HC65000250_03700002404	NONCDM CHARGE RECORD PHARMACY	250		1.80	N/A
HC65000250_03700003201	NONCDM CHARGE RECORD PHARMACY	250		3.40	N/A
HC65000250_03700047709	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_03700074108	NONCDM CHARGE RECORD PHARMACY	250		2.21	N/A
HC65000250_03700080301	NONCDM CHARGE RECORD PHARMACY	250		30.09	N/A
HC65000250_03786490599	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_03848514001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_03877904195	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_03932802415	NONCDM CHARGE RECORD PHARMACY	250		180.00	N/A
HC65000250_03932805750	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_03932810710	NONCDM CHARGE RECORD PHARMACY	250		2.94	N/A
HC65000250_03982203105	NONCDM CHARGE RECORD PHARMACY	250		8.14	N/A
HC65000250_03982210001	NONCDM CHARGE RECORD PHARMACY	250		58.20	N/A
HC65000250_03982211001	NONCDM CHARGE RECORD PHARMACY	250		19.95	N/A
HC65000250_03982212012	NONCDM CHARGE RECORD PHARMACY	250		66.48	N/A
HC65000250_03982212015	NONCDM CHARGE RECORD PHARMACY	250		63.15	N/A
HC65000250_03982299001	NONCDM CHARGE RECORD PHARMACY	250		2.57	N/A
HC65000250_03982299002	NONCDM CHARGE RECORD PHARMACY	250		2.63	N/A
HC65000250_04009310232	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04009310609	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04056512249	NONCDM CHARGE RECORD PHARMACY	250		685.44	N/A
HC65000250_04110081123	NONCDM CHARGE RECORD PHARMACY	250		28.44	N/A
HC65000250_04110081124	NONCDM CHARGE RECORD PHARMACY	250		21.02	N/A
HC65000250_04110081163	NONCDM CHARGE RECORD PHARMACY	250		13.26	N/A
HC65000250_04110082073	NONCDM CHARGE RECORD PHARMACY	250		52.84	N/A
HC65000250_04110082076	NONCDM CHARGE RECORD PHARMACY	250		29.99	N/A
HC65000250_04116700391	NONCDM CHARGE RECORD PHARMACY	250		11.84	N/A
HC65000250_04116700609	NONCDM CHARGE RECORD PHARMACY	250		1.23	N/A
HC65000250_04116705840	NONCDM CHARGE RECORD PHARMACY	250		8.04	N/A
HC65000250_04116706003	NONCDM CHARGE RECORD PHARMACY	250		12.75	N/A
HC65000250_04116760352	NONCDM CHARGE RECORD PHARMACY	250	Z7610	35.10	N/A
HC65000250_04116775142	NONCDM CHARGE RECORD PHARMACY	250		50.88	N/A
HC65000250_04167936513	NONCDM CHARGE RECORD PHARMACY	250		0.93	N/A
HC65000250_04202310401	NONCDM CHARGE RECORD PHARMACY	250		53.30	N/A
HC65000250_04202310405	NONCDM CHARGE RECORD PHARMACY	250		41.33	N/A
HC65000250_04202311310	NONCDM CHARGE RECORD PHARMACY	250		26.74	N/A
HC65000250_04202311510	NONCDM CHARGE RECORD PHARMACY	250		12.78	N/A
HC65000250_04203710478	NONCDM CHARGE RECORD PHARMACY	250		26.91	N/A
HC65000250_04219232901	NONCDM CHARGE RECORD PHARMACY	250		3.56	N/A
HC65000250_04219233001	NONCDM CHARGE RECORD PHARMACY	250		3.96	N/A
HC65000250_04219233901	NONCDM CHARGE RECORD PHARMACY	250		2.65	N/A
HC65000250_04219234001	NONCDM CHARGE RECORD PHARMACY	250		2.70	N/A
HC65000250_04219236610	NONCDM CHARGE RECORD PHARMACY	250		2.46	N/A
HC65000250_04219260816	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_04219261501	NONCDM CHARGE RECORD PHARMACY	250		4.47	N/A
HC65000250_04219280201	NONCDM CHARGE RECORD PHARMACY	250		7.20	N/A
HC65000250_04229107715	NONCDM CHARGE RECORD PHARMACY	250		15.66	N/A
HC65000250_04229118490	NONCDM CHARGE RECORD PHARMACY	250		1.03	N/A
HC65000250_04229118590	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04229118790	NONCDM CHARGE RECORD PHARMACY	250		1.53	N/A
HC65000250_04229137490	NONCDM CHARGE RECORD PHARMACY	250		2.01	N/A
HC65000250_04229141260	NONCDM CHARGE RECORD PHARMACY	250		1.86	N/A
HC65000250_04229141360	NONCDM CHARGE RECORD PHARMACY	250		1.76	N/A
HC65000250_04229146601	NONCDM CHARGE RECORD PHARMACY	250		1.02	N/A
HC65000250_04229156090	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04229156290	NONCDM CHARGE RECORD PHARMACY	250		1.75	N/A
HC65000250_04229162230	NONCDM CHARGE RECORD PHARMACY	250		1.27	N/A
HC65000250_04229165712	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04229177360	NONCDM CHARGE RECORD PHARMACY	250		1.75	N/A
HC65000250_04229180030	NONCDM CHARGE RECORD PHARMACY	250		5.43	N/A
HC65000250_04229180815	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_04229200120	NONCDM CHARGE RECORD PHARMACY	250		3.97	N/A
HC65000250_04229200320	NONCDM CHARGE RECORD PHARMACY	250		8.09	N/A
HC65000250_04229203820	NONCDM CHARGE RECORD PHARMACY	250		3.04	N/A
HC65000250_04229203920	NONCDM CHARGE RECORD PHARMACY	250		3.53	N/A
HC65000250_04229205403	NONCDM CHARGE RECORD PHARMACY	250		54.44	N/A
HC65000250_04249430112	NONCDM CHARGE RECORD PHARMACY	250		130.59	N/A
HC65000250_04249430124	NONCDM CHARGE RECORD PHARMACY	250		123.75	N/A
HC65000250_04249440901	NONCDM CHARGE RECORD PHARMACY	250	Z7610	238.49	N/A
HC65000250_04257114126	NONCDM CHARGE RECORD PHARMACY	250		203.99	N/A
HC65000250_04257122130	NONCDM CHARGE RECORD PHARMACY	250		47.76	N/A
HC65000250_04265812204	NONCDM CHARGE RECORD PHARMACY	250		1.02	N/A
HC65000250_04270210215	NONCDM CHARGE RECORD PHARMACY	250		540.00	N/A
HC65000250_04270210305	NONCDM CHARGE RECORD PHARMACY	250		240.00	N/A
HC65000250_04279400908	NONCDM CHARGE RECORD PHARMACY	250		180.00	N/A
HC65000250_04279401008	NONCDM CHARGE RECORD PHARMACY	250		1,020.06	N/A
HC65000250_04279401812	NONCDM CHARGE RECORD PHARMACY	250		3.72	N/A
HC65000250_04279401912	NONCDM CHARGE RECORD PHARMACY	250		5.03	N/A
HC65000250_04279910601	NONCDM CHARGE RECORD PHARMACY	250		8.33	N/A
HC65000250_04279911901	NONCDM CHARGE RECORD PHARMACY	250		2.04	N/A
HC65000250_04279912001	NONCDM CHARGE RECORD PHARMACY	250		3.96	N/A
HC65000250_04279921701	NONCDM CHARGE RECORD PHARMACY	250		31.40	N/A
HC65000250_04279980601	NONCDM CHARGE RECORD PHARMACY	250		24.00	N/A
HC65000250_04280608701	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04280610201	NONCDM CHARGE RECORD PHARMACY	250		7.49	N/A
HC65000250_04280614301	NONCDM CHARGE RECORD PHARMACY	250		75.98	N/A
HC65000250_04280626301	NONCDM CHARGE RECORD PHARMACY	250	Z7610	8.53	N/A
HC65000250_04280631205	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04280631250	NONCDM CHARGE RECORD PHARMACY	250		1.35	N/A
HC65000250_04280650109	NONCDM CHARGE RECORD PHARMACY	250		74.37	N/A
HC65000250_04280650209	NONCDM CHARGE RECORD PHARMACY	250		103.67	N/A
HC65000250_04280654909	NONCDM CHARGE RECORD PHARMACY	250		1.97	N/A
HC65000250_04280655212	NONCDM CHARGE RECORD PHARMACY	250		1.20	N/A
HC65000250_04280671401	NONCDM CHARGE RECORD PHARMACY	250		1.03	N/A
HC65000250_04280671405	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_04285800101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04285800110	NONCDM CHARGE RECORD PHARMACY	250		2.69	N/A
HC65000250_04285800301	NONCDM CHARGE RECORD PHARMACY	250		1.14	N/A
HC65000250_04285810301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04285810401	NONCDM CHARGE RECORD PHARMACY	250		1.26	N/A
HC65000250_04285810450	NONCDM CHARGE RECORD PHARMACY	250		1.47	N/A
HC65000250_04285811830	NONCDM CHARGE RECORD PHARMACY	250		14.11	N/A
HC65000250_04285830125	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04285830225	NONCDM CHARGE RECORD PHARMACY	250		1.31	N/A
HC65000250_04285850103	NONCDM CHARGE RECORD PHARMACY	250		3.12	N/A
HC65000250_04285870101	NONCDM CHARGE RECORD PHARMACY	250		6.23	N/A
HC65000250_04293770110	NONCDM CHARGE RECORD PHARMACY	250		5.10	N/A
HC65000250_04306387160	NONCDM CHARGE RECORD PHARMACY	250		5.86	N/A
HC65000250_04306398001	NONCDM CHARGE RECORD PHARMACY	250		1.22	N/A
HC65000250_04306600710	NONCDM CHARGE RECORD PHARMACY	250	J3490	38.64	N/A
HC65000250_04319901401	NONCDM CHARGE RECORD PHARMACY	250		7.68	N/A
HC65000250_04329255554	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04329255606	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04329255881	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04338609019	NONCDM CHARGE RECORD PHARMACY	250		96.00	N/A
HC65000250_04338616006	NONCDM CHARGE RECORD PHARMACY	250		2.95	N/A
HC65000250_04338616012	NONCDM CHARGE RECORD PHARMACY	250		1.55	N/A
HC65000250_04338616106	NONCDM CHARGE RECORD PHARMACY	250		5.79	N/A
HC65000250_04338633001	NONCDM CHARGE RECORD PHARMACY	250		1.84	N/A
HC65000250_04354722610	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354726810	NONCDM CHARGE RECORD PHARMACY	250		3.00	N/A
HC65000250_04354727010	NONCDM CHARGE RECORD PHARMACY	250		3.00	N/A
HC65000250_04354727503	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354727509	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354727603	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354727609	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354727611	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354728110	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354728111	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354728210	NONCDM CHARGE RECORD PHARMACY	250		1.51	N/A
HC65000250_04354728810	NONCDM CHARGE RECORD PHARMACY	250		1.50	N/A
HC65000250_04354733510	NONCDM CHARGE RECORD PHARMACY	250		0.72	N/A
HC65000250_04354733610	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354733650	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354733710	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_04354733810	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354734709	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_04354735110	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354735210	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_04354735310	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_04354735410	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_04354735411	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354735610	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_04354737803	NONCDM CHARGE RECORD PHARMACY	250		122.62	N/A
HC65000250_04354738609	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354739710	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_04354740110	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354740111	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354740210	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354740211	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354740310	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354740350	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_04354740610	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354741009	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354741109	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04354743603	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_04359816430	NONCDM CHARGE RECORD PHARMACY	250		1.26	N/A
HC65000250_04359821025	NONCDM CHARGE RECORD PHARMACY	250		45.00	N/A
HC65000250_04359821050	NONCDM CHARGE RECORD PHARMACY	250		74.40	N/A
HC65000250_04359821055	NONCDM CHARGE RECORD PHARMACY	250		69.42	N/A
HC65000250_04359823018	NONCDM CHARGE RECORD PHARMACY	250		5.50	N/A
HC65000250_04359843611	NONCDM CHARGE RECORD PHARMACY	250		5.08	N/A
HC65000250_04359844670	NONCDM CHARGE RECORD PHARMACY	250		2.35	N/A
HC65000250_04359844674	NONCDM CHARGE RECORD PHARMACY	250		10.28	N/A
HC65000250_04359844774	NONCDM CHARGE RECORD PHARMACY	250		10.19	N/A
HC65000250_04359844828	NONCDM CHARGE RECORD PHARMACY	250		9.82	N/A
HC65000250_04359865530	NONCDM CHARGE RECORD PHARMACY	250		2.46	N/A
HC65000250_04359872101	NONCDM CHARGE RECORD PHARMACY	250		19.62	N/A
HC65000250_04456722110	NONCDM CHARGE RECORD PHARMACY	250		66.00	N/A
HC65000250_04456722210	NONCDM CHARGE RECORD PHARMACY	250		132.00	N/A
HC65000250_04467710020	NONCDM CHARGE RECORD PHARMACY	250		36.00	N/A
HC65000250_04467710202	NONCDM CHARGE RECORD PHARMACY	250		12.04	N/A
HC65000250_04467710302	NONCDM CHARGE RECORD PHARMACY	250		11.97	N/A
HC65000250_04561100938	NONCDM CHARGE RECORD PHARMACY	250		8.00	N/A
HC65000250_04580200403	NONCDM CHARGE RECORD PHARMACY	250		22.13	N/A
HC65000250_04580204635	NONCDM CHARGE RECORD PHARMACY	250		236.97	N/A
HC65000250_04580204811	NONCDM CHARGE RECORD PHARMACY	250		126.00	N/A
HC65000250_04580204835	NONCDM CHARGE RECORD PHARMACY	250		83.97	N/A
HC65000250_04580204935	NONCDM CHARGE RECORD PHARMACY	250	Z7610	49.05	N/A
HC65000250_04580205435	NONCDM CHARGE RECORD PHARMACY	250		29.79	N/A
HC65000250_04580205535	NONCDM CHARGE RECORD PHARMACY	250		27.09	N/A
HC65000250_04580205635	NONCDM CHARGE RECORD PHARMACY	250		191.43	N/A
HC65000250_04580205911	NONCDM CHARGE RECORD PHARMACY	250		126.00	N/A
HC65000250_04580205935	NONCDM CHARGE RECORD PHARMACY	250		83.16	N/A
HC65000250_04580206001	NONCDM CHARGE RECORD PHARMACY	250		10.31	N/A
HC65000250_04580206003	NONCDM CHARGE RECORD PHARMACY	250		14.78	N/A
HC65000250_04580206070	NONCDM CHARGE RECORD PHARMACY	250		0.90	N/A
HC65000250_04580206170	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04580206335	NONCDM CHARGE RECORD PHARMACY	250		21.60	N/A
HC65000250_04580206336	NONCDM CHARGE RECORD PHARMACY	250	Z7610	48.96	N/A
HC65000250_04580206435	NONCDM CHARGE RECORD PHARMACY	250		19.24	N/A
HC65000250_04580206535	NONCDM CHARGE RECORD PHARMACY	250		49.14	N/A
HC65000250_04580209851	NONCDM CHARGE RECORD PHARMACY	250		80.28	N/A
HC65000250_04580214301	NONCDM CHARGE RECORD PHARMACY	250		12.01	N/A
HC65000250_04580214303	NONCDM CHARGE RECORD PHARMACY	250		17.14	N/A
HC65000250_04580214370	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_04580217453	NONCDM CHARGE RECORD PHARMACY	250		17.04	N/A
HC65000250_04580218816	NONCDM CHARGE RECORD PHARMACY	250		15.73	N/A
HC65000250_04580227603	NONCDM CHARGE RECORD PHARMACY	250		12.60	N/A
HC65000250_04580235758	NONCDM CHARGE RECORD PHARMACY	250		12.55	N/A
HC65000250_04580235803	NONCDM CHARGE RECORD PHARMACY	250		12.94	N/A
HC65000250_04580236862	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_04580239504	NONCDM CHARGE RECORD PHARMACY	250		16.27	N/A
HC65000250_04580241059	NONCDM CHARGE RECORD PHARMACY	250		10.60	N/A
HC65000250_04580243321	NONCDM CHARGE RECORD PHARMACY	250		2.07	N/A
HC65000250_04580243401	NONCDM CHARGE RECORD PHARMACY	250		18.90	N/A
HC65000250_04580243411	NONCDM CHARGE RECORD PHARMACY	250		27.36	N/A
HC65000250_04580243803	NONCDM CHARGE RECORD PHARMACY	250		12.33	N/A
HC65000250_04580246564	NONCDM CHARGE RECORD PHARMACY	250	Z7610	132.48	N/A
HC65000250_04580249071	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04580258046	NONCDM CHARGE RECORD PHARMACY	250		114.18	N/A
HC65000250_04580258084	NONCDM CHARGE RECORD PHARMACY	250		115.00	N/A
HC65000250_04580265078	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04580265087	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_04580273030	NONCDM CHARGE RECORD PHARMACY	250		1.50	N/A
HC65000250_04580273033	NONCDM CHARGE RECORD PHARMACY	250		1.36	N/A
HC65000250_04580273230	NONCDM CHARGE RECORD PHARMACY	250		1.72	N/A
HC65000250_04580273233	NONCDM CHARGE RECORD PHARMACY	250		1.58	N/A
HC65000250_04580275830	NONCDM CHARGE RECORD PHARMACY	250		58.49	N/A
HC65000250_04580275930	NONCDM CHARGE RECORD PHARMACY	250		58.49	N/A
HC65000250_04580286802	NONCDM CHARGE RECORD PHARMACY	250		43.79	N/A
HC65000250_04580286866	NONCDM CHARGE RECORD PHARMACY	250		12.25	N/A
HC65000250_04580295243	NONCDM CHARGE RECORD PHARMACY	250		1.23	N/A
HC65000250_04580295301	NONCDM CHARGE RECORD PHARMACY	250		73.80	N/A
HC65000250_04596334202	NONCDM CHARGE RECORD PHARMACY	250		6.73	N/A
HC65000250_04596343965	NONCDM CHARGE RECORD PHARMACY	250		27.00	N/A
HC65000250_04596355650	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04612224905	NONCDM CHARGE RECORD PHARMACY	250		11.97	N/A
HC65000250_04612226378	NONCDM CHARGE RECORD PHARMACY	250		1.08	N/A
HC65000250_04612264513	NONCDM CHARGE RECORD PHARMACY	250		9.63	N/A
HC65000250_04628700601	NONCDM CHARGE RECORD PHARMACY	250		80.81	N/A
HC65000250_04628700660	NONCDM CHARGE RECORD PHARMACY	250		120.25	N/A
HC65000250_04628700901	NONCDM CHARGE RECORD PHARMACY	250	Z7610	78.27	N/A
HC65000250_04628702004	NONCDM CHARGE RECORD PHARMACY	250		33.09	N/A
HC65000250_04628750001	NONCDM CHARGE RECORD PHARMACY	250		0.09	N/A
HC65000250_04628750030	NONCDM CHARGE RECORD PHARMACY	250		11.63	N/A
HC65000250_04658111020	NONCDM CHARGE RECORD PHARMACY	250		0.74	N/A
HC65000250_04658111060	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04658121006	NONCDM CHARGE RECORD PHARMACY	250		3.77	N/A
HC65000250_04658183006	NONCDM CHARGE RECORD PHARMACY	250		7.66	N/A
HC65000250_04687600025	NONCDM CHARGE RECORD PHARMACY	250		23.86	N/A
HC65000250_04733500788	NONCDM CHARGE RECORD PHARMACY	250		22.70	N/A
HC65000250_04733523783	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_04733532286	NONCDM CHARGE RECORD PHARMACY	250		1.22	N/A
HC65000250_04733537983	NONCDM CHARGE RECORD PHARMACY	250		122.95	N/A
HC65000250_04733571186	NONCDM CHARGE RECORD PHARMACY	250		2.51	N/A
HC65000250_04733589413	NONCDM CHARGE RECORD PHARMACY	250		1.25	N/A
HC65000250_04733593144	NONCDM CHARGE RECORD PHARMACY	250		33.72	N/A
HC65000250_04733593244	NONCDM CHARGE RECORD PHARMACY	250		376.62	N/A
HC65000250_04733595688	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_04746900464	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5.00	N/A
HC65000250_04746900465	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04778129603	NONCDM CHARGE RECORD PHARMACY	250		5.29	N/A
HC65000250_04778129803	NONCDM CHARGE RECORD PHARMACY	250		4.90	N/A
HC65000250_04778130801	NONCDM CHARGE RECORD PHARMACY	250		14.09	N/A
HC65000250_04778135603	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_04778135703	NONCDM CHARGE RECORD PHARMACY	250		34.49	N/A
HC65000250_04778138426	NONCDM CHARGE RECORD PHARMACY	250		9.64	N/A
HC65000250_04778142347	NONCDM CHARGE RECORD PHARMACY	250		97.45	N/A
HC65000250_04778142447	NONCDM CHARGE RECORD PHARMACY	250		42.44	N/A
HC65000250_04778142647	NONCDM CHARGE RECORD PHARMACY	250		76.00	N/A
HC65000250_04778142747	NONCDM CHARGE RECORD PHARMACY	250		115.40	N/A
HC65000250_04778142847	NONCDM CHARGE RECORD PHARMACY	250		165.35	N/A
HC65000250_04778157701	NONCDM CHARGE RECORD PHARMACY	250		10.46	N/A
HC65000250_04778158717	NONCDM CHARGE RECORD PHARMACY	250		5.88	N/A
HC65000250_04778161617	NONCDM CHARGE RECORD PHARMACY	250	J3490	25.20	N/A
HC65000250_04778164390	NONCDM CHARGE RECORD PHARMACY	250		2.46	N/A
HC65000250_04778164690	NONCDM CHARGE RECORD PHARMACY	250		2.75	N/A
HC65000250_04778164990	NONCDM CHARGE RECORD PHARMACY	250		2.79	N/A
HC65000250_04778165790	NONCDM CHARGE RECORD PHARMACY	250		3.29	N/A
HC65000250_04778166290	NONCDM CHARGE RECORD PHARMACY	250		3.43	N/A
HC65000250_04778166590	NONCDM CHARGE RECORD PHARMACY	250		4.03	N/A
HC65000250_04778172902	NONCDM CHARGE RECORD PHARMACY	250		30.00	N/A
HC65000250_04843310101	NONCDM CHARGE RECORD PHARMACY	250		1.22	N/A
HC65000250_04843310401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04843311001	NONCDM CHARGE RECORD PHARMACY	250		1.05	N/A
HC65000250_04843320230	NONCDM CHARGE RECORD PHARMACY	250		4.87	N/A
HC65000250_04843323015	NONCDM CHARGE RECORD PHARMACY	250		172.54	N/A
HC65000250_04858200330	NONCDM CHARGE RECORD PHARMACY	250		28.38	N/A
HC65000250_04858200440	NONCDM CHARGE RECORD PHARMACY	250		42.00	N/A
HC65000250_04858280220	NONCDM CHARGE RECORD PHARMACY	250		17.06	N/A
HC65000250_04923020620	NONCDM CHARGE RECORD PHARMACY	250		13.71	N/A
HC65000250_04923020650	NONCDM CHARGE RECORD PHARMACY	250		15.00	N/A
HC65000250_04923020692	NONCDM CHARGE RECORD PHARMACY	250		18.75	N/A
HC65000250_04923020950	NONCDM CHARGE RECORD PHARMACY	250		15.00	N/A
HC65000250_04923020992	NONCDM CHARGE RECORD PHARMACY	250		24.80	N/A
HC65000250_04928175221	NONCDM CHARGE RECORD PHARMACY	250		52.43	N/A
HC65000250_04934800110	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04934801134	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.18	N/A
HC65000250_04934802827	NONCDM CHARGE RECORD PHARMACY	250		9.24	N/A
HC65000250_04934803210	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04934803729	NONCDM CHARGE RECORD PHARMACY	250		6.74	N/A
HC65000250_04934804537	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04934809529	NONCDM CHARGE RECORD PHARMACY	250		13.73	N/A
HC65000250_04934810717	NONCDM CHARGE RECORD PHARMACY	250		34.56	N/A
HC65000250_04934814546	NONCDM CHARGE RECORD PHARMACY	250	Z7610	10.67	N/A
HC65000250_04934814707	NONCDM CHARGE RECORD PHARMACY	250		0.91	N/A
HC65000250_04934815078	NONCDM CHARGE RECORD PHARMACY	250		50.27	N/A
HC65000250_04934815472	NONCDM CHARGE RECORD PHARMACY	250		16.50	N/A
HC65000250_04934817934	NONCDM CHARGE RECORD PHARMACY	250		10.00	N/A
HC65000250_04934818520	NONCDM CHARGE RECORD PHARMACY	250		7.96	N/A
HC65000250_04934818810	NONCDM CHARGE RECORD PHARMACY	250		0.51	N/A
HC65000250_04934819878	NONCDM CHARGE RECORD PHARMACY	250		15.73	N/A
HC65000250_04934827472	NONCDM CHARGE RECORD PHARMACY	250		10.16	N/A
HC65000250_04934833736	NONCDM CHARGE RECORD PHARMACY	250		14.87	N/A
HC65000250_04934839736	NONCDM CHARGE RECORD PHARMACY	250	Z7610	10.62	N/A
HC65000250_04934853077	NONCDM CHARGE RECORD PHARMACY	250		40.50	N/A
HC65000250_04934854301	NONCDM CHARGE RECORD PHARMACY	250		4.91	N/A
HC65000250_04934857308	NONCDM CHARGE RECORD PHARMACY	250		1.35	N/A
HC65000250_04934863634	NONCDM CHARGE RECORD PHARMACY	250		1.84	N/A
HC65000250_04934863904	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04934874027	NONCDM CHARGE RECORD PHARMACY	250		19.71	N/A
HC65000250_04934881705	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04934881709	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04934881813	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_04934886137	NONCDM CHARGE RECORD PHARMACY	250		1.24	N/A
HC65000250_04934895344	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04934898023	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_04934898115	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04941105030	NONCDM CHARGE RECORD PHARMACY	250		128.88	N/A
HC65000250_04941105208	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1,046.94	N/A
HC65000250_04945240502	NONCDM CHARGE RECORD PHARMACY	250		1.23	N/A
HC65000250_04945276802	NONCDM CHARGE RECORD PHARMACY	250		0.86	N/A
HC65000250_04948308010	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04948322110	NONCDM CHARGE RECORD PHARMACY	250		2.88	N/A
HC65000250_04948334150	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_04948348110	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04948348112	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_04948368703	NONCDM CHARGE RECORD PHARMACY	250		6.00	N/A
HC65000250_04970220548	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2.77	N/A
HC65000250_04970222318	NONCDM CHARGE RECORD PHARMACY	250		155.62	N/A
HC65000250_04970222813	NONCDM CHARGE RECORD PHARMACY	250		377.03	N/A
HC65000250_04970223113	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_04988405401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04988405501	NONCDM CHARGE RECORD PHARMACY	250		1.44	N/A
HC65000250_04988412201	NONCDM CHARGE RECORD PHARMACY	250		2.45	N/A
HC65000250_04988412205	NONCDM CHARGE RECORD PHARMACY	250		2.46	N/A
HC65000250_04988412301	NONCDM CHARGE RECORD PHARMACY	250		3.49	N/A
HC65000250_04988417004	NONCDM CHARGE RECORD PHARMACY	250	Z7610	119.04	N/A
HC65000250_04988425601	NONCDM CHARGE RECORD PHARMACY	250		1.29	N/A
HC65000250_04988425701	NONCDM CHARGE RECORD PHARMACY	250		2.76	N/A
HC65000250_04988428901	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_04988430101	NONCDM CHARGE RECORD PHARMACY	250		25.95	N/A
HC65000250_04988430702	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5.54	N/A
HC65000250_04988431155	NONCDM CHARGE RECORD PHARMACY	250		18.81	N/A
HC65000250_04988440191	NONCDM CHARGE RECORD PHARMACY	250		39.85	N/A
HC65000250_04988446565	NONCDM CHARGE RECORD PHARMACY	250		12.27	N/A
HC65000250_04988465809	NONCDM CHARGE RECORD PHARMACY	250		14.10	N/A
HC65000250_04988465909	NONCDM CHARGE RECORD PHARMACY	250		14.10	N/A
HC65000250_04988472401	NONCDM CHARGE RECORD PHARMACY	250		3.39	N/A
HC65000250_04988490761	NONCDM CHARGE RECORD PHARMACY	250		49.10	N/A
HC65000250_04988498401	NONCDM CHARGE RECORD PHARMACY	250		7.09	N/A
HC65000250_04999984830	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.01	N/A
HC65000250_05010223023	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.01	N/A
HC65000250_05011132703	NONCDM CHARGE RECORD PHARMACY	250		1.27	N/A
HC65000250_05011132801	NONCDM CHARGE RECORD PHARMACY	250		1.77	N/A
HC65000250_05011132803	NONCDM CHARGE RECORD PHARMACY	250		1.68	N/A
HC65000250_05011133301	NONCDM CHARGE RECORD PHARMACY	250		1.82	N/A
HC65000250_05011133401	NONCDM CHARGE RECORD PHARMACY	250		3.06	N/A
HC65000250_05011133402	NONCDM CHARGE RECORD PHARMACY	250		3.04	N/A
HC65000250_05011139801	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05011143301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05011143302	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_05011143401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05011156001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05011156101	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_05011164701	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05011178710	NONCDM CHARGE RECORD PHARMACY	250		12.23	N/A
HC65000250_05011178766	NONCDM CHARGE RECORD PHARMACY	250		7.58	N/A
HC65000250_05011178910	NONCDM CHARGE RECORD PHARMACY	250		27.63	N/A
HC65000250_05011191501	NONCDM CHARGE RECORD PHARMACY	250		2.85	N/A
HC65000250_05011191601	NONCDM CHARGE RECORD PHARMACY	250		3.16	N/A
HC65000250_05011191701	NONCDM CHARGE RECORD PHARMACY	250		3.19	N/A
HC65000250_05011191801	NONCDM CHARGE RECORD PHARMACY	250		11.67	N/A
HC65000250_05019014123	NONCDM CHARGE RECORD PHARMACY	250		3.79	N/A
HC65000250_05019014263	NONCDM CHARGE RECORD PHARMACY	250		3.79	N/A
HC65000250_05022817705	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05022835090	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05022842360	NONCDM CHARGE RECORD PHARMACY	250		4.20	N/A
HC65000250_05022842730	NONCDM CHARGE RECORD PHARMACY	250		2.00	N/A
HC65000250_05022842790	NONCDM CHARGE RECORD PHARMACY	250		2.00	N/A
HC65000250_05022843301	NONCDM CHARGE RECORD PHARMACY	250	Z7610	4.50	N/A
HC65000250_05022846501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05026805015	NONCDM CHARGE RECORD PHARMACY	250		8.89	N/A
HC65000250_05026806215	NONCDM CHARGE RECORD PHARMACY	250		6.86	N/A
HC65000250_05026806915	NONCDM CHARGE RECORD PHARMACY	250		11.46	N/A
HC65000250_05026809315	NONCDM CHARGE RECORD PHARMACY	250		1.76	N/A
HC65000250_05026809415	NONCDM CHARGE RECORD PHARMACY	250		2.16	N/A
HC65000250_05026809515	NONCDM CHARGE RECORD PHARMACY	250		2.26	N/A
HC65000250_05026809815	NONCDM CHARGE RECORD PHARMACY	250	Z7610	9.38	N/A
HC65000250_05026810515	NONCDM CHARGE RECORD PHARMACY	250		14.25	N/A
HC65000250_05026810915	NONCDM CHARGE RECORD PHARMACY	250		3.76	N/A
HC65000250_05026811015	NONCDM CHARGE RECORD PHARMACY	250		4.11	N/A
HC65000250_05026811115	NONCDM CHARGE RECORD PHARMACY	250		4.27	N/A
HC65000250_05026811215	NONCDM CHARGE RECORD PHARMACY	250		4.76	N/A
HC65000250_05026813115	NONCDM CHARGE RECORD PHARMACY	250		7.50	N/A
HC65000250_05026814013	NONCDM CHARGE RECORD PHARMACY	250		15.60	N/A
HC65000250_05026814115	NONCDM CHARGE RECORD PHARMACY	250		12.62	N/A
HC65000250_05026815115	NONCDM CHARGE RECORD PHARMACY	250		2.41	N/A
HC65000250_05026815215	NONCDM CHARGE RECORD PHARMACY	250		2.66	N/A
HC65000250_05026816815	NONCDM CHARGE RECORD PHARMACY	250		6.58	N/A
HC65000250_05026817715	NONCDM CHARGE RECORD PHARMACY	250		6.35	N/A
HC65000250_05026817815	NONCDM CHARGE RECORD PHARMACY	250		29.19	N/A
HC65000250_05026817913	NONCDM CHARGE RECORD PHARMACY	250		34.97	N/A
HC65000250_05026818915	NONCDM CHARGE RECORD PHARMACY	250		3.03	N/A
HC65000250_05026819015	NONCDM CHARGE RECORD PHARMACY	250		4.10	N/A
HC65000250_05026826815	NONCDM CHARGE RECORD PHARMACY	250		1.56	N/A
HC65000250_05026828213	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5.71	N/A
HC65000250_05026828713	NONCDM CHARGE RECORD PHARMACY	250		7.26	N/A
HC65000250_05026830315	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05026831012	NONCDM CHARGE RECORD PHARMACY	250		6.72	N/A
HC65000250_05026831215	NONCDM CHARGE RECORD PHARMACY	250	Z7610	7.90	N/A
HC65000250_05026831415	NONCDM CHARGE RECORD PHARMACY	250		6.90	N/A
HC65000250_05026832115	NONCDM CHARGE RECORD PHARMACY	250		8.41	N/A
HC65000250_05026833015	NONCDM CHARGE RECORD PHARMACY	250		4.93	N/A
HC65000250_05026833915	NONCDM CHARGE RECORD PHARMACY	250		14.93	N/A
HC65000250_05026834615	NONCDM CHARGE RECORD PHARMACY	250		1.37	N/A
HC65000250_05026835015	NONCDM CHARGE RECORD PHARMACY	250		2.05	N/A
HC65000250_05026835115	NONCDM CHARGE RECORD PHARMACY	250		4.30	N/A
HC65000250_05026835213	NONCDM CHARGE RECORD PHARMACY	250		7.25	N/A
HC65000250_05026839115	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5.80	N/A
HC65000250_05026840215	NONCDM CHARGE RECORD PHARMACY	250		2.62	N/A
HC65000250_05026841112	NONCDM CHARGE RECORD PHARMACY	250		35.60	N/A
HC65000250_05026843015	NONCDM CHARGE RECORD PHARMACY	250		2.10	N/A
HC65000250_05026844715	NONCDM CHARGE RECORD PHARMACY	250		5.24	N/A
HC65000250_05026845115	NONCDM CHARGE RECORD PHARMACY	250		4.14	N/A
HC65000250_05026847013	NONCDM CHARGE RECORD PHARMACY	250		25.93	N/A
HC65000250_05026847615	NONCDM CHARGE RECORD PHARMACY	250		4.99	N/A
HC65000250_05026850515	NONCDM CHARGE RECORD PHARMACY	250		2.03	N/A
HC65000250_05026852015	NONCDM CHARGE RECORD PHARMACY	250		1.79	N/A
HC65000250_05026852215	NONCDM CHARGE RECORD PHARMACY	250		3.55	N/A
HC65000250_05026852315	NONCDM CHARGE RECORD PHARMACY	250		4.07	N/A
HC65000250_05026852415	NONCDM CHARGE RECORD PHARMACY	250		1.43	N/A
HC65000250_05026852515	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05026854115	NONCDM CHARGE RECORD PHARMACY	250		4.28	N/A
HC65000250_05026857315	NONCDM CHARGE RECORD PHARMACY	250		6.28	N/A
HC65000250_05026857415	NONCDM CHARGE RECORD PHARMACY	250		5.64	N/A
HC65000250_05026857515	NONCDM CHARGE RECORD PHARMACY	250		2.50	N/A
HC65000250_05026858315	NONCDM CHARGE RECORD PHARMACY	250		2.34	N/A
HC65000250_05026858515	NONCDM CHARGE RECORD PHARMACY	250		1.67	N/A
HC65000250_05026859415	NONCDM CHARGE RECORD PHARMACY	250		1.44	N/A
HC65000250_05026859515	NONCDM CHARGE RECORD PHARMACY	250		1.52	N/A
HC65000250_05026859715	NONCDM CHARGE RECORD PHARMACY	250		6.85	N/A
HC65000250_05026859815	NONCDM CHARGE RECORD PHARMACY	250		11.01	N/A
HC65000250_05026859915	NONCDM CHARGE RECORD PHARMACY	250		13.46	N/A
HC65000250_05026860115	NONCDM CHARGE RECORD PHARMACY	250		18.35	N/A
HC65000250_05026860315	NONCDM CHARGE RECORD PHARMACY	250		2.81	N/A
HC65000250_05026860415	NONCDM CHARGE RECORD PHARMACY	250		2.95	N/A
HC65000250_05026862115	NONCDM CHARGE RECORD PHARMACY	250		3.04	N/A
HC65000250_05026862815	NONCDM CHARGE RECORD PHARMACY	250	Z7610	18.35	N/A
HC65000250_05026863015	NONCDM CHARGE RECORD PHARMACY	250		2.03	N/A
HC65000250_05026863115	NONCDM CHARGE RECORD PHARMACY	250		3.04	N/A
HC65000250_05026863215	NONCDM CHARGE RECORD PHARMACY	250		2.73	N/A
HC65000250_05026863315	NONCDM CHARGE RECORD PHARMACY	250		6.17	N/A
HC65000250_05026863615	NONCDM CHARGE RECORD PHARMACY	250		1.67	N/A
HC65000250_05026863915	NONCDM CHARGE RECORD PHARMACY	250		1.30	N/A
HC65000250_05026864015	NONCDM CHARGE RECORD PHARMACY	250		3.99	N/A
HC65000250_05026864615	NONCDM CHARGE RECORD PHARMACY	250		7.81	N/A
HC65000250_05026867113	NONCDM CHARGE RECORD PHARMACY	250		5.57	N/A
HC65000250_05026868415	NONCDM CHARGE RECORD PHARMACY	250		5.79	N/A
HC65000250_05026868515	NONCDM CHARGE RECORD PHARMACY	250		8.87	N/A
HC65000250_05026868615	NONCDM CHARGE RECORD PHARMACY	250		3.53	N/A
HC65000250_05026868715	NONCDM CHARGE RECORD PHARMACY	250		3.91	N/A
HC65000250_05026869415	NONCDM CHARGE RECORD PHARMACY	250		36.68	N/A
HC65000250_05026870015	NONCDM CHARGE RECORD PHARMACY	250		2.72	N/A
HC65000250_05026870115	NONCDM CHARGE RECORD PHARMACY	250		2.97	N/A
HC65000250_05026870215	NONCDM CHARGE RECORD PHARMACY	250		3.26	N/A
HC65000250_05026871715	NONCDM CHARGE RECORD PHARMACY	250		7.14	N/A
HC65000250_05026872815	NONCDM CHARGE RECORD PHARMACY	250		1.80	N/A
HC65000250_05026873015	NONCDM CHARGE RECORD PHARMACY	250		2.38	N/A
HC65000250_05026873212	NONCDM CHARGE RECORD PHARMACY	250		50.08	N/A
HC65000250_05026873813	NONCDM CHARGE RECORD PHARMACY	250	Z7610	6.44	N/A
HC65000250_05026874015	NONCDM CHARGE RECORD PHARMACY	250		26.57	N/A
HC65000250_05026875415	NONCDM CHARGE RECORD PHARMACY	250		2.14	N/A
HC65000250_05026875515	NONCDM CHARGE RECORD PHARMACY	250		1.84	N/A
HC65000250_05026875615	NONCDM CHARGE RECORD PHARMACY	250		2.43	N/A
HC65000250_05026875915	NONCDM CHARGE RECORD PHARMACY	250		3.86	N/A
HC65000250_05026876415	NONCDM CHARGE RECORD PHARMACY	250		4.33	N/A
HC65000250_05026876615	NONCDM CHARGE RECORD PHARMACY	250		4.47	N/A
HC65000250_05026878815	NONCDM CHARGE RECORD PHARMACY	250		15.54	N/A
HC65000250_05026880015	NONCDM CHARGE RECORD PHARMACY	250		6.44	N/A
HC65000250_05026881615	NONCDM CHARGE RECORD PHARMACY	250		3.63	N/A
HC65000250_05026884915	NONCDM CHARGE RECORD PHARMACY	250		2.29	N/A
HC65000250_05026885115	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_05026885215	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_05026885515	NONCDM CHARGE RECORD PHARMACY	250		1.25	N/A
HC65000250_05026885815	NONCDM CHARGE RECORD PHARMACY	250		1.41	N/A
HC65000250_05026886015	NONCDM CHARGE RECORD PHARMACY	250		1.39	N/A
HC65000250_05026886315	NONCDM CHARGE RECORD PHARMACY	250		1.40	N/A
HC65000250_05026886515	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.48	N/A
HC65000250_05026886715	NONCDM CHARGE RECORD PHARMACY	250		2.03	N/A
HC65000250_05026886815	NONCDM CHARGE RECORD PHARMACY	250		1.87	N/A
HC65000250_05028932501	NONCDM CHARGE RECORD PHARMACY	250		0.31	N/A
HC65000250_05028942001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05038304205	NONCDM CHARGE RECORD PHARMACY	250		5.66	N/A
HC65000250_05038304224	NONCDM CHARGE RECORD PHARMACY	250	Z7610	9.90	N/A
HC65000250_05038304248	NONCDM CHARGE RECORD PHARMACY	250		1.54	N/A
HC65000250_05038305008	NONCDM CHARGE RECORD PHARMACY	250		1.98	N/A
HC65000250_05038306307	NONCDM CHARGE RECORD PHARMACY	250		2.93	N/A
HC65000250_05038306312	NONCDM CHARGE RECORD PHARMACY	250		2.98	N/A
HC65000250_05038307913	NONCDM CHARGE RECORD PHARMACY	250		8.78	N/A
HC65000250_05038308707	NONCDM CHARGE RECORD PHARMACY	250		3.89	N/A
HC65000250_05038308712	NONCDM CHARGE RECORD PHARMACY	250		3.86	N/A
HC65000250_05038317104	NONCDM CHARGE RECORD PHARMACY	250	Z7610	9.85	N/A
HC65000250_05038317290	NONCDM CHARGE RECORD PHARMACY	250		5.27	N/A
HC65000250_05038323210	NONCDM CHARGE RECORD PHARMACY	250		210.00	N/A
HC65000250_05038326715	NONCDM CHARGE RECORD PHARMACY	250		150.57	N/A
HC65000250_05038328616	NONCDM CHARGE RECORD PHARMACY	250		52.38	N/A
HC65000250_05038334911	NONCDM CHARGE RECORD PHARMACY	250		3.65	N/A
HC65000250_05038356510	NONCDM CHARGE RECORD PHARMACY	250		6.11	N/A
HC65000250_05038362750	NONCDM CHARGE RECORD PHARMACY	250		1.04	N/A
HC65000250_05038370016	NONCDM CHARGE RECORD PHARMACY	250		6.12	N/A
HC65000250_05038374016	NONCDM CHARGE RECORD PHARMACY	250		3.09	N/A
HC65000250_05038374120	NONCDM CHARGE RECORD PHARMACY	250		288.96	N/A
HC65000250_05038377111	NONCDM CHARGE RECORD PHARMACY	250		3.37	N/A
HC65000250_05038377116	NONCDM CHARGE RECORD PHARMACY	250		1.65	N/A
HC65000250_05038377504	NONCDM CHARGE RECORD PHARMACY	250		6.13	N/A
HC65000250_05038377517	NONCDM CHARGE RECORD PHARMACY	250		4.90	N/A
HC65000250_05038377916	NONCDM CHARGE RECORD PHARMACY	250		41.15	N/A
HC65000250_05038377931	NONCDM CHARGE RECORD PHARMACY	250		6.41	N/A
HC65000250_05038377933	NONCDM CHARGE RECORD PHARMACY	250		5.60	N/A
HC65000250_05038378130	NONCDM CHARGE RECORD PHARMACY	250		62.46	N/A
HC65000250_05038379516	NONCDM CHARGE RECORD PHARMACY	250		42.45	N/A
HC65000250_05038380416	NONCDM CHARGE RECORD PHARMACY	250		4.04	N/A
HC65000250_05038380716	NONCDM CHARGE RECORD PHARMACY	250		1.82	N/A
HC65000250_05038381016	NONCDM CHARGE RECORD PHARMACY	250		44.58	N/A
HC65000250_05038382416	NONCDM CHARGE RECORD PHARMACY	250		0.42	N/A
HC65000250_05038391750	NONCDM CHARGE RECORD PHARMACY	250		1.37	N/A
HC65000250_05038392493	NONCDM CHARGE RECORD PHARMACY	250		4.52	N/A
HC65000250_05038393093	NONCDM CHARGE RECORD PHARMACY	250		8.20	N/A
HC65000250_05038396134	NONCDM CHARGE RECORD PHARMACY	250		3.69	N/A
HC65000250_05038396608	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3.73	N/A
HC65000250_05041977301	NONCDM CHARGE RECORD PHARMACY	250		27.42	N/A
HC65000250_05042828360	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_05045809801	NONCDM CHARGE RECORD PHARMACY	250		56.38	N/A
HC65000250_05045814030	NONCDM CHARGE RECORD PHARMACY	250		105.08	N/A
HC65000250_05045814130	NONCDM CHARGE RECORD PHARMACY	250		101.89	N/A
HC65000250_05045857710	NONCDM CHARGE RECORD PHARMACY	250		49.09	N/A
HC65000250_05045857810	NONCDM CHARGE RECORD PHARMACY	250		96.55	N/A
HC65000250_05045857910	NONCDM CHARGE RECORD PHARMACY	250		96.37	N/A
HC65000250_05045857930	NONCDM CHARGE RECORD PHARMACY	250		95.75	N/A
HC65000250_05045858010	NONCDM CHARGE RECORD PHARMACY	250		96.70	N/A
HC65000250_05045858030	NONCDM CHARGE RECORD PHARMACY	250		93.99	N/A
HC65000250_05045858090	NONCDM CHARGE RECORD PHARMACY	250		96.33	N/A
HC65000250_05045859060	NONCDM CHARGE RECORD PHARMACY	250		6.54	N/A
HC65000250_05045859601	NONCDM CHARGE RECORD PHARMACY	250		29.48	N/A
HC65000250_05045863965	NONCDM CHARGE RECORD PHARMACY	250		37.42	N/A
HC65000250_05045882002	NONCDM CHARGE RECORD PHARMACY	250		46.10	N/A
HC65000250_05047400148	NONCDM CHARGE RECORD PHARMACY	250		68.00	N/A
HC65000250_05047457066	NONCDM CHARGE RECORD PHARMACY	250		121.48	N/A
HC65000250_05047477066	NONCDM CHARGE RECORD PHARMACY	250		121.48	N/A
HC65000250_05047480203	NONCDM CHARGE RECORD PHARMACY	250		118.56	N/A
HC65000250_05047480403	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_05047480503	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_05047480603	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_05047487015	NONCDM CHARGE RECORD PHARMACY	250		393.83	N/A
HC65000250_05058041202	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05058045711	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05058045811	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_05058049660	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05058053408	NONCDM CHARGE RECORD PHARMACY	250		18.93	N/A
HC65000250_05058060002	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_05058093201	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.32	N/A
HC65000250_05074211301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05074211808	NONCDM CHARGE RECORD PHARMACY	250		18.75	N/A
HC65000250_05074217501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05074219001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05074223301	NONCDM CHARGE RECORD PHARMACY	250		3.00	N/A
HC65000250_05074226001	NONCDM CHARGE RECORD PHARMACY	250		2.86	N/A
HC65000250_05074226101	NONCDM CHARGE RECORD PHARMACY	250		3.63	N/A
HC65000250_05074226201	NONCDM CHARGE RECORD PHARMACY	250		4.65	N/A
HC65000250_05074251530	NONCDM CHARGE RECORD PHARMACY	250		188.41	N/A
HC65000250_05074261501	NONCDM CHARGE RECORD PHARMACY	250		1.54	N/A
HC65000250_05074261601	NONCDM CHARGE RECORD PHARMACY	250		1.57	N/A
HC65000250_05080404760	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107902003	NONCDM CHARGE RECORD PHARMACY	250		109.45	N/A
HC65000250_05107902320	NONCDM CHARGE RECORD PHARMACY	250		16.15	N/A
HC65000250_05107902420	NONCDM CHARGE RECORD PHARMACY	250		18.60	N/A
HC65000250_05107905120	NONCDM CHARGE RECORD PHARMACY	250		1.71	N/A
HC65000250_05107905820	NONCDM CHARGE RECORD PHARMACY	250		11.40	N/A
HC65000250_05107907220	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_05107907420	NONCDM CHARGE RECORD PHARMACY	250		1.37	N/A
HC65000250_05107907520	NONCDM CHARGE RECORD PHARMACY	250		1.32	N/A
HC65000250_05107907620	NONCDM CHARGE RECORD PHARMACY	250		1.66	N/A
HC65000250_05107908320	NONCDM CHARGE RECORD PHARMACY	250		6.18	N/A
HC65000250_05107908620	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107909303	NONCDM CHARGE RECORD PHARMACY	250		18.32	N/A
HC65000250_05107910320	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_05107910720	NONCDM CHARGE RECORD PHARMACY	250		1.72	N/A
HC65000250_05107911820	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2.99	N/A
HC65000250_05107911920	NONCDM CHARGE RECORD PHARMACY	250		2.99	N/A
HC65000250_05107913120	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107913320	NONCDM CHARGE RECORD PHARMACY	250		3.43	N/A
HC65000250_05107914120	NONCDM CHARGE RECORD PHARMACY	250		3.02	N/A
HC65000250_05107914220	NONCDM CHARGE RECORD PHARMACY	250		3.36	N/A
HC65000250_05107916403	NONCDM CHARGE RECORD PHARMACY	250		51.19	N/A
HC65000250_05107916503	NONCDM CHARGE RECORD PHARMACY	250		197.63	N/A
HC65000250_05107917020	NONCDM CHARGE RECORD PHARMACY	250		5.12	N/A
HC65000250_05107917220	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107918020	NONCDM CHARGE RECORD PHARMACY	250		2.11	N/A
HC65000250_05107918220	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_05107920406	NONCDM CHARGE RECORD PHARMACY	250		51.82	N/A
HC65000250_05107920520	NONCDM CHARGE RECORD PHARMACY	250		1.88	N/A
HC65000250_05107920620	NONCDM CHARGE RECORD PHARMACY	250		2.41	N/A
HC65000250_05107925520	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_05107927303	NONCDM CHARGE RECORD PHARMACY	250		34.05	N/A
HC65000250_05107928420	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_05107928520	NONCDM CHARGE RECORD PHARMACY	250		0.95	N/A
HC65000250_05107929920	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107930020	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107930630	NONCDM CHARGE RECORD PHARMACY	250		9.04	N/A
HC65000250_05107934820	NONCDM CHARGE RECORD PHARMACY	250		20.83	N/A
HC65000250_05107937420	NONCDM CHARGE RECORD PHARMACY	250		3.86	N/A
HC65000250_05107937520	NONCDM CHARGE RECORD PHARMACY	250		2.95	N/A
HC65000250_05107938520	NONCDM CHARGE RECORD PHARMACY	250		4.71	N/A
HC65000250_05107938620	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_05107939120	NONCDM CHARGE RECORD PHARMACY	250		4.61	N/A
HC65000250_05107941720	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_05107941820	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107942520	NONCDM CHARGE RECORD PHARMACY	250		2.62	N/A
HC65000250_05107943620	NONCDM CHARGE RECORD PHARMACY	250		3.20	N/A
HC65000250_05107943720	NONCDM CHARGE RECORD PHARMACY	250		4.21	N/A
HC65000250_05107944020	NONCDM CHARGE RECORD PHARMACY	250		2.98	N/A
HC65000250_05107944120	NONCDM CHARGE RECORD PHARMACY	250		3.29	N/A
HC65000250_05107944220	NONCDM CHARGE RECORD PHARMACY	250		3.36	N/A
HC65000250_05107944320	NONCDM CHARGE RECORD PHARMACY	250		3.96	N/A
HC65000250_05107944420	NONCDM CHARGE RECORD PHARMACY	250		2.62	N/A
HC65000250_05107944520	NONCDM CHARGE RECORD PHARMACY	250		4.08	N/A
HC65000250_05107945120	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107945320	NONCDM CHARGE RECORD PHARMACY	250		6.98	N/A
HC65000250_05107945820	NONCDM CHARGE RECORD PHARMACY	250		3.72	N/A
HC65000250_05107948020	NONCDM CHARGE RECORD PHARMACY	250		3.67	N/A
HC65000250_05107949920	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_05107951920	NONCDM CHARGE RECORD PHARMACY	250		38.24	N/A
HC65000250_05107952720	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107954420	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.85	N/A
HC65000250_05107954720	NONCDM CHARGE RECORD PHARMACY	250	Z7610	7.77	N/A
HC65000250_05107956620	NONCDM CHARGE RECORD PHARMACY	250		3.19	N/A
HC65000250_05107958106	NONCDM CHARGE RECORD PHARMACY	250		15.72	N/A
HC65000250_05107959720	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107962006	NONCDM CHARGE RECORD PHARMACY	250		1.65	N/A
HC65000250_05107963020	NONCDM CHARGE RECORD PHARMACY	250		9.06	N/A
HC65000250_05107963220	NONCDM CHARGE RECORD PHARMACY	250		21.54	N/A
HC65000250_05107964420	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107968420	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107968520	NONCDM CHARGE RECORD PHARMACY	250		1.29	N/A
HC65000250_05107969020	NONCDM CHARGE RECORD PHARMACY	250		4.30	N/A
HC65000250_05107972220	NONCDM CHARGE RECORD PHARMACY	250		16.37	N/A
HC65000250_05107972420	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107972520	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_05107973420	NONCDM CHARGE RECORD PHARMACY	250		2.46	N/A
HC65000250_05107973520	NONCDM CHARGE RECORD PHARMACY	250		3.37	N/A
HC65000250_05107974720	NONCDM CHARGE RECORD PHARMACY	250		2.20	N/A
HC65000250_05107975320	NONCDM CHARGE RECORD PHARMACY	250		1.87	N/A
HC65000250_05107975920	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_05107976608	NONCDM CHARGE RECORD PHARMACY	250		8.83	N/A
HC65000250_05107976708	NONCDM CHARGE RECORD PHARMACY	250	Z7610	14.91	N/A
HC65000250_05107978220	NONCDM CHARGE RECORD PHARMACY	250		4.92	N/A
HC65000250_05107979020	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107980120	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107981020	NONCDM CHARGE RECORD PHARMACY	250		1.90	N/A
HC65000250_05107981120	NONCDM CHARGE RECORD PHARMACY	250		3.79	N/A
HC65000250_05107981320	NONCDM CHARGE RECORD PHARMACY	250		36.13	N/A
HC65000250_05107982120	NONCDM CHARGE RECORD PHARMACY	250		3.49	N/A
HC65000250_05107986901	NONCDM CHARGE RECORD PHARMACY	250		12.67	N/A
HC65000250_05107987220	NONCDM CHARGE RECORD PHARMACY	250		1.54	N/A
HC65000250_05107988620	NONCDM CHARGE RECORD PHARMACY	250		4.52	N/A
HC65000250_05107988820	NONCDM CHARGE RECORD PHARMACY	250		4.79	N/A
HC65000250_05107992120	NONCDM CHARGE RECORD PHARMACY	250		3.90	N/A
HC65000250_05107992220	NONCDM CHARGE RECORD PHARMACY	250		9.90	N/A
HC65000250_05107992320	NONCDM CHARGE RECORD PHARMACY	250		5.35	N/A
HC65000250_05107992420	NONCDM CHARGE RECORD PHARMACY	250		19.87	N/A
HC65000250_05107992520	NONCDM CHARGE RECORD PHARMACY	250		23.36	N/A
HC65000250_05107992820	NONCDM CHARGE RECORD PHARMACY	250		2.72	N/A
HC65000250_05107993020	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_05107993120	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_05107993220	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107993520	NONCDM CHARGE RECORD PHARMACY	250		2.13	N/A
HC65000250_05107993620	NONCDM CHARGE RECORD PHARMACY	250		1.42	N/A
HC65000250_05107993820	NONCDM CHARGE RECORD PHARMACY	250		1.75	N/A
HC65000250_05107994320	NONCDM CHARGE RECORD PHARMACY	250		7.37	N/A
HC65000250_05107995820	NONCDM CHARGE RECORD PHARMACY	250		18.79	N/A
HC65000250_05107995920	NONCDM CHARGE RECORD PHARMACY	250		19.72	N/A
HC65000250_05107996620	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107997820	NONCDM CHARGE RECORD PHARMACY	250		2.28	N/A
HC65000250_05107997920	NONCDM CHARGE RECORD PHARMACY	250		2.40	N/A
HC65000250_05107998520	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107998620	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107999120	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05107999220	NONCDM CHARGE RECORD PHARMACY	250		0.57	N/A
HC65000250_05107999820	NONCDM CHARGE RECORD PHARMACY	250	Z7610	4.46	N/A
HC65000250_05122400750	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05122401060	NONCDM CHARGE RECORD PHARMACY	250		1.37	N/A
HC65000250_05122410750	NONCDM CHARGE RECORD PHARMACY	250		1.32	N/A
HC65000250_05122416299	NONCDM CHARGE RECORD PHARMACY	250		3.72	N/A
HC65000250_05124815001	NONCDM CHARGE RECORD PHARMACY	250		77.10	N/A
HC65000250_05129362801	NONCDM CHARGE RECORD PHARMACY	250		5.71	N/A
HC65000250_05129369601	NONCDM CHARGE RECORD PHARMACY	250		54.30	N/A
HC65000250_05129380401	NONCDM CHARGE RECORD PHARMACY	250		2.40	N/A
HC65000250_05129381001	NONCDM CHARGE RECORD PHARMACY	250		3.78	N/A
HC65000250_05129381101	NONCDM CHARGE RECORD PHARMACY	250		4.77	N/A
HC65000250_05129382001	NONCDM CHARGE RECORD PHARMACY	250		1.37	N/A
HC65000250_05129382101	NONCDM CHARGE RECORD PHARMACY	250		2.49	N/A
HC65000250_05140743501	NONCDM CHARGE RECORD PHARMACY	250		9.69	N/A
HC65000250_05155200516	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05155200556	NONCDM CHARGE RECORD PHARMACY	250		4.96	N/A
HC65000250_05155200699	NONCDM CHARGE RECORD PHARMACY	250		24.62	N/A
HC65000250_05155201069	NONCDM CHARGE RECORD PHARMACY	250		11.78	N/A
HC65000250_05155202109	NONCDM CHARGE RECORD PHARMACY	250		60.00	N/A
HC65000250_05155202699	NONCDM CHARGE RECORD PHARMACY	250		8.83	N/A
HC65000250_05155204549	NONCDM CHARGE RECORD PHARMACY	250		17.73	N/A
HC65000250_05155213451	NONCDM CHARGE RECORD PHARMACY	250		6.61	N/A
HC65000250_05164585101	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_05166072411	NONCDM CHARGE RECORD PHARMACY	250		2.76	N/A
HC65000250_05166099628	NONCDM CHARGE RECORD PHARMACY	250		5.50	N/A
HC65000250_05167212631	NONCDM CHARGE RECORD PHARMACY	250		125.73	N/A
HC65000250_05167212632	NONCDM CHARGE RECORD PHARMACY	250		176.58	N/A
HC65000250_05167212821	NONCDM CHARGE RECORD PHARMACY	250	Z7610	12.55	N/A
HC65000250_05167212822	NONCDM CHARGE RECORD PHARMACY	250	Z7610	37.80	N/A
HC65000250_05167212841	NONCDM CHARGE RECORD PHARMACY	250	Z7610	26.01	N/A
HC65000250_05167212848	NONCDM CHARGE RECORD PHARMACY	250	Z7610	59.52	N/A
HC65000250_05167213861	NONCDM CHARGE RECORD PHARMACY	250		213.24	N/A
HC65000250_05167213862	NONCDM CHARGE RECORD PHARMACY	250		437.22	N/A
HC65000250_05167220021	NONCDM CHARGE RECORD PHARMACY	250		30.48	N/A
HC65000250_05167220022	NONCDM CHARGE RECORD PHARMACY	250		38.07	N/A
HC65000250_05167220102	NONCDM CHARGE RECORD PHARMACY	250		19.77	N/A
HC65000250_05167220356	NONCDM CHARGE RECORD PHARMACY	250		48.33	N/A
HC65000250_05167220620	NONCDM CHARGE RECORD PHARMACY	250	Z7610	42.84	N/A
HC65000250_05167221142	NONCDM CHARGE RECORD PHARMACY	250		3.66	N/A
HC65000250_05167221162	NONCDM CHARGE RECORD PHARMACY	250		3.27	N/A
HC65000250_05167221164	NONCDM CHARGE RECORD PHARMACY	250		3.58	N/A
HC65000250_05167240011	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05167240025	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05167240051	NONCDM CHARGE RECORD PHARMACY	250		4.60	N/A
HC65000250_05167240231	NONCDM CHARGE RECORD PHARMACY	250		13.75	N/A
HC65000250_05167240479	NONCDM CHARGE RECORD PHARMACY	250		1.64	N/A
HC65000250_05167240481	NONCDM CHARGE RECORD PHARMACY	250		108.74	N/A
HC65000250_05175405013	NONCDM CHARGE RECORD PHARMACY	250		23.97	N/A
HC65000250_05175420014	NONCDM CHARGE RECORD PHARMACY	250		20.55	N/A
HC65000250_05175450015	NONCDM CHARGE RECORD PHARMACY	250		44.35	N/A
HC65000250_05175460004	NONCDM CHARGE RECORD PHARMACY	250		22.80	N/A
HC65000250_05175460014	NONCDM CHARGE RECORD PHARMACY	250		41.32	N/A
HC65000250_05180100630	NONCDM CHARGE RECORD PHARMACY	250		4.30	N/A
HC65000250_05180101130	NONCDM CHARGE RECORD PHARMACY	250		3.05	N/A
HC65000250_05180101230	NONCDM CHARGE RECORD PHARMACY	250		3.07	N/A
HC65000250_05180101330	NONCDM CHARGE RECORD PHARMACY	250		2.84	N/A
HC65000250_05180101430	NONCDM CHARGE RECORD PHARMACY	250		2.85	N/A
HC65000250_05182400703	NONCDM CHARGE RECORD PHARMACY	250		9.69	N/A
HC65000250_05186207901	NONCDM CHARGE RECORD PHARMACY	250		1.78	N/A
HC65000250_05186232001	NONCDM CHARGE RECORD PHARMACY	250		6.35	N/A
HC65000250_05186244760	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05186245304	NONCDM CHARGE RECORD PHARMACY	250		79.58	N/A
HC65000250_05186287006	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_05192712340	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3.66	N/A
HC65000250_05199100633	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_05199133106	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05199173801	NONCDM CHARGE RECORD PHARMACY	250		4.23	N/A
HC65000250_05199183716	NONCDM CHARGE RECORD PHARMACY	250		1.17	N/A
HC65000250_05199183801	NONCDM CHARGE RECORD PHARMACY	250		3.44	N/A
HC65000250_05199187733	NONCDM CHARGE RECORD PHARMACY	250		8.39	N/A
HC65000250_05199190001	NONCDM CHARGE RECORD PHARMACY	250	Z7610	4.28	N/A
HC65000250_05199194333	NONCDM CHARGE RECORD PHARMACY	250		17.65	N/A
HC65000250_05224410010	NONCDM CHARGE RECORD PHARMACY	250		14.94	N/A
HC65000250_05224430010	NONCDM CHARGE RECORD PHARMACY	250		27.85	N/A
HC65000250_05226810001	NONCDM CHARGE RECORD PHARMACY	250		102.94	N/A
HC65000250_05237602102	NONCDM CHARGE RECORD PHARMACY	250		0.32	N/A
HC65000250_05238012724	NONCDM CHARGE RECORD PHARMACY	250		33.28	N/A
HC65000250_05238031015	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.37	N/A
HC65000250_05253610303	NONCDM CHARGE RECORD PHARMACY	250		56.40	N/A
HC65000250_05253618003	NONCDM CHARGE RECORD PHARMACY	250		29.93	N/A
HC65000250_05256500950	NONCDM CHARGE RECORD PHARMACY	250		251.87	N/A
HC65000250_05256502520	NONCDM CHARGE RECORD PHARMACY	250		244.56	N/A
HC65000250_05256503915	NONCDM CHARGE RECORD PHARMACY	250		69.21	N/A
HC65000250_05256504215	NONCDM CHARGE RECORD PHARMACY	250		36.00	N/A
HC65000250_05256505115	NONCDM CHARGE RECORD PHARMACY	250		60.03	N/A
HC65000250_05256508515	NONCDM CHARGE RECORD PHARMACY	250		236.97	N/A
HC65000250_05256512207	NONCDM CHARGE RECORD PHARMACY	250		26.45	N/A
HC65000250_05265240011	NONCDM CHARGE RECORD PHARMACY	250		153.59	N/A
HC65000250_05265250011	NONCDM CHARGE RECORD PHARMACY	250		93.79	N/A
HC65000250_05281718110	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_05281721010	NONCDM CHARGE RECORD PHARMACY	250		1.21	N/A
HC65000250_05281728010	NONCDM CHARGE RECORD PHARMACY	250		2.40	N/A
HC65000250_05281732510	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.11	N/A
HC65000250_05281733200	NONCDM CHARGE RECORD PHARMACY	250		0.95	N/A
HC65000250_05281733210	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05281736790	NONCDM CHARGE RECORD PHARMACY	250		15.00	N/A
HC65000250_05295925100	NONCDM CHARGE RECORD PHARMACY	250		53.40	N/A
HC65000250_05295927308	NONCDM CHARGE RECORD PHARMACY	250	Z7610	4.88	N/A
HC65000250_05319124401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05332993913	NONCDM CHARGE RECORD PHARMACY	250		17.44	N/A
HC65000250_05332994675	NONCDM CHARGE RECORD PHARMACY	250		1.26	N/A
HC65000250_05332998004	NONCDM CHARGE RECORD PHARMACY	250		3.54	N/A
HC65000250_05333500689	NONCDM CHARGE RECORD PHARMACY	250	Z7610	6.61	N/A
HC65000250_05348912002	NONCDM CHARGE RECORD PHARMACY	250		3.70	N/A
HC65000250_05348914305	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_05348914401	NONCDM CHARGE RECORD PHARMACY	250		3.74	N/A
HC65000250_05348936901	NONCDM CHARGE RECORD PHARMACY	250		0.51	N/A
HC65000250_05348938601	NONCDM CHARGE RECORD PHARMACY	250		1.32	N/A
HC65000250_05348950001	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_05348964801	NONCDM CHARGE RECORD PHARMACY	250		41.75	N/A
HC65000250_05374611001	NONCDM CHARGE RECORD PHARMACY	250		1.23	N/A
HC65000250_05374617360	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_05374651401	NONCDM CHARGE RECORD PHARMACY	250		2.11	N/A
HC65000250_05374654201	NONCDM CHARGE RECORD PHARMACY	250		3.89	N/A
HC65000250_05374654401	NONCDM CHARGE RECORD PHARMACY	250		1.54	N/A
HC65000250_05374654501	NONCDM CHARGE RECORD PHARMACY	250		2.17	N/A
HC65000250_05374664101	NONCDM CHARGE RECORD PHARMACY	250		2.43	N/A
HC65000250_05409218981	NONCDM CHARGE RECORD PHARMACY	250		18.22	N/A
HC65000250_05409219112	NONCDM CHARGE RECORD PHARMACY	250		36.43	N/A
HC65000250_05409238701	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_05416200005	NONCDM CHARGE RECORD PHARMACY	250		1.05	N/A
HC65000250_05416219016	NONCDM CHARGE RECORD PHARMACY	250		1.98	N/A
HC65000250_05445821360	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05448214407	NONCDM CHARGE RECORD PHARMACY	250	Z7610	6.40	N/A
HC65000250_05448214801	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.01	N/A
HC65000250_05462960101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05464356491	NONCDM CHARGE RECORD PHARMACY	250		59.68	N/A
HC65000250_05464390071	NONCDM CHARGE RECORD PHARMACY	250		61.96	N/A
HC65000250_05473814001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05479950505	NONCDM CHARGE RECORD PHARMACY	250	Z7610	150.84	N/A
HC65000250_05483800530	NONCDM CHARGE RECORD PHARMACY	250		13.10	N/A
HC65000250_05483800650	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05483820980	NONCDM CHARGE RECORD PHARMACY	250		1.81	N/A
HC65000250_05483850115	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2.17	N/A
HC65000250_05483851080	NONCDM CHARGE RECORD PHARMACY	250		1.05	N/A
HC65000250_05483855680	NONCDM CHARGE RECORD PHARMACY	250		18.01	N/A
HC65000250_05486861500	NONCDM CHARGE RECORD PHARMACY	250		0.00	N/A
HC65000250_05487900101	NONCDM CHARGE RECORD PHARMACY	250		2.28	N/A
HC65000250_05487900201	NONCDM CHARGE RECORD PHARMACY	250		3.60	N/A
HC65000250_05493250181	NONCDM CHARGE RECORD PHARMACY	250		7.98	N/A
HC65000250_05511114330	NONCDM CHARGE RECORD PHARMACY	250		4.68	N/A
HC65000250_05511117915	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_05511118015	NONCDM CHARGE RECORD PHARMACY	250		0.96	N/A
HC65000250_05511119690	NONCDM CHARGE RECORD PHARMACY	250		1.08	N/A
HC65000250_05511122990	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05511123105	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05511123190	NONCDM CHARGE RECORD PHARMACY	250		1.22	N/A
HC65000250_05511126281	NONCDM CHARGE RECORD PHARMACY	250		22.57	N/A
HC65000250_05511126381	NONCDM CHARGE RECORD PHARMACY	250		24.73	N/A
HC65000250_05511128130	NONCDM CHARGE RECORD PHARMACY	250		8.42	N/A
HC65000250_05511129109	NONCDM CHARGE RECORD PHARMACY	250		12.15	N/A
HC65000250_05511129198	NONCDM CHARGE RECORD PHARMACY	250		12.58	N/A
HC65000250_05511132001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05511132101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05511132890	NONCDM CHARGE RECORD PHARMACY	250		2.42	N/A
HC65000250_05511134201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05511134301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05511135260	NONCDM CHARGE RECORD PHARMACY	250		3.50	N/A
HC65000250_05511135360	NONCDM CHARGE RECORD PHARMACY	250		3.50	N/A
HC65000250_05511135560	NONCDM CHARGE RECORD PHARMACY	250		3.50	N/A
HC65000250_05511146701	NONCDM CHARGE RECORD PHARMACY	250		2.92	N/A
HC65000250_05511153201	NONCDM CHARGE RECORD PHARMACY	250		5.60	N/A
HC65000250_05511159490	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5.50	N/A
HC65000250_05511168205	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05511172590	NONCDM CHARGE RECORD PHARMACY	250		2.55	N/A
HC65000250_05511172901	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05511173001	NONCDM CHARGE RECORD PHARMACY	250		1.26	N/A
HC65000250_05511179630	NONCDM CHARGE RECORD PHARMACY	250		6.67	N/A
HC65000250_05515012215	NONCDM CHARGE RECORD PHARMACY	250		70.20	N/A
HC65000250_05515012315	NONCDM CHARGE RECORD PHARMACY	250		136.20	N/A
HC65000250_05515012316	NONCDM CHARGE RECORD PHARMACY	250		136.20	N/A
HC65000250_05515012499	NONCDM CHARGE RECORD PHARMACY	250		83.61	N/A
HC65000250_05515016102	NONCDM CHARGE RECORD PHARMACY	250		21.86	N/A
HC65000250_05515016710	NONCDM CHARGE RECORD PHARMACY	250	S0020	9.72	N/A
HC65000250_05515016830	NONCDM CHARGE RECORD PHARMACY	250		5.42	N/A
HC65000250_05515016910	NONCDM CHARGE RECORD PHARMACY	250		9.29	N/A
HC65000250_05515017030	NONCDM CHARGE RECORD PHARMACY	250		6.93	N/A
HC65000250_05515017110	NONCDM CHARGE RECORD PHARMACY	250		7.66	N/A
HC65000250_05515017230	NONCDM CHARGE RECORD PHARMACY	250		25.56	N/A
HC65000250_05515022110	NONCDM CHARGE RECORD PHARMACY	250		33.00	N/A
HC65000250_05515022220	NONCDM CHARGE RECORD PHARMACY	250		36.76	N/A
HC65000250_05515022610	NONCDM CHARGE RECORD PHARMACY	250		69.00	N/A
HC65000250_05515023510	NONCDM CHARGE RECORD PHARMACY	250		25.39	N/A
HC65000250_05515023620	NONCDM CHARGE RECORD PHARMACY	250		54.00	N/A
HC65000250_05515034225	NONCDM CHARGE RECORD PHARMACY	250		147.25	N/A
HC65000250_05529960104	NONCDM CHARGE RECORD PHARMACY	250		53.28	N/A
HC65000250_05551307330	NONCDM CHARGE RECORD PHARMACY	250		161.34	N/A
HC65000250_05551380060	NONCDM CHARGE RECORD PHARMACY	250		41.44	N/A
HC65000250_05618412041	NONCDM CHARGE RECORD PHARMACY	250		31.14	N/A
HC65000250_05618412105	NONCDM CHARGE RECORD PHARMACY	250		18.09	N/A
HC65000250_05707400177	NONCDM CHARGE RECORD PHARMACY	250		4.24	N/A
HC65000250_05723700330	NONCDM CHARGE RECORD PHARMACY	250		2.22	N/A
HC65000250_05723700830	NONCDM CHARGE RECORD PHARMACY	250		1.72	N/A
HC65000250_05723701830	NONCDM CHARGE RECORD PHARMACY	250		2.08	N/A
HC65000250_05723701890	NONCDM CHARGE RECORD PHARMACY	250		2.58	N/A
HC65000250_05723701899	NONCDM CHARGE RECORD PHARMACY	250		1.85	N/A
HC65000250_05723701930	NONCDM CHARGE RECORD PHARMACY	250		2.46	N/A
HC65000250_05723703101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05723704001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05723704230	NONCDM CHARGE RECORD PHARMACY	250		2.40	N/A
HC65000250_05723704960	NONCDM CHARGE RECORD PHARMACY	250		12.03	N/A
HC65000250_05723705060	NONCDM CHARGE RECORD PHARMACY	250		12.66	N/A
HC65000250_05723707710	NONCDM CHARGE RECORD PHARMACY	250		2.63	N/A
HC65000250_05723711490	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_05723711901	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05723712201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05723712401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05723712701	NONCDM CHARGE RECORD PHARMACY	250		1.39	N/A
HC65000250_05723716130	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_05723717201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05723717401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05723722301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05723723301	NONCDM CHARGE RECORD PHARMACY	250		0.35	N/A
HC65000250_05764800201	NONCDM CHARGE RECORD PHARMACY	250		3.49	N/A
HC65000250_05766411788	NONCDM CHARGE RECORD PHARMACY	250		2.22	N/A
HC65000250_05766416752	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_05766437708	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05766439488	NONCDM CHARGE RECORD PHARMACY	250		2.04	N/A
HC65000250_05766450658	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05766450888	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05766476113	NONCDM CHARGE RECORD PHARMACY	250		3.00	N/A
HC65000250_05784113001	NONCDM CHARGE RECORD PHARMACY	250		72.80	N/A
HC65000250_05784113013	NONCDM CHARGE RECORD PHARMACY	250		71.96	N/A
HC65000250_05789611114	NONCDM CHARGE RECORD PHARMACY	250		0.80	N/A
HC65000250_05789611314	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789618105	NONCDM CHARGE RECORD PHARMACY	250		8.37	N/A
HC65000250_05789620005	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789620110	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789620401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789630301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789630310	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789630401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789642501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789642601	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789644101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789644125	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789645101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789645401	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_05789645501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789645506	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789645806	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789646208	NONCDM CHARGE RECORD PHARMACY	250		1.46	N/A
HC65000250_05789655501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789661912	NONCDM CHARGE RECORD PHARMACY	250	Z7610	15.00	N/A
HC65000250_05789663506	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789675201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789679901	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789685101	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_05789685906	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789686406	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789686501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789687503	NONCDM CHARGE RECORD PHARMACY	250		1.29	N/A
HC65000250_05789690101	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_05789692101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05789698101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05823207193	NONCDM CHARGE RECORD PHARMACY	250		26.44	N/A
HC65000250_05846800211	NONCDM CHARGE RECORD PHARMACY	250		0.00	N/A
HC65000250_05846801301	NONCDM CHARGE RECORD PHARMACY	250		35.69	N/A
HC65000250_05846801322	NONCDM CHARGE RECORD PHARMACY	250	Z7610	107.09	N/A
HC65000250_05860202224	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05865750508	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.05	N/A
HC65000250_05865750916	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05865752816	NONCDM CHARGE RECORD PHARMACY	250		5.78	N/A
HC65000250_05865764501	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_05865770301	NONCDM CHARGE RECORD PHARMACY	250		3.46	N/A
HC65000250_05891401460	NONCDM CHARGE RECORD PHARMACY	250		2.99	N/A
HC65000250_05891411210	NONCDM CHARGE RECORD PHARMACY	250	Z7610	19.10	N/A
HC65000250_05891417014	NONCDM CHARGE RECORD PHARMACY	250		16.42	N/A
HC65000250_05891421460	NONCDM CHARGE RECORD PHARMACY	250		2.06	N/A
HC65000250_05891450156	NONCDM CHARGE RECORD PHARMACY	250		232.36	N/A
HC65000250_05891478510	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_05898001110	NONCDM CHARGE RECORD PHARMACY	250		14.48	N/A
HC65000250_05898040925	NONCDM CHARGE RECORD PHARMACY	250		2.15	N/A
HC65000250_05901141020	NONCDM CHARGE RECORD PHARMACY	250		26.91	N/A
HC65000250_05901141520	NONCDM CHARGE RECORD PHARMACY	250		40.21	N/A
HC65000250_05901142020	NONCDM CHARGE RECORD PHARMACY	250		50.21	N/A
HC65000250_05901144020	NONCDM CHARGE RECORD PHARMACY	250		85.09	N/A
HC65000250_05901642019	NONCDM CHARGE RECORD PHARMACY	250		1.74	N/A
HC65000250_05921224256	NONCDM CHARGE RECORD PHARMACY	250		83.81	N/A
HC65000250_05921224955	NONCDM CHARGE RECORD PHARMACY	250		83.89	N/A
HC65000250_05921242510	NONCDM CHARGE RECORD PHARMACY	250		66.06	N/A
HC65000250_05936560651	NONCDM CHARGE RECORD PHARMACY	250		74.26	N/A
HC65000250_05941710210	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_05941710310	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_05957241000	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_05965101890	NONCDM CHARGE RECORD PHARMACY	250		2.14	N/A
HC65000250_05965105290	NONCDM CHARGE RECORD PHARMACY	250		1.64	N/A
HC65000250_05965125601	NONCDM CHARGE RECORD PHARMACY	250		1.40	N/A
HC65000250_05965129960	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05967627801	NONCDM CHARGE RECORD PHARMACY	250		228.34	N/A
HC65000250_05967656201	NONCDM CHARGE RECORD PHARMACY	250		176.57	N/A
HC65000250_05967656630	NONCDM CHARGE RECORD PHARMACY	250		365.98	N/A
HC65000250_05967657001	NONCDM CHARGE RECORD PHARMACY	250		70.32	N/A
HC65000250_05967657101	NONCDM CHARGE RECORD PHARMACY	250		141.15	N/A
HC65000250_05974601032	NONCDM CHARGE RECORD PHARMACY	250	Z7610	9.97	N/A
HC65000250_05974611306	NONCDM CHARGE RECORD PHARMACY	250		1.79	N/A
HC65000250_05974611506	NONCDM CHARGE RECORD PHARMACY	250		2.85	N/A
HC65000250_05974630632	NONCDM CHARGE RECORD PHARMACY	250		5.16	N/A
HC65000250_05974630732	NONCDM CHARGE RECORD PHARMACY	250		7.54	N/A
HC65000250_05974636290	NONCDM CHARGE RECORD PHARMACY	250		1.53	N/A
HC65000250_05974638306	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05974638406	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05974638506	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05976200161	NONCDM CHARGE RECORD PHARMACY	250		6.21	N/A
HC65000250_05976200501	NONCDM CHARGE RECORD PHARMACY	250		16.99	N/A
HC65000250_05976200551	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05976200731	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_05976200741	NONCDM CHARGE RECORD PHARMACY	250		1.38	N/A
HC65000250_05976200751	NONCDM CHARGE RECORD PHARMACY	250		3.08	N/A
HC65000250_05976201041	NONCDM CHARGE RECORD PHARMACY	250		1.63	N/A
HC65000250_05976201171	NONCDM CHARGE RECORD PHARMACY	250		13.97	N/A
HC65000250_05976201562	NONCDM CHARGE RECORD PHARMACY	250		1.81	N/A
HC65000250_05976202601	NONCDM CHARGE RECORD PHARMACY	250		18.86	N/A
HC65000250_05976205312	NONCDM CHARGE RECORD PHARMACY	250		3.58	N/A
HC65000250_05976205401	NONCDM CHARGE RECORD PHARMACY	250		1.78	N/A
HC65000250_05976205421	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.90	N/A
HC65000250_05976207072	NONCDM CHARGE RECORD PHARMACY	250		44.75	N/A
HC65000250_05976210051	NONCDM CHARGE RECORD PHARMACY	250		32.16	N/A
HC65000250_05976210611	NONCDM CHARGE RECORD PHARMACY	250		2.42	N/A
HC65000250_05976212061	NONCDM CHARGE RECORD PHARMACY	250		4.08	N/A
HC65000250_05976212071	NONCDM CHARGE RECORD PHARMACY	250		5.28	N/A
HC65000250_05976212103	NONCDM CHARGE RECORD PHARMACY	250		8.96	N/A
HC65000250_05976213441	NONCDM CHARGE RECORD PHARMACY	250		1.29	N/A
HC65000250_05976213501	NONCDM CHARGE RECORD PHARMACY	250		83.97	N/A
HC65000250_05976217101	NONCDM CHARGE RECORD PHARMACY	250		18.60	N/A
HC65000250_05976217102	NONCDM CHARGE RECORD PHARMACY	250		20.83	N/A
HC65000250_05976221983	NONCDM CHARGE RECORD PHARMACY	250		6.32	N/A
HC65000250_05976221987	NONCDM CHARGE RECORD PHARMACY	250	Z7610	10.20	N/A
HC65000250_05976223506	NONCDM CHARGE RECORD PHARMACY	250	Z7610	7.07	N/A
HC65000250_05976231201	NONCDM CHARGE RECORD PHARMACY	250		22.34	N/A
HC65000250_05976231301	NONCDM CHARGE RECORD PHARMACY	250		7.93	N/A
HC65000250_05976231401	NONCDM CHARGE RECORD PHARMACY	250		18.44	N/A
HC65000250_05976233041	NONCDM CHARGE RECORD PHARMACY	250		4.93	N/A
HC65000250_05976233043	NONCDM CHARGE RECORD PHARMACY	250		4.51	N/A
HC65000250_05976233281	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05976237184	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_05976237191	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05976237201	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_05976237211	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05976250001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_05976250005	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_05976250071	NONCDM CHARGE RECORD PHARMACY	250		2.06	N/A
HC65000250_05976250072	NONCDM CHARGE RECORD PHARMACY	250		1.21	N/A
HC65000250_05976250081	NONCDM CHARGE RECORD PHARMACY	250		5.77	N/A
HC65000250_05976250082	NONCDM CHARGE RECORD PHARMACY	250		5.77	N/A
HC65000250_05976250141	NONCDM CHARGE RECORD PHARMACY	250		5.94	N/A
HC65000250_05976250501	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2.50	N/A
HC65000250_05976252101	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_05976253101	NONCDM CHARGE RECORD PHARMACY	250		1.81	N/A
HC65000250_05976253501	NONCDM CHARGE RECORD PHARMACY	250		4.42	N/A
HC65000250_06025800601	NONCDM CHARGE RECORD PHARMACY	250		3.26	N/A
HC65000250_06025816001	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06025817201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06025819309	NONCDM CHARGE RECORD PHARMACY	250		2.86	N/A
HC65000250_06026770550	NONCDM CHARGE RECORD PHARMACY	250	J3490	642.00	N/A
HC65000250_06042919515	NONCDM CHARGE RECORD PHARMACY	250		19.78	N/A
HC65000250_06043203732	NONCDM CHARGE RECORD PHARMACY	250		7.34	N/A
HC65000250_06043206500	NONCDM CHARGE RECORD PHARMACY	250		36.14	N/A
HC65000250_06043206575	NONCDM CHARGE RECORD PHARMACY	250		30.83	N/A
HC65000250_06043209216	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2.40	N/A
HC65000250_06043212608	NONCDM CHARGE RECORD PHARMACY	250		5.92	N/A
HC65000250_06043212616	NONCDM CHARGE RECORD PHARMACY	250		1.93	N/A
HC65000250_06043212916	NONCDM CHARGE RECORD PHARMACY	250		10.02	N/A
HC65000250_06043215016	NONCDM CHARGE RECORD PHARMACY	250		1.07	N/A
HC65000250_06043221208	NONCDM CHARGE RECORD PHARMACY	250	Z7610	7.62	N/A
HC65000250_06043226415	NONCDM CHARGE RECORD PHARMACY	250		7.83	N/A
HC65000250_06043246551	NONCDM CHARGE RECORD PHARMACY	250		208.00	N/A
HC65000250_06043253716	NONCDM CHARGE RECORD PHARMACY	250		3.64	N/A
HC65000250_06043253760	NONCDM CHARGE RECORD PHARMACY	250		76.26	N/A
HC65000250_06043260416	NONCDM CHARGE RECORD PHARMACY	250		5.49	N/A
HC65000250_06043260616	NONCDM CHARGE RECORD PHARMACY	250		2.64	N/A
HC65000250_06043260816	NONCDM CHARGE RECORD PHARMACY	250		9.71	N/A
HC65000250_06043262116	NONCDM CHARGE RECORD PHARMACY	250		1.11	N/A
HC65000250_06043265104	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.01	N/A
HC65000250_06043274116	NONCDM CHARGE RECORD PHARMACY	250		168.03	N/A
HC65000250_06050500336	NONCDM CHARGE RECORD PHARMACY	250		1.81	N/A
HC65000250_06050500551	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06050500800	NONCDM CHARGE RECORD PHARMACY	250		1.77	N/A
HC65000250_06050501410	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06050501420	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06050501651	NONCDM CHARGE RECORD PHARMACY	250		3.30	N/A
HC65000250_06050501709	NONCDM CHARGE RECORD PHARMACY	250		2.33	N/A
HC65000250_06050502533	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06050504025	NONCDM CHARGE RECORD PHARMACY	250		115.21	N/A
HC65000250_06050508261	NONCDM CHARGE RECORD PHARMACY	250		216.00	N/A
HC65000250_06050508271	NONCDM CHARGE RECORD PHARMACY	250		216.00	N/A
HC65000250_06050513251	NONCDM CHARGE RECORD PHARMACY	250		7.52	N/A
HC65000250_06050525788	NONCDM CHARGE RECORD PHARMACY	250		1.27	N/A
HC65000250_06050525789	NONCDM CHARGE RECORD PHARMACY	250		1.11	N/A
HC65000250_06050525798	NONCDM CHARGE RECORD PHARMACY	250		1.80	N/A
HC65000250_06050525799	NONCDM CHARGE RECORD PHARMACY	250		1.81	N/A
HC65000250_06050525808	NONCDM CHARGE RECORD PHARMACY	250		1.81	N/A
HC65000250_06050525809	NONCDM CHARGE RECORD PHARMACY	250		1.80	N/A
HC65000250_06050526561	NONCDM CHARGE RECORD PHARMACY	250		1.65	N/A
HC65000250_06050526718	NONCDM CHARGE RECORD PHARMACY	250		1.81	N/A
HC65000250_06050526719	NONCDM CHARGE RECORD PHARMACY	250		1.81	N/A
HC65000250_06050531100	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_06050531110	NONCDM CHARGE RECORD PHARMACY	250		1.27	N/A
HC65000250_06050531130	NONCDM CHARGE RECORD PHARMACY	250		2.05	N/A
HC65000250_06050531707	NONCDM CHARGE RECORD PHARMACY	250		4.83	N/A
HC65000250_06050532506	NONCDM CHARGE RECORD PHARMACY	250		70.30	N/A
HC65000250_06050532516	NONCDM CHARGE RECORD PHARMACY	250		22.50	N/A
HC65000250_06050532753	NONCDM CHARGE RECORD PHARMACY	250		4.76	N/A
HC65000250_06050534383	NONCDM CHARGE RECORD PHARMACY	250		8.83	N/A
HC65000250_06050546423	NONCDM CHARGE RECORD PHARMACY	250		4.95	N/A
HC65000250_06050546433	NONCDM CHARGE RECORD PHARMACY	250		4.22	N/A
HC65000250_06050547133	NONCDM CHARGE RECORD PHARMACY	250		47.56	N/A
HC65000250_06050570802	NONCDM CHARGE RECORD PHARMACY	250		97.44	N/A
HC65000250_06050570812	NONCDM CHARGE RECORD PHARMACY	250		27.42	N/A
HC65000250_06050570832	NONCDM CHARGE RECORD PHARMACY	250		74.22	N/A
HC65000250_06063141230	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06068710521	NONCDM CHARGE RECORD PHARMACY	250		8.38	N/A
HC65000250_06068711221	NONCDM CHARGE RECORD PHARMACY	250		5.44	N/A
HC65000250_06068711301	NONCDM CHARGE RECORD PHARMACY	250		1.54	N/A
HC65000250_06068712401	NONCDM CHARGE RECORD PHARMACY	250		1.63	N/A
HC65000250_06068712765	NONCDM CHARGE RECORD PHARMACY	250		18.21	N/A
HC65000250_06068712801	NONCDM CHARGE RECORD PHARMACY	250		6.05	N/A
HC65000250_06068712901	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06068714301	NONCDM CHARGE RECORD PHARMACY	250		1.29	N/A
HC65000250_06068715201	NONCDM CHARGE RECORD PHARMACY	250		1.91	N/A
HC65000250_06068715721	NONCDM CHARGE RECORD PHARMACY	250		56.07	N/A
HC65000250_06068716101	NONCDM CHARGE RECORD PHARMACY	250		5.29	N/A
HC65000250_06068716201	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_06068716301	NONCDM CHARGE RECORD PHARMACY	250		2.09	N/A
HC65000250_06068717357	NONCDM CHARGE RECORD PHARMACY	250		2.90	N/A
HC65000250_06068717801	NONCDM CHARGE RECORD PHARMACY	250		4.22	N/A
HC65000250_06068718457	NONCDM CHARGE RECORD PHARMACY	250		4.00	N/A
HC65000250_06068718821	NONCDM CHARGE RECORD PHARMACY	250		24.71	N/A
HC65000250_06068719501	NONCDM CHARGE RECORD PHARMACY	250		1.98	N/A
HC65000250_06068720601	NONCDM CHARGE RECORD PHARMACY	250		2.34	N/A
HC65000250_06068721001	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06068721121	NONCDM CHARGE RECORD PHARMACY	250		4.47	N/A
HC65000250_06068721501	NONCDM CHARGE RECORD PHARMACY	250		11.96	N/A
HC65000250_06068721701	NONCDM CHARGE RECORD PHARMACY	250		3.67	N/A
HC65000250_06068722401	NONCDM CHARGE RECORD PHARMACY	250		1.30	N/A
HC65000250_06068722901	NONCDM CHARGE RECORD PHARMACY	250		4.03	N/A
HC65000250_06068723001	NONCDM CHARGE RECORD PHARMACY	250		3.36	N/A
HC65000250_06068724201	NONCDM CHARGE RECORD PHARMACY	250		2.33	N/A
HC65000250_06068724501	NONCDM CHARGE RECORD PHARMACY	250		8.40	N/A
HC65000250_06068724967	NONCDM CHARGE RECORD PHARMACY	250		13.06	N/A
HC65000250_06068725301	NONCDM CHARGE RECORD PHARMACY	250		2.65	N/A
HC65000250_06068725601	NONCDM CHARGE RECORD PHARMACY	250		8.40	N/A
HC65000250_06068728101	NONCDM CHARGE RECORD PHARMACY	250		2.20	N/A
HC65000250_06068728201	NONCDM CHARGE RECORD PHARMACY	250		10.23	N/A
HC65000250_06068728621	NONCDM CHARGE RECORD PHARMACY	250		41.38	N/A
HC65000250_06068729201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06068730225	NONCDM CHARGE RECORD PHARMACY	250		17.51	N/A
HC65000250_06068730301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06068730601	NONCDM CHARGE RECORD PHARMACY	250		5.52	N/A
HC65000250_06068731009	NONCDM CHARGE RECORD PHARMACY	250		6.04	N/A
HC65000250_06068731201	NONCDM CHARGE RECORD PHARMACY	250		11.03	N/A
HC65000250_06068731325	NONCDM CHARGE RECORD PHARMACY	250	Z7610	21.46	N/A
HC65000250_06068731725	NONCDM CHARGE RECORD PHARMACY	250		11.50	N/A
HC65000250_06068732501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06068732701	NONCDM CHARGE RECORD PHARMACY	250		1.95	N/A
HC65000250_06068732831	NONCDM CHARGE RECORD PHARMACY	250		49.57	N/A
HC65000250_06068732865	NONCDM CHARGE RECORD PHARMACY	250		40.17	N/A
HC65000250_06068733665	NONCDM CHARGE RECORD PHARMACY	250		6.60	N/A
HC65000250_06068734001	NONCDM CHARGE RECORD PHARMACY	250		6.59	N/A
HC65000250_06068734501	NONCDM CHARGE RECORD PHARMACY	250		3.79	N/A
HC65000250_06068734601	NONCDM CHARGE RECORD PHARMACY	250		2.79	N/A
HC65000250_06068735501	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_06068735601	NONCDM CHARGE RECORD PHARMACY	250		2.94	N/A
HC65000250_06068735701	NONCDM CHARGE RECORD PHARMACY	250		2.91	N/A
HC65000250_06068736801	NONCDM CHARGE RECORD PHARMACY	250		2.94	N/A
HC65000250_06068736901	NONCDM CHARGE RECORD PHARMACY	250		3.01	N/A
HC65000250_06068737321	NONCDM CHARGE RECORD PHARMACY	250		61.98	N/A
HC65000250_06068738001	NONCDM CHARGE RECORD PHARMACY	250		2.72	N/A
HC65000250_06068738401	NONCDM CHARGE RECORD PHARMACY	250		6.49	N/A
HC65000250_06068738425	NONCDM CHARGE RECORD PHARMACY	250		9.26	N/A
HC65000250_06068738701	NONCDM CHARGE RECORD PHARMACY	250		5.87	N/A
HC65000250_06068738921	NONCDM CHARGE RECORD PHARMACY	250		29.90	N/A
HC65000250_06068739101	NONCDM CHARGE RECORD PHARMACY	250		6.30	N/A
HC65000250_06068740101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06068740925	NONCDM CHARGE RECORD PHARMACY	250		8.45	N/A
HC65000250_06068741094	NONCDM CHARGE RECORD PHARMACY	250		330.00	N/A
HC65000250_06068742321	NONCDM CHARGE RECORD PHARMACY	250		15.24	N/A
HC65000250_06068742401	NONCDM CHARGE RECORD PHARMACY	250		2.59	N/A
HC65000250_06068742501	NONCDM CHARGE RECORD PHARMACY	250		6.83	N/A
HC65000250_06068742865	NONCDM CHARGE RECORD PHARMACY	250		5.40	N/A
HC65000250_06068743001	NONCDM CHARGE RECORD PHARMACY	250		35.56	N/A
HC65000250_06068743301	NONCDM CHARGE RECORD PHARMACY	250		2.57	N/A
HC65000250_06068743601	NONCDM CHARGE RECORD PHARMACY	250		8.72	N/A
HC65000250_06068743701	NONCDM CHARGE RECORD PHARMACY	250		2.02	N/A
HC65000250_06068743901	NONCDM CHARGE RECORD PHARMACY	250		2.71	N/A
HC65000250_06068744301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06068744601	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_06068745001	NONCDM CHARGE RECORD PHARMACY	250		3.49	N/A
HC65000250_06068745121	NONCDM CHARGE RECORD PHARMACY	250		25.00	N/A
HC65000250_06068745301	NONCDM CHARGE RECORD PHARMACY	250		2.80	N/A
HC65000250_06068745701	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06068745801	NONCDM CHARGE RECORD PHARMACY	250		6.24	N/A
HC65000250_06068746101	NONCDM CHARGE RECORD PHARMACY	250		5.93	N/A
HC65000250_06068746401	NONCDM CHARGE RECORD PHARMACY	250		2.83	N/A
HC65000250_06068746801	NONCDM CHARGE RECORD PHARMACY	250		0.95	N/A
HC65000250_06068747301	NONCDM CHARGE RECORD PHARMACY	250		8.36	N/A
HC65000250_06068747501	NONCDM CHARGE RECORD PHARMACY	250		3.51	N/A
HC65000250_06068748401	NONCDM CHARGE RECORD PHARMACY	250		8.16	N/A
HC65000250_06068748701	NONCDM CHARGE RECORD PHARMACY	250		4.38	N/A
HC65000250_06068748801	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06068749101	NONCDM CHARGE RECORD PHARMACY	250		1.24	N/A
HC65000250_06068749221	NONCDM CHARGE RECORD PHARMACY	250		21.00	N/A
HC65000250_06068749301	NONCDM CHARGE RECORD PHARMACY	250		6.65	N/A
HC65000250_06068749501	NONCDM CHARGE RECORD PHARMACY	250		8.26	N/A
HC65000250_06068749701	NONCDM CHARGE RECORD PHARMACY	250		2.40	N/A
HC65000250_06068750201	NONCDM CHARGE RECORD PHARMACY	250		7.32	N/A
HC65000250_06068750401	NONCDM CHARGE RECORD PHARMACY	250	Z7610	7.13	N/A
HC65000250_06068750525	NONCDM CHARGE RECORD PHARMACY	250	Z7610	160.00	N/A
HC65000250_06068750601	NONCDM CHARGE RECORD PHARMACY	250		8.09	N/A
HC65000250_06068750801	NONCDM CHARGE RECORD PHARMACY	250		4.07	N/A
HC65000250_06068751901	NONCDM CHARGE RECORD PHARMACY	250		4.26	N/A
HC65000250_06068752601	NONCDM CHARGE RECORD PHARMACY	250		2.46	N/A
HC65000250_06068752801	NONCDM CHARGE RECORD PHARMACY	250		1.81	N/A
HC65000250_06068753001	NONCDM CHARGE RECORD PHARMACY	250		4.37	N/A
HC65000250_06068753601	NONCDM CHARGE RECORD PHARMACY	250	Z7610	13.20	N/A
HC65000250_06068754401	NONCDM CHARGE RECORD PHARMACY	250		1.35	N/A
HC65000250_06068754921	NONCDM CHARGE RECORD PHARMACY	250		8.40	N/A
HC65000250_06068755001	NONCDM CHARGE RECORD PHARMACY	250		4.43	N/A
HC65000250_06068755501	NONCDM CHARGE RECORD PHARMACY	250		1.41	N/A
HC65000250_06068755632	NONCDM CHARGE RECORD PHARMACY	250		30.60	N/A
HC65000250_06068755901	NONCDM CHARGE RECORD PHARMACY	250		1.49	N/A
HC65000250_06068756201	NONCDM CHARGE RECORD PHARMACY	250		2.04	N/A
HC65000250_06068756901	NONCDM CHARGE RECORD PHARMACY	250		3.21	N/A
HC65000250_06068757901	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.26	N/A
HC65000250_06068758001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06068758121	NONCDM CHARGE RECORD PHARMACY	250		5.00	N/A
HC65000250_06068758501	NONCDM CHARGE RECORD PHARMACY	250		1.46	N/A
HC65000250_06068759101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06068759221	NONCDM CHARGE RECORD PHARMACY	250		5.87	N/A
HC65000250_06068759301	NONCDM CHARGE RECORD PHARMACY	250		1.09	N/A
HC65000250_06068759501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06068760201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06068762201	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_06068762301	NONCDM CHARGE RECORD PHARMACY	250		6.43	N/A
HC65000250_06075818805	NONCDM CHARGE RECORD PHARMACY	250		26.16	N/A
HC65000250_06075880105	NONCDM CHARGE RECORD PHARMACY	250		33.25	N/A
HC65000250_06075880205	NONCDM CHARGE RECORD PHARMACY	250		17.88	N/A
HC65000250_06079341130	NONCDM CHARGE RECORD PHARMACY	250		74.59	N/A
HC65000250_06126932560	NONCDM CHARGE RECORD PHARMACY	250		2.50	N/A
HC65000250_06126932610	NONCDM CHARGE RECORD PHARMACY	250		1.96	N/A
HC65000250_06131401601	NONCDM CHARGE RECORD PHARMACY	250		195.45	N/A
HC65000250_06131401910	NONCDM CHARGE RECORD PHARMACY	250		203.94	N/A
HC65000250_06131414305	NONCDM CHARGE RECORD PHARMACY	250		90.00	N/A
HC65000250_06131420315	NONCDM CHARGE RECORD PHARMACY	250		471.35	N/A
HC65000250_06131420415	NONCDM CHARGE RECORD PHARMACY	250		483.93	N/A
HC65000250_06131420615	NONCDM CHARGE RECORD PHARMACY	250		507.33	N/A
HC65000250_06131422605	NONCDM CHARGE RECORD PHARMACY	250		31.02	N/A
HC65000250_06131422705	NONCDM CHARGE RECORD PHARMACY	250		53.77	N/A
HC65000250_06131423710	NONCDM CHARGE RECORD PHARMACY	250		135.00	N/A
HC65000250_06131424501	NONCDM CHARGE RECORD PHARMACY	250		305.88	N/A
HC65000250_06131435501	NONCDM CHARGE RECORD PHARMACY	250		61.20	N/A
HC65000250_06131439601	NONCDM CHARGE RECORD PHARMACY	250		68.91	N/A
HC65000250_06131462810	NONCDM CHARGE RECORD PHARMACY	250		60.46	N/A
HC65000250_06131463006	NONCDM CHARGE RECORD PHARMACY	250		108.00	N/A
HC65000250_06131465605	NONCDM CHARGE RECORD PHARMACY	250		126.72	N/A
HC65000250_06131465625	NONCDM CHARGE RECORD PHARMACY	250		80.10	N/A
HC65000250_06131466505	NONCDM CHARGE RECORD PHARMACY	250		385.50	N/A
HC65000250_06144211201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06144212110	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06144212601	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06144214101	NONCDM CHARGE RECORD PHARMACY	250		1.49	N/A
HC65000250_06144214201	NONCDM CHARGE RECORD PHARMACY	250		1.53	N/A
HC65000250_06157007301	NONCDM CHARGE RECORD PHARMACY	250		14.99	N/A
HC65000250_06157007901	NONCDM CHARGE RECORD PHARMACY	250		27.23	N/A
HC65000250_06157013120	NONCDM CHARGE RECORD PHARMACY	250		52.44	N/A
HC65000250_06157013150	NONCDM CHARGE RECORD PHARMACY	250		83.01	N/A
HC65000250_06157013155	NONCDM CHARGE RECORD PHARMACY	250		74.23	N/A
HC65000250_06174801201	NONCDM CHARGE RECORD PHARMACY	250		29.57	N/A
HC65000250_06174801206	NONCDM CHARGE RECORD PHARMACY	250		30.31	N/A
HC65000250_06174801211	NONCDM CHARGE RECORD PHARMACY	250		29.22	N/A
HC65000250_06178706204	NONCDM CHARGE RECORD PHARMACY	250		1.86	N/A
HC65000250_06187411520	NONCDM CHARGE RECORD PHARMACY	250		253.54	N/A
HC65000250_06195806011	NONCDM CHARGE RECORD PHARMACY	250		107.30	N/A
HC65000250_06195807011	NONCDM CHARGE RECORD PHARMACY	250		342.13	N/A
HC65000250_06195810031	NONCDM CHARGE RECORD PHARMACY	250		39.82	N/A
HC65000250_06195814011	NONCDM CHARGE RECORD PHARMACY	250		49.79	N/A
HC65000250_06195823011	NONCDM CHARGE RECORD PHARMACY	250		243.03	N/A
HC65000250_06199006112	NONCDM CHARGE RECORD PHARMACY	250		43.28	N/A
HC65000250_06203756005	NONCDM CHARGE RECORD PHARMACY	250		3.93	N/A
HC65000250_06203759990	NONCDM CHARGE RECORD PHARMACY	250		5.19	N/A
HC65000250_06203760090	NONCDM CHARGE RECORD PHARMACY	250		10.31	N/A
HC65000250_06203783001	NONCDM CHARGE RECORD PHARMACY	250		4.49	N/A
HC65000250_06210333300	NONCDM CHARGE RECORD PHARMACY	250		11.09	N/A
HC65000250_06210333304	NONCDM CHARGE RECORD PHARMACY	250	Z7610	31.87	N/A
HC65000250_06213519222	NONCDM CHARGE RECORD PHARMACY	250		4.14	N/A
HC65000250_06217510701	NONCDM CHARGE RECORD PHARMACY	250		1.98	N/A
HC65000250_06217511837	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06217511937	NONCDM CHARGE RECORD PHARMACY	250		1.30	N/A
HC65000250_06217518146	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06217526037	NONCDM CHARGE RECORD PHARMACY	250		6.42	N/A
HC65000250_06217526137	NONCDM CHARGE RECORD PHARMACY	250		11.11	N/A
HC65000250_06217526237	NONCDM CHARGE RECORD PHARMACY	250		12.82	N/A
HC65000250_06217527137	NONCDM CHARGE RECORD PHARMACY	250		4.45	N/A
HC65000250_06217589143	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06233200131	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06233200191	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06233201231	NONCDM CHARGE RECORD PHARMACY	250		2.19	N/A
HC65000250_06233202531	NONCDM CHARGE RECORD PHARMACY	250		20.62	N/A
HC65000250_06233203231	NONCDM CHARGE RECORD PHARMACY	250		1.80	N/A
HC65000250_06233203331	NONCDM CHARGE RECORD PHARMACY	250		1.79	N/A
HC65000250_06233203731	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06233206130	NONCDM CHARGE RECORD PHARMACY	250		30.00	N/A
HC65000250_06233211990	NONCDM CHARGE RECORD PHARMACY	250		1.93	N/A
HC65000250_06233212090	NONCDM CHARGE RECORD PHARMACY	250		2.13	N/A
HC65000250_06233219030	NONCDM CHARGE RECORD PHARMACY	250		54.84	N/A
HC65000250_06233219130	NONCDM CHARGE RECORD PHARMACY	250		59.41	N/A
HC65000250_06233224631	NONCDM CHARGE RECORD PHARMACY	250		4.85	N/A
HC65000250_06233225130	NONCDM CHARGE RECORD PHARMACY	250		11.85	N/A
HC65000250_06248400202	NONCDM CHARGE RECORD PHARMACY	250		136.47	N/A
HC65000250_06253000011	NONCDM CHARGE RECORD PHARMACY	250		21.00	N/A
HC65000250_06254140410	NONCDM CHARGE RECORD PHARMACY	250		28.93	N/A
HC65000250_06254230104	NONCDM CHARGE RECORD PHARMACY	250		14.67	N/A
HC65000250_06254230117	NONCDM CHARGE RECORD PHARMACY	250		14.27	N/A
HC65000250_06255913807	NONCDM CHARGE RECORD PHARMACY	250		128.52	N/A
HC65000250_06255915710	NONCDM CHARGE RECORD PHARMACY	250		8.08	N/A
HC65000250_06255919016	NONCDM CHARGE RECORD PHARMACY	250		1.25	N/A
HC65000250_06255923001	NONCDM CHARGE RECORD PHARMACY	250		1.63	N/A
HC65000250_06255924101	NONCDM CHARGE RECORD PHARMACY	250		55.17	N/A
HC65000250_06255949001	NONCDM CHARGE RECORD PHARMACY	250		3.00	N/A
HC65000250_06255953201	NONCDM CHARGE RECORD PHARMACY	250		3.60	N/A
HC65000250_06255972101	NONCDM CHARGE RECORD PHARMACY	250		15.00	N/A
HC65000250_06255982001	NONCDM CHARGE RECORD PHARMACY	250		7.61	N/A
HC65000250_06255982101	NONCDM CHARGE RECORD PHARMACY	250		9.08	N/A
HC65000250_06255982201	NONCDM CHARGE RECORD PHARMACY	250		10.49	N/A
HC65000250_06255983003	NONCDM CHARGE RECORD PHARMACY	250		108.48	N/A
HC65000250_06258415901	NONCDM CHARGE RECORD PHARMACY	250		37.83	N/A
HC65000250_06258426501	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_06258426601	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06258426701	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06258473301	NONCDM CHARGE RECORD PHARMACY	250		1.41	N/A
HC65000250_06258473401	NONCDM CHARGE RECORD PHARMACY	250		1.82	N/A
HC65000250_06258489701	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_06258498401	NONCDM CHARGE RECORD PHARMACY	250		1.90	N/A
HC65000250_06258499401	NONCDM CHARGE RECORD PHARMACY	250		1.99	N/A
HC65000250_06275614201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06275614301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06275614586	NONCDM CHARGE RECORD PHARMACY	250		3.50	N/A
HC65000250_06275614686	NONCDM CHARGE RECORD PHARMACY	250		3.50	N/A
HC65000250_06275618388	NONCDM CHARGE RECORD PHARMACY	250		1.80	N/A
HC65000250_06275618488	NONCDM CHARGE RECORD PHARMACY	250		3.30	N/A
HC65000250_06275625802	NONCDM CHARGE RECORD PHARMACY	250		1.26	N/A
HC65000250_06275643088	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06275651818	NONCDM CHARGE RECORD PHARMACY	250		1.61	N/A
HC65000250_06275651888	NONCDM CHARGE RECORD PHARMACY	250		1.78	N/A
HC65000250_06275652069	NONCDM CHARGE RECORD PHARMACY	250		10.63	N/A
HC65000250_06275653886	NONCDM CHARGE RECORD PHARMACY	250		25.64	N/A
HC65000250_06275658988	NONCDM CHARGE RECORD PHARMACY	250		3.80	N/A
HC65000250_06275671186	NONCDM CHARGE RECORD PHARMACY	250		2.51	N/A
HC65000250_06275679688	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06275679788	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_06285627230	NONCDM CHARGE RECORD PHARMACY	250	Z7610	106.60	N/A
HC65000250_06285627430	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.01	N/A
HC65000250_06285658252	NONCDM CHARGE RECORD PHARMACY	250		78.86	N/A
HC65000250_06285658352	NONCDM CHARGE RECORD PHARMACY	250	Z7610	158.40	N/A
HC65000250_06285658446	NONCDM CHARGE RECORD PHARMACY	250	Z7610	287.81	N/A
HC65000250_06301001030	NONCDM CHARGE RECORD PHARMACY	250		24.28	N/A
HC65000250_06302985041	NONCDM CHARGE RECORD PHARMACY	250	Z7610	27.22	N/A
HC65000250_06330401760	NONCDM CHARGE RECORD PHARMACY	250		4.00	N/A
HC65000250_06330409719	NONCDM CHARGE RECORD PHARMACY	250		11.36	N/A
HC65000250_06330419130	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06330462501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06330462601	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06330469201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06330471990	NONCDM CHARGE RECORD PHARMACY	250		4.67	N/A
HC65000250_06330496201	NONCDM CHARGE RECORD PHARMACY	250		18.02	N/A
HC65000250_06330496230	NONCDM CHARGE RECORD PHARMACY	250		19.86	N/A
HC65000250_06332306403	NONCDM CHARGE RECORD PHARMACY	250		5.99	N/A
HC65000250_06332308305	NONCDM CHARGE RECORD PHARMACY	250	J3490	113.10	N/A
HC65000250_06332308605	NONCDM CHARGE RECORD PHARMACY	250		94.94	N/A
HC65000250_06332308861	NONCDM CHARGE RECORD PHARMACY	250		16.41	N/A
HC65000250_06332308863	NONCDM CHARGE RECORD PHARMACY	250	J3490	9.67	N/A
HC65000250_06332308950	NONCDM CHARGE RECORD PHARMACY	250		124.20	N/A
HC65000250_06332309330	NONCDM CHARGE RECORD PHARMACY	250		31.63	N/A
HC65000250_06332317005	NONCDM CHARGE RECORD PHARMACY	250		91.42	N/A
HC65000250_06332317015	NONCDM CHARGE RECORD PHARMACY	250		76.52	N/A
HC65000250_06332318410	NONCDM CHARGE RECORD PHARMACY	250		25.81	N/A
HC65000250_06332318500	NONCDM CHARGE RECORD PHARMACY	250	J3490	462.00	N/A
HC65000250_06332318510	NONCDM CHARGE RECORD PHARMACY	250		15.25	N/A
HC65000250_06332318550	NONCDM CHARGE RECORD PHARMACY	250		2.13	N/A
HC65000250_06332318600	NONCDM CHARGE RECORD PHARMACY	250		40.10	N/A
HC65000250_06332318610	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06332318730	NONCDM CHARGE RECORD PHARMACY	250		2.75	N/A
HC65000250_06332320102	NONCDM CHARGE RECORD PHARMACY	250		15.60	N/A
HC65000250_06332320500	NONCDM CHARGE RECORD PHARMACY	250		131.00	N/A
HC65000250_06332325410	NONCDM CHARGE RECORD PHARMACY	250		87.99	N/A
HC65000250_06332338510	NONCDM CHARGE RECORD PHARMACY	250		114.42	N/A
HC65000250_06332338620	NONCDM CHARGE RECORD PHARMACY	250		179.61	N/A
HC65000250_06332340703	NONCDM CHARGE RECORD PHARMACY	250		29.41	N/A
HC65000250_06332342405	NONCDM CHARGE RECORD PHARMACY	250		19.42	N/A
HC65000250_06332342605	NONCDM CHARGE RECORD PHARMACY	250		39.00	N/A
HC65000250_06332346157	NONCDM CHARGE RECORD PHARMACY	250		79.29	N/A
HC65000250_06332346217	NONCDM CHARGE RECORD PHARMACY	250		20.47	N/A
HC65000250_06332346231	NONCDM CHARGE RECORD PHARMACY	250		32.55	N/A
HC65000250_06332346237	NONCDM CHARGE RECORD PHARMACY	250		31.77	N/A
HC65000250_06332346357	NONCDM CHARGE RECORD PHARMACY	250		27.83	N/A
HC65000250_06332346417	NONCDM CHARGE RECORD PHARMACY	250		27.48	N/A
HC65000250_06332346437	NONCDM CHARGE RECORD PHARMACY	250		7.69	N/A
HC65000250_06332346557	NONCDM CHARGE RECORD PHARMACY	250		51.69	N/A
HC65000250_06332346617	NONCDM CHARGE RECORD PHARMACY	250		11.53	N/A
HC65000250_06332346637	NONCDM CHARGE RECORD PHARMACY	250		21.59	N/A
HC65000250_06332346817	NONCDM CHARGE RECORD PHARMACY	250		36.84	N/A
HC65000250_06332346837	NONCDM CHARGE RECORD PHARMACY	250		33.25	N/A
HC65000250_06332347217	NONCDM CHARGE RECORD PHARMACY	250		2.85	N/A
HC65000250_06332347233	NONCDM CHARGE RECORD PHARMACY	250		39.60	N/A
HC65000250_06332347237	NONCDM CHARGE RECORD PHARMACY	250		32.64	N/A
HC65000250_06332348157	NONCDM CHARGE RECORD PHARMACY	250	J3490	0.48	N/A
HC65000250_06332348217	NONCDM CHARGE RECORD PHARMACY	250		17.94	N/A
HC65000250_06332348227	NONCDM CHARGE RECORD PHARMACY	250		10.60	N/A
HC65000250_06332348257	NONCDM CHARGE RECORD PHARMACY	250		31.14	N/A
HC65000250_06332348327	NONCDM CHARGE RECORD PHARMACY	250		14.69	N/A
HC65000250_06332348717	NONCDM CHARGE RECORD PHARMACY	250		50.43	N/A
HC65000250_06332348737	NONCDM CHARGE RECORD PHARMACY	250		32.85	N/A
HC65000250_06332348817	NONCDM CHARGE RECORD PHARMACY	250		49.98	N/A
HC65000250_06332348831	NONCDM CHARGE RECORD PHARMACY	250		68.76	N/A
HC65000250_06332348837	NONCDM CHARGE RECORD PHARMACY	250		54.36	N/A
HC65000250_06332348921	NONCDM CHARGE RECORD PHARMACY	250		62.88	N/A
HC65000250_06332348927	NONCDM CHARGE RECORD PHARMACY	250		38.71	N/A
HC65000250_06332349227	NONCDM CHARGE RECORD PHARMACY	250		13.84	N/A
HC65000250_06332349405	NONCDM CHARGE RECORD PHARMACY	250		42.75	N/A
HC65000250_06332362353	NONCDM CHARGE RECORD PHARMACY	250		18.00	N/A
HC65000250_06332366005	NONCDM CHARGE RECORD PHARMACY	250		7.11	N/A
HC65000250_06332369030	NONCDM CHARGE RECORD PHARMACY	250		19.98	N/A
HC65000250_06332369130	NONCDM CHARGE RECORD PHARMACY	250		6.67	N/A
HC65000250_06332369404	NONCDM CHARGE RECORD PHARMACY	250		76.75	N/A
HC65000250_06332369504	NONCDM CHARGE RECORD PHARMACY	250	Z7610	61.39	N/A
HC65000250_06332373820	NONCDM CHARGE RECORD PHARMACY	250		3.77	N/A
HC65000250_06332373912	NONCDM CHARGE RECORD PHARMACY	250		5.37	N/A
HC65000250_06332373916	NONCDM CHARGE RECORD PHARMACY	250		4.38	N/A
HC65000250_06332378110	NONCDM CHARGE RECORD PHARMACY	250		23.10	N/A
HC65000250_06332378220	NONCDM CHARGE RECORD PHARMACY	250	J3490	66.00	N/A
HC65000250_06332382000	NONCDM CHARGE RECORD PHARMACY	250		132.00	N/A
HC65000250_06332394004	NONCDM CHARGE RECORD PHARMACY	250		83.26	N/A
HC65000250_06339520113	NONCDM CHARGE RECORD PHARMACY	250		18.32	N/A
HC65000250_06340230230	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.01	N/A
HC65000250_06340230410	NONCDM CHARGE RECORD PHARMACY	250		154.01	N/A
HC65000250_06340230430	NONCDM CHARGE RECORD PHARMACY	250		262.71	N/A
HC65000250_06340230810	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06340291130	NONCDM CHARGE RECORD PHARMACY	250		110.24	N/A
HC65000250_06340291164	NONCDM CHARGE RECORD PHARMACY	250		109.00	N/A
HC65000250_06345940430	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06348168706	NONCDM CHARGE RECORD PHARMACY	250		128.27	N/A
HC65000250_06371301972	NONCDM CHARGE RECORD PHARMACY	250		33.34	N/A
HC65000250_06371301973	NONCDM CHARGE RECORD PHARMACY	250		146.61	N/A
HC65000250_06371301974	NONCDM CHARGE RECORD PHARMACY	250		164.58	N/A
HC65000250_06373602403	NONCDM CHARGE RECORD PHARMACY	250		50.27	N/A
HC65000250_06373612002	NONCDM CHARGE RECORD PHARMACY	250	Z7610	50.27	N/A
HC65000250_06373901510	NONCDM CHARGE RECORD PHARMACY	250		2.08	N/A
HC65000250_06373901610	NONCDM CHARGE RECORD PHARMACY	250		3.04	N/A
HC65000250_06373901810	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373902910	NONCDM CHARGE RECORD PHARMACY	250		2.75	N/A
HC65000250_06373905110	NONCDM CHARGE RECORD PHARMACY	250		1.28	N/A
HC65000250_06373905269	NONCDM CHARGE RECORD PHARMACY	250		9.83	N/A
HC65000250_06373905910	NONCDM CHARGE RECORD PHARMACY	250		3.39	N/A
HC65000250_06373906010	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373907310	NONCDM CHARGE RECORD PHARMACY	250		0.89	N/A
HC65000250_06373907910	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373908010	NONCDM CHARGE RECORD PHARMACY	250		1.41	N/A
HC65000250_06373909810	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373910310	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373912710	NONCDM CHARGE RECORD PHARMACY	250		1.60	N/A
HC65000250_06373912810	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373916510	NONCDM CHARGE RECORD PHARMACY	250		2.27	N/A
HC65000250_06373919861	NONCDM CHARGE RECORD PHARMACY	250		3.50	N/A
HC65000250_06373921201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373921202	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373921210	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373922510	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373922810	NONCDM CHARGE RECORD PHARMACY	250		2.06	N/A
HC65000250_06373923610	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06373925110	NONCDM CHARGE RECORD PHARMACY	250		2.57	N/A
HC65000250_06373925340	NONCDM CHARGE RECORD PHARMACY	250		1.58	N/A
HC65000250_06373926310	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373926910	NONCDM CHARGE RECORD PHARMACY	250		2.84	N/A
HC65000250_06373929101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373929310	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_06373932710	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373932810	NONCDM CHARGE RECORD PHARMACY	250		1.11	N/A
HC65000250_06373934910	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373935010	NONCDM CHARGE RECORD PHARMACY	250		1.28	N/A
HC65000250_06373935410	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373935810	NONCDM CHARGE RECORD PHARMACY	250		2.25	N/A
HC65000250_06373936610	NONCDM CHARGE RECORD PHARMACY	250		5.80	N/A
HC65000250_06373940310	NONCDM CHARGE RECORD PHARMACY	250		1.28	N/A
HC65000250_06373941010	NONCDM CHARGE RECORD PHARMACY	250		1.48	N/A
HC65000250_06373941110	NONCDM CHARGE RECORD PHARMACY	250		1.04	N/A
HC65000250_06373941510	NONCDM CHARGE RECORD PHARMACY	250		9.75	N/A
HC65000250_06373943201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373943210	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373943401	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_06373944710	NONCDM CHARGE RECORD PHARMACY	250	Z7610	4.46	N/A
HC65000250_06373947801	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373947802	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373947810	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06373947910	NONCDM CHARGE RECORD PHARMACY	250		1.98	N/A
HC65000250_06373948010	NONCDM CHARGE RECORD PHARMACY	250		2.91	N/A
HC65000250_06373948310	NONCDM CHARGE RECORD PHARMACY	250		1.37	N/A
HC65000250_06373948610	NONCDM CHARGE RECORD PHARMACY	250		1.49	N/A
HC65000250_06373952201	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_06373952301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373952510	NONCDM CHARGE RECORD PHARMACY	250		22.03	N/A
HC65000250_06373953110	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373954410	NONCDM CHARGE RECORD PHARMACY	250		1.10	N/A
HC65000250_06373954510	NONCDM CHARGE RECORD PHARMACY	250		3.08	N/A
HC65000250_06373955910	NONCDM CHARGE RECORD PHARMACY	250		0.94	N/A
HC65000250_06373956010	NONCDM CHARGE RECORD PHARMACY	250		3.97	N/A
HC65000250_06373956710	NONCDM CHARGE RECORD PHARMACY	250		2.30	N/A
HC65000250_06373956910	NONCDM CHARGE RECORD PHARMACY	250		4.40	N/A
HC65000250_06373957010	NONCDM CHARGE RECORD PHARMACY	250		1.23	N/A
HC65000250_06373957110	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06373957210	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373957310	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06373959110	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373964510	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_06373964910	NONCDM CHARGE RECORD PHARMACY	250		3.38	N/A
HC65000250_06373966510	NONCDM CHARGE RECORD PHARMACY	250		3.01	N/A
HC65000250_06373967010	NONCDM CHARGE RECORD PHARMACY	250		1.24	N/A
HC65000250_06373967210	NONCDM CHARGE RECORD PHARMACY	250		0.96	N/A
HC65000250_06373967310	NONCDM CHARGE RECORD PHARMACY	250		2.94	N/A
HC65000250_06373967710	NONCDM CHARGE RECORD PHARMACY	250		5.93	N/A
HC65000250_06373968410	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373968610	NONCDM CHARGE RECORD PHARMACY	250		3.13	N/A
HC65000250_06373969101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373969110	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373969810	NONCDM CHARGE RECORD PHARMACY	250		4.06	N/A
HC65000250_06373970010	NONCDM CHARGE RECORD PHARMACY	250		1.22	N/A
HC65000250_06373970110	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373977710	NONCDM CHARGE RECORD PHARMACY	250		21.75	N/A
HC65000250_06373978710	NONCDM CHARGE RECORD PHARMACY	250		1.71	N/A
HC65000250_06373979510	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373979610	NONCDM CHARGE RECORD PHARMACY	250		3.05	N/A
HC65000250_06373979733	NONCDM CHARGE RECORD PHARMACY	250		17.24	N/A
HC65000250_06373988810	NONCDM CHARGE RECORD PHARMACY	250		3.64	N/A
HC65000250_06373994310	NONCDM CHARGE RECORD PHARMACY	250		1.65	N/A
HC65000250_06373996310	NONCDM CHARGE RECORD PHARMACY	250		1.33	N/A
HC65000250_06373996940	NONCDM CHARGE RECORD PHARMACY	250		1.06	N/A
HC65000250_06373997210	NONCDM CHARGE RECORD PHARMACY	250		3.45	N/A
HC65000250_06373998410	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06373999764	NONCDM CHARGE RECORD PHARMACY	250		187.22	N/A
HC65000250_06380701117	NONCDM CHARGE RECORD PHARMACY	250		23.10	N/A
HC65000250_06380710001	NONCDM CHARGE RECORD PHARMACY	250		1.31	N/A
HC65000250_06380710011	NONCDM CHARGE RECORD PHARMACY	250		4.20	N/A
HC65000250_06382400815	NONCDM CHARGE RECORD PHARMACY	250		2.34	N/A
HC65000250_06382400834	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2.57	N/A
HC65000250_06382400840	NONCDM CHARGE RECORD PHARMACY	250		2.57	N/A
HC65000250_06382400850	NONCDM CHARGE RECORD PHARMACY	250		2.20	N/A
HC65000250_06382405634	NONCDM CHARGE RECORD PHARMACY	250		2.83	N/A
HC65000250_06382472482	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06382473016	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06382473216	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06425311123	NONCDM CHARGE RECORD PHARMACY	250		2.37	N/A
HC65000250_06438073706	NONCDM CHARGE RECORD PHARMACY	250		2.17	N/A
HC65000250_06438074207	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06438075806	NONCDM CHARGE RECORD PHARMACY	250		2.30	N/A
HC65000250_06438075906	NONCDM CHARGE RECORD PHARMACY	250		2.48	N/A
HC65000250_06438083406	NONCDM CHARGE RECORD PHARMACY	250		3.91	N/A
HC65000250_06438097025	NONCDM CHARGE RECORD PHARMACY	250		3.10	N/A
HC65000250_06459730160	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06467978102	NONCDM CHARGE RECORD PHARMACY	250		3.72	N/A
HC65000250_06467992302	NONCDM CHARGE RECORD PHARMACY	250		2.23	N/A
HC65000250_06467992402	NONCDM CHARGE RECORD PHARMACY	250		2.83	N/A
HC65000250_06472013910	NONCDM CHARGE RECORD PHARMACY	250		10.46	N/A
HC65000250_06476408060	NONCDM CHARGE RECORD PHARMACY	250		37.11	N/A
HC65000250_06476411901	NONCDM CHARGE RECORD PHARMACY	250		43.15	N/A
HC65000250_06476424060	NONCDM CHARGE RECORD PHARMACY	250		37.11	N/A
HC65000250_06476430114	NONCDM CHARGE RECORD PHARMACY	250		118.76	N/A
HC65000250_06476445124	NONCDM CHARGE RECORD PHARMACY	250		128.82	N/A
HC65000250_06476454311	NONCDM CHARGE RECORD PHARMACY	250		83.02	N/A
HC65000250_06476454411	NONCDM CHARGE RECORD PHARMACY	250		82.97	N/A
HC65000250_06476472007	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06476472030	NONCDM CHARGE RECORD PHARMACY	250		81.73	N/A
HC65000250_06476473007	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06476473030	NONCDM CHARGE RECORD PHARMACY	250		75.60	N/A
HC65000250_06476475030	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06476491830	NONCDM CHARGE RECORD PHARMACY	250		66.01	N/A
HC65000250_06489666101	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06489666201	NONCDM CHARGE RECORD PHARMACY	250		0.00	N/A
HC65000250_06489666209	NONCDM CHARGE RECORD PHARMACY	250		0.00	N/A
HC65000250_06489666301	NONCDM CHARGE RECORD PHARMACY	250		0.00	N/A
HC65000250_06489666401	NONCDM CHARGE RECORD PHARMACY	250		16.57	N/A
HC65000250_06489666499	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06498010401	NONCDM CHARGE RECORD PHARMACY	250		2.03	N/A
HC65000250_06498014612	NONCDM CHARGE RECORD PHARMACY	250		9.71	N/A
HC65000250_06498029410	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06498033901	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06498040709	NONCDM CHARGE RECORD PHARMACY	250		56.48	N/A
HC65000250_06498050448	NONCDM CHARGE RECORD PHARMACY	250		4.45	N/A
HC65000250_06498051305	NONCDM CHARGE RECORD PHARMACY	250		31.19	N/A
HC65000250_06498051405	NONCDM CHARGE RECORD PHARMACY	250		57.90	N/A
HC65000250_06498052810	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06516205827	NONCDM CHARGE RECORD PHARMACY	250		5.73	N/A
HC65000250_06516218810	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06516218910	NONCDM CHARGE RECORD PHARMACY	250		0.90	N/A
HC65000250_06516219010	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_06516219050	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_06516224709	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06516232109	NONCDM CHARGE RECORD PHARMACY	250		2.81	N/A
HC65000250_06516236110	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_06516236111	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06516237210	NONCDM CHARGE RECORD PHARMACY	250		3.63	N/A
HC65000250_06516241503	NONCDM CHARGE RECORD PHARMACY	250	J0574	0.01	N/A
HC65000250_06516244110	NONCDM CHARGE RECORD PHARMACY	250		1.23	N/A
HC65000250_06516244210	NONCDM CHARGE RECORD PHARMACY	250		1.89	N/A
HC65000250_06516246410	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06516246450	NONCDM CHARGE RECORD PHARMACY	250		0.86	N/A
HC65000250_06516246510	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06516246550	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_06516246610	NONCDM CHARGE RECORD PHARMACY	250		0.83	N/A
HC65000250_06516246650	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06516247505	NONCDM CHARGE RECORD PHARMACY	250	Z7610	11.11	N/A
HC65000250_06516251150	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06516254410	NONCDM CHARGE RECORD PHARMACY	250		1.54	N/A
HC65000250_06516255610	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06516257110	NONCDM CHARGE RECORD PHARMACY	250		1.59	N/A
HC65000250_06516257210	NONCDM CHARGE RECORD PHARMACY	250		2.05	N/A
HC65000250_06516257310	NONCDM CHARGE RECORD PHARMACY	250		3.02	N/A
HC65000250_06516259020	NONCDM CHARGE RECORD PHARMACY	250		2.73	N/A
HC65000250_06516259606	NONCDM CHARGE RECORD PHARMACY	250		7.99	N/A
HC65000250_06516262710	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06516263609	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_06516263709	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06516264978	NONCDM CHARGE RECORD PHARMACY	250		21.73	N/A
HC65000250_06516267384	NONCDM CHARGE RECORD PHARMACY	250		9.63	N/A
HC65000250_06516268110	NONCDM CHARGE RECORD PHARMACY	250		2.02	N/A
HC65000250_06516268210	NONCDM CHARGE RECORD PHARMACY	250		2.88	N/A
HC65000250_06516268690	NONCDM CHARGE RECORD PHARMACY	250		22.93	N/A
HC65000250_06516269890	NONCDM CHARGE RECORD PHARMACY	250		3.47	N/A
HC65000250_06516271110	NONCDM CHARGE RECORD PHARMACY	250		2.32	N/A
HC65000250_06516271310	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06516275003	NONCDM CHARGE RECORD PHARMACY	250		4.25	N/A
HC65000250_06516275110	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06516275310	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06516275350	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06516277810	NONCDM CHARGE RECORD PHARMACY	250		13.35	N/A
HC65000250_06516283366	NONCDM CHARGE RECORD PHARMACY	250		191.70	N/A
HC65000250_06516283703	NONCDM CHARGE RECORD PHARMACY	250		1.59	N/A
HC65000250_06516289703	NONCDM CHARGE RECORD PHARMACY	250		1.84	N/A
HC65000250_06516289803	NONCDM CHARGE RECORD PHARMACY	250		1.76	N/A
HC65000250_06516299208	NONCDM CHARGE RECORD PHARMACY	250		54.38	N/A
HC65000250_06516299708	NONCDM CHARGE RECORD PHARMACY	250		54.50	N/A
HC65000250_06521905229	NONCDM CHARGE RECORD PHARMACY	250		127.74	N/A
HC65000250_06521905429	NONCDM CHARGE RECORD PHARMACY	250		112.70	N/A
HC65000250_06559710130	NONCDM CHARGE RECORD PHARMACY	250		39.54	N/A
HC65000250_06559710330	NONCDM CHARGE RECORD PHARMACY	250		47.17	N/A
HC65000250_06559770118	NONCDM CHARGE RECORD PHARMACY	250		22.32	N/A
HC65000250_06562801610	NONCDM CHARGE RECORD PHARMACY	250		19.27	N/A
HC65000250_06562806201	NONCDM CHARGE RECORD PHARMACY	250		14.34	N/A
HC65000250_06562806301	NONCDM CHARGE RECORD PHARMACY	250		21.72	N/A
HC65000250_06562807003	NONCDM CHARGE RECORD PHARMACY	250	Z7610	22.20	N/A
HC65000250_06562807005	NONCDM CHARGE RECORD PHARMACY	250		20.58	N/A
HC65000250_06562820605	NONCDM CHARGE RECORD PHARMACY	250		26.17	N/A
HC65000250_06562820810	NONCDM CHARGE RECORD PHARMACY	250		17.08	N/A
HC65000250_06564915090	NONCDM CHARGE RECORD PHARMACY	250		0.00	N/A
HC65000250_06564930103	NONCDM CHARGE RECORD PHARMACY	250		164.40	N/A
HC65000250_06564930302	NONCDM CHARGE RECORD PHARMACY	250		266.61	N/A
HC65000250_06564930303	NONCDM CHARGE RECORD PHARMACY	250		270.26	N/A
HC65000250_06564931112	NONCDM CHARGE RECORD PHARMACY	250		2.62	N/A
HC65000250_06564941124	NONCDM CHARGE RECORD PHARMACY	250		68.99	N/A
HC65000250_06586200601	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586200605	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586200801	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_06586201901	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586201905	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586202106	NONCDM CHARGE RECORD PHARMACY	250		10.60	N/A
HC65000250_06586202760	NONCDM CHARGE RECORD PHARMACY	250		4.00	N/A
HC65000250_06586204824	NONCDM CHARGE RECORD PHARMACY	250		1.80	N/A
HC65000250_06586206201	NONCDM CHARGE RECORD PHARMACY	250		0.51	N/A
HC65000250_06586206299	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586206301	NONCDM CHARGE RECORD PHARMACY	250		0.91	N/A
HC65000250_06586206399	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586206401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586207360	NONCDM CHARGE RECORD PHARMACY	250		15.00	N/A
HC65000250_06586210701	NONCDM CHARGE RECORD PHARMACY	250		9.09	N/A
HC65000250_06586211601	NONCDM CHARGE RECORD PHARMACY	250		1.78	N/A
HC65000250_06586214150	NONCDM CHARGE RECORD PHARMACY	250		82.74	N/A
HC65000250_06586214636	NONCDM CHARGE RECORD PHARMACY	250		10.12	N/A
HC65000250_06586214736	NONCDM CHARGE RECORD PHARMACY	250		10.63	N/A
HC65000250_06586214905	NONCDM CHARGE RECORD PHARMACY	250		1.50	N/A
HC65000250_06586214990	NONCDM CHARGE RECORD PHARMACY	250		2.39	N/A
HC65000250_06586217760	NONCDM CHARGE RECORD PHARMACY	250		5.00	N/A
HC65000250_06586218501	NONCDM CHARGE RECORD PHARMACY	250		1.14	N/A
HC65000250_06586218730	NONCDM CHARGE RECORD PHARMACY	250		1.09	N/A
HC65000250_06586219201	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_06586219301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586219399	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586220290	NONCDM CHARGE RECORD PHARMACY	250		1.10	N/A
HC65000250_06586220390	NONCDM CHARGE RECORD PHARMACY	250		1.11	N/A
HC65000250_06586221150	NONCDM CHARGE RECORD PHARMACY	250		3.34	N/A
HC65000250_06586221901	NONCDM CHARGE RECORD PHARMACY	250		6.15	N/A
HC65000250_06586222660	NONCDM CHARGE RECORD PHARMACY	250		5.60	N/A
HC65000250_06586223703	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06586224608	NONCDM CHARGE RECORD PHARMACY	250		1.45	N/A
HC65000250_06586235705	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586235730	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586237401	NONCDM CHARGE RECORD PHARMACY	250		1.48	N/A
HC65000250_06586239010	NONCDM CHARGE RECORD PHARMACY	250		3.11	N/A
HC65000250_06586239110	NONCDM CHARGE RECORD PHARMACY	250		5.07	N/A
HC65000250_06586241901	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586245860	NONCDM CHARGE RECORD PHARMACY	250		3.95	N/A
HC65000250_06586245960	NONCDM CHARGE RECORD PHARMACY	250		6.95	N/A
HC65000250_06586247501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586249647	NONCDM CHARGE RECORD PHARMACY	250		1.83	N/A
HC65000250_06586251230	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586252201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586252890	NONCDM CHARGE RECORD PHARMACY	250		2.95	N/A
HC65000250_06586253401	NONCDM CHARGE RECORD PHARMACY	250		21.45	N/A
HC65000250_06586253650	NONCDM CHARGE RECORD PHARMACY	250		2.28	N/A
HC65000250_06586253750	NONCDM CHARGE RECORD PHARMACY	250		2.61	N/A
HC65000250_06586253820	NONCDM CHARGE RECORD PHARMACY	250		4.80	N/A
HC65000250_06586255990	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586257030	NONCDM CHARGE RECORD PHARMACY	250		2.44	N/A
HC65000250_06586257390	NONCDM CHARGE RECORD PHARMACY	250		3.17	N/A
HC65000250_06586257490	NONCDM CHARGE RECORD PHARMACY	250		1.33	N/A
HC65000250_06586259601	NONCDM CHARGE RECORD PHARMACY	250	Z7610	14.90	N/A
HC65000250_06586259801	NONCDM CHARGE RECORD PHARMACY	250		1.90	N/A
HC65000250_06586260130	NONCDM CHARGE RECORD PHARMACY	250		3.60	N/A
HC65000250_06586261990	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586262690	NONCDM CHARGE RECORD PHARMACY	250	Z7610	12.25	N/A
HC65000250_06586264163	NONCDM CHARGE RECORD PHARMACY	250		8.44	N/A
HC65000250_06586266130	NONCDM CHARGE RECORD PHARMACY	250		4.85	N/A
HC65000250_06586266230	NONCDM CHARGE RECORD PHARMACY	250		5.20	N/A
HC65000250_06586266330	NONCDM CHARGE RECORD PHARMACY	250		5.22	N/A
HC65000250_06586267001	NONCDM CHARGE RECORD PHARMACY	250		1.86	N/A
HC65000250_06586267101	NONCDM CHARGE RECORD PHARMACY	250		1.86	N/A
HC65000250_06586271160	NONCDM CHARGE RECORD PHARMACY	250		44.55	N/A
HC65000250_06586274130	NONCDM CHARGE RECORD PHARMACY	250		1.50	N/A
HC65000250_06586275250	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.12	N/A
HC65000250_06586275360	NONCDM CHARGE RECORD PHARMACY	250		23.81	N/A
HC65000250_06586276990	NONCDM CHARGE RECORD PHARMACY	250		4.52	N/A
HC65000250_06586278201	NONCDM CHARGE RECORD PHARMACY	250		9.72	N/A
HC65000250_06586283030	NONCDM CHARGE RECORD PHARMACY	250		4.95	N/A
HC65000250_06586284130	NONCDM CHARGE RECORD PHARMACY	250		12.63	N/A
HC65000250_06586284230	NONCDM CHARGE RECORD PHARMACY	250		13.07	N/A
HC65000250_06586285901	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06586292127	NONCDM CHARGE RECORD PHARMACY	250		2.33	N/A
HC65000250_06586292730	NONCDM CHARGE RECORD PHARMACY	250		1.60	N/A
HC65000250_06586293630	NONCDM CHARGE RECORD PHARMACY	250		8.90	N/A
HC65000250_06586294760	NONCDM CHARGE RECORD PHARMACY	250		13.56	N/A
HC65000250_06630246760	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06655300101	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06655300201	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_06655300401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06655300801	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06668510121	NONCDM CHARGE RECORD PHARMACY	250		3.69	N/A
HC65000250_06668900450	NONCDM CHARGE RECORD PHARMACY	250		28.81	N/A
HC65000250_06668900550	NONCDM CHARGE RECORD PHARMACY	250		24.46	N/A
HC65000250_06668900802	NONCDM CHARGE RECORD PHARMACY	250		72.00	N/A
HC65000250_06668900816	NONCDM CHARGE RECORD PHARMACY	250		1.51	N/A
HC65000250_06668902050	NONCDM CHARGE RECORD PHARMACY	250		9.65	N/A
HC65000250_06668902350	NONCDM CHARGE RECORD PHARMACY	250		24.00	N/A
HC65000250_06668903150	NONCDM CHARGE RECORD PHARMACY	250		32.40	N/A
HC65000250_06668903650	NONCDM CHARGE RECORD PHARMACY	250		44.01	N/A
HC65000250_06668903799	NONCDM CHARGE RECORD PHARMACY	250		5.11	N/A
HC65000250_06668903850	NONCDM CHARGE RECORD PHARMACY	250		8.01	N/A
HC65000250_06668905499	NONCDM CHARGE RECORD PHARMACY	250		9.72	N/A
HC65000250_06668905599	NONCDM CHARGE RECORD PHARMACY	250		12.49	N/A
HC65000250_06668905699	NONCDM CHARGE RECORD PHARMACY	250		13.28	N/A
HC65000250_06668906099	NONCDM CHARGE RECORD PHARMACY	250		15.68	N/A
HC65000250_06668906242	NONCDM CHARGE RECORD PHARMACY	250		309.44	N/A
HC65000250_06668920204	NONCDM CHARGE RECORD PHARMACY	250		91.78	N/A
HC65000250_06668920304	NONCDM CHARGE RECORD PHARMACY	250		120.14	N/A
HC65000250_06668920308	NONCDM CHARGE RECORD PHARMACY	250		180.00	N/A
HC65000250_06668971116	NONCDM CHARGE RECORD PHARMACY	250	Z7610	10.22	N/A
HC65000250_06668977508	NONCDM CHARGE RECORD PHARMACY	250		3.60	N/A
HC65000250_06668979050	NONCDM CHARGE RECORD PHARMACY	250		61.79	N/A
HC65000250_06675817013	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2.96	N/A
HC65000250_06675819013	NONCDM CHARGE RECORD PHARMACY	250		3.25	N/A
HC65000250_06682504720	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3.96	N/A
HC65000250_06686910490	NONCDM CHARGE RECORD PHARMACY	250		0.00	N/A
HC65000250_06686920490	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06699301968	NONCDM CHARGE RECORD PHARMACY	250		215.89	N/A
HC65000250_06699302227	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06699305702	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.14	N/A
HC65000250_06699306880	NONCDM CHARGE RECORD PHARMACY	250		2.26	N/A
HC65000250_06699314130	NONCDM CHARGE RECORD PHARMACY	250		37.36	N/A
HC65000250_06699342285	NONCDM CHARGE RECORD PHARMACY	250		64.76	N/A
HC65000250_06699383102	NONCDM CHARGE RECORD PHARMACY	250		57.25	N/A
HC65000250_06725365110	NONCDM CHARGE RECORD PHARMACY	250		8.17	N/A
HC65000250_06738682019	NONCDM CHARGE RECORD PHARMACY	250		175.15	N/A
HC65000250_06745700110	NONCDM CHARGE RECORD PHARMACY	250		6.87	N/A
HC65000250_06745716202	NONCDM CHARGE RECORD PHARMACY	250		468.76	N/A
HC65000250_06745718120	NONCDM CHARGE RECORD PHARMACY	250		21.57	N/A
HC65000250_06745722805	NONCDM CHARGE RECORD PHARMACY	250		18.49	N/A
HC65000250_06745743322	NONCDM CHARGE RECORD PHARMACY	250		5.36	N/A
HC65000250_06745743810	NONCDM CHARGE RECORD PHARMACY	250		28.92	N/A
HC65000250_06745747520	NONCDM CHARGE RECORD PHARMACY	250	J3490	91.76	N/A
HC65000250_06745785204	NONCDM CHARGE RECORD PHARMACY	250		125.55	N/A
HC65000250_06745790210	NONCDM CHARGE RECORD PHARMACY	250		49.65	N/A
HC65000250_06754611114	NONCDM CHARGE RECORD PHARMACY	250		869.50	N/A
HC65000250_06754621221	NONCDM CHARGE RECORD PHARMACY	250		1,305.00	N/A
HC65000250_06761810160	NONCDM CHARGE RECORD PHARMACY	250		1.49	N/A
HC65000250_06761811128	NONCDM CHARGE RECORD PHARMACY	250		1.47	N/A
HC65000250_06761830010	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06761830011	NONCDM CHARGE RECORD PHARMACY	250		1.23	N/A
HC65000250_06761830020	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06761830050	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06761831030	NONCDM CHARGE RECORD PHARMACY	250		2.39	N/A
HC65000250_06761831060	NONCDM CHARGE RECORD PHARMACY	250		2.16	N/A
HC65000250_06777725101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06787711601	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06787712405	NONCDM CHARGE RECORD PHARMACY	250		73.61	N/A
HC65000250_06787712420	NONCDM CHARGE RECORD PHARMACY	250		35.16	N/A
HC65000250_06787714601	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06787719790	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06787719805	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06787719905	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06787722001	NONCDM CHARGE RECORD PHARMACY	250		0.92	N/A
HC65000250_06787722305	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06787722310	NONCDM CHARGE RECORD PHARMACY	250		3.25	N/A
HC65000250_06787725115	NONCDM CHARGE RECORD PHARMACY	250		25.47	N/A
HC65000250_06787725130	NONCDM CHARGE RECORD PHARMACY	250		36.54	N/A
HC65000250_06787726030	NONCDM CHARGE RECORD PHARMACY	250		6.84	N/A
HC65000250_06787726118	NONCDM CHARGE RECORD PHARMACY	250		4.95	N/A
HC65000250_06787728660	NONCDM CHARGE RECORD PHARMACY	250		12.70	N/A
HC65000250_06787728890	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06787732005	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06787739230	NONCDM CHARGE RECORD PHARMACY	250		2.78	N/A
HC65000250_06787743103	NONCDM CHARGE RECORD PHARMACY	250		1.40	N/A
HC65000250_06787744630	NONCDM CHARGE RECORD PHARMACY	250		1.53	N/A
HC65000250_06787745430	NONCDM CHARGE RECORD PHARMACY	250		10.00	N/A
HC65000250_06787749301	NONCDM CHARGE RECORD PHARMACY	250		1.50	N/A
HC65000250_06787750651	NONCDM CHARGE RECORD PHARMACY	250		5.37	N/A
HC65000250_06787756101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06787757305	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06800138200	NONCDM CHARGE RECORD PHARMACY	250		3.41	N/A
HC65000250_06800139708	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06808402701	NONCDM CHARGE RECORD PHARMACY	250		1.93	N/A
HC65000250_06808404001	NONCDM CHARGE RECORD PHARMACY	250		4.47	N/A
HC65000250_06808404101	NONCDM CHARGE RECORD PHARMACY	250		13.63	N/A
HC65000250_06808404401	NONCDM CHARGE RECORD PHARMACY	250		5.08	N/A
HC65000250_06808404501	NONCDM CHARGE RECORD PHARMACY	250		1.94	N/A
HC65000250_06808405201	NONCDM CHARGE RECORD PHARMACY	250		1.98	N/A
HC65000250_06808405921	NONCDM CHARGE RECORD PHARMACY	250	Z7610	14.47	N/A
HC65000250_06808407001	NONCDM CHARGE RECORD PHARMACY	250		2.09	N/A
HC65000250_06808407521	NONCDM CHARGE RECORD PHARMACY	250		165.16	N/A
HC65000250_06808408201	NONCDM CHARGE RECORD PHARMACY	250		5.59	N/A
HC65000250_06808409301	NONCDM CHARGE RECORD PHARMACY	250		2.19	N/A
HC65000250_06808409701	NONCDM CHARGE RECORD PHARMACY	250		2.22	N/A
HC65000250_06808409801	NONCDM CHARGE RECORD PHARMACY	250		2.70	N/A
HC65000250_06808410309	NONCDM CHARGE RECORD PHARMACY	250		16.62	N/A
HC65000250_06808410801	NONCDM CHARGE RECORD PHARMACY	250		2.33	N/A
HC65000250_06808410901	NONCDM CHARGE RECORD PHARMACY	250		5.46	N/A
HC65000250_06808411101	NONCDM CHARGE RECORD PHARMACY	250		3.60	N/A
HC65000250_06808417521	NONCDM CHARGE RECORD PHARMACY	250		58.84	N/A
HC65000250_06808418901	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06808419901	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06808420201	NONCDM CHARGE RECORD PHARMACY	250		3.25	N/A
HC65000250_06808420301	NONCDM CHARGE RECORD PHARMACY	250		3.90	N/A
HC65000250_06808420401	NONCDM CHARGE RECORD PHARMACY	250		3.16	N/A
HC65000250_06808420501	NONCDM CHARGE RECORD PHARMACY	250		3.82	N/A
HC65000250_06808421401	NONCDM CHARGE RECORD PHARMACY	250		2.78	N/A
HC65000250_06808422001	NONCDM CHARGE RECORD PHARMACY	250		4.29	N/A
HC65000250_06808422901	NONCDM CHARGE RECORD PHARMACY	250		2.81	N/A
HC65000250_06808424301	NONCDM CHARGE RECORD PHARMACY	250		2.63	N/A
HC65000250_06808424401	NONCDM CHARGE RECORD PHARMACY	250		6.64	N/A
HC65000250_06808424801	NONCDM CHARGE RECORD PHARMACY	250		1.71	N/A
HC65000250_06808425221	NONCDM CHARGE RECORD PHARMACY	250		15.19	N/A
HC65000250_06808425301	NONCDM CHARGE RECORD PHARMACY	250		1.61	N/A
HC65000250_06808425401	NONCDM CHARGE RECORD PHARMACY	250		1.86	N/A
HC65000250_06808425501	NONCDM CHARGE RECORD PHARMACY	250		2.27	N/A
HC65000250_06808426901	NONCDM CHARGE RECORD PHARMACY	250		11.23	N/A
HC65000250_06808427101	NONCDM CHARGE RECORD PHARMACY	250		1.63	N/A
HC65000250_06808428001	NONCDM CHARGE RECORD PHARMACY	250		9.28	N/A
HC65000250_06808428101	NONCDM CHARGE RECORD PHARMACY	250		4.70	N/A
HC65000250_06808428201	NONCDM CHARGE RECORD PHARMACY	250		4.37	N/A
HC65000250_06808428401	NONCDM CHARGE RECORD PHARMACY	250		5.59	N/A
HC65000250_06808428801	NONCDM CHARGE RECORD PHARMACY	250		5.06	N/A
HC65000250_06808429521	NONCDM CHARGE RECORD PHARMACY	250		6.80	N/A
HC65000250_06808431001	NONCDM CHARGE RECORD PHARMACY	250		8.77	N/A
HC65000250_06808431301	NONCDM CHARGE RECORD PHARMACY	250		5.03	N/A
HC65000250_06808431801	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06808431901	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06808432601	NONCDM CHARGE RECORD PHARMACY	250		3.25	N/A
HC65000250_06808432701	NONCDM CHARGE RECORD PHARMACY	250		4.59	N/A
HC65000250_06808432821	NONCDM CHARGE RECORD PHARMACY	250	Z7610	17.54	N/A
HC65000250_06808434201	NONCDM CHARGE RECORD PHARMACY	250		2.03	N/A
HC65000250_06808434301	NONCDM CHARGE RECORD PHARMACY	250		2.48	N/A
HC65000250_06808434401	NONCDM CHARGE RECORD PHARMACY	250		2.75	N/A
HC65000250_06808434601	NONCDM CHARGE RECORD PHARMACY	250		3.08	N/A
HC65000250_06808434701	NONCDM CHARGE RECORD PHARMACY	250		3.63	N/A
HC65000250_06808435501	NONCDM CHARGE RECORD PHARMACY	250		2.33	N/A
HC65000250_06808435721	NONCDM CHARGE RECORD PHARMACY	250		9.56	N/A
HC65000250_06808436009	NONCDM CHARGE RECORD PHARMACY	250		3.90	N/A
HC65000250_06808436601	NONCDM CHARGE RECORD PHARMACY	250		8.70	N/A
HC65000250_06808437201	NONCDM CHARGE RECORD PHARMACY	250		1.59	N/A
HC65000250_06808437301	NONCDM CHARGE RECORD PHARMACY	250		5.55	N/A
HC65000250_06808437601	NONCDM CHARGE RECORD PHARMACY	250		3.16	N/A
HC65000250_06808439665	NONCDM CHARGE RECORD PHARMACY	250		9.57	N/A
HC65000250_06808440001	NONCDM CHARGE RECORD PHARMACY	250		2.74	N/A
HC65000250_06808441501	NONCDM CHARGE RECORD PHARMACY	250		13.12	N/A
HC65000250_06808442301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06808444401	NONCDM CHARGE RECORD PHARMACY	250		4.13	N/A
HC65000250_06808444601	NONCDM CHARGE RECORD PHARMACY	250		17.29	N/A
HC65000250_06808445821	NONCDM CHARGE RECORD PHARMACY	250		11.34	N/A
HC65000250_06808445921	NONCDM CHARGE RECORD PHARMACY	250		11.94	N/A
HC65000250_06808447201	NONCDM CHARGE RECORD PHARMACY	250		1.30	N/A
HC65000250_06808448201	NONCDM CHARGE RECORD PHARMACY	250		3.39	N/A
HC65000250_06808449101	NONCDM CHARGE RECORD PHARMACY	250		3.56	N/A
HC65000250_06808449401	NONCDM CHARGE RECORD PHARMACY	250		7.41	N/A
HC65000250_06808451101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06808451201	NONCDM CHARGE RECORD PHARMACY	250		1.40	N/A
HC65000250_06808453601	NONCDM CHARGE RECORD PHARMACY	250		1.53	N/A
HC65000250_06808454101	NONCDM CHARGE RECORD PHARMACY	250		20.94	N/A
HC65000250_06808454921	NONCDM CHARGE RECORD PHARMACY	250		22.46	N/A
HC65000250_06808457201	NONCDM CHARGE RECORD PHARMACY	250		5.01	N/A
HC65000250_06808459025	NONCDM CHARGE RECORD PHARMACY	250		3.52	N/A
HC65000250_06808459101	NONCDM CHARGE RECORD PHARMACY	250		3.00	N/A
HC65000250_06808459201	NONCDM CHARGE RECORD PHARMACY	250		4.15	N/A
HC65000250_06808459701	NONCDM CHARGE RECORD PHARMACY	250		8.86	N/A
HC65000250_06808459801	NONCDM CHARGE RECORD PHARMACY	250		14.76	N/A
HC65000250_06808460321	NONCDM CHARGE RECORD PHARMACY	250		18.73	N/A
HC65000250_06808460501	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06808460621	NONCDM CHARGE RECORD PHARMACY	250		11.39	N/A
HC65000250_06808461021	NONCDM CHARGE RECORD PHARMACY	250	Z7610	16.22	N/A
HC65000250_06808461701	NONCDM CHARGE RECORD PHARMACY	250		1.42	N/A
HC65000250_06808462121	NONCDM CHARGE RECORD PHARMACY	250		66.00	N/A
HC65000250_06808464301	NONCDM CHARGE RECORD PHARMACY	250		1.46	N/A
HC65000250_06808465401	NONCDM CHARGE RECORD PHARMACY	250		7.64	N/A
HC65000250_06808467521	NONCDM CHARGE RECORD PHARMACY	250		10.60	N/A
HC65000250_06808467601	NONCDM CHARGE RECORD PHARMACY	250		2.93	N/A
HC65000250_06808468301	NONCDM CHARGE RECORD PHARMACY	250		9.55	N/A
HC65000250_06808469201	NONCDM CHARGE RECORD PHARMACY	250		9.19	N/A
HC65000250_06808469701	NONCDM CHARGE RECORD PHARMACY	250		3.94	N/A
HC65000250_06808470825	NONCDM CHARGE RECORD PHARMACY	250		3.67	N/A
HC65000250_06808470901	NONCDM CHARGE RECORD PHARMACY	250		3.28	N/A
HC65000250_06808471301	NONCDM CHARGE RECORD PHARMACY	250		3.72	N/A
HC65000250_06808472301	NONCDM CHARGE RECORD PHARMACY	250		2.86	N/A
HC65000250_06808472801	NONCDM CHARGE RECORD PHARMACY	250		11.10	N/A
HC65000250_06808472921	NONCDM CHARGE RECORD PHARMACY	250		21.00	N/A
HC65000250_06808473501	NONCDM CHARGE RECORD PHARMACY	250		16.16	N/A
HC65000250_06808473701	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06808474001	NONCDM CHARGE RECORD PHARMACY	250		4.66	N/A
HC65000250_06808474825	NONCDM CHARGE RECORD PHARMACY	250		9.38	N/A
HC65000250_06808475025	NONCDM CHARGE RECORD PHARMACY	250		4.18	N/A
HC65000250_06808475635	NONCDM CHARGE RECORD PHARMACY	250		26.83	N/A
HC65000250_06808476201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06808476521	NONCDM CHARGE RECORD PHARMACY	250		3.32	N/A
HC65000250_06808477401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06808477601	NONCDM CHARGE RECORD PHARMACY	250		1.30	N/A
HC65000250_06808478201	NONCDM CHARGE RECORD PHARMACY	250		2.14	N/A
HC65000250_06808478261	NONCDM CHARGE RECORD PHARMACY	250		2.14	N/A
HC65000250_06808478301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06808480521	NONCDM CHARGE RECORD PHARMACY	250		9.94	N/A
HC65000250_06808480801	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06808481309	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06808482321	NONCDM CHARGE RECORD PHARMACY	250		8.88	N/A
HC65000250_06808484301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06808484401	NONCDM CHARGE RECORD PHARMACY	250		4.05	N/A
HC65000250_06808484501	NONCDM CHARGE RECORD PHARMACY	250		3.20	N/A
HC65000250_06808484701	NONCDM CHARGE RECORD PHARMACY	250		3.00	N/A
HC65000250_06808485101	NONCDM CHARGE RECORD PHARMACY	250		5.53	N/A
HC65000250_06808485125	NONCDM CHARGE RECORD PHARMACY	250		5.08	N/A
HC65000250_06808485301	NONCDM CHARGE RECORD PHARMACY	250		5.03	N/A
HC65000250_06808485601	NONCDM CHARGE RECORD PHARMACY	250		4.42	N/A
HC65000250_06808485901	NONCDM CHARGE RECORD PHARMACY	250		1.50	N/A
HC65000250_06808486301	NONCDM CHARGE RECORD PHARMACY	250		3.23	N/A
HC65000250_06808487001	NONCDM CHARGE RECORD PHARMACY	250		1.70	N/A
HC65000250_06808487501	NONCDM CHARGE RECORD PHARMACY	250		3.00	N/A
HC65000250_06808488201	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2.88	N/A
HC65000250_06808489501	NONCDM CHARGE RECORD PHARMACY	250		2.94	N/A
HC65000250_06808489509	NONCDM CHARGE RECORD PHARMACY	250		3.18	N/A
HC65000250_06808489925	NONCDM CHARGE RECORD PHARMACY	250		6.40	N/A
HC65000250_06808491231	NONCDM CHARGE RECORD PHARMACY	250		12.66	N/A
HC65000250_06808496425	NONCDM CHARGE RECORD PHARMACY	250		15.23	N/A
HC65000250_06808496525	NONCDM CHARGE RECORD PHARMACY	250		255.00	N/A
HC65000250_06808499601	NONCDM CHARGE RECORD PHARMACY	250		8.93	N/A
HC65000250_06809400162	NONCDM CHARGE RECORD PHARMACY	250		7.46	N/A
HC65000250_06809400462	NONCDM CHARGE RECORD PHARMACY	250		11.83	N/A
HC65000250_06809400762	NONCDM CHARGE RECORD PHARMACY	250		18.15	N/A
HC65000250_06809400862	NONCDM CHARGE RECORD PHARMACY	250		22.74	N/A
HC65000250_06809401561	NONCDM CHARGE RECORD PHARMACY	250		6.71	N/A
HC65000250_06809401962	NONCDM CHARGE RECORD PHARMACY	250	Z7610	8.58	N/A
HC65000250_06809410961	NONCDM CHARGE RECORD PHARMACY	250		1.32	N/A
HC65000250_06809419359	NONCDM CHARGE RECORD PHARMACY	250		4.37	N/A
HC65000250_06809425061	NONCDM CHARGE RECORD PHARMACY	250		10.62	N/A
HC65000250_06809425062	NONCDM CHARGE RECORD PHARMACY	250		21.12	N/A
HC65000250_06809449461	NONCDM CHARGE RECORD PHARMACY	250		7.06	N/A
HC65000250_06809449462	NONCDM CHARGE RECORD PHARMACY	250		5.79	N/A
HC65000250_06809450359	NONCDM CHARGE RECORD PHARMACY	250		10.42	N/A
HC65000250_06809450362	NONCDM CHARGE RECORD PHARMACY	250		9.34	N/A
HC65000250_06809475059	NONCDM CHARGE RECORD PHARMACY	250		22.98	N/A
HC65000250_06809476462	NONCDM CHARGE RECORD PHARMACY	250		35.01	N/A
HC65000250_06813420116	NONCDM CHARGE RECORD PHARMACY	250		68.00	N/A
HC65000250_06813436301	NONCDM CHARGE RECORD PHARMACY	250	Z7610	64.55	N/A
HC65000250_06817600011	NONCDM CHARGE RECORD PHARMACY	250		2.85	N/A
HC65000250_06818011416	NONCDM CHARGE RECORD PHARMACY	250		2.67	N/A
HC65000250_06818012201	NONCDM CHARGE RECORD PHARMACY	250		1.67	N/A
HC65000250_06818012202	NONCDM CHARGE RECORD PHARMACY	250		1.72	N/A
HC65000250_06818015001	NONCDM CHARGE RECORD PHARMACY	250		26.66	N/A
HC65000250_06818015701	NONCDM CHARGE RECORD PHARMACY	250	Z7610	11.45	N/A
HC65000250_06818016013	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06818028001	NONCDM CHARGE RECORD PHARMACY	250		2.75	N/A
HC65000250_06818028101	NONCDM CHARGE RECORD PHARMACY	250		7.63	N/A
HC65000250_06818044101	NONCDM CHARGE RECORD PHARMACY	250		2.36	N/A
HC65000250_06818046701	NONCDM CHARGE RECORD PHARMACY	250		1.31	N/A
HC65000250_06818046801	NONCDM CHARGE RECORD PHARMACY	250		1.28	N/A
HC65000250_06818046901	NONCDM CHARGE RECORD PHARMACY	250		2.06	N/A
HC65000250_06818051701	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06818055409	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06818056601	NONCDM CHARGE RECORD PHARMACY	250		3.31	N/A
HC65000250_06818058901	NONCDM CHARGE RECORD PHARMACY	250		1.96	N/A
HC65000250_06818059001	NONCDM CHARGE RECORD PHARMACY	250		2.06	N/A
HC65000250_06818065806	NONCDM CHARGE RECORD PHARMACY	250	Z7610	15.56	N/A
HC65000250_06818065906	NONCDM CHARGE RECORD PHARMACY	250		22.04	N/A
HC65000250_06818065907	NONCDM CHARGE RECORD PHARMACY	250		21.93	N/A
HC65000250_06818067801	NONCDM CHARGE RECORD PHARMACY	250		9.64	N/A
HC65000250_06818085473	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06818096501	NONCDM CHARGE RECORD PHARMACY	250		2.19	N/A
HC65000250_06818096509	NONCDM CHARGE RECORD PHARMACY	250		2.19	N/A
HC65000250_06818096609	NONCDM CHARGE RECORD PHARMACY	250		2.51	N/A
HC65000250_06818096909	NONCDM CHARGE RECORD PHARMACY	250		2.81	N/A
HC65000250_06818097901	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06818098003	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06818098101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06830847547	NONCDM CHARGE RECORD PHARMACY	250		9.14	N/A
HC65000250_06830848047	NONCDM CHARGE RECORD PHARMACY	250		10.77	N/A
HC65000250_06838200414	NONCDM CHARGE RECORD PHARMACY	250		6.50	N/A
HC65000250_06838200514	NONCDM CHARGE RECORD PHARMACY	250		7.95	N/A
HC65000250_06838202201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06838203406	NONCDM CHARGE RECORD PHARMACY	250		2.45	N/A
HC65000250_06838203516	NONCDM CHARGE RECORD PHARMACY	250		2.69	N/A
HC65000250_06838205001	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06838209201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06838209205	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06838209401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06838209405	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06838212116	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06838212205	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06838212216	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06838212305	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06838213201	NONCDM CHARGE RECORD PHARMACY	250		1.66	N/A
HC65000250_06838213210	NONCDM CHARGE RECORD PHARMACY	250		1.65	N/A
HC65000250_06838213616	NONCDM CHARGE RECORD PHARMACY	250		1.17	N/A
HC65000250_06838213716	NONCDM CHARGE RECORD PHARMACY	250		1.64	N/A
HC65000250_06838214601	NONCDM CHARGE RECORD PHARMACY	250		1.25	N/A
HC65000250_06838218001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06838222705	NONCDM CHARGE RECORD PHARMACY	250		1.59	N/A
HC65000250_06838225501	NONCDM CHARGE RECORD PHARMACY	250		3.29	N/A
HC65000250_06838225601	NONCDM CHARGE RECORD PHARMACY	250		3.20	N/A
HC65000250_06838225605	NONCDM CHARGE RECORD PHARMACY	250		3.20	N/A
HC65000250_06838235316	NONCDM CHARGE RECORD PHARMACY	250		2.04	N/A
HC65000250_06838244614	NONCDM CHARGE RECORD PHARMACY	250		183.17	N/A
HC65000250_06838247178	NONCDM CHARGE RECORD PHARMACY	250		9.00	N/A
HC65000250_06838247278	NONCDM CHARGE RECORD PHARMACY	250		9.53	N/A
HC65000250_06838252001	NONCDM CHARGE RECORD PHARMACY	250		34.68	N/A
HC65000250_06838253601	NONCDM CHARGE RECORD PHARMACY	250		6.02	N/A
HC65000250_06838255901	NONCDM CHARGE RECORD PHARMACY	250		6.03	N/A
HC65000250_06838271119	NONCDM CHARGE RECORD PHARMACY	250		25.89	N/A
HC65000250_06838277177	NONCDM CHARGE RECORD PHARMACY	250		52.31	N/A
HC65000250_06838277277	NONCDM CHARGE RECORD PHARMACY	250		50.07	N/A
HC65000250_06838277305	NONCDM CHARGE RECORD PHARMACY	250		1.90	N/A
HC65000250_06838277306	NONCDM CHARGE RECORD PHARMACY	250		1.90	N/A
HC65000250_06838277316	NONCDM CHARGE RECORD PHARMACY	250		1.90	N/A
HC65000250_06838280505	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06838280601	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06838285701	NONCDM CHARGE RECORD PHARMACY	250		1.27	N/A
HC65000250_06838292106	NONCDM CHARGE RECORD PHARMACY	250	Z7610	15.68	N/A
HC65000250_06846210230	NONCDM CHARGE RECORD PHARMACY	250		6.00	N/A
HC65000250_06846212601	NONCDM CHARGE RECORD PHARMACY	250		0.93	N/A
HC65000250_06846212701	NONCDM CHARGE RECORD PHARMACY	250		1.41	N/A
HC65000250_06846212801	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06846213001	NONCDM CHARGE RECORD PHARMACY	250		0.00	N/A
HC65000250_06846215713	NONCDM CHARGE RECORD PHARMACY	250		2.83	N/A
HC65000250_06846215813	NONCDM CHARGE RECORD PHARMACY	250		3.80	N/A
HC65000250_06846216305	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06846216501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06846218117	NONCDM CHARGE RECORD PHARMACY	250		54.99	N/A
HC65000250_06846219001	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_06846219005	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06846219913	NONCDM CHARGE RECORD PHARMACY	250		4.75	N/A
HC65000250_06846220013	NONCDM CHARGE RECORD PHARMACY	250		4.75	N/A
HC65000250_06846220030	NONCDM CHARGE RECORD PHARMACY	250		7.23	N/A
HC65000250_06846220901	NONCDM CHARGE RECORD PHARMACY	250		5.42	N/A
HC65000250_06846222301	NONCDM CHARGE RECORD PHARMACY	250		1.23	N/A
HC65000250_06846222901	NONCDM CHARGE RECORD PHARMACY	250		2.65	N/A
HC65000250_06846223301	NONCDM CHARGE RECORD PHARMACY	250		2.28	N/A
HC65000250_06846223401	NONCDM CHARGE RECORD PHARMACY	250		2.28	N/A
HC65000250_06846225301	NONCDM CHARGE RECORD PHARMACY	250		0.94	N/A
HC65000250_06846225501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06846225601	NONCDM CHARGE RECORD PHARMACY	250		1.02	N/A
HC65000250_06846226001	NONCDM CHARGE RECORD PHARMACY	250		1.86	N/A
HC65000250_06846226190	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06846226390	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06846227501	NONCDM CHARGE RECORD PHARMACY	250		4.40	N/A
HC65000250_06846229201	NONCDM CHARGE RECORD PHARMACY	250		3.61	N/A
HC65000250_06846229301	NONCDM CHARGE RECORD PHARMACY	250		1.94	N/A
HC65000250_06846229305	NONCDM CHARGE RECORD PHARMACY	250		1.84	N/A
HC65000250_06846230201	NONCDM CHARGE RECORD PHARMACY	250		1.49	N/A
HC65000250_06846230450	NONCDM CHARGE RECORD PHARMACY	250		7.23	N/A
HC65000250_06846231417	NONCDM CHARGE RECORD PHARMACY	250		125.73	N/A
HC65000250_06846233090	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06846233190	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06846233290	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_06846233390	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06846238160	NONCDM CHARGE RECORD PHARMACY	250		7.78	N/A
HC65000250_06846238829	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06846239790	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06846240467	NONCDM CHARGE RECORD PHARMACY	250	Z7610	35.02	N/A
HC65000250_06846240601	NONCDM CHARGE RECORD PHARMACY	250		1.21	N/A
HC65000250_06846241060	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06846242169	NONCDM CHARGE RECORD PHARMACY	250		234.66	N/A
HC65000250_06846243630	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06846243730	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06846243790	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06846243830	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06846246706	NONCDM CHARGE RECORD PHARMACY	250		5.75	N/A
HC65000250_06846247101	NONCDM CHARGE RECORD PHARMACY	250		2.87	N/A
HC65000250_06846252965	NONCDM CHARGE RECORD PHARMACY	250	Z7610	267.48	N/A
HC65000250_06846257330	NONCDM CHARGE RECORD PHARMACY	250		55.66	N/A
HC65000250_06846263945	NONCDM CHARGE RECORD PHARMACY	250		4.93	N/A
HC65000250_06846279917	NONCDM CHARGE RECORD PHARMACY	250	Z7610	125.73	N/A
HC65000250_06846280701	NONCDM CHARGE RECORD PHARMACY	250		7.57	N/A
HC65000250_06846280801	NONCDM CHARGE RECORD PHARMACY	250		8.50	N/A
HC65000250_06858500575	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06868217030	NONCDM CHARGE RECORD PHARMACY	250		321.53	N/A
HC65000250_06868230210	NONCDM CHARGE RECORD PHARMACY	250		6.12	N/A
HC65000250_06868281305	NONCDM CHARGE RECORD PHARMACY	250		66.00	N/A
HC65000250_06878410212	NONCDM CHARGE RECORD PHARMACY	250		1.38	N/A
HC65000250_06885001201	NONCDM CHARGE RECORD PHARMACY	250		4.68	N/A
HC65000250_06885001202	NONCDM CHARGE RECORD PHARMACY	250		4.68	N/A
HC65000250_06896834108	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06907614601	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06909712203	NONCDM CHARGE RECORD PHARMACY	250		0.95	N/A
HC65000250_06909712303	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06909712805	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_06909714260	NONCDM CHARGE RECORD PHARMACY	250		99.00	N/A
HC65000250_06909722843	NONCDM CHARGE RECORD PHARMACY	250		18.90	N/A
HC65000250_06909732187	NONCDM CHARGE RECORD PHARMACY	250		62.50	N/A
HC65000250_06909741002	NONCDM CHARGE RECORD PHARMACY	250		21.57	N/A
HC65000250_06909745805	NONCDM CHARGE RECORD PHARMACY	250		8.82	N/A
HC65000250_06909752444	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.01	N/A
HC65000250_06909764202	NONCDM CHARGE RECORD PHARMACY	250		92.40	N/A
HC65000250_06909784607	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_06909785605	NONCDM CHARGE RECORD PHARMACY	250		2.05	N/A
HC65000250_06909786107	NONCDM CHARGE RECORD PHARMACY	250		2.94	N/A
HC65000250_06909786283	NONCDM CHARGE RECORD PHARMACY	250		3.55	N/A
HC65000250_06909786707	NONCDM CHARGE RECORD PHARMACY	250		3.49	N/A
HC65000250_06923810541	NONCDM CHARGE RECORD PHARMACY	250		15.88	N/A
HC65000250_06923810561	NONCDM CHARGE RECORD PHARMACY	250		19.65	N/A
HC65000250_06923811005	NONCDM CHARGE RECORD PHARMACY	250		1.65	N/A
HC65000250_06923811261	NONCDM CHARGE RECORD PHARMACY	250		46.62	N/A
HC65000250_06923811543	NONCDM CHARGE RECORD PHARMACY	250		2.15	N/A
HC65000250_06923811669	NONCDM CHARGE RECORD PHARMACY	250		2.14	N/A
HC65000250_06923812501	NONCDM CHARGE RECORD PHARMACY	250		0.00	N/A
HC65000250_06923813421	NONCDM CHARGE RECORD PHARMACY	250		3.18	N/A
HC65000250_06923814203	NONCDM CHARGE RECORD PHARMACY	250		6.00	N/A
HC65000250_06923814711	NONCDM CHARGE RECORD PHARMACY	250		40.27	N/A
HC65000250_06923814901	NONCDM CHARGE RECORD PHARMACY	250		2.72	N/A
HC65000250_06923815031	NONCDM CHARGE RECORD PHARMACY	250		78.39	N/A
HC65000250_06923815221	NONCDM CHARGE RECORD PHARMACY	250		9.90	N/A
HC65000250_06923815323	NONCDM CHARGE RECORD PHARMACY	250		84.06	N/A
HC65000250_06923815325	NONCDM CHARGE RECORD PHARMACY	250		42.03	N/A
HC65000250_06923815345	NONCDM CHARGE RECORD PHARMACY	250		87.48	N/A
HC65000250_06923815401	NONCDM CHARGE RECORD PHARMACY	250		6.52	N/A
HC65000250_06923816052	NONCDM CHARGE RECORD PHARMACY	250		120.00	N/A
HC65000250_06923816058	NONCDM CHARGE RECORD PHARMACY	250		120.00	N/A
HC65000250_06923818361	NONCDM CHARGE RECORD PHARMACY	250		2.03	N/A
HC65000250_06931513401	NONCDM CHARGE RECORD PHARMACY	250		1.44	N/A
HC65000250_06931513701	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06931513710	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06931514001	NONCDM CHARGE RECORD PHARMACY	250		8.82	N/A
HC65000250_06931521101	NONCDM CHARGE RECORD PHARMACY	250		5.02	N/A
HC65000250_06931530802	NONCDM CHARGE RECORD PHARMACY	250		62.75	N/A
HC65000250_06931530805	NONCDM CHARGE RECORD PHARMACY	250		80.83	N/A
HC65000250_06931590401	NONCDM CHARGE RECORD PHARMACY	250		0.98	N/A
HC65000250_06931590501	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_06931590510	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06933913819	NONCDM CHARGE RECORD PHARMACY	250		11.43	N/A
HC65000250_06933915019	NONCDM CHARGE RECORD PHARMACY	250		13.64	N/A
HC65000250_06936722001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06937431625	NONCDM CHARGE RECORD PHARMACY	250		133.50	N/A
HC65000250_06937450425	NONCDM CHARGE RECORD PHARMACY	250		162.00	N/A
HC65000250_06937450428	NONCDM CHARGE RECORD PHARMACY	250		162.00	N/A
HC65000250_06937451101	NONCDM CHARGE RECORD PHARMACY	250		27.44	N/A
HC65000250_06945211420	NONCDM CHARGE RECORD PHARMACY	250		26.20	N/A
HC65000250_06945213117	NONCDM CHARGE RECORD PHARMACY	250		9.60	N/A
HC65000250_06945213217	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_06945213317	NONCDM CHARGE RECORD PHARMACY	250		9.60	N/A
HC65000250_06945214320	NONCDM CHARGE RECORD PHARMACY	250		1.80	N/A
HC65000250_06945214330	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06945215020	NONCDM CHARGE RECORD PHARMACY	250		2.09	N/A
HC65000250_06945215120	NONCDM CHARGE RECORD PHARMACY	250		2.18	N/A
HC65000250_06945215673	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.36	N/A
HC65000250_06945220713	NONCDM CHARGE RECORD PHARMACY	250		1.68	N/A
HC65000250_06945220720	NONCDM CHARGE RECORD PHARMACY	250		1.62	N/A
HC65000250_06945222384	NONCDM CHARGE RECORD PHARMACY	250		179.56	N/A
HC65000250_06953602515	NONCDM CHARGE RECORD PHARMACY	250		14.65	N/A
HC65000250_06953605015	NONCDM CHARGE RECORD PHARMACY	250		18.99	N/A
HC65000250_06953610015	NONCDM CHARGE RECORD PHARMACY	250		21.33	N/A
HC65000250_06954313120	NONCDM CHARGE RECORD PHARMACY	250		16.74	N/A
HC65000250_06954323460	NONCDM CHARGE RECORD PHARMACY	250	Z7610	42.34	N/A
HC65000250_06954326790	NONCDM CHARGE RECORD PHARMACY	250		2.66	N/A
HC65000250_06954338090	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06954338810	NONCDM CHARGE RECORD PHARMACY	250		6.47	N/A
HC65000250_06958411110	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06958461150	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06958468410	NONCDM CHARGE RECORD PHARMACY	250		1.48	N/A
HC65000250_06961800858	NONCDM CHARGE RECORD PHARMACY	250		1.25	N/A
HC65000250_06961801501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06961803301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06961805801	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_06961806401	NONCDM CHARGE RECORD PHARMACY	250		6.01	N/A
HC65000250_06968011530	NONCDM CHARGE RECORD PHARMACY	250		112.01	N/A
HC65000250_06968013060	NONCDM CHARGE RECORD PHARMACY	250		13.88	N/A
HC65000250_06978418010	NONCDM CHARGE RECORD PHARMACY	250		9.50	N/A
HC65000250_06978420096	NONCDM CHARGE RECORD PHARMACY	250		17.54	N/A
HC65000250_06978442012	NONCDM CHARGE RECORD PHARMACY	250		17.21	N/A
HC65000250_06991810101	NONCDM CHARGE RECORD PHARMACY	250		6.29	N/A
HC65000250_06991830130	NONCDM CHARGE RECORD PHARMACY	250		26.07	N/A
HC65000250_06991856030	NONCDM CHARGE RECORD PHARMACY	250		123.92	N/A
HC65000250_06996800609	NONCDM CHARGE RECORD PHARMACY	250		0.94	N/A
HC65000250_07001006301	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_07001006401	NONCDM CHARGE RECORD PHARMACY	250		1.30	N/A
HC65000250_07001006501	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07001006505	NONCDM CHARGE RECORD PHARMACY	250		0.64	N/A
HC65000250_07001006510	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07001049101	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_07001049201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07001075401	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_07001075405	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07001077001	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07001077005	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07006901325	NONCDM CHARGE RECORD PHARMACY	250		15.49	N/A
HC65000250_07006913101	NONCDM CHARGE RECORD PHARMACY	250		34.81	N/A
HC65000250_07006918101	NONCDM CHARGE RECORD PHARMACY	250		445.14	N/A
HC65000250_07006919101	NONCDM CHARGE RECORD PHARMACY	250		455.31	N/A
HC65000250_07006923101	NONCDM CHARGE RECORD PHARMACY	250		67.52	N/A
HC65000250_07006927125	NONCDM CHARGE RECORD PHARMACY	250		59.90	N/A
HC65000250_07006936210	NONCDM CHARGE RECORD PHARMACY	250		118.49	N/A
HC65000250_07012115767	NONCDM CHARGE RECORD PHARMACY	250		119.54	N/A
HC65000250_07015610401	NONCDM CHARGE RECORD PHARMACY	250		1.38	N/A
HC65000250_07019900632	NONCDM CHARGE RECORD PHARMACY	250		876.53	N/A
HC65000250_07037700712	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07040818534	NONCDM CHARGE RECORD PHARMACY	250		9.45	N/A
HC65000250_07040823932	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1,040.35	N/A
HC65000250_07040864434	NONCDM CHARGE RECORD PHARMACY	250		86.46	N/A
HC65000250_07043600704	NONCDM CHARGE RECORD PHARMACY	250		137.14	N/A
HC65000250_07043601004	NONCDM CHARGE RECORD PHARMACY	250		5.89	N/A
HC65000250_07043615541	NONCDM CHARGE RECORD PHARMACY	250		2.48	N/A
HC65000250_07067700341	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07067700511	NONCDM CHARGE RECORD PHARMACY	250		7.00	N/A
HC65000250_07067700531	NONCDM CHARGE RECORD PHARMACY	250		6.93	N/A
HC65000250_07067700541	NONCDM CHARGE RECORD PHARMACY	250		5.79	N/A
HC65000250_07067700581	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07067700681	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_07070026894	NONCDM CHARGE RECORD PHARMACY	250		481.92	N/A
HC65000250_07071011101	NONCDM CHARGE RECORD PHARMACY	250		1.92	N/A
HC65000250_07071011373	NONCDM CHARGE RECORD PHARMACY	250		2.80	N/A
HC65000250_07071011611	NONCDM CHARGE RECORD PHARMACY	250		0.94	N/A
HC65000250_07071011803	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65000250_07074812906	NONCDM CHARGE RECORD PHARMACY	250		16.00	N/A
HC65000250_07086011626	NONCDM CHARGE RECORD PHARMACY	250		69.00	N/A
HC65000250_07086030005	NONCDM CHARGE RECORD PHARMACY	250		11.01	N/A
HC65000250_07095401910	NONCDM CHARGE RECORD PHARMACY	250		2.59	N/A
HC65000250_07095403620	NONCDM CHARGE RECORD PHARMACY	250		331.74	N/A
HC65000250_07095414010	NONCDM CHARGE RECORD PHARMACY	250		1.76	N/A
HC65000250_07095421210	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07095431610	NONCDM CHARGE RECORD PHARMACY	250		30.55	N/A
HC65000250_07120597730	NONCDM CHARGE RECORD PHARMACY	250		1.62	N/A
HC65000250_07124712601	NONCDM CHARGE RECORD PHARMACY	250		2.44	N/A
HC65000250_07126925010	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07126950010	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07127925010	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07132180320	NONCDM CHARGE RECORD PHARMACY	250		1.11	N/A
HC65000250_07135101101	NONCDM CHARGE RECORD PHARMACY	250		2.03	N/A
HC65000250_07135101312	NONCDM CHARGE RECORD PHARMACY	250		9.69	N/A
HC65000250_07139901101	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07139938846	NONCDM CHARGE RECORD PHARMACY	250		4.48	N/A
HC65000250_07139951012	NONCDM CHARGE RECORD PHARMACY	250		48.00	N/A
HC65000250_07145600101	NONCDM CHARGE RECORD PHARMACY	250		163.71	N/A
HC65000250_07169905030	NONCDM CHARGE RECORD PHARMACY	250	Z7610	235.28	N/A
HC65000250_07174011230	NONCDM CHARGE RECORD PHARMACY	250		22.47	N/A
HC65000250_07193003512	NONCDM CHARGE RECORD PHARMACY	250		2.34	N/A
HC65000250_07193003712	NONCDM CHARGE RECORD PHARMACY	250		4.44	N/A
HC65000250_07214003263	NONCDM CHARGE RECORD PHARMACY	250		29.46	N/A
HC65000250_07214045231	NONCDM CHARGE RECORD PHARMACY	250		22.20	N/A
HC65000250_07220501190	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07220501290	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07220501390	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07220504930	NONCDM CHARGE RECORD PHARMACY	250		65.00	N/A
HC65000250_07226612225	NONCDM CHARGE RECORD PHARMACY	250		7.53	N/A
HC65000250_07226614610	NONCDM CHARGE RECORD PHARMACY	250		48.47	N/A
HC65000250_07230511230	NONCDM CHARGE RECORD PHARMACY	250		3.25	N/A
HC65000250_07230515030	NONCDM CHARGE RECORD PHARMACY	250		3.39	N/A
HC65000250_07248510805	NONCDM CHARGE RECORD PHARMACY	250	J3490	174.50	N/A
HC65000250_07248510825	NONCDM CHARGE RECORD PHARMACY	250		60.97	N/A
HC65000250_07250820407	NONCDM CHARGE RECORD PHARMACY	250		71.54	N/A
HC65000250_07257201525	NONCDM CHARGE RECORD PHARMACY	250		30.80	N/A
HC65000250_07257205210	NONCDM CHARGE RECORD PHARMACY	250		49.15	N/A
HC65000250_07257248110	NONCDM CHARGE RECORD PHARMACY	250		47.85	N/A
HC65000250_07257265010	NONCDM CHARGE RECORD PHARMACY	250	J3490	22.08	N/A
HC65000250_07257265110	NONCDM CHARGE RECORD PHARMACY	250		40.90	N/A
HC65000250_07257274020	NONCDM CHARGE RECORD PHARMACY	250		25.58	N/A
HC65000250_07257800201	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07261174010	NONCDM CHARGE RECORD PHARMACY	250		5.88	N/A
HC65000250_07278909401	NONCDM CHARGE RECORD PHARMACY	250		2.88	N/A
HC65000250_07330245601	NONCDM CHARGE RECORD PHARMACY	250		214.50	N/A
HC65000250_07430000070	NONCDM CHARGE RECORD PHARMACY	250		20.18	N/A
HC65000250_07430001067	NONCDM CHARGE RECORD PHARMACY	250		28.99	N/A
HC65000250_07430008186	NONCDM CHARGE RECORD PHARMACY	250		10.50	N/A
HC65000250_07431200640	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07431201380	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07431202832	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07431205800	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07431219377	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07582611810	NONCDM CHARGE RECORD PHARMACY	250		37.24	N/A
HC65000250_07583401060	NONCDM CHARGE RECORD PHARMACY	250		1.94	N/A
HC65000250_07583412401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07583415801	NONCDM CHARGE RECORD PHARMACY	250		1.45	N/A
HC65000250_07583415901	NONCDM CHARGE RECORD PHARMACY	250		1.39	N/A
HC65000250_07583417001	NONCDM CHARGE RECORD PHARMACY	250		31.52	N/A
HC65000250_07583420501	NONCDM CHARGE RECORD PHARMACY	250		2.74	N/A
HC65000250_07583422101	NONCDM CHARGE RECORD PHARMACY	250		3.98	N/A
HC65000250_07620410001	NONCDM CHARGE RECORD PHARMACY	250		1.26	N/A
HC65000250_07620460001	NONCDM CHARGE RECORD PHARMACY	250		3.91	N/A
HC65000250_07620480001	NONCDM CHARGE RECORD PHARMACY	250		9.59	N/A
HC65000250_07620490001	NONCDM CHARGE RECORD PHARMACY	250		9.59	N/A
HC65000250_07628221490	NONCDM CHARGE RECORD PHARMACY	250		1.05	N/A
HC65000250_07628232901	NONCDM CHARGE RECORD PHARMACY	250		1.45	N/A
HC65000250_07628266339	NONCDM CHARGE RECORD PHARMACY	250		21.00	N/A
HC65000250_07632933011	NONCDM CHARGE RECORD PHARMACY	250		58.11	N/A
HC65000250_07632933041	NONCDM CHARGE RECORD PHARMACY	250		54.79	N/A
HC65000250_07632933521	NONCDM CHARGE RECORD PHARMACY	250		83.90	N/A
HC65000250_07632963005	NONCDM CHARGE RECORD PHARMACY	250		128.78	N/A
HC65000250_07638510401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07638511401	NONCDM CHARGE RECORD PHARMACY	250		1.72	N/A
HC65000250_07638512301	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07638512350	NONCDM CHARGE RECORD PHARMACY	250		1.01	N/A
HC65000250_07638512401	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07638513401	NONCDM CHARGE RECORD PHARMACY	250		5.82	N/A
HC65000250_07638888025	NONCDM CHARGE RECORD PHARMACY	250	Z7610	210.63	N/A
HC65000250_07643930910	NONCDM CHARGE RECORD PHARMACY	250		1.38	N/A
HC65000250_07643935310	NONCDM CHARGE RECORD PHARMACY	250		1.95	N/A
HC65000250_07647800105	NONCDM CHARGE RECORD PHARMACY	250		766.56	N/A
HC65000250_07651802050	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_07733311810	NONCDM CHARGE RECORD PHARMACY	250		1.43	N/A
HC65000250_07733330810	NONCDM CHARGE RECORD PHARMACY	250		1.45	N/A
HC65000250_07733351610	NONCDM CHARGE RECORD PHARMACY	250		1.55	N/A
HC65000250_07733371510	NONCDM CHARGE RECORD PHARMACY	250		1.24	N/A
HC65000250_07733380050	NONCDM CHARGE RECORD PHARMACY	250		5.63	N/A
HC65000250_07733383110	NONCDM CHARGE RECORD PHARMACY	250		1.22	N/A
HC65000250_07733383510	NONCDM CHARGE RECORD PHARMACY	250		1.72	N/A
HC65000250_07733393410	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07733393710	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07733393810	NONCDM CHARGE RECORD PHARMACY	250		1.26	N/A
HC65000250_07733394010	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07733394810	NONCDM CHARGE RECORD PHARMACY	250		1.36	N/A
HC65000250_07733395110	NONCDM CHARGE RECORD PHARMACY	250		1.54	N/A
HC65000250_07733398310	NONCDM CHARGE RECORD PHARMACY	250		1.40	N/A
HC65000250_07811201103	NONCDM CHARGE RECORD PHARMACY	250		22.30	N/A
HC65000250_07811273621	NONCDM CHARGE RECORD PHARMACY	250		28.26	N/A
HC65000250_07985400938	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_07985405024	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07985420010	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07985420080	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_07985420195	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_07985495010	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_08008799734	NONCDM CHARGE RECORD PHARMACY	250	Z7610	10.75	N/A
HC65000250_08068100400	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_08068104100	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_08068105700	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_08068107100	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_08068108000	NONCDM CHARGE RECORD PHARMACY	250		2.17	N/A
HC65000250_08068109800	NONCDM CHARGE RECORD PHARMACY	250		0.90	N/A
HC65000250_08068110400	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_08068113100	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_08068113500	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_08068114101	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_08068116800	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_08068116801	NONCDM CHARGE RECORD PHARMACY	250		0.99	N/A
HC65000250_08068116900	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_08142102004	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_08290236712	NONCDM CHARGE RECORD PHARMACY	250		5.15	N/A
HC65000250_08290236850	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_08290306544	NONCDM CHARGE RECORD PHARMACY	250		2.60	N/A
HC65000250_08290306546	NONCDM CHARGE RECORD PHARMACY	250		2.70	N/A
HC65000250_08290306547	NONCDM CHARGE RECORD PHARMACY	250		1.76	N/A
HC65000250_08290306553	NONCDM CHARGE RECORD PHARMACY	250		4.26	N/A
HC65000250_08349020760	NONCDM CHARGE RECORD PHARMACY	250		4.39	N/A
HC65000250_08380007906	NONCDM CHARGE RECORD PHARMACY	250	Z7610	46.36	N/A
HC65000250_08679001930	NONCDM CHARGE RECORD PHARMACY	250		1.43	N/A
HC65000250_08770140271	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_08770140754	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_08770142902	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_08770170344	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_09277160002	NONCDM CHARGE RECORD PHARMACY	250		22.37	N/A
HC65000250_09999903368	NONCDM CHARGE RECORD PHARMACY	250		0.97	N/A
HC65000250_09999903394	NONCDM CHARGE RECORD PHARMACY	250		52.20	N/A
HC65000250_09999903809	NONCDM CHARGE RECORD PHARMACY	250		450.00	N/A
HC65000250_09999903899	NONCDM CHARGE RECORD PHARMACY	250		9.90	N/A
HC65000250_09999904219	NONCDM CHARGE RECORD PHARMACY	250		15.84	N/A
HC65000250_09999904226	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1.00	N/A
HC65000250_09999904530	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5.23	N/A
HC65000250_11822308910	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_54629000938	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0.05	N/A
HC65000250_54629005024	NONCDM CHARGE RECORD PHARMACY	250		0.85	N/A
HC65000250_54629005701	NONCDM CHARGE RECORD PHARMACY	250		1.00	N/A
HC65000250_94688014230	NONCDM CHARGE RECORD PHARMACY	250		7.01	N/A
HC65000255	MEDICATION-RADIOLOGY	255		N/A	N/A
HC65000256	MEDICATION-EXPERIMENTAL/RESEARCH	256		N/A	N/A
HC65000259	MEDICATION-INVESTIGATIONAL	259		N/A	N/A
HC65000259_00002791001	NONCDM CHARGE RECORD PHARMACY	259	J3490	0.01	N/A
HC65000259_00002795001	NONCDM CHARGE RECORD PHARMACY	259	Q0245	0.01	N/A
HC65000259_06195829011	NONCDM CHARGE RECORD PHARMACY	259	J3490	3,762.66	N/A
HC65000259_06195829012	NONCDM CHARGE RECORD PHARMACY	259	J3490	3,879.17	N/A
HC65000259_07777700001	NONCDM CHARGE RECORD PHARMACY	259	J3490	0.01	N/A
HC65000259_07777700024	NONCDM CHARGE RECORD PHARMACY	259	J3490	0.01	N/A
HC65000259_07777700026	NONCDM CHARGE RECORD PHARMACY	259	J3490	0.01	N/A
HC65000259_07777700043	NONCDM CHARGE RECORD PHARMACY	259	J3490	0.01	N/A
HC65000259_07777700044	NONCDM CHARGE RECORD PHARMACY	259	J3490	0.01	N/A
HC65000259_07777700047	NONCDM CHARGE RECORD PHARMACY	259	J3490	0.01	N/A
HC65000259_07777700054	NONCDM CHARGE RECORD PHARMACY	259	C9399	0.01	N/A
HC65000259_07777700055	NONCDM CHARGE RECORD PHARMACY	259		0.01	N/A
HC65000259_07777700056	NONCDM CHARGE RECORD PHARMACY	259	J3490	0.01	N/A
HC65000259_07777700059	NONCDM CHARGE RECORD PHARMACY	259		0.01	N/A
HC65000259_07777700064	NONCDM CHARGE RECORD PHARMACY	259	J7639	0.00	N/A
HC65000259_07777700067	NONCDM CHARGE RECORD PHARMACY	259	J3490	0.01	N/A
HC65000259_07777700068	NONCDM CHARGE RECORD PHARMACY	259		0.01	N/A
HC65000259_07777700069	NONCDM CHARGE RECORD PHARMACY	259		0.00	N/A
HC65000259_07777700081	NONCDM CHARGE RECORD PHARMACY	259	C9399	0.01	N/A
HC65000259_07777700084	NONCDM CHARGE RECORD PHARMACY	259		0.01	N/A
HC65000259_07777700087	NONCDM CHARGE RECORD PHARMACY	259		0.01	N/A
HC65000259_09999900219	NONCDM CHARGE RECORD PHARMACY	259	Z7610	0.01	N/A
HC65000259_09999903858	NONCDM CHARGE RECORD PHARMACY	259	J9039	0.00	N/A
HC65000259_09999903859	NONCDM CHARGE RECORD PHARMACY	259		0.01	N/A
HC65000259_09999903929	NONCDM CHARGE RECORD PHARMACY	259	J3490	0.01	N/A
HC65000259_09999904156	NONCDM CHARGE RECORD PHARMACY	259		0.00	N/A
HC65000259_09999904157	NONCDM CHARGE RECORD PHARMACY	259		0.01	N/A
HC65000259_09999904158	NONCDM CHARGE RECORD PHARMACY	259		0.01	N/A
HC65000259_09999904411	NONCDM CHARGE RECORD PHARMACY	259	J3490	0.01	N/A
HC65000343_01199412113	NONCDM CHARGE RECORD PHARMACY	250	A9556	128.44	N/A
HC65000343_01715629918	NONCDM CHARGE RECORD PHARMACY	250	A9505	48.75	N/A
HC65000634	DRUG - EPOGEN<10,000 UNITS	634		N/A	N/A
HC65000635	DRUG - EPOGEN>10,000 UNITS	635		N/A	N/A
HC65000636	DRUG - DETAILED CODING	636		622.91	N/A
HC65000636_00000366800	NONCDM CHARGE RECORD PHARMACY	636	J3010	42.00	N/A
HC65000636_00002143380	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65000636_00002143480	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65000636_00002734901	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65000636_00002762301	NONCDM CHARGE RECORD PHARMACY	636	J9305	444.86	N/A
HC65000636_00002764001	NONCDM CHARGE RECORD PHARMACY	636	J9305	445.56	N/A
HC65000636_00002766901	NONCDM CHARGE RECORD PHARMACY	636	J9308	369.50	N/A
HC65000636_00002767801	NONCDM CHARGE RECORD PHARMACY	636	J9308	369.50	N/A
HC65000636_00002771559	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.00	N/A
HC65000636_00002791001	NONCDM CHARGE RECORD PHARMACY	636	Q0239	0.02	N/A
HC65000636_00002814801	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65000636_00002821517	NONCDM CHARGE RECORD PHARMACY	636		935.00	N/A
HC65000636_00003029305	NONCDM CHARGE RECORD PHARMACY	636	J3301	14.04	N/A
HC65000636_00003029320	NONCDM CHARGE RECORD PHARMACY	636	J3301	14.25	N/A
HC65000636_00003037113	NONCDM CHARGE RECORD PHARMACY	636	J0485	22.71	N/A
HC65000636_00003049420	NONCDM CHARGE RECORD PHARMACY	636	J3301	14.29	N/A
HC65000636_00003218713	NONCDM CHARGE RECORD PHARMACY	636	J0129	216.23	N/A
HC65000636_00003229111	NONCDM CHARGE RECORD PHARMACY	636	J9176	39.42	N/A
HC65000636_00003232711	NONCDM CHARGE RECORD PHARMACY	636	J9228	902.62	N/A
HC65000636_00003232822	NONCDM CHARGE RECORD PHARMACY	636	J9228	902.87	N/A
HC65000636_00003256016	NONCDM CHARGE RECORD PHARMACY	636	J3490	170.56	N/A
HC65000636_00003373413	NONCDM CHARGE RECORD PHARMACY	636	J9299	154.46	N/A
HC65000636_00003377211	NONCDM CHARGE RECORD PHARMACY	636	J9299	165.58	N/A
HC65000636_00003377412	NONCDM CHARGE RECORD PHARMACY	636	J9299	132.23	N/A
HC65000636_00004110150	NONCDM CHARGE RECORD PHARMACY	636	J8521	14.27	N/A
HC65000636_00005197102	NONCDM CHARGE RECORD PHARMACY	636	90670	1,207.52	N/A
HC65000636_00005197105	NONCDM CHARGE RECORD PHARMACY	636	90670	1,157.10	N/A
HC65000636_00006302500	NONCDM CHARGE RECORD PHARMACY	636	J0565	228.00	N/A
HC65000636_00006302602	NONCDM CHARGE RECORD PHARMACY	636	J9271	289.92	N/A
HC65000636_00006302604	NONCDM CHARGE RECORD PHARMACY	636	J9271	0.00	N/A
HC65000636_00006306100	NONCDM CHARGE RECORD PHARMACY	636	J1453	13.12	N/A
HC65000636_00006306104	NONCDM CHARGE RECORD PHARMACY	636	J1453	13.39	N/A
HC65000636_00006384371	NONCDM CHARGE RECORD PHARMACY	636	J1335	385.98	N/A
HC65000636_00006412102	NONCDM CHARGE RECORD PHARMACY	636	90649	0.01	N/A
HC65000636_00006430502	NONCDM CHARGE RECORD PHARMACY	636	Q5104	452.03	N/A
HC65000636_00006468100	NONCDM CHARGE RECORD PHARMACY	636	90707	474.28	N/A
HC65000636_00006482700	NONCDM CHARGE RECORD PHARMACY	636	90716	835.16	N/A
HC65000636_00006483703	NONCDM CHARGE RECORD PHARMACY	636	90732	594.22	N/A
HC65000636_00006489700	NONCDM CHARGE RECORD PHARMACY	636	90647	154.94	N/A
HC65000636_00006494300	NONCDM CHARGE RECORD PHARMACY	636	90732	647.33	N/A
HC65000636_00006498100	NONCDM CHARGE RECORD PHARMACY	636	90744	0.01	N/A
HC65000636_00006542312	NONCDM CHARGE RECORD PHARMACY	636	C9399	692.80	N/A
HC65000636_00008092355	NONCDM CHARGE RECORD PHARMACY	636	C9113	30.05	N/A
HC65000636_00008092360	NONCDM CHARGE RECORD PHARMACY	636	C9113	10.92	N/A
HC65000636_00008104110	NONCDM CHARGE RECORD PHARMACY	636	J7520	190.44	N/A
HC65000636_00008451001	NONCDM CHARGE RECORD PHARMACY	636	J9300	52,196.28	N/A
HC65000636_00009000302	NONCDM CHARGE RECORD PHARMACY	636	J2930	58.58	N/A
HC65000636_00009001103	NONCDM CHARGE RECORD PHARMACY	636	J1720	0.07	N/A
HC65000636_00009001104	NONCDM CHARGE RECORD PHARMACY	636	J1720	89.51	N/A
HC65000636_00009001306	NONCDM CHARGE RECORD PHARMACY	636	J1720	37.35	N/A
HC65000636_00009001612	NONCDM CHARGE RECORD PHARMACY	636	J1720	68.50	N/A
HC65000636_00009001820	NONCDM CHARGE RECORD PHARMACY	636	J2930	43.94	N/A
HC65000636_00009003928	NONCDM CHARGE RECORD PHARMACY	636	J2920	36.00	N/A
HC65000636_00009003932	NONCDM CHARGE RECORD PHARMACY	636	J2920	36.19	N/A
HC65000636_00009004722	NONCDM CHARGE RECORD PHARMACY	636	J2930	56.85	N/A
HC65000636_00009004726	NONCDM CHARGE RECORD PHARMACY	636	J2930	58.31	N/A
HC65000636_00009004727	NONCDM CHARGE RECORD PHARMACY	636	J2930	32.34	N/A
HC65000636_00009028002	NONCDM CHARGE RECORD PHARMACY	636	J1030	55.01	N/A
HC65000636_00009041701	NONCDM CHARGE RECORD PHARMACY	636	J1071	0.08	N/A
HC65000636_00009043601	NONCDM CHARGE RECORD PHARMACY	636		480.00	N/A
HC65000636_00009069801	NONCDM CHARGE RECORD PHARMACY	636	J2930	23.05	N/A
HC65000636_00009075801	NONCDM CHARGE RECORD PHARMACY	636	J2930	35.27	N/A
HC65000636_00009077526	NONCDM CHARGE RECORD PHARMACY	636	J3490	8.95	N/A
HC65000636_00009082501	NONCDM CHARGE RECORD PHARMACY	636	J1720	34.90	N/A
HC65000636_00009085608	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,133.39	N/A
HC65000636_00009090218	NONCDM CHARGE RECORD PHARMACY	636	J3490	9.73	N/A
HC65000636_00009307301	NONCDM CHARGE RECORD PHARMACY	636	J1030	63.48	N/A
HC65000636_00009307303	NONCDM CHARGE RECORD PHARMACY	636	J1030	63.71	N/A
HC65000636_00009307322	NONCDM CHARGE RECORD PHARMACY	636	J1030	63.72	N/A
HC65000636_00009307323	NONCDM CHARGE RECORD PHARMACY	636	J1030	63.65	N/A
HC65000636_00009347501	NONCDM CHARGE RECORD PHARMACY	636	J1040	109.20	N/A
HC65000636_00009347503	NONCDM CHARGE RECORD PHARMACY	636	J1040	110.38	N/A
HC65000636_00009514004	NONCDM CHARGE RECORD PHARMACY	636	J2020	108.37	N/A
HC65000636_00009722402	NONCDM CHARGE RECORD PHARMACY	636	J3590	33,730.09	N/A
HC65000636_00009752903	NONCDM CHARGE RECORD PHARMACY	636	J9206	44.37	N/A
HC65000636_00009752904	NONCDM CHARGE RECORD PHARMACY	636	J9206	73.55	N/A
HC65000636_00019086207	NONCDM CHARGE RECORD PHARMACY	636	Q9958	0.58	N/A
HC65000636_00019481604	NONCDM CHARGE RECORD PHARMACY	636	Q9963	3.30	N/A
HC65000636_00023114501	NONCDM CHARGE RECORD PHARMACY	636	J0585	12.76	N/A
HC65000636_00023608210	NONCDM CHARGE RECORD PHARMACY	636	J1750	91.29	N/A
HC65000636_00024279210	NONCDM CHARGE RECORD PHARMACY	636	J2916	38.16	N/A
HC65000636_00024515010	NONCDM CHARGE RECORD PHARMACY	636	J2783	2,349.49	N/A
HC65000636_00024582411	NONCDM CHARGE RECORD PHARMACY	636	J9043	1,188.78	N/A
HC65000636_00024584305	NONCDM CHARGE RECORD PHARMACY	636	J2820	316.96	N/A
HC65000636_00024591401	NONCDM CHARGE RECORD PHARMACY	636	J3590	1,938.64	N/A
HC65000636_00024591502	NONCDM CHARGE RECORD PHARMACY	636	C9399	0.01	N/A
HC65000636_00024591801	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65000636_00026378555	NONCDM CHARGE RECORD PHARMACY	636	J7192	0.00	N/A
HC65000636_00037900105	NONCDM CHARGE RECORD PHARMACY	636	J1980	9,031.52	N/A
HC65000636_00046074905	NONCDM CHARGE RECORD PHARMACY	636	J1410	1,918.61	N/A
HC65000636_00049001383	NONCDM CHARGE RECORD PHARMACY	636	J0295	45.78	N/A
HC65000636_00049001481	NONCDM CHARGE RECORD PHARMACY	636	J0295	23.91	N/A
HC65000636_00049001483	NONCDM CHARGE RECORD PHARMACY	636	J0295	45.60	N/A
HC65000636_00049052022	NONCDM CHARGE RECORD PHARMACY	636	J2540	8.46	N/A
HC65000636_00049052083	NONCDM CHARGE RECORD PHARMACY	636	J2540	8.45	N/A
HC65000636_00049319001	NONCDM CHARGE RECORD PHARMACY	636	J3465	18.29	N/A
HC65000636_00049319028	NONCDM CHARGE RECORD PHARMACY	636	J3465	67.35	N/A
HC65000636_00049392083	NONCDM CHARGE RECORD PHARMACY	636	J3486	149.66	N/A
HC65000636_00049419001	NONCDM CHARGE RECORD PHARMACY	636	J3490	452.25	N/A
HC65000636_00052031510	NONCDM CHARGE RECORD PHARMACY	636	J0725	45.67	N/A
HC65000636_00053768032	NONCDM CHARGE RECORD PHARMACY	636	P9047	540.00	N/A
HC65000636_00053768033	NONCDM CHARGE RECORD PHARMACY	636	P9047	540.00	N/A
HC65000636_00054001720	NONCDM CHARGE RECORD PHARMACY	636	J7512	0.17	N/A
HC65000636_00054001725	NONCDM CHARGE RECORD PHARMACY	636	J7512	0.14	N/A
HC65000636_00054001729	NONCDM CHARGE RECORD PHARMACY	636	J7512	0.12	N/A
HC65000636_00054001820	NONCDM CHARGE RECORD PHARMACY	636	J7512	0.10	N/A
HC65000636_00054001920	NONCDM CHARGE RECORD PHARMACY	636	J7512	0.05	N/A
HC65000636_00054001925	NONCDM CHARGE RECORD PHARMACY	636	J7512	0.05	N/A
HC65000636_00054016625	NONCDM CHARGE RECORD PHARMACY	636	J7517	4.53	N/A
HC65000636_00054047021	NONCDM CHARGE RECORD PHARMACY	636	J7527	47.57	N/A
HC65000636_00054317644	NONCDM CHARGE RECORD PHARMACY	636	J8540	2.12	N/A
HC65000636_00054317757	NONCDM CHARGE RECORD PHARMACY	636	J8540	3.18	N/A
HC65000636_00054317763	NONCDM CHARGE RECORD PHARMACY	636	J8540	1.71	N/A
HC65000636_00054417925	NONCDM CHARGE RECORD PHARMACY	636	J8540	0.53	N/A
HC65000636_00054418025	NONCDM CHARGE RECORD PHARMACY	636	J8540	0.46	N/A
HC65000636_00054418125	NONCDM CHARGE RECORD PHARMACY	636	J8540	0.43	N/A
HC65000636_00054418225	NONCDM CHARGE RECORD PHARMACY	636	J8540	0.45	N/A
HC65000636_00054418325	NONCDM CHARGE RECORD PHARMACY	636	J8540	0.51	N/A
HC65000636_00054418425	NONCDM CHARGE RECORD PHARMACY	636	J8540	0.48	N/A
HC65000636_00054472825	NONCDM CHARGE RECORD PHARMACY	636	J7512	0.22	N/A
HC65000636_00054474125	NONCDM CHARGE RECORD PHARMACY	636	J7512	1.21	N/A
HC65000636_00054817425	NONCDM CHARGE RECORD PHARMACY	636	J8540	1.32	N/A
HC65000636_00054817525	NONCDM CHARGE RECORD PHARMACY	636	J8540	0.57	N/A
HC65000636_00054817625	NONCDM CHARGE RECORD PHARMACY	636	J8540	0.66	N/A
HC65000636_00054817925	NONCDM CHARGE RECORD PHARMACY	636	J8540	0.54	N/A
HC65000636_00054818025	NONCDM CHARGE RECORD PHARMACY	636	J8540	0.51	N/A
HC65000636_00054818125	NONCDM CHARGE RECORD PHARMACY	636	J8540	0.52	N/A
HC65000636_00054872425	NONCDM CHARGE RECORD PHARMACY	636	J7512	0.25	N/A
HC65000636_00054873925	NONCDM CHARGE RECORD PHARMACY	636	J7512	1.34	N/A
HC65000636_00054874025	NONCDM CHARGE RECORD PHARMACY	636	J7512	0.56	N/A
HC65000636_00065009265	NONCDM CHARGE RECORD PHARMACY	636	J3490	288.62	N/A
HC65000636_00065054301	NONCDM CHARGE RECORD PHARMACY	636	J3300	20.35	N/A
HC65000636_00068059701	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,071.36	N/A
HC65000636_00068059901	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,071.36	N/A
HC65000636_00069005801	NONCDM CHARGE RECORD PHARMACY	636	J1644	2.00	N/A
HC65000636_00069005901	NONCDM CHARGE RECORD PHARMACY	636	J1644	1.38	N/A
HC65000636_00069005903	NONCDM CHARGE RECORD PHARMACY	636	J1644	4.60	N/A
HC65000636_00069023420	NONCDM CHARGE RECORD PHARMACY	636	J2704	0.91	N/A
HC65000636_00069023801	NONCDM CHARGE RECORD PHARMACY	636	J9999	482.06	N/A
HC65000636_00069024810	NONCDM CHARGE RECORD PHARMACY	636	J2704	1.28	N/A
HC65000636_00069024901	NONCDM CHARGE RECORD PHARMACY	636	J9999	452.03	N/A
HC65000636_00069029310	NONCDM CHARGE RECORD PHARMACY	636	Q5110	4.36	N/A
HC65000636_00069030501	NONCDM CHARGE RECORD PHARMACY	636	Q5116	481.30	N/A
HC65000636_00069031501	NONCDM CHARGE RECORD PHARMACY	636	Q5118	368.04	N/A
HC65000636_00069034201	NONCDM CHARGE RECORD PHARMACY	636	Q5118	366.42	N/A
HC65000636_00069080901	NONCDM CHARGE RECORD PHARMACY	636	Q5103	274.67	N/A
HC65000636_00069130510	NONCDM CHARGE RECORD PHARMACY	636	Q5106	28.33	N/A
HC65000636_00069130610	NONCDM CHARGE RECORD PHARMACY	636	Q5106	66.18	N/A
HC65000636_00069130710	NONCDM CHARGE RECORD PHARMACY	636	Q5106	66.00	N/A
HC65000636_00069130810	NONCDM CHARGE RECORD PHARMACY	636	Q5106	66.15	N/A
HC65000636_00069130904	NONCDM CHARGE RECORD PHARMACY	636	Q5106	66.18	N/A
HC65000636_00069131110	NONCDM CHARGE RECORD PHARMACY	636	Q5106	66.18	N/A
HC65000636_00069303020	NONCDM CHARGE RECORD PHARMACY	636	J9000	42.66	N/A
HC65000636_00069303120	NONCDM CHARGE RECORD PHARMACY	636	J9000	60.26	N/A
HC65000636_00069303220	NONCDM CHARGE RECORD PHARMACY	636	J9000	28.95	N/A
HC65000636_00069306030	NONCDM CHARGE RECORD PHARMACY	636	Q0144	25.50	N/A
HC65000636_00069307030	NONCDM CHARGE RECORD PHARMACY	636	Q0144	17.61	N/A
HC65000636_00069315083	NONCDM CHARGE RECORD PHARMACY	636	J0456	36.04	N/A
HC65000636_00069403201	NONCDM CHARGE RECORD PHARMACY	636	J9000	40.86	N/A
HC65000636_00069547102	NONCDM CHARGE RECORD PHARMACY	636	Q2009	79.14	N/A
HC65000636_00069547402	NONCDM CHARGE RECORD PHARMACY	636	J3490	77.44	N/A
HC65000636_00069600121	NONCDM CHARGE RECORD PHARMACY	636	J3490	74.06	N/A
HC65000636_00069600125	NONCDM CHARGE RECORD PHARMACY	636	J3490	151.14	N/A
HC65000636_00074012402	NONCDM CHARGE RECORD PHARMACY	636	J0135	8,952.30	N/A
HC65000636_00074024302	NONCDM CHARGE RECORD PHARMACY	636	J0135	0.01	N/A
HC65000636_00074310832	NONCDM CHARGE RECORD PHARMACY	636	J7515	5.82	N/A
HC65000636_00074334603	NONCDM CHARGE RECORD PHARMACY	636	J9217	10,473.36	N/A
HC65000636_00074364103	NONCDM CHARGE RECORD PHARMACY	636	J1950	8,710.22	N/A
HC65000636_00074364203	NONCDM CHARGE RECORD PHARMACY	636	J9217	10,244.02	N/A
HC65000636_00074366303	NONCDM CHARGE RECORD PHARMACY	636	J1950	4,449.61	N/A
HC65000636_00074379902	NONCDM CHARGE RECORD PHARMACY	636	J0135	3,580.91	N/A
HC65000636_00074433902	NONCDM CHARGE RECORD PHARMACY	636	J0135	0.00	N/A
HC65000636_00074437805	NONCDM CHARGE RECORD PHARMACY	636	J3490	267.72	N/A
HC65000636_00074438010	NONCDM CHARGE RECORD PHARMACY	636	J3490	241.42	N/A
HC65000636_00074438081	NONCDM CHARGE RECORD PHARMACY	636	J3490	165.00	N/A
HC65000636_00074438220	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,782.00	N/A
HC65000636_00074438293	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,782.00	N/A
HC65000636_00074969403	NONCDM CHARGE RECORD PHARMACY	636	J1950	0.00	N/A
HC65000636_00075062160	NONCDM CHARGE RECORD PHARMACY	636	J1650	49.67	N/A
HC65000636_00075062430	NONCDM CHARGE RECORD PHARMACY	636	J1650	49.62	N/A
HC65000636_00075062603	NONCDM CHARGE RECORD PHARMACY	636	J1650	49.62	N/A
HC65000636_00078010901	NONCDM CHARGE RECORD PHARMACY	636	J7516	361.20	N/A
HC65000636_00078011022	NONCDM CHARGE RECORD PHARMACY	636	J7502	89.98	N/A
HC65000636_00078024015	NONCDM CHARGE RECORD PHARMACY	636	J7515	23.40	N/A
HC65000636_00078024615	NONCDM CHARGE RECORD PHARMACY	636	J7515	12.06	N/A
HC65000636_00078024815	NONCDM CHARGE RECORD PHARMACY	636	J7502	54.12	N/A
HC65000636_00078038566	NONCDM CHARGE RECORD PHARMACY	636	J7518	34.26	N/A
HC65000636_00078041420	NONCDM CHARGE RECORD PHARMACY	636	J7527	55.64	N/A
HC65000636_00078041720	NONCDM CHARGE RECORD PHARMACY	636	J7527	55.64	N/A
HC65000636_00078046791	NONCDM CHARGE RECORD PHARMACY	636	J0895	204.26	N/A
HC65000636_00078068306	NONCDM CHARGE RECORD PHARMACY	636	J9261	295.77	N/A
HC65000636_00078068615	NONCDM CHARGE RECORD PHARMACY	636		0.01	N/A
HC65000636_00078068655	NONCDM CHARGE RECORD PHARMACY	636		2,041.43	N/A
HC65000636_00078069061	NONCDM CHARGE RECORD PHARMACY	636	J9302	34.80	N/A
HC65000636_00078081881	NONCDM CHARGE RECORD PHARMACY	636	J2353	1,279.42	N/A
HC65000636_00078082581	NONCDM CHARGE RECORD PHARMACY	636	J2353	1,277.23	N/A
HC65000636_00078088361	NONCDM CHARGE RECORD PHARMACY	636	J0791	89.15	N/A
HC65000636_00085151903	NONCDM CHARGE RECORD PHARMACY	636	J8700	0.00	N/A
HC65000636_00085300403	NONCDM CHARGE RECORD PHARMACY	636	J8700	0.01	N/A
HC65000636_00085432001	NONCDM CHARGE RECORD PHARMACY	636	J0702	22.99	N/A
HC65000636_00085433101	NONCDM CHARGE RECORD PHARMACY	636	J3490	3,182.65	N/A
HC65000636_00088221900	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.00	N/A
HC65000636_00088221905	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.00	N/A
HC65000636_00088502005	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.00	N/A
HC65000636_00093574065	NONCDM CHARGE RECORD PHARMACY	636	J7515	6.60	N/A
HC65000636_00093574265	NONCDM CHARGE RECORD PHARMACY	636	J7502	25.83	N/A
HC65000636_00093733401	NONCDM CHARGE RECORD PHARMACY	636	J7517	3.86	N/A
HC65000636_00093901865	NONCDM CHARGE RECORD PHARMACY	636	J7515	6.59	N/A
HC65000636_00131181067	NONCDM CHARGE RECORD PHARMACY	636	C9254	2.40	N/A
HC65000636_00143908601	NONCDM CHARGE RECORD PHARMACY	636	J9000	42.00	N/A
HC65000636_00143921010	NONCDM CHARGE RECORD PHARMACY	636	J2400	79.32	N/A
HC65000636_00143921701	NONCDM CHARGE RECORD PHARMACY	636	J3590	1,796.06	N/A
HC65000636_00143921801	NONCDM CHARGE RECORD PHARMACY	636	J3590	669.40	N/A
HC65000636_00143924510	NONCDM CHARGE RECORD PHARMACY	636	J9130	36.00	N/A
HC65000636_00143926225	NONCDM CHARGE RECORD PHARMACY	636	J0690	3.16	N/A
HC65000636_00143927310	NONCDM CHARGE RECORD PHARMACY	636	J1110	897.00	N/A
HC65000636_00143928410	NONCDM CHARGE RECORD PHARMACY	636	C9113	38.21	N/A
HC65000636_00143929701	NONCDM CHARGE RECORD PHARMACY	636	J3490	3,190.95	N/A
HC65000636_00143929810	NONCDM CHARGE RECORD PHARMACY	636	J2916	9.84	N/A
HC65000636_00143930010	NONCDM CHARGE RECORD PHARMACY	636	C9113	17.71	N/A
HC65000636_00143931724	NONCDM CHARGE RECORD PHARMACY	636	J1956	4.82	N/A
HC65000636_00143931810	NONCDM CHARGE RECORD PHARMACY	636	J3490	11.99	N/A
HC65000636_00143937101	NONCDM CHARGE RECORD PHARMACY	636	J9000	15.03	N/A
HC65000636_00143938401	NONCDM CHARGE RECORD PHARMACY	636	J1453	2.60	N/A
HC65000636_00143950301	NONCDM CHARGE RECORD PHARMACY	636	J1120	263.02	N/A
HC65000636_00143950401	NONCDM CHARGE RECORD PHARMACY	636	J9060	15.08	N/A
HC65000636_00143951001	NONCDM CHARGE RECORD PHARMACY	636	J9181	5.62	N/A
HC65000636_00143951910	NONCDM CHARGE RECORD PHARMACY	636	J9260	13.15	N/A
HC65000636_00143953101	NONCDM CHARGE RECORD PHARMACY	636	J9208	220.44	N/A
HC65000636_00143953225	NONCDM CHARGE RECORD PHARMACY	636	J3490	128.42	N/A
HC65000636_00143954701	NONCDM CHARGE RECORD PHARMACY	636	J9000	40.03	N/A
HC65000636_00143954901	NONCDM CHARGE RECORD PHARMACY	636	J9000	40.75	N/A
HC65000636_00143955201	NONCDM CHARGE RECORD PHARMACY	636	J0640	21.52	N/A
HC65000636_00143955301	NONCDM CHARGE RECORD PHARMACY	636	J0640	36.00	N/A
HC65000636_00143955401	NONCDM CHARGE RECORD PHARMACY	636	J0640	48.00	N/A
HC65000636_00143955501	NONCDM CHARGE RECORD PHARMACY	636	J0640	60.00	N/A
HC65000636_00143955901	NONCDM CHARGE RECORD PHARMACY	636	J0883	23.78	N/A
HC65000636_00143956410	NONCDM CHARGE RECORD PHARMACY	636	J2760	2,674.97	N/A
HC65000636_00143957010	NONCDM CHARGE RECORD PHARMACY	636	J2916	37.91	N/A
HC65000636_00143957510	NONCDM CHARGE RECORD PHARMACY	636	J2001	0.19	N/A
HC65000636_00143957710	NONCDM CHARGE RECORD PHARMACY	636	J2001	1.72	N/A
HC65000636_00143958301	NONCDM CHARGE RECORD PHARMACY	636	J9206	24.00	N/A
HC65000636_00143959425	NONCDM CHARGE RECORD PHARMACY	636	J2001	1.01	N/A
HC65000636_00143959525	NONCDM CHARGE RECORD PHARMACY	636	J2001	2.57	N/A
HC65000636_00143960601	NONCDM CHARGE RECORD PHARMACY	636	J9025	6.00	N/A
HC65000636_00143962201	NONCDM CHARGE RECORD PHARMACY	636	J3490	5.39	N/A
HC65000636_00143963310	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,220.40	N/A
HC65000636_00143965901	NONCDM CHARGE RECORD PHARMACY	636	J1071	0.32	N/A
HC65000636_00143967325	NONCDM CHARGE RECORD PHARMACY	636	J1953	1.24	N/A
HC65000636_00143968910	NONCDM CHARGE RECORD PHARMACY	636	J3490	291.48	N/A
HC65000636_00143970101	NONCDM CHARGE RECORD PHARMACY	636	J9206	31.82	N/A
HC65000636_00143970910	NONCDM CHARGE RECORD PHARMACY	636	J2260	57.77	N/A
HC65000636_00143971010	NONCDM CHARGE RECORD PHARMACY	636	J2260	33.75	N/A
HC65000636_00143971910	NONCDM CHARGE RECORD PHARMACY	636	J2260	23.88	N/A
HC65000636_00143972024	NONCDM CHARGE RECORD PHARMACY	636	J1956	15.49	N/A
HC65000636_00143972124	NONCDM CHARGE RECORD PHARMACY	636	J1956	26.29	N/A
HC65000636_00143972224	NONCDM CHARGE RECORD PHARMACY	636	J1956	35.87	N/A
HC65000636_00143972601	NONCDM CHARGE RECORD PHARMACY	636	J1071	0.03	N/A
HC65000636_00143972905	NONCDM CHARGE RECORD PHARMACY	636	J0515	172.73	N/A
HC65000636_00143974410	NONCDM CHARGE RECORD PHARMACY	636	J1626	5.36	N/A
HC65000636_00143974610	NONCDM CHARGE RECORD PHARMACY	636	J3105	23.28	N/A
HC65000636_00143985001	NONCDM CHARGE RECORD PHARMACY	636	J2930	33.96	N/A
HC65000636_00143985101	NONCDM CHARGE RECORD PHARMACY	636	J2930	30.23	N/A
HC65000636_00143985625	NONCDM CHARGE RECORD PHARMACY	636	J0696	3.25	N/A
HC65000636_00143985725	NONCDM CHARGE RECORD PHARMACY	636	J0696	3.68	N/A
HC65000636_00143985825	NONCDM CHARGE RECORD PHARMACY	636	J0696	2.72	N/A
HC65000636_00143987210	NONCDM CHARGE RECORD PHARMACY	636	J1800	49.38	N/A
HC65000636_00143987525	NONCDM CHARGE RECORD PHARMACY	636	J0282	2.59	N/A
HC65000636_00143989010	NONCDM CHARGE RECORD PHARMACY	636	J2405	1.18	N/A
HC65000636_00143992390	NONCDM CHARGE RECORD PHARMACY	636	J0690	15.54	N/A
HC65000636_00143992490	NONCDM CHARGE RECORD PHARMACY	636	J0690	4.03	N/A
HC65000636_00143998303	NONCDM CHARGE RECORD PHARMACY	636	J0690	3.10	N/A
HC65000636_00169720101	NONCDM CHARGE RECORD PHARMACY	636	J7189	11.26	N/A
HC65000636_00169720201	NONCDM CHARGE RECORD PHARMACY	636	J7189	11.40	N/A
HC65000636_00169720501	NONCDM CHARGE RECORD PHARMACY	636	J7189	9.60	N/A
HC65000636_00169770521	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65000636_00173051700	NONCDM CHARGE RECORD PHARMACY	636	J1325	128.88	N/A
HC65000636_00173051900	NONCDM CHARGE RECORD PHARMACY	636	J3490	270.84	N/A
HC65000636_00173085702	NONCDM CHARGE RECORD PHARMACY	636	J3490	169.20	N/A
HC65000636_00173086910	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65000636_00173088101	NONCDM CHARGE RECORD PHARMACY	636	J2182	171.22	N/A
HC65000636_00173089201	NONCDM CHARGE RECORD PHARMACY	636	J2182	0.00	N/A
HC65000636_00173089242	NONCDM CHARGE RECORD PHARMACY	636	J2182	189.82	N/A
HC65000636_00173089601	NONCDM CHARGE RECORD PHARMACY	636	C9069	407.67	N/A
HC65000636_00206885216	NONCDM CHARGE RECORD PHARMACY	636	J2543	20.60	N/A
HC65000636_00228315603	NONCDM CHARGE RECORD PHARMACY	636	J0571	7.45	N/A
HC65000636_00264194020	NONCDM CHARGE RECORD PHARMACY	636	J3480	0.93	N/A
HC65000636_00264310511	NONCDM CHARGE RECORD PHARMACY	636	J0690	18.18	N/A
HC65000636_00264312511	NONCDM CHARGE RECORD PHARMACY	636	J0694	87.68	N/A
HC65000636_00264315311	NONCDM CHARGE RECORD PHARMACY	636	J0696	24.84	N/A
HC65000636_00264570510	NONCDM CHARGE RECORD PHARMACY	636	J1644	2.77	N/A
HC65000636_00264705510	NONCDM CHARGE RECORD PHARMACY	636	J2400	101.77	N/A
HC65000636_00264757810	NONCDM CHARGE RECORD PHARMACY	636	J2150	14.29	N/A
HC65000636_00264785000	NONCDM CHARGE RECORD PHARMACY	636		667.07	N/A
HC65000636_00264957710	NONCDM CHARGE RECORD PHARMACY	636	J1644	3.50	N/A
HC65000636_00264958720	NONCDM CHARGE RECORD PHARMACY	636	J1644	3.35	N/A
HC65000636_00264959820	NONCDM CHARGE RECORD PHARMACY	636	J2001	0.24	N/A
HC65000636_00270014957	NONCDM CHARGE RECORD PHARMACY	636	Q9958	1.10	N/A
HC65000636_00270014960	NONCDM CHARGE RECORD PHARMACY	636	Q9958	1.85	N/A
HC65000636_00270044540	NONCDM CHARGE RECORD PHARMACY	636	Q9963	3.52	N/A
HC65000636_00270055615	NONCDM CHARGE RECORD PHARMACY	636	J2805	487.15	N/A
HC65000636_00270131430	NONCDM CHARGE RECORD PHARMACY	636	Q9966	5.06	N/A
HC65000636_00270131630	NONCDM CHARGE RECORD PHARMACY	636	Q9967	5.88	N/A
HC65000636_00270131635	NONCDM CHARGE RECORD PHARMACY	636	Q9967	5.83	N/A
HC65000636_00270141111	NONCDM CHARGE RECORD PHARMACY	636	Q9966	38.77	N/A
HC65000636_00270141125	NONCDM CHARGE RECORD PHARMACY	636	Q9966	26.56	N/A
HC65000636_00270141215	NONCDM CHARGE RECORD PHARMACY	636	Q9967	34.35	N/A
HC65000636_00270516413	NONCDM CHARGE RECORD PHARMACY	636	A9577	34.90	N/A
HC65000636_00310072010	NONCDM CHARGE RECORD PHARMACY	636	J9395	581.72	N/A
HC65000636_00310173030	NONCDM CHARGE RECORD PHARMACY	636	J0517	987.12	N/A
HC65000636_00310450012	NONCDM CHARGE RECORD PHARMACY	636	J9173	406.94	N/A
HC65000636_00310461150	NONCDM CHARGE RECORD PHARMACY	636	J9173	0.00	N/A
HC65000636_00310652401	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65000636_00338004931	NONCDM CHARGE RECORD PHARMACY	636		0.01	N/A
HC65000636_00338006301	NONCDM CHARGE RECORD PHARMACY	636	Q2050	3,746.88	N/A
HC65000636_00338006910	NONCDM CHARGE RECORD PHARMACY	636	J1885	7.75	N/A
HC65000636_00338007225	NONCDM CHARGE RECORD PHARMACY	636	J1885	6.65	N/A
HC65000636_00338035702	NONCDM CHARGE RECORD PHARMACY	636	J2150	56.10	N/A
HC65000636_00338043103	NONCDM CHARGE RECORD PHARMACY	636	J1644	27.00	N/A
HC65000636_00338050348	NONCDM CHARGE RECORD PHARMACY	636	J1580	20.87	N/A
HC65000636_00338051141	NONCDM CHARGE RECORD PHARMACY	636	J1580	10.81	N/A
HC65000636_00338070348	NONCDM CHARGE RECORD PHARMACY	636	J3480	1.05	N/A
HC65000636_00338070548	NONCDM CHARGE RECORD PHARMACY	636	J3480	2.78	N/A
HC65000636_00338070948	NONCDM CHARGE RECORD PHARMACY	636	J3480	4.62	N/A
HC65000636_00338100702	NONCDM CHARGE RECORD PHARMACY	636	J1265	7.35	N/A
HC65000636_00338100703	NONCDM CHARGE RECORD PHARMACY	636	J1265	5.79	N/A
HC65000636_00338100902	NONCDM CHARGE RECORD PHARMACY	636	J1265	5.06	N/A
HC65000636_00338102541	NONCDM CHARGE RECORD PHARMACY	636	J2540	12.90	N/A
HC65000636_00338107502	NONCDM CHARGE RECORD PHARMACY	636	J1250	100.47	N/A
HC65000636_00338130501	NONCDM CHARGE RECORD PHARMACY	636	J9209	39.60	N/A
HC65000636_00338171540	NONCDM CHARGE RECORD PHARMACY	636	J3475	4.76	N/A
HC65000636_00338350841	NONCDM CHARGE RECORD PHARMACY	636	J0690	13.93	N/A
HC65000636_00338355248	NONCDM CHARGE RECORD PHARMACY	636	J3370	78.65	N/A
HC65000636_00338381424	NONCDM CHARGE RECORD PHARMACY	636	J3490	73.00	N/A
HC65000636_00338399301	NONCDM CHARGE RECORD PHARMACY	636	J9208	209.26	N/A
HC65000636_00338604537	NONCDM CHARGE RECORD PHARMACY	636	J1450	5.62	N/A
HC65000636_00338955524	NONCDM CHARGE RECORD PHARMACY	636	J3490	277.35	N/A
HC65000636_00338955810	NONCDM CHARGE RECORD PHARMACY	636	J1327	107.34	N/A
HC65000636_00407069015	NONCDM CHARGE RECORD PHARMACY	636	A9579	33.33	N/A
HC65000636_00407069020	NONCDM CHARGE RECORD PHARMACY	636	A9579	30.88	N/A
HC65000636_00407141220	NONCDM CHARGE RECORD PHARMACY	636	Q9965	13.81	N/A
HC65000636_00407141230	NONCDM CHARGE RECORD PHARMACY	636	Q9965	4.69	N/A
HC65000636_00407141233	NONCDM CHARGE RECORD PHARMACY	636	Q9965	4.54	N/A
HC65000636_00407141250	NONCDM CHARGE RECORD PHARMACY	636	Q9965	4.57	N/A
HC65000636_00407141310	NONCDM CHARGE RECORD PHARMACY	636	Q9967	24.12	N/A
HC65000636_00407141351	NONCDM CHARGE RECORD PHARMACY	636	Q9967	5.40	N/A
HC65000636_00407141361	NONCDM CHARGE RECORD PHARMACY	636	Q9967	5.56	N/A
HC65000636_00407141363	NONCDM CHARGE RECORD PHARMACY	636	Q9967	5.45	N/A
HC65000636_00407141366	NONCDM CHARGE RECORD PHARMACY	636	Q9967	4.94	N/A
HC65000636_00407141386	NONCDM CHARGE RECORD PHARMACY	636	Q9967	5.56	N/A
HC65000636_00407141388	NONCDM CHARGE RECORD PHARMACY	636	Q9967	5.30	N/A
HC65000636_00407141390	NONCDM CHARGE RECORD PHARMACY	636	Q9967	5.14	N/A
HC65000636_00407141403	NONCDM CHARGE RECORD PHARMACY	636	Q9967	5.41	N/A
HC65000636_00407141451	NONCDM CHARGE RECORD PHARMACY	636	Q9967	5.88	N/A
HC65000636_00407141482	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6.06	N/A
HC65000636_00407141484	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6.05	N/A
HC65000636_00407141489	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6.06	N/A
HC65000636_00407141491	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6.05	N/A
HC65000636_00407141493	NONCDM CHARGE RECORD PHARMACY	636	Q9967	5.57	N/A
HC65000636_00407141494	NONCDM CHARGE RECORD PHARMACY	636	Q9967	5.15	N/A
HC65000636_00407141498	NONCDM CHARGE RECORD PHARMACY	636	Q9967	4.91	N/A
HC65000636_00407222301	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6.17	N/A
HC65000636_00407222302	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6.17	N/A
HC65000636_00407222303	NONCDM CHARGE RECORD PHARMACY	636	Q9967	5.68	N/A
HC65000636_00407222304	NONCDM CHARGE RECORD PHARMACY	636	Q9967	5.24	N/A
HC65000636_00407222316	NONCDM CHARGE RECORD PHARMACY	636	Q9967	7.87	N/A
HC65000636_00407222317	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6.35	N/A
HC65000636_00407222319	NONCDM CHARGE RECORD PHARMACY	636	Q9967	5.96	N/A
HC65000636_00407222364	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6.32	N/A
HC65000636_00409018101	NONCDM CHARGE RECORD PHARMACY	636	J9201	53.03	N/A
HC65000636_00409018125	NONCDM CHARGE RECORD PHARMACY	636	J9201	53.81	N/A
HC65000636_00409018301	NONCDM CHARGE RECORD PHARMACY	636	J9201	53.46	N/A
HC65000636_00409018501	NONCDM CHARGE RECORD PHARMACY	636	J9201	55.24	N/A
HC65000636_00409018601	NONCDM CHARGE RECORD PHARMACY	636	J9201	55.17	N/A
HC65000636_00409021202	NONCDM CHARGE RECORD PHARMACY	636	J2260	28.27	N/A
HC65000636_00409030201	NONCDM CHARGE RECORD PHARMACY	636	J9351	20.58	N/A
HC65000636_00409032320	NONCDM CHARGE RECORD PHARMACY	636	J9040	123.59	N/A
HC65000636_00409052825	NONCDM CHARGE RECORD PHARMACY	636	J1956	23.93	N/A
HC65000636_00409080601	NONCDM CHARGE RECORD PHARMACY	636	J0690	2.53	N/A
HC65000636_00409103630	NONCDM CHARGE RECORD PHARMACY	636	J0670	10.68	N/A
HC65000636_00409104130	NONCDM CHARGE RECORD PHARMACY	636	J0670	11.14	N/A
HC65000636_00409106720	NONCDM CHARGE RECORD PHARMACY	636	J0670	15.04	N/A
HC65000636_00409110301	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,622.13	N/A
HC65000636_00409111301	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,300.00	N/A
HC65000636_00409113403	NONCDM CHARGE RECORD PHARMACY	636	J2270	0.76	N/A
HC65000636_00409113502	NONCDM CHARGE RECORD PHARMACY	636	J2270	1.51	N/A
HC65000636_00409114001	NONCDM CHARGE RECORD PHARMACY	636	J0883	6.46	N/A
HC65000636_00409117102	NONCDM CHARGE RECORD PHARMACY	636	J3490	51.04	N/A
HC65000636_00409117630	NONCDM CHARGE RECORD PHARMACY	636	J2175	25.40	N/A
HC65000636_00409117830	NONCDM CHARGE RECORD PHARMACY	636	J2175	26.71	N/A
HC65000636_00409117930	NONCDM CHARGE RECORD PHARMACY	636	J2175	37.94	N/A
HC65000636_00409120703	NONCDM CHARGE RECORD PHARMACY	636	J1580	6.99	N/A
HC65000636_00409120725	NONCDM CHARGE RECORD PHARMACY	636	J1580	5.29	N/A
HC65000636_00409121501	NONCDM CHARGE RECORD PHARMACY	636	J2310	114.51	N/A
HC65000636_00409121901	NONCDM CHARGE RECORD PHARMACY	636	J2310	178.11	N/A
HC65000636_00409127332	NONCDM CHARGE RECORD PHARMACY	636	J3360	77.04	N/A
HC65000636_00409128305	NONCDM CHARGE RECORD PHARMACY	636	J1170	18.68	N/A
HC65000636_00409128331	NONCDM CHARGE RECORD PHARMACY	636	J1170	15.34	N/A
HC65000636_00409128337	NONCDM CHARGE RECORD PHARMACY	636	J1170	22.48	N/A
HC65000636_00409131230	NONCDM CHARGE RECORD PHARMACY	636	J1170	11.40	N/A
HC65000636_00409131632	NONCDM CHARGE RECORD PHARMACY	636	J1644	3.97	N/A
HC65000636_00409131702	NONCDM CHARGE RECORD PHARMACY	636	J1165	4.02	N/A
HC65000636_00409132305	NONCDM CHARGE RECORD PHARMACY	636	J2001	2.00	N/A
HC65000636_00409139051	NONCDM CHARGE RECORD PHARMACY	636	J2185	17.95	N/A
HC65000636_00409139122	NONCDM CHARGE RECORD PHARMACY	636	J2185	46.28	N/A
HC65000636_00409141204	NONCDM CHARGE RECORD PHARMACY	636	J3490	15.72	N/A
HC65000636_00409141210	NONCDM CHARGE RECORD PHARMACY	636	J3490	69.24	N/A
HC65000636_00409146301	NONCDM CHARGE RECORD PHARMACY	636	J2300	21.70	N/A
HC65000636_00409163010	NONCDM CHARGE RECORD PHARMACY	636	J0461	0.34	N/A
HC65000636_00409166020	NONCDM CHARGE RECORD PHARMACY	636	J3490	157.56	N/A
HC65000636_00409166050	NONCDM CHARGE RECORD PHARMACY	636	J3490	274.49	N/A
HC65000636_00409188602	NONCDM CHARGE RECORD PHARMACY	636		0.46	N/A
HC65000636_00409189001	NONCDM CHARGE RECORD PHARMACY	636	J2270	13.79	N/A
HC65000636_00409189023	NONCDM CHARGE RECORD PHARMACY	636	J2270	23.96	N/A
HC65000636_00409189101	NONCDM CHARGE RECORD PHARMACY	636	J2270	11.72	N/A
HC65000636_00409189123	NONCDM CHARGE RECORD PHARMACY	636	J2270	19.81	N/A
HC65000636_00409189301	NONCDM CHARGE RECORD PHARMACY	636	J2270	11.18	N/A
HC65000636_00409193202	NONCDM CHARGE RECORD PHARMACY	636	J0153	10.77	N/A
HC65000636_00409198530	NONCDM CHARGE RECORD PHARMACY	636	J2060	17.53	N/A
HC65000636_00409206605	NONCDM CHARGE RECORD PHARMACY	636	J2001	2.35	N/A
HC65000636_00409216877	NONCDM CHARGE RECORD PHARMACY	636	J3475	1.61	N/A
HC65000636_00409226720	NONCDM CHARGE RECORD PHARMACY	636	J3490	2.86	N/A
HC65000636_00409226754	NONCDM CHARGE RECORD PHARMACY	636	J3490	3.71	N/A
HC65000636_00409230505	NONCDM CHARGE RECORD PHARMACY	636	J2250	1.22	N/A
HC65000636_00409230517	NONCDM CHARGE RECORD PHARMACY	636	J2250	1.91	N/A
HC65000636_00409230801	NONCDM CHARGE RECORD PHARMACY	636	J2250	1.25	N/A
HC65000636_00409230802	NONCDM CHARGE RECORD PHARMACY	636	J2250	1.00	N/A
HC65000636_00409233610	NONCDM CHARGE RECORD PHARMACY	636	J0895	56.50	N/A
HC65000636_00409233934	NONCDM CHARGE RECORD PHARMACY	636	J3490	44.59	N/A
HC65000636_00409234401	NONCDM CHARGE RECORD PHARMACY	636	J1250	35.47	N/A
HC65000636_00409234402	NONCDM CHARGE RECORD PHARMACY	636	J1250	33.45	N/A
HC65000636_00409234732	NONCDM CHARGE RECORD PHARMACY	636	J1250	37.70	N/A
HC65000636_00409255201	NONCDM CHARGE RECORD PHARMACY	636	J1170	10.91	N/A
HC65000636_00409259603	NONCDM CHARGE RECORD PHARMACY	636	J2250	1.06	N/A
HC65000636_00409259605	NONCDM CHARGE RECORD PHARMACY	636	J2250	0.89	N/A
HC65000636_00409263405	NONCDM CHARGE RECORD PHARMACY	636	J1170	5.10	N/A
HC65000636_00409272001	NONCDM CHARGE RECORD PHARMACY	636	J1644	10.99	N/A
HC65000636_00409272002	NONCDM CHARGE RECORD PHARMACY	636	J1644	1.99	N/A
HC65000636_00409272101	NONCDM CHARGE RECORD PHARMACY	636	J1644	2.40	N/A
HC65000636_00409272301	NONCDM CHARGE RECORD PHARMACY	636	J1644	2.40	N/A
HC65000636_00409272302	NONCDM CHARGE RECORD PHARMACY	636	J1644	1.38	N/A
HC65000636_00409336501	NONCDM CHARGE RECORD PHARMACY	636	J1170	5.61	N/A
HC65000636_00409337504	NONCDM CHARGE RECORD PHARMACY	636	J3490	210.00	N/A
HC65000636_00409338513	NONCDM CHARGE RECORD PHARMACY	636	J2543	22.99	N/A
HC65000636_00409339004	NONCDM CHARGE RECORD PHARMACY	636	J2543	25.42	N/A
HC65000636_00409341401	NONCDM CHARGE RECORD PHARMACY	636	J2765	6.06	N/A
HC65000636_00409357801	NONCDM CHARGE RECORD PHARMACY	636	J3260	11.91	N/A
HC65000636_00409371901	NONCDM CHARGE RECORD PHARMACY	636	J0290	10.85	N/A
HC65000636_00409379301	NONCDM CHARGE RECORD PHARMACY	636		16.37	N/A
HC65000636_00409379501	NONCDM CHARGE RECORD PHARMACY	636	J1885	17.17	N/A
HC65000636_00409379601	NONCDM CHARGE RECORD PHARMACY	636	J1885	4.54	N/A
HC65000636_00409381412	NONCDM CHARGE RECORD PHARMACY	636	J2274	18.70	N/A
HC65000636_00409381512	NONCDM CHARGE RECORD PHARMACY	636	J2274	27.69	N/A
HC65000636_00409403101	NONCDM CHARGE RECORD PHARMACY	636	J2150	13.12	N/A
HC65000636_00409409001	NONCDM CHARGE RECORD PHARMACY	636		481.03	N/A
HC65000636_00409409201	NONCDM CHARGE RECORD PHARMACY	636		480.00	N/A
HC65000636_00409427601	NONCDM CHARGE RECORD PHARMACY	636	J2001	0.42	N/A
HC65000636_00409427602	NONCDM CHARGE RECORD PHARMACY	636	J2001	12.85	N/A
HC65000636_00409427701	NONCDM CHARGE RECORD PHARMACY	636	J2001	0.31	N/A
HC65000636_00409427702	NONCDM CHARGE RECORD PHARMACY	636	J2001	0.06	N/A
HC65000636_00409427801	NONCDM CHARGE RECORD PHARMACY	636	J2001	0.93	N/A
HC65000636_00409427902	NONCDM CHARGE RECORD PHARMACY	636	J2001	0.66	N/A
HC65000636_00409428202	NONCDM CHARGE RECORD PHARMACY	636	J2001	1.53	N/A
HC65000636_00409428301	NONCDM CHARGE RECORD PHARMACY	636	J2001	1.31	N/A
HC65000636_00409433201	NONCDM CHARGE RECORD PHARMACY	636	J3370	47.16	N/A
HC65000636_00409468812	NONCDM CHARGE RECORD PHARMACY	636	J1450	34.16	N/A
HC65000636_00409468818	NONCDM CHARGE RECORD PHARMACY	636	J1450	45.79	N/A
HC65000636_00409468823	NONCDM CHARGE RECORD PHARMACY	636	J1450	58.20	N/A
HC65000636_00409469924	NONCDM CHARGE RECORD PHARMACY	636	J2704	1.28	N/A
HC65000636_00409469930	NONCDM CHARGE RECORD PHARMACY	636	J2704	1.56	N/A
HC65000636_00409469933	NONCDM CHARGE RECORD PHARMACY	636	J2704	1.28	N/A
HC65000636_00409471302	NONCDM CHARGE RECORD PHARMACY	636	J2001	1.87	N/A
HC65000636_00409471332	NONCDM CHARGE RECORD PHARMACY	636	J2001	3.56	N/A
HC65000636_00409471365	NONCDM CHARGE RECORD PHARMACY	636	J2001	2.43	N/A
HC65000636_00409475503	NONCDM CHARGE RECORD PHARMACY	636	J2405	1.72	N/A
HC65000636_00409475901	NONCDM CHARGE RECORD PHARMACY	636	J2405	1.01	N/A
HC65000636_00409477601	NONCDM CHARGE RECORD PHARMACY	636	J2001	54.60	N/A
HC65000636_00409477702	NONCDM CHARGE RECORD PHARMACY	636	J0744	9.29	N/A
HC65000636_00409477723	NONCDM CHARGE RECORD PHARMACY	636	J0744	14.40	N/A
HC65000636_00409485605	NONCDM CHARGE RECORD PHARMACY	636	J1720	12.00	N/A
HC65000636_00409490334	NONCDM CHARGE RECORD PHARMACY	636	J2001	2.04	N/A
HC65000636_00409491134	NONCDM CHARGE RECORD PHARMACY	636	J0461	0.62	N/A
HC65000636_00409492134	NONCDM CHARGE RECORD PHARMACY	636	J0171	3.05	N/A
HC65000636_00409508216	NONCDM CHARGE RECORD PHARMACY	636	J0713	13.87	N/A
HC65000636_00409508411	NONCDM CHARGE RECORD PHARMACY	636	J0713	19.20	N/A
HC65000636_00409508611	NONCDM CHARGE RECORD PHARMACY	636	J0713	18.00	N/A
HC65000636_00409582001	NONCDM CHARGE RECORD PHARMACY	636	J1265	3.50	N/A
HC65000636_00409592101	NONCDM CHARGE RECORD PHARMACY	636	J0280	106.13	N/A
HC65000636_00409592201	NONCDM CHARGE RECORD PHARMACY	636	J0280	35.08	N/A
HC65000636_00409593301	NONCDM CHARGE RECORD PHARMACY	636	J0878	0.86	N/A
HC65000636_00409610202	NONCDM CHARGE RECORD PHARMACY	636	J1940	24.26	N/A
HC65000636_00409610204	NONCDM CHARGE RECORD PHARMACY	636	J1940	8.62	N/A
HC65000636_00409610210	NONCDM CHARGE RECORD PHARMACY	636	J1940	6.91	N/A
HC65000636_00409610225	NONCDM CHARGE RECORD PHARMACY	636	J1940	20.27	N/A
HC65000636_00409610226	NONCDM CHARGE RECORD PHARMACY	636	J1940	8.70	N/A
HC65000636_00409647644	NONCDM CHARGE RECORD PHARMACY	636	J1364	501.60	N/A
HC65000636_00409647844	NONCDM CHARGE RECORD PHARMACY	636	J1364	112.65	N/A
HC65000636_00409648201	NONCDM CHARGE RECORD PHARMACY	636	J1364	468.34	N/A
HC65000636_00409650901	NONCDM CHARGE RECORD PHARMACY	636	J3370	46.00	N/A
HC65000636_00409651001	NONCDM CHARGE RECORD PHARMACY	636	J3370	57.11	N/A
HC65000636_00409653301	NONCDM CHARGE RECORD PHARMACY	636	J3370	31.92	N/A
HC65000636_00409653321	NONCDM CHARGE RECORD PHARMACY	636	J3370	24.25	N/A
HC65000636_00409653331	NONCDM CHARGE RECORD PHARMACY	636	J3370	10.85	N/A
HC65000636_00409655701	NONCDM CHARGE RECORD PHARMACY	636	J1071	0.00	N/A
HC65000636_00409656201	NONCDM CHARGE RECORD PHARMACY	636	J1071	0.58	N/A
HC65000636_00409656202	NONCDM CHARGE RECORD PHARMACY	636	J1071	0.00	N/A
HC65000636_00409663501	NONCDM CHARGE RECORD PHARMACY	636	J3480	9.09	N/A
HC65000636_00409665106	NONCDM CHARGE RECORD PHARMACY	636	J3480	2.95	N/A
HC65000636_00409665305	NONCDM CHARGE RECORD PHARMACY	636	J3480	1.78	N/A
HC65000636_00409672723	NONCDM CHARGE RECORD PHARMACY	636	J3475	22.20	N/A
HC65000636_00409672903	NONCDM CHARGE RECORD PHARMACY	636	J3475	0.83	N/A
HC65000636_00409672923	NONCDM CHARGE RECORD PHARMACY	636	J3475	5.45	N/A
HC65000636_00409672924	NONCDM CHARGE RECORD PHARMACY	636	J3475	21.86	N/A
HC65000636_00409677802	NONCDM CHARGE RECORD PHARMACY	636	J2060	5.44	N/A
HC65000636_00409707726	NONCDM CHARGE RECORD PHARMACY	636	J3480	4.76	N/A
HC65000636_00409724101	NONCDM CHARGE RECORD PHARMACY	636	J0171	3.69	N/A
HC65000636_00409724161	NONCDM CHARGE RECORD PHARMACY	636	J0171	0.56	N/A
HC65000636_00409729973	NONCDM CHARGE RECORD PHARMACY	636		935.00	N/A
HC65000636_00409733201	NONCDM CHARGE RECORD PHARMACY	636	J0696	2.19	N/A
HC65000636_00409733220	NONCDM CHARGE RECORD PHARMACY	636	J0696	2.25	N/A
HC65000636_00409733410	NONCDM CHARGE RECORD PHARMACY	636	J0696	2.52	N/A
HC65000636_00409733503	NONCDM CHARGE RECORD PHARMACY	636	J0696	2.40	N/A
HC65000636_00409733520	NONCDM CHARGE RECORD PHARMACY	636	J0696	2.14	N/A
HC65000636_00409733604	NONCDM CHARGE RECORD PHARMACY	636	J0696	1.76	N/A
HC65000636_00409733701	NONCDM CHARGE RECORD PHARMACY	636	J0696	3.87	N/A
HC65000636_00409733720	NONCDM CHARGE RECORD PHARMACY	636	J0696	4.51	N/A
HC65000636_00409733801	NONCDM CHARGE RECORD PHARMACY	636	J0696	2.54	N/A
HC65000636_00409762003	NONCDM CHARGE RECORD PHARMACY	636	J1644	32.78	N/A
HC65000636_00409771503	NONCDM CHARGE RECORD PHARMACY	636	J2150	51.89	N/A
HC65000636_00409779362	NONCDM CHARGE RECORD PHARMACY	636	J1644	2.29	N/A
HC65000636_00409780922	NONCDM CHARGE RECORD PHARMACY	636	J1265	7.80	N/A
HC65000636_00409781022	NONCDM CHARGE RECORD PHARMACY	636	J1265	5.25	N/A
HC65000636_00409909311	NONCDM CHARGE RECORD PHARMACY	636	J3010	2.33	N/A
HC65000636_00409909332	NONCDM CHARGE RECORD PHARMACY	636	J3010	3.86	N/A
HC65000636_00409909335	NONCDM CHARGE RECORD PHARMACY	636	J3010	3.89	N/A
HC65000636_00409909338	NONCDM CHARGE RECORD PHARMACY	636	J3010	0.82	N/A
HC65000636_00409909422	NONCDM CHARGE RECORD PHARMACY	636	J3010	2.80	N/A
HC65000636_00409909425	NONCDM CHARGE RECORD PHARMACY	636	J3010	4.02	N/A
HC65000636_00409909431	NONCDM CHARGE RECORD PHARMACY	636	J3010	3.82	N/A
HC65000636_00409909461	NONCDM CHARGE RECORD PHARMACY	636	J3010	4.28	N/A
HC65000636_00409915701	NONCDM CHARGE RECORD PHARMACY	636		25.66	N/A
HC65000636_00409915725	NONCDM CHARGE RECORD PHARMACY	636	J3430	25.35	N/A
HC65000636_00409915801	NONCDM CHARGE RECORD PHARMACY	636		28.32	N/A
HC65000636_00409963005	NONCDM CHARGE RECORD PHARMACY	636	J0461	3.34	N/A
HC65000636_00456040010	NONCDM CHARGE RECORD PHARMACY	636	J0712	31.46	N/A
HC65000636_00456060010	NONCDM CHARGE RECORD PHARMACY	636	J0712	20.66	N/A
HC65000636_00456270010	NONCDM CHARGE RECORD PHARMACY	636	J0714	536.80	N/A
HC65000636_00469042099	NONCDM CHARGE RECORD PHARMACY	636	J1833	16.87	N/A
HC65000636_00469060773	NONCDM CHARGE RECORD PHARMACY	636	J7507	19.00	N/A
HC65000636_00469087130	NONCDM CHARGE RECORD PHARMACY	636	J0153	21.77	N/A
HC65000636_00469305130	NONCDM CHARGE RECORD PHARMACY	636	J0289	308.62	N/A
HC65000636_00469321110	NONCDM CHARGE RECORD PHARMACY	636	J2248	11.22	N/A
HC65000636_00469325010	NONCDM CHARGE RECORD PHARMACY	636	J2248	11.22	N/A
HC65000636_00469650189	NONCDM CHARGE RECORD PHARMACY	636	J2785	359.61	N/A
HC65000636_00517003125	NONCDM CHARGE RECORD PHARMACY	636	J3420	41.94	N/A
HC65000636_00517037405	NONCDM CHARGE RECORD PHARMACY	636	Q9968	28.54	N/A
HC65000636_00517040125	NONCDM CHARGE RECORD PHARMACY	636	J0461	1.18	N/A
HC65000636_00517042001	NONCDM CHARGE RECORD PHARMACY	636	J1380	76.05	N/A
HC65000636_00517065001	NONCDM CHARGE RECORD PHARMACY	636	J1439	8.77	N/A
HC65000636_00517071001	NONCDM CHARGE RECORD PHARMACY	636	J1451	103.06	N/A
HC65000636_00517072001	NONCDM CHARGE RECORD PHARMACY	636	J0702	28.61	N/A
HC65000636_00517074020	NONCDM CHARGE RECORD PHARMACY	636	J2210	162.52	N/A
HC65000636_00517090125	NONCDM CHARGE RECORD PHARMACY	636	J0360	31.39	N/A
HC65000636_00517095501	NONCDM CHARGE RECORD PHARMACY	636	J2358	12.39	N/A
HC65000636_00517101025	NONCDM CHARGE RECORD PHARMACY	636	J0461	0.74	N/A
HC65000636_00517182510	NONCDM CHARGE RECORD PHARMACY	636	J2800	59.37	N/A
HC65000636_00517234010	NONCDM CHARGE RECORD PHARMACY	636	J1756	2.91	N/A
HC65000636_00517234025	NONCDM CHARGE RECORD PHARMACY	636	J1756	2.45	N/A
HC65000636_00517400225	NONCDM CHARGE RECORD PHARMACY	636	J2440	390.44	N/A
HC65000636_00517420125	NONCDM CHARGE RECORD PHARMACY	636	J3410	122.30	N/A
HC65000636_00517560125	NONCDM CHARGE RECORD PHARMACY	636	J3410	58.64	N/A
HC65000636_00517620225	NONCDM CHARGE RECORD PHARMACY	636		480.00	N/A
HC65000636_00517656025	NONCDM CHARGE RECORD PHARMACY	636		487.78	N/A
HC65000636_00548560100	NONCDM CHARGE RECORD PHARMACY	636	J1650	9.00	N/A
HC65000636_00548560200	NONCDM CHARGE RECORD PHARMACY	636	J1650	8.99	N/A
HC65000636_00548560300	NONCDM CHARGE RECORD PHARMACY	636	J1650	9.00	N/A
HC65000636_00548560400	NONCDM CHARGE RECORD PHARMACY	636	J1650	7.36	N/A
HC65000636_00548560500	NONCDM CHARGE RECORD PHARMACY	636	J1650	9.04	N/A
HC65000636_00548560600	NONCDM CHARGE RECORD PHARMACY	636	J1650	9.04	N/A
HC65000636_00548560800	NONCDM CHARGE RECORD PHARMACY	636	J1650	6.34	N/A
HC65000636_00548590000	NONCDM CHARGE RECORD PHARMACY	636	J0834	564.25	N/A
HC65000636_00548950200	NONCDM CHARGE RECORD PHARMACY	636	J3490	6,492.00	N/A
HC65000636_00574080530	NONCDM CHARGE RECORD PHARMACY	636	J0132	18.80	N/A
HC65000636_00574082001	NONCDM CHARGE RECORD PHARMACY	636	J1071	0.54	N/A
HC65000636_00574082010	NONCDM CHARGE RECORD PHARMACY	636	J1071	0.10	N/A
HC65000636_00574082701	NONCDM CHARGE RECORD PHARMACY	636	J1071	0.01	N/A
HC65000636_00574082710	NONCDM CHARGE RECORD PHARMACY	636	J1071	0.02	N/A
HC65000636_00574085010	NONCDM CHARGE RECORD PHARMACY	636	J1110	788.10	N/A
HC65000636_00591213651	NONCDM CHARGE RECORD PHARMACY	636	J2704	0.72	N/A
HC65000636_00591213668	NONCDM CHARGE RECORD PHARMACY	636	J2704	1.71	N/A
HC65000636_00591213695	NONCDM CHARGE RECORD PHARMACY	636	J2704	1.58	N/A
HC65000636_00597005345	NONCDM CHARGE RECORD PHARMACY	636	J1610	1,029.60	N/A
HC65000636_00597019705	NONCDM CHARGE RECORD PHARMACY	636	C9399	24,858.30	N/A
HC65000636_00597026010	NONCDM CHARGE RECORD PHARMACY	636	J1610	1,029.60	N/A
HC65000636_00641012125	NONCDM CHARGE RECORD PHARMACY	636	J1170	3.77	N/A
HC65000636_00641036725	NONCDM CHARGE RECORD PHARMACY	636	J1100	0.81	N/A
HC65000636_00641037625	NONCDM CHARGE RECORD PHARMACY	636	J1200	4.04	N/A
HC65000636_00641039112	NONCDM CHARGE RECORD PHARMACY	636	J1644	10.71	N/A
HC65000636_00641040012	NONCDM CHARGE RECORD PHARMACY	636	J1644	3.00	N/A
HC65000636_00641047625	NONCDM CHARGE RECORD PHARMACY	636	J2560	101.79	N/A
HC65000636_00641047725	NONCDM CHARGE RECORD PHARMACY	636	J2560	238.37	N/A
HC65000636_00641049325	NONCDM CHARGE RECORD PHARMACY	636	J1165	3.79	N/A
HC65000636_00641139735	NONCDM CHARGE RECORD PHARMACY	636	J3230	208.00	N/A
HC65000636_00641139835	NONCDM CHARGE RECORD PHARMACY	636	J3230	188.45	N/A
HC65000636_00641141035	NONCDM CHARGE RECORD PHARMACY	636	J1160	19.61	N/A
HC65000636_00641234141	NONCDM CHARGE RECORD PHARMACY	636	J1170	12.29	N/A
HC65000636_00641600610	NONCDM CHARGE RECORD PHARMACY	636	J0461	0.26	N/A
HC65000636_00641600710	NONCDM CHARGE RECORD PHARMACY	636	J3490	69.91	N/A
HC65000636_00641600810	NONCDM CHARGE RECORD PHARMACY	636	J3490	19.42	N/A
HC65000636_00641601310	NONCDM CHARGE RECORD PHARMACY	636	J3490	19.35	N/A
HC65000636_00641601410	NONCDM CHARGE RECORD PHARMACY	636	J3490	100.54	N/A
HC65000636_00641601510	NONCDM CHARGE RECORD PHARMACY	636	J3490	49.37	N/A
HC65000636_00641601910	NONCDM CHARGE RECORD PHARMACY	636	J2274	44.06	N/A
HC65000636_00641602010	NONCDM CHARGE RECORD PHARMACY	636	J2274	49.86	N/A
HC65000636_00641602725	NONCDM CHARGE RECORD PHARMACY	636	J3010	5.81	N/A
HC65000636_00641602825	NONCDM CHARGE RECORD PHARMACY	636	J3010	6.53	N/A
HC65000636_00641602925	NONCDM CHARGE RECORD PHARMACY	636	J3010	1.79	N/A
HC65000636_00641603001	NONCDM CHARGE RECORD PHARMACY	636	J3010	5.99	N/A
HC65000636_00641603901	NONCDM CHARGE RECORD PHARMACY	636	J2274	62.42	N/A
HC65000636_00641604425	NONCDM CHARGE RECORD PHARMACY	636	J2060	5.23	N/A
HC65000636_00641604610	NONCDM CHARGE RECORD PHARMACY	636	J2060	6.39	N/A
HC65000636_00641604825	NONCDM CHARGE RECORD PHARMACY	636	J2060	2.70	N/A
HC65000636_00641605225	NONCDM CHARGE RECORD PHARMACY	636	J2175	13.53	N/A
HC65000636_00641605325	NONCDM CHARGE RECORD PHARMACY	636	J2175	16.47	N/A
HC65000636_00641605710	NONCDM CHARGE RECORD PHARMACY	636	J2250	1.95	N/A
HC65000636_00641605725	NONCDM CHARGE RECORD PHARMACY	636	J2250	1.95	N/A
HC65000636_00641605910	NONCDM CHARGE RECORD PHARMACY	636	J2250	1.14	N/A
HC65000636_00641606001	NONCDM CHARGE RECORD PHARMACY	636	J2250	2.25	N/A
HC65000636_00641606010	NONCDM CHARGE RECORD PHARMACY	636	J2250	0.83	N/A
HC65000636_00641606125	NONCDM CHARGE RECORD PHARMACY	636	J2250	1.44	N/A
HC65000636_00641607025	NONCDM CHARGE RECORD PHARMACY	636	J2270	3.74	N/A
HC65000636_00641607825	NONCDM CHARGE RECORD PHARMACY	636	J2405	1.32	N/A
HC65000636_00641607901	NONCDM CHARGE RECORD PHARMACY	636	J2405	1.18	N/A
HC65000636_00641608025	NONCDM CHARGE RECORD PHARMACY	636	J2405	0.90	N/A
HC65000636_00641610325	NONCDM CHARGE RECORD PHARMACY	636	J2800	90.11	N/A
HC65000636_00641611610	NONCDM CHARGE RECORD PHARMACY	636	J0295	24.30	N/A
HC65000636_00641611710	NONCDM CHARGE RECORD PHARMACY	636	J0295	27.17	N/A
HC65000636_00641612525	NONCDM CHARGE RECORD PHARMACY	636	J2270	13.91	N/A
HC65000636_00641612725	NONCDM CHARGE RECORD PHARMACY	636	J2270	12.04	N/A
HC65000636_00641613225	NONCDM CHARGE RECORD PHARMACY	636	J2310	109.97	N/A
HC65000636_00641613825	NONCDM CHARGE RECORD PHARMACY	636	J1165	3.48	N/A
HC65000636_00641614225	NONCDM CHARGE RECORD PHARMACY	636	J2370	2.82	N/A
HC65000636_00641614525	NONCDM CHARGE RECORD PHARMACY	636	J1100	1.54	N/A
HC65000636_00641614910	NONCDM CHARGE RECORD PHARMACY	636	J2710	6.00	N/A
HC65000636_00641615125	NONCDM CHARGE RECORD PHARMACY	636	J1170	27.93	N/A
HC65000636_00641616110	NONCDM CHARGE RECORD PHARMACY	636	J3490	96.27	N/A
HC65000636_00641616210	NONCDM CHARGE RECORD PHARMACY	636	J3490	14.82	N/A
HC65000636_00641616610	NONCDM CHARGE RECORD PHARMACY	636	J0278	7.68	N/A
HC65000636_00641617410	NONCDM CHARGE RECORD PHARMACY	636	J2354	13.45	N/A
HC65000636_00641617510	NONCDM CHARGE RECORD PHARMACY	636	J2354	9.75	N/A
HC65000636_00641617610	NONCDM CHARGE RECORD PHARMACY	636	J2354	10.66	N/A
HC65000636_00641617801	NONCDM CHARGE RECORD PHARMACY	636	J2354	6.68	N/A
HC65000636_00641618425	NONCDM CHARGE RECORD PHARMACY	636	J1160	24.99	N/A
HC65000636_00641619010	NONCDM CHARGE RECORD PHARMACY	636	J2250	0.97	N/A
HC65000636_00641620410	NONCDM CHARGE RECORD PHARMACY	636	J1644	6.67	N/A
HC65000636_00641623125	NONCDM CHARGE RECORD PHARMACY	636	J0360	41.48	N/A
HC65000636_00641921710	NONCDM CHARGE RECORD PHARMACY	636	J3490	13.21	N/A
HC65000636_00641921910	NONCDM CHARGE RECORD PHARMACY	636	J3490	34.80	N/A
HC65000636_00703003101	NONCDM CHARGE RECORD PHARMACY	636	J1030	52.20	N/A
HC65000636_00703003104	NONCDM CHARGE RECORD PHARMACY	636	J1030	52.20	N/A
HC65000636_00703005101	NONCDM CHARGE RECORD PHARMACY	636	J1040	85.80	N/A
HC65000636_00703005104	NONCDM CHARGE RECORD PHARMACY	636	J1040	89.61	N/A
HC65000636_00703011301	NONCDM CHARGE RECORD PHARMACY	636	J1170	40.03	N/A
HC65000636_00703011303	NONCDM CHARGE RECORD PHARMACY	636	J1170	4.51	N/A
HC65000636_00703115303	NONCDM CHARGE RECORD PHARMACY	636	J3490	210.00	N/A
HC65000636_00703150102	NONCDM CHARGE RECORD PHARMACY	636	J0270	7.09	N/A
HC65000636_00703204503	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,639.69	N/A
HC65000636_00703315401	NONCDM CHARGE RECORD PHARMACY	636	J9040	314.05	N/A
HC65000636_00703321601	NONCDM CHARGE RECORD PHARMACY	636	J9267	0.00	N/A
HC65000636_00703321701	NONCDM CHARGE RECORD PHARMACY	636	J9267	2.64	N/A
HC65000636_00703330104	NONCDM CHARGE RECORD PHARMACY	636	J2354	13.01	N/A
HC65000636_00703331104	NONCDM CHARGE RECORD PHARMACY	636	J2354	9.75	N/A
HC65000636_00703332104	NONCDM CHARGE RECORD PHARMACY	636	J2354	10.50	N/A
HC65000636_00703334301	NONCDM CHARGE RECORD PHARMACY	636	J2354	7.20	N/A
HC65000636_00703342911	NONCDM CHARGE RECORD PHARMACY	636	J9208	215.04	N/A
HC65000636_00703367501	NONCDM CHARGE RECORD PHARMACY	636	J9260	10.84	N/A
HC65000636_00703367801	NONCDM CHARGE RECORD PHARMACY	636	J9260	9.89	N/A
HC65000636_00703398501	NONCDM CHARGE RECORD PHARMACY	636	J9263	3.00	N/A
HC65000636_00703398601	NONCDM CHARGE RECORD PHARMACY	636	J9263	6.98	N/A
HC65000636_00703424401	NONCDM CHARGE RECORD PHARMACY	636	J9045	43.77	N/A
HC65000636_00703424481	NONCDM CHARGE RECORD PHARMACY	636	J9045	40.59	N/A
HC65000636_00703424601	NONCDM CHARGE RECORD PHARMACY	636	J9045	35.88	N/A
HC65000636_00703424801	NONCDM CHARGE RECORD PHARMACY	636	J9045	42.70	N/A
HC65000636_00703424891	NONCDM CHARGE RECORD PHARMACY	636	J9045	43.32	N/A
HC65000636_00703450204	NONCDM CHARGE RECORD PHARMACY	636	J2765	18.11	N/A
HC65000636_00703450284	NONCDM CHARGE RECORD PHARMACY	636	J2765	16.10	N/A
HC65000636_00703468001	NONCDM CHARGE RECORD PHARMACY	636	J9293	201.01	N/A
HC65000636_00703471401	NONCDM CHARGE RECORD PHARMACY	636	J9351	10.19	N/A
HC65000636_00703505103	NONCDM CHARGE RECORD PHARMACY	636	J2597	110.90	N/A
HC65000636_00703505401	NONCDM CHARGE RECORD PHARMACY	636	J2597	125.70	N/A
HC65000636_00703507503	NONCDM CHARGE RECORD PHARMACY	636	J9130	49.23	N/A
HC65000636_00703514001	NONCDM CHARGE RECORD PHARMACY	636	J0640	59.58	N/A
HC65000636_00703514501	NONCDM CHARGE RECORD PHARMACY	636	J0640	16.07	N/A
HC65000636_00703523313	NONCDM CHARGE RECORD PHARMACY	636	J9150	388.56	N/A
HC65000636_00703565301	NONCDM CHARGE RECORD PHARMACY	636	J9181	5.02	N/A
HC65000636_00703574711	NONCDM CHARGE RECORD PHARMACY	636	J9060	21.55	N/A
HC65000636_00703574811	NONCDM CHARGE RECORD PHARMACY	636	J9060	22.66	N/A
HC65000636_00703701103	NONCDM CHARGE RECORD PHARMACY	636	J1631	0.01	N/A
HC65000636_00703722102	NONCDM CHARGE RECORD PHARMACY	636	J2405	3.00	N/A
HC65000636_00703851023	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.92	N/A
HC65000636_00703853023	NONCDM CHARGE RECORD PHARMACY	636	J1650	26.08	N/A
HC65000636_00703854023	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.89	N/A
HC65000636_00703856023	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.93	N/A
HC65000636_00703858023	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.93	N/A
HC65000636_00703861023	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.93	N/A
HC65000636_00703868023	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.93	N/A
HC65000636_00703903203	NONCDM CHARGE RECORD PHARMACY	636	J0278	8.67	N/A
HC65000636_00703904003	NONCDM CHARGE RECORD PHARMACY	636	J0278	3.71	N/A
HC65000636_00781210301	NONCDM CHARGE RECORD PHARMACY	636	J7507	15.49	N/A
HC65000636_00781305995	NONCDM CHARGE RECORD PHARMACY	636	J1160	17.23	N/A
HC65000636_00781307912	NONCDM CHARGE RECORD PHARMACY	636	J9395	255.00	N/A
HC65000636_00781309895	NONCDM CHARGE RECORD PHARMACY	636	J2185	19.47	N/A
HC65000636_00781309896	NONCDM CHARGE RECORD PHARMACY	636	J2185	16.59	N/A
HC65000636_00781311095	NONCDM CHARGE RECORD PHARMACY	636	J2543	22.05	N/A
HC65000636_00781311395	NONCDM CHARGE RECORD PHARMACY	636	J2543	25.11	N/A
HC65000636_00781311495	NONCDM CHARGE RECORD PHARMACY	636	J2543	29.55	N/A
HC65000636_00781315095	NONCDM CHARGE RECORD PHARMACY	636	J3490	161.50	N/A
HC65000636_00781315295	NONCDM CHARGE RECORD PHARMACY	636	J3490	885.50	N/A
HC65000636_00781315395	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,670.32	N/A
HC65000636_00781315401	NONCDM CHARGE RECORD PHARMACY	636	Q0138	10.23	N/A
HC65000636_00781315695	NONCDM CHARGE RECORD PHARMACY	636	J0131	2.12	N/A
HC65000636_00781315895	NONCDM CHARGE RECORD PHARMACY	636	J0583	15.74	N/A
HC65000636_00781315972	NONCDM CHARGE RECORD PHARMACY	636	J2358	15.93	N/A
HC65000636_00781320885	NONCDM CHARGE RECORD PHARMACY	636	J0696	1.58	N/A
HC65000636_00781320895	NONCDM CHARGE RECORD PHARMACY	636	J0696	5.64	N/A
HC65000636_00781321046	NONCDM CHARGE RECORD PHARMACY	636	J0696	6.68	N/A
HC65000636_00781323295	NONCDM CHARGE RECORD PHARMACY	636	C9113	29.16	N/A
HC65000636_00781323394	NONCDM CHARGE RECORD PHARMACY	636	J9070	169.29	N/A
HC65000636_00781325394	NONCDM CHARGE RECORD PHARMACY	636	J9025	18.68	N/A
HC65000636_00781325594	NONCDM CHARGE RECORD PHARMACY	636	J9070	395.55	N/A
HC65000636_00781326995	NONCDM CHARGE RECORD PHARMACY	636	J3490	283.61	N/A
HC65000636_00781328809	NONCDM CHARGE RECORD PHARMACY	636	J3490	47.10	N/A
HC65000636_00781328909	NONCDM CHARGE RECORD PHARMACY	636	J3490	47.89	N/A
HC65000636_00781329009	NONCDM CHARGE RECORD PHARMACY	636	J3490	38.14	N/A
HC65000636_00781331275	NONCDM CHARGE RECORD PHARMACY	636	J2469	61.82	N/A
HC65000636_00781331495	NONCDM CHARGE RECORD PHARMACY	636	J0883	26.40	N/A
HC65000636_00781331570	NONCDM CHARGE RECORD PHARMACY	636	J9263	3.00	N/A
HC65000636_00781331780	NONCDM CHARGE RECORD PHARMACY	636	J9263	3.00	N/A
HC65000636_00781340095	NONCDM CHARGE RECORD PHARMACY	636	J0290	24.89	N/A
HC65000636_00781340295	NONCDM CHARGE RECORD PHARMACY	636	J0290	27.43	N/A
HC65000636_00781340495	NONCDM CHARGE RECORD PHARMACY	636	J0290	20.64	N/A
HC65000636_00781340795	NONCDM CHARGE RECORD PHARMACY	636	J0290	21.11	N/A
HC65000636_00781340895	NONCDM CHARGE RECORD PHARMACY	636	J0290	20.02	N/A
HC65000636_00781341195	NONCDM CHARGE RECORD PHARMACY	636	J0330	11.40	N/A
HC65000636_00781341694	NONCDM CHARGE RECORD PHARMACY	636	J3465	36.62	N/A
HC65000636_00781342292	NONCDM CHARGE RECORD PHARMACY	636	J2370	1.91	N/A
HC65000636_00781343395	NONCDM CHARGE RECORD PHARMACY	636	J2020	307.50	N/A
HC65000636_00781344095	NONCDM CHARGE RECORD PHARMACY	636	J0834	463.90	N/A
HC65000636_00781344395	NONCDM CHARGE RECORD PHARMACY	636	J1652	40.05	N/A
HC65000636_00781345095	NONCDM CHARGE RECORD PHARMACY	636	J0690	46.73	N/A
HC65000636_00781345196	NONCDM CHARGE RECORD PHARMACY	636	J0690	11.43	N/A
HC65000636_00781345295	NONCDM CHARGE RECORD PHARMACY	636	J0690	13.35	N/A
HC65000636_00781345895	NONCDM CHARGE RECORD PHARMACY	636	J2370	2.64	N/A
HC65000636_00781346595	NONCDM CHARGE RECORD PHARMACY	636	J1652	35.37	N/A
HC65000636_00781346670	NONCDM CHARGE RECORD PHARMACY	636	J2370	2.22	N/A
HC65000636_00781348192	NONCDM CHARGE RECORD PHARMACY	636	J3243	15.02	N/A
HC65000636_00781375595	NONCDM CHARGE RECORD PHARMACY	636	J3490	185.30	N/A
HC65000636_00781400332	NONCDM CHARGE RECORD PHARMACY	636	J1950	696.13	N/A
HC65000636_00781502201	NONCDM CHARGE RECORD PHARMACY	636	J7509	5.57	N/A
HC65000636_00781921395	NONCDM CHARGE RECORD PHARMACY	636	J2543	22.55	N/A
HC65000636_00781921495	NONCDM CHARGE RECORD PHARMACY	636	J2543	21.34	N/A
HC65000636_00781922191	NONCDM CHARGE RECORD PHARMACY	636	J3490	66.75	N/A
HC65000636_00781922291	NONCDM CHARGE RECORD PHARMACY	636	J3490	68.68	N/A
HC65000636_00781925394	NONCDM CHARGE RECORD PHARMACY	636	J9025	18.68	N/A
HC65000636_00781931780	NONCDM CHARGE RECORD PHARMACY	636	J9263	3.00	N/A
HC65000636_00781940295	NONCDM CHARGE RECORD PHARMACY	636	J0290	20.09	N/A
HC65000636_00781940495	NONCDM CHARGE RECORD PHARMACY	636	J0290	20.73	N/A
HC65000636_00781940795	NONCDM CHARGE RECORD PHARMACY	636	J0290	21.12	N/A
HC65000636_00781940895	NONCDM CHARGE RECORD PHARMACY	636	J0290	20.10	N/A
HC65000636_00904662361	NONCDM CHARGE RECORD PHARMACY	636	J7507	7.98	N/A
HC65000636_00904662461	NONCDM CHARGE RECORD PHARMACY	636	J7507	15.07	N/A
HC65000636_00904670806	NONCDM CHARGE RECORD PHARMACY	636	Q0144	7.41	N/A
HC65000636_00904709761	NONCDM CHARGE RECORD PHARMACY	636	J7507	8.20	N/A
HC65000636_00942064104	NONCDM CHARGE RECORD PHARMACY	636	J3490	60.00	N/A
HC65000636_00944049302	NONCDM CHARGE RECORD PHARMACY	636	P9047	347.10	N/A
HC65000636_00944265804	NONCDM CHARGE RECORD PHARMACY	636	J1566	577.30	N/A
HC65000636_00944270002	NONCDM CHARGE RECORD PHARMACY	636	J1569	0.00	N/A
HC65000636_00944270005	NONCDM CHARGE RECORD PHARMACY	636	J1569	417.96	N/A
HC65000636_00944270006	NONCDM CHARGE RECORD PHARMACY	636	J1569	428.94	N/A
HC65000636_00944270007	NONCDM CHARGE RECORD PHARMACY	636	J1569	434.76	N/A
HC65000636_00944292302	NONCDM CHARGE RECORD PHARMACY	636	J7192	9.12	N/A
HC65000636_00944304610	NONCDM CHARGE RECORD PHARMACY	636	J7192	9.12	N/A
HC65000636_00944305202	NONCDM CHARGE RECORD PHARMACY	636	J7192	7.42	N/A
HC65000636_00944305302	NONCDM CHARGE RECORD PHARMACY	636	J7192	9.30	N/A
HC65000636_00944305402	NONCDM CHARGE RECORD PHARMACY	636	J7192	10.44	N/A
HC65000636_00955100310	NONCDM CHARGE RECORD PHARMACY	636	J1650	13.61	N/A
HC65000636_00955100410	NONCDM CHARGE RECORD PHARMACY	636	J1650	12.80	N/A
HC65000636_00955100610	NONCDM CHARGE RECORD PHARMACY	636	J1650	12.82	N/A
HC65000636_00955100810	NONCDM CHARGE RECORD PHARMACY	636	J1650	12.82	N/A
HC65000636_00955102001	NONCDM CHARGE RECORD PHARMACY	636	J9171	32.35	N/A
HC65000636_00955102104	NONCDM CHARGE RECORD PHARMACY	636	J9171	32.43	N/A
HC65000636_00990707426	NONCDM CHARGE RECORD PHARMACY	636		7.67	N/A
HC65000636_00990707526	NONCDM CHARGE RECORD PHARMACY	636	J3480	2.08	N/A
HC65000636_00990707714	NONCDM CHARGE RECORD PHARMACY	636	J3480	3.51	N/A
HC65000636_00990707726	NONCDM CHARGE RECORD PHARMACY	636	J3480	2.66	N/A
HC65000636_00990711807	NONCDM CHARGE RECORD PHARMACY	636		573.31	N/A
HC65000636_00990771503	NONCDM CHARGE RECORD PHARMACY	636	J2150	11.43	N/A
HC65000636_00990798302	NONCDM CHARGE RECORD PHARMACY	636	Q0243	0.01	N/A
HC65000636_00990798361	NONCDM CHARGE RECORD PHARMACY	636	Q0243	0.01	N/A
HC65000636_00990798413	NONCDM CHARGE RECORD PHARMACY	636		0.01	N/A
HC65000636_00990799009	NONCDM CHARGE RECORD PHARMACY	636		604.37	N/A
HC65000636_01001905561	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,789.57	N/A
HC65000636_01001907587	NONCDM CHARGE RECORD PHARMACY	636	J3490	3,023.40	N/A
HC65000636_01001967210	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,806.50	N/A
HC65000636_01001992501	NONCDM CHARGE RECORD PHARMACY	636	J9208	220.44	N/A
HC65000636_01001992602	NONCDM CHARGE RECORD PHARMACY	636	J9208	209.25	N/A
HC65000636_01001993801	NONCDM CHARGE RECORD PHARMACY	636	J9070	342.17	N/A
HC65000636_01001993901	NONCDM CHARGE RECORD PHARMACY	636	J9070	341.53	N/A
HC65000636_01001995301	NONCDM CHARGE RECORD PHARMACY	636	J9209	39.27	N/A
HC65000636_01001995501	NONCDM CHARGE RECORD PHARMACY	636	J9070	416.32	N/A
HC65000636_01001995550	NONCDM CHARGE RECORD PHARMACY	636	J9070	395.56	N/A
HC65000636_01001995601	NONCDM CHARGE RECORD PHARMACY	636	J9070	436.84	N/A
HC65000636_01001995701	NONCDM CHARGE RECORD PHARMACY	636	J9070	422.67	N/A
HC65000636_01012232510	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,220.40	N/A
HC65000636_01012262010	NONCDM CHARGE RECORD PHARMACY	636	C9460	92.04	N/A
HC65000636_01045471210	NONCDM CHARGE RECORD PHARMACY	636	J0587	32.82	N/A
HC65000636_01059900301	NONCDM CHARGE RECORD PHARMACY	636	J7401	35.53	N/A
HC65000636_01199401104	NONCDM CHARGE RECORD PHARMACY	636	Q9957	1,593.80	N/A
HC65000636_01199401116	NONCDM CHARGE RECORD PHARMACY	636	Q9957	1,381.01	N/A
HC65000636_01353331801	NONCDM CHARGE RECORD PHARMACY	636	90375	2,011.32	N/A
HC65000636_01353331803	NONCDM CHARGE RECORD PHARMACY	636	90375	2,011.32	N/A
HC65000636_01353331805	NONCDM CHARGE RECORD PHARMACY	636	90375	2,011.31	N/A
HC65000636_01353333504	NONCDM CHARGE RECORD PHARMACY	636	J1460	275.55	N/A
HC65000636_01353360250	NONCDM CHARGE RECORD PHARMACY	636	J3490	58,523.33	N/A
HC65000636_01353363402	NONCDM CHARGE RECORD PHARMACY	636	90389	2,503.80	N/A
HC65000636_01353363603	NONCDM CHARGE RECORD PHARMACY	636	90371	530.70	N/A
HC65000636_01353363605	NONCDM CHARGE RECORD PHARMACY	636	90371	960.28	N/A
HC65000636_01353368416	NONCDM CHARGE RECORD PHARMACY	636	P9047	165.00	N/A
HC65000636_01353368520	NONCDM CHARGE RECORD PHARMACY	636	P9045	391.20	N/A
HC65000636_01353370501	NONCDM CHARGE RECORD PHARMACY	636	J0256	30.89	N/A
HC65000636_01353380012	NONCDM CHARGE RECORD PHARMACY	636	J1561	366.98	N/A
HC65000636_01353380020	NONCDM CHARGE RECORD PHARMACY	636	J1561	129.40	N/A
HC65000636_01353380024	NONCDM CHARGE RECORD PHARMACY	636	J1459	257.17	N/A
HC65000636_01353380040	NONCDM CHARGE RECORD PHARMACY	636	J1561	390.36	N/A
HC65000636_01353380071	NONCDM CHARGE RECORD PHARMACY	636	J1561	242.81	N/A
HC65000636_01478901505	NONCDM CHARGE RECORD PHARMACY	636	J3490	3,574.38	N/A
HC65000636_01478960010	NONCDM CHARGE RECORD PHARMACY	636	J9017	167.00	N/A
HC65000636_01478990002	NONCDM CHARGE RECORD PHARMACY	636	J2690	998.40	N/A
HC65000636_01505405001	NONCDM CHARGE RECORD PHARMACY	636	J0586	6.70	N/A
HC65000636_01505405306	NONCDM CHARGE RECORD PHARMACY	636	J0586	10.02	N/A
HC65000636_01505410604	NONCDM CHARGE RECORD PHARMACY	636	J1930	0.00	N/A
HC65000636_01505411203	NONCDM CHARGE RECORD PHARMACY	636	J1930	0.00	N/A
HC65000636_01505411204	NONCDM CHARGE RECORD PHARMACY	636	J1930	0.00	N/A
HC65000636_01671401610	NONCDM CHARGE RECORD PHARMACY	636	J1650	21.09	N/A
HC65000636_01671403610	NONCDM CHARGE RECORD PHARMACY	636	J1650	28.55	N/A
HC65000636_01671406610	NONCDM CHARGE RECORD PHARMACY	636	J1650	30.01	N/A
HC65000636_01671422132	NONCDM CHARGE RECORD PHARMACY	636	Q0166	37.90	N/A
HC65000636_01671446801	NONCDM CHARGE RECORD PHARMACY	636	J8521	92.31	N/A
HC65000636_01671481501	NONCDM CHARGE RECORD PHARMACY	636	J3489	151.17	N/A
HC65000636_01671485901	NONCDM CHARGE RECORD PHARMACY	636	J9070	406.67	N/A
HC65000636_01671488601	NONCDM CHARGE RECORD PHARMACY	636	J9040	133.49	N/A
HC65000636_01671493001	NONCDM CHARGE RECORD PHARMACY	636	J9201	59.81	N/A
HC65000636_01672904201	NONCDM CHARGE RECORD PHARMACY	636	J7507	3.86	N/A
HC65000636_01672904301	NONCDM CHARGE RECORD PHARMACY	636	J7507	5.30	N/A
HC65000636_01672910811	NONCDM CHARGE RECORD PHARMACY	636	J9280	947.97	N/A
HC65000636_01672911408	NONCDM CHARGE RECORD PHARMACY	636	J9181	5.62	N/A
HC65000636_01672911431	NONCDM CHARGE RECORD PHARMACY	636	J9181	5.40	N/A
HC65000636_01672911505	NONCDM CHARGE RECORD PHARMACY	636	J9280	1,459.62	N/A
HC65000636_01672911638	NONCDM CHARGE RECORD PHARMACY	636	J9280	947.97	N/A
HC65000636_01672915131	NONCDM CHARGE RECORD PHARMACY	636	J9351	20.67	N/A
HC65000636_01672922405	NONCDM CHARGE RECORD PHARMACY	636	J0894	46.68	N/A
HC65000636_01672923993	NONCDM CHARGE RECORD PHARMACY	636	J3490	64.71	N/A
HC65000636_01672924231	NONCDM CHARGE RECORD PHARMACY	636	J3489	84.46	N/A
HC65000636_01672925938	NONCDM CHARGE RECORD PHARMACY	636	J1327	119.54	N/A
HC65000636_01672926003	NONCDM CHARGE RECORD PHARMACY	636	J1327	143.36	N/A
HC65000636_01672926231	NONCDM CHARGE RECORD PHARMACY	636	J9181	5.62	N/A
HC65000636_01672926764	NONCDM CHARGE RECORD PHARMACY	636	J9171	6.38	N/A
HC65000636_01672927638	NONCDM CHARGE RECORD PHARMACY	636	J9190	32.79	N/A
HC65000636_01672927667	NONCDM CHARGE RECORD PHARMACY	636	J9190	68.05	N/A
HC65000636_01672927668	NONCDM CHARGE RECORD PHARMACY	636	J9190	76.50	N/A
HC65000636_01672927703	NONCDM CHARGE RECORD PHARMACY	636	J9260	11.17	N/A
HC65000636_01672927730	NONCDM CHARGE RECORD PHARMACY	636	J9260	21.36	N/A
HC65000636_01672927735	NONCDM CHARGE RECORD PHARMACY	636	J9260	10.16	N/A
HC65000636_01672928811	NONCDM CHARGE RECORD PHARMACY	636	J9060	21.66	N/A
HC65000636_01672928838	NONCDM CHARGE RECORD PHARMACY	636	J9060	18.00	N/A
HC65000636_01672929512	NONCDM CHARGE RECORD PHARMACY	636	J9045	21.58	N/A
HC65000636_01672929805	NONCDM CHARGE RECORD PHARMACY	636	J2405	0.74	N/A
HC65000636_01672930610	NONCDM CHARGE RECORD PHARMACY	636	J9025	7.20	N/A
HC65000636_01672933205	NONCDM CHARGE RECORD PHARMACY	636	J9263	3.00	N/A
HC65000636_01672936468	NONCDM CHARGE RECORD PHARMACY	636	J3243	15.02	N/A
HC65000636_01723842406	NONCDM CHARGE RECORD PHARMACY	636	J3490	475.00	N/A
HC65000636_01747801502	NONCDM CHARGE RECORD PHARMACY	636	J0500	324.28	N/A
HC65000636_01747803002	NONCDM CHARGE RECORD PHARMACY	636	J3010	14.48	N/A
HC65000636_01747803005	NONCDM CHARGE RECORD PHARMACY	636	J3010	5.41	N/A
HC65000636_01747804001	NONCDM CHARGE RECORD PHARMACY	636	J2060	9.74	N/A
HC65000636_01747804532	NONCDM CHARGE RECORD PHARMACY	636	J3490	607.53	N/A
HC65000636_01747810730	NONCDM CHARGE RECORD PHARMACY	636	J3490	100.80	N/A
HC65000636_01747825310	NONCDM CHARGE RECORD PHARMACY	636	J3490	280.58	N/A
HC65000636_01747838020	NONCDM CHARGE RECORD PHARMACY	636	J1230	17.14	N/A
HC65000636_01747841510	NONCDM CHARGE RECORD PHARMACY	636	J3490	283.74	N/A
HC65000636_01747842020	NONCDM CHARGE RECORD PHARMACY	636	J3490	9.99	N/A
HC65000636_01747851002	NONCDM CHARGE RECORD PHARMACY	636	J3490	469.72	N/A
HC65000636_01747852410	NONCDM CHARGE RECORD PHARMACY	636	J2250	1.38	N/A
HC65000636_01747854005	NONCDM CHARGE RECORD PHARMACY	636	J1170	3.30	N/A
HC65000636_01747854202	NONCDM CHARGE RECORD PHARMACY	636	J0153	5.80	N/A
HC65000636_01747854602	NONCDM CHARGE RECORD PHARMACY	636	J1626	11.32	N/A
HC65000636_01747893101	NONCDM CHARGE RECORD PHARMACY	636	J0636	4.50	N/A
HC65000636_01747893415	NONCDM CHARGE RECORD PHARMACY	636	J0360	52.69	N/A
HC65000636_01747893705	NONCDM CHARGE RECORD PHARMACY	636	J3490	16.95	N/A
HC65000636_01747893710	NONCDM CHARGE RECORD PHARMACY	636	J3490	42.19	N/A
HC65000636_01747893726	NONCDM CHARGE RECORD PHARMACY	636	J3490	65.34	N/A
HC65000636_01747895302	NONCDM CHARGE RECORD PHARMACY	636	J0153	2.48	N/A
HC65000636_01785637221	NONCDM CHARGE RECORD PHARMACY	636	J7512	4.16	N/A
HC65000636_01865711704	NONCDM CHARGE RECORD PHARMACY	636	J3473	3.49	N/A
HC65000636_01951581652	NONCDM CHARGE RECORD PHARMACY	636	90686	96.56	N/A
HC65000636_01951581852	NONCDM CHARGE RECORD PHARMACY	636	90686	101.30	N/A
HC65000636_02315516641	NONCDM CHARGE RECORD PHARMACY	636	J3490	99.34	N/A
HC65000636_02315518631	NONCDM CHARGE RECORD PHARMACY	636	J3489	360.00	N/A
HC65000636_02315521631	NONCDM CHARGE RECORD PHARMACY	636	J0740	4,440.00	N/A
HC65000636_02315524041	NONCDM CHARGE RECORD PHARMACY	636	J2765	12.30	N/A
HC65000636_02315529041	NONCDM CHARGE RECORD PHARMACY	636	J0278	13.52	N/A
HC65000636_02315529441	NONCDM CHARGE RECORD PHARMACY	636	J0780	58.85	N/A
HC65000636_02315529442	NONCDM CHARGE RECORD PHARMACY	636	J0780	68.59	N/A
HC65000636_02315547342	NONCDM CHARGE RECORD PHARMACY	636	J1940	8.47	N/A
HC65000636_02315549742	NONCDM CHARGE RECORD PHARMACY	636	J0780	111.00	N/A
HC65000636_02315554741	NONCDM CHARGE RECORD PHARMACY	636	J2405	0.69	N/A
HC65000636_02315554742	NONCDM CHARGE RECORD PHARMACY	636	J2405	0.66	N/A
HC65000636_02315554931	NONCDM CHARGE RECORD PHARMACY	636	J2405	0.75	N/A
HC65000636_02315560041	NONCDM CHARGE RECORD PHARMACY	636	J2250	1.64	N/A
HC65000636_02315560141	NONCDM CHARGE RECORD PHARMACY	636	J2250	0.75	N/A
HC65000636_02315560142	NONCDM CHARGE RECORD PHARMACY	636	J2250	0.77	N/A
HC65000636_02420101020	NONCDM CHARGE RECORD PHARMACY	636	J2515	363.08	N/A
HC65000636_02420110024	NONCDM CHARGE RECORD PHARMACY	636	J0131	2.38	N/A
HC65000636_02433805008	NONCDM CHARGE RECORD PHARMACY	636	C9399	98,971.44	N/A
HC65000636_02433815020	NONCDM CHARGE RECORD PHARMACY	636	J3316	0.00	N/A
HC65000636_02502110299	NONCDM CHARGE RECORD PHARMACY	636	J0690	3.60	N/A
HC65000636_02502110510	NONCDM CHARGE RECORD PHARMACY	636	J0696	2.12	N/A
HC65000636_02502110610	NONCDM CHARGE RECORD PHARMACY	636	J0696	3.27	N/A
HC65000636_02502110910	NONCDM CHARGE RECORD PHARMACY	636	J0694	33.64	N/A
HC65000636_02502111020	NONCDM CHARGE RECORD PHARMACY	636	J0694	29.96	N/A
HC65000636_02502111382	NONCDM CHARGE RECORD PHARMACY	636	J1450	54.00	N/A
HC65000636_02502111487	NONCDM CHARGE RECORD PHARMACY	636	J0744	21.85	N/A
HC65000636_02502111504	NONCDM CHARGE RECORD PHARMACY	636	J3490	15.15	N/A
HC65000636_02502111506	NONCDM CHARGE RECORD PHARMACY	636	J3490	11.90	N/A
HC65000636_02502112120	NONCDM CHARGE RECORD PHARMACY	636	J0692	18.82	N/A
HC65000636_02502112250	NONCDM CHARGE RECORD PHARMACY	636	J0692	20.47	N/A
HC65000636_02502112720	NONCDM CHARGE RECORD PHARMACY	636	J0713	15.60	N/A
HC65000636_02502112850	NONCDM CHARGE RECORD PHARMACY	636	J0713	15.16	N/A
HC65000636_02502112999	NONCDM CHARGE RECORD PHARMACY	636	J0713	21.91	N/A
HC65000636_02502113281	NONCDM CHARGE RECORD PHARMACY	636	J1956	42.00	N/A
HC65000636_02502113283	NONCDM CHARGE RECORD PHARMACY	636	J1956	23.89	N/A
HC65000636_02502113410	NONCDM CHARGE RECORD PHARMACY	636	J0290	13.75	N/A
HC65000636_02502113510	NONCDM CHARGE RECORD PHARMACY	636	J0290	18.00	N/A
HC65000636_02502113720	NONCDM CHARGE RECORD PHARMACY	636	J0290	11.17	N/A
HC65000636_02502114330	NONCDM CHARGE RECORD PHARMACY	636	J0295	29.33	N/A
HC65000636_02502115799	NONCDM CHARGE RECORD PHARMACY	636	J3370	25.24	N/A
HC65000636_02502115899	NONCDM CHARGE RECORD PHARMACY	636	J3370	27.00	N/A
HC65000636_02502116224	NONCDM CHARGE RECORD PHARMACY	636	J2700	16.88	N/A
HC65000636_02502116430	NONCDM CHARGE RECORD PHARMACY	636	J2543	22.57	N/A
HC65000636_02502116530	NONCDM CHARGE RECORD PHARMACY	636	J2543	23.33	N/A
HC65000636_02502117302	NONCDM CHARGE RECORD PHARMACY	636	J0278	8.48	N/A
HC65000636_02502117916	NONCDM CHARGE RECORD PHARMACY	636	J0878	4.68	N/A
HC65000636_02502117967	NONCDM CHARGE RECORD PHARMACY	636	J0878	0.92	N/A
HC65000636_02502118466	NONCDM CHARGE RECORD PHARMACY	636	J1450	24.00	N/A
HC65000636_02502118467	NONCDM CHARGE RECORD PHARMACY	636	J1450	13.83	N/A
HC65000636_02502118482	NONCDM CHARGE RECORD PHARMACY	636	J1450	44.55	N/A
HC65000636_02502118487	NONCDM CHARGE RECORD PHARMACY	636	J1450	142.56	N/A
HC65000636_02502118510	NONCDM CHARGE RECORD PHARMACY	636	J1570	360.00	N/A
HC65000636_02502120111	NONCDM CHARGE RECORD PHARMACY	636	J9209	24.00	N/A
HC65000636_02502120401	NONCDM CHARGE RECORD PHARMACY	636	J9390	150.00	N/A
HC65000636_02502120405	NONCDM CHARGE RECORD PHARMACY	636	J9390	61.59	N/A
HC65000636_02502123320	NONCDM CHARGE RECORD PHARMACY	636	J9263	2.07	N/A
HC65000636_02502123410	NONCDM CHARGE RECORD PHARMACY	636	J9201	72.30	N/A
HC65000636_02502123550	NONCDM CHARGE RECORD PHARMACY	636	J9201	59.58	N/A
HC65000636_02502123604	NONCDM CHARGE RECORD PHARMACY	636	J9351	22.50	N/A
HC65000636_02502124504	NONCDM CHARGE RECORD PHARMACY	636	J9171	5.88	N/A
HC65000636_02502130520	NONCDM CHARGE RECORD PHARMACY	636	J1205	288.79	N/A
HC65000636_02502130884	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,950.06	N/A
HC65000636_02502130982	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,087.40	N/A
HC65000636_02502131002	NONCDM CHARGE RECORD PHARMACY	636	J3490	780.00	N/A
HC65000636_02502131104	NONCDM CHARGE RECORD PHARMACY	636	J1940	8.35	N/A
HC65000636_02502131110	NONCDM CHARGE RECORD PHARMACY	636	J1940	3.84	N/A
HC65000636_02502131501	NONCDM CHARGE RECORD PHARMACY	636	J2370	0.84	N/A
HC65000636_02502131598	NONCDM CHARGE RECORD PHARMACY	636	J2370	1.78	N/A
HC65000636_02502140001	NONCDM CHARGE RECORD PHARMACY	636		25.30	N/A
HC65000636_02502140010	NONCDM CHARGE RECORD PHARMACY	636	J1644	2.15	N/A
HC65000636_02502140030	NONCDM CHARGE RECORD PHARMACY	636	J1644	1.36	N/A
HC65000636_02502140102	NONCDM CHARGE RECORD PHARMACY	636	J1644	31.20	N/A
HC65000636_02502140201	NONCDM CHARGE RECORD PHARMACY	636	J1644	3.13	N/A
HC65000636_02502140301	NONCDM CHARGE RECORD PHARMACY	636	J1644	2.40	N/A
HC65000636_02502140851	NONCDM CHARGE RECORD PHARMACY	636	J1327	133.14	N/A
HC65000636_02502140910	NONCDM CHARGE RECORD PHARMACY	636	J1327	151.30	N/A
HC65000636_02502145301	NONCDM CHARGE RECORD PHARMACY	636	J2354	8.68	N/A
HC65000636_02502146274	NONCDM CHARGE RECORD PHARMACY	636	J9395	581.72	N/A
HC65000636_02502150002	NONCDM CHARGE RECORD PHARMACY	636	J3411	30.48	N/A
HC65000636_02502160820	NONCDM CHARGE RECORD PHARMACY	636	J2704	1.67	N/A
HC65000636_02502160850	NONCDM CHARGE RECORD PHARMACY	636	J2704	1.75	N/A
HC65000636_02502160851	NONCDM CHARGE RECORD PHARMACY	636	J2704	1.75	N/A
HC65000636_02502167166	NONCDM CHARGE RECORD PHARMACY	636	J2795	0.74	N/A
HC65000636_02502167182	NONCDM CHARGE RECORD PHARMACY	636	J2795	1.37	N/A
HC65000636_02502167650	NONCDM CHARGE RECORD PHARMACY	636	J2515	270.00	N/A
HC65000636_02502170102	NONCDM CHARGE RECORD PHARMACY	636	J1885	1.64	N/A
HC65000636_02502177702	NONCDM CHARGE RECORD PHARMACY	636	J2405	2.63	N/A
HC65000636_02502178305	NONCDM CHARGE RECORD PHARMACY	636	J2469	60.00	N/A
HC65000636_02502180601	NONCDM CHARGE RECORD PHARMACY	636	J1630	29.52	N/A
HC65000636_02502181230	NONCDM CHARGE RECORD PHARMACY	636	J0132	14.66	N/A
HC65000636_02502181430	NONCDM CHARGE RECORD PHARMACY	636	J0640	60.00	N/A
HC65000636_02502181630	NONCDM CHARGE RECORD PHARMACY	636	J0640	57.66	N/A
HC65000636_02502182682	NONCDM CHARGE RECORD PHARMACY	636	J3489	270.00	N/A
HC65000636_02502182850	NONCDM CHARGE RECORD PHARMACY	636	J0640	60.00	N/A
HC65000636_02502183082	NONCDM CHARGE RECORD PHARMACY	636	J3489	420.00	N/A
HC65000636_02568200701	NONCDM CHARGE RECORD PHARMACY	636	J2840	392.29	N/A
HC65000636_02568202201	NONCDM CHARGE RECORD PHARMACY	636	J1303	1,001.62	N/A
HC65000636_02568202501	NONCDM CHARGE RECORD PHARMACY	636	J1303	1,280.80	N/A
HC65000636_02750500367	NONCDM CHARGE RECORD PHARMACY	636	J3490	420.00	N/A
HC65000636_03023789006	NONCDM CHARGE RECORD PHARMACY	636	Q2043	375,615.00	N/A
HC65000636_03600000924	NONCDM CHARGE RECORD PHARMACY	636	J0744	15.00	N/A
HC65000636_03600001225	NONCDM CHARGE RECORD PHARMACY	636	J2405	1.43	N/A
HC65000636_03600024201	NONCDM CHARGE RECORD PHARMACY	636	J3260	7.32	N/A
HC65000636_03600028225	NONCDM CHARGE RECORD PHARMACY	636	J1940	12.91	N/A
HC65000636_03600028325	NONCDM CHARGE RECORD PHARMACY	636	J1940	8.68	N/A
HC65000636_03600028425	NONCDM CHARGE RECORD PHARMACY	636	J1940	3.90	N/A
HC65000636_03600032402	NONCDM CHARGE RECORD PHARMACY	636	J3490	4.46	N/A
HC65000636_03982201901	NONCDM CHARGE RECORD PHARMACY	636	J1120	189.59	N/A
HC65000636_03982201907	NONCDM CHARGE RECORD PHARMACY	636	J1120	189.00	N/A
HC65000636_03982204121	NONCDM CHARGE RECORD PHARMACY	636	J3260	69.95	N/A
HC65000636_03982207062	NONCDM CHARGE RECORD PHARMACY	636	J3490	450.00	N/A
HC65000636_03982210001	NONCDM CHARGE RECORD PHARMACY	636	J3490	112.12	N/A
HC65000636_03982210555	NONCDM CHARGE RECORD PHARMACY	636	J0285	262.20	N/A
HC65000636_03982210771	NONCDM CHARGE RECORD PHARMACY	636	J3465	68.20	N/A
HC65000636_03982221002	NONCDM CHARGE RECORD PHARMACY	636	J9120	8,850.00	N/A
HC65000636_04202310501	NONCDM CHARGE RECORD PHARMACY	636	J3490	32.54	N/A
HC65000636_04202310701	NONCDM CHARGE RECORD PHARMACY	636	J0770	168.00	N/A
HC65000636_04202310706	NONCDM CHARGE RECORD PHARMACY	636	J0770	168.00	N/A
HC65000636_04202311625	NONCDM CHARGE RECORD PHARMACY	636	J2590	21.44	N/A
HC65000636_04202311801	NONCDM CHARGE RECORD PHARMACY	636	J3250	198.24	N/A
HC65000636_04202311925	NONCDM CHARGE RECORD PHARMACY	636	J3250	250.90	N/A
HC65000636_04202312306	NONCDM CHARGE RECORD PHARMACY	636	J3490	531.84	N/A
HC65000636_04202313101	NONCDM CHARGE RECORD PHARMACY	636	J0770	167.94	N/A
HC65000636_04202314625	NONCDM CHARGE RECORD PHARMACY	636	J3490	101.48	N/A
HC65000636_04202315925	NONCDM CHARGE RECORD PHARMACY	636	J0171	8.94	N/A
HC65000636_04202316410	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,501.47	N/A
HC65000636_04202316425	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,089.93	N/A
HC65000636_04202316801	NONCDM CHARGE RECORD PHARMACY	636	J0171	5.00	N/A
HC65000636_04202317325	NONCDM CHARGE RECORD PHARMACY	636	J1570	432.00	N/A
HC65000636_04202318620	NONCDM CHARGE RECORD PHARMACY	636	J3490	258.00	N/A
HC65000636_04202320101	NONCDM CHARGE RECORD PHARMACY	636	J3490	672.80	N/A
HC65000636_04202321410	NONCDM CHARGE RECORD PHARMACY	636	J2370	2.64	N/A
HC65000636_04202321501	NONCDM CHARGE RECORD PHARMACY	636	J2370	2.58	N/A
HC65000636_04202322110	NONCDM CHARGE RECORD PHARMACY	636	J1335	459.50	N/A
HC65000636_04257124469	NONCDM CHARGE RECORD PHARMACY	636	J0706	24.81	N/A
HC65000636_04265801001	NONCDM CHARGE RECORD PHARMACY	636	J3490	381.82	N/A
HC65000636_04265802101	NONCDM CHARGE RECORD PHARMACY	636	J9150	349.71	N/A
HC65000636_04265802102	NONCDM CHARGE RECORD PHARMACY	636	J9150	114.46	N/A
HC65000636_04280640001	NONCDM CHARGE RECORD PHARMACY	636	J7509	1.29	N/A
HC65000636_04285850103	NONCDM CHARGE RECORD PHARMACY	636	J0571	0.92	N/A
HC65000636_04306601610	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,219.04	N/A
HC65000636_04306655712	NONCDM CHARGE RECORD PHARMACY	636	J3490	480.00	N/A
HC65000636_04359826202	NONCDM CHARGE RECORD PHARMACY	636	J9395	210.00	N/A
HC65000636_04359828335	NONCDM CHARGE RECORD PHARMACY	636	Q2050	2,823.86	N/A
HC65000636_04359830562	NONCDM CHARGE RECORD PHARMACY	636	J9025	24.00	N/A
HC65000636_04359830920	NONCDM CHARGE RECORD PHARMACY	636	J9027	792.38	N/A
HC65000636_04359840516	NONCDM CHARGE RECORD PHARMACY	636	J3430	25.38	N/A
HC65000636_04359852936	NONCDM CHARGE RECORD PHARMACY	636	J2710	4.30	N/A
HC65000636_04359854125	NONCDM CHARGE RECORD PHARMACY	636	Q2050	2,325.00	N/A
HC65000636_04359854910	NONCDM CHARGE RECORD PHARMACY	636	J2704	1.68	N/A
HC65000636_04359860710	NONCDM CHARGE RECORD PHARMACY	636	J1652	14.70	N/A
HC65000636_04359869858	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,921.11	N/A
HC65000636_04359883936	NONCDM CHARGE RECORD PHARMACY	636	J2800	32.94	N/A
HC65000636_04359884858	NONCDM CHARGE RECORD PHARMACY	636	J3486	156.34	N/A
HC65000636_04359890158	NONCDM CHARGE RECORD PHARMACY	636	J1335	344.53	N/A
HC65000636_04359891758	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,913.94	N/A
HC65000636_04359893109	NONCDM CHARGE RECORD PHARMACY	636	J2597	57.00	N/A
HC65000636_04382510201	NONCDM CHARGE RECORD PHARMACY	636	J0131	2.84	N/A
HC65000636_04397525214	NONCDM CHARGE RECORD PHARMACY	636	Z7610	26.53	N/A
HC65000636_04408735351	NONCDM CHARGE RECORD PHARMACY	636	J9023	497.59	N/A
HC65000636_04420625105	NONCDM CHARGE RECORD PHARMACY	636	P9047	493.95	N/A
HC65000636_04420625110	NONCDM CHARGE RECORD PHARMACY	636	P9047	535.51	N/A
HC65000636_04420631025	NONCDM CHARGE RECORD PHARMACY	636	P9045	538.93	N/A
HC65000636_04420631050	NONCDM CHARGE RECORD PHARMACY	636	P9045	540.00	N/A
HC65000636_04420643605	NONCDM CHARGE RECORD PHARMACY	636	J1459	376.39	N/A
HC65000636_04420643710	NONCDM CHARGE RECORD PHARMACY	636	J1459	369.00	N/A
HC65000636_04420643820	NONCDM CHARGE RECORD PHARMACY	636	J1459	409.77	N/A
HC65000636_04420643940	NONCDM CHARGE RECORD PHARMACY	636	J1459	387.10	N/A
HC65000636_04456710310	NONCDM CHARGE RECORD PHARMACY	636	J0290	16.50	N/A
HC65000636_04456721110	NONCDM CHARGE RECORD PHARMACY	636	J0295	57.47	N/A
HC65000636_04456723525	NONCDM CHARGE RECORD PHARMACY	636	J0713	17.44	N/A
HC65000636_04456723610	NONCDM CHARGE RECORD PHARMACY	636	J0713	16.75	N/A
HC65000636_04456723706	NONCDM CHARGE RECORD PHARMACY	636	J0713	6.01	N/A
HC65000636_04456724010	NONCDM CHARGE RECORD PHARMACY	636	J0692	18.19	N/A
HC65000636_04456724110	NONCDM CHARGE RECORD PHARMACY	636	J0692	22.90	N/A
HC65000636_04456724525	NONCDM CHARGE RECORD PHARMACY	636	J0694	47.81	N/A
HC65000636_04456724625	NONCDM CHARGE RECORD PHARMACY	636	J0694	57.08	N/A
HC65000636_04456740110	NONCDM CHARGE RECORD PHARMACY	636	J2185	21.31	N/A
HC65000636_04456741024	NONCDM CHARGE RECORD PHARMACY	636	J3475	24.30	N/A
HC65000636_04456742024	NONCDM CHARGE RECORD PHARMACY	636	J3475	24.95	N/A
HC65000636_04456742124	NONCDM CHARGE RECORD PHARMACY	636	J3475	6.73	N/A
HC65000636_04456743524	NONCDM CHARGE RECORD PHARMACY	636	J1956	43.20	N/A
HC65000636_04456750601	NONCDM CHARGE RECORD PHARMACY	636	J9267	1.97	N/A
HC65000636_04456762024	NONCDM CHARGE RECORD PHARMACY	636	J0610	26.99	N/A
HC65000636_04456770025	NONCDM CHARGE RECORD PHARMACY	636	J0696	3.03	N/A
HC65000636_04456770125	NONCDM CHARGE RECORD PHARMACY	636	J0696	3.96	N/A
HC65000636_04456770225	NONCDM CHARGE RECORD PHARMACY	636	J0696	4.39	N/A
HC65000636_04456770810	NONCDM CHARGE RECORD PHARMACY	636	J0690	4.75	N/A
HC65000636_04456780110	NONCDM CHARGE RECORD PHARMACY	636	J2543	21.37	N/A
HC65000636_04456780210	NONCDM CHARGE RECORD PHARMACY	636	J2543	23.91	N/A
HC65000636_04456782010	NONCDM CHARGE RECORD PHARMACY	636	J1335	525.41	N/A
HC65000636_04594515702	NONCDM CHARGE RECORD PHARMACY	636	J0475	334.44	N/A
HC65000636_04596361356	NONCDM CHARGE RECORD PHARMACY	636	J9267	0.00	N/A
HC65000636_04596361451	NONCDM CHARGE RECORD PHARMACY	636	J9206	63.78	N/A
HC65000636_04596362151	NONCDM CHARGE RECORD PHARMACY	636	J9185	587.25	N/A
HC65000636_04596373355	NONCDM CHARGE RECORD PHARMACY	636	J9000	48.43	N/A
HC65000636_04678322152	NONCDM CHARGE RECORD PHARMACY	636	J3490	240.00	N/A
HC65000636_04733515440	NONCDM CHARGE RECORD PHARMACY	636	J9201	168.00	N/A
HC65000636_04733533040	NONCDM CHARGE RECORD PHARMACY	636	J1205	598.80	N/A
HC65000636_04733536140	NONCDM CHARGE RECORD PHARMACY	636	J0894	45.00	N/A
HC65000636_04733536141	NONCDM CHARGE RECORD PHARMACY	636	J0894	45.00	N/A
HC65000636_04733589072	NONCDM CHARGE RECORD PHARMACY	636	Z7610	0.15	N/A
HC65000636_04778157807	NONCDM CHARGE RECORD PHARMACY	636	J1190	2,626.75	N/A
HC65000636_04778158468	NONCDM CHARGE RECORD PHARMACY	636	J1885	3.36	N/A
HC65000636_04778158656	NONCDM CHARGE RECORD PHARMACY	636	J3490	25.49	N/A
HC65000636_04778158868	NONCDM CHARGE RECORD PHARMACY	636	J2250	1.92	N/A
HC65000636_04778158991	NONCDM CHARGE RECORD PHARMACY	636	J2250	0.71	N/A
HC65000636_04778159891	NONCDM CHARGE RECORD PHARMACY	636	J3370	17.83	N/A
HC65000636_04778310101	NONCDM CHARGE RECORD PHARMACY	636	J1290	3,042.13	N/A
HC65000636_04810204720	NONCDM CHARGE RECORD PHARMACY	636	J8540	0.62	N/A
HC65000636_04928121515	NONCDM CHARGE RECORD PHARMACY	636	90714	205.42	N/A
HC65000636_04928140015	NONCDM CHARGE RECORD PHARMACY	636	90715	251.95	N/A
HC65000636_04928154503	NONCDM CHARGE RECORD PHARMACY	636	90648	100.10	N/A
HC65000636_04928158905	NONCDM CHARGE RECORD PHARMACY	636	90733	392.48	N/A
HC65000636_04928186010	NONCDM CHARGE RECORD PHARMACY	636	90713	206.49	N/A
HC65000636_04940110101	NONCDM CHARGE RECORD PHARMACY	636	J0490	271.52	N/A
HC65000636_04940110201	NONCDM CHARGE RECORD PHARMACY	636	J0490	224.70	N/A
HC65000636_05009019440	NONCDM CHARGE RECORD PHARMACY	636	90670	0.01	N/A
HC65000636_05024204062	NONCDM CHARGE RECORD PHARMACY	636	J2357	7.18	N/A
HC65000636_05024204164	NONCDM CHARGE RECORD PHARMACY	636	J2997	451.32	N/A
HC65000636_05024204413	NONCDM CHARGE RECORD PHARMACY	636	J2997	528.02	N/A
HC65000636_05024205121	NONCDM CHARGE RECORD PHARMACY	636	J9312	534.43	N/A
HC65000636_05024205306	NONCDM CHARGE RECORD PHARMACY	636	J9312	534.69	N/A
HC65000636_05024206001	NONCDM CHARGE RECORD PHARMACY	636	J9035	427.06	N/A
HC65000636_05024206010	NONCDM CHARGE RECORD PHARMACY	636	J9035	469.85	N/A
HC65000636_05024206101	NONCDM CHARGE RECORD PHARMACY	636	J9035	388.69	N/A
HC65000636_05024206110	NONCDM CHARGE RECORD PHARMACY	636	J9035	472.00	N/A
HC65000636_05024207001	NONCDM CHARGE RECORD PHARMACY	636	J9301	404.66	N/A
HC65000636_05024207701	NONCDM CHARGE RECORD PHARMACY	636	J9356	467.52	N/A
HC65000636_05024208527	NONCDM CHARGE RECORD PHARMACY	636	J2997	496.00	N/A
HC65000636_05024208701	NONCDM CHARGE RECORD PHARMACY	636	J9354	191.98	N/A
HC65000636_05024208801	NONCDM CHARGE RECORD PHARMACY	636	J9354	168.71	N/A
HC65000636_05024210801	NONCDM CHARGE RECORD PHARMACY	636	J9311	281.85	N/A
HC65000636_05024213201	NONCDM CHARGE RECORD PHARMACY	636	J9355	598.24	N/A
HC65000636_05024213501	NONCDM CHARGE RECORD PHARMACY	636	J3262	34.59	N/A
HC65000636_05024213601	NONCDM CHARGE RECORD PHARMACY	636	J3262	27.14	N/A
HC65000636_05024213701	NONCDM CHARGE RECORD PHARMACY	636	J3262	34.59	N/A
HC65000636_05024214501	NONCDM CHARGE RECORD PHARMACY	636	J9306	75.06	N/A
HC65000636_05024215001	NONCDM CHARGE RECORD PHARMACY	636	J2350	332.09	N/A
HC65000636_05024221401	NONCDM CHARGE RECORD PHARMACY	636	J2357	166.33	N/A
HC65000636_05024221501	NONCDM CHARGE RECORD PHARMACY	636	J2357	169.54	N/A
HC65000636_05024291701	NONCDM CHARGE RECORD PHARMACY	636	J9022	424.02	N/A
HC65000636_05024291801	NONCDM CHARGE RECORD PHARMACY	636	J9022	466.99	N/A
HC65000636_05026807612	NONCDM CHARGE RECORD PHARMACY	636	Z7610	18.82	N/A
HC65000636_05038392493	NONCDM CHARGE RECORD PHARMACY	636	J0571	2.26	N/A
HC65000636_05041932005	NONCDM CHARGE RECORD PHARMACY	636	A9581	85.18	N/A
HC65000636_05041932511	NONCDM CHARGE RECORD PHARMACY	636	A9585	4.98	N/A
HC65000636_05041932512	NONCDM CHARGE RECORD PHARMACY	636	A9585	4.98	N/A
HC65000636_05041932537	NONCDM CHARGE RECORD PHARMACY	636	A9585	4.98	N/A
HC65000636_05045825501	NONCDM CHARGE RECORD PHARMACY	636	J1630	123.81	N/A
HC65000636_05045856301	NONCDM CHARGE RECORD PHARMACY	636	J2426	0.00	N/A
HC65000636_05045856401	NONCDM CHARGE RECORD PHARMACY	636	J2426	0.00	N/A
HC65000636_05047450858	NONCDM CHARGE RECORD PHARMACY	636	J3490	819.82	N/A
HC65000636_05063312011	NONCDM CHARGE RECORD PHARMACY	636	J1162	23,457.47	N/A
HC65000636_05107950820	NONCDM CHARGE RECORD PHARMACY	636	J7518	24.31	N/A
HC65000636_05107962006	NONCDM CHARGE RECORD PHARMACY	636	J7500	3.29	N/A
HC65000636_05107972120	NONCDM CHARGE RECORD PHARMACY	636	J7517	2.72	N/A
HC65000636_05107981720	NONCDM CHARGE RECORD PHARMACY	636	J7507	8.49	N/A
HC65000636_05107981820	NONCDM CHARGE RECORD PHARMACY	636	J7507	6.90	N/A
HC65000636_05114402001	NONCDM CHARGE RECORD PHARMACY	636	J9177	164.40	N/A
HC65000636_05175405001	NONCDM CHARGE RECORD PHARMACY	636	J0706	26.16	N/A
HC65000636_05175405021	NONCDM CHARGE RECORD PHARMACY	636	J0706	20.57	N/A
HC65000636_05175410004	NONCDM CHARGE RECORD PHARMACY	636	J3475	3.07	N/A
HC65000636_05175442004	NONCDM CHARGE RECORD PHARMACY	636	J3490	92.85	N/A
HC65000636_05175450601	NONCDM CHARGE RECORD PHARMACY	636	J0702	23.79	N/A
HC65000636_05199114417	NONCDM CHARGE RECORD PHARMACY	636	J2210	96.63	N/A
HC65000636_05199173520	NONCDM CHARGE RECORD PHARMACY	636	Q0166	21.60	N/A
HC65000636_05428810310	NONCDM CHARGE RECORD PHARMACY	636	J0171	6.61	N/A
HC65000636_05428811105	NONCDM CHARGE RECORD PHARMACY	636	J1980	198.00	N/A
HC65000636_05428813501	NONCDM CHARGE RECORD PHARMACY	636	Z7610	33.60	N/A
HC65000636_05448214701	NONCDM CHARGE RECORD PHARMACY	636		230.41	N/A
HC65000636_05464356470	NONCDM CHARGE RECORD PHARMACY	636		480.00	N/A
HC65000636_05486825231	NONCDM CHARGE RECORD PHARMACY	636	J0885	0.00	N/A
HC65000636_05487900308	NONCDM CHARGE RECORD PHARMACY	636	J8540	1.08	N/A
HC65000636_05487902101	NONCDM CHARGE RECORD PHARMACY	636	Z7610	30.00	N/A
HC65000636_05487902201	NONCDM CHARGE RECORD PHARMACY	636	J8530	21.00	N/A
HC65000636_05511152501	NONCDM CHARGE RECORD PHARMACY	636	J7507	2.21	N/A
HC65000636_05511155610	NONCDM CHARGE RECORD PHARMACY	636	J0894	97.78	N/A
HC65000636_05511165301	NONCDM CHARGE RECORD PHARMACY	636	J7520	81.83	N/A
HC65000636_05511167802	NONCDM CHARGE RECORD PHARMACY	636	J1652	58.57	N/A
HC65000636_05511167810	NONCDM CHARGE RECORD PHARMACY	636	J1652	52.47	N/A
HC65000636_05511168010	NONCDM CHARGE RECORD PHARMACY	636	J1652	50.14	N/A
HC65000636_05511168102	NONCDM CHARGE RECORD PHARMACY	636	J1652	32.59	N/A
HC65000636_05511168507	NONCDM CHARGE RECORD PHARMACY	636	J3489	140.63	N/A
HC65000636_05511168852	NONCDM CHARGE RECORD PHARMACY	636	J3489	350.53	N/A
HC65000636_05511169407	NONCDM CHARGE RECORD PHARMACY	636	J2469	31.58	N/A
HC65000636_05513513201	NONCDM CHARGE RECORD PHARMACY	636	C9399	177.23	N/A
HC65000636_05515011620	NONCDM CHARGE RECORD PHARMACY	636	J0295	15.54	N/A
HC65000636_05515011720	NONCDM CHARGE RECORD PHARMACY	636	J0295	17.81	N/A
HC65000636_05515012030	NONCDM CHARGE RECORD PHARMACY	636	J3490	58.20	N/A
HC65000636_05515015410	NONCDM CHARGE RECORD PHARMACY	636	J0133	0.68	N/A
HC65000636_05515015411	NONCDM CHARGE RECORD PHARMACY	636	J0133	0.68	N/A
HC65000636_05515015520	NONCDM CHARGE RECORD PHARMACY	636	J0133	0.63	N/A
HC65000636_05515015730	NONCDM CHARGE RECORD PHARMACY	636	J1956	42.00	N/A
HC65000636_05515015872	NONCDM CHARGE RECORD PHARMACY	636	J2001	9.61	N/A
HC65000636_05515015974	NONCDM CHARGE RECORD PHARMACY	636	J2001	0.02	N/A
HC65000636_05515016102	NONCDM CHARGE RECORD PHARMACY	636	J2001	8.37	N/A
HC65000636_05515016205	NONCDM CHARGE RECORD PHARMACY	636	J2001	2.68	N/A
HC65000636_05515016330	NONCDM CHARGE RECORD PHARMACY	636	J2001	0.73	N/A
HC65000636_05515016505	NONCDM CHARGE RECORD PHARMACY	636	J2001	1.36	N/A
HC65000636_05515016613	NONCDM CHARGE RECORD PHARMACY	636	J3490	222.47	N/A
HC65000636_05515017301	NONCDM CHARGE RECORD PHARMACY	636	J3030	147.29	N/A
HC65000636_05515017305	NONCDM CHARGE RECORD PHARMACY	636	J3030	150.00	N/A
HC65000636_05515017410	NONCDM CHARGE RECORD PHARMACY	636	J0456	37.20	N/A
HC65000636_05515017705	NONCDM CHARGE RECORD PHARMACY	636	J1953	0.94	N/A
HC65000636_05515018003	NONCDM CHARGE RECORD PHARMACY	636	J0282	2.51	N/A
HC65000636_05515018310	NONCDM CHARGE RECORD PHARMACY	636	J3490	251.24	N/A
HC65000636_05515018810	NONCDM CHARGE RECORD PHARMACY	636	J3490	183.75	N/A
HC65000636_05515019410	NONCDM CHARGE RECORD PHARMACY	636	J3490	26.34	N/A
HC65000636_05515019830	NONCDM CHARGE RECORD PHARMACY	636	J2795	1.44	N/A
HC65000636_05515020010	NONCDM CHARGE RECORD PHARMACY	636	J2795	0.79	N/A
HC65000636_05515020210	NONCDM CHARGE RECORD PHARMACY	636	C9113	29.98	N/A
HC65000636_05515020830	NONCDM CHARGE RECORD PHARMACY	636	J2185	28.71	N/A
HC65000636_05515020902	NONCDM CHARGE RECORD PHARMACY	636	J3490	161.91	N/A
HC65000636_05515021899	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,850.00	N/A
HC65000636_05515021910	NONCDM CHARGE RECORD PHARMACY	636	J1327	273.98	N/A
HC65000636_05515022810	NONCDM CHARGE RECORD PHARMACY	636	J3243	12.48	N/A
HC65000636_05515024110	NONCDM CHARGE RECORD PHARMACY	636	J0883	23.40	N/A
HC65000636_05515024251	NONCDM CHARGE RECORD PHARMACY	636	J2020	154.66	N/A
HC65000636_05515025110	NONCDM CHARGE RECORD PHARMACY	636	J2001	1.56	N/A
HC65000636_05515025350	NONCDM CHARGE RECORD PHARMACY	636	J2001	1.01	N/A
HC65000636_05515025520	NONCDM CHARGE RECORD PHARMACY	636	J2001	0.31	N/A
HC65000636_05515028209	NONCDM CHARGE RECORD PHARMACY	636	J1335	315.45	N/A
HC65000636_05515028220	NONCDM CHARGE RECORD PHARMACY	636	J1335	329.79	N/A
HC65000636_05515030201	NONCDM CHARGE RECORD PHARMACY	636	J2370	2.25	N/A
HC65000636_05515030801	NONCDM CHARGE RECORD PHARMACY	636	J2358	21.26	N/A
HC65000636_05515032225	NONCDM CHARGE RECORD PHARMACY	636	J1940	11.71	N/A
HC65000636_05515032425	NONCDM CHARGE RECORD PHARMACY	636	J1940	3.83	N/A
HC65000636_05539010110	NONCDM CHARGE RECORD PHARMACY	636	J3105	24.00	N/A
HC65000636_05539050002	NONCDM CHARGE RECORD PHARMACY	636	J3490	8.10	N/A
HC65000636_05539050005	NONCDM CHARGE RECORD PHARMACY	636	J3490	10.74	N/A
HC65000636_05539056505	NONCDM CHARGE RECORD PHARMACY	636	J3490	13.20	N/A
HC65000636_05551303201	NONCDM CHARGE RECORD PHARMACY	636	J0881	46.44	N/A
HC65000636_05551313201	NONCDM CHARGE RECORD PHARMACY	636	Q5117	533.00	N/A
HC65000636_05551314101	NONCDM CHARGE RECORD PHARMACY	636	Q5117	525.07	N/A
HC65000636_05551314410	NONCDM CHARGE RECORD PHARMACY	636	J0885	99.48	N/A
HC65000636_05551316001	NONCDM CHARGE RECORD PHARMACY	636	J9039	704.64	N/A
HC65000636_05551319001	NONCDM CHARGE RECORD PHARMACY	636	J2505	30,203.41	N/A
HC65000636_05551319201	NONCDM CHARGE RECORD PHARMACY	636	J2505	35,318.79	N/A
HC65000636_05551320601	NONCDM CHARGE RECORD PHARMACY	636	Q5107	406.44	N/A
HC65000636_05551320701	NONCDM CHARGE RECORD PHARMACY	636	Q5107	406.04	N/A
HC65000636_05551322101	NONCDM CHARGE RECORD PHARMACY	636	J2796	479.47	N/A
HC65000636_05551322301	NONCDM CHARGE RECORD PHARMACY	636	J2796	481.34	N/A
HC65000636_05551347810	NONCDM CHARGE RECORD PHARMACY	636	J0885	98.07	N/A
HC65000636_05551353010	NONCDM CHARGE RECORD PHARMACY	636	J1442	6.30	N/A
HC65000636_05551354610	NONCDM CHARGE RECORD PHARMACY	636	J1442	6.27	N/A
HC65000636_05551371001	NONCDM CHARGE RECORD PHARMACY	636	J0897	131.62	N/A
HC65000636_05551373001	NONCDM CHARGE RECORD PHARMACY	636	J0897	122.12	N/A
HC65000636_05551395401	NONCDM CHARGE RECORD PHARMACY	636	J9303	762.47	N/A
HC65000636_05551395601	NONCDM CHARGE RECORD PHARMACY	636	J9303	637.50	N/A
HC65000636_05556622000	NONCDM CHARGE RECORD PHARMACY	636	J2597	243.42	N/A
HC65000636_05556623000	NONCDM CHARGE RECORD PHARMACY	636	J2597	123.23	N/A
HC65000636_05789403001	NONCDM CHARGE RECORD PHARMACY	636	J1745	670.55	N/A
HC65000636_05789405427	NONCDM CHARGE RECORD PHARMACY	636	J3358	73.97	N/A
HC65000636_05789406103	NONCDM CHARGE RECORD PHARMACY	636	J3357	911.00	N/A
HC65000636_05789435001	NONCDM CHARGE RECORD PHARMACY	636	J1602	235.12	N/A
HC65000636_05789450101	NONCDM CHARGE RECORD PHARMACY	636	C9399	43,004.61	N/A
HC65000636_05789450205	NONCDM CHARGE RECORD PHARMACY	636	J9145	335.47	N/A
HC65000636_05789450220	NONCDM CHARGE RECORD PHARMACY	636	J9145	338.80	N/A
HC65000636_05789450301	NONCDM CHARGE RECORD PHARMACY	636	C9062	263.48	N/A
HC65000636_05790224905	NONCDM CHARGE RECORD PHARMACY	636	J9019	2,418.50	N/A
HC65000636_05816081011	NONCDM CHARGE RECORD PHARMACY	636	90700	141.18	N/A
HC65000636_05816081152	NONCDM CHARGE RECORD PHARMACY	636	90723	493.95	N/A
HC65000636_05816081552	NONCDM CHARGE RECORD PHARMACY	636	90636	436.96	N/A
HC65000636_05816081811	NONCDM CHARGE RECORD PHARMACY	636	90648	63.41	N/A
HC65000636_05816081912	NONCDM CHARGE RECORD PHARMACY	636	C9399	0.01	N/A
HC65000636_05816082052	NONCDM CHARGE RECORD PHARMACY	636	90744	146.62	N/A
HC65000636_05816082311	NONCDM CHARGE RECORD PHARMACY	636		0.01	N/A
HC65000636_05816082652	NONCDM CHARGE RECORD PHARMACY	636	90632	287.75	N/A
HC65000636_05816084211	NONCDM CHARGE RECORD PHARMACY	636	90715	245.27	N/A
HC65000636_05816084234	NONCDM CHARGE RECORD PHARMACY	636	90715	247.86	N/A
HC65000636_05816084252	NONCDM CHARGE RECORD PHARMACY	636	90715	244.99	N/A
HC65000636_05816088552	NONCDM CHARGE RECORD PHARMACY	636	90686	9.01	N/A
HC65000636_05816095509	NONCDM CHARGE RECORD PHARMACY	636	90734	823.18	N/A
HC65000636_05816095801	NONCDM CHARGE RECORD PHARMACY	636	90734	784.50	N/A
HC65000636_05816096412	NONCDM CHARGE RECORD PHARMACY	636	90675	2,134.71	N/A
HC65000636_05816097620	NONCDM CHARGE RECORD PHARMACY	636	90620	1,071.00	N/A
HC65000636_05839413403	NONCDM CHARGE RECORD PHARMACY	636	J7195	0.00	N/A
HC65000636_05839413603	NONCDM CHARGE RECORD PHARMACY	636	J7195	0.00	N/A
HC65000636_05839463503	NONCDM CHARGE RECORD PHARMACY	636	J7195	8.49	N/A
HC65000636_05839463703	NONCDM CHARGE RECORD PHARMACY	636	J7195	6.07	N/A
HC65000636_05840602104	NONCDM CHARGE RECORD PHARMACY	636	J1438	0.01	N/A
HC65000636_05840605504	NONCDM CHARGE RECORD PHARMACY	636	J1438	4,167.72	N/A
HC65000636_05846800302	NONCDM CHARGE RECORD PHARMACY	636	J3240	6,085.82	N/A
HC65000636_05846800401	NONCDM CHARGE RECORD PHARMACY	636	J0180	1,125.38	N/A
HC65000636_05846800701	NONCDM CHARGE RECORD PHARMACY	636	J1931	58.08	N/A
HC65000636_05846802251	NONCDM CHARGE RECORD PHARMACY	636	C9047	3,981.82	N/A
HC65000636_05846803573	NONCDM CHARGE RECORD PHARMACY	636	J0202	0.00	N/A
HC65000636_05891408052	NONCDM CHARGE RECORD PHARMACY	636	J0500	477.81	N/A
HC65000636_05914804580	NONCDM CHARGE RECORD PHARMACY	636	J0401	0.00	N/A
HC65000636_05914807280	NONCDM CHARGE RECORD PHARMACY	636	J0400	0.00	N/A
HC65000636_05926710002	NONCDM CHARGE RECORD PHARMACY	636	91300	0.01	N/A
HC65000636_05926710003	NONCDM CHARGE RECORD PHARMACY	636	91300	0.01	N/A
HC65000636_05933877501	NONCDM CHARGE RECORD PHARMACY	636	Q0138	13.19	N/A
HC65000636_05957210201	NONCDM CHARGE RECORD PHARMACY	636	J9025	35.11	N/A
HC65000636_05957271101	NONCDM CHARGE RECORD PHARMACY	636	J0896	206.47	N/A
HC65000636_05957277501	NONCDM CHARGE RECORD PHARMACY	636	J0896	206.47	N/A
HC65000636_05963026610	NONCDM CHARGE RECORD PHARMACY	636	J0693	5.55	N/A
HC65000636_05967631001	NONCDM CHARGE RECORD PHARMACY	636	J0885	160.35	N/A
HC65000636_05967634001	NONCDM CHARGE RECORD PHARMACY	636	J0885	160.35	N/A
HC65000636_05973042031	NONCDM CHARGE RECORD PHARMACY	636	90371	405.44	N/A
HC65000636_05974600106	NONCDM CHARGE RECORD PHARMACY	636	J7509	1.93	N/A
HC65000636_05974617106	NONCDM CHARGE RECORD PHARMACY	636	J7512	1.00	N/A
HC65000636_05974617206	NONCDM CHARGE RECORD PHARMACY	636	J7512	0.25	N/A
HC65000636_05974617306	NONCDM CHARGE RECORD PHARMACY	636	J7512	0.14	N/A
HC65000636_05974617506	NONCDM CHARGE RECORD PHARMACY	636	J7512	0.06	N/A
HC65000636_05974617509	NONCDM CHARGE RECORD PHARMACY	636	J7512	0.07	N/A
HC65000636_05992360110	NONCDM CHARGE RECORD PHARMACY	636	J2430	51.55	N/A
HC65000636_06043246608	NONCDM CHARGE RECORD PHARMACY	636	J8540	1.29	N/A
HC65000636_06050501330	NONCDM CHARGE RECORD PHARMACY	636	J7515	16.80	N/A
HC65000636_06050501340	NONCDM CHARGE RECORD PHARMACY	636	J7502	67.06	N/A
HC65000636_06050507595	NONCDM CHARGE RECORD PHARMACY	636	J0694	42.24	N/A
HC65000636_06050507690	NONCDM CHARGE RECORD PHARMACY	636	J0690	6.00	N/A
HC65000636_06050507924	NONCDM CHARGE RECORD PHARMACY	636	J1650	9.02	N/A
HC65000636_06050507944	NONCDM CHARGE RECORD PHARMACY	636	J1650	9.00	N/A
HC65000636_06050507954	NONCDM CHARGE RECORD PHARMACY	636	J1650	8.99	N/A
HC65000636_06050546323	NONCDM CHARGE RECORD PHARMACY	636	Z7610	26.38	N/A
HC65000636_06050561305	NONCDM CHARGE RECORD PHARMACY	636	J2405	0.63	N/A
HC65000636_06050561425	NONCDM CHARGE RECORD PHARMACY	636	J0690	4.29	N/A
HC65000636_06050561434	NONCDM CHARGE RECORD PHARMACY	636	J0690	5.06	N/A
HC65000636_06050561444	NONCDM CHARGE RECORD PHARMACY	636	J0692	19.84	N/A
HC65000636_06050561454	NONCDM CHARGE RECORD PHARMACY	636	J0692	14.10	N/A
HC65000636_06050561464	NONCDM CHARGE RECORD PHARMACY	636	J0692	23.27	N/A
HC65000636_06050561470	NONCDM CHARGE RECORD PHARMACY	636	J0692	26.78	N/A
HC65000636_06050561474	NONCDM CHARGE RECORD PHARMACY	636	J0692	28.73	N/A
HC65000636_06050561484	NONCDM CHARGE RECORD PHARMACY	636	J0696	5.18	N/A
HC65000636_06050561931	NONCDM CHARGE RECORD PHARMACY	636	J2469	84.00	N/A
HC65000636_06057441141	NONCDM CHARGE RECORD PHARMACY	636	90378	9,439.32	N/A
HC65000636_06068727121	NONCDM CHARGE RECORD PHARMACY	636	Q0144	22.66	N/A
HC65000636_06068728201	NONCDM CHARGE RECORD PHARMACY	636	Q0144	18.24	N/A
HC65000636_06068743801	NONCDM CHARGE RECORD PHARMACY	636	J7517	3.83	N/A
HC65000636_06068749401	NONCDM CHARGE RECORD PHARMACY	636	Z7610	3.75	N/A
HC65000636_06079360010	NONCDM CHARGE RECORD PHARMACY	636	J0558	68.62	N/A
HC65000636_06079370010	NONCDM CHARGE RECORD PHARMACY	636	J0561	90.37	N/A
HC65000636_06079370110	NONCDM CHARGE RECORD PHARMACY	636	J0558	73.48	N/A
HC65000636_06079370210	NONCDM CHARGE RECORD PHARMACY	636	J0561	60.53	N/A
HC65000636_06126941020	NONCDM CHARGE RECORD PHARMACY	636	J9181	89.22	N/A
HC65000636_06131431801	NONCDM CHARGE RECORD PHARMACY	636	Q5101	5.44	N/A
HC65000636_06131431810	NONCDM CHARGE RECORD PHARMACY	636	Q5101	0.00	N/A
HC65000636_06131432601	NONCDM CHARGE RECORD PHARMACY	636	Q5101	5.47	N/A
HC65000636_06170330538	NONCDM CHARGE RECORD PHARMACY	636	J9100	37.65	N/A
HC65000636_06170330906	NONCDM CHARGE RECORD PHARMACY	636	J9370	34.64	N/A
HC65000636_06170330916	NONCDM CHARGE RECORD PHARMACY	636	J9370	22.29	N/A
HC65000636_06170330925	NONCDM CHARGE RECORD PHARMACY	636	J9370	31.68	N/A
HC65000636_06170331922	NONCDM CHARGE RECORD PHARMACY	636	J9100	5.45	N/A
HC65000636_06170332322	NONCDM CHARGE RECORD PHARMACY	636	J9040	278.07	N/A
HC65000636_06170332418	NONCDM CHARGE RECORD PHARMACY	636	J2430	76.76	N/A
HC65000636_06170332618	NONCDM CHARGE RECORD PHARMACY	636	J2430	90.94	N/A
HC65000636_06170333922	NONCDM CHARGE RECORD PHARMACY	636	J9045	0.01	N/A
HC65000636_06170333950	NONCDM CHARGE RECORD PHARMACY	636	J9045	30.49	N/A
HC65000636_06170333956	NONCDM CHARGE RECORD PHARMACY	636	J9045	28.94	N/A
HC65000636_06170334222	NONCDM CHARGE RECORD PHARMACY	636	J9267	1.54	N/A
HC65000636_06170334250	NONCDM CHARGE RECORD PHARMACY	636	J9267	1.26	N/A
HC65000636_06170336318	NONCDM CHARGE RECORD PHARMACY	636	J9263	2.62	N/A
HC65000636_06170336322	NONCDM CHARGE RECORD PHARMACY	636	J9263	2.62	N/A
HC65000636_06170340841	NONCDM CHARGE RECORD PHARMACY	636	J9260	10.74	N/A
HC65000636_06175500801	NONCDM CHARGE RECORD PHARMACY	636	J9119	157.64	N/A
HC65000636_06175503901	NONCDM CHARGE RECORD PHARMACY	636	Q0243	0.01	N/A
HC65000636_06195829011	NONCDM CHARGE RECORD PHARMACY	636	C9399	3,840.89	N/A
HC65000636_06195829012	NONCDM CHARGE RECORD PHARMACY	636	C9399	3,800.11	N/A
HC65000636_06199002113	NONCDM CHARGE RECORD PHARMACY	636	J2370	1.54	N/A
HC65000636_06199002122	NONCDM CHARGE RECORD PHARMACY	636	J2370	1.96	N/A
HC65000636_06199002131	NONCDM CHARGE RECORD PHARMACY	636	J2370	1.79	N/A
HC65000636_06199006112	NONCDM CHARGE RECORD PHARMACY	636	J3490	51.34	N/A
HC65000636_06229532681	NONCDM CHARGE RECORD PHARMACY	636	J2001	23.70	N/A
HC65000636_06232744444	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,226.40	N/A
HC65000636_06275601540	NONCDM CHARGE RECORD PHARMACY	636	J1071	0.00	N/A
HC65000636_06275601640	NONCDM CHARGE RECORD PHARMACY	636	J1071	0.21	N/A
HC65000636_06275601740	NONCDM CHARGE RECORD PHARMACY	636	J1071	0.16	N/A
HC65000636_06275612944	NONCDM CHARGE RECORD PHARMACY	636	C9113	34.26	N/A
HC65000636_06275651244	NONCDM CHARGE RECORD PHARMACY	636	J0456	15.30	N/A
HC65000636_06275652940	NONCDM CHARGE RECORD PHARMACY	636	J2597	98.33	N/A
HC65000636_06285638901	NONCDM CHARGE RECORD PHARMACY	636	J9179	724.50	N/A
HC65000636_06285679701	NONCDM CHARGE RECORD PHARMACY	636	J2469	120.00	N/A
HC65000636_06293522305	NONCDM CHARGE RECORD PHARMACY	636	J9217	2,710.14	N/A
HC65000636_06302004901	NONCDM CHARGE RECORD PHARMACY	636	J9041	274.51	N/A
HC65000636_06332301002	NONCDM CHARGE RECORD PHARMACY	636	J1580	19.35	N/A
HC65000636_06332301020	NONCDM CHARGE RECORD PHARMACY	636	J1580	13.48	N/A
HC65000636_06332301201	NONCDM CHARGE RECORD PHARMACY	636	J2590	8.94	N/A
HC65000636_06332301210	NONCDM CHARGE RECORD PHARMACY	636	J2590	11.75	N/A
HC65000636_06332301211	NONCDM CHARGE RECORD PHARMACY	636	J2590	17.96	N/A
HC65000636_06332301230	NONCDM CHARGE RECORD PHARMACY	636	J2590	10.67	N/A
HC65000636_06332301302	NONCDM CHARGE RECORD PHARMACY	636		33.74	N/A
HC65000636_06332301309	NONCDM CHARGE RECORD PHARMACY	636	J3411	21.09	N/A
HC65000636_06332302425	NONCDM CHARGE RECORD PHARMACY	636	J2150	27.45	N/A
HC65000636_06332304401	NONCDM CHARGE RECORD PHARMACY	636	J3420	41.28	N/A
HC65000636_06332304710	NONCDM CHARGE RECORD PHARMACY	636	J1644	2.06	N/A
HC65000636_06332306402	NONCDM CHARGE RECORD PHARMACY	636	J3475	4.74	N/A
HC65000636_06332306403	NONCDM CHARGE RECORD PHARMACY	636	J3475	5.07	N/A
HC65000636_06332306410	NONCDM CHARGE RECORD PHARMACY	636	J3475	1.05	N/A
HC65000636_06332306411	NONCDM CHARGE RECORD PHARMACY	636	J3475	1.08	N/A
HC65000636_06332306423	NONCDM CHARGE RECORD PHARMACY	636	J3475	3.60	N/A
HC65000636_06332310351	NONCDM CHARGE RECORD PHARMACY	636	J9060	19.82	N/A
HC65000636_06332310365	NONCDM CHARGE RECORD PHARMACY	636	J9060	20.25	N/A
HC65000636_06332310601	NONCDM CHARGE RECORD PHARMACY	636	J3475	5.97	N/A
HC65000636_06332310605	NONCDM CHARGE RECORD PHARMACY	636	J3475	23.93	N/A
HC65000636_06332310615	NONCDM CHARGE RECORD PHARMACY	636	J3475	0.90	N/A
HC65000636_06332311710	NONCDM CHARGE RECORD PHARMACY	636	J9190	18.00	N/A
HC65000636_06332311719	NONCDM CHARGE RECORD PHARMACY	636	J9190	15.00	N/A
HC65000636_06332311720	NONCDM CHARGE RECORD PHARMACY	636	J9190	18.00	N/A
HC65000636_06332311761	NONCDM CHARGE RECORD PHARMACY	636	J9190	15.42	N/A
HC65000636_06332311805	NONCDM CHARGE RECORD PHARMACY	636	J1644	6.84	N/A
HC65000636_06332312020	NONCDM CHARGE RECORD PHARMACY	636	J9100	6.24	N/A
HC65000636_06332312820	NONCDM CHARGE RECORD PHARMACY	636	J9130	36.00	N/A
HC65000636_06332313011	NONCDM CHARGE RECORD PHARMACY	636	J3490	157.96	N/A
HC65000636_06332313013	NONCDM CHARGE RECORD PHARMACY	636	J3490	139.78	N/A
HC65000636_06332313210	NONCDM CHARGE RECORD PHARMACY	636	J9293	237.80	N/A
HC65000636_06332313212	NONCDM CHARGE RECORD PHARMACY	636	J9293	327.05	N/A
HC65000636_06332313610	NONCDM CHARGE RECORD PHARMACY	636	J9040	198.72	N/A
HC65000636_06332314210	NONCDM CHARGE RECORD PHARMACY	636	J9208	348.30	N/A
HC65000636_06332316101	NONCDM CHARGE RECORD PHARMACY	636	J1885	20.95	N/A
HC65000636_06332316201	NONCDM CHARGE RECORD PHARMACY	636	J1885	13.87	N/A
HC65000636_06332316212	NONCDM CHARGE RECORD PHARMACY	636	J1885	2.61	N/A
HC65000636_06332316501	NONCDM CHARGE RECORD PHARMACY	636	J1100	3.92	N/A
HC65000636_06332316505	NONCDM CHARGE RECORD PHARMACY	636	J1100	1.88	N/A
HC65000636_06332316530	NONCDM CHARGE RECORD PHARMACY	636	J1100	1.70	N/A
HC65000636_06332317302	NONCDM CHARGE RECORD PHARMACY	636	J1580	46.12	N/A
HC65000636_06332318001	NONCDM CHARGE RECORD PHARMACY	636	J3415	94.39	N/A
HC65000636_06332319202	NONCDM CHARGE RECORD PHARMACY	636	J9185	1,223.46	N/A
HC65000636_06332320102	NONCDM CHARGE RECORD PHARMACY	636	J2001	7.09	N/A
HC65000636_06332320110	NONCDM CHARGE RECORD PHARMACY	636	J2001	1.27	N/A
HC65000636_06332320202	NONCDM CHARGE RECORD PHARMACY	636	J2001	3.82	N/A
HC65000636_06332322110	NONCDM CHARGE RECORD PHARMACY	636	J3370	42.00	N/A
HC65000636_06332322138	NONCDM CHARGE RECORD PHARMACY	636	J3370	42.00	N/A
HC65000636_06332322905	NONCDM CHARGE RECORD PHARMACY	636	J2720	14.75	N/A
HC65000636_06332322915	NONCDM CHARGE RECORD PHARMACY	636	J2720	10.43	N/A
HC65000636_06332322930	NONCDM CHARGE RECORD PHARMACY	636	J2720	8.84	N/A
HC65000636_06332322935	NONCDM CHARGE RECORD PHARMACY	636	J2720	6.76	N/A
HC65000636_06332323710	NONCDM CHARGE RECORD PHARMACY	636	J0690	4.75	N/A
HC65000636_06332323861	NONCDM CHARGE RECORD PHARMACY	636	J0690	4.81	N/A
HC65000636_06332326037	NONCDM CHARGE RECORD PHARMACY	636	J0670	14.80	N/A
HC65000636_06332326201	NONCDM CHARGE RECORD PHARMACY	636	J1644	4.99	N/A
HC65000636_06332326206	NONCDM CHARGE RECORD PHARMACY	636	J1644	4.91	N/A
HC65000636_06332326226	NONCDM CHARGE RECORD PHARMACY	636	J1644	2.40	N/A
HC65000636_06332326255	NONCDM CHARGE RECORD PHARMACY	636	J1644	2.40	N/A
HC65000636_06332326530	NONCDM CHARGE RECORD PHARMACY	636	J2920	24.26	N/A
HC65000636_06332326910	NONCDM CHARGE RECORD PHARMACY	636	J2704	1.47	N/A
HC65000636_06332326929	NONCDM CHARGE RECORD PHARMACY	636	J2704	1.74	N/A
HC65000636_06332326937	NONCDM CHARGE RECORD PHARMACY	636	J2704	0.72	N/A
HC65000636_06332326950	NONCDM CHARGE RECORD PHARMACY	636	J2704	1.27	N/A
HC65000636_06332326959	NONCDM CHARGE RECORD PHARMACY	636	J2704	0.72	N/A
HC65000636_06332326965	NONCDM CHARGE RECORD PHARMACY	636	J2704	1.78	N/A
HC65000636_06332326967	NONCDM CHARGE RECORD PHARMACY	636	J2704	0.72	N/A
HC65000636_06332327050	NONCDM CHARGE RECORD PHARMACY	636	J2704	1.68	N/A
HC65000636_06332327301	NONCDM CHARGE RECORD PHARMACY	636	J3030	294.00	N/A
HC65000636_06332327602	NONCDM CHARGE RECORD PHARMACY	636	J1644	39.57	N/A
HC65000636_06332327810	NONCDM CHARGE RECORD PHARMACY	636	J9360	24.78	N/A
HC65000636_06332328002	NONCDM CHARGE RECORD PHARMACY	636	J1940	12.60	N/A
HC65000636_06332328004	NONCDM CHARGE RECORD PHARMACY	636	J1940	18.73	N/A
HC65000636_06332328206	NONCDM CHARGE RECORD PHARMACY	636	J3490	26.03	N/A
HC65000636_06332328420	NONCDM CHARGE RECORD PHARMACY	636	J3370	31.08	N/A
HC65000636_06332328502	NONCDM CHARGE RECORD PHARMACY	636	J2795	1.41	N/A
HC65000636_06332328561	NONCDM CHARGE RECORD PHARMACY	636	J2795	1.21	N/A
HC65000636_06332328565	NONCDM CHARGE RECORD PHARMACY	636	J2795	1.52	N/A
HC65000636_06332328623	NONCDM CHARGE RECORD PHARMACY	636	J2795	0.87	N/A
HC65000636_06332328630	NONCDM CHARGE RECORD PHARMACY	636	J2795	1.38	N/A
HC65000636_06332328631	NONCDM CHARGE RECORD PHARMACY	636	J2795	1.22	N/A
HC65000636_06332328635	NONCDM CHARGE RECORD PHARMACY	636	J2795	1.24	N/A
HC65000636_06332328821	NONCDM CHARGE RECORD PHARMACY	636	J2795	0.76	N/A
HC65000636_06332329337	NONCDM CHARGE RECORD PHARMACY	636	J0670	11.14	N/A
HC65000636_06332329561	NONCDM CHARGE RECORD PHARMACY	636	J3370	44.23	N/A
HC65000636_06332330351	NONCDM CHARGE RECORD PHARMACY	636	J3260	33.20	N/A
HC65000636_06332330474	NONCDM CHARGE RECORD PHARMACY	636	J2543	43.14	N/A
HC65000636_06332330602	NONCDM CHARGE RECORD PHARMACY	636	J3260	19.06	N/A
HC65000636_06332330630	NONCDM CHARGE RECORD PHARMACY	636	J3260	6.55	N/A
HC65000636_06332331110	NONCDM CHARGE RECORD PHARMACY	636	J3490	32.40	N/A
HC65000636_06332331461	NONCDM CHARGE RECORD PHARMACY	636	J3370	17.50	N/A
HC65000636_06332331510	NONCDM CHARGE RECORD PHARMACY	636	J1570	583.62	N/A
HC65000636_06332331801	NONCDM CHARGE RECORD PHARMACY	636	J1626	10.62	N/A
HC65000636_06332332225	NONCDM CHARGE RECORD PHARMACY	636	J0743	82.14	N/A
HC65000636_06332332293	NONCDM CHARGE RECORD PHARMACY	636	J0743	37.50	N/A
HC65000636_06332332510	NONCDM CHARGE RECORD PHARMACY	636	J0133	1.12	N/A
HC65000636_06332332514	NONCDM CHARGE RECORD PHARMACY	636	J0133	0.26	N/A
HC65000636_06332332520	NONCDM CHARGE RECORD PHARMACY	636	J0133	1.03	N/A
HC65000636_06332334125	NONCDM CHARGE RECORD PHARMACY	636	J0694	37.54	N/A
HC65000636_06332335120	NONCDM CHARGE RECORD PHARMACY	636	J3490	918.00	N/A
HC65000636_06332335550	NONCDM CHARGE RECORD PHARMACY	636	J3490	43.20	N/A
HC65000636_06332336019	NONCDM CHARGE RECORD PHARMACY	636	J0610	64.17	N/A
HC65000636_06332336059	NONCDM CHARGE RECORD PHARMACY	636	J0610	30.19	N/A
HC65000636_06332336061	NONCDM CHARGE RECORD PHARMACY	636	J3490	144.00	N/A
HC65000636_06332337302	NONCDM CHARGE RECORD PHARMACY	636	J2405	3.38	N/A
HC65000636_06332337601	NONCDM CHARGE RECORD PHARMACY	636	J2354	14.91	N/A
HC65000636_06332337701	NONCDM CHARGE RECORD PHARMACY	636	J2354	14.54	N/A
HC65000636_06332337905	NONCDM CHARGE RECORD PHARMACY	636	J2354	14.91	N/A
HC65000636_06332339306	NONCDM CHARGE RECORD PHARMACY	636	J0770	171.89	N/A
HC65000636_06332339810	NONCDM CHARGE RECORD PHARMACY	636	J0456	44.16	N/A
HC65000636_06332340005	NONCDM CHARGE RECORD PHARMACY	636	J1953	0.95	N/A
HC65000636_06332340120	NONCDM CHARGE RECORD PHARMACY	636	J3490	180.74	N/A
HC65000636_06332340126	NONCDM CHARGE RECORD PHARMACY	636	J3490	157.03	N/A
HC65000636_06332340220	NONCDM CHARGE RECORD PHARMACY	636	J3490	383.97	N/A
HC65000636_06332340230	NONCDM CHARGE RECORD PHARMACY	636	J3490	174.10	N/A
HC65000636_06332340302	NONCDM CHARGE RECORD PHARMACY	636	J3490	18.58	N/A
HC65000636_06332340310	NONCDM CHARGE RECORD PHARMACY	636	J3490	20.09	N/A
HC65000636_06332340703	NONCDM CHARGE RECORD PHARMACY	636	J0706	14.22	N/A
HC65000636_06332341125	NONCDM CHARGE RECORD PHARMACY	636	J2250	3.41	N/A
HC65000636_06332341210	NONCDM CHARGE RECORD PHARMACY	636	J2250	3.32	N/A
HC65000636_06332341510	NONCDM CHARGE RECORD PHARMACY	636	J2710	18.47	N/A
HC65000636_06332341605	NONCDM CHARGE RECORD PHARMACY	636	J3490	84.00	N/A
HC65000636_06332341710	NONCDM CHARGE RECORD PHARMACY	636	J3490	490.35	N/A
HC65000636_06332341820	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,623.00	N/A
HC65000636_06332343400	NONCDM CHARGE RECORD PHARMACY	636	J0131	2.29	N/A
HC65000636_06332345101	NONCDM CHARGE RECORD PHARMACY	636	J2270	17.35	N/A
HC65000636_06332345201	NONCDM CHARGE RECORD PHARMACY	636	J2270	19.35	N/A
HC65000636_06332345401	NONCDM CHARGE RECORD PHARMACY	636	J2270	13.36	N/A
HC65000636_06332345501	NONCDM CHARGE RECORD PHARMACY	636	J2270	29.71	N/A
HC65000636_06332347401	NONCDM CHARGE RECORD PHARMACY	636	J1630	33.17	N/A
HC65000636_06332347637	NONCDM CHARGE RECORD PHARMACY	636	J2400	36.96	N/A
HC65000636_06332347827	NONCDM CHARGE RECORD PHARMACY	636	J2400	70.23	N/A
HC65000636_06332348457	NONCDM CHARGE RECORD PHARMACY	636	J2001	1.33	N/A
HC65000636_06332348526	NONCDM CHARGE RECORD PHARMACY	636	J2001	0.48	N/A
HC65000636_06332348527	NONCDM CHARGE RECORD PHARMACY	636	J2001	0.87	N/A
HC65000636_06332348557	NONCDM CHARGE RECORD PHARMACY	636	J2001	1.49	N/A
HC65000636_06332348617	NONCDM CHARGE RECORD PHARMACY	636	J2001	0.90	N/A
HC65000636_06332348627	NONCDM CHARGE RECORD PHARMACY	636	J2001	0.35	N/A
HC65000636_06332348657	NONCDM CHARGE RECORD PHARMACY	636	J2001	0.35	N/A
HC65000636_06332349157	NONCDM CHARGE RECORD PHARMACY	636	J2001	1.34	N/A
HC65000636_06332349226	NONCDM CHARGE RECORD PHARMACY	636	J2001	0.46	N/A
HC65000636_06332349227	NONCDM CHARGE RECORD PHARMACY	636	J2001	7.21	N/A
HC65000636_06332349237	NONCDM CHARGE RECORD PHARMACY	636	J2001	1.80	N/A
HC65000636_06332349257	NONCDM CHARGE RECORD PHARMACY	636	J2001	3.86	N/A
HC65000636_06332349507	NONCDM CHARGE RECORD PHARMACY	636	J2001	1.30	N/A
HC65000636_06332350601	NONCDM CHARGE RECORD PHARMACY	636	J1100	3.66	N/A
HC65000636_06332350720	NONCDM CHARGE RECORD PHARMACY	636	J2185	14.06	N/A
HC65000636_06332350721	NONCDM CHARGE RECORD PHARMACY	636	J2185	7.79	N/A
HC65000636_06332350830	NONCDM CHARGE RECORD PHARMACY	636	J2185	17.37	N/A
HC65000636_06332350831	NONCDM CHARGE RECORD PHARMACY	636	J2185	7.50	N/A
HC65000636_06332352277	NONCDM CHARGE RECORD PHARMACY	636	J1644	2.16	N/A
HC65000636_06332352374	NONCDM CHARGE RECORD PHARMACY	636	J1644	1.98	N/A
HC65000636_06332352603	NONCDM CHARGE RECORD PHARMACY	636	J0883	11.00	N/A
HC65000636_06332353190	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.90	N/A
HC65000636_06332353198	NONCDM CHARGE RECORD PHARMACY	636	J1650	6.02	N/A
HC65000636_06332353383	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.95	N/A
HC65000636_06332353393	NONCDM CHARGE RECORD PHARMACY	636	J1650	6.02	N/A
HC65000636_06332353587	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.85	N/A
HC65000636_06332353598	NONCDM CHARGE RECORD PHARMACY	636	J1650	6.02	N/A
HC65000636_06332353784	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.92	N/A
HC65000636_06332353903	NONCDM CHARGE RECORD PHARMACY	636	J1650	14.08	N/A
HC65000636_06332354001	NONCDM CHARGE RECORD PHARMACY	636		61.95	N/A
HC65000636_06332354011	NONCDM CHARGE RECORD PHARMACY	636	J1644	4.36	N/A
HC65000636_06332354013	NONCDM CHARGE RECORD PHARMACY	636	J1644	20.56	N/A
HC65000636_06332354015	NONCDM CHARGE RECORD PHARMACY	636	J1644	4.24	N/A
HC65000636_06332354036	NONCDM CHARGE RECORD PHARMACY	636	J1644	1.42	N/A
HC65000636_06332354057	NONCDM CHARGE RECORD PHARMACY	636	J1644	1.45	N/A
HC65000636_06332354067	NONCDM CHARGE RECORD PHARMACY	636	J1644	1.61	N/A
HC65000636_06332354201	NONCDM CHARGE RECORD PHARMACY	636	J1644	0.00	N/A
HC65000636_06332354302	NONCDM CHARGE RECORD PHARMACY	636	J1644	6.80	N/A
HC65000636_06332354313	NONCDM CHARGE RECORD PHARMACY	636	J1644	6.64	N/A
HC65000636_06332354501	NONCDM CHARGE RECORD PHARMACY	636	J1642	0.97	N/A
HC65000636_06332356210	NONCDM CHARGE RECORD PHARMACY	636	J0583	12.51	N/A
HC65000636_06332356397	NONCDM CHARGE RECORD PHARMACY	636	J3490	186.11	N/A
HC65000636_06332356586	NONCDM CHARGE RECORD PHARMACY	636	J1650	14.08	N/A
HC65000636_06332356883	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.94	N/A
HC65000636_06332356884	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.93	N/A
HC65000636_06332356887	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.91	N/A
HC65000636_06332358499	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.93	N/A
HC65000636_06332358696	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.93	N/A
HC65000636_06332359303	NONCDM CHARGE RECORD PHARMACY	636	J1610	1,015.45	N/A
HC65000636_06332359403	NONCDM CHARGE RECORD PHARMACY	636	J1610	826.49	N/A
HC65000636_06332359613	NONCDM CHARGE RECORD PHARMACY	636	J1610	987.93	N/A
HC65000636_06332359616	NONCDM CHARGE RECORD PHARMACY	636	J1610	972.00	N/A
HC65000636_06332359710	NONCDM CHARGE RECORD PHARMACY	636	J0895	76.99	N/A
HC65000636_06332359930	NONCDM CHARGE RECORD PHARMACY	636	J0895	52.17	N/A
HC65000636_06332360401	NONCDM CHARGE RECORD PHARMACY	636	J1800	55.49	N/A
HC65000636_06332360584	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.89	N/A
HC65000636_06332360594	NONCDM CHARGE RECORD PHARMACY	636	J1650	6.02	N/A
HC65000636_06332360788	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.88	N/A
HC65000636_06332360798	NONCDM CHARGE RECORD PHARMACY	636	J1650	6.02	N/A
HC65000636_06332360990	NONCDM CHARGE RECORD PHARMACY	636	J1650	11.88	N/A
HC65000636_06332361401	NONCDM CHARGE RECORD PHARMACY	636	J0360	42.12	N/A
HC65000636_06332361455	NONCDM CHARGE RECORD PHARMACY	636	J0360	14.70	N/A
HC65000636_06332361603	NONCDM CHARGE RECORD PHARMACY	636	J0282	1.90	N/A
HC65000636_06332361609	NONCDM CHARGE RECORD PHARMACY	636	J0282	1.94	N/A
HC65000636_06332361720	NONCDM CHARGE RECORD PHARMACY	636	J2260	326.77	N/A
HC65000636_06332362353	NONCDM CHARGE RECORD PHARMACY	636	Q0240	0.01	N/A
HC65000636_06332363150	NONCDM CHARGE RECORD PHARMACY	636	J0640	64.80	N/A
HC65000636_06332363710	NONCDM CHARGE RECORD PHARMACY	636	J9017	356.40	N/A
HC65000636_06332364220	NONCDM CHARGE RECORD PHARMACY	636	J3475	2.76	N/A
HC65000636_06332364250	NONCDM CHARGE RECORD PHARMACY	636	J3475	2.82	N/A
HC65000636_06332364907	NONCDM CHARGE RECORD PHARMACY	636	J3490	658.90	N/A
HC65000636_06332364916	NONCDM CHARGE RECORD PHARMACY	636	J3490	633.48	N/A
HC65000636_06332365102	NONCDM CHARGE RECORD PHARMACY	636	J0153	53.22	N/A
HC65000636_06332365820	NONCDM CHARGE RECORD PHARMACY	636	J1205	263.02	N/A
HC65000636_06332365827	NONCDM CHARGE RECORD PHARMACY	636	J1205	243.45	N/A
HC65000636_06332365903	NONCDM CHARGE RECORD PHARMACY	636	J3490	3,101.51	N/A
HC65000636_06332366401	NONCDM CHARGE RECORD PHARMACY	636	J1200	16.29	N/A
HC65000636_06332366501	NONCDM CHARGE RECORD PHARMACY	636	J3105	107.94	N/A
HC65000636_06332367120	NONCDM CHARGE RECORD PHARMACY	636	J3490	156.00	N/A
HC65000636_06332370800	NONCDM CHARGE RECORD PHARMACY	636	J0290	14.76	N/A
HC65000636_06332371050	NONCDM CHARGE RECORD PHARMACY	636	J0640	31.59	N/A
HC65000636_06332371100	NONCDM CHARGE RECORD PHARMACY	636	J0640	47.23	N/A
HC65000636_06332371313	NONCDM CHARGE RECORD PHARMACY	636	J2020	82.39	N/A
HC65000636_06332372110	NONCDM CHARGE RECORD PHARMACY	636	J9041	274.80	N/A
HC65000636_06332372303	NONCDM CHARGE RECORD PHARMACY	636	J3490	384.35	N/A
HC65000636_06332372810	NONCDM CHARGE RECORD PHARMACY	636	J2248	11.01	N/A
HC65000636_06332372910	NONCDM CHARGE RECORD PHARMACY	636	J2248	11.20	N/A
HC65000636_06332373510	NONCDM CHARGE RECORD PHARMACY	636	J2430	211.20	N/A
HC65000636_06332373820	NONCDM CHARGE RECORD PHARMACY	636		480.00	N/A
HC65000636_06332373912	NONCDM CHARGE RECORD PHARMACY	636		498.96	N/A
HC65000636_06332375101	NONCDM CHARGE RECORD PHARMACY	636	J2370	1.90	N/A
HC65000636_06332375110	NONCDM CHARGE RECORD PHARMACY	636	J2370	2.59	N/A
HC65000636_06332375113	NONCDM CHARGE RECORD PHARMACY	636	J2370	1.92	N/A
HC65000636_06332376210	NONCDM CHARGE RECORD PHARMACY	636	J9351	35.25	N/A
HC65000636_06332376350	NONCDM CHARGE RECORD PHARMACY	636	J9267	2.59	N/A
HC65000636_06332377810	NONCDM CHARGE RECORD PHARMACY	636	J2800	33.30	N/A
HC65000636_06332380601	NONCDM CHARGE RECORD PHARMACY	636	J3010	10.44	N/A
HC65000636_06332380602	NONCDM CHARGE RECORD PHARMACY	636	J3010	6.51	N/A
HC65000636_06332380620	NONCDM CHARGE RECORD PHARMACY	636	J3010	5.09	N/A
HC65000636_06332380650	NONCDM CHARGE RECORD PHARMACY	636	J3010	6.00	N/A
HC65000636_06332385115	NONCDM CHARGE RECORD PHARMACY	636	J1170	6.67	N/A
HC65000636_06332385225	NONCDM CHARGE RECORD PHARMACY	636	J1170	16.97	N/A
HC65000636_06332388330	NONCDM CHARGE RECORD PHARMACY	636	J9000	39.99	N/A
HC65000636_06332388510	NONCDM CHARGE RECORD PHARMACY	636	J3490	681.42	N/A
HC65000636_06332396010	NONCDM CHARGE RECORD PHARMACY	636	J3243	18.72	N/A
HC65000636_06332396505	NONCDM CHARGE RECORD PHARMACY	636	J3480	3.72	N/A
HC65000636_06332396510	NONCDM CHARGE RECORD PHARMACY	636	J3480	1.48	N/A
HC65000636_06332396520	NONCDM CHARGE RECORD PHARMACY	636	J3480	0.87	N/A
HC65000636_06332396600	NONCDM CHARGE RECORD PHARMACY	636	J3489	360.00	N/A
HC65000636_06332396730	NONCDM CHARGE RECORD PHARMACY	636	J3480	0.80	N/A
HC65000636_06345910310	NONCDM CHARGE RECORD PHARMACY	636	Q5115	507.33	N/A
HC65000636_06345910450	NONCDM CHARGE RECORD PHARMACY	636		419.43	N/A
HC65000636_06345934804	NONCDM CHARGE RECORD PHARMACY	636	J9034	148.43	N/A
HC65000636_06345939008	NONCDM CHARGE RECORD PHARMACY	636	J9033	178.31	N/A
HC65000636_06345939120	NONCDM CHARGE RECORD PHARMACY	636	J9033	178.31	N/A
HC65000636_06373951810	NONCDM CHARGE RECORD PHARMACY	636	J7512	0.20	N/A
HC65000636_06373951910	NONCDM CHARGE RECORD PHARMACY	636	J7512	0.22	N/A
HC65000636_06373992025	NONCDM CHARGE RECORD PHARMACY	636	J1644	12.97	N/A
HC65000636_06373993128	NONCDM CHARGE RECORD PHARMACY	636	J1644	2.32	N/A
HC65000636_06373998625	NONCDM CHARGE RECORD PHARMACY	636	J1644	4.01	N/A
HC65000636_06380760005	NONCDM CHARGE RECORD PHARMACY	636	J1642	0.12	N/A
HC65000636_06380760051	NONCDM CHARGE RECORD PHARMACY	636	J1642	0.13	N/A
HC65000636_06380760055	NONCDM CHARGE RECORD PHARMACY	636	J1642	0.11	N/A
HC65000636_06383338602	NONCDM CHARGE RECORD PHARMACY	636	C9132	15.11	N/A
HC65000636_06383338702	NONCDM CHARGE RECORD PHARMACY	636	C9132	15.08	N/A
HC65000636_06383361502	NONCDM CHARGE RECORD PHARMACY	636	J7187	7.58	N/A
HC65000636_06383361702	NONCDM CHARGE RECORD PHARMACY	636	J7187	8.34	N/A
HC65000636_06383382502	NONCDM CHARGE RECORD PHARMACY	636	J0597	291.21	N/A
HC65000636_06425322235	NONCDM CHARGE RECORD PHARMACY	636	J1642	1.20	N/A
HC65000636_06425333323	NONCDM CHARGE RECORD PHARMACY	636	J1642	0.20	N/A
HC65000636_06425333333	NONCDM CHARGE RECORD PHARMACY	636	J1642	0.20	N/A
HC65000636_06425333335	NONCDM CHARGE RECORD PHARMACY	636	J1642	0.12	N/A
HC65000636_06425344422	NONCDM CHARGE RECORD PHARMACY	636	J1642	6.50	N/A
HC65000636_06440600801	NONCDM CHARGE RECORD PHARMACY	636	J2323	31.62	N/A
HC65000636_06467903401	NONCDM CHARGE RECORD PHARMACY	636	J2543	25.22	N/A
HC65000636_06476430020	NONCDM CHARGE RECORD PHARMACY	636	J3380	112.37	N/A
HC65000636_06521901410	NONCDM CHARGE RECORD PHARMACY	636	J0290	13.50	N/A
HC65000636_06521919030	NONCDM CHARGE RECORD PHARMACY	636	J3465	63.33	N/A
HC65000636_06521925701	NONCDM CHARGE RECORD PHARMACY	636	J3490	123.64	N/A
HC65000636_06521942710	NONCDM CHARGE RECORD PHARMACY	636	J2704	0.90	N/A
HC65000636_06525013309	NONCDM CHARGE RECORD PHARMACY	636	C9290	8.44	N/A
HC65000636_06525026609	NONCDM CHARGE RECORD PHARMACY	636	C9290	7.70	N/A
HC65000636_06528216051	NONCDM CHARGE RECORD PHARMACY	636	J2001	1.48	N/A
HC65000636_06559740601	NONCDM CHARGE RECORD PHARMACY	636	J9358	139.16	N/A
HC65000636_06564955102	NONCDM CHARGE RECORD PHARMACY	636	J2212	7.75	N/A
HC65000636_06564955103	NONCDM CHARGE RECORD PHARMACY	636	J2212	7.20	N/A
HC65000636_06564955107	NONCDM CHARGE RECORD PHARMACY	636	J2212	6.54	N/A
HC65000636_06586264163	NONCDM CHARGE RECORD PHARMACY	636	Q0144	8.44	N/A
HC65000636_06628811001	NONCDM CHARGE RECORD PHARMACY	636	J0690	2.91	N/A
HC65000636_06668930708	NONCDM CHARGE RECORD PHARMACY	636	J7517	10.91	N/A
HC65000636_06673394823	NONCDM CHARGE RECORD PHARMACY	636	J9055	404.92	N/A
HC65000636_06673395823	NONCDM CHARGE RECORD PHARMACY	636	J9055	403.66	N/A
HC65000636_06675805002	NONCDM CHARGE RECORD PHARMACY	636	J9171	35.91	N/A
HC65000636_06679416002	NONCDM CHARGE RECORD PHARMACY	636	J2274	59.48	N/A
HC65000636_06679420641	NONCDM CHARGE RECORD PHARMACY	636	J0295	39.07	N/A
HC65000636_06679421741	NONCDM CHARGE RECORD PHARMACY	636	J2543	20.89	N/A
HC65000636_06679423042	NONCDM CHARGE RECORD PHARMACY	636	J3490	68.24	N/A
HC65000636_06715710151	NONCDM CHARGE RECORD PHARMACY	636	J3490	340.03	N/A
HC65000636_06745711850	NONCDM CHARGE RECORD PHARMACY	636	J3490	68.18	N/A
HC65000636_06745712410	NONCDM CHARGE RECORD PHARMACY	636	J1200	4.95	N/A
HC65000636_06745715303	NONCDM CHARGE RECORD PHARMACY	636	J0282	4.74	N/A
HC65000636_06745715309	NONCDM CHARGE RECORD PHARMACY	636	J0282	3.24	N/A
HC65000636_06745715318	NONCDM CHARGE RECORD PHARMACY	636	J0282	3.38	N/A
HC65000636_06745716302	NONCDM CHARGE RECORD PHARMACY	636	J3490	669.65	N/A
HC65000636_06745719602	NONCDM CHARGE RECORD PHARMACY	636	J3411	28.70	N/A
HC65000636_06745719710	NONCDM CHARGE RECORD PHARMACY	636	J3490	124.20	N/A
HC65000636_06745719803	NONCDM CHARGE RECORD PHARMACY	636	J3490	412.48	N/A
HC65000636_06745719805	NONCDM CHARGE RECORD PHARMACY	636	J3490	666.94	N/A
HC65000636_06745721102	NONCDM CHARGE RECORD PHARMACY	636	J1451	58.89	N/A
HC65000636_06745721720	NONCDM CHARGE RECORD PHARMACY	636	J1230	32.68	N/A
HC65000636_06745722005	NONCDM CHARGE RECORD PHARMACY	636	Q9968	119.91	N/A
HC65000636_06745722702	NONCDM CHARGE RECORD PHARMACY	636	J0834	529.01	N/A
HC65000636_06745723901	NONCDM CHARGE RECORD PHARMACY	636	J2354	11.62	N/A
HC65000636_06745726330	NONCDM CHARGE RECORD PHARMACY	636	J1205	315.00	N/A
HC65000636_06745729101	NONCDM CHARGE RECORD PHARMACY	636	J0360	71.79	N/A
HC65000636_06745729202	NONCDM CHARGE RECORD PHARMACY	636	J2310	87.23	N/A
HC65000636_06745729750	NONCDM CHARGE RECORD PHARMACY	636	C9399	11,400.00	N/A
HC65000636_06745731625	NONCDM CHARGE RECORD PHARMACY	636	J0894	47.40	N/A
HC65000636_06745734001	NONCDM CHARGE RECORD PHARMACY	636	J3370	34.73	N/A
HC65000636_06745734105	NONCDM CHARGE RECORD PHARMACY	636	J3370	42.15	N/A
HC65000636_06745734910	NONCDM CHARGE RECORD PHARMACY	636	J0295	14.00	N/A
HC65000636_06745737499	NONCDM CHARGE RECORD PHARMACY	636	J1644	3.10	N/A
HC65000636_06745738599	NONCDM CHARGE RECORD PHARMACY	636	J1644	2.48	N/A
HC65000636_06745739054	NONCDM CHARGE RECORD PHARMACY	636	J3489	66.00	N/A
HC65000636_06745741805	NONCDM CHARGE RECORD PHARMACY	636	J1100	0.59	N/A
HC65000636_06745742254	NONCDM CHARGE RECORD PHARMACY	636	J1100	0.75	N/A
HC65000636_06745742312	NONCDM CHARGE RECORD PHARMACY	636	J1100	1.18	N/A
HC65000636_06745742612	NONCDM CHARGE RECORD PHARMACY	636	J1630	7.00	N/A
HC65000636_06745742830	NONCDM CHARGE RECORD PHARMACY	636	J3260	15.06	N/A
HC65000636_06745743010	NONCDM CHARGE RECORD PHARMACY	636	J2430	155.76	N/A
HC65000636_06745743710	NONCDM CHARGE RECORD PHARMACY	636	J3490	100.16	N/A
HC65000636_06745744022	NONCDM CHARGE RECORD PHARMACY	636	J2405	0.82	N/A
HC65000636_06745744560	NONCDM CHARGE RECORD PHARMACY	636	J3490	924.60	N/A
HC65000636_06745744610	NONCDM CHARGE RECORD PHARMACY	636	J2430	187.12	N/A
HC65000636_06745745010	NONCDM CHARGE RECORD PHARMACY	636	J9065	210.00	N/A
HC65000636_06745745220	NONCDM CHARGE RECORD PHARMACY	636	J9100	5.92	N/A
HC65000636_06745747322	NONCDM CHARGE RECORD PHARMACY	636	J3260	10.82	N/A
HC65000636_06745751305	NONCDM CHARGE RECORD PHARMACY	636	J9120	8,748.42	N/A
HC65000636_06745751625	NONCDM CHARGE RECORD PHARMACY	636	J3490	138.00	N/A
HC65000636_06745751701	NONCDM CHARGE RECORD PHARMACY	636	J3490	44.42	N/A
HC65000636_06745751920	NONCDM CHARGE RECORD PHARMACY	636	J9280	853.17	N/A
HC65000636_06745752433	NONCDM CHARGE RECORD PHARMACY	636	J1740	490.00	N/A
HC65000636_06745752810	NONCDM CHARGE RECORD PHARMACY	636	J0640	60.00	N/A
HC65000636_06745752920	NONCDM CHARGE RECORD PHARMACY	636	J0640	60.00	N/A
HC65000636_06745753035	NONCDM CHARGE RECORD PHARMACY	636	J0640	15.85	N/A
HC65000636_06745753208	NONCDM CHARGE RECORD PHARMACY	636	J9171	12.00	N/A
HC65000636_06745755300	NONCDM CHARGE RECORD PHARMACY	636		18.90	N/A
HC65000636_06745758210	NONCDM CHARGE RECORD PHARMACY	636	J1652	31.45	N/A
HC65000636_06745758406	NONCDM CHARGE RECORD PHARMACY	636	J1652	23.40	N/A
HC65000636_06745761910	NONCDM CHARGE RECORD PHARMACY	636	J3489	282.00	N/A
HC65000636_06745762910	NONCDM CHARGE RECORD PHARMACY	636	J1327	95.35	N/A
HC65000636_06745763110	NONCDM CHARGE RECORD PHARMACY	636	J1327	107.63	N/A
HC65000636_06745764099	NONCDM CHARGE RECORD PHARMACY	636	J0780	88.46	N/A
HC65000636_06745765725	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,938.00	N/A
HC65000636_06745766205	NONCDM CHARGE RECORD PHARMACY	636	J9351	22.50	N/A
HC65000636_06745779005	NONCDM CHARGE RECORD PHARMACY	636	J1953	1.23	N/A
HC65000636_06745783306	NONCDM CHARGE RECORD PHARMACY	636	Q5108	2,087.50	N/A
HC65000636_06745783902	NONCDM CHARGE RECORD PHARMACY	636	J3490	780.00	N/A
HC65000636_06745784330	NONCDM CHARGE RECORD PHARMACY	636	J2020	199.10	N/A
HC65000636_06745784550	NONCDM CHARGE RECORD PHARMACY	636	Q5114	528.18	N/A
HC65000636_06745784744	NONCDM CHARGE RECORD PHARMACY	636	Q5114	528.18	N/A
HC65000636_06745785204	NONCDM CHARGE RECORD PHARMACY	636	J3490	207.92	N/A
HC65000636_06745785350	NONCDM CHARGE RECORD PHARMACY	636	J1120	239.75	N/A
HC65000636_06745785502	NONCDM CHARGE RECORD PHARMACY	636	J0153	5.66	N/A
HC65000636_06745785620	NONCDM CHARGE RECORD PHARMACY	636	J0153	11.14	N/A
HC65000636_06745785730	NONCDM CHARGE RECORD PHARMACY	636	J0153	12.22	N/A
HC65000636_06745786050	NONCDM CHARGE RECORD PHARMACY	636	J0456	35.76	N/A
HC65000636_06745786301	NONCDM CHARGE RECORD PHARMACY	636	J1626	5.64	N/A
HC65000636_06745788799	NONCDM CHARGE RECORD PHARMACY	636	J1050	1.80	N/A
HC65000636_06745788910	NONCDM CHARGE RECORD PHARMACY	636	J1453	3.29	N/A
HC65000636_06745795310	NONCDM CHARGE RECORD PHARMACY	636	J1644	2.16	N/A
HC65000636_06745799115	NONCDM CHARGE RECORD PHARMACY	636		555.78	N/A
HC65000636_06768410001	NONCDM CHARGE RECORD PHARMACY	636	Q9967	1.87	N/A
HC65000636_06785004110	NONCDM CHARGE RECORD PHARMACY	636	J3490	61.52	N/A
HC65000636_06785004210	NONCDM CHARGE RECORD PHARMACY	636	J3490	36.00	N/A
HC65000636_06787147906	NONCDM CHARGE RECORD PHARMACY	636	J1430	2,565.07	N/A
HC65000636_06787723022	NONCDM CHARGE RECORD PHARMACY	636	J7517	63.41	N/A
HC65000636_06787726601	NONCDM CHARGE RECORD PHARMACY	636	J7517	1.33	N/A
HC65000636_06787749301	NONCDM CHARGE RECORD PHARMACY	636	J7500	1.64	N/A
HC65000636_06791901201	NONCDM CHARGE RECORD PHARMACY	636	J0878	5.35	N/A
HC65000636_06800133964	NONCDM CHARGE RECORD PHARMACY	636	J3370	47.36	N/A
HC65000636_06808414901	NONCDM CHARGE RECORD PHARMACY	636	J7509	9.82	N/A
HC65000636_06808422901	NONCDM CHARGE RECORD PHARMACY	636	J7500	4.06	N/A
HC65000636_06808444901	NONCDM CHARGE RECORD PHARMACY	636	J7507	12.62	N/A
HC65000636_06808445001	NONCDM CHARGE RECORD PHARMACY	636	J7507	13.72	N/A
HC65000636_06808445101	NONCDM CHARGE RECORD PHARMACY	636	J7507	18.60	N/A
HC65000636_06808490721	NONCDM CHARGE RECORD PHARMACY	636	J7518	22.35	N/A
HC65000636_06809410110	NONCDM CHARGE RECORD PHARMACY	636	J2760	2,518.80	N/A
HC65000636_06838247001	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,300.00	N/A
HC65000636_06838291010	NONCDM CHARGE RECORD PHARMACY	636	J3490	139.16	N/A
HC65000636_06838291601	NONCDM CHARGE RECORD PHARMACY	636	J7509	2.47	N/A
HC65000636_06840311006	NONCDM CHARGE RECORD PHARMACY	636	J3490	68,760.00	N/A
HC65000636_06851652141	NONCDM CHARGE RECORD PHARMACY	636	P9045	276.00	N/A
HC65000636_06851652142	NONCDM CHARGE RECORD PHARMACY	636	P9045	276.00	N/A
HC65000636_06851652145	NONCDM CHARGE RECORD PHARMACY	636	P9045	125.29	N/A
HC65000636_06851652161	NONCDM CHARGE RECORD PHARMACY	636	P9047	272.96	N/A
HC65000636_06851652162	NONCDM CHARGE RECORD PHARMACY	636	P9047	262.82	N/A
HC65000636_06851652165	NONCDM CHARGE RECORD PHARMACY	636	P9047	174.43	N/A
HC65000636_06868201227	NONCDM CHARGE RECORD PHARMACY	636	C9399	22,794.00	N/A
HC65000636_06872790003	NONCDM CHARGE RECORD PHARMACY	636	J3490	53,257.60	N/A
HC65000636_06881713450	NONCDM CHARGE RECORD PHARMACY	636	J9264	87.08	N/A
HC65000636_06898262302	NONCDM CHARGE RECORD PHARMACY	636	P9045	415.50	N/A
HC65000636_06898262303	NONCDM CHARGE RECORD PHARMACY	636	P9045	415.50	N/A
HC65000636_06898264301	NONCDM CHARGE RECORD PHARMACY	636	P9047	343.31	N/A
HC65000636_06898264302	NONCDM CHARGE RECORD PHARMACY	636	P9047	344.40	N/A
HC65000636_06909752235	NONCDM CHARGE RECORD PHARMACY	636	J3490	5,401.64	N/A
HC65000636_06909780540	NONCDM CHARGE RECORD PHARMACY	636	J9025	12.60	N/A
HC65000636_06909792735	NONCDM CHARGE RECORD PHARMACY	636	J2469	78.00	N/A
HC65000636_06933913632	NONCDM CHARGE RECORD PHARMACY	636	J3360	69.00	N/A
HC65000636_06933913634	NONCDM CHARGE RECORD PHARMACY	636	J3360	42.13	N/A
HC65000636_06937431410	NONCDM CHARGE RECORD PHARMACY	636	J2250	1.52	N/A
HC65000636_06937431625	NONCDM CHARGE RECORD PHARMACY	636	J3490	133.50	N/A
HC65000636_06954337110	NONCDM CHARGE RECORD PHARMACY	636	J2469	25.70	N/A
HC65000636_06968011225	NONCDM CHARGE RECORD PHARMACY	636	J3420	20.60	N/A
HC65000636_06978400306	NONCDM CHARGE RECORD PHARMACY	636	J3490	44.10	N/A
HC65000636_06980042031	NONCDM CHARGE RECORD PHARMACY	636	90371	637.12	N/A
HC65000636_06985301021	NONCDM CHARGE RECORD PHARMACY	636	C9041	1,622.30	N/A
HC65000636_06991889910	NONCDM CHARGE RECORD PHARMACY	636	J2597	114.39	N/A
HC65000636_06991890110	NONCDM CHARGE RECORD PHARMACY	636	J2597	101.51	N/A
HC65000636_07000408544	NONCDM CHARGE RECORD PHARMACY	636	J2590	37.00	N/A
HC65000636_07000410069	NONCDM CHARGE RECORD PHARMACY	636	J2270	21.48	N/A
HC65000636_07000430069	NONCDM CHARGE RECORD PHARMACY	636	J1170	33.00	N/A
HC65000636_07002019101	NONCDM CHARGE RECORD PHARMACY	636	J9207	592.80	N/A
HC65000636_07002019111	NONCDM CHARGE RECORD PHARMACY	636	J9207	592.80	N/A
HC65000636_07006902125	NONCDM CHARGE RECORD PHARMACY	636	J1100	3.14	N/A
HC65000636_07006906401	NONCDM CHARGE RECORD PHARMACY	636	J2795	3.93	N/A
HC65000636_07006907110	NONCDM CHARGE RECORD PHARMACY	636	J2310	115.58	N/A
HC65000636_07006915110	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,079.28	N/A
HC65000636_07010042402	NONCDM CHARGE RECORD PHARMACY	636	J3490	575.93	N/A
HC65000636_07011410101	NONCDM CHARGE RECORD PHARMACY	636	Q5111	2,087.50	N/A
HC65000636_07012110031	NONCDM CHARGE RECORD PHARMACY	636	J1327	127.96	N/A
HC65000636_07012110492	NONCDM CHARGE RECORD PHARMACY	636	J3301	12.29	N/A
HC65000636_07012110495	NONCDM CHARGE RECORD PHARMACY	636	J3301	12.75	N/A
HC65000636_07012114537	NONCDM CHARGE RECORD PHARMACY	636	J2185	81.07	N/A
HC65000636_07012115735	NONCDM CHARGE RECORD PHARMACY	636	J1030	63.72	N/A
HC65000636_07012115775	NONCDM CHARGE RECORD PHARMACY	636	J2370	2.34	N/A
HC65000636_07012116477	NONCDM CHARGE RECORD PHARMACY	636	J3243	12.48	N/A
HC65000636_07012116515	NONCDM CHARGE RECORD PHARMACY	636	J3301	12.75	N/A
HC65000636_07025733051	NONCDM CHARGE RECORD PHARMACY	636	J2792	205.84	N/A
HC65000636_07025756001	NONCDM CHARGE RECORD PHARMACY	636	J0475	1,063.99	N/A
HC65000636_07025756301	NONCDM CHARGE RECORD PHARMACY	636	J0475	598.93	N/A
HC65000636_07043601982	NONCDM CHARGE RECORD PHARMACY	636	J0456	28.20	N/A
HC65000636_07051526010	NONCDM CHARGE RECORD PHARMACY	636	J1160	501.38	N/A
HC65000636_07059402304	NONCDM CHARGE RECORD PHARMACY	636	J0770	168.00	N/A
HC65000636_07059403502	NONCDM CHARGE RECORD PHARMACY	636	J3243	12.60	N/A
HC65000636_07065500206	NONCDM CHARGE RECORD PHARMACY	636	J1450	28.24	N/A
HC65000636_07071014781	NONCDM CHARGE RECORD PHARMACY	636	J1451	88.45	N/A
HC65000636_07072095036	NONCDM CHARGE RECORD PHARMACY	636	J9202	4,027.46	N/A
HC65000636_07084216010	NONCDM CHARGE RECORD PHARMACY	636	J2265	9.73	N/A
HC65000636_07086010010	NONCDM CHARGE RECORD PHARMACY	636	J0456	29.53	N/A
HC65000636_07086010410	NONCDM CHARGE RECORD PHARMACY	636	J3370	41.78	N/A
HC65000636_07086010520	NONCDM CHARGE RECORD PHARMACY	636	J3370	10.26	N/A
HC65000636_07086012566	NONCDM CHARGE RECORD PHARMACY	636	J0456	20.85	N/A
HC65000636_07086012620	NONCDM CHARGE RECORD PHARMACY	636	J2540	8.63	N/A
HC65000636_07086020005	NONCDM CHARGE RECORD PHARMACY	636	J9267	2.70	N/A
HC65000636_07086020017	NONCDM CHARGE RECORD PHARMACY	636	J9267	2.01	N/A
HC65000636_07086020050	NONCDM CHARGE RECORD PHARMACY	636	J9267	2.36	N/A
HC65000636_07086020910	NONCDM CHARGE RECORD PHARMACY	636	J9209	24.60	N/A
HC65000636_07086030105	NONCDM CHARGE RECORD PHARMACY	636	J3490	19.76	N/A
HC65000636_07086030125	NONCDM CHARGE RECORD PHARMACY	636	J3490	58.50	N/A
HC65000636_07086040010	NONCDM CHARGE RECORD PHARMACY	636	J3490	41.05	N/A
HC65000636_07086040210	NONCDM CHARGE RECORD PHARMACY	636	J3490	41.16	N/A
HC65000636_07086045401	NONCDM CHARGE RECORD PHARMACY	636	J2597	78.75	N/A
HC65000636_07086045410	NONCDM CHARGE RECORD PHARMACY	636	J2597	78.75	N/A
HC65000636_07086060110	NONCDM CHARGE RECORD PHARMACY	636	J2250	0.72	N/A
HC65000636_07086060503	NONCDM CHARGE RECORD PHARMACY	636	J3490	32.52	N/A
HC65000636_07086070002	NONCDM CHARGE RECORD PHARMACY	636	J1885	10.80	N/A
HC65000636_07086070103	NONCDM CHARGE RECORD PHARMACY	636	J1885	5.86	N/A
HC65000636_07086078010	NONCDM CHARGE RECORD PHARMACY	636	J1453	7.02	N/A
HC65000636_07086080101	NONCDM CHARGE RECORD PHARMACY	636	J3105	83.13	N/A
HC65000636_07128501021	NONCDM CHARGE RECORD PHARMACY	636	J3490	834.00	N/A
HC65000636_07128501081	NONCDM CHARGE RECORD PHARMACY	636	J3490	864.00	N/A
HC65000636_07128620406	NONCDM CHARGE RECORD PHARMACY	636	J2270	9.14	N/A
HC65000636_07128800520	NONCDM CHARGE RECORD PHARMACY	636	J0295	30.03	N/A
HC65000636_07128800630	NONCDM CHARGE RECORD PHARMACY	636	J0295	30.04	N/A
HC65000636_07128810610	NONCDM CHARGE RECORD PHARMACY	636	J9040	121.84	N/A
HC65000636_07128810920	NONCDM CHARGE RECORD PHARMACY	636	J9100	5.33	N/A
HC65000636_07128811310	NONCDM CHARGE RECORD PHARMACY	636	J9201	55.14	N/A
HC65000636_07128811450	NONCDM CHARGE RECORD PHARMACY	636	J9201	55.12	N/A
HC65000636_07128840003	NONCDM CHARGE RECORD PHARMACY	636	J1644	28.50	N/A
HC65000636_07128840202	NONCDM CHARGE RECORD PHARMACY	636	J1644	14.58	N/A
HC65000636_07128840211	NONCDM CHARGE RECORD PHARMACY	636	J1644	2.37	N/A
HC65000636_07128880702	NONCDM CHARGE RECORD PHARMACY	636	J2370	1.92	N/A
HC65000636_07133610001	NONCDM CHARGE RECORD PHARMACY	636	J0222	570.00	N/A
HC65000636_07183758435	NONCDM CHARGE RECORD PHARMACY	636	J2820	253.83	N/A
HC65000636_07186320206	NONCDM CHARGE RECORD PHARMACY	636	J3490	30.75	N/A
HC65000636_07207802610	NONCDM CHARGE RECORD PHARMACY	636	J1327	40.00	N/A
HC65000636_07219604311	NONCDM CHARGE RECORD PHARMACY	636	J7999	268.50	N/A
HC65000636_07219660441	NONCDM CHARGE RECORD PHARMACY	636	J2590	20.00	N/A
HC65000636_07220500792	NONCDM CHARGE RECORD PHARMACY	636	J8521	3.00	N/A
HC65000636_07220503101	NONCDM CHARGE RECORD PHARMACY	636	J0894	45.00	N/A
HC65000636_07226610201	NONCDM CHARGE RECORD PHARMACY	636	J3490	8.29	N/A
HC65000636_07226611825	NONCDM CHARGE RECORD PHARMACY	636	J1885	5.18	N/A
HC65000636_07226616010	NONCDM CHARGE RECORD PHARMACY	636	J3486	113.56	N/A
HC65000636_07226616042	NONCDM CHARGE RECORD PHARMACY	636	J3486	59.73	N/A
HC65000636_07248510125	NONCDM CHARGE RECORD PHARMACY	636	J1200	27.95	N/A
HC65000636_07248510610	NONCDM CHARGE RECORD PHARMACY	636	J1953	1.26	N/A
HC65000636_07257201610	NONCDM CHARGE RECORD PHARMACY	636	J0290	6.21	N/A
HC65000636_07257201710	NONCDM CHARGE RECORD PHARMACY	636	J0290	3.51	N/A
HC65000636_07257206125	NONCDM CHARGE RECORD PHARMACY	636		2.19	N/A
HC65000636_07257206201	NONCDM CHARGE RECORD PHARMACY	636	J0696	1.66	N/A
HC65000636_07257206225	NONCDM CHARGE RECORD PHARMACY	636	J0696	1.78	N/A
HC65000636_07257210001	NONCDM CHARGE RECORD PHARMACY	636	J0878	0.69	N/A
HC65000636_07257212025	NONCDM CHARGE RECORD PHARMACY	636	J1100	1.53	N/A
HC65000636_07257212225	NONCDM CHARGE RECORD PHARMACY	636	J1100	0.74	N/A
HC65000636_07257214002	NONCDM CHARGE RECORD PHARMACY	636	J3360	55.18	N/A
HC65000636_07257215010	NONCDM CHARGE RECORD PHARMACY	636	J3490	241.16	N/A
HC65000636_07257217025	NONCDM CHARGE RECORD PHARMACY	636	J3010	4.96	N/A
HC65000636_07257217125	NONCDM CHARGE RECORD PHARMACY	636	J3010	5.10	N/A
HC65000636_07257217201	NONCDM CHARGE RECORD PHARMACY	636	J3010	5.18	N/A
HC65000636_07257225025	NONCDM CHARGE RECORD PHARMACY	636	J1644	9.86	N/A
HC65000636_07257225525	NONCDM CHARGE RECORD PHARMACY	636	J1644	1.99	N/A
HC65000636_07257226525	NONCDM CHARGE RECORD PHARMACY	636	J0360	22.55	N/A
HC65000636_07257235001	NONCDM CHARGE RECORD PHARMACY	636	J3490	2.75	N/A
HC65000636_07257237025	NONCDM CHARGE RECORD PHARMACY	636	J2001	1.60	N/A
HC65000636_07257237225	NONCDM CHARGE RECORD PHARMACY	636	J2001	0.74	N/A
HC65000636_07257238025	NONCDM CHARGE RECORD PHARMACY	636	J2060	3.74	N/A
HC65000636_07257241510	NONCDM CHARGE RECORD PHARMACY	636	J2185	5.29	N/A
HC65000636_07257241610	NONCDM CHARGE RECORD PHARMACY	636	J2185	6.93	N/A
HC65000636_07257243025	NONCDM CHARGE RECORD PHARMACY	636	J2250	2.00	N/A
HC65000636_07257247010	NONCDM CHARGE RECORD PHARMACY	636	J3490	232.38	N/A
HC65000636_07257248110	NONCDM CHARGE RECORD PHARMACY	636	J3490	179.12	N/A
HC65000636_07257252025	NONCDM CHARGE RECORD PHARMACY	636		1.01	N/A
HC65000636_07257255010	NONCDM CHARGE RECORD PHARMACY	636	C9113	16.98	N/A
HC65000636_07257257125	NONCDM CHARGE RECORD PHARMACY	636	J2370	1.19	N/A
HC65000636_07257257310	NONCDM CHARGE RECORD PHARMACY	636	J2543	12.74	N/A
HC65000636_07257257410	NONCDM CHARGE RECORD PHARMACY	636	J2543	8.42	N/A
HC65000636_07257275010	NONCDM CHARGE RECORD PHARMACY	636	J0330	9.76	N/A
HC65000636_07257280102	NONCDM CHARGE RECORD PHARMACY	636	J3370	10.60	N/A
HC65000636_07257280301	NONCDM CHARGE RECORD PHARMACY	636	J3370	9.89	N/A
HC65000636_07257280501	NONCDM CHARGE RECORD PHARMACY	636	J3370	8.84	N/A
HC65000636_07261164225	NONCDM CHARGE RECORD PHARMACY	636	J3490	9.26	N/A
HC65000636_07261171601	NONCDM CHARGE RECORD PHARMACY	636	J1190	2,350.73	N/A
HC65000636_07261171925	NONCDM CHARGE RECORD PHARMACY	636	J1885	6.94	N/A
HC65000636_07261172225	NONCDM CHARGE RECORD PHARMACY	636	J1885	5.40	N/A
HC65000636_07261174910	NONCDM CHARGE RECORD PHARMACY	636	J2250	0.71	N/A
HC65000636_07264733104	NONCDM CHARGE RECORD PHARMACY	636	J7509	1.28	N/A
HC65000636_07269495401	NONCDM CHARGE RECORD PHARMACY	636	J9266	103,067.60	N/A
HC65000636_07276918103	NONCDM CHARGE RECORD PHARMACY	636	J2547	9.50	N/A
HC65000636_07353520801	NONCDM CHARGE RECORD PHARMACY	636	J9349	72.00	N/A
HC65000636_07360700110	NONCDM CHARGE RECORD PHARMACY	636	J3490	59,760.00	N/A
HC65000636_07360700111	NONCDM CHARGE RECORD PHARMACY	636	J3490	82,170.00	N/A
HC65000636_07598711111	NONCDM CHARGE RECORD PHARMACY	636	J9216	0.01	N/A
HC65000636_07601400310	NONCDM CHARGE RECORD PHARMACY	636	J2710	5.57	N/A
HC65000636_07601400410	NONCDM CHARGE RECORD PHARMACY	636	J2370	2.65	N/A
HC65000636_07601400425	NONCDM CHARGE RECORD PHARMACY	636	J2370	7.61	N/A
HC65000636_07601400525	NONCDM CHARGE RECORD PHARMACY	636	J3490	170.53	N/A
HC65000636_07604500410	NONCDM CHARGE RECORD PHARMACY	636	J2270	10.71	N/A
HC65000636_07604500411	NONCDM CHARGE RECORD PHARMACY	636	J2270	18.50	N/A
HC65000636_07604500510	NONCDM CHARGE RECORD PHARMACY	636	J2270	16.08	N/A
HC65000636_07604500511	NONCDM CHARGE RECORD PHARMACY	636	J2270	13.35	N/A
HC65000636_07604500610	NONCDM CHARGE RECORD PHARMACY	636	J2270	17.21	N/A
HC65000636_07604500906	NONCDM CHARGE RECORD PHARMACY	636	J1170	25.36	N/A
HC65000636_07604500910	NONCDM CHARGE RECORD PHARMACY	636	J1170	10.57	N/A
HC65000636_07604500911	NONCDM CHARGE RECORD PHARMACY	636	J1170	21.06	N/A
HC65000636_07604501010	NONCDM CHARGE RECORD PHARMACY	636	J1170	21.60	N/A
HC65000636_07604501011	NONCDM CHARGE RECORD PHARMACY	636	J1170	24.39	N/A
HC65000636_07604510610	NONCDM CHARGE RECORD PHARMACY	636	J1100	2.35	N/A
HC65000636_07604510910	NONCDM CHARGE RECORD PHARMACY	636	J1100	3.32	N/A
HC65000636_07612579025	NONCDM CHARGE RECORD PHARMACY	636	P9045	288.00	N/A
HC65000636_07612579210	NONCDM CHARGE RECORD PHARMACY	636	P9047	287.52	N/A
HC65000636_07631002425	NONCDM CHARGE RECORD PHARMACY	636	J1455	380.20	N/A
HC65000636_07632912401	NONCDM CHARGE RECORD PHARMACY	636		151.60	N/A
HC65000636_07632933161	NONCDM CHARGE RECORD PHARMACY	636	J0171	5.13	N/A
HC65000636_07632933391	NONCDM CHARGE RECORD PHARMACY	636	J0461	0.54	N/A
HC65000636_07632933401	NONCDM CHARGE RECORD PHARMACY	636	J0461	2.01	N/A
HC65000636_07632933691	NONCDM CHARGE RECORD PHARMACY	636	J2310	96.06	N/A
HC65000636_07632933901	NONCDM CHARGE RECORD PHARMACY	636	J2001	3.42	N/A
HC65000636_07632933995	NONCDM CHARGE RECORD PHARMACY	636	J2690	510.00	N/A
HC65000636_07632990600	NONCDM CHARGE RECORD PHARMACY	636	J0171	5.01	N/A
HC65000636_07638871325	NONCDM CHARGE RECORD PHARMACY	636	J8510	0.01	N/A
HC65000636_07647850120	NONCDM CHARGE RECORD PHARMACY	636	J2515	363.07	N/A
HC65000636_07647850150	NONCDM CHARGE RECORD PHARMACY	636	J2515	270.84	N/A
HC65000636_08290306414	NONCDM CHARGE RECORD PHARMACY	636	J1642	0.54	N/A
HC65000636_08290306424	NONCDM CHARGE RECORD PHARMACY	636	J1642	0.06	N/A
HC65000636_08290306514	NONCDM CHARGE RECORD PHARMACY	636	J1642	0.12	N/A
HC65000636_08290306515	NONCDM CHARGE RECORD PHARMACY	636	J1642	0.06	N/A
HC65000636_09999600025	NONCDM CHARGE RECORD PHARMACY	636		480.00	N/A
HC65000636_09999800522	NONCDM CHARGE RECORD PHARMACY	636		480.00	N/A
HC65000636_09999900120	NONCDM CHARGE RECORD PHARMACY	636		480.00	N/A
HC65000636_09999904236	NONCDM CHARGE RECORD PHARMACY	636	J0698	9.75	N/A
HC65000636_09999904512	NONCDM CHARGE RECORD PHARMACY	636	J0698	10.07	N/A
HC65000636_66647218211	NONCDM CHARGE RECORD PHARMACY	636	J3010	41.70	N/A
HC65000637	DRUG - SELF-ADMINISTRABLE	636		N/A	N/A
HC65000637_00002751001	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.00	N/A
HC65000637_00002751017	NONCDM CHARGE RECORD PHARMACY	636	J1815	8.14	N/A
HC65000637_00002751101	NONCDM CHARGE RECORD PHARMACY	636	J1815	8.54	N/A
HC65000637_00002771459	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.01	N/A
HC65000637_00002771559	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.00	N/A
HC65000637_00002775205	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.01	N/A
HC65000637_00002821501	NONCDM CHARGE RECORD PHARMACY	636	J1815	4.45	N/A
HC65000637_00002821517	NONCDM CHARGE RECORD PHARMACY	636	J1815	4.44	N/A
HC65000637_00002822259	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.00	N/A
HC65000637_00002831501	NONCDM CHARGE RECORD PHARMACY	636	J1815	4.45	N/A
HC65000637_00002831517	NONCDM CHARGE RECORD PHARMACY	636	J1815	4.46	N/A
HC65000637_00002871517	NONCDM CHARGE RECORD PHARMACY	636	J1815	4.44	N/A
HC65000637_00002879959	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.00	N/A
HC65000637_00002882427	NONCDM CHARGE RECORD PHARMACY	636	J1815	5.14	N/A
HC65000637_00024586900	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.00	N/A
HC65000637_00024586903	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.00	N/A
HC65000637_00024592410	NONCDM CHARGE RECORD PHARMACY	636	J1815	3.92	N/A
HC65000637_00024592500	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.01	N/A
HC65000637_00024592505	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.00	N/A
HC65000637_00024592605	NONCDM CHARGE RECORD PHARMACY	636	J1815	3.92	N/A
HC65000637_00088222033	NONCDM CHARGE RECORD PHARMACY	636	J1815	8.49	N/A
HC65000637_00088250033	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.01	N/A
HC65000637_00088250205	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.00	N/A
HC65000637_00088502101	NONCDM CHARGE RECORD PHARMACY	636	J1815	8.51	N/A
HC65000637_00169183311	NONCDM CHARGE RECORD PHARMACY	636	J1815	4.43	N/A
HC65000637_00169183411	NONCDM CHARGE RECORD PHARMACY	636	J1815	4.13	N/A
HC65000637_00169210011	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.01	N/A
HC65000637_00169210125	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.01	N/A
HC65000637_00169255013	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.00	N/A
HC65000637_00169266015	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.00	N/A
HC65000637_00169368512	NONCDM CHARGE RECORD PHARMACY	636	J1815	9.00	N/A
HC65000637_00169368712	NONCDM CHARGE RECORD PHARMACY	636	J1815	9.16	N/A
HC65000637_00169406012	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65000637_00169633910	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.01	N/A
HC65000637_00169643810	NONCDM CHARGE RECORD PHARMACY	636	J1815	0.00	N/A
HC65000637_00169750111	NONCDM CHARGE RECORD PHARMACY	636	J1815	9.33	N/A
HC65000637_00378696112	NONCDM CHARGE RECORD PHARMACY	636	J1595	0.01	N/A
HC65000637_04408700443	NONCDM CHARGE RECORD PHARMACY	636	J1826	0.01	N/A
HC65000637_06665823407	NONCDM CHARGE RECORD PHARMACY	636	J3490	872.31	N/A
HC65000637_06745767502	NONCDM CHARGE RECORD PHARMACY	636	J0630	13,577.30	N/A
HC65000637_06854632512	NONCDM CHARGE RECORD PHARMACY	636	J1595	0.01	N/A
HC65000777	MEDICATION-DEFAULT	250		N/A	N/A
HC65000777_01951581852	NONCDM CHARGE RECORD PHARMACY	250		0.01	N/A
HC65001250	MED - GENERAL W/O J-CODE	250		N/A	N/A
HC65001258	MED - IV SOLUTION W/J-CODE	636		N/A	N/A
HC65001258_00264151032	NONCDM CHARGE RECORD PHARMACY	636	J7060	11.40	N/A
HC65001258_00264180032	NONCDM CHARGE RECORD PHARMACY	258	J7050	13.55	N/A
HC65001258_00264751000	NONCDM CHARGE RECORD PHARMACY	636	J7060	9.75	N/A
HC65001258_00264751010	NONCDM CHARGE RECORD PHARMACY	636	J7060	11.30	N/A
HC65001258_00264751020	NONCDM CHARGE RECORD PHARMACY	258	J7060	14.60	N/A
HC65001258_00264762500	NONCDM CHARGE RECORD PHARMACY	636	J7070	16.67	N/A
HC65001258_00264763600	NONCDM CHARGE RECORD PHARMACY	258	J7042	9.00	N/A
HC65001258_00264780000	NONCDM CHARGE RECORD PHARMACY	636	J7030	12.00	N/A
HC65001258_00264780009	NONCDM CHARGE RECORD PHARMACY	636	J7030	13.50	N/A
HC65001258_00264780010	NONCDM CHARGE RECORD PHARMACY	258	J7040	10.72	N/A
HC65001258_00264780020	NONCDM CHARGE RECORD PHARMACY	636	J7050	14.25	N/A
HC65001258_00264780200	NONCDM CHARGE RECORD PHARMACY	258	J7030	14.17	N/A
HC65001258_00264780210	NONCDM CHARGE RECORD PHARMACY	258	J7030	6.70	N/A
HC65001258_00264780510	NONCDM CHARGE RECORD PHARMACY	636	J7050	6.48	N/A
HC65001258_00264786500	NONCDM CHARGE RECORD PHARMACY	636	J7030	24.00	N/A
HC65001258_00338001701	NONCDM CHARGE RECORD PHARMACY	636	J7060	58.64	N/A
HC65001258_00338001702	NONCDM CHARGE RECORD PHARMACY	258	J7060	21.16	N/A
HC65001258_00338001703	NONCDM CHARGE RECORD PHARMACY	258	J7060	20.15	N/A
HC65001258_00338001704	NONCDM CHARGE RECORD PHARMACY	636	J7060	12.65	N/A
HC65001258_00338001731	NONCDM CHARGE RECORD PHARMACY	258	J7060	11.51	N/A
HC65001258_00338001738	NONCDM CHARGE RECORD PHARMACY	258	J7060	13.11	N/A
HC65001258_00338004304	NONCDM CHARGE RECORD PHARMACY	636	J7030	26.22	N/A
HC65001258_00338004901	NONCDM CHARGE RECORD PHARMACY	636	J7050	33.00	N/A
HC65001258_00338004902	NONCDM CHARGE RECORD PHARMACY	258	J7050	17.92	N/A
HC65001258_00338004903	NONCDM CHARGE RECORD PHARMACY	636	J7040	22.00	N/A
HC65001258_00338004904	NONCDM CHARGE RECORD PHARMACY	258	J7030	24.50	N/A
HC65001258_00338004910	NONCDM CHARGE RECORD PHARMACY	258	J7050	10.36	N/A
HC65001258_00338004931	NONCDM CHARGE RECORD PHARMACY	258	J7050	11.38	N/A
HC65001258_00338004938	NONCDM CHARGE RECORD PHARMACY	258	J7050	12.22	N/A
HC65001258_00338004948	NONCDM CHARGE RECORD PHARMACY	258	J7050	13.38	N/A
HC65001258_00338005403	NONCDM CHARGE RECORD PHARMACY	258	J7050	15.52	N/A
HC65001258_00338007704	NONCDM CHARGE RECORD PHARMACY	636	J7042	15.00	N/A
HC65001258_00338008503	NONCDM CHARGE RECORD PHARMACY	258	J7042	24.49	N/A
HC65001258_00338008504	NONCDM CHARGE RECORD PHARMACY	258	J7042	15.00	N/A
HC65001258_00338011702	NONCDM CHARGE RECORD PHARMACY	258	J7120	28.98	N/A
HC65001258_00338011703	NONCDM CHARGE RECORD PHARMACY	258	J7120	31.23	N/A
HC65001258_00338011704	NONCDM CHARGE RECORD PHARMACY	258	J7120	24.06	N/A
HC65001258_00338012504	NONCDM CHARGE RECORD PHARMACY	636	J7070	28.50	N/A
HC65001258_00338022104	NONCDM CHARGE RECORD PHARMACY	258		77.92	N/A
HC65001258_00338055118	NONCDM CHARGE RECORD PHARMACY	258	J7060	30.28	N/A
HC65001258_00338055311	NONCDM CHARGE RECORD PHARMACY	636	J7050	59.40	N/A
HC65001258_00338055318	NONCDM CHARGE RECORD PHARMACY	258	J7050	30.61	N/A
HC65001258_00338068304	NONCDM CHARGE RECORD PHARMACY	636	J7070	54.00	N/A
HC65001258_00338069104	NONCDM CHARGE RECORD PHARMACY	636	J7030	49.50	N/A
HC65001258_00338069504	NONCDM CHARGE RECORD PHARMACY	636	J7030	60.00	N/A
HC65001258_00338080304	NONCDM CHARGE RECORD PHARMACY	636	J7042	27.00	N/A
HC65001258_00338081104	NONCDM CHARGE RECORD PHARMACY	258	J7120	60.00	N/A
HC65001258_00338634602	NONCDM CHARGE RECORD PHARMACY	636	J7060	31.50	N/A
HC65001258_00338634603	NONCDM CHARGE RECORD PHARMACY	636	J7060	33.00	N/A
HC65001258_00338915930	NONCDM CHARGE RECORD PHARMACY	258	J7050	34.43	N/A
HC65001258_00409488810	NONCDM CHARGE RECORD PHARMACY	636	J7030	13.05	N/A
HC65001258_00409488850	NONCDM CHARGE RECORD PHARMACY	636	J7030	25.17	N/A
HC65001258_00409710167	NONCDM CHARGE RECORD PHARMACY	258	J7050	14.50	N/A
HC65001258_00409710709	NONCDM CHARGE RECORD PHARMACY	258	J7042	21.00	N/A
HC65001258_00409710909	NONCDM CHARGE RECORD PHARMACY	636	J7042	24.00	N/A
HC65001258_00409711509	NONCDM CHARGE RECORD PHARMACY	258	J7030	42.00	N/A
HC65001258_00409711609	NONCDM CHARGE RECORD PHARMACY	258	J7030	54.00	N/A
HC65001258_00409767009	NONCDM CHARGE RECORD PHARMACY	258		30.00	N/A
HC65001258_00409790109	NONCDM CHARGE RECORD PHARMACY	636	J7042	21.00	N/A
HC65001258_00409790209	NONCDM CHARGE RECORD PHARMACY	258	J7042	6.00	N/A
HC65001258_00409790309	NONCDM CHARGE RECORD PHARMACY	636	J7042	21.00	N/A
HC65001258_00409790409	NONCDM CHARGE RECORD PHARMACY	636	J7042	6.00	N/A
HC65001258_00409790509	NONCDM CHARGE RECORD PHARMACY	636	J7070	42.00	N/A
HC65001258_00409792202	NONCDM CHARGE RECORD PHARMACY	258	J7060	39.90	N/A
HC65001258_00409792203	NONCDM CHARGE RECORD PHARMACY	636	J7060	23.65	N/A
HC65001258_00409792209	NONCDM CHARGE RECORD PHARMACY	258	J7060	13.54	N/A
HC65001258_00409792261	NONCDM CHARGE RECORD PHARMACY	636	J7060	1.00	N/A
HC65001258_00409792313	NONCDM CHARGE RECORD PHARMACY	636	J7060	9.43	N/A
HC65001258_00409792323	NONCDM CHARGE RECORD PHARMACY	636	J7060	3.37	N/A
HC65001258_00409792336	NONCDM CHARGE RECORD PHARMACY	636	J7060	11.61	N/A
HC65001258_00409792409	NONCDM CHARGE RECORD PHARMACY	636	J7042	14.97	N/A
HC65001258_00409792602	NONCDM CHARGE RECORD PHARMACY	636	J7042	31.50	N/A
HC65001258_00409792603	NONCDM CHARGE RECORD PHARMACY	258	J7042	33.00	N/A
HC65001258_00409792609	NONCDM CHARGE RECORD PHARMACY	258	J7042	15.00	N/A
HC65001258_00409792903	NONCDM CHARGE RECORD PHARMACY	636	J7070	33.00	N/A
HC65001258_00409792909	NONCDM CHARGE RECORD PHARMACY	636	J7070	30.00	N/A
HC65001258_00409794103	NONCDM CHARGE RECORD PHARMACY	258	J7042	33.00	N/A
HC65001258_00409794109	NONCDM CHARGE RECORD PHARMACY	258	J7042	15.00	N/A
HC65001258_00409795309	NONCDM CHARGE RECORD PHARMACY	258	J7120	30.00	N/A
HC65001258_00409796509	NONCDM CHARGE RECORD PHARMACY	636	Z7610	30.00	N/A
HC65001258_00409798302	NONCDM CHARGE RECORD PHARMACY	258	J7050	30.40	N/A
HC65001258_00409798303	NONCDM CHARGE RECORD PHARMACY	258	J7040	31.91	N/A
HC65001258_00409798309	NONCDM CHARGE RECORD PHARMACY	258	J7030	29.42	N/A
HC65001258_00409798325	NONCDM CHARGE RECORD PHARMACY	258	J7050	30.67	N/A
HC65001258_00409798355	NONCDM CHARGE RECORD PHARMACY	636	J7040	26.40	N/A
HC65001258_00409798361	NONCDM CHARGE RECORD PHARMACY	636	J7050	32.20	N/A
HC65001258_00409798406	NONCDM CHARGE RECORD PHARMACY	636	J7050	10.80	N/A
HC65001258_00409798413	NONCDM CHARGE RECORD PHARMACY	258	J7050	14.70	N/A
HC65001258_00409798423	NONCDM CHARGE RECORD PHARMACY	258	J7050	24.21	N/A
HC65001258_00409798503	NONCDM CHARGE RECORD PHARMACY	636	J7030	37.13	N/A
HC65001258_00409798509	NONCDM CHARGE RECORD PHARMACY	258	J7030	25.64	N/A
HC65001258_00409799309	NONCDM CHARGE RECORD PHARMACY	636	J7042	6.00	N/A
HC65001258_00409925739	NONCDM CHARGE RECORD PHARMACY	636	J7030	17.90	N/A
HC65001258_00990710709	NONCDM CHARGE RECORD PHARMACY	258	J7042	21.03	N/A
HC65001258_00990710909	NONCDM CHARGE RECORD PHARMACY	258	J7042	24.00	N/A
HC65001258_00990711109	NONCDM CHARGE RECORD PHARMACY	258	J7120	54.00	N/A
HC65001258_00990711509	NONCDM CHARGE RECORD PHARMACY	258	J7030	42.00	N/A
HC65001258_00990711609	NONCDM CHARGE RECORD PHARMACY	258	J7030	48.27	N/A
HC65001258_00990767009	NONCDM CHARGE RECORD PHARMACY	258		30.97	N/A
HC65001258_00990790109	NONCDM CHARGE RECORD PHARMACY	258	J7042	21.00	N/A
HC65001258_00990790209	NONCDM CHARGE RECORD PHARMACY	258	J7042	21.00	N/A
HC65001258_00990790309	NONCDM CHARGE RECORD PHARMACY	258	J7042	21.00	N/A
HC65001258_00990790409	NONCDM CHARGE RECORD PHARMACY	258	J7042	21.00	N/A
HC65001258_00990790509	NONCDM CHARGE RECORD PHARMACY	636	J7070	42.00	N/A
HC65001258_00990792202	NONCDM CHARGE RECORD PHARMACY	258	J7060	26.34	N/A
HC65001258_00990792203	NONCDM CHARGE RECORD PHARMACY	258	J7060	80.80	N/A
HC65001258_00990792209	NONCDM CHARGE RECORD PHARMACY	258	J7060	14.83	N/A
HC65001258_00990792225	NONCDM CHARGE RECORD PHARMACY	258	J7060	31.30	N/A
HC65001258_00990792261	NONCDM CHARGE RECORD PHARMACY	258	J7060	26.07	N/A
HC65001258_00990792311	NONCDM CHARGE RECORD PHARMACY	636	J7060	6.60	N/A
HC65001258_00990792313	NONCDM CHARGE RECORD PHARMACY	258	J7060	12.61	N/A
HC65001258_00990792323	NONCDM CHARGE RECORD PHARMACY	258	J7060	12.77	N/A
HC65001258_00990792336	NONCDM CHARGE RECORD PHARMACY	258	J7060	12.60	N/A
HC65001258_00990792337	NONCDM CHARGE RECORD PHARMACY	258	J7060	12.58	N/A
HC65001258_00990792403	NONCDM CHARGE RECORD PHARMACY	636	J7042	33.00	N/A
HC65001258_00990792409	NONCDM CHARGE RECORD PHARMACY	636	J7042	15.00	N/A
HC65001258_00990792602	NONCDM CHARGE RECORD PHARMACY	636	J7042	31.50	N/A
HC65001258_00990792603	NONCDM CHARGE RECORD PHARMACY	258	J7042	33.00	N/A
HC65001258_00990792609	NONCDM CHARGE RECORD PHARMACY	258	J7042	15.00	N/A
HC65001258_00990792909	NONCDM CHARGE RECORD PHARMACY	258	J7070	30.00	N/A
HC65001258_00990794103	NONCDM CHARGE RECORD PHARMACY	636	J7042	33.00	N/A
HC65001258_00990794109	NONCDM CHARGE RECORD PHARMACY	258	J7042	15.00	N/A
HC65001258_00990795309	NONCDM CHARGE RECORD PHARMACY	258	J7120	30.00	N/A
HC65001258_00990798302	NONCDM CHARGE RECORD PHARMACY	258	J7030	28.68	N/A
HC65001258_00990798303	NONCDM CHARGE RECORD PHARMACY	258	J7040	27.81	N/A
HC65001258_00990798309	NONCDM CHARGE RECORD PHARMACY	258	J7030	26.17	N/A
HC65001258_00990798325	NONCDM CHARGE RECORD PHARMACY	636	J7050	31.50	N/A
HC65001258_00990798361	NONCDM CHARGE RECORD PHARMACY	258	J7030	13.66	N/A
HC65001258_00990798413	NONCDM CHARGE RECORD PHARMACY	258	J7030	17.36	N/A
HC65001258_00990798420	NONCDM CHARGE RECORD PHARMACY	636	J7050	13.35	N/A
HC65001258_00990798423	NONCDM CHARGE RECORD PHARMACY	258	J7030	13.03	N/A
HC65001258_00990798436	NONCDM CHARGE RECORD PHARMACY	636	J7050	8.86	N/A
HC65001258_00990798437	NONCDM CHARGE RECORD PHARMACY	258	J7050	11.33	N/A
HC65001258_00990798509	NONCDM CHARGE RECORD PHARMACY	258	J7030	27.01	N/A
HC65001258_00990799309	NONCDM CHARGE RECORD PHARMACY	636	J7042	21.00	N/A
HC65001258_00990925739	NONCDM CHARGE RECORD PHARMACY	258	J7030	42.00	N/A
HC65001258_02457111306	NONCDM CHARGE RECORD PHARMACY	636	A4706	210.00	N/A
HC65001258_06332353075	NONCDM CHARGE RECORD PHARMACY	258	J7050	11.43	N/A
HC65001258_06332362353	NONCDM CHARGE RECORD PHARMACY	258	J7050	17.94	N/A
HC65001258_06332362361	NONCDM CHARGE RECORD PHARMACY	636	J7050	18.00	N/A
HC65001258_06332362374	NONCDM CHARGE RECORD PHARMACY	258	J7050	20.41	N/A
HC65001258_06332362450	NONCDM CHARGE RECORD PHARMACY	636	J7060	11.89	N/A
HC65001258_06332362461	NONCDM CHARGE RECORD PHARMACY	258	J7060	13.16	N/A
HC65001258_06332362474	NONCDM CHARGE RECORD PHARMACY	636	J7060	17.94	N/A
HC65001278	DRUG/IMPLANT - LARC	636		N/A	N/A
HC65001278_00023585801	NONCDM CHARGE RECORD PHARMACY	636	J7297	4,977.80	N/A
HC65001278_00052433001	NONCDM CHARGE RECORD PHARMACY	636	J7307	5,768.09	N/A
HC65001278_05041942301	NONCDM CHARGE RECORD PHARMACY	636	J7298	5,995.68	N/A
HC65001278_05936551281	NONCDM CHARGE RECORD PHARMACY	636	J7300	5,307.00	N/A
HC65001278_07820614501	NONCDM CHARGE RECORD PHARMACY	636	J7307	6,183.84	N/A
HC65001636	DRUG - NON-COVERED MEDICARE	636		N/A	N/A
HC65001636_00009074635	NONCDM CHARGE RECORD PHARMACY	636	J1050	0.00	N/A
HC65001636_00009737611	NONCDM CHARGE RECORD PHARMACY	636	J1050	4.52	N/A
HC65001636_00548540000	NONCDM CHARGE RECORD PHARMACY	636	J1050	0.00	N/A
HC65001636_00548570100	NONCDM CHARGE RECORD PHARMACY	636	J1050	2.05	N/A
HC65001636_05976245371	NONCDM CHARGE RECORD PHARMACY	636	J1050	0.00	N/A
HC65001636_05976245382	NONCDM CHARGE RECORD PHARMACY	636	J1050	0.00	N/A
HC65002250	MED - IRRIGATION SOLUTION	250		8.50	N/A
HC65002250_00264210100	NONCDM CHARGE RECORD PHARMACY	250		18.00	N/A
HC65002250_00264785000	NONCDM CHARGE RECORD PHARMACY	250		1.37	N/A
HC65002250_00338000404	NONCDM CHARGE RECORD PHARMACY	250		12.26	N/A
HC65002250_00338004747	NONCDM CHARGE RECORD PHARMACY	250		63.06	N/A
HC65002250_00338004802	NONCDM CHARGE RECORD PHARMACY	250		5.37	N/A
HC65002250_00338004803	NONCDM CHARGE RECORD PHARMACY	250		4.20	N/A
HC65002250_00338004804	NONCDM CHARGE RECORD PHARMACY	250		19.17	N/A
HC65002250_00409613803	NONCDM CHARGE RECORD PHARMACY	250		31.97	N/A
HC65002250_00409613822	NONCDM CHARGE RECORD PHARMACY	250		21.11	N/A
HC65002250_00409713809	NONCDM CHARGE RECORD PHARMACY	250		29.88	N/A
HC65002250_00409713909	NONCDM CHARGE RECORD PHARMACY	250		29.27	N/A
HC65002250_00409713936	NONCDM CHARGE RECORD PHARMACY	250		33.32	N/A
HC65002250_00409782808	NONCDM CHARGE RECORD PHARMACY	250		72.00	N/A
HC65002250_00409797205	NONCDM CHARGE RECORD PHARMACY	250		24.00	N/A
HC65002250_00409797207	NONCDM CHARGE RECORD PHARMACY	250		36.00	N/A
HC65002250_00409797208	NONCDM CHARGE RECORD PHARMACY	250		54.00	N/A
HC65002250_00409799009	NONCDM CHARGE RECORD PHARMACY	250		29.63	N/A
HC65002250_00436067216	NONCDM CHARGE RECORD PHARMACY	250		56.76	N/A
HC65002250_00436093616	NONCDM CHARGE RECORD PHARMACY	250		56.76	N/A
HC65002250_00990613822	NONCDM CHARGE RECORD PHARMACY	250		100.00	N/A
HC65002250_00990614309	NONCDM CHARGE RECORD PHARMACY	250		30.00	N/A
HC65002250_00990711807	NONCDM CHARGE RECORD PHARMACY	250		5.48	N/A
HC65002250_00990713809	NONCDM CHARGE RECORD PHARMACY	250		30.00	N/A
HC65002250_00990713909	NONCDM CHARGE RECORD PHARMACY	250		29.10	N/A
HC65002250_00990782808	NONCDM CHARGE RECORD PHARMACY	250		71.58	N/A
HC65002250_00990797207	NONCDM CHARGE RECORD PHARMACY	250		1,500.00	N/A
HC65002250_00990797208	NONCDM CHARGE RECORD PHARMACY	250		20.46	N/A
HC65002250_00990799009	NONCDM CHARGE RECORD PHARMACY	250		1.11	N/A
HC65002258	MED - IV SOLUTION W/O J-CODE	258		N/A	N/A
HC65002258_00264196510	NONCDM CHARGE RECORD PHARMACY	250		102.00	N/A
HC65002258_00264752020	NONCDM CHARGE RECORD PHARMACY	250		11.70	N/A
HC65002258_00264770700	NONCDM CHARGE RECORD PHARMACY	250		33.75	N/A
HC65002258_00264934155	NONCDM CHARGE RECORD PHARMACY	250		29.26	N/A
HC65002258_00338002302	NONCDM CHARGE RECORD PHARMACY	250		22.13	N/A
HC65002258_00338022104	NONCDM CHARGE RECORD PHARMACY	250		79.70	N/A
HC65002258_00338071906	NONCDM CHARGE RECORD PHARMACY	250		1.86	N/A
HC65002258_00409155554	NONCDM CHARGE RECORD PHARMACY	250		393.00	N/A
HC65002258_00409724803	NONCDM CHARGE RECORD PHARMACY	250		90.00	N/A
HC65002258_00409767009	NONCDM CHARGE RECORD PHARMACY	250		30.00	N/A
HC65002258_00409793002	NONCDM CHARGE RECORD PHARMACY	250		31.50	N/A
HC65002258_00409793003	NONCDM CHARGE RECORD PHARMACY	250		28.38	N/A
HC65002258_00409793009	NONCDM CHARGE RECORD PHARMACY	250		29.24	N/A
HC65002258_00409796509	NONCDM CHARGE RECORD PHARMACY	250		30.00	N/A
HC65002258_00990712007	NONCDM CHARGE RECORD PHARMACY	250		1.92	N/A
HC65002258_00990767003	NONCDM CHARGE RECORD PHARMACY	250		33.00	N/A
HC65002258_00990767009	NONCDM CHARGE RECORD PHARMACY	250		30.03	N/A
HC65002258_00990793002	NONCDM CHARGE RECORD PHARMACY	250		24.00	N/A
HC65002258_00990793003	NONCDM CHARGE RECORD PHARMACY	250		32.72	N/A
HC65002258_00990793009	NONCDM CHARGE RECORD PHARMACY	250		29.92	N/A
HC65002258_09999900203	NONCDM CHARGE RECORD PHARMACY	250		1.62	N/A
HC65002636	DRUG - DETAILED CODING MCARE ALT	636		N/A	N/A
HC65002636_00002418230	NONCDM CHARGE RECORD PHARMACY	636	J3490	926.40	N/A
HC65002636_00003052811	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00008103006	NONCDM CHARGE RECORD PHARMACY	636	Z7610	180.70	N/A
HC65002636_00009023301	NONCDM CHARGE RECORD PHARMACY	636	J3490	97.09	N/A
HC65002636_00009023303	NONCDM CHARGE RECORD PHARMACY	636	J3490	83.92	N/A
HC65002636_00009029703	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,346.04	N/A
HC65002636_00009035301	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,110.68	N/A
HC65002636_00023320502	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00023320503	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00023320508	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00023361525	NONCDM CHARGE RECORD PHARMACY	636	Z7610	0.01	N/A
HC65002636_00023917705	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00023921105	NONCDM CHARGE RECORD PHARMACY	636	J3490	777.64	N/A
HC65002636_00023932105	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00023932115	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00029152722	NONCDM CHARGE RECORD PHARMACY	636	Z7610	624.69	N/A
HC65002636_00037682210	NONCDM CHARGE RECORD PHARMACY	636	J3490	942.42	N/A
HC65002636_00046087221	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,373.96	N/A
HC65002636_00054042825	NONCDM CHARGE RECORD PHARMACY	636	J3490	823.24	N/A
HC65002636_00054048114	NONCDM CHARGE RECORD PHARMACY	636	J7527	0.00	N/A
HC65002636_00054052021	NONCDM CHARGE RECORD PHARMACY	636	J3490	116.32	N/A
HC65002636_00054855025	NONCDM CHARGE RECORD PHARMACY	636	J8610	18.24	N/A
HC65002636_00064501030	NONCDM CHARGE RECORD PHARMACY	636	Z7610	1,228.86	N/A
HC65002636_00065026002	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00065026005	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00065027510	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00065027515	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00065063136	NONCDM CHARGE RECORD PHARMACY	636	J3490	95.34	N/A
HC65002636_00065064725	NONCDM CHARGE RECORD PHARMACY	636	J3490	475.08	N/A
HC65002636_00065064835	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,369.26	N/A
HC65002636_00065065435	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,286.17	N/A
HC65002636_00065401303	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,025.59	N/A
HC65002636_00065853302	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,494.54	N/A
HC65002636_00069018921	NONCDM CHARGE RECORD PHARMACY	636	Z7610	0.01	N/A
HC65002636_00074057611	NONCDM CHARGE RECORD PHARMACY	636	J3490	701.48	N/A
HC65002636_00074057622	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00078027422	NONCDM CHARGE RECORD PHARMACY	636	J7502	58.88	N/A
HC65002636_00078040134	NONCDM CHARGE RECORD PHARMACY	636	Z7610	561.83	N/A
HC65002636_00078059287	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00078065515	NONCDM CHARGE RECORD PHARMACY	636	Z7610	0.01	N/A
HC65002636_00078065615	NONCDM CHARGE RECORD PHARMACY	636	Z7610	0.00	N/A
HC65002636_00078068515	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,091.17	N/A
HC65002636_00078079975	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,494.54	N/A
HC65002636_00078087601	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,369.26	N/A
HC65002636_00085132801	NONCDM CHARGE RECORD PHARMACY	636	J3490	616.76	N/A
HC65002636_00085222301	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,868.10	N/A
HC65002636_00085461005	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,264.56	N/A
HC65002636_00085720607	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,264.56	N/A
HC65002636_00093112589	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.00	N/A
HC65002636_00093356026	NONCDM CHARGE RECORD PHARMACY	636	J3490	590.88	N/A
HC65002636_00093408563	NONCDM CHARGE RECORD PHARMACY	636	J3490	618.12	N/A
HC65002636_00168009930	NONCDM CHARGE RECORD PHARMACY	636	Z7610	250.20	N/A
HC65002636_00168020437	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,440.00	N/A
HC65002636_00172731320	NONCDM CHARGE RECORD PHARMACY	636	J7502	28.30	N/A
HC65002636_00173069504	NONCDM CHARGE RECORD PHARMACY	636	J3490	910.39	N/A
HC65002636_00173069600	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00173069604	NONCDM CHARGE RECORD PHARMACY	636	J3490	901.72	N/A
HC65002636_00173069700	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00173069704	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,483.78	N/A
HC65002636_00173071520	NONCDM CHARGE RECORD PHARMACY	636	J3490	615.61	N/A
HC65002636_00173071522	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,283.32	N/A
HC65002636_00173071620	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,548.00	N/A
HC65002636_00173071622	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,257.01	N/A
HC65002636_00173071722	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,913.70	N/A
HC65002636_00173071820	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,174.15	N/A
HC65002636_00173071920	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,580.13	N/A
HC65002636_00173088710	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00173088714	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,095.25	N/A
HC65002636_00186037020	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00245086070	NONCDM CHARGE RECORD PHARMACY	636	J3490	733.74	N/A
HC65002636_00254204502	NONCDM CHARGE RECORD PHARMACY	636	Z7610	328.94	N/A
HC65002636_00378087399	NONCDM CHARGE RECORD PHARMACY	636	J3490	375.09	N/A
HC65002636_00378427093	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_00378870006	NONCDM CHARGE RECORD PHARMACY	636	J3490	450.00	N/A
HC65002636_00469052014	NONCDM CHARGE RECORD PHARMACY	636	J3490	562.72	N/A
HC65002636_00472024260	NONCDM CHARGE RECORD PHARMACY	636	J3490	594.00	N/A
HC65002636_00527172874	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,606.43	N/A
HC65002636_00527196174	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,323.00	N/A
HC65002636_00527197174	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,323.00	N/A
HC65002636_00527213335	NONCDM CHARGE RECORD PHARMACY	636	J3490	217.04	N/A
HC65002636_00574402235	NONCDM CHARGE RECORD PHARMACY	636	J3490	592.20	N/A
HC65002636_00591115930	NONCDM CHARGE RECORD PHARMACY	636	J3490	3,839.94	N/A
HC65002636_00591231215	NONCDM CHARGE RECORD PHARMACY	636	J3490	867.47	N/A
HC65002636_00591248279	NONCDM CHARGE RECORD PHARMACY	636	J3490	300.00	N/A
HC65002636_00597002402	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,558.50	N/A
HC65002636_00597008717	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,534.21	N/A
HC65002636_00597010051	NONCDM CHARGE RECORD PHARMACY	636	J3490	447.94	N/A
HC65002636_00597010061	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,731.44	N/A
HC65002636_00713063737	NONCDM CHARGE RECORD PHARMACY	636	J3490	588.06	N/A
HC65002636_00713065540	NONCDM CHARGE RECORD PHARMACY	636	J3490	386.82	N/A
HC65002636_00781618667	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,345.10	N/A
HC65002636_00781635587	NONCDM CHARGE RECORD PHARMACY	636	Z7610	720.02	N/A
HC65002636_00904655304	NONCDM CHARGE RECORD PHARMACY	636	J3490	37.14	N/A
HC65002636_01012251001	NONCDM CHARGE RECORD PHARMACY	636	J3490	3,081.31	N/A
HC65002636_01012251003	NONCDM CHARGE RECORD PHARMACY	636	J3490	10,173.50	N/A
HC65002636_01048101128	NONCDM CHARGE RECORD PHARMACY	636	J3490	89.87	N/A
HC65002636_01063140701	NONCDM CHARGE RECORD PHARMACY	636	J3490	419.98	N/A
HC65002636_01198018005	NONCDM CHARGE RECORD PHARMACY	636	J3490	630.09	N/A
HC65002636_01198018010	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,833.18	N/A
HC65002636_01366851501	NONCDM CHARGE RECORD PHARMACY	636	J3490	209.97	N/A
HC65002636_01671415601	NONCDM CHARGE RECORD PHARMACY	636	J3490	254.50	N/A
HC65002636_01671450201	NONCDM CHARGE RECORD PHARMACY	636	Z7610	333.45	N/A
HC65002636_01671470401	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.00	N/A
HC65002636_01671487801	NONCDM CHARGE RECORD PHARMACY	636	J3490	387.43	N/A
HC65002636_01671487802	NONCDM CHARGE RECORD PHARMACY	636	J3490	550.50	N/A
HC65002636_01671488501	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,100.16	N/A
HC65002636_01671488502	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,117.88	N/A
HC65002636_01671489701	NONCDM CHARGE RECORD PHARMACY	636	J3490	580.97	N/A
HC65002636_01672948601	NONCDM CHARGE RECORD PHARMACY	636	J8610	4.35	N/A
HC65002636_01747820910	NONCDM CHARGE RECORD PHARMACY	636	J3490	192.12	N/A
HC65002636_01747820919	NONCDM CHARGE RECORD PHARMACY	636	J3490	87.71	N/A
HC65002636_01747860510	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,257.66	N/A
HC65002636_01747862512	NONCDM CHARGE RECORD PHARMACY	636	J3490	93.30	N/A
HC65002636_02420829525	NONCDM CHARGE RECORD PHARMACY	636	J3490	303.42	N/A
HC65002636_02420834205	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,182.06	N/A
HC65002636_02420846325	NONCDM CHARGE RECORD PHARMACY	636	J3490	104.35	N/A
HC65002636_02420848610	NONCDM CHARGE RECORD PHARMACY	636	J3490	276.87	N/A
HC65002636_02420863110	NONCDM CHARGE RECORD PHARMACY	636	J3490	503.40	N/A
HC65002636_02420863562	NONCDM CHARGE RECORD PHARMACY	636	J3490	503.40	N/A
HC65002636_02420872002	NONCDM CHARGE RECORD PHARMACY	636	J3490	323.40	N/A
HC65002636_02420879535	NONCDM CHARGE RECORD PHARMACY	636	J3490	92.42	N/A
HC65002636_02433823012	NONCDM CHARGE RECORD PHARMACY	636	J3490	293.06	N/A
HC65002636_02433826012	NONCDM CHARGE RECORD PHARMACY	636	J3490	498.37	N/A
HC65002636_02576773545	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,337.82	N/A
HC65002636_02859512049	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,122.38	N/A
HC65002636_03172274920	NONCDM CHARGE RECORD PHARMACY	636	J3490	35.25	N/A
HC65002636_04056512151	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,095.28	N/A
HC65002636_04202310301	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,503.36	N/A
HC65002636_04202310706	NONCDM CHARGE RECORD PHARMACY	636	J0770	168.00	N/A
HC65002636_04202313101	NONCDM CHARGE RECORD PHARMACY	636	Z7610	167.94	N/A
HC65002636_04249434001	NONCDM CHARGE RECORD PHARMACY	636	Z7610	952.83	N/A
HC65002636_04257114726	NONCDM CHARGE RECORD PHARMACY	636	J3490	299.09	N/A
HC65002636_04279401008	NONCDM CHARGE RECORD PHARMACY	636	Z7610	340.00	N/A
HC65002636_04359832675	NONCDM CHARGE RECORD PHARMACY	636	J3490	936.55	N/A
HC65002636_04397525314	NONCDM CHARGE RECORD PHARMACY	636	Z7610	193.01	N/A
HC65002636_04580211222	NONCDM CHARGE RECORD PHARMACY	636	J3490	53.99	N/A
HC65002636_04580213970	NONCDM CHARGE RECORD PHARMACY	636	J3490	763.98	N/A
HC65002636_04580214464	NONCDM CHARGE RECORD PHARMACY	636	J3490	727.92	N/A
HC65002636_04580221001	NONCDM CHARGE RECORD PHARMACY	636	J3490	239.15	N/A
HC65002636_04733523583	NONCDM CHARGE RECORD PHARMACY	636	J8610	7.42	N/A
HC65002636_04733589272	NONCDM CHARGE RECORD PHARMACY	636	Z7610	9.53	N/A
HC65002636_04778173002	NONCDM CHARGE RECORD PHARMACY	636	J3490	65.45	N/A
HC65002636_04988416111	NONCDM CHARGE RECORD PHARMACY	636	J3490	449.22	N/A
HC65002636_05009022790	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_05024210040	NONCDM CHARGE RECORD PHARMACY	636	J3490	698.84	N/A
HC65002636_05038323310	NONCDM CHARGE RECORD PHARMACY	636	J3490	300.00	N/A
HC65002636_05041917103	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_05048401030	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,527.95	N/A
HC65002636_05107955068	NONCDM CHARGE RECORD PHARMACY	636	J3490	701.88	N/A
HC65002636_05107967005	NONCDM CHARGE RECORD PHARMACY	636	J8610	16.62	N/A
HC65002636_05167212641	NONCDM CHARGE RECORD PHARMACY	636	J3490	110.97	N/A
HC65002636_05167212642	NONCDM CHARGE RECORD PHARMACY	636	Z7610	155.52	N/A
HC65002636_05167212675	NONCDM CHARGE RECORD PHARMACY	636	J3490	386.82	N/A
HC65002636_05167212982	NONCDM CHARGE RECORD PHARMACY	636	Z7610	228.24	N/A
HC65002636_05167213120	NONCDM CHARGE RECORD PHARMACY	636	J3490	119.99	N/A
HC65002636_05167213121	NONCDM CHARGE RECORD PHARMACY	636	J3490	81.81	N/A
HC65002636_05167213702	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,994.76	N/A
HC65002636_05167230202	NONCDM CHARGE RECORD PHARMACY	636	J3490	672.30	N/A
HC65002636_05167241186	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_05199181403	NONCDM CHARGE RECORD PHARMACY	636	J3490	130.50	N/A
HC65002636_05201508001	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,265.94	N/A
HC65002636_05256500814	NONCDM CHARGE RECORD PHARMACY	636	J3490	52.85	N/A
HC65002636_05456966330	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_05515023410	NONCDM CHARGE RECORD PHARMACY	636	J3490	11.49	N/A
HC65002636_05556628001	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,683.91	N/A
HC65002636_05789415012	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.00	N/A
HC65002636_05891430180	NONCDM CHARGE RECORD PHARMACY	636	J3490	3,844.44	N/A
HC65002636_05914802050	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,972.56	N/A
HC65002636_05914802150	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,342.63	N/A
HC65002636_05965121430	NONCDM CHARGE RECORD PHARMACY	636	J3490	110.05	N/A
HC65002636_05976200491	NONCDM CHARGE RECORD PHARMACY	636	J7509	5.16	N/A
HC65002636_05976203332	NONCDM CHARGE RECORD PHARMACY	636	Z7610	43.62	N/A
HC65002636_06050508150	NONCDM CHARGE RECORD PHARMACY	636	J3490	766.98	N/A
HC65002636_06050508236	NONCDM CHARGE RECORD PHARMACY	636	J3490	449.22	N/A
HC65002636_06050508301	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_06050508335	NONCDM CHARGE RECORD PHARMACY	636	J3490	232.33	N/A
HC65002636_06050547040	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,710.97	N/A
HC65002636_06050547050	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,387.54	N/A
HC65002636_06068736325	NONCDM CHARGE RECORD PHARMACY	636	Z7610	940.02	N/A
HC65002636_06068752321	NONCDM CHARGE RECORD PHARMACY	636	J3490	283.00	N/A
HC65002636_06075811905	NONCDM CHARGE RECORD PHARMACY	636	J3490	256.59	N/A
HC65002636_06079321505	NONCDM CHARGE RECORD PHARMACY	636	J3490	559.86	N/A
HC65002636_06131404475	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,070.10	N/A
HC65002636_06131412605	NONCDM CHARGE RECORD PHARMACY	636	J3490	165.88	N/A
HC65002636_06131454701	NONCDM CHARGE RECORD PHARMACY	636	J3490	63.97	N/A
HC65002636_06131454703	NONCDM CHARGE RECORD PHARMACY	636	J3490	78.55	N/A
HC65002636_06131463136	NONCDM CHARGE RECORD PHARMACY	636	J3490	100.97	N/A
HC65002636_06131463705	NONCDM CHARGE RECORD PHARMACY	636	J3490	265.50	N/A
HC65002636_06131464511	NONCDM CHARGE RECORD PHARMACY	636	J3490	503.40	N/A
HC65002636_06131464705	NONCDM CHARGE RECORD PHARMACY	636	J3490	698.10	N/A
HC65002636_06131464725	NONCDM CHARGE RECORD PHARMACY	636	J3490	148.83	N/A
HC65002636_06195819011	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_06195825011	NONCDM CHARGE RECORD PHARMACY	636	J3490	643.27	N/A
HC65002636_06195825013	NONCDM CHARGE RECORD PHARMACY	636	Z7610	104.43	N/A
HC65002636_06248400202	NONCDM CHARGE RECORD PHARMACY	636	J3490	180.33	N/A
HC65002636_06332311310	NONCDM CHARGE RECORD PHARMACY	636	J3490	459.62	N/A
HC65002636_06332336711	NONCDM CHARGE RECORD PHARMACY	636	J3490	8.02	N/A
HC65002636_06332339306	NONCDM CHARGE RECORD PHARMACY	636	J0770	167.94	N/A
HC65002636_06371301985	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,616.87	N/A
HC65002636_06495036204	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,400.37	N/A
HC65002636_06498030130	NONCDM CHARGE RECORD PHARMACY	636	J3490	119.34	N/A
HC65002636_06498032005	NONCDM CHARGE RECORD PHARMACY	636	J3490	386.82	N/A
HC65002636_06498032430	NONCDM CHARGE RECORD PHARMACY	636	J3490	119.34	N/A
HC65002636_06498041812	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_06516267684	NONCDM CHARGE RECORD PHARMACY	636	J3490	120.06	N/A
HC65002636_06516283596	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,800.00	N/A
HC65002636_06516289129	NONCDM CHARGE RECORD PHARMACY	636	J3490	720.02	N/A
HC65002636_06564920175	NONCDM CHARGE RECORD PHARMACY	636	J3490	680.71	N/A
HC65002636_06586284003	NONCDM CHARGE RECORD PHARMACY	636	J3490	697.67	N/A
HC65002636_06649065020	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,774.08	N/A
HC65002636_06699396245	NONCDM CHARGE RECORD PHARMACY	636	J3490	827.28	N/A
HC65002636_06787741984	NONCDM CHARGE RECORD PHARMACY	636	J3490	21.00	N/A
HC65002636_06787747379	NONCDM CHARGE RECORD PHARMACY	636	J3490	72.09	N/A
HC65002636_06787763633	NONCDM CHARGE RECORD PHARMACY	636	Z7610	16.97	N/A
HC65002636_06791902010	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,066.63	N/A
HC65002636_06818096256	NONCDM CHARGE RECORD PHARMACY	636	J3490	212.04	N/A
HC65002636_06838238401	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,077.18	N/A
HC65002636_06838244614	NONCDM CHARGE RECORD PHARMACY	636	J3490	863.32	N/A
HC65002636_06846218022	NONCDM CHARGE RECORD PHARMACY	636	J3490	53.31	N/A
HC65002636_06846256435	NONCDM CHARGE RECORD PHARMACY	636	Z7610	1,994.76	N/A
HC65002636_06846258476	NONCDM CHARGE RECORD PHARMACY	636	J8501	455.96	N/A
HC65002636_06846258576	NONCDM CHARGE RECORD PHARMACY	636	J8501	405.49	N/A
HC65002636_06868220175	NONCDM CHARGE RECORD PHARMACY	636	J3490	602.32	N/A
HC65002636_06868265020	NONCDM CHARGE RECORD PHARMACY	636	Z7610	1,534.50	N/A
HC65002636_06868265220	NONCDM CHARGE RECORD PHARMACY	636	Z7610	1,820.28	N/A
HC65002636_06880361210	NONCDM CHARGE RECORD PHARMACY	636	J3490	411.60	N/A
HC65002636_06931531228	NONCDM CHARGE RECORD PHARMACY	636	J3490	416.30	N/A
HC65002636_06934410233	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,316.35	N/A
HC65002636_06946815104	NONCDM CHARGE RECORD PHARMACY	636	J3490	24,078.00	N/A
HC65002636_06968012035	NONCDM CHARGE RECORD PHARMACY	636	J3490	310.24	N/A
HC65002636_07006905101	NONCDM CHARGE RECORD PHARMACY	636	J3490	240.00	N/A
HC65002636_07006942103	NONCDM CHARGE RECORD PHARMACY	636	J3490	44.14	N/A
HC65002636_07012710010	NONCDM CHARGE RECORD PHARMACY	636	J3490	190.18	N/A
HC65002636_07051571101	NONCDM CHARGE RECORD PHARMACY	636	J3490	26.97	N/A
HC65002636_07051571201	NONCDM CHARGE RECORD PHARMACY	636	Z7610	1,645.24	N/A
HC65002636_07059402602	NONCDM CHARGE RECORD PHARMACY	636	J3490	68.92	N/A
HC65002636_07059404902	NONCDM CHARGE RECORD PHARMACY	636	J3490	3.37	N/A
HC65002636_07071012773	NONCDM CHARGE RECORD PHARMACY	636	Z7610	0.01	N/A
HC65002636_07072749725	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.01	N/A
HC65002636_07086010310	NONCDM CHARGE RECORD PHARMACY	636	J3490	10.78	N/A
HC65002636_07248520290	NONCDM CHARGE RECORD PHARMACY	636	J3490	7.33	N/A
HC65002636_07260656601	NONCDM CHARGE RECORD PHARMACY	636	J3490	0.00	N/A
HC65002636_08065183150	NONCDM CHARGE RECORD PHARMACY	636	J3490	631.19	N/A
HC65002636_08065183905	NONCDM CHARGE RECORD PHARMACY	636	J3490	956.07	N/A
HC65002636_53276101008	NONCDM CHARGE RECORD PHARMACY	636	J3490	630.00	N/A
HC65002636_53276101009	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,266.67	N/A
HC65003250	MED - GENERAL ALT COMMCRL J3490	250		N/A	N/A
HC65200250	MED - WOUND TOPICAL PRODUCT (NO NDC)	636		640.49	N/A
HC65200250_05531000301	NONCDM CHARGE RECORD PHARMACY	636	Q4186	635.50	N/A
HC65200250_05531000308	NONCDM CHARGE RECORD PHARMACY	636	Q4186	477.00	N/A
HC65200250_09999903891	NONCDM CHARGE RECORD PHARMACY	636	Q4196	444.00	N/A
HC65200250_09999903892	NONCDM CHARGE RECORD PHARMACY	636	Q4196	336.00	N/A
HC65200250_09999903893	NONCDM CHARGE RECORD PHARMACY	636	Q4196	0.00	N/A
HC65200250_09999903894	NONCDM CHARGE RECORD PHARMACY	636	Q4196	0.00	N/A
HC65200250_09999904155	NONCDM CHARGE RECORD PHARMACY	636	Q4196	675.00	N/A
HC65200250_09999904204	NONCDM CHARGE RECORD PHARMACY	636	Q4151	604.69	N/A
HC65200250_09999904205	NONCDM CHARGE RECORD PHARMACY	636	Q4151	337.50	N/A
HC65200250_09999904463	NONCDM CHARGE RECORD PHARMACY	636	Q4196	625.00	N/A
HC65200250_09999904464	NONCDM CHARGE RECORD PHARMACY	636	Q4196	648.00	N/A
HC65200636	MED - WOUND TOPICAL PRODUCT (W/NDC)	636		N/A	N/A
HC65200636_08541000101	NONCDM CHARGE RECORD PHARMACY	636	Q4106	251.05	N/A
HC65200636_09978000199	NONCDM CHARGE RECORD PHARMACY	636	Q4101	272.05	N/A
HC65500754	DRUG - BLOOD PRODUCT	636		N/A	N/A
HC65500754_00562780501	NONCDM CHARGE RECORD PHARMACY	636	90384	708.00	N/A
HC65500754_00562780505	NONCDM CHARGE RECORD PHARMACY	636	90384	708.00	N/A
HC65500754_00562780525	NONCDM CHARGE RECORD PHARMACY	636	90384	708.00	N/A
HC65600343_01199409036	NONCDM CHARGE RECORD PHARMACY	250	A9512	1.76	N/A
HC65600343_01199412711	NONCDM CHARGE RECORD PHARMACY	250	A9558	269.00	N/A
HC65600343_01715602101	NONCDM CHARGE RECORD PHARMACY	250	A9570	4,062.50	N/A
HC65600343_01715602305	NONCDM CHARGE RECORD PHARMACY	250	A9521	3,693.55	N/A
HC65600343_01715602630	NONCDM CHARGE RECORD PHARMACY	250	A9502	105.54	N/A
HC65600343_01715621001	NONCDM CHARGE RECORD PHARMACY	255	A9584	8,021.00	N/A
HC65600343_01715625108	NONCDM CHARGE RECORD PHARMACY	250	A9548	1,859.95	N/A
HC65600343_04002851130	NONCDM CHARGE RECORD PHARMACY	250	A9552	376.60	N/A
HC65600343_04554814110	NONCDM CHARGE RECORD PHARMACY	250	A9500	105.63	N/A
HC65600343_04556700301	NONCDM CHARGE RECORD PHARMACY	250	A9541	333.28	N/A
HC65600343_04556700601	NONCDM CHARGE RECORD PHARMACY	250	A9538	204.23	N/A
HC65600343_04556704551	NONCDM CHARGE RECORD PHARMACY	250	A9537	99.94	N/A
HC65600343_04556704552	NONCDM CHARGE RECORD PHARMACY	250	A9537	175.34	N/A
HC65600343_04881510011	NONCDM CHARGE RECORD PHARMACY	255	A9509	991.25	N/A
HC65600343_06517427030	NONCDM CHARGE RECORD PHARMACY	250	A9540	641.35	N/A
HC65600343_06517428830	NONCDM CHARGE RECORD PHARMACY	250	A9539	392.60	N/A
HC65600343_06517466030	NONCDM CHARGE RECORD PHARMACY	250	A9503	122.32	N/A
HC65600343_06948800140	NONCDM CHARGE RECORD PHARMACY	255	A9587	210.65	N/A
HC65600343_06993200101	NONCDM CHARGE RECORD PHARMACY	255	A9588	1,274.10	N/A
HC65600343_06993200130	NONCDM CHARGE RECORD PHARMACY	255	A9588	1,380.28	N/A
HC65600343_06994506820	NONCDM CHARGE RECORD PHARMACY	250	A9560	611.42	N/A
HC65600343_06994509620	NONCDM CHARGE RECORD PHARMACY	250	A9562	1,165.94	N/A
HC65600343_06994560220	NONCDM CHARGE RECORD PHARMACY	255	A9516	99.94	N/A
HC65600344_06517488025	NONCDM CHARGE RECORD PHARMACY	255	A9517	95.56	N/A
HC83000711	ALBUMIN 5% 250ML	636	P9041	500.00	400.00
HC43000520	FILM DUPLICATION (STATISTIC)	270		N/A	N/A
HC51080000	KIT HICKMAN/BROVIAC REPAIR	272		517.00	N/A
HC51080018	KIT TPN/CVP DRESSING	272		65.00	N/A
HC51080026	IVS TUBING	272		7.00	N/A
HC51080034	NEEDLE HUBER/PORT-A-CATH	272		20.00	N/A
HC51080042	MOUTHPIECE PNEUMOTACH PREVENT	272		30.00	N/A
HC51080059	SENSOR SPHB, SPMET, SPO2	272		33.00	N/A
HC51080067	AEROCHAMBER	272		26.00	N/A
HC51080075	MASK OXYGEN	272	A7015	8.00	N/A
HC51080083	NEBULIZER	272		13.00	N/A
HC51080091	TUBE TRACH NO CUFF	272	A7520	143.00	N/A
HC51080109	TUBE TRACH PEDS/NEO CUFFED	272	A7521	463.00	N/A
HC51080117	BANDGE ELASTC(ACE/COBAN) PER5ROLLS	272		7.00	N/A
HC51080125	STRAP CLAVICLE	272		26.00	N/A
HC51080133	SPLINT FINGER	272		7.00	N/A
HC51080141	SLING ARM PEDS	272	A4565	7.00	N/A
HC51080158	CASTING SUPPLIES FIBERGLASS	270		85.00	N/A
HC51080166	CASTING MATERIAL PLASTER	272	A4580	59.00	N/A
HC51080174	SLING ARM	272	A4565	20.00	N/A
HC51080182	ORTHTC WRIST-HAND NONMOLD PREFAB	274	L3908	244.00	N/A
HC51080190	ORTHSS HIPABDCTN CONTROL PAVLIK	274	L1620	520.00	N/A
HC51080208	IMMOBILIZER KNEE	274	L1830	365.00	N/A
HC51080216	SANDAL PLASTAZOTE EACH	274	L3265	263.00	N/A
HC51080224	SET INF PUMP TUBE URO/CAVERNO	272		40.00	N/A
HC51080232	CATHETER DUAL LUMEN URODYNAMCS	272		34.00	N/A
HC51080240	CATHETER PRESSURE ABDOMINL URO	272		49.00	N/A
HC51080257	DOME TRANSDUCR PRESSUR URODYN	272		23.00	N/A
HC51080265	ELECTRODE WIRED PRE-GELLED URO	272		20.00	N/A
HC51080273	TUBE FEEDING ENTERAL NG W/O STYLET	272	B4082	40.00	N/A
HC62200001	CATH IV BASIC	272		59.00	N/A
HC62200019	CAUTERY CORD	272		208.00	N/A
HC62200027	CAUTERY TIP                       D	272		130.00	N/A
HC62200035	PAD MAMMOGRAPHY	270		9.00	N/A
HC62200050	ABDUCTION PILLOW	270		85.00	N/A
HC62200068	ABLATION DEVICE	272	C1886	11,683.75	N/A
HC62200076	ABLATION DEVICE(CARDIAC TISS)	272	C1886	18,850.00	N/A
HC62200084	ACAPELLA W/MOUTHPIECE (RESP)	270		130.00	N/A
HC62200092	ADAPTER AIRWAY/RESPIRATORY        E	270		164.00	N/A
HC62200100	ADAPTER CATH URETERAL/URINARY     C	272		91.00	N/A
HC62200118	ADAPTER DIALYSIS	272		14.00	N/A
HC62200126	ADAPTER FEEDING TUBE	270		56.00	N/A
HC62200134	ADAPTER SUCTION-IRRIGATION	272		95.00	N/A
HC62200142	ADAPTER/CONNECTOR IV	272		52.00	N/A
HC62200159	ADAPTOR CATH UROLOGICAL	272		39.00	N/A
HC62200167	ADAPTOR/CONNECTOR IRRIG TUR	272		104.00	N/A
HC62200175	AEROCHAMBER	270		39.00	N/A
HC62200183	AIRWAY SPECIALIZED	270		42.00	N/A
HC62200191	AMNIHOOK	272		26.00	N/A
HC62200209	ARTERIAL LINE	272		308.00	N/A
HC62200217	WAND ARTHRO                       M	272		780.00	N/A
HC62200225	ASPIRATOR MECONIUM	272		91.00	N/A
HC62200233	ASPIRATOR ULTRASONIC SURG         E	272		2,579.57	N/A
HC62200241	SET AUTOTRANSFUSE                AK	272		910.00	N/A
HC62200258	BAG BILE	272		72.00	N/A
HC62200266	BAG BLOOD COLLECTION APHERESIS	270		39.00	N/A
HC62200274	BAG COLOSTOMY/ILEOSTOMY/LOOP	272		13.00	N/A
HC62200282	BAG DECANTER	272		46.00	N/A
HC62200290	BAG DIALYSIS ACCESSORY	272		18.00	N/A
HC62200308	BAG/POUCH DRAINAGE	272		85.00	N/A
HC62200316	BAG ENEMA W/ W/O TUBING	272		65.00	N/A
HC62200324	BAG FEEDING	272		38.00	N/A
HC62200332	BAG NEONATAL HYPERIFLATION	270		238.00	N/A
HC62200340	BAG PRESSURE	272		39.00	N/A
HC62200357	BAG URINARY DRAINAGE	272		72.00	N/A
HC62200365	BAG URINARY LEG	272		33.00	N/A
HC62200373	BAG VENTRICULAR DRAIN	272		130.00	N/A
HC62200381	BAND LIGATOR	272		1,300.00	N/A
HC62200399	BANDAGE COMPRESSION	270		104.00	N/A
HC62200407	BANDAGE ELASTIC(ACE AND COBAN)	270		13.00	N/A
HC62200415	BANDAGE ESMARK	272		20.00	N/A
HC62200423	BANDAGE KLING	270		13.00	N/A
HC62200431	BANDAGE LEG COMP	270		107.00	N/A
HC62200449	BANDS RADIAL OCCLUSIVE	272		195.00	N/A
HC62200456	BASKET RETRIEVAL                  O	272		973.57	N/A
HC62200464	BASKET RETRIEVAL                  N	272		943.00	N/A
HC62200472	BINDER ABDOMINAL BASIC            C	270		98.00	N/A
HC62200480	BINDER BREAST	270		65.00	N/A
HC62200498	BIO GLUE W/APPLICATOR	278		2,600.00	N/A
HC62200506	DEVICE BIOPSY	272		385.00	N/A
HC62200514	BITE BLOCK	270		20.00	N/A
HC62200522	BLADE INCISIONAL                  E	272		325.00	N/A
HC62200530	BLADE INCISIONAL                  D	272		260.00	N/A
HC62200548	BLADE DERMATOME	272		195.00	N/A
HC62200555	BLADE INCISIONAL                  G	272		455.00	N/A
HC62200563	BLADE INDIANACTOME	272		416.00	N/A
HC62200571	BLADE BEAVER                      C	272		195.00	N/A
HC62200589	BLADE NEURO                       H	272		377.78	N/A
HC62200597	BLADE OPHTHALM                    Q	272		312.00	N/A
HC62200605	BLADE SHAVER                      F	272		389.24	N/A
HC62200613	BLADE TREPHINE                    F	272		390.00	N/A
HC62200621	BLANKET HYPER/HYPOTHERMIA         C	272		98.00	N/A
HC62200639	NEEDLE BONE MARROW ADD'L	272		101.00	N/A
HC62200647	BOARD PATIENT COMMUNICATION	270		39.00	N/A
HC62200654	BODY ALIGNER	272		385.00	N/A
HC62200662	BONE MARROW SUPPLY FEE	272		103.00	163.00
HC62200670	BONE MARROW TRAY	272		182.07	139.50
HC62200688	TAMP BONE KYPHOPLASTY             J	278		3,575.00	N/A
HC62200696	BONE WAX	272		111.00	N/A
HC62200704	BOOT BUCKS TRACTION UNIT	272		289.00	N/A
HC62200712	BOOT WAFFLE DISP	270		100.00	N/A
HC62200720	BOTTLE DRAIN DBL DUAL LUMEN	272		196.00	N/A
HC62200738	BOTTLE EVAC ADULT/PEDS	272		125.00	N/A
HC62200746	BOTTLE FEEDING	272		77.00	N/A
HC62200753	BOWL CEMENT MIXING	272		348.00	N/A
HC62200761	BREAST PUMP	272		267.00	N/A
HC62200779	BREAST SHIELD	270		33.00	N/A
HC62200787	BRIDGE CARDIAC OUTPUT	272		178.00	N/A
HC62200795	BRUSH BRONCHIAL	272		315.00	N/A
HC62200803	BRUSH CYTOLOGY                    G	272		325.00	N/A
HC62200811	BRUSH ERCP                        M	272		774.00	N/A
HC62200829	BRUSH MEDULLARY CANAL             E	272		176.00	N/A
HC62200837	BULB IRRIGATION	270		13.00	N/A
HC62200845	BURR                              G	272		455.85	N/A
HC62200852	BURR MIDAS REX/ANSPACH            F	272		390.00	N/A
HC62200860	BURN PADS	272		250.00	N/A
HC62200878	BURR                              E	272		325.00	N/A
HC62200886	BURR ORTHO                        F	272		210.17	N/A
HC62200894	BURR                              F	272		389.80	N/A
HC62200902	BUTTON GASTRIC EXTENSION	272		618.00	N/A
HC62200936	CABLE INTRAUTERINE PRESSURE	270		371.00	N/A
HC62200944	CABLE PACING DISP                 E	272		228.00	N/A
HC62200951	CANNISTER SUCTION	270		36.00	N/A
HC62200969	CANNULA AORTIC ARCH               D	272		130.00	N/A
HC62200977	CANNULA AORTIC ROOT	272		101.00	N/A
HC62200985	CANNULA ARTERIAL                  V	272		1,470.00	N/A
HC62200993	CANNULA CORONARY	272		722.00	N/A
HC62201009	CANNULA ERCP                      G	272		228.00	N/A
HC62201017	CANNULA INTRAOCULAR               C	272		83.00	N/A
HC62201025	CANNULA INNER DISPOSABLE	272		65.00	N/A
HC62201033	CANNULA NASAL	270		13.00	N/A
HC62201041	TUBING NASAL CPAP	270		43.00	N/A
HC62201058	CANNULA OXYGEN	270		65.00	N/A
HC62201066	CANNULA RETROPLEGIA	272		358.00	N/A
HC62201074	CANNULA TRACH INNER               B	272	A4623	98.00	N/A
HC62201082	CANNULA HOLDER/GRIP SKIN TENDER	272		36.00	N/A
HC62201090	CANNULA VEIN IRRIGATION	272		469.00	N/A
HC62201108	CANNULA VENOUS                    F	272		208.00	N/A
HC62201116	CAP PEG	272		38.00	N/A
HC62201124	CAP/IV INJECTION	272		7.00	N/A
HC62201132	CARTRIDGE HIGH FREQ JET	272		941.00	N/A
HC62201140	CARTRIDGE (DIALYSIS)	272		1,245.00	N/A
HC62201157	CASTING MATERIAL FIBERGLASS	272		39.00	N/A
HC62201165	CASTING MATERIAL PLASTER	272		143.00	N/A
HC62201173	CASTING SUPPLIES SYNTHETIC	272		209.00	N/A
HC62201181	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP V	272	C1733	2,925.00	N/A
HC62201199	CATH ABR TRIPLE LUMEN	272		430.00	N/A
HC62201207	CATH ADAPTOR	272		131.00	N/A
HC62201215	CATH A-LINE INSYTE	272		94.00	N/A
HC62201223	CATH ARTERY PULMONARY	272		260.00	N/A
HC62201231	CATH BARTHOLIN GLAND	272		68.00	N/A
HC62201249	CATH BONNANO	272		228.00	N/A
HC62201256	CATH BRINKLEY	272		157.00	N/A
HC62201264	CATH BRONCH VENTILATION	272		163.00	N/A
HC62201272	CATH CENTRAL VENOUS               F	272	C1751	260.00	N/A
HC62201280	CATH CENTRAL VENOUS MULT LUMEN    I	272	C1751	455.00	N/A
HC62201298	CATH CHOLANGIOGRAM	272	C1887	130.00	N/A
HC62201306	CATH CONDOM	272		13.00	N/A
HC62201314	CATH DIAGNOSTIC                   D	272		130.00	N/A
HC62201322	CATH DIAGNOSTIC                   M	272		748.91	N/A
HC62201330	CATH DIALYSIS SHORT-TERM          J	278	C1752	621.95	N/A
HC62201348	CATH DRAINAGE                     F	272	C1729	260.00	N/A
HC62201355	CATH EPIDURAL	272		339.00	N/A
HC62201363	CATH ERCP (PUSHING)               C	272		391.00	N/A
HC62201371	CATH ESOPHAGEAL PH	272		299.00	N/A
HC62201389	CATH EXCHANGE PTCA	272		612.00	N/A
HC62201397	CATH FEM ART SET	272		170.00	N/A
HC62201405	CATH FLUSH	272		274.00	N/A
HC62201413	CATH FOGARTY                      I	272	C1757	455.00	N/A
HC62201421	CATH FOLEY                        B	272		65.00	N/A
HC62201439	CATH FOLEY TEMP SENSOR	272		117.00	N/A
HC62201447	CATH GASTRO TUBE	272		1,092.00	N/A
HC62201454	CATH HYDRAGLIDE PVC ATRIUM	272		683.00	N/A
HC62201462	CATH INTRA AORTIC BALLOON         D	272		3,250.00	N/A
HC62201470	CATH INFUS/THROMBOLYSS(CRAGG-MCNAMARA)L	272	C1887	640.97	N/A
HC62201488	CATH INTRODUCER	272		213.00	N/A
HC62201496	CATH INTRODUCER PEEL-AWAY         L	272	C1892	325.00	N/A
HC62201504	CATH MALECOT	272		169.00	N/A
HC62201512	CATH NEPHROSTOMY                  I	272	C1729	455.00	N/A
HC62201520	CATH PLUG	272		13.00	N/A
HC62201538	CATH RADIAL ARTERY	272		176.00	N/A
HC62201546	CATH ROBINSON/STRAIGHT	272		39.00	N/A
HC62201553	CATH SILICONE	272		157.44	N/A
HC62201561	CATH SUCTION	272		27.00	N/A
HC62201579	CATH SUPRAPUBIC/CYSTOSCOPIC       H	272	C2627	390.00	N/A
HC62201587	CATH THORACIC	272		177.00	N/A
HC62201595	TROCAR ENDO                       G	272		325.00	N/A
HC62201603	CATH UMBILICAL SINGLE LUMEN       D	272		130.00	N/A
HC62201611	CATH URETERAL                     P	272	C1758	286.00	N/A
HC62201629	CATH URETERAL DUAL LUMEN          V	272	C1758	442.00	N/A
HC62201637	CATH URETERAL                     M	272	C1758	199.09	N/A
HC62201645	CATH URINARY	272		130.00	N/A
HC62201652	CATH VASCULAR	272		787.00	N/A
HC62201660	CAUTERY BOVIE	272		94.00	N/A
HC62201678	CAUTERY EYE	272		134.00	N/A
HC62201686	CAUTERY HEMO ERASER (EYE)	272		134.00	N/A
HC62201694	CAUTERY HOOK ASSEMBLY            AO	272		1,138.00	N/A
HC62201702	CAUTERY PENCIL                    D	272		129.00	N/A
HC62201710	CEMENT INJECTOR	272		406.00	N/A
HC62201728	CEMENT VERTEBROPLASTY	272		406.00	N/A
HC62201744	CHEST DRAINAGE (PLEUREVAC)	272		397.00	N/A
HC62201751	CHEST TUBE                        B	272		65.00	N/A
HC62201769	CIRCUIT AEROSOL/IPPB	270		98.00	N/A
HC62201777	CIRCUIT VENT BIPAP	270		169.00	N/A
HC62201785	CIRCUIT VENT HI-FREQ	270		811.00	N/A
HC62201793	CIRCUIT VENT                      D	270		182.00	N/A
HC62201801	CIRCUM' DEVICE/CLAMP DISPOSABLE	272		99.00	N/A
HC62201819	CLAMP MORGAN	272		74.00	N/A
HC62201827	CLAMP UMBILICAL CORD STRL	272		13.00	N/A
HC62201835	CLIP COLOSTOMY BAG	272		26.00	N/A
HC62201843	CLIP FOGARTY SOFT JAW	272		105.00	N/A
HC62201850	CLIP GUN COMPLETE	272		326.00	N/A
HC62201868	CLIP HEMO (PKG)	272		16.00	N/A
HC62201876	CLIP RANEY	272		215.00	N/A
HC62201884	CLIPPER BLADE	272		33.00	N/A
HC62201892	CLIPPER HEAD SNG/USE FOR 3M	272		33.00	N/A
HC62201900	CLOSURE DRAINABLE POUCH	272		33.00	N/A
HC62201918	COAGULATION SUCTION	272		64.91	N/A
HC62201926	COLLAR CERVICAL HARD	270		221.00	N/A
HC62201934	COLLAR CERVICAL PHILADELPHIA	274	L0160	130.00	N/A
HC62201942	COLLAR CERVICAL SOFT	274	L0120	82.00	N/A
HC62201959	CONCHA COLUMN STANDARD	272		218.00	N/A
HC62201967	CONNECTOR 5-1	272		26.00	N/A
HC62201975	CONNECTOR SURGICAL	272		274.00	N/A
HC62201983	CONNECTOR Y/T	272		42.00	N/A
HC62201991	COOKS TRIPLE LUMEN	272		325.00	N/A
HC62202007	CO-SET CARDIAC OUTPUT	272		207.00	N/A
HC62202015	COVER FOOT AV IMPULSE	272		504.00	N/A
HC62202023	CRUTCHES	272		42.00	N/A
HC62202031	INJECTOR KIT DOUBLE	272		103.33	N/A
HC62202049	INJECTOR KIT SINGLE	272		85.00	N/A
HC62202056	KIT BIOPSY GUN	272		202.00	N/A
HC62202064	KIT DRAINAGE	272		494.00	N/A
HC62202072	NEEDLE BIOPSY/ASPIRATION          E	272		164.00	N/A
HC62202080	NEEDLE BX SPECIALTY	272		241.00	N/A
HC62202098	NEEDLE CHIBA	272		46.00	N/A
HC62202106	NEEDLE DEVICE	272		207.19	N/A
HC62202114	NEEDLE THORAC/PARACENTESIS	272		73.00	N/A
HC62202122	CURRETTE VACCUUM SUCTION	272		352.00	N/A
HC62202130	CURVED LIFT STRL	272		168.00	N/A
HC62202148	DEFOGGER(FRED)	272		26.00	N/A
HC62202155	DERMABOND                         E	272		195.00	N/A
HC62202163	DERMACARRIER	272		91.00	N/A
HC62202171	DETECTOR CO2 (RESP)	270		469.00	N/A
HC62202189	DEVICE BLADDER MONITOR	272		307.00	N/A
HC62202197	DEVICE CIRCULATORY ENHANCER	270		335.00	N/A
HC62202205	DEVICE ERCP LOCKING	272		95.00	N/A
HC62202213	DEVICE EXPRESS CORE BX	272		246.00	N/A
HC62202221	DEVICE COMPRESSION FEMORAL        D	272		130.00	N/A
HC62202239	DEVICE COMPRESSION FEMORAL        C	272		98.00	N/A
HC62202247	DEVICE HOLD OCCL LEVERAGE	272		228.00	N/A
HC62202254	DEVICE INFLAT ENCORE              D	272		234.00	N/A
HC62202262	DEVICE KYPHOPLASTY BONE FILLER	272		460.00	N/A
HC62202270	DISSECTOR CURVED SHORT	272		845.00	N/A
HC62202288	DONUT PILLOW INFANT/PREMIE	272		85.00	N/A
HC62202296	DRAIN	272	C1729	267.00	N/A
HC62202304	DRAIN ADAPTOR                     A	272	C1729	20.00	N/A
HC62202312	SET AUTOTRANSFUSE                 Q	272	C1729	390.00	N/A
HC62202320	DRAIN BLAKE                        B	272	C1729	52.00	N/A
HC62202338	DRAIN DEAVER	272	C1729	26.00	N/A
HC62202346	DRAIN JACKSON PRATT	272	C1729	39.00	N/A
HC62202353	DRAIN PENROSE	272	C1729	20.00	N/A
HC62202361	DRAIN SILICONE	272	C1729	98.00	N/A
HC62202379	DRAIN SUCTION ROUND OR FLAT	272	C1729	98.00	N/A
HC62202387	DRAIN WOUND	272	C1729	46.00	N/A
HC62202395	DRESSING ALLEVYN	272		164.00	N/A
HC62202403	DRESSING AQUACEL ROPE	272		85.00	N/A
HC62202411	DRESSING AQUAPHOR GUAZE	272		46.00	N/A
HC62202429	DRESSING BAND UNIV. FACIAL	272		326.00	N/A
HC62202437	DRESSING BIOBRANE	272	A6251	303.00	N/A
HC62202445	DRESSING BURN NET	272		33.00	N/A
HC62202452	DRESSING DUODERM	272		20.00	N/A
HC62202460	DRESSING FOAM (HYDROFERA)	272		59.00	N/A
HC62202478	DRESSING TEGADERM MOISTURE PERMEABLE	272		65.00	N/A
HC62202486	BARRIER ADHESION PELVIC(INTERCEED)	278	C1765	1,147.61	N/A
HC62202494	DRESSING INTERDRY AG PKG	272		190.00	N/A
HC62202502	DRESSING MICRODON	272		81.00	N/A
HC62202510	DRESSING OPSITE	272		13.00	N/A
HC62202528	DRESSING OXYCEL	272		311.00	N/A
HC62202536	DRESSING RAYON	272		181.00	N/A
HC62202544	HEMOSTATIC GEL/SURGICEL           G	272		312.60	N/A
HC62202551	DRESSING TEGADERM	272		13.00	N/A
HC62202569	DRESSING VASELINE	272		26.00	N/A
HC62202577	DRESSING VIASORB	272		77.00	N/A
HC62202585	DRESSING VIGILON	272		46.00	N/A
HC62202593	DRESSING VISCOPASTE ROLL	272	A6456	20.00	N/A
HC62202601	DRESSING WOUND	272		43.00	N/A
HC62202619	KIT DRESSING WOUND NEG PRESSURE   D	272	A6550	324.13	N/A
HC62202627	DRILL/DRILL BITS SINGLE USE       A	272		666.72	N/A
HC62202635	EAR TUBES-DRAIN	272		49.32	N/A
HC62202643	EJECTOR SALIVA FLEXIBLE	272		75.00	N/A
HC62202650	ELECTRODE  LAP                    E	272		195.00	N/A
HC62202668	ELECTRODE DISP	272		65.00	N/A
HC62202676	ELECTRODE EEG (DISP)	272		65.00	N/A
HC62202684	ELECTRODE FETAL SCALP HELIX	272		98.00	N/A
HC62202692	ELECTRODE LEEP LOOPS              N	272		260.00	N/A
HC62202700	ELECTRODE PACER TEMPORARY	272		975.00	N/A
HC62202718	ELECTRODE PACING/DEFIB TEMPORARY  H	272		390.00	N/A
HC62202726	ELECTRODE QUICK COMBO	272		116.00	N/A
HC62202734	ELECTRODE RESECTOSCOPE            E	272		389.00	N/A
HC62202742	ELECTRODE ROLLER BALL             G	272		325.00	N/A
HC62202759	ELECTRODE TUR LOOP	272		313.00	N/A
HC62202767	ELECTRODE VAPORTRODE/VAPRTOME	272		673.00	N/A
HC62202775	CATH EP DIAG/MAPPING<20 ELECT     V	272	C1732	7,800.00	N/A
HC62202783	ELECTRODES 4 CHANNEL NIM	272		424.00	N/A
HC62202791	EMBOLIC PROTECT SYSTEM CAROTID	278	C1884	6,371.00	N/A
HC62202809	EMBOLIZATION PROTECTIVE SYSTEM    Q	278	C1884	6,500.00	N/A
HC62202817	EMG NEEDLE	270		79.00	N/A
HC62202825	BAG/POUCH RETRIEVAL SPECMN ENDO   G	272		488.00	N/A
HC62202833	ENDO BALLOON PERITONEAL SYSTEM	272		982.00	N/A
HC62202841	CLIP ENDOSCOPIC                   H	272		390.00	N/A
HC62202858	APPLIER LIGA/HEMOCLIP ENDO        L	272		650.00	N/A
HC62202866	ENDO INSTRUMENT	272		1,880.50	N/A
HC62202874	CUTTER LINEAR ENDO                O	272		1,052.00	N/A
HC62202882	ENDO LOOP	272		259.00	N/A
HC62202890	NEEDLE ENDOSCOPIC                 F	272		260.00	N/A
HC62202908	BAG/POUCH RETRIEVAL SPECMN ENDO   D	272		293.00	N/A
HC62202916	ENDO PUSHER	272		118.00	N/A
HC62202924	ENDO REDUCER	272		65.00	N/A
HC62202932	STAPLE CARTRG/ENDO RELOAD         H	272		390.00	N/A
HC62202940	SCISSORS ENDOSCOPIC               L	272		650.00	N/A
HC62202957	ENDO SCRUB SHEATH	272		215.00	N/A
HC62202965	ENDO STAPLER                      K	272		715.00	N/A
HC62202973	ENDO STAPLER SKIN	272		686.00	N/A
HC62202981	ENDO STITCH/CATCH	272		715.00	N/A
HC62202999	TROCAR ENDO                       F	272		260.00	N/A
HC62203005	CLIP ENDOSCOPIC                   L	272		650.00	N/A
HC62203013	ENDOCURIE RIBBON LONG	272		371.00	N/A
HC62203021	ENDOSCOPIC SYSTEM	272		2,150.00	N/A
HC62203039	ET BAG COLOSTOMY	272		364.00	N/A
HC62203047	ET BARRIER DUODEEM	272		111.00	N/A
HC62203054	ET BARRIER WOUND CARE	272		146.00	N/A
HC62203062	ET BELT	272		74.00	N/A
HC62203070	ET CLAMP OSOTOMY/ HOLLISTER	272		29.00	N/A
HC62203088	ET DRESS STOMAHESIVE	272		157.00	N/A
HC62203104	ET POUCH                          B	272		65.00	N/A
HC62203112	ET POUCH/BAG UROSTOMY	272		241.00	N/A
HC62203120	ET POWDER STOMAHESIVE	272		59.00	N/A
HC62203138	ET SET COLO/ILEO	272		198.00	N/A
HC62203146	ET SET IRRIGATION	272		33.00	N/A
HC62203153	ET SKIN CARE KIT	272		137.00	N/A
HC62203161	ET SKIN SPRAY	272		137.00	N/A
HC62203179	ET TAPE HYPAFIX	272		125.00	N/A
HC62203187	ET WAFER	272		64.00	N/A
HC62203195	EVACUATED IV BOTTLE	272		31.00	N/A
HC62203203	EVACUATED IV BOTTLE 150ML	272		31.00	N/A
HC62203211	EVACUATED IV BOTTLE 250ML	272		33.00	N/A
HC62203229	EVACUATED IV BOTTLE 500ML	272		33.00	N/A
HC62203237	EVACUATOR BLADDER	272		74.00	N/A
HC62203245	EVACUATOR ELLIK	272		194.00	N/A
HC62203252	EYE OCCLUDER	272		36.00	N/A
HC62203260	EYE PATCH	270		13.00	N/A
HC62203278	SYSTEM COMPRESSION (FEMOSTOP)	272		342.00	N/A
HC62203286	FEMORAL CANAL BRUSH	272		124.00	N/A
HC62203294	FIBER LASER                       K	272		1,391.57	N/A
HC62203302	FIBRIN SEALANT                    P	278		1,916.66	N/A
HC62203310	FILTER BACTERIA	272		72.00	N/A
HC62203328	FILTER BLOOD	272		64.00	N/A
HC62203336	FILTER IV	272		52.00	N/A
HC62203344	FILTER MILIPORE	272		26.00	N/A
HC62203351	FILTER PALL	272		26.00	N/A
HC62203369	FILTER PULMONARY	272		99.00	N/A
HC62203377	FILTER RESPIRATORY	272		52.00	N/A
HC62203393	FLOWMETER	270		146.00	N/A
HC62203401	FORCEP BIOPSY                     F	272		358.00	N/A
HC62203419	FORCEP BIOPSY DISP                J	272		582.00	N/A
HC62203427	FORCEP JEWELER BIPOLAR            F	272		260.00	N/A
HC62203435	FORCEPS GRASPING	272		1,573.00	N/A
HC62203443	GAS INTRAOCULAR                   D	272		970.00	N/A
HC62203468	HANDPIECE VESSEL SEALER DEVICE    A	272		975.00	N/A
HC62203476	SCALPEL SHEARS HARMONIC	272		1,560.00	N/A
HC62203484	HEMOCONCENTATOR	272		260.00	N/A
HC62203492	SEALANT (FLOSEAL) KIT 10CC	278		1,103.49	N/A
HC62203500	HOLDER IV/PICC	272		13.00	N/A
HC62203518	HOLDER TUBE{ET,NG&TRACH}	270		39.00	N/A
HC62203526	HUMIDIFIERS	270		59.00	N/A
HC62203534	IMMOBILIZER SHOULDER	274	L3670	104.00	N/A
HC62203542	IMMOBILZER KNEE	274	L1830	46.00	N/A
HC62203559	INSTRUMENT SINGLE PATIENT USE	272		65.00	N/A
HC62203567	IRRIGATION SOL ACETIC ACID	272		33.00	N/A
HC62203575	IRRIGATION SOL H2O	272		33.00	N/A
HC62203583	IRRIGATION SOL LR	272		33.00	N/A
HC62203591	IRRIGATION SOL NS	272		33.00	N/A
HC62203609	IRRIGATION SOL SORBITOL	272		33.00	N/A
HC62203617	IRRIGATOR BLADDER	272		91.00	N/A
HC62203625	IRRIGATOR OPHTHALMIC	272		77.00	N/A
HC62203633	SOLUTION DEBRIDEMENT WOUND	272		195.00	N/A
HC62203641	KIT ACCESSORY                     F	272		455.00	N/A
HC62203658	KIT ACCESSORY & LAPAROSCOPIC	272		211.00	N/A
HC62203666	KIT ARTHROSCOPY DISPSBLS          M	272		748.00	N/A
HC62203674	KIT ANEURYSM	272		1,199.00	N/A
HC62203682	KIT ANGIO TOUCH HAND CONTROL	272		676.00	N/A
HC62203690	KIT ANGIOGRAPHY	272		178.00	N/A
HC62203708	KIT ARTERIAL LINE	272		61.00	N/A
HC62203716	KIT BIOPSY	272		65.00	N/A
HC62203724	KIT BONE PREP	272		499.00	N/A
HC62203732	KIT BREAST PUMP ELECTRIC	272		77.00	N/A
HC62203740	KIT CATH CV	272		624.00	N/A
HC62203757	KIT CATH RADIAL ARTERY	272	C1769	293.00	N/A
HC62203765	KIT CATH SUCTION	272		44.00	N/A
HC62203773	KIT CELL SAVER	272		455.00	N/A
HC62203781	KIT CHOLANGIOGRAM	272		374.00	N/A
HC62203799	KIT COOK TRIPLE LUMEN CATH	272		793.00	N/A
HC62203807	KIT CRANIOPLASTIC RESIN	278		4,173.00	N/A
HC62203815	KIT CVP MANOMETER	272		176.00	N/A
HC62203823	CATH DIALYSIS SHORT-TERM          K	272	C1752	696.00	N/A
HC62203831	KIT DIALYSIS	272		313.00	N/A
HC62203849	KIT DISSECTOR HYDRO PUMP	272		1,646.00	N/A
HC62203856	KIT EPIDURAL	272		109.00	N/A
HC62203864	KIT EXTRACTION CUP	272		78.00	N/A
HC62203872	KIT FECAL MANAGEMENT              O	270		1,040.00	N/A
HC62203880	KIT FEMALE CATH	272		33.00	N/A
HC62203898	KIT HEMOFILTRATION	272		715.00	N/A
HC62203906	KIT HEMOSEEL(SEAL)	278		2,535.00	N/A
HC62203914	SEALANT (FLOSEAL) KIT 5CC	278		608.72	N/A
HC62203922	KIT REPAIR BROVIAC/CV/HICKMAN     G	272		683.00	N/A
HC62203930	KIT HYSTEROSALPINGOGRAM	272		293.00	N/A
HC62203948	KIT INFLATION	272		293.53	N/A
HC62203955	KIT INTRAUTERINE PRESSURE	272		129.00	N/A
HC62203963	INTRODUCER/SHEATH(FLEXOR TIBIAL)  G	272	C1894	325.00	N/A
HC62203971	INTRODUCER/SHEATH                 D	272	C1894	130.01	N/A
HC62203989	KIT INTRODUCER NEPHR/BILI/GI	272	C1894	660.00	N/A
HC62203997	KIT IV START W/TEGADERM	272		23.00	N/A
HC62204003	KIT KYPHOPAK 1ST FRACTURE         E	278		11,099.00	N/A
HC62204011	KIT KYPHOPAK ADD'L FRACTURE	278		6,578.00	N/A
HC62204029	KIT LASER VEIN ABLATION	272	C1888	2,049.00	N/A
HC62204037	KIT MANIFOLD	272		325.00	N/A
HC62204045	KIT MANIFOLD SPECIALTY	272		556.00	N/A
HC62204052	KIT MICROINTRODUCER	272		118.00	N/A
HC62204060	KIT MICROPUNCTURE(SPECIALTY)	272		390.00	N/A
HC62204078	KIT MICROPUNCTURE(STANDARD)	272		130.00	N/A
HC62204086	KIT NEEDLE GUIDE (PICC)	272	C1751	195.00	N/A
HC62204094	KIT NEEDLE US VACUUM ASSIST	272		846.00	N/A
HC62204102	PACK OPEN HEART	272		195.00	N/A
HC62204110	KIT ORAL SUCTION/CATH	272		72.00	N/A
HC62204128	KIT PERCUTANEOUS CATH	272		910.00	N/A
HC62204136	KIT PERITONEAL DRAINAGE ACCESS	278	A4301	1,600.00	N/A
HC62204144	KIT PHACO	272		95.00	N/A
HC62204151	KIT PNEUMOTHORAX	272		550.00	N/A
HC62204169	KIT POST OP CATARACT	272		189.00	N/A
HC62204177	KIT PRESSURE MONITOR/TRANSDUCER   C	272		98.00	N/A
HC62204185	KIT PTCA CUSTOM NAMIC	272		397.00	N/A
HC62204193	KIT RADICAL PROSTATECTOMY	272		332.00	N/A
HC62204201	KIT REPAIR BROVIAC/CV/HICKMAN     D	272		488.00	N/A
HC62204219	KIT RESPIRATORY	270		241.00	N/A
HC62204227	KIT ROTALINK	272	C1724	4,454.00	N/A
HC62204235	KIT SHOULDER SUSPENSION	272		189.00	N/A
HC62204243	CATH SUPRAPUBIC/CYSTOSCOPIC       F	272	C2627	261.04	N/A
HC62204250	KIT TEST PYLORI HELICOBACTER	272		91.00	N/A
HC62204268	KIT TIPS	272		1,625.00	N/A
HC62204276	KIT TPN/CVP DRESSING	272		98.00	N/A
HC62204284	KIT TRACH	272	A4624	255.00	N/A
HC62204292	KIT TRACH COLLAR	272		65.00	N/A
HC62204300	KIT PRESSURE MONITOR/TRANSDUCER   E	272		195.00	N/A
HC62204318	KIT TRANSJUGULAR VENOUS ACCESS	278	C1751	2,600.00	N/A
HC62204326	KIT TRIPLE LUMEN/IV CATH	272		793.00	N/A
HC62204334	KIT TWIST DRILL DISP	272		1,438.00	N/A
HC62204342	KIT VERTEBROPLASTY DISP	272		7,449.00	N/A
HC62204359	KIT W/ TRACH PERCUTANEOUS         F	272	A7520	1,300.00	N/A
HC62204367	KIT WOUND VAC	272		137.00	N/A
HC62204375	KIT VACUUM EXTRACTION	272		98.00	N/A
HC62204383	KIT/TRAY BIOPSY                   G	272		325.00	N/A
HC62204391	KIT/TRAY SUTURE REMOVAL	272		30.00	N/A
HC62204409	KNIFE COLD DISP	272		491.00	N/A
HC62204417	KNIFE MICROSURGICAL	272		237.00	N/A
HC62204425	KNIFE MYRINGOTOMY	272		79.00	N/A
HC62204433	BLADE OPHTHALM                    J	272		130.00	N/A
HC62204441	KNIFE SURGICAL	272		33.00	N/A
HC62204458	BEAD LC MICROSPHERE PER VIAL	278		6,000.00	N/A
HC62204466	SYSTEM DELIVERY LEAD              B	272	C1887	650.00	N/A
HC62204474	LENS VITRECTOMY FLAT	272		111.00	N/A
HC62204482	APPLIER LIGA/HEMOCLIP ENDO        D	272		130.00	N/A
HC62204490	LIGHT FLEXIBLE DISP	272		78.00	N/A
HC62204508	LINE PRESSURE MONITOR	272		111.00	N/A
HC62204516	LINE PRESSURE TRANSDUCER	272		111.00	N/A
HC62204524	LINER SUCTION CANNISTER	272		13.00	N/A
HC62204532	LITE PIPE	272		276.00	N/A
HC62204540	LOOPS CYSTO	272		385.00	N/A
HC62204557	LOOPS VASCULAR	272		20.00	N/A
HC62204565	LUER LOCK W/INJ CAP	272		108.00	N/A
HC62204573	CATH CARDIAC	278		1,066.00	N/A
HC62204581	M: GI LAB MISC SUPPLY	270		N/A	N/A
HC62204599	PROGRAMMER NEUROSTIM PAT          B	271	C1787	1,625.00	N/A
HC62204607	RECHARGER BATTERY NRST RPLCMNT	271	L8689	3,550.63	N/A
HC62204615	ANTENNA TRANSMIT EXT NEUROSTIM	271	L8683	251.00	N/A
HC62204623	M: NRSTM TRNSMTR BLADDER BOWEL	272	L8684	6,337.50	N/A
HC62204631	M: SYSTEM ENT STEALTH	278		1,793.26	N/A
HC62204649	M: SYSTEM NERVE RESPONSE	272		6,490.00	N/A
HC62204656	M: SYSTEM NEURO STEALTH	278		13,023.00	N/A
HC62204664	MAGNET DEVICE	272		208.00	N/A
HC62204672	MALLET	272		127.00	N/A
HC62204680	MASK BIPAP	272		177.00	N/A
HC62204698	MASK OXYGEN	272		39.00	N/A
HC62204706	MASK TRACH	272		59.00	N/A
HC62204714	MATTRESS ALTERNATING PRESSURE	270		104.00	N/A
HC62204722	METERED DOSE INHALER	270		52.00	N/A
HC62204730	M: MISC GENERAL SUPPLY	270		738.11	N/A
HC62204748	M: MISC ORTHOTICS	274		1,849.38	N/A
HC62204755	MODULE OB CUSTOM DISP PACK	272		163.00	N/A
HC62204763	MORCELLATOR	272	C1782	2,084.00	N/A
HC62204771	MORGAN LENS	272		75.00	N/A
HC62204789	MOUTH PIECE SGL USE	272		17.00	N/A
HC62204797	PACKING NASAL                     C	272		98.00	N/A
HC62204805	PACKING/BALLOON NASAL             F	270		260.00	N/A
HC62204813	SPLINT NASAL                      D	272		130.00	N/A
HC62204821	NASAL TAMPON	272		159.00	N/A
HC62204839	NEBULIZER (GENERIC)	272		121.00	N/A
HC62204847	NEEDLE ASPIRATION                 H	272		403.00	N/A
HC62204854	NEEDLE ASPIRATION TRANS-BRONCH	272		514.00	N/A
HC62204862	NEEDLE BIOPSY                     F	272		143.00	N/A
HC62204870	NEEDLE BIOPSY BONE                L	272		650.00	N/A
HC62204888	NEEDLE BIOPSY BONE VERTEBROPLASTY K	272		585.00	N/A
HC62204896	NEEDLE BONE MARROW                H	272		488.00	70.50
HC62204904	NEEDLE DOPPLER	272		358.00	N/A
HC62204912	NEEDLE GUIDE STEREOTACTIC BX	272		98.00	N/A
HC62204938	NEEDLE HUBER/PORT-A-CATH	272		53.00	N/A
HC62204946	NEEDLE INFUSAID	272		62.00	N/A
HC62204953	SPHINCTEROTOME NEEDLE KNIFE	272		650.00	N/A
HC62204961	NEEDLE RETROBULBAR	272		337.00	N/A
HC62204979	NEEDLE SCALP VEIN	272		33.00	N/A
HC62204987	NEEDLE SCLEROTHERAPY	272		95.00	N/A
HC62204995	NEEDLE SPECIALTY	272		320.00	N/A
HC62205000	NEEDLE SPINAL                     C	272		98.00	N/A
HC62205018	NEEDLE STEREOTACTIC BX	272		1,723.00	N/A
HC62205026	NEEDLE SUTURE GRICE	272		174.00	N/A
HC62205034	NEEDLE TRANSSEPTAL	272		715.00	N/A
HC62205042	NEEDLE WIRE LOCALIZATION          F	272	C1819	260.00	N/A
HC62205059	NERVE LOCATOR DISP	272		162.42	N/A
HC62205067	NURSER CLEFT PALATE	270		118.00	N/A
HC62205075	OBTURATOR                         H	272		260.00	N/A
HC62205083	OFF PUMP SUCTION SYS-STABILZER	272		4,265.00	N/A
HC62205109	CABLE PACER DISP                  C	272		207.00	N/A
HC62205117	PACK ACL	272		306.00	N/A
HC62205125	PACK ANGIO COMBO	272		553.00	N/A
HC62205133	PACK ANGIO	272		585.00	N/A
HC62205141	PACK ARTHROSCOPY	272		81.00	N/A
HC62205158	PACK ARTHROSCOPY ACCESSORY	272		130.00	N/A
HC62205166	PACK BASIC	272		272.00	N/A
HC62205174	PACK CARDIAC ACCESSORY	272		1,164.00	N/A
HC62205182	PACK CAROTID	272		81.00	N/A
HC62205190	PACK CAT SCAN PROCEDURE	272		29.00	N/A
HC62205208	PACK CELL SAVER	272		998.00	N/A
HC62205216	PACK CRANIOTOMY	272		170.00	N/A
HC62205224	PACK C-SECTION	272		101.00	N/A
HC62205232	KIT CUSA	272		943.00	N/A
HC62205240	PACK CYSTOSCOPY	272		81.00	N/A
HC62205257	PACK ENDOSCOPY	272		130.00	N/A
HC62205265	PACK EYE	272		202.00	N/A
HC62205273	PACK FACET INJECTION	272		116.00	N/A
HC62205281	PACK GEN/GYN	272		117.00	N/A
HC62205299	PACK HIP TOTAL	272		251.00	N/A
HC62205307	PACK KNEE TOTAL	272		205.00	N/A
HC62205315	PACK LAMINECTOMY	272		192.00	N/A
HC62205323	PACK LAP CHOLE	272		152.00	N/A
HC62205331	PACK LAPAROSCOPIC	272		147.00	N/A
HC62205349	PACK LAPAROTOMY	272		137.00	N/A
HC62205356	PACK LEFT HEART	272		618.00	N/A
HC62205364	PACK LITHOTOMY	272		65.00	N/A
HC62205372	PACK MAJOR	272		68.00	N/A
HC62205380	PACK MINOR	272		55.00	N/A
HC62205398	PACK NEURO	272		1,171.00	N/A
HC62205406	PACK ORTHO ACCESSARY	272		98.00	N/A
HC62205414	PACK ORTHO MAJOR	272		253.89	N/A
HC62205422	KIT PERFUSION                     C	272		3,250.00	N/A
HC62205430	PACK TOTAL JOINT	272		230.00	N/A
HC62205448	PACK UNIVERSAL	272		130.00	N/A
HC62205455	PACK UROLOGY CYSTO MAJOR	272		130.00	N/A
HC62205463	PACK UROLOGY CYSTO MINOR	272		117.00	N/A
HC62205471	PACK VAGINAL DELIVERY	272		98.00	N/A
HC62205489	PACK VASCULAR	272		792.00	N/A
HC62205497	KIT VITRECTOMY PROBE              J	272		1,300.00	N/A
HC62205505	PACKING IODOFROM	272		117.00	N/A
HC62205513	PACKING NUGAUZE	272		29.00	N/A
HC62205521	PACKING VAGINAL	272		104.00	N/A
HC62205539	PAD ACRYLON	272		196.00	N/A
HC62205547	PAD BREAST	272		20.00	N/A
HC62205554	PAD CPM	272		139.00	N/A
HC62205562	PAD DEFIBRILLATION/ECG       D	272		104.00	N/A
HC62205570	PAD GROUNDING	272		65.00	N/A
HC62205588	HEMOSTATIC GEL/GELFOAM/PAD         G	272		332.00	N/A
HC62205596	PAD INCONTINENT/AIR THERAPY	272		126.00	N/A
HC62205604	PAD SPECIALTY/HYPER/OTHERMIA	272		176.00	N/A
HC62205612	PAD/PROTECTOR HEEL ELBOW	272		52.00	N/A
HC62205620	PADS WITCH HAZEL (TUCKS)	270		13.00	N/A
HC62205638	PAIN PUMP W/ SYSTEM               Q	272		1,343.33	N/A
HC62205646	PEN SKIN MARKER	272		39.00	N/A
HC62205653	PERFORATOR	272		559.82	N/A
HC62205679	PICC LINE INTRODUCER	272	C1751	711.00	N/A
HC62205687	PILLOW CERVICAL	270		121.00	N/A
HC62205695	PIN PASSING	272		426.00	N/A
HC62205703	PINS CRW HEAD DISP	272		2,688.00	N/A
HC62205711	PLUG SILICONE	272		107.00	N/A
HC62205729	TRAP POLYP	272		60.00	N/A
HC62205737	POST OP SHOE	270		55.00	N/A
HC62205745	PRESSURE WIRE	272		2,113.00	N/A
HC62205752	PROBE ABLATION  CRYO              I	272	C2618	6,500.00	N/A
HC62205760	PROBE BICAP WITH NEEDLE	272		1,170.00	N/A
HC62205778	PROBE FLOW VASCULAR UTZ           N	272		876.00	N/A
HC62205786	PROBE CAUTERY	272		709.00	N/A
HC62205794	PROBE ENDO EYE	272		322.00	N/A
HC62205802	PROBE GALACTOGRAM	272		293.00	N/A
HC62205810	PROBE HEMOSTASIS (BICAP)          K	272		1,424.00	N/A
HC62205828	PROBE LASER                       N	272		910.00	N/A
HC62205836	PROBE LITHOTRIPTOR                N	272		893.75	N/A
HC62205844	PROBE PERCUTANEOUS	272		1,561.00	N/A
HC62205851	PROBE PRASS STANDARD NIM	272		644.00	N/A
HC62205877	PROBE RECTAL/ESOPHAGEAL	272		195.00	N/A
HC62205885	PROBE STEREO GUIDE	272		693.00	N/A
HC62205893	PUNCH AORTIC                      O	272		488.00	N/A
HC62205901	PUNCH SKIN BX	272		46.00	N/A
HC62205919	PUSHER OCCLUSION COIL	272		511.00	N/A
HC62205927	RESERVIOR JACKSON PRATT	272		224.00	N/A
HC62205935	RESIN ACRYLIC	272		514.00	N/A
HC62205943	RESPIRATORY  EXERCISER	270		72.00	N/A
HC62205950	RESUSCITATOR	272		130.00	N/A
HC62205968	RETRACTOR STAYS ELASTIC	272		410.00	N/A
HC62205976	DEVICE RETRIEVAL                  C	272	C1773	1,946.75	N/A
HC62205984	RETRIEVAL NET	272		296.00	N/A
HC62205992	RING INFLATABLE	270		126.00	N/A
HC62206008	M: RT MISC SUPPLY	270		N/A	N/A
HC62206016	SALINE LOCK	272		78.00	N/A
HC62206024	SCALPEL	272		111.00	N/A
HC62206032	SCISSORS EYE(DISP)	272		460.00	N/A
HC62206040	SCREWS LONG HEAD 4 (SRS)	272		455.00	N/A
HC62206057	SENSOR BISPECTRAL INDEX	270		239.00	N/A
HC62206065	SENSOR IN-LINE	272		371.00	N/A
HC62206073	SENSOR LOW LEVEL	272		208.00	N/A
HC62206081	SET AMPLATZ	272	C1769	1,560.00	N/A
HC62206099	SET ANCHOR GASTROINTESTINAL	272		191.00	N/A
HC62206107	SET ANGIO PUMP W/BAG	272		393.00	N/A
HC62206115	SET ARTERIAL LINE	272		60.00	N/A
HC62206123	SET TUBING	272		195.00	N/A
HC62206131	SET BLOOD Y TYPE	272		49.00	N/A
HC62206149	SET CAP/DIAPH H, FREQ OSCILL      I	272		104.00	N/A
HC62206156	SET CARDIOPLEGIA	272		413.00	N/A
HC62206164	SET CATH FIXATION	272		680.00	N/A
HC62206172	SET CHEST DRAINAGE	272		163.00	N/A
HC62206180	SET DIALYSIS PREWARM	272		711.00	N/A
HC62206198	SET ENTERAL FEEDING W/BAG	272		107.00	N/A
HC62206206	SET FLUID TRANSFER	272		65.00	N/A
HC62206214	SET FRAGMATONE	272		250.00	N/A
HC62206222	SET GALACTOGRAM INFUSION	272		247.00	N/A
HC62206230	SET INFANT GAVAGE	272		111.00	N/A
HC62206248	SET INTRODUCER MICROPUNC	272		107.00	N/A
HC62206255	SET IPPB	272		78.00	N/A
HC62206263	SET IRRIGATION CYSTO/URO	272		98.00	N/A
HC62206271	SET IV TAXOL	272		86.00	N/A
HC62206289	SET IV/PORT ERCP EXTENSION	272		53.00	N/A
HC62206297	SET LACRIMAL INTUBATION	272		207.00	N/A
HC62206305	SET LITHOTRIPTOR	272		996.00	N/A
HC62206313	SET LIVER BIOPSY	272		1,560.00	N/A
HC62206321	SET LUMBAR DRAIN	272		712.00	N/A
HC62206339	SET NEEDLE INTRAOSEOUS	272		313.00	N/A
HC62206347	SET PERFUSION	272		325.00	N/A
HC62206354	SET PROSTATE STABILIZATION	272		397.00	N/A
HC62206370	SET SUSPENSION EYE(FRONTALIS)	272		252.00	N/A
HC62206388	SET THERM FOR CARDIAC OUTPUT	272		147.00	N/A
HC62206396	SET THORACENTESIS	272		517.00	N/A
HC62206404	SET THROMBECTOMY PUMP	272		1,117.00	N/A
HC62206412	SET TUBING VGFI	272		373.00	N/A
HC62206420	SET URICATH	272		293.00	N/A
HC62206438	SET VACUUM CANNISTER W/O GEL	272		117.00	N/A
HC62206446	MARKER SHADOWFORM/VISICOIL	272	A4648	499.00	N/A
HC62206453	SHEATH ABLATION	272		654.00	N/A
HC62206461	INTRODUCER/SHEATH                 J	272	C1894	520.00	N/A
HC62206479	SHEATHS ILLUMINATOR	272		1,190.00	N/A
HC62206487	SHEEPSKIN	270		121.00	N/A
HC62206495	SHELL BREAST	272		87.00	N/A
HC62206503	SHIELD EYE                        D	272		57.00	N/A
HC62206511	SHIELD FULLER	272		31.00	N/A
HC62206529	SHUNT CAROTID	272		279.27	N/A
HC62206537	SIZER MAMMARY                     C	272		132.57	N/A
HC62206545	SKIN ADHESIVE TOP 0.5ML APPL	272		65.00	N/A
HC62206552	SLEEVE COMPRESSION                E	272		195.00	N/A
HC62206560	SLING ARM	270	A4565	98.00	N/A
HC62206586	SNARE                             G	272		325.00	N/A
HC62206594	SNARE DLP TOURNIKWIK	272		316.00	N/A
HC62206602	SNARE                             E	272		195.00	N/A
HC62206610	SOLUTION BSS	272		72.00	N/A
HC62206628	SOLUTION BSS PLUS 500ML	272		403.00	N/A
HC62206636	SOLUTION CONCHA WATER	272		74.00	N/A
HC62206644	SOLUTION DIALYSIS	272		81.00	N/A
HC62206651	SPECULUM VAGINAL (DISP)	272		85.00	N/A
HC62206669	SPHINCTEROTOME                    H	272		1,040.00	N/A
HC62206677	SPHINCTEROTOME W/WIRE             M	272		1,690.00	N/A
HC62206685	SPIROMETER INCENTIVE	270		9.00	N/A
HC62206693	ORTHTC ANKLE CONTROL STIRRUP	270		72.00	N/A
HC62206701	BOOT WLKNG AIR W/WO JNTS PREFB    C	274	L4360	98.00	N/A
HC62206719	ORTHOTIC WHFO D-RING              C	274	L3908	98.00	N/A
HC62206727	SPLINT CLAVICLE	270		46.00	N/A
HC62206735	SPLINT FINGER	270		52.00	N/A
HC62206743	SPLINT LEG	274	L1830	143.00	N/A
HC62206750	SPLINT FULL LEG AIR PREFAB	270		143.00	N/A
HC62206768	SPLINT MULTI-PODUS BOOT	274	L4386	182.00	N/A
HC62206776	ORTHOTIC FX WRIST PREFAB	274	L3984	177.00	N/A
HC62206792	STAPLE REMOVER	272		30.00	N/A
HC62206800	STAPLER SKIN                      D	272		130.00	N/A
HC62206818	STAYS UROLOGY[LONESTAR]	272		124.00	N/A
HC62206826	STERI STRIP	272		13.00	N/A
HC62206834	STIMULATOR NERVE LOCATOR	272		335.00	N/A
HC62206842	STOCKINETTE	272		26.00	N/A
HC62206859	STOCKINGS TED HOSE THIGH HI	272	A4495	38.00	N/A
HC62206883	STRAP CLAVICLE	270		178.00	N/A
HC62206891	STRAP MONTGOMERY	272		26.00	N/A
HC62206909	STRAPS LEG BAG	270		60.00	N/A
HC62206917	STYLET INTUBATION	272		36.00	N/A
HC62206925	SUCTION COLLECTION DEVICE         A	272		33.00	N/A
HC62206933	SUCTION IRRIGATOR	272		332.00	N/A
HC62206941	SUCTION TRAP MICRODEBRIDER	272		384.00	N/A
HC62206958	SUCTION YANKAUER	272		30.00	N/A
HC62206966	SUPPORT LUMBAR-SACRAL	270		241.00	N/A
HC62206974	SUPPORTER ATHLETIC	270		134.00	N/A
HC62206982	SUPPORTER COTTON	272		46.00	N/A
HC62206990	SUTURE                            B	272		39.00	N/A
HC62207006	SUTURE CARDIOVASCULAR             G	272		169.00	N/A
HC62207014	SUTURE EYE                        D	272		91.00	N/A
HC62207022	SUTURE GENERAL MULTI PKG	272		267.00	N/A
HC62207030	SUTURE                            C	272		65.14	N/A
HC62207048	SUTURE LAURUS                     O	272		377.00	N/A
HC62207055	SUTURE NEURO                      D	272		91.00	N/A
HC62207063	SUTURE                            D	272		91.42	N/A
HC62207071	SUTURE RETRIEVER	272		286.00	N/A
HC62207089	SUTURE WIRE	272		134.00	N/A
HC62207097	SUTURE SPECIALTY                  S	272		481.00	N/A
HC62207105	SYRINGE ANGIO	272		33.00	N/A
HC62207113	SYRINGE KYPHOPLASTY INFLATION	272		477.00	N/A
HC62207121	SYSTEM CORE BIOPSY GUN	272		42.00	N/A
HC62207139	SYSTEM DALL MILES CABLE GRIP	272		1,780.84	N/A
HC62207147	SYSTEM RAPID REFILL INJECTION	272		98.00	N/A
HC62207154	SYSTEM STEALTH ALL	272		8,069.00	N/A
HC62207162	TAPE HYPAFIX	272		156.00	N/A
HC62207170	TAPE RADIOPAQUE	270		111.00	N/A
HC62207188	TENT RESPIRATORY/AEROSOL	270		150.00	N/A
HC62207196	TIP SUCTION	272		52.00	N/A
HC62207204	TIP VITALVUE SUCTION/IRRIG	272		417.00	N/A
HC62207212	DEVICE TORQUE                     D	272		130.00	N/A
HC62207220	TOURNIQUET	270		150.00	N/A
HC62207238	TRACH PLUG	272		65.00	N/A
HC62207246	KIT PRESSURE MONITOR/TRANSDUCER   B	272		65.00	N/A
HC62207253	TRAY AMNIOCENTESIS	272		241.00	N/A
HC62207261	TRAY ANGIO	272		692.00	N/A
HC62207287	TRAY BONE MARROW                  Q	272		312.00	N/A
HC62207303	TRAY CUTDOWN	272		926.00	N/A
HC62207311	TRAY DIALYSIS	272		1,114.00	N/A
HC62207329	TRAY EYE CARE	272		124.00	N/A
HC62207337	TRAY FOLEY CATH	272		33.00	N/A
HC62207345	TRAY FOLEY CATH W/URINEMETER	272		108.95	N/A
HC62207352	TRAY GASTRIC LAVAGE	272		176.00	N/A
HC62207360	TRAY GENERAL PURPOSE DISP	272		143.00	N/A
HC62207378	TRAY HYPERAL DRESSING(DISP)	272		160.00	N/A
HC62207386	TRAY INCISION & DRAINAGE DISP	272		299.00	N/A
HC62207394	TRAY INTUBATION	270		252.00	N/A
HC62207402	TRAY IRRIGATION	272		33.00	N/A
HC62207410	TRAY LACERATION DISPOSABLE	272		163.00	N/A
HC62207428	TRAY LUMBAR PUNCTURE	272		337.00	N/A
HC62207444	TRAY MYELOGRAM DISP	272		186.00	N/A
HC62207451	TRAY NASAL	272		989.00	N/A
HC62207469	TRAY NASAL HEMORRHAGE	272		228.00	N/A
HC62207477	TRAY PARACERVICAL	272		228.00	N/A
HC62207485	TRAY PELVIC EXAM	272		163.00	N/A
HC62207493	TRAY PERICARIOCENTESIS	272		592.00	N/A
HC62207501	TRAY PLASTIC SUTURE	272		676.00	N/A
HC62207519	TRAY SPINAL/EPIDURAL	272		52.00	N/A
HC62207527	TRAY THORAC/PARACENTESIS          U	272		520.00	N/A
HC62207535	TRAY TRACH CARE/CLEANING	272		85.00	N/A
HC62207543	CATH UMBILICAL DOUBLE LUMEN	272		124.00	N/A
HC62207550	TRAY UNIVERSAL PROCEDURE	272		124.00	N/A
HC62207568	CATH URETHRAL TRAY                C	272		98.00	N/A
HC62207576	VACUUM TREPHINE	272		334.00	N/A
HC62207584	TUBE ASPIRATING	272		68.00	N/A
HC62207592	TUBE CANTOR	272		506.00	N/A
HC62207600	TUBE CONNECTING	272		27.00	N/A
HC62207618	TUBE DRAINAGE CONNECTING	272		65.00	N/A
HC62207626	TUBE EMG REINFORCED NIM	272		963.00	N/A
HC62207634	TUBE ET                           B	272		65.00	N/A
HC62207659	TUBE GASTROSTOMY                  L	278	B4087	650.00	N/A
HC62207667	TUBE GAUZE	270		107.00	N/A
HC62207675	TUBE GAVAGE/FEEDING INFANTS	272		20.00	N/A
HC62207683	TUBE INSUFFLATOR                  E	272		195.00	N/A
HC62207691	TUBE JEUJUNOSTOMY	272		627.00	N/A
HC62207709	TUBE LAVAGE	272		345.00	N/A
HC62207717	TUBE MYRINGOTOMY	272		211.00	N/A
HC62207725	TUBE NASO GASTRIC	272		33.00	N/A
HC62207733	TUBE NASOPHARYNGEAL	272		33.00	N/A
HC62207741	TUBE SALEM SUMP	272		33.00	N/A
HC62207758	TUBE SILASTIC	272		39.00	N/A
HC62207766	TUBE TRACH NO CUFF                F	272	A7520	260.00	N/A
HC62207774	TUBE URINARY EXTENSION	272		42.00	N/A
HC62207782	IVS TUBING  BLOOD/FLUID WARMER	272		163.00	N/A
HC62207790	TUBING  PRESSURE	272		85.00	N/A
HC62207808	TUBING ARTHROSCOPIC PUMP	272		192.00	N/A
HC62207816	IVS TUBING BLOOD PUMP	272		124.00	N/A
HC62207824	TUBING EXTENSION FEEDING	270		26.00	N/A
HC62207832	TUBING HEMODYNAMIC	272		124.00	N/A
HC62207840	TUBING HIGH PRESSURE	272		111.00	N/A
HC62207857	TUBING HYSTEROSCOPY               D	272		260.00	N/A
HC62207865	TUBING IRRIGATION                 H	272		312.00	N/A
HC62207873	IVS TUBING	272		46.00	N/A
HC62207881	IVS TUBING EXTENSION	272		7.00	N/A
HC62207899	IVS TUBING HOT LINE	272		46.00	N/A
HC62207907	TUBING MICRODEBRIDER	272		194.00	N/A
HC62207915	TUBING OXYGEN	272		26.00	N/A
HC62207923	TUBING PCA	272		33.00	N/A
HC62207931	IVS TUBING PLUMSET	272		39.00	N/A
HC62207949	TUBING PRESSURE MONITOR	272		53.00	N/A
HC62207956	TUBING SCD	272		189.00	N/A
HC62207964	TUBING SET ASPIRATING CYSTO	272		39.00	N/A
HC62207972	TUBING SILICON	272		218.00	N/A
HC62207980	TUBING SUCTION	272		43.00	N/A
HC62207998	TUBING SUCTION NEZHAT DORSEY	272		176.00	N/A
HC62208004	TUBING UTERINE VAC	272		53.00	N/A
HC62208012	TUBING VACUUM DELIVERY	272		103.00	N/A
HC62208020	TUNNELER SURGICAL                 F	272		290.41	N/A
HC62208038	URINE METER	272		44.00	N/A
HC62208046	URINE STRAINER	270		38.00	N/A
HC62208053	NEEDLE BIOPSY THYROID	272		140.00	N/A
HC62208061	MANIPULATOR UTERINE               G	272		324.70	N/A
HC62208079	VACUUM CURRETTE	272		35.00	N/A
HC62208087	VACUUM SUCTION (NEWBORN)	272		156.00	N/A
HC62208095	VALVE ANTI REFLUX	272		88.00	N/A
HC62208103	VALVE BIOPSY	272		816.00	N/A
HC62208111	VALVE CHEST DRAIN	272		104.00	N/A
HC62208129	VALVE HEIMLICH CHEST DRAIN	272		117.00	N/A
HC62208137	VALVE NON-REBREATHING TEE	272		88.00	N/A
HC62208145	VALVE PEEP	272		191.00	N/A
HC62208152	VALVE SUCTION	272		53.00	N/A
HC62208160	VALVE TRACH SPEAKING              L	274	L8501	650.00	N/A
HC62208178	VALVULTOME	272		6,107.00	N/A
HC62208186	VEIN STRIPPER	272		85.00	N/A
HC62208194	VESSEL DILATOR                    C	272		104.00	N/A
HC62208210	WAFFLE WHEEL CHAIR	270		52.00	N/A
HC62208228	WOUND CARE LOTION/GEL/CRM/OINT	270		78.00	N/A
HC62208236	DRAIN PLEURAL W/VAC BOTTLE	272		2,223.00	N/A
HC62208244	CLIP TISSUE MARKER	272	A4648	260.00	N/A
HC62208251	CATHETER ENTEROCLYSIS	272		722.00	N/A
HC62208277	KIT PERICARDIOCENTESIS	272		585.00	N/A
HC62208285	SET VAGINAL DILATORS	272		124.00	N/A
HC62208459	ACAPELLA DEVICE	270		252.00	N/A
HC62208467	NEEDLE GUIDE ENDOCAVITY	272		166.00	N/A
HC62208475	PROSTATE BIOPSY NEEDLE	272		697.00	N/A
HC62208483	PACK KYPHOPLASTY	272		86.00	N/A
HC62208491	PAD EXTERNAL CLOSURE	272		209.00	N/A
HC62208509	DISC COMPRESSION	270		46.00	N/A
HC62208525	STAPLER POWERED	272		722.00	N/A
HC62208533	BIT VERTEBROPLASTY	272		338.00	N/A
HC62208541	CANNULA WATERS	272		441.00	N/A
HC62208558	CONNECTOR COBE	272		125.00	N/A
HC62208566	HAND ACCESS DEVICE                B	272		780.00	N/A
HC62208582	VASCULAR PUNCH	272		393.00	N/A
HC62208590	KIT HEART LASER CO2	272		9,133.00	N/A
HC62208608	SYSTEM VEIN HARVESTING	272		2,961.00	N/A
HC62208616	VEST CHEST/AIRWAY CLEARANCE	270		257.00	N/A
HC62208624	PLUG STOPCOCK	272		13.00	N/A
HC62208632	DRIVER CATH CAPSULE EGD	272		542.00	N/A
HC62208640	ET PASTE STOMAHESIVE	272		120.00	N/A
HC62208657	ECP TIGHTS	270		59.00	N/A
HC62208665	FIBER LASER - GREEN LIGHT         T	272		3,955.69	N/A
HC62208673	GUIDEWIRE                         S	272	C1769	1,444.60	N/A
HC62208681	CATH HANDLE SINUS GUIDE	272		179.00	N/A
HC62208699	DEVICE INFLATE SINUS BALLOON	272		242.00	N/A
HC62208707	CATH GUIDE F S OR M SINUPLASTY	272	C1887	1,380.21	N/A
HC62208715	CATH BALLOON SINUPLASTY           I	272	C1726	2,274.04	N/A
HC62208723	CATHETER IRRIGATION SINUPLASTY	272		407.00	N/A
HC62208731	CATH BALLOON SINUPLASTY           J	272	C1726	2,600.00	N/A
HC62208749	ENDO LOOP MONO LINA GOLD	272		1,138.00	N/A
HC62208756	PADS BREAST HYDROGEL	270		29.00	N/A
HC62208764	SHIELD NIPPLE	270		14.00	N/A
HC62208772	M: SYSTEM FIXATION ABSORBABLE	278		N/A	N/A
HC62208798	CATH INTRACARDIAC ECHO/UTZ        C	272	C1759	3,900.00	N/A
HC62208806	CATH INTRAVASC ULTRASOUND	272	C1753	2,739.43	N/A
HC62208814	CATH PACING TRANSESOPHAGEAL	272	C1756	2,232.00	N/A
HC62208822	END CAP	272		20.00	N/A
HC62208830	VALVE HEMOSTATIC	272		111.00	N/A
HC62208848	INFUSION WIRE	272		260.00	N/A
HC62208871	SET DRAINAGE ANCHOR	272		247.00	N/A
HC62208889	ADVANCER ROTALINK	272		849.00	N/A
HC62208897	CABLE THRESHOLD	272		351.00	N/A
HC62208905	BALLOON VALVULOPLASTY	272	C1725	2,657.00	N/A
HC62208913	CATH PTCA BALLOON NON-LASER CRYO  Z	272	C1725	6,500.00	N/A
HC62208921	DEVICE EXCHANGE CATH/WIRE	272		224.00	N/A
HC62208939	SYSTEM CONTRAST SAVER	272		148.00	N/A
HC62208947	SYSTEM CONTRAST SPIKE/BAG	272		148.00	N/A
HC62208954	NEEDLE PERCUTANEOUS	272		178.00	N/A
HC62208962	CLIP WIRE ROTABLATOR	272		150.00	N/A
HC62208970	PADS DEFIBRILLATOR HANDS FREE	272		148.00	N/A
HC62208988	ROTABLATOR LUBRICANT	272		319.00	N/A
HC62208996	CATH DIAGNOSTIC RADIAL	272		208.00	N/A
HC62209002	SPLINT FOOT	270		553.00	N/A
HC62209010	IVS TUBING/CASSETTE PUMP	272		52.00	N/A
HC62209028	CATH SEGURA BASKET                R	272		683.00	N/A
HC62209036	LARYNGOSCOPE BLADE DISP INFANT	272		33.00	N/A
HC62209044	DRESSING SORBAVIEW	272		33.00	N/A
HC62209051	MATTRESS WAFFLE OVERLAY	270		85.00	N/A
HC62209085	HOOK PHLEBECTOMY	272		893.00	N/A
HC62209101	CT ELECTRODE SPRSLIM 2.0 CM EA	272		4,449.00	N/A
HC62209127	M: MISC GENERAL SUPPLY	270		932.82	N/A
HC62209135	TRAY ARTHROGRAM(DISP)	272		346.00	N/A
HC62209143	BLANKET TEMP MNGMNT SYSTEM/BOX	270		3,010.00	N/A
HC62209150	KIT TISSUE EXPANDER	272		1,908.00	N/A
HC62209168	STAPLE STONE/TABLE	272		330.00	N/A
HC62209176	DEVICE ABLATION GYN KIT	272		3,704.00	N/A
HC62209184	NEEDLE PERCUTANEOUS	272		170.00	N/A
HC62209192	CAP PIN PROTECTOR	272		13.00	N/A
HC62209200	BONE TUNNELING SYSTEM	272		637.00	N/A
HC62209226	SUTURE CAPTURING DEVICE(VAG)	272		497.00	N/A
HC62209234	TUBE T	272		62.00	N/A
HC62209259	SYSTEM ANASTOMOSIS DEVICE	272		2,418.00	N/A
HC62209267	KIT TUBING BREAST PUMP	272		91.00	N/A
HC62209275	MASK/SHADES BILI' LIGHTS	270		33.00	N/A
HC62209283	INFLATOR FOR BALLOON              K	272		275.76	N/A
HC62209291	BALLOON TAMPONADE GYN (BAKRI)	270	C1726	670.00	N/A
HC62209309	DECOMPRESSION SYSTEM-IO-FLEX	272		8,125.00	N/A
HC62209317	PROBE PH	272		325.00	N/A
HC62209325	DEVICE RETRIEVAL SPIDER NET       E	272		260.00	N/A
HC62209333	MANIFOLD INCL 4 PORT NEPTUNE	272		52.00	N/A
HC62209341	MANIFOLD SINGLE PORT NEPTUNE	272		16.00	N/A
HC62209358	APPLIER PORT RAPIDPORT EZ	272		2,258.00	N/A
HC62209366	POSITIONER FLUIDIZED SML Z-FLO	271		130.00	N/A
HC62209374	POSITIONER FLUIDIZED MED Z-FLO	271		455.00	N/A
HC62209382	BRUSH CYTOLOGY BRONCHIAL          G	272		315.00	N/A
HC62209390	BRUSH BIOPSY TRACKING	272		130.00	N/A
HC62209408	BRUSH CYTOLOGY NDLTIP TRACKING    E	272		178.00	N/A
HC62209416	CATH BASKET RETRIEVAL AIRWAY      Y	272		910.00	N/A
HC62209424	COIL MARKER FIDUCIAL	272	A4648	390.00	N/A
HC62209432	KIT LOCATABLE GUIDE (LARGE)	272		3,234.00	N/A
HC62209440	SENSOR SPHB, SPMET, SPO2	272		455.00	N/A
HC62209457	GLIDESCOPE GVL 0-2	272		62.00	N/A
HC62209465	GLIDESCOPE GVL 3-4	272		47.00	N/A
HC62209473	M:MISC GENERAL SURGERY SUPPLY	272		1,034.82	N/A
HC62209481	SPLINT WRIST PREFAB	274	L3984	143.00	N/A
HC62209499	CONTACT LENS REMOVER	270		35.00	N/A
HC62209507	M:MISC NEURO SURGERY SUPPLY	272		1,449.94	N/A
HC62209515	M:MISC PLASTIC SURGERY SUPPLY	272		N/A	N/A
HC62209523	M:MISC SPINE SURGERY SUPPLY	272		1,893.18	N/A
HC62209531	M:MISC SUPPLY ORTHO	272		1,001.72	N/A
HC62209549	M:MISC VASCULAR SURGERY SUPPLY	272		1,524.88	N/A
HC62209556	SYSTEM SINUS ILLUMINATION	272		1,395.00	N/A
HC62209564	TRACTION BUCKS UNIT	270		289.00	N/A
HC62209572	TRACTION CERVICAL UNIT	270		377.00	N/A
HC62209580	TRACTION KIRSCHNER WIRE UNIT	270		914.00	N/A
HC62209598	TRACTION PELVIC UNIT	270		553.00	N/A
HC62209606	TRACTION RUSSELLS UNIT	270		465.00	N/A
HC62209614	SLING CUFF AND COLLAR	270		147.00	N/A
HC62209622	SLING KODEL	270		163.00	N/A
HC62209630	SLING PELVIC CANVAS	270		306.00	N/A
HC62209648	CATH PASSER IDD THERAPY	272		319.00	N/A
HC62209655	KIT ACCESSORY IDD THERAPY	272		280.00	N/A
HC62209663	CATH ACCESS PORT IDD THERAPY	272		82.00	N/A
HC62209671	CATHETER IMPEDANCE PH	272		355.00	N/A
HC62209689	OVERTUBE ESOPHAGEAL	272		504.00	N/A
HC62209697	DEVICE CAPSULE ENDOSCP DELIVER	272		488.00	N/A
HC62209705	DEVICE HEMOSTATIC CLIPPING	272		598.00	N/A
HC62209713	FORCEP HOT BIOPSY                 G	272		434.00	N/A
HC62209721	G-TUBE DECLOGGER	272		140.00	N/A
HC62209739	STENT REMOVER                     F	272	C1773	780.00	N/A
HC62209747	CIRCUIT VENT HBO ADAPTABLE	272		202.00	N/A
HC62209754	IVS TUBING HBO ADAPTABLE	272		98.00	N/A
HC62209762	COMPARTM'L PRESS' MSRMT SUPPLY	272		352.00	N/A
HC62209770	TRANSCUTANEOUS MNTR SUPPLIES	272		208.00	N/A
HC62209788	KIT CATH LT HEART FLUSH DEVICE	272		140.00	N/A
HC62209796	KIT ACCESSORY PACEMAKER	272		139.00	N/A
HC62209804	KIT CATH RT HEART FLUSH DEVICE	272		57.00	N/A
HC62209812	DEVICE STABIL'ZN IAB STATLOCK	272		57.00	N/A
HC62209861	CATHETER MICRO CTO (CORSAIR)      W	272		3,250.00	N/A
HC62210133	TUBE TRACH PEDS/NEO CUFFED	272	A7521	577.82	N/A
HC62210141	CANNULA SAMPLING CO2 W/W-O O2	272		51.00	N/A
HC62210158	KIT PROVOC ASTHMA METHACHOLINE	272		118.00	N/A
HC62210166	CIRCUIT VENT KIT W/CHAMBER O2 ADAPT	272		126.00	N/A
HC62210174	HEADGEAR OPTILIFE	272		30.00	N/A
HC62210182	CATH EMBOLECTOMY ARTERIAL FOGARTY F	272	C1757	260.00	N/A
HC62210190	FORCEP BIOPSY DISP/TRACKING       E	272		358.00	N/A
HC62210208	NEEDLE BIOPSY TRACKING	272		260.00	N/A
HC62210224	NG CLOG ZAPPER KIT	270		126.00	N/A
HC62210232	FILTER CONT VENOVENOUS HEMO'EA	272		1,294.00	N/A
HC62210240	CANNULA ECMO	278		7,638.00	N/A
HC62210257	OXYGENATOR ECMO	272		4,281.00	N/A
HC62210265	PACK TUBING ECMO	272		1,058.00	N/A
HC62210273	SPLINT WRIST/ HAND RESTING	274	L3807	293.00	N/A
HC62210281	ORTHOTIC WHFO NO JOINT CONTOUR    E	274	L3807	195.00	N/A
HC62210299	CATH SUCTION ELBOW INLINE	272		98.00	N/A
HC62210307	TUBE REPOGLE 8 FRENCH	272		166.00	N/A
HC62210315	BALLOON BIOFEEDBACK	272	C1726	715.00	N/A
HC62210323	BALLOON EXPANDER AAA STENT	272	C1725	1,447.00	N/A
HC62210331	BALLOON SIZING SEPTAL DEFECT	272	C1725	897.00	N/A
HC62210349	BRA SURGICAL POST OP	270		55.07	N/A
HC62210356	COLLAR CERVICAL MIAMI J           D	274	L0172	130.00	N/A
HC62210364	DEVICE ELECTROSURG ABLAT ENDOVASC	272	C1888	8,125.00	N/A
HC62210372	DRESSING PROFORE BANDAGE SYS	272		42.00	N/A
HC62210380	EMBOLIC PROTECT SYSTEM; VASC      G	272	C1884	3,250.00	N/A
HC62210398	GUIDE ROD                         H	272		418.15	N/A
HC62210406	INSUFFLATOR LAPAROSCOPIC	272		38.00	N/A
HC62210414	KIT CASS KNEE NAVITRAKER	272		1,300.00	N/A
HC62210422	KIT INTRASPINAL TRIAL	272	C1755	429.00	N/A
HC62210430	KIT PUMP REFILL                   C	272		488.00	N/A
HC62210463	SUTURE ACCESSORY	272		384.00	N/A
HC62210471	GLOVE NEOPRENE W/THUMB SPLINT	271		26.00	N/A
HC62210489	LOOP THUMB ROLYAN	271		26.00	N/A
HC62210497	PROTECTOR PALM	271	A9270	26.00	N/A
HC62210505	BLOCK FOAM EXERCISE	271	A9300	26.00	N/A
HC62210513	GLOVE COMPRESSION OPEN FINGER	271	E1399	49.00	N/A
HC62210521	ORTHOTIC WHFO RESTING ADAPTABL    B	274	L3807	65.00	N/A
HC62210539	ORTHOTIC WHFO NO JOINT RESTING    G	274	L3807	325.00	N/A
HC62210547	ORTHTC HAND FUNCTIONL POSITION    D	274	L3807	130.00	N/A
HC62210554	ORTHOTIC LIMB UPPER /WRIST	274	L3999	65.00	N/A
HC62210562	CATH SELECT NEURO                 A	272	C1887	390.00	N/A
HC62210570	KIT ASPIRATION THROMBO NEURO	272		650.00	N/A
HC62210588	TUBING ASPIRATION NEURO	272		1,203.00	N/A
HC62210596	CATH THROMBECT DELIV INCL NEURO   M	272	C1887	1,950.00	N/A
HC62210604	GUIDEWIRE(MIRAGE/X-CELERATOR)     X	272	C1769	1,950.00	N/A
HC62210612	CATH MICRO NEURO(HEADWAY/MAGIC)   N	272	C1887	2,275.00	N/A
HC62210620	CATH ANGIO(BNCHMRK/ECHELN/EXCELSR/DAC57/HEADWY)Q	272	C1887	3,250.00	N/A
HC62210638	CATH GUIDING REPERFUS(MARKSMAN)   T	272	C1887	4,225.00	N/A
HC62210646	CATH BALLOON NEURO(SCEPTER)       B	272	C2628	4,550.00	N/A
HC62210653	DEVICE EMBOLIC PROTECT NEURO	272	C1884	6,484.00	N/A
HC62210661	DEVICE CLOT SEPARATOR NEURO      AD	272	C1887	9,100.00	N/A
HC62210679	DEVICE RETRIEVAL NEURO FB         F	272	C1773	9,750.00	N/A
HC62210687	SYSTEM MICRODELIVERY FOR STENT	272		18,334.00	N/A
HC62210695	DEVICE CLOSURE NEUROVASCULAR	278	C1760	6,338.00	N/A
HC62210703	SET DECOMPRESSION COLON	272		553.00	N/A
HC62210729	WRAP COMPRESSION KNEE/HIP	270		121.00	N/A
HC62210737	SYSTEM ENTERAL FEED PRESRELIEF	270		26.00	N/A
HC62210745	RETAINER NOSTRIL	272		130.00	N/A
HC62210752	CATH ACCESS DUODENOSCOPE	272		2,470.00	N/A
HC62210760	PROBE BILIARY DIRECT VISUAL	272		2,340.00	N/A
HC62210778	FORCEPS BILIARY BX (SPYBITE)	272		1,609.00	N/A
HC62210786	DEVICE ELECTROSURGICAL CUT-CAUTERY H	272		400.00	N/A
HC62210794	KIT INTRAOP PERFUSION (SPY)	272		3,883.75	N/A
HC62210802	SET PERITONEAL DIALYSIS	272		290.00	N/A
HC62210810	CAPSULE DISSOLVABLE DX RFID	270		98.00	N/A
HC62210828	POSITIONER FLUIDIZED UTILITY	271		98.00	N/A
HC62210836	POSITIONER FLUIDIZED FULL BODY	271		390.00	N/A
HC62210844	TRANSDCR OPTCL DATA  RSO2 P/A	271		390.00	N/A
HC62210851	TRANSDCR OPTCL DATARSO2WIRELSS	271		503.00	N/A
HC62210869	SPINAL HOOK DEVICE	272		260.00	N/A
HC62210885	M: CLAMP SPINAL	272		N/A	N/A
HC62210893	CIRCUIT VENT                      B	270		64.00	N/A
HC62210901	KIT PRESSURE MONITORING W/SWAN	272		131.00	N/A
HC62210919	KIT CARDIOPLEGIA CANNULA	272		358.00	N/A
HC62210927	CANNULA ENDO ARTERIAL	272		1,677.00	N/A
HC62210935	PACK LVAD/RVAD	272		975.00	N/A
HC62210943	SET CPS CIRCUIT PERFUSION	272		3,900.00	N/A
HC62210950	M: PERFUSION MISC SUPPLY	272		2,849.49	N/A
HC62210968	PUMP CENTRIFUGAL	272		397.00	N/A
HC62210976	COIL FLOW MID-CAB SHUNTS	272		374.00	N/A
HC62210984	PACK PERFUSION - ADULT	272		2,974.00	N/A
HC62210992	CANNULA AORTIC EASY FLOW	272		611.00	N/A
HC62211008	CANNULA AORTIC PEDS	272		319.00	N/A
HC62211016	CANNULA ARTERIAL PEDS             P	272		1,138.00	N/A
HC62211024	CANNULA ARTERIAL STRAIGHT         N	272		953.00	N/A
HC62211032	CANNULA AORTIC FEMORAL (CPS) EXISTS	272		676.00	N/A
HC62211040	CANNULA VENOUS FEMORAL            Q	272		1,381.00	N/A
HC62211057	CANNULA VENOUS STRAIGHT           K	272		576.00	N/A
HC62211065	CATHETER ENDOCLAMP	272		9,799.00	N/A
HC62211073	CATHETER ENDOVENT PULMONARY	272		4,615.00	N/A
HC62211081	CATHETER SINUS ENDO PLEDGE	272		6,744.00	N/A
HC62211099	RESERVOIR CELL SAVER              D	272		130.00	N/A
HC62211107	PACK CELL SAVER TUBING	272		211.00	N/A
HC62211115	TUBING SUCTION CELL SAVER	272		91.00	N/A
HC62211123	HOLDER SUTURE OCOTOBASE	272		325.00	N/A
HC62211131	KIT BLOWER/MISTER CLEARVIEW	272		732.00	N/A
HC62211149	OXYGENATOR PEDIATRIC              C	272		2,048.00	N/A
HC62211156	PACK SUCTION SUPPLEMENT	272		147.00	N/A
HC62211164	SENSOR GAS CBP	272		446.00	N/A
HC62211172	KIT PERFUSION - PEDS	272		1,804.00	N/A
HC62211180	RETRACTOR HEART POSITIONER	272		2,322.00	N/A
HC62211198	STABILIZER HEART OCTOPUS          O	272		5,850.00	N/A
HC62211206	KIT PERITONEAL LAVAGE	272		109.00	N/A
HC62211214	INJECTOR UTERINE	272		257.00	N/A
HC62211222	INJECTOR UTERINE	272		257.00	N/A
HC62211230	CATH CHEST(ARGYLE)	272		53.00	N/A
HC62211248	M: ROD MAXILLOFACIAL	278	L8699	N/A	N/A
HC62211255	SYSTEM DELIVERY SEPTAL DEFECT	272		1,963.00	N/A
HC62211263	SYSTEM EXCHANGE SEPTAL DEFECT	272		1,963.00	N/A
HC62211271	AUTO TRANSFUSION SUPPLIES	270		1,256.00	N/A
HC62211289	NG CLOG ZAPPER KIT	272		70.00	N/A
HC62211313	KIT VENT THORACIC (URESIL)	272		748.00	N/A
HC62211321	NEEDLE CATH CENTESIS/CV	272	C1729	61.00	N/A
HC62211339	TUBE TRACH CUFFED                 E	272	A7521	195.05	N/A
HC62211347	TUBE TRACH NO-CUFF                D	272	A7520	130.00	N/A
HC62211354	DRESSING SACRUM 18X18CM (MEPILEX)	272		25.00	N/A
HC62211362	DRESSING SACRUM 23X23CM (MEPILEX)	272		35.00	N/A
HC62211370	OXISENSOR ADULT OR PEDS	272		33.00	N/A
HC62211388	TRAY CIRCUMCISION DISPOSABLE	272		42.00	N/A
HC62211396	IVS-INTL PERIPH SUPPLIES/TUBINGS	272		38.00	N/A
HC62211404	KIT VENTRICULOSTOMY ACCESS	272	A4301	1,014.00	N/A
HC62211412	SYSTEM VENTRICULAR DRAINAGE	272	A4301	852.00	N/A
HC62211420	SENSOR PRESSURE HEMODYN (FLOTRAC)	272		978.00	N/A
HC62211438	TUBE TRACH CUFFED ADJUSTABLE      G	272	A7521	325.00	N/A
HC62211446	AIRWAY MASK LARYNGEAL (LMA)	272		42.00	N/A
HC62211453	NEBULIZER W/ RESERVOIR	272		17.00	N/A
HC62211461	CATH GUID NEURO/PERIPH(DI058X115/NAVIEN)W	272	C1887	5,200.00	N/A
HC62211479	PROBE VASCULAR PARSONNET	272		226.00	N/A
HC62211487	PACK CATARACT CUSTOM	272		1,112.00	N/A
HC62211503	BLADE INCISIONAL                  M	272		845.00	N/A
HC62211511	BLADE SAW                         L	272		176.00	N/A
HC62211529	INSERTER TIP SURGICAL             L	272		650.00	N/A
HC62211537	SCREW EXTRACTOR BOLT	272		397.00	N/A
HC62211545	CATH IRRIG/DRAIN SINUSPLASTY	272		503.00	N/A
HC62211552	NEEDLE ACCESS SPINAL INSULATED	272		894.00	N/A
HC62211560	CATH BALLOON SINUPLASTY           G	272	C1726	1,625.00	N/A
HC62211578	SET TUBING DUAL WND IRRIG/SUCTN	272		243.00	N/A
HC62211586	CASSETTE WND IRRIG/SUCTN	272		178.00	N/A
HC62211594	DRESSING HYDROCOLLD WND FILLER	272		27.00	N/A
HC62211602	DRESSING HYDROGEL WND FILLER SM	272		46.00	N/A
HC62211610	DEVICE COMPRESSION RADIAL	272		73.00	N/A
HC62211628	PAD TEMP MNGMNT SYSTEM/BOX	272		1,079.00	N/A
HC62211636	CATH SUCTION INLINE CLOSED RESP	272		57.00	N/A
HC62211644	CATH ANGIOGRAPHY                  B	272	C1887	64.90	N/A
HC62211651	DRESSING ANTIMIC PROTECTV DISC	272		13.00	N/A
HC62211669	CATH DRAINAGE                     Y	272	C1729	3,900.00	N/A
HC62211677	CATH SUCTION REPLOGLE NG	272		29.00	N/A
HC62211685	KIT DRESSING WOUND NEG PRESSURE   E	272		390.00	N/A
HC62211693	DRESSING SACRUM<324CM SQ(MEPILEX)	272		18.00	N/A
HC62211701	CATHETER ASPIRATION	272		133.00	N/A
HC62211719	DRESSING HYDROGEL WND FILLER LG	272		355.00	N/A
HC62211727	KIT POSITNR FLUIDZD FB+UTIL W-COVER	270		519.00	N/A
HC62211735	CATH GUIDING DEFLECTABLE          T	272	C1887	2,275.00	N/A
HC62211743	CATH GUIDING DEFLECTABLE          Z	272	C1887	6,175.00	N/A
HC62211750	KIT CATH IV PERIPH LONGTERM	272		156.00	N/A
HC62211768	CATH BALLOON PTA(GATEWAY)         S	272	C1725	3,900.00	N/A
HC62211776	CATH PTA ANGIOPLS BALLOON NON-LSR Q	272	C1725	2,600.00	N/A
HC62211784	GUIDEWIRE(X-PEDION ANGIO)         Q	272	C1769	1,138.00	N/A
HC62211800	CIRCUIT VENT O2 HIGH FLOW THERAPY	272		302.00	N/A
HC62211818	CATH ANGIO MICRO(DIAG/MARTHN/EXCLSR)Q	272	C1887	2,763.48	N/A
HC62211826	PAD STOMA TRACHEOSTOMY	272		52.00	N/A
HC62211834	DEVICE THROMBECT MECH NEURO       D	272	C1757	23,563.00	N/A
HC62211842	CATH MICRO'P'VASC INJECT SOL/COIL P	272	C1887	3,250.00	N/A
HC62211859	KIT/SYS CATH MICRO'P'VASC INJ/COIL DEL	272	C1887	1,300.00	N/A
HC62211867	CATH PTCA ANGIOPLASTY NON-LASER   M	272	C1725	1,625.00	N/A
HC62211875	NEEDLE ENDOSCOPIC                 J	272		520.00	N/A
HC62211883	TRAY FOLEY CATH STATLOCK	272	A4314	52.00	N/A
HC62211891	TRAY URINEMETER ADD A FOLEY IC	272	A4354	43.00	N/A
HC62211909	SET VACUUM CANNISTER W/GEL	272		156.66	N/A
HC62211917	DSG ABD ABTHERA OPEN	272		1,196.00	N/A
HC62211925	CATH SHEATH GUIDING	272	C1887	195.00	N/A
HC62211933	STAPLER ENDO POWERED	272		1,015.00	N/A
HC62211941	DRESSING SACRUM10X20CM(MEPILEX)	272	A6212	66.00	N/A
HC62211958	KIT CRICOTHYROTOMY EMERGENCY      H	272	A7520	390.00	N/A
HC62211966	GUIDEWIRE BILIARY CURVED TIP      H	272	C1769	488.00	N/A
HC62211974	SPHINCTEROTOME CANNULATING        L	272		1,560.00	N/A
HC62211982	TIP PROBE SUCTION LAPARASCOPIC	272		477.00	N/A
HC62212006	CATH BALLOON SIZING HALO ESOPH    Q	272	C1726	1,300.00	N/A
HC62212014	GUIDEWIRE(E.G. HALO/SUPER STIFF)  G	272	C1769	423.00	N/A
HC62212022	CAP ENDO HALO	272		92.00	N/A
HC62212030	CANNULA PERFUSN VENOUS FEMORAL    M	272		811.00	N/A
HC62212048	BLADE BONE/ENDO SHAVER            C	272		195.00	N/A
HC62212055	SET AUTOTRANSFUSE CONSTAVAC       A	272	C1729	52.00	N/A
HC62212063	CATH ANGIOG PERIPH CTO CROSSING  AQ	272	C1887	13,000.00	N/A
HC62212071	HEMOSTATIC GEL/GELFOAM/PAD        D	272		104.00	N/A
HC62212105	TIP CAUTERY SINGLE USE ROBOTIC	272		293.00	N/A
HC62212113	PORT SINGLE-SITE ROBOTIC	272		488.00	N/A
HC62212139	TUBE FEEDING ENTERAL NG W/O STYLET	272	B4082	40.00	N/A
HC62212147	TUBE FEEDING ENTERAL NG W/STYLET	272	B4081	52.00	N/A
HC62212154	TUBE GASTROSTOMY STRD BUTTON/NONE A	272	B4087	33.00	N/A
HC62212162	TUBE FEEDING NG >36IN-NO STYLET	272		90.00	N/A
HC62212170	TUBE FEEDING NG>36IN TRACKABLE STYLET	272		164.00	N/A
HC62212188	CATH BALLOON SINUPLASTY SYSTEM    J	272	C1726	2,600.00	N/A
HC62212196	CATH PTA ANGIOPLS BALLOON NON-LSR E	272	C1725	455.00	N/A
HC62212204	CATH ANGIOGRAPHY W/BALLOON        E	272	C1887	195.00	N/A
HC62212212	CATH PTCA BALLOON NON-LASER       E	272	C1725	650.00	N/A
HC62212220	COLLAR CERV SEMI-RIDG OCC/MAND SUP	274	L0160	35.00	N/A
HC62212238	COLLAR CERV CALIF TRACH	274	L0172	34.00	N/A
HC62212246	MARKER DEVICE BIOPSY	272	A4648	220.00	N/A
HC62212253	TROCAR ENDO W-W/O SLEEVE	272		83.00	N/A
HC62212261	CATH ANGIOG GUIDING(SLIP/GLIDE)   E	272	C1887	195.00	N/A
HC62212279	KIT INTRODUCER PERC MRI VISIBLE	272		792.00	N/A
HC62212287	FORCEP BIOPSY URETEROSCOP DISP	272		1,053.00	N/A
HC62212295	CATH RETRIEV STONE BACKSTOP GEL  AI	272		1,235.00	N/A
HC62212303	GUIDEWIRE(E.G. BENTSON)           A	272	C1769	33.04	N/A
HC62212311	GUIDEWIRE(ADVANTAGE/URO ANGLE/STRGHT)J	272	C1769	618.00	N/A
HC62212329	COLLAR CERV RIGID TRACHEA OPEN LG	274	L0172	52.00	N/A
HC62212337	COLLAR CERVICAL MIAMI J PEDS      E	274	L0172	195.00	N/A
HC62212345	COLLAR CERV 2 PIECE W-THORA EXTN	274	L0174	868.00	N/A
HC62212352	PAD COLLAR REPLACEMENT	274	L4210	68.00	N/A
HC62212360	M: BLADE MICRODEBRIDER	272		N/A	N/A
HC62212378	INTRODUCER/SHEATH                 A	272	C1894	33.00	N/A
HC62212386	INTRODUCER/SHEATH(PINNACL 25CM/VSI)B	272	C1894	64.99	N/A
HC62212394	INTRODUCER/SHEATH                 K	272	C1894	554.19	N/A
HC62212402	INTRODUCER/SHEATH                 L	272	C1894	650.00	N/A
HC62212410	INTRODUCER/SHEATH                 M	272	C1894	715.00	N/A
HC62212428	INTRODUCER/SHEATH                 O	272	C1894	822.25	N/A
HC62212436	INTRODUCER/SHEATH                 P	272	C1894	910.00	N/A
HC62212444	INTRODUCER/SHEATH                 Q	272	C1894	975.00	N/A
HC62212451	INTRODUCER/SHEATH                 T	272	C1894	1,518.83	N/A
HC62212469	LARYNGOSCOPE BLADE W-HANDLE DISP	272		51.00	N/A
HC62212477	LARYNGOSCOPE HANDLE ONLY DISP	270		72.00	N/A
HC62212485	HANDPIECE VESSEL SEALER DEVICE    C	272		1,625.00	N/A
HC62212493	KIT PUMP REFILL SYNCHROMED	272	A4220	65.00	N/A
HC62212501	ELECTRODE UROLOGICAL/ELECTROSURGICL	272		1,405.72	N/A
HC62212519	CATH MICRO NEURO(ARC132)         AA	272	C1887	6,500.00	N/A
HC62212527	INTRODUCER/SHEATH                 Y	272	C1894	3,210.00	N/A
HC62212535	FORCEP BIOPSY DISP                C	272		163.00	N/A
HC62212543	FORCEP BIOPSY DISP                D	272		228.00	N/A
HC62212550	FORCEP BIOPSY DISP                H	272		488.00	N/A
HC62212568	FORCEP BIOPSY DISP                I	272		553.00	N/A
HC62212576	NEEDLE BIOPSY EBUS	272		372.00	N/A
HC62212584	CATH PTCA BALLOON NON-LASER       D	272	C1725	520.00	N/A
HC62212592	CATH PTCA BALLOON NON-LASER       F	272	C1725	780.00	N/A
HC62212600	CATH PTCA BALLOON NON-LASER       G	272	C1725	910.00	N/A
HC62212618	CATH PTCA BALLOON NON-LASER       H	272	C1725	975.00	N/A
HC62212626	CATH PTCA BALLOON NON-LASER       I	272	C1725	1,040.00	N/A
HC62212634	CATH PTCA BALLOON NON-LASER       J	272	C1725	1,105.00	N/A
HC62212642	CATH PTCA BALLOON NON-LASER       L	272	C1725	1,448.96	N/A
HC62212659	CATH MICRO CTO/REPRFNS(ENTEER/5MAX ACE)AJ	272	C1887	8,450.00	N/A
HC62212667	CATHETER MICRO CTO(VIANCE)       AG	272	C1887	6,500.00	N/A
HC62212675	GUIDEWIRE(COONS/ROSEN)            B	272	C1769	98.51	N/A
HC62212683	GUIDEWIRE(GLIDEWIRE ANGL)         C	272	C1769	162.42	N/A
HC62212691	GUIDEWIRE                         D	272	C1769	227.95	N/A
HC62212709	GUIDEWIRE                         F	272	C1769	357.90	N/A
HC62212717	GUIDEWIRE(NITREX)                 I	272	C1769	553.00	N/A
HC62212725	GUIDEWIRE                         L	272	C1769	748.00	N/A
HC62212733	GUIDEWIRE                         M	272	C1769	813.00	N/A
HC62212741	GUIDEWIRE                         N	272	C1769	878.00	N/A
HC62212758	GUIDEWIRE                         O	272	C1769	1,008.00	N/A
HC62212766	GUIDEWIRE                         R	272	C1769	1,268.00	N/A
HC62212774	GUIDEWIRE(SYNCHRO/TRANSEND)       T	272	C1769	1,463.00	N/A
HC62212782	GUIDEWIRE(CHIKAI)                 U	272	C1769	1,593.00	N/A
HC62212790	GUIDEWIRE(AVIGO/NEURVSCLR SFT TIP)V	272	C1769	1,723.00	N/A
HC62212808	GUIDEWIRE                         W	272	C1769	1,853.00	N/A
HC62212816	GUIDEWIRE                         Y	272	C1769	2,178.00	N/A
HC62212824	GUIDEWIRE                         Z	272	C1769	2,275.00	N/A
HC62212832	GUIDEWIRE                        AA	272	C1769	2,373.00	N/A
HC62212840	STYLET CARDIAC                    G	272		390.00	N/A
HC62212857	TUBING IRRIGATION MICRODEBRIDER	272		98.00	N/A
HC62212865	BLADE BONE SHAVER                 B	272		130.00	N/A
HC62212873	BLADE SHAVER                      D	272		260.00	N/A
HC62212881	BLADE SHAVER ORTHO                E	272		325.00	N/A
HC62212899	BLADE SHAVER                      G	272		455.00	N/A
HC62212907	BLADE SHAVER                      H	272		520.00	N/A
HC62212915	BLADE SHAVER                      I	272		643.50	N/A
HC62212923	BLADE SHAVER                      J	272		650.00	N/A
HC62212931	BLADE SHAVER                      K	272		715.00	N/A
HC62212949	BLADE SHAVER                      L	272		780.00	N/A
HC62212956	BLADE SHAVER                      M	272		656.66	N/A
HC62212964	BLADE SHAVER                      N	272		910.00	N/A
HC62212972	BLADE SHAVER                      O	272		975.00	N/A
HC62212980	BLADE SHAVER                      P	272		1,040.00	N/A
HC62212998	BLADE SHAVER                      Q	272		1,105.00	N/A
HC62213004	BLADE SHAVER                      R	272		1,170.00	N/A
HC62213012	BLADE SHAVER                      S	272		1,235.00	N/A
HC62213020	BLADE SHAVER                      T	272		1,300.00	N/A
HC62213038	BLADE SHAVER                      U	272		1,365.00	N/A
HC62213046	BLADE SHAVER                      V	272		1,430.00	N/A
HC62213053	BLADE SHAVER                      W	272		1,495.00	N/A
HC62213061	BLADE SHAVER                      X	272		1,560.00	N/A
HC62213079	BLADE SHAVER                      Z	272		1,625.00	N/A
HC62213087	BLADE KNIFE                       B	272		130.00	N/A
HC62213095	BLADE INCISIONAL ORTHO            E	272		325.00	N/A
HC62213103	BLADE INCISIONAL                  H	272		520.00	N/A
HC62213111	BLADE INCISIONAL                  I	272		585.00	N/A
HC62213129	BLADE INCISIONAL                  J	272		650.00	N/A
HC62213137	BLADE INCISIONAL                  K	272		715.00	N/A
HC62213145	BLADE OSTEOTOME/CUP               J	272		780.00	N/A
HC62213152	BLADE INCISIONAL                  N	272		910.00	N/A
HC62213160	BLADE INCISIONAL                  O	272		975.00	N/A
HC62213178	BURR                              A	272		65.45	N/A
HC62213186	BURR                              C	272		194.27	N/A
HC62213194	BURR                              D	272		291.20	N/A
HC62213202	BURR                              H	272		517.58	N/A
HC62213210	BURR                              I	272		585.00	N/A
HC62213228	BURR                              J	272		650.00	N/A
HC62213236	BURR                              K	272		715.00	N/A
HC62213244	BURR                              L	272		780.05	N/A
HC62213251	BURR                              M	272		569.35	N/A
HC62213269	BURR                              N	272		910.00	N/A
HC62213277	BURR                              O	272		975.00	N/A
HC62213285	BURR                              P	272		1,040.00	N/A
HC62213293	BURR                              Q	272		1,105.00	N/A
HC62213301	BURR                              R	272		1,170.00	N/A
HC62213319	BURR                              S	272		1,381.71	N/A
HC62213327	PACK LAP GASTRIC BY-PASS	272		10,117.00	N/A
HC62213335	CATH ATHERECTOMY ROTATNL (STEALTH)	272	C1724	11,034.00	N/A
HC62213343	STOCKINGS TED HOSE KNEE HI	272	A4500	33.00	N/A
HC62213350	KIT NEBULIZER AERONEB SOLO	272	E0574	139.00	N/A
HC62213368	REAMER                            G	272		260.00	N/A
HC62213376	REAMER                            H	272		325.00	N/A
HC62213384	REAMER                            I	272		383.98	N/A
HC62213392	REAMER                            J	272		455.00	N/A
HC62213400	REAMER                            K	272		520.00	N/A
HC62213418	REAMER                            L	272		585.00	N/A
HC62213426	REAMER                            M	272		830.97	N/A
HC62213434	REAMER                            N	272		577.69	N/A
HC62213442	REAMER                            O	272		780.00	N/A
HC62213459	REAMER                            P	272		845.00	N/A
HC62213467	REAMER                            Q	272		920.83	N/A
HC62213475	REAMER                            R	272		975.00	N/A
HC62213483	REAMER                            S	272		1,039.93	N/A
HC62213491	REAMER                            T	272		4,101.50	N/A
HC62213509	REAMER                            U	272		1,170.00	N/A
HC62213517	REAMER                            V	272		1,235.00	N/A
HC62213525	REAMER                            W	272		1,300.00	N/A
HC62213533	REAMER                            X	272		1,365.00	N/A
HC62213541	REAMER                            Y	272		1,430.00	N/A
HC62213558	REAMER                            Z	272		1,495.00	N/A
HC62213566	REAMER                            AA	272		1,560.16	N/A
HC62213574	REAMER                            AB	272		1,625.00	N/A
HC62213582	REAMER                            AC	272		1,690.00	N/A
HC62213590	REAMER                            AD	272		1,755.00	N/A
HC62213608	REAMER                            AE	272		1,683.76	N/A
HC62213616	REAMER                            AF	272		1,885.00	N/A
HC62213624	APPLICATOR/TIP SYRINGE ONLY       E	272		195.00	N/A
HC62213632	CANNULA AORTIC FILTERING	272		1,381.00	N/A
HC62213640	CANNULA TROCAR	272		488.00	N/A
HC62213657	CATHETER PICC PEDS	272	C1751	325.00	N/A
HC62213665	WOUND FILLER DRY FORM PER GM	272	A6262	156.00	N/A
HC62213681	CANNULA ARTERIAL                  A	272		130.00	N/A
HC62213699	FORCEP OPTHALMIC DISPOSABLE	272		507.00	N/A
HC62213707	PACK CATARACT CUSTOM W/O BSS	272		174.00	N/A
HC62213715	NEEDLE MICROTIP/TIP PHACOEMULS	272		200.00	N/A
HC62213723	GAS INTRAOCULAR                   A	272		276.00	N/A
HC62213731	PACK VITRECTOMY W/O BSS	272		168.00	N/A
HC62213749	KIT VITREORETINAL PERFLUORON 5ML	272	C1784	1,470.00	N/A
HC62213756	KIT VITREORETINAL PERFLUORON 7ML	272	C1784	2,131.00	N/A
HC62213764	BAG AUTOTRANSFUSION	272		39.00	N/A
HC62213772	DRESSING TUBE W/-W/O ELASTIC PER YD	272	A6457	35.00	N/A
HC62213780	CANNULA ARTHROSCOPIC              C	272		98.06	N/A
HC62213798	CANNULA INFUSION/IRRIG OPHTH	272		81.00	N/A
HC62213806	SEAL ENDO ROBOTIC                 B	272		65.00	N/A
HC62213814	DRESSING THERABOND	272		26.00	N/A
HC62213822	NEEDLE SURG OPTHALMIC	272		70.00	N/A
HC62213830	KIT DRESSING	272		40.00	N/A
HC62213848	KIT CATH HEART RT	272		43.00	N/A
HC62213855	NEEDLE NERVE/REGION BLOCK	272		51.00	N/A
HC62213863	PACK MINOR ACCESSORY	272		35.00	N/A
HC62213871	PROBE MYOCARDIAL TEMP	272		52.00	N/A
HC62213889	SET IRRIG TUBING LAPAROSCOPY	272		95.00	N/A
HC62213897	TIP SUCTION/IRRIG	272		34.01	N/A
HC62213905	KIT REPAIR BAG PLEURAL DRAINAGE	272		40.00	N/A
HC62213913	SLEEVE VITRECTOMY	272		117.00	N/A
HC62213921	DRESSING DYNA-FLEX	272		36.00	N/A
HC62213939	CANNULA PERFUSION                 F	272		260.31	N/A
HC62213947	BLADE INCISIONAL                  A	272		65.00	N/A
HC62213954	BLADE SHAVER                      A	272		65.00	N/A
HC62213962	BURR                              B	272		130.00	N/A
HC62213970	CATH PTCA BALLOON NON-LASER       B	272	C1725	260.00	N/A
HC62213988	CATH PTCA BALLOON NON-LASER       C	272	C1725	390.00	N/A
HC62213996	FORCEP BIOPSY DISP                A	272		49.00	N/A
HC62214002	FORCEP BIOPSY DISP                B	272		98.00	N/A
HC62214010	SET CATH CVC QUAD LUMEN	272		243.00	N/A
HC62214028	DRESSING NONADHERENT OWENS	272		38.00	N/A
HC62214036	SPLINT FOOT DROP PREFAB	274	L4398	82.00	N/A
HC62214044	DEVICE PRESS BONE (HENSLER)	272		1,268.00	N/A
HC62214051	CLAMP ABLATION (ISOL SYNERGY)	272		9,132.50	N/A
HC62214069	SET AUTOTRANSFUS(CONSTAVAC CBCII)AP	272		2,340.00	N/A
HC62214077	CANNULA TARGETNG NEEDLE(STREAMLINE)	272		516.00	N/A
HC62214085	NEEDLE TROCAR TARGET(STREAMLINE)  M	272		722.00	N/A
HC62214093	NEEDLE TARGETING(STREAMLINE)      Q	272		1,235.00	N/A
HC62214101	CATH URETERAL                     A	272	C1758	13.00	N/A
HC62214119	CATH URETERAL                     B	272	C1758	26.00	N/A
HC62214127	CATH URETERAL                     C	272	C1758	39.46	N/A
HC62214135	CATH URETERAL                     D	272	C1758	52.00	N/A
HC62214143	CATH URETERAL                     E	272	C1758	65.00	N/A
HC62214150	CATH URETERAL                     F	272	C1758	78.00	N/A
HC62214168	CATH URETERAL                     G	272	C1758	91.00	N/A
HC62214176	CATH URETERAL                     I	272	C1758	117.00	N/A
HC62214184	CATH URETERAL                     J	272	C1758	130.00	N/A
HC62214192	CATH URETERAL                     K	272	C1758	156.00	N/A
HC62214200	CATH URETERAL                     L	272	C1758	182.00	N/A
HC62214218	CATH URETERAL                     N	272	C1758	234.00	N/A
HC62214226	CATH URETERAL                     O	272	C1758	260.00	N/A
HC62214242	CATH URETERAL                     Q	272	C1758	312.00	N/A
HC62214259	CATH URETERAL                     R	272	C1758	338.00	N/A
HC62214267	CATH URETERAL                     S	272	C1758	354.25	N/A
HC62214275	CATH URETERAL                     T	272	C1758	390.00	N/A
HC62214283	CATH URETERAL                     U	272	C1758	416.00	N/A
HC62214291	CATH URETERAL                     W	272	C1758	468.00	N/A
HC62214309	CATH URETERAL                     X	272	C1758	494.00	N/A
HC62214317	CATH URETERAL                     Y	272	C1758	520.00	N/A
HC62214325	CATH URETERAL                     Z	272	C1758	546.00	N/A
HC62214333	CLAMP INSERT	272		30.00	N/A
HC62214341	PROBE PEDICLE	272		1,004.00	N/A
HC62214358	TUBING AUTOTRANSFUSE              B	272		65.00	N/A
HC62214366	SET AUTOTRANSFUSE                 S	272		442.00	N/A
HC62214374	SHEARS COAGULATING HARMONIC       N	272		975.00	N/A
HC62214382	STAPLE CARTRG/RELOAD LIN CUT      N	272		358.00	N/A
HC62214390	STYLET TUNNELING DIALYSIS	272		625.00	N/A
HC62214408	TROCAR ENDO                       A	272		46.00	N/A
HC62214416	DEVICE PASSING NEEDLE ARTHR	272		455.00	N/A
HC62214424	KNIFE CANNULATED RETRACT	272		587.91	N/A
HC62214432	NEEDLE INJ FENESTRATED	272		130.00	N/A
HC62214440	KIT ARTHROSCOPY DISPSBLS          R	272		1,463.00	N/A
HC62214457	SUTURE SET FOOT/ANKLE	272		3,088.00	N/A
HC62214465	CHARGER BATTERY NEUROSTIM         A	270		4,645.21	N/A
HC62214473	CHARGER BATTERY NEUROSTIM         B	270		8,187.00	N/A
HC62214499	RETRACTOR DISPOSABLE              E	272		325.00	N/A
HC62214507	RETRACTOR DISPOSABLE              F	272		443.46	N/A
HC62214515	RETRACTOR DISPOSABLE              G	272		585.00	N/A
HC62214523	RETRACTOR DISPOSABLE              H	272		715.00	N/A
HC62214531	RETRACTOR DISPOSABLE              I	272		845.00	N/A
HC62214549	RETRACTOR DISPOSABLE              J	272		975.00	N/A
HC62214556	RETRACTOR DISPOSABLE              K	272		1,105.00	N/A
HC62214564	CLIP STIMULATION NERVE            E	272		910.00	N/A
HC62214572	PROBE ELECTROSURG LAPARASCOPIC DISP	272		361.00	N/A
HC62214580	KIT SPINAL ACCESS DISPOSBL(MAXCESS)	272		4,160.00	N/A
HC62214598	PROBE CATH V-PACING TRANSLUM	272		376.00	N/A
HC62214606	SYRINGE BONE MARROW ASPIRATION 10CC	272		694.00	N/A
HC62214614	SYRINGE BONE MARROW ASPIRATION 20CC	272		1,232.00	N/A
HC62214622	ADAPTER SIDEARM ENDO	272		46.00	N/A
HC62214630	CAP KIT LEAD PACEMAKER            A	272		65.00	N/A
HC62214648	CAP KIT LEAD PACEMAKER            B	272		113.00	N/A
HC62214655	DEVICE SUTURE ENDO                C	272		130.07	N/A
HC62214663	KIT SEALANT FIBRIN	272		173.64	N/A
HC62214671	STAPLE CARTRG/ENDO RELOAD         B	272		65.06	N/A
HC62214689	TIP SUCTION OPTHALMIC	272		96.00	N/A
HC62214697	VALVE ENDOSCOPIC                  A	272		33.00	N/A
HC62214705	ADAPTER PTCA W/GUIDEWIRE	272	C1769	277.00	N/A
HC62214713	CATH PTCA BALLOON NON-LASER       N	272	C1725	1,950.00	N/A
HC62214721	CATH PTA ANGIOPLS BALLOON NON-LSR P	272	C1725	2,275.00	N/A
HC62214739	CATH PTCA BALLOON NON-LASER       P	272	C1725	2,600.00	N/A
HC62214747	CATH PTA ANGIOPLS BALLOON NON-LSR S	272	C1725	3,250.00	N/A
HC62214754	CATH PTCA BALLOON NON-LASER       T	272	C1725	3,900.00	N/A
HC62214762	CATH PTCA BALLOON NON-LASER       U	272	C1725	4,225.00	N/A
HC62214770	CATH PTCA BALLOON NON-LASER       V	272	C1725	4,550.00	N/A
HC62214788	CATH PTCA BALLOON NON-LASER       W	272	C1725	4,875.00	N/A
HC62214796	CATH PTA ANGIOPLS BALLOON NON-LSR Y	272	C1725	5,200.00	N/A
HC62214804	CATH PTCA BALLOON NON-LASER       Y	272	C1725	5,850.00	N/A
HC62214812	BASKET RETRIEVAL                  F	272		286.00	N/A
HC62214945	BLADE CUP                         N	272		910.00	N/A
HC62214952	BLADE CUP/OSTOETOME               O	272		943.00	N/A
HC62215082	BLADE CUP                        AB	272		1,950.00	N/A
HC62215157	BLADE SAW                         A	272		13.00	N/A
HC62215165	BLADE SAW                         B	272		26.00	N/A
HC62215173	BLADE SAW                         C	272		39.00	N/A
HC62215181	BLADE SAW                         D	272		52.00	N/A
HC62215199	BLADE SAW                         E	272		65.00	N/A
HC62215207	BLADE SAW                         F	272		78.00	N/A
HC62215215	BLADE SAW                         G	272		91.00	N/A
HC62215223	BLADE SAW                         H	272		104.21	N/A
HC62215231	BLADE SAW                         I	272		116.73	N/A
HC62215249	BLADE SAW                         J	272		130.00	N/A
HC62215256	BLADE SAW                         K	272		155.94	N/A
HC62215264	BLADE SAW                         M	272		342.19	N/A
HC62215272	BLADE SAW                         N	272		234.00	N/A
HC62215280	BLADE SAW                         O	272		260.00	N/A
HC62215298	BLADE SAW                         P	272		286.00	N/A
HC62215306	BLADE SAW                         Q	272		326.76	N/A
HC62215314	BLADE SAW                         R	272		338.00	N/A
HC62215322	BLADE SAW                         S	272		364.00	N/A
HC62215330	BLADE SAW                         T	272		390.00	N/A
HC62215348	BLADE SAW                         U	272		416.00	N/A
HC62215355	BLADE SAW                         V	272		333.09	N/A
HC62215363	BLADE SAW                         W	272		468.00	N/A
HC62215371	BLADE SAW                         X	272		394.91	N/A
HC62215389	BLADE SAW                         Y	272		520.00	N/A
HC62215397	BLADE SAW                         Z	272		546.00	N/A
HC62215405	DEVICE SUTURE ENDOSCOPIC          K	272		1,300.00	N/A
HC62215413	DEVICE TROCHANTER GALILEO	272		293.00	N/A
HC62215421	ELECTRODE SURGICAL	272		98.08	N/A
HC62215439	FORCEPS BIPOLAR DISPOSABLE        K	272		585.00	N/A
HC62215447	KIT DECOMPRESSION SPINAL          C	272		1,950.00	N/A
HC62215454	KIT DECOMPRESSION SPINAL          D	272		3,900.00	N/A
HC62215462	KIT HARVESTING BONE GRAFT         W	272		3,250.00	N/A
HC62215470	KNIFE BAYONET                     A	272		433.67	N/A
HC62215488	KNIFE BAYONET                     G	272		1,073.00	N/A
HC62215496	PROBE SPINAL DISPOSABLE          AA	272		2,091.38	N/A
HC62215504	PROBE SPINAL DISPOSABLE           D	272		585.00	N/A
HC62215512	RETRACTOR TUBE SPINAL ENDOSCOPIC	272		937.00	N/A
HC62215520	RETRIEVER STENT BILI SOEHENDRA	272		407.00	N/A
HC62215538	ROD WORKING SPINAL	272		282.00	N/A
HC62215546	SUTURE                            A	272		13.00	N/A
HC62215553	SUTURE                            E	272		117.01	N/A
HC62215561	SUTURE                            F	272		142.70	N/A
HC62215579	SUTURE                            H	272		195.01	N/A
HC62215587	SUTURE                            I	272		220.24	N/A
HC62215595	SUTURE                            J	272		244.97	N/A
HC62215603	SUTURE                            K	272		273.00	N/A
HC62215611	SUTURE                            L	272		299.00	N/A
HC62215629	SUTURE                            M	272		325.00	N/A
HC62215637	SUTURE                            N	272		351.00	N/A
HC62215645	SUTURE                            P	272		403.00	N/A
HC62215652	SUTURE                            Q	272		429.00	N/A
HC62215660	SUTURE                            R	272		455.00	N/A
HC62215678	SUTURE                            T	272		507.00	N/A
HC62215686	SUTURE                            U	272		533.00	N/A
HC62215694	SUTURE                            V	272		559.50	N/A
HC62215702	SUTURE                            W	272		585.00	N/A
HC62215710	SUTURE                            X	272		611.00	N/A
HC62215728	SUTURE                            Y	272		637.00	N/A
HC62215736	SUTURE                            Z	272		663.00	N/A
HC62215744	BLADE SHAVER                     AH	272		4,225.00	N/A
HC62215751	TEMPLATE ORTHO/ROD SPINAL         H	272		312.00	N/A
HC62215769	ADAPTER INJECTION SPINAL	272		1,080.00	N/A
HC62215777	PIN/WIRE FIXATION TEMPORARY       M	272		368.37	N/A
HC62215785	FORCEPS BIPOLAR DISPOSABLE        M	272		780.00	N/A
HC62215793	FORCEPS BIPOLAR DISPOSABLE        P	272		1,170.00	N/A
HC62215801	NEEDLE BIOPSY                     A	272		13.00	N/A
HC62215819	NEEDLE BIOPSY                     B	272		39.00	N/A
HC62215827	NEEDLE BIOPSY                     C	272		65.00	N/A
HC62215835	NEEDLE BIOPSY                     D	272		91.00	N/A
HC62215843	NEEDLE BIOPSY                     E	272		117.87	N/A
HC62215850	NEEDLE BIOPSY                     G	272		176.04	N/A
HC62215868	NEEDLE BIOPSY                     H	272		195.00	N/A
HC62215876	NEEDLE BIOPSY                     I	272		221.00	N/A
HC62215884	NEEDLE BIOPSY                     J	272		247.00	N/A
HC62215892	NEEDLE BIOPSY                     K	272		273.00	N/A
HC62215900	TRAY BONE MARROW                  D	272		52.00	N/A
HC62215918	TRAY BONE MARROW                  E	272		65.00	N/A
HC62215926	TRAY BONE MARROW                  F	272		78.00	N/A
HC62215934	TRAY BONE MARROW                  G	272		91.00	N/A
HC62215942	TRAY BONE MARROW                  H	272		104.00	N/A
HC62215959	TRAY BONE MARROW                  I	272		117.00	N/A
HC62215967	TRAY BONE MARROW                  J	272		130.00	N/A
HC62215975	TRAY BONE MARROW                  AE	272		676.00	N/A
HC62215983	CATH ERCP (PUSHING)               A	272		130.00	N/A
HC62215991	CATH BALLOON DIL NON VASCULAR     D	272	C1726	130.00	N/A
HC62216007	CATH BALLOON DIL NON VASCULAR     F	272	C1726	260.00	N/A
HC62216015	CATH BALLOON DIL NON VASCULAR     H	272	C1726	390.00	N/A
HC62216023	CATH BALLOON DIL NON VASCULAR     L	272	C1726	650.00	N/A
HC62216031	CATH BALLOON DIL NON VASCULAR     M	272	C1726	780.00	N/A
HC62216049	PROBE HEMOSTASIS (BICAP)          H	272		1,040.00	N/A
HC62216056	DEVICE SUTURING ENDOSCOPIC        D	272		260.00	N/A
HC62216064	DEVICE SUTURE ENDO                E	272		390.00	N/A
HC62216072	DEVICE SUTURE ENDO                F	272		520.00	N/A
HC62216080	DEVICE SUTURING ENDOSCOPIC        G	272		650.00	N/A
HC62216098	DEVICE SUTURE ENDO                H	272		780.00	N/A
HC62216106	STENT REMOVER                     C	272		390.00	N/A
HC62216114	STENT REMOVER                     D	272		520.00	N/A
HC62216122	STENT REMOVER                     E	272		650.00	N/A
HC62216130	STENT REMOVER                     G	272		917.53	N/A
HC62216148	SPHINCTEROTOME CANNULATING        G	272		910.00	N/A
HC62216155	SPHINCTEROTOME CANNULATING        H	272		1,040.00	N/A
HC62216163	SPHINCTEROTOME CANNULATING        I	272		1,170.00	N/A
HC62216171	SPHINCTEROTOME CANNULATING        J	272		1,300.00	N/A
HC62216189	SPHINCTEROTOME CANNULATING        K	272		1,430.00	N/A
HC62216197	SPHINCTEROTOME                    E	272		650.00	N/A
HC62216205	SPHINCTEROTOME                    F	272		780.00	N/A
HC62216213	SPHINCTEROTOME                    G	272		910.00	N/A
HC62216221	SHEARS COAGULATING HARMONIC       O	272		1,105.00	N/A
HC62216239	SHEARS COAGULATING HARMONIC       P	272		1,235.00	N/A
HC62216247	SHEARS COAGULATING HARMONIC       Q	272		1,398.00	N/A
HC62216254	STABILIZER HEART OCTOPUS          E	272		2,600.00	N/A
HC62216262	STABILIZER HEART OCTOPUS          L	272		4,875.00	N/A
HC62216270	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP Y	272	C1733	3,905.25	N/A
HC62216296	TEMPLATE ORTHO/ROD SPINAL         M	272		442.00	N/A
HC62216304	NEEDLE BIOPSY BONE                F	272		260.00	N/A
HC62216312	NEEDLE BIOPSY BONE                I	272		455.00	N/A
HC62216320	NEEDLE INTRODUCER                 E	272		325.00	N/A
HC62216338	NEEDLE INTRODUCER                 I	272		455.00	N/A
HC62216346	NEEDLE INTRODUCER                 J	272		488.00	N/A
HC62216353	NEEDLE INTRODUCER                 N	272		618.00	N/A
HC62216361	NEEDLE INTRODUCER                 O	272		650.00	N/A
HC62216379	NEEDLE BONE MARROW                D	272		358.00	N/A
HC62216387	PIN/WIRE FIXATION TEMPORARY       A	272		13.00	N/A
HC62216395	PIN/WIRE FIXATION TEMPORARY       B	272		29.19	N/A
HC62216403	PIN/WIRE FIXATION TEMPORARY       C	272		38.98	N/A
HC62216411	PIN/WIRE FIXATION TEMPORARY       D	272		51.69	N/A
HC62216429	PIN/WIRE FIXATION TEMPORARY       E	272		62.79	N/A
HC62216437	PIN/WIRE FIXATION TEMPORARY       F	272		77.97	N/A
HC62216445	PIN/WIRE FIXATION TEMPORARY       G	272		91.00	N/A
HC62216452	PIN/WIRE FIXATION TEMPORARY       H	272		103.84	N/A
HC62216460	PIN/WIRE FIXATION TEMPORARY       I	272		116.35	N/A
HC62216478	PIN/WIRE FIXATION TEMPORARY       J	272		130.68	N/A
HC62216486	PIN/WIRE FIXATION TEMPORARY       K	272		157.51	N/A
HC62216494	PIN/WIRE FIXATION TEMPORARY       L	272		171.60	N/A
HC62216502	KIT SPINAL ACCESS DISPOSBL        E	272		3,640.00	N/A
HC62216510	PIN/WIRE FIXATION TEMPORARY       N	272		241.59	N/A
HC62216528	PIN/WIRE FIXATION TEMPORARY       O	272		248.98	N/A
HC62216536	PIN/WIRE FIXATION TEMPORARY       P	272		284.99	N/A
HC62216544	PIN/WIRE FIXATION TEMPORARY       Q	272		314.54	N/A
HC62216551	PIN/WIRE FIXATION TEMPORARY       R	272		337.79	N/A
HC62216569	PIN/WIRE FIXATION TEMPORARY       S	272		362.90	N/A
HC62216577	PIN/WIRE FIXATION TEMPORARY       T	272		389.83	N/A
HC62216585	PIN/WIRE FIXATION TEMPORARY       U	272		414.20	N/A
HC62216593	PIN/WIRE FIXATION TEMPORARY       V	272		442.00	N/A
HC62216601	PIN/WIRE FIXATION TEMPORARY       W	272		477.10	N/A
HC62216619	PIN/WIRE FIXATION TEMPORARY       X	272		493.71	N/A
HC62216627	PIN/WIRE FIXATION TEMPORARY       Y	272		519.80	N/A
HC62216635	PIN/WIRE FIXATION TEMPORARY       Z	272		546.00	N/A
HC62216643	PIN/WIRE FIXATION TEMPORARY       AA	272		513.50	N/A
HC62216650	PIN/WIRE FIXATION TEMPORARY       AB	272		600.27	N/A
HC62216668	PIN/WIRE FIXATION TEMPORARY       AC	272		623.03	N/A
HC62216676	PIN/WIRE FIXATION TEMPORARY       AD	272		585.62	N/A
HC62216684	PIN/WIRE FIXATION TEMPORARY       AE	272		810.33	N/A
HC62216692	PIN/WIRE FIXATION TEMPORARY       AF	272		910.11	N/A
HC62216700	PIN/WIRE FIXATION TEMPORARY       AG	272		801.80	N/A
HC62216718	PIN/WIRE FIXATION TEMPORARY       AH	272		1,170.00	N/A
HC62216726	PIN/WIRE FIXATION TEMPORARY       AI	272		1,300.00	N/A
HC62216734	PIN/WIRE FIXATION TEMPORARY      AJ	272		1,430.00	N/A
HC62216759	PIN/WIRE FIXATION TEMPORARY      AL	272		1,690.00	N/A
HC62216767	CATH EP DIAG/ABLAT 3D/VECT        E	272	C1732	1,625.00	N/A
HC62216775	TUBING IRRIGATION                 D	272		208.00	N/A
HC62216783	INSERTER TIP SURGICAL             H	272		390.00	N/A
HC62216791	INFLATOR FOR BALLOON              U	272		611.00	N/A
HC62216809	BALLOON VERTEBRAL	278	C1725	4,225.00	N/A
HC62216817	NEEDLE INSUFFLATION	272		108.00	N/A
HC62216825	POST ANCHOR SPINAL DISPOSABLE     G	272		416.00	N/A
HC62216833	POST ANCHOR SPINAL DISPOSABLE     O	272		624.00	N/A
HC62216841	ENDO STAPLER                      V	272		1,415.32	N/A
HC62216858	ENDO STAPLER                      W	272		1,495.00	N/A
HC62216866	ENDO STAPLER                      X	272		1,560.00	N/A
HC62216874	ENDO STAPLER                      Y	272		1,625.00	N/A
HC62216882	ENDO STAPLER                      Z	272		1,690.00	N/A
HC62216890	ENDO STAPLER                     AA	272		1,755.00	N/A
HC62216908	ENDO STAPLER                     AB	272		1,820.00	N/A
HC62216916	ENDO STAPLER                     AC	272		1,850.37	N/A
HC62216924	ENDO STAPLER                     AD	272		1,950.00	N/A
HC62216932	ENDO STAPLER                     AE	272		2,015.00	N/A
HC62216940	TAMP BONE KYPHOPLASTY             C	272		1,300.00	N/A
HC62216957	KIT MONITORING NERVE(S) SPINAL    F	272		2,925.00	N/A
HC62216965	PUNCH AORTIC                      B	272		65.80	N/A
HC62216973	PIN/WIRE FIXATION TEMPORARY      AV	272		2,990.00	N/A
HC62216981	NEEDLE TARGETING                  G	278		325.00	N/A
HC62216999	NEEDLE TARGETING                  H	278		390.00	N/A
HC62217005	KIT SPINAL ACCESS DISPOSBL        D	272		3,294.36	N/A
HC62217013	KIT SPINAL ACCESS DISPOSBL       AB	272		9,620.00	N/A
HC62217021	PROBE SPINAL DISPOSABLE           F	272		715.00	N/A
HC62217039	PROBE SPINAL DISPOSABLE           K	272		1,040.00	N/A
HC62217047	WRENCH TORQUE SHAFT SPINAL (DISP)	272		585.00	N/A
HC62217054	WRENCH TIP SPINAL (DISP)	272		1,073.00	N/A
HC62217062	WIRE PACING TEMP                  C	272		45.96	N/A
HC62217070	TUNNELER SURGICAL                 B	272		163.00	N/A
HC62217088	SHIM DEVICE ACCESS SPINAL         X	272		1,720.00	N/A
HC62217096	KIT CHEST TUBE INSERTION	272		260.00	N/A
HC62217104	CATH ANGIOGRAPHY(LB HNB)          A	272	C1887	33.30	N/A
HC62217112	CATH ANGIOGRAPHY GUIDING          C	272	C1887	98.00	N/A
HC62217120	ADVANCER SYSTM ROTALINK	272	C1894	862.00	N/A
HC62217138	KIT PTCA SYRINGE (CUSTOM)	272		49.00	N/A
HC62217146	KIT ROTATOR LEAD PACER	272		65.00	N/A
HC62217153	SLITTER CATH ADJUST	272		53.00	N/A
HC62217161	ORTHOTIC ANKLE RIGID PNEUM/GEL PRFB	274	L4350	33.00	N/A
HC62217179	ORTHOTIC KNEE ELASTIC W/JOINTS PRFB	274	L1812	46.00	N/A
HC62217187	PAD BOOT	274		252.00	N/A
HC62217195	ORTHOTIC WHFO 1+JOINT(S) PREFAB	274	L3931	161.00	N/A
HC62217203	VEST SYSTEM OSCIL FREQU HI CHEST	271	A7025	225.00	N/A
HC62217211	NEEDLES 5/PACK ENDOSCOPIC         W	272		634.00	N/A
HC62217229	TUBE ENDOBRONCHIAL	272		177.00	N/A
HC62217237	KIT TUBE TRACH CUFFED             O	272	A7521	1,040.00	N/A
HC62217245	BLADE MILL BONE	272		1,300.00	N/A
HC62217252	CURETTE ADENOID	272		614.00	N/A
HC62217260	PUNCH ATHROSCOPIC ROTARY	272		3,234.00	N/A
HC62217278	PASSER SUTURE                     B	272		72.00	N/A
HC62217286	PASSER SUTURE                     M	272		787.00	N/A
HC62217294	KIT HARVESTING BONE GRAFT         N	272		910.00	N/A
HC62217302	STRIPPER TENDON	272		1,658.00	N/A
HC62217310	DEVICE CHECK NEURO SURG SPINAL	272		3,176.00	N/A
HC62217328	RETRACTOR MIS SPINAL              C	272		1,950.00	N/A
HC62217336	CANNULA BIOPSY BREAST	272		134.00	N/A
HC62217344	RFID CHANDELIER OPTHALMIC	272		342.00	N/A
HC62217351	SCRAPER MEMBRANE OPHTH	272		417.00	N/A
HC62217369	KIT DEVICE RETRIEVAL NEURO FB     S	272	C1773	23,400.00	N/A
HC62217377	STOPCOCK LUER LOCK ENDOSCOPE	272		369.00	N/A
HC62217385	DEVICE FIXATION TACKER(LAP)	272		2,176.00	N/A
HC62217393	PUSHER KNOT ENDO                  D	272		455.00	N/A
HC62217401	SEALER BIPOLAR AQUAMANTYS	272		1,758.00	N/A
HC62217419	DEVICE LIGATOR                    K	272		1,170.00	N/A
HC62217427	DEVICE LIGATOR                    M	272		1,430.00	N/A
HC62217435	FORCEPS BIPOLAR DISPOSABLE        O	272		1,029.12	N/A
HC62217443	FORCEPS BIPOLAR DISPOSABLE        Q	272		1,300.00	N/A
HC62217450	REAMER                            B	272		39.00	N/A
HC62217468	REAMER                            D	272		65.00	N/A
HC62217476	KIT MIXER THROMBIN AUTOLOGUS	272		130.00	N/A
HC62217484	KIT CONCENTRATOR PLATELETS        R	272		1,625.00	N/A
HC62217492	KIT CONCENTRATOR PLATELETS        X	272		3,900.00	N/A
HC62217500	DRESSING AQUACEL AG	272		117.00	N/A
HC62217518	DRESSING SACRUM<324CM SQ(MEPITEL)	272	A6208	36.00	N/A
HC62217526	DRESSING FILM IV (MEPITEL)	272	A6257	43.00	N/A
HC62217534	RETRACTOR DISPOSABLE              B	272		129.93	N/A
HC62217542	KIT CONCENTRATOR PLATELETS        M	272		780.00	N/A
HC62217559	KIT TUBE TRACH PEDS/NEO NO CUFF   Q	272	A7520	1,322.75	N/A
HC62217567	MARKER SPHERE PASSIVE REFLECTIVE	272	A4648	62.00	N/A
HC62217575	SEPARATOR PLASMA PLASMAFLO	272		127.00	N/A
HC62217583	DRAIN ADAPTOR                     D	272		59.00	N/A
HC62217591	AWL SPINAL SINGLE PATIENT USE     C	272		390.00	N/A
HC62217609	AWL SPINAL SINGLE PATIENT USE     D	272		455.00	N/A
HC62217617	AWL SPINAL SINGLE PATIENT USE     E	272		520.00	N/A
HC62217625	AWL SPINAL SINGLE PATIENT USE     G	272		650.00	N/A
HC62217633	AWL SPINAL SINGLE PATIENT USE     H	272		715.00	N/A
HC62217641	AWL SPINAL SINGLE PATIENT USE     I	272		780.00	N/A
HC62217658	AWL SPINAL SINGLE PATIENT USE     J	272		845.00	N/A
HC62217666	AWL SPINAL SINGLE PATIENT USE     K	272		910.00	N/A
HC62217674	AWL SPINAL SINGLE PATIENT USE     N	272		1,105.00	N/A
HC62217682	AWL SPINAL SINGLE PATIENT USE     Q	272		1,300.00	N/A
HC62217690	AWL SPINAL SINGLE PATIENT USE     R	272		1,430.00	N/A
HC62217708	AWL SPINAL SINGLE PATIENT USE     S	272		1,560.00	N/A
HC62217716	AWL SPINAL SINGLE PATIENT USE     V	272		1,950.00	N/A
HC62217724	AWL SPINAL SINGLE PATIENT USE     X	272		2,210.00	N/A
HC62217732	PUNCH SPINAL	272		1,277.00	N/A
HC62217740	ELECTRODE NEUROMONITORING SPINAL	272		887.00	N/A
HC62217757	TEMPLATE ORTHO/ROD SPINAL         C	272		182.00	N/A
HC62217765	TEMPLATE ORTHO/ROD SPINAL         D	272		208.00	N/A
HC62217773	TEMPLATE ORTHO/ROD SPINAL         E	272		234.00	N/A
HC62217781	NEEDLE BONE MARROW                G	272		455.00	N/A
HC62217799	NEEDLE BONE MARROW                K	272		585.00	N/A
HC62217807	TEMPLATE STAPLE SPINAL            C	272		455.00	N/A
HC62217815	TEMPLATE STAPLE SPINAL            G	272		585.00	N/A
HC62217823	TEMPLATE STAPLE SPINAL            L	272		748.00	N/A
HC62217831	CLOSURE WND EXPANDER TISSUE       A	272		3,085.00	N/A
HC62217849	CLOSURE WND EXPANDER TISSUE       B	272		3,410.00	N/A
HC62217856	SHIM DEVICE ACCESS SPINAL         Q	272		780.00	N/A
HC62217864	SET PIN DISTRACTORS-COUNT 2       A	272		650.00	N/A
HC62217872	SET PIN DISTRACTORS-COUNT 2       B	272		1,352.00	N/A
HC62217880	SET PIN DISTRACTORS-COUNT 10      A	272		3,244.00	N/A
HC62217898	SET PIN DISTRACTORS-COUNT 10      B	272		6,754.00	N/A
HC62217906	CATH MICRO NEURO (AXS CATALYST)  AH	272	C1887	7,150.00	N/A
HC62217914	PASSER SUTURE ORTHOPAEDIC        AA	272		2,925.00	N/A
HC62217922	PUSHER/CUTTER KNOT SUTURE ARTHRS  E	272		390.00	N/A
HC62217930	CATH DIAGNOSTIC                   I	272		487.91	N/A
HC62217948	CATH EMBOLECTOMY FOGARTY          E	272	C1757	209.06	N/A
HC62217955	ORTHOSIS SHOULDER FIGURE 8 PREFAB	274	L3660	239.00	N/A
HC62217963	TUBE ET                           D	272		130.00	N/A
HC62217971	TUBE ET                           E	272		195.00	N/A
HC62217989	INSERTER TIP SURGICAL             G	272		325.00	N/A
HC62217997	GUIDE SHAFT DRIVER ORTHO	272		667.00	N/A
HC62218003	PROBE ABLATION                    J	272		520.00	N/A
HC62218011	TUBING SET OPHTH INJECT/EXTRACT	272		192.00	N/A
HC62218029	BLADE OPHTHALM                    Z	272		547.00	N/A
HC62218037	BLADE OPHTHALM                    D	272		52.00	N/A
HC62218045	BLADE OPHTHALM                    B	272		26.00	N/A
HC62218052	SHIELD EYE                        L	272		182.00	N/A
HC62218060	BASKET RETRIEVAL                  K	272		585.00	N/A
HC62218078	STAPLE CARTRG/ENDO RELOAD         D	272		130.00	N/A
HC62218086	TROCAR BALLOON	272		686.00	N/A
HC62218094	TUBING IRRIGATION/SUCTION	272		86.00	N/A
HC62218102	FIBER LASER                       D	272		775.40	N/A
HC62218110	CAPSULE PH (IMPLANT)              C	272		880.00	N/A
HC62218128	ELECTRODE LEEP LOOPS              C	272		39.00	N/A
HC62218136	PROBE APC/ARGON PLASMA COAGULATOR	272		689.00	N/A
HC62218144	ELECTRODE  LAP                    D	272		130.00	N/A
HC62218151	CAUTERY HOOK ASSEMBLY             C	272		39.00	N/A
HC62218169	KIT REPAIR PORT ACCESS LAP-BAND   C	272		1,950.00	N/A
HC62218177	KIT REPAIR PORT ACCESS LAP-BAND   D	272		2,275.00	N/A
HC62218185	HEMOSTATIC GEL/GELFOAM/PAD        R	272		1,625.00	N/A
HC62218193	TRAY THORAC/PARACENTESIS          G	272		156.00	N/A
HC62218201	KIT FECAL MANAGEMENT              G	272		325.00	N/A
HC62218219	CATH DIAGNOSTIC                   R	272		1,625.00	N/A
HC62218227	CATH DIAGNOSTIC                   S	272		1,950.00	N/A
HC62218235	CATH INTRODUCER PEEL-AWAY         F	272	C1892	130.00	N/A
HC62218243	CATH INTRODUCER PEEL-AWAY         G	272	C1892	163.00	N/A
HC62218250	CATH INTRODUCER PEEL-AWAY         H	272	C1892	195.00	N/A
HC62218268	CATH INTRODUCER PEEL-AWAY         I	272	C1892	228.00	N/A
HC62218276	CATH INTRODUCER PEEL-AWAY         J	272	C1892	260.00	N/A
HC62218284	CATH INTRODUCER PEEL-AWAY        AA	272	C1892	1,300.00	N/A
HC62218292	CATH INTRODUCER PEEL-AWAY        AB	272	C1892	1,625.00	N/A
HC62218300	ENDO STAPLER                      B	272		130.00	N/A
HC62218318	ENDO STAPLER                      C	272		195.00	N/A
HC62218326	ENDO STAPLER                      D	272		260.00	N/A
HC62218334	ENDO STAPLER                      E	272		325.00	N/A
HC62218342	ENDO STAPLER                      G	272		455.00	N/A
HC62218359	ENDO STAPLER                      H	272		520.00	N/A
HC62218367	ENDO STAPLER                      I	272		585.00	N/A
HC62218375	ENDO STAPLER                      J	272		650.00	N/A
HC62218383	ENDO STAPLER                      L	272		780.00	N/A
HC62218391	ENDO STAPLER                      M	272		765.63	N/A
HC62218409	ENDO STAPLER                      N	272		875.84	N/A
HC62218417	ENDO STAPLER                      O	272		975.00	N/A
HC62218425	ENDO STAPLER                      P	272		1,040.00	N/A
HC62218433	ENDO STAPLER                      Q	272		1,105.00	N/A
HC62218441	ENDO STAPLER                      R	272		1,170.00	N/A
HC62218458	ENDO STAPLER                      S	272		1,234.35	N/A
HC62218466	ENDO STAPLER                      T	272		1,300.00	N/A
HC62218474	LEAD DELIVERY SYSTEM              J	272		2,600.00	N/A
HC62218482	ENDO STAPLER                     AI	272		2,275.00	N/A
HC62218490	ENDO STAPLER                     AJ	272		2,340.00	N/A
HC62218508	ENDO STAPLER                     AQ	272		3,250.00	N/A
HC62218516	STAPLE CARTRG/RELOAD LIN CUT      H	272		163.00	N/A
HC62218524	APPLICATOR W/MIXING TIP ORTHO	272		179.00	N/A
HC62218532	KIT MONITORING NERVE(S) SPINAL    I	272		3,900.00	N/A
HC62218540	KIT MONITORING NERVE(S) SPINAL    J	272		4,225.00	N/A
HC62218557	KIT ACP AUTO COND PLASMA SERIES II	272		813.00	N/A
HC62218565	STAPLE CARTRG/ENDO RELOAD         F	272		260.00	N/A
HC62218573	STAPLE CARTRG/ENDO RELOAD         G	272		130.00	N/A
HC62218581	STAPLE CARTRG/ENDO RELOAD         P	272		1,170.00	N/A
HC62218599	STAPLE CARTRG/ENDO RELOAD         Q	272		1,300.00	N/A
HC62218607	PROBE SPINAL DISPOSABLE           H	272		845.00	N/A
HC62218615	ELECTRODE HOOK ARTHROSCOPIC	272		73.00	N/A
HC62218623	DEVICE RETRIEVAL                  I	272	C1773	3,900.00	N/A
HC62218631	DEVICE RETRIEVAL                  F	272	C1773	4,335.50	N/A
HC62218649	TRACKER INSTRUMENT FUSION ENT	272		520.00	N/A
HC62218656	TUBE LEAD INSERT ELECTRODE ARRAY W/STYLET	272		488.00	N/A
HC62218664	OBTURATOR BLADELESS ROBOTIC	272		82.00	N/A
HC62218672	DRILL/DRILL BITS SINGLE USE       B	272		65.00	N/A
HC62218680	DRILL/DRILL BITS SINGLE USE       C	272		98.64	N/A
HC62218698	DRILL/DRILL BITS SINGLE USE       D	272		186.88	N/A
HC62218706	DRILL/DRILL BITS SINGLE USE       E	272		169.20	N/A
HC62218714	DRILL/DRILL BITS SINGLE USE       F	272		195.00	N/A
HC62218722	DRILL/DRILL BITS SINGLE USE       G	272		226.62	N/A
HC62218730	DRILL/DRILL BITS SINGLE USE       H	272		263.42	N/A
HC62218748	DRILL/DRILL BITS SINGLE USE       I	272		306.54	N/A
HC62218755	DRILL/DRILL BITS SINGLE USE       J	272		333.17	N/A
HC62218763	DRILL/DRILL BITS SINGLE USE       K	272		419.13	N/A
HC62218771	DRILL/DRILL BITS SINGLE USE       L	272		458.57	N/A
HC62218789	DRILL/DRILL BITS SINGLE USE       M	272		536.51	N/A
HC62218797	DRILL/DRILL BITS SINGLE USE       N	272		585.23	N/A
HC62218805	DRILL/DRILL BITS SINGLE USE       O	272		647.60	N/A
HC62218813	DRILL/DRILL BITS SINGLE USE       P	272		719.09	N/A
HC62218821	DRILL/DRILL BITS SINGLE USE       Q	272		755.58	N/A
HC62218839	DRILL/DRILL BITS SINGLE USE       R	272		847.94	N/A
HC62218847	DRILL/DRILL BITS SINGLE USE       S	272		947.41	N/A
HC62218854	DRILL/DRILL BITS SINGLE USE       T	272		953.95	N/A
HC62218862	DRILL/DRILL BITS SINGLE USE       U	272		1,034.78	N/A
HC62218870	DRILL/DRILL BITS SINGLE USE       V	272		1,082.77	N/A
HC62218888	DRILL/DRILL BITS SINGLE USE       W	272		1,166.52	N/A
HC62218896	DRILL/DRILL BITS SINGLE USE       X	272		1,029.13	N/A
HC62218904	DRILL/DRILL BITS SINGLE USE       Y	272		1,199.58	N/A
HC62218912	DRILL/DRILL BITS SINGLE USE       Z	272		1,259.27	N/A
HC62218920	DRILL/DRILL BITS SINGLE USE      AA	272		1,271.73	N/A
HC62218938	DRILL/DRILL BITS SINGLE USE      AB	272		1,418.39	N/A
HC62218946	DRILL/DRILL BITS SINGLE USE      AC	272		1,559.91	N/A
HC62218953	DRILL/DRILL BITS SINGLE USE      AD	272		1,627.02	N/A
HC62218961	DRILL/DRILL BITS SINGLE USE      AE	272		1,756.12	N/A
HC62218979	DRILL/DRILL BITS SINGLE USE      AF	272		1,895.64	N/A
HC62218987	DRILL/DRILL BITS SINGLE USE      AH	272		2,192.68	N/A
HC62218995	RETRACTOR MIS SPINAL              I	272		3,900.00	N/A
HC62219001	RETRACTOR MIS SPINAL              K	272		4,559.86	N/A
HC62219019	RETRACTOR MIS SPINAL              O	272		5,850.00	N/A
HC62219027	RETRACTOR MIS SPINAL              Q	272		6,500.00	N/A
HC62219035	FIBRIN SEALANT                    J	278		780.00	N/A
HC62219043	PORT INSTRMNT MULTI LAPAROSCPC	272		1,777.00	N/A
HC62219050	DEVICE RETRIEVAL VASC             A	272	C1773	1,300.00	N/A
HC62219068	DEVICE INFLATION (CALIBER/PRESTO)	272		82.00	N/A
HC62219076	CAP ENDOSEAL	272		52.00	N/A
HC62219084	ORTHOTIC KNEE W/JNTS PRFB CUSTM   C	274	L1832	455.00	N/A
HC62219092	TUBE CALIBRATION GASTRIC BANDING	272		407.00	N/A
HC62219100	ADHESIVE SKIN CARDIAC/PCMKR	272		78.00	N/A
HC62219118	BINDER/ORTHOSIS LUMBAR/SACRAL PRFB	274	L0625	49.00	N/A
HC62219126	BOOT WLKNG AIR W/WO JNTS PREFB    D	274	L4360	130.00	N/A
HC62219134	CANNULA ARTHRSCPC(STICK SWITCHING)H	272		423.00	N/A
HC62219142	CANNULA CURVED DUAL ELECTROSURG	272		105.00	N/A
HC62219159	CANNULA TIP SOFT LONG	272		975.00	N/A
HC62219167	CATH ATRIOSEPTISTOTOMY	272		2,243.00	N/A
HC62219175	CATH CAVITY MAMMOSITE EVAL	272		485.00	N/A
HC62219183	CATH CTO-CROSSER	272	C1887	8,450.00	N/A
HC62219191	CATH DIALYSIS SHORT-TERM          C	278	C1752	163.00	N/A
HC62219209	CATH EP QUAD RPRSD                H	272	C1730	390.00	N/A
HC62219217	CATH MICROCATHETER NEUROVASC      K	272	C1887	1,372.00	N/A
HC62219225	CATH SIALOGRAPHY	272		86.00	N/A
HC62219233	CATH THROMBECTOMY/EMBOLECTOMY     E	272	C1757	390.00	N/A
HC62219241	CUTTER SUTURE INCL SURECUT        Q	272		1,300.00	N/A
HC62219258	DEVICE DELIVERY SUTURE INCL LARIAT	272		16,088.00	N/A
HC62219266	DEVICE LIGATOR                    G	272		650.00	N/A
HC62219274	DEVICE RETRIEVAL                  H	272	C1773	3,575.00	N/A
HC62219282	DILATOR FASCIAL INCL URO	272		47.00	N/A
HC62219290	DILATOR RENAL AMPLATZ	272	C1726	1,347.00	N/A
HC62219316	EMBOLIZATN PROTECT SYSTEM(SPIDER) H	278	C1884	3,575.00	N/A
HC62219324	EMBOLIZATION PROTECTIVE SYSTEM    J	278	C1884	4,225.00	N/A
HC62219332	EMBOLIZATN PROTECT SYSTEM(EZ)     L	278	C1884	4,875.00	N/A
HC62219340	GUIDE TIBIAL ORTHO	272		1,190.00	N/A
HC62219357	GUIDE TRANSPORTAL ACL	272		2,844.00	N/A
HC62219365	GUIDEWIRE                        AE	272	C1769	3,575.00	N/A
HC62219373	HOOK MARKING ORTHO	272		1,300.00	N/A
HC62219381	INTRO/SHEATH STEERABLE NON-PEEL   F	272	C1766	2,925.00	N/A
HC62219399	KIT ABLATION VEIN LASER	272		1,515.00	N/A
HC62219407	KIT ACCESSORY STIMULATOR NERVE	272		243.75	N/A
HC62219415	KIT CATH ARTERIAL	272		42.00	N/A
HC62219423	KIT MONITORING NERVE(S) SPINAL    K	272		3,880.50	N/A
HC62219449	KIT SPINAL ACCESS DISPOSBL        F	272		3,900.00	N/A
HC62219456	KIT STARTER B-CPAP INFANT	272		228.00	N/A
HC62219464	SYSTEM DELIVERY LEAD              J	272	C1887	2,275.00	N/A
HC62219472	NEEDLE ACCESS FISTULA DIALYSIS	272		309.00	N/A
HC62219480	ORTHOTIC AF PREFAB W/FIT& ADJUST	274	L1930	120.00	N/A
HC62219498	ORTHOSIS ANKLE GAUNTLET PRFB	274	L1902	66.00	N/A
HC62219506	ORTHOSIS ANKLE/FT PRFB CUSTMZD    C	274	L4396	130.00	N/A
HC62219514	ORTHOSIS ANKLE/FT PRFB CUSTMZD    D	274	L4396	195.00	N/A
HC62219522	PASSER SURGICAL INCL PERITONEAL   I	272		462.00	N/A
HC62219530	PASSER SUTURE                     E	272		202.00	N/A
HC62219548	PROBE LITHOTRIPTOR ELECTRHYDRLC   Y	272		4,011.00	N/A
HC62219555	PROBE SPINAL DISPOSABLE           O	272		345.32	N/A
HC62219563	PULLER SUTURE INCL TENSURE	272		650.00	N/A
HC62219589	SHIM DEVICE ACCESS SPINAL        AE	272		2,600.00	N/A
HC62219597	STAPLE CARTRG/ENDO RELOAD         E	272		195.00	N/A
HC62219605	STYLET CARDIAC                    B	272		98.00	N/A
HC62219613	TUBE ET                           J	272		520.00	N/A
HC62219621	TUBE TRACH CUFFED ADJUSTABLE      K	272	A7521	585.00	N/A
HC62219639	TUBE TRACH CUFFED                 N	272	A7521	910.00	N/A
HC62219647	VALVE TRACH SPEAKING              E	274	L8501	195.00	N/A
HC62219654	PRESSURIZER FEMORAL	272		49.00	N/A
HC62219662	KIT INSTRUMENTS ENDOBUTTON	272		1,109.00	N/A
HC62219670	DILATOR SPINE KOROS	272		722.00	N/A
HC62219688	DILATOR SPINE/NERVE NEUROVISION	272		2,038.00	N/A
HC62219696	KIT VITRECTOMY PROBE              B	272		260.00	N/A
HC62219704	KIT VITRECTOMY PROBE              C	272		390.00	N/A
HC62219712	KIT VITRECTOMY PROBE              I	272		1,170.00	N/A
HC62219720	KIT VITRECTOMY PROBE              K	272		1,625.00	N/A
HC62219738	KIT VITRECTOMY PROBE              M	272		2,275.00	N/A
HC62219746	KIT VITRECTOMY PROBE              N	272		2,600.00	N/A
HC62219753	KIT VITRECTOMY PROBE              Z	272		6,500.00	N/A
HC62219761	INSTRUMENT KYPHO PAC BEVELED	272		533.00	N/A
HC62219779	PROBE FLOW PERFUSION	272		74.00	N/A
HC62219787	PUMP BLOOD CENTRIFUGAL	272		577.00	N/A
HC62219795	KIT PERFUSION                     D	272		3,575.00	N/A
HC62219803	SIZER MAMMARY                     L	272		924.65	N/A
HC62219811	PROGRAMMER NEUROSTIM PAT          F	271	C1787	2,996.25	N/A
HC62219829	PROGRAMMER NEUROSTIM PAT          H	271	C1787	3,119.19	N/A
HC62219837	HAND ACCESS DEVICE                G	272		1,625.00	N/A
HC62219845	DRAIN BLAKE ROUND                 H	272		208.00	N/A
HC62219852	TUBE ET NIM                       O	272		1,040.00	N/A
HC62219860	ORTHOTIC WHFO NEO/INFANT PREFAB   A	274	L3908	33.00	N/A
HC62219878	CATH FOLLOWER URETH PHILLIPS	272		36.00	N/A
HC62219886	ADAPTER ARTHROSCPC	272		585.00	N/A
HC62219894	BLADE SAW                        AE	272		715.00	N/A
HC62219902	CANNULA ARTHRSCPC ROTATING        K	272		1,836.00	N/A
HC62219910	CANNULA ARTHRSCPC ROTATING/BUR    E	272		780.00	N/A
HC62219928	CONNECTOR LUERLOCK ICP	272		155.00	N/A
HC62219936	DISSECTOR ULTRASONIC CORDLESS	272		1,950.00	N/A
HC62219944	KNIFE BAYONET                     K	272		1,983.00	N/A
HC62219951	OBTURATOR ARTHRO                  E	272		390.00	N/A
HC62219969	OBTURATOR ARTHRO                  G	272		520.00	N/A
HC62219977	KIT INSTRUMENTS UROLIFT	272		1,138.00	N/A
HC62219985	BASKET RETRIEVAL                  M	272		748.00	N/A
HC62219993	FASTENERS/ANCHORS TUBE GI-SET OF 3	272		354.00	N/A
HC62220009	DEVICE BIOPSY BREAST              M	272		780.00	N/A
HC62220017	BLADE ENDOSCOPIC CARPAL TUNNEL	272		673.00	N/A
HC62220025	PROBE ABLATION RF BIPOLR ARTHROSCPC	272		543.00	N/A
HC62220033	DEVICE SUTURE ENDO                I	272		1,040.00	N/A
HC62220041	PROBE SPINAL DISPOSABLE           V	272		1,755.00	N/A
HC62220058	RETRACTOR DISPOSABLE              C	272		195.00	N/A
HC62220066	RETRACTOR DISPOSABLE              D	272		260.00	N/A
HC62220074	EXTRACTOR KATZ SURGICAL	272		342.00	N/A
HC62220082	CATH THROMBECTOMY/EMBOLECTOMY     N	272	C1757	910.00	N/A
HC62220090	CATH BALLOON DIL NON VASCULAR     A	272	C1726	33.00	N/A
HC62220108	ACCESS PORTL TRANSJUG INTRAHEP HSKL	272		2,048.00	N/A
HC62220116	KIT MONITORING NERVE(S) SPINAL    G	272		3,250.00	N/A
HC62220124	KIT MONITORING NERVE(S) SPINAL    M	272		5,525.00	N/A
HC62220132	OVERTUBE ENDOSCOPIC               C	272	A4270	1,300.00	N/A
HC62220140	OVERTUBE ENDOSCOPIC               D	272	A4270	1,625.00	N/A
HC62220157	CATH BALLOON MANOMETRY ANORECTAL	272		144.00	N/A
HC62220165	BLADE SAW                        AA	272		628.36	N/A
HC62220173	CANNULA ARTHROSCOPIC              E	272		195.00	N/A
HC62220181	CATH THROMBECTOMY/EMBOLECTOMY     O	272	C1757	1,040.00	N/A
HC62220199	CATH THROMBECTOMY/EMBOLECTOMY     P	272	C1757	1,170.00	N/A
HC62220207	CATH THROMBECTOMY/EMBOLECTOMY     Q	272	C1757	1,300.00	N/A
HC62220215	CATH THROMBECTOMY/EMBOLECTOMY     R	272	C1757	1,625.00	N/A
HC62220223	CLIP STIMULATION NERVE            I	272		1,625.00	N/A
HC62220231	CUP UTERINE KOH	272		802.00	N/A
HC62220249	EXERCISER EXPIRATORY THER/MASK PEP	272		83.00	N/A
HC62220256	KIT MONITORING NERVE(S) SPINAL    C	272		1,950.00	N/A
HC62220264	KIT MONITORING NERVE(S) SPINAL    D	272		2,275.00	N/A
HC62220272	KIT MONITORING NERVE(S) SPINAL    E	272		2,600.00	N/A
HC62220280	SYSTEM DELIVERY LEAD              M	272	C1887	3,250.00	N/A
HC62220298	NEEDLE ENDOSCOPIC                 E	272		195.00	N/A
HC62220306	ORTHOTIC KNEE ELSTC W/JNT PRFB CSTM	274	L1810	66.00	N/A
HC62220314	ORTHOTIC KNEE W/JNTS PRFB CUSTM   O	274	L1832	1,625.00	N/A
HC62220322	ORTHOTIC TLSO 4MOD SACRO-SCAP PRE	274	L0464	4,066.00	N/A
HC62220330	PIN DISTRACTOR	272		72.00	N/A
HC62220348	PUNCH ARTHROSCOPIC	272		390.00	N/A
HC62220355	RETRACTOR DISPOSABLE              N	272		1,495.00	N/A
HC62220363	SHIM DEVICE ACCESS SPINAL        AK	272		6,500.00	N/A
HC62220371	ADAPTOR/SPLINT WALKER WRIST	274	A4570	85.00	N/A
HC62220389	CATH ANGIOG GUIDING DUAL ACCESS(ENVOY)J	272	C1887	1,170.00	N/A
HC62220397	CATH INTRODUCER PEEL-AWAY         C	272	C1892	52.00	N/A
HC62220405	FIT TALAR LOCKING TRIAL	272		1,690.00	N/A
HC62220413	KIT ARTHROSCOPY DISPSBLS          J	272		488.00	N/A
HC62220421	KNIFE ANNULOTOMY (MAXCESS)	272		2,593.50	N/A
HC62220439	PUSHER KNOT ENDO                  L	272		1,625.00	N/A
HC62220447	TEMPLATE ORTHO/ROD SPINAL         W	272		910.00	N/A
HC62220454	SPRAY ADHESIVE OSTOMY	272		53.00	N/A
HC62220462	MOLD/FORM CEMENT TIBIAL KNEE	272		2,600.00	N/A
HC62220470	KIT INSERTN PICC PEDS-NO CATH	272		43.00	N/A
HC62220488	APPLICATOR/TIP SYRINGE ONLY       B	272		65.00	N/A
HC62220496	APPLICATOR/TIP SYRINGE ONLY       D	272		130.00	N/A
HC62220504	APPLICATOR/TIP SYRINGE ONLY       F	272		263.40	N/A
HC62220512	APPLICATOR/TIP SYRINGE ONLY       I	272		455.00	N/A
HC62220520	DEVICE LIGATOR                    E	272		520.00	N/A
HC62220538	DERMABOND                         F	272		259.98	N/A
HC62220546	CUTTER LAPAROSCOPIC               S	272		1,990.00	N/A
HC62220553	FILTER HARVESTER BONE/BONE MARROW	272		898.00	N/A
HC62220561	INTRO/SHEATH EP FIXED NON-PEEL    E	272	C1893	390.00	N/A
HC62220579	INTRO/SHEATH EP FIXED NON-PEEL    H	272	C1893	585.00	N/A
HC62220587	NEEDLE DELIVERY CEMENT	272		164.00	N/A
HC62220595	SHEARS COAGULATING HARMONIC       R	272		1,692.36	N/A
HC62220603	INTRO/SHEATH EP FIXED NON-PEEL    B	272	C1893	195.00	N/A
HC62220611	MASK CPAP	272		78.00	N/A
HC62220629	HEADGEAR CPAP AIRLIFE	272		52.00	N/A
HC62220637	HEADGEAR CPAP BONNET	272		36.00	N/A
HC62220645	DEVICE TORQUE                     B	272		65.00	N/A
HC62220652	KIT ACCESSORY                     A	272		130.00	N/A
HC62220660	KIT ACCESSORY                     B	272		195.00	N/A
HC62220678	KIT ACCESSORY                     C	272		260.00	N/A
HC62220686	KIT ACCESSORY                     D	272		325.00	N/A
HC62220694	KIT ACCESSORY                     I	272		650.00	N/A
HC62220702	KIT ACCESSORY PROSTHESIS PENILE	272		2,452.19	N/A
HC62220710	NEEDLE BIOPSY/ASPIRATION          C	272		98.00	N/A
HC62220728	COUNTERSINK CANNULATED            E	272		325.00	N/A
HC62220736	COUNTERSINK CANNULATED            L	272		845.00	N/A
HC62220744	COUNTERSINK CANNULATED            O	272		1,039.15	N/A
HC62220751	DEVICE INDEFLATOR	272		160.00	N/A
HC62220769	SUPPORT/BRACE LIMB	274	A4467	43.00	N/A
HC62220777	CANNULA ARTHROSCOPIC              H	272		390.00	N/A
HC62220785	OXYGENATOR ECMO PEDS	272		6,452.00	N/A
HC62220793	TRAY DRAIN PNEUMOPERICARDIUM	272	C1729	416.00	N/A
HC62220801	SUCTION DEVICE ENDOSCOPIC BIOVAC	272		358.00	N/A
HC62220819	CUFF AORTIC ROOT EXPOSURE DEVICE	272		244.00	N/A
HC62220827	BAG/POUCH RETRIEVAL SPECMN ENDO   C	272		230.34	N/A
HC62220835	BAG/POUCH RETRIEVAL SPECMN ENDO   M	272		878.00	N/A
HC62220843	BINDER ABDOMINAL BASIC            A	270		33.00	N/A
HC62220850	BINDER ABDOMINAL BASIC            B	270		65.00	N/A
HC62220868	BLADE INCISIONAL                  C	272		194.37	N/A
HC62220876	BLADE INCISIONAL                  V	272		1,950.00	N/A
HC62220884	BLANKET HYPER/HYPOTHERMIA         A	272		33.00	N/A
HC62220892	BLANKET HYPER/HYPOTHERMIA         B	272		65.00	N/A
HC62220900	BLANKET HYPER/HYPOTHERMIA         R	272		1,040.00	N/A
HC62220918	BRUSH CYTOLOGY                    A	272		33.00	N/A
HC62220926	CABLE PACING DISP                 B	272		65.00	N/A
HC62220934	CATH CENTRAL VENOUS               A	272	C1751	33.00	N/A
HC62220942	CATH CENTRAL VENOUS               C	272	C1751	98.00	N/A
HC62220959	CATH CENTRAL VENOUS               D	272	C1751	130.00	N/A
HC62220967	CATH CENTRAL VENOUS               E	272	C1751	195.00	N/A
HC62220975	CATH FOLEY                        A	272		33.00	N/A
HC62220983	CATH IV ANGIOGRAPHIC	272		52.00	N/A
HC62220991	CATH UMBILICAL                    A	272		33.00	N/A
HC62221007	CATH UMBILICAL                    C	272		98.00	N/A
HC62221015	CATH URETHRAL TRAY                B	272		65.00	N/A
HC62221023	ET POUCH                          A	272		33.00	N/A
HC62221031	ET POUCH                          C	272		98.00	N/A
HC62221049	EVACUATOR BLADDER W/ADAPTER	272		65.11	N/A
HC62221056	KIT CANISTER BIOPSY CARTILAGE	272		1,609.00	N/A
HC62221064	KIT CELL SAVER                    E	272		195.00	N/A
HC62221072	KIT CELL SAVER                    G	272		325.00	N/A
HC62221080	KIT CELL SAVER                    O	272		1,040.00	N/A
HC62221098	KIT CRICOTHYROTOMY EMERGENCY      J	272		520.00	N/A
HC62221106	KIT CRICOTHYROTOMY EMERGENCY      R	272		1,625.00	N/A
HC62221114	KIT PRESSURE MONITOR INTRACOMPRTMNT	272		222.00	N/A
HC62221122	KIT PRESSURE MONITOR/TRANSDUCER   A	272		33.00	N/A
HC62221148	KIT PRESSURE MONITOR/TRANSDUCER   F	272		260.00	N/A
HC62221155	KIT SUPRA PUBIC CATH              B	272		65.00	N/A
HC62221163	KIT SUPRA PUBIC CATH              D	272		130.00	N/A
HC62221171	KIT SUPRA PUBIC CATH              G	272		325.00	N/A
HC62221189	KIT TEMP MNGMNT-HEAD WRP-VEST-BLNKT	272		1,058.00	N/A
HC62221197	KIT W/ TRACH PERCUTANEOUS         C	272	A7520	910.00	N/A
HC62221205	KIT W/ TRACH PERCUTANEOUS         D	272	A7520	1,040.00	N/A
HC62221213	KIT W/ TRACH PERCUTANEOUS         E	272	A7520	1,170.00	N/A
HC62221221	KIT/TRAY BIOPSY                   B	272		65.00	N/A
HC62221239	NEEDLE ENDOSCOPIC                 A	272		33.00	N/A
HC62221247	NEEDLE ENDOSCOPIC                 B	272		65.00	N/A
HC62221254	NEEDLE ENDOSCOPIC                 D	272		130.00	N/A
HC62221262	NEEDLE SPINAL                     A	272		33.00	N/A
HC62221270	POSITIONER FLUIDIZED FULL BODY PEDS	272		199.00	N/A
HC62221288	RESERVOIR CELL SAVER              E	272		195.00	N/A
HC62221296	RESERVOIR CELL SAVER              F	272		260.00	N/A
HC62221304	RESERVOIR CELL SAVER              G	272		325.00	N/A
HC62221312	RESERVOIR CELL SAVER              H	272		390.00	N/A
HC62221320	RESERVOIR CELL SAVER              K	272		585.00	N/A
HC62221338	SET AUTOTRANSFUSE                 K	272		234.00	N/A
HC62221346	SLEEVE COMPRESSION                C	272		98.00	N/A
HC62221353	SLEEVE COMPRESSION                D	272		130.00	N/A
HC62221361	SPLINT FOOT DROP PREFAB	274	L4398	283.00	N/A
HC62221379	STAPLER SKIN                      F	272		260.00	N/A
HC62221387	SUCTION COLLECTION DEVICE         B	272		65.00	N/A
HC62221395	TRAY INTUBATION RETROGRADE	272		455.00	N/A
HC62221403	TRAY THORAC/PARACENTESIS          B	272		78.00	N/A
HC62221411	TRAY THORAC/PARACENTESIS          F	272		130.00	N/A
HC62221429	TROCAR ENDO                       B	272		65.00	N/A
HC62221437	TROCAR ENDO                       C	272		98.00	N/A
HC62221445	TROCAR ENDO                       D	272		130.00	N/A
HC62221452	TROCAR ENDO                       E	272		195.00	N/A
HC62221460	TROCAR ENDO                       H	272		390.00	N/A
HC62221478	TROCAR ENDO                       I	272		455.00	N/A
HC62221486	TROCAR ENDO                       L	272		650.00	N/A
HC62221494	TUBE INSUFFLATOR                  B	272		65.00	N/A
HC62221502	TUBE INSUFFLATOR                  D	272		130.00	N/A
HC62221510	TUBE INSUFFLATOR                  G	272		325.00	N/A
HC62221528	TUBE TRACH CUFFED                 C	272	A7521	98.00	N/A
HC62221536	TUBE TRACH CUFFED                 D	272	A7521	130.00	N/A
HC62221544	TUBE TRACH CUFFED                 F	272	A7521	260.00	N/A
HC62221551	TUBE TRACH NO CUFF                B	272	A7520	65.00	N/A
HC62221569	TUBE TRACH NO-CUFF                E	272	A7520	194.64	N/A
HC62221577	MANIPULATOR UTERINE               C	272		98.00	N/A
HC62221585	VALVE HEMOSTATIC W/GUIDEWIRE	272	C1769	215.00	N/A
HC62221593	CANNULA CEMENT BONE               E	272		195.00	N/A
HC62221601	CANNULA CEMENT BONE               Q	272		1,300.00	N/A
HC62221619	CANNULA REDUCER ENDOWRIST	272		85.00	N/A
HC62221627	CANNULA TRACH INNER               C	272	A4623	163.00	N/A
HC62221635	CATH GUIDING EXTENSION(GUIDEZILLA)Q	272	C1887	1,300.00	N/A
HC62221643	NEEDLE WIRE LOCALIZATION          E	272	C1819	101.00	N/A
HC62221650	DILATOR SPINE	272		499.00	N/A
HC62221668	DRESSING SURGICEL                 C	272		98.00	N/A
HC62221676	GUIDE DRILL TRANSTIBIAL FEMORAL   U	272		2,600.00	N/A
HC62221684	KIT ARTHROSCOPY DISPSBLS          T	272		1,528.00	N/A
HC62221692	KIT SPINAL ACCESS DISPOSBL        M	272		5,980.00	N/A
HC62221700	NEEDLE WIRE LOCALIZATION          A	272	C1819	33.00	N/A
HC62221718	NEEDLE WIRE LOCALIZATION          B	272	C1819	65.00	N/A
HC62221726	SET TUBING STABILZR ENDOWRST ROBOTIC	272		910.00	N/A
HC62221734	SNARE                             B	272		65.09	N/A
HC62221742	BOTTLE REPLACEMENT DRAINAGE	272		74.00	N/A
HC62221759	CLIP ENDOSCOPIC                   A	272		33.54	N/A
HC62221767	CLIP ENDOSCOPIC                   E	272		195.00	N/A
HC62221775	CLIP ENDOSCOPIC                   I	272		455.00	N/A
HC62221783	HEMOSTATIC GEL/GELFOAM/PAD        B	272		65.00	N/A
HC62221791	TAP SURGICAL                      F	272		260.00	N/A
HC62221809	TAP SURGICAL                      J	272		520.00	N/A
HC62221817	TAP SURGICAL                      K	272		560.63	N/A
HC62221825	TAP SURGICAL                      L	272		650.00	N/A
HC62221833	TAP SURGICAL                      M	272		780.00	N/A
HC62221841	TAP SURGICAL                      N	272		910.00	N/A
HC62221858	TAP SURGICAL                      O	272		1,040.00	N/A
HC62221866	TAP SURGICAL                      P	272		1,170.00	N/A
HC62221874	TAP SURGICAL                      Q	272		1,300.00	N/A
HC62221882	TAP SURGICAL                      R	272		1,614.44	N/A
HC62221890	TAP SURGICAL                      S	272		1,922.38	N/A
HC62221908	CATH INTRODUCER PEEL-AWAY         T	272	C1892	1,040.00	N/A
HC62221916	PROBE SPINAL DISPOSABLE           B	272		455.00	N/A
HC62221924	PLEDGET CARDIOVASCULAR (6/PK)	272		36.00	N/A
HC62221932	KIT TRACKING JOINT ORTHO ROBOTIC	272		735.00	N/A
HC62221940	PINS BONE REFERENCE ROBOTIC(2 PK)	272		436.00	N/A
HC62221957	TUBING IRRIGATION  HF ROBOTIC        C	272		150.00	N/A
HC62221965	PIN CHECKPOINT TIBL/FEMORAL ROBOTIC	272		234.00	N/A
HC62221973	PIN CHECKPOINT KNEE ROBOTIC	272		319.00	N/A
HC62221981	PIN CHECKPOINT HEX ROBOTIC	272		296.00	N/A
HC62221999	BLADE TREPHINE                    B	272		130.00	N/A
HC62222005	BLADE TREPHINE                    C	272		195.00	N/A
HC62222013	GRASPER ALLIGATOR ENDO            L	272		650.00	N/A
HC62222021	TUBE INSUFFLATOR                  F	272		260.00	N/A
HC62222039	CATHETER VENOGRAM BALLOON	272		325.00	N/A
HC62222047	VESSEL DILATOR                    B	272		52.00	N/A
HC62222054	CATH DIAGNOSTIC                   H	272		390.00	N/A
HC62222062	CATH CENTRAL VENOUS               H	272	C1751	390.00	N/A
HC62222070	CATH CENTRAL VENOUS               M	272	C1751	780.00	N/A
HC62222088	DEVICE RETRIEVAL                  D	272	C1773	2,275.00	N/A
HC62222096	OXYGENATOR PEDIATRIC              I	272		3,900.00	N/A
HC62222104	GUIDE PIN ORTHO                   K	272		585.00	N/A
HC62222112	GUIDE PIN ORTHO                   I	272		496.78	N/A
HC62222120	BLADE TREPHINE                    B	272		130.00	N/A
HC62222138	BLADE TREPHINE                    C	272		195.00	N/A
HC62222146	CASSETTE PURGE LVAD/RVAD	272		650.00	N/A
HC62222153	GUIDEWIRE                         K	272	C1769	682.59	N/A
HC62222161	TRAY EXCHANGE TRANSFUSION	272		143.00	N/A
HC62222179	CANNULA PERFUSION W/FILTER        Q	272		1,356.00	N/A
HC62222187	NEEDLE BX HIP TAPERED COBALT/FNA(SHARKCORE)	272		1,625.00	N/A
HC62222195	BARRIER/BAG DEFECT WALL VENTRAL/ABD	272		991.00	N/A
HC62222203	SYRINGE BONE MARROW ASPIRATION 30CC	272		1,466.00	N/A
HC62222211	CATH GUIDING                      D	272	C1887	130.00	N/A
HC62222229	CATH GUIDING                      F	272	C1887	260.00	N/A
HC62222237	SLEEVE COMPRESSION                B	272		65.00	N/A
HC62222245	INTRODUCER/SHEATH(PINNACL 10CM/RO)    C	272	C1894	98.00	N/A
HC62222252	CATH EP DX <20 ELECTRODES         G	272	C1730	910.00	N/A
HC62222260	CATH EP DX <20 ELECTRODES         H	272	C1730	1,040.00	N/A
HC62222278	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP F	272	C1733	260.00	N/A
HC62222286	CANNULA ARTHROSCOPIC              F	272		260.00	N/A
HC62222294	SUPPORT/BRACE KNEE                F	274	A4467	148.00	N/A
HC62222302	MANOMETER INSPIRATORY	272		38.00	N/A
HC62222310	DEVICE BIOPSY BREAST              Q	272		1,300.00	N/A
HC62222328	PROBE ABLATION                    R	272		1,625.00	N/A
HC62222336	TUBE INSUFFLATOR                  A	272		33.00	N/A
HC62222344	OVERTUBE ENDOSCOPIC               A	272		650.00	N/A
HC62222351	KIT PROCEDURE HYSTEROSCOPIC	272		1,170.00	N/A
HC62222369	BAG/POUCH RETRIEVAL SPECMN ENDO   F	272		423.00	N/A
HC62222377	ASPIRATOR ULTRASONIC SURG         B	272		1,720.79	N/A
HC62222385	GUIDE DRILL                       P	272		1,170.00	N/A
HC62222393	GUIDE DRILL                       Q	272		1,300.00	N/A
HC62222401	GUIDE ROD                         B	272		65.00	N/A
HC62222419	GUIDE ROD                         G	272		325.00	N/A
HC62222427	INSERTER FUNNEL IMPLANT BREAST	272		338.00	N/A
HC62222435	SNARE                             A	272		33.00	N/A
HC62222443	TUBE INSERTN LEAD ELECTRODE SINGLE	272		2,990.00	N/A
HC62222450	WAND ARTHRO                       D	272		130.00	N/A
HC62222468	WAND ARTHRO                       K	272		585.00	N/A
HC62222476	WAND ARTHRO                       L	272		650.00	N/A
HC62222484	WAND ARTHRO                       N	272		910.00	N/A
HC62222492	WAND ARTHRO                       O	272		1,040.00	N/A
HC62222500	WAND ARTHRO                       P	272		1,170.00	N/A
HC62222518	WAND ARTHRO                       Q	272		1,300.00	N/A
HC62222526	CABLE PACING DISP                 A	272		33.00	N/A
HC62222534	CATH NEPHROSTOMY                  A	272	C1729	33.00	N/A
HC62222542	CATH NEPHROSTOMY                  F	272	C1729	260.00	N/A
HC62222559	CATH NEPHROSTOMY                  G	272	C1729	325.00	N/A
HC62222567	CATH BALLOON RENAL                N	272	C1726	910.00	N/A
HC62222575	CATH BALLOON RENAL                O	272	C1726	1,035.67	N/A
HC62222583	TUBING ASPIRATOR ULTRASONIC       O	272		1,050.00	N/A
HC62222591	ELECTRODE ROLLER BALL             B	272		65.00	N/A
HC62222609	ELECTRODE ROLLER BALL             H	272		390.00	N/A
HC62222617	ELECTRODE ROLLER BALL             I	272		455.00	N/A
HC62222625	ELECTRODE ROLLER BALL             L	272		650.00	N/A
HC62222633	INTRO/SHEATH EP FIXED NON-PEEL    S	272	C1893	2,600.00	N/A
HC62222641	PROBE FLOW VASCULAR               B	272		78.00	N/A
HC62222658	SCALPEL HARMONIC ELECTRODE HOOK	272		471.00	N/A
HC62222666	TUBING ASPIRATOR ULTRASONIC       S	272		2,486.25	N/A
HC62222674	ADAPTER AIRWAY/RESP CPAP          B	272		78.00	N/A
HC62222682	BLADE OPHTHALM                    F	272		78.00	N/A
HC62222690	BLADE SHAVER                      B	272		130.00	N/A
HC62222708	CANNULA CORONARY SOFT-TIP	272		65.00	N/A
HC62222716	CANNULA PERFUSION ARTRL/VENOUS    B	272		65.00	N/A
HC62222724	CANNULA PERFUSION                 D	272		144.83	N/A
HC62222732	CAUTERY PENCIL                    A	272		33.00	N/A
HC62222740	CAUTERY PENCIL                    B	272		65.00	N/A
HC62222757	CAUTERY PENCIL                    C	272		98.00	N/A
HC62222765	CAUTERY PENCIL                    E	272		195.00	N/A
HC62222773	CHEST TUBE                        A	272		33.00	N/A
HC62222781	DEVICE CLOSURE VASCULAR           J	272	C1760	520.00	N/A
HC62222799	DEVICE CLOSURE VASCULAR           L	272	C1760	633.75	N/A
HC62222807	DEVICE INFLAT ENCORE              B	272		116.96	N/A
HC62222815	SCISSORS ENDOSCOPIC               D	272		129.97	N/A
HC62222823	FORCEPS BIPOLAR                   B	272		149.08	N/A
HC62222831	FORCEPS BIPOLAR DISPOSABLE        D	272		130.01	N/A
HC62222849	INFLATOR FOR BALLOON              F	272		156.00	N/A
HC62222856	PAD GROUNDING                     A	272		33.00	N/A
HC62222864	PAIN PUMP W/ SYSTEM               K	272		548.44	N/A
HC62222872	PAIN PUMP W/ SYSTEM               M	272		780.00	N/A
HC62222880	PAIN PUMP W/ SYSTEM               S	272		1,977.08	N/A
HC62222898	PROBE LASER                       G	272		325.00	N/A
HC62222906	PROBE LASER                       J	272		520.00	N/A
HC62222914	PROBE LASER                       L	272		650.00	N/A
HC62222922	PROBE LASER                       M	272		780.00	N/A
HC62222930	TUBING IRRIGATION                 B	272		104.00	N/A
HC62222948	MANIPULATOR UTERINE               E	272		195.00	N/A
HC62222955	CANNULA ARTERIAL                  J	272		650.00	N/A
HC62222963	CANNULA ARTERIAL                  K	272		780.00	N/A
HC62222971	DILATOR/BOUGIE ESOPHAGEAL	272		335.00	N/A
HC62222989	DISSECTOR BALLOON ENDOSCOPIC      D	272		1,300.00	N/A
HC62222997	ELECTRODE BIPOLAR HYSTERO TWIZZEL	272		1,325.25	N/A
HC62223003	DEVICE ELECTROSURGICAL CUT-CAUTERY N	272		966.00	N/A
HC62223011	ELECTRODE RESECTOSCOPE            K	272		910.00	N/A
HC62223029	HANDPIECE ILLUMINATOR/SUCTION	272		878.00	N/A
HC62223037	APPLIER LIGA/HEMOCLIP ENDO        I	272		455.00	N/A
HC62223045	APPLIER LIGA/HEMOCLIP ENDO        J	272		520.00	N/A
HC62223052	APPLIER LIGA/HEMOCLIP ENDO        N	272		780.00	N/A
HC62223060	APPLIER LIGA/HEMOCLIP ENDO        P	272		910.00	N/A
HC62223078	SLEEVE HOLDING ORTHO	272		390.00	N/A
HC62223086	TUBING ASPIRATOR (SONASTAR)       S	272		1,950.00	N/A
HC62223094	TUBING PERFUSION PACK PUMP	272		224.00	N/A
HC62223102	CANNULA VENOUS                    C	272		98.00	N/A
HC62223110	CATH EMBOLECTOMY FOGARTY          D	272	C1757	130.51	N/A
HC62223128	DEVICE COUPLER ANASTAMOSIS	272		880.00	N/A
HC62223136	FIBER LASER                       L	272		2,790.13	N/A
HC62223144	FIBER LASER                       M	272		2,600.00	N/A
HC62223151	NEEDLE ENDOSCOPIC                 C	272		98.00	N/A
HC62223169	CONNECTOR ASSIST PUMP VENTRICULAR	272		894.00	N/A
HC62223177	DEVICE ILLUMINATION MAST	272		1,661.00	N/A
HC62223185	DEVICE PEP OSCILLATING	272	E0484	146.00	N/A
HC62223193	MANIFOLD 3 VALVE CARDIAC	272		91.00	N/A
HC62223201	TUBE NASOJEJUNAL	272		144.00	N/A
HC62223219	CATH INTRODUCER PEEL-AWAY         N	272		455.00	N/A
HC62223227	INTRODUCER/SHEATH                 S	272	C1894	1,105.00	N/A
HC62223235	KIT HEMORRHOID SLIDE ONE	272		1,699.00	N/A
HC62223243	PROBE DOPPLER NEURO	272		1,930.50	N/A
HC62223250	WIRE PACING TEMP                  F	272		142.95	N/A
HC62223268	CATH PTA ANGIOPLS BALLOON NON-LSR G	272	C1725	585.00	N/A
HC62223276	SYSTEM LEAD EXTRACTION	272		749.00	N/A
HC62223284	TUBE BRACHY TX SEED ADMIN         A	272		65.00	N/A
HC62223292	TEMPLATE BRACHYTHERAPY            I	272		455.00	N/A
HC62223300	TEMPLATE BRACHYTHERAPY            L	272		780.00	N/A
HC62223318	KIT ACCESSORY                     J	272		780.00	N/A
HC62223326	KIT ACCESSORY                     K	272		910.00	N/A
HC62223334	CATH PTA ANGIOPLS BALLOON NON-LSR K	272	C1725	1,040.00	N/A
HC62223342	CATH PTA ANGIOPLS BALLOON NON-LSR B	272	C1725	260.02	N/A
HC62223359	DEVICE SUTURE ENDO                R	278		3,962.00	N/A
HC62223367	CATH MICRO NEURO(FUBUKI)          H	272	C1887	910.00	N/A
HC62223375	CATH MICROCATHETER NEUROVASC      I	272	C1887	1,040.00	N/A
HC62223383	CATH MICRO NEURO(ENVOY/REBAR)     L	272	C1887	1,625.00	N/A
HC62223391	SPLINT ELBOW/KNEE                 B	272		65.00	N/A
HC62223409	CATH PTA ANGIOPLS BALLOON NON-LSR I	272	C1725	780.00	N/A
HC62223417	CATH PTA ANGIOPLS BALLOON NON-LSR N	272	C1725	1,625.00	N/A
HC62223425	CATH EP DX <20 ELECTRODES         D	272	C1730	130.00	N/A
HC62223433	CATH EP DX <20 ELECTRODES RPRSD   I	272	C1730	455.00	N/A
HC62223441	CATH EP DX <20 ELECTRODES RPRSD   D	272	C1730	130.00	N/A
HC62223458	INTRODUCER/SHEATH                 W	272	C1894	2,284.39	N/A
HC62223466	ORTHOTIC LMBR1-5SAG PNL ANT/POST CSTM	274	L0627	1,281.00	N/A
HC62223474	COVER ORTHOTIC  'CTLS' UPRIGHT	274	L1120	139.00	N/A
HC62223482	ORTHOTIC KNEE W/JNTS PRFB CUSTM   A	274	L1832	130.00	N/A
HC62223490	ORTHOTIC ANKLE FOOT TIBIAL FX RT	274	L2112	1,669.00	N/A
HC62223508	ORTHOTIC HAND SPREADING PREFAB	274	L3923	79.00	N/A
HC62223516	ORTHOSIS HUMERAL FRACTURE	274	L3980	1,170.00	N/A
HC62223524	SOCK FRACTURE ORTHOTIC	274	L3995	108.00	N/A
HC62223532	CANNULA ENDOSCOPIC SPINAL	272		1,284.00	N/A
HC62223540	DILATOR SET URETHRAL	272		653.00	N/A
HC62223557	DRILL/DRILL BITS SINGLE USE      AG	272		1,604.11	N/A
HC62223565	DRILL/DRILL BITS SINGLE USE      AK	272		2,600.00	N/A
HC62223573	ELECTRODE HOOK LAPAROSCOPIC	272		148.00	N/A
HC62223581	SEALER VESSEL LAPAROSCOPIC	272		2,113.00	N/A
HC62223599	SNARE                             N	272		910.00	N/A
HC62223607	SNARE                             O	272		1,040.00	N/A
HC62223615	SNARE                             Q	272		1,300.00	N/A
HC62223623	SNARE                             S	272		1,950.00	N/A
HC62223631	STAPLE CARTRG/ENDO RELOAD         I	272		455.00	N/A
HC62223649	STAPLE CARTRG/ENDO RELOAD         J	272		520.00	N/A
HC62223656	STAPLE CARTRG/ENDO RELOAD         O	272		1,040.00	N/A
HC62223664	SYSTEM DETACHMENT COIL	272		650.00	N/A
HC62223672	SYSTEM DETACHMENT COIL/PLUG (MVP)	272		3,250.00	N/A
HC62223680	FUNNEL GRAFT BONE BIOCARTLG	272		91.00	N/A
HC62223698	NEEDLE BONE MARROW                Q	272		1,300.00	N/A
HC62223706	SENSOR CARDIAC OUTPUT	272		494.00	N/A
HC62223714	SYSTEM MIX/DELIVR GRAFT BIOCARTLG	272		615.00	N/A
HC62223722	CATH NEPHROSTOMY                  H	272	C1729	390.00	N/A
HC62223730	KIT CONCENTRATOR PLATELETS        F	272		260.00	N/A
HC62223748	SYSTEM DELIVERY LEAD              C	272	C1887	780.00	N/A
HC62223755	SYSTEM DELIVERY LEAD              I	272	C1887	1,950.00	N/A
HC62223763	CLIP MAGAZINE RANEY SCALP	272		46.00	N/A
HC62223771	DISSECTOR BALLOON ENDOSCOPIC      F	272		1,950.00	N/A
HC62223789	INK INDIA SINGLE-DOSE             C	272		98.00	N/A
HC62223797	PACKING NASAL                     A	272		33.00	N/A
HC62223805	PACKING NASAL                     B	272		65.00	N/A
HC62223813	PACKING NASAL                     E	272		202.31	N/A
HC62223821	SET DRILL BIT W/PIN(S)            F	272		260.00	N/A
HC62223839	SET DRILL BIT W/PIN(S)            I	272		455.00	N/A
HC62223847	SET DRILL BIT W/PIN(S)            M	272		780.00	N/A
HC62223854	SYSTEM DELIVERY LEAD              K	272	C1887	2,600.00	N/A
HC62223862	TEMPLATE ORTHO/ROD SPINAL         A	272		130.00	N/A
HC62223870	CATH EP DX 20+ ELECTRODES RPRSD   O	272	C1731	1,040.00	N/A
HC62223888	PORT ENDOSCOPIC	272		150.00	N/A
HC62223896	CANNULA VENOUS                    D	272		130.00	N/A
HC62223904	CATH DIAGNOSTIC                   F	272		260.00	N/A
HC62223912	INTRODUCER/SHEATH(NEURON MAX)     U	272	C1894	1,625.00	N/A
HC62223920	NEEDLE SPINAL                     B	272		65.00	N/A
HC62223938	PATCH 3D REFERENCE EP	272		1,300.00	N/A
HC62223946	SYSTEM COLLECTION/TRANSFER FAT	272		2,750.00	N/A
HC62223953	TAP SURGICAL                      T	272		2,275.00	N/A
HC62223961	TAP SURGICAL                      U	272		2,600.00	N/A
HC62223979	CANNISTER SUCTION NEURO/SPINAL	272		1,170.00	N/A
HC62223987	MANIPULATOR UTERINE               D	272		130.00	N/A
HC62223995	TOOL ACCESSORY PCMKR	272		1,625.00	N/A
HC62224001	TUBING SUCTN/IRRIG NEURO/SPINAL	272		390.00	N/A
HC62224019	SCISSORS ENDOSCOPIC               H	272		390.00	N/A
HC62224027	SNARE                             D	272		130.00	N/A
HC62224035	CATH EXCHANGER AIRWAY	272		195.00	N/A
HC62224043	SET DILATORS	272		260.00	N/A
HC62224050	VALVE ENDOSCOPIC                  G	272		325.00	N/A
HC62224068	HOLDER PIN	272		241.00	N/A
HC62224076	ATTACHMENT DISTAL COLONOSCOPE	272		83.00	N/A
HC62224084	CANNULA AORTIC ARCH               B	272		65.00	N/A
HC62224092	CANNULA ERCP                      E	272		163.00	N/A
HC62224100	CUTTER LINEAR ENDO                G	272		325.00	N/A
HC62224118	CUTTER LINEAR ENDO                M	272		780.00	N/A
HC62224126	CUTTER LINEAR ENDO                P	272		1,170.00	N/A
HC62224134	ELECTRODE SEALING (E.G. LIGASURE)	272		455.00	N/A
HC62224142	GUIDE PIN ORTHO                   B	272		65.00	N/A
HC62224159	HANDPIECE IRRIGATOR SUCTION	272		130.00	N/A
HC62224167	SET SHEATH DILATOR	272		3,250.00	N/A
HC62224175	SHEARS COAGULATING HARMONIC       K	272		585.00	N/A
HC62224183	SNARE                             F	272		260.00	N/A
HC62224191	CAUTERY TIP                       F	272		260.00	N/A
HC62224209	ELECTRODE LOOP                    E	272		195.00	N/A
HC62224217	GUIDE DRILLL                      M	272		780.00	N/A
HC62224225	GUIDE ROD                         K	272		585.00	N/A
HC62224233	PROBE ELECTROHEMOSTASIS	272		429.00	N/A
HC62224241	SYSTEM DELIVERY SEPTAL DEFECT     U	272		2,600.00	N/A
HC62224258	PICK INTRAOCULAR DISPOSABLE	272		130.00	N/A
HC62224266	PROBE HEMOSTASIS (BICAP)          E	272		650.00	N/A
HC62224274	NEEDLE ENDOSCOPIC                 G	272		325.00	N/A
HC62224282	DEVICE FIXATION SOFT TISSUE	272		1,658.00	N/A
HC62224290	KIT ARTHROSCOPY DISPSBLS          K	272		585.00	N/A
HC62224308	KIT ARTHROSCOPY DISPSBLS          O	272		1,040.00	N/A
HC62224316	RASP SPINAL DISPSBL	272		1,040.00	N/A
HC62224324	APPLIER CLIP ENDO                 Q	272		1,300.00	N/A
HC62224332	TUNNELER SURGICAL                 Q	272		1,300.00	N/A
HC62224340	APPLIER LIGA/HEMOCLIP ENDO        F	272		260.00	N/A
HC62224357	CANNULA INTRAOCULAR               E	272		169.00	N/A
HC62224365	CANNULA SUCTION & COAGULATION	272		780.00	N/A
HC62224373	CIRCUIT VENT SHORT WIRE HEATED	272		390.00	N/A
HC62224381	COLLAR CERVICAL MIAMI J           F	274	L0172	260.00	N/A
HC62224399	CUTTER DISC SPINAL	272		585.00	N/A
HC62224407	CUTTER RPRSD	272		72.00	N/A
HC62224415	DERMABOND                         H	272		390.00	N/A
HC62224423	EXTRACTOR TISSUE SPINAL	272		437.00	N/A
HC62224431	HOOK DISSECTING ENDO	272		455.00	N/A
HC62224449	INJECTOR GUN CEMENT	272		1,662.00	N/A
HC62224456	INTRO/SHEATH EP FIXED NON-PEEL    P	272	C1893	1,639.13	N/A
HC62224464	KIT REPAIR LEAD PCMKR	272		325.00	N/A
HC62224472	NEEDLE BIOPSY NASHOLD             Q	272		1,235.00	N/A
HC62224480	NEEDLE BIOPSY BONE                O	272		1,040.00	N/A
HC62224498	PASSER SUTURE                     J	272		520.00	N/A
HC62224506	PROBE LITHOTRIPTOR KIDNEY         T	272		2,754.76	N/A
HC62224514	SPLINT ELBOW/KNEE                 F	272		260.00	N/A
HC62224522	SYSTEM MIXING BONE CEMENT VACUUM	272		780.00	N/A
HC62224530	TIP MIX LUERLOCK CORTOSS (CEMENT)	272		910.00	N/A
HC62224548	KIT HEYMAN CATH URETHRA OBSTRUCT	272		728.00	N/A
HC62224555	WAND ARTHRO                       F	272		260.00	N/A
HC62224563	CABLE ELECTRODE MICRO TARGET/SCREEN	272		293.00	N/A
HC62224571	DEVICE SUTURE ENDOSCOPIC          O	272		2,730.00	N/A
HC62224589	DILATOR SET VASCULAR	272		650.49	N/A
HC62224597	SHEATH STAPLER ROBOTIC	272		65.00	N/A
HC62224605	CATH EP DX <20 ELECTRODES RPRSD   M	272	C1730	780.00	N/A
HC62224613	SEALER VESSEL ROBOTIC	272		1,950.00	N/A
HC62224621	SUCTION IRRIGATOR ROBOTIC	272		715.00	N/A
HC62224639	REAMER                           AJ	272		2,340.00	N/A
HC62224647	CATH DUODENOSCP DIGTL ACCESS/DELVRY	272		7,963.00	N/A
HC62224654	ADAPTER CATH URETERAL/URINARY     A	272		39.00	N/A
HC62224662	CATH SENSING PRESSUR INTRNL ABDOMEN	272		107.00	N/A
HC62224670	CATH SENSING PRESSUR INTRNL VESICAL	272		160.00	N/A
HC62224688	TUBING URO INFUSE PUMP	272		39.00	N/A
HC62224696	CATH EP DIAG/ABLAT 3D/VECT RPRSD	272	C1732	130.00	N/A
HC62224704	ELECTRODE ENDOSCOPIC BALL TIP	272		543.00	N/A
HC62224712	ELECTRODE NEEDLE UROLOGICAL HF	272		1,625.00	N/A
HC62224720	ORTHOTIC WHO W/O JOINTS SPICA	274	L3906	111.00	N/A
HC62224738	SYSTEM ILLUMINATION ENDOSCOPIC	272		988.00	N/A
HC62224746	WRAP COMPRESSION BACK/SPINE	271		156.00	N/A
HC62224753	CATH EP DX <20 ELECTRODES   RPRSD H	272	C1730	390.00	N/A
HC62224761	CATH THROMBECTOMY                AC	272	C1757	5,850.00	N/A
HC62224779	CATH THROMBECTOMY/EMBOLECTOMY     V	272	C1757	3,900.00	N/A
HC62224787	GUIDE PIN ORTHO                   D	272		130.00	N/A
HC62224795	HANDPIECE VESSEL SEALER DEVICE    F	272		1,950.00	N/A
HC62224803	KIT REPAIR CATH DIALYSIS PERITONEAL	272		208.00	N/A
HC62224811	CATH BLOCKER BRONCH/TRACH	272		390.00	N/A
HC62224829	CATH GUIDNG(PX400/SILICONE/STRYKER BLLN)R	272	C1887	3,575.00	N/A
HC62224837	CATH GUIDE REPERFUS(DAC/FLOWGATE) S	272	C1887	3,900.00	N/A
HC62224845	KIT PLACEMENT SHUNT ELECTROMAGNETIC	272		2,145.00	N/A
HC62224852	NEEDLE PROBE VASCULAR SMART	272		390.00	N/A
HC62224860	SPLINT FINGER OUTRIGGER           A	272		39.00	N/A
HC62224878	SPLINT FINGER OUTRIGGER           B	272		72.00	N/A
HC62224886	WRAP COLD BAG GEL CERVICAL	272		78.00	N/A
HC62224894	DILATOR VESSEL                    A	272		33.00	N/A
HC62224902	CATH PTA ANGIOPLS BALLOON NON-LSR H	272	C1725	650.00	N/A
HC62224910	CATH ANGIOGRAPHY                  J	272	C1887	521.76	N/A
HC62224928	CATH BALLOON DIL NON VASCULAR     S	272	C1726	1,950.00	N/A
HC62224936	DEVICE CLOSURE VASCULAR           A	272	C1760	33.00	N/A
HC62224944	GUIDE DRILL                       I	272		471.90	N/A
HC62224951	PROBE LITHOTRIPTOR                F	272		260.00	N/A
HC62224969	PROBE LITHOTRIPTOR                M	272		780.00	N/A
HC62224977	PROBE LITHOTRIPTOR                R	272		1,625.00	N/A
HC62224985	RETRIEVER SUTURE                  D	272		130.00	N/A
HC62224993	MOLDS/FORMS CEMENT FEM&TIB KNEE	272		8,938.00	N/A
HC62225008	SLEEVE TROCAR RPRSD               B	272		70.00	N/A
HC62225016	SPLINT NERVE RADIAL HAND-BASED	274	L3923	342.00	N/A
HC62225024	SET REMOVAL NUCLEUS SPINAL	272		2,431.00	N/A
HC62225032	NEEDLE ASPIRAT(EUS SLIMLIN22/25GA)L	272		650.00	N/A
HC62225040	NEEDLE ASPIRAT(EUS SLIMLIN 19GA)  Q	272		1,300.00	N/A
HC62225057	INTRO/SHEATH EP FIXED NON-PEEL    Q	272	C1893	1,950.00	N/A
HC62225065	DEVICE LIGATOR                    B	272		325.00	N/A
HC62225073	DILATOR SET URETHRAL PEDIATRIC	272		260.00	N/A
HC62225081	SEAL ENDO ROBOTIC                 A	272		33.00	N/A
HC62225099	SEAL ENDO ROBOTIC                 D	272		130.00	N/A
HC62225107	CATH PTA ANGIOPLS BALLOON NON-LSR A	272	C1725	130.00	N/A
HC62225115	CUSHION WHEEL CHAIR	272		78.00	N/A
HC62225123	GUIDE DRILL                       K	272		585.00	N/A
HC62225131	NEEDLE BIOPSY EUS                 F	272		260.00	N/A
HC62225149	TUBE INSUFFLATOR                  J	272		520.00	N/A
HC62225156	RESERVOIR CSF VENTRICULAR	272		410.00	N/A
HC62225164	ORTHOTIC WHFO D-RING              A	274	L3908	33.00	N/A
HC62225172	ORTHOTIC WHFO D-RING              B	274	L3908	65.00	N/A
HC62225180	STRAP FLEXION FINGER	274	L3908	39.00	N/A
HC62225198	SYSTEM DELIVERY STENT BILIARY	272		260.00	N/A
HC62225206	CATH OCCLUSION                    F	272	C2628	260.00	N/A
HC62225214	ET PORT DRAIN FISTULA	272		65.00	N/A
HC62225222	KIT DRESSING WOUND NEG PRESSURE   J	272		780.00	N/A
HC62225230	ROD EXTRACTION CONICAL	272		975.00	N/A
HC62225248	KIT CAUTERY LEEP (REDIKIT)	272		585.00	N/A
HC62225255	GUIDE BX NEEDLE PROSTATE	272		65.00	N/A
HC62225263	SPLINT RESTRICTION CMC THUMB	274	L3923	65.00	N/A
HC62225271	SENSOR OXIMETRY CEREBRAL SOMATIC	272		258.80	N/A
HC62225289	SIZER MAMMARY                     G	272		501.15	N/A
HC62225297	CATH EP DX 20+ ELECTRODES RPRSD   N	272	C1731	910.00	N/A
HC62225305	EXTRACTOR NAIL	272		846.56	N/A
HC62225313	GUIDE ROD                         M	272		780.00	N/A
HC62225321	CANNULA ARTHROSCOPIC              L	272		650.00	N/A
HC62225339	CANNULA ARTHROSCOPIC              N	272		910.00	N/A
HC62225347	CANNULA ARTHROSCOPIC              Q	272		1,300.00	N/A
HC62225354	CATH ERCP (PUSHING)               B	272		325.00	N/A
HC62225362	KIT REPAIR BROVIAC/CV/HICKMAN     C	272		423.00	N/A
HC62225370	KIT REPAIR BROVIAC/CV/HICKMAN     E	272		553.00	N/A
HC62225388	KIT REPAIR BROVIAC/CV/HICKMAN     F	272		618.00	N/A
HC62225396	OVERTUBE LIGATNG HEMOSTATC ENDO	272		325.00	N/A
HC62225404	PUSHER KNOT ENDO                  G	272		650.00	N/A
HC62225412	PUSHER KNOT ENDO                  H	272		780.00	N/A
HC62225420	ANCHOR CLIP ENDOSCOPIC	272		1,300.00	N/A
HC62225438	GRASPER TWIN ENDOSCOPIC	272		1,950.00	N/A
HC62225446	DEVICE RESECTION MUCOSAL ENDO(EMR)	272		1,057.00	N/A
HC62225453	FIBER OPTIC ERCP	272		910.00	N/A
HC62225461	CATH BALLOON UTZ BRONCHOSCOPC	272		98.00	N/A
HC62225479	IMMOBILIZER SHOULDER PEDS	274	L3670	260.00	N/A
HC62225487	KIT PROCESSING MARROW BONE	272		3,250.00	N/A
HC62225495	TUBE SPLINTING ENDOSCOPIC	272		1,057.00	N/A
HC62225503	CASTING MATERIAL THERMOPLSTC EA ROLL	272		72.00	N/A
HC62225511	NEEDLE BIOPSY EUS                 O	272		1,040.00	N/A
HC62225529	CATH UMBILICAL                    G	272		228.00	N/A
HC62225537	ELEVATOR KNEE FOAM W/COVER	272		104.00	N/A
HC62225545	EXTENDER CATH DIALYSIS PERITONEAL	272		488.00	N/A
HC62225552	INJECTOR GRAFT/STENT	272		813.00	N/A
HC62225560	DRESSNG ENDOFRM TEMPLT 2X2 COLLAGEN	272		39.00	N/A
HC62225578	KIT INSERTION IABP	272		520.00	N/A
HC62225594	DRESSING COLLAGEN W/ AG	272		273.00	N/A
HC62225602	PUNCH AORTIC                      C	272		98.00	N/A
HC62225628	CATH TRANSLUM ANGIO LASER         K	272	C1885	4,550.00	N/A
HC62225644	CATH EP/ABLATION COOL-TIP         L	272	C2630	6,175.00	N/A
HC62225651	SET TUBING CATH COOL-TIP	272		341.00	N/A
HC62225669	CATH EP DIAG/ABLAT 3D/VECT       AA	272	C1732	11,050.00	N/A
HC62225677	CATH EP DIAG/ABLAT 3D/VECT       AB	272	C1732	11,700.00	N/A
HC62225685	CATH TRANSLUM ANGIO LASER         T	272	C1885	8,450.00	N/A
HC62225693	CATH TRANSLUM ANGIO LASER         Z	272	C1885	11,700.00	N/A
HC62225701	CANNISTER WOUND NEG PRESSURE	272		98.00	N/A
HC62225719	DRESSNG ENDOFRM TEMPLT 4X5 COLLAGEN	272		130.00	N/A
HC62225727	SHEARS COAGULATING HARMONIC       T	272		1,950.00	N/A
HC62225735	ASPIRATOR ULTRASONIC SURG         C	272		1,950.00	N/A
HC62225743	CATH GUIDING                      M	272	C1887	780.00	N/A
HC62225750	KIT DRESSING WOUND NEG PRESSURE   K	272		910.00	N/A
HC62225768	KIT DRESSING WOUND NEG PRESSURE   N	272		1,300.00	N/A
HC62225776	SYSTEM DRESSING WOUND NEG PRES    R	272		1,625.00	N/A
HC62225784	SYSTEM DRESSING WOUND NEG PRES    T	272		2,277.08	N/A
HC62225792	TEMPLATE ORTHO/ROD SPINAL         S	272		624.00	N/A
HC62225800	DEVICE SUTURING ENDOSCPC OVERSTITCH O	272		3,120.00	N/A
HC62225818	GUIDE DRILL                       H	272		390.00	N/A
HC62225826	GUIDE DRILL                       I	272		599.63	N/A
HC62225834	GUIDE DRILL                       J	272		568.75	N/A
HC62225842	GUIDE DRILL                       L	272		650.00	N/A
HC62225859	GUIDE DRILL                       M	272		812.50	N/A
HC62225867	GUIDE DRILL                       N	272		910.00	N/A
HC62225875	GUIDE DRILL                       O	272		1,040.00	N/A
HC62225883	GUIDE DRILL                       R	272		1,625.00	N/A
HC62225891	GUIDE DRILL                       W	272		3,250.00	N/A
HC62225909	ADAPTOR EXT BRACHYTHERAPY	272		98.00	N/A
HC62225917	BASKET RETRIEVAL                  H	272		423.00	N/A
HC62225925	COLLAR GYN BRACHYTHERAPY	272		228.00	N/A
HC62225933	GUIDE VAGINAL BRACHYTHERAPY	272		390.00	N/A
HC62225941	TUBE INSERT TONGUE BRACHYTHERAPY	272		65.00	N/A
HC62225958	TAP SURGICAL                      H	272		390.00	N/A
HC62225966	TEMPLATE BRACHYTHERAPY            B	272		65.00	N/A
HC62225974	TEMPLATE BRACHYTHERAPY            D	272		130.00	N/A
HC62225982	BLADE SHAVER                      C	272		194.48	N/A
HC62225990	COUNTERSINK                       G	272		520.00	N/A
HC62226006	COUNTERSINK                       K	272		760.76	N/A
HC62226014	COUNTERSINK                       Q	272		1,245.08	N/A
HC62226022	COUNTERSINK                       R	272		1,625.00	N/A
HC62226030	M: MODEL CUSTOM CRANIOMAXILLOFACIAL	272		10,400.00	N/A
HC62226048	SET NEEDLE INTRAOSEOUS      C	272		98.00	N/A
HC62226055	SPIKE BONE ORTHO	272		260.00	N/A
HC62226063	TAP SURGICAL                     H	272		390.00	N/A
HC62226071	TEMPLATE BRACHYTHERAPY            B	272		65.00	N/A
HC62226089	TIP SACRO SURG DISP	272		228.00	N/A
HC62226097	DRILL/DRILL BITS SINGLE USE      AI	272		2,275.00	N/A
HC62226105	DRILL/DRILL BITS SINGLE USE      AJ	272		2,405.00	N/A
HC62226113	DRILL/DRILL BITS SINGLE USE      AL	272		3,061.70	N/A
HC62226121	DRILL/DRILL BITS SINGLE USE      AM	272		3,250.00	N/A
HC62226139	KIT ACCESSORY                     P	272		1,560.00	N/A
HC62226147	ELECTRODE RESECTOSCOPE            N	272		1,300.00	N/A
HC62226154	CATH INTRACARDIAC ECHO/UTZ RPRSD  B	272	C1759	2,275.00	N/A
HC62226162	CARTRIDGE MECHNCL WOUND NEG PRESSURE	272		390.00	N/A
HC62226170	KIT DRESSING WOUND NEG PRESSURE   A	272	A6550	130.48	N/A
HC62226188	KIT DRESSING WOUND NEG PRESSURE   B	272	A6550	197.25	N/A
HC62226196	STRAP WOUND CARE	272		33.00	N/A
HC62226204	BLADE SHAVER                      AC	272		1,820.00	N/A
HC62226212	CAUTERY PENCIL                    F	272		260.00	N/A
HC62226220	CUTTER LEAD	272		163.00	N/A
HC62226238	DRILL/DRILL BITS SINGLE USE      AR	272		4,488.25	N/A
HC62226246	INTRODUCER/SHEATH                 E	272	C1894	195.00	N/A
HC62226253	KIT ACCESSORY                     G	272		520.00	N/A
HC62226261	KIT DILATOR SPINAL	272		3,250.00	N/A
HC62226279	NEEDLE BIOPSY BONE                M	272		780.00	N/A
HC62226287	NEEDLE BONE MARROW                O	272		1,040.00	N/A
HC62226295	NEEDLE INSERTION NEUROSTIM	272		520.00	N/A
HC62226303	NEEDLE SPINAL                     G	272		325.00	N/A
HC62226311	PICK VEIN	272		65.00	N/A
HC62226329	PIN/WIRE FIXATION TEMPORARY      AM	272		1,950.00	N/A
HC62226337	PROBE SPINAL DISPOSABLE           A	272		371.48	N/A
HC62226345	PROBE SPINAL DISPOSABLE          AC	272		2,340.00	N/A
HC62226352	PROGRAMMER NEUROSTIM PAT          H	271	C1787	6,337.50	N/A
HC62226360	PROTECTOR CORNEAL	272		650.00	N/A
HC62226378	PUSHER KNOT ENDO                  I	272		910.00	N/A
HC62226386	RETRACTOR DISPOSABLE              M	272		1,300.00	N/A
HC62226394	RETRACTOR MIS SPINAL              B	272		1,300.00	N/A
HC62226402	RETRACTOR MIS SPINAL              T	272		9,188.40	N/A
HC62226410	SET CARDIOPLEGIA                                        B	272		65.00	N/A
HC62226428	SLEEVE SUTURE LEAD PACEMAKER	272		130.00	N/A
HC62226436	STABILIZER LEAD PACING	272		130.00	N/A
HC62226444	STYLET CARDIAC                    C	272		163.00	N/A
HC62226451	TIP DISSECTOR MICRO ULTRSONC (SONOPET)	272		2,600.00	N/A
HC62226469	TOOL INSERTION TRANSVALVULAR	272		65.00	N/A
HC62226477	TUBE BRACHY TX SEED ADMIN         G	272		260.00	N/A
HC62226485	WAND LARYNGEAL	272		2,080.00	N/A
HC62226493	CABLE LIGHT MIS SPINAL DISP	272		1,950.00	N/A
HC62226501	CHARGER BATTERY NEUROSTIM         B	271	L8689	4,875.00	N/A
HC62226519	COLLAR CERV OCC/MAND SUP MULTI POST	274	L0180	455.00	N/A
HC62226527	COVER/SLEEVE PROBE	272		358.00	N/A
HC62226535	DRESSING FOAM W/BRDR&ANTIMIC<OR=48SQ IN	272	A6213	85.00	N/A
HC62226543	DRESSING FOAM W/BRDR&ANTIMIC>48SQ IN	272	A6214	130.00	N/A
HC62226550	ELECTRODE EEG/EMG DISP	272		455.00	N/A
HC62226568	INTRODUCER/SHEATH                 F	272	C1894	260.00	N/A
HC62226576	KIT DELIVERY GRAFT	272		2,275.00	N/A
HC62226584	PIN/WIRE FIXATION TEMPORARY      AW	272		3,250.00	N/A
HC62226592	PROBE SPINAL DISPOSABLE          AC	272		2,340.00	N/A
HC62226600	RETRACTOR MIS SPINAL              A	272		650.00	N/A
HC62226618	RETRACTOR MIS SPINAL              D	272		2,275.00	N/A
HC62226626	SLEEVE IMPACTOR	272		195.00	N/A
HC62226634	TAP SURGICAL                      I	272		455.00	N/A
HC62226642	TAP SURGICAL                      V	272		2,925.00	N/A
HC62226659	TAP SURGICAL                      X	272		3,575.00	N/A
HC62226667	TEMPLATE ORTHO/ROD SPINAL         V	272		780.00	N/A
HC62226675	INTRODUCER/SHEATH                 X	272	C1894	2,600.00	N/A
HC62226683	CABLE PACING DISP                 D	272		130.00	N/A
HC62226691	EXTENDER TAB SPINAL	272		1,300.00	N/A
HC62226709	GUIDE DRILL                       E	272		195.00	N/A
HC62226717	GUIDEWIRE                         A	272	C1769	42.15	N/A
HC62226725	GUIDEWIRE                         C	272	C1769	130.00	N/A
HC62226733	MOLD/FORM CEMENT	272		1,625.00	N/A
HC62226741	RETRACTOR MIS SPINAL              A	272		650.00	N/A
HC62226758	WOUND FILLER POWDER COLLAGEN-1GM	272	A6011	2,113.00	N/A
HC62226766	FORCEPS BIOPSY MICRO(MORAY)	272		1,788.00	N/A
HC62226774	COUNTERSINK CANNULATED            G	272		583.05	N/A
HC62226782	GUIDE DRILL                       W	272		5,850.00	N/A
HC62226790	KIT/TRAY BX(ONCONTROL S/L NEEDLE) I	272	C1830	455.00	N/A
HC62226808	TAMP BONE KYPHOPLASTY             B	272		975.00	N/A
HC62226816	TROCAR ENDO                       O	272		1,040.00	N/A
HC62226824	BOWL CEMENT MIXING                E	272		195.00	N/A
HC62226832	CATH CENTRAL VENOUS               G	272		325.00	N/A
HC62226840	CATH INFUS/THROMBOLYSS(CRAGG-MCNAMARA)H	272	C1887	390.00	N/A
HC62226857	CATH PTA ANGIOPLS BALLOON NON-LSR J	272	C1725	893.75	N/A
HC62226865	CIRCUIT VENT                      A	272		33.00	N/A
HC62226873	DILATOR URETERAL	272		423.00	N/A
HC62226881	GUIDEWIRE                         G	272	C1769	424.68	N/A
HC62226899	GUIDEWIRE                         I	272	C1769	521.26	N/A
HC62226907	HANDPIECE VESSEL SEALER DEVICE    B	272		1,300.55	N/A
HC62226915	KIT ABALATION (MAZE)	272		65,000.00	N/A
HC62226923	CANNULA ARTERIAL                  B	272		260.00	N/A
HC62226931	DEVICE EMULSION SUBMUCOSAL INJ AMPOULE	272		264.00	N/A
HC62226949	WOUND FILLER GEL COLLAGEN-28GM	272	A6011	260.00	N/A
HC62226956	CANNULA ARTERIAL                  C	272		260.00	N/A
HC62226964	CANNULA PERFUSION                 O	272		1,040.00	N/A
HC62226972	CATH FOLLOWER URETH PHILLIPS      F	272		195.00	N/A
HC62226980	CATH NEPHROSTOMY                  N	272	C1729	780.00	N/A
HC62226998	CATH PTA ANGIOPLS BALLOON NON-LSR C	272	C1725	325.00	N/A
HC62227004	DEVICE INFLATN ACCESS ABD	272		2,150.00	N/A
HC62227012	DILATOR BALLOON ENDO PULM	272	C1726	975.00	N/A
HC62227020	DISSECTOR NEURO	272		130.00	N/A
HC62227038	ELECTRODE BIPOLAR ENDO	272		2,275.00	N/A
HC62227046	KNIFE URETHROTOME	272		910.00	N/A
HC62227053	PROBE OPTHALMIC	272		78.00	N/A
HC62227061	PROBE SINUS	272		789.75	N/A
HC62227079	SUMP INTRACARDIAC PEDS	272		39.00	N/A
HC62227087	TUBE TRACH CUFFED                 L	272	A7521	650.00	N/A
HC62227095	TUBE TRACH CUFFED                 M	272	A7521	780.00	N/A
HC62227103	CATH GUIDING (GUIDEZILLA II)      P	272	C1887	1,170.00	N/A
HC62227111	CONTROL DOSE C02 MANUAL PAT(AEROFORM)	272		1,021.00	N/A
HC62227129	INTRODUCER/SHEATH                 V	272	C1894	1,776.13	N/A
HC62227137	PROBE ABLATION                   AS	272		7,685.69	N/A
HC62227145	KIT EXTRACT RESURFAC HIP	272		2,600.00	N/A
HC62227152	DRILL/DRILL BITS SINGLE USE      AO	272		4,166.32	N/A
HC62227160	BLADE INCISIONAL                  T	272		1,300.00	N/A
HC62227178	COUNTERSINK CANNULATED            M	272		910.00	N/A
HC62227186	REAMER                           AG	272		2,145.00	N/A
HC62227194	BLADE HOOK  ENDOSCOPIC	272		1,170.00	N/A
HC62227202	CATH IV MIDLINE                   D	278	C1751	130.00	N/A
HC62227210	CATH IV MIDLINE                   E	278	C1751	195.00	N/A
HC62227228	CATH IV MIDLINE                   F	278	C1751	260.00	N/A
HC62227236	CATH IV MIDLINE                   H	278	C1751	390.00	N/A
HC62227244	CATH IV MIDLINE                   I	278	C1751	455.00	N/A
HC62227251	CATH IV MIDLINE                   J	278	C1751	520.00	N/A
HC62227269	FIBER LASER                       F	272		650.00	N/A
HC62227277	FIBER LASER                       G	272		897.33	N/A
HC62227285	FIBER LASER                       H	272		908.90	N/A
HC62227293	DEVICE TIF (ESOPHYX)	272		9,019.00	N/A
HC62227301	FASTENERS TIF(SEROSAFUSE CARTRIDGE)	272		1,381.00	N/A
HC62227319	ELECTRODE BIPOLAR ENDO            D	272		1,625.00	N/A
HC62227327	WAND BREAST BIOPSY                N	272		975.00	N/A
HC62227335	GUIDE PIN ORTHO                   H	272		390.00	N/A
HC62227343	BAG/POUCH RETRIEVAL SPECMN ENDO   B	272		130.00	N/A
HC62227350	TIP SUCTION/IRRIG                 D	272		130.00	N/A
HC62227368	CUTTER SEALER BIPOLAR ULTRASONIC	272		1,300.00	N/A
HC62227376	KIT CONCENTRATOR PLATELETS        J	272		585.00	N/A
HC62227384	NEEDLE DELIVERY BIOCARTILAGE	272		195.00	N/A
HC62227392	KIT CONCENTRATOR PLATELETS        O	272		1,040.00	N/A
HC62227400	DRESSING ANTIMIC MICRO-CURRENT    A	272		33.00	N/A
HC62227418	DRESSING ANTIMIC MICRO-CURRENT    B	272		65.00	N/A
HC62227426	DRESSING ANTIMIC MICRO-CURRENT    C	272		98.00	N/A
HC62227434	DRESSING ANTIMIC MICRO-CURRENT    D	272		130.00	N/A
HC62227442	DRESSING ANTIMIC MICRO-CURRENT    E	272		195.00	N/A
HC62227459	GUIDE COMPONENT KNEE CUSTOM PATIENT	272		1,625.00	N/A
HC62227467	OBTURATOR                         C	272		98.00	N/A
HC62227475	BALLOON LATEX EUS	272		65.00	N/A
HC62227483	CAP ENDOSCOPIC HYBRID             D	272		130.00	N/A
HC62227491	OVERTUBE ENDOSCOPIC               B	272	A4270	975.00	N/A
HC62227509	KIT COLON W-BTTNS,BX CAP,VALVE ENDO	272		910.00	N/A
HC62227517	KIT COLON W-SEAL ,HYDRA, ORCA VALVE	272		358.00	N/A
HC62227525	FORCEPS BIPOLAR DISPOSABLE        L	272		910.00	N/A
HC62227533	SPHINCTEROTOME                    C	272		390.00	N/A
HC62227541	SHIELD COLLAGEN CORNEAL	272		683.00	N/A
HC62227558	GUIDE PIN ORTHO                   L	272		650.00	N/A
HC62227566	PUNCH ARTHROSCOPIC                B	272		260.00	N/A
HC62227574	REAMER                            F	272		195.00	N/A
HC62227582	REAMER                           AH	272		2,015.00	N/A
HC62227590	REAMER                           AK	272		2,600.00	N/A
HC62227608	TAP SURGICAL                      G	272		325.00	N/A
HC62227624	NOTCHER TUNNEL                    R	272		1,625.00	N/A
HC62227632	CANNULA PERFUSION RETROGRADE	272		1,950.00	N/A
HC62227640	CATH EP DX <20 ELECTRODES RPRSD   M	272	C1730	845.00	N/A
HC62227657	CATH INTRACARDIAC ECHO/UTZ RPRSD  F	272	C1759	4,550.00	N/A
HC62227665	COUNTERSINK                       C	272		260.00	N/A
HC62227673	ELECTRODE LOOP CUTTING BIPOLAR	272		1,136.78	N/A
HC62227681	ELECTRODE MONOPOLAR BALL	272		1,625.00	N/A
HC62227699	ILLUMINATOR STRIP RETRACTOR	272		650.00	N/A
HC62227707	KIT CASS KNEE 2 POD IASSIST	272		4,680.00	N/A
HC62227715	TUBING HYSTEROSCOPY               F	272		390.00	N/A
HC62227723	TUBING HYSTEROSCOPY               H	272		520.00	N/A
HC62227731	TUBING SINUS	272		130.00	N/A
HC62227749	BLADE ROBOTIC (SNAP-FIT)	272		195.00	N/A
HC62227756	COVER TIP ACCESSORY ROBOTIC	272		65.00	N/A
HC62227764	TIP DISSECTOR MICRO	272		194.67	N/A
HC62227772	SET TUBING HARVESTER GRAFT ENDO	272		1,625.00	N/A
HC62227780	RETRIEVER GRAFT	272		195.00	N/A
HC62227798	PROTECTOR OVERFLOW BACTERIA (DHS)	272		260.00	N/A
HC62227806	CANNISTER COLLECTING TISSUE (DHS)	272		260.00	N/A
HC62227814	KIT REPAIR BROVIAC/CV/HICKMAN     H	272		748.00	N/A
HC62227822	POSITIONER FLUIDIZED SMALL	272		52.00	N/A
HC62227830	POSITIONER FLUIDIZED LARGE	272		195.00	N/A
HC62227848	HEADREST PUPILLOMETER	272		98.00	N/A
HC62227855	CANNULA ARTHROSCOPIC              P	272		1,170.00	N/A
HC62227863	DRESSING CLOT QUICK	272	A6222	572.00	N/A
HC62227871	KIT ARTHROSCOPY DISPSBLS          Y	272		2,600.00	N/A
HC62227889	KIT REPAIR BROVIAC/CV/HICKMAN     I	272		813.00	N/A
HC62227897	OBTURATOR ARTHRO                  K	272		1,040.00	N/A
HC62227905	PUNCH ARTHROSCOPIC                E	272		650.00	N/A
HC62227913	SHEATH ARTHROSCOPIC               E	272		260.00	N/A
HC62227921	SHEATH ARTHROSCOPIC               H	272		650.00	N/A
HC62227939	CARTRIDGE MECHNCL WOUND NEG PRESSURE D	272		650.00	N/A
HC62227947	KIT DRESSING WOUND NEG PRESSURE C	272		260.00	N/A
HC62227954	SYSTEM DRESSING WOUND NEG PRES S	272		1,950.00	N/A
HC62227962	SYSTEM LAVAGE CLEANING WOUND	272		195.00	N/A
HC62227970	PASSER SUTURE	272		2,275.00	N/A
HC62227988	EMBOLIZATION PROTECTIVE SYSTEM (TCAR) X	272	C1884	11,212.77	N/A
HC62227996	APPLICATOR/TIP SYRINGE ONLY	272		195.40	N/A
HC62228002	LOOP PLASMA	272		1,625.00	N/A
HC62228010	MARKER GRAFT RADIOPAQUE	272		33.00	N/A
HC62228028	AWL SINGLE PATIENT USE	272		130.00	N/A
HC62228036	CATH INTRACARDIAC ECHO/UTZ        H	272	C1759	9,100.00	N/A
HC62228044	GRASPER ENDO	272		194.82	N/A
HC62228051	KIT NASAL PAP ADULT	272	A7027	130.00	N/A
HC62228069	MOLD/FORM CEMENT ADAPTER FEMORAL	272		845.00	N/A
HC62228077	MOLD/FORM CEMENT SPACER FEMORAL	272		16,038.75	N/A
HC62228085	MOLD/FORM CEMENT STEM HIP	272		4,225.00	N/A
HC62228093	PATCH WIRELESS MONITOR MATERNAL-FETAL	270		163.00	N/A
HC62228101	SYSTEM DRESSING WOUND NEG PRES    P	272		975.00	N/A
HC62228119	ORTH ELBOW ADJUST POSITION LOCK PREFAB CUSTOM	274	L3760	1,434.00	N/A
HC62228127	ORTH EWHO RIGID W/O JOINTS CUSTOM	274	L3763	2,418.00	N/A
HC62228135	ORTH EWHO W/NONTORSION JOINT(S) CUSTOM	274	L3764	2,779.00	N/A
HC62228143	ORTH WHFO, RIGID W/O JOINTS CUSTOM	274	L3808	1,304.00	N/A
HC62228150	ORTH WHFO DYNAMIC FLEX HINGE CABLE DRIVEN CUSTOM	274	L3901	5,759.00	N/A
HC62228168	ORTH WHFO EXT POWERED ELECTRIC CUSTOM	274	L3904	11,528.00	N/A
HC62228176	ORTH WHO W/NONTORSION JOINTS CUSTOM	274	L3905	2,844.00	N/A
HC62228184	ORTH HFO FLEX GLOVE W/ELSTC FNGR CNTRL PREFAB OTS	274	L3912	374.00	N/A
HC62228192	ORTH HFO W/O JOINTS CUSTOM	274	L3913	777.00	N/A
HC62228200	ORTH WHO W/NONTORSION JOINT(S) PREFAB CUSTOM	274	L3915	1,525.00	N/A
HC62228218	ORTH WHO NONTORSION JOINT(S) PREFAB OTS	274	L3916	1,525.00	N/A
HC62228226	ORTH HFO METACARPAL FRACTURE PREFAB CUSTOM	274	L3917	303.00	N/A
HC62228234	ORTH HO METACARPAL FRACTURE PREFAB OTS	274	L3918	303.00	N/A
HC62228242	ORTH HO W/O JOINTS CUSTOM	274	L3919	777.00	N/A
HC62228259	ORTH HFO W/NONTORSION JOINT(S) CUSTOM	274	L3921	920.00	N/A
HC62228267	ORTH HFO W/O JOINTS PREFAB OTS	274	L3924	257.00	N/A
HC62228275	ORTH FO PIP/DIP W/ JOINT/SPRING PREFAB OTS	274	L3925	189.00	N/A
HC62228283	ORTH FO PIP/DIP W/O JOINT/SPRING PREFAB OTS	274	L3927	101.00	N/A
HC62228291	ORTH FO W/O JOINTS CUSTOM	274	L3933	611.00	N/A
HC62228309	SIZER MAMMARY                     O	272		975.00	N/A
HC62228317	STAPLER SINGLE USE ROBOTIC	272		1,690.00	N/A
HC62228325	STAPLE CARTRG/ENDO RELOAD         M	272		779.79	N/A
HC62228333	PROBE TURBINATE                   L	272		650.00	N/A
HC62228341	PROBE TURBINATE                   N	272		910.00	N/A
HC62228358	SET SHEATH DILATOR (TRUSEAL WATCHMAN)	272	C1766	4,550.00	N/A
HC62228366	KIT TRANSSEPTAL (WATCHMAN)	272		2,763.00	N/A
HC62228374	NEEDLE TRANSSEPTAL NRG (WATCHMAN)	272		1,609.00	N/A
HC62228382	WIRE PIGTAIL PROTRACK (WATCHMAN)	272	C1769	634.00	N/A
HC62228390	SHEATH TRANSSEPTAL GUIDE KIT(WATCHMAN)	272	C1893	2,682.00	N/A
HC62228408	SHEATH STEERBL GUIDE SUREFLEX (WATCHMAN)	272	C1766	2,925.00	N/A
HC62228416	ORTH WHFO W/NONTORSION JOINT(S) CUSTOM	274	L3806	1,303.00	N/A
HC62228424	ORTH FINGER NONTORSION JOINT CUSTOM	274	L3935	633.00	N/A
HC62228432	SHEATH GUIDING TORFLEX (WATCHMAN)	272	C1893	520.00	N/A
HC62228440	DEVICE REVASC/THROMBCT(EMBOTRAP)	272	C1757	19,500.00	N/A
HC62228457	KIT SUTURE WIRE LASSO	272		1,300.00	N/A
HC62228465	PASSER SUTURE                     N	272		910.00	N/A
HC62228473	BASKET RETRIEVAL BILIARY (SPYGLASS)	272		1,650.00	N/A
HC62228481	NEEDLE TARGETING                  E	272		195.00	N/A
HC62228499	BRONCHOSCOPE ASCOPE SLIM DISP	272		888.00	N/A
HC62228507	BRONCHOSCOPE ASCOPE REG DISP	272		888.00	N/A
HC62228515	BRONCHOSCOPE ASCOPE LRG DISP	272		1,021.00	N/A
HC62228523	SYSTEM THROMBECTOMY(CAPERE?)	272	C1757	1.01	N/A
HC62228531	SPLINT NASAL(POSISEP)             I	272		460.97	N/A
HC62228549	ELECTRODE PACING/DEFIB TEMPORARY  K	272		585.00	N/A
HC62228556	ELECTRODE PACING/DEFIB TEMPORARY  L	272		650.00	N/A
HC62228564	ELECTRODE PACING/DEFIB(ONESTEP)	272		260.00	N/A
HC62228572	DEVICE EXCHANGE	272	C1725	2,113.00	N/A
HC62228580	STAPLER INTERNAL EEA	272		3,825.00	N/A
HC62228598	DEVICE CLOSURE SKIN(ZIPLINE)	272		358.00	N/A
HC62228606	WOUND FILLER GEL(PLUROGEL)-1.75OZ	272	A6261	317.00	N/A
HC62228614	WOUND FILLER GEL(PLUROGEL)-14.1OZ	272	A6261	2,124.00	N/A
HC62228622	KIT ROTAPRO	272	C1724	4,363.00	N/A
HC62228630	CARTRIDGE ENZYME DIGEST RELIZORB	272		127.00	N/A
HC62228648	APPLIER CLIP CLOSURE ANASTOMOSIS	272		3,247.00	N/A
HC62228655	GUIDEWIRE(BABYWIRE)               B	272		60.00	N/A
HC62228663	GUIDEWIRE(BABYWIRE)               A	272		40.00	N/A
HC62228671	PAD DEFIBRILLATION/ECG	272		57.00	N/A
HC62228689	PROBE ABLATION  CRYO              A	272	C2618	4,050.00	N/A
HC62228697	DEVICE SUTURE CAPIO	272		1,920.01	N/A
HC62228705	IVS TUBING PUMP RAPID INFUSER	272		475.00	N/A
HC62228713	SYSTEM EMBOLECTOMY(CAPERE?) G200036	624	C1757	1.01	N/A
HC62228721	SLEEP REMOTE(INSPIRE?)	270	C1787	18,550.00	N/A
HC62228739	SENSORS TRACKER VPAD?	272		1,400.00	N/A
HC62228747	BRUSH(ALWAYS-ON TIP TRACKED?)	272		1,843.00	N/A
HC62228754	FORCEPS(ALWAYS-ON TIP TRACKED?)	272		1,843.00	N/A
HC62228762	NEEDLE 19G HISTO(ALWAYS-ON TIP TRACKED?)	272		1,843.00	N/A
HC62228770	NEEDLE 22G SPIN FLEX?(ALWAYS-ON TIP TRACKED?)	272		2,764.00	N/A
HC62228788	KIT SPIN PERC?(ALWAYS-ON TIP TRACKED?)	272		2,325.00	N/A
HC62228796	SYSTEM ENDOAVF WAVELINQ?	272		22,750.00	N/A
HC62228804	DEVICE CLOSURE VASCULAR?????????? M	272	C1760	800.00	N/A
HC62228812	SET NEURO MRI GUIDED ABLATE (INSIGHTEC?)	272		9,750.00	N/A
HC62228820	SCISSORS ENDOSCOPIC               Q	272		1,050.00	N/A
HC62228838	CATH MEASUREMENT ENDOFLIP	272	C1726	1,283.00	N/A
HC62290424	CATH SENSING PRESSUR INTRNL ABDOMEN	272		107.00	N/A
HC62290432	WOUND FILLER POWDER COLLAGEN-5GM	272	A6011	6,338.00	N/A
HC62290440	TUBING URO INFUSE PUMP	272		39.00	N/A
HC62290556	GUIDE PIN ORTHO                   N	272		910.00	N/A
HC62300009	RETRACTOR ATRIAL SHORT ROBOTIC	272		959.00	N/A
HC62300017	SCISSORS CURVED ROBOTIC           I	272		455.00	N/A
HC62300025	CAUTERY LTD REUSE/'PERMANT' ROBOTIC	272		650.00	N/A
HC62300058	APPLIER CLIP ROBOTIC              B	272		56.00	N/A
HC62300066	CAUTERY MONOPOLAR ROBOTIC	272		699.00	N/A
HC62300074	DISSECTOR ROBOTIC                 F	272		293.00	N/A
HC62300082	DISSECTOR ROBOTIC                 I	272		390.00	N/A
HC62300090	DISSECTOR ROBOTIC                 Z	272		943.00	N/A
HC62300108	DRIVER NEEDLE ROBOTIC	272		748.00	N/A
HC62300116	FORCEP ROBOTIC                    L	272		677.00	N/A
HC62300124	GRASPER ROBOTIC                   C	272		390.00	N/A
HC62300132	GRASPER ROBOTIC                   E	272		650.00	N/A
HC62300140	GRASPER ROBOTIC                   F	272		780.00	N/A
HC62300157	SCISSORS CURVED ROBOTIC           N	272		910.00	N/A
HC62300165	SCISSORS POTTS ROBOTIC	272		634.00	N/A
HC62300173	TIP CAUTERY HOOK ROBOTIC          L	272		488.00	N/A
HC62300181	TIP CAUTERY HOOK ROBOTIC          Q	272		650.00	N/A
HC62300199	TIP CAUTERY HOOK ROBOTIC          F	272		293.00	N/A
HC62300207	CABLE EP                         A	272		33.00	N/A
HC62300215	CABLE EP                         E	272		163.00	N/A
HC62300223	CATH INTRACARDIAC ECHO/UTZ RPRSD  C	272	C1759	2,925.00	N/A
HC62300231	HOOK VALVE ROBOTIC	272		390.00	N/A
HC62300249	GRASPER ANVIL ROBOTIC             F	272		260.00	N/A
HC62300256	STAPLER ROBOTIC (ENDOWRIST)	272		455.00	N/A
HC62300264	SHEARS HARMONIC ROBOTIC	272		182.00	N/A
HC62300272	FORCEP ROBOTIC                    H	272		390.00	N/A
HC62300280	FORCEP ROBOTIC                    J	272		520.00	N/A
HC62300298	FORCEP ROBOTIC                    K	272		585.00	N/A
HC62300306	FORCEP ROBOTIC                    M	272		780.00	N/A
HC62300314	FORCEP ROBOTIC                    N	272		918.23	N/A
HC62300439	HOLDER BLADE ROBOTIC (SNAP-FIT)	272		260.00	N/A
HC62300447	FORCEP ROBOTIC                    F	272		260.00	N/A
HC62300454	DRIVER NEEDLE ROBOTIC             I	272		390.00	N/A
HC62300462	STABILIZER ENDOWRIST ROBOTIC	272		7,150.00	N/A
HC62300470	FORCEP ROBOTIC                    N	272		910.00	N/A
HC62300488	DISSECTOR ROBOTIC                 S	272		715.00	N/A
HC62300496	SUCTION IRRIGATOR ROBOTIC	272		98.00	N/A
HC62300504	DRIVER NEEDLE ROBOTIC             O	272		910.00	N/A
HC62800008	M: ANCHOR BONE SOFT TISSUE	278	C1713	1,526.07	N/A
HC62800016	BALLOON BILIARY	272	C1726	714.82	N/A
HC62800024	BALLOON DILATOR BILIARY/NEPHRO	272	C1726	1,014.00	N/A
HC62800032	BALLOON ERCP	272	C1726	845.00	N/A
HC62800040	BALLOON ESOPHAGEAL	272	C1726	845.00	N/A
HC62800057	BALLOON HYSTEROSALPINGOGRAM	272	C1726	325.00	N/A
HC62800065	CATH PTA ANGIOPLS BALLOON NON-LSR M	272	C1725	1,300.00	N/A
HC62800073	CATH PTCA BALLOON NON-LASER       K	272	C1725	1,170.00	N/A
HC62800081	CATH PTA ANGIOPLS BALLOON NON-LSR L	272	C1725	1,170.00	N/A
HC62800099	CATH PTCA BALLOON NON-LASER       Q	272	C1725	2,925.00	N/A
HC62800107	CATH PTA ANGIOPLS BALLOON NON-LSR R	272	C1725	2,925.00	N/A
HC62800115	BALLOON TAMPONADE UTERINE	272	C1726	1,976.00	N/A
HC62800123	BALLOON UTERINE	272	C1726	1,976.00	N/A
HC62800131	CATH ABLAT VASC NON CARDIAC	272	C1888	3,900.00	N/A
HC62800149	CATH ANGIOGRAPHY W/BALLOON        O	272	C1887	1,040.00	N/A
HC62800156	CATH BALLOON PTA(COYOTE)          H	272	C1725	975.00	N/A
HC62800164	CATH ATHERECTOMY DIRECTIONAL      E	272	C1714	8,887.00	N/A
HC62800172	CATH ATHERECTOMY DIRECTIONAL      H	272	C1714	11,245.00	N/A
HC62800180	CATH ATHERECTOMY ROTATIONAL      AH	272	C1724	7,150.00	N/A
HC62800198	CATH BALLOON DIL NON VASCULAR     J	272	C1726	570.88	N/A
HC62800206	CATH BALLOON DILAT URO MAX        J	272	C1726	520.00	N/A
HC62800214	CATH BALLOON PYLORIC              T	272	C1726	2,275.00	N/A
HC62800222	CATH BALLOON RETRIEVAL            F	272	C1773	488.00	N/A
HC62800230	CATH BALLOON THERMACHOICE         U	272	C1726	2,600.00	N/A
HC62800248	CATH BALLOON ULTRA THIN           H	272	C1726	390.00	N/A
HC62800255	CATH BRACHY TX SEED ADMIN         K	272	C1728	9,100.00	N/A
HC62800263	CATH CORONARY SINUS	272	C1887	3,458.00	N/A
HC62800271	CATH DILATOR                      I	272	C1726	455.00	N/A
HC62800289	CATH THROMBECTOMY/EMBOLECTOMY     T	272	C1757	2,275.00	N/A
HC62800297	CATH EP DIAG/ABLAT 3D/VECT        W	272	C1732	8,450.00	N/A
HC62800305	CATH EP DX <20 ELECTRODES         Y	272	C1730	5,200.00	N/A
HC62800313	CATH EP DX <20 ELECTRODES         N	272	C1730	2,340.00	N/A
HC62800321	CATH EP DX 20+ ELECTRODES         J	272	C1731	4,940.00	N/A
HC62800339	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP W	272	C1733	3,250.00	N/A
HC62800347	CATH EP/ABLATION COOL-TIP         G	272	C2630	4,550.00	N/A
HC62800354	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP AG	272	C1733	6,500.00	N/A
HC62800362	CATH GUIDING                      K	272	C1887	585.00	N/A
HC62800370	CATH GUIDING                      R	272	C1887	1,612.72	N/A
HC62800388	CATH INFUSION                     Q	272	C1887	1,300.00	N/A
HC62800396	CATH INTRA AORTIC BALLOON         C	278		2,617.73	N/A
HC62800404	CATH INTRACARDIAC ECHO/UTZ RPRSD  E	272	C1759	3,900.00	N/A
HC62800412	CATH IVUS PV LARGE VESSEL	272	C1753	2,737.00	N/A
HC62800420	CATH IVUS PV SMALL VESSEL	272	C1753	2,737.00	N/A
HC62800438	CATH NON VASC DIL RENAL	272	C1726	742.00	N/A
HC62800446	CATH PICC                         L	278	C1751	722.00	N/A
HC62800453	CATH QUINTON                      Q	278	C1751	1,300.00	N/A
HC62800461	CATH SINGLE LUMEN	278		325.00	N/A
HC62800479	CATH SWAN GANZ/THERMODILUTION     P	278		1,138.00	N/A
HC62800495	CATH SWAN GANZ/THERMODILUTION     M	278		722.00	N/A
HC62800503	CATH THROMBECTOMY/EMBOLECTOMY     U	272	C1757	2,600.00	N/A
HC62800511	CATH THROMBECTOMY                AG	272	C1757	6,500.00	N/A
HC62800529	CATH TRANSLUM ANGIO LASER         U	272	C1885	9,100.00	N/A
HC62800537	CATH TRIPLE LUMEN	278		325.00	N/A
HC62800545	CATH OCCLUSION                    H	272	C2628	390.00	N/A
HC62800552	CATH OCCLUSION                    Q	272	C2628	1,301.68	N/A
HC62800560	DEVICE CLOSURE FASCIA	272		406.00	N/A
HC62800578	DEVICE CLOSURE VASCULAR           Q	272	C1760	779.01	N/A
HC62800586	DEVICE THROMBECTOMY/EMBOLECTOMY   X	272	C1757	3,575.00	N/A
HC62800594	GUIDEWIRE                         E	272	C1769	294.45	N/A
HC62800602	GUIDEWIRE(X-PEDION HYDROPHILIC)   P	272	C1769	1,073.00	N/A
HC62800610	M: ADAPTER/EXTEND NEURSTM LEAD	278	C1883	3,081.00	N/A
HC62800628	M: ADAPTER/EXTEND PACING LEAD	275	C1883	3,714.75	N/A
HC62800636	M: AICD DUAL CHAMBER	275	C1721	38,649.00	N/A
HC62800644	M: AICD NON-SINGLE/NON-DUAL	275	C1882	52,301.26	N/A
HC62800651	M: AICD SINGLE CHAMBER	275	C1722	41,913.90	N/A
HC62800669	M: ALLOGRAFT	278		4,184.51	N/A
HC62800677	M: ANKLE COMPONENT	278	L8699	13,541.67	N/A
HC62800685	M: BAND GASTRIC	278	A4301	N/A	N/A
HC62800693	M: BONE/BONE PLATE	278	L8699	5,029.43	N/A
HC62800701	M: BONE GRAFT/PUTTY/GEL	278	L8699	4,823.46	N/A
HC62800719	M: BONE MORPHOGENET PRTN INFUSE	278	L8699	N/A	N/A
HC62800727	M: BONE MORPHOGENET PROTN OP1	278	L8699	N/A	N/A
HC62800735	M:BONE PLUG	278		344.50	N/A
HC62800743	M: PROSTHESIS BREAST IMPLANT	278	C1789	4,197.17	N/A
HC62800750	M: BREAST MAMMOSITE	278	C1728	N/A	N/A
HC62800768	M: BURR HOLE COVER	278	L8699	618.01	N/A
HC62800776	TUBE GASTROSTOMY LOWPRFL BTTN     H	278	B4088	390.00	N/A
HC62800784	CABLE DALL MILES	278		1,380.80	N/A
HC62800792	CAPSULE PH (IMPLANT)              I	278		1,560.00	N/A
HC62800800	RECORDER CARDIAC EVENT(MEDTRONIC LINQ)	278	C1764	16,167.22	N/A
HC62800818	CATH CVP/PICC GROSHONG	278	C1751	494.00	N/A
HC62800826	CATH HEMO/PERI DIAL LONG TERM     O	278	C1750	1,039.94	N/A
HC62800834	CATH HEMO/PERI DIAL SHORT TRM     N	278	C1752	943.00	N/A
HC62800842	M: CATH HEMODIAL PORT/RSRV LNG TRM	278	C1750	N/A	N/A
HC62800859	M: CATH HEMODIAL EXTERNAL LNG TRM	278	C1750	1,056.17	N/A
HC62800867	CATH HICKMAN/BROVIAC              L	278	C1751	650.00	N/A
HC62800875	M: CATH VENTRICULAR NEURO	278	A4301	2,283.52	N/A
HC62800883	CATHETER PERITONEAL              AH	278	A4301	1,560.00	N/A
HC62800891	CATHETER PLEURAL/KIT	278		1,560.00	N/A
HC62800909	M: CEMENT BONE	278	L8699	820.92	N/A
HC62800917	M: CEMENT RESTRICTOR	278	L8699	333.84	N/A
HC62800925	M: CEMENT SPACER	278	L8699	364.00	N/A
HC62800933	M: CLIP ANEURYSM	278		1,318.69	N/A
HC62800941	M: DEVICE INVESTIGATIONAL	624	C1889	N/A	N/A
HC62800958	COIL EMBOLIZATION                 J	278		1,217.00	N/A
HC62800966	M: CORNEAL TRANSPLANT ACQ	278	V2785	12,869.93	N/A
HC62800974	M: DISK ARTIFICIAL SPINE LUMBAR	278	L8699	N/A	N/A
HC62800982	M: EAR OSSICULAR PROSTHESIS	278	L8613	1,355.25	N/A
HC62800990	M: ELBOW COMPONENT	278	C1776	15,009.80	N/A
HC62801006	M: ELECTRODE NEUROSTIM EACH	278	C1778	29,907.13	N/A
HC62801014	M: EYE TUTOPLAST	278		N/A	N/A
HC62801022	M: NAIL FEMORAL ANCHOR BONE-BONE	278	C1713	3,579.09	N/A
HC62801030	FILTER VENA CAVA (E.G.GUNTHER)    G	278	C1880	4,070.00	N/A
HC62801048	M: FIXATOR	278	L8699	1,583.07	N/A
HC62801055	M: GENRTR DUAL NRSTM NON-RECHG	278	C1767	30,143.75	N/A
HC62801063	M: GENRTR DUAL NRSTM RE-CHRG&CHRGR	278	L8687	45,667.61	N/A
HC62801071	M: GENRTR SNGL NRSTM NON-RECHG	278	C1767	57,218.75	N/A
HC62801089	M: GI LAB MISC IMPLANT	278		1,764.75	N/A
HC62801097	M: GRAFT CARDIO-VASCULAR	278	C1768	1,403.33	N/A
HC62801105	M: GRAFT PATCH	278	C1768	1,119.92	N/A
HC62801113	M: GRAFT PERI STRIP BIO VASC	278	C1768	N/A	N/A
HC62801121	M: GRAFT VASCULAR	278	C1768	16,506.22	N/A
HC62801139	M: LINER ACETABULAR HIP	278	C1776	2,791.86	N/A
HC62801147	M: SHELL ACETABULAR HIP	278	C1776	3,362.28	N/A
HC62801154	M: CUP ACETABULAR HIP	278	C1776	3,219.03	N/A
HC62801162	M:HIP FEM HEAD JOINT DEVICE	278	C1776	2,075.86	N/A
HC62801170	M: STEM FEMORAL HIP	278	C1776	6,815.77	N/A
HC62801188	M: COMPONENT MISC/REVISION HIP	278	C1776	3,823.10	N/A
HC62801196	M: I.M. ROD	278	L8699	1,186.25	N/A
HC62801204	M: INJ BULK AGENT (DURASPHERE/COAPTITE)	278	L8606	0.01	N/A
HC62801212	M: INTERSPINOUS DEVICE/ XSTOP	278	C1821	N/A	N/A
HC62801220	M: INTRASPINAL CATHETER	278	C1755	2,863.77	N/A
HC62801238	M: IOL ANTERIOR CHAMBER	276	V2630	N/A	N/A
HC62801246	M: IOL POSTERIOR CHAMBER	276	V2632	500.16	N/A
HC62801253	M: IOL PRESBYOPIA CORRECTNG	276	V2788	N/A	N/A
HC62801261	M: JOINT SMALL(FINGER/TOE)	278	C1776	3,318.47	N/A
HC62801279	KIT CVP (PASSPORT)	278	C1751	867.00	N/A
HC62801287	M: COMPONENT FEMORAL KNEE	278	C1776	5,359.97	N/A
HC62801295	M: KNEE MISC COMPONENT	278	L8699	2,962.09	N/A
HC62801303	M: KNEE PATELLA	278	L8699	1,324.06	N/A
HC62801311	M: BASEPLATE TIBIAL KNEE	278	C1776	4,018.55	N/A
HC62801329	M: INSERT TIBIAL KNEE	278	C1776	3,770.94	N/A
HC62801337	M: LEAD CORONARY VENOUS	275	C1900	5,355.04	N/A
HC62801345	M: LEAD ICD ENDO DUAL COIL	275	C1895	9,678.18	N/A
HC62801352	M: LEAD ICD ENDO SNGL COIL	275	C1777	9,114.97	N/A
HC62801360	M: LEAD ICD NON-SNGL/DUAL	275	C1896	14,625.00	N/A
HC62801378	M: LEAD NEUROSTIM TEST KIT	278	C1897	N/A	N/A
HC62801394	M: LEAD PCMKR NON-TRANSVENOUS	275	C1898	1,214.43	N/A
HC62801402	M: LEAD PCMKR TRANSVENOUS	275	C1779	1,340.86	N/A
HC62801410	M: LEAD/ELECTRODE NEUROSTIM EA	278	C1778	19,722.21	N/A
HC62801428	M: MANDIBULAR COMPONENT	278	L8699	N/A	N/A
HC62801436	M: MAXILLOFACIAL	278	L8699	N/A	N/A
HC62801444	M: MESH HERNIA/CRANIOFACIAL/BONE	278	C1781	2,109.43	N/A
HC62801451	M: MESH COMPOSIX	278	C1781	2,531.75	N/A
HC62801469	M: MESH TITANIUM	278	C1781	N/A	N/A
HC62801477	M: MISC ORTHO IMPLANT	278	L8699	4,449.56	N/A
HC62801485	M: MISC SPINAL IMPLANT	278	L8699	4,377.27	N/A
HC62801493	NEEDLE BRACHYTHERAPY TANDEM CLICK	278	C1715	348.00	N/A
HC62801501	M: NEUROSTIM RECEIVR RADIOFREQ	278	C1816	59,962.50	N/A
HC62801519	M: OCULAR	278	L8610	1,076.87	N/A
HC62801527	M: PACEMAKER GENERATOR	275	C2621	11,604.82	N/A
HC62801535	M: PACEMAKER LEADS	275	C1779	N/A	N/A
HC62801543	PARTICLES EMBOLIZ (EMBOSPHERE)    M	278		910.00	N/A
HC62801550	M: PCMKR DUAL NON-RATE RESP	275	C2619	16,900.00	N/A
HC62801568	M: PACEMAKER DUAL CHMBR RATE RESPONSIVE	275	C1785	11,926.54	N/A
HC62801576	M: PCMKR OTHER THAN SNGL/DUAL	275	C2621	18,780.60	N/A
HC62801584	M: PCMKR SNGL NON-RATE RESP	275	C2620	N/A	N/A
HC62801592	M: PACEMAKER SNGL CHMBR RATE RESPONSIVE	275	C1786	10,389.52	N/A
HC62801600	PEG REPLACEMENT	278		230.26	N/A
HC62801618	M: PENILE PROSTH (INFLAT)	278	C1813	23,476.33	N/A
HC62801626	M: PENILE PROSTH (NON INFLAT)	278	C2622	N/A	N/A
HC62801634	M: PIN ABSORABLE	278	L8699	N/A	N/A
HC62801642	M: PIN ACL	278	L8699	598.00	N/A
HC62801659	M:PIN/K-WIRE/STEINMAN ANCHOR BN-BN	278	C1713	244.42	N/A
HC62801667	M: PIN TRANSFIXAT'N ANCHOR BONE-BNE	278	C1713	794.59	N/A
HC62801675	M: PINS NEUFELD/KNOWLES	278	L8699	N/A	N/A
HC62801683	M: PLATE MAXILLOFACIAL	278	C1713	842.13	N/A
HC62801691	M: PLATE NEURO	278	C1713	627.77	N/A
HC62801709	M: PLATE LOCKING CARDIAC	278	C1713	341.97	N/A
HC62801717	M: PLATE ORTHO	278	C1713	2,643.22	N/A
HC62801725	PORT INDWELLING W/CATH            K	278	C1788	1,625.00	N/A
HC62801733	PORT INDWELLING W/CATH            M	278	C1788	2,275.00	N/A
HC62801741	M: PUMP INFUSION NON PROGRAMBL	278	C2626	N/A	N/A
HC62801758	M: PUMP INFUSION PROGRAMABLE	278	C1772	32,499.38	N/A
HC62801766	M: RETIN DET SCLERAL EXOPLANT	278		N/A	N/A
HC62801774	OIL SILICON TAMPONADE RETINAL	278	C1814	1,203.28	N/A
HC62801782	RING FALLOPIAN	278		150.18	N/A
HC62801790	M: RING HEART	278		N/A	N/A
HC62801808	M: ROD ORTHO	278	L8699	1,003.49	N/A
HC62801816	M: SCREW INTERFERENCE	278	C1713	786.17	N/A
HC62801824	M: SCREW MAXILLOFACIAL	278	C1713	202.45	N/A
HC62801832	M: SCREW NEURO	278	C1713	923.42	N/A
HC62801840	M: SCREW ORTHO	278	C1713	451.16	N/A
HC62801857	M: SEPTAL DEFECT IMPLANT SYS	278	C1817	28,140.11	N/A
HC62801865	TUBE JEJUN STD TRANSG/SET PEG     M	278	B4087	778.43	N/A
HC62801873	M: SHOULDER GLENOID	278	C1776	4,375.98	N/A
HC62801881	M: SHOULDER HUMERAL HEAD	278	C1776	4,007.67	N/A
HC62801899	M: STEM HUMERAL SHOULDER	278	C1776	8,814.87	N/A
HC62801907	M: SHUNT CONNECTOR	278		437.74	N/A
HC62801915	M: SHUNT NEURO	278		11,231.72	N/A
HC62801923	M: SHUNT PERITONEAL	278	A4301	2,011.74	N/A
HC62801931	M: SHUNT VASCULAR	278		2,271.75	N/A
HC62801949	M: JOINT SILASTIC	278	C1763	585.43	N/A
HC62801956	M: SLING VAGINAL	278	C1771	4,863.65	N/A
HC62801964	M: CAGE SPINAL	278	L8699	10,897.14	N/A
HC62801972	M: NUT SPINAL	278		190.67	N/A
HC62801980	M: PLATE SPINAL	278	L8699	5,877.20	N/A
HC62801998	M: ROD SPINAL	278	L8699	816.20	N/A
HC62802004	M: SPACER/STABILIZER SPINAL	278	L8699	8,990.40	N/A
HC62802012	M: TRANSCONEC/CROSSBRAC SPINAL	278	L8699	2,071.50	N/A
HC62802020	M:STAPLE FIXATION ANCHOR BONE-BONE	278	C1713	3,115.81	N/A
HC62802038	M: STENT ABD AORTIC ANEURYSM	278	C1874	49,653.18	N/A
HC62802046	STENT NON-COAT/NON-COV W-DEL     AD	278	C1876	5,850.00	N/A
HC62802053	STENT ENDOPRSTH TIPS(VIATORR)     K	278	C1874	13,650.00	N/A
HC62802061	STENT CORO COVRD W/DEL SYS	278	C1874	9,263.00	N/A
HC62802079	STENT BILIARY PLASTIC             L	278	C2617	618.00	N/A
HC62802087	STENT CAROTID	278	C1874	10,400.00	N/A
HC62802095	STENT COAT/COVRD W/O DEL SYS	278	C1875	8,060.00	N/A
HC62802103	STENT ENDOPRSTH PVD(VIABAHN)      G	278	C1874	10,400.00	N/A
HC62802111	STENT PV SELF EXP CVRD/DEL SPX	278	C1874	10,855.00	N/A
HC62802129	STENT DES CORO COV W/DEL SYS      V	278	C1874	10,075.00	N/A
HC62802137	STENT PV BARE METAL W/O DEL SYS	278	C1877	4,672.31	N/A
HC62802145	M: STENT NON CORON W/DELIV SYS	278	C2625	1,638.45	N/A
HC62802152	STENT CORO BARE METAL W/DEL       J	278	C1876	5,850.00	N/A
HC62802160	M: STENT PALMAZ	278	C1874	N/A	N/A
HC62802178	STENT PANCREATIC                  M	278	C2617	250.87	N/A
HC62802186	STENT NON-COAT/NON-COV W-DEL     AG	278	C1876	7,150.00	N/A
HC62802194	STENT NON-CORON TEMP NO DELIV SYS L	278	C2617	650.00	N/A
HC62802202	M: STENT URINARY DIVERSN W/DEL SYS	278	C2625	446.55	N/A
HC62802210	M: STENT WALLSTENT	278	C1874	N/A	N/A
HC62802228	M: SYRINGE CONTIGEN	278	L8603	1,608.75	N/A
HC62802236	M: TISSUE DURA DERM	278		6,144.79	N/A
HC62802244	M:PROSTHESIS BREAST TISS EXPANDER	278	C1789	5,622.87	N/A
HC62802251	M: TISSUE FASCIA LATA HUMAN	278	C1762	2,666.09	N/A
HC62802269	TUBE JEJUN LOWPRO TG BUTTON	278	B4088	1,071.24	N/A
HC62802277	TUBE JEJUNOSTOMY STANDARD         J	278	B4087	520.00	N/A
HC62802285	M: URINARY SPHINCTER	278	C1815	15,839.69	N/A
HC62802293	M: VALVE GLAUCOMA (OCULAR I:)	278	C1783	N/A	N/A
HC62802301	M: VALVE HEART	278		105,625.00	N/A
HC62802319	M: VALVE PUDENZ FLUSH	278		N/A	N/A
HC62802327	M: WASHER/NUT ORTHO/SPINAL	278		163.63	N/A
HC62802335	M: WEDGE ORTHO	278	L8699	5,235.01	N/A
HC62802343	M: WIRE TITANIUM/STAIN STEEL	278	L8699	269.16	N/A
HC62802350	INTRODUCER/SHEATH                 I	272	C1894	457.43	N/A
HC62802368	INTRO/SHEATH EP FIXED NON-PEEL    J	272	C1893	715.00	N/A
HC62802376	INTRO/SHEATH EP FIXED PEEL       AK	272	C1892	1,311.20	N/A
HC62802384	INTRO/SHEATH EP FIXED PEEL       AN	272	C1892	3,575.00	N/A
HC62802392	INTRO/SHEATH EP LASER             F	272	C2629	455.00	N/A
HC62802400	INTRODUCER/SHEATH                 F	272	C1894	261.50	N/A
HC62802418	INTRODUCER BLADDER STIM	272	C1894	780.00	N/A
HC62802426	INTRODUCER/SHEATH                 H	272	C1894	390.00	N/A
HC62802434	INTRODUCER COAXIAL	272	C1894	176.00	N/A
HC62802442	INTRODUCER EP STEERBL NON-PEEL	272	C1894	676.00	N/A
HC62802459	INTRODUCER GUIDE	272	C1894	148.00	N/A
HC62802467	INTRODUCER KYPHOPLASTY OSTEO	272	C1894	3,478.00	N/A
HC62802475	INTRODUCER DIALYSIS PEEL AWAY	272	C1894	719.00	N/A
HC62802483	INTRODUCER/SHEATH(FLEXOR CHECK-FLO)E	272	C1894	195.00	N/A
HC62802491	INTRODUCER/SHEATH                 N	272	C1894	780.00	N/A
HC62802509	INTRODUCER SUPRAPUB FOLEY CATH	272	C1894	1,253.00	N/A
HC62802525	KIT CVP LINE	278	C1751	293.00	N/A
HC62802533	KIT DILATORS RENAL	272	C1726	780.00	N/A
HC62802541	KIT PICC LINE                     M	278	C1751	845.00	N/A
HC62802558	KIT QUINTON MAHURKAR CATH	278	C1751	1,448.00	N/A
HC62802566	CATH EP DIAG/MAPPING<20 ELECT     R	272	C1732	5,850.00	N/A
HC62802574	WIRE BENTSON	272	C1769	91.00	N/A
HC62802582	WIRE INTERVENTIONAL	272	C1769	358.00	N/A
HC62802590	WIRE INTERVENTIONAL SPECIALTY	272	C1769	1,099.00	N/A
HC62802608	WIRE PACING TEMP                  T	272		390.00	N/A
HC62802616	WIRE TEFLON BENTSON	272	C1769	85.00	N/A
HC62802624	TUBE GASTROSTOMY LOWPRFL BTTN     O	278	B4088	1,011.00	N/A
HC62802632	BUTTON TEFLON/PLASTIC	278		117.00	N/A
HC62802640	NEEDLE HDR BREAST IMPLANT	278	C1715	49.00	N/A
HC62802657	VALVE HANCOCK II MEDTRONIC	278		21,158.00	N/A
HC62802665	NEEDLE TEMPLAT ENDOCURR	278	C1715	588.00	N/A
HC62802673	M: RING ORTHO	278	L8699	243.75	N/A
HC62802681	M: RING RETINAL	278		N/A	N/A
HC62802699	M: ICP CATH/MONITOR KIT	278	C1889	N/A	N/A
HC62802707	M: VALVE HEART-HOMOGEN	278		N/A	N/A
HC62802715	M: VALVE HEART-MECHANICAL	278		N/A	N/A
HC62802731	GOLD SEED MARKER FIDUCIAL EA      A	278	A4648	579.69	N/A
HC62802749	M: SYSTEM KNEE TOTAL	278	C1776	16,250.00	N/A
HC62802756	STENT ESOPHAGEAL;CVRD;DEL         C	278	C1874	7,873.54	N/A
HC62802764	ADAPT/EXT PACING LEAD SPX	272	C1883	2,425.00	N/A
HC62802772	M: IOL A-C ASTIGMATISM CORRCTNG	276	V2787	N/A	N/A
HC62802780	BEAD DC MICROSPHERE PER VIAL	278		5,282.00	N/A
HC62802798	SYSTEM SEAL HEART STRING	278		1,521.00	N/A
HC62802806	CAPSULE ENDOSCOPY (PILL CAM)	278		1,580.00	N/A
HC62802814	BALLOON HDR APPLICATOR	278	C1728	2,022.00	N/A
HC62802822	PROGRAMMER IDD TX (CONTROL)	271		2,584.00	N/A
HC62802830	KIT STENT BILIARY PLASTIC	278	C2617	712.00	N/A
HC62802848	SET PEG 14-20 FR  CONMED          G	278	B4087	325.00	N/A
HC62802855	STENT COLONIC/DUOD NOCOV&DEL	278	C1876	8,068.49	N/A
HC62802863	TUBE GASTROSTOMY STANDARD         E	278	B4087	211.81	N/A
HC62802871	TUBE JEJUN STANDRD TRANSGAS       L	278	B4087	658.26	N/A
HC62802889	M: VALVE CONDUIT PULMONARY H020003	278	C1889	23,058.75	N/A
HC62802897	SEALANT PULMONARY (PROGEL)	278	C2615	2,979.67	N/A
HC62802905	PARTICLES EMBOLIZATION            Q	278		1,300.00	N/A
HC62802913	COIL NEUROVASC(HELIX/ULTRA HELICAL)AA	278		4,550.00	N/A
HC62802921	COIL NEUROVASC(TARGET 360 SOFT/ULTRA)AK	278		5,850.00	N/A
HC62802939	COIL NEUROVASCULAR               AO	278		7,150.00	N/A
HC62802947	EMBOLIC LIQUID ONYX PER VIAL(LOW VIS)	278		10,027.00	N/A
HC62802954	STENT NEUROVASCULAR               D	278	C1876	8,450.00	N/A
HC62802962	COIL NEUROVASCULAR               AR	278		9,100.00	N/A
HC62802970	STENT NEUROVASCULAR               O	278	C1876	18,200.00	N/A
HC62802988	DEVICE FLOW DIVERSION PIPELINE	278	C1781	45,175.00	N/A
HC62802996	RECORDER CARDC EVNT(BIOTRONIK BIOMNTR 2AF)	278	C1764	15,925.00	N/A
HC62803002	M: GRAFT PORCINE	278	C1768	N/A	N/A
HC62803010	M: IOL IRIS SUPPORTED	276	V2631	N/A	N/A
HC62803028	M: STENT INLAY LUBRICIOUS	278	C2625	N/A	N/A
HC62803036	M: CLAMP IMPLANT SPINAL	278	L8699	2,185.18	N/A
HC62803044	M: COCHLEAR DEVICE/SYSTEM	278	L8614	N/A	N/A
HC62803051	M: HOOK IMPLANT SPINAL	278	L8699	1,312.38	N/A
HC62803069	M: INTRATUBAL OCCLUSION DEVICE	278	A4264	N/A	N/A
HC62803077	M: LVAD/RVAD IMPLANT	278		72,730.45	N/A
HC62803085	M: RING HEART MITRAL	278		8,821.94	N/A
HC62803093	M: RING HEART TRICUSPID	278		9,438.54	N/A
HC62803101	M: VALVE HEART MECH AORTIC	278		97,348.73	N/A
HC62803119	M: VALVE HEART MECH MITRAL	278		16,327.54	N/A
HC62803127	M: VALVE HEART MECH PULM	278		N/A	N/A
HC62803135	M: VALVE HEART MECH TRICUSPID	278		N/A	N/A
HC62803143	M: VALVE HEART TISSUE AORTIC	278		51,784.83	N/A
HC62803150	M: VALVE HEART TISSUE MITRAL	278		19,503.75	N/A
HC62803168	M: VALVE HEART TISSUE PULM	278		N/A	N/A
HC62803176	M: VALVE HEART TISSUE TRICUSPID	278		N/A	N/A
HC62803184	M: PROSTHESIS TESTIS IMPLANT	278		7,806.50	N/A
HC62803192	DEVICE MECH' OCCLUDE(COIL/PLUG)	278	C1760	7,947.00	N/A
HC62803200	M: PARTICLES OCCUSION	278		N/A	N/A
HC62803218	M: NAIL TIBIAL ANCHOR BONE-BONE	278	C1713	6,707.94	N/A
HC62803226	M: BUTTON CONT LP ANCHOR SOFT TISS-B	278	C1713	832.96	N/A
HC62803234	M: CUP/SHELL JNT DEVICE FEM HEAD HIP	278	C1776	1,767.19	N/A
HC62803242	M: JOINT DEVICE LINER FEM HEAD HIP	278	C1776	2,293.12	N/A
HC62803259	M: MENISC REPAIR ANCHOR SOFT TISS-B	278	C1713	1,513.07	N/A
HC62803267	M: MESH TISS CONNECTV NON-HUMAN/SYN	278	C1763	2,473.23	N/A
HC62803275	M: SUTURE KNOTLS ANCHR SFT TISS-BONE	278	C1713	1,194.20	N/A
HC62803283	KIT MONITOR PRESSURE ICP	272	C1729	2,751.00	N/A
HC62803291	SYSTEM PORT EVACUATING SUBDURAL	278		5,613.00	N/A
HC62803309	CATH VENTRICL EXT DRAIN/MONITR	278	A4301	2,284.28	N/A
HC62803317	STENT ENDOPRSTH AAA               V	278	C1874	31,555.48	N/A
HC62803325	STENT ENDOPRSTH AAA               I	278	C1874	11,375.00	N/A
HC62803333	DEVICE CLOSURE VASCULAR PLUG      U	272	C1760	2,623.11	N/A
HC62803341	M: SURGIMEND COLLGN MTRX FETAL/0.5CM2	278	C9358	12,090.00	N/A
HC62803358	M: SURGIMEND COLLGN MTRX NEONTL/0.5CM2	278	C9360	20,433.21	N/A
HC62803366	COIL CEREBRAL ANEURYSM            A	278		72.00	N/A
HC62803408	M: INTEGRA WOUND MATRIX INJ 1CC	278	Q4114	15,523.69	N/A
HC62803432	M: STRATTICE TM PER SQ CM	278	Q4130	19,025.96	N/A
HC62803440	M: MEMBRANE AMNIOTIC PER PROC	278	V2790	1,301.94	N/A
HC62803457	M: NAIL ORTHO	278	C1713	7,312.22	N/A
HC62803465	M: NAIL TROCHANTERIC ANCHR B-B	278	C1713	6,338.70	N/A
HC62803473	M: COVER SCREW	278	C1776	N/A	N/A
HC62803499	M: JOINT MAJOR(SHOULDER/ANKLE)	278	C1776	6,202.92	N/A
HC62803507	M: STEM KNEE	278	C1776	3,976.53	N/A
HC62803515	CAP END SCREW	278		228.96	N/A
HC62803523	COUNTERSINK CANNULATED            F	272		453.92	N/A
HC62803531	M: KIT WRIST FIXATION	278	L8699	N/A	N/A
HC62803549	M: DISK ARTIFICIAL SPINE CERVICAL	278	L8699	19,396.20	N/A
HC62803556	M: SLEEVE FEMORAL CENTERING	278	L8699	1,471.17	N/A
HC62803564	M: SLEEVE FEMORAL PROXIMAL	278	L8699	1,928.36	N/A
HC62803572	M: SLEEVE ORTHO MODULAR	278	C1776	4,448.41	N/A
HC62803580	M: SLEEVE SCREW RESORBABLE	278	L8699	966.88	N/A
HC62803598	M: SYSTM&DEVICE CNTRCPTV OCCL TUBAL	278	A4264	N/A	N/A
HC62803606	HEMOSTATIC GEL/GELFOAM/PAD        I	272		642.74	N/A
HC62803622	M: SYSTEM HIP REPLACEMENT	278	C1776	5,083.93	N/A
HC62803630	M: SHOULDER TOTAL	278	C1776	12,756.09	N/A
HC62803648	KIT CATH HEMO/PERI DIALYS LG TRM  N	278	C1750	893.81	N/A
HC62803655	M: BARRIER ADHESION SURGICAL	278		922.01	N/A
HC62803663	M: SHOULDER HEMI	278	C1776	N/A	N/A
HC62803671	CATH ABLAT TISS COOL-TIP(HALO 360)I	272	C1886	7,719.00	N/A
HC62803689	CATH ABLAT TISS(E.G.HALO 60/90)   E	272	C1886	3,900.00	N/A
HC62803697	CATH ABLATION THERMO HALO        AD	272	C1886	5,525.00	N/A
HC62803705	COIL EMBOLIZATION MICROCOIL       C	278		298.00	N/A
HC62803713	KIT CATH HEMO DIAL SHORT TERM     V	278	C1752	2,958.00	N/A
HC62803721	CATHETER PACING BIPOLAR           E	272	C1779	186.40	N/A
HC62803739	STENT NON-COAT/NON-COV W-DEL      S	278	C1876	1,950.00	N/A
HC62803747	STENT NON-COAT/NON-COV W-DEL      V	278	C1876	2,894.53	N/A
HC62803754	STENT NON-COAT/NON-COV W-DEL      X	278	C1876	3,480.21	N/A
HC62803762	STENT NON-COAT/NON-COV W-DEL     AE	278	C1876	6,175.00	N/A
HC62803770	STENT NON-COAT/NON-COV W-DEL     AH	278	C1876	7,800.00	N/A
HC62803788	STENT NON-CORON TEMP NO DELIV SYS F	278	C2617	293.84	N/A
HC62803796	M: SCREW SOFT TISSUE ABSORBABLE	278	C1713	N/A	N/A
HC62803804	COIL EMBOLIZATION FIBERED         M	278		1,537.00	N/A
HC62803812	STENT DES CORO COV W/DEL SYS      M	278	C1874	5,200.00	N/A
HC62803820	STENT DES CORO COV W/DEL SYS      N	278	C1874	5,525.00	N/A
HC62803838	STENT DES CORO COV W/DEL SYS      X	278	C1874	11,111.75	N/A
HC62803846	STENT DES CORO COV W/DEL SYS      O	278	C1874	5,850.00	N/A
HC62803853	STENT DES CORO COV W/DEL SYS      Q	278	C1874	6,500.00	N/A
HC62803861	STENT CORO BARE METAL W/DEL       C	278	C1876	2,207.00	N/A
HC62803879	STENT CORO BARE METAL W/DEL       D	278	C1876	2,397.00	N/A
HC62803887	STENT CORO BARE METAL W/DEL       E	278	C1876	2,600.00	N/A
HC62803895	STENT CORO BARE METAL W/DEL       F	278	C1876	3,250.00	N/A
HC62803903	STENT CORO BARE METAL W/DEL       G	278	C1876	3,900.00	N/A
HC62803911	STENT CORO BARE METAL W/DEL       H	278	C1876	4,550.00	N/A
HC62803929	STENT CORO BARE METAL W/DEL       I	278	C1876	5,200.00	N/A
HC62803937	STENT DES CORO COV W/DEL SYS      L	278	C1874	4,875.00	N/A
HC62803945	M: PORT SUBQ BAND GASTRIC	278		2,470.00	N/A
HC62803952	STENT URETERAL                    C	278	C2617	95.19	N/A
HC62803960	STENT URETERAL                    G	278	C2617	342.00	N/A
HC62803978	STENT URETERAL                    H	278	C2617	365.69	N/A
HC62803986	STENT PANC/URETERAL               J	278	C2617	501.84	N/A
HC62803994	FILTER VENA CAVA  (E.G.TRAPEASE)  B	278	C1880	2,373.00	N/A
HC62804000	FILTER VENA CAVA (E.G.OPTEASE)    C	278	C1880	2,509.00	N/A
HC62804018	FILTER VENA CAVA(DENLI-ECLPS-MERIDN) D	278	C1880	2,988.41	N/A
HC62804026	FILTER VENA CAVA (E.G.ELITE)      E	278	C1880	3,380.00	N/A
HC62804034	FILTER VENA CAVA  (E.G. ALN)      F	278	C1880	3,660.00	N/A
HC62804042	FILTER VENA CAVA                  H	278	C1880	4,558.00	N/A
HC62804059	KIT CATH VENTRICULAR	278	A4301	501.00	N/A
HC62804067	M: DEVICE REFLUX MANAGEMENT	278		17,875.00	N/A
HC62804075	M:GUIDE NERVE(NEURAGEN)PER CM	278	C9352	6,522.75	N/A
HC62804083	M:PROTECTOR NERVE(NEURAWRAP)PER CM	278	C9353	7,798.38	N/A
HC62804091	M:FILLER BONE PUTTY(MOZAIK/OS)PER0.5CC	278	C9359	N/A	N/A
HC62804109	M:FILLER BONE STRIP(MOZAIK)EA0.5CC	278	C9362	3,250.00	N/A
HC62804117	M: AGENT BULKING INJ (DEFLUX)	278	L8604	3,608.03	N/A
HC62804133	M: STENT ENDOVASC AV DIALYSIS	278	C1874	N/A	N/A
HC62804158	M: GRAFT VASCULAR SYNTHETIC	278	L8670	4,741.88	N/A
HC62804166	COIL EMBOLIZATION                 D	278		390.00	N/A
HC62804174	COIL EMBOLIZATION                 F	278		650.00	N/A
HC62804182	COIL EMBOLIZATION                 G	278		741.00	N/A
HC62804190	COIL EMBOLIZATION                 H	278		910.00	N/A
HC62804208	COIL EMBOLIZATION                 I	278		1,040.00	N/A
HC62804216	COIL EMBOLIZATION                 E	278		520.00	N/A
HC62804224	COIL EMBOLIZATION                 K	278		1,300.00	N/A
HC62804232	COIL EMBOLIZATION                 L	278		1,430.00	N/A
HC62804240	COIL EMBOLIZATION                 N	278		1,690.00	N/A
HC62804257	COIL EMBOLIZATION                 O	278		1,820.00	N/A
HC62804265	COIL EMBOLIZATION                 P	278		1,950.00	N/A
HC62804273	COIL EMBOLIZATION                 Q	278		2,080.00	N/A
HC62804281	COIL EMBOLIZ(CONCERTO HELIX NYLON)R	278		2,210.00	N/A
HC62804299	COIL EMBOLIZATION                 S	278		2,340.00	N/A
HC62804307	COIL EMBOLIZATION                 T	278		2,470.00	N/A
HC62804315	COIL EMBOLIZATION                 U	278		2,600.00	N/A
HC62804331	COIL EMBOLIZ(BARR PLAT DETACH)    W	278		2,860.00	N/A
HC62804349	COIL EMBOLIZATION                 X	278		2,990.00	N/A
HC62804356	COIL EMBOLIZATION                 Y	278		3,120.00	N/A
HC62804364	COIL EMBOLIZATION                 Z	278		3,250.00	N/A
HC62804372	COIL EMBOLIZATION                AA	278		3,380.00	N/A
HC62804380	COIL EMBOLIZATION                AB	278		3,510.00	N/A
HC62804398	COIL EMBOLIZATION                AC	278		3,640.00	N/A
HC62804406	COIL EMBOLIZ(AXIUM PRIME 3D 3MM) AD	278		3,770.00	N/A
HC62804414	STENT TRACHEOBRONC COV W/DEL SYS  E	278	C1874	6,500.00	N/A
HC62804422	STENT TRACHEOBRONC COV W/DEL SYS  F	278	C1874	7,743.13	N/A
HC62804430	STENT TRACHEOBRONC COV W/DEL SYS  G	278	C1874	7,800.00	N/A
HC62804448	STENT TRACHEOBRONC COV W/DEL SYS  H	278	C1874	8,450.00	N/A
HC62804455	M: SCREW SPINAL	278	L8699	1,447.16	N/A
HC62804463	M: BAR PECTUS	278	L8699	4,640.70	N/A
HC62804471	KIT KYPHOPLASTY BALLOON AUGMENTATN	278	C1726	3,738.00	N/A
HC62804489	M: SYSTEM VENTRICULAR RESERVOIR	278	A4301	1,298.57	N/A
HC62804497	COIL EMBOLIZATION                 B	278		741.00	N/A
HC62804505	M: BOLT LOCKING	278	L8699	1,343.32	N/A
HC62804513	M: CABLE ORTHO/SPINAL	278	L8699	1,707.42	N/A
HC62804521	M: CAP ORTHO/SPINAL	278	L8699	239.40	N/A
HC62804539	M: IOL  NEW TECHNOLOGY	278	C1780	N/A	N/A
HC62804547	M: NAIL BLADE	278	C1713	2,910.13	N/A
HC62804562	CATH PICC PEDS                    G	278	C1751	325.00	N/A
HC62804570	M: PEG ORTHO	278	L8699	248.96	N/A
HC62804588	STENT CORO BARE METAL W/DEL       A	278	C1876	910.00	N/A
HC62804596	STENT CORO BARE METAL W/DEL       B	278	C1876	1,556.00	N/A
HC62804604	STENT CORO BARE METAL W/DEL       K	278	C1876	6,500.00	N/A
HC62804612	STENT DES CORO COV W/DEL SYS      D	278	C1874	2,275.00	N/A
HC62804620	STENT DES CORO COV W/DEL SYS      I	278	C1874	3,900.00	N/A
HC62804638	STENT DES CORO COV W/DEL SYS      R	278	C1874	7,150.00	N/A
HC62804646	STENT DES CORO COV W/DEL SYS      T	278	C1874	8,450.00	N/A
HC62804653	FILTER VENA CAVA                  A	278	C1880	1,772.00	N/A
HC62804661	STAPLE REINFORCEMENT(SEAMGUARD)???? B	272		497.56	N/A
HC62804679	STAPLE REINFORCEMENT(SEAMGUARD)???? D	272		887.00	N/A
HC62804687	CATH EP DIAG/MAPPING<20 ELECT     L	272	C1732	3,900.00	N/A
HC62804695	SYSTEM DRAIN PLEURAL/PERIT (ASPIRA)	278	C1729	9,100.00	N/A
HC62804703	M: FILLER BONE SOLID/WEDGE	278	L8699	4,281.88	N/A
HC62804711	M: REPL JOINT INTERPHALAN 2/+	278	L8659	N/A	N/A
HC62804729	M: PLUG ORTHO/SPINAL	278	L8699	179.97	N/A
HC62804737	M: NECK FEMORAL HIP	278	C1776	6,584.76	N/A
HC62804745	M: SADDLE/CRADLE SPINAL	278	L8699	N/A	N/A
HC62804752	M: FIXATOR STERNAL CABLE/ZIP	278	L8699	2,086.28	N/A
HC62804760	M: IMPLANT JOINT METACARPOPHALANGL	278	L8630	N/A	N/A
HC62804778	M: REPL JNT PHAL METACARP2/+METAL+CER	278	L8631	N/A	N/A
HC62804786	M: IMPLANT JOINT METATARSAL	278	L8641	N/A	N/A
HC62804794	M: IMPLANT HALLUX (GREAT TOE)	278	L8642	6,264.54	N/A
HC62804802	M: SPACER JNT INTERPHAL SILICN/= EA	278	L8658	N/A	N/A
HC62804810	M: REPL JNT INTRPHAL FINGR2/+METL-CER	278	L8659	2,557.75	N/A
HC62804828	CLIP LEFT ATRIAL APPENDAGE-LAA    A	278		5,185.23	N/A
HC62804836	CLIP LEFT ATRIAL APPENDAGE-LAA    B	278		7,850.46	N/A
HC62804844	GUIDE PIN ORTHO                   F	272		260.00	N/A
HC62804851	M: CONNECTOR ROD TO ROD	278	L8699	6,662.50	N/A
HC62804869	M: CONNECTOR/COUPLER SPINAL	278	L8699	2,362.13	N/A
HC62804877	M: DEVICE INTERBODY FUSION SPINAL	278	L8699	12,465.68	N/A
HC62804885	M: PLATE TACK	278	C1713	N/A	N/A
HC62804893	STENT NON CORON W/DELIV SYS       D	278	C2625	453.64	N/A
HC62804901	STENT NON CORON W/DELIV SYS       E	278	C2625	520.00	N/A
HC62804919	STENT BILIARY COVRD W/DELSYS      A	278	C1874	2,600.00	N/A
HC62804927	STENT BILIARY COVRD W/DELSYS      B	278	C1874	2,925.00	N/A
HC62804935	STENT BILIARY COVRD W/DELSYS      C	278	C1874	3,250.00	N/A
HC62804943	STENT BILIARY COVRD W/DELSYS      T	278	C1874	8,753.80	N/A
HC62804950	STENT BILIARY COVRD W/DELSYS      U	278	C1874	9,100.00	N/A
HC62804968	STENT BILIARY COVRD W/DELSYS      V	278	C1874	9,425.00	N/A
HC62804976	TUBE GASTROSTOMY KIT              I	278	B4087	455.00	N/A
HC62804984	M: OFFSET SPINAL	278	L8699	587.22	N/A
HC62804992	M: CRIMP CABLE	278	L8699	1,376.38	N/A
HC62805007	M: CAP END CAGE	278	L8699	3,605.91	N/A
HC62805015	CATH EP DX <20 ELECTRODES         E	272	C1730	650.00	N/A
HC62805023	M: KIT BALLN AUGMENTATION VERTEBRAL	278		3,233.75	N/A
HC62805031	CATH MAPPING PH ESOPHAGEAL	272	C1732	1,788.00	N/A
HC62805049	M: HEAD SCREW SPINAL	278		N/A	N/A
HC62805056	CATH PTCA BALLOON NON-LASER       R	272	C1725	3,250.00	N/A
HC62805064	CATH EP DIAG/ABLAT 3D/VECT        Q	272	C1732	6,760.00	N/A
HC62805072	CATH EP DIAG/ABLAT 3D/VECT        V	272	C1732	7,800.00	N/A
HC62805080	CATH EP DIAG/ABLAT 3D/VECT        X	272	C1732	9,100.00	N/A
HC62805098	CATH EP DX 20+ ELECTRODES         E	272	C1731	3,640.00	N/A
HC62805106	CATH EP DX 20+ ELECTRODES         O	272	C1731	6,240.00	N/A
HC62805114	CATH PTCA BALLOON NON-LASER       X	272	C1725	5,200.00	N/A
HC62805122	M: CRIMP SPINAL	278		N/A	N/A
HC62805130	M:IMPLANT UROLIFT TIE-BACK (EACH)	278	C1889	2,519.00	N/A
HC62805148	M: BLOCKER SPINAL	278	L8699	N/A	N/A
HC62805155	SET NEEDLE TARGETING W/WIRE       X	278		1,625.00	N/A
HC62805163	M: SYS DELIV SCP KNEE W/ BONE SUBST	278	C1713	N/A	N/A
HC62805171	M: MISC SURGICAL IMPLANT	278		6,105.95	N/A
HC62805189	M: SLING MALE	278		N/A	N/A
HC62805197	M: IMPLANT PECTORAL	278		N/A	N/A
HC62805205	M: BLOCK ORTHO	278	L8699	3,946.10	N/A
HC62805213	M: PLUG SCLERAL OPTHALMIC	278		N/A	N/A
HC62805221	HEMOSTAT VITAGEL SURGICAL	272		1,690.00	N/A
HC62805239	M: RAIL SPINAL	278	L8699	N/A	N/A
HC62805247	M: SLEEVE RIB VEPTR	278	L8699	N/A	N/A
HC62805254	M: SLEEVE/COLLAR SPINAL	278	L8699	N/A	N/A
HC62805262	M: STAPLE SPINAL	278		N/A	N/A
HC62805270	DEVICE EMBOLIZATION NEURO(PIPELINE)	278		43,225.00	N/A
HC62805288	STENT NON-COAT/NON-COV W-DEL     AJ	278	C1876	8,450.00	N/A
HC62805296	CATHETER PERITONEAL               F	278	A4301	414.60	N/A
HC62805304	STENT BILIARY PLASTIC             F	278	C2617	455.00	N/A
HC62805312	CATH SWAN GANZ/THERMODILUTION     D	272		130.00	N/A
HC62805320	CATH SWAN GANZ/THERMODILUTION     E	272		163.00	N/A
HC62805338	CATH SWAN GANZ/THERMODILUTION     G	272		325.00	N/A
HC62805353	M:STIMULATOR SPINAL BONE SPF	278	E0749	55,250.00	N/A
HC62805361	M: CABLE ORTHO	278	L8699	2,581.26	N/A
HC62805379	M: LEAD PACEMAKER/ICD COMBO	275	C1899	11,969.75	N/A
HC62805387	CATH ATHERECTOMY ROTATNL (PREDATOR)	272	C1724	9,734.00	N/A
HC62805395	M: DART CHONDRAL	278	C1713	N/A	N/A
HC62805403	M: LINER/CUP HUMERAL	278	C1776	3,872.54	N/A
HC62805411	M: MATRIX WOUND FLOWABLE 3 ML	278	Q4114	6,946.88	N/A
HC62805429	M: SYSTEM REVISION HIP	278	C1776	8,125.00	N/A
HC62805437	M: SYSTEM REVISION KNEE	278	C1776	8,064.88	N/A
HC62805445	M: SYSTEM REVISION SHOULDER	278	C1776	26,000.00	N/A
HC62805452	M: IMPLANT SINUS DRUG-ELUTING	278	C2625	2,981.63	N/A
HC62805460	CATH INTRACARDIAC ECHO/UTZ        F	272	C1759	8,775.00	N/A
HC62805478	CATH PTCA BALLOON NON-LASER      AD	272	C1725	9,100.00	N/A
HC62805486	TUBE GASTROSTOMY REPLACE PEG      C	272	B4087	96.46	N/A
HC62805494	CATH EP DIAG/ABLAT 3D/VECT        T	272	C1732	6,500.00	N/A
HC62805502	CATH EP DIAG/ABLAT 3D/VECT        U	272	C1732	7,150.00	N/A
HC62805510	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP T	272	C1733	2,275.00	N/A
HC62805528	CATH GUIDING CARDIAC              S	272	C1887	1,950.00	N/A
HC62805536	M: SYSTEM KNEE MPFL LIGAMENT RECON	278	C1713	4,832.75	N/A
HC62805544	CATH THROMBOLYSIS/RX DELIVERY    AN	272	C1757	11,050.00	N/A
HC62805551	CATH EP/ABLATION COOL-TIP         S	272	C2630	10,400.00	N/A
HC62805569	CATH DIALYSIS SHORT-TERM          G	278	C1752	423.00	N/A
HC62805577	CATH EP/ABLATION COOL-TIP         I	272	C2630	5,200.00	N/A
HC62805585	CATH EP/ABLATION COOL-TIP         Q	272	C2630	9,100.00	N/A
HC62805593	CATH ANGIO/GUID NEURO/PERIPH(DAC44)R	272	C1887	3,575.00	N/A
HC62805601	CATH THROMBECTOMY/EMBOLECTOMY     V	272	C1757	2,925.00	N/A
HC62805619	DEVICE ABLAT COOL-TIP NONVASC     F	272	C1886	4,225.00	N/A
HC62805627	DEVICE ABLAT COOL-TIP NONVASC     H	272	C1886	4,908.09	N/A
HC62805635	DEVICE ABLAT COOL-TIP NONVASC     I	272	C1886	5,200.00	N/A
HC62805643	DEVICE ABLAT COOL-TIP NONVASC    AG	272	C1886	6,500.00	N/A
HC62805650	DEVICE ABLAT COOL-TIP NONVASC    AN	272	C1886	11,050.00	N/A
HC62805668	INTRO/SHEATH EP LASER             P	272	C2629	1,950.00	N/A
HC62805676	M: PIN EXTERNAL FIXATION	278	C1713	444.50	N/A
HC62805684	CATH EP DX 20+ ELECTRODES         L	272	C1731	5,460.00	N/A
HC62805692	CATH GUIDING NEURO(DI058X125)    V	272	C1887	4,875.00	N/A
HC62805700	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP U	272	C1733	2,600.00	N/A
HC62805718	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP AD	272	C1733	5,525.00	N/A
HC62805726	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP AE	272	C1733	5,850.00	N/A
HC62805734	CATH PICC PEDS                    C	278	C1751	98.00	N/A
HC62805742	FIBRIN SEALANT                    I	278		650.00	N/A
HC62805759	FIBRIN SEALANT                    O	278		1,345.19	N/A
HC62805767	FIBRIN SEALANT                    S	278		2,984.59	N/A
HC62805775	HEMOSTATIC GEL/GELFOAM/PAD        E	272		296.59	N/A
HC62805783	HEMOSTATIC GEL/GELFOAM/PAD        F	272		472.74	N/A
HC62805791	HEMOSTATIC GEL/GELFOAM/PAD         H	272		657.37	N/A
HC62805809	HEMOSTATIC GEL/GELFOAM/PAD        J	272		449.80	N/A
HC62805817	HEMOSTATIC GEL/GELFOAM/PAD        K	272		531.02	N/A
HC62805825	HEMOSTATIC GEL/GELFOAM/PAD        L	272		650.00	N/A
HC62805833	HEMOSTATIC GEL/GELFOAM/PAD        M	272		1,304.27	N/A
HC62805841	HEMOSTATIC GEL/GELFOAM/PAD        N	272		895.38	N/A
HC62805858	INTRO/SHEATH EP LASER            AH	272	C2629	9,125.35	N/A
HC62805866	M: MATRISTEM MULTILAYER MATRIX PER SQ CM (LC)	278	C1763	4,476.59	N/A
HC62805874	CATH PICC PEDS                    B	278	C1751	65.00	N/A
HC62805882	CATH EP DX <20 ELECTRODES         B	272	C1730	260.00	N/A
HC62805890	CATH EP DX <20 ELECTRODES         C	272	C1730	390.00	N/A
HC62805908	CATH EP DX <20 ELECTRODES         D	272	C1730	520.00	N/A
HC62805916	CATH EP DX <20 ELECTRODES         J	272	C1730	1,300.00	N/A
HC62805924	CATH EP DX <20 ELECTRODES         K	272	C1730	1,560.00	N/A
HC62805932	CATH EP DX <20 ELECTRODES         Q	272	C1730	3,120.00	N/A
HC62805940	CATH EP DX <20 ELECTRODES         U	272	C1730	4,160.00	N/A
HC62805957	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP S	272	C1733	1,950.00	N/A
HC62805965	CATH PTCA ANGIOPLASTY NON-LASER   O	272	C1725	2,275.00	N/A
HC62805973	INTRO/SHEATH STEERABLE NON-PEEL   C	272	C1766	1,950.00	N/A
HC62805981	FIBRIN SEALANT                    G	278		430.11	N/A
HC62805999	FIBRIN SEALANT                    H	278		776.53	N/A
HC62806005	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP AT	272	C1733	16,900.00	N/A
HC62806013	INTRO/SHEATH STEERABLE NON-PEEL   I	272	C1766	3,900.00	N/A
HC62806021	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP AS	272	C1733	15,600.00	N/A
HC62806039	CATH DIALYSIS SHORT-TERM          D	278	C1752	228.00	N/A
HC62806047	CATH DIALYSIS SHORT-TERM          E	278	C1752	293.00	N/A
HC62806054	CATH DIALYSIS SHORT-TERM          F	278	C1752	358.00	N/A
HC62806062	CATH HEMO/PERI DIAL LONG TERM     L	278	C1750	649.15	N/A
HC62806070	CATH HICKMAN/BROVIAC              H	278	C1751	383.50	N/A
HC62806088	CATH HICKMAN/BROVIAC              I	278	C1751	455.00	N/A
HC62806096	CATH HICKMAN/BROVIAC              J	278	C1751	520.00	N/A
HC62806104	CATH SWAN GANZ/THERMODILUTION     I	272		455.00	N/A
HC62806112	TUBE GASTROSTOMY STANDARD         C	278	B4087	98.18	N/A
HC62806120	PORT INDWELLING W/CATH            G	278	C1788	1,089.22	N/A
HC62806138	PORT INDWELLING W/CATH            J	278	C1788	1,300.00	N/A
HC62806153	CATH BALLOON DUCT LACRIMAL        T	272	C1726	2,275.00	N/A
HC62806161	CATH EP DX <20 ELECTRODES         L	272	C1730	1,820.00	N/A
HC62806179	CATH EP DX 20+ ELECTRODES         C	272	C1731	3,120.00	N/A
HC62806187	CATH THROMBECTOMY                AH	272	C1757	7,150.00	N/A
HC62806195	FILTER VENA CAVA (E.G.CELECT)     I	278	C1880	4,957.00	N/A
HC62806203	M: ARTHROFLEX-Q4125	278	Q4125	8,812.38	N/A
HC62806211	STENT DES CORO COV W/DEL SYS      S	278	C1874	7,800.00	N/A
HC62806229	CATH THROMBECTOMY/REPERFUS(3MAX) AD	272	C1757	5,525.00	N/A
HC62806237	CATH PTA W/BALLOON RX(DCB)        D	272	C2623	4,550.00	N/A
HC62806245	SYSTEM PERFUSION VENOUS(ANGIOVAC)	278		42,250.00	N/A
HC62806252	CATH PTA W/BALLOON RX(DCB)        E	272	C2623	4,875.00	N/A
HC62806260	CATH PTA W/BALLOON RX(DCB)        F	272	C2623	5,200.00	N/A
HC62806278	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP X	272	C1733	3,575.00	N/A
HC62806286	KIT CATH GASTROSTOMY PEG          G	278	B4087	325.00	N/A
HC62806294	CATH ATHERCTMY ROTATNL(DIAMNDBCK) B	272	C1724	11,050.00	N/A
HC62806302	CATH ATHERCTMY ROTATNL(DIAMNDBCK) D	272	C1724	12,350.00	N/A
HC62806310	TUBE GASTROSTOMY STNDRD BTTN OPT  F	278	B4087	260.00	N/A
HC62806328	TUBE GASTROSTOMY STNDRD BTTN OPT  G	278	B4087	316.28	N/A
HC62806336	TUBE GASTROSTOMY STNDRD BTTN OPT  H	278	B4087	390.00	N/A
HC62806344	TUBE GASTROSTOMY LOWPRFL BTTN OPT G	278	B4088	325.00	N/A
HC62806351	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP AA	272	C1733	4,875.00	N/A
HC62806369	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP AF	272	C1733	6,175.00	N/A
HC62806377	M: SCAFFOLD COLLAGEN CARDIOVASCULAR	278		4,550.00	N/A
HC62806385	M: DEVICE/PUMP CIRC EXTRACORPOREAL	278		N/A	N/A
HC62806393	CATH EP DX <20 ELECTRODES         I	272	C1730	1,170.00	N/A
HC62806401	M: MATRISTEM BURN MATRIX PER SQ CM	278	C1763	N/A	N/A
HC62806419	M: MATRISTEM MICROMATRIX PER 1MG	278	Q4118	5,155.11	N/A
HC62806427	PORT INDWELLING W/CATH            E	278	C1788	651.63	N/A
HC62806435	PORT INDWELLING W/CATH            F	278	C1788	1,358.99	N/A
HC62806443	PORT INDWELLING W/CATH            I	278	C1788	1,170.00	N/A
HC62806450	STENT NON-COAT/NON-COV W-DEL      I	278	C1876	455.00	N/A
HC62806468	GOLD SEED MARKER FIDUCIAL EA(NASHLUND)H	278	A4648	455.00	N/A
HC62806476	GOLD SEED MARKER FIDUCIAL EA(ALPHAOMEGA)M	278	A4648	780.00	N/A
HC62806484	CATH BRACHY TX SEED ADMIN         C	272	C1728	4,940.00	N/A
HC62806492	PROBE ABLATION                   AT	272		6,500.00	N/A
HC62806500	PROBE TEMPERATURE ESOPHAGEAL	272	C1732	2,113.00	N/A
HC62806518	KIT CATH GASTROSTOMY PEG          L	278	B4087	650.00	N/A
HC62806526	STENT NON-COAT/NON-COV W-DEL     AA	278	C1876	4,550.00	N/A
HC62806534	TUBE JEJUN STANDRD TRANSGAS       G	278	B4087	325.00	N/A
HC62806542	DEVICE CLOS VASC(ANGIOSEAL/MYNX/PROGLIDE)L	272	C1760	659.91	N/A
HC62806559	CATH BALLOON NEURO(HYPERGLIDE/SCEPTER XC)H	272	C2628	6,192.00	N/A
HC62806567	CATH BALLOON NEURO(HYPERFORM)     I	272	C2628	6,549.00	N/A
HC62806575	COIL EMBOLIZATION                AG	278		4,550.00	N/A
HC62806583	COIL EMBOLIZ(AXIUM HELIX BARE)   AH	278		4,875.00	N/A
HC62806591	COIL EMBOLIZ(HELIX BARE SUPER SFT)AI	278		5,200.00	N/A
HC62806609	COIL EMBOLIZ(PRIME/NYLON HELIX)  AJ	278		5,525.00	N/A
HC62806617	COIL EMBOLIZATION(3D/SMART)      AK	278		5,850.00	N/A
HC62806625	COIL EMBOLIZ(3D PRIME BARE SUPER SFT)AN	278		6,825.00	N/A
HC62806633	DIVERTER FLOW NEUROVASC(PIPELINE SM)C	278		44,525.00	N/A
HC62806641	DIVERTER FLOW NEUROVASC(PIPELINE LG)E	278		48,734.00	N/A
HC62806658	CATH BALLOON RETRIEVAL            D	272	C1773	325.00	N/A
HC62806666	CATH PICC PEDS                    H	278	C1751	390.00	N/A
HC62806674	INTRO/SHEATH STEERABLE NON-PEEL   E	272	C1766	2,600.00	N/A
HC62806682	STENT URETERAL ENDOPYELOTOMY     AB	278	C2617	4,875.00	N/A
HC62806690	MARKER TISSUE 3D	278	A4648	3,250.00	N/A
HC62806708	CATH EP DIAG/ABLAT 3D/VECT        N	272	C1732	4,550.00	N/A
HC62806716	DEVICE REVSC/THROMBCT(CAPTUR/SOLITAIR/TREVO)E	272	C1757	24,830.00	N/A
HC62806724	CATH EP/ABLATION COOL-TIP         T	272	C2630	11,050.00	N/A
HC62806732	COIL EMBOLIZ(PRIME 3D ES)        AM	278		6,500.00	N/A
HC62806740	KIT LIQ EMBOL ANEURYSM(ONYX HD-500)H060003	278	C1889	24,359.00	N/A
HC62806757	CATH THROMBECTOMY                AL	272	C1757	9,750.00	N/A
HC62806765	POUCH/ENVELOPE PACEMAKER          E	278		2,871.61	N/A
HC62806773	POUCH/ENVELOPE PACEMAKER          G	278		3,243.85	N/A
HC62806781	M: GRAFT DURA REPAIR	278		3,068.35	N/A
HC62806799	STENT ENDOPRSTH AAA               K	278	C1874	13,000.00	N/A
HC62806807	STENT ENDOPRSTH AAA               L	278	C1874	14,300.00	N/A
HC62806815	STENT ENDOPRSTH AAA               M	278	C1874	15,901.17	N/A
HC62806823	STENT ENDOPRSTH AAA               S	278	C1874	23,400.00	N/A
HC62806831	STENT ENDOPRSTH AAA               W	278	C1874	32,500.00	N/A
HC62806849	STENT ENDOPRSTH TAA              AE	278	C1874	65,471.25	N/A
HC62806856	HEMOSTATIC GEL/GELFOAM/PAD        Y	272		2,766.41	N/A
HC62806864	STENT ENDOPRSTH AAA               F	278	C1874	10,075.00	N/A
HC62806872	STENT ENDOPRSTH PVD(VIABAHN)      F	278	C1874	10,599.88	N/A
HC62806880	STENT ENDOPRSTH PVD(VIABAHN)      H	278	C1874	11,180.50	N/A
HC62806898	STENT ENDOPRSTH PVD(VIABAHN)      J	278	C1874	12,273.95	N/A
HC62806906	CATH SWAN GANZ/THERMODILUTION     L	278		618.00	N/A
HC62806914	STENT EXTENDER ENDOGRAFT AAA      J	278	C1874	4,225.00	N/A
HC62806922	STENT ENDOPRSTH TAA               W	278	C1874	32,500.00	N/A
HC62806930	STENT ENDOPRSTH TAA              AB	278	C1874	48,750.00	N/A
HC62806948	KIT ANEURYSM ENCAPSULTNG NEUROVASC	278		3,452.00	N/A
HC62806955	WAND ASPIRATION/IRRIG NEUROVASC	278		18,054.00	N/A
HC62806963	SENSOR PULMONARY ARTERY PRESS IMPL WIRELESS SYS	278	C2624	74,588.00	N/A
HC62806971	STENT BILIARY COVRD W/DELSYS      K	278	C1874	5,850.00	N/A
HC62806989	CATH BI-CAVAL PERFUSION	272		7,638.00	N/A
HC62806997	CATH SWAN GANZ/THERMODILUTION     R	278		1,625.00	N/A
HC62807003	STENT NON-COAT/NON-COV W-DEL      T	278	C1876	2,275.00	N/A
HC62807011	PROBE ABLATION CRYO               C	272	C2618	8,828.87	N/A
HC62807029	STENT NON CORON W/DELIV SYS       B	278	C2625	259.63	N/A
HC62807037	CATH ATHERECTOMY ROTATIONAL      AE	272	C1724	5,850.00	N/A
HC62807045	COIL NEUROVASCULAR(TARGET SOFT)  AC	278		5,200.00	N/A
HC62807052	COIL NEUROVASC(TARGET 360 NANO)  AM	278		6,500.00	N/A
HC62807060	COIL NEUROVASCULAR               AP	278		7,800.00	N/A
HC62807078	COIL NEUROVASC(TARGET XL 360 SOFT)AJ	278		8,450.00	N/A
HC62807086	KIT KYPHOPAK 1ST FRACTURE         C	278		8,840.00	N/A
HC62807094	PROBE ABLATION CRYO               H	272	C2618	7,962.50	N/A
HC62807102	PROBE LITHOTRIPTOR ELECTRHYDRLC  AE	278		5,850.00	N/A
HC62807110	CATH ABLATION CARDIAC	272	C1733	10,725.00	N/A
HC62807128	CATH THROMBECTOMY                AD	272	C1757	6,175.00	N/A
HC62807136	CATH THROMBECTOMY                AI	272	C1757	9,100.00	N/A
HC62807144	STENT NON-COAT/NON-COV W-DEL     AI	278	C1876	8,288.00	N/A
HC62807151	STENT NON-COAT/NON-COV W-DEL     AB	278	C1876	4,875.00	N/A
HC62807169	COIL EMBOLIZ(PRIME/HYPERSOFT 3D) AL	278		6,175.00	N/A
HC62807177	DIVERTER FLOW NEUROVASC(PIPELINE FLX 16)D	278		46,215.00	N/A
HC62807185	DIVERTER FLOW NEUROVASC(PIPELINE FLX 35)F	278		50,310.00	N/A
HC62807193	STENT NEUROVASC WINGSPAN H050001	278	C1876	23,709.00	N/A
HC62807201	STENT NEUROVASC LVIS MICROVENTION H130005	278	C1876	23,400.00	N/A
HC62807219	COIL NEUROVASCULAR               AD	278		4,221.18	N/A
HC62807227	PARTICLES EMBOLIZ (CONTOUR)       G	278		325.00	N/A
HC62807235	STENT NON-COAT/NON-COV W-DEL     AF	278	C1876	6,500.00	N/A
HC62807243	STENT ENDOPRSTH TAA              AD	278	C1874	55,250.00	N/A
HC62807250	TUBE GASTROSTOMY LOWPRFL BTTN OPT L	278	B4088	650.00	N/A
HC62807268	STENT COV W/DEL SYS PVD           M	278	C1874	15,600.00	N/A
HC62807276	DEVICE CONTRACEPTION IUD PARAGARD	278	J7300	742.00	N/A
HC62807284	CATH PTA W/BALLOON RX(DCB)        H	272	C2623	5,850.00	N/A
HC62807292	PARTICLES EMBOLIZ (EMBOSPHERE 400)J	278		520.00	N/A
HC62807300	STENT TRACHEOBRONC COV W/DEL SYS  C	278	C1874	5,687.50	N/A
HC62807318	STENT TRACHEOBRONC COV W/DEL SYS  L	278	C1874	11,050.00	N/A
HC62807326	STENT COVRD W/DEL SYS(AXIOS)     AE	278	C1874	14,300.00	N/A
HC62807334	CLIP ENDOSCOPIC                   R	278		1,625.00	N/A
HC62807342	CLIP ENDOSCOPIC                   S	278		1,950.00	N/A
HC62807359	CLIP ENDOSCOPIC                   Q	278		1,300.00	N/A
HC62807375	M: EPIFIX INJECTABLE PER 1 MG	278	Q4145	N/A	N/A
HC62807391	M: CLARIXFLO PER 1MG	278	Q4155	7,632.08	N/A
HC62807409	STENT ENDOPRSTH AAA               P	278	C1874	19,500.00	N/A
HC62807417	STENT ENDOPRSTH TAA              AF	278	C1874	65,471.25	N/A
HC62807433	POLYMER FILLER RING GRAFT/STENT	278		2,437.50	N/A
HC62807441	STENT NON-COAT/NON-COV W-DEL      U	278	C1876	2,600.00	N/A
HC62807458	STENT NON-COAT/NON-COV W-DEL     AC	278	C1876	5,200.00	N/A
HC62807466	GOLD SEED MARKER FIDUCIAL DELVRY SYS(DSF2201)	278	A4648	1,625.00	N/A
HC62807490	M: CLAMP CRANIAL IMPLANTABLE	278	C1713	N/A	N/A
HC62807508	M: BODY DISTRACTOR MAXILLARY	278	C1713	N/A	N/A
HC62807516	M: FOOTPLATE ANT DISTRACTOR MAXILLARY	278	C1713	N/A	N/A
HC62807524	M: FOOTPLATE POST DISTRACTOR MAXILLARY	278	C1713	N/A	N/A
HC62807532	M: SCREW MACHINE DISTRACTOR MAXILLARY	278	C1713	N/A	N/A
HC62807540	M: ARM EXTENSION DISTRACTOR	278	C1713	N/A	N/A
HC62807557	M: CAP END DISTRACTOR	278		2,928.25	N/A
HC62807565	M: FOOTPLATE A/B/C STYLE DISTRACTOR	278	C1713	N/A	N/A
HC62807573	M: PLATE W/DISTRACTOR RIDGE ALVEOLAR	278	C1713	N/A	N/A
HC62807581	M: SPLINT RIB INSERTED	278	C1713	N/A	N/A
HC62807599	KIT CATH HEMO/PERI DIALYS LG TRM  S	278	C1750	1,296.38	N/A
HC62807607	M: CLIP JOINT SMALL	278	C1776	3,120.00	N/A
HC62807615	M: CENTRALIZER HIP	278	C1776	243.75	N/A
HC62807623	M: INSERT HIP	278	C1776	2,293.20	N/A
HC62807631	M: COLLAR STEM HIP	278	C1776	7,150.00	N/A
HC62807649	M: IMPLANT TARSI SINUS	278	L8699	3,233.75	N/A
HC62807656	M: PROSTHESIS LARYNGEAL	278	L8699	650.00	N/A
HC62807664	M: STAPLE BONE	278	C1713	3,129.35	N/A
HC62807672	M: STEM ANKLE TIBIAL	278	C1713	1,658.00	N/A
HC62807680	M: STEM INTERPHALANGEAL	278	C1713	3,900.00	N/A
HC62807698	CAP KIT LEAD PACEMAKER            I	278		455.00	N/A
HC62807706	CATH HEMO/PERI DIAL LONG TERM     E	278	C1750	195.00	N/A
HC62807714	M: ANCHOR LEAD NEUROSTIM	278		6,520.46	N/A
HC62807722	M: BODY VERTEBRAL REPLACEMENT	278	L8699	15,678.00	N/A
HC62807730	M: DISC INVERVERTEBRAL ARTIFICIAL	278	C1713	16,603.84	N/A
HC62807748	M: GENRTR NRSTM HI FREQU RE-CHRG&CHRGR	278	C1822	87,343.75	N/A
HC62807755	M: GRAFT REPAIR NERVE	278		6,557.13	N/A
HC62807763	M: RING ACETABULAR HIP	278	L8699	1,014.00	N/A
HC62807771	M: HIP FEM MODULAR COMPONENT	278	C1776	12,746.65	N/A
HC62807789	M: PIN CABLE	278	L8699	2,022.00	N/A
HC62807797	M: PLUG PORT NEUROSTIMULATOR	278	L8699	494.00	N/A
HC62807805	M: SPACER HUMERAL SHOULDER	278	C1776	3,279.61	N/A
HC62807813	M: LINER SHOULDER	278	C1776	2,832.14	N/A
HC62807821	STAPLE REINFORCEMENT(SEAMGUARD)???? C	272		548.81	N/A
HC62807839	PLUG PORT LEAD GENERATOR PULSE	278		44,346.25	N/A
HC62807854	STENT EXTENDER ENDOGRAFT AAA      Q	278	C1874	6,500.00	N/A
HC62807862	STENT EXTENDER ENDOGRAFT TAA      O	278	C1874	17,875.00	N/A
HC62807870	M: PACEMAKER LEADLESS SNGL CHMBR MICRA VR	275	C1786	37,485.59	N/A
HC62807888	M: MATRIX VIAFLOW WOUND FLOWABLE 2ML	278	C9399	10,565.75	N/A
HC62807896	M: STEM ELBOW	278	C1776	5,850.00	N/A
HC62807904	M: CONNECTOR JOINT NAIL TO NAIL	278	C1713	845.00	N/A
HC62807912	STENT URETERAL                    E	278	C2617	190.45	N/A
HC62807920	SEALANT TISSUE HYDROGEL	278		2,500.96	N/A
HC62807938	SEALANT TISSUE HYDROGEL ET	278		3,217.50	N/A
HC62807946	FIBRIN SEALANT                    D	278		217.88	N/A
HC62807953	STENT ENDOPRSTH AAA               C	278	C1874	8,805.13	N/A
HC62807961	STENT ENDOPRSTH LEG ILIAC         A	278	C1874	6,500.00	N/A
HC62807979	STENT ENDOPRSTH LEG ILIAC         G	278	C1874	12,836.10	N/A
HC62807987	STENT ENDOPRSTH TAA              AC	278	C1874	52,000.00	N/A
HC62807995	STENT URETERAL                    L	278	C2617	660.44	N/A
HC62808001	M: MATERIAL VOCAL CORD MEDIALIZATION SYNTHETIC             NONPS	278	C1878	2,031.25	N/A
HC62808019	SPACER HYDROGEL PROSTATE-RECTUM	278	C1889	9,263.00	N/A
HC62808027	M: CAGE ACETABULAR	278	C1776	13,056.00	N/A
HC62808035	SYSTEM REFLECTOR RADAR LOCALIZ(SCOUT)	278	A4648	1,456.43	N/A
HC62808043	SEALANT STENT ENDOPRSTH	278		780.00	N/A
HC62808050	STENT ENDOPRSTH AAA               Y	278	C1874	39,000.00	N/A
HC62808068	STENT ENDOPRSTH AAA              AA	278	C1874	45,500.00	N/A
HC62808076	STENT ENDOPRSTH TAA              AA	278	C1874	45,500.00	N/A
HC62808084	STENT EXTENDER ENDOGRAFT AAA      X	278	C1874	11,111.75	N/A
HC62808092	STENT EXTENDER ENDOGRAFT AAA     AD	278	C1874	16,900.00	N/A
HC62808100	STENT EXTENDER ENDOGRAFT AAA      V	278	C1874	11,612.25	N/A
HC62808118	STENT ENDOPRSTH TAA IDE G040175	624	C1874	48,750.00	N/A
HC62808134	G130136 KIT STENTS ENDOPRSTH ASC AORTA	624	C1874	48,750.00	N/A
HC62808142	I:FECAL MICROBIOTA (FMP250)	278		1,698.00	N/A
HC62808159	STENT COV W/DEL SYS PVD           B	278	C1874	7,638.00	N/A
HC62808167	DEVICE REPAIR SUTURE MENISCAL	278	C1713	1,578.57	N/A
HC62808175	G150087 KIT STENTS ENDOPRSTH DSC AORTA	624	C1874	1.01	N/A
HC62808183	STENT DES CORO COV GRAFTMASTER H000001	278	C1874	7,800.00	N/A
HC62808191	STENT NEUROVASC NEUROFORM ATLAS  H020002	278	C1876	23,563.00	N/A
HC62808209	STENT NEUROVASC CODMAN ENTRPRS H060001	278	C1876	24,528.00	N/A
HC62808217	DEVICE NEUROVASC PULSERIDER H160002	278	C1876	40,625.00	N/A
HC62808225	M: CENTRALIZER KNEE	278	C1776	195.00	N/A
HC62808233	M: BEARING TIBIAL	278	C1776	3,221.56	N/A
HC62808290	STENT TRANSCAROTID COV W/DEL SYS	278	C1874	8,287.63	N/A
HC62808308	M: ADAPTER SHOULDER	278	C1776	812.50	N/A
HC62808316	M: HIP FEM MODULAR COMPONENT ADAPTER	278	C1776	21,120.94	N/A
HC62808324	G170044 GENERATOR VITARIA IDE	624	C1767	1.01	N/A
HC62808332	G170044 LEAD VITARIA	624	C1778	1.01	N/A
HC62808340	KIT SPRAYER & POWDER HEMOSTATIC	278	C1052	9,659.09	N/A
HC62808357	STENT NON-COAT/NON-COV W-DEL      R	278	C1876	1,623.09	N/A
HC62808365	DEVICE CLOSURE LAA (WATCHMAN)	278	C1760	55,250.00	N/A
HC62808373	M: BONE GRAFT MATRIX(FIBERGRAFT BG)	278	L8699	11,919.24	N/A
HC62808381	CATHETER PACING BIPOLAR           G	272	C1779	325.00	N/A
HC62808399	STENT DES CORO COV W/DEL SYS      E	278	C1874	2,600.00	N/A
HC62808407	STENT DES CORO COV W/DEL SYS      G	278	C1874	3,250.00	N/A
HC62808415	CATH VENTRICULAR NEURO	278	A4301	1,212.16	N/A
HC62808423	RECORDER CARDIAC EVENT(ABBOTT/BOSTON SCI)	278	C1764	14,625.00	N/A
HC62808431	STENT EXTENDER ENDOGRAFT AAA      Q	278	C1874	6,500.00	N/A
HC62808449	MONITOR CARDIAC ECG	278	C1889	14,625.00	N/A
HC62808456	IMPLANT/INSERT DEVICE DEPENDENT NONE	278	C1890	0.01	N/A
HC62808464	M: PACEMAKER LEADLESS SNGL CHMBR MICRA AV	275	C1786	42,046.88	N/A
HC62808514	CLIP DELIVERY SYSTEM MITRACLIP	278		97,500.00	N/A
HC62808522	PARTICLES EMBOLIZ (EMBOCUBES)	278		33.00	N/A
HC62808530	GENERATOR PULSE NEUROSTIM(INSPIRE?)	278	C1767	61,587.50	N/A
HC62808548	LEAD SENSING RESPIRATORY(INSPIRE?)	278	C1778	10,968.75	N/A
HC62808555	M: PARTICLES EMBOLIZ  SLURRY	278	C1889	N/A	N/A
HC62808563	SYSTEM SHUNT INTERATRIAL G180020	624	C1889	1.01	N/A
HC62808571	STENT FULLY COVERED VIABIL	278	C1874	7,800.00	N/A
HC62808589	SYSTEM STENT-GRAFT THORACIC RELAY BRANCH IDE G160237	624	C1874	65,000.00	N/A
HC62808597	CATH LITHOTRIPSY CORONARY TRANSLUM INTRAVASC	272	C1761	15,275.00	N/A
HC62808605	BONE GRAFT INFUSE? IDE G180160	624	L8699	1.01	N/A
HC62808613	NEEDLE BRACHYTHERAPY METAL CLICK	278	C1715	315.00	N/A
HC62808621	CATH/TUBE BRACHY CLICK FIT	278	C1728	315.00	N/A
HC62899999	MULTIPLE ITEMS DOC AND CHRGE (UNBILLABLE EAP)	279		N/A	N/A
HC65000272	SUPPLY GENERAL- PHARMACY (NO NDC)	272		15.60	N/A
HC65000278	SUPPLY IMPLANT- PHARMACY (NO NDC)	278		N/A	N/A
HC65600278	SUPPLY IMPLANT-THERAPEUTIC (NO NDC)	278		96,000.00	N/A
HC65800005	IODINE-125 NONSTRND PER SOURCE	278	C2639	216.00	N/A
HC65800013	PALLADIUM-103 NONSTRND PER SOURCE	278	C2641	358.00	N/A
HC65800021	CESIUM-131 NONSTRND PER SOURCE	278	C2643	406.00	N/A
HC65800039	M: SEED(S) GOLD BRACHYTHERAPY	278	C1716	618.00	N/A
HC65800047	BRACHY NONSTRNDED GOLD 198 SRC	278	C1716	618.00	N/A
HC65800054	BRACHY SEED HDR IRIDIUM 192	278	C1717	878.00	N/A
HC65800062	BRACHY SEED IRIDIUM-192\NON HI	278	C1719	202.00	N/A
HC65800088	BRACHYTX NONSTRAND NOS PER SRC	278	C2699	195.00	N/A
HC65800104	IODINE-125 STRANDED PER SOURCE	278	C2638	328.00	N/A
HC65800112	PALLADIUM-103 STRANDED PER SOURCE	278	C2640	390.00	N/A
HC83000117	FILTER,BLOOD PRODUCT	270		72.00	19.25
HC11200110	TRANSPORT EXTERNAL ADULT RN ICU ACCOMP(STATISTICAL)	222		N/A	N/A
HC11200128	TRANSPORT EXTERNAL ADULT RN CCU ACCOMP(STATISTICAL)	222		N/A	N/A
HC11200136	TRANSPORT EXTERNAL OB HI RISK RN ACCOMP(STATISTICAL)	222		N/A	N/A
HC11200144	TRANSPORT EXTERNAL NICU RN ACCOMP(STATISTICAL)	222		N/A	N/A
HC11200151	TRANSPORT EXTERNAL PICU RN ACCOMP(STATISTICAL)	222		N/A	N/A
HC11200169	TRANSPORT EXTERNAL PEDIATRIC RN ACCOMP (STATISTICAL)	222		N/A	N/A
HC25002734	CHANGE GT TUBE W/REV TRACT W/O IMAGE ENDO INCL REMVL	450	43763	1,659.00	N/A
HC25002742	INSERT PICC <5 YR AGE W/ IMAGING	450	36572	2,967.00	N/A
HC25090002	P: TRACHEOSTOMY+ ADULT TRACH TUBE			N/A	N/A
HC25090010	P: TRACHEOSTOMY+PEDS CUFFED TUBE			N/A	N/A
HC25090028	P: INTUBATION+ ET TUBE			N/A	N/A
HC25090036	P: THORACENTESIS PNCT(W/O IMAGE)-BI+ 2 TRAYS			N/A	N/A
HC25090044	P: THORACENTESIS PNCT(W/O IMAGE)-L +1 TRAY			N/A	N/A
HC25090051	P: THORACENTESIS PUNC(W/O IMAGE)-R,+1 TRAY			N/A	N/A
HC25090069	P: INSRTCTW/H20 SEAL B+2PLRVC2CTUBES			N/A	N/A
HC25090077	P: INSRT CTW/H20 SEAL L+PLRVC,CTUBE			N/A	N/A
HC25090085	P: INSRT CTW/H20 SEAL R+PLRVC,CTUBE			N/A	N/A
HC25090093	P: PERICARDIOCENTESIS INIT+TRAY			N/A	N/A
HC25090101	P: TRSFSN BLD&/CMPNTS+FLTR,WRMR TUB			N/A	N/A
HC25090119	P: PLCMNT CVC<5 YR+TRPL LMN CATH			N/A	N/A
HC25090127	P: PLCMNT CVC>5 YR+TRPL LMN CATH			N/A	N/A
HC25090135	P: INSERT PICC <5 YR AGE + PICC LINE			N/A	N/A
HC25090143	P: INSERT PICC >5 YR AGE + PICC LINE			N/A	N/A
HC25090150	P: INSRT NDL INTRAOSSS INF+SET NDL			N/A	N/A
HC25090168	P: GSTRC INTB ASP THER'LVG+TBS NG&LVG			N/A	N/A
HC25090176	P: CHNG GT TB W/O IMG/ENDO+CTH FOLEY			N/A	N/A
HC25090184	P: I&D  PERIANAL ABSCESS			N/A	N/A
HC25090192	P: INCSN EXTRNL HEMORRHOID+TRAY			N/A	N/A
HC25090200	P: PARACNTSS ABD W/O IMGNG+TRAY			N/A	N/A
HC25090218	P: ASPRTN BLADDER TROCAR+CATH			N/A	N/A
HC25090226	P: BLADDR IRRG SIMPL+ CATH FOLEY			N/A	N/A
HC25090234	P: INSRT BLADDR CATH-NON INDWLL+CATH			N/A	N/A
HC25090242	P: INSRT BLADDR CATH-TEMP FOLEY+TRAY			N/A	N/A
HC25090259	P: INSRT BLADDR CTH-TEMP-COMPLX+TRAY			N/A	N/A
HC25090267	P: LUMBAR PUNCTURE DIAGNOSTIC+TRAY			N/A	N/A
HC25090275	P: BLOOD PATCH(INJ EPIDURAL)+TRAY LP			N/A	N/A
HC25090283	P: CARDIOVERSION EXTERNAL+ELECTRODE			N/A	N/A
HC25090291	P: IV INF HYDRATION 1ST HR			N/A	N/A
HC25090309	P: IV INFUSION TX 1ST HR			N/A	N/A
HC25090317	P: IV PUSH SINGLE/INITIAL INJ			N/A	N/A
HC25090325	P: I&D ABSCESS			N/A	N/A
HC25090333	P: I&D HEMATOMA			N/A	N/A
HC25090341	P: I&D POSTOP WOUND			N/A	N/A
HC25090358	P: LAC REPAIR 12.6-20CM			N/A	N/A
HC25090366	P: LAC REPAIR 2.6-7.5CM			N/A	N/A
HC25090374	P: LAC REPAIR 20.1-30CM(LG)			N/A	N/A
HC25090382	P: LAC REPAIR 30.0+CM			N/A	N/A
HC25090390	P: LAC RPR 7.6-12.5CM(MED)			N/A	N/A
HC25090408	P: LAC REPAIR TO 2.5 CM(SM)			N/A	N/A
HC25090416	P: LAC REPAIR 12.6-20CM+STAPLR SKIN			N/A	N/A
HC25090424	P: LAC REPAIR 2.6-7.5CM+STAPLER SKIN			N/A	N/A
HC25090432	P: LAC RPR20.1-30CM(LG)+STAPLER SKIN			N/A	N/A
HC25090440	P: LAC REPAIR 30.0+CM+STAPLER SKIN			N/A	N/A
HC25090457	P: LAC RPR7.6-12.5CM(MED)+STPLR SKN			N/A	N/A
HC25090465	P: LAC RPR TO 2.5 CM(SM)+STAPLER SKN			N/A	N/A
HC25090473	P: LAC REPAIR 2.6-7.5CM+DERMABOND			N/A	N/A
HC25090481	P: LAC RPR7.6-12.5CM(MED)+DERMABOND			N/A	N/A
HC25090499	P: LAC RPR TO 2.5 CM(SM)+DERMABOND			N/A	N/A
HC25090507	P: NASAL EPISTAXIS+TAMPON			N/A	N/A
HC25090515	P: NASAL EPISTAXIS+PACKING/BALLOON			N/A	N/A
HC25090531	P: I&D ABSCESS			N/A	N/A
HC25090549	P: THORACNT PNCT-BI+2THORA VENT KITS			N/A	N/A
HC25090556	P: THORACENT PNCT-L+1THORA VENT KIT			N/A	N/A
HC25090564	P: THORACENT PNCT-R+1THORA VENT KIT			N/A	N/A
HC25090572	P: SINGLE PULSE OX W/PROBE			N/A	N/A
HC25090580	P: MULTIPLE PULSE OX W/PROBE			N/A	N/A
HC25090598	P: INSERT PICC >5 YR AGE W/ IMAGING + PICC LINE			N/A	N/A
HC25090606	P: INSERT PICC <5 YR AGE W/ IMAGING + PICC LINE			N/A	N/A
HC27001916	CHANGE GT TUBE W/REV TRACT W/O IMAGE/ENDO INCL REMVL	750	43763	3,992.00	N/A
HC29000528	EVAL COMP PREVNTV MED NEW 18-39	770		349.00	N/A
HC29000536	EVAL COMP PREVNTV MED NEW 40-64	770		349.00	N/A
HC31090004	P: PT DEVEL' TESTING 75 MIN/C			N/A	N/A
HC31090012	P: PT-EVAL 45 MIN/C			N/A	N/A
HC31090020	P: PT DEVEL' TESTING 90 MIN/C			N/A	N/A
HC31090038	P: PT-EVAL 60MIN/C			N/A	N/A
HC31090046	P: PT DEVEL' TESTING 120 MIN/C			N/A	N/A
HC31090053	P: PT-EVAL 75MIN/C			N/A	N/A
HC31090061	P: PT DEVEL' TESTING 150 MIN/C			N/A	N/A
HC31090079	P: PT-EVAL 90MIN/C			N/A	N/A
HC31090087	P: PT DEVEL' TESTING 180 MIN/C			N/A	N/A
HC31090095	P: PT-EVAL 120MIN/C			N/A	N/A
HC31090103	P: PT-INITIAL EVAL 150MIN/C			N/A	N/A
HC31090111	P: PT-INITIAL EVAL 180MIN/C			N/A	N/A
HC31090129	P: PT DEVEL' TESTING 45 MIN/C			N/A	N/A
HC31090137	P: PT DEVEL' TESTING 60 MIN/C			N/A	N/A
HC32001729	OT-DYSPHAG/SWAL TX ADD'L 15MIN/C	430	X4112	198.00	N/A
HC32090003	P: OT-EVAL 45 MIN/C			N/A	N/A
HC32090011	P: OT-EVAL 60MIN/C			N/A	N/A
HC32090029	P: OT-EVAL 75MIN/C			N/A	N/A
HC32090037	P: OT-EVAL 90MIN/C			N/A	N/A
HC32090045	P: OT-EVAL 120MIN/C			N/A	N/A
HC32090052	P: OT-EVAL 150MIN/C			N/A	N/A
HC32090060	P: OT-EVAL 180MIN/C			N/A	N/A
HC36800522	PULM REHAB ONE HR PER SESS'N	948	94625	633.00	N/A
HC36800910	PULM REHAB PER SESSION (90MIN) W POX2	948	94626	743.00	N/A
HC37090008	P: MNT INITIAL ASSESS 30 MIN-OP			N/A	N/A
HC37090016	P: MNT INITIAL ASSESS 45 MIN-OP			N/A	N/A
HC37090024	P: MNT INITIAL ASSESS 60 MIN-OP			N/A	N/A
HC37090032	P: MNT INITIAL ASSESS 75 MIN-OP			N/A	N/A
HC37090040	P: MNT INITIAL ASSESS 90 MIN-OP			N/A	N/A
HC37090057	P: MNT RE-ASSESS 30 MIN-OP			N/A	N/A
HC37090065	P: MNT RE-ASSESS 45 MIN-OP			N/A	N/A
HC37090073	P: MNT RE-ASSESS 60 MIN-OP			N/A	N/A
HC37090081	P: MNT THERAPY GROUP 60 MIN-OP/M			N/A	N/A
HC37090099	P: MNT INITIAL ASSESS 30 MIN-IP (ST)			N/A	N/A
HC37090107	P: MNT INITIAL ASSESS 45 MIN-IP (ST)			N/A	N/A
HC37090115	P: MNT INITIAL ASSESS 60 MIN-IP (ST)			N/A	N/A
HC37090123	P: MNT INITIAL ASSESS 75 MIN-IP (ST)			N/A	N/A
HC37090131	P: MNT INITIAL ASSESS 90 MIN-IP (ST)			N/A	N/A
HC37090149	P: MNT RE-ASSESS 30 MIN-IP (ST)			N/A	N/A
HC37090156	P: MNT RE-ASSESS 45 MIN-IP (ST)			N/A	N/A
HC37090164	P: MNT RE-ASSESS 60 MIN-IP (ST)			N/A	N/A
HC37090172	P: MNT RE-ASSESS 75MIN-IP(ST)			N/A	N/A
HC38420220	ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS	489		24,512.00	N/A
HC39001227	AHCP CONSULT TELEPHONE PER 15MIN/C	914	Z5406	74.00	N/A
HC42000653	CV STRESS TEST NUCLEAR (ST)	482		N/A	N/A
HC42090001	P: COMPLETE TEE			N/A	N/A
HC42090019	P: COMPLETE CONGENITAL ECHO			N/A	N/A
HC42090027	P: LTD/FU CONGENITAL ECHO			N/A	N/A
HC42090035	P: CONGENITAL TEE			N/A	N/A
HC42090043	P:STRESS ECHO TREAD/DOPLER/CLR			N/A	N/A
HC42090050	P:STRESS ECHO RX DOPLER/CLRFLW			N/A	N/A
HC42090068	P: STRESS NUCLEAR TREADMILL			N/A	N/A
HC42090076	P: STRESS NUCLEAR PHARMACOLOGI			N/A	N/A
HC42090084	P: 30 DAY EVENT MONITOR			N/A	N/A
HC42090092	P:STRESS ECHO PHARAMACOLOGIC			N/A	N/A
HC42090100	P:STRESS ECHO TREADMILL			N/A	N/A
HC42090134	P: COMPLETE ECHOCARDIOGRAM			N/A	N/A
HC42090142	P: LTD/FU ECHOCARDIOGRAM			N/A	N/A
HC42090167	P: ECHO LMT/FOL-UP W/DOPP FLO, W/WO CONTR			N/A	N/A
HC42090175	P: ECHO STRESS W/WO DOPP-PHARM, W/WO CON			N/A	N/A
HC42090183	P: ECHO STRESS W/DOPP W/WO CONTRAST			N/A	N/A
HC43000512	CONSULTATION 15MIN (STATISTIC)	401		N/A	N/A
HC44002657	FLUOROSCOPY ASSIST OR <1HR(ST)	320		N/A	N/A
HC44002665	FLUORSOCOPY ASSIST OR >1HR(ST)	320		N/A	N/A
HC44002673	PHYSICIAN READING(STATISTICAL)	320		N/A	N/A
HC44504926	PERC DILAT EXIST TRACT UROLOGIC PX W/IMAGE &TUBE PLC; NEW ACCESS RNL COL-LT	361	50437	13,770.00	N/A
HC44504934	PERC DILAT EXIST TRACT UROLOGIC PX W/IMAGE &TUBE PLC; NEW ACCESS RNL COL-RT	361	50437	13,770.00	N/A
HC44504942	PERC DILAT EXIST TRACT UROLOGIC PX W/IMAGE &TUBE PLC; NEW ACCESS RNL COL-BIL	361	50437	24,782.00	N/A
HC44504959	PERC DILAT EXIST TRACT UROLOGIC PX W/IMAGE /&TUBE-LT	361	50436	8,380.00	N/A
HC44504967	PERC DILAT EXIST TRACT UROLOGIC PX W/IMAGE /&TUBE-RT	361	50436	8,380.00	N/A
HC44504975	PERC DILAT EXIST TRACT UROLOGIC PX W/IMAGE /&TUBE-BIL	361	50436	12,598.00	N/A
HC44701209	EXTRA PUMP TIME/.5 HR	480		1,473.00	N/A
HC44703296	REMOVE TRANSCATH PACER LEADLESS RV INCL ALL IMAGING	481	33275	11,710.00	N/A
HC44703742	RT HRT CATH CONGEN DEFECTS INCLUDE IMAG;NRML NATIVE CONNECT	481	93593	26,843.00	N/A
HC44703759	RT HRT CATH CONGEN DEFECTS INCLUDE IMAG;ABNRML NATIVE CONNECT'	481	93594	27,253.00	N/A
HC44703767	LT HRT CATH CONGEN DEFECTS INCLUDE IMAG; NRML/ABNRML NATIVE CONNECT'	481	93595	28,050.00	N/A
HC44703775	RT & LT HRT CATH CONGEN DEFECT INCLUDE IMAGE;NRML NATIVE CONNECT	481	93596	28,600.00	N/A
HC44703783	RT & LT HRT CATH CONGEN DEFECT INCLUDE IMAGE; ABNRML NATIVE CONNECT	481	93597	29,700.00	N/A
HC44703791	CARDIAC OUTPUT MEASUREMENT, THERMO/OTHR W/ HRT CATH CONGEN DEFECT+	481	93598	550.00	N/A
HC44703809	EV REPAIR STENT PLACE COARCT AORTA ACROSS MAJOR SIDE BRANCHES	360	33894	60,500.00	N/A
HC44703817	EV REPAIR STENT PLACE COARCT AORTA NOT CROSSING MAJOR SIDE BRANCHES	360	33895	51,700.00	N/A
HC44703825	PTA NATIVE/RECURRENT COARCTATION AORTA	360	33897	27,500.00	N/A
HC44790004	P: TEVAR W/ LT SUB; INT'L ENDO& DIST EXTS CELIAC/S&I			N/A	N/A
HC44790012	P: TEVAR; INITIAL ENDO & DIST EXTS TO CELIAC/S&I			N/A	N/A
HC44790020	P: TEVAR; PLCMT PROX EXT PROTH; INITIAL/S&I			N/A	N/A
HC44790038	P: TEVAR; PLCMT PROX EXT PROTH; EACH ADD'L+/S&I			N/A	N/A
HC44790046	P: TEVAR; PLCMT OF DISTAL EXTS PROTH(S) DELAYED/S&I			N/A	N/A
HC46502787	INSERT PICC <5 YR AGE W/IMAGING	361	36572	7,656.00	N/A
HC46590147	P:CIRCUMCISION PROC/DISP SUPPLIES			N/A	N/A
HC47290002	P:IORT POST OP DAY 0			N/A	N/A
HC51003911	CHANGE GT TUBE W/REV TRACT W/O IMAGE/ENDO INCL REMVL	750	43763	388.00	N/A
HC51010007	MD DEV PT REPORT; INTERMEDIATE	510	Z4303	147.00	N/A
HC51010015	MD DEV PT REPORT; COMPREHENSIVE	510	Z4304	262.00	N/A
HC51010023	MD TEAM CONFERENCE PER CASE	510	Z4306	185.00	N/A
HC51010031	MD GROUP TEACH/COUNS SESSION	510	Z4313	159.00	N/A
HC51010049	MD PT/FAMILY CONFERENCE 30MIN	510	Z4315	177.00	N/A
HC51020006	RN ASSESSMENT EA 30MIN	510	Z4301	83.00	N/A
HC51020014	RN DEV PT REPORT; INTERMEDIATE	510	Z4303	147.00	N/A
HC51020022	RN DEV PT REPORT;COMPREHENSIVE	510	Z4304	262.00	N/A
HC51020030	RN TEAM CONF PRTCPNT PER 15MIN	510	Z4310	49.00	N/A
HC51020048	RN GROUP TEACH/COUNS SESSION	510	Z4314	74.00	N/A
HC51020055	RN CONSULT TELEPHONE PER 15MIN	510	Z5406	47.00	N/A
HC51020063	RN COORDINATOR ACTIVITIES CASE	510	Z4300	302.00	N/A
HC51020246	NP DEV PT REPORT; COMPREHENSIVE	510	Z4304	262.00	N/A
HC51020253	NP COORDINATOR ACTIVITIES CASE	510	Z4300	302.00	N/A
HC51020261	NP TEAM CONFER PRTCPNT PER 15MIN	510	Z4310	49.00	N/A
HC51020428	NP DEV PT REPORT; INTERMEDIATE	510	Z4303	147.00	N/A
HC51030005	SW ASSESS/INTERVENTION EA 30MIN	510	Z4307	86.00	N/A
HC51030013	SW TEAM CONF PRTCPNT PER 15MIN	510	Z4311	45.00	N/A
HC51030021	SW CONSULT TELEPHONE PER 15MIN	510	Z5406	47.00	N/A
HC51030039	SW COORDINATOR ACTIVITIES CASE	510	Z4300	302.00	N/A
HC51040004	RD ASSESS/EDUCATE PER 30MIN	510	Z4308	86.00	N/A
HC51040012	RD TEAM CONF PRTCPNT PER 15MIN	510	Z4312	45.00	N/A
HC51040020	RD CONSULT TELEPHONE PER 15MIN	510	Z5406	47.00	N/A
HC51040038	RD COORDINATOR ACTIVITIES CASE	510	Z4300	302.00	N/A
HC51050003	RT ASSESS/INTERVENTION EA 30MIN	510	Z4309	61.00	N/A
HC51050011	RT TEAM CONF PER CASE	510	Z4302	40.00	N/A
HC51050029	RT CONSULT TELEPHONE PER 15MIN	510	Z5406	47.00	N/A
HC51060002	AHCP COORDINATE ACTIVITIES CASE	510	Z4300	302.00	N/A
HC51060010	AHCP GROUP TEACH/COUNS SESSION	510	Z4314	74.00	N/A
HC51060028	AHCP TEAM CONF PRTCPNT EA 15MIN	510	Z4302	43.00	N/A
HC51060036	AHCP CONSULT TELEPHONE PER 15MIN	510	Z5406	47.00	N/A
HC51060044	AHCP ASSESS/INTERVEN PER 30MIN	510	Z4309	90.00	N/A
HC51060333	PT CONSULT TELEPHONE PER 15MIN	510	Z5406	47.00	N/A
HC51060341	OT CONSULT TELEPHONE PER 15MIN	510	Z5406	47.00	N/A
HC51070274	PSYCH ASSESS/INTERVEN EA30MIN/MCL	510	Z4309	90.00	N/A
HC51070712	PSYCH TEAM CONF PRTCPNT PER 15MIN	510	Z4302	27.00	N/A
HC62290010	P:AMNIOCENTESIS			N/A	N/A
HC62290028	P:AMNIOINFUSION			N/A	N/A
HC62290036	P:BOA			N/A	N/A
HC62290101	P:EXT BREECH VERSION			N/A	N/A
HC62290127	P:CERCLAGE REMOVAL LVL 2			N/A	N/A
HC62290150	P:AMNIOCENTESIS THERAPEUTIC			N/A	N/A
HC62290184	P:VAGINAL DELIVERY			N/A	N/A
HC62290192	P:VAGINAL DELIVERY TWINS			N/A	N/A
HC62290200	P:VAGINAL DELIVERY W/EPI			N/A	N/A
HC62290218	P:VAGINAL DELIVERY NO IV			N/A	N/A
HC62290325	P:C-SECTION W/GENERAL QUINTS			N/A	N/A
HC62290333	P:VAGINAL DELIVERY TWINS W/EPI			N/A	N/A
HC62290341	P:BLOOD PATCH PROCEDURE			N/A	N/A
HC62290374	P: SYSTEM SINUPLASTY SPIN F,S,/M			N/A	N/A
HC62290382	P: KIT SINUS DILATION VENTERA			N/A	N/A
HC62890009	P:PERITONEAL CATH KIT/3COMPNTS			N/A	N/A
HC62890090	P: AICD SINGLE CHAMBER C1722 W/LEAD C1777 OR C1895 OR C1898			N/A	N/A
HC62890108	P: PACER CR 3 CHAMBERS C2621 W/ 3 LEADS C1898 &/ C1900			N/A	N/A
HC62890116	P: PACER SNGL RATE C1786 RSPNSV W/LEAD C1779 OR C1898			N/A	N/A
HC62890132	P: PACER CRT-P C2621 W/ 2 LEADS C1898			N/A	N/A
HC62890140	P: PACER CRT-P C2621 W/ 1 LEAD C1898			N/A	N/A
HC62890157	P: AICD NOT S/D C1882 3LDSC1777/1898/1895/1900W/SHEATH C1894			N/A	N/A
HC62890165	P: AICD DUAL CHAMBER C1721 W/2LEADS C1777 OR C1898			N/A	N/A
HC62890173	P: AICD SINGLE CHAMBER C1722 W/LEAD C1898			N/A	N/A
HC62890181	P: AICD C1721 W/C1777/C1892/C1895/C1896/C1898			N/A	N/A
HC62890199	P: AICD C1722 W/C1777/C1892/C1895/C1896/C1898			N/A	N/A
HC62890207	P: AICD C1882 W/C1777/C1892/C1893/C1895/C1896/C1898/C1900			N/A	N/A
HC62890215	P: PACER DUAL RR C1785 W/ 2 LEADS C1779&/C1898&/C1899&/C1900			N/A	N/A
HC62890223	P: AICD DUAL C1721W/C1777&/ C1895&/ C1898(3)			N/A	N/A
HC62890231	P: AICD SINGLE C1722 W/LEAD C1777 OR C1895(1)			N/A	N/A
HC62890249	P: PACER DUAL RRSPNSV C1785 W/ 2 LEADS C1779&/C1895&/C1896			N/A	N/A
HC65000343	MEDICATION-DIAGNOSTIC	343		63.58	N/A
HC65000344	MEDICATION-THERAPEUTIC	344		N/A	N/A
HC65000888	PHARMACY CONVERSION			N/A	N/A
HC65600343	NM MEDICATION-DIAGNOSTIC	343		589.02	N/A
HC65600344	NM MEDICATION-THERAPEUTIC	344		96.55	N/A
HC65601344	NM MEDICATION-THERAPEUTIC (340B)	344		1,044.25	N/A
HC65890006	P: PALLADIUM 103 20 SEEDS			N/A	N/A
HC65890014	P:PALLADIUM103 NONSTRND20SEEDS			N/A	N/A
HC65890022	P:IODINE 125 NONSTRND 20SEEDS			N/A	N/A
HC73000176	HEMOPERFUSION DRY RUN	880		1,724.00	N/A
HC73000218	DIALYSIS;CANCEL-HOSP ISSUE(QA)	803		N/A	N/A
HC81101669	P:POC CHEMISTRY & HH (PCCHHE)			N/A	N/A
HC81101990	M: MISC CHEMISTRY PROC	301		N/A	N/A
HC81190035	P: BASIC METAB PAN/ION'D CA &HCT(POS)			N/A	N/A
HC81190050	P: POS EG7 CARTRIDGE			N/A	N/A
HC81190068	P: POS CG4 CARTRIDGE			N/A	N/A
HC82200585	TISSUE EXAM - OP	310		599.00	325.00
HC82202326	MD CALLBACK 1/2 HR (STAT)	310		N/A	N/A
HC82290016	P:BONE MARROW ASP/BX PROCEDURE			N/A	N/A
HC82290024	P:ASPIRATION BONE MARROW			N/A	N/A
HC82290032	P:BONE MARROW ASP/BX BILATERAL			N/A	N/A
HC82290040	P:BONE MARROW ASP/BX LEFT			N/A	N/A
HC82290057	P:BONE MARROW ASP/BX RIGHT			N/A	N/A
HC82290065	P: BONE MARROW ASPIRATION BILAT			N/A	N/A
HC82290073	P: BONE MARROW ASPIRATION LEFT			N/A	N/A
HC82290081	P: BONE MARROW ASPIRATION RIGHT			N/A	N/A
HC82290099	P: MISMATCH REPAIR-MLH1 MSH2 MSH6 PMS2			N/A	N/A
HC83000901	BLOOD DELIVERY-ZONE1-MHL	300		36.00	21.00
HC83001081	M: MISC BLOOD BANK	300		N/A	N/A
HC83090001	P: CRYO UNIT & THAWING PROCEDURE			N/A	N/A
HC83090019	P: PLASMA CRYO REDUCED UNIT & THAWING			N/A	N/A
HC83090027	P: FFP UNIT AND THAWING			N/A	N/A
HC83090035	P: RBC ALIQUOT & SPLITTING PROCEDURE			N/A	N/A
HC83090043	P: BLOOD TYPE; ABO & RH(D)			N/A	N/A
HC83090050	P: FFP, RBC LR/CMV- & POOL&THAW			N/A	N/A
HC83090068	P: PLATELET ALIQUOT & SPLITTING			N/A	N/A
HC83090092	P: PLASMA ALIQUOT & SPLITTING PROCEDURE	390		N/A	N/A
HC83090100	P: PLASMA ALIQUOT CONVALESCENT & SPLITTING PROCEDURE	830		N/A	N/A
HC83504118	M: MISC PATHOLOGY-AU	310		80.88	N/A
HC83504126	M: MISC PATHOLOGY-CS	310		160.00	N/A
HC83504159	M: MISC PATHOLOGY-EM	310		N/A	N/A
HC83504167	M: MISC PATHOLOGY-GZ	310		N/A	N/A
HC83504175	M: MISC PATHOLOGY-HP	310		N/A	N/A
HC83504183	M: MISC PATHOLOGY-IM	310		N/A	N/A
HC83504191	M: MISC PATHOLOGY-JH	310		N/A	N/A
HC83504217	M: MISC PATHOLOGY-LR	310		N/A	N/A
HC83504225	M: MISC PATHOLOGY-MA	310		141.02	N/A
HC83504233	M: MISC PATHOLOGY-MG	310		N/A	N/A
HC83504258	M: MISC PATHOLOGY-PI	310		N/A	N/A
HC83504266	M: MISC PATHOLOGY-SU	310		301.76	N/A
HC83504274	M: MISC PATHOLOGY-U2	310		N/A	N/A
HC83504290	M: MISC PATHOLOGY-VU	310		N/A	N/A
HC83504308	M: MISC PATHOLOGY-WD	310		N/A	N/A
HC83504472	M: MISC PATHOLOGY-GC	310		N/A	N/A
HC83504480	M: MISC PATHOLOGY-UM	310		N/A	N/A
HC83504613	M: MISC PATHOLOGY-MY	310		212.87	N/A
HC83504621	M: MISC PATHOLOGY-NY	310		N/A	N/A
HC83504639	M: MISC PATHOLOGY-PU	310		N/A	N/A
HC83504647	M: MISC PATHOLOGY-SD	310		N/A	N/A
HC83504654	M: MISC PATHOLOGY-SJ	310		N/A	N/A
HC83504670	M: MISC PATHOLOGY-UF	310		N/A	N/A
HC83504761	M: MISC PATHOLOGY-UW	310		31.22	N/A
HC83505081	M: MISC PATHOLOGY-	310		325.00	N/A
HC83505123	M: MISC PATHOLOGY-GH	310		N/A	N/A
HC83505131	M: MISC PATHOLOGY-RT	310		N/A	N/A
HC83505149	M: MISC PATHOLOGY-UP	310		N/A	N/A
HC83505271	M: MISC PATHOLOGY-AP	310		86.10	N/A
HC83505289	M: MISC PATHOLOGY-FM	310		N/A	N/A
HC83505297	M: MISC PATHOLOGY-AI	310		N/A	N/A
HC83505305	M: MISC PATHOLOGY-BT	310		N/A	N/A
HC83505313	M: MISC PATHOLOGY-NG	310		268.84	N/A
HC83505354	M: MISC PATHOLOGY-BR	310		N/A	N/A
HC83505396	M: MISC PATHOLOGY-PP	310		N/A	N/A
HC83505404	M: MISC PATHOLOGY-SC	310		209.50	N/A
HC83505438	M: MISC PATHOLOGY-CE	310		N/A	N/A
HC83505446	M: MISC PATHOLOGY-SF	310		N/A	N/A
HC83505453	M: MISC PATHOLOGY-UC	310		143.02	N/A
HC83505545	M: MISC PATHOLOGY-CC	310		N/A	N/A
HC83505552	M: MISC PATHOLOGY-JN	310		N/A	N/A
HC83505560	M: MISC PATHOLOGY-MC	310		N/A	N/A
HC83505578	M: MISC PATHOLOGY-NW	310		N/A	N/A
HC83505586	M: MISC PATHOLOGY-OU	310		N/A	N/A
HC83505594	M: MISC PATHOLOGY-SH	310		N/A	N/A
HC83505628	M: MISC PATHOLOGY-CA	310		N/A	N/A
HC83505776	M: MISC PATHOLOGY-CF	310		N/A	N/A
HC83505784	M: MISC PATHOLOGY-FN	310		N/A	N/A
HC83505792	M: MISC PATHOLOGY-NF	310		N/A	N/A
HC83505818	M: PATH REF LAB-BC	310		N/A	N/A
HC83505859	M: MISC PATHOLOGY -NC	310		N/A	N/A
HC83505867	M: MISC PATHOLOGY -HB	310		N/A	N/A
HC83505958	M: MISC PATHOLOGY-PA	310		60.91	N/A
HC83505966	M: MISC PATHOLOGY-VA	310		N/A	N/A
HC83505974	M: MISC PATHOLOGY-CM	310		N/A	N/A
HC83590091	P:IMMUNOHISTOCHEM X 6-HP			N/A	N/A
HC83590109	P:IMMUNOHISTOCHEM X 5-HP			N/A	N/A
HC83590117	P:IMMUNOHISTOCHEM X 4-HP			N/A	N/A
HC83590133	P:RENAL BIOPSY-CS			N/A	N/A
HC83590240	P:IMMUNOHISTOCHEM X 7 - HP			N/A	N/A
HC83590331	P: FLOW CYTOM MKR PERIPH BLD 1ST+23 ADD-NG			N/A	N/A
HC83590349	P: MISMATCH REPAIR-MLH1 MSH2 MSH6 PMS2 -NG			N/A	N/A
HC83590356	M: MISC PATHOLOGY-SK	310		N/A	N/A
HC83590364	P: MUSCLE BIOPSY PANEL-U2			N/A	N/A
HC83590380	P: FLOW CYT MKR CD4/CD8 BAL-NG			N/A	N/A
HC84201094	SWINE FLU; STATISTIC SCREEN	306		N/A	N/A
HC84290006	P:CULTURE STOOL W ADD' PATHOGN			N/A	N/A
HC84290014	P:CULTURE OTHER AEROB& ANAEROB			N/A	N/A
HC84290022	P:OVA/PARASITES W/TRICHR STAIN			N/A	N/A
HC84290030	P:BACTERIAL ANTIGENS (PNL)			N/A	N/A
HC84290048	P:PARASITE CRYPTO/GIARD			N/A	N/A
HC84290055	P:INFLUENZA VIRUS H1N1/A/B PCR			N/A	N/A
HC84290089	P: RESPIRATORY PANEL BY PCR			N/A	N/A
HC84290105	P:CULTURE DNA/RNA PCR PANEL			N/A	N/A
HC84290121	P: PNEUMONIA PANEL BY PCR			N/A	N/A
HC84600246	M: MISC CYTOLOGY PROCEDURE	311		N/A	N/A
HC84600279	M: MISC CYTOGENIC STUDY	311		N/A	N/A
HC89004295	M: MISC REF LAB-SU	300		226.82	N/A
HC89004907	M: MISC REF LAB-CA	300		55.67	N/A
HC89004915	M: MISC REF LAB-GE	300		N/A	N/A
HC89004923	M:MISC REF LAB-AA	300		N/A	N/A
HC89004931	M: MISC REF LAB-LA	300		N/A	N/A
HC89010334	M: MISC REF LAB-AH	300		N/A	N/A
HC89010367	M: MISC REF LAB-AT	300		581.59	N/A
HC89010375	M: MISC REF LAB-AU	300		54.76	N/A
HC89010383	M: MISC REF LAB-BW	300		607.00	N/A
HC89010391	M: MISC REF LAB-CS	300		N/A	N/A
HC89010409	M: MISC REF LAB-DN	300		N/A	N/A
HC89010417	M: MISC REF LAB-EC	300		N/A	N/A
HC89010425	M: MISC REF LAB-ES	300		152.73	N/A
HC89010433	M: MISC REF LAB-FT	300		239.45	N/A
HC89010441	M: MISC REF LAB-GC	300		66.52	N/A
HC89010458	M: MISC REF LAB-GL	300		N/A	N/A
HC89010466	M: MISC REF LAB-GZ	300		1,346.61	N/A
HC89010474	M: MISC REF LAB-HP	300		N/A	N/A
HC89010482	M: MISC REF LAB-LC	300		184.17	N/A
HC89010490	M: MISC REF LAB-MA	300		168.58	N/A
HC89010508	M: MISC REF LAB-OC	300		N/A	N/A
HC89010516	M: MISC REF LAB-PR	300		218.45	N/A
HC89010524	M: MISC REF LAB-PS	300		N/A	N/A
HC89010532	M: MISC REF LAB-QD	300		17.50	N/A
HC89010540	M: MISC REF LAB-QN	300		175.80	N/A
HC89010557	M: MISC REF LAB-RD	300		N/A	N/A
HC89010565	M: MISC REF LAB-SL	300		N/A	N/A
HC89010573	M: MISC REF LAB-US	300		N/A	N/A
HC89010581	M: MISC REF LAB-U2	300		29.69	N/A
HC89010599	M: MISC REF LAB-UD	300		42.00	N/A
HC89010607	M: MISC REF LAB OTHER	300		209.34	N/A
HC89015051	M: MISC CYTOGENIC STUDY-GZ	311		N/A	N/A
HC89017925	M: MISC REF LAB-HC	300		N/A	N/A
HC89017933	M: MISC REF LAB-WD	300		N/A	N/A
HC89017958	M: MISC REF LAB-AG	300		1,285.00	N/A
HC89017966	M: MISC REF LAB-CD	300		N/A	N/A
HC89017974	M: MISC REF LAB-CL	300		N/A	N/A
HC89017982	M: MISC REF LAB-LB	300		N/A	N/A
HC89017990	M: MISC REF LAB-RT	300		N/A	N/A
HC89018006	M: MISC REF LAB-GH	300		N/A	N/A
HC89018014	M: MISC REF LAB-GX	300		N/A	N/A
HC89018022	M: MISC REF LAB-GF	300		907.05	N/A
HC89018048	M: MISC REF LAB-SA	300		N/A	N/A
HC89018113	M: MISC REF LAB-GN	300		N/A	N/A
HC89020762	M: MISC REF LAB-UC	300		461.00	N/A
HC89020911	M: MISC REF LAB-CN	300		360.31	N/A
HC89021240	M: MISC REF LAB-IS	300		275.00	N/A
HC89021299	M: MISC REF LAB-BA	300		N/A	N/A
HC89021307	M: MISC REF LAB-ML	300		N/A	N/A
HC89021398	M: MISC REF LAB-FL	300		163.33	N/A
HC89021406	M: MISC REF LAB-CT	300		N/A	N/A
HC89021521	M: MISC REF LAB-CE	300		N/A	N/A
HC89021539	M: MISC REF LAB -KI	300		183.89	N/A
HC89021547	M: MISC REF LAB-UX	300		N/A	N/A
HC89022180	M: MISC REF LAB-BG	300		1,200.00	N/A
HC89022198	M: MISC REF LAB-BP	300		N/A	N/A
HC89022206	M: MISC REF LAB-CC	300		31.21	N/A
HC89022214	M: MISC REF LAB-DR	300		200.00	N/A
HC89022222	M: MISC REF LAB-FG	300		616.67	N/A
HC89022248	M: MISC REF LAB-GG	300		622.22	N/A
HC89022255	M: MISC REF LAB-IC	300		870.97	N/A
HC89022263	M: MISC REF LAB-JN	300		N/A	N/A
HC89022271	M: MISC REF LAB-MC	300		N/A	N/A
HC89022289	M: MISC REF LAB-NP	300		N/A	N/A
HC89022297	M: MISC REF LAB-NW	300		1,608.86	N/A
HC89022305	M: MISC REF LAB-OU	300		N/A	N/A
HC89022313	M: MISC REF LAB-PG	300		963.00	N/A
HC89022321	M: MISC REF LAB-SH	300		187.98	N/A
HC89022420	M: MISC REF LAB -CO	300		N/A	N/A
HC89022537	M: MISC REF LAB -KR	300		1,929.42	N/A
HC89022545	M: MISC REF LAB -MN	300		139.44	N/A
HC89022552	M: MISC REF LAB -NJ	300		130.20	N/A
HC89022677	M: MISC REF LAB-SS	300		108.00	N/A
HC89022750	M:  MISC REF LAB -CG	300		4,000.00	N/A
HC89022768	M: MISC REF LAB -GI	300		2,741.36	N/A
HC89022834	M: MISC REF LAB-VC	300		164.00	N/A
HC89022842	M: MISC REF LAB-BD	300		N/A	N/A
HC89022859	M: MISC REF LAB-MV	300		97.00	N/A
HC89022867	M: MISC REF LAB-NM	300		494.00	N/A
HC89022875	M: MISC REF LAB-EG	300		N/A	N/A
HC89023048	M: MISC REF LAB-ED	300		N/A	N/A
HC89023055	M: MISC REF LAB -GR	300		N/A	N/A
HC89023089	M: MISC REF LAB -MI	300		N/A	N/A
HC89023105	M: MISC REF LAB-QI	300		N/A	N/A
HC89023113	M: MISC REF LAB-GD	300		N/A	N/A
HC89023170	M: MISC REF LAB-JU	300		N/A	N/A
HC89023303	M: MISC REF LAB-HG	300		N/A	N/A
HC89023337	M: MISC REF LAB-UH	300		N/A	N/A
HC89023485	M: MISC REF LAB -WI	300		N/A	N/A
HC89090005	P:NEWBORN SCREENING PROGRAM PANEL -GE			N/A	N/A
HC89090013	P:SPERM AB-AU			N/A	N/A
HC89090021	P:HISTOPLASMA AB BY CF - AU			N/A	N/A
HC89090039	P:CPK ISO - AU			N/A	N/A
HC89090047	P:CHROMOSOME ANALYSIS TISSU-GZ			N/A	N/A
HC89090054	P:LDH ISOENZYMES-AU			N/A	N/A
HC89090062	P: VAP CHOLESTEROL TEST-AU			N/A	N/A
HC89090070	P:CHROMOSOME ANALYSIS POC-GZ			N/A	N/A
HC89090088	P:CHROMOSOME ANALYSS CRD BL-GZ			N/A	N/A
HC89090096	P: CHROMO ANALYSIS BLOOD-GZ			N/A	N/A
HC89090104	P:CHROMOSOME ANALYSIS AMNIO-GZ			N/A	N/A
HC89090112	P:ANA 12 PLUS POSITIVE-RD			N/A	N/A
HC89090120	P:ANA 12 PLUS - RD			N/A	N/A
HC89090138	P:CMV AB IGG IGM-AU			N/A	N/A
HC89090146	P:FETAL LUNG PROFILE-FE			N/A	N/A
HC89090161	P:IMMUNOGLOB G CSF INDEX-AU			N/A	N/A
HC89090187	P:B.PARAPERTUSSIS/PERT DFA-U2			N/A	N/A
HC89090195	P:CULTURE BORD PERTUSSIS -U2			N/A	N/A
HC89090203	P:TOXOPLASMA IGG&IGM -AU			N/A	N/A
HC89090211	P:HYPERSENS PNEUMO EXT-AU			N/A	N/A
HC89090229	P:ALLERGEN SO CALIF PANEL-AU			N/A	N/A
HC89090237	P:ALLERGEN FOOD PANEL ADULT-AU			N/A	N/A
HC89090245	P:ALLERGEN GRASS PANEL-AU			N/A	N/A
HC89090252	P:ALLERGEN WEEDS PANEL-AU			N/A	N/A
HC89090260	P:ALLERGEN FOOD PANEL PED 9-AU			N/A	N/A
HC89090278	P:ALLERGEN MOLD PANEL-AU			N/A	N/A
HC89090286	P:ALLERGEN FOOD EXT/PNL AD-AU			N/A	N/A
HC89090294	P:FLUORIDE URINE-AU			N/A	N/A
HC89090328	P:ENCEPHALITIS-ARBOVIRS ABS-AU			N/A	N/A
HC89090336	P:CELIAC SEROLOGY(1105PNL2)-PR			N/A	N/A
HC89090351	P:IBD SEROLOGY 7 (1007)-PR			N/A	N/A
HC89090369	P:ANA 12-RD			N/A	N/A
HC89090377	P:ANA 12 POSITIVE-RD			N/A	N/A
HC89090393	P:LIBRIUM & NORDIAZEPAM			N/A	N/A
HC89090419	P:CULTURE - CHLAMYDIA-FT			N/A	N/A
HC89090427	P:17-KETOSTEROID FRAC/CR OTHR-			N/A	N/A
HC89090435	P:ANNEXIN AB V IGM, IGG- ES			N/A	N/A
HC89090443	P:11-DEHYROTHROMBOXANE B2 UR P			N/A	N/A
HC89090450	P:PARO NOCT HGBUR RBC - ES			N/A	N/A
HC89090468	P:VONWILL'D FCTR 2N&FCTVIII-EC			N/A	N/A
HC89090476	P:MYCOPLASMA PNEUMONIAE AB-AU			N/A	N/A
HC89090484	P: COXSACKIE A AB PANEL-FT			N/A	N/A
HC89090492	P:VARICELLA ABS-IGG/IGM-AU			N/A	N/A
HC89090500	P:IMMUNOCOMPROMISED VIRAL PNL-FT			N/A	N/A
HC89090518	P:CULTURE AFB+STAIN-FT			N/A	N/A
HC89090542	P:VAP CHOLESTEROL TEST-AH			N/A	N/A
HC89090559	P:TORCH ANTIBODIES, IGM-AU			N/A	N/A
HC89090567	P:TORCH ANTIBODIES, IGG-AU			N/A	N/A
HC89090575	P:HEAVY METALS-AU			N/A	N/A
HC89090583	P:HEAVY METALS 6-URINE-AU			N/A	N/A
HC89090591	P:PNEUMOCOCCAL AB-AU			N/A	N/A
HC89090609	P:PARVOVIRUS B19 AB PANEL-AU			N/A	N/A
HC89090617	P:ANTICARDIOLIPIN AB IGG/IGM-AU			N/A	N/A
HC89090625	P:RUBELLA IGG/IGM-AU			N/A	N/A
HC89090633	P:LYMPH PAN-3 CD4&CD8-AU			N/A	N/A
HC89090641	P:INSECTICIDE EXPOSURE PANEL-AU			N/A	N/A
HC89090658	P:PHENYTOIN FREE & TOTAL-AU			N/A	N/A
HC89090666	P:HYPERSENSITIVITY PNEUMO I -AU			N/A	N/A
HC89090674	P:HERPES 1&2 GLYCO IGG-AU			N/A	N/A
HC89090682	P:HERPES PANEL 1&2, IGG/IGM -AU			N/A	N/A
HC89090690	P:H. PYLORI PANEL -AU			N/A	N/A
HC89090708	P:GLOMERULAR BSMT MEM PANEL-AU			N/A	N/A
HC89090724	P:EBV AB PANEL-AU			N/A	N/A
HC89090732	P:MULTIPLE SCLEROSIS PROFILE-AU			N/A	N/A
HC89090740	P:APOLIPOPROTEIN B/A RATIO-AU			N/A	N/A
HC89090757	P:FUNGAL ANTIBODIES BY CF SERUM-AU			N/A	N/A
HC89090765	P:HERPES BY DFA-AU			N/A	N/A
HC89090773	P:COENZYME Q10-AU			N/A	N/A
HC89090781	P:CULTURE CHLAMYDIA PNUEM-AU			N/A	N/A
HC89090799	P:LYMPHOCYTE PANEL-5 TOT ENUM-AU			N/A	N/A
HC89090807	P:PARAINFLUENZA ANTIBODIES-AU			N/A	N/A
HC89090815	P:COCCIDIOIDOMYCOSIS AB CSF -AU			N/A	N/A
HC89090823	P: PAROX NOCT HEMATURIA, RBC-AU			N/A	N/A
HC89090898	P: MICROSPORIDIA-MOD TRICHRM-AU			N/A	N/A
HC89090914	P:NEWBORN SCREENING(PKU) PANEL			N/A	N/A
HC89090922	P: CHROMO ANALYSIS BM-GZ			N/A	N/A
HC89090930	P: CHROMO ANALYSIS POC-GZ			N/A	N/A
HC89090948	P: HIV PHENOSENSE GT-VI			N/A	N/A
HC89090955	P: HIV PHENOTYPE-COMPREHENSV-VI			N/A	N/A
HC89090971	P: HLA ANTIBODY DETECTION-AU			N/A	N/A
HC89090997	P: CHROMOSOME ANALYS BM-AU			N/A	N/A
HC89091003	P: CHROMOSOME ANALYS PB-AU			N/A	N/A
HC89091011	P: CHROMOSOME ANALYS AF-AU			N/A	N/A
HC89091029	P: CHROMOSOME FISH INTERPHAS-AU			N/A	N/A
HC89091045	P: CHROMOSOME ANALYS POC-AU			N/A	N/A
HC89091078	P: CELIAC SEROLOGY(CAT #1155)-PR			N/A	N/A
HC89091128	P: TPMT ENZYME(CAT#3320)-PR			N/A	N/A
HC89091136	P: THIOPUR METABOL(CAT#3200)-PR			N/A	N/A
HC89091151	P:RESP REGION13 ALLERGN(28)-AU			N/A	N/A
HC89091169	P: B PERTUSSIS/PARAPERTUSSIS PCR-AU			N/A	N/A
HC89091177	P: IBD SGI DX 2013 (CAT #1800) -PR			N/A	N/A
HC89091193	P:CEL GENETICS (CAT #6260-2013) -PR			N/A	N/A
HC89091201	P:CEL PLUS-GEN&SER (CAT #6360-2013)-PR			N/A	N/A
HC89091227	P: GM1 AUTO ANTIBODY-AT			N/A	N/A
HC89091243	P: BCR/ABL T(9:22)RT/PCR 2013-AU			N/A	N/A
HC89091250	P: CHLAMYDIA AB (PNL)-AU	302		N/A	N/A
HC89091284	P: DIBUCAINE NO +PSEUDOCHOLIN-AU			N/A	N/A
HC89091300	P:ALLERGEN,PEANUT COMPONNTS-AU			N/A	N/A
HC89091318	P: NK FUNCTION-CN			N/A	N/A
HC89091326	P: FACTOR VIII BETHESDA -ES			N/A	N/A
HC89091334	P:  FACTOR IX BETHESDA TITER -ES			N/A	N/A
HC89091383	P: IMIPRAMINE & DESIPRAMINE 1 OR 2-AU			N/A	N/A
HC89091441	P: RX OF ABUSE MECONM POS RFLX CONFIRM AMPHETAMINES ONLY -AU			N/A	N/A
HC89091458	P: OPIATES, URINE, QUANTITATIVE-AU			N/A	N/A
HC89091474	P: RX OF ABUSE MEC POS RFLX CONFIRM AMPHTMINS-MDA,MDEA,MDMA -AU			N/A	N/A
HC89091482	P: RX OF ABUSE MEC POS RFLX CONFIRM OPIATES-OXYCODONE -AU			N/A	N/A
HC89091490	P: FUNGAL ANTIBODIES BY IMMUNODILUTION			N/A	N/A
HC89091508	P: DISACCHARIDASE TISSUE-AU			N/A	N/A
HC89091524	M: MISC REF LAB-U9	300		614.00	N/A
HC89091599	P: STEROID COMPREHENSIVE-QN			N/A	N/A
HC89091607	P: HLA CLASS I TYPING(A/B/C LOCUS)-U9			N/A	N/A
HC89091615	P: HLA CLASS II TYPING(D LOCUS)-U9			N/A	N/A
HC89091623	P: BILIRUBIN, CSF(2005248)-AU			N/A	N/A
HC89501001	M: MISC RL BLOOD BANK -SB	300		N/A	N/A
HC89501019	M: MISC RL BLOOD BANK -AA	300		N/A	N/A
HC89590012	P:ABO RH BLOOD GROUP- SB			N/A	N/A

Section: Discounted Cash Pricing Policy
Policy Line
Payment discount rates
a. California Residents
       i. Inpatient – 150% of the Medicare Inpatient Prospective System (IPPS) rates
      ii. Outpatient Surgery – 150% of Medicare Outpatient Prospective Payment Services (OPPS) rates per CPT/HCPC code services
     iii. Outpatient non-surgical – 150% of Medicare Outpatient Prospective Payment Services (OPPS) rates per CPT/HCPC code services iv. Robotic assisted procedure (S2900) – additional charge of $2,800 applies to outpatient surgeries only; no additional mark-up on inpatient surgeries.
      v. If the CPT/HCPC code cannot be determined, then OP pricing will be determined as follows:
                 1. 1 st hour in the OR : $1,200. Subsequent 15 minutes: $300 each.
                2. Implants: acquisition cost plus 10% markup.
vi. All monies are due prior to services being rendered for pre-scheduled services. If immediate care is required, then the following deposits are due and the balance will be paid after services are rendered:
               1. $5,000 for IP
               2. $2,500 for OP
b. Non-California residents
      i. Inpatient – 180% of the Medicare Inpatient Prospective System (IPPS) rates
     ii. Outpatient Surgery – 180% of Medicare Outpatient Prospective Payment Services (OPPS) rates per CPT/HCPC code services
    iii. Outpatient non-surgical – 180% of Medicare Outpatient Prospective Payment Services (OPPS) rates per CPT/HCPC code services
    iv. Robotic assisted procedure (S2900) – additional charge of $2,800 applies to outpatient surgeries only; no additional mark-up on inpatient surgeries.
     v. If the CPT/HCPC code cannot be determined, then OP pricing will be determined as follows:
             1. 1 st hour in the OR : $1,400. Subsequent 15 minutes: $350 each.
             2. Implants: acquisition cost plus 10% markup.
vi. All monies are due prior to services being rendered for pre-scheduled services. If immediate care is required, then the following deposits are due and the balance will be paid after services are rendered:
             1. $6,000 IP
             2. $3,000 OP

Section: Inpatient De-identified Minimum Negotiated Charge
MS-DRG	Description	De-Identified Minimum Negotiated Charge
025	Craniotomy And Endovascular Intracranial Procedures With Mcc	36763.0
027	Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc	2462.0
033	Ventricular Shunt Procedures Without Cc/Mcc	1578.0
059	Multiple Sclerosis And Cerebellar Ataxia With Cc	16561.0
060	Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc	6309.0
064	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	10542.0
065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	2313.0
066	Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc	3945.0
069	Transient Ischemia Without Thrombolytic	1578.0
086	Traumatic Stupor And Coma <1 Hour With Cc	10721.0
101	Seizures Without Mcc	4980.0
165	Major Chest Procedures Without Cc/Mcc	33487.0
175	Pulmonary Embolism With Mcc Or Acute Cor Pulmonale	3156.0
176	Pulmonary Embolism Without Mcc	5529.0
177	Respiratory Infections And Inflammations With Mcc	6312.0
178	Respiratory Infections And Inflammations With Cc	8849.0
180	Respiratory Neoplasms With Mcc	6312.0
189	Pulmonary Edema And Respiratory Failure	4734.0
190	Chronic Obstructive Pulmonary Disease With Mcc	3945.0
191	Chronic Obstructive Pulmonary Disease With Cc	7454.0
193	Simple Pneumonia And Pleurisy With Mcc	7212.0
194	Simple Pneumonia And Pleurisy With Cc	4734.0
208	Respiratory System Diagnosis With Ventilator Support <=96 Hours	12591.0
216	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc	20514.0
219	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc	9641.0
220	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc	14772.0
233	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	16160.0
235	Coronary Bypass Without Cardiac Catheterization With Mcc	8080.0
236	Coronary Bypass Without Cardiac Catheterization Without Mcc	16160.0
239	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc	14202.0
243	Permanent Cardiac Pacemaker Implant With Cc	4734.0
246	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents	7196.0
247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	3156.0
266	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	57382.0
267	Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc	45360.0
269	Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc	5923.0
280	Acute Myocardial Infarction, Discharged Alive With Mcc	6312.0
281	Acute Myocardial Infarction, Discharged Alive With Cc	3945.0
282	Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc	12686.0
286	Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc	10121.0
287	Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc	4693.0
291	Heart Failure And Shock With Mcc	5618.0
292	Heart Failure And Shock With Cc	3156.0
299	Peripheral Vascular Disorders With Mcc	3156.0
305	Hypertension Without Mcc	4925.0
308	Cardiac Arrhythmia And Conduction Disorders With Mcc	3156.0
309	Cardiac Arrhythmia And Conduction Disorders With Cc	2313.0
310	Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc	3156.0
312	Syncope And Collapse	2313.0
313	Chest Pain	1578.0
314	Other Circulatory System Diagnoses With Mcc	13698.0
315	Other Circulatory System Diagnoses With Cc	5344.0
327	Stomach, Esophageal And Duodenal Procedures With Cc	21326.0
328	Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc	34679.0
329	Major Small And Large Bowel Procedures With Mcc	11565.0
330	Major Small And Large Bowel Procedures With Cc	6312.0
331	Major Small And Large Bowel Procedures Without Cc/Mcc	20680.0
343	Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc	6634.0
368	Major Esophageal Disorders With Mcc	5355.0
371	Major Gastrointestinal Disorders And Peritoneal Infections With Mcc	14245.0
372	Major Gastrointestinal Disorders And Peritoneal Infections With Cc	5523.0
377	Gastrointestinal Hemorrhage With Mcc	4734.0
378	Gastrointestinal Hemorrhage With Cc	4626.0
379	Gastrointestinal Hemorrhage Without Cc/Mcc	3156.0
387	Inflammatory Bowel Disease Without Cc/Mcc	12487.0
389	Gastrointestinal Obstruction With Cc	5125.0
390	Gastrointestinal Obstruction Without Cc/Mcc	3156.0
391	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	6470.0
392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	3156.0
394	Other Digestive System Diagnoses With Cc	4734.0
405	Pancreas, Liver And Shunt Procedures With Mcc	46352.0
406	Pancreas, Liver And Shunt Procedures With Cc	23474.0
417	Laparoscopic Cholecystectomy Without C.D.E. With Mcc	3156.0
418	Laparoscopic Cholecystectomy Without C.D.E. With Cc	4734.0
419	Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc	3156.0
432	Cirrhosis And Alcoholic Hepatitis With Mcc	8071.0
433	Cirrhosis And Alcoholic Hepatitis With Cc	7492.0
438	Disorders Of Pancreas Except Malignancy With Mcc	20226.0
439	Disorders Of Pancreas Except Malignancy With Cc	14767.0
440	Disorders Of Pancreas Except Malignancy Without Cc/Mcc	4334.0
446	Disorders Of The Biliary Tract Without Cc/Mcc	14268.0
453	Combined Anterior And Posterior Spinal Fusion With Mcc	14202.0
454	Combined Anterior And Posterior Spinal Fusion With Cc	6312.0
455	Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc	27297.0
460	Spinal Fusion Except Cervical Without Mcc	3945.0
470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	1578.0
472	Cervical Spinal Fusion With Cc	1578.0
473	Cervical Spinal Fusion Without Cc/Mcc	1578.0
480	Hip And Femur Procedures Except Major Joint With Mcc	9658.0
481	Hip And Femur Procedures Except Major Joint With Cc	6312.0
482	Hip And Femur Procedures Except Major Joint Without Cc/Mcc	4734.0
483	Major Joint Or Limb Reattachment Procedures Of Upper Extremities	4626.0
494	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc	21030.0
504	Foot Procedures With Cc	4734.0
517	Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc	11313.0
522	Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc	4734.0
536	Fractures Of Hip And Pelvis Without Mcc	1578.0
552	Medical Back Problems Without Mcc	4734.0
558	Tendonitis, Myositis And Bursitis Without Mcc	15050.0
602	Cellulitis With Mcc	4734.0
603	Cellulitis Without Mcc	4734.0
617	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc	6312.0
620	O.R. Procedures For Obesity With Cc	29046.0
621	O.R. Procedures For Obesity Without Cc/Mcc	1578.0
637	Diabetes With Mcc	8282.0
638	Diabetes With Cc	4734.0
639	Diabetes Without Cc/Mcc	10651.0
640	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc	4734.0
641	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc	3156.0
660	Kidney And Ureter Procedures For Non-Neoplasm With Cc	8163.0
661	Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc	1578.0
673	Other Kidney And Urinary Tract Procedures With Mcc	12624.0
674	Other Kidney And Urinary Tract Procedures With Cc	7696.0
682	Renal Failure With Mcc	4734.0
683	Renal Failure With Cc	3156.0
689	Kidney And Urinary Tract Infections With Mcc	3945.0
690	Kidney And Urinary Tract Infections Without Mcc	2995.0
694	Urinary Stones Without Mcc	5024.0
698	Other Kidney And Urinary Tract Diagnoses With Mcc	6312.0
699	Other Kidney And Urinary Tract Diagnoses With Cc	3156.0
743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	13998.0
768	Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C	3130.0
776	Postpartum And Post Abortion Diagnoses Without O.R. Procedures	13532.0
784	Cesarean Section With Sterilization With Cc	7193.0
785	Cesarean Section With Sterilization Without Cc/Mcc	4726.0
786	Cesarean Section Without Sterilization With Mcc	7782.0
787	Cesarean Section Without Sterilization With Cc	10885.0
788	Cesarean Section Without Sterilization Without Cc/Mcc	4726.0
789	Neonates, Died Or Transferred To Another Acute Care Facility	1572.0
792	Prematurity Without Major Problems	1130.0
793	Full Term Neonate With Major Problems	2055.0
794	Neonate With Other Significant Problems	1130.0
795	Normal Newborn	1312.0
805	Vaginal Delivery Without Sterilization Or D&C With Mcc	3189.0
806	Vaginal Delivery Without Sterilization Or D&C With Cc	3189.0
807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	2778.0
811	Red Blood Cell Disorders With Mcc	12382.0
812	Red Blood Cell Disorders Without Mcc	5605.0
831	Other Antepartum Diagnoses Without O.R. Procedures With Mcc	17516.0
832	Other Antepartum Diagnoses Without O.R. Procedures With Cc	11620.0
833	Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc	2022.0
847	Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc	11046.0
853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	15175.0
854	Infectious And Parasitic Diseases With O.R. Procedures With Cc	12627.0
862	Postoperative And Post-Traumatic Infections With Mcc	13192.0
863	Postoperative And Post-Traumatic Infections Without Mcc	4502.0
864	Fever And Inflammatory Conditions	6255.0
870	Septicemia Or Severe Sepsis With Mv >96 Hours	34435.0
871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	8080.0
872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	4626.0
894	Alcohol, Drug Abuse Or Dependence, Left Ama	3897.0
896	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc	11452.0
897	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc	4103.0
917	Poisoning And Toxic Effects Of Drugs With Mcc	8456.0
919	Complications Of Treatment With Mcc	8006.0
948	Signs And Symptoms Without Mcc	4900.0

Section: Inpatient De-identified Maximum Negotiated Charge
MS-DRG	Description	De-Identified Maximum Negotiated Charge
025	Craniotomy And Endovascular Intracranial Procedures With Mcc	43566.0
027	Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc	44416.0
033	Ventricular Shunt Procedures Without Cc/Mcc	1578.0
059	Multiple Sclerosis And Cerebellar Ataxia With Cc	16561.0
060	Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc	6309.0
064	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	15729.0
065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	17821.0
066	Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc	6959.0
069	Transient Ischemia Without Thrombolytic	13752.0
086	Traumatic Stupor And Coma <1 Hour With Cc	10721.0
101	Seizures Without Mcc	24837.0
165	Major Chest Procedures Without Cc/Mcc	33487.0
175	Pulmonary Embolism With Mcc Or Acute Cor Pulmonale	27012.0
176	Pulmonary Embolism Without Mcc	15512.0
177	Respiratory Infections And Inflammations With Mcc	51695.0
178	Respiratory Infections And Inflammations With Cc	8849.0
180	Respiratory Neoplasms With Mcc	6312.0
189	Pulmonary Edema And Respiratory Failure	10199.0
190	Chronic Obstructive Pulmonary Disease With Mcc	9641.0
191	Chronic Obstructive Pulmonary Disease With Cc	7454.0
193	Simple Pneumonia And Pleurisy With Mcc	11028.0
194	Simple Pneumonia And Pleurisy With Cc	4734.0
208	Respiratory System Diagnosis With Ventilator Support <=96 Hours	12591.0
216	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc	43281.0
219	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc	66275.0
220	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc	43281.0
233	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	22676.0
235	Coronary Bypass Without Cardiac Catheterization With Mcc	106651.0
236	Coronary Bypass Without Cardiac Catheterization Without Mcc	16160.0
239	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc	14202.0
243	Permanent Cardiac Pacemaker Implant With Cc	20707.0
246	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents	65083.0
247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	41398.0
266	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	57382.0
267	Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc	45360.0
269	Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc	5923.0
280	Acute Myocardial Infarction, Discharged Alive With Mcc	17970.0
281	Acute Myocardial Infarction, Discharged Alive With Cc	16259.0
282	Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc	12686.0
286	Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc	37325.0
287	Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc	19483.0
291	Heart Failure And Shock With Mcc	32189.0
292	Heart Failure And Shock With Cc	5548.0
299	Peripheral Vascular Disorders With Mcc	3156.0
305	Hypertension Without Mcc	4925.0
308	Cardiac Arrhythmia And Conduction Disorders With Mcc	10118.0
309	Cardiac Arrhythmia And Conduction Disorders With Cc	6429.0
310	Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc	13856.0
312	Syncope And Collapse	14654.0
313	Chest Pain	11617.0
314	Other Circulatory System Diagnoses With Mcc	13698.0
315	Other Circulatory System Diagnoses With Cc	5344.0
327	Stomach, Esophageal And Duodenal Procedures With Cc	21326.0
328	Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc	34679.0
329	Major Small And Large Bowel Procedures With Mcc	85372.0
330	Major Small And Large Bowel Procedures With Cc	71271.0
331	Major Small And Large Bowel Procedures Without Cc/Mcc	29886.0
343	Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc	14306.0
368	Major Esophageal Disorders With Mcc	5355.0
371	Major Gastrointestinal Disorders And Peritoneal Infections With Mcc	14245.0
372	Major Gastrointestinal Disorders And Peritoneal Infections With Cc	8370.0
377	Gastrointestinal Hemorrhage With Mcc	31471.0
378	Gastrointestinal Hemorrhage With Cc	27775.0
379	Gastrointestinal Hemorrhage Without Cc/Mcc	10487.0
387	Inflammatory Bowel Disease Without Cc/Mcc	12487.0
389	Gastrointestinal Obstruction With Cc	6961.0
390	Gastrointestinal Obstruction Without Cc/Mcc	10188.0
391	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	21826.0
392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	21409.0
394	Other Digestive System Diagnoses With Cc	13594.0
405	Pancreas, Liver And Shunt Procedures With Mcc	46352.0
406	Pancreas, Liver And Shunt Procedures With Cc	23474.0
417	Laparoscopic Cholecystectomy Without C.D.E. With Mcc	42357.0
418	Laparoscopic Cholecystectomy Without C.D.E. With Cc	29510.0
419	Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc	22981.0
432	Cirrhosis And Alcoholic Hepatitis With Mcc	39189.0
433	Cirrhosis And Alcoholic Hepatitis With Cc	7492.0
438	Disorders Of Pancreas Except Malignancy With Mcc	20226.0
439	Disorders Of Pancreas Except Malignancy With Cc	14767.0
440	Disorders Of Pancreas Except Malignancy Without Cc/Mcc	10593.0
446	Disorders Of The Biliary Tract Without Cc/Mcc	14268.0
453	Combined Anterior And Posterior Spinal Fusion With Mcc	14202.0
454	Combined Anterior And Posterior Spinal Fusion With Cc	126975.0
455	Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc	118471.0
460	Spinal Fusion Except Cervical Without Mcc	68677.0
470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	15624.0
472	Cervical Spinal Fusion With Cc	53354.0
473	Cervical Spinal Fusion Without Cc/Mcc	44361.0
480	Hip And Femur Procedures Except Major Joint With Mcc	25064.0
481	Hip And Femur Procedures Except Major Joint With Cc	17195.0
482	Hip And Femur Procedures Except Major Joint Without Cc/Mcc	13762.0
483	Major Joint Or Limb Reattachment Procedures Of Upper Extremities	19532.0
494	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc	21030.0
504	Foot Procedures With Cc	4734.0
517	Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc	11313.0
522	Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc	17947.0
536	Fractures Of Hip And Pelvis Without Mcc	1578.0
552	Medical Back Problems Without Mcc	7927.0
558	Tendonitis, Myositis And Bursitis Without Mcc	15050.0
602	Cellulitis With Mcc	4734.0
603	Cellulitis Without Mcc	23864.0
617	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc	6312.0
620	O.R. Procedures For Obesity With Cc	30798.0
621	O.R. Procedures For Obesity Without Cc/Mcc	44650.0
637	Diabetes With Mcc	8282.0
638	Diabetes With Cc	5990.0
639	Diabetes Without Cc/Mcc	10651.0
640	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc	10389.0
641	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc	6409.0
660	Kidney And Ureter Procedures For Non-Neoplasm With Cc	25214.0
661	Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc	18585.0
673	Other Kidney And Urinary Tract Procedures With Mcc	12624.0
674	Other Kidney And Urinary Tract Procedures With Cc	7696.0
682	Renal Failure With Mcc	12171.0
683	Renal Failure With Cc	15363.0
689	Kidney And Urinary Tract Infections With Mcc	3945.0
690	Kidney And Urinary Tract Infections Without Mcc	22198.0
694	Urinary Stones Without Mcc	13474.0
698	Other Kidney And Urinary Tract Diagnoses With Mcc	45028.0
699	Other Kidney And Urinary Tract Diagnoses With Cc	4973.0
743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	23577.0
768	Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C	19574.0
776	Postpartum And Post Abortion Diagnoses Without O.R. Procedures	13532.0
784	Cesarean Section With Sterilization With Cc	16695.0
785	Cesarean Section With Sterilization Without Cc/Mcc	13125.0
786	Cesarean Section Without Sterilization With Mcc	28332.0
787	Cesarean Section Without Sterilization With Cc	21249.0
788	Cesarean Section Without Sterilization Without Cc/Mcc	21249.0
789	Neonates, Died Or Transferred To Another Acute Care Facility	6900.0
792	Prematurity Without Major Problems	65347.0
793	Full Term Neonate With Major Problems	64668.0
794	Neonate With Other Significant Problems	24462.0
795	Normal Newborn	4840.0
805	Vaginal Delivery Without Sterilization Or D&C With Mcc	21249.0
806	Vaginal Delivery Without Sterilization Or D&C With Cc	16479.0
807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	19159.0
811	Red Blood Cell Disorders With Mcc	12382.0
812	Red Blood Cell Disorders Without Mcc	15381.0
831	Other Antepartum Diagnoses Without O.R. Procedures With Mcc	19600.0
832	Other Antepartum Diagnoses Without O.R. Procedures With Cc	13598.0
833	Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc	9382.0
847	Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc	16153.0
853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	129465.0
854	Infectious And Parasitic Diseases With O.R. Procedures With Cc	35576.0
862	Postoperative And Post-Traumatic Infections With Mcc	13192.0
863	Postoperative And Post-Traumatic Infections Without Mcc	17671.0
864	Fever And Inflammatory Conditions	6255.0
870	Septicemia Or Severe Sepsis With Mv >96 Hours	51924.0
871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	52341.0
872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	28692.0
894	Alcohol, Drug Abuse Or Dependence, Left Ama	3897.0
896	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc	11452.0
897	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc	14449.0
917	Poisoning And Toxic Effects Of Drugs With Mcc	8456.0
919	Complications Of Treatment With Mcc	32220.0
948	Signs And Symptoms Without Mcc	4900.0

Section: Inpatient Payer Specific Charge 1
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
CALOPTIMA MEDI-CAL	025	Craniotomy And Endovascular Intracranial Procedures With Mcc	43566.0
CALOPTIMA MEDI-CAL	060	Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc	6309.0
CALOPTIMA MEDI-CAL	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	7661.0
CALOPTIMA MEDI-CAL	066	Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc	6959.0
CALOPTIMA MEDI-CAL	101	Seizures Without Mcc	4980.0
CALOPTIMA MEDI-CAL	175	Pulmonary Embolism With Mcc Or Acute Cor Pulmonale	13608.0
CALOPTIMA MEDI-CAL	176	Pulmonary Embolism Without Mcc	5529.0
CALOPTIMA MEDI-CAL	177	Respiratory Infections And Inflammations With Mcc	12591.0
CALOPTIMA MEDI-CAL	178	Respiratory Infections And Inflammations With Cc	8849.0
CALOPTIMA MEDI-CAL	189	Pulmonary Edema And Respiratory Failure	8848.0
CALOPTIMA MEDI-CAL	193	Simple Pneumonia And Pleurisy With Mcc	7212.0
CALOPTIMA MEDI-CAL	208	Respiratory System Diagnosis With Ventilator Support <=96 Hours	12591.0
CALOPTIMA MEDI-CAL	216	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc	43281.0
CALOPTIMA MEDI-CAL	220	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc	43281.0
CALOPTIMA MEDI-CAL	246	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents	18201.0
CALOPTIMA MEDI-CAL	247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	16519.0
CALOPTIMA MEDI-CAL	280	Acute Myocardial Infarction, Discharged Alive With Mcc	9013.0
CALOPTIMA MEDI-CAL	281	Acute Myocardial Infarction, Discharged Alive With Cc	7025.0
CALOPTIMA MEDI-CAL	286	Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc	14231.0
CALOPTIMA MEDI-CAL	287	Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc	7755.0
CALOPTIMA MEDI-CAL	291	Heart Failure And Shock With Mcc	7740.0
CALOPTIMA MEDI-CAL	292	Heart Failure And Shock With Cc	5548.0
CALOPTIMA MEDI-CAL	305	Hypertension Without Mcc	4925.0
CALOPTIMA MEDI-CAL	310	Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc	4765.0
CALOPTIMA MEDI-CAL	312	Syncope And Collapse	4394.0
CALOPTIMA MEDI-CAL	313	Chest Pain	4638.0
CALOPTIMA MEDI-CAL	315	Other Circulatory System Diagnoses With Cc	5344.0
CALOPTIMA MEDI-CAL	330	Major Small And Large Bowel Procedures With Cc	15038.0
CALOPTIMA MEDI-CAL	343	Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc	6634.0
CALOPTIMA MEDI-CAL	368	Major Esophageal Disorders With Mcc	5355.0
CALOPTIMA MEDI-CAL	372	Major Gastrointestinal Disorders And Peritoneal Infections With Cc	8370.0
CALOPTIMA MEDI-CAL	377	Gastrointestinal Hemorrhage With Mcc	17998.0
CALOPTIMA MEDI-CAL	378	Gastrointestinal Hemorrhage With Cc	6217.0
CALOPTIMA MEDI-CAL	389	Gastrointestinal Obstruction With Cc	5125.0
CALOPTIMA MEDI-CAL	390	Gastrointestinal Obstruction Without Cc/Mcc	3927.0
CALOPTIMA MEDI-CAL	391	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	6470.0
CALOPTIMA MEDI-CAL	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	4858.0
CALOPTIMA MEDI-CAL	394	Other Digestive System Diagnoses With Cc	5544.0
CALOPTIMA MEDI-CAL	417	Laparoscopic Cholecystectomy Without C.D.E. With Mcc	14286.0
CALOPTIMA MEDI-CAL	418	Laparoscopic Cholecystectomy Without C.D.E. With Cc	12637.0
CALOPTIMA MEDI-CAL	419	Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc	8464.0
CALOPTIMA MEDI-CAL	432	Cirrhosis And Alcoholic Hepatitis With Mcc	8071.0
CALOPTIMA MEDI-CAL	433	Cirrhosis And Alcoholic Hepatitis With Cc	7492.0
CALOPTIMA MEDI-CAL	438	Disorders Of Pancreas Except Malignancy With Mcc	20226.0
CALOPTIMA MEDI-CAL	440	Disorders Of Pancreas Except Malignancy Without Cc/Mcc	4334.0
CALOPTIMA MEDI-CAL	454	Combined Anterior And Posterior Spinal Fusion With Cc	27297.0
CALOPTIMA MEDI-CAL	455	Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc	27297.0
CALOPTIMA MEDI-CAL	460	Spinal Fusion Except Cervical Without Mcc	27297.0
CALOPTIMA MEDI-CAL	470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	12551.0
CALOPTIMA MEDI-CAL	472	Cervical Spinal Fusion With Cc	16723.0
CALOPTIMA MEDI-CAL	473	Cervical Spinal Fusion Without Cc/Mcc	16552.0
CALOPTIMA MEDI-CAL	552	Medical Back Problems Without Mcc	4797.0
CALOPTIMA MEDI-CAL	603	Cellulitis Without Mcc	4849.0
CALOPTIMA MEDI-CAL	621	O.R. Procedures For Obesity Without Cc/Mcc	9190.0
CALOPTIMA MEDI-CAL	637	Diabetes With Mcc	8282.0
CALOPTIMA MEDI-CAL	638	Diabetes With Cc	5679.0
CALOPTIMA MEDI-CAL	640	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc	5801.0
CALOPTIMA MEDI-CAL	641	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc	4861.0
CALOPTIMA MEDI-CAL	660	Kidney And Ureter Procedures For Non-Neoplasm With Cc	8163.0
CALOPTIMA MEDI-CAL	674	Other Kidney And Urinary Tract Procedures With Cc	7696.0
CALOPTIMA MEDI-CAL	682	Renal Failure With Mcc	7696.0
CALOPTIMA MEDI-CAL	683	Renal Failure With Cc	4946.0
CALOPTIMA MEDI-CAL	690	Kidney And Urinary Tract Infections Without Mcc	4768.0
CALOPTIMA MEDI-CAL	694	Urinary Stones Without Mcc	5024.0
CALOPTIMA MEDI-CAL	698	Other Kidney And Urinary Tract Diagnoses With Mcc	9744.0
CALOPTIMA MEDI-CAL	699	Other Kidney And Urinary Tract Diagnoses With Cc	4973.0
CALOPTIMA MEDI-CAL	768	Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C	3130.0
CALOPTIMA MEDI-CAL	785	Cesarean Section With Sterilization Without Cc/Mcc	4726.0
CALOPTIMA MEDI-CAL	788	Cesarean Section Without Sterilization Without Cc/Mcc	4726.0
CALOPTIMA MEDI-CAL	792	Prematurity Without Major Problems	1130.0
CALOPTIMA MEDI-CAL	793	Full Term Neonate With Major Problems	2115.0
CALOPTIMA MEDI-CAL	794	Neonate With Other Significant Problems	1130.0
CALOPTIMA MEDI-CAL	805	Vaginal Delivery Without Sterilization Or D&C With Mcc	3189.0
CALOPTIMA MEDI-CAL	806	Vaginal Delivery Without Sterilization Or D&C With Cc	3189.0
CALOPTIMA MEDI-CAL	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	2778.0
CALOPTIMA MEDI-CAL	811	Red Blood Cell Disorders With Mcc	12382.0
CALOPTIMA MEDI-CAL	812	Red Blood Cell Disorders Without Mcc	5605.0
CALOPTIMA MEDI-CAL	833	Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc	2022.0
CALOPTIMA MEDI-CAL	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	20302.0
CALOPTIMA MEDI-CAL	854	Infectious And Parasitic Diseases With O.R. Procedures With Cc	12627.0
CALOPTIMA MEDI-CAL	862	Postoperative And Post-Traumatic Infections With Mcc	13192.0
CALOPTIMA MEDI-CAL	863	Postoperative And Post-Traumatic Infections Without Mcc	4502.0
CALOPTIMA MEDI-CAL	864	Fever And Inflammatory Conditions	6255.0
CALOPTIMA MEDI-CAL	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	15551.0
CALOPTIMA MEDI-CAL	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	6077.0
CALOPTIMA MEDI-CAL	894	Alcohol, Drug Abuse Or Dependence, Left Ama	3897.0
CALOPTIMA MEDI-CAL	896	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc	11452.0
CALOPTIMA MEDI-CAL	897	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc	4103.0
CALOPTIMA MEDI-CAL	917	Poisoning And Toxic Effects Of Drugs With Mcc	8456.0
CALOPTIMA MEDI-CAL	919	Complications Of Treatment With Mcc	8006.0
CALOPTIMA MEDI-CAL	948	Signs And Symptoms Without Mcc	4900.0

Section: Inpatient Payer Specific Charge 2
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	025	Craniotomy And Endovascular Intracranial Procedures With Mcc	36763.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	177	Respiratory Infections And Inflammations With Mcc	15306.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	190	Chronic Obstructive Pulmonary Disease With Mcc	9443.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	193	Simple Pneumonia And Pleurisy With Mcc	11028.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	219	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc	66275.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	243	Permanent Cardiac Pacemaker Implant With Cc	20707.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	267	Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc	45360.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	280	Acute Myocardial Infarction, Discharged Alive With Mcc	13434.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	281	Acute Myocardial Infarction, Discharged Alive With Cc	7848.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	291	Heart Failure And Shock With Mcc	11132.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	308	Cardiac Arrhythmia And Conduction Disorders With Mcc	9994.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	309	Cardiac Arrhythmia And Conduction Disorders With Cc	6380.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	327	Stomach, Esophageal And Duodenal Procedures With Cc	21326.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	330	Major Small And Large Bowel Procedures With Cc	14930.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	371	Major Gastrointestinal Disorders And Peritoneal Infections With Mcc	14245.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	377	Gastrointestinal Hemorrhage With Mcc	14812.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	378	Gastrointestinal Hemorrhage With Cc	8338.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	389	Gastrointestinal Obstruction With Cc	6961.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	391	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	10346.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	6500.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	405	Pancreas, Liver And Shunt Procedures With Mcc	46352.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	406	Pancreas, Liver And Shunt Procedures With Cc	23474.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	417	Laparoscopic Cholecystectomy Without C.D.E. With Mcc	19938.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	15624.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	480	Hip And Femur Procedures Except Major Joint With Mcc	25064.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	481	Hip And Femur Procedures Except Major Joint With Cc	17195.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	482	Hip And Femur Procedures Except Major Joint Without Cc/Mcc	13762.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	483	Major Joint Or Limb Reattachment Procedures Of Upper Extremities	19532.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	522	Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc	17947.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	640	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc	10389.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	641	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc	6409.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	682	Renal Failure With Mcc	12171.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	698	Other Kidney And Urinary Tract Diagnoses With Mcc	13268.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	40087.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	870	Septicemia Or Severe Sepsis With Mv >96 Hours	51924.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	15369.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	8567.0

Section: Inpatient Payer Specific Charge 3
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
MONARCH HEALTH PLAN SENIOR	025	Craniotomy And Endovascular Intracranial Procedures With Mcc	37211.0
MONARCH HEALTH PLAN SENIOR	177	Respiratory Infections And Inflammations With Mcc	15466.0
MONARCH HEALTH PLAN SENIOR	266	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	57382.0
MONARCH HEALTH PLAN SENIOR	291	Heart Failure And Shock With Mcc	11121.0
MONARCH HEALTH PLAN SENIOR	312	Syncope And Collapse	7085.0
MONARCH HEALTH PLAN SENIOR	329	Major Small And Large Bowel Procedures With Mcc	35126.0
MONARCH HEALTH PLAN SENIOR	377	Gastrointestinal Hemorrhage With Mcc	15034.0
MONARCH HEALTH PLAN SENIOR	389	Gastrointestinal Obstruction With Cc	6961.0
MONARCH HEALTH PLAN SENIOR	454	Combined Anterior And Posterior Spinal Fusion With Cc	49355.0
MONARCH HEALTH PLAN SENIOR	455	Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc	38853.0
MONARCH HEALTH PLAN SENIOR	460	Spinal Fusion Except Cervical Without Mcc	31956.0
MONARCH HEALTH PLAN SENIOR	470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	15624.0
MONARCH HEALTH PLAN SENIOR	481	Hip And Femur Procedures Except Major Joint With Cc	16850.0
MONARCH HEALTH PLAN SENIOR	621	O.R. Procedures For Obesity Without Cc/Mcc	13363.0
MONARCH HEALTH PLAN SENIOR	854	Infectious And Parasitic Diseases With O.R. Procedures With Cc	17186.0
MONARCH HEALTH PLAN SENIOR	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	15369.0

Section: Inpatient Payer Specific Charge 4
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
HERITAGE PROVIDER NETWORK SENIOR	027	Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc	20540.0
HERITAGE PROVIDER NETWORK SENIOR	177	Respiratory Infections And Inflammations With Mcc	15427.0
HERITAGE PROVIDER NETWORK SENIOR	191	Chronic Obstructive Pulmonary Disease With Cc	7454.0
HERITAGE PROVIDER NETWORK SENIOR	247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	16443.0
HERITAGE PROVIDER NETWORK SENIOR	291	Heart Failure And Shock With Mcc	10670.0
HERITAGE PROVIDER NETWORK SENIOR	308	Cardiac Arrhythmia And Conduction Disorders With Mcc	9994.0
HERITAGE PROVIDER NETWORK SENIOR	313	Chest Pain	6150.0
HERITAGE PROVIDER NETWORK SENIOR	330	Major Small And Large Bowel Procedures With Cc	20987.0
HERITAGE PROVIDER NETWORK SENIOR	390	Gastrointestinal Obstruction Without Cc/Mcc	5039.0
HERITAGE PROVIDER NETWORK SENIOR	454	Combined Anterior And Posterior Spinal Fusion With Cc	49355.0
HERITAGE PROVIDER NETWORK SENIOR	455	Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc	38853.0
HERITAGE PROVIDER NETWORK SENIOR	470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	15624.0
HERITAGE PROVIDER NETWORK SENIOR	552	Medical Back Problems Without Mcc	7927.0
HERITAGE PROVIDER NETWORK SENIOR	641	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc	6409.0
HERITAGE PROVIDER NETWORK SENIOR	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	15361.0

Section: Inpatient Payer Specific Charge 5
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
MEMORIALCARE MEDICAL FOUNDATION VALUATION	027	Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc	2462.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	033	Ventricular Shunt Procedures Without Cc/Mcc	1578.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	064	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	10542.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	066	Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc	3945.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	069	Transient Ischemia Without Thrombolytic	1578.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	175	Pulmonary Embolism With Mcc Or Acute Cor Pulmonale	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	177	Respiratory Infections And Inflammations With Mcc	6312.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	180	Respiratory Neoplasms With Mcc	6312.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	189	Pulmonary Edema And Respiratory Failure	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	190	Chronic Obstructive Pulmonary Disease With Mcc	3945.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	193	Simple Pneumonia And Pleurisy With Mcc	8679.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	194	Simple Pneumonia And Pleurisy With Cc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	216	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc	20514.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	220	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc	14772.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	233	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	16160.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	235	Coronary Bypass Without Cardiac Catheterization With Mcc	8080.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	236	Coronary Bypass Without Cardiac Catheterization Without Mcc	16160.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	239	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc	14202.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	243	Permanent Cardiac Pacemaker Implant With Cc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	246	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents	7196.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	280	Acute Myocardial Infarction, Discharged Alive With Mcc	6312.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	281	Acute Myocardial Infarction, Discharged Alive With Cc	3945.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	286	Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc	10121.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	287	Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc	4693.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	291	Heart Failure And Shock With Mcc	5618.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	292	Heart Failure And Shock With Cc	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	299	Peripheral Vascular Disorders With Mcc	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	308	Cardiac Arrhythmia And Conduction Disorders With Mcc	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	309	Cardiac Arrhythmia And Conduction Disorders With Cc	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	310	Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	312	Syncope And Collapse	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	313	Chest Pain	1578.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	314	Other Circulatory System Diagnoses With Mcc	13698.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	330	Major Small And Large Bowel Procedures With Cc	6312.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	372	Major Gastrointestinal Disorders And Peritoneal Infections With Cc	5523.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	377	Gastrointestinal Hemorrhage With Mcc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	378	Gastrointestinal Hemorrhage With Cc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	379	Gastrointestinal Hemorrhage Without Cc/Mcc	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	389	Gastrointestinal Obstruction With Cc	6312.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	390	Gastrointestinal Obstruction Without Cc/Mcc	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	394	Other Digestive System Diagnoses With Cc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	417	Laparoscopic Cholecystectomy Without C.D.E. With Mcc	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	418	Laparoscopic Cholecystectomy Without C.D.E. With Cc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	419	Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	453	Combined Anterior And Posterior Spinal Fusion With Mcc	14202.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	454	Combined Anterior And Posterior Spinal Fusion With Cc	6312.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	460	Spinal Fusion Except Cervical Without Mcc	3945.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	1578.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	472	Cervical Spinal Fusion With Cc	1578.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	473	Cervical Spinal Fusion Without Cc/Mcc	1578.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	480	Hip And Femur Procedures Except Major Joint With Mcc	9658.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	481	Hip And Femur Procedures Except Major Joint With Cc	6312.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	482	Hip And Femur Procedures Except Major Joint Without Cc/Mcc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	483	Major Joint Or Limb Reattachment Procedures Of Upper Extremities	6312.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	504	Foot Procedures With Cc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	522	Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	536	Fractures Of Hip And Pelvis Without Mcc	1578.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	552	Medical Back Problems Without Mcc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	602	Cellulitis With Mcc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	603	Cellulitis Without Mcc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	617	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc	6312.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	621	O.R. Procedures For Obesity Without Cc/Mcc	1578.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	638	Diabetes With Cc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	640	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	641	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	661	Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc	1578.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	673	Other Kidney And Urinary Tract Procedures With Mcc	12624.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	682	Renal Failure With Mcc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	683	Renal Failure With Cc	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	689	Kidney And Urinary Tract Infections With Mcc	3945.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	690	Kidney And Urinary Tract Infections Without Mcc	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	698	Other Kidney And Urinary Tract Diagnoses With Mcc	6312.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	699	Other Kidney And Urinary Tract Diagnoses With Cc	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	847	Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc	11046.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	18242.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	863	Postoperative And Post-Traumatic Infections Without Mcc	6312.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	870	Septicemia Or Severe Sepsis With Mv >96 Hours	34435.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	8080.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	5523.0

Section: Inpatient Payer Specific Charge 6
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
UNITED HEALTHCARE PREFERRED	027	Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc	44416.0
UNITED HEALTHCARE PREFERRED	059	Multiple Sclerosis And Cerebellar Ataxia With Cc	16561.0
UNITED HEALTHCARE PREFERRED	177	Respiratory Infections And Inflammations With Mcc	30268.0
UNITED HEALTHCARE PREFERRED	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	12247.0
UNITED HEALTHCARE PREFERRED	455	Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc	100371.0
UNITED HEALTHCARE PREFERRED	621	O.R. Procedures For Obesity Without Cc/Mcc	29927.0
UNITED HEALTHCARE PREFERRED	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	18116.0
UNITED HEALTHCARE PREFERRED	768	Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C	7426.0
UNITED HEALTHCARE PREFERRED	788	Cesarean Section Without Sterilization Without Cc/Mcc	10620.0
UNITED HEALTHCARE PREFERRED	793	Full Term Neonate With Major Problems	13114.0
UNITED HEALTHCARE PREFERRED	794	Neonate With Other Significant Problems	9354.0
UNITED HEALTHCARE PREFERRED	795	Normal Newborn	3050.0
UNITED HEALTHCARE PREFERRED	806	Vaginal Delivery Without Sterilization Or D&C With Cc	7426.0
UNITED HEALTHCARE PREFERRED	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	7426.0
UNITED HEALTHCARE PREFERRED	833	Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc	8588.0
UNITED HEALTHCARE PREFERRED	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	30373.0
UNITED HEALTHCARE PREFERRED	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	16413.0

Section: Inpatient Payer Specific Charge 7
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE CROSS SENIOR	064	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	15729.0
BLUE CROSS SENIOR	177	Respiratory Infections And Inflammations With Mcc	15427.0
BLUE CROSS SENIOR	291	Heart Failure And Shock With Mcc	11121.0
BLUE CROSS SENIOR	517	Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc	11313.0
BLUE CROSS SENIOR	698	Other Kidney And Urinary Tract Diagnoses With Mcc	13268.0

Section: Inpatient Payer Specific Charge 8
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE CROSS NON-MCS	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	17821.0
BLUE CROSS NON-MCS	069	Transient Ischemia Without Thrombolytic	13752.0
BLUE CROSS NON-MCS	165	Major Chest Procedures Without Cc/Mcc	33487.0
BLUE CROSS NON-MCS	175	Pulmonary Embolism With Mcc Or Acute Cor Pulmonale	27012.0
BLUE CROSS NON-MCS	176	Pulmonary Embolism Without Mcc	15512.0
BLUE CROSS NON-MCS	177	Respiratory Infections And Inflammations With Mcc	32307.0
BLUE CROSS NON-MCS	235	Coronary Bypass Without Cardiac Catheterization With Mcc	106651.0
BLUE CROSS NON-MCS	247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	34476.0
BLUE CROSS NON-MCS	281	Acute Myocardial Infarction, Discharged Alive With Cc	16259.0
BLUE CROSS NON-MCS	282	Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc	12686.0
BLUE CROSS NON-MCS	286	Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc	37325.0
BLUE CROSS NON-MCS	287	Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc	19483.0
BLUE CROSS NON-MCS	291	Heart Failure And Shock With Mcc	22160.0
BLUE CROSS NON-MCS	312	Syncope And Collapse	14654.0
BLUE CROSS NON-MCS	329	Major Small And Large Bowel Procedures With Mcc	85372.0
BLUE CROSS NON-MCS	330	Major Small And Large Bowel Procedures With Cc	44541.0
BLUE CROSS NON-MCS	331	Major Small And Large Bowel Procedures Without Cc/Mcc	29886.0
BLUE CROSS NON-MCS	377	Gastrointestinal Hemorrhage With Mcc	31471.0
BLUE CROSS NON-MCS	378	Gastrointestinal Hemorrhage With Cc	17358.0
BLUE CROSS NON-MCS	387	Inflammatory Bowel Disease Without Cc/Mcc	12487.0
BLUE CROSS NON-MCS	390	Gastrointestinal Obstruction Without Cc/Mcc	10188.0
BLUE CROSS NON-MCS	391	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	21826.0
BLUE CROSS NON-MCS	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	13380.0
BLUE CROSS NON-MCS	417	Laparoscopic Cholecystectomy Without C.D.E. With Mcc	42357.0
BLUE CROSS NON-MCS	418	Laparoscopic Cholecystectomy Without C.D.E. With Cc	29510.0
BLUE CROSS NON-MCS	419	Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc	22981.0
BLUE CROSS NON-MCS	432	Cirrhosis And Alcoholic Hepatitis With Mcc	32861.0
BLUE CROSS NON-MCS	439	Disorders Of Pancreas Except Malignancy With Cc	14767.0
BLUE CROSS NON-MCS	440	Disorders Of Pancreas Except Malignancy Without Cc/Mcc	10593.0
BLUE CROSS NON-MCS	446	Disorders Of The Biliary Tract Without Cc/Mcc	14268.0
BLUE CROSS NON-MCS	455	Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc	83539.0
BLUE CROSS NON-MCS	460	Spinal Fusion Except Cervical Without Mcc	68677.0
BLUE CROSS NON-MCS	472	Cervical Spinal Fusion With Cc	53354.0
BLUE CROSS NON-MCS	473	Cervical Spinal Fusion Without Cc/Mcc	44361.0
BLUE CROSS NON-MCS	558	Tendonitis, Myositis And Bursitis Without Mcc	15050.0
BLUE CROSS NON-MCS	603	Cellulitis Without Mcc	14914.0
BLUE CROSS NON-MCS	620	O.R. Procedures For Obesity With Cc	30798.0
BLUE CROSS NON-MCS	621	O.R. Procedures For Obesity Without Cc/Mcc	27905.0
BLUE CROSS NON-MCS	639	Diabetes Without Cc/Mcc	10651.0
BLUE CROSS NON-MCS	660	Kidney And Ureter Procedures For Non-Neoplasm With Cc	25214.0
BLUE CROSS NON-MCS	661	Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc	18585.0
BLUE CROSS NON-MCS	683	Renal Failure With Cc	15363.0
BLUE CROSS NON-MCS	690	Kidney And Urinary Tract Infections Without Mcc	13873.0
BLUE CROSS NON-MCS	694	Urinary Stones Without Mcc	13474.0
BLUE CROSS NON-MCS	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	19792.0
BLUE CROSS NON-MCS	768	Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C	13125.0
BLUE CROSS NON-MCS	776	Postpartum And Post Abortion Diagnoses Without O.R. Procedures	13532.0
BLUE CROSS NON-MCS	785	Cesarean Section With Sterilization Without Cc/Mcc	13125.0
BLUE CROSS NON-MCS	786	Cesarean Section Without Sterilization With Mcc	18105.0
BLUE CROSS NON-MCS	787	Cesarean Section Without Sterilization With Cc	13125.0
BLUE CROSS NON-MCS	788	Cesarean Section Without Sterilization Without Cc/Mcc	13125.0
BLUE CROSS NON-MCS	792	Prematurity Without Major Problems	64106.0
BLUE CROSS NON-MCS	793	Full Term Neonate With Major Problems	4647.0
BLUE CROSS NON-MCS	794	Neonate With Other Significant Problems	3098.0
BLUE CROSS NON-MCS	805	Vaginal Delivery Without Sterilization Or D&C With Mcc	13125.0
BLUE CROSS NON-MCS	806	Vaginal Delivery Without Sterilization Or D&C With Cc	13125.0
BLUE CROSS NON-MCS	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	13125.0
BLUE CROSS NON-MCS	812	Red Blood Cell Disorders Without Mcc	15381.0
BLUE CROSS NON-MCS	831	Other Antepartum Diagnoses Without O.R. Procedures With Mcc	19600.0
BLUE CROSS NON-MCS	832	Other Antepartum Diagnoses Without O.R. Procedures With Cc	13598.0
BLUE CROSS NON-MCS	833	Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc	9382.0
BLUE CROSS NON-MCS	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	86797.0
BLUE CROSS NON-MCS	863	Postoperative And Post-Traumatic Infections Without Mcc	17671.0
BLUE CROSS NON-MCS	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	32711.0
BLUE CROSS NON-MCS	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	17932.0
BLUE CROSS NON-MCS	897	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc	14449.0
BLUE CROSS NON-MCS	919	Complications Of Treatment With Mcc	32220.0

Section: Inpatient Payer Specific Charge 9
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
EDINGER VALUATION	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	2313.0
EDINGER VALUATION	177	Respiratory Infections And Inflammations With Mcc	11565.0
EDINGER VALUATION	193	Simple Pneumonia And Pleurisy With Mcc	10549.0
EDINGER VALUATION	233	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	22676.0
EDINGER VALUATION	243	Permanent Cardiac Pacemaker Implant With Cc	8744.0
EDINGER VALUATION	269	Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc	5923.0
EDINGER VALUATION	281	Acute Myocardial Infarction, Discharged Alive With Cc	6939.0
EDINGER VALUATION	291	Heart Failure And Shock With Mcc	9252.0
EDINGER VALUATION	309	Cardiac Arrhythmia And Conduction Disorders With Cc	2313.0
EDINGER VALUATION	312	Syncope And Collapse	2313.0
EDINGER VALUATION	329	Major Small And Large Bowel Procedures With Mcc	11565.0
EDINGER VALUATION	330	Major Small And Large Bowel Procedures With Cc	9252.0
EDINGER VALUATION	377	Gastrointestinal Hemorrhage With Mcc	6431.0
EDINGER VALUATION	378	Gastrointestinal Hemorrhage With Cc	4626.0
EDINGER VALUATION	391	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	6939.0
EDINGER VALUATION	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	4626.0
EDINGER VALUATION	418	Laparoscopic Cholecystectomy Without C.D.E. With Cc	9252.0
EDINGER VALUATION	481	Hip And Femur Procedures Except Major Joint With Cc	9252.0
EDINGER VALUATION	483	Major Joint Or Limb Reattachment Procedures Of Upper Extremities	4626.0
EDINGER VALUATION	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	15175.0
EDINGER VALUATION	854	Infectious And Parasitic Diseases With O.R. Procedures With Cc	16191.0
EDINGER VALUATION	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	9252.0
EDINGER VALUATION	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	4626.0

Section: Inpatient Payer Specific Charge 10
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
UNITED HEALTHCARE SENIOR	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	8539.0
UNITED HEALTHCARE SENIOR	086	Traumatic Stupor And Coma <1 Hour With Cc	10721.0
UNITED HEALTHCARE SENIOR	177	Respiratory Infections And Inflammations With Mcc	15427.0
UNITED HEALTHCARE SENIOR	189	Pulmonary Edema And Respiratory Failure	10199.0
UNITED HEALTHCARE SENIOR	243	Permanent Cardiac Pacemaker Implant With Cc	20685.0
UNITED HEALTHCARE SENIOR	266	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	57382.0
UNITED HEALTHCARE SENIOR	286	Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc	18148.0
UNITED HEALTHCARE SENIOR	287	Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc	9598.0
UNITED HEALTHCARE SENIOR	291	Heart Failure And Shock With Mcc	10909.0
UNITED HEALTHCARE SENIOR	308	Cardiac Arrhythmia And Conduction Disorders With Mcc	10118.0
UNITED HEALTHCARE SENIOR	309	Cardiac Arrhythmia And Conduction Disorders With Cc	6429.0
UNITED HEALTHCARE SENIOR	310	Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc	4845.0
UNITED HEALTHCARE SENIOR	313	Chest Pain	6150.0
UNITED HEALTHCARE SENIOR	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	6500.0
UNITED HEALTHCARE SENIOR	603	Cellulitis Without Mcc	7146.0
UNITED HEALTHCARE SENIOR	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	34707.0
UNITED HEALTHCARE SENIOR	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	15369.0
UNITED HEALTHCARE SENIOR	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	8567.0

Section: Inpatient Payer Specific Charge 11
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
CIGNA	101	Seizures Without Mcc	24837.0
CIGNA	177	Respiratory Infections And Inflammations With Mcc	51695.0
CIGNA	330	Major Small And Large Bowel Procedures With Cc	71271.0
CIGNA	378	Gastrointestinal Hemorrhage With Cc	27775.0
CIGNA	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	21409.0
CIGNA	603	Cellulitis Without Mcc	23864.0
CIGNA	621	O.R. Procedures For Obesity Without Cc/Mcc	44650.0
CIGNA	690	Kidney And Urinary Tract Infections Without Mcc	22198.0
CIGNA	698	Other Kidney And Urinary Tract Diagnoses With Mcc	45028.0
CIGNA	786	Cesarean Section Without Sterilization With Mcc	28332.0
CIGNA	787	Cesarean Section Without Sterilization With Cc	21249.0
CIGNA	788	Cesarean Section Without Sterilization Without Cc/Mcc	21249.0
CIGNA	789	Neonates, Died Or Transferred To Another Acute Care Facility	1572.0
CIGNA	792	Prematurity Without Major Problems	65347.0
CIGNA	793	Full Term Neonate With Major Problems	4716.0
CIGNA	794	Neonate With Other Significant Problems	3144.0
CIGNA	805	Vaginal Delivery Without Sterilization Or D&C With Mcc	21249.0
CIGNA	806	Vaginal Delivery Without Sterilization Or D&C With Cc	14166.0
CIGNA	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	14166.0
CIGNA	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	52341.0
CIGNA	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	28692.0

Section: Inpatient Payer Specific Charge 12
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
AETNA HMO	177	Respiratory Infections And Inflammations With Mcc	38423.0
AETNA HMO	246	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents	65083.0
AETNA HMO	247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	41398.0
AETNA HMO	291	Heart Failure And Shock With Mcc	27920.0
AETNA HMO	328	Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc	34679.0
AETNA HMO	343	Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc	14306.0
AETNA HMO	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	15916.0
AETNA HMO	432	Cirrhosis And Alcoholic Hepatitis With Mcc	39189.0
AETNA HMO	454	Combined Anterior And Posterior Spinal Fusion With Cc	126975.0
AETNA HMO	455	Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc	99758.0
AETNA HMO	621	O.R. Procedures For Obesity Without Cc/Mcc	33240.0
AETNA HMO	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	23577.0
AETNA HMO	768	Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C	19574.0
AETNA HMO	784	Cesarean Section With Sterilization With Cc	16695.0
AETNA HMO	786	Cesarean Section Without Sterilization With Mcc	19574.0
AETNA HMO	787	Cesarean Section Without Sterilization With Cc	19574.0
AETNA HMO	788	Cesarean Section Without Sterilization Without Cc/Mcc	19574.0
AETNA HMO	792	Prematurity Without Major Problems	11632.0
AETNA HMO	793	Full Term Neonate With Major Problems	19484.0
AETNA HMO	794	Neonate With Other Significant Problems	8788.0
AETNA HMO	795	Normal Newborn	2104.0
AETNA HMO	805	Vaginal Delivery Without Sterilization Or D&C With Mcc	13816.0
AETNA HMO	806	Vaginal Delivery Without Sterilization Or D&C With Cc	13816.0
AETNA HMO	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	13816.0
AETNA HMO	833	Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc	8532.0
AETNA HMO	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	102956.0
AETNA HMO	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	38900.0

Section: Inpatient Payer Specific Charge 13
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE CROSS SELECT HMO	177	Respiratory Infections And Inflammations With Mcc	21000.0
BLUE CROSS SELECT HMO	330	Major Small And Large Bowel Procedures With Cc	28952.0
BLUE CROSS SELECT HMO	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	8697.0
BLUE CROSS SELECT HMO	494	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc	21030.0
BLUE CROSS SELECT HMO	621	O.R. Procedures For Obesity Without Cc/Mcc	18138.0
BLUE CROSS SELECT HMO	788	Cesarean Section Without Sterilization Without Cc/Mcc	8531.0
BLUE CROSS SELECT HMO	792	Prematurity Without Major Problems	2014.0
BLUE CROSS SELECT HMO	794	Neonate With Other Significant Problems	2014.0
BLUE CROSS SELECT HMO	805	Vaginal Delivery Without Sterilization Or D&C With Mcc	8531.0
BLUE CROSS SELECT HMO	806	Vaginal Delivery Without Sterilization Or D&C With Cc	8531.0
BLUE CROSS SELECT HMO	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	8531.0
BLUE CROSS SELECT HMO	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	21263.0
BLUE CROSS SELECT HMO	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	11656.0

Section: Inpatient Payer Specific Charge 14
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE CROSS VIVITY - NON CITY	177	Respiratory Infections And Inflammations With Mcc	22356.0
BLUE CROSS VIVITY - NON CITY	331	Major Small And Large Bowel Procedures Without Cc/Mcc	20680.0
BLUE CROSS VIVITY - NON CITY	621	O.R. Procedures For Obesity Without Cc/Mcc	19309.0
BLUE CROSS VIVITY - NON CITY	786	Cesarean Section Without Sterilization With Mcc	17416.0
BLUE CROSS VIVITY - NON CITY	787	Cesarean Section Without Sterilization With Cc	10885.0
BLUE CROSS VIVITY - NON CITY	788	Cesarean Section Without Sterilization Without Cc/Mcc	10431.0
BLUE CROSS VIVITY - NON CITY	789	Neonates, Died Or Transferred To Another Acute Care Facility	5680.0
BLUE CROSS VIVITY - NON CITY	792	Prematurity Without Major Problems	18814.0
BLUE CROSS VIVITY - NON CITY	793	Full Term Neonate With Major Problems	11558.0
BLUE CROSS VIVITY - NON CITY	794	Neonate With Other Significant Problems	2430.0
BLUE CROSS VIVITY - NON CITY	806	Vaginal Delivery Without Sterilization Or D&C With Cc	10431.0
BLUE CROSS VIVITY - NON CITY	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	10431.0
BLUE CROSS VIVITY - NON CITY	847	Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc	16153.0
BLUE CROSS VIVITY - NON CITY	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	12408.0

Section: Inpatient Payer Specific Charge 15
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE SHIELD COVERED CALIFORNIA	177	Respiratory Infections And Inflammations With Mcc	23050.0
BLUE SHIELD COVERED CALIFORNIA	247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	24799.0
BLUE SHIELD COVERED CALIFORNIA	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	9281.0
BLUE SHIELD COVERED CALIFORNIA	621	O.R. Procedures For Obesity Without Cc/Mcc	19160.0
BLUE SHIELD COVERED CALIFORNIA	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	13998.0
BLUE SHIELD COVERED CALIFORNIA	788	Cesarean Section Without Sterilization Without Cc/Mcc	12261.0
BLUE SHIELD COVERED CALIFORNIA	794	Neonate With Other Significant Problems	5889.0
BLUE SHIELD COVERED CALIFORNIA	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	12261.0
BLUE SHIELD COVERED CALIFORNIA	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	22746.0
BLUE SHIELD COVERED CALIFORNIA	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	12667.0

Section: Inpatient Payer Specific Charge 16
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE SHIELD HMO	177	Respiratory Infections And Inflammations With Mcc	27405.0
BLUE SHIELD HMO	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	11035.0
BLUE SHIELD HMO	394	Other Digestive System Diagnoses With Cc	13594.0
BLUE SHIELD HMO	419	Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc	18937.0
BLUE SHIELD HMO	621	O.R. Procedures For Obesity Without Cc/Mcc	22780.0
BLUE SHIELD HMO	788	Cesarean Section Without Sterilization Without Cc/Mcc	14996.0
BLUE SHIELD HMO	789	Neonates, Died Or Transferred To Another Acute Care Facility	6900.0
BLUE SHIELD HMO	793	Full Term Neonate With Major Problems	13196.0
BLUE SHIELD HMO	794	Neonate With Other Significant Problems	7049.0
BLUE SHIELD HMO	805	Vaginal Delivery Without Sterilization Or D&C With Mcc	14996.0
BLUE SHIELD HMO	806	Vaginal Delivery Without Sterilization Or D&C With Cc	14996.0
BLUE SHIELD HMO	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	14996.0
BLUE SHIELD HMO	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	27045.0

Section: Inpatient Payer Specific Charge 17
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE SHIELD PPO	177	Respiratory Infections And Inflammations With Mcc	30715.0
BLUE SHIELD PPO	287	Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc	18713.0
BLUE SHIELD PPO	313	Chest Pain	11617.0
BLUE SHIELD PPO	330	Major Small And Large Bowel Procedures With Cc	41038.0
BLUE SHIELD PPO	331	Major Small And Large Bowel Procedures Without Cc/Mcc	27434.0
BLUE SHIELD PPO	378	Gastrointestinal Hemorrhage With Cc	16048.0
BLUE SHIELD PPO	379	Gastrointestinal Hemorrhage Without Cc/Mcc	10487.0
BLUE SHIELD PPO	603	Cellulitis Without Mcc	13699.0
BLUE SHIELD PPO	621	O.R. Procedures For Obesity Without Cc/Mcc	25531.0
BLUE SHIELD PPO	661	Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc	17704.0
BLUE SHIELD PPO	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	18653.0
BLUE SHIELD PPO	787	Cesarean Section Without Sterilization With Cc	16479.0
BLUE SHIELD PPO	788	Cesarean Section Without Sterilization Without Cc/Mcc	16479.0
BLUE SHIELD PPO	792	Prematurity Without Major Problems	10367.0
BLUE SHIELD PPO	793	Full Term Neonate With Major Problems	23388.0
BLUE SHIELD PPO	794	Neonate With Other Significant Problems	7069.0
BLUE SHIELD PPO	805	Vaginal Delivery Without Sterilization Or D&C With Mcc	16479.0
BLUE SHIELD PPO	806	Vaginal Delivery Without Sterilization Or D&C With Cc	16479.0
BLUE SHIELD PPO	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	16479.0
BLUE SHIELD PPO	831	Other Antepartum Diagnoses Without O.R. Procedures With Mcc	17516.0
BLUE SHIELD PPO	832	Other Antepartum Diagnoses Without O.R. Procedures With Cc	11620.0
BLUE SHIELD PPO	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	30311.0
BLUE SHIELD PPO	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	16879.0
BLUE SHIELD PPO	897	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc	13347.0

Section: Inpatient Payer Specific Charge 18
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE SHIELD SENIOR	177	Respiratory Infections And Inflammations With Mcc	15446.0
BLUE SHIELD SENIOR	291	Heart Failure And Shock With Mcc	10914.0
BLUE SHIELD SENIOR	308	Cardiac Arrhythmia And Conduction Disorders With Mcc	10118.0
BLUE SHIELD SENIOR	378	Gastrointestinal Hemorrhage With Cc	8338.0
BLUE SHIELD SENIOR	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	15616.0

Section: Inpatient Payer Specific Charge 19
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE SHIELD TRIO	177	Respiratory Infections And Inflammations With Mcc	23980.0
BLUE SHIELD TRIO	794	Neonate With Other Significant Problems	6624.0
BLUE SHIELD TRIO	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	13122.0

Section: Inpatient Payer Specific Charge 20
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
HEALTHCARE PARTNERS COMMERCIAL	177	Respiratory Infections And Inflammations With Mcc	31933.0
HEALTHCARE PARTNERS COMMERCIAL	330	Major Small And Large Bowel Procedures With Cc	42970.0
HEALTHCARE PARTNERS COMMERCIAL	417	Laparoscopic Cholecystectomy Without C.D.E. With Mcc	41049.0
HEALTHCARE PARTNERS COMMERCIAL	787	Cesarean Section Without Sterilization With Cc	18417.0
HEALTHCARE PARTNERS COMMERCIAL	788	Cesarean Section Without Sterilization Without Cc/Mcc	15496.0
HEALTHCARE PARTNERS COMMERCIAL	792	Prematurity Without Major Problems	40212.0
HEALTHCARE PARTNERS COMMERCIAL	794	Neonate With Other Significant Problems	24462.0
HEALTHCARE PARTNERS COMMERCIAL	795	Normal Newborn	3818.0
HEALTHCARE PARTNERS COMMERCIAL	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	11405.0
HEALTHCARE PARTNERS COMMERCIAL	854	Infectious And Parasitic Diseases With O.R. Procedures With Cc	35576.0
HEALTHCARE PARTNERS COMMERCIAL	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	31813.0

Section: Inpatient Payer Specific Charge 21
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
HERITAGE PROVIDER NETWORK HMO	177	Respiratory Infections And Inflammations With Mcc	9950.0
HERITAGE PROVIDER NETWORK HMO	330	Major Small And Large Bowel Procedures With Cc	15165.0
HERITAGE PROVIDER NETWORK HMO	419	Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc	8380.0
HERITAGE PROVIDER NETWORK HMO	621	O.R. Procedures For Obesity Without Cc/Mcc	9608.0
HERITAGE PROVIDER NETWORK HMO	768	Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C	5834.0
HERITAGE PROVIDER NETWORK HMO	784	Cesarean Section With Sterilization With Cc	7193.0
HERITAGE PROVIDER NETWORK HMO	785	Cesarean Section With Sterilization Without Cc/Mcc	7482.0
HERITAGE PROVIDER NETWORK HMO	786	Cesarean Section Without Sterilization With Mcc	7782.0
HERITAGE PROVIDER NETWORK HMO	788	Cesarean Section Without Sterilization Without Cc/Mcc	7857.0
HERITAGE PROVIDER NETWORK HMO	793	Full Term Neonate With Major Problems	2055.0
HERITAGE PROVIDER NETWORK HMO	794	Neonate With Other Significant Problems	1588.0
HERITAGE PROVIDER NETWORK HMO	795	Normal Newborn	1350.0
HERITAGE PROVIDER NETWORK HMO	805	Vaginal Delivery Without Sterilization Or D&C With Mcc	3862.0
HERITAGE PROVIDER NETWORK HMO	806	Vaginal Delivery Without Sterilization Or D&C With Cc	5997.0
HERITAGE PROVIDER NETWORK HMO	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	4575.0
HERITAGE PROVIDER NETWORK HMO	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	20707.0

Section: Inpatient Payer Specific Charge 22
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
MEMORIALCARE MEDICAL FOUNDATION-GNP	177	Respiratory Infections And Inflammations With Mcc	9641.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	190	Chronic Obstructive Pulmonary Disease With Mcc	9641.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	193	Simple Pneumonia And Pleurisy With Mcc	9641.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	219	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc	9641.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	291	Heart Failure And Shock With Mcc	9641.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	312	Syncope And Collapse	9641.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	378	Gastrointestinal Hemorrhage With Cc	9641.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	9641.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	9641.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	9641.0

Section: Inpatient Payer Specific Charge 23
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	177	Respiratory Infections And Inflammations With Mcc	51398.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	291	Heart Failure And Shock With Mcc	32189.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	19436.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	603	Cellulitis Without Mcc	21664.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	621	O.R. Procedures For Obesity Without Cc/Mcc	34004.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	787	Cesarean Section Without Sterilization With Cc	18996.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	788	Cesarean Section Without Sterilization Without Cc/Mcc	15489.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	793	Full Term Neonate With Major Problems	17949.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	794	Neonate With Other Significant Problems	11103.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	795	Normal Newborn	4840.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	806	Vaginal Delivery Without Sterilization Or D&C With Cc	10598.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	10598.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	129465.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	47833.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	26047.0

Section: Inpatient Payer Specific Charge 24
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
CAREMORE SENIOR	280	Acute Myocardial Infarction, Discharged Alive With Mcc	17970.0
CAREMORE SENIOR	291	Heart Failure And Shock With Mcc	20965.0
CAREMORE SENIOR	522	Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc	13665.0
CAREMORE SENIOR	603	Cellulitis Without Mcc	8985.0
CAREMORE SENIOR	638	Diabetes With Cc	5990.0
CAREMORE SENIOR	690	Kidney And Urinary Tract Infections Without Mcc	2995.0
CAREMORE SENIOR	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	27224.0
CAREMORE SENIOR	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	21340.0

Section: Inpatient Payer Specific Charge 25
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE CROSS EXCHANGE	291	Heart Failure And Shock With Mcc	14404.0
BLUE CROSS EXCHANGE	788	Cesarean Section Without Sterilization Without Cc/Mcc	8531.0
BLUE CROSS EXCHANGE	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	8531.0

Section: Inpatient Payer Specific Charge 26
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
UNIVERSAL CARE SENIOR	291	Heart Failure And Shock With Mcc	11132.0

Section: Inpatient Payer Specific Charge 27
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
HEALTH NET HMO & PPO	310	Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc	13856.0
HEALTH NET HMO & PPO	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	18975.0
HEALTH NET HMO & PPO	455	Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc	118471.0
HEALTH NET HMO & PPO	621	O.R. Procedures For Obesity Without Cc/Mcc	39573.0
HEALTH NET HMO & PPO	788	Cesarean Section Without Sterilization Without Cc/Mcc	14274.0
HEALTH NET HMO & PPO	794	Neonate With Other Significant Problems	7617.0
HEALTH NET HMO & PPO	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	14274.0
HEALTH NET HMO & PPO	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	46389.0

Section: Inpatient Payer Specific Charge 28
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
HEALTH NET SENIOR	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	6630.0

Section: Inpatient Payer Specific Charge 29
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
MONARCH HEALTH PLAN COMMERCIAL	620	O.R. Procedures For Obesity With Cc	29046.0
MONARCH HEALTH PLAN COMMERCIAL	621	O.R. Procedures For Obesity Without Cc/Mcc	26396.0
MONARCH HEALTH PLAN COMMERCIAL	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	18931.0
MONARCH HEALTH PLAN COMMERCIAL	768	Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C	5908.0
MONARCH HEALTH PLAN COMMERCIAL	788	Cesarean Section Without Sterilization Without Cc/Mcc	9657.0
MONARCH HEALTH PLAN COMMERCIAL	793	Full Term Neonate With Major Problems	64668.0
MONARCH HEALTH PLAN COMMERCIAL	794	Neonate With Other Significant Problems	23353.0
MONARCH HEALTH PLAN COMMERCIAL	805	Vaginal Delivery Without Sterilization Or D&C With Mcc	4885.0
MONARCH HEALTH PLAN COMMERCIAL	806	Vaginal Delivery Without Sterilization Or D&C With Cc	5908.0
MONARCH HEALTH PLAN COMMERCIAL	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	4885.0

Section: Inpatient Payer Specific Charge 30
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
TRICARE WEST	621	O.R. Procedures For Obesity Without Cc/Mcc	8826.0
TRICARE WEST	788	Cesarean Section Without Sterilization Without Cc/Mcc	8897.0
TRICARE WEST	794	Neonate With Other Significant Problems	1417.0
TRICARE WEST	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	3721.0

Section: Inpatient Payer Specific Charge 31
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
AETNA WHOLE HEALTH HMO	788	Cesarean Section Without Sterilization Without Cc/Mcc	12204.0
AETNA WHOLE HEALTH HMO	794	Neonate With Other Significant Problems	13361.0
AETNA WHOLE HEALTH HMO	795	Normal Newborn	1312.0
AETNA WHOLE HEALTH HMO	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	8614.0

Section: Inpatient Payer Specific Charge 32
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
HEALTH NET ENHANCED PPO	788	Cesarean Section Without Sterilization Without Cc/Mcc	9991.0
HEALTH NET ENHANCED PPO	794	Neonate With Other Significant Problems	4687.0
HEALTH NET ENHANCED PPO	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	9991.0

Section: Inpatient Payer Specific Charge 33
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
AETNA PPO	794	Neonate With Other Significant Problems	9423.0
AETNA PPO	795	Normal Newborn	4320.0
AETNA PPO	807	Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc	19159.0

Section: Outpatient De-identified Minimum Negotiated Charge
APC	Description	De-Identified Minimum Negotiated Charge
1506	New Technology - Level 6 ($401 - $500)	197.0
5012	Clinic Visits and Related Services	115.0
5021	Level 1 Type A ED Visits	22.0
5022	Level 2 Type A ED Visits	41.0
5023	Level 3 Type A ED Visits	75.0
5024	Level 4 Type A ED Visits	156.0
5025	Level 5 Type A ED Visits	384.0
5051	Level 1 Skin Procedures	65.0
5052	Level 2 Skin Procedures	114.0
5053	Level 3 Skin Procedures	202.0
5054	Level 4 Skin Procedures	1675.0
5055	Level 5 Skin Procedures	5236.0
5071	Level 1 Excision/ Biopsy/ Incision and Drainage	120.0
5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1639.0
5073	Level 3 Excision/ Biopsy/ Incision and Drainage	1090.0
5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	1675.0
5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	4549.0
5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	9911.0
5094	Level 4 Breast/Lymphatic Surgery and Related Procedures	16872.0
5112	Level 2 Musculoskeletal Procedures	1048.0
5113	Level 3 Musculoskeletal Procedures	2080.0
5114	Level 4 Musculoskeletal Procedures	2636.0
5115	Level 5 Musculoskeletal Procedures	2769.0
5116	Level 6 Musculoskeletal Procedures	16838.0
5153	Level 3 Airway Endoscopy	1744.0
5154	Level 4 Airway Endoscopy	2617.0
5155	Level 5 Airway Endoscopy	1675.0
5164	Level 4 ENT Procedures	9747.0
5181	Level 1 Vascular Procedures	725.0
5182	Level 2 Vascular Procedures	405.0
5183	Level 3 Vascular Procedures	691.0
5184	Level 4 Vascular Procedures	5558.0
5191	Level 1 Endovascular Procedures	2231.0
5193	Level 3 Endovascular Procedures	2769.0
5194	Level 4 Endovascular Procedures	18205.0
5213	Level 3 Electrophysiologic Procedures	2231.0
5222	Level 2 Pacemaker and Similar Procedures	5402.0
5223	Level 3 Pacemaker and Similar Procedures	9296.0
5232	Level 2 ICD and Similar Procedures	31863.0
5241	Level 1 Blood Product Exchange and Related Services	737.0
5301	Level 1 Upper GI Procedures	473.0
5302	Level 2 Upper GI Procedures	1030.0
5303	Level 3 Upper GI Procedures	3590.0
5311	Level 1 Lower GI Procedures	1030.0
5312	Level 2 Lower GI Procedures	1030.0
5313	Level 3 Lower GI Procedures	2224.0
5331	Complex GI Procedures	17912.0
5341	Abdominal/Peritoneal/Biliary and Related Procedures	2145.0
5361	Level 1 Laparoscopy and Related Services	11.0
5362	Level 2 Laparoscopy and Related Services	2093.0
5371	Level 1 Urology and Related Services	312.0
5372	Level 2 Urology and Related Services	674.0
5373	Level 3 Urology and Related Services	671.0
5374	Level 4 Urology and Related Services	1675.0
5375	Level 5 Urology and Related Services	67.0
5401	Dialysis	986.0
5411	Level 1 Gynecologic Procedures	44.0
5414	Level 4 Gynecologic Procedures	1582.0
5415	Level 5 Gynecologic Procedures	1582.0
5416	Level 6 Gynecologic Procedures	24202.0
5431	Level 1 Nerve Procedures	2021.0
5441	Level 1 Nerve Injections	79.0
5442	Level 2 Nerve Injections	790.0
5463	Level 3 Neurostimulator and Related Procedures	13092.0
5465	Level 5 Neurostimulator and Related Procedures	20963.0
5471	Implantation of Drug Infusion Device	20502.0
5521	Level 1 Imaging without Contrast	2.0
5522	Level 2 Imaging without Contrast	18.0
5523	Level 3 Imaging without Contrast	1.0
5524	Level 4 Imaging without Contrast	261.0
5571	Level 1 Imaging with Contrast	174.0
5572	Level 2 Imaging with Contrast	63.0
5573	Level 3 Imaging with Contrast	545.0
5591	Level 1 Nuclear Medicine and Related Services	223.0
5592	Level 2 Nuclear Medicine and Related Services	241.0
5593	Level 3 Nuclear Medicine and Related Services	660.0
5594	Level 4 Nuclear Medicine and Related Services	4.0
5672	Level 2 Pathology	3.0
5673	Level 3 Pathology	74.0
5674	Level 4 Pathology	2125.0
5691	Level 1 Drug Administration	3.0
5692	Level 2 Drug Administration	3.0
5693	Level 3 Drug Administration	1.0
5694	Level 4 Drug Administration	469.0
5721	Level 1 Diagnostic Tests and Related Services	45.0
5722	Level 2 Diagnostic Tests and Related Services	204.0
5723	Level 3 Diagnostic Tests and Related Services	370.0
5731	Level 1 Minor Procedures	22.0
5733	Level 3 Minor Procedures	24.0
5734	Level 4 Minor Procedures	65.0
5741	Level 1 Electronic Analysis of Devices	63.0
5771	Cardiac Rehabilitation	152.0
5781	Resuscitation and Cardioversion	374.0
N700	Non-OPPS Clinic Services	34.0
N800	Clinical Diagnostic Lab Services	3.0
N801	Therapy Services	108.0
N804	Mammography Services	9.0
N900	Non-covered Services	6.0
N902	Packaged Services	1.0
N905	Not Recognized by OPPS	38.0

Section: Outpatient De-identified Maximum Negotiated Charge
APC	Description	De-Identified Maximum Negotiated Charge
1506	New Technology - Level 6 ($401 - $500)	5240.0
5012	Clinic Visits and Related Services	220.0
5021	Level 1 Type A ED Visits	622.0
5022	Level 2 Type A ED Visits	1250.0
5023	Level 3 Type A ED Visits	2661.0
5024	Level 4 Type A ED Visits	6021.0
5025	Level 5 Type A ED Visits	10693.0
5051	Level 1 Skin Procedures	1885.0
5052	Level 2 Skin Procedures	2748.0
5053	Level 3 Skin Procedures	1944.0
5054	Level 4 Skin Procedures	6110.0
5055	Level 5 Skin Procedures	12546.0
5071	Level 1 Excision/ Biopsy/ Incision and Drainage	3225.0
5072	Level 2 Excision/ Biopsy/ Incision and Drainage	7813.0
5073	Level 3 Excision/ Biopsy/ Incision and Drainage	9767.0
5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	14552.0
5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	25853.0
5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	9911.0
5094	Level 4 Breast/Lymphatic Surgery and Related Procedures	53177.0
5112	Level 2 Musculoskeletal Procedures	8476.0
5113	Level 3 Musculoskeletal Procedures	10082.0
5114	Level 4 Musculoskeletal Procedures	23924.0
5115	Level 5 Musculoskeletal Procedures	48225.0
5116	Level 6 Musculoskeletal Procedures	56757.0
5153	Level 3 Airway Endoscopy	4307.0
5154	Level 4 Airway Endoscopy	3614.0
5155	Level 5 Airway Endoscopy	1675.0
5164	Level 4 ENT Procedures	9747.0
5181	Level 1 Vascular Procedures	6555.0
5182	Level 2 Vascular Procedures	5192.0
5183	Level 3 Vascular Procedures	15949.0
5184	Level 4 Vascular Procedures	16992.0
5191	Level 1 Endovascular Procedures	20148.0
5193	Level 3 Endovascular Procedures	35773.0
5194	Level 4 Endovascular Procedures	57248.0
5213	Level 3 Electrophysiologic Procedures	76457.0
5222	Level 2 Pacemaker and Similar Procedures	9499.0
5223	Level 3 Pacemaker and Similar Procedures	12118.0
5232	Level 2 ICD and Similar Procedures	121401.0
5241	Level 1 Blood Product Exchange and Related Services	3079.0
5301	Level 1 Upper GI Procedures	8343.0
5302	Level 2 Upper GI Procedures	5788.0
5303	Level 3 Upper GI Procedures	15857.0
5311	Level 1 Lower GI Procedures	4244.0
5312	Level 2 Lower GI Procedures	5500.0
5313	Level 3 Lower GI Procedures	10158.0
5331	Complex GI Procedures	17912.0
5341	Abdominal/Peritoneal/Biliary and Related Procedures	11339.0
5361	Level 1 Laparoscopy and Related Services	20148.0
5362	Level 2 Laparoscopy and Related Services	31729.0
5371	Level 1 Urology and Related Services	1675.0
5372	Level 2 Urology and Related Services	674.0
5373	Level 3 Urology and Related Services	6452.0
5374	Level 4 Urology and Related Services	17198.0
5375	Level 5 Urology and Related Services	15723.0
5401	Dialysis	2852.0
5411	Level 1 Gynecologic Procedures	1344.0
5414	Level 4 Gynecologic Procedures	13229.0
5415	Level 5 Gynecologic Procedures	15707.0
5416	Level 6 Gynecologic Procedures	24202.0
5431	Level 1 Nerve Procedures	6375.0
5441	Level 1 Nerve Injections	2769.0
5442	Level 2 Nerve Injections	4610.0
5463	Level 3 Neurostimulator and Related Procedures	13092.0
5465	Level 5 Neurostimulator and Related Procedures	69758.0
5471	Implantation of Drug Infusion Device	20502.0
5521	Level 1 Imaging without Contrast	525.0
5522	Level 2 Imaging without Contrast	1275.0
5523	Level 3 Imaging without Contrast	3875.0
5524	Level 4 Imaging without Contrast	5171.0
5571	Level 1 Imaging with Contrast	3558.0
5572	Level 2 Imaging with Contrast	5504.0
5573	Level 3 Imaging with Contrast	3859.0
5591	Level 1 Nuclear Medicine and Related Services	2318.0
5592	Level 2 Nuclear Medicine and Related Services	2754.0
5593	Level 3 Nuclear Medicine and Related Services	41894.0
5594	Level 4 Nuclear Medicine and Related Services	12547.0
5672	Level 2 Pathology	839.0
5673	Level 3 Pathology	1037.0
5674	Level 4 Pathology	2125.0
5691	Level 1 Drug Administration	3.0
5692	Level 2 Drug Administration	10787.0
5693	Level 3 Drug Administration	5345.0
5694	Level 4 Drug Administration	10530.0
5721	Level 1 Diagnostic Tests and Related Services	45.0
5722	Level 2 Diagnostic Tests and Related Services	2252.0
5723	Level 3 Diagnostic Tests and Related Services	4815.0
5731	Level 1 Minor Procedures	577.0
5733	Level 3 Minor Procedures	1507.0
5734	Level 4 Minor Procedures	863.0
5741	Level 1 Electronic Analysis of Devices	63.0
5771	Cardiac Rehabilitation	2996.0
5781	Resuscitation and Cardioversion	8722.0
N700	Non-OPPS Clinic Services	1122.0
N800	Clinical Diagnostic Lab Services	430.0
N801	Therapy Services	1856.0
N804	Mammography Services	1022.0
N900	Non-covered Services	95.0
N902	Packaged Services	4055.0
N905	Not Recognized by OPPS	724.0

Section: Outpatient Payer Specific Charge 1
Payer	APC	Description	Payer Specific Negotiated Charge
AETNA HMO	1506	New Technology - Level 6 ($401 - $500)	2747.0
AETNA HMO	5021	Level 1 Type A ED Visits	622.0
AETNA HMO	5022	Level 2 Type A ED Visits	1250.0
AETNA HMO	5023	Level 3 Type A ED Visits	2661.0
AETNA HMO	5024	Level 4 Type A ED Visits	2748.0
AETNA HMO	5025	Level 5 Type A ED Visits	2756.0
AETNA HMO	5051	Level 1 Skin Procedures	1866.0
AETNA HMO	5052	Level 2 Skin Procedures	2748.0
AETNA HMO	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	2121.0
AETNA HMO	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	2563.0
AETNA HMO	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	3935.0
AETNA HMO	5113	Level 3 Musculoskeletal Procedures	2080.0
AETNA HMO	5114	Level 4 Musculoskeletal Procedures	6329.0
AETNA HMO	5115	Level 5 Musculoskeletal Procedures	9460.0
AETNA HMO	5154	Level 4 Airway Endoscopy	2617.0
AETNA HMO	5181	Level 1 Vascular Procedures	2121.0
AETNA HMO	5182	Level 2 Vascular Procedures	2128.0
AETNA HMO	5183	Level 3 Vascular Procedures	3256.0
AETNA HMO	5191	Level 1 Endovascular Procedures	10435.0
AETNA HMO	5193	Level 3 Endovascular Procedures	13575.0
AETNA HMO	5194	Level 4 Endovascular Procedures	18205.0
AETNA HMO	5241	Level 1 Blood Product Exchange and Related Services	2122.0
AETNA HMO	5301	Level 1 Upper GI Procedures	2712.0
AETNA HMO	5312	Level 2 Lower GI Procedures	3001.0
AETNA HMO	5313	Level 3 Lower GI Procedures	3298.0
AETNA HMO	5341	Abdominal/Peritoneal/Biliary and Related Procedures	3283.0
AETNA HMO	5361	Level 1 Laparoscopy and Related Services	4276.0
AETNA HMO	5362	Level 2 Laparoscopy and Related Services	4421.0
AETNA HMO	5374	Level 4 Urology and Related Services	2940.0
AETNA HMO	5375	Level 5 Urology and Related Services	3822.0
AETNA HMO	5401	Dialysis	2852.0
AETNA HMO	5411	Level 1 Gynecologic Procedures	982.0
AETNA HMO	5414	Level 4 Gynecologic Procedures	2358.0
AETNA HMO	5431	Level 1 Nerve Procedures	2021.0
AETNA HMO	5465	Level 5 Neurostimulator and Related Procedures	27616.0
AETNA HMO	5521	Level 1 Imaging without Contrast	422.0
AETNA HMO	5522	Level 2 Imaging without Contrast	982.0
AETNA HMO	5523	Level 3 Imaging without Contrast	955.0
AETNA HMO	5524	Level 4 Imaging without Contrast	2879.0
AETNA HMO	5571	Level 1 Imaging with Contrast	1710.0
AETNA HMO	5572	Level 2 Imaging with Contrast	955.0
AETNA HMO	5591	Level 1 Nuclear Medicine and Related Services	2066.0
AETNA HMO	5592	Level 2 Nuclear Medicine and Related Services	2754.0
AETNA HMO	5593	Level 3 Nuclear Medicine and Related Services	3111.0
AETNA HMO	5594	Level 4 Nuclear Medicine and Related Services	1991.0
AETNA HMO	5674	Level 4 Pathology	2125.0
AETNA HMO	5692	Level 2 Drug Administration	685.0
AETNA HMO	5693	Level 3 Drug Administration	794.0
AETNA HMO	5694	Level 4 Drug Administration	4177.0
AETNA HMO	5731	Level 1 Minor Procedures	341.0
AETNA HMO	5733	Level 3 Minor Procedures	361.0
AETNA HMO	5734	Level 4 Minor Procedures	857.0
AETNA HMO	5771	Cardiac Rehabilitation	2179.0
AETNA HMO	5781	Resuscitation and Cardioversion	4822.0
AETNA HMO	N700	Non-OPPS Clinic Services	982.0
AETNA HMO	N800	Clinical Diagnostic Lab Services	254.0
AETNA HMO	N801	Therapy Services	1116.0
AETNA HMO	N804	Mammography Services	688.0
AETNA HMO	N902	Packaged Services	4055.0
AETNA HMO	N905	Not Recognized by OPPS	385.0

Section: Outpatient Payer Specific Charge 2
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE CROSS NON-MCS	1506	New Technology - Level 6 ($401 - $500)	3007.0
BLUE CROSS NON-MCS	5012	Clinic Visits and Related Services	220.0
BLUE CROSS NON-MCS	5021	Level 1 Type A ED Visits	259.0
BLUE CROSS NON-MCS	5022	Level 2 Type A ED Visits	469.0
BLUE CROSS NON-MCS	5023	Level 3 Type A ED Visits	825.0
BLUE CROSS NON-MCS	5024	Level 4 Type A ED Visits	1684.0
BLUE CROSS NON-MCS	5025	Level 5 Type A ED Visits	2973.0
BLUE CROSS NON-MCS	5051	Level 1 Skin Procedures	469.0
BLUE CROSS NON-MCS	5052	Level 2 Skin Procedures	1232.0
BLUE CROSS NON-MCS	5053	Level 3 Skin Procedures	1944.0
BLUE CROSS NON-MCS	5054	Level 4 Skin Procedures	6110.0
BLUE CROSS NON-MCS	5055	Level 5 Skin Procedures	12546.0
BLUE CROSS NON-MCS	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	2215.0
BLUE CROSS NON-MCS	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	5233.0
BLUE CROSS NON-MCS	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	8442.0
BLUE CROSS NON-MCS	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	11686.0
BLUE CROSS NON-MCS	5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	25853.0
BLUE CROSS NON-MCS	5094	Level 4 Breast/Lymphatic Surgery and Related Procedures	53177.0
BLUE CROSS NON-MCS	5112	Level 2 Musculoskeletal Procedures	4960.0
BLUE CROSS NON-MCS	5113	Level 3 Musculoskeletal Procedures	10082.0
BLUE CROSS NON-MCS	5114	Level 4 Musculoskeletal Procedures	22316.0
BLUE CROSS NON-MCS	5115	Level 5 Musculoskeletal Procedures	44140.0
BLUE CROSS NON-MCS	5116	Level 6 Musculoskeletal Procedures	56757.0
BLUE CROSS NON-MCS	5164	Level 4 ENT Procedures	9747.0
BLUE CROSS NON-MCS	5181	Level 1 Vascular Procedures	2236.0
BLUE CROSS NON-MCS	5182	Level 2 Vascular Procedures	5009.0
BLUE CROSS NON-MCS	5183	Level 3 Vascular Procedures	10193.0
BLUE CROSS NON-MCS	5184	Level 4 Vascular Procedures	16992.0
BLUE CROSS NON-MCS	5191	Level 1 Endovascular Procedures	10354.0
BLUE CROSS NON-MCS	5193	Level 3 Endovascular Procedures	35773.0
BLUE CROSS NON-MCS	5194	Level 4 Endovascular Procedures	57248.0
BLUE CROSS NON-MCS	5213	Level 3 Electrophysiologic Procedures	76457.0
BLUE CROSS NON-MCS	5241	Level 1 Blood Product Exchange and Related Services	2567.0
BLUE CROSS NON-MCS	5301	Level 1 Upper GI Procedures	2973.0
BLUE CROSS NON-MCS	5302	Level 2 Upper GI Procedures	5788.0
BLUE CROSS NON-MCS	5311	Level 1 Lower GI Procedures	4244.0
BLUE CROSS NON-MCS	5312	Level 2 Lower GI Procedures	5136.0
BLUE CROSS NON-MCS	5313	Level 3 Lower GI Procedures	8703.0
BLUE CROSS NON-MCS	5331	Complex GI Procedures	17912.0
BLUE CROSS NON-MCS	5341	Abdominal/Peritoneal/Biliary and Related Procedures	11339.0
BLUE CROSS NON-MCS	5361	Level 1 Laparoscopy and Related Services	18025.0
BLUE CROSS NON-MCS	5362	Level 2 Laparoscopy and Related Services	31729.0
BLUE CROSS NON-MCS	5373	Level 3 Urology and Related Services	6387.0
BLUE CROSS NON-MCS	5374	Level 4 Urology and Related Services	10958.0
BLUE CROSS NON-MCS	5375	Level 5 Urology and Related Services	15723.0
BLUE CROSS NON-MCS	5411	Level 1 Gynecologic Procedures	607.0
BLUE CROSS NON-MCS	5414	Level 4 Gynecologic Procedures	9344.0
BLUE CROSS NON-MCS	5415	Level 5 Gynecologic Procedures	15707.0
BLUE CROSS NON-MCS	5416	Level 6 Gynecologic Procedures	24202.0
BLUE CROSS NON-MCS	5431	Level 1 Nerve Procedures	6375.0
BLUE CROSS NON-MCS	5441	Level 1 Nerve Injections	930.0
BLUE CROSS NON-MCS	5442	Level 2 Nerve Injections	4508.0
BLUE CROSS NON-MCS	5521	Level 1 Imaging without Contrast	288.0
BLUE CROSS NON-MCS	5522	Level 2 Imaging without Contrast	388.0
BLUE CROSS NON-MCS	5523	Level 3 Imaging without Contrast	820.0
BLUE CROSS NON-MCS	5524	Level 4 Imaging without Contrast	1720.0
BLUE CROSS NON-MCS	5571	Level 1 Imaging with Contrast	636.0
BLUE CROSS NON-MCS	5572	Level 2 Imaging with Contrast	1311.0
BLUE CROSS NON-MCS	5573	Level 3 Imaging with Contrast	3859.0
BLUE CROSS NON-MCS	5591	Level 1 Nuclear Medicine and Related Services	1343.0
BLUE CROSS NON-MCS	5592	Level 2 Nuclear Medicine and Related Services	1743.0
BLUE CROSS NON-MCS	5593	Level 3 Nuclear Medicine and Related Services	5472.0
BLUE CROSS NON-MCS	5594	Level 4 Nuclear Medicine and Related Services	5281.0
BLUE CROSS NON-MCS	5672	Level 2 Pathology	538.0
BLUE CROSS NON-MCS	5673	Level 3 Pathology	1037.0
BLUE CROSS NON-MCS	5692	Level 2 Drug Administration	730.0
BLUE CROSS NON-MCS	5693	Level 3 Drug Administration	725.0
BLUE CROSS NON-MCS	5694	Level 4 Drug Administration	6874.0
BLUE CROSS NON-MCS	5722	Level 2 Diagnostic Tests and Related Services	942.0
BLUE CROSS NON-MCS	5723	Level 3 Diagnostic Tests and Related Services	1737.0
BLUE CROSS NON-MCS	5731	Level 1 Minor Procedures	194.0
BLUE CROSS NON-MCS	5733	Level 3 Minor Procedures	198.0
BLUE CROSS NON-MCS	5734	Level 4 Minor Procedures	399.0
BLUE CROSS NON-MCS	5771	Cardiac Rehabilitation	2480.0
BLUE CROSS NON-MCS	5781	Resuscitation and Cardioversion	3751.0
BLUE CROSS NON-MCS	N700	Non-OPPS Clinic Services	150.0
BLUE CROSS NON-MCS	N800	Clinical Diagnostic Lab Services	107.0
BLUE CROSS NON-MCS	N801	Therapy Services	808.0
BLUE CROSS NON-MCS	N804	Mammography Services	292.0
BLUE CROSS NON-MCS	N905	Not Recognized by OPPS	149.0

Section: Outpatient Payer Specific Charge 3
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE CROSS SELECT HMO	1506	New Technology - Level 6 ($401 - $500)	1514.0
BLUE CROSS SELECT HMO	5012	Clinic Visits and Related Services	143.0
BLUE CROSS SELECT HMO	5022	Level 2 Type A ED Visits	233.0
BLUE CROSS SELECT HMO	5023	Level 3 Type A ED Visits	411.0
BLUE CROSS SELECT HMO	5024	Level 4 Type A ED Visits	838.0
BLUE CROSS SELECT HMO	5025	Level 5 Type A ED Visits	1480.0
BLUE CROSS SELECT HMO	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	2639.0
BLUE CROSS SELECT HMO	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	9960.0
BLUE CROSS SELECT HMO	5115	Level 5 Musculoskeletal Procedures	22149.0
BLUE CROSS SELECT HMO	5183	Level 3 Vascular Procedures	5079.0
BLUE CROSS SELECT HMO	5191	Level 1 Endovascular Procedures	5160.0
BLUE CROSS SELECT HMO	5301	Level 1 Upper GI Procedures	1951.0
BLUE CROSS SELECT HMO	5313	Level 3 Lower GI Procedures	2224.0
BLUE CROSS SELECT HMO	5341	Abdominal/Peritoneal/Biliary and Related Procedures	5647.0
BLUE CROSS SELECT HMO	5361	Level 1 Laparoscopy and Related Services	8976.0
BLUE CROSS SELECT HMO	5362	Level 2 Laparoscopy and Related Services	15800.0
BLUE CROSS SELECT HMO	5374	Level 4 Urology and Related Services	5457.0
BLUE CROSS SELECT HMO	5375	Level 5 Urology and Related Services	7829.0
BLUE CROSS SELECT HMO	5411	Level 1 Gynecologic Procedures	302.0
BLUE CROSS SELECT HMO	5414	Level 4 Gynecologic Procedures	4653.0
BLUE CROSS SELECT HMO	5593	Level 3 Nuclear Medicine and Related Services	4172.0
BLUE CROSS SELECT HMO	5672	Level 2 Pathology	113.0
BLUE CROSS SELECT HMO	5692	Level 2 Drug Administration	113.0
BLUE CROSS SELECT HMO	5693	Level 3 Drug Administration	361.0
BLUE CROSS SELECT HMO	5694	Level 4 Drug Administration	1162.0
BLUE CROSS SELECT HMO	5731	Level 1 Minor Procedures	113.0
BLUE CROSS SELECT HMO	N700	Non-OPPS Clinic Services	75.0
BLUE CROSS SELECT HMO	N800	Clinical Diagnostic Lab Services	69.0
BLUE CROSS SELECT HMO	N804	Mammography Services	190.0

Section: Outpatient Payer Specific Charge 4
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE CROSS VIVITY - NON CITY	1506	New Technology - Level 6 ($401 - $500)	1148.0
BLUE CROSS VIVITY - NON CITY	5022	Level 2 Type A ED Visits	186.0
BLUE CROSS VIVITY - NON CITY	5023	Level 3 Type A ED Visits	327.0
BLUE CROSS VIVITY - NON CITY	5024	Level 4 Type A ED Visits	666.0
BLUE CROSS VIVITY - NON CITY	5025	Level 5 Type A ED Visits	1193.0
BLUE CROSS VIVITY - NON CITY	5051	Level 1 Skin Procedures	186.0
BLUE CROSS VIVITY - NON CITY	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	877.0
BLUE CROSS VIVITY - NON CITY	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	2134.0
BLUE CROSS VIVITY - NON CITY	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	3341.0
BLUE CROSS VIVITY - NON CITY	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	4452.0
BLUE CROSS VIVITY - NON CITY	5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	7802.0
BLUE CROSS VIVITY - NON CITY	5115	Level 5 Musculoskeletal Procedures	17682.0
BLUE CROSS VIVITY - NON CITY	5182	Level 2 Vascular Procedures	1982.0
BLUE CROSS VIVITY - NON CITY	5183	Level 3 Vascular Procedures	4035.0
BLUE CROSS VIVITY - NON CITY	5241	Level 1 Blood Product Exchange and Related Services	1016.0
BLUE CROSS VIVITY - NON CITY	5301	Level 1 Upper GI Procedures	1141.0
BLUE CROSS VIVITY - NON CITY	5312	Level 2 Lower GI Procedures	2033.0
BLUE CROSS VIVITY - NON CITY	5313	Level 3 Lower GI Procedures	3445.0
BLUE CROSS VIVITY - NON CITY	5361	Level 1 Laparoscopy and Related Services	7135.0
BLUE CROSS VIVITY - NON CITY	5362	Level 2 Laparoscopy and Related Services	12559.0
BLUE CROSS VIVITY - NON CITY	5374	Level 4 Urology and Related Services	4337.0
BLUE CROSS VIVITY - NON CITY	5375	Level 5 Urology and Related Services	6223.0
BLUE CROSS VIVITY - NON CITY	5411	Level 1 Gynecologic Procedures	360.0
BLUE CROSS VIVITY - NON CITY	5414	Level 4 Gynecologic Procedures	3698.0
BLUE CROSS VIVITY - NON CITY	5441	Level 1 Nerve Injections	368.0
BLUE CROSS VIVITY - NON CITY	5593	Level 3 Nuclear Medicine and Related Services	3228.0
BLUE CROSS VIVITY - NON CITY	5692	Level 2 Drug Administration	107.0
BLUE CROSS VIVITY - NON CITY	5693	Level 3 Drug Administration	287.0
BLUE CROSS VIVITY - NON CITY	5731	Level 1 Minor Procedures	107.0
BLUE CROSS VIVITY - NON CITY	N700	Non-OPPS Clinic Services	102.0
BLUE CROSS VIVITY - NON CITY	N800	Clinical Diagnostic Lab Services	73.0

Section: Outpatient Payer Specific Charge 5
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE SHIELD PPO	1506	New Technology - Level 6 ($401 - $500)	4086.0
BLUE SHIELD PPO	5021	Level 1 Type A ED Visits	389.0
BLUE SHIELD PPO	5022	Level 2 Type A ED Visits	781.0
BLUE SHIELD PPO	5023	Level 3 Type A ED Visits	1705.0
BLUE SHIELD PPO	5024	Level 4 Type A ED Visits	3517.0
BLUE SHIELD PPO	5025	Level 5 Type A ED Visits	7531.0
BLUE SHIELD PPO	5051	Level 1 Skin Procedures	1166.0
BLUE SHIELD PPO	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	1466.0
BLUE SHIELD PPO	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	6351.0
BLUE SHIELD PPO	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	1466.0
BLUE SHIELD PPO	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	6351.0
BLUE SHIELD PPO	5094	Level 4 Breast/Lymphatic Surgery and Related Procedures	18487.0
BLUE SHIELD PPO	5112	Level 2 Musculoskeletal Procedures	5256.0
BLUE SHIELD PPO	5113	Level 3 Musculoskeletal Procedures	7258.0
BLUE SHIELD PPO	5114	Level 4 Musculoskeletal Procedures	8885.0
BLUE SHIELD PPO	5115	Level 5 Musculoskeletal Procedures	16927.0
BLUE SHIELD PPO	5182	Level 2 Vascular Procedures	4745.0
BLUE SHIELD PPO	5183	Level 3 Vascular Procedures	10203.0
BLUE SHIELD PPO	5191	Level 1 Endovascular Procedures	14167.0
BLUE SHIELD PPO	5193	Level 3 Endovascular Procedures	14167.0
BLUE SHIELD PPO	5241	Level 1 Blood Product Exchange and Related Services	1466.0
BLUE SHIELD PPO	5301	Level 1 Upper GI Procedures	6351.0
BLUE SHIELD PPO	5312	Level 2 Lower GI Procedures	4745.0
BLUE SHIELD PPO	5361	Level 1 Laparoscopy and Related Services	8975.0
BLUE SHIELD PPO	5362	Level 2 Laparoscopy and Related Services	10203.0
BLUE SHIELD PPO	5373	Level 3 Urology and Related Services	4745.0
BLUE SHIELD PPO	5374	Level 4 Urology and Related Services	5548.0
BLUE SHIELD PPO	5375	Level 5 Urology and Related Services	8975.0
BLUE SHIELD PPO	5411	Level 1 Gynecologic Procedures	1305.0
BLUE SHIELD PPO	5414	Level 4 Gynecologic Procedures	6351.0
BLUE SHIELD PPO	5441	Level 1 Nerve Injections	1466.0
BLUE SHIELD PPO	5471	Implantation of Drug Infusion Device	20502.0
BLUE SHIELD PPO	5521	Level 1 Imaging without Contrast	512.0
BLUE SHIELD PPO	5522	Level 2 Imaging without Contrast	982.0
BLUE SHIELD PPO	5523	Level 3 Imaging without Contrast	3875.0
BLUE SHIELD PPO	5524	Level 4 Imaging without Contrast	3382.0
BLUE SHIELD PPO	5571	Level 1 Imaging with Contrast	695.0
BLUE SHIELD PPO	5572	Level 2 Imaging with Contrast	5504.0
BLUE SHIELD PPO	5591	Level 1 Nuclear Medicine and Related Services	2318.0
BLUE SHIELD PPO	5592	Level 2 Nuclear Medicine and Related Services	1590.0
BLUE SHIELD PPO	5593	Level 3 Nuclear Medicine and Related Services	9732.0
BLUE SHIELD PPO	5594	Level 4 Nuclear Medicine and Related Services	12547.0
BLUE SHIELD PPO	5692	Level 2 Drug Administration	401.0
BLUE SHIELD PPO	5693	Level 3 Drug Administration	1205.0
BLUE SHIELD PPO	5694	Level 4 Drug Administration	7990.0
BLUE SHIELD PPO	5722	Level 2 Diagnostic Tests and Related Services	1380.0
BLUE SHIELD PPO	5731	Level 1 Minor Procedures	401.0
BLUE SHIELD PPO	5733	Level 3 Minor Procedures	156.0
BLUE SHIELD PPO	5734	Level 4 Minor Procedures	863.0
BLUE SHIELD PPO	5771	Cardiac Rehabilitation	2194.0
BLUE SHIELD PPO	5781	Resuscitation and Cardioversion	8136.0
BLUE SHIELD PPO	N700	Non-OPPS Clinic Services	929.0
BLUE SHIELD PPO	N800	Clinical Diagnostic Lab Services	299.0
BLUE SHIELD PPO	N801	Therapy Services	1062.0
BLUE SHIELD PPO	N804	Mammography Services	1022.0
BLUE SHIELD PPO	N905	Not Recognized by OPPS	452.0

Section: Outpatient Payer Specific Charge 6
Payer	APC	Description	Payer Specific Negotiated Charge
CALOPTIMA MEDI-CAL	1506	New Technology - Level 6 ($401 - $500)	197.0
CALOPTIMA MEDI-CAL	5021	Level 1 Type A ED Visits	22.0
CALOPTIMA MEDI-CAL	5022	Level 2 Type A ED Visits	44.0
CALOPTIMA MEDI-CAL	5023	Level 3 Type A ED Visits	88.0
CALOPTIMA MEDI-CAL	5024	Level 4 Type A ED Visits	202.0
CALOPTIMA MEDI-CAL	5025	Level 5 Type A ED Visits	384.0
CALOPTIMA MEDI-CAL	5051	Level 1 Skin Procedures	65.0
CALOPTIMA MEDI-CAL	5052	Level 2 Skin Procedures	114.0
CALOPTIMA MEDI-CAL	5053	Level 3 Skin Procedures	202.0
CALOPTIMA MEDI-CAL	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	120.0
CALOPTIMA MEDI-CAL	5182	Level 2 Vascular Procedures	405.0
CALOPTIMA MEDI-CAL	5183	Level 3 Vascular Procedures	691.0
CALOPTIMA MEDI-CAL	5191	Level 1 Endovascular Procedures	2258.0
CALOPTIMA MEDI-CAL	5301	Level 1 Upper GI Procedures	473.0
CALOPTIMA MEDI-CAL	5361	Level 1 Laparoscopy and Related Services	11.0
CALOPTIMA MEDI-CAL	5373	Level 3 Urology and Related Services	671.0
CALOPTIMA MEDI-CAL	5375	Level 5 Urology and Related Services	2061.0
CALOPTIMA MEDI-CAL	5411	Level 1 Gynecologic Procedures	44.0
CALOPTIMA MEDI-CAL	5441	Level 1 Nerve Injections	79.0
CALOPTIMA MEDI-CAL	5442	Level 2 Nerve Injections	790.0
CALOPTIMA MEDI-CAL	5521	Level 1 Imaging without Contrast	2.0
CALOPTIMA MEDI-CAL	5522	Level 2 Imaging without Contrast	44.0
CALOPTIMA MEDI-CAL	5523	Level 3 Imaging without Contrast	1.0
CALOPTIMA MEDI-CAL	5593	Level 3 Nuclear Medicine and Related Services	1461.0
CALOPTIMA MEDI-CAL	5594	Level 4 Nuclear Medicine and Related Services	8.0
CALOPTIMA MEDI-CAL	5672	Level 2 Pathology	3.0
CALOPTIMA MEDI-CAL	5691	Level 1 Drug Administration	3.0
CALOPTIMA MEDI-CAL	5692	Level 2 Drug Administration	3.0
CALOPTIMA MEDI-CAL	5693	Level 3 Drug Administration	1.0
CALOPTIMA MEDI-CAL	5731	Level 1 Minor Procedures	22.0
CALOPTIMA MEDI-CAL	5733	Level 3 Minor Procedures	24.0
CALOPTIMA MEDI-CAL	5734	Level 4 Minor Procedures	181.0
CALOPTIMA MEDI-CAL	N700	Non-OPPS Clinic Services	50.0
CALOPTIMA MEDI-CAL	N800	Clinical Diagnostic Lab Services	3.0
CALOPTIMA MEDI-CAL	N902	Packaged Services	1.0

Section: Outpatient Payer Specific Charge 7
Payer	APC	Description	Payer Specific Negotiated Charge
CIGNA	1506	New Technology - Level 6 ($401 - $500)	2759.0
CIGNA	5021	Level 1 Type A ED Visits	279.0
CIGNA	5022	Level 2 Type A ED Visits	561.0
CIGNA	5023	Level 3 Type A ED Visits	1138.0
CIGNA	5024	Level 4 Type A ED Visits	2536.0
CIGNA	5025	Level 5 Type A ED Visits	2946.0
CIGNA	5051	Level 1 Skin Procedures	843.0
CIGNA	5055	Level 5 Skin Procedures	5236.0
CIGNA	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	3115.0
CIGNA	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	5063.0
CIGNA	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	9767.0
CIGNA	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	10086.0
CIGNA	5094	Level 4 Breast/Lymphatic Surgery and Related Procedures	16872.0
CIGNA	5112	Level 2 Musculoskeletal Procedures	2946.0
CIGNA	5113	Level 3 Musculoskeletal Procedures	5236.0
CIGNA	5114	Level 4 Musculoskeletal Procedures	10158.0
CIGNA	5115	Level 5 Musculoskeletal Procedures	15488.0
CIGNA	5153	Level 3 Airway Endoscopy	4307.0
CIGNA	5181	Level 1 Vascular Procedures	6555.0
CIGNA	5182	Level 2 Vascular Procedures	4900.0
CIGNA	5183	Level 3 Vascular Procedures	9929.0
CIGNA	5191	Level 1 Endovascular Procedures	6349.0
CIGNA	5232	Level 2 ICD and Similar Procedures	31863.0
CIGNA	5241	Level 1 Blood Product Exchange and Related Services	3079.0
CIGNA	5301	Level 1 Upper GI Procedures	8343.0
CIGNA	5303	Level 3 Upper GI Procedures	15857.0
CIGNA	5313	Level 3 Lower GI Procedures	10158.0
CIGNA	5341	Abdominal/Peritoneal/Biliary and Related Procedures	9952.0
CIGNA	5361	Level 1 Laparoscopy and Related Services	10158.0
CIGNA	5362	Level 2 Laparoscopy and Related Services	10158.0
CIGNA	5373	Level 3 Urology and Related Services	5014.0
CIGNA	5374	Level 4 Urology and Related Services	10158.0
CIGNA	5375	Level 5 Urology and Related Services	314.0
CIGNA	5411	Level 1 Gynecologic Procedures	945.0
CIGNA	5414	Level 4 Gynecologic Procedures	10158.0
CIGNA	5415	Level 5 Gynecologic Procedures	10158.0
CIGNA	5465	Level 5 Neurostimulator and Related Procedures	20963.0
CIGNA	5521	Level 1 Imaging without Contrast	325.0
CIGNA	5522	Level 2 Imaging without Contrast	437.0
CIGNA	5523	Level 3 Imaging without Contrast	924.0
CIGNA	5524	Level 4 Imaging without Contrast	2655.0
CIGNA	5571	Level 1 Imaging with Contrast	892.0
CIGNA	5572	Level 2 Imaging with Contrast	1550.0
CIGNA	5593	Level 3 Nuclear Medicine and Related Services	6457.0
CIGNA	5594	Level 4 Nuclear Medicine and Related Services	6144.0
CIGNA	5692	Level 2 Drug Administration	327.0
CIGNA	5693	Level 3 Drug Administration	573.0
CIGNA	5694	Level 4 Drug Administration	9018.0
CIGNA	5722	Level 2 Diagnostic Tests and Related Services	2252.0
CIGNA	5731	Level 1 Minor Procedures	314.0
CIGNA	5733	Level 3 Minor Procedures	333.0
CIGNA	5771	Cardiac Rehabilitation	1866.0
CIGNA	5781	Resuscitation and Cardioversion	2946.0
CIGNA	N700	Non-OPPS Clinic Services	720.0
CIGNA	N800	Clinical Diagnostic Lab Services	235.0
CIGNA	N801	Therapy Services	706.0
CIGNA	N804	Mammography Services	490.0
CIGNA	N905	Not Recognized by OPPS	355.0

Section: Outpatient Payer Specific Charge 8
Payer	APC	Description	Payer Specific Negotiated Charge
EDINGER VALUATION	1506	New Technology - Level 6 ($401 - $500)	1014.0
EDINGER VALUATION	5021	Level 1 Type A ED Visits	144.0
EDINGER VALUATION	5022	Level 2 Type A ED Visits	290.0
EDINGER VALUATION	5023	Level 3 Type A ED Visits	578.0
EDINGER VALUATION	5024	Level 4 Type A ED Visits	1014.0
EDINGER VALUATION	5025	Level 5 Type A ED Visits	1446.0
EDINGER VALUATION	5051	Level 1 Skin Procedures	290.0
EDINGER VALUATION	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	2456.0
EDINGER VALUATION	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	2456.0
EDINGER VALUATION	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	2456.0
EDINGER VALUATION	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	2456.0
EDINGER VALUATION	5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	5476.0
EDINGER VALUATION	5115	Level 5 Musculoskeletal Procedures	8298.0
EDINGER VALUATION	5153	Level 3 Airway Endoscopy	2209.0
EDINGER VALUATION	5181	Level 1 Vascular Procedures	2456.0
EDINGER VALUATION	5182	Level 2 Vascular Procedures	2456.0
EDINGER VALUATION	5183	Level 3 Vascular Procedures	2456.0
EDINGER VALUATION	5191	Level 1 Endovascular Procedures	3271.0
EDINGER VALUATION	5193	Level 3 Endovascular Procedures	7083.0
EDINGER VALUATION	5213	Level 3 Electrophysiologic Procedures	3271.0
EDINGER VALUATION	5222	Level 2 Pacemaker and Similar Procedures	8805.0
EDINGER VALUATION	5223	Level 3 Pacemaker and Similar Procedures	9959.0
EDINGER VALUATION	5241	Level 1 Blood Product Exchange and Related Services	2209.0
EDINGER VALUATION	5301	Level 1 Upper GI Procedures	2456.0
EDINGER VALUATION	5302	Level 2 Upper GI Procedures	1510.0
EDINGER VALUATION	5312	Level 2 Lower GI Procedures	1510.0
EDINGER VALUATION	5341	Abdominal/Peritoneal/Biliary and Related Procedures	3189.0
EDINGER VALUATION	5361	Level 1 Laparoscopy and Related Services	2976.0
EDINGER VALUATION	5362	Level 2 Laparoscopy and Related Services	2456.0
EDINGER VALUATION	5371	Level 1 Urology and Related Services	578.0
EDINGER VALUATION	5373	Level 3 Urology and Related Services	2456.0
EDINGER VALUATION	5374	Level 4 Urology and Related Services	2456.0
EDINGER VALUATION	5375	Level 5 Urology and Related Services	2456.0
EDINGER VALUATION	5441	Level 1 Nerve Injections	2456.0
EDINGER VALUATION	5524	Level 4 Imaging without Contrast	2209.0
EDINGER VALUATION	5593	Level 3 Nuclear Medicine and Related Services	2209.0
EDINGER VALUATION	5672	Level 2 Pathology	238.0
EDINGER VALUATION	5673	Level 3 Pathology	944.0
EDINGER VALUATION	5693	Level 3 Drug Administration	2209.0
EDINGER VALUATION	5694	Level 4 Drug Administration	1252.0
EDINGER VALUATION	5731	Level 1 Minor Procedures	277.0
EDINGER VALUATION	5733	Level 3 Minor Procedures	1192.0
EDINGER VALUATION	5781	Resuscitation and Cardioversion	2209.0
EDINGER VALUATION	N801	Therapy Services	922.0
EDINGER VALUATION	N902	Packaged Services	262.0
EDINGER VALUATION	N905	Not Recognized by OPPS	313.0

Section: Outpatient Payer Specific Charge 9
Payer	APC	Description	Payer Specific Negotiated Charge
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	1506	New Technology - Level 6 ($401 - $500)	5240.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5021	Level 1 Type A ED Visits	622.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5022	Level 2 Type A ED Visits	1250.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5023	Level 3 Type A ED Visits	2534.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5024	Level 4 Type A ED Visits	6021.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5025	Level 5 Type A ED Visits	6698.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5051	Level 1 Skin Procedures	1885.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	3225.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	5192.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	5192.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	11585.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5113	Level 3 Musculoskeletal Procedures	8008.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5114	Level 4 Musculoskeletal Procedures	23924.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5115	Level 5 Musculoskeletal Procedures	48225.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5116	Level 6 Musculoskeletal Procedures	28257.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5182	Level 2 Vascular Procedures	5192.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5183	Level 3 Vascular Procedures	15949.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5191	Level 1 Endovascular Procedures	20148.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5232	Level 2 ICD and Similar Procedures	121401.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5241	Level 1 Blood Product Exchange and Related Services	759.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5301	Level 1 Upper GI Procedures	5192.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5312	Level 2 Lower GI Procedures	5500.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5341	Abdominal/Peritoneal/Biliary and Related Procedures	8008.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5361	Level 1 Laparoscopy and Related Services	20148.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5362	Level 2 Laparoscopy and Related Services	21829.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5373	Level 3 Urology and Related Services	6452.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5374	Level 4 Urology and Related Services	12425.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5375	Level 5 Urology and Related Services	67.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5411	Level 1 Gynecologic Procedures	1122.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5441	Level 1 Nerve Injections	1680.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5521	Level 1 Imaging without Contrast	88.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5522	Level 2 Imaging without Contrast	123.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5523	Level 3 Imaging without Contrast	256.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5524	Level 4 Imaging without Contrast	1693.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5571	Level 1 Imaging with Contrast	200.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5572	Level 2 Imaging with Contrast	420.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5573	Level 3 Imaging with Contrast	1680.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5591	Level 1 Nuclear Medicine and Related Services	405.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5592	Level 2 Nuclear Medicine and Related Services	519.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5593	Level 3 Nuclear Medicine and Related Services	2972.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5594	Level 4 Nuclear Medicine and Related Services	1594.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5692	Level 2 Drug Administration	1122.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5693	Level 3 Drug Administration	635.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5694	Level 4 Drug Administration	10530.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5722	Level 2 Diagnostic Tests and Related Services	1524.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5731	Level 1 Minor Procedures	67.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5733	Level 3 Minor Procedures	591.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	5771	Cardiac Rehabilitation	2996.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	N700	Non-OPPS Clinic Services	1122.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	N800	Clinical Diagnostic Lab Services	46.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	N801	Therapy Services	1712.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	N804	Mammography Services	138.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	N900	Non-covered Services	6.0
UNITED HEALTHCARE NON-PREFERRED/ALL PAYER	N905	Not Recognized by OPPS	724.0

Section: Outpatient Payer Specific Charge 10
Payer	APC	Description	Payer Specific Negotiated Charge
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5012	Clinic Visits and Related Services	115.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5411	Level 1 Gynecologic Procedures	200.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5521	Level 1 Imaging without Contrast	105.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5522	Level 2 Imaging without Contrast	83.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5523	Level 3 Imaging without Contrast	419.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5524	Level 4 Imaging without Contrast	375.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5571	Level 1 Imaging with Contrast	174.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5572	Level 2 Imaging with Contrast	774.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5591	Level 1 Nuclear Medicine and Related Services	321.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5592	Level 2 Nuclear Medicine and Related Services	346.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5593	Level 3 Nuclear Medicine and Related Services	975.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5594	Level 4 Nuclear Medicine and Related Services	1182.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5672	Level 2 Pathology	118.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5673	Level 3 Pathology	304.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5692	Level 2 Drug Administration	20.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5693	Level 3 Drug Administration	148.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5694	Level 4 Drug Administration	469.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5722	Level 2 Diagnostic Tests and Related Services	346.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5723	Level 3 Diagnostic Tests and Related Services	370.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5731	Level 1 Minor Procedures	43.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5733	Level 3 Minor Procedures	47.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5734	Level 4 Minor Procedures	65.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5771	Cardiac Rehabilitation	237.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5781	Resuscitation and Cardioversion	701.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	N800	Clinical Diagnostic Lab Services	27.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	N801	Therapy Services	156.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	N902	Packaged Services	37.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	N905	Not Recognized by OPPS	54.0

Section: Outpatient Payer Specific Charge 11
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE SHIELD TRIO	5021	Level 1 Type A ED Visits	322.0
BLUE SHIELD TRIO	5022	Level 2 Type A ED Visits	647.0
BLUE SHIELD TRIO	5023	Level 3 Type A ED Visits	1416.0
BLUE SHIELD TRIO	5024	Level 4 Type A ED Visits	3305.0
BLUE SHIELD TRIO	5025	Level 5 Type A ED Visits	5659.0
BLUE SHIELD TRIO	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	5394.0
BLUE SHIELD TRIO	5361	Level 1 Laparoscopy and Related Services	9958.0
BLUE SHIELD TRIO	5522	Level 2 Imaging without Contrast	570.0
BLUE SHIELD TRIO	5731	Level 1 Minor Procedures	332.0
BLUE SHIELD TRIO	N800	Clinical Diagnostic Lab Services	248.0
BLUE SHIELD TRIO	N801	Therapy Services	1705.0

Section: Outpatient Payer Specific Charge 12
Payer	APC	Description	Payer Specific Negotiated Charge
HEALTH NET HMO & PPO	5021	Level 1 Type A ED Visits	454.0
HEALTH NET HMO & PPO	5022	Level 2 Type A ED Visits	990.0
HEALTH NET HMO & PPO	5023	Level 3 Type A ED Visits	2109.0
HEALTH NET HMO & PPO	5024	Level 4 Type A ED Visits	4500.0
HEALTH NET HMO & PPO	5025	Level 5 Type A ED Visits	6841.0
HEALTH NET HMO & PPO	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	2646.0
HEALTH NET HMO & PPO	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	7813.0
HEALTH NET HMO & PPO	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	7938.0
HEALTH NET HMO & PPO	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	14552.0
HEALTH NET HMO & PPO	5114	Level 4 Musculoskeletal Procedures	18840.0
HEALTH NET HMO & PPO	5115	Level 5 Musculoskeletal Procedures	33347.0
HEALTH NET HMO & PPO	5182	Level 2 Vascular Procedures	2646.0
HEALTH NET HMO & PPO	5191	Level 1 Endovascular Procedures	13229.0
HEALTH NET HMO & PPO	5301	Level 1 Upper GI Procedures	4851.0
HEALTH NET HMO & PPO	5312	Level 2 Lower GI Procedures	5380.0
HEALTH NET HMO & PPO	5361	Level 1 Laparoscopy and Related Services	13780.0
HEALTH NET HMO & PPO	5362	Level 2 Laparoscopy and Related Services	31143.0
HEALTH NET HMO & PPO	5374	Level 4 Urology and Related Services	17198.0
HEALTH NET HMO & PPO	5411	Level 1 Gynecologic Procedures	836.0
HEALTH NET HMO & PPO	5414	Level 4 Gynecologic Procedures	13229.0
HEALTH NET HMO & PPO	5415	Level 5 Gynecologic Procedures	13780.0
HEALTH NET HMO & PPO	5521	Level 1 Imaging without Contrast	432.0
HEALTH NET HMO & PPO	5522	Level 2 Imaging without Contrast	1051.0
HEALTH NET HMO & PPO	5523	Level 3 Imaging without Contrast	2121.0
HEALTH NET HMO & PPO	5524	Level 4 Imaging without Contrast	2365.0
HEALTH NET HMO & PPO	5572	Level 2 Imaging with Contrast	4829.0
HEALTH NET HMO & PPO	5593	Level 3 Nuclear Medicine and Related Services	6813.0
HEALTH NET HMO & PPO	5692	Level 2 Drug Administration	10787.0
HEALTH NET HMO & PPO	5693	Level 3 Drug Administration	280.0
HEALTH NET HMO & PPO	5722	Level 2 Diagnostic Tests and Related Services	1518.0
HEALTH NET HMO & PPO	5723	Level 3 Diagnostic Tests and Related Services	3175.0
HEALTH NET HMO & PPO	5731	Level 1 Minor Procedures	280.0
HEALTH NET HMO & PPO	5733	Level 3 Minor Procedures	572.0
HEALTH NET HMO & PPO	N700	Non-OPPS Clinic Services	578.0
HEALTH NET HMO & PPO	N800	Clinical Diagnostic Lab Services	209.0
HEALTH NET HMO & PPO	N801	Therapy Services	1856.0
HEALTH NET HMO & PPO	N804	Mammography Services	564.0
HEALTH NET HMO & PPO	N900	Non-covered Services	37.0
HEALTH NET HMO & PPO	N902	Packaged Services	163.0

Section: Outpatient Payer Specific Charge 13
Payer	APC	Description	Payer Specific Negotiated Charge
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5021	Level 1 Type A ED Visits	85.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5022	Level 2 Type A ED Visits	153.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5023	Level 3 Type A ED Visits	270.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5024	Level 4 Type A ED Visits	623.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5025	Level 5 Type A ED Visits	1114.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	688.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1641.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	3794.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5114	Level 4 Musculoskeletal Procedures	7308.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5115	Level 5 Musculoskeletal Procedures	14525.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5181	Level 1 Vascular Procedures	738.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5182	Level 2 Vascular Procedures	1638.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5183	Level 3 Vascular Procedures	3334.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5191	Level 1 Endovascular Procedures	3382.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5193	Level 3 Endovascular Procedures	11710.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5213	Level 3 Electrophysiologic Procedures	25010.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5222	Level 2 Pacemaker and Similar Procedures	9499.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5223	Level 3 Pacemaker and Similar Procedures	12118.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5232	Level 2 ICD and Similar Procedures	38265.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5241	Level 1 Blood Product Exchange and Related Services	737.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5301	Level 1 Upper GI Procedures	945.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5303	Level 3 Upper GI Procedures	3590.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5312	Level 2 Lower GI Procedures	1680.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5341	Abdominal/Peritoneal/Biliary and Related Procedures	3711.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5361	Level 1 Laparoscopy and Related Services	5896.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5373	Level 3 Urology and Related Services	2089.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5374	Level 4 Urology and Related Services	3584.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5375	Level 5 Urology and Related Services	5143.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5401	Dialysis	2151.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5522	Level 2 Imaging without Contrast	127.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5523	Level 3 Imaging without Contrast	268.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5524	Level 4 Imaging without Contrast	563.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5571	Level 1 Imaging with Contrast	208.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5572	Level 2 Imaging with Contrast	845.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5593	Level 3 Nuclear Medicine and Related Services	2290.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5594	Level 4 Nuclear Medicine and Related Services	1729.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5672	Level 2 Pathology	177.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5722	Level 2 Diagnostic Tests and Related Services	364.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5731	Level 1 Minor Procedures	29.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5771	Cardiac Rehabilitation	676.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5781	Resuscitation and Cardioversion	786.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	N801	Therapy Services	553.0

Section: Outpatient Payer Specific Charge 14
Payer	APC	Description	Payer Specific Negotiated Charge
KAISER SENIOR NON-CONTRACTED	5021	Level 1 Type A ED Visits	85.0
KAISER SENIOR NON-CONTRACTED	5022	Level 2 Type A ED Visits	153.0
KAISER SENIOR NON-CONTRACTED	5023	Level 3 Type A ED Visits	270.0
KAISER SENIOR NON-CONTRACTED	5024	Level 4 Type A ED Visits	432.0
KAISER SENIOR NON-CONTRACTED	5025	Level 5 Type A ED Visits	1067.0

Section: Outpatient Payer Specific Charge 15
Payer	APC	Description	Payer Specific Negotiated Charge
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5021	Level 1 Type A ED Visits	98.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5022	Level 2 Type A ED Visits	198.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5023	Level 3 Type A ED Visits	394.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5024	Level 4 Type A ED Visits	691.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5025	Level 5 Type A ED Visits	986.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5054	Level 4 Skin Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5112	Level 2 Musculoskeletal Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5114	Level 4 Musculoskeletal Procedures	4159.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5115	Level 5 Musculoskeletal Procedures	7455.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5116	Level 6 Musculoskeletal Procedures	16838.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5155	Level 5 Airway Endoscopy	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5181	Level 1 Vascular Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5182	Level 2 Vascular Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5183	Level 3 Vascular Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5191	Level 1 Endovascular Procedures	2231.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5193	Level 3 Endovascular Procedures	5245.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5213	Level 3 Electrophysiologic Procedures	2231.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5222	Level 2 Pacemaker and Similar Procedures	5402.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5223	Level 3 Pacemaker and Similar Procedures	9296.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5232	Level 2 ICD and Similar Procedures	36815.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5241	Level 1 Blood Product Exchange and Related Services	1507.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5301	Level 1 Upper GI Procedures	1030.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5302	Level 2 Upper GI Procedures	1030.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5311	Level 1 Lower GI Procedures	1030.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5312	Level 2 Lower GI Procedures	1030.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5341	Abdominal/Peritoneal/Biliary and Related Procedures	2145.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5361	Level 1 Laparoscopy and Related Services	2195.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5362	Level 2 Laparoscopy and Related Services	2093.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5371	Level 1 Urology and Related Services	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5373	Level 3 Urology and Related Services	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5374	Level 4 Urology and Related Services	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5375	Level 5 Urology and Related Services	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5401	Dialysis	986.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5414	Level 4 Gynecologic Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5415	Level 5 Gynecologic Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5441	Level 1 Nerve Injections	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5442	Level 2 Nerve Injections	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5465	Level 5 Neurostimulator and Related Procedures	27899.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5524	Level 4 Imaging without Contrast	2231.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5573	Level 3 Imaging with Contrast	1507.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5593	Level 3 Nuclear Medicine and Related Services	986.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5672	Level 2 Pathology	21.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5692	Level 2 Drug Administration	369.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5693	Level 3 Drug Administration	663.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5694	Level 4 Drug Administration	1507.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5722	Level 2 Diagnostic Tests and Related Services	1507.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5723	Level 3 Diagnostic Tests and Related Services	1030.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5731	Level 1 Minor Procedures	277.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5733	Level 3 Minor Procedures	1507.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5734	Level 4 Minor Procedures	421.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5771	Cardiac Rehabilitation	1772.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5781	Resuscitation and Cardioversion	1507.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	N801	Therapy Services	937.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	N902	Packaged Services	550.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	N905	Not Recognized by OPPS	313.0

Section: Outpatient Payer Specific Charge 16
Payer	APC	Description	Payer Specific Negotiated Charge
MONARCH HEALTH PLAN SENIOR	5021	Level 1 Type A ED Visits	85.0
MONARCH HEALTH PLAN SENIOR	5022	Level 2 Type A ED Visits	153.0
MONARCH HEALTH PLAN SENIOR	5023	Level 3 Type A ED Visits	270.0
MONARCH HEALTH PLAN SENIOR	5024	Level 4 Type A ED Visits	551.0
MONARCH HEALTH PLAN SENIOR	5025	Level 5 Type A ED Visits	1131.0
MONARCH HEALTH PLAN SENIOR	5051	Level 1 Skin Procedures	153.0
MONARCH HEALTH PLAN SENIOR	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	725.0
MONARCH HEALTH PLAN SENIOR	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1639.0
MONARCH HEALTH PLAN SENIOR	5115	Level 5 Musculoskeletal Procedures	14494.0
MONARCH HEALTH PLAN SENIOR	5153	Level 3 Airway Endoscopy	1744.0
MONARCH HEALTH PLAN SENIOR	5154	Level 4 Airway Endoscopy	3614.0
MONARCH HEALTH PLAN SENIOR	5181	Level 1 Vascular Procedures	725.0
MONARCH HEALTH PLAN SENIOR	5183	Level 3 Vascular Procedures	3334.0
MONARCH HEALTH PLAN SENIOR	5191	Level 1 Endovascular Procedures	3378.0
MONARCH HEALTH PLAN SENIOR	5193	Level 3 Endovascular Procedures	11718.0
MONARCH HEALTH PLAN SENIOR	5223	Level 3 Pacemaker and Similar Procedures	12118.0
MONARCH HEALTH PLAN SENIOR	5241	Level 1 Blood Product Exchange and Related Services	840.0
MONARCH HEALTH PLAN SENIOR	5301	Level 1 Upper GI Procedures	2553.0
MONARCH HEALTH PLAN SENIOR	5361	Level 1 Laparoscopy and Related Services	5896.0
MONARCH HEALTH PLAN SENIOR	5362	Level 2 Laparoscopy and Related Services	10379.0
MONARCH HEALTH PLAN SENIOR	5371	Level 1 Urology and Related Services	312.0
MONARCH HEALTH PLAN SENIOR	5372	Level 2 Urology and Related Services	674.0
MONARCH HEALTH PLAN SENIOR	5373	Level 3 Urology and Related Services	2089.0
MONARCH HEALTH PLAN SENIOR	5374	Level 4 Urology and Related Services	3592.0
MONARCH HEALTH PLAN SENIOR	5375	Level 5 Urology and Related Services	5143.0
MONARCH HEALTH PLAN SENIOR	5441	Level 1 Nerve Injections	304.0
MONARCH HEALTH PLAN SENIOR	5593	Level 3 Nuclear Medicine and Related Services	2660.0

Section: Outpatient Payer Specific Charge 17
Payer	APC	Description	Payer Specific Negotiated Charge
UNITED HEALTHCARE PREFERRED	5021	Level 1 Type A ED Visits	622.0
UNITED HEALTHCARE PREFERRED	5022	Level 2 Type A ED Visits	1250.0
UNITED HEALTHCARE PREFERRED	5023	Level 3 Type A ED Visits	1324.0
UNITED HEALTHCARE PREFERRED	5024	Level 4 Type A ED Visits	3693.0
UNITED HEALTHCARE PREFERRED	5025	Level 5 Type A ED Visits	3693.0
UNITED HEALTHCARE PREFERRED	5051	Level 1 Skin Procedures	1324.0
UNITED HEALTHCARE PREFERRED	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	1888.0
UNITED HEALTHCARE PREFERRED	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	3024.0
UNITED HEALTHCARE PREFERRED	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	3024.0
UNITED HEALTHCARE PREFERRED	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	6830.0
UNITED HEALTHCARE PREFERRED	5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	9415.0
UNITED HEALTHCARE PREFERRED	5112	Level 2 Musculoskeletal Procedures	1048.0
UNITED HEALTHCARE PREFERRED	5113	Level 3 Musculoskeletal Procedures	7948.0
UNITED HEALTHCARE PREFERRED	5114	Level 4 Musculoskeletal Procedures	12150.0
UNITED HEALTHCARE PREFERRED	5115	Level 5 Musculoskeletal Procedures	29570.0
UNITED HEALTHCARE PREFERRED	5154	Level 4 Airway Endoscopy	3448.0
UNITED HEALTHCARE PREFERRED	5183	Level 3 Vascular Procedures	9066.0
UNITED HEALTHCARE PREFERRED	5191	Level 1 Endovascular Procedures	11562.0
UNITED HEALTHCARE PREFERRED	5193	Level 3 Endovascular Procedures	27075.0
UNITED HEALTHCARE PREFERRED	5241	Level 1 Blood Product Exchange and Related Services	953.0
UNITED HEALTHCARE PREFERRED	5341	Abdominal/Peritoneal/Biliary and Related Procedures	9066.0
UNITED HEALTHCARE PREFERRED	5361	Level 1 Laparoscopy and Related Services	12150.0
UNITED HEALTHCARE PREFERRED	5362	Level 2 Laparoscopy and Related Services	12150.0
UNITED HEALTHCARE PREFERRED	5374	Level 4 Urology and Related Services	8538.0
UNITED HEALTHCARE PREFERRED	5375	Level 5 Urology and Related Services	5836.0
UNITED HEALTHCARE PREFERRED	5411	Level 1 Gynecologic Procedures	1033.0
UNITED HEALTHCARE PREFERRED	5414	Level 4 Gynecologic Procedures	6830.0
UNITED HEALTHCARE PREFERRED	5415	Level 5 Gynecologic Procedures	9066.0
UNITED HEALTHCARE PREFERRED	5441	Level 1 Nerve Injections	699.0
UNITED HEALTHCARE PREFERRED	5465	Level 5 Neurostimulator and Related Procedures	69758.0
UNITED HEALTHCARE PREFERRED	5521	Level 1 Imaging without Contrast	132.0
UNITED HEALTHCARE PREFERRED	5522	Level 2 Imaging without Contrast	123.0
UNITED HEALTHCARE PREFERRED	5523	Level 3 Imaging without Contrast	256.0
UNITED HEALTHCARE PREFERRED	5524	Level 4 Imaging without Contrast	791.0
UNITED HEALTHCARE PREFERRED	5571	Level 1 Imaging with Contrast	200.0
UNITED HEALTHCARE PREFERRED	5572	Level 2 Imaging with Contrast	420.0
UNITED HEALTHCARE PREFERRED	5573	Level 3 Imaging with Contrast	699.0
UNITED HEALTHCARE PREFERRED	5593	Level 3 Nuclear Medicine and Related Services	4085.0
UNITED HEALTHCARE PREFERRED	5594	Level 4 Nuclear Medicine and Related Services	1804.0
UNITED HEALTHCARE PREFERRED	5693	Level 3 Drug Administration	443.0
UNITED HEALTHCARE PREFERRED	5694	Level 4 Drug Administration	6060.0
UNITED HEALTHCARE PREFERRED	5731	Level 1 Minor Procedures	67.0
UNITED HEALTHCARE PREFERRED	5733	Level 3 Minor Procedures	293.0
UNITED HEALTHCARE PREFERRED	5771	Cardiac Rehabilitation	410.0
UNITED HEALTHCARE PREFERRED	5781	Resuscitation and Cardioversion	3711.0
UNITED HEALTHCARE PREFERRED	N700	Non-OPPS Clinic Services	1033.0
UNITED HEALTHCARE PREFERRED	N800	Clinical Diagnostic Lab Services	46.0
UNITED HEALTHCARE PREFERRED	N801	Therapy Services	615.0
UNITED HEALTHCARE PREFERRED	N804	Mammography Services	138.0

Section: Outpatient Payer Specific Charge 18
Payer	APC	Description	Payer Specific Negotiated Charge
UNITED HEALTHCARE SENIOR	5021	Level 1 Type A ED Visits	85.0
UNITED HEALTHCARE SENIOR	5022	Level 2 Type A ED Visits	153.0
UNITED HEALTHCARE SENIOR	5023	Level 3 Type A ED Visits	270.0
UNITED HEALTHCARE SENIOR	5024	Level 4 Type A ED Visits	551.0
UNITED HEALTHCARE SENIOR	5025	Level 5 Type A ED Visits	1114.0
UNITED HEALTHCARE SENIOR	5051	Level 1 Skin Procedures	153.0
UNITED HEALTHCARE SENIOR	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	725.0
UNITED HEALTHCARE SENIOR	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1639.0
UNITED HEALTHCARE SENIOR	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	2761.0
UNITED HEALTHCARE SENIOR	5115	Level 5 Musculoskeletal Procedures	14570.0
UNITED HEALTHCARE SENIOR	5191	Level 1 Endovascular Procedures	3378.0
UNITED HEALTHCARE SENIOR	5193	Level 3 Endovascular Procedures	11715.0
UNITED HEALTHCARE SENIOR	5213	Level 3 Electrophysiologic Procedures	25014.0
UNITED HEALTHCARE SENIOR	5223	Level 3 Pacemaker and Similar Procedures	12118.0
UNITED HEALTHCARE SENIOR	5241	Level 1 Blood Product Exchange and Related Services	840.0
UNITED HEALTHCARE SENIOR	5301	Level 1 Upper GI Procedures	1552.0
UNITED HEALTHCARE SENIOR	5311	Level 1 Lower GI Procedures	2478.0
UNITED HEALTHCARE SENIOR	5361	Level 1 Laparoscopy and Related Services	5896.0
UNITED HEALTHCARE SENIOR	5373	Level 3 Urology and Related Services	2097.0
UNITED HEALTHCARE SENIOR	5374	Level 4 Urology and Related Services	3584.0
UNITED HEALTHCARE SENIOR	5375	Level 5 Urology and Related Services	5147.0
UNITED HEALTHCARE SENIOR	5463	Level 3 Neurostimulator and Related Procedures	13092.0
UNITED HEALTHCARE SENIOR	5521	Level 1 Imaging without Contrast	94.0
UNITED HEALTHCARE SENIOR	5522	Level 2 Imaging without Contrast	127.0
UNITED HEALTHCARE SENIOR	5523	Level 3 Imaging without Contrast	268.0
UNITED HEALTHCARE SENIOR	5524	Level 4 Imaging without Contrast	563.0
UNITED HEALTHCARE SENIOR	5571	Level 1 Imaging with Contrast	208.0
UNITED HEALTHCARE SENIOR	5572	Level 2 Imaging with Contrast	437.0
UNITED HEALTHCARE SENIOR	5591	Level 1 Nuclear Medicine and Related Services	946.0
UNITED HEALTHCARE SENIOR	5593	Level 3 Nuclear Medicine and Related Services	2674.0
UNITED HEALTHCARE SENIOR	5594	Level 4 Nuclear Medicine and Related Services	1729.0
UNITED HEALTHCARE SENIOR	5693	Level 3 Drug Administration	746.0
UNITED HEALTHCARE SENIOR	5722	Level 2 Diagnostic Tests and Related Services	308.0
UNITED HEALTHCARE SENIOR	5731	Level 1 Minor Procedures	29.0
UNITED HEALTHCARE SENIOR	5771	Cardiac Rehabilitation	811.0
UNITED HEALTHCARE SENIOR	5781	Resuscitation and Cardioversion	1217.0
UNITED HEALTHCARE SENIOR	N801	Therapy Services	378.0
UNITED HEALTHCARE SENIOR	N804	Mammography Services	113.0

Section: Outpatient Payer Specific Charge 19
Payer	APC	Description	Payer Specific Negotiated Charge
AETNA WHOLE HEALTH HMO	5022	Level 2 Type A ED Visits	1250.0
AETNA WHOLE HEALTH HMO	5023	Level 3 Type A ED Visits	1713.0
AETNA WHOLE HEALTH HMO	5024	Level 4 Type A ED Visits	1715.0
AETNA WHOLE HEALTH HMO	5025	Level 5 Type A ED Visits	1735.0
AETNA WHOLE HEALTH HMO	5114	Level 4 Musculoskeletal Procedures	2636.0
AETNA WHOLE HEALTH HMO	5361	Level 1 Laparoscopy and Related Services	1322.0
AETNA WHOLE HEALTH HMO	5362	Level 2 Laparoscopy and Related Services	2767.0
AETNA WHOLE HEALTH HMO	5521	Level 1 Imaging without Contrast	525.0
AETNA WHOLE HEALTH HMO	5522	Level 2 Imaging without Contrast	564.0
AETNA WHOLE HEALTH HMO	5523	Level 3 Imaging without Contrast	595.0
AETNA WHOLE HEALTH HMO	5571	Level 1 Imaging with Contrast	917.0
AETNA WHOLE HEALTH HMO	5572	Level 2 Imaging with Contrast	595.0
AETNA WHOLE HEALTH HMO	5692	Level 2 Drug Administration	8759.0
AETNA WHOLE HEALTH HMO	5694	Level 4 Drug Administration	2397.0
AETNA WHOLE HEALTH HMO	5731	Level 1 Minor Procedures	222.0
AETNA WHOLE HEALTH HMO	N800	Clinical Diagnostic Lab Services	165.0
AETNA WHOLE HEALTH HMO	N801	Therapy Services	992.0
AETNA WHOLE HEALTH HMO	N804	Mammography Services	447.0
AETNA WHOLE HEALTH HMO	N902	Packaged Services	87.0

Section: Outpatient Payer Specific Charge 20
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE CROSS SENIOR	5022	Level 2 Type A ED Visits	153.0
BLUE CROSS SENIOR	5023	Level 3 Type A ED Visits	270.0
BLUE CROSS SENIOR	5024	Level 4 Type A ED Visits	551.0
BLUE CROSS SENIOR	5025	Level 5 Type A ED Visits	1099.0
BLUE CROSS SENIOR	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	6448.0
BLUE CROSS SENIOR	5114	Level 4 Musculoskeletal Procedures	7436.0
BLUE CROSS SENIOR	5115	Level 5 Musculoskeletal Procedures	14457.0
BLUE CROSS SENIOR	5191	Level 1 Endovascular Procedures	3380.0
BLUE CROSS SENIOR	5241	Level 1 Blood Product Exchange and Related Services	840.0
BLUE CROSS SENIOR	5371	Level 1 Urology and Related Services	580.0
BLUE CROSS SENIOR	5375	Level 5 Urology and Related Services	5143.0
BLUE CROSS SENIOR	5521	Level 1 Imaging without Contrast	94.0
BLUE CROSS SENIOR	5522	Level 2 Imaging without Contrast	127.0
BLUE CROSS SENIOR	5523	Level 3 Imaging without Contrast	268.0
BLUE CROSS SENIOR	5524	Level 4 Imaging without Contrast	563.0
BLUE CROSS SENIOR	5571	Level 1 Imaging with Contrast	208.0
BLUE CROSS SENIOR	5572	Level 2 Imaging with Contrast	429.0
BLUE CROSS SENIOR	5592	Level 2 Nuclear Medicine and Related Services	570.0
BLUE CROSS SENIOR	5593	Level 3 Nuclear Medicine and Related Services	2238.0
BLUE CROSS SENIOR	5594	Level 4 Nuclear Medicine and Related Services	1729.0
BLUE CROSS SENIOR	5731	Level 1 Minor Procedures	29.0
BLUE CROSS SENIOR	5771	Cardiac Rehabilitation	1023.0
BLUE CROSS SENIOR	N801	Therapy Services	397.0
BLUE CROSS SENIOR	N804	Mammography Services	113.0

Section: Outpatient Payer Specific Charge 21
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE SHIELD COVERED CALIFORNIA	5022	Level 2 Type A ED Visits	589.0
BLUE SHIELD COVERED CALIFORNIA	5023	Level 3 Type A ED Visits	1275.0
BLUE SHIELD COVERED CALIFORNIA	5024	Level 4 Type A ED Visits	2604.0
BLUE SHIELD COVERED CALIFORNIA	5025	Level 5 Type A ED Visits	5557.0
BLUE SHIELD COVERED CALIFORNIA	5051	Level 1 Skin Procedures	878.0
BLUE SHIELD COVERED CALIFORNIA	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	1090.0
BLUE SHIELD COVERED CALIFORNIA	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	4725.0
BLUE SHIELD COVERED CALIFORNIA	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	1090.0
BLUE SHIELD COVERED CALIFORNIA	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	2513.0
BLUE SHIELD COVERED CALIFORNIA	5113	Level 3 Musculoskeletal Procedures	6677.0
BLUE SHIELD COVERED CALIFORNIA	5114	Level 4 Musculoskeletal Procedures	3489.0
BLUE SHIELD COVERED CALIFORNIA	5115	Level 5 Musculoskeletal Procedures	13749.0
BLUE SHIELD COVERED CALIFORNIA	5183	Level 3 Vascular Procedures	7591.0
BLUE SHIELD COVERED CALIFORNIA	5191	Level 1 Endovascular Procedures	10540.0
BLUE SHIELD COVERED CALIFORNIA	5241	Level 1 Blood Product Exchange and Related Services	1090.0
BLUE SHIELD COVERED CALIFORNIA	5301	Level 1 Upper GI Procedures	3531.0
BLUE SHIELD COVERED CALIFORNIA	5303	Level 3 Upper GI Procedures	7873.0
BLUE SHIELD COVERED CALIFORNIA	5361	Level 1 Laparoscopy and Related Services	6677.0
BLUE SHIELD COVERED CALIFORNIA	5362	Level 2 Laparoscopy and Related Services	7591.0
BLUE SHIELD COVERED CALIFORNIA	5375	Level 5 Urology and Related Services	6677.0
BLUE SHIELD COVERED CALIFORNIA	5441	Level 1 Nerve Injections	1090.0
BLUE SHIELD COVERED CALIFORNIA	5521	Level 1 Imaging without Contrast	381.0
BLUE SHIELD COVERED CALIFORNIA	5522	Level 2 Imaging without Contrast	634.0
BLUE SHIELD COVERED CALIFORNIA	5523	Level 3 Imaging without Contrast	2884.0
BLUE SHIELD COVERED CALIFORNIA	5524	Level 4 Imaging without Contrast	2549.0
BLUE SHIELD COVERED CALIFORNIA	5571	Level 1 Imaging with Contrast	615.0
BLUE SHIELD COVERED CALIFORNIA	5572	Level 2 Imaging with Contrast	4148.0
BLUE SHIELD COVERED CALIFORNIA	5591	Level 1 Nuclear Medicine and Related Services	1181.0
BLUE SHIELD COVERED CALIFORNIA	5592	Level 2 Nuclear Medicine and Related Services	1185.0
BLUE SHIELD COVERED CALIFORNIA	5593	Level 3 Nuclear Medicine and Related Services	4181.0
BLUE SHIELD COVERED CALIFORNIA	5594	Level 4 Nuclear Medicine and Related Services	9537.0
BLUE SHIELD COVERED CALIFORNIA	5672	Level 2 Pathology	302.0
BLUE SHIELD COVERED CALIFORNIA	5692	Level 2 Drug Administration	460.0
BLUE SHIELD COVERED CALIFORNIA	5693	Level 3 Drug Administration	1183.0
BLUE SHIELD COVERED CALIFORNIA	5694	Level 4 Drug Administration	4870.0
BLUE SHIELD COVERED CALIFORNIA	5722	Level 2 Diagnostic Tests and Related Services	1018.0
BLUE SHIELD COVERED CALIFORNIA	5723	Level 3 Diagnostic Tests and Related Services	4815.0
BLUE SHIELD COVERED CALIFORNIA	5731	Level 1 Minor Procedures	302.0
BLUE SHIELD COVERED CALIFORNIA	5733	Level 3 Minor Procedures	116.0
BLUE SHIELD COVERED CALIFORNIA	5734	Level 4 Minor Procedures	644.0
BLUE SHIELD COVERED CALIFORNIA	5771	Cardiac Rehabilitation	1929.0
BLUE SHIELD COVERED CALIFORNIA	5781	Resuscitation and Cardioversion	8722.0
BLUE SHIELD COVERED CALIFORNIA	N700	Non-OPPS Clinic Services	544.0
BLUE SHIELD COVERED CALIFORNIA	N800	Clinical Diagnostic Lab Services	225.0
BLUE SHIELD COVERED CALIFORNIA	N801	Therapy Services	1044.0
BLUE SHIELD COVERED CALIFORNIA	N804	Mammography Services	777.0
BLUE SHIELD COVERED CALIFORNIA	N902	Packaged Services	69.0
BLUE SHIELD COVERED CALIFORNIA	N905	Not Recognized by OPPS	171.0

Section: Outpatient Payer Specific Charge 22
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE SHIELD HMO	5022	Level 2 Type A ED Visits	740.0
BLUE SHIELD HMO	5023	Level 3 Type A ED Visits	1518.0
BLUE SHIELD HMO	5024	Level 4 Type A ED Visits	3435.0
BLUE SHIELD HMO	5025	Level 5 Type A ED Visits	6409.0
BLUE SHIELD HMO	5051	Level 1 Skin Procedures	1126.0
BLUE SHIELD HMO	5055	Level 5 Skin Procedures	5830.0
BLUE SHIELD HMO	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	1424.0
BLUE SHIELD HMO	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	6169.0
BLUE SHIELD HMO	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	7050.0
BLUE SHIELD HMO	5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	4549.0
BLUE SHIELD HMO	5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	9911.0
BLUE SHIELD HMO	5113	Level 3 Musculoskeletal Procedures	4549.0
BLUE SHIELD HMO	5114	Level 4 Musculoskeletal Procedures	3715.0
BLUE SHIELD HMO	5115	Level 5 Musculoskeletal Procedures	8274.0
BLUE SHIELD HMO	5183	Level 3 Vascular Procedures	9911.0
BLUE SHIELD HMO	5191	Level 1 Endovascular Procedures	13761.0
BLUE SHIELD HMO	5213	Level 3 Electrophysiologic Procedures	13761.0
BLUE SHIELD HMO	5241	Level 1 Blood Product Exchange and Related Services	1424.0
BLUE SHIELD HMO	5313	Level 3 Lower GI Procedures	7050.0
BLUE SHIELD HMO	5361	Level 1 Laparoscopy and Related Services	8718.0
BLUE SHIELD HMO	5362	Level 2 Laparoscopy and Related Services	9911.0
BLUE SHIELD HMO	5375	Level 5 Urology and Related Services	4549.0
BLUE SHIELD HMO	5414	Level 4 Gynecologic Procedures	3274.0
BLUE SHIELD HMO	5441	Level 1 Nerve Injections	1424.0
BLUE SHIELD HMO	5442	Level 2 Nerve Injections	4610.0
BLUE SHIELD HMO	5693	Level 3 Drug Administration	796.0
BLUE SHIELD HMO	5731	Level 1 Minor Procedures	379.0
BLUE SHIELD HMO	N700	Non-OPPS Clinic Services	1067.0
BLUE SHIELD HMO	N800	Clinical Diagnostic Lab Services	283.0

Section: Outpatient Payer Specific Charge 23
Payer	APC	Description	Payer Specific Negotiated Charge
HEALTH NET ENHANCED PPO	5022	Level 2 Type A ED Visits	693.0
HEALTH NET ENHANCED PPO	5023	Level 3 Type A ED Visits	1674.0
HEALTH NET ENHANCED PPO	5024	Level 4 Type A ED Visits	3352.0
HEALTH NET ENHANCED PPO	5025	Level 5 Type A ED Visits	4790.0
HEALTH NET ENHANCED PPO	5361	Level 1 Laparoscopy and Related Services	9646.0
HEALTH NET ENHANCED PPO	5362	Level 2 Laparoscopy and Related Services	17170.0
HEALTH NET ENHANCED PPO	5411	Level 1 Gynecologic Procedures	777.0
HEALTH NET ENHANCED PPO	5521	Level 1 Imaging without Contrast	269.0
HEALTH NET ENHANCED PPO	5522	Level 2 Imaging without Contrast	699.0
HEALTH NET ENHANCED PPO	5524	Level 4 Imaging without Contrast	2865.0
HEALTH NET ENHANCED PPO	5571	Level 1 Imaging with Contrast	1839.0
HEALTH NET ENHANCED PPO	5572	Level 2 Imaging with Contrast	2695.0
HEALTH NET ENHANCED PPO	5594	Level 4 Nuclear Medicine and Related Services	4848.0
HEALTH NET ENHANCED PPO	5731	Level 1 Minor Procedures	196.0
HEALTH NET ENHANCED PPO	5781	Resuscitation and Cardioversion	3148.0
HEALTH NET ENHANCED PPO	N800	Clinical Diagnostic Lab Services	146.0
HEALTH NET ENHANCED PPO	N801	Therapy Services	656.0
HEALTH NET ENHANCED PPO	N804	Mammography Services	395.0

Section: Outpatient Payer Specific Charge 24
Payer	APC	Description	Payer Specific Negotiated Charge
HEALTH NET MEDI-CAL	5022	Level 2 Type A ED Visits	41.0
HEALTH NET MEDI-CAL	5023	Level 3 Type A ED Visits	82.0
HEALTH NET MEDI-CAL	5024	Level 4 Type A ED Visits	194.0
HEALTH NET MEDI-CAL	5025	Level 5 Type A ED Visits	410.0

Section: Outpatient Payer Specific Charge 25
Payer	APC	Description	Payer Specific Negotiated Charge
HEALTHCARE PARTNERS COMMERCIAL	5022	Level 2 Type A ED Visits	317.0
HEALTHCARE PARTNERS COMMERCIAL	5023	Level 3 Type A ED Visits	559.0
HEALTHCARE PARTNERS COMMERCIAL	5024	Level 4 Type A ED Visits	1117.0
HEALTHCARE PARTNERS COMMERCIAL	5025	Level 5 Type A ED Visits	2208.0
HEALTHCARE PARTNERS COMMERCIAL	5051	Level 1 Skin Procedures	317.0
HEALTHCARE PARTNERS COMMERCIAL	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	3394.0
HEALTHCARE PARTNERS COMMERCIAL	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	7855.0
HEALTHCARE PARTNERS COMMERCIAL	5114	Level 4 Musculoskeletal Procedures	15116.0
HEALTHCARE PARTNERS COMMERCIAL	5183	Level 3 Vascular Procedures	6902.0
HEALTHCARE PARTNERS COMMERCIAL	5191	Level 1 Endovascular Procedures	7020.0
HEALTHCARE PARTNERS COMMERCIAL	5241	Level 1 Blood Product Exchange and Related Services	1543.0
HEALTHCARE PARTNERS COMMERCIAL	5301	Level 1 Upper GI Procedures	2170.0
HEALTHCARE PARTNERS COMMERCIAL	5361	Level 1 Laparoscopy and Related Services	12205.0
HEALTHCARE PARTNERS COMMERCIAL	5373	Level 3 Urology and Related Services	4325.0
HEALTHCARE PARTNERS COMMERCIAL	5375	Level 5 Urology and Related Services	10646.0
HEALTHCARE PARTNERS COMMERCIAL	5411	Level 1 Gynecologic Procedures	411.0
HEALTHCARE PARTNERS COMMERCIAL	5522	Level 2 Imaging without Contrast	461.0
HEALTHCARE PARTNERS COMMERCIAL	5571	Level 1 Imaging with Contrast	431.0
HEALTHCARE PARTNERS COMMERCIAL	5572	Level 2 Imaging with Contrast	888.0
HEALTHCARE PARTNERS COMMERCIAL	5591	Level 1 Nuclear Medicine and Related Services	910.0
HEALTHCARE PARTNERS COMMERCIAL	5592	Level 2 Nuclear Medicine and Related Services	1180.0
HEALTHCARE PARTNERS COMMERCIAL	5593	Level 3 Nuclear Medicine and Related Services	5095.0
HEALTHCARE PARTNERS COMMERCIAL	5722	Level 2 Diagnostic Tests and Related Services	753.0
HEALTHCARE PARTNERS COMMERCIAL	5731	Level 1 Minor Procedures	59.0
HEALTHCARE PARTNERS COMMERCIAL	5771	Cardiac Rehabilitation	1680.0
HEALTHCARE PARTNERS COMMERCIAL	N700	Non-OPPS Clinic Services	239.0
HEALTHCARE PARTNERS COMMERCIAL	N800	Clinical Diagnostic Lab Services	123.0
HEALTHCARE PARTNERS COMMERCIAL	N801	Therapy Services	855.0
HEALTHCARE PARTNERS COMMERCIAL	N804	Mammography Services	297.0

Section: Outpatient Payer Specific Charge 26
Payer	APC	Description	Payer Specific Negotiated Charge
HERITAGE PROVIDER NETWORK HMO	5022	Level 2 Type A ED Visits	794.0
HERITAGE PROVIDER NETWORK HMO	5023	Level 3 Type A ED Visits	1609.0
HERITAGE PROVIDER NETWORK HMO	5024	Level 4 Type A ED Visits	3840.0
HERITAGE PROVIDER NETWORK HMO	5025	Level 5 Type A ED Visits	5026.0
HERITAGE PROVIDER NETWORK HMO	5114	Level 4 Musculoskeletal Procedures	3892.0
HERITAGE PROVIDER NETWORK HMO	5191	Level 1 Endovascular Procedures	3892.0
HERITAGE PROVIDER NETWORK HMO	5301	Level 1 Upper GI Procedures	3728.0
HERITAGE PROVIDER NETWORK HMO	5361	Level 1 Laparoscopy and Related Services	2850.0
HERITAGE PROVIDER NETWORK HMO	5362	Level 2 Laparoscopy and Related Services	3892.0
HERITAGE PROVIDER NETWORK HMO	5375	Level 5 Urology and Related Services	4018.0
HERITAGE PROVIDER NETWORK HMO	5411	Level 1 Gynecologic Procedures	1344.0
HERITAGE PROVIDER NETWORK HMO	5414	Level 4 Gynecologic Procedures	1582.0
HERITAGE PROVIDER NETWORK HMO	5415	Level 5 Gynecologic Procedures	1582.0
HERITAGE PROVIDER NETWORK HMO	5522	Level 2 Imaging without Contrast	1275.0
HERITAGE PROVIDER NETWORK HMO	5571	Level 1 Imaging with Contrast	3558.0
HERITAGE PROVIDER NETWORK HMO	5593	Level 3 Nuclear Medicine and Related Services	3892.0
HERITAGE PROVIDER NETWORK HMO	5672	Level 2 Pathology	839.0
HERITAGE PROVIDER NETWORK HMO	5731	Level 1 Minor Procedures	339.0
HERITAGE PROVIDER NETWORK HMO	5771	Cardiac Rehabilitation	774.0
HERITAGE PROVIDER NETWORK HMO	N700	Non-OPPS Clinic Services	699.0
HERITAGE PROVIDER NETWORK HMO	N800	Clinical Diagnostic Lab Services	190.0
HERITAGE PROVIDER NETWORK HMO	N801	Therapy Services	1012.0

Section: Outpatient Payer Specific Charge 27
Payer	APC	Description	Payer Specific Negotiated Charge
HERITAGE PROVIDER NETWORK SENIOR	5022	Level 2 Type A ED Visits	184.0
HERITAGE PROVIDER NETWORK SENIOR	5023	Level 3 Type A ED Visits	324.0
HERITAGE PROVIDER NETWORK SENIOR	5024	Level 4 Type A ED Visits	622.0
HERITAGE PROVIDER NETWORK SENIOR	5025	Level 5 Type A ED Visits	1255.0
HERITAGE PROVIDER NETWORK SENIOR	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	787.0
HERITAGE PROVIDER NETWORK SENIOR	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1639.0
HERITAGE PROVIDER NETWORK SENIOR	5115	Level 5 Musculoskeletal Procedures	14515.0
HERITAGE PROVIDER NETWORK SENIOR	5184	Level 4 Vascular Procedures	5570.0
HERITAGE PROVIDER NETWORK SENIOR	5191	Level 1 Endovascular Procedures	3391.0
HERITAGE PROVIDER NETWORK SENIOR	5193	Level 3 Endovascular Procedures	11731.0
HERITAGE PROVIDER NETWORK SENIOR	5301	Level 1 Upper GI Procedures	1048.0
HERITAGE PROVIDER NETWORK SENIOR	5361	Level 1 Laparoscopy and Related Services	5904.0
HERITAGE PROVIDER NETWORK SENIOR	5362	Level 2 Laparoscopy and Related Services	10379.0
HERITAGE PROVIDER NETWORK SENIOR	5374	Level 4 Urology and Related Services	3584.0
HERITAGE PROVIDER NETWORK SENIOR	5375	Level 5 Urology and Related Services	5143.0
HERITAGE PROVIDER NETWORK SENIOR	5571	Level 1 Imaging with Contrast	208.0
HERITAGE PROVIDER NETWORK SENIOR	5572	Level 2 Imaging with Contrast	556.0
HERITAGE PROVIDER NETWORK SENIOR	5593	Level 3 Nuclear Medicine and Related Services	1522.0
HERITAGE PROVIDER NETWORK SENIOR	5672	Level 2 Pathology	177.0
HERITAGE PROVIDER NETWORK SENIOR	5722	Level 2 Diagnostic Tests and Related Services	308.0
HERITAGE PROVIDER NETWORK SENIOR	5731	Level 1 Minor Procedures	29.0
HERITAGE PROVIDER NETWORK SENIOR	5771	Cardiac Rehabilitation	947.0
HERITAGE PROVIDER NETWORK SENIOR	5781	Resuscitation and Cardioversion	938.0
HERITAGE PROVIDER NETWORK SENIOR	N801	Therapy Services	378.0

Section: Outpatient Payer Specific Charge 28
Payer	APC	Description	Payer Specific Negotiated Charge
KAISER COMMERCIAL NON-CONTRACTED	5022	Level 2 Type A ED Visits	1125.0
KAISER COMMERCIAL NON-CONTRACTED	5023	Level 3 Type A ED Visits	2281.0
KAISER COMMERCIAL NON-CONTRACTED	5024	Level 4 Type A ED Visits	5096.0
KAISER COMMERCIAL NON-CONTRACTED	5025	Level 5 Type A ED Visits	10693.0
KAISER COMMERCIAL NON-CONTRACTED	5051	Level 1 Skin Procedures	1709.0
KAISER COMMERCIAL NON-CONTRACTED	5112	Level 2 Musculoskeletal Procedures	8476.0
KAISER COMMERCIAL NON-CONTRACTED	5593	Level 3 Nuclear Medicine and Related Services	41894.0
KAISER COMMERCIAL NON-CONTRACTED	5731	Level 1 Minor Procedures	577.0
KAISER COMMERCIAL NON-CONTRACTED	N800	Clinical Diagnostic Lab Services	430.0

Section: Outpatient Payer Specific Charge 29
Payer	APC	Description	Payer Specific Negotiated Charge
MEMORIALCARE MEDICAL FOUNDATION-GNP	5022	Level 2 Type A ED Visits	491.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5023	Level 3 Type A ED Visits	491.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5024	Level 4 Type A ED Visits	491.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5025	Level 5 Type A ED Visits	491.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	2769.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	2769.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	2769.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5114	Level 4 Musculoskeletal Procedures	2769.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5115	Level 5 Musculoskeletal Procedures	2769.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5183	Level 3 Vascular Procedures	2769.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5191	Level 1 Endovascular Procedures	2769.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5193	Level 3 Endovascular Procedures	2769.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5213	Level 3 Electrophysiologic Procedures	2769.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5241	Level 1 Blood Product Exchange and Related Services	1478.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5361	Level 1 Laparoscopy and Related Services	2769.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5362	Level 2 Laparoscopy and Related Services	2769.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5375	Level 5 Urology and Related Services	2769.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5441	Level 1 Nerve Injections	2769.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5731	Level 1 Minor Procedures	129.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5781	Resuscitation and Cardioversion	661.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	N801	Therapy Services	434.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	N902	Packaged Services	111.0

Section: Outpatient Payer Specific Charge 30
Payer	APC	Description	Payer Specific Negotiated Charge
MONARCH HEALTH PLAN COMMERCIAL	5022	Level 2 Type A ED Visits	307.0
MONARCH HEALTH PLAN COMMERCIAL	5023	Level 3 Type A ED Visits	540.0
MONARCH HEALTH PLAN COMMERCIAL	5024	Level 4 Type A ED Visits	951.0
MONARCH HEALTH PLAN COMMERCIAL	5025	Level 5 Type A ED Visits	2151.0
MONARCH HEALTH PLAN COMMERCIAL	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	3282.0
MONARCH HEALTH PLAN COMMERCIAL	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	7581.0
MONARCH HEALTH PLAN COMMERCIAL	5115	Level 5 Musculoskeletal Procedures	29060.0
MONARCH HEALTH PLAN COMMERCIAL	5183	Level 3 Vascular Procedures	6675.0
MONARCH HEALTH PLAN COMMERCIAL	5241	Level 1 Blood Product Exchange and Related Services	1681.0
MONARCH HEALTH PLAN COMMERCIAL	5361	Level 1 Laparoscopy and Related Services	11804.0
MONARCH HEALTH PLAN COMMERCIAL	5362	Level 2 Laparoscopy and Related Services	20779.0
MONARCH HEALTH PLAN COMMERCIAL	5373	Level 3 Urology and Related Services	4182.0
MONARCH HEALTH PLAN COMMERCIAL	5375	Level 5 Urology and Related Services	10296.0
MONARCH HEALTH PLAN COMMERCIAL	5411	Level 1 Gynecologic Procedures	397.0
MONARCH HEALTH PLAN COMMERCIAL	5593	Level 3 Nuclear Medicine and Related Services	5415.0
MONARCH HEALTH PLAN COMMERCIAL	5693	Level 3 Drug Administration	475.0
MONARCH HEALTH PLAN COMMERCIAL	5731	Level 1 Minor Procedures	58.0
MONARCH HEALTH PLAN COMMERCIAL	N700	Non-OPPS Clinic Services	105.0

Section: Outpatient Payer Specific Charge 31
Payer	APC	Description	Payer Specific Negotiated Charge
TRICARE WEST	5022	Level 2 Type A ED Visits	129.0
TRICARE WEST	5023	Level 3 Type A ED Visits	282.0
TRICARE WEST	5024	Level 4 Type A ED Visits	620.0
TRICARE WEST	5025	Level 5 Type A ED Visits	1558.0
TRICARE WEST	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	2514.0
TRICARE WEST	5361	Level 1 Laparoscopy and Related Services	3568.0
TRICARE WEST	5362	Level 2 Laparoscopy and Related Services	6297.0
TRICARE WEST	5411	Level 1 Gynecologic Procedures	143.0
TRICARE WEST	5521	Level 1 Imaging without Contrast	95.0
TRICARE WEST	5522	Level 2 Imaging without Contrast	308.0
TRICARE WEST	5523	Level 3 Imaging without Contrast	770.0
TRICARE WEST	5571	Level 1 Imaging with Contrast	829.0
TRICARE WEST	5572	Level 2 Imaging with Contrast	996.0
TRICARE WEST	5593	Level 3 Nuclear Medicine and Related Services	4116.0
TRICARE WEST	5731	Level 1 Minor Procedures	65.0
TRICARE WEST	N700	Non-OPPS Clinic Services	150.0
TRICARE WEST	N801	Therapy Services	307.0
TRICARE WEST	N804	Mammography Services	142.0

Section: Outpatient Payer Specific Charge 32
Payer	APC	Description	Payer Specific Negotiated Charge
AETNA PPO	5023	Level 3 Type A ED Visits	2659.0
AETNA PPO	5024	Level 4 Type A ED Visits	2683.0
AETNA PPO	5025	Level 5 Type A ED Visits	2681.0
AETNA PPO	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	2269.0
AETNA PPO	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	2743.0
AETNA PPO	5241	Level 1 Blood Product Exchange and Related Services	2269.0
AETNA PPO	5361	Level 1 Laparoscopy and Related Services	3065.0
AETNA PPO	5521	Level 1 Imaging without Contrast	519.0
AETNA PPO	5522	Level 2 Imaging without Contrast	1098.0
AETNA PPO	5523	Level 3 Imaging without Contrast	955.0
AETNA PPO	5524	Level 4 Imaging without Contrast	5171.0
AETNA PPO	5572	Level 2 Imaging with Contrast	955.0
AETNA PPO	5693	Level 3 Drug Administration	888.0
AETNA PPO	5694	Level 4 Drug Administration	3872.0
AETNA PPO	5731	Level 1 Minor Procedures	419.0
AETNA PPO	N800	Clinical Diagnostic Lab Services	313.0
AETNA PPO	N801	Therapy Services	1845.0
AETNA PPO	N804	Mammography Services	703.0

Section: Outpatient Payer Specific Charge 33
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE CROSS EXCHANGE	5023	Level 3 Type A ED Visits	411.0
BLUE CROSS EXCHANGE	5024	Level 4 Type A ED Visits	658.0
BLUE CROSS EXCHANGE	5025	Level 5 Type A ED Visits	1387.0
BLUE CROSS EXCHANGE	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	1125.0
BLUE CROSS EXCHANGE	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	2496.0
BLUE CROSS EXCHANGE	5361	Level 1 Laparoscopy and Related Services	8976.0
BLUE CROSS EXCHANGE	5362	Level 2 Laparoscopy and Related Services	15800.0
BLUE CROSS EXCHANGE	5692	Level 2 Drug Administration	2776.0
BLUE CROSS EXCHANGE	5694	Level 4 Drug Administration	906.0
BLUE CROSS EXCHANGE	5731	Level 1 Minor Procedures	113.0
BLUE CROSS EXCHANGE	N800	Clinical Diagnostic Lab Services	69.0
BLUE CROSS EXCHANGE	N801	Therapy Services	674.0
BLUE CROSS EXCHANGE	N804	Mammography Services	190.0

Section: Outpatient Payer Specific Charge 34
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE SHIELD SENIOR	5023	Level 3 Type A ED Visits	270.0
BLUE SHIELD SENIOR	5024	Level 4 Type A ED Visits	551.0
BLUE SHIELD SENIOR	5025	Level 5 Type A ED Visits	886.0
BLUE SHIELD SENIOR	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1639.0
BLUE SHIELD SENIOR	5183	Level 3 Vascular Procedures	3338.0
BLUE SHIELD SENIOR	5374	Level 4 Urology and Related Services	3584.0
BLUE SHIELD SENIOR	5375	Level 5 Urology and Related Services	5143.0
BLUE SHIELD SENIOR	5463	Level 3 Neurostimulator and Related Procedures	13092.0
BLUE SHIELD SENIOR	5524	Level 4 Imaging without Contrast	563.0
BLUE SHIELD SENIOR	5593	Level 3 Nuclear Medicine and Related Services	2667.0
BLUE SHIELD SENIOR	5731	Level 1 Minor Procedures	29.0

Section: Outpatient Payer Specific Charge 35
Payer	APC	Description	Payer Specific Negotiated Charge
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5023	Level 3 Type A ED Visits	75.0

Section: Outpatient Payer Specific Charge 36
Payer	APC	Description	Payer Specific Negotiated Charge
CAREMORE SENIOR	5023	Level 3 Type A ED Visits	270.0
CAREMORE SENIOR	5024	Level 4 Type A ED Visits	551.0
CAREMORE SENIOR	5025	Level 5 Type A ED Visits	1037.0
CAREMORE SENIOR	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1747.0
CAREMORE SENIOR	5113	Level 3 Musculoskeletal Procedures	3306.0
CAREMORE SENIOR	5115	Level 5 Musculoskeletal Procedures	14570.0
CAREMORE SENIOR	5181	Level 1 Vascular Procedures	725.0
CAREMORE SENIOR	5182	Level 2 Vascular Procedures	1642.0
CAREMORE SENIOR	5183	Level 3 Vascular Procedures	3342.0
CAREMORE SENIOR	5184	Level 4 Vascular Procedures	5558.0
CAREMORE SENIOR	5191	Level 1 Endovascular Procedures	3429.0
CAREMORE SENIOR	5361	Level 1 Laparoscopy and Related Services	5896.0
CAREMORE SENIOR	5374	Level 4 Urology and Related Services	3584.0
CAREMORE SENIOR	5375	Level 5 Urology and Related Services	5151.0
CAREMORE SENIOR	5401	Dialysis	2693.0
CAREMORE SENIOR	5441	Level 1 Nerve Injections	304.0
CAREMORE SENIOR	5593	Level 3 Nuclear Medicine and Related Services	2756.0
CAREMORE SENIOR	5731	Level 1 Minor Procedures	29.0
CAREMORE SENIOR	N801	Therapy Services	1026.0

Section: Outpatient Payer Specific Charge 37
Payer	APC	Description	Payer Specific Negotiated Charge
CENTRAL HEALTH SENIOR	5023	Level 3 Type A ED Visits	297.0
CENTRAL HEALTH SENIOR	5024	Level 4 Type A ED Visits	552.0
CENTRAL HEALTH SENIOR	5025	Level 5 Type A ED Visits	1141.0
CENTRAL HEALTH SENIOR	5312	Level 2 Lower GI Procedures	4424.0
CENTRAL HEALTH SENIOR	5593	Level 3 Nuclear Medicine and Related Services	3161.0
CENTRAL HEALTH SENIOR	5731	Level 1 Minor Procedures	32.0

Section: Outpatient Payer Specific Charge 38
Payer	APC	Description	Payer Specific Negotiated Charge
DIGNITY HEALTH MEDI-CAL	5023	Level 3 Type A ED Visits	94.0
DIGNITY HEALTH MEDI-CAL	5024	Level 4 Type A ED Visits	156.0
DIGNITY HEALTH MEDI-CAL	5025	Level 5 Type A ED Visits	617.0

Section: Outpatient Payer Specific Charge 39
Payer	APC	Description	Payer Specific Negotiated Charge
FIRST HEALTH PPO	5023	Level 3 Type A ED Visits	1859.0
FIRST HEALTH PPO	5024	Level 4 Type A ED Visits	2515.0
FIRST HEALTH PPO	5025	Level 5 Type A ED Visits	5028.0
FIRST HEALTH PPO	N804	Mammography Services	678.0

Section: Outpatient Payer Specific Charge 40
Payer	APC	Description	Payer Specific Negotiated Charge
LA CARE HMO/SENIOR	5023	Level 3 Type A ED Visits	275.0

Section: Outpatient Payer Specific Charge 41
Payer	APC	Description	Payer Specific Negotiated Charge
MONARCH HEALTH PLAN COVERED CALIFORNIA	5023	Level 3 Type A ED Visits	405.0

Section: Outpatient Payer Specific Charge 42
Payer	APC	Description	Payer Specific Negotiated Charge
MULTIPLAN COMPLEMENTARY NETWORK	5023	Level 3 Type A ED Visits	1408.0
MULTIPLAN COMPLEMENTARY NETWORK	5024	Level 4 Type A ED Visits	3120.0
MULTIPLAN COMPLEMENTARY NETWORK	5025	Level 5 Type A ED Visits	417.0
MULTIPLAN COMPLEMENTARY NETWORK	5731	Level 1 Minor Procedures	417.0
MULTIPLAN COMPLEMENTARY NETWORK	N800	Clinical Diagnostic Lab Services	311.0

Section: Outpatient Payer Specific Charge 43
Payer	APC	Description	Payer Specific Negotiated Charge
MULTIPLAN PRIMARY NETWORK	5023	Level 3 Type A ED Visits	2139.0
MULTIPLAN PRIMARY NETWORK	5024	Level 4 Type A ED Visits	4196.0
MULTIPLAN PRIMARY NETWORK	5025	Level 5 Type A ED Visits	6657.0
MULTIPLAN PRIMARY NETWORK	5731	Level 1 Minor Procedures	391.0
MULTIPLAN PRIMARY NETWORK	N804	Mammography Services	787.0

Section: Outpatient Payer Specific Charge 44
Payer	APC	Description	Payer Specific Negotiated Charge
SELECT HEALTH COMMERCIAL	5023	Level 3 Type A ED Visits	371.0
SELECT HEALTH COMMERCIAL	5025	Level 5 Type A ED Visits	1524.0
SELECT HEALTH COMMERCIAL	5693	Level 3 Drug Administration	5345.0
SELECT HEALTH COMMERCIAL	5731	Level 1 Minor Procedures	39.0
SELECT HEALTH COMMERCIAL	N800	Clinical Diagnostic Lab Services	69.0
SELECT HEALTH COMMERCIAL	N801	Therapy Services	387.0
SELECT HEALTH COMMERCIAL	N804	Mammography Services	190.0

Section: Outpatient Payer Specific Charge 45
Payer	APC	Description	Payer Specific Negotiated Charge
UNIVERSAL CARE SENIOR	5023	Level 3 Type A ED Visits	270.0
UNIVERSAL CARE SENIOR	5024	Level 4 Type A ED Visits	551.0
UNIVERSAL CARE SENIOR	5025	Level 5 Type A ED Visits	1090.0
UNIVERSAL CARE SENIOR	5731	Level 1 Minor Procedures	29.0

Section: Outpatient Payer Specific Charge 46
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE CROSS MCS	5024	Level 4 Type A ED Visits	1693.0
BLUE CROSS MCS	5025	Level 5 Type A ED Visits	3177.0
BLUE CROSS MCS	5522	Level 2 Imaging without Contrast	636.0
BLUE CROSS MCS	5572	Level 2 Imaging with Contrast	1425.0
BLUE CROSS MCS	5731	Level 1 Minor Procedures	209.0
BLUE CROSS MCS	N804	Mammography Services	315.0

Section: Outpatient Payer Specific Charge 47
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE SHIELD TANDEM PPO	5024	Level 4 Type A ED Visits	2247.0
BLUE SHIELD TANDEM PPO	5521	Level 1 Imaging without Contrast	289.0
BLUE SHIELD TANDEM PPO	5731	Level 1 Minor Procedures	333.0
BLUE SHIELD TANDEM PPO	N804	Mammography Services	849.0

Section: Outpatient Payer Specific Charge 48
Payer	APC	Description	Payer Specific Negotiated Charge
CITIZENS CHOICE	5024	Level 4 Type A ED Visits	424.0
CITIZENS CHOICE	5025	Level 5 Type A ED Visits	830.0
CITIZENS CHOICE	5373	Level 3 Urology and Related Services	2126.0
CITIZENS CHOICE	N801	Therapy Services	365.0

Section: Outpatient Payer Specific Charge 49
Payer	APC	Description	Payer Specific Negotiated Charge
HEALTH NET SENIOR	5024	Level 4 Type A ED Visits	708.0
HEALTH NET SENIOR	5025	Level 5 Type A ED Visits	1107.0

Section: Outpatient Payer Specific Charge 50
Payer	APC	Description	Payer Specific Negotiated Charge
HUMANA CHOICECARE	5024	Level 4 Type A ED Visits	2800.0
HUMANA CHOICECARE	5731	Level 1 Minor Procedures	444.0
HUMANA CHOICECARE	N804	Mammography Services	894.0

Section: Outpatient Payer Specific Charge 51
Payer	APC	Description	Payer Specific Negotiated Charge
HUMANA SENIOR	5024	Level 4 Type A ED Visits	661.0
HUMANA SENIOR	5025	Level 5 Type A ED Visits	986.0
HUMANA SENIOR	N801	Therapy Services	683.0
HUMANA SENIOR	N804	Mammography Services	143.0

Section: Outpatient Payer Specific Charge 52
Payer	APC	Description	Payer Specific Negotiated Charge
LAKEWOOD IPA	5025	Level 5 Type A ED Visits	1472.0
LAKEWOOD IPA	5411	Level 1 Gynecologic Procedures	221.0
LAKEWOOD IPA	5522	Level 2 Imaging without Contrast	286.0
LAKEWOOD IPA	5571	Level 1 Imaging with Contrast	847.0
LAKEWOOD IPA	5593	Level 3 Nuclear Medicine and Related Services	1553.0
LAKEWOOD IPA	5731	Level 1 Minor Procedures	66.0
LAKEWOOD IPA	N801	Therapy Services	401.0
LAKEWOOD IPA	N804	Mammography Services	145.0

Section: Outpatient Payer Specific Charge 53
Payer	APC	Description	Payer Specific Negotiated Charge
TRICARE VETERANS CHOICE	5025	Level 5 Type A ED Visits	1897.0

Section: Outpatient Payer Specific Charge 54
Payer	APC	Description	Payer Specific Negotiated Charge
EDINGER MEDICAL GROUP IPA-GNP	5411	Level 1 Gynecologic Procedures	79.0
EDINGER MEDICAL GROUP IPA-GNP	5521	Level 1 Imaging without Contrast	76.0
EDINGER MEDICAL GROUP IPA-GNP	5522	Level 2 Imaging without Contrast	120.0
EDINGER MEDICAL GROUP IPA-GNP	5523	Level 3 Imaging without Contrast	318.0
EDINGER MEDICAL GROUP IPA-GNP	5524	Level 4 Imaging without Contrast	261.0
EDINGER MEDICAL GROUP IPA-GNP	5571	Level 1 Imaging with Contrast	303.0
EDINGER MEDICAL GROUP IPA-GNP	5572	Level 2 Imaging with Contrast	521.0
EDINGER MEDICAL GROUP IPA-GNP	5573	Level 3 Imaging with Contrast	545.0
EDINGER MEDICAL GROUP IPA-GNP	5591	Level 1 Nuclear Medicine and Related Services	223.0
EDINGER MEDICAL GROUP IPA-GNP	5592	Level 2 Nuclear Medicine and Related Services	241.0
EDINGER MEDICAL GROUP IPA-GNP	5593	Level 3 Nuclear Medicine and Related Services	660.0
EDINGER MEDICAL GROUP IPA-GNP	5594	Level 4 Nuclear Medicine and Related Services	821.0
EDINGER MEDICAL GROUP IPA-GNP	5672	Level 2 Pathology	80.0
EDINGER MEDICAL GROUP IPA-GNP	5673	Level 3 Pathology	74.0
EDINGER MEDICAL GROUP IPA-GNP	5692	Level 2 Drug Administration	102.0
EDINGER MEDICAL GROUP IPA-GNP	5693	Level 3 Drug Administration	1250.0
EDINGER MEDICAL GROUP IPA-GNP	5694	Level 4 Drug Administration	711.0
EDINGER MEDICAL GROUP IPA-GNP	5721	Level 1 Diagnostic Tests and Related Services	45.0
EDINGER MEDICAL GROUP IPA-GNP	5722	Level 2 Diagnostic Tests and Related Services	204.0
EDINGER MEDICAL GROUP IPA-GNP	5731	Level 1 Minor Procedures	30.0
EDINGER MEDICAL GROUP IPA-GNP	5733	Level 3 Minor Procedures	53.0
EDINGER MEDICAL GROUP IPA-GNP	5734	Level 4 Minor Procedures	71.0
EDINGER MEDICAL GROUP IPA-GNP	5741	Level 1 Electronic Analysis of Devices	63.0
EDINGER MEDICAL GROUP IPA-GNP	5771	Cardiac Rehabilitation	152.0
EDINGER MEDICAL GROUP IPA-GNP	5781	Resuscitation and Cardioversion	374.0
EDINGER MEDICAL GROUP IPA-GNP	N700	Non-OPPS Clinic Services	70.0
EDINGER MEDICAL GROUP IPA-GNP	N800	Clinical Diagnostic Lab Services	19.0
EDINGER MEDICAL GROUP IPA-GNP	N801	Therapy Services	108.0
EDINGER MEDICAL GROUP IPA-GNP	N804	Mammography Services	65.0
EDINGER MEDICAL GROUP IPA-GNP	N900	Non-covered Services	95.0
EDINGER MEDICAL GROUP IPA-GNP	N902	Packaged Services	656.0
EDINGER MEDICAL GROUP IPA-GNP	N905	Not Recognized by OPPS	38.0

Section: Outpatient Payer Specific Charge 55
Payer	APC	Description	Payer Specific Negotiated Charge
MONARCH HEALTH PLAN-OTHER ANCILLARY	5411	Level 1 Gynecologic Procedures	198.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5594	Level 4 Nuclear Medicine and Related Services	4.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5672	Level 2 Pathology	177.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5722	Level 2 Diagnostic Tests and Related Services	308.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5731	Level 1 Minor Procedures	29.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5733	Level 3 Minor Procedures	65.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5771	Cardiac Rehabilitation	541.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	N700	Non-OPPS Clinic Services	34.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	N800	Clinical Diagnostic Lab Services	4.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	N801	Therapy Services	683.0

Section: Outpatient Payer Specific Charge 56
Payer	APC	Description	Payer Specific Negotiated Charge
MONARCH HEALTH PLAN-RAD ANCILLARY	5411	Level 1 Gynecologic Procedures	122.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5521	Level 1 Imaging without Contrast	74.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5522	Level 2 Imaging without Contrast	142.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5523	Level 3 Imaging without Contrast	488.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5524	Level 4 Imaging without Contrast	400.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5571	Level 1 Imaging with Contrast	186.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5572	Level 2 Imaging with Contrast	806.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5591	Level 1 Nuclear Medicine and Related Services	343.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5592	Level 2 Nuclear Medicine and Related Services	380.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5593	Level 3 Nuclear Medicine and Related Services	1059.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5594	Level 4 Nuclear Medicine and Related Services	1243.0
MONARCH HEALTH PLAN-RAD ANCILLARY	N804	Mammography Services	100.0
MONARCH HEALTH PLAN-RAD ANCILLARY	N902	Packaged Services	134.0

Section: Outpatient Payer Specific Charge 57
Payer	APC	Description	Payer Specific Negotiated Charge
MEMORIALCARE MEDICAL FOUNDATION-CAPITATED	5521	Level 1 Imaging without Contrast	10.0
MEMORIALCARE MEDICAL FOUNDATION-CAPITATED	5522	Level 2 Imaging without Contrast	18.0
MEMORIALCARE MEDICAL FOUNDATION-CAPITATED	5572	Level 2 Imaging with Contrast	63.0
MEMORIALCARE MEDICAL FOUNDATION-CAPITATED	N804	Mammography Services	9.0

Section: Outpatient Payer Specific Charge 58
Payer	APC	Description	Payer Specific Negotiated Charge
NOBLE AMA IPA SENIOR	5593	Level 3 Nuclear Medicine and Related Services	1025.0
NOBLE AMA IPA SENIOR	5731	Level 1 Minor Procedures	31.0

Section: Outpatient Payer Specific Charge 59
Payer	APC	Description	Payer Specific Negotiated Charge
SELECT HEALTH MEDI-CAL	5731	Level 1 Minor Procedures	34.0

Section: Outpatient Payer Specific Charge 60
Payer	APC	Description	Payer Specific Negotiated Charge
SEOUL MEDICAL GROUP IPA	5731	Level 1 Minor Procedures	29.0