Coffeyville Regional Medical Center PRICING TRANSPARENCY .

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Coffeyville Regional Medical Center PRICING TRANSPARENCY LISTCharge DescriptionStandard PricePrivate RoomSNF PrivateNon Skilled PrivateIsolation/NP/Sterile RoomICU Hosp Convenience Semi PrPrivate At Semi RateSemi Private RoomICU Hosp Covenience Semi-Pr RmSNF Semi PrivateNon Skilled Semi-POB/Gyn RoomNursery Care Level 1Nursery Level 2Nursery Level 3Nursery Level 4Administration Subq/IM InjICU RoomXopenex 0.63mgXopenex 1.25mgIpratroplum 0.5mgRaemin Epinephrine 0.5mLAugmentin 125/5 75 mLNeomycin 500 TabBactroban 2% OintSuprax 100mg/5mL SuspZithromaxVibramycin 100 CapBiaxin 250Biaxin 500Duricef/Ultracef CapCipro 500 mg TabAmoxil 250 CapAmoxil 500 CapAmoxil Susp 125-80mLAugmentin 250/5 75mLVancocin 125 CapPen V-K 250 TabVancocin 250 CapEES 400 TabEryped 200/5 100mLEmycin 333Emycin 250Flagyl 250 TabAmpicillin 500 mg CapClaforan 1 gm Inj 788.00 452.00 368.00 893.00 788.00 788.00 788.00 788.00 420.00 342.00 525.00 525.00 630.00 945.00 1,155.00 98.00 1,575.00 17.00 17.00 9.00 12.00 33.00 3.00 35.00 68.00 18.00 8.00 8.00 8.00 7.00 8.00 3.00 3.00 10.00 61.00 11.00 3.00 21.00 3.00 18.00 3.00 3.00 4.00 3.00 27.00

Bactrim DS TabBactrim Susp 100mLKeflex 250 CapKeflex 500 CapCephalexin 250/5 100mLCleocin 150 CapTetracycline 250mg CapMacrodantin 50 CapMysoline TabDitropan TabPhisohex 3% CleanserAntacid 30mL UdAlupent Inhaler 14gmDiamox TabNaprosyn TabAuralgan OticKaopectate 360 mLProctofoam Hc AerosolOphthetic 0.5% Ophth SolAnaprox TabNystatin Cream 15gmUrecholine Tab 5mg TabHiprex-Urex TabTylenol Drops 15mLDimetapp Elix 30mLDilantn 125/5 30mLNiacin 25-50 TabBumex TabSilvadene 60gmFiorinal Cap-TabCitrate Of MagnesiaLopid CapNitro PadsNitro HTValiumAnusol HC SupposPilocar 4% Ophth SolCapotenProlixin TabMidrin CapTylenol SupposNitrobid CapInsulin InjSulf-10 10% Ophth SolAnsaid 100mgXanax 0.25 mg TabAldactone-Aldactazide 4.00 23.00 4.00 6.00 55.00 4.00 3.00 3.00 3.00 3.00 29.00 3.00 47.00 3.00 3.00 29.00 14.00 53.00 10.00 4.00 11.00 3.00 3.00 10.00 5.00 11.00 3.00 3.00 17.00 3.00 6.00 4.00 5.00 3.00 3.00 5.00 29.00 4.00 5.00 3.00 3.00 3.00 6.00 27.00 4.00 3.00 3.00

Donnatal Elixir 30mLEvac-Q-KitAldomet TabPediapred Liquid 30mLAfrin 0.05% Nasal SprayCardizem CD 150mgKlonopinTylenol 2-3-4 TabCalcium Lact-TabColchicine TabVistaril CapTigan SupposAntabuse 250mg TabCortef 10mgDyrenium CapDisalcid 500 TabLactinex TabLugols Sol ozQuinaglute TabDemerol 50 TabVisine Ophth SolZovirax 5% OintUrispas TabKCl Liquid 20eq BulkTheodur TabElavil 10-25TucksZyloprim 100mg TabParafon Forte TabParegoric 5mLBeta-Val 0.1% CreamParlodel TabVaseline TubeHomatropine 5% Ophth SolAnusol OintProp-Thioracil TabA & D OintBicitra-Polycitra ozTrental 400 TabMicronase TabInh TabMaxzideEpsom SaltsSilver Nitrate StickVosol HC Otic SolLacrilube NP Ophth OintMonistat Derm 2% Cream 5.00 24.00 3.00 11.00 10.00 4.00 3.00 3.00 3.00 3.00 3.00 5.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 8.00 88.00 3.00 3.00 3.00 3.00 9.00 3.00 3.00 4.00 25.00 4.00 7.00 7.00 10.00 3.00 5.00 3.00 3.00 3.00 3.00 3.00 4.00 3.00 92.00 23.00 29.00

Zinc Oxide 20% OintAntacid TabAsendin TabTriamCinolone 0.1% CreamASA SupposPersantine TabThrombinar AR 1000 UMylicon Drop 30 mLTobrex Ophth OintPhazyme TabIsmo Tab 20mgCardizem 60 TabFeldene 20 CapBacitracin Zinc OintTussionex SuspFmL Opht Sol 5ccPhenobarb 30mg TabBenzoin Tr. ozEpinephrine 1mg/mL AmpGenoptic Ophth SolArtane 2-5 TabMag Ox TabProcardia CapLoniten 2.5 mg TabSeconal CapMS ContinPremarin Vaginal CreamTambocor TabNolvadex TabK-Phos Nutral CapCaladryl Lotion 6 ozProventil Inhaler 17gmTobrex Ophth SolDacriose Ophth SolnQuinamm TabPremarin TabAzulfidine TabAtarax TabProstin-E 2 SuppTUMS TabSod Bicarb TabPamelor 10mg CapVentolin 2mg/5mLChloraseptic SprayReglan 5mg/5mLColestid 5 mg PktCalamine Lotion 4 oz 7.00 3.00 3.00 23.00 3.00 3.00 16.00 24.00 45.00 3.00 3.00 3.00 5.00 8.00 12.00 29.00 3.00 5.00 10.00 33.00 3.00 3.00 3.00 3.00 4.00 5.00 77.00 4.00 4.00 3.00 14.00 55.00 45.00 10.00 3.00 3.00 3.00 3.00 433.00 3.00 3.00 3.00 6.00 11.00 6.00 4.00 6.00

Dilaudid TabMevacor 20 mgCardizem CD 240mgHaldol 2mg/mL 15mLHytrin TabsHaldol TabLotrisone CreamKayexelate 15 gmHydrodiuril TabPyridium TabPerdiem GranulesSodium Chloride TabCatapres TTS-1Cortisporin Otic SuspErythromycin Ophth OintCompazine SupposFlorinef TabSymmetrel CapPeriactin TabBenadryl CapQuinidine TabPot Phosp 66 mEqNorvasc TabDermoplast SprayInspireaseVisken TabBentyl Tab Cap3Imodium CapMidamor TabAerozin SprayTerazol-7 Vaginal CreamInderal TabCatapres TTS 2-3Ritalin 10 TabCyclogyl 1% Opth SolnDecadron Opth 0.1%Indocin CapIpecac Syr 15mLRestoril 15 CapLasix 60 mL SolRefresh Ophth SolRelafen TabsIsordil TabSolu Cortef 250 InjLanoxin Elixir 60 mLRobaxin 500-750 TabDulcolax Supp. 4.00 5.00 5.00 50.00 4.00 5.00 42.00 20.00 3.00 3.00 31.00 3.00 14.00 47.00 26.00 7.00 3.00 4.00 3.00 3.00 3.00 17.00 4.00 8.00 31.00 3.00 3.00 3.00 3.00 16.00 55.00 3.00 33.00 3.00 17.00 35.00 3.00 4.00 3.00 20.00 4.00 3.00 3.00 23.00 49.00 3.00 3.00

Cordarone 200 mgDomeboro PktCapozide TabVerapamil TabWellbutrin TabDiflucan Tab 100mgSolu Medrol 500 InjMethergine 0.2 mg/mL AmpDuragesic 25mcg/Hr PatchCarafate TabSerax CapSinequan CapsCatapres TabSinement TabAltace 2.5mg CapSoma TabRisperdal 3mg TabGentamicin 0.1% CreamMonistat 3 Vag SupposDdavp Nasal Spr.Pepcid 20 mg TabCerumenex 10% Otic SolNystatin Susp 60mLGlycerin ozCytotec TabTenex TabStelazine TabEulexin CapCarafate Susp 30mLK-Lyte TabProvera TabVoltaren TabLanoxin TabPrinivil\Zestril TabAmbien 5 mg TabCogentin TabSudafed 60 TabEucerin Cream ozSerevent Inhaler 7gmLibrax CapRythmol 150mg TabDiprolene 0.05% OintmentDesitin OintLubriderm LotionMaxair Inhaler 26 gmMasse Breast CreamLioresal Tab 6.00 3.00 4.00 3.00 3.00 16.00 68.00 8.00 25.00 3.00 4.00 4.00 3.00 3.00 3.00 5.00 10.00 33.00 19.00 273.00 4.00 40.00 47.00 3.00 3.00 3.00 5.00 4.00 8.00 4.00 3.00 4.00 3.00 3.00 5.00 3.00 3.00 17.00 72.00 3.00 3.00 109.00 7.00 12.00 59.00 12.00 3.00

EMLA CreamProcardia Xl 30Maxitrol Ophth SolNicotine PatchTenormin 50 TabClaritin 10mgLomotil TabCitrucel PktCardene SR 30Tegretol TabPlaquenil 200MCardene 30mgHumabid TabCodimal DmProzac CapsNizoral Cr 15gmCoumadin TabDemadex TabBetagan 0.5% Ophth SolAnbesol LiquidPaxil 20mg TabAccupril 10 mgThorazine 25-50 TabOcufen 0.03% Ophth SolElocon Cream 0.1%Desyrel TabMedrol Tab 4Thyroid TabXYLOCAINE 2GM INJGoLYTELY SolEstraderm PktMellaril TabsTofranil TabXylocaine 100 InjTorodol 10mg TabNeosporin Ophth OintVasotec2.5mg/2mLDecadron Elix 1 ozDecadron TabMetamuCil PakLotensin 10 mg TabTiclid TabMinipress CapLozol TabMotrin TabDepakote TabsTriavil Tab 17.00 4.00 47.00 8.00 3.00 5.00 3.00 3.00 3.00 3.00 4.00 3.00 3.00 5.00 6.00 33.00 3.00 3.00 42.00 12.00 5.00 3.00 3.00 35.00 35.00 5.00 3.00 3.00 12.25 33.00 7.00 3.00 3.00 12.00 4.00 38.00 59.00 11.00 4.00 3.00 3.00 4.00 3.00 3.00 3.00 3.00 3.00

Daypro TabsZocor 10mg TabMylicon TabPeridex Oral RinseAk-Dilate 2.5% Eye DropsBetadine DoucheBetamethasone Dp 0.05%Betoptic 0.25% Ophth SolBisacodyl 5mg TabBlocadren 10mg TabCaptoen 50mg TabCatapres-TTS 3 PatchEfudex 5% CreamFer-In-Sol 220mg/5mLFleet Phosphosoda 45mLGlynase 3mg PrestabIsopto Hyoscine 0.25%Lotrimin 1% CreamMaxzide 50/75 TabletMycelex 10 mg TrochePerphenazine 4mg TabPred Forte 1% Ophth SuspPreparation H SupposRheumatrex 2.5mg TabSlow-Mag 64mg Tab SaTobradex Ophth SuspUrised TabVantin 200mg TabDermagran Ointment 113gmAldactone 25/50 mg TabActigall 300 mg CapGlucophage 500 mg TabGlucophage 850 mg TabChromagen CapClomid 50 mg TabRowasa Enema 4gm/60mLCleocin 2% Vag CrmPotassium Acetate 40 mEqNeutra-Phos PktAsacol 400 mg TabLuvox 50 mg TabHyzaar 50/12.5 TabAcular Ophth Sol 0.5%Ciloxan Ophth Sol 0.3%Ocuflox Ophth Sol 0.3%Elimite Cream 5%Sulfamylon Cream 3.00 5.00 3.00 27.00 5.00 2.00 47.00 23.00 3.00 3.00 4.00 39.00 82.00 23.00 5.00 3.00 27.00 27.00 3.00 3.00 3.00 55.00 3.00 9.00 3.00 51.00 3.00 9.00 45.00 3.00 6.00 3.00 3.00 3.00 17.00 21.00 70.00 7.00 3.00 3.00 5.00 4.00 66.00 25.00 47.00 45.00 45.00

Muro 128 5% Ophth OintUltram 50 mg TabKytril 1 mg TabLevbid .375 mg ER TabZiac 5 mg TabCarmexChapstickFosamax 10 mg TabOgen .625 TabOcupress 1% Ophth SolTrusopt 2% Ophth SolMetrogel Vaginal .75%Duratears Ophth OintSerzone 100/150 mg TabPlendil 5 mg TabLactaid CapletMentholatum OintNeurontin 100 mg CapPeri-Colace SyrupBiaxin 125/5 100mLCataflam 50 mg TabAnafranil 50 mg CapDiprolene AF.05% CreamClozaril 25 mg TabAldactone 100 mg TabGerivite Liquid 30mLClozaril 100 mg TabTrandate 100mg TabNitroglycerin 2.5 mg CapBenadryl CreamPhoslo 667 mg TabAtenolol 25 mg TabAveeno BathUnivasc 15 mg TabEskalith CR 450 mg TabPolysporin OintBetagan 25% Ophth SolLotrel 5/20 CapSectral 200 mg CapImodium A-D Liquid 60mLMethocarbamol 500 mg TabMiacalcin Nasal SprayAquaphor OintMetronidazole 500 mg TabLoxitane 5 mg CapsuleLevsin Sl 0.125 mg TabDantrium 25 mg Cap 27.00 3.00 87.00 3.00 3.00 6.00 4.00 5.00 3.00 39.00 49.00 59.00 19.00 3.00 3.00 3.00 8.00 3.00 5.00 59.00 4.00 4.00 55.00 4.00 4.00 6.00 9.00 3.00 3.00 12.00 3.00 3.00 5.00 3.00 3.00 11.00 35.00 4.00 4.00 12.00 3.00 60.00 18.00 4.00 3.00 3.00 3.00

Lotensin 20 mg TabImitrex 25 mg TabSporanox 100 mg CapPrecose 50 mg TabPrevacid 30mg CapAmaryl 2 mg TabQuestran Light PktTriamCinolone .1% OintAmoxicillin 250/5 150mLAtivan 1mg TabSeptra DS TabBuspar 10 mg TabCaptoen 25mg TabCardizem CD 180 mgCeftin 250 mg TabCepacol LozengeClaritin-D TabCodiclear DH SyrupCodimal DH Syrup 30mLCompazine 10mg TabAK-Spore HC Ophth OintCoumadin 7.5 mg TabDeclomycin 300mg TabTrazodone 100mg TabDiabinese 250mg TabEffexor 37.5 mg TabEffexor 50 mg TabEffexor 75 mg TbGaviscon Liquid 360mLGelfoam Sponge 12-7mmHabitrol 14 mg/24 HrHaloperidol 5 mg TabHytone 2.5% CreamInderal LA 60 mg CapInderal LA 80 mg CapIsoptin SR 180 mg TabIsoptin SR 240 mg TabIsopio Carbachol 3%Klonopin 1 mg TabLodine 400 mg TabLoxitane 25 mg CapMacrobid 100 mg CapMedrol 16 mg TabMinipress 5 mg CapMS Contin 15 mg TabNaprosyn 500 mg TabNeptazane 50 mg Tab 3.00 25.00 14.00 3.00 9.00 3.00 4.00 23.00 17.00 3.00 4.00 4.00 3.00 4.00 8.00 3.00 4.00 2.00 5.00 3.00 39.00 3.00 16.00 3.00 3.00 4.00 4.00 4.00 16.00 12.00 9.00 3.00 47.00 3.00 4.00 4.00 4.00 47.00 3.00 4.00 5.00 4.00 4.00 4.00 3.00 4.00 3.00

Pamelor 25 mg CapPhenergan 25 mg SupposPhenergan 50 mg SupposPilocar 6% Ophth SolFluphenazine 5 mg TabProventil 4 mg RepetabsPyridium 200 mg TabSinemet-25/100 TabSinemet CR 25/100 TabSinemet-25/250 TabSinemet CR 50/200 TabStelazine 2 mg TabTrifluoperazine 5 mg TabSudafed Cough SyrupTimoptic 0.5% Ophth SolVasotec 10 mg TabVasotec 5 mg TabVoltaren 75 mg TabWellbutrin 75 mg TabXanax 1 mg TabZestril 20 mg TabZinc Sulfate 220 mg CapZocor 20 mg TabTapazole 5mg/10mg TabZyrtec 10mg TabEstraderm 0.05mg PatchRobitussin 30mLRobitussin-DM 30mLAugmentin 875 TabCentrum Silver TabletAdderall 10mg TabletMedrol 4 mg Dose PakLibrium 5 mg CapSular 10mg TabPediotic Susp 7.5mLPrempro 0.625/2.5Revia 50mgNaprelan 500 TabletNorflex 100mg TabVoltaren Ophth 2.5mLPrelone 15mg/5mLClaritin-D 24 HrAccolate 20mgCefzil 125/5 (50mL)Ceftin 125/5 (50mL)Flovent 110 mcg InhalerVantin 50/5 (100mL) 4.00 7.00 8.00 31.00 5.00 3.00 4.00 3.00 3.00 3.00 5.00 3.00 4.00 12.00 42.00 4.00 4.00 4.00 3.00 4.00 3.00 3.00 9.00 3.00 5.00 7.00 5.00 5.00 11.00 3.00 3.00 35.00 3.00 3.00 33.00 3.00 11.00 4.00 5.00 44.00 17.00 6.00 4.00 33.00 35.00 109.00 68.00

Colestid 1 gmAccupril 5mgMavik 2 mg TabDiovan 80 mg CapsuleGI CocktailLamisil 250 mg TabTinactin SprayXalatanFamvir 500 mg TabNeurontin 400mg CapMycolog OintZithromax 200/5Naprelan 375 TabAmaryl 1mg TabZithromax 100/5Aricept 5mgLevaquin 500 mg TabWellbutrin SR 150 mg TabCodeine 30mgMuro 128 5%Lamictal 100 mgTimoptic XE 0.5%Flovent 44mcgAllegra 60mgLamictal 25 mgPaxil 10mg TabZiac 2.5mgCombivent InhalerSynthroid 0.075 mg TabTegretol-XR 100mgDuragesic 50 mcg/Hr PatchDuragesic 100mcg/Hr PatchDuragesic 75 mcg/Hr PatchSeroquel 20 mgLoniten 10 mg TabSeroquel 100mgVicoprofen 7.5/200Tarka 4/240Polytrim OphthProcanbid 500mgEffexor-XR 37.5 mgNupercainal OintBetapace 80mg TabViokase TabZovirax 400mgAltace 5 mg CapArthrotec 50 3.00 3.00 3.00 11.00 11.00 14.00 10.00 83.00 16.00 4.00 27.00 57.00 4.00 3.00 58.00 10.00 16.00 4.00 3.00 25.00 5.00 33.00 96.00 3.00 5.00 6.00 4.00 81.00 3.00 3.00 35.00 68.00 55.00 4.00 4.00 6.00 3.00 4.00 49.00 3.00 5.00 13.00 6.00 3.00 6.00 3.00 4.00

Duricef 250/5Avapro 150mgEvista 60 mgLamisil Cream 1%Sulf-10 Ophth OintPrandin 0.5 mgHelidac TherapyGranulex SprayMephyton 5 mgOxycontin 10mgZomig 5mgAugmentin 200/5 50mLAugmentin 400/5 50mLZebeta 5mgZarontin 250mgFloxin 0.3% OticPancrease CapCalmoseptine OintCelexa 20mgTimoptic XE 0.25%Ziac 10mgTricor 67 mgCelebrex 200 mgCelebrex 100 mgLithobid 300 mgSingulair 10 mgMegace SuspensionBentyl SyrupCosopt 0.5% Opth DropsGlyset 25mg TabLibruim 25 mg CapCortisporin Otic SolutionDDA VP 0.1mg TabletTopamax 100mg TabAK Spore SolErythromycin 500 mg TabAtrovent Nasal SprayMirapex 0.25mg TabCitrical w/Vit DTopamax 25mg TabVasotec 2.5mg TabAmoxicillin 875mg TabProcto Cream HC 2.5%Kenalog In Orabase PasteMonistat 7 Daily CreamTamiflu 75mg CapRelenza Inhaler 32.00 4.00 6.00 66.00 38.00 3.00 33.00 39.00 3.00 4.00 33.00 35.00 68.00 4.00 3.00 66.00 3.00 12.00 6.00 31.00 4.00 3.00 7.00 4.00 3.00 6.00 3.00 3.00 90.00 3.00 7.00 80.00 5.00 8.00 50.00 3.00 70.00 4.00 3.00 4.00 3.00 4.00 60.00 37.00 12.00 12.00 97.00

Optipranolol Eye DropsPrandin 1mgRefresh Pm OintClimara 0.5mg PatchAspercremeArimidex 1mgNicotrol InhalerPolyvisol w/Iron DropsImitrex Nasal SprayOrtho-Novum 1/35Visken 5mg TabZinc LozengeLevaquin 250 mg TabVitamin B12 1000 mcg TabOrajelSaliva SubstituteActidose w/Sorbitol 50gmPletal 100mg TabDilantin 30mg CapsuleDiabetic Tussin DM LiquidHydrea 500mg CapsuleMag Tab SRProvigil 100mg TabLidex 0.05% CreamDetrol 2mgImuran 50mg TabletFluphenazine 5mg/mL ConcenMeningococcal Vacc 1 VialCarbachol 1.5% 15mL BtlTransderm Scop 1.5mg PatchCelexa Oral Solution 10mg/5mLMethadone 10mgGlucotrol XL 2.5mgOxycontin 20mg UD TabOxycontin 80mg UD TabTerazosin HCL 5mg CapMetoclopramide 10 mg TabCaltrate PlusCaltrate 600 TabMycolog CreamGlyburide 2.5 mg TabPhenergan 25mgSpectazole CreamTriaminic DM Cough SyrupGlipizide XL 5mgMethylphenidate HCL 20 mg TabHaloperidol 0.5mg Tablet 35.00 3.00 19.00 14.00 12.00 15.00 12.00 17.00 46.00 12.00 4.00 9.00 17.00 3.00 12.00 3.00 12.00 5.00 3.00 12.00 4.00 3.00 15.00 29.00 7.00 8.00 7.00 285.00 80.00 17.00 10.00 7.00 3.00 10.00 29.00 5.00 3.00 3.00 3.00 44.00 3.00 3.00 33.00 12.00 3.00 7.00 3.00

Thorazine 10mg TabD5W 500 mLNormal Saline 100 mLNormal Saline 250 mLNormal Saline 1000 mLPepcid 20 mg, IVLR 1000 mLD5W 100 cc 500 mL UnitsNormal Saline 250mLNORMAL SALINE 250CC UNITSAzactam 2gm VialNafcillin 2 gmAMPICILLIN 2GM ADD-VANTMefoxin 1 gm InjDoxycycline 100mg I.V.Gentamicin 80 mg/2 mLNitroprusside 50mg VialEphedrine 50mg/mL VialDoxapram 400mg VialActidose 25gmFolic Acid 5mg/mL VialRobinul 0.2mg/mL VialTrandate 100mg/20mLLevophed 4 mg/4 mL AmpLorpressor 5 mg InjSodium Bicarb 50mEqZovirax 500mg InjSterile Water 1000mLVerapamil 5mg/2mLPitocin 10U/mL VialHealon 10mg/mLSufenta 50mcg/mLAtropine 0.4mg/mL VialBentyl 20mg/2mLCalcium Chloride InjMVI 12 VialCardizem 25 mg Inj VialNTG InjIndigo-Carmine 40 mg AmpPepcid 20mg I.V.Thiamine 100mg/mL VialDopamine InjRomazicon VialMarcaine Ed InjDobutrex VialHespan Inj 500 mLDexamethasone 10mg/mL Via 3.00 47.00 47.00 53.00 47.00 18.00 40.00 45.00 45.00 38.00 63.00 30.00 36.00 23.00 47.00 12.00 35.00 7.00 92.00 20.00 7.00 8.00 70.00 28.00 16.00 28.00 125.00 28.00 28.00 7.00 177.00 33.00 6.00 29.00 12.00 12.00 28.00 55.00 23.00 12.00 6.00 27.00 17.00 17.00 136.00 153.00 23.00

Acetylcysteine 20% VialCardene 25 mg IVMagnesium Sulfate 5 gmZithromax 500mg IvSorbitol 3% 3000mLNS 1000mL w/KCl 20mEqD5Ns 1000mL w/KCl 20mEqD5-500mL InjD5-500mL Unit InjSodium Chloride 0.9% 50mLNS 100mL InjNS 25 mL InjBuretrolD5 Elect 48 InjD5 1\2NS 20KCl Inj1\2 NS 1000 InjNS 500 InjLR 250 mLD5W 1000 ccD5W 500 Inj (258)D5 NS 1000 Inj (258)Nitroglycerin 25mg/250mL PremxSodium Chloride 9% 50mL AddbagCleocin T 1% SolBSS 15mLBumex 1mg VialNorcuron 10mg VialNeosporin G.U. IrrigationBetadine SpraySynthroid 200 mcg VialZemuron 10mLXylocaine Viscous 20mLHibiclens 4% LiquidAdrenalin 1mg/mL VialLidocaine Viscous 100mLN-C Infusion, Initial,1st HourNon-Chemo Infusion, Add'l HrsN/C Infusion,Addl Drug,1st HrIV Inj, Addl DrugHydra IV Inf, Init, 31M-1 HrIV Hydration, Addl HoursN-C Infusion,Therapy, 1st HourNCinfusion,Therapy Add'l n,Addl HoursAdmin IV Inj/Op,InitialAdmin IV Inj Additional 5.00 53.00 12.00 45.00 74.00 69.00 66.00 27.00 27.00 27.00 27.00 25.00 17.00 28.00 28.00 28.00 31.00 28.00 31.00 31.00 28.00 61.00 54.00 29.00 14.00 10.00 55.00 16.00 12.00 109.00 40.00 6.00 12.00 50.00 12.00 369.00 263.00 390.00 199.00 369.00 145.00 369.00 263.00 368.00 263.00 199.00 199.00

PORT A CATH ACCESSAdmin IV Inj InitialAdmin IV Inj,InitialAdmin IV Inj Add'l Same DrugN-C Infusion,Initial,1st HourN-C Infusion, Addt'l HoursAdmin W.H. IV InjectionAdmin W.H. Subq/Im InjectionNon-Chemo(Hydration)Inf 1st HrAdmin WH IV Inj AdditionalAdmin W.H.Infusion Ther,1st HrAdmin WH Infusion Ther Addl HrAdmin Inv Inj Add'l Same DrugHydration IV Infusion InitN-C Hydrate Infusion Add'l HrsAdminister Subq/Im InjectionAdminister IV InjectionIV Inj Additional DrugN/C Infusion, Initial, 1st HrN/C Infusion,Addl HoursInfusion Addl Sequential 1sthrCast Arm AdultCast Leg ShortEndometrial Ablation UnitCast Long LegDisp Respirex I.S.Suction D&C SupplyLOOP STONE EXTRCTR 6LACRIMAL INTUBATION SETIndiana TomeABD BINDER, MEDARTHROSCOPY DRAPEMesalt 4X4GLOVE-ULTRAFEE SZ 8Oasis Ultra Tri-Layer 5x7 cmTriple Antibiotic OintAerochamberH2O Irrig S\C TopiclNS Irrig S\C TopicalH2O Irrig Bag InjMidstream CollectorFoley 16 Fr 5ccBetadine SwabstickHemat Foly 24Fr 30ccBladr Cre Tray 16\18Staple RemoverCatheter Leg Bag 171.00 174.00 199.00 199.00 369.00 263.00 177.00 98.00 369.00 199.00 369.00 263.00 199.00 140.00 70.00 98.00 191.00 199.00 369.00 263.00 391.00 120.00 183.00 3,388.00 367.00 34.00 38.00 236.00 153.00 270.00 31.00 91.00 6.00 5.50 930.00 8.00 51.00 28.00 28.00 28.00 11.00 32.00 9.00 66.00 47.00 23.00 26.00

Phosphate EnemaCoude 20 Fr CathSteristrip 1/4Leg Bag StrapPre-Cut Softwick 2X2Softwick 4X4Roll Kling BondRoll Kerlix EaTape Micro 1 InTape Micro 2 InTray IrrigatiomStraight Cath Fr 5ccSuture Removal TraySterile Spec ContDurapore Tape 2Foley 20 Fr 5ccCulturetteClosed Drainage BagButterflyCath Tray w/oIodoform Gauze 1/2Cathtr Tip Syrg 60ccTelpha PadAdaptic Drsg. EachDurapore Tape 1Nugauze, PlainHuber NeedlesCombiderm Drsg 4X42 3/4 Flange1 3/4 Flange2 3/4 BagIleostomy BagOstomy PasteTry Bldr Cre Sz 16-184X4 IV Drain Sponge Prcut SofwTegaderm Oval 5X6Aquacel Wound PackingMontgomery StrapsLeg BagCath Secure TabsCath Sterile PlugConform Bandages 4Saf-GelDuoderm SpotsBandage, Act 4Xeroform Dress 1X8Dressing Trans w/Pad 3.5X4 11.00 4.00 12.00 10.00 9.00 9.00 9.00 13.00 9.00 11.00 15.00 26.00 12.00 9.00 13.00 32.00 9.00 27.00 9.00 20.00 31.00 9.00 9.00 15.00 10.00 31.00 23.00 23.00 19.00 17.00 13.00 15.00 31.00 18.00 9.00 8.00 31.00 15.00 25.00 27.00 10.00 10.00 49.00 11.00 15.00 10.00 8.00

Infusion Set 20X1Iodoform Gauze 1Oxygen Therapy Per HourIodosorb 40 gmOxygen Per Hour2X3 BIOCLUSIVEAdd A Line TubingBlood Collection BottleCoban 2Huber Point NeedleInjection Site SuppliesIV Admin Set w/Inj SiteJelco Size 18Jelco Size 20X1 InJelco #22X1Threaded Lock CannulaCvp Dressing TrayRape Examination KitIN LINE FILTERJelco #20Jelco #22Huber NeedleBIOCLUSIVE 2X3 DRSGContinue Flo TubingBaxter Interlink SetIV Admin Set W Inj SiteBlood Y SetJELCO #184 X 5 BioclusiveAquacel AG Foam 4X4Prisma DressingOral Nasal Endo TubeEye Shields SDN100Eye Shields/Frames SLFN100Trocar, Blunt Tip 12mmSteribump Universal SterileKCI AbtheraAintree Intubation CatheterExchange Cath for Dbl LumenANES Ext Set 0051Vented Ntg Set 7552PCA Set MiniMinidrip SetCont Flo SetAdd A Line SetY-Type Blood SetAnes Ext Set w /Stop 21.00 30.00 19.00 25.00 19.00 9.00 23.00 23.00 16.00 26.00 14.00 23.00 12.00 12.00 11.00 10.00 16.00 762.00 17.00 12.00 12.00 25.00 7.00 23.00 21.00 23.00 32.00 6.00 13.00 20.00 26.00 24.00 1.82 3.71 203.00 108.00 938.40 171.60 191.55 11.00 50.00 40.00 20.00 26.00 13.00 28.00 11.00

4-Way StopcockAnti-Siphon Pump Set100 mL Drug Reservoir250 mL Drug ReservoirAqucel Extra 4X5IOL LensGII AnchorPanalok, AnchorSTEINMANN PIN 1/32 X 9Biliary Drainage CathEthicon 18 Ligaclip CartridgeStraight Cath SpecimenEIA Antigen DetectionROM PlusFetal FibronectinLeukocyte AssessmentAmylase-UrineBlood GasesBody Fluid-CellBody Fluid-DiffProcessing & HandlingVenipuncture/StickBlood Draw Via VADCapillary Blood SpecimenSpecimen-TravelNasal Smear-EOSFern TestRSV AntigenRapid Strep ScreenASPERGILUSBLASTOMYCESHistoplasmaViscosityBk Virus, QN DNA PCRSerum SerotoninANCAPhenytoin, FreeTricyclic Antidepressant ScrnParoxetine (Paxil)Mutation Identify by p C Virus RNA By PCRHIV-1 AMP PROBE TECHHepatitis C By PCRAllergen Specific IgE,QualHPV Hybrid Capture 5.00 14.00 14.00 16.00 18.00 437.00 565.00 609.00 86.40 221.76 9.18 13.00 72.00 375.00 261.00 24.00 37.00 117.00 53.00 48.00 25.00 25.00 163.00 16.00 14.00 21.00 24.00 219.00 151.00 86.12 17.00 53.00 47.00 184.00 194.00 90.00 162.27 278.34 183.68 59.00 183.68 70.92 118.00 129.00 184.00 78.00 95.00

Chlamydia TrachomatisNeisseria GonorrhoeaeHSV,I And IIHep C GenotypeInfect Agent AmpDRUGS OF ABUSE & ALCOHOLCrystal ExamBETA STREP (GROUP B) ANTIGENStreptococcus Pneumoniae AntigNephelometry Each AnalytePTHCollagen Cross LinksDrug ConfirmationGonadotropin Releasing HormoneCarnitineInf Agent Detect, Nucleic AcidInf Agent Detect, NA, Amp ProbAmikacin TroughCaffeine Autologous Bld UnitCoombs DirectFresh Frozen Plasma, ThawAntigen Typing, MultipleAntibody Workup, SimpleAntigen Typing, SimpleCoombs IndirectCrossmatch RoutineSerum Adsorption For Ab IDBlood Typing, ABOBlood Typing, RHRH Pheno TypeSingle DatSputum CollectionVenipunctureUAAlcoholPhosphorus,Urine (24Hr)Uric Acid, Other Source 24 HrCalcium,Urine Quant, TimedPRIMIDONE/MYSOLINEAcetone SerumAlka PhosDigoxinAmmonia 117.00 117.00 293.00 735.00 144.00 54.00 224.00 46.00 87.00 55.00 65.00 75.00 62.00 71.00 66.00 105.00 37.00 53.00 115.70 95.00 95.00 132.00 98.00 132.00 44.00 152.00 153.00 79.00 132.00 70.00 45.00 34.00 26.00 74.00 14.00 82.00 14.00 17.00 160.00 28.00 32.00 35.00 59.00 47.00 33.00 105.00 157.00

AmylaseComp Met Panel (Chem12)PH,Blood GasesEthosuximide, Serum (#007443)BicarbStool Occult Blood-DiagnosticBilirubin DirectSodium UrineBilirubin TotalTheophyllineBUNCalciumDilantinPhenobarbitalT3 UptakeThyroxine, Total (T4)HCG (Quan)TSHTegretolBlood ChloridesBNPUrine ChloridesCholesterolHDL CholCPK TotalCPK inineElectrolyte PanelAcetaminophen LevelAlbuminFerritinGentamicinGlucose(Quan)Not Reag StripGlucose, 1Hour Post DoseGlucose Tol (3 Specimens)Glucose Tol Ea Add'lHemoglobin A1CLDHLipaseLipid PanelLithium phorus 97.00 105.00 77.00 88.00 48.00 54.00 74.00 20.00 78.00 156.00 54.00 61.00 146.00 162.00 89.00 105.00 108.00 228.00 172.00 59.00 257.00 57.00 59.00 89.00 91.00 155.00 31.98 40.00 59.00 31.00 164.00 61.00 168.00 102.00 51.00 41.00 196.00 49.00 88.00 79.00 92.00 95.00 97.00 89.00 80.00 80.00 67.00

Potassium K-BloodPotassium K-UrineSalicylate LevelSerum IronIBCSGOTSGPTPSA TotalProstate Cancer ScreeningBasic Metabolic PanelSodium, SerumTotal ProteinProtein,Total,UrineProtein,Total,Other SourceTriglyceridesCarbon MonoxideHepatic Function PanelUric AcidChem-PG TestStone AnalysisFetal Lung Maturity AssessmentTroponin IMyoglobinQualitative CKMBRenal Function PanelTranscortinAmino Acid Quant, 6 or More EaLactic AcidOCCULT BLOOD SCREEN 1-3 SPECOccult Blood,OtherOccult Blood, Feces DiagMicro, 24 Hr UAMicroalbumin, Random UAThyroxine, Free, DirectMicroalb, Random UrineReducing SubstanceTriage ER Drug ScrnPH,Not BloodUrine Drug Screen 12Vancomycin24 Hour Urea NitrogenDepakote(Val Acid) LvlGGT5HIAA UrineDrug Pr Bl For Amph & THC24 Hr Urine Pro ElectraACTH, Plasma 53.00 59.00 89.00 84.00 112.00 60.00 69.00 107.00 107.00 79.00 54.00 61.00 61.00 61.00 79.00 72.00 134.00 60.00 77.00 95.00 219.00 108.00 75.00 80.00 92.00 114.48 788.22 88.00 18.00 31.00 31.00 61.00 61.00 49.00 61.00 158.00 81.00 16.00 216.00 97.00 20.00 102.00 34.00 76.00 45.00 77.00 185.00

ADHAldolaseGrowth HormoneLorazepam/AtivanTobramycinAlk Phos IsoenzymesAngiotension Conv EnzLipoproteinVitamin B12Ionized CalciumID By High ResolutionCortisol TotalVitamin K1Vitamin AVitamin EC-Peptide SerumPrealbuminCreatinine-Urine LabcorpOSMOLARITY BLOODEstradiolImmunoassay, Tt NOSEstrogens, TotalFolates, RBCFolate, SerumFSHGlycohemoglobin, TotalHaptoglobinHemoglobinopathy ProfHemosiderin, UrineLDL/Assay of Blood LipoproteinDNA/RNA Direct ProbeImmunoglobulin EInsulinLamotrigine (Lamictal)LeadMercuryLead, Blood(Pediatric)Beta 2 Microglobulin,SerumLHProgesteroneProlactinProtien Elect, SerumProtien Elect, InterpImmunoassay, Analyte, QuantPTH, Intact ITestosteroneUrine Drug Screen 110.00 57.00 66.00 69.00 46.00 87.00 77.00 68.00 90.00 73.00 59.00 113.00 161.37 139.29 167.01 104.00 76.00 31.98 70.00 196.00 57.00 133.00 100.00 97.00 133.00 56.00 108.00 81.00 63.00 67.32 73.00 99.00 90.00 60.00 52.00 65.00 52.00 71.00 130.00 94.00 124.00 63.00 57.00 57.00 242.00 164.00 112.00

CEARenin, PlasmaAldosterone, SerumCortisol,Urinary Free HPLCTransferrinHomocystine Plasma/SerumGammaglobulin, A,D,G,M EachTacrolimusSirolimus (Rapamune)Vit D 1,25 DihydroxyHemoglobin ChromatographyEstriolAFP, SerumFRUCTOSAMINEThyroxine, Free,DirectVitamin B-6Amphetamine LevelMetanephrinesVit B1 (Thiamine)Alpha-1 Antitryspin, SerumVMA, UrineCatecholamines, ROGESTERONE, 17-dImmunoassay Analyte Not InfectEnzymatic DesignDHEAAndrostenedioneANDROSTANEDIOL GLUCURONIDESHBGTestosterone, FreeT3, FreeOxalateCitrateCYCLOSPORINE,BLOODFecal Fat,QualitativeOligoclonal ImmunePHOSPHATIDYLGLYCEROLFETAL LUNG MATURITY,LS RATIOTopiramate(Topamax) SerumPSA FreeAmiodarone/CordaroneOrganic Acid Analysis,UrineTSIDexamethasone 111.00 125.00 193.00 104.00 122.00 279.00 146.25 105.00 60.00 164.00 78.00 109.00 88.00 54.00 42.00 220.00 41.00 103.00 114.00 79.00 115.00 181.00 58.00 18.00 88.00 83.00 57.00 19.00 100.00 186.00 164.00 201.00 170.00 132.00 76.00 158.00 105.71 28.00 80.00 39.00 89.00 73.00 57.00 103.00 68.00 735.00 62.00

DOT/SLOT BLOT PRODUCTIONMethymalonic Acid,Serum And URVolatilesUrine MyoglobinCholinesterase SerumHaldolPorphyrins,24Hr UrineNicotene Metabolite ScreenClozapineMeconium Drug ScreenMycophenolic Acid & MetaboliteSIGNAL AMPLIFICATION,EACH SEQAMPLIFICATION,1ST 2 NUC ACIDAMPLIFICATION,EACH ADDLMUTATION SCREENINGELASTASE, PANCREATICArsenicCadmium, BloodGabapentin (Neurontin)ZincAmitriptylineFluourescense In Paraffin BlckAntithyroglogin AntibodiesHydrocorticosteroids 004242Total ProtienCOBALTB-HydroxybutyrateVit D2/D3PROTOPORPHYRIN, RBC, QUANCYSTATIN CThyrotropinTHYROXINEPreg Assoc Plasma ProteinBile AcidsNicotine & Metabolite, QuanOrganic Acids Tot Quan Ea SpecHCG QuanKetone Bodies, QualCalcium,Urine,Quant,TimedAssay Of CopperSynthetic Cannabinoids WBCalprotectin, FecalOxcarbazepineLevetiracetam (Keppra)Lipoprotein AIGG Subclasses 1, 2, 3 or 4 EaDHEA-S 17.00 70.00 63.00 75.00 103.00 61.00 95.00 61.00 78.00 109.00 78.00 65.00 123.00 65.00 65.00 45.00 74.00 81.00 38.00 51.00 73.00 147.00 137.00 70.00 61.00 63.00 47.00 238.00 32.00 45.00 57.00 52.00 59.00 70.00 96.00 66.00 108.00 47.00 21.00 47.00 37.00 84.00 57.00 57.00 48.00 100.23 298.00

Factor II (Prothrombin). DNATeichoic AcidEverolimusNMR LipoprofileLppla Lipoprotein AssociatedT3 (Triiodothyronine)ChromiumLacosamideCystine 24 Hr UrVitamin CEthylene GlycolPyruvic AcidGAD-65 AutoantibodyVit D 25-HydroxyVenous Blood Gas (VBG)RA Latex w/TiterRotavirusMycoplasma PneumoniacH. Pylori CRMCSED Rate Non-AutomatedASO TiterReactive ProtLE LatexMono Or HeterophileCHR URT Anti IgE Recp AbAntinuclear AntibodiesLeptospirosis 1gmAntismooth Muscle AbCA 15-3 (27.29)CA 125Hep B Core AbCyclic Citrullinated PeptidecmV Ab, IgMFEB AGG DISComplement C3Complement C2Complement C4Comp C1 Esterase InhibitComp C1 Eserase Inhib, FnctlRisperidoneEBVHep B Surface AbHep B Surface AntigenHep A Antibody,TotalHEP A IGM ANTIBODYHep C Virus AbHep B Core IgM 90.00 61.00 240.00 137.00 146.00 62.00 62.00 158.00 424.56 66.45 101.55 55.35 48.00 120.00 117.00 74.00 36.00 112.00 87.00 56.00 91.00 67.00 61.00 67.00 35.00 70.00 41.00 78.00 140.00 94.00 70.00 53.00 113.00 83.00 165.00 165.00 165.00 165.00 165.00 93.06 60.00 73.00 48.00 72.00 74.19 71.00 54.00

Panel 083824Bacterium NosLyme AntibodyRPR(STS)Rubella AntibodyThyroid AntithyroglobBordella Pertussis AntibodiesMicrosomal AntibodiesRocky Mtn Spotted FeverIFE SerumHEP C VIRUS, RIBACardiolipin Ab, Each Ig ClassDNA, Ab, NativeENA,AbRheumatoid Factor QuantitativeAllergen Specific IgE, EachIFE, UrineWest Nile Virus, AbToxo IgGToxo IgMCAT SCRATCH DISEASE ABLYME,WESTERN BLOTC-Reactive Protein,CardiacComplement,TotalHEP BE NFLUENZA VIRUSChromogranin ATULAREMIA ANTIBODIESYERSINIACA 19-9HSV 1HSV 2PLATELET Ab TESTIntrinsic Factor AbHSV IgM I/IIParvovirusB CELLS, TOTAL COUNTC-Reactive Protein/CRPCOCCIDIOIDES AbMumps Ab IgM Or IgGRubeola Antibodies, IgMChlamydia Ab IgGVaricella Zoster Virus, IgMVaricella Zoster Virus, IgG 104.00 52.00 120.00 26.00 82.00 109.00 71.00 80.00 198.00 152.00 85.85 122.00 95.00 82.00 40.00 25.00 94.00 57.00 70.00 70.00 29.00 83.00 96.00 124.00 47.00 50.00 50.00 18.00 59.00 90.00 39.00 39.00 90.00 60.00 73.00 50.00 82.00 121.00 68.00 139.00 41.00 21.00 102.00 107.00 53.00 105.00 105.00

Anti-Islet Cell AntibodyEhrlichia AntibodiesBeta-2 Glycoprotein I Ab,G,A,MFrancisella TularensisProtozoa NosWest Nile Virus, Ab, IgMClopidogrel GenotypeTB Test Lab Corp IncubatedQuantiferon-TB GoldB CEL

Kayexelate 15 gm 20.00 Hydrodiuril Tab 3.00 Pyridium Tab 3.00 Perdiem Granules 31.00 Sodium Chloride Tab 3.00 Catapres TTS-1 14.00 Cortisporin Otic Susp 47.00 Erythromycin Ophth Oint 26.00 Compazine Suppos 7.00 Florinef Tab 3.00 Symmetrel Cap 4.00 Periactin Tab 3.00 Benadryl Cap

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