Procedure"& ,|Code Type"& ,|Code"& ,|NDC"& ,|Rev Code"& ,|Procedure Description"& ,|Quantity"& ,|IP Price"& ,|OP Price"& ,|In/Out Same Charge?"& ,|In/Out Charge"& ,|De-identified Minimum IP Charge"& ,|De-identified Minimum OP Charge"& ,|De-identified Maximum Charge IP"& ,|De-identified Maximum Charge OP"& ,|AETNA HMO/POS & PPO: CHILDREN'S - Inpatient"& ,|AETNA HMO/POS & PPO: CHILDREN'S - Outpatient"& ,|AMBETTER: CHILDREN'S"& ,|AMERIGROUP - Scottish Rite - Inpatient"& ,|AMERIGROUP - Scottish Rite - Outpatient"& ,|AMERIGROUP PEACHCARE FOR KIDS - Scottish Rite - Inpatient"& ,|AMERIGROUP PEACHCARE FOR KIDS- Scottish Rite - Outpatient"& ,|ARCHBOLD: CHILDREN'S"& ,|BCBS HMO/POS/PPO: CHILDREN'S"& ,|BCBS PAR: CHILDREN'S"& ,|BEECH STREET PPO: CHILDREN'S"& ,|CARESOURCE - Scottish Rite - Inpatient"& ,|CARESOURCE - Scottish Rite - Outpatient"& ,|CARESOURCE PEACHCARE FOR KIDS - Scottish Rite - Inpatient"& ,|CARESOURCE PEACHCARE FOR KIDS - Scottish Rite - Outpatient"& ,|CHEROKEE COUNTY: CHILDREN'S"& ,|CIGNA HMO/POS & PPO: CHILDREN'S"& ,|CIGNA OSCAR: CHILDREN'S"& ,|COVENTRY FIRST HEALTH NETWORK: CHILDREN'S"& ,|COVENTRY NATIONAL NETWORK: CHILDREN'S"& ,|HEALTH PLAN SELECT (ATHENS AREA) POS: CHILDREN'S"& ,|HUMANA HMO/POS & PPO: CHILDREN'S"& ,|KAISER HMO/POS PPO & EPO: CHILDREN'S"& ,|LIFEWELL PPO, EPO/POS: CHILDREN'S"& ,|MEMORIAL PPO: CHILDREN'S"& ,|MULTIPLAN PPO: CHILDREN'S"& ,|NORTHEAST GEORGIA HEALTH PARTNERS PPO: CHILDREN'S"& ,|NOVANET PPO: CHILDREN'S"& ,|PEACHSTATE - Scottish Rite - Inpatient"& ,|PEACHSTATE - Scottish Rite - Outpatient"& ,|PEACHSTATE PEACHCARE FOR KIDS - Scottish Rite - Inpatient"& ,|PEACHSTATE PEACHCARE FOR KIDS - Scottish Rite - Outpatient"& ,|PHCS PPO: CHILDREN'S"& ,|QUIKTRIP: CHILDREN'S"& ,|STARCARE PPO: CHILDREN'S"& ,|UNITED HEALTHCARE HMO/POS & PPO: CHILDREN'S"& ,|VERACITY BENEFITS: CHILDREN'S"& ,|WELLCARE - Scottish Rite - Inpatient"& ,|WELLCARE - Scottish Rite - Outpatient"& ,|WELLCARE PEACHCARE FOR KIDS - Scottish Rite - Inpatient"& ,|WELLCARE PEACHCARE FOR KIDS - Scottish Rite - Outpatient 25001009"& ,|EAP"& ,|HCPCS Q9966"& ,|"& ,|0250 - PHARMACY - GENERAL"& ,|LOCM OMNIPAQUE 240, PER ML"& ,|1"& ,|12.5"& ,|12.5"& ,|TRUE"& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 "& ,| 12.50 27009888"& ,|EAP"& ,|HCPCS C1729"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|FUHRMAN PLEURAL DRAIN 6.0 (85948)"& ,|1"& ,|1,469.77"& ,|1,469.77"& ,|TRUE"& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 "& ,| 1,469.77 27009889"& ,|EAP"& ,|HCPCS C1751"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH TRIPLE LUMEN UVC 5FR"& ,|1"& ,|559.42"& ,|559.42"& ,|TRUE"& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 "& ,| 559.42 27009890"& ,|EAP"& ,|Custom 27009890"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|BARRIER OSTOMY SKIN 8X8"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27009893"& ,|EAP"& ,|HCPCS C1880"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|FILTER FEMORAL 310 IVC"& ,|1"& ,|4,480.60"& ,|4,480.60"& ,|TRUE"& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 "& ,| 4,480.60 27009895"& ,|EAP"& ,|Custom 27009895"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|NEEDLE EZ-10 PED 15MM 15GA"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 36001008"& ,|EAP"& ,|CPT� 61708"& ,|"& ,|0360 - OPERATING ROOM SERVICES - GENERAL"& ,|ANEURYSM REAPIR IN BRAIN"& ,|1"& ,|10,180.50"& ,|10,180.50"& ,|TRUE"& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 "& ,| 10,180.50 36005074"& ,|EAP"& ,|CPT� 36160"& ,|"& ,|0360 - OPERATING ROOM SERVICES - GENERAL"& ,|INSERTION OF NEEDLE OR CATHETER INTO AORTA"& ,|1"& ,|721"& ,|721"& ,|TRUE"& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 "& ,| 721.00 27001235"& ,|EAP"& ,|Custom 27001235"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|RADIOLOGY VENT SUPPLIES"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27009897"& ,|EAP"& ,|Custom 27009897"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|FOLEY SECUREMENT DEVICE"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27009898"& ,|EAP"& ,|Custom 27009898"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SYSTEM RECOVERY CONE REMOVAL"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27009899"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SPHERE, EMBOSPHERE"& ,|1"& ,|1,281.09"& ,|1,281.09"& ,|TRUE"& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 "& ,| 1,281.09 27009901"& ,|EAP"& ,|Custom 27009901"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH URINARY DRAIN 5FR"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27009902"& ,|EAP"& ,|HCPCS C1874"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|STENT COVERED 5X38X120"& ,|1"& ,|14,386.00"& ,|14,386.00"& ,|TRUE"& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 "& ,| 14,386.00 27009903"& ,|EAP"& ,|Custom 27009903"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|RING TRANSJUGULAR INTRAHEPATIC"& ,|1"& ,|1,853.04"& ,|1,853.04"& ,|TRUE"& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 "& ,| 1,853.04 27009904"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON Z-MED 12X3X100"& ,|1"& ,|5,335.17"& ,|5,335.17"& ,|TRUE"& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 "& ,| 5,335.17 27009905"& ,|EAP"& ,|Custom 27009905"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON Z-MED 18X4MM"& ,|1"& ,|4,936.68"& ,|4,936.68"& ,|TRUE"& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 "& ,| 4,936.68 27009906"& ,|EAP"& ,|Custom 27009906"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON Z-MED 20X4MM"& ,|1"& ,|5,070.29"& ,|5,070.29"& ,|TRUE"& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 "& ,| 5,070.29 27009907"& ,|EAP"& ,|HCPCS L8624"& ,|"& ,|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES"& ,|NUCLEUS FREEDOM RECHGBATT KIT"& ,|1"& ,|2,145.00"& ,|2,145.00"& ,|TRUE"& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 "& ,| 2,145.00 27009908"& ,|EAP"& ,|HCPCS V5267"& ,|"& ,|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES"& ,|NUCLEUS FREEDOM SNUGFIT"& ,|1"& ,|132.5"& ,|132.5"& ,|TRUE"& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 "& ,| 132.50 27009909"& ,|EAP"& ,|HCPCS L8616"& ,|"& ,|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES"& ,|NUCLEUS FREEDOM BABYWORN CABLE"& ,|1"& ,|860"& ,|860"& ,|TRUE"& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 "& ,| 860.00 27009910"& ,|EAP"& ,|Custom 27009910"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|WRAP PLEXI PULSE FOOT LARGE"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27009911"& ,|EAP"& ,|Custom 27009911"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|WRAP PLEXI PULSE FOOT MEDIUM"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27009913"& ,|EAP"& ,|Custom 27009913"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|FILTER HEMOFILTER HF400"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 36005076"& ,|EAP"& ,|CPT� 27052"& ,|"& ,|0360 - OPERATING ROOM SERVICES - GENERAL"& ,|ARTHROTOMY, WITH BIOPSY, HIP JOINT"& ,|1"& ,|9,586.00"& ,|9,586.00"& ,|TRUE"& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 "& ,| 9,586.00 34011013"& ,|EAP"& ,|CPT� 78445"& ,|"& ,|0340 - NUCLEAR MEDICINE - GENERAL"& ,|NON-CARDIAC VASCULAR FLOW IMAGING"& ,|1"& ,|1,632.00"& ,|1,632.00"& ,|TRUE"& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 "& ,| 1,632.00 27009914"& ,|EAP"& ,|Custom 27009914"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH OXIMETRY 5.5FR 8CM"& ,|1"& ,|3,672.99"& ,|3,672.99"& ,|TRUE"& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 "& ,| 3,672.99 27009915"& ,|EAP"& ,|Custom 27009915"& ,|"& ,|0270 - 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CARDIOLOGY - ECHOCARDIOLOGY"& ,|COMPLETE NON-CONGENITAL ECHO"& ,|1"& ,|3,534.00"& ,|3,534.00"& ,|TRUE"& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 "& ,| 3,534.00 27009917"& ,|EAP"& ,|Custom 27009917"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|TUBE CHEST THAL-QUICK 8FR"& ,|1"& ,|1,626.88"& ,|1,626.88"& ,|TRUE"& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 27009919"& ,|EAP"& ,|Custom 27009919"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|TUBE CHEST THAL-QUICK 12FR"& ,|1"& ,|1,626.88"& ,|1,626.88"& ,|TRUE"& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 "& ,| 1,626.88 27009920"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SUTURE ANCHOR SET"& ,|1"& ,|909.32"& ,|909.32"& ,|TRUE"& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 "& ,| 909.32 34014436"& ,|EAP"& ,|HCPCS A9569"& ,|"& ,|0341 - NUCLEAR MEDICINE - DIAGNOSTIC"& ,|NM ISOTOPE TECHNETIUM TC-99M AUTO WBC"& ,|1"& ,|3,340.00"& ,|3,340.00"& ,|TRUE"& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 "& ,| 3,340.00 27041826"& ,|EAP"& ,|HCPCS L5858"& ,|"& ,|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES"& ,|MICROPROCESSOR STANCE ONLY L5858"& ,|1"& ,|41,658.50"& ,|41,658.50"& ,|TRUE"& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 "& ,| 41,658.50 27041828"& ,|EAP"& ,|HCPCS L3913"& ,|"& ,|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES"& ,|HAND FOOT ORTHOSIS WITHOUT JOINT CUSTOM FABRICATED L3913"& ,|1"& ,|571"& ,|571"& ,|TRUE"& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 "& ,| 571.00 27085097"& ,|EAP"& ,|HCPCS C1722"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEFIBRILLATOR ICD SECURA D224VRC"& ,|1"& ,|43,028.26"& ,|43,028.26"& ,|TRUE"& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 "& ,| 43,028.26 27085098"& ,|EAP"& ,|HCPCS C1721"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEFIBRILLAT ICD SECURA D224DRG"& ,|1"& ,|52,681.56"& ,|52,681.56"& ,|TRUE"& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 "& ,| 52,681.56 27085105"& ,|EAP"& ,|HCPCS C1785"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|PACEMAKER ADAPTA� ADDS1"& ,|1"& ,|10,952.65"& ,|10,952.65"& ,|TRUE"& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 "& ,| 10,952.65 27085109"& ,|EAP"& ,|HCPCS C1898"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|PACER LEADS # 4968-25CM"& ,|1"& ,|3,215.29"& ,|3,215.29"& ,|TRUE"& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 27085110"& ,|EAP"& ,|HCPCS C1898"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|PACER LEAD -50 # 4965-50"& ,|1"& ,|3,059.45"& ,|3,059.45"& ,|TRUE"& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 "& ,| 3,059.45 27085111"& ,|EAP"& ,|HCPCS C1898"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|PACER LEAD-35 # 4965-35CM"& ,|1"& ,|2,546.11"& ,|2,546.11"& ,|TRUE"& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 27085112"& ,|EAP"& ,|HCPCS C1898"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|PACER LEADS # 4965-25CM"& ,|1"& ,|2,546.11"& ,|2,546.11"& ,|TRUE"& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 27085114"& ,|EAP"& ,|HCPCS C1777"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|ST. JUDE DEFIBRILLATOR LEAD"& ,|1"& ,|14,954.05"& ,|14,954.05"& ,|TRUE"& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 "& ,| 14,954.05 27085116"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|PLUG PIN DF 1# 6719"& ,|1"& ,|364.22"& ,|364.22"& ,|TRUE"& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 "& ,| 364.22 27085118"& ,|EAP"& ,|Custom 27085118"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|WRENCH # 5873"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27085120"& ,|EAP"& ,|Custom 27085120"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SLEEVE STERILE # 6177"& ,|1"& ,|120.21"& ,|120.21"& ,|TRUE"& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 "& ,| 120.21 37001044"& ,|EAP"& ,|Custom 37001044"& ,|"& ,|0370 - ANESTHESIA - GENERAL"& ,|ANESTHESIA PER 15 MIN,TO 1HR"& ,|1"& ,|289.5"& ,|289.5"& ,|TRUE"& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 "& ,| 289.50 37001045"& ,|EAP"& ,|Custom 37001045"& ,|"& ,|0370 - ANESTHESIA - GENERAL"& ,|ANESTHESIA PER 30 MIN, TO 90 MIN"& ,|1"& ,|1,060.00"& ,|1,060.00"& ,|TRUE"& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 "& ,| 1,060.00 71001030"& ,|EAP"& ,|Custom 71001030"& ,|"& ,|0710 - RECOVERY ROOM - GENERAL"& ,|PACU, PER 15 MINUTES TO 1 HOUR"& ,|1"& ,|272.5"& ,|272.5"& ,|TRUE"& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 "& ,| 272.50 71001031"& ,|EAP"& ,|Custom 71001031"& ,|"& ,|0710 - RECOVERY ROOM - GENERAL"& ,|PACU, PER 30 MINUTES TO 90 MINUTES"& ,|1"& ,|260"& ,|260"& ,|TRUE"& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 "& ,| 260.00 25001177"& ,|EAP"& ,|HCPCS Q9965"& ,|"& ,|0250 - PHARMACY - GENERAL"& ,|OPTIRAY CONTRAST 160, PER ML"& ,|1"& ,|9"& ,|9"& ,|TRUE"& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 "& ,| 9.00 11031000"& ,|EAP"& ,|Custom 11031000"& ,|"& ,|0113 - R&B - PRIVATE (MEDICAL OR GENERAL) - PEDIATRIC"& ,|ROOM/BED PRIVATE - PEDIATRIC"& ,|1"& ,|2,615.00"& ,|2,615.00"& ,|TRUE"& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 "& ,| 2,615.00 11081000"& ,|EAP"& ,|Custom 11081000"& ,|"& ,|0118 - R&B - PRIVATE (MEDICAL OR GENERAL) - REHABILITIATION"& ,|ROOM/BED PRIVATE- REHAB"& ,|1"& ,|3,942.00"& ,|3,942.00"& ,|TRUE"& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 "& ,| 3,942.00 20031000"& ,|EAP"& ,|Custom 20031000"& ,|"& ,|0203 - INTENSIVE CARE - PEDIATRIC"& ,|ROOM/BED ICU - PEDIATRIC"& ,|1"& ,|8,327.50"& ,|8,327.50"& ,|TRUE"& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 "& ,| 8,327.50 20061000"& ,|EAP"& ,|Custom 20061000"& ,|"& ,|0206 - INTENSIVE CARE - INTERMEDIATE INTENSIVE CARE UNIT (ICU)"& ,|ROOM/BED ICU - INTERMEDIATE"& ,|1"& ,|2,693.50"& ,|2,693.50"& ,|TRUE"& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 "& ,| 2,693.50 20061001"& ,|EAP"& ,|Custom 20061001"& ,|"& ,|0206 - INTENSIVE CARE - INTERMEDIATE INTENSIVE CARE UNIT (ICU)"& ,|ROOM/BED PRIVATE - BONE MARROW TRANSPLANT"& ,|1"& ,|4,140.50"& ,|4,140.50"& ,|TRUE"& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 "& ,| 4,140.50 21001000"& ,|EAP"& ,|Custom 21001000"& ,|"& ,|0210 - CORONARY CARE - GENERAL"& ,|ROOM/BED ICU - CARDIAC"& ,|1"& ,|10,766.50"& ,|10,766.50"& ,|TRUE"& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 "& ,| 10,766.50 27001250"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE TSCF21-50-3 J"& ,|1"& ,|188.99"& ,|188.99"& ,|TRUE"& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 27001251"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON CUTTING 6X2X90"& ,|1"& ,|7,567.11"& ,|7,567.11"& ,|TRUE"& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 27001252"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON CUTTING 7X2X90"& ,|1"& ,|7,567.11"& ,|7,567.11"& ,|TRUE"& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 27001253"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON CUTTING 8X2X90"& ,|1"& ,|7,567.11"& ,|7,567.11"& ,|TRUE"& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 "& ,| 7,567.11 27001254"& ,|EAP"& ,|HCPCS C1894"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SET MICROPUNCTURE 4FR"& ,|1"& ,|448.37"& ,|448.37"& ,|TRUE"& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 "& ,| 448.37 27001256"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 14FRX1.2CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27001257"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 14FRX2.0CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27001258"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 16FRX1.7CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27001259"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|KIT FEED GASTROSTMY 18FRX3.0CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27001269"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 16FRX4.5CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27001273"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON TYSHAK MINI 8MMX2CM"& ,|1"& ,|4,902.58"& ,|4,902.58"& ,|TRUE"& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 27001274"& ,|EAP"& ,|HCPCS C1894"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER ONE PIECE KIT 5FR"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27001672"& ,|EAP"& ,|Custom 27001672"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER NO GWIRE 7FRX70CM"& ,|1"& ,|941.72"& ,|941.72"& ,|TRUE"& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 "& ,| 941.72 27001673"& ,|EAP"& ,|HCPCS C1894"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER/SHEATH, OTHER THAN GUIDING, OTHER THAN INTRACARDIAC ELECTROPHYSIOLOGICAL, NON-LASER 10FRX38CM"& ,|1"& ,|1,217.08"& ,|1,217.08"& ,|TRUE"& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 "& ,| 1,217.08 27001674"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE ROSEN 35-220-1.5"& ,|1"& ,|213.53"& ,|213.53"& ,|TRUE"& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 27001675"& ,|EAP"& ,|Custom 27001675"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON BIB 12MMX3.5CM"& ,|1"& ,|6,701.75"& ,|6,701.75"& ,|TRUE"& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 "& ,| 6,701.75 27001676"& ,|EAP"& ,|Custom 27001676"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON ULTRA THIN"& ,|1"& ,|2,470.14"& ,|2,470.14"& ,|TRUE"& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 "& ,| 2,470.14 27001677"& ,|EAP"& ,|Custom 27001677"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BIO F CRV 4MM"& ,|1"& ,|16,845.68"& ,|16,845.68"& ,|TRUE"& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 "& ,| 16,845.68 27001678"& ,|EAP"& ,|HCPCS C1887"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH GLIDE ANG TIP 5FRX100CM"& ,|1"& ,|759.76"& ,|759.76"& ,|TRUE"& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 27001681"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL MWCE 38-3-2"& ,|1"& ,|463.74"& ,|463.74"& ,|TRUE"& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 "& ,| 463.74 27001682"& ,|EAP"& ,|Custom 27001682"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|WANDA PLASMA TURBINATE"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27001683"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL MWCE 38-5-8"& ,|1"& ,|253.14"& ,|253.14"& ,|TRUE"& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 "& ,| 253.14 27001684"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE HELIX SEPTAL OCCL 20MM"& ,|1"& ,|21,154.87"& ,|21,154.87"& ,|TRUE"& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 "& ,| 21,154.87 27001685"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE HELIX SEPTAL OCCL 25MM"& ,|1"& ,|24,286.16"& ,|24,286.16"& ,|TRUE"& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 27001686"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE HELIX SEPTAL OCCL 30MM"& ,|1"& ,|24,286.16"& ,|24,286.16"& ,|TRUE"& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 "& ,| 24,286.16 27001687"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE HELIX SEPTAL OCCL 35MM"& ,|1"& ,|19,001.10"& ,|19,001.10"& ,|TRUE"& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 "& ,| 19,001.10 27001688"& ,|EAP"& ,|Custom 27001688"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON 40MMX4CM"& ,|1"& ,|2,461.49"& ,|2,461.49"& ,|TRUE"& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 "& ,| 2,461.49 27001689"& ,|EAP"& ,|Custom 27001689"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BIO B CRV 4MM"& ,|1"& ,|16,010.38"& ,|16,010.38"& ,|TRUE"& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 "& ,| 16,010.38 27001691"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH MPA2 5FR 100CM .038IN"& ,|1"& ,|159.98"& ,|159.98"& ,|TRUE"& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 "& ,| 159.98 27001692"& ,|EAP"& ,|HCPCS C1894"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER/SHEATH, AXCESS, OTHER THAN GUIDING, OTHER THAN INTRACARDIAC ELECTROPHYSIOLOGICAL, NON-LASER 7FR 038 45CM"& ,|1"& ,|1,069.14"& ,|1,069.14"& ,|TRUE"& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 "& ,| 1,069.14 27001693"& ,|EAP"& ,|HCPCS C1894"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER/SHEATH, AXCESS, OTHER THAN GUIDING, OTHER THAN INTRACARDIAC ELECTROPHYSIOLOGICAL, NON-LASER 8FR 038 45CM"& ,|1"& ,|133.95"& ,|133.95"& ,|TRUE"& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 "& ,| 133.95 27001694"& ,|EAP"& ,|HCPCS C1894"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER/SHEATH, AXCESS, OTHER THAN GUIDING, OTHER THAN INTRACARDIAC ELECTROPHYSIOLOGICAL, NON-LASER 9FR 038 45CM"& ,|1"& ,|142.74"& ,|142.74"& ,|TRUE"& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 "& ,| 142.74 27001695"& ,|EAP"& ,|Custom 27001695"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH INFINITI 3D RC 4FRX100CM"& ,|1"& ,|205.4"& ,|205.4"& ,|TRUE"& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 27001696"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON TYSHAK II 12X4"& ,|1"& ,|4,569.50"& ,|4,569.50"& ,|TRUE"& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 "& ,| 4,569.50 27001697"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON TYSHAK II 10X3"& ,|1"& ,|4,750.10"& ,|4,750.10"& ,|TRUE"& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 27001698"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-008"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001699"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-009"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001700"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-010"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001701"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-011"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001702"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-012"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001703"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-013"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001704"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-014"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001705"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-015"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001706"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-016"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001707"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-017"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001708"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-018"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001709"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-019"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001710"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-020"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001711"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-022"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001712"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-024"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001713"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-026"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001714"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-028"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001715"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-030"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001716"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-032"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001717"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-034"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001718"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-036"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27001719"& ,|EAP"& ,|Custom 27001719"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SHEATH AMPLATZER 9 7F 45/80"& ,|1"& ,|4,105.67"& ,|4,105.67"& ,|TRUE"& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 27001720"& ,|EAP"& ,|Custom 27001720"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SHEATH AMPLATZER 9 8F 45/80"& ,|1"& ,|4,105.67"& ,|4,105.67"& ,|TRUE"& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 27001721"& ,|EAP"& ,|Custom 27001721"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SHEATH AMPLATZER 9 10F 45/80"& ,|1"& ,|4,105.67"& ,|4,105.67"& ,|TRUE"& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 27001722"& ,|EAP"& ,|Custom 27001722"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SHEATH AMPLATZER 9 12F 45/80"& ,|1"& ,|4,105.67"& ,|4,105.67"& ,|TRUE"& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 27001723"& ,|EAP"& ,|Custom 27001723"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON AMPLATZER 25CC"& ,|1"& ,|3,032.62"& ,|3,032.62"& ,|TRUE"& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 27001724"& ,|EAP"& ,|Custom 27001724"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON AMPLATZER 34CC"& ,|1"& ,|3,032.62"& ,|3,032.62"& ,|TRUE"& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 "& ,| 3,032.62 27001725"& ,|EAP"& ,|Custom 27001725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER NO GWIRE 10FRX30CM"& ,|1"& ,|942.47"& ,|942.47"& ,|TRUE"& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 "& ,| 942.47 27001726"& ,|EAP"& ,|HCPCS C1894"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER NO GWIRE 12FRX30CM"& ,|1"& ,|995.71"& ,|995.71"& ,|TRUE"& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 "& ,| 995.71 27001729"& ,|EAP"& ,|Custom 27001729"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON KIT LP 18FRX1.2CM"& ,|1"& ,|2,048.57"& ,|2,048.57"& ,|TRUE"& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 27001730"& ,|EAP"& ,|Custom 27001730"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON KIT LP 18FRX1.7CM"& ,|1"& ,|2,048.57"& ,|2,048.57"& ,|TRUE"& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 27001734"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL MWCE 25-3-3"& ,|1"& ,|560.04"& ,|560.04"& ,|TRUE"& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 27001735"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL MWCE 38-5-3"& ,|1"& ,|215.89"& ,|215.89"& ,|TRUE"& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 27001736"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL MWCE 35-3-5"& ,|1"& ,|214.45"& ,|214.45"& ,|TRUE"& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 27001737"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL MWCE 38-2-3"& ,|1"& ,|215.89"& ,|215.89"& ,|TRUE"& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 "& ,| 215.89 27001744"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE TSF 18-50"& ,|1"& ,|188.99"& ,|188.99"& ,|TRUE"& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 27001745"& ,|EAP"& ,|HCPCS C1877"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|STENT BILIARY 25 MM"& ,|1"& ,|4,209.36"& ,|4,209.36"& ,|TRUE"& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 "& ,| 4,209.36 27001746"& ,|EAP"& ,|HCPCS C1877"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|STENT BILIARY MOUNTED 9 19 80"& ,|1"& ,|4,127.19"& ,|4,127.19"& ,|TRUE"& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 "& ,| 4,127.19 27001747"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE TSCF 18-50-3 J"& ,|1"& ,|188.99"& ,|188.99"& ,|TRUE"& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 "& ,| 188.99 27001748"& ,|EAP"& ,|Custom 27001748"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SHEATH AMPLATZER 9 6F 45/80"& ,|1"& ,|4,105.67"& ,|4,105.67"& ,|TRUE"& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 27001749"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL MWCE 25-2.5-2"& ,|1"& ,|205.11"& ,|205.11"& ,|TRUE"& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 27001751"& ,|EAP"& ,|HCPCS C1773"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SNARE GOOSE NECK AMPLATZ 5MM"& ,|1"& ,|3,230.79"& ,|3,230.79"& ,|TRUE"& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 27001752"& ,|EAP"& ,|Custom 27001752"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON SYMMETRY 2X2X90CM"& ,|1"& ,|3,231.66"& ,|3,231.66"& ,|TRUE"& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 27001753"& ,|EAP"& ,|Custom 27001753"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|NEEDLE BROCKENBROUGH 18GX71CM"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27001754"& ,|EAP"& ,|Custom 27001754"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|KIT JACKSON PRATT"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27001755"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON TYSHAK II 5X2"& ,|1"& ,|4,750.10"& ,|4,750.10"& ,|TRUE"& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 27001756"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON TYSHAK II 6X2"& ,|1"& ,|4,750.10"& ,|4,750.10"& ,|TRUE"& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 27001757"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON TYSHAK II 7X2"& ,|1"& ,|4,750.10"& ,|4,750.10"& ,|TRUE"& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 27001758"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON TYSHAK II 8X3"& ,|1"& ,|4,750.10"& ,|4,750.10"& ,|TRUE"& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 27001759"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON TYSHAK II 12X3"& ,|1"& ,|4,750.10"& ,|4,750.10"& ,|TRUE"& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 27001760"& ,|EAP"& ,|HCPCS C1773"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SNARE GOOSE NECK AMPLATZ 15MM"& ,|1"& ,|3,230.79"& ,|3,230.79"& ,|TRUE"& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 "& ,| 3,230.79 27002643"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 14FRX3.5CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27002644"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 16FRX1.5CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27002645"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 18FRX2.3CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27002646"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 18FRX2.7CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27002651"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL MWCE 38-10-8"& ,|1"& ,|205.11"& ,|205.11"& ,|TRUE"& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 "& ,| 205.11 27002653"& ,|EAP"& ,|HCPCS C1887"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH GLIDE ANG TIP 5FRX65CM"& ,|1"& ,|759.76"& ,|759.76"& ,|TRUE"& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 27002657"& ,|EAP"& ,|Custom 27002657"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SUTURE GUT CHROMIC 4-0 18IN PS-4C BROWN"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27002658"& ,|EAP"& ,|Custom 27002658"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SUTURE ETHILON 2-0 18IN PS BLACK"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27002662"& ,|EAP"& ,|HCPCS X4000"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SUTURE GUT CHROMIC DOUBLE ARMED 6-0 18IN G-1 BROWN"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27002663"& ,|EAP"& ,|HCPCS X4000"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SUTURE PROLENE 5-0 18IN PC-1 BLUE"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27002700"& ,|EAP"& ,|Custom 27002700"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CANNULA SGL STAGE VENOUS 12FR"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27002706"& ,|EAP"& ,|Custom 27002706"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CANNULA ART FEM BIOMED 8FR"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27002707"& ,|EAP"& ,|Custom 27002707"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CANNULA ART FEM BIOMED 10FR"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27002710"& ,|EAP"& ,|Custom 27002710"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON KIT LP 18FRX2.4CM"& ,|1"& ,|2,048.57"& ,|2,048.57"& ,|TRUE"& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 27002711"& ,|EAP"& ,|Custom 27002711"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON KIT LP 18FRX3.4CM"& ,|1"& ,|2,048.57"& ,|2,048.57"& ,|TRUE"& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 27002713"& ,|EAP"& ,|Custom 27002713"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON KIT LP 24FRX4.4CM"& ,|1"& ,|2,048.57"& ,|2,048.57"& ,|TRUE"& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 27002714"& ,|EAP"& ,|Custom 27002714"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|TUBE CONTINUOUS RT ANGLE 18FR"& ,|1"& ,|68.99"& ,|68.99"& ,|TRUE"& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 "& ,| 68.99 27003299"& ,|EAP"& ,|Custom 27003299"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON CADIO 2X10MM"& ,|1"& ,|8,865.15"& ,|8,865.15"& ,|TRUE"& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 "& ,| 8,865.15 27003300"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON SAVVY 4X2X80"& ,|1"& ,|3,802.79"& ,|3,802.79"& ,|TRUE"& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 "& ,| 3,802.79 27003301"& ,|EAP"& ,|Custom 27003301"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH FST TRACLER 5FR 325"& ,|1"& ,|3,889.33"& ,|3,889.33"& ,|TRUE"& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 "& ,| 3,889.33 27003302"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH MULTIPURPOSE 4FRX80CM"& ,|1"& ,|205.4"& ,|205.4"& ,|TRUE"& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 27003303"& ,|EAP"& ,|Custom 27003303"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH MULTI-TRACK 3FR 80CM"& ,|1"& ,|509.16"& ,|509.16"& ,|TRUE"& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 "& ,| 509.16 27003304"& ,|EAP"& ,|Custom 27003304"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH ANGIO MULTITRACK 4FRX80CM"& ,|1"& ,|628.05"& ,|628.05"& ,|TRUE"& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 "& ,| 628.05 27003305"& ,|EAP"& ,|Custom 27003305"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH PARK BLADE 5.7FRX59CM"& ,|1"& ,|13,945.33"& ,|13,945.33"& ,|TRUE"& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 "& ,| 13,945.33 27003306"& ,|EAP"& ,|HCPCS C1730"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH QUAD CRD-2 5FR"& ,|1"& ,|1,292.67"& ,|1,292.67"& ,|TRUE"& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 "& ,| 1,292.67 27003307"& ,|EAP"& ,|Custom 27003307"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH SUPER TORQUE 5FR JL4"& ,|1"& ,|381.3"& ,|381.3"& ,|TRUE"& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 "& ,| 381.30 27003308"& ,|EAP"& ,|Custom 27003308"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH TRACKER TURBO 18IN"& ,|1"& ,|4,451.81"& ,|4,451.81"& ,|TRUE"& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 "& ,| 4,451.81 27003309"& ,|EAP"& ,|Custom 27003309"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH THROMBECTOMY XPEEDIOR 6FR"& ,|1"& ,|8,994.95"& ,|8,994.95"& ,|TRUE"& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 "& ,| 8,994.95 27003310"& ,|EAP"& ,|Custom 27003310"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|DELIVERY SYSTEM ATRIAL SEPTAL DEFECTS 10F"& ,|1"& ,|6,130.61"& ,|6,130.61"& ,|TRUE"& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 27003311"& ,|EAP"& ,|Custom 27003311"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|DELIVERY SYSTEM ATRIAL SEPTAL DEFECTS 12F"& ,|1"& ,|6,130.61"& ,|6,130.61"& ,|TRUE"& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 27003312"& ,|EAP"& ,|Custom 27003312"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|DELIVERY SYSTEM ATRIAL SEPTAL DEFECTS 6F"& ,|1"& ,|6,130.61"& ,|6,130.61"& ,|TRUE"& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 27003313"& ,|EAP"& ,|Custom 27003313"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|DELIVERY SYSTEM ATRIAL SEPTAL DEFECTS 7F"& ,|1"& ,|6,130.61"& ,|6,130.61"& ,|TRUE"& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 27003314"& ,|EAP"& ,|Custom 27003314"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|DELIVERY SYSTEM ATRIAL SEPTAL DEFECTS 8F"& ,|1"& ,|6,130.61"& ,|6,130.61"& ,|TRUE"& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 27003315"& ,|EAP"& ,|Custom 27003315"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|DELIVERY SYSTEM ATRIAL SEPTAL DEFECTS 9F"& ,|1"& ,|6,130.61"& ,|6,130.61"& ,|TRUE"& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 27003316"& ,|EAP"& ,|Custom 27003316"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|FORCEP BIOPSY 5FR 1.5 100CM"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27003317"& ,|EAP"& ,|Custom 27003317"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|FORCEP RAT TOOTH 3FRX115CM"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27003318"& ,|EAP"& ,|Custom 27003318"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|FORCEP RAT TOOTH 3FRX65CM"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27003319"& ,|EAP"& ,|HCPCS C1894"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER 5FR 13CM"& ,|1"& ,|504.16"& ,|504.16"& ,|TRUE"& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 "& ,| 504.16 27003320"& ,|EAP"& ,|HCPCS C1894"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER 7FR 13CM"& ,|1"& ,|272.05"& ,|272.05"& ,|TRUE"& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 "& ,| 272.05 27003321"& ,|EAP"& ,|HCPCS C1894"& ,|"& ,|0270 - 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MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|PATCH EXTERNAL BIOSENSE"& ,|1"& ,|4,209.51"& ,|4,209.51"& ,|TRUE"& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 "& ,| 4,209.51 27003324"& ,|EAP"& ,|Custom 27003324"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SEQURE BASKET"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27003325"& ,|EAP"& ,|Custom 27003325"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SHEATH BCH 11FR"& ,|1"& ,|1,277.77"& ,|1,277.77"& ,|TRUE"& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 "& ,| 1,277.77 27003326"& ,|EAP"& ,|HCPCS C1877"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|STENT BILIARY MOUNTED 3 12 80"& ,|1"& ,|4,614.87"& ,|4,614.87"& ,|TRUE"& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 "& ,| 4,614.87 27003327"& ,|EAP"& ,|Custom 27003327"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|VALVE HEMOSTASIS"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27003721"& ,|EAP"& ,|Custom 27003721"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|TUBE BOLUS MICROVASIVE 24FR"& ,|1"& ,|124.34"& ,|124.34"& ,|TRUE"& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 "& ,| 124.34 27003722"& ,|EAP"& ,|Custom 27003722"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|TUBE DECOMPRESSION 18FRX1.2CM"& ,|1"& ,|139.26"& ,|139.26"& ,|TRUE"& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 27003724"& ,|EAP"& ,|Custom 27003724"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|TUBE DECOMPRESSION 18FRX4.4CM"& ,|1"& ,|139.26"& ,|139.26"& ,|TRUE"& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 27003725"& ,|EAP"& ,|Custom 27003725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|TUBE DECOMPRESSION 24FRX1.2CM"& ,|1"& ,|119.36"& ,|119.36"& ,|TRUE"& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 "& ,| 119.36 27003726"& ,|EAP"& ,|Custom 27003726"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|TUBE DECOMPRESSION 24FRX1.7CM"& ,|1"& ,|139.26"& ,|139.26"& ,|TRUE"& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 27003727"& ,|EAP"& ,|Custom 27003727"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|TUBE DECOMPRESSION 24FRX2.4CM"& ,|1"& ,|139.26"& ,|139.26"& ,|TRUE"& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 27003728"& ,|EAP"& ,|Custom 27003728"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|TUBE DECOMPRESSION 24FRX4.4CM"& ,|1"& ,|139.26"& ,|139.26"& ,|TRUE"& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 27003733"& ,|EAP"& ,|Custom 27003733"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON SYMMETRY 3X2X90"& ,|1"& ,|3,231.66"& ,|3,231.66"& ,|TRUE"& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 "& ,| 3,231.66 27003735"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|KIT FEED GASTROSTMY 24FRX2.5CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27003742"& ,|EAP"& ,|Custom 27003742"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CANNULA ART FEM BIOMED 12FR"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27003743"& ,|EAP"& ,|Custom 27003743"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CANNULA ART FEM BIOMED 14FR"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27003745"& ,|EAP"& ,|Custom 27003745"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CANNULA VENOUS FEM BIOMED 10FR"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27003748"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE PDA OCCLUDER 5/4"& ,|1"& ,|5,616.56"& ,|5,616.56"& ,|TRUE"& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 27003749"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE PDA OCCLUDER 6/4"& ,|1"& ,|5,616.56"& ,|5,616.56"& ,|TRUE"& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 27003750"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE PDA OCCLUDER 10/8"& ,|1"& ,|5,616.56"& ,|5,616.56"& ,|TRUE"& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 27003751"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE PDA OCCLUDER 12/10"& ,|1"& ,|5,616.56"& ,|5,616.56"& ,|TRUE"& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 "& ,| 5,616.56 27003752"& ,|EAP"& ,|Custom 27003752"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SHEATH PDA 6FR"& ,|1"& ,|4,105.67"& ,|4,105.67"& ,|TRUE"& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 "& ,| 4,105.67 27003753"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON TYSHAK MINI 4MMX2CM"& ,|1"& ,|4,902.58"& ,|4,902.58"& ,|TRUE"& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 27003754"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON TYSHAK MINI 5MMX2CM"& ,|1"& ,|4,902.58"& ,|4,902.58"& ,|TRUE"& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 27003755"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|"GUIDE WIRE ANGLED .025""X180CM""& ,|1"& ,|814.3"& ,|814.3"& ,|TRUE"& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 "& ,| 814.30 27003756"& ,|EAP"& ,|Custom 27003756"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|FORCEP BIOPSY 6FR N F STRGHT"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27003757"& ,|EAP"& ,|Custom 27003757"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|FORCEP BIOPSY 6FR 105CM"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27003758"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-004"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27003759"& ,|EAP"& ,|HCPCS C1733"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH FREEZOR 3 7FRX4MM"& ,|1"& ,|10,754.95"& ,|10,754.95"& ,|TRUE"& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 "& ,| 10,754.95 27003760"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 16FRX1.2CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27003763"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE EXCH TSF-25-260"& ,|1"& ,|264.42"& ,|264.42"& ,|TRUE"& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 "& ,| 264.42 27003764"& ,|EAP"& ,|Custom 27003764"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|TUBE FEED 16FR 30CM GJ"& ,|1"& ,|2,487.45"& ,|2,487.45"& ,|TRUE"& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 "& ,| 2,487.45 27003765"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 16FRX2.7CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27003766"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL MWCE 18-2-2"& ,|1"& ,|267.84"& ,|267.84"& ,|TRUE"& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 27003767"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL MWCE 18-3-3"& ,|1"& ,|267.84"& ,|267.84"& ,|TRUE"& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 "& ,| 267.84 27003769"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL MWC 25-5-5"& ,|1"& ,|560.04"& ,|560.04"& ,|TRUE"& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 "& ,| 560.04 27003770"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL MWCE 38-3-5"& ,|1"& ,|205.76"& ,|205.76"& ,|TRUE"& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 "& ,| 205.76 27003771"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL MWCE 38-4-3"& ,|1"& ,|233.53"& ,|233.53"& ,|TRUE"& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 27003772"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL MWCE 38-5-5"& ,|1"& ,|280.12"& ,|280.12"& ,|TRUE"& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 "& ,| 280.12 27003776"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL MWCE 38-8-8"& ,|1"& ,|374.77"& ,|374.77"& ,|TRUE"& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 "& ,| 374.77 27003778"& ,|EAP"& ,|HCPCS A7521"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|TUBE TRACH UNCUFFED SILICONEL 4X6MM"& ,|1"& ,|1,066.44"& ,|1,066.44"& ,|TRUE"& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 27003779"& ,|EAP"& ,|HCPCS A7521"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|TUBE TRACH UNCUFFED SILICONE 4.5MM"& ,|1"& ,|1,066.44"& ,|1,066.44"& ,|TRUE"& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 "& ,| 1,066.44 27003780"& ,|EAP"& ,|HCPCS A7521"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|TUBE TRACH UNCUFFED SILICONE 5X7.3MM"& ,|1"& ,|1,093.76"& ,|1,093.76"& ,|TRUE"& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 27003782"& ,|EAP"& ,|Custom 27003782"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|ELECTRODE PAIRED SUBDERMAL"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27003786"& ,|EAP"& ,|Custom 27003786"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH FOLEY TEMP PROBE 10FR"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27003975"& ,|EAP"& ,|HCPCS X3100"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|DERMABOND"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27003999"& ,|EAP"& ,|HCPCS X4000"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SUTURE GUT CHROMIC 4-0 54IN TIE BROWN"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27004000"& ,|EAP"& ,|Custom 27004000"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SUTURE GUT CHROMIC DOUBLE ARMED 4-0 18IN G-3 BROWN"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27004002"& ,|EAP"& ,|Custom 27004002"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SUTURE GUT CHROMIC 6-0 18IN PS-6 BROWN"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27004011"& ,|EAP"& ,|HCPCS X4000"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SUTURE ETHILON 5-0 18IN PC-1 BLACK"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27004019"& ,|EAP"& ,|Custom 27004019"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SUTURE ETHILON 3-0 18IN PS-1 BLACK"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27005038"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|PARTICLES PVA 500 710"& ,|1"& ,|703.86"& ,|703.86"& ,|TRUE"& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 "& ,| 703.86 27005039"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 16FRX3CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27005040"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 16FRX3.5CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27005043"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|KIT FEED GASTROSTMY 20FRX3.0CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27005044"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|KIT FEED GASTROSTMY 20FRX3.5CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27005045"& ,|EAP"& ,|HCPCS A7521"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|TRACH BIVONA FLEXTEND NEO 2.5"& ,|1"& ,|1,771.15"& ,|1,771.15"& ,|TRUE"& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 "& ,| 1,771.15 27005046"& ,|EAP"& ,|HCPCS A7521"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|TUBE TRACH UNCUFFED SILICONE 5.5X8MM"& ,|1"& ,|1,093.76"& ,|1,093.76"& ,|TRUE"& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 "& ,| 1,093.76 27005048"& ,|EAP"& ,|HCPCS C1730"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH ABLATION STD CRV 6FR"& ,|1"& ,|7,307.50"& ,|7,307.50"& ,|TRUE"& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 "& ,| 7,307.50 27005054"& ,|EAP"& ,|HCPCS A7521"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|TRACH BIVONA PED TTS CUF 3.0"& ,|1"& ,|2,104.39"& ,|2,104.39"& ,|TRUE"& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 "& ,| 2,104.39 27005055"& ,|EAP"& ,|Custom 27005055"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH THERMODILUTION 5FR"& ,|1"& ,|1,380.35"& ,|1,380.35"& ,|TRUE"& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 "& ,| 1,380.35 27005057"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 20FRX2.5CM"& ,|1"& ,|1,155.31"& ,|1,155.31"& ,|TRUE"& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 "& ,| 1,155.31 27005067"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 16FRX1.0CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27005074"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 12FRX1CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27005075"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 12FRX1.2CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27005076"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 12FRX1.5CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27005077"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 12FRX1.7CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27005078"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 12FRX2.0CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27005079"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 12FRX2.3CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27005080"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 12FRX2.5CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27005082"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-005"& ,|1"& ,|13,678.44"& ,|13,678.44"& ,|TRUE"& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 "& ,| 13,678.44 27005083"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE AMPLATZER S/O 9-006"& ,|1"& ,|16,766.76"& ,|16,766.76"& ,|TRUE"& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 "& ,| 16,766.76 27005084"& ,|EAP"& ,|Custom 27005084"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER SET 3FRX7CM"& ,|1"& ,|1,606.47"& ,|1,606.47"& ,|TRUE"& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 "& ,| 1,606.47 27005085"& ,|EAP"& ,|Custom 27005085"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER SET 4FRX7CM"& ,|1"& ,|2,043.17"& ,|2,043.17"& ,|TRUE"& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 "& ,| 2,043.17 27005086"& ,|EAP"& ,|Custom 27005086"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER SHEATH HEMO 5FRX7CM"& ,|1"& ,|273.87"& ,|273.87"& ,|TRUE"& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 "& ,| 273.87 27005087"& ,|EAP"& ,|Custom 27005087"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER SET 6FRX7CM"& ,|1"& ,|1,104.78"& ,|1,104.78"& ,|TRUE"& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 "& ,| 1,104.78 27005091"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE TSCFB 35-145-15"& ,|1"& ,|141.41"& ,|141.41"& ,|TRUE"& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 "& ,| 141.41 27005092"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE ANGLED 035 150"& ,|1"& ,|490.92"& ,|490.92"& ,|TRUE"& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 27005093"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE STRAIGHT .035-150"& ,|1"& ,|490.92"& ,|490.92"& ,|TRUE"& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 "& ,| 490.92 27005163"& ,|EAP"& ,|HCPCS C1894"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER FLEXOR 5.5X38X40"& ,|1"& ,|890.86"& ,|890.86"& ,|TRUE"& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 "& ,| 890.86 27005164"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE GRANDSLAM 300CM .014"& ,|1"& ,|1,184.69"& ,|1,184.69"& ,|TRUE"& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 "& ,| 1,184.69 27005166"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON Z-MED II 20X4MM"& ,|1"& ,|3,324.50"& ,|3,324.50"& ,|TRUE"& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 27005167"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON Z-MED II 22X4MM"& ,|1"& ,|4,532.50"& ,|4,532.50"& ,|TRUE"& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 "& ,| 4,532.50 27005168"& ,|EAP"& ,|Custom 27005168"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON Z-MED II 25X5MM"& ,|1"& ,|3,324.50"& ,|3,324.50"& ,|TRUE"& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 "& ,| 3,324.50 27005169"& ,|EAP"& ,|HCPCS C1773"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|DELIVERY SYSTEM PATENT DUCTUS ARTERIOSUS 5F"& ,|1"& ,|6,130.61"& ,|6,130.61"& ,|TRUE"& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 27005170"& ,|EAP"& ,|HCPCS C1773"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|DELIVERY SYSTEM PATENT DUCTUS ARTERIOSUS 6F"& ,|1"& ,|6,130.61"& ,|6,130.61"& ,|TRUE"& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 27005171"& ,|EAP"& ,|HCPCS C1773"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|DELIVERY SYSTEM PATENT DUCTUS ARTERIOSUS 7F"& ,|1"& ,|6,130.61"& ,|6,130.61"& ,|TRUE"& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 "& ,| 6,130.61 27005172"& ,|EAP"& ,|HCPCS C1733"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH ABLATION 5FRX45MM"& ,|1"& ,|4,754.69"& ,|4,754.69"& ,|TRUE"& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 "& ,| 4,754.69 27005173"& ,|EAP"& ,|Custom 27005173"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH SGL MARINER 5FRX35MM"& ,|1"& ,|5,663.32"& ,|5,663.32"& ,|TRUE"& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 "& ,| 5,663.32 27005174"& ,|EAP"& ,|HCPCS C1733"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH ABLATION SM CRV 7FR"& ,|1"& ,|8,781.47"& ,|8,781.47"& ,|TRUE"& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 27005175"& ,|EAP"& ,|HCPCS C1733"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BLAZER II XP LG CURVE 7FR"& ,|1"& ,|11,100.09"& ,|11,100.09"& ,|TRUE"& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 "& ,| 11,100.09 27005176"& ,|EAP"& ,|HCPCS C1733"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BLAZER II XP LG CURVE 8FR"& ,|1"& ,|11,596.05"& ,|11,596.05"& ,|TRUE"& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 "& ,| 11,596.05 27005177"& ,|EAP"& ,|Custom 27005177"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BIO D CRV 8MM"& ,|1"& ,|18,284.25"& ,|18,284.25"& ,|TRUE"& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 "& ,| 18,284.25 27005178"& ,|EAP"& ,|HCPCS C1874"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|STENT COVERED ICAST 7X16X80"& ,|1"& ,|13,507.50"& ,|13,507.50"& ,|TRUE"& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 "& ,| 13,507.50 27005179"& ,|EAP"& ,|HCPCS C1874"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|STENT COVERED 6FRX5MMX80CM"& ,|1"& ,|7,026.00"& ,|7,026.00"& ,|TRUE"& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 "& ,| 7,026.00 27005180"& ,|EAP"& ,|HCPCS C1874"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|STENT COVERED 9FRX38X120"& ,|1"& ,|7,837.47"& ,|7,837.47"& ,|TRUE"& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 "& ,| 7,837.47 27005181"& ,|EAP"& ,|Custom 27005181"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BIO F CRV 8MM"& ,|1"& ,|18,585.89"& ,|18,585.89"& ,|TRUE"& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 "& ,| 18,585.89 27005182"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE VSD 10MM"& ,|1"& ,|19,994.73"& ,|19,994.73"& ,|TRUE"& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 27005183"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE VSD 4MM"& ,|1"& ,|19,994.73"& ,|19,994.73"& ,|TRUE"& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 27005184"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE VSD 6MM"& ,|1"& ,|19,994.73"& ,|19,994.73"& ,|TRUE"& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 27005185"& ,|EAP"& ,|HCPCS C1817"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|DEVICE VSD 8MM"& ,|1"& ,|19,994.73"& ,|19,994.73"& ,|TRUE"& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 "& ,| 19,994.73 27005479"& ,|EAP"& ,|Custom 27005479"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SUTURE MONOCRYL 6-0 18IN PS-6 UNDYED"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27005492"& ,|EAP"& ,|Custom 27005492"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SUTURE PROLENE DOUBLE ARMED 2-0 36IN SH BLUE"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27005497"& ,|EAP"& ,|HCPCS X4000"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SUTURE PROLENE 6-0 18IN PC-1 BLUE"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27005503"& ,|EAP"& ,|Custom 27005503"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SUTURE PERMA HAND SILK 2-0 18IN PS BLACK"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27005508"& ,|EAP"& ,|Custom 27005508"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SUTURE PERMA HAND SILK 3-0 30IN BLACK"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27005524"& ,|EAP"& ,|HCPCS X4000"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SUTURE COATED VICRYL 5-0 18IN PC-1 UNDYED"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27005525"& ,|EAP"& ,|Custom 27005525"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SUTURE VICRYL RAPIDE 5-0 18IN P-3 UNDYED"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27005526"& ,|EAP"& ,|HCPCS X4000"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SUTURE COATED VICRYL 6-0 18IN PC-1 UNDYED"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27006803"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE TSF 32-145CM"& ,|1"& ,|213.53"& ,|213.53"& ,|TRUE"& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 "& ,| 213.53 27006804"& ,|EAP"& ,|HCPCS C1893"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER/SHEATH, GUIDING, INTRACARDIAC ELECTROPHYSIOLOGICAL, FIXED-CURVE, OTHER THAN PEEL-AWAY"& ,|1"& ,|1,778.60"& ,|1,778.60"& ,|TRUE"& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 "& ,| 1,778.60 27006805"& ,|EAP"& ,|HCPCS C1893"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER/SHEATH, GUIDING, INTRACARDIAC ELECTROPHYSIOLOGICAL, FIXED-CURVE, OTHER THAN PEEL-AWAY"& ,|1"& ,|1,832.60"& ,|1,832.60"& ,|TRUE"& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 "& ,| 1,832.60 27006806"& ,|EAP"& ,|Custom 27006806"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON Z-MED 22X4MM"& ,|1"& ,|4,800.03"& ,|4,800.03"& ,|TRUE"& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 "& ,| 4,800.03 27006807"& ,|EAP"& ,|Custom 27006807"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON Z-MED 25X4MM"& ,|1"& ,|4,659.50"& ,|4,659.50"& ,|TRUE"& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 "& ,| 4,659.50 27006808"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE EXCHANGE TSF38-260CM"& ,|1"& ,|161.64"& ,|161.64"& ,|TRUE"& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 "& ,| 161.64 27006809"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON DILATOR 12 4.5/5.8/120"& ,|1"& ,|3,127.81"& ,|3,127.81"& ,|TRUE"& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 27006810"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON DILATOR 14 4/5.8/75E"& ,|1"& ,|3,127.81"& ,|3,127.81"& ,|TRUE"& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 27006811"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON DILATOR 16-4-5.8/120"& ,|1"& ,|3,127.81"& ,|3,127.81"& ,|TRUE"& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 "& ,| 3,127.81 27006812"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON ULTRA THIN 8MMX3CM"& ,|1"& ,|2,210.54"& ,|2,210.54"& ,|TRUE"& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 27006813"& ,|EAP"& ,|HCPCS C1733"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH ABLATION LGC 7FR"& ,|1"& ,|8,781.47"& ,|8,781.47"& ,|TRUE"& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 27006814"& ,|EAP"& ,|HCPCS C1730"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH ABLATION LGC 8FR"& ,|1"& ,|9,948.65"& ,|9,948.65"& ,|TRUE"& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 "& ,| 9,948.65 27006815"& ,|EAP"& ,|HCPCS C1733"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH ABLATION STD CUR 7FR"& ,|1"& ,|8,781.47"& ,|8,781.47"& ,|TRUE"& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 "& ,| 8,781.47 27006816"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON DILATOR 18 4/5.8/120E"& ,|1"& ,|2,721.09"& ,|2,721.09"& ,|TRUE"& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 "& ,| 2,721.09 27006817"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON DILATOR 16-6/5.8/75"& ,|1"& ,|3,984.52"& ,|3,984.52"& ,|TRUE"& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 "& ,| 3,984.52 27006819"& ,|EAP"& ,|HCPCS C1887"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH GLIDE ANG TIP 4FRX65CM"& ,|1"& ,|759.76"& ,|759.76"& ,|TRUE"& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 "& ,| 759.76 27006820"& ,|EAP"& ,|Custom 27006820"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON SYMMETRY 4X2X90CM"& ,|1"& ,|3,577.80"& ,|3,577.80"& ,|TRUE"& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 "& ,| 3,577.80 27006821"& ,|EAP"& ,|Custom 27006821"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON Z-MED 15X3MM"& ,|1"& ,|6,401.50"& ,|6,401.50"& ,|TRUE"& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 "& ,| 6,401.50 27006822"& ,|EAP"& ,|Custom 27006822"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON X-MED 10X3X100"& ,|1"& ,|3,418.40"& ,|3,418.40"& ,|TRUE"& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 "& ,| 3,418.40 27006824"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE COPE .018-125CM"& ,|1"& ,|532.13"& ,|532.13"& ,|TRUE"& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 "& ,| 532.13 27006825"& ,|EAP"& ,|Custom 27006825"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|FORCEP BIOPSY 7FR 105CM"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27006826"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL EMBOLIZATION 38-8-5"& ,|1"& ,|233.53"& ,|233.53"& ,|TRUE"& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 "& ,| 233.53 27006827"& ,|EAP"& ,|Custom 27006827"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH CORONARY 4FR JL4"& ,|1"& ,|205.4"& ,|205.4"& ,|TRUE"& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 27006828"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|KIT FEED GASTROSTMY 18FRX2.5CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006829"& ,|EAP"& ,|Custom 27006829"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|PACK HYPOSPADIAS SETUP"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27006830"& ,|EAP"& ,|Custom 27006830"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|PACK FUSION FUEGG CHOA"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27006831"& ,|EAP"& ,|Custom 27006831"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH TRANSSEPTAL PEDIATRIC 7FR"& ,|1"& ,|1,022.71"& ,|1,022.71"& ,|TRUE"& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 "& ,| 1,022.71 27006832"& ,|EAP"& ,|Custom 27006832"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH TRANSSEPTAL ADULT 7FR"& ,|1"& ,|1,076.70"& ,|1,076.70"& ,|TRUE"& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 "& ,| 1,076.70 27006833"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 18FRX1.2CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006834"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 20FRX1.2CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006835"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 12FRX2.7CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006836"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 12FRX3.0CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006837"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 20FRX2.3CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006838"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 24FRX2.3CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006839"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 24FRX3.0CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006840"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH PIGTAIL 4FR X 90CM"& ,|1"& ,|348.14"& ,|348.14"& ,|TRUE"& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 27006841"& ,|EAP"& ,|Custom 27006841"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH CORONARY 4FR JL2.0"& ,|1"& ,|290.12"& ,|290.12"& ,|TRUE"& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 27006842"& ,|EAP"& ,|Custom 27006842"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH CORONARY 4FR JL3.0"& ,|1"& ,|290.12"& ,|290.12"& ,|TRUE"& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 "& ,| 290.12 27006846"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL EMBOLIZATION MWCE 35-5-5"& ,|1"& ,|214.45"& ,|214.45"& ,|TRUE"& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 27006847"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL EMBOLIZATION MWCE 35-4-3"& ,|1"& ,|214.45"& ,|214.45"& ,|TRUE"& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 "& ,| 214.45 27006848"& ,|EAP"& ,|Custom 27006848"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH HIS WOVEN 6F 40MM"& ,|1"& ,|4,365.28"& ,|4,365.28"& ,|TRUE"& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 "& ,| 4,365.28 27006849"& ,|EAP"& ,|Custom 27006849"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH HIS WOVEN 6F 50MM"& ,|1"& ,|2,677.83"& ,|2,677.83"& ,|TRUE"& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 27006850"& ,|EAP"& ,|Custom 27006850"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH HIS WOVEN 6F 60MM"& ,|1"& ,|2,677.83"& ,|2,677.83"& ,|TRUE"& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 "& ,| 2,677.83 27006851"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 20FRX2.7CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006852"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 24FRX3.5CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006858"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON TYSHAK II 14X3"& ,|1"& ,|4,750.10"& ,|4,750.10"& ,|TRUE"& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 27006859"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON TYSHAK II 16X4"& ,|1"& ,|4,750.10"& ,|4,750.10"& ,|TRUE"& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 27006860"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON TYSHAK II 18X4"& ,|1"& ,|4,750.10"& ,|4,750.10"& ,|TRUE"& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 "& ,| 4,750.10 27006861"& ,|EAP"& ,|Custom 27006861"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|TUBE DECOMPRESSION 24FRX3.4"& ,|1"& ,|139.26"& ,|139.26"& ,|TRUE"& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 "& ,| 139.26 27006862"& ,|EAP"& ,|Custom 27006862"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|KIT CATH PREP CUSTOM"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27006863"& ,|EAP"& ,|HCPCS C1889"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|COIL EMBOLIZATION MWCE 25-1.2-2"& ,|1"& ,|539"& ,|539"& ,|TRUE"& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 27006864"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|KIT FEED GASTROSTMY 18FRX1.5CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006866"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE TSCF 18-145-3 J"& ,|1"& ,|254.97"& ,|254.97"& ,|TRUE"& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 27006867"& ,|EAP"& ,|HCPCS C1893"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER SWARTZ SR2 8FRX63CM"& ,|1"& ,|2,210.54"& ,|2,210.54"& ,|TRUE"& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 27006868"& ,|EAP"& ,|HCPCS C1893"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER SWARTZ SR3 8FRX60CM"& ,|1"& ,|2,210.54"& ,|2,210.54"& ,|TRUE"& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 27006869"& ,|EAP"& ,|Custom 27006869"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH CORONARY 4FR JR3.5"& ,|1"& ,|205.4"& ,|205.4"& ,|TRUE"& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 27006921"& ,|EAP"& ,|Custom 27006921"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CROWN DENTAL STAINLESS STEEL CROWN 1ST MOLAR LL3"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27006922"& ,|EAP"& ,|Custom 27006922"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CROWN DENTAL STAINLESS STEEL CROWN 1ST MOLAR LL4"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27006923"& ,|EAP"& ,|Custom 27006923"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CROWN DENTAL STAINLESS STEEL CROWN 1ST MOLAR LR3"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27006924"& ,|EAP"& ,|Custom 27006924"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CROWN DENTAL STAINLESS STEEL CROWN 1ST MOLAR LR4"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27006925"& ,|EAP"& ,|Custom 27006925"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CROWN DENTAL STAINLESS STEEL CROWN 1ST MOLAR LR6"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27006931"& ,|EAP"& ,|HCPCS C1894"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER 5FR .021IN"& ,|1"& ,|194.79"& ,|194.79"& ,|TRUE"& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 "& ,| 194.79 27006932"& ,|EAP"& ,|HCPCS C1894"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER 6FR .021IN"& ,|1"& ,|190.65"& ,|190.65"& ,|TRUE"& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 "& ,| 190.65 27006933"& ,|EAP"& ,|HCPCS C1894"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER 7FR .021IN"& ,|1"& ,|198.94"& ,|198.94"& ,|TRUE"& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 "& ,| 198.94 27006934"& ,|EAP"& ,|Custom 27006934"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH CORONARY 4FR JL 3.5"& ,|1"& ,|205.4"& ,|205.4"& ,|TRUE"& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 "& ,| 205.40 27006935"& ,|EAP"& ,|HCPCS C1894"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER ONE PIECE KIT 6FR"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27006936"& ,|EAP"& ,|HCPCS C1894"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER VENOUS 5X.021X8.5"& ,|1"& ,|348.14"& ,|348.14"& ,|TRUE"& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 "& ,| 348.14 27006937"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE TSCF-21-145-3 J"& ,|1"& ,|254.97"& ,|254.97"& ,|TRUE"& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 27006938"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE TSF 25-145"& ,|1"& ,|254.97"& ,|254.97"& ,|TRUE"& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 27006939"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE AMP STIF THSF 38 260"& ,|1"& ,|522.67"& ,|522.67"& ,|TRUE"& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 "& ,| 522.67 27006940"& ,|EAP"& ,|Custom 27006940"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON WEDGE SINGLE 5FRX60CM"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27006941"& ,|EAP"& ,|Custom 27006941"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON WEDGE SINGLE 5FRX110CM"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27006942"& ,|EAP"& ,|Custom 27006942"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON WEDGE 6X110CM"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27006945"& ,|EAP"& ,|Custom 27006945"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON BERMAN 5X50CM"& ,|1"& ,|1,746.21"& ,|1,746.21"& ,|TRUE"& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 "& ,| 1,746.21 27006946"& ,|EAP"& ,|Custom 27006946"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON BERMAN 6X90CM"& ,|1"& ,|1,713.81"& ,|1,713.81"& ,|TRUE"& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 27006947"& ,|EAP"& ,|Custom 27006947"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON BERMAN 5X80CM"& ,|1"& ,|1,400.66"& ,|1,400.66"& ,|TRUE"& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 "& ,| 1,400.66 27006948"& ,|EAP"& ,|Custom 27006948"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON WEDGE SINGLE 4FRX60CM"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27006949"& ,|EAP"& ,|Custom 27006949"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON BERMAN 7X90CM"& ,|1"& ,|1,713.81"& ,|1,713.81"& ,|TRUE"& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 "& ,| 1,713.81 27006950"& ,|EAP"& ,|Custom 27006950"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON BERMAN 8FRX110CM"& ,|1"& ,|644.26"& ,|644.26"& ,|TRUE"& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 "& ,| 644.26 27006951"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE DEFLECT 25-100-5"& ,|1"& ,|1,049.70"& ,|1,049.70"& ,|TRUE"& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 27006952"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE EXCHANGE 35-260CM"& ,|1"& ,|181.86"& ,|181.86"& ,|TRUE"& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 "& ,| 181.86 27006953"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE TSF 18-145CM"& ,|1"& ,|294.26"& ,|294.26"& ,|TRUE"& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 "& ,| 294.26 27006954"& ,|EAP"& ,|Custom 27006954"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH TRANSSEPTAL ADULT 8FR"& ,|1"& ,|1,260.27"& ,|1,260.27"& ,|TRUE"& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 "& ,| 1,260.27 27006955"& ,|EAP"& ,|Custom 27006955"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|ELECTRODE BIPOLAR BALLOON 5 FR"& ,|1"& ,|2,210.54"& ,|2,210.54"& ,|TRUE"& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 27006956"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|KIT FEED GASTROSTMY 18FRX1.7CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006957"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|KIT FEED GASTROSTMY 18FRX2.0CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006958"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 24FRX1.7CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006960"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 16FRX2.5CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006961"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 16FRX2.0CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006962"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 16FRX2.3CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006963"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 20FRX1.7CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006964"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 20FRX2.0CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006965"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 24FRX1.5CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006966"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 24FRX2.0CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27006969"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE EXCHANGE TSF-28-260"& ,|1"& ,|392.5"& ,|392.5"& ,|TRUE"& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 "& ,| 392.50 27006970"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE EXCHANGE TSF 21-260"& ,|1"& ,|254.97"& ,|254.97"& ,|TRUE"& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 "& ,| 254.97 27006971"& ,|EAP"& ,|Custom 27006971"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|NEEDLE BIOPSY TEMNO COAXL 18GX4IN"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27006972"& ,|EAP"& ,|Custom 27006972"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|NEEDLE BIOPSY TEMNO COAXL 18GX6IN"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27006973"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE TSF 21-50CM"& ,|1"& ,|235.08"& ,|235.08"& ,|TRUE"& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 "& ,| 235.08 27006981"& ,|EAP"& ,|Custom 27006981"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|G BUTTON 18FRX4.4CM"& ,|1"& ,|2,048.57"& ,|2,048.57"& ,|TRUE"& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 27006983"& ,|EAP"& ,|Custom 27006983"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|G BUTTON 24FRX3.4CM"& ,|1"& ,|2,048.57"& ,|2,048.57"& ,|TRUE"& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 "& ,| 2,048.57 27006984"& ,|EAP"& ,|Custom 27006984"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|SHEATH 11FR 12CM"& ,|1"& ,|2,634.56"& ,|2,634.56"& ,|TRUE"& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 "& ,| 2,634.56 27006985"& ,|EAP"& ,|HCPCS C1769"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GUIDE WIRE DFLCT TIP 25-125 -5"& ,|1"& ,|1,049.70"& ,|1,049.70"& ,|TRUE"& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 "& ,| 1,049.70 27006987"& ,|EAP"& ,|HCPCS C1893"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER HEMOSTASIS SR4 8FR"& ,|1"& ,|2,210.54"& ,|2,210.54"& ,|TRUE"& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 27006988"& ,|EAP"& ,|Custom 27006988"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON BIB 10MMX2.5CM"& ,|1"& ,|5,620.05"& ,|5,620.05"& ,|TRUE"& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 27006989"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON BIB 12MMX3CM"& ,|1"& ,|8,282.85"& ,|8,282.85"& ,|TRUE"& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 27006990"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON TYSHAK MINI 10X2X65"& ,|1"& ,|4,902.58"& ,|4,902.58"& ,|TRUE"& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 27006991"& ,|EAP"& ,|HCPCS C1893"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER HEMOSTASIS SL2 8FR"& ,|1"& ,|1,940.58"& ,|1,940.58"& ,|TRUE"& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 27006992"& ,|EAP"& ,|HCPCS C1893"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER HEMOSTASIS SL3 8FR"& ,|1"& ,|1,940.58"& ,|1,940.58"& ,|TRUE"& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 "& ,| 1,940.58 27006993"& ,|EAP"& ,|HCPCS C1893"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER HEMOSTASIS SAFL 8FR"& ,|1"& ,|2,210.54"& ,|2,210.54"& ,|TRUE"& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 27006994"& ,|EAP"& ,|HCPCS C1893"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER HEMOSTASIS SEPT 8FR"& ,|1"& ,|2,210.54"& ,|2,210.54"& ,|TRUE"& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 "& ,| 2,210.54 27006995"& ,|EAP"& ,|HCPCS C1893"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|INTRODUCER HEMOSTASIS RAMP 8FR"& ,|1"& ,|2,156.55"& ,|2,156.55"& ,|TRUE"& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 "& ,| 2,156.55 27006996"& ,|EAP"& ,|Custom 27006996"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON BIB 8MMX2.5CM"& ,|1"& ,|5,620.05"& ,|5,620.05"& ,|TRUE"& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 "& ,| 5,620.05 27006997"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON BIB 16X3.0"& ,|1"& ,|8,282.85"& ,|8,282.85"& ,|TRUE"& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 "& ,| 8,282.85 27006998"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON DILATOR 20MMX3CM"& ,|1"& ,|2,693.32"& ,|2,693.32"& ,|TRUE"& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 "& ,| 2,693.32 27006999"& ,|EAP"& ,|HCPCS C1725"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|CATH BALLOON TYSHAK MINI 6MMX2CM"& ,|1"& ,|4,902.58"& ,|4,902.58"& ,|TRUE"& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 "& ,| 4,902.58 27041829"& ,|EAP"& ,|HCPCS A8004"& ,|"& ,|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES"& ,|REPLACEMENT SOFT INTERFACE FOR HELMET A8004"& ,|1"& ,|210.5"& ,|210.5"& ,|TRUE"& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 27081174"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|PLATE 6-HOLE"& ,|1"& ,|4,247.99"& ,|4,247.99"& ,|TRUE"& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 "& ,| 4,247.99 27081196"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|PLATE HTO"& ,|1"& ,|4,532.95"& ,|4,532.95"& ,|TRUE"& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 "& ,| 4,532.95 27081251"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW 35MM"& ,|1"& ,|898.52"& ,|898.52"& ,|TRUE"& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 "& ,| 898.52 27081376"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW SET"& ,|1"& ,|1,423.74"& ,|1,423.74"& ,|TRUE"& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 "& ,| 1,423.74 27081468"& ,|EAP"& ,|Custom 27081468"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|BOLT TSRH LONG PST 30 5.5X40"& ,|1"& ,|3,426.45"& ,|3,426.45"& ,|TRUE"& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 27081490"& ,|EAP"& ,|Custom 27081490"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|CAGE TITANIUM 12MM X 80MM"& ,|1"& ,|12,257.34"& ,|12,257.34"& ,|TRUE"& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 "& ,| 12,257.34 27081499"& ,|EAP"& ,|Custom 27081499"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|CAP ROUND 5 END SMALL 12MM"& ,|1"& ,|568.21"& ,|568.21"& ,|TRUE"& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 "& ,| 568.21 27083656"& ,|EAP"& ,|Custom 27083656"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|KIT CHEMO REPAIR ITEM #2412"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27084008"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 14FRX2.7CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27084009"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 14FRX0.8CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27084010"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 14FRX1.0CM"& ,|1"& ,|2,097.16"& ,|2,097.16"& ,|TRUE"& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 "& ,| 2,097.16 27084011"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 14FRX1.5CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27084076"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 14FRX2.5CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27084077"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 14FRX3.0CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27084098"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|PLATE CHIN 7MM"& ,|1"& ,|1,101.50"& ,|1,101.50"& ,|TRUE"& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 "& ,| 1,101.50 27084301"& ,|EAP"& ,|HCPCS B4088"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|GASTROSTOMY BUTTON LP MIC-KEY 14FRX1.7CM"& ,|1"& ,|1,154.99"& ,|1,154.99"& ,|TRUE"& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 "& ,| 1,154.99 27084320"& ,|EAP"& ,|HCPCS C1772"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|BALCOFEN PUMP 2.0ML"& ,|1"& ,|28,113.00"& ,|28,113.00"& ,|TRUE"& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 "& ,| 28,113.00 27084427"& ,|EAP"& ,|HCPCS C1898"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|LEAD UNIPOLAR EPICARDIAL 15CM"& ,|1"& ,|2,546.11"& ,|2,546.11"& ,|TRUE"& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 "& ,| 2,546.11 27085030"& ,|EAP"& ,|Custom 27085030"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|TAP 2.0MM SD FOR POWER DRIVER"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27085138"& ,|EAP"& ,|Custom 27085138"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|CONNECTOR"& ,|1"& ,|1,917.06"& ,|1,917.06"& ,|TRUE"& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 "& ,| 1,917.06 27085193"& ,|EAP"& ,|Custom 27085193"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|CONNECTOR OFFSET NEUTRAL"& ,|1"& ,|3,048.09"& ,|3,048.09"& ,|TRUE"& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 "& ,| 3,048.09 27085232"& ,|EAP"& ,|Custom 27085232"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|CROSSLINK 22MM"& ,|1"& ,|3,561.42"& ,|3,561.42"& ,|TRUE"& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 "& ,| 3,561.42 27085266"& ,|EAP"& ,|Custom 27085266"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|CROSSLINK SFX-F6"& ,|1"& ,|6,464.67"& ,|6,464.67"& ,|TRUE"& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 "& ,| 6,464.67 27085552"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|INJECTABLE PRO-DENSE 10CC"& ,|1"& ,|2,852.50"& ,|2,852.50"& ,|TRUE"& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 "& ,| 2,852.50 27085556"& ,|EAP"& ,|Custom 27085556"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|JURGAN PIN BALL 3/16IN"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 27085571"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|K-WIRE 1/8 X 12IN"& ,|1"& ,|327.92"& ,|327.92"& ,|TRUE"& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 "& ,| 327.92 27085582"& ,|EAP"& ,|HCPCS C1898"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|LEAD PACE 35CM"& ,|1"& ,|3,215.29"& ,|3,215.29"& ,|TRUE"& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 "& ,| 3,215.29 27085583"& ,|EAP"& ,|HCPCS C1895"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|LEAD PACER"& ,|1"& ,|15,692.56"& ,|15,692.56"& ,|TRUE"& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 "& ,| 15,692.56 27085930"& ,|EAP"& ,|Custom 27085930"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|NASAL ONLAY 41X3X 9"& ,|1"& ,|940"& ,|940"& ,|TRUE"& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 "& ,| 940.00 27086210"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|PLATE CHIKN 8MM"& ,|1"& ,|1,549.09"& ,|1,549.09"& ,|TRUE"& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 "& ,| 1,549.09 27086410"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|PLATE PEANUT 16MM"& ,|1"& ,|1,966.21"& ,|1,966.21"& ,|TRUE"& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 "& ,| 1,966.21 27086473"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|PLATE TIBIA 8-HOLE4.5MM"& ,|1"& ,|5,047.45"& ,|5,047.45"& ,|TRUE"& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 "& ,| 5,047.45 27086633"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|ROD COCR - 480MM"& ,|1"& ,|4,748.13"& ,|4,748.13"& ,|TRUE"& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 "& ,| 4,748.13 27086692"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW MULTIAXIAL TI 6.5X45MM"& ,|1"& ,|3,777.47"& ,|3,777.47"& ,|TRUE"& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 27086724"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW 1.5 X4MM"& ,|1"& ,|1,359.47"& ,|1,359.47"& ,|TRUE"& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 "& ,| 1,359.47 27086839"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW 4.5X30MM"& ,|1"& ,|4,948.81"& ,|4,948.81"& ,|TRUE"& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 "& ,| 4,948.81 27086938"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW 60MM"& ,|1"& ,|1,204.80"& ,|1,204.80"& ,|TRUE"& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 "& ,| 1,204.80 27087374"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW CORTEX 3.5MMX34MM"& ,|1"& ,|265.25"& ,|265.25"& ,|TRUE"& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 "& ,| 265.25 27087514"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW CORTICAL 4.5X 30"& ,|1"& ,|1,090.39"& ,|1,090.39"& ,|TRUE"& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 "& ,| 1,090.39 27087515"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW CORTICAL 4.5X 50"& ,|1"& ,|604.25"& ,|604.25"& ,|TRUE"& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 "& ,| 604.25 27087556"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW ER SQ FIT S TAP 1.4X5"& ,|1"& ,|141.2"& ,|141.2"& ,|TRUE"& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 27087557"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW ER SQ FIT S TAP 1.4X7"& ,|1"& ,|141.2"& ,|141.2"& ,|TRUE"& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 "& ,| 141.20 27087563"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW EXPED POLY 7X65"& ,|1"& ,|3,426.45"& ,|3,426.45"& ,|TRUE"& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 27087580"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW EXPEDIUM UNI 5.5X35"& ,|1"& ,|4,128.49"& ,|4,128.49"& ,|TRUE"& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 "& ,| 4,128.49 27087581"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW EXTRACTION CONC"& ,|1"& ,|661.12"& ,|661.12"& ,|TRUE"& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 "& ,| 661.12 27087629"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW HA150/60"& ,|1"& ,|1,312.89"& ,|1,312.89"& ,|TRUE"& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 "& ,| 1,312.89 27087691"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW LEGACY 5.5X40"& ,|1"& ,|4,485.84"& ,|4,485.84"& ,|TRUE"& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 "& ,| 4,485.84 27087731"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW LEGACY8.5X40"& ,|1"& ,|3,426.45"& ,|3,426.45"& ,|TRUE"& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 27087766"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW LOCKING 3.5X16MM"& ,|1"& ,|862.48"& ,|862.48"& ,|TRUE"& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 27087941"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW NON-LOCK 3.5X18MM"& ,|1"& ,|862.48"& ,|862.48"& ,|TRUE"& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 "& ,| 862.48 27088001"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW PEANUT 24MM"& ,|1"& ,|916.53"& ,|916.53"& ,|TRUE"& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 "& ,| 916.53 27088023"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW POLY 5.0X25MM"& ,|1"& ,|3,426.45"& ,|3,426.45"& ,|TRUE"& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 27088025"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW POLY 5.5 X 30"& ,|1"& ,|3,426.45"& ,|3,426.45"& ,|TRUE"& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 "& ,| 3,426.45 27088089"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW REDUCTION 7.5X45"& ,|1"& ,|3,777.47"& ,|3,777.47"& ,|TRUE"& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 "& ,| 3,777.47 27088144"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW SQ FIT S TAP 1.2MMX4.0MM"& ,|1"& ,|538.91"& ,|538.91"& ,|TRUE"& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 "& ,| 538.91 27088145"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW SQ FIT S TAP 2.0MMX10MM"& ,|1"& ,|436.27"& ,|436.27"& ,|TRUE"& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 "& ,| 436.27 27088156"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW TAPERED CORTICAL 130/50"& ,|1"& ,|1,337.88"& ,|1,337.88"& ,|TRUE"& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 "& ,| 1,337.88 27088157"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW TAPERED CORTICAL 170/40"& ,|1"& ,|1,369.47"& ,|1,369.47"& ,|TRUE"& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 27088158"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW TAPERED CORTICAL 220/40"& ,|1"& ,|1,369.47"& ,|1,369.47"& ,|TRUE"& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 27088159"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW TAPERED CORTICAL 250/10"& ,|1"& ,|1,369.47"& ,|1,369.47"& ,|TRUE"& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 "& ,| 1,369.47 27088228"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SCREW UNIPLAINER 5.5X30"& ,|1"& ,|4,967.67"& ,|4,967.67"& ,|TRUE"& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 "& ,| 4,967.67 27088324"& ,|EAP"& ,|HCPCS C1713"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|SPACER 0 DEGREE 14MM X 25MM"& ,|1"& ,|17,141.51"& ,|17,141.51"& ,|TRUE"& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 "& ,| 17,141.51 27088462"& ,|EAP"& ,|Custom 27088462"& ,|"& ,|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS"& ,|VALVE NASAL EXTERNAL"& ,|1"& ,|1,210.81"& ,|1,210.81"& ,|TRUE"& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 "& ,| 1,210.81 27088487"& ,|EAP"& ,|HCPCS C1751"& ,|"& ,|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL"& ,|VAXCEL PASV VALVE"& ,|1"& ,|2,326.52"& ,|2,326.52"& ,|TRUE"& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 "& ,| 2,326.52 30002000"& ,|EAP"& ,|CPT� 83695"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|APOLIPOPROTEIN ASSAY"& ,|1"& ,|107"& ,|107"& ,|TRUE"& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 30002001"& ,|EAP"& ,|CPT� 84143"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|17 HYDROXYPREGNENOLONE"& ,|1"& ,|357"& ,|357"& ,|TRUE"& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 30002002"& ,|EAP"& ,|CPT� 82135"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|5 AMINOLEVULINIC ACID URINE"& ,|1"& ,|210"& ,|210"& ,|TRUE"& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 30002004"& ,|EAP"& ,|CPT� 80299"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|5-FLUORO CYSTINE"& ,|1"& ,|289"& ,|289"& ,|TRUE"& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 30002005"& ,|EAP"& ,|CPT� 83497"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HYDROXYINDOLACETIC ACID, 5-(HIAA, 24 HR URINE"& ,|1"& ,|138"& ,|138"& ,|TRUE"& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 30002006"& ,|EAP"& ,|CPT� 82542"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|6 METHYL MERCAPTOPURINE"& ,|1"& ,|491.5"& ,|491.5"& ,|TRUE"& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 30002007"& ,|EAP"& ,|CPT� 82542"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|6 THIOGUANINE"& ,|1"& ,|491.5"& ,|491.5"& ,|TRUE"& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 30002008"& ,|EAP"& ,|CPT� 82542"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|7-DEHYDROCHOLESTEROL"& ,|1"& ,|697.5"& ,|697.5"& ,|TRUE"& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 30002009"& ,|EAP"& ,|CPT� 86606"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|A FUMIGATUS IGE"& ,|1"& ,|244"& ,|244"& ,|TRUE"& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 30002010"& ,|EAP"& ,|CPT� 86606"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY TO ASPERGILLUS (FUNGUS)"& ,|1"& ,|244"& ,|244"& ,|TRUE"& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 30002011"& ,|EAP"& ,|CPT� 86860"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|SCREENING TEST FOR RED BLOOD CELL ANTIBODIES"& ,|1"& ,|331"& ,|331"& ,|TRUE"& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 30002012"& ,|EAP"& ,|CPT� 86860"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|REMOVAL OF ANTIBODIES FROM SURFACE OF RED BLOOD CELL"& ,|1"& ,|268"& ,|268"& ,|TRUE"& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 "& ,| 268.00 30002013"& ,|EAP"& ,|CPT� 82657"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ABC ENZYMES MULTI"& ,|1"& ,|359"& ,|359"& ,|TRUE"& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 30002014"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|ABS CD16 CD56 CD"& ,|1"& ,|62"& ,|62"& ,|TRUE"& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 30002015"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|ABS CD19 CD"& ,|1"& ,|62"& ,|62"& ,|TRUE"& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 30002016"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|ABS CD4 CD45 RA"& ,|1"& ,|62"& ,|62"& ,|TRUE"& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 30002017"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|ABS CD8 CD3"& ,|1"& ,|62"& ,|62"& ,|TRUE"& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 30002018"& ,|EAP"& ,|CPT� 86850"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ASSESSMENT OF ANTIBODY TO HUMAN LEUKOCYTE ANTIGENS (HLA) WITH HIGH DEFINITION QUALITATIVE PANEL FOR IDENTIFICATION OF ANTIBODY SPECIFICITIES, HLA CLASS II"& ,|1"& ,|126"& ,|126"& ,|TRUE"& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 "& ,| 126.00 30002019"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|ABSOLUTE CD3"& ,|1"& ,|62"& ,|62"& ,|TRUE"& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 30002020"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|ABSOLUTE CD4 CD3"& ,|1"& ,|62"& ,|62"& ,|TRUE"& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 30002021"& ,|EAP"& ,|CPT� 85048"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|ABSOLUTE LYMPHOCYTES"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002022"& ,|EAP"& ,|CPT� 80307"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ACETAMINOPHEN"& ,|1"& ,|484.5"& ,|484.5"& ,|TRUE"& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 30002023"& ,|EAP"& ,|CPT� 82010"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ACETONE/KETONES SERUM QN"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002024"& ,|EAP"& ,|CPT� 83519"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ACETYLCHOLINE BINDING AB"& ,|1"& ,|201.5"& ,|201.5"& ,|TRUE"& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 30002025"& ,|EAP"& ,|CPT� 83516"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ACETYLCHOLINE REC BLOCKING AB"& ,|1"& ,|171"& ,|171"& ,|TRUE"& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 30002026"& ,|EAP"& ,|CPT� 83516"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ACETYLCHOLINE MODULAT ANTIBODY"& ,|1"& ,|256.5"& ,|256.5"& ,|TRUE"& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 30002027"& ,|EAP"& ,|CPT� 87206"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|ACID FAST STAIN"& ,|1"& ,|97"& ,|97"& ,|TRUE"& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 30002028"& ,|EAP"& ,|CPT� 85347"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|ACTIVATED COAGULATION TIME"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 30002029"& ,|EAP"& ,|CPT� 85307"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|ACTIVATED PROTEIN C RESISTANCE"& ,|1"& ,|452.5"& ,|452.5"& ,|TRUE"& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 "& ,| 452.50 30002030"& ,|EAP"& ,|CPT� 82017"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ACYLCARNITINES; QUANTITATIVE, EACH, PLASMA"& ,|1"& ,|533"& ,|533"& ,|TRUE"& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 "& ,| 533.00 30002031"& ,|EAP"& ,|CPT� 82542"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ACYLGLYCINE URINE PROFILE"& ,|1"& ,|965.5"& ,|965.5"& ,|TRUE"& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 "& ,| 965.50 30002032"& ,|EAP"& ,|CPT� 85246"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|ADAMS TS 13 ACTIVITY"& ,|1"& ,|534"& ,|534"& ,|TRUE"& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 "& ,| 534.00 30002033"& ,|EAP"& ,|CPT� 85335"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|ADAMS13 FACTOR INHIBITOR"& ,|1"& ,|297.5"& ,|297.5"& ,|TRUE"& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 "& ,| 297.50 30002034"& ,|EAP"& ,|CPT� 87301"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|ADENO ANTIGEN-STOOL"& ,|1"& ,|244"& ,|244"& ,|TRUE"& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 30002035"& ,|EAP"& ,|CPT� 84311"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|SPECTROPHOTOMETRY, ANALYTE NOT,RBC"& ,|1"& ,|244"& ,|244"& ,|TRUE"& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 30002036"& ,|EAP"& ,|CPT� 87799"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|ADENOVIRUS DNA BY PCR"& ,|1"& ,|927"& ,|927"& ,|TRUE"& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 "& ,| 927.00 30002037"& ,|EAP"& ,|CPT� 87260"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|ADENOVIRUS FA"& ,|1"& ,|240"& ,|240"& ,|TRUE"& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 30002038"& ,|EAP"& ,|CPT� 82024"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ADRENOCORTICOTROPIC (ACTH)"& ,|1"& ,|593"& ,|593"& ,|TRUE"& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 "& ,| 593.00 30002039"& ,|EAP"& ,|CPT� 86316"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|AFP OTHER ANTIGEN, QUANTITATIVE, CSF"& ,|1"& ,|440.5"& ,|440.5"& ,|TRUE"& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 30002040"& ,|EAP"& ,|CPT� 82040"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|OR ALBUMIN"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002041"& ,|EAP"& ,|CPT� 82040"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|OR ALBUMIN, BLOOD"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002042"& ,|EAP"& ,|CPT� 80307"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ALCOHOL (ETHANOL)"& ,|1"& ,|256.5"& ,|256.5"& ,|TRUE"& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 30002043"& ,|EAP"& ,|CPT� 82085"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ALDOLASE"& ,|1"& ,|256.5"& ,|256.5"& ,|TRUE"& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 30002044"& ,|EAP"& ,|CPT� 82088"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ALDOSTERONE"& ,|1"& ,|797"& ,|797"& ,|TRUE"& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 "& ,| 797.00 30002045"& ,|EAP"& ,|CPT� 82088"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ALDOSTERONE, URINE"& ,|1"& ,|137.5"& ,|137.5"& ,|TRUE"& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 "& ,| 137.50 30002047"& ,|EAP"& ,|CPT� 82103"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ALPHA 1 ANTI STOOL"& ,|1"& ,|291"& ,|291"& ,|TRUE"& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 30002048"& ,|EAP"& ,|CPT� 82105"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ALPHA FETOPROTEIN SERUM"& ,|1"& ,|440.5"& ,|440.5"& ,|TRUE"& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 30002049"& ,|EAP"& ,|CPT� 82103"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ALPHA-1 ANTITRYPSIN"& ,|1"& ,|369"& ,|369"& ,|TRUE"& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 30002050"& ,|EAP"& ,|CPT� 82104"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ALPHA-1 ANTITRYPSIN PHENO"& ,|1"& ,|99"& ,|99"& ,|TRUE"& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 "& ,| 99.00 30002052"& ,|EAP"& ,|CPT� 83021"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ALPHA-CHROMATOGRAPHY"& ,|1"& ,|194.5"& ,|194.5"& ,|TRUE"& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 30002053"& ,|EAP"& ,|CPT� 83020"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ALPHA-HEMOGLOBIN FRACT/QUANT"& ,|1"& ,|323.5"& ,|323.5"& ,|TRUE"& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 "& ,| 323.50 30002057"& ,|EAP"& ,|CPT� 84460"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ALT/SGPT"& ,|1"& ,|264"& ,|264"& ,|TRUE"& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 30002058"& ,|EAP"& ,|CPT� 80150"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|AMIKACIN PEAK"& ,|1"& ,|278"& ,|278"& ,|TRUE"& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 30002059"& ,|EAP"& ,|CPT� 80150"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|AMIKACIN RANDOM"& ,|1"& ,|278"& ,|278"& ,|TRUE"& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 30002060"& ,|EAP"& ,|CPT� 80150"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|AMIKACIN TROUGH"& ,|1"& ,|278"& ,|278"& ,|TRUE"& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 30002061"& ,|EAP"& ,|CPT� 82139"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|AMINO ACID CSF"& ,|1"& ,|1,093.50"& ,|1,093.50"& ,|TRUE"& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 "& ,| 1,093.50 30002062"& ,|EAP"& ,|CPT� 82139"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|AMINO ACID QUANT"& ,|1"& ,|1,886.50"& ,|1,886.50"& ,|TRUE"& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 "& ,| 1,886.50 30002063"& ,|EAP"& ,|CPT� 82657"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|AMINOLEVULINIC ACID DE (ALA D)"& ,|1"& ,|301"& ,|301"& ,|TRUE"& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 30002064"& ,|EAP"& ,|CPT� 80299"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|AMIODARONE"& ,|1"& ,|189.5"& ,|189.5"& ,|TRUE"& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 "& ,| 189.50 30002065"& ,|EAP"& ,|CPT� 82140"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|AMMONIA"& ,|1"& ,|244"& ,|244"& ,|TRUE"& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 30002066"& ,|EAP"& ,|CPT� 82140"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|AMMONIA 24H UR KID"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002067"& ,|EAP"& ,|CPT� 86753"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTIBODY; PARVOVIRUS"& ,|1"& ,|120"& ,|120"& ,|TRUE"& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 30002070"& ,|EAP"& ,|CPT� 82150"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|AMYLASE BLOOD"& ,|1"& ,|251"& ,|251"& ,|TRUE"& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 30002071"& ,|EAP"& ,|CPT� 82150"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|AMYLASE ISOENZYMES"& ,|1"& ,|735"& ,|735"& ,|TRUE"& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 "& ,| 735.00 30002072"& ,|EAP"& ,|CPT� 86038"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANA (NOT A PROFILE)"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002073"& ,|EAP"& ,|CPT� 86038"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANA ANTIBODY IGG"& ,|1"& ,|20.5"& ,|20.5"& ,|TRUE"& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 "& ,| 20.50 30002074"& ,|EAP"& ,|CPT� 86038"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANA PATTERN 1 SCREENING"& ,|1"& ,|41"& ,|41"& ,|TRUE"& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 30002075"& ,|EAP"& ,|CPT� 86038"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANA PATTERN 2 SCREENING"& ,|1"& ,|41"& ,|41"& ,|TRUE"& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 30002076"& ,|EAP"& ,|Custom 30002076"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANA REFLEX BATTERY"& ,|1"& ,|34.5"& ,|34.5"& ,|TRUE"& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 "& ,| 34.50 30002077"& ,|EAP"& ,|CPT� 86039"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANA TITER ARUP"& ,|1"& ,|27"& ,|27"& ,|TRUE"& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 "& ,| 27.00 30002078"& ,|EAP"& ,|CPT� 86256"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|MEASURE AB ANCA FA TITER"& ,|1"& ,|222"& ,|222"& ,|TRUE"& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 30002079"& ,|EAP"& ,|CPT� 82157"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANDROSTENEDIONE"& ,|1"& ,|568"& ,|568"& ,|TRUE"& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 30002080"& ,|EAP"& ,|CPT� 82164"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANGIOTENSIN I ENZYME (ACE)"& ,|1"& ,|264"& ,|264"& ,|TRUE"& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 30002081"& ,|EAP"& ,|CPT� 83516"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|IMMUNOASSAY ANAL ANTI MITOCHONDRIAL ANTIBODY"& ,|1"& ,|77"& ,|77"& ,|TRUE"& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 30002082"& ,|EAP"& ,|CPT� 86255"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|SCREEN FOR ANTI SMOOTH MUSCLE"& ,|1"& ,|92.5"& ,|92.5"& ,|TRUE"& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 30002083"& ,|EAP"& ,|CPT� 86376"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|STEM CELLS COUNT, TOTAL"& ,|1"& ,|95.5"& ,|95.5"& ,|TRUE"& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 "& ,| 95.50 30002084"& ,|EAP"& ,|CPT� 86225"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTIBODY DNA DOUBLE STRAND"& ,|1"& ,|349"& ,|349"& ,|TRUE"& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 30002085"& ,|EAP"& ,|CPT� 86226"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTIBODY DNA SINGLE STRAND"& ,|1"& ,|70.5"& ,|70.5"& ,|TRUE"& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 30002086"& ,|EAP"& ,|CPT� 86658"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY TO WESTERN EQUINE VIRUS (VIRAL ENCEPHALITIS)"& ,|1"& ,|107"& ,|107"& ,|TRUE"& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 30002087"& ,|EAP"& ,|CPT� 86021"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTIBODY IDENTIFICATION TEST FOR WHITE BLOOD CELL ANTIBODIES"& ,|1"& ,|1,233.00"& ,|1,233.00"& ,|TRUE"& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 "& ,| 1,233.00 30002088"& ,|EAP"& ,|CPT� 86022"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTIBODY ID, PLATELET"& ,|1"& ,|914.5"& ,|914.5"& ,|TRUE"& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 30002089"& ,|EAP"& ,|CPT� 86870"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|REMOVAL OF ANTIBODIES FROM SURFACE OF RED BLOOD CELL"& ,|1"& ,|471"& ,|471"& ,|TRUE"& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 "& ,| 471.00 30002090"& ,|EAP"& ,|CPT� 86870"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|IDENTIFICATION OF RED BLOOD CELL ANTIBODIES"& ,|1"& ,|310.5"& ,|310.5"& ,|TRUE"& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 "& ,| 310.50 30002091"& ,|EAP"& ,|CPT� 84432"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|THYRO REFLEX LCMS OR CIA"& ,|1"& ,|359"& ,|359"& ,|TRUE"& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 30002092"& ,|EAP"& ,|CPT� 86147"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|CARDIOLIPIN ANTIBODY (TISSUE ANTIBODY) MEASUREMENT"& ,|1"& ,|92.5"& ,|92.5"& ,|TRUE"& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 "& ,| 92.50 30002093"& ,|EAP"& ,|CPT� 86147"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|CARDIOLIPIN ANTIBODY (TISSUE ANTIBODY) MEASUREMENT"& ,|1"& ,|57"& ,|57"& ,|TRUE"& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 30002094"& ,|EAP"& ,|CPT� 86147"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTICARDIOLIPIN AB IGM"& ,|1"& ,|114.5"& ,|114.5"& ,|TRUE"& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 30002095"& ,|EAP"& ,|CPT� 86215"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTI-DNASE B"& ,|1"& ,|293.5"& ,|293.5"& ,|TRUE"& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 30002096"& ,|EAP"& ,|CPT� 83516"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|IMMUNOASSAY ANAL ANTI-ENDOMYSIAL AB"& ,|1"& ,|359"& ,|359"& ,|TRUE"& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 30002097"& ,|EAP"& ,|CPT� 88346"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|ANTI-ENDOMYSIAL INDIRECT, IGA"& ,|1"& ,|232.5"& ,|232.5"& ,|TRUE"& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 30002098"& ,|EAP"& ,|CPT� 88371"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|ANTI-ENTEROCYTE WESTERN BLOT"& ,|1"& ,|859"& ,|859"& ,|TRUE"& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 "& ,| 859.00 30002099"& ,|EAP"& ,|CPT� 86902"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|ANTIGEN RBC SCRN RGNT SERUM QTY 1"& ,|1"& ,|244"& ,|244"& ,|TRUE"& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 30002100"& ,|EAP"& ,|CPT� 86341"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|INSULIN ANTIBODY MEASUREMENT"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002101"& ,|EAP"& ,|CPT� 86905"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|ANTIGEN RBC TYPING NON ABO/RH"& ,|1"& ,|232.5"& ,|232.5"& ,|TRUE"& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 30002102"& ,|EAP"& ,|CPT� 83516"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTIGLIADIN ANTIBODIES"& ,|1"& ,|79"& ,|79"& ,|TRUE"& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 "& ,| 79.00 30002103"& ,|EAP"& ,|CPT� 83520"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|IMMUNOASSAY FOR ANALYTE, IGA"& ,|1"& ,|184.5"& ,|184.5"& ,|TRUE"& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 30002104"& ,|EAP"& ,|CPT� 83520"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|IMMUNOASSAY FOR ANALYTE, IGG"& ,|1"& ,|184.5"& ,|184.5"& ,|TRUE"& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 30002105"& ,|EAP"& ,|CPT� 83516"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTI-MPO AB"& ,|1"& ,|171"& ,|171"& ,|TRUE"& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 30002106"& ,|EAP"& ,|CPT� 86255"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTI-NEUTROPHIL CYT AB"& ,|1"& ,|423.5"& ,|423.5"& ,|TRUE"& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 30002107"& ,|EAP"& ,|CPT� 86038"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTINUCLEAR ANTIB (ANA) SCREEN SCREENING"& ,|1"& ,|252"& ,|252"& ,|TRUE"& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 "& ,| 252.00 30002108"& ,|EAP"& ,|CPT� 85410"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|ANTIPLASMIN ASSAY"& ,|1"& ,|510.5"& ,|510.5"& ,|TRUE"& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 30002109"& ,|EAP"& ,|CPT� 86849"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|EACH ANTIPROTHROMBIN IGG"& ,|1"& ,|279.5"& ,|279.5"& ,|TRUE"& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 "& ,| 279.50 30002110"& ,|EAP"& ,|CPT� 86147"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|EACH ANTIPROTHROMBIN IGM"& ,|1"& ,|281.5"& ,|281.5"& ,|TRUE"& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 "& ,| 281.50 30002111"& ,|EAP"& ,|CPT� 86255"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|SCREEN FOR ANTI-RETICULAN ANTIBODIES"& ,|1"& ,|46"& ,|46"& ,|TRUE"& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 "& ,| 46.00 30002112"& ,|EAP"& ,|CPT� 86800"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|ANTI-THROGLOBULIN"& ,|1"& ,|68.5"& ,|68.5"& ,|TRUE"& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 30002113"& ,|EAP"& ,|CPT� 85301"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|ANTITHROMBIN III ANTIGEN"& ,|1"& ,|293.5"& ,|293.5"& ,|TRUE"& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 30002114"& ,|EAP"& ,|CPT� 85300"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|ANTITHROMBIN III ASSAY"& ,|1"& ,|480"& ,|480"& ,|TRUE"& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 30002115"& ,|EAP"& ,|CPT� 83520"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|IMMUNOASSAY FOR ANALYTE, IGA"& ,|1"& ,|457.5"& ,|457.5"& ,|TRUE"& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 30002116"& ,|EAP"& ,|CPT� 82175"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ARSENIC"& ,|1"& ,|357"& ,|357"& ,|TRUE"& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 30002117"& ,|EAP"& ,|CPT� 86060"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|MEASUREMENT FOR STREP ANTIBODY (STREP THROAT)"& ,|1"& ,|118"& ,|118"& ,|TRUE"& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 30002118"& ,|EAP"& ,|CPT� 86606"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ASPERGILLUS"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002119"& ,|EAP"& ,|CPT� 86606"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ASPERGILLUS ANTIBODY"& ,|1"& ,|71.5"& ,|71.5"& ,|TRUE"& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 30002120"& ,|EAP"& ,|CPT� 86606"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ASPERGILLUS FUMIGATUS #1"& ,|1"& ,|82"& ,|82"& ,|TRUE"& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 30002121"& ,|EAP"& ,|CPT� 86606"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ASPERGILLUS FUMIGATUS #6"& ,|1"& ,|82"& ,|82"& ,|TRUE"& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 30002122"& ,|EAP"& ,|CPT� 84450"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|AST-SGOT"& ,|1"& ,|222"& ,|222"& ,|TRUE"& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 30002123"& ,|EAP"& ,|CPT� 86331"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|AUREOBASIDIUM PULLULANS"& ,|1"& ,|82"& ,|82"& ,|TRUE"& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 30002125"& ,|EAP"& ,|CPT� 88263"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|AUTISMREHENSIVE METABOLIC PANEL- COUNT 15-20 CELLS"& ,|1"& ,|1,557.00"& ,|1,557.00"& ,|TRUE"& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 "& ,| 1,557.00 30002130"& ,|EAP"& ,|CPT� 88273"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|AUTISM-FISH ANAL 10-30 CELLS"& ,|1"& ,|391.5"& ,|391.5"& ,|TRUE"& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 "& ,| 391.50 30002131"& ,|EAP"& ,|CPT� 88271"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|AUTISM-FISH DNA PROBE"& ,|1"& ,|263"& ,|263"& ,|TRUE"& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 "& ,| 263.00 30002132"& ,|EAP"& ,|CPT� 81243"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|AUTISM-FISH INTERP/REPORT"& ,|1"& ,|475"& ,|475"& ,|TRUE"& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 30002135"& ,|EAP"& ,|CPT� 81228"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|AUTISM-TISSUE CULTURE"& ,|1"& ,|475"& ,|475"& ,|TRUE"& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 30002136"& ,|EAP"& ,|CPT� 86611"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY TO ASPERGILLUS (FUNGUS)"& ,|1"& ,|277.5"& ,|277.5"& ,|TRUE"& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 30002137"& ,|EAP"& ,|CPT� 86611"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|B HENSELAE IGM"& ,|1"& ,|277.5"& ,|277.5"& ,|TRUE"& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 "& ,| 277.50 30002138"& ,|EAP"& ,|CPT� 86615"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|B. PERTUSSIS ANTIBODY IGG"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002139"& ,|EAP"& ,|CPT� 86615"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|B. PERTUSSIS ANTIBODY IGM"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002140"& ,|EAP"& ,|CPT� 86615"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|B.PERTUSSIS ANTIBODY IGA"& ,|1"& ,|117.5"& ,|117.5"& ,|TRUE"& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 30002141"& ,|EAP"& ,|CPT� 88230"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|BASELINE BREAKAGE"& ,|1"& ,|608.5"& ,|608.5"& ,|TRUE"& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 30002142"& ,|EAP"& ,|CPT� 80048"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|BASIC METABOLIC PANEL"& ,|1"& ,|301"& ,|301"& ,|TRUE"& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 30002147"& ,|EAP"& ,|CPT� 81206"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|BCR/ABL ISOL/EXTRCT"& ,|1"& ,|952.5"& ,|952.5"& ,|TRUE"& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 "& ,| 952.50 30002150"& ,|EAP"& ,|CPT� G0452"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|BCR/ABL REVERSE TRANSCRIPT"& ,|1"& ,|476"& ,|476"& ,|TRUE"& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 "& ,| 476.00 30002151"& ,|EAP"& ,|HCPCS 80346"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|BENZODIAZEPINES"& ,|1"& ,|107"& ,|107"& ,|TRUE"& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 30002152"& ,|EAP"& ,|CPT� 87185"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|BETA-LACTAMASE"& ,|1"& ,|32"& ,|32"& ,|TRUE"& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 30002153"& ,|EAP"& ,|CPT� 84702"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GONADOTROPIN, CHORIONIC, CSF"& ,|1"& ,|336"& ,|336"& ,|TRUE"& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 30002154"& ,|EAP"& ,|CPT� 82239"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|BILE ACIDS; TOTAL, TOTAL"& ,|1"& ,|568"& ,|568"& ,|TRUE"& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 30002155"& ,|EAP"& ,|CPT� 82248"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|BILIRUBIN DIRECT"& ,|1"& ,|304.5"& ,|304.5"& ,|TRUE"& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 "& ,| 304.50 30002156"& ,|EAP"& ,|CPT� 82247"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|BILIRUBIN TOTAL"& ,|1"& ,|120"& ,|120"& ,|TRUE"& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 30002157"& ,|EAP"& ,|CPT� 99001"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|BIOPSY SHIPPING"& ,|1"& ,|131"& ,|131"& ,|TRUE"& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 30002158"& ,|EAP"& ,|CPT� 82261"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|BIOTINIDASE"& ,|1"& ,|369"& ,|369"& ,|TRUE"& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 30002159"& ,|EAP"& ,|CPT� 87799"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|BK VIRUS BY PCR"& ,|1"& ,|631.5"& ,|631.5"& ,|TRUE"& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 "& ,| 631.50 30002160"& ,|EAP"& ,|CPT� 87799"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|BKV INFECT AGENT DETECT 1ST"& ,|1"& ,|992"& ,|992"& ,|TRUE"& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 "& ,| 992.00 30002161"& ,|EAP"& ,|CPT� 87799"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|BKV INFECT AGENT DETECT 2ND"& ,|1"& ,|401.5"& ,|401.5"& ,|TRUE"& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 30002162"& ,|EAP"& ,|CPT� 86612"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|BLASTOMYCES-ANTIBODIES"& ,|1"& ,|377.5"& ,|377.5"& ,|TRUE"& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 30002163"& ,|EAP"& ,|CPT� 87497"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|BLD CMV QUANTITATION"& ,|1"& ,|345.5"& ,|345.5"& ,|TRUE"& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 30002164"& ,|EAP"& ,|CPT� 86890"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|BLOOD PROCESSING AUTOLOGOUS"& ,|1"& ,|319.5"& ,|319.5"& ,|TRUE"& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 "& ,| 319.50 30002165"& ,|EAP"& ,|CPT� 86945"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|BLOOD PRODUCT IRRADIATION"& ,|1"& ,|226"& ,|226"& ,|TRUE"& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 30002166"& ,|EAP"& ,|CPT� 86999"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|BLOOD PRODUCT WASH PREP"& ,|1"& ,|705"& ,|705"& ,|TRUE"& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 "& ,| 705.00 30002167"& ,|EAP"& ,|CPT� 86900"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|BLOOD TYPING ABO"& ,|1"& ,|107"& ,|107"& ,|TRUE"& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 30002168"& ,|EAP"& ,|CPT� 86900"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|BLOOD TYPING, SEROLOGIC, (ARC)"& ,|1"& ,|73"& ,|73"& ,|TRUE"& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 30002169"& ,|EAP"& ,|CPT� 86901"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|BLOOD TYPING RH (D)"& ,|1"& ,|107"& ,|107"& ,|TRUE"& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 30002170"& ,|EAP"& ,|CPT� 86901"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|BLOOD TYPING, SEROLOGIC; RH, (ARC)"& ,|1"& ,|51"& ,|51"& ,|TRUE"& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 30002171"& ,|EAP"& ,|CPT� 83880"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|BNP (NATRIURETIC PEPTIDE)"& ,|1"& ,|418.5"& ,|418.5"& ,|TRUE"& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 30002172"& ,|EAP"& ,|CPT� 88305"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|BONE MARROW BIOPSY -TISSUE EXAM"& ,|1"& ,|1,186.50"& ,|1,186.50"& ,|TRUE"& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 "& ,| 1,186.50 30002173"& ,|EAP"& ,|CPT� 85097"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|BONE MARROW INTERPRETATION"& ,|1"& ,|359"& ,|359"& ,|TRUE"& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 30002174"& ,|EAP"& ,|CPT� 86622"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|BRUCELLA ANTIBODY"& ,|1"& ,|42"& ,|42"& ,|TRUE"& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 "& ,| 42.00 30002175"& ,|EAP"& ,|CPT� 87205"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|BUFFY COAT GRAM STAIN"& ,|1"& ,|158"& ,|158"& ,|TRUE"& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 30002176"& ,|EAP"& ,|CPT� 80299"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|BUSULFAN"& ,|1"& ,|166.5"& ,|166.5"& ,|TRUE"& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 30002177"& ,|EAP"& ,|CPT� 87324"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|C DIFF TOXINS A & B"& ,|1"& ,|305"& ,|305"& ,|TRUE"& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 "& ,| 305.00 30002178"& ,|EAP"& ,|CPT� 86631"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA)"& ,|1"& ,|70.5"& ,|70.5"& ,|TRUE"& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 30002179"& ,|EAP"& ,|CPT� 86632"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTIBODY; CHLAMYDIA"& ,|1"& ,|70.5"& ,|70.5"& ,|TRUE"& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 30002180"& ,|EAP"& ,|CPT� 86631"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTIBODY; CHLAMYDIA"& ,|1"& ,|70.5"& ,|70.5"& ,|TRUE"& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 30002181"& ,|EAP"& ,|CPT� 86632"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTIBODY; CHLAMYDIA, IGM"& ,|1"& ,|70.5"& ,|70.5"& ,|TRUE"& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 30002182"& ,|EAP"& ,|CPT� 86631"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTIBODY; CHLAMYDIA"& ,|1"& ,|70.5"& ,|70.5"& ,|TRUE"& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 30002183"& ,|EAP"& ,|CPT� 86632"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTIBODY; CHLAMYDIA, IGM"& ,|1"& ,|70.5"& ,|70.5"& ,|TRUE"& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 "& ,| 70.50 30002184"& ,|EAP"& ,|CPT� 86160"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|C-1-ESTERASE INHIBITOR"& ,|1"& ,|107"& ,|107"& ,|TRUE"& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 30002185"& ,|EAP"& ,|CPT� 86161"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|C-1-ESTERASE INHIBITOR FUNCT"& ,|1"& ,|107"& ,|107"& ,|TRUE"& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 30002186"& ,|EAP"& ,|CPT� 86160"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|MEASURE IMMUNE PROTEIN C3"& ,|1"& ,|270"& ,|270"& ,|TRUE"& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 30002187"& ,|EAP"& ,|CPT� 86160"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|MEASURE IMMUNE PROTEIN C4"& ,|1"& ,|274.5"& ,|274.5"& ,|TRUE"& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 30002188"& ,|EAP"& ,|CPT� 86329"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|IMMUNOLOGIC ANALYSIS TECHNIQUE ON SERUM"& ,|1"& ,|473"& ,|473"& ,|TRUE"& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 "& ,| 473.00 30002189"& ,|EAP"& ,|CPT� 81372"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CADAVERIC DONOR HLABC"& ,|1"& ,|2,546.50"& ,|2,546.50"& ,|TRUE"& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 "& ,| 2,546.50 30002190"& ,|EAP"& ,|CPT� 81375"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|HLA CLASS II TYPING LOW RESOLUTION HLA-DRB1/3/4/5 AND -DQB1"& ,|1"& ,|2,510.50"& ,|2,510.50"& ,|TRUE"& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 "& ,| 2,510.50 30002197"& ,|EAP"& ,|CPT� 80155"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CAFFEINE"& ,|1"& ,|406.5"& ,|406.5"& ,|TRUE"& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 30002198"& ,|EAP"& ,|CPT� 82308"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CALCITONIN"& ,|1"& ,|457.5"& ,|457.5"& ,|TRUE"& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 30002199"& ,|EAP"& ,|CPT� 82340"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CALCIUM 24H UR KID STN"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002200"& ,|EAP"& ,|CPT� 82310"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|CALCIUM BY AA (PTHNT)"& ,|1"& ,|40"& ,|40"& ,|TRUE"& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 30002201"& ,|EAP"& ,|CPT� 82310"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CALCIUM TOTAL"& ,|1"& ,|195"& ,|195"& ,|TRUE"& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 30002202"& ,|EAP"& ,|CPT� 82340"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CALCIUM URINE QN"& ,|1"& ,|149.5"& ,|149.5"& ,|TRUE"& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 30002203"& ,|EAP"& ,|CPT� 86304"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CANCER ANTIGEN 125"& ,|1"& ,|82"& ,|82"& ,|TRUE"& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 30002204"& ,|EAP"& ,|CPT� 86301"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CANCER ANTIGEN-GI REPORT"& ,|1"& ,|76"& ,|76"& ,|TRUE"& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 30002205"& ,|EAP"& ,|CPT� 82800"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CAPILLARY POC PH"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 30002206"& ,|EAP"& ,|CPT� 82373"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|CARB DEF TRANSFERRIN"& ,|1"& ,|858.5"& ,|858.5"& ,|TRUE"& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 "& ,| 858.50 30002207"& ,|EAP"& ,|CPT� 80156"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CARBAMAZEPINE (TEGRETOL)"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002208"& ,|EAP"& ,|CPT� 82374"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CARBON DIOXIDE (BICARB)"& ,|1"& ,|138"& ,|138"& ,|TRUE"& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 30002209"& ,|EAP"& ,|CPT� 82375"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CARBOXYHEMOGLOBIN"& ,|1"& ,|166.5"& ,|166.5"& ,|TRUE"& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 30002210"& ,|EAP"& ,|CPT� 82379"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CARNITINE TOTAL AND FREE QN"& ,|1"& ,|1,313.50"& ,|1,313.50"& ,|TRUE"& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 "& ,| 1,313.50 30002211"& ,|EAP"& ,|CPT� 82380"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CAROTENE"& ,|1"& ,|171"& ,|171"& ,|TRUE"& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 30002212"& ,|EAP"& ,|CPT� 82384"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CATECHOLAMINES BLOOD"& ,|1"& ,|560.5"& ,|560.5"& ,|TRUE"& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 30002213"& ,|EAP"& ,|CPT� 85025"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|CBC AUTO W/AUTOMATED DIFFERENTIAL"& ,|1"& ,|270"& ,|270"& ,|TRUE"& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 30002214"& ,|EAP"& ,|CPT� 85025"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|CBC AUTO W/AUTOMATED PARTIAL DIFFERENTIAL"& ,|1"& ,|270"& ,|270"& ,|TRUE"& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 30002215"& ,|EAP"& ,|CPT� 85027"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|CBC AUTO W/O DIFFERENTIAL"& ,|1"& ,|270"& ,|270"& ,|TRUE"& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 30002216"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CD16 CD56 CD3"& ,|1"& ,|62"& ,|62"& ,|TRUE"& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 30002217"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CD19 CD3"& ,|1"& ,|62"& ,|62"& ,|TRUE"& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 30002218"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CD3"& ,|1"& ,|359"& ,|359"& ,|TRUE"& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 30002219"& ,|EAP"& ,|CPT� 86367"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|CD34"& ,|1"& ,|163.5"& ,|163.5"& ,|TRUE"& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 "& ,| 163.50 30002220"& ,|EAP"& ,|CPT� 86361"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|CD4 ABSOLUTE COUNT"& ,|1"& ,|142"& ,|142"& ,|TRUE"& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 "& ,| 142.00 30002221"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CD4 CD45"& ,|1"& ,|62"& ,|62"& ,|TRUE"& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 30002222"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CD4 CD45 RA"& ,|1"& ,|62"& ,|62"& ,|TRUE"& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 30002223"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CD4 CD45 RO"& ,|1"& ,|62"& ,|62"& ,|TRUE"& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 30002224"& ,|EAP"& ,|CPT� 86360"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|CD4 CD8 CD4CD8 RATIO"& ,|1"& ,|250.5"& ,|250.5"& ,|TRUE"& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 "& ,| 250.50 30002225"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CD4 CD8 RATIO"& ,|1"& ,|62"& ,|62"& ,|TRUE"& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 30002226"& ,|EAP"& ,|CPT� 86360"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|CD4/CD8 ABSOLUTE"& ,|1"& ,|265.5"& ,|265.5"& ,|TRUE"& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 "& ,| 265.50 30002227"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CD4+CD3"& ,|1"& ,|62"& ,|62"& ,|TRUE"& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 30002228"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CD8 CD3"& ,|1"& ,|62"& ,|62"& ,|TRUE"& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 30002229"& ,|EAP"& ,|CPT� 82378"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CEA"& ,|1"& ,|377.5"& ,|377.5"& ,|TRUE"& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 30002230"& ,|EAP"& ,|CPT� 89050"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|CELL COUNT BODY FLUID"& ,|1"& ,|173.5"& ,|173.5"& ,|TRUE"& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 "& ,| 173.50 30002231"& ,|EAP"& ,|CPT� 86353"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS OF CELL FUNCTION AND ANALYSIS FOR GENETIC MARKER"& ,|1"& ,|1,298.00"& ,|1,298.00"& ,|TRUE"& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 "& ,| 1,298.00 30002232"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CELL3 LYMPH PROF TRN"& ,|1"& ,|62"& ,|62"& ,|TRUE"& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 "& ,| 62.00 30002233"& ,|EAP"& ,|CPT� 86353"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|CELLULAR IMMUNE PROFILE"& ,|1"& ,|1,494.00"& ,|1,494.00"& ,|TRUE"& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 "& ,| 1,494.00 30002234"& ,|EAP"& ,|CPT� 86038"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|CENTROMERE AB SCREENING"& ,|1"& ,|41"& ,|41"& ,|TRUE"& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 30002235"& ,|EAP"& ,|CPT� 82390"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CERULOPLASMIN"& ,|1"& ,|331"& ,|331"& ,|TRUE"& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 30002238"& ,|EAP"& ,|CPT� 81223"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CFTR-MOLECULE ISOLATE NUCLEIC"& ,|1"& ,|5,495.00"& ,|5,495.00"& ,|TRUE"& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 "& ,| 5,495.00 30002242"& ,|EAP"& ,|CPT� 87490"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CHLAMYDIA ANTIGEN BY PROBE"& ,|1"& ,|239"& ,|239"& ,|TRUE"& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 "& ,| 239.00 30002243"& ,|EAP"& ,|CPT� 87491"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CHLAMYDIA TRACH BY LCR"& ,|1"& ,|106.5"& ,|106.5"& ,|TRUE"& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 "& ,| 106.50 30002244"& ,|EAP"& ,|CPT� 87270"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CHLAMYDIA-FA-SMEAR"& ,|1"& ,|251.5"& ,|251.5"& ,|TRUE"& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 "& ,| 251.50 30002245"& ,|EAP"& ,|CPT� 82436"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CHLORIDE 24H UR KID STN"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002246"& ,|EAP"& ,|CPT� 82435"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CHLORIDE BLOOD"& ,|1"& ,|158"& ,|158"& ,|TRUE"& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 30002247"& ,|EAP"& ,|CPT� 82465"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|WHOLE CHOLESTEROL"& ,|1"& ,|201.5"& ,|201.5"& ,|TRUE"& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 30002248"& ,|EAP"& ,|CPT� 83718"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CHOLESTEROL HDL"& ,|1"& ,|174.5"& ,|174.5"& ,|TRUE"& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 30002249"& ,|EAP"& ,|CPT� 88289"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CHROM ADDITIONAL HIGH RESOLUTION"& ,|1"& ,|560.5"& ,|560.5"& ,|TRUE"& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 30002250"& ,|EAP"& ,|CPT� 88237"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CHROM ANAL BONE MAR NEOPLASTIC"& ,|1"& ,|2,748.00"& ,|2,748.00"& ,|TRUE"& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 "& ,| 2,748.00 30002251"& ,|EAP"& ,|CPT� 88230"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CHROM ANAL LYMPHCYT NONNEOPLAS"& ,|1"& ,|614"& ,|614"& ,|TRUE"& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 "& ,| 614.00 30002252"& ,|EAP"& ,|Custom 30002252"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CHROMOSONE ANALYSIS INFANT"& ,|1"& ,|1,755.50"& ,|1,755.50"& ,|TRUE"& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 "& ,| 1,755.50 30002253"& ,|EAP"& ,|CPT� 88264"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CHROM ANALYSIS 20-25 CELLS"& ,|1"& ,|1,124.50"& ,|1,124.50"& ,|TRUE"& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 30002254"& ,|EAP"& ,|CPT� 88237"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CHROM TISSUE CULTURE"& ,|1"& ,|1,124.50"& ,|1,124.50"& ,|TRUE"& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 "& ,| 1,124.50 30002256"& ,|EAP"& ,|CPT� 88299"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|CHROMOS MICROARRAY ANAL TEST"& ,|1"& ,|7,332.00"& ,|7,332.00"& ,|TRUE"& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 "& ,| 7,332.00 30002257"& ,|EAP"& ,|CPT� 88283"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CHROMOSOME ADDITIONAL BANDING"& ,|1"& ,|1,527.00"& ,|1,527.00"& ,|TRUE"& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 "& ,| 1,527.00 30002258"& ,|EAP"& ,|CPT� 88285"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CHROMOSOME ADDITIONAL CELL COUNT"& ,|1"& ,|359"& ,|359"& ,|TRUE"& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 30002259"& ,|EAP"& ,|CPT� 88264"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CHROMOSOME EXT BAND"& ,|1"& ,|2,181.00"& ,|2,181.00"& ,|TRUE"& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 "& ,| 2,181.00 30002260"& ,|EAP"& ,|CPT� 82507"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CITRATE"& ,|1"& ,|434"& ,|434"& ,|TRUE"& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 30002261"& ,|EAP"& ,|CPT� 82507"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CITRATE 24H UR KID"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002262"& ,|EAP"& ,|CPT� 80500"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|CLINICAL CONSULTATION"& ,|1"& ,|475"& ,|475"& ,|TRUE"& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 30002263"& ,|EAP"& ,|CPT� 87077"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CLO-TEST-READ ONLY"& ,|1"& ,|57.5"& ,|57.5"& ,|TRUE"& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 30002264"& ,|EAP"& ,|CPT� 81228"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|CMA-INTERPRETATION AND REPORT"& ,|1"& ,|8,744.50"& ,|8,744.50"& ,|TRUE"& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 "& ,| 8,744.50 30002265"& ,|EAP"& ,|CPT� 88271"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CMA-MOLECULAR CYTOG DNA PROBE"& ,|1"& ,|823"& ,|823"& ,|TRUE"& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 "& ,| 823.00 30002266"& ,|EAP"& ,|CPT� 86644"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTIBODY; CYTOMEGALOVIRUS, IGG"& ,|1"& ,|244"& ,|244"& ,|TRUE"& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 30002267"& ,|EAP"& ,|CPT� 86645"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|CMV ANTIBODIES,IGM"& ,|1"& ,|289"& ,|289"& ,|TRUE"& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 "& ,| 289.00 30002268"& ,|EAP"& ,|CPT� 87496"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CMV PCR TISSUE BX"& ,|1"& ,|296"& ,|296"& ,|TRUE"& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 "& ,| 296.00 30002269"& ,|EAP"& ,|CPT� 86644"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY TO CYTOMEGALOVIRUS (CMV)"& ,|1"& ,|155.5"& ,|155.5"& ,|TRUE"& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 30002271"& ,|EAP"& ,|CPT� 86635"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTIBODY; COCCIDIOIDE, FUNGAL"& ,|1"& ,|71.5"& ,|71.5"& ,|TRUE"& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 30002272"& ,|EAP"& ,|CPT� 83789"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|COENZYME Q10"& ,|1"& ,|1,027.50"& ,|1,027.50"& ,|TRUE"& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 "& ,| 1,027.50 30002273"& ,|EAP"& ,|CPT� 86157"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|MEASUREMENT OF COLD AGGLUTININ (PROTEIN) TO DETECT INFECTION OR DISEASE"& ,|1"& ,|147"& ,|147"& ,|TRUE"& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 "& ,| 147.00 30002274"& ,|EAP"& ,|CPT� 80307"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|COMPREHENSIVE DRUG SCREEN, URINE"& ,|1"& ,|274.5"& ,|274.5"& ,|TRUE"& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 30002275"& ,|EAP"& ,|CPT� 86162"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|MEASURE IMMUNE PROTEIN COMPLEMENT 50"& ,|1"& ,|377.5"& ,|377.5"& ,|TRUE"& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 30002276"& ,|EAP"& ,|CPT� 86160"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|COMPLIMENT COMPONENT 3"& ,|1"& ,|107"& ,|107"& ,|TRUE"& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 30002277"& ,|EAP"& ,|CPT� 80053"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|COMPREHENSIVE METABOLIC PANEL"& ,|1"& ,|450"& ,|450"& ,|TRUE"& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 30002278"& ,|EAP"& ,|CPT� 88321"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|CONSULT 1 PATH REFERRED SLIDE"& ,|1"& ,|761.5"& ,|761.5"& ,|TRUE"& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 30002279"& ,|EAP"& ,|CPT� 88323"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|CONSULT 2 PATH REFERRED SLIDE"& ,|1"& ,|761.5"& ,|761.5"& ,|TRUE"& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 "& ,| 761.50 30002280"& ,|EAP"& ,|CPT� 88332"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|CONSULT PATH SURG EA ADITIONAL FROZEN"& ,|1"& ,|579.5"& ,|579.5"& ,|TRUE"& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 30002281"& ,|EAP"& ,|CPT� 88329"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|CONSULT PATH SURGERY"& ,|1"& ,|572.5"& ,|572.5"& ,|TRUE"& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 "& ,| 572.50 30002282"& ,|EAP"& ,|CPT� 88331"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|CONSULT PATH SURGERY W/FROZEN"& ,|1"& ,|579.5"& ,|579.5"& ,|TRUE"& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 30002283"& ,|EAP"& ,|CPT� 86880"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|COOMBS DIRECT"& ,|1"& ,|184.5"& ,|184.5"& ,|TRUE"& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 30002284"& ,|EAP"& ,|CPT� 86880"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|COOMBS DIRECT, (ARC) EA"& ,|1"& ,|51"& ,|51"& ,|TRUE"& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 30002285"& ,|EAP"& ,|CPT� 86850"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|SCREENING TEST FOR RED BLOOD CELL ANTIBODIES"& ,|1"& ,|220"& ,|220"& ,|TRUE"& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 "& ,| 220.00 30002286"& ,|EAP"& ,|CPT� 82525"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|COPPER"& ,|1"& ,|293.5"& ,|293.5"& ,|TRUE"& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 30002287"& ,|EAP"& ,|CPT� 82525"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|COPPER, LIVER TISSUE REPORT"& ,|1"& ,|696.5"& ,|696.5"& ,|TRUE"& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 "& ,| 696.50 30002288"& ,|EAP"& ,|CPT� 82525"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|COPPER, UR UG/24HRS"& ,|1"& ,|14.5"& ,|14.5"& ,|TRUE"& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 30002289"& ,|EAP"& ,|CPT� 82525"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|COPPER, UR UG/G CREATININE"& ,|1"& ,|14.5"& ,|14.5"& ,|TRUE"& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 "& ,| 14.50 30002290"& ,|EAP"& ,|CPT� 82525"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|COPPER, URINE"& ,|1"& ,|70"& ,|70"& ,|TRUE"& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 "& ,| 70.00 30002291"& ,|EAP"& ,|CPT� 82533"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CORTISOL"& ,|1"& ,|394.5"& ,|394.5"& ,|TRUE"& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 "& ,| 394.50 30002292"& ,|EAP"& ,|CPT� 82530"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CORTISOL FREE"& ,|1"& ,|174.5"& ,|174.5"& ,|TRUE"& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 30002293"& ,|EAP"& ,|CPT� 86658"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|COXSACKIE A9 BY IMMUNOASSAY"& ,|1"& ,|94"& ,|94"& ,|TRUE"& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 30002294"& ,|EAP"& ,|CPT� 84681"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|C-PEPTIDE"& ,|1"& ,|264"& ,|264"& ,|TRUE"& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 30002295"& ,|EAP"& ,|CPT� 82552"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CPK ISOENZYME"& ,|1"& ,|282"& ,|282"& ,|TRUE"& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 30002296"& ,|EAP"& ,|CPT� 82553"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CPK ISOSENZYMES STAT ONLY"& ,|1"& ,|228"& ,|228"& ,|TRUE"& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 "& ,| 228.00 30002297"& ,|EAP"& ,|CPT� 86140"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|C-REACTIVE PROTEIN"& ,|1"& ,|158"& ,|158"& ,|TRUE"& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 30002298"& ,|EAP"& ,|CPT� 82540"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|CREATINE CGUAN"& ,|1"& ,|365"& ,|365"& ,|TRUE"& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 30002299"& ,|EAP"& ,|CPT� 82550"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CREATINE KINASE (CPK)"& ,|1"& ,|43.5"& ,|43.5"& ,|TRUE"& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 "& ,| 43.50 30002300"& ,|EAP"& ,|CPT� 82565"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CREATININE"& ,|1"& ,|138"& ,|138"& ,|TRUE"& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 30002301"& ,|EAP"& ,|CPT� 82570"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CREATININE 24 HR UR"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002302"& ,|EAP"& ,|CPT� 82575"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CREATININE CLEARANCE"& ,|1"& ,|388.5"& ,|388.5"& ,|TRUE"& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 30002303"& ,|EAP"& ,|CPT� 82570"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|CREATININE; OTHER SOURCE, OTHER SOURCE"& ,|1"& ,|150"& ,|150"& ,|TRUE"& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 "& ,| 150.00 30002304"& ,|EAP"& ,|CPT� 86922"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|CROSSMATCH, ANTIGLOBULIN"& ,|1"& ,|302.5"& ,|302.5"& ,|TRUE"& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 "& ,| 302.50 30002305"& ,|EAP"& ,|CPT� 86922"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|CROSSMATCH, ANTIGLOBULIN (ARC)"& ,|1"& ,|359"& ,|359"& ,|TRUE"& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 30002306"& ,|EAP"& ,|CPT� 86920"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|BLOOD UNIT COMPATIBILITY (CROSSMATCH), IMMEDIATE SPIN TECHNIQUE"& ,|1"& ,|342.5"& ,|342.5"& ,|TRUE"& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 "& ,| 342.50 30002307"& ,|EAP"& ,|CPT� 82585"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CRYOFIBRINOGEN"& ,|1"& ,|152.5"& ,|152.5"& ,|TRUE"& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 30002308"& ,|EAP"& ,|CPT� 82595"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CRYOGLOBULIN"& ,|1"& ,|131"& ,|131"& ,|TRUE"& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 30002309"& ,|EAP"& ,|HCPCS P9012"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|CRYOPRECIPITATE 1 UNIT"& ,|1"& ,|400.5"& ,|400.5"& ,|TRUE"& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 "& ,| 400.50 30002310"& ,|EAP"& ,|CPT� 87327"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CRYPTOCOCCAL AG, SERUM"& ,|1"& ,|423.5"& ,|423.5"& ,|TRUE"& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 30002311"& ,|EAP"& ,|CPT� 86641"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|CRYPTOCOCCAL ANTIBODY"& ,|1"& ,|278"& ,|278"& ,|TRUE"& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 30002312"& ,|EAP"& ,|CPT� 86403"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|NITROBLUE TETRAZOLIUM DYE TEST TO MEASURE WHITE BLOOD CELL FUNCTION"& ,|1"& ,|423.5"& ,|423.5"& ,|TRUE"& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 30002313"& ,|EAP"& ,|CPT� 87272"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CRYPTOSPOR AG BY FA"& ,|1"& ,|122"& ,|122"& ,|TRUE"& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 "& ,| 122.00 30002314"& ,|EAP"& ,|CPT� 89060"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|CRYSTAL IDENTIFICATION"& ,|1"& ,|347"& ,|347"& ,|TRUE"& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 "& ,| 347.00 30002315"& ,|EAP"& ,|CPT� 82042"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|QUANTITATIVE CSF ALBUMIN"& ,|1"& ,|33.5"& ,|33.5"& ,|TRUE"& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 30002316"& ,|EAP"& ,|CPT� 87497"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CSF CMV QUANTITATION"& ,|1"& ,|345.5"& ,|345.5"& ,|TRUE"& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 30002317"& ,|EAP"& ,|CPT� 87799"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CSF EBV QUANTITATION"& ,|1"& ,|853.5"& ,|853.5"& ,|TRUE"& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 30002318"& ,|EAP"& ,|CPT� 87498"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CSF ENTEROVIRUS RNA"& ,|1"& ,|190"& ,|190"& ,|TRUE"& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 "& ,| 190.00 30002319"& ,|EAP"& ,|CPT� 82945"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CSF GLUCOSE"& ,|1"& ,|107"& ,|107"& ,|TRUE"& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 30002320"& ,|EAP"& ,|CPT� 87529"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CSF HERPES SIMPLEX DNA"& ,|1"& ,|171"& ,|171"& ,|TRUE"& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 30002321"& ,|EAP"& ,|CPT� 87529"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CSF HERPES SIMPLEX DNA"& ,|1"& ,|740.5"& ,|740.5"& ,|TRUE"& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 "& ,| 740.50 30002322"& ,|EAP"& ,|CPT� 82784"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CSF IGG"& ,|1"& ,|33.5"& ,|33.5"& ,|TRUE"& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 30002323"& ,|EAP"& ,|CPT� 83615"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CSF LDH"& ,|1"& ,|278"& ,|278"& ,|TRUE"& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 30002324"& ,|EAP"& ,|CPT� 84157"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CSF PROTEIN"& ,|1"& ,|171"& ,|171"& ,|TRUE"& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 30002325"& ,|EAP"& ,|CPT� 86592"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|TUBERCULOSIS TEST"& ,|1"& ,|78"& ,|78"& ,|TRUE"& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 30002326"& ,|EAP"& ,|CPT� 87116"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE AFB/TB/MYCOBACT ISOLATE"& ,|1"& ,|440.5"& ,|440.5"& ,|TRUE"& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 30002327"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE GC GENITAL/GRAM"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002328"& ,|EAP"& ,|CPT� 87109"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE MYCOPLASMA PNEUMONIAE"& ,|1"& ,|157"& ,|157"& ,|TRUE"& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 "& ,| 157.00 30002329"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE ABSCESS AEROBIC UC"& ,|1"& ,|97"& ,|97"& ,|TRUE"& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 30002330"& ,|EAP"& ,|CPT� 87075"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE ABSCESS ANAEROBIC UC"& ,|1"& ,|120"& ,|120"& ,|TRUE"& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 30002331"& ,|EAP"& ,|CPT� 87077"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE AEROBIC ID"& ,|1"& ,|282"& ,|282"& ,|TRUE"& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 30002332"& ,|EAP"& ,|CPT� 87116"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE AFB BLOOD"& ,|1"& ,|440.5"& ,|440.5"& ,|TRUE"& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 30002333"& ,|EAP"& ,|CPT� 87075"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE ANAEROBIC"& ,|1"& ,|406.5"& ,|406.5"& ,|TRUE"& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 30002334"& ,|EAP"& ,|CPT� 87076"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE ANAEROBIC ID"& ,|1"& ,|357"& ,|357"& ,|TRUE"& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 30002335"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE APPENDIX"& ,|1"& ,|243.5"& ,|243.5"& ,|TRUE"& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 "& ,| 243.50 30002336"& ,|EAP"& ,|CPT� 87040"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE BLOOD+YEAST"& ,|1"& ,|388.5"& ,|388.5"& ,|TRUE"& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 30002337"& ,|EAP"& ,|CPT� 87040"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE BLOOD"& ,|1"& ,|388.5"& ,|388.5"& ,|TRUE"& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 30002338"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE BODY FLUIDS"& ,|1"& ,|244"& ,|244"& ,|TRUE"& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 30002339"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE BONE"& ,|1"& ,|244"& ,|244"& ,|TRUE"& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 30002340"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE BONE MARROW"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002342"& ,|EAP"& ,|CPT� 87075"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE C DIFFERENCE"& ,|1"& ,|293"& ,|293"& ,|TRUE"& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 "& ,| 293.00 30002343"& ,|EAP"& ,|CPT� 87110"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE CHLAMYDIA"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002344"& ,|EAP"& ,|CPT� 87110"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE CHLAMYDIA PNEUMONIAE"& ,|1"& ,|560.5"& ,|560.5"& ,|TRUE"& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 30002345"& ,|EAP"& ,|CPT� 87252"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE CMV RAPID + CONV"& ,|1"& ,|617"& ,|617"& ,|TRUE"& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 30002346"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE CORNEA"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002347"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE CSF"& ,|1"& ,|244"& ,|244"& ,|TRUE"& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 30002348"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE CYSTIC"& ,|1"& ,|256.5"& ,|256.5"& ,|TRUE"& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 30002349"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE DUODENAL ASP"& ,|1"& ,|186.5"& ,|186.5"& ,|TRUE"& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 "& ,| 186.50 30002350"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE EAR"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002351"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE ESOPH WASH"& ,|1"& ,|256"& ,|256"& ,|TRUE"& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 30002352"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE EYE"& ,|1"& ,|201.5"& ,|201.5"& ,|TRUE"& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 30002353"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE FLUID"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002354"& ,|EAP"& ,|CPT� 87102"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE FUNGUS+SMEAR"& ,|1"& ,|244"& ,|244"& ,|TRUE"& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 30002355"& ,|EAP"& ,|CPT� 87106"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE FUNGI IDENTIFICATION"& ,|1"& ,|307.5"& ,|307.5"& ,|TRUE"& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 30002356"& ,|EAP"& ,|CPT� 87103"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE FUNGUS, BLOOD"& ,|1"& ,|270"& ,|270"& ,|TRUE"& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 30002357"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE GASTRIC ASP"& ,|1"& ,|244"& ,|244"& ,|TRUE"& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 30002358"& ,|EAP"& ,|CPT� 87081"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE GC"& ,|1"& ,|331"& ,|331"& ,|TRUE"& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 30002359"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE GENITAL"& ,|1"& ,|244"& ,|244"& ,|TRUE"& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 30002360"& ,|EAP"& ,|CPT� 87252"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE HERPES RAPID"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002361"& ,|EAP"& ,|CPT� 87071"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE INDWELLING TIPS"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002362"& ,|EAP"& ,|CPT� 87081"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE LEGIONELLA"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002363"& ,|EAP"& ,|CPT� 87081"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE MRSA"& ,|1"& ,|336"& ,|336"& ,|TRUE"& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 30002364"& ,|EAP"& ,|CPT� 87109"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE MYCOPLASMA"& ,|1"& ,|437.5"& ,|437.5"& ,|TRUE"& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 "& ,| 437.50 30002365"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE RESPIRATORY"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002366"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE RESPIRATORY BILL ONLY"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002367"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE SINUS"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002368"& ,|EAP"& ,|CPT� 87045"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE STOOL"& ,|1"& ,|331"& ,|331"& ,|TRUE"& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 30002369"& ,|EAP"& ,|CPT� 87046"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE STOOL ECOLI SCREEN"& ,|1"& ,|331"& ,|331"& ,|TRUE"& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 30002370"& ,|EAP"& ,|CPT� 87081"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE STREP SCREEN"& ,|1"& ,|158"& ,|158"& ,|TRUE"& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 30002371"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE THROAT"& ,|1"& ,|326.5"& ,|326.5"& ,|TRUE"& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 30002372"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE TISSUE"& ,|1"& ,|341"& ,|341"& ,|TRUE"& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 30002373"& ,|EAP"& ,|CPT� 87140"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE TYPING FLUORESCENT"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002374"& ,|EAP"& ,|CPT� 87086"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE URINALYSIS"& ,|1"& ,|369"& ,|369"& ,|TRUE"& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 "& ,| 369.00 30002375"& ,|EAP"& ,|CPT� 87252"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE VIRAL"& ,|1"& ,|617"& ,|617"& ,|TRUE"& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 "& ,| 617.00 30002376"& ,|EAP"& ,|CPT� 87254"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE VIRAL RESPIR, SHELL 2"& ,|1"& ,|333"& ,|333"& ,|TRUE"& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 "& ,| 333.00 30002377"& ,|EAP"& ,|CPT� 87254"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE VIRAL RESPIRATORY"& ,|1"& ,|137"& ,|137"& ,|TRUE"& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 30002378"& ,|EAP"& ,|CPT� 87081"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE VRE"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002379"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE WOUND/ABS/ASP"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002380"& ,|EAP"& ,|CPT� 87070"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE WOUND DEEP"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002381"& ,|EAP"& ,|CPT� 87102"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE YEAST"& ,|1"& ,|244"& ,|244"& ,|TRUE"& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 30002382"& ,|EAP"& ,|CPT� 87081"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CULTURE, PERTUSSIS"& ,|1"& ,|120"& ,|120"& ,|TRUE"& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 30002383"& ,|EAP"& ,|CPT� 87207"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CYCLOSPORA STOOL"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002384"& ,|EAP"& ,|CPT� 80158"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CYCLOSPORINE (SANDIMMUNE)"& ,|1"& ,|383"& ,|383"& ,|TRUE"& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 30002385"& ,|EAP"& ,|CPT� 88104"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CYTOPATH FLUID SMEAR"& ,|1"& ,|345.5"& ,|345.5"& ,|TRUE"& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 30002386"& ,|EAP"& ,|CPT� 87015"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|CYTOSPIN"& ,|1"& ,|40"& ,|40"& ,|TRUE"& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 "& ,| 40.00 30002387"& ,|EAP"& ,|CPT� 88108"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|CYTOSPIN PREP"& ,|1"& ,|94"& ,|94"& ,|TRUE"& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 30002388"& ,|EAP"& ,|CPT� 86807"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|IMMUNOLOGIC ANAL CYTOTOXIC PRA STND METHOD"& ,|1"& ,|1,785.00"& ,|1,785.00"& ,|TRUE"& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 "& ,| 1,785.00 30002390"& ,|EAP"& ,|CPT� 85379"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|D-DIMER, QUANTITATIVE"& ,|1"& ,|241"& ,|241"& ,|TRUE"& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 "& ,| 241.00 30002391"& ,|EAP"& ,|CPT� 88291"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|DEB INTERPRETATION"& ,|1"& ,|484"& ,|484"& ,|TRUE"& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 30002392"& ,|EAP"& ,|CPT� 88249"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|DEB TEST"& ,|1"& ,|2,129.00"& ,|2,129.00"& ,|TRUE"& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 "& ,| 2,129.00 30002393"& ,|EAP"& ,|CPT� 88311"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|DECALCIFICATION"& ,|1"& ,|251"& ,|251"& ,|TRUE"& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 30002394"& ,|EAP"& ,|CPT� 82633"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|DEOXYCORTICOSTERONE"& ,|1"& ,|677"& ,|677"& ,|TRUE"& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 "& ,| 677.00 30002395"& ,|EAP"& ,|CPT� 82634"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|DEOXYCORTISOL"& ,|1"& ,|634.5"& ,|634.5"& ,|TRUE"& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 "& ,| 634.50 30002396"& ,|EAP"& ,|CPT� 86890"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|DESIG-DONOR SURCHARGE"& ,|1"& ,|331"& ,|331"& ,|TRUE"& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 30002397"& ,|EAP"& ,|CPT� 82626"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|DHEA"& ,|1"& ,|568"& ,|568"& ,|TRUE"& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 30002398"& ,|EAP"& ,|CPT� 82627"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|DHEA-S"& ,|1"& ,|531"& ,|531"& ,|TRUE"& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 30002399"& ,|EAP"& ,|CPT� 82657"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|DHR ENZYME ACTIVITY"& ,|1"& ,|160.5"& ,|160.5"& ,|TRUE"& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 "& ,| 160.50 30002400"& ,|EAP"& ,|CPT� 85004"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|DIFFERENTIAL WBC"& ,|1"& ,|97"& ,|97"& ,|TRUE"& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 30002401"& ,|EAP"& ,|CPT� 86978"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|PRETREATMENT OF SERUM FOR USE IN RED BLOOD CELL ANTIBODY ANALYSIS AND MEASUREMENT"& ,|1"& ,|138"& ,|138"& ,|TRUE"& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 30002402"& ,|EAP"& ,|CPT� 88271"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|DIGEORGE FISH UNCULTURE"& ,|1"& ,|941"& ,|941"& ,|TRUE"& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 30002403"& ,|EAP"& ,|CPT� 80162"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|DIGOXIN (LANOXIN)"& ,|1"& ,|274"& ,|274"& ,|TRUE"& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 30002404"& ,|EAP"& ,|CPT� 82642"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|DIHYDROTESTOSTERONE"& ,|1"& ,|412"& ,|412"& ,|TRUE"& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 30002405"& ,|EAP"& ,|CPT� 80164"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|DIPROPYLACETIC ACID (VALPROIC)"& ,|1"& ,|349"& ,|349"& ,|TRUE"& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 "& ,| 349.00 30002406"& ,|EAP"& ,|CPT� 86317"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR DETECTION OF TUMOR MARKER"& ,|1"& ,|138"& ,|138"& ,|TRUE"& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 30002409"& ,|EAP"& ,|CPT� 81479"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|FGFR3 ACHONDROPLASIA"& ,|1"& ,|3,728.50"& ,|3,728.50"& ,|TRUE"& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 "& ,| 3,728.50 30002411"& ,|EAP"& ,|CPT� 81404"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|DNA DIGESTION-GEN"& ,|1"& ,|1,310.00"& ,|1,310.00"& ,|TRUE"& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 30002412"& ,|EAP"& ,|CPT� 88182"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|DNA INDEX B, FLOW CYTOMETRY"& ,|1"& ,|712.5"& ,|712.5"& ,|TRUE"& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 "& ,| 712.50 30002416"& ,|EAP"& ,|CPT� 81400"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|DNA SEPARATION-GEN"& ,|1"& ,|812"& ,|812"& ,|TRUE"& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 "& ,| 812.00 30002420"& ,|EAP"& ,|CPT� 87184"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|DTEST"& ,|1"& ,|57.5"& ,|57.5"& ,|TRUE"& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 30002421"& ,|EAP"& ,|CPT� 86663"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY TO ENTEROVIRUS (GASTROINTESTINAL VIRUS)"& ,|1"& ,|97"& ,|97"& ,|TRUE"& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 30002422"& ,|EAP"& ,|CPT� 86664"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|EB VIRUS, NUCLEAR ANTIGEN"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002423"& ,|EAP"& ,|CPT� 86665"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|EB VIRUS, VIRAL CAPSID (VCA)"& ,|1"& ,|288.5"& ,|288.5"& ,|TRUE"& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 "& ,| 288.50 30002424"& ,|EAP"& ,|CPT� 87798"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|EBV PCR TISSUE BX"& ,|1"& ,|632"& ,|632"& ,|TRUE"& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 "& ,| 632.00 30002425"& ,|EAP"& ,|CPT� 87799"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|EBV DNA ULTRA QUANTITATIVE"& ,|1"& ,|853.5"& ,|853.5"& ,|TRUE"& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 "& ,| 853.50 30002426"& ,|EAP"& ,|CPT� 86682"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ECHINOCOCCUS ANTIBODY IGG"& ,|1"& ,|341"& ,|341"& ,|TRUE"& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 "& ,| 341.00 30002427"& ,|EAP"& ,|CPT� 87427"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|EHEC TOXIN BY EIA"& ,|1"& ,|224.5"& ,|224.5"& ,|TRUE"& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 "& ,| 224.50 30002428"& ,|EAP"& ,|CPT� 86666"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|EHRLICHIA CHAFFEENSIS"& ,|1"& ,|169"& ,|169"& ,|TRUE"& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 "& ,| 169.00 30002432"& ,|EAP"& ,|CPT� 81479"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ELA2 MOLECULAR ISOLAT/EXTRACT"& ,|1"& ,|3,088.00"& ,|3,088.00"& ,|TRUE"& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 "& ,| 3,088.00 30002435"& ,|EAP"& ,|CPT� 80051"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ELECTROLYTE PANEL"& ,|1"& ,|232.5"& ,|232.5"& ,|TRUE"& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 30002436"& ,|EAP"& ,|CPT� 88348"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|ELECTRON MICROSCOPY DIAGNOSTIC"& ,|1"& ,|2,867.50"& ,|2,867.50"& ,|TRUE"& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 "& ,| 2,867.50 30002437"& ,|EAP"& ,|Custom 30002437"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|EMERGENCY SERVICE FEE, ARC"& ,|1"& ,|885.5"& ,|885.5"& ,|TRUE"& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 "& ,| 885.50 30002438"& ,|EAP"& ,|CPT� 88348"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|EMORY ELECTRON MICROSCOPY"& ,|1"& ,|2,829.50"& ,|2,829.50"& ,|TRUE"& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 "& ,| 2,829.50 30002439"& ,|EAP"& ,|CPT� 86651"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ENCEPH CALIFORNIA (LA CROSSE)"& ,|1"& ,|190.5"& ,|190.5"& ,|TRUE"& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 30002440"& ,|EAP"& ,|CPT� 86652"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ENCEPH EASTERN EQUIINE"& ,|1"& ,|190.5"& ,|190.5"& ,|TRUE"& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 30002441"& ,|EAP"& ,|CPT� 86653"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ENCEPH ST LOUIS"& ,|1"& ,|190.5"& ,|190.5"& ,|TRUE"& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 30002442"& ,|EAP"& ,|CPT� 86654"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ENCEPH WESTERN EQUINE"& ,|1"& ,|190.5"& ,|190.5"& ,|TRUE"& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 "& ,| 190.50 30002443"& ,|EAP"& ,|CPT� 86651"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ENCEPHALITIS, CA"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002444"& ,|EAP"& ,|CPT� 86652"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY TO LA CROSSE (CALIFORNIA) VIRUS (ENCEPHALITIS CAUSING VIRUS)"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002445"& ,|EAP"& ,|CPT� 86653"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY TO EASTERN EQUINE VIRUS (VIRAL ENCEPHALITIS)"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002446"& ,|EAP"& ,|CPT� 86654"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY TO ST. LOUIS VIRUS (VIRAL ENCEPHALITIS)"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002447"& ,|EAP"& ,|CPT� 88342"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|ENTEROCYTE IMMUNOCYTOCHEMISTRY"& ,|1"& ,|560.5"& ,|560.5"& ,|TRUE"& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 30002448"& ,|EAP"& ,|CPT� 87498"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|ENTEROVIRUS BY PCR"& ,|1"& ,|629.5"& ,|629.5"& ,|TRUE"& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 30002449"& ,|EAP"& ,|CPT� 81220"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ENZYMATIC ACTION"& ,|1"& ,|841.5"& ,|841.5"& ,|TRUE"& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 "& ,| 841.50 30002450"& ,|EAP"& ,|CPT� 88319"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|ENZYME HISTOCHEM EUH"& ,|1"& ,|384.5"& ,|384.5"& ,|TRUE"& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 30002451"& ,|EAP"& ,|CPT� 85048"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|EOSINOPHIL COUNT BLOOD"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002452"& ,|EAP"& ,|CPT� 88104"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|EOSINOPHIL CT BRONCH WASHING"& ,|1"& ,|345.5"& ,|345.5"& ,|TRUE"& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 30002453"& ,|EAP"& ,|CPT� 82668"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ERYTHROPOIETIN"& ,|1"& ,|727.5"& ,|727.5"& ,|TRUE"& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 "& ,| 727.50 30002454"& ,|EAP"& ,|CPT� 87184"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|ESBL CONFIRMATION"& ,|1"& ,|73"& ,|73"& ,|TRUE"& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 30002455"& ,|EAP"& ,|CPT� 82670"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ESTRADIOL TOTAL"& ,|1"& ,|457.5"& ,|457.5"& ,|TRUE"& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 "& ,| 457.50 30002456"& ,|EAP"& ,|CPT� 82672"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ESTROGEN"& ,|1"& ,|1,392.50"& ,|1,392.50"& ,|TRUE"& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 "& ,| 1,392.50 30002457"& ,|EAP"& ,|CPT� 82671"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ESTROGEN FRACT"& ,|1"& ,|450"& ,|450"& ,|TRUE"& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 30002458"& ,|EAP"& ,|CPT� 82679"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ESTRONE"& ,|1"& ,|326.5"& ,|326.5"& ,|TRUE"& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 30002459"& ,|EAP"& ,|CPT� 80168"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ETHOSUXIMIDE"& ,|1"& ,|327"& ,|327"& ,|TRUE"& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 "& ,| 327.00 30002460"& ,|EAP"& ,|CPT� 82693"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ETHYLENE GLYCOL"& ,|1"& ,|138"& ,|138"& ,|TRUE"& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 30002461"& ,|EAP"& ,|CPT� 85360"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|EUGLOBULIN LYSIS TIME"& ,|1"& ,|188"& ,|188"& ,|TRUE"& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 30002462"& ,|EAP"& ,|CPT� 36450"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|EXCHANGE BLOOD TRANSFUSION, NEWBORN"& ,|1"& ,|877"& ,|877"& ,|TRUE"& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 "& ,| 877.00 30002464"& ,|EAP"& ,|CPT� 85335"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|F8 INHIBITOR, REFACTOR"& ,|1"& ,|674"& ,|674"& ,|TRUE"& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 30002465"& ,|EAP"& ,|CPT� 85240"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|F8 REFACTO ASSAY"& ,|1"& ,|674"& ,|674"& ,|TRUE"& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 "& ,| 674.00 30002466"& ,|EAP"& ,|CPT� 85280"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FACTOR 12 ASSAY"& ,|1"& ,|560.5"& ,|560.5"& ,|TRUE"& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 30002468"& ,|EAP"& ,|CPT� 85220"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FACTOR 5 PROACCELERIN"& ,|1"& ,|377.5"& ,|377.5"& ,|TRUE"& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 30002472"& ,|EAP"& ,|CPT� 85335"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FACTOR 8 HUMAN INHIBITOR"& ,|1"& ,|553.5"& ,|553.5"& ,|TRUE"& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 "& ,| 553.50 30002473"& ,|EAP"& ,|CPT� 85335"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FACTOR 8 INHIBITOR (PORCINE) TEST"& ,|1"& ,|783.5"& ,|783.5"& ,|TRUE"& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 "& ,| 783.50 30002474"& ,|EAP"& ,|CPT� 85335"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FACTOR 9 INHIBITOR TEST"& ,|1"& ,|606"& ,|606"& ,|TRUE"& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 "& ,| 606.00 30002475"& ,|EAP"& ,|HCPCS J7192"& ,|"& ,|0250 - PHARMACY - GENERAL"& ,|Hchg Factor Advate 100 Iu"& ,|1"& ,|502.5"& ,|502.5"& ,|TRUE"& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 "& ,| 502.50 30002476"& ,|EAP"& ,|HCPCS J7194"& ,|"& ,|0250 - PHARMACY - GENERAL"& ,|Hchg Factor Bebulin 100 Iu"& ,|1"& ,|306.5"& ,|306.5"& ,|TRUE"& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 30002477"& ,|EAP"& ,|HCPCS J7195"& ,|"& ,|0250 - PHARMACY - GENERAL"& ,|FACTOR BENEFIX 100 IU"& ,|1"& ,|412.5"& ,|412.5"& ,|TRUE"& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 30002478"& ,|EAP"& ,|HCPCS J7198"& ,|"& ,|0250 - PHARMACY - GENERAL"& ,|Hchg Factor Feiba 100 Iu"& ,|1"& ,|412.5"& ,|412.5"& ,|TRUE"& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 30002479"& ,|EAP"& ,|HCPCS J7187"& ,|"& ,|0250 - PHARMACY - GENERAL"& ,|FACTOR HUMATE (VWF) 100IU"& ,|1"& ,|604"& ,|604"& ,|TRUE"& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 "& ,| 604.00 30002480"& ,|EAP"& ,|CPT� 85250"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FACTOR 9 RANDOM"& ,|1"& ,|475.5"& ,|475.5"& ,|TRUE"& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 30002481"& ,|EAP"& ,|HCPCS J7192"& ,|"& ,|0250 - PHARMACY - GENERAL"& ,|Hchg Factor Kogenate 100 Iu"& ,|1"& ,|514.5"& ,|514.5"& ,|TRUE"& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 30002482"& ,|EAP"& ,|HCPCS J7192"& ,|"& ,|0250 - PHARMACY - GENERAL"& ,|Hchg Factor Recombinate 100 Iu"& ,|1"& ,|706.5"& ,|706.5"& ,|TRUE"& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 "& ,| 706.50 30002483"& ,|EAP"& ,|HCPCS J7192"& ,|"& ,|0250 - PHARMACY - GENERAL"& ,|Hchg Factor Refacto 100 Iu"& ,|1"& ,|412.5"& ,|412.5"& ,|TRUE"& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 "& ,| 412.50 30002484"& ,|EAP"& ,|HCPCS J7197"& ,|"& ,|0250 - PHARMACY - GENERAL"& ,|Hchg Factor Thrombate 100 Iu"& ,|1"& ,|514.5"& ,|514.5"& ,|TRUE"& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 "& ,| 514.50 30002485"& ,|EAP"& ,|CPT� 85220"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FACTOR V"& ,|1"& ,|673.5"& ,|673.5"& ,|TRUE"& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 30002486"& ,|EAP"& ,|CPT� 85230"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FACTOR VII"& ,|1"& ,|673.5"& ,|673.5"& ,|TRUE"& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 "& ,| 673.50 30002487"& ,|EAP"& ,|CPT� 85240"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FACTOR 8 ASSAY"& ,|1"& ,|659.5"& ,|659.5"& ,|TRUE"& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 30002488"& ,|EAP"& ,|CPT� 85247"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FACTOR VIII VW MULTIMETRIC"& ,|1"& ,|711"& ,|711"& ,|TRUE"& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 30002489"& ,|EAP"& ,|CPT� 85245"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FACTOR VIII VW RISTOCETIN"& ,|1"& ,|711"& ,|711"& ,|TRUE"& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 "& ,| 711.00 30002490"& ,|EAP"& ,|CPT� 85260"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FACTOR X STUART-PROWER"& ,|1"& ,|585"& ,|585"& ,|TRUE"& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 30002491"& ,|EAP"& ,|CPT� 85270"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FACTOR XI"& ,|1"& ,|560.5"& ,|560.5"& ,|TRUE"& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 30002492"& ,|EAP"& ,|CPT� 85290"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FACTOR XIII"& ,|1"& ,|608.5"& ,|608.5"& ,|TRUE"& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 30002493"& ,|EAP"& ,|CPT� 85362"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FDP/FSP AGGLUTINATION SEMIQUANTITATIVE"& ,|1"& ,|282.5"& ,|282.5"& ,|TRUE"& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 30002494"& ,|EAP"& ,|CPT� 82438"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|FECAL CHLORIDE"& ,|1"& ,|57.5"& ,|57.5"& ,|TRUE"& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 "& ,| 57.50 30002495"& ,|EAP"& ,|CPT� 82656"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|FECAL ELASTASE I"& ,|1"& ,|384"& ,|384"& ,|TRUE"& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 "& ,| 384.00 30002496"& ,|EAP"& ,|CPT� 82705"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FECAL FATS QUAL"& ,|1"& ,|171"& ,|171"& ,|TRUE"& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 30002497"& ,|EAP"& ,|CPT� 84999"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|FECAL POTASSIUM"& ,|1"& ,|43"& ,|43"& ,|TRUE"& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 "& ,| 43.00 30002498"& ,|EAP"& ,|CPT� 84302"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|FECAL SODIUM"& ,|1"& ,|51"& ,|51"& ,|TRUE"& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 30002499"& ,|EAP"& ,|CPT� 80339"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FELBAMATE (FELBATOL)"& ,|1"& ,|195"& ,|195"& ,|TRUE"& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 30002500"& ,|EAP"& ,|CPT� 82728"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FERRITIN"& ,|1"& ,|293.5"& ,|293.5"& ,|TRUE"& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 30002501"& ,|EAP"& ,|CPT� 85384"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FIBRINOGEN"& ,|1"& ,|293.5"& ,|293.5"& ,|TRUE"& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 30002502"& ,|EAP"& ,|CPT� 85385"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FIBRINOGEN-ANTIGEN"& ,|1"& ,|480"& ,|480"& ,|TRUE"& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 30002503"& ,|EAP"& ,|CPT� 88233"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FIBROBLAST TISSUE CULTURE"& ,|1"& ,|1,084.00"& ,|1,084.00"& ,|TRUE"& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 "& ,| 1,084.00 30002504"& ,|EAP"& ,|CPT� 88172"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FINE NEEDLE ASPIRATION EVALUATION"& ,|1"& ,|606.5"& ,|606.5"& ,|TRUE"& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 "& ,| 606.50 30002505"& ,|EAP"& ,|CPT� 88230"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FISH DIGEORGE NC"& ,|1"& ,|902.5"& ,|902.5"& ,|TRUE"& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 "& ,| 902.50 30002506"& ,|EAP"& ,|CPT� 88271"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FISH DNA PROBE"& ,|1"& ,|256.5"& ,|256.5"& ,|TRUE"& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 30002507"& ,|EAP"& ,|CPT� 88275"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FISH INTERPHASE ANALYZE CELLS"& ,|1"& ,|609"& ,|609"& ,|TRUE"& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 30002508"& ,|EAP"& ,|Custom 30002508"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FISH MICRO DELETION NO CHROMOSONE"& ,|1"& ,|1,595.00"& ,|1,595.00"& ,|TRUE"& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 30002509"& ,|EAP"& ,|CPT� 88230"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FISH MOLECULAR TEST"& ,|1"& ,|697.5"& ,|697.5"& ,|TRUE"& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 "& ,| 697.50 30002510"& ,|EAP"& ,|Custom 30002510"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FISH22 ANALYSIS BLOOD ST"& ,|1"& ,|1,595.00"& ,|1,595.00"& ,|TRUE"& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 "& ,| 1,595.00 30002511"& ,|EAP"& ,|CPT� 88275"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FISHQS 88275"& ,|1"& ,|941"& ,|941"& ,|TRUE"& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 30002512"& ,|EAP"& ,|CPT� 88291"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FISHQS 88291"& ,|1"& ,|941"& ,|941"& ,|TRUE"& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 "& ,| 941.00 30002513"& ,|EAP"& ,|CPT� 88273"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FISHQT 88273"& ,|1"& ,|480"& ,|480"& ,|TRUE"& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 30002514"& ,|EAP"& ,|CPT� 88291"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FISHQT 88291"& ,|1"& ,|480"& ,|480"& ,|TRUE"& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 30002515"& ,|EAP"& ,|CPT� 88271"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FISHQT88271"& ,|1"& ,|480"& ,|480"& ,|TRUE"& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 30002516"& ,|EAP"& ,|CPT� 80299"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FLECAINIDE"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002517"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FLOW CYTOMETRY PER CELL MARKER"& ,|1"& ,|2,123.00"& ,|2,123.00"& ,|TRUE"& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 "& ,| 2,123.00 30002518"& ,|EAP"& ,|CPT� 88189"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|FLOW CYTOMETRY, INTERPRETATION, >16 MARKERS"& ,|1"& ,|447"& ,|447"& ,|TRUE"& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 "& ,| 447.00 30002519"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FLOW CYTOMETRY, 1ST MARKER"& ,|1"& ,|210.5"& ,|210.5"& ,|TRUE"& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 "& ,| 210.50 30002520"& ,|EAP"& ,|CPT� 88185"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FLOW CYTOMETRY, ADDITIONAL MARKER"& ,|1"& ,|174.5"& ,|174.5"& ,|TRUE"& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 30002521"& ,|EAP"& ,|CPT� 88185"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FLOW CYTOMETRY, EACH ADDITIONAL MARKER"& ,|1"& ,|97.5"& ,|97.5"& ,|TRUE"& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 30002522"& ,|EAP"& ,|CPT� 88189"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FLOW INTERP, 15 OR MORE"& ,|1"& ,|447.5"& ,|447.5"& ,|TRUE"& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 "& ,| 447.50 30002523"& ,|EAP"& ,|CPT� 88187"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FLOW INTERP, 2-8 MARKERS"& ,|1"& ,|273.5"& ,|273.5"& ,|TRUE"& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 "& ,| 273.50 30002524"& ,|EAP"& ,|CPT� 88188"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FLOW INTERP, 9-15 MARKERS"& ,|1"& ,|341.5"& ,|341.5"& ,|TRUE"& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 "& ,| 341.50 30002525"& ,|EAP"& ,|CPT� 82150"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FLUID AMYLASE"& ,|1"& ,|195"& ,|195"& ,|TRUE"& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 30002526"& ,|EAP"& ,|CPT� 82247"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FLUID BILIRUBIN"& ,|1"& ,|152.5"& ,|152.5"& ,|TRUE"& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 30002527"& ,|EAP"& ,|CPT� 84540"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FLUID BUN"& ,|1"& ,|174.5"& ,|174.5"& ,|TRUE"& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 30002528"& ,|EAP"& ,|CPT� 82310"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FLUID CALCIUM"& ,|1"& ,|152.5"& ,|152.5"& ,|TRUE"& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 30002529"& ,|EAP"& ,|CPT� 82438"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FLUID CHLORIDE"& ,|1"& ,|158"& ,|158"& ,|TRUE"& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 30002530"& ,|EAP"& ,|CPT� 82570"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FLUID CREATININE"& ,|1"& ,|78"& ,|78"& ,|TRUE"& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 30002531"& ,|EAP"& ,|CPT� 82945"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FLUID GLUCOSE"& ,|1"& ,|107"& ,|107"& ,|TRUE"& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 "& ,| 107.00 30002532"& ,|EAP"& ,|CPT� 85014"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|FLUID HCT"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002533"& ,|EAP"& ,|CPT� 83615"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FLUID LDH"& ,|1"& ,|278"& ,|278"& ,|TRUE"& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 "& ,| 278.00 30002534"& ,|EAP"& ,|CPT� 83735"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FLUID MAGNESIUN"& ,|1"& ,|152"& ,|152"& ,|TRUE"& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 "& ,| 152.00 30002535"& ,|EAP"& ,|CPT� 83986"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FLUID PH"& ,|1"& ,|82"& ,|82"& ,|TRUE"& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 30002536"& ,|EAP"& ,|CPT� 84132"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ARUP FLUID POTASSIUM"& ,|1"& ,|78"& ,|78"& ,|TRUE"& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 30002537"& ,|EAP"& ,|CPT� 84157"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FLUID PROTEIN"& ,|1"& ,|171"& ,|171"& ,|TRUE"& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 30002538"& ,|EAP"& ,|CPT� 84302"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FLUID SODIUM"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002539"& ,|EAP"& ,|CPT� 84478"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FLUID TRIGLYCERIDES"& ,|1"& ,|138"& ,|138"& ,|TRUE"& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 30002540"& ,|EAP"& ,|CPT� 89051"& ,|"& ,|0309 - LABORATORY - OTHER LABORATORY"& ,|FLUIDS, CELL COUNT & DIFFERENCE"& ,|1"& ,|344"& ,|344"& ,|TRUE"& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 "& ,| 344.00 30002541"& ,|EAP"& ,|CPT� 86780"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTIBODY; TOXOPLASMA, IGM"& ,|1"& ,|210"& ,|210"& ,|TRUE"& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 30002542"& ,|EAP"& ,|CPT� 82746"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FOLATE SERUM"& ,|1"& ,|256.5"& ,|256.5"& ,|TRUE"& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 30002543"& ,|EAP"& ,|CPT� 82747"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FOLIC ACID RBC"& ,|1"& ,|326.5"& ,|326.5"& ,|TRUE"& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 30002544"& ,|EAP"& ,|CPT� 83001"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FOLLICLE STIM HORM (FSH)"& ,|1"& ,|510.5"& ,|510.5"& ,|TRUE"& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 30002545"& ,|EAP"& ,|Custom 30002545"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FRAGILE X FEMALES"& ,|1"& ,|1,417.00"& ,|1,417.00"& ,|TRUE"& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 30002546"& ,|EAP"& ,|Custom 30002546"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|FRAGILE X MALES"& ,|1"& ,|1,417.00"& ,|1,417.00"& ,|TRUE"& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 "& ,| 1,417.00 30002550"& ,|EAP"& ,|CPT� 81404"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FRDA ISOLATION OR EXTRACTION"& ,|1"& ,|5,304.00"& ,|5,304.00"& ,|TRUE"& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 "& ,| 5,304.00 30002554"& ,|EAP"& ,|CPT� 84202"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FREE ERYTH-PROTOPORPHYRIN"& ,|1"& ,|475.5"& ,|475.5"& ,|TRUE"& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 30002555"& ,|EAP"& ,|CPT� 82725"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FREE FATTY ACIDS"& ,|1"& ,|215"& ,|215"& ,|TRUE"& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 30002556"& ,|EAP"& ,|HCPCS P9017"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|FRESH FROZEN PLASMA PARTIAL UNIT"& ,|1"& ,|358.5"& ,|358.5"& ,|TRUE"& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 "& ,| 358.50 30002557"& ,|EAP"& ,|HCPCS P9017"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|FRESH FROZEN PLASMA 1 UNIT"& ,|1"& ,|440"& ,|440"& ,|TRUE"& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 "& ,| 440.00 30002558"& ,|EAP"& ,|HCPCS P9017"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|FRESH FROZEN PLASMA PEDIATRIC DOSE"& ,|1"& ,|383"& ,|383"& ,|TRUE"& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 30002559"& ,|EAP"& ,|CPT� 82985"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|FRUCTOSAMINE"& ,|1"& ,|68.5"& ,|68.5"& ,|TRUE"& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 "& ,| 68.50 30002560"& ,|EAP"& ,|CPT� 87206"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|FUNGUS SMEAR PAS"& ,|1"& ,|158"& ,|158"& ,|TRUE"& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 30002561"& ,|EAP"& ,|CPT� 87186"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|FUNGUS SUSCEPTIBILITY"& ,|1"& ,|328.5"& ,|328.5"& ,|TRUE"& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 "& ,| 328.50 30002562"& ,|EAP"& ,|CPT� 82955"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|G6PD; QUANTITATIVE"& ,|1"& ,|210"& ,|210"& ,|TRUE"& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 30002563"& ,|EAP"& ,|CPT� 80171"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|SERUM GABAPENTIN"& ,|1"& ,|171"& ,|171"& ,|TRUE"& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 30002564"& ,|EAP"& ,|CPT� 84378"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GAL-1-P"& ,|1"& ,|896.5"& ,|896.5"& ,|TRUE"& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 "& ,| 896.50 30002565"& ,|EAP"& ,|CPT� 82760"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GALACTOSE"& ,|1"& ,|716"& ,|716"& ,|TRUE"& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 "& ,| 716.00 30002566"& ,|EAP"& ,|CPT� 82775"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GALACTOSE-1-PHOSPHATE URIDYLTR"& ,|1"& ,|338"& ,|338"& ,|TRUE"& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 "& ,| 338.00 30002567"& ,|EAP"& ,|CPT� 82941"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GASTRIN"& ,|1"& ,|326.5"& ,|326.5"& ,|TRUE"& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 30002568"& ,|EAP"& ,|CPT� 83918"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GC/MS ANALYTE SINGLE SM PHASE"& ,|1"& ,|209"& ,|209"& ,|TRUE"& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 "& ,| 209.00 30002569"& ,|EAP"& ,|CPT� 80170"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GENTAMICIN PEAK"& ,|1"& ,|274.5"& ,|274.5"& ,|TRUE"& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 30002570"& ,|EAP"& ,|CPT� 80170"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GENTAMICIN RANDOM"& ,|1"& ,|274"& ,|274"& ,|TRUE"& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 "& ,| 274.00 30002571"& ,|EAP"& ,|CPT� 80170"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GENTAMICIN TROUGH"& ,|1"& ,|274.5"& ,|274.5"& ,|TRUE"& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 30002572"& ,|EAP"& ,|CPT� 82977"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GGT/GGTP"& ,|1"& ,|222"& ,|222"& ,|TRUE"& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 30002573"& ,|EAP"& ,|CPT� 86674"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY TO FRANCISELLA TULARENSIS (BACTERIA TRANSMITTED BY RODENTS)"& ,|1"& ,|114.5"& ,|114.5"& ,|TRUE"& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 30002574"& ,|EAP"& ,|CPT� 87300"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|GIARDIA ANTIGEN"& ,|1"& ,|213"& ,|213"& ,|TRUE"& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 30002575"& ,|EAP"& ,|CPT� 87329"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|GIARDIA ANTIGEN EIA"& ,|1"& ,|215"& ,|215"& ,|TRUE"& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 "& ,| 215.00 30002576"& ,|EAP"& ,|CPT� 83516"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GLOMERULAR BASEMENT MEMBRANE"& ,|1"& ,|225"& ,|225"& ,|TRUE"& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 "& ,| 225.00 30002577"& ,|EAP"& ,|CPT� 82943"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GLUCAGON"& ,|1"& ,|531"& ,|531"& ,|TRUE"& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 "& ,| 531.00 30002578"& ,|EAP"& ,|CPT� 82435"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GLUCOSE 1 HR PC"& ,|1"& ,|194.5"& ,|194.5"& ,|TRUE"& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 "& ,| 194.50 30002579"& ,|EAP"& ,|CPT� 82950"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GLUCOSE 2 HR PC"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002580"& ,|EAP"& ,|CPT� 82951"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GLUCOSE TOLERANCE 1ST 3 SPEC"& ,|1"& ,|484"& ,|484"& ,|TRUE"& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 30002581"& ,|EAP"& ,|CPT� 82952"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GLUCOSE TOLERANCE ADDL SPEC"& ,|1"& ,|149"& ,|149"& ,|TRUE"& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 30002582"& ,|EAP"& ,|CPT� 82947"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GLUCOSE WHOLE BLOOD"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002583"& ,|EAP"& ,|CPT� 82947"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|EXCEPT GLUCOSE, BLOOD"& ,|1"& ,|138"& ,|138"& ,|TRUE"& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 30002584"& ,|EAP"& ,|CPT� 82542"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|GLUTARIC ACID"& ,|1"& ,|609"& ,|609"& ,|TRUE"& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 30002585"& ,|EAP"& ,|CPT� 82978"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GLUTATHIONE"& ,|1"& ,|282.5"& ,|282.5"& ,|TRUE"& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 "& ,| 282.50 30002586"& ,|EAP"& ,|CPT� 82979"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GLUTATHIONE REDUCTASE RBC"& ,|1"& ,|213"& ,|213"& ,|TRUE"& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 "& ,| 213.00 30002587"& ,|EAP"& ,|CPT� 88309"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|GMCMP LEVEL VI"& ,|1"& ,|1,807.00"& ,|1,807.00"& ,|TRUE"& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 "& ,| 1,807.00 30002588"& ,|EAP"& ,|CPT� 88307"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|GMDC LEVEL V"& ,|1"& ,|1,589.00"& ,|1,589.00"& ,|TRUE"& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 "& ,| 1,589.00 30002589"& ,|EAP"& ,|CPT� 88305"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|GMDM LEVEL IV"& ,|1"& ,|770"& ,|770"& ,|TRUE"& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 "& ,| 770.00 30002590"& ,|EAP"& ,|CPT� 88304"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|GMDS LEVEL III"& ,|1"& ,|450"& ,|450"& ,|TRUE"& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 "& ,| 450.00 30002591"& ,|EAP"& ,|CPT� 87205"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|GRAM STAIN"& ,|1"& ,|48"& ,|48"& ,|TRUE"& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 30002592"& ,|EAP"& ,|HCPCS P9050"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|GRANULOCYTE PHERESIS"& ,|1"& ,|14,975.00"& ,|14,975.00"& ,|TRUE"& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 "& ,| 14,975.00 30002593"& ,|EAP"& ,|CPT� 88302"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|GROSS & MICRO LEVEL II"& ,|1"& ,|579.5"& ,|579.5"& ,|TRUE"& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 "& ,| 579.50 30002594"& ,|EAP"& ,|CPT� 88305"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|GROSS & MICRO LEVEL IV"& ,|1"& ,|475.5"& ,|475.5"& ,|TRUE"& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 "& ,| 475.50 30002595"& ,|EAP"& ,|CPT� 88300"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|GROSS ONLY LEVEL I"& ,|1"& ,|274.5"& ,|274.5"& ,|TRUE"& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 30002596"& ,|EAP"& ,|CPT� 88312"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|GROUP I SPECIAL STAINS"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002597"& ,|EAP"& ,|CPT� 88313"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|GROUP II SPECIAL STAINS"& ,|1"& ,|301"& ,|301"& ,|TRUE"& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 30002598"& ,|EAP"& ,|CPT� 83003"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GROWTH HORMONE (HGH)"& ,|1"& ,|510.5"& ,|510.5"& ,|TRUE"& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 30002599"& ,|EAP"& ,|CPT� 82570"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|GUANIDINOACETATE"& ,|1"& ,|365"& ,|365"& ,|TRUE"& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 "& ,| 365.00 30002600"& ,|EAP"& ,|CPT� 86677"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY TO GIARDIA LAMBLIA (INTESTINAL PARASITE)"& ,|1"& ,|184.5"& ,|184.5"& ,|TRUE"& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 30002601"& ,|EAP"& ,|CPT� 86677"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY TO HELICOBACTER PYLORI (GASTROINTESTINAL BACTERIA)"& ,|1"& ,|184.5"& ,|184.5"& ,|TRUE"& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 30002602"& ,|EAP"& ,|CPT� 86677"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY TO HELICOBACTER PYLORI (GASTROINTESTINAL BACTERIA)"& ,|1"& ,|184.5"& ,|184.5"& ,|TRUE"& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 "& ,| 184.50 30002603"& ,|EAP"& ,|CPT� 87385"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HA HISTOPLASMA AGENT-URINE"& ,|1"& ,|440.5"& ,|440.5"& ,|TRUE"& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 30002604"& ,|EAP"& ,|CPT� 82955"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HAE G-6-PD QN RBC"& ,|1"& ,|291"& ,|291"& ,|TRUE"& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 "& ,| 291.00 30002605"& ,|EAP"& ,|CPT� 84087"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HAE GLUCOSE PHOSP ISOMERASE"& ,|1"& ,|322.5"& ,|322.5"& ,|TRUE"& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 30002606"& ,|EAP"& ,|CPT� 83021"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HAE HEMOGLOBIN A(2) AND F"& ,|1"& ,|480"& ,|480"& ,|TRUE"& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 30002607"& ,|EAP"& ,|CPT� 83068"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HAE HEMOGLOBIN STABILITY"& ,|1"& ,|226"& ,|226"& ,|TRUE"& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 "& ,| 226.00 30002608"& ,|EAP"& ,|CPT� 83020"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HAE HEMOGLON ELECTRO-ALKALINE"& ,|1"& ,|355"& ,|355"& ,|TRUE"& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 "& ,| 355.00 30002609"& ,|EAP"& ,|CPT� 85060"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HAE MORPHOLOGY REVIEW"& ,|1"& ,|418.5"& ,|418.5"& ,|TRUE"& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 30002610"& ,|EAP"& ,|CPT� 85557"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HAE OSMOTIC FRAGILIY"& ,|1"& ,|384.5"& ,|384.5"& ,|TRUE"& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 "& ,| 384.50 30002611"& ,|EAP"& ,|CPT� 84220"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HAE PYRUVATE KINASE"& ,|1"& ,|259.5"& ,|259.5"& ,|TRUE"& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 "& ,| 259.50 30002612"& ,|EAP"& ,|CPT� 82657"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HAE RBC ENZYMES MULTIPLE"& ,|1"& ,|480"& ,|480"& ,|TRUE"& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 30002613"& ,|EAP"& ,|CPT� 83010"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HAPTOGLOBIN QN"& ,|1"& ,|388.5"& ,|388.5"& ,|TRUE"& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 "& ,| 388.50 30002614"& ,|EAP"& ,|CPT� 84703"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HCG QL"& ,|1"& ,|336"& ,|336"& ,|TRUE"& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 30002615"& ,|EAP"& ,|CPT� 84702"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HCG QN"& ,|1"& ,|336"& ,|336"& ,|TRUE"& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 30002616"& ,|EAP"& ,|CPT� 84702"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HCG TUMOR MARKER"& ,|1"& ,|336"& ,|336"& ,|TRUE"& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 30002617"& ,|EAP"& ,|CPT� 85441"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|HEINZ BODIES DIRECT"& ,|1"& ,|461"& ,|461"& ,|TRUE"& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 "& ,| 461.00 30002618"& ,|EAP"& ,|CPT� 85014"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|HEMATOCRIT NON SPUN"& ,|1"& ,|158"& ,|158"& ,|TRUE"& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 30002621"& ,|EAP"& ,|CPT� 81405"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HBA1 HBA2 GENE SEQUENCE"& ,|1"& ,|455.5"& ,|455.5"& ,|TRUE"& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 30002623"& ,|EAP"& ,|CPT� 81257"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HBA1 HBA2 GENE ANALYSIS"& ,|1"& ,|597"& ,|597"& ,|TRUE"& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 "& ,| 597.00 30002624"& ,|EAP"& ,|CPT� 81256"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HEMOCHROM HFE, 3 MUTATION"& ,|1"& ,|955.5"& ,|955.5"& ,|TRUE"& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 "& ,| 955.50 30002625"& ,|EAP"& ,|CPT� 85018"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|POC HEMOGLOBIN"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 30002626"& ,|EAP"& ,|CPT� 83021"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HEMOGLOBIN A2 QUANT"& ,|1"& ,|149.5"& ,|149.5"& ,|TRUE"& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 30002627"& ,|EAP"& ,|CPT� 83021"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HEMOGLOBIN ELECTROPHORESIS"& ,|1"& ,|412"& ,|412"& ,|TRUE"& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 "& ,| 412.00 30002628"& ,|EAP"& ,|CPT� 83036"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HEMOGLOBIN GLYCATED"& ,|1"& ,|264"& ,|264"& ,|TRUE"& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 30002629"& ,|EAP"& ,|CPT� 82820"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HEMOGLOBIN OXYGEN AFFINITY"& ,|1"& ,|131"& ,|131"& ,|TRUE"& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 30002630"& ,|EAP"& ,|CPT� 83051"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HEMOGLOBIN PLASMA"& ,|1"& ,|264"& ,|264"& ,|TRUE"& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 30002631"& ,|EAP"& ,|CPT� 83068"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HEMOGLOBIN STABILITY SCREEN"& ,|1"& ,|345.5"& ,|345.5"& ,|TRUE"& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 30002632"& ,|EAP"& ,|CPT� 86022"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTIBODY ID, PLATELET HEP IND THROMB"& ,|1"& ,|539"& ,|539"& ,|TRUE"& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 "& ,| 539.00 30002633"& ,|EAP"& ,|CPT� 85520"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|HEPARIN ASSAY"& ,|1"& ,|240"& ,|240"& ,|TRUE"& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 30002634"& ,|EAP"& ,|CPT� 85525"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|HEPARIN REMOVAL"& ,|1"& ,|149.5"& ,|149.5"& ,|TRUE"& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 30002635"& ,|EAP"& ,|CPT� 80076"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HEPATIC FUNCTION PANEL"& ,|1"& ,|359"& ,|359"& ,|TRUE"& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 30002636"& ,|EAP"& ,|CPT� 86709"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|MEASUREMENT OF HEPATITIS A ANTIBODY"& ,|1"& ,|251"& ,|251"& ,|TRUE"& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 "& ,| 251.00 30002637"& ,|EAP"& ,|CPT� 86708"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|HEPATITIS BE ANTIBODY MEASUREMENT"& ,|1"& ,|377.5"& ,|377.5"& ,|TRUE"& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 30002638"& ,|EAP"& ,|CPT� 80074"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HEPATITIS ACUTE PANEL"& ,|1"& ,|293.5"& ,|293.5"& ,|TRUE"& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 30002639"& ,|EAP"& ,|CPT� 86790"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HEPATITIS ANTIBODY"& ,|1"& ,|149"& ,|149"& ,|TRUE"& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 "& ,| 149.00 30002640"& ,|EAP"& ,|CPT� 86705"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|HEPATITIS B CORE ANTIBODY (IGM) MEASUREMENT"& ,|1"& ,|264"& ,|264"& ,|TRUE"& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 30002641"& ,|EAP"& ,|CPT� 86704"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY TO HIV-1 AND HIV-2 VIRUS"& ,|1"& ,|78"& ,|78"& ,|TRUE"& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 30002642"& ,|EAP"& ,|CPT� 87340"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|HEPATITIS B SURFACE ANTIGEN"& ,|1"& ,|174.5"& ,|174.5"& ,|TRUE"& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 "& ,| 174.50 30002643"& ,|EAP"& ,|CPT� 86706"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|HEPATITIS B SURFACE ANTIBODY MEASUREMENT"& ,|1"& ,|201.5"& ,|201.5"& ,|TRUE"& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 30002644"& ,|EAP"& ,|CPT� 87340"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|HEPATITIS B SURFACE ANTIGEN"& ,|1"& ,|51"& ,|51"& ,|TRUE"& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 30002645"& ,|EAP"& ,|CPT� 87517"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|HEPATITIS B VIRAL DNA"& ,|1"& ,|326.5"& ,|326.5"& ,|TRUE"& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 30002646"& ,|EAP"& ,|CPT� 87350"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|HEPATITIS BE ANTIGEN"& ,|1"& ,|78"& ,|78"& ,|TRUE"& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 30002647"& ,|EAP"& ,|CPT� 86707"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|HEPATITIS B SURFACE ANTIBODY MEASUREMENT"& ,|1"& ,|382.5"& ,|382.5"& ,|TRUE"& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 "& ,| 382.50 30002648"& ,|EAP"& ,|CPT� 86803"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|THYROGLOBULIN (THYROID PROTEIN) ANTIBODY MEASUREMENT"& ,|1"& ,|57"& ,|57"& ,|TRUE"& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 "& ,| 57.00 30002649"& ,|EAP"& ,|CPT� 86803"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|HEPATITIS C AB TOTAL"& ,|1"& ,|77"& ,|77"& ,|TRUE"& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 30002650"& ,|EAP"& ,|CPT� 87522"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|HEPATITIS C CONFIRMATION EMORY"& ,|1"& ,|322.5"& ,|322.5"& ,|TRUE"& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 "& ,| 322.50 30002651"& ,|EAP"& ,|CPT� 87522"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|HEPATITIS C DNA BRANCH"& ,|1"& ,|629.5"& ,|629.5"& ,|TRUE"& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 30002652"& ,|EAP"& ,|CPT� 86804"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|HEPATITIS C RIBA CONFIRMATION"& ,|1"& ,|340.5"& ,|340.5"& ,|TRUE"& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 30002657"& ,|EAP"& ,|CPT� 87522"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HEPATITIS C RNA QANTIFICATION"& ,|1"& ,|544"& ,|544"& ,|TRUE"& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 "& ,| 544.00 30002658"& ,|EAP"& ,|CPT� 87521"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HEPTATITS C RNA PCR"& ,|1"& ,|643.5"& ,|643.5"& ,|TRUE"& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 "& ,| 643.50 30002660"& ,|EAP"& ,|CPT� 86694"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|HERPES SIMPLEX IGM"& ,|1"& ,|114.5"& ,|114.5"& ,|TRUE"& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 "& ,| 114.50 30002661"& ,|EAP"& ,|CPT� 86694"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|HERPES SIMPLEX NON-SPECIFIC"& ,|1"& ,|222"& ,|222"& ,|TRUE"& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 30002662"& ,|EAP"& ,|CPT� 87529"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|HERPES SIMPLEX PCR"& ,|1"& ,|741.5"& ,|741.5"& ,|TRUE"& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 "& ,| 741.50 30002663"& ,|EAP"& ,|CPT� 86645"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|INFECTIOUS AGENT"& ,|1"& ,|232.5"& ,|232.5"& ,|TRUE"& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 30002664"& ,|EAP"& ,|CPT� 87533"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HHV INFECT AGENT DETECT"& ,|1"& ,|701"& ,|701"& ,|TRUE"& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 "& ,| 701.00 30002665"& ,|EAP"& ,|CPT� 88314"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|HISTOCHEM STAIN W/FROZEN EUH"& ,|1"& ,|331"& ,|331"& ,|TRUE"& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 30002666"& ,|EAP"& ,|CPT� 88319"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|HISTOCHEMISTRY STAIN ENZYME"& ,|1"& ,|659.5"& ,|659.5"& ,|TRUE"& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 "& ,| 659.50 30002667"& ,|EAP"& ,|CPT� 86698"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HISTOPLASMA ANTIBODY"& ,|1"& ,|71.5"& ,|71.5"& ,|TRUE"& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 30002668"& ,|EAP"& ,|CPT� 87385"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HISTOPLASMA ANTIGEN"& ,|1"& ,|434"& ,|434"& ,|TRUE"& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 30002669"& ,|EAP"& ,|CPT� 86701"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HIV 1 ANTIBODY"& ,|1"& ,|349.5"& ,|349.5"& ,|TRUE"& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 "& ,| 349.50 30002670"& ,|EAP"& ,|CPT� 87535"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|HIV 1 PCR"& ,|1"& ,|695"& ,|695"& ,|TRUE"& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 "& ,| 695.00 30002671"& ,|EAP"& ,|CPT� 86703"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY TO HIV-1 AND HIV-2 VIRUS"& ,|1"& ,|96"& ,|96"& ,|TRUE"& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 "& ,| 96.00 30002672"& ,|EAP"& ,|CPT� 86703"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY TO HIV-2 VIRUS"& ,|1"& ,|118"& ,|118"& ,|TRUE"& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 "& ,| 118.00 30002673"& ,|EAP"& ,|CPT� 86689"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY TO HUMAN T-CELL LYMPHOTROPIC VIRUS, TYPE 2 (HTLV-2)"& ,|1"& ,|378"& ,|378"& ,|TRUE"& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 "& ,| 378.00 30002674"& ,|EAP"& ,|CPT� 86701"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANALYSIS FOR ANTIBODY TO HIV -1 VIRUS"& ,|1"& ,|97"& ,|97"& ,|TRUE"& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 30002675"& ,|EAP"& ,|CPT� 87535"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|HIV-1 QUANT BY PCR"& ,|1"& ,|484"& ,|484"& ,|TRUE"& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 "& ,| 484.00 30002676"& ,|EAP"& ,|CPT� 87536"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HIV-1 RNA QNT BY PCR"& ,|1"& ,|585"& ,|585"& ,|TRUE"& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 "& ,| 585.00 30002677"& ,|EAP"& ,|CPT� 86832"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ASSESSMENT OF ANTIBODIES TO CLASS I AND CLASS II HUMAN LEUKOCYTE ANTIGENS (HLA) ANTIGENS"& ,|1"& ,|679"& ,|679"& ,|TRUE"& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 "& ,| 679.00 30002678"& ,|EAP"& ,|CPT� 81372"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|HLA CLASS II LOW ONE LOCUS"& ,|1"& ,|1,655.00"& ,|1,655.00"& ,|TRUE"& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 "& ,| 1,655.00 30002679"& ,|EAP"& ,|CPT� 86825"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HLA ALLO CDC"& ,|1"& ,|574"& ,|574"& ,|TRUE"& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 30002680"& ,|EAP"& ,|CPT� 86825"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HLA ALLO FLOW"& ,|1"& ,|1,050.00"& ,|1,050.00"& ,|TRUE"& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 30002681"& ,|EAP"& ,|CPT� 86825"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HLA AUTO CDC"& ,|1"& ,|574"& ,|574"& ,|TRUE"& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 "& ,| 574.00 30002682"& ,|EAP"& ,|CPT� 86825"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HLA AUTO FLOW"& ,|1"& ,|1,050.00"& ,|1,050.00"& ,|TRUE"& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 "& ,| 1,050.00 30002683"& ,|EAP"& ,|CPT� 88240"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|TISSUE CULTURE TO IDENTIFY WHITE BLOOD CELL DISORDERS"& ,|1"& ,|560.5"& ,|560.5"& ,|TRUE"& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 30002684"& ,|EAP"& ,|CPT� 81382"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|HLA CLASS II TYPING HIGH RESOLUTION ONE LOCUS"& ,|1"& ,|1,379.50"& ,|1,379.50"& ,|TRUE"& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 "& ,| 1,379.50 30002685"& ,|EAP"& ,|CPT� 86808"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|HLA FLOW BEAD I & II"& ,|1"& ,|1,245.00"& ,|1,245.00"& ,|TRUE"& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 "& ,| 1,245.00 30002686"& ,|EAP"& ,|CPT� 86813"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|IMMUNOLOGIC ANAL HLA TYPING MULTI ANTIGEN A/B/C"& ,|1"& ,|2,929.50"& ,|2,929.50"& ,|TRUE"& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 "& ,| 2,929.50 30002687"& ,|EAP"& ,|CPT� 81376"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|HLA CLASS I/II LOW RESOLUTION"& ,|1"& ,|3,846.00"& ,|3,846.00"& ,|TRUE"& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 "& ,| 3,846.00 30002688"& ,|EAP"& ,|CPT� 86812"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|HLA TYPING SINGLE ANTIG A/B/C"& ,|1"& ,|598.5"& ,|598.5"& ,|TRUE"& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 "& ,| 598.50 30002689"& ,|EAP"& ,|CPT� 86833"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ASSESSMENT OF ANTIBODY TO HUMAN LEUKOCYTE ANTIGENS (HLA) WITH HIGH DEFINITION QUALITATIVE PANEL FOR IDENTIFICATION OF ANTIBODY SPECIFICITIES, HLA CLASS I"& ,|1"& ,|1,326.50"& ,|1,326.50"& ,|TRUE"& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 "& ,| 1,326.50 30002690"& ,|EAP"& ,|CPT� 86805"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|CONFIRMATION TEST FOR HEPATITIS C ANTIBODY"& ,|1"& ,|570.5"& ,|570.5"& ,|TRUE"& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 "& ,| 570.50 30002691"& ,|EAP"& ,|CPT� 86808"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|HLAPRA PANEL"& ,|1"& ,|1,257.00"& ,|1,257.00"& ,|TRUE"& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 "& ,| 1,257.00 30002694"& ,|EAP"& ,|CPT� 81401"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HLP MOLECULAR GEL ELECTROPHOR"& ,|1"& ,|2,222.00"& ,|2,222.00"& ,|TRUE"& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 "& ,| 2,222.00 30002696"& ,|EAP"& ,|CPT� 81254"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HLP MOLECULAR ISOLATE NUCLEIC"& ,|1"& ,|2,221.00"& ,|2,221.00"& ,|TRUE"& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 "& ,| 2,221.00 30002698"& ,|EAP"& ,|CPT� 81404"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HLP MOLECULAR NUCLEIC AMPLIFIC"& ,|1"& ,|1,609.50"& ,|1,609.50"& ,|TRUE"& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 "& ,| 1,609.50 30002699"& ,|EAP"& ,|CPT� 83090"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HOMOCYSTINE"& ,|1"& ,|121.5"& ,|121.5"& ,|TRUE"& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 "& ,| 121.50 30002700"& ,|EAP"& ,|CPT� 87176"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|HOMOGENIZATION"& ,|1"& ,|35"& ,|35"& ,|TRUE"& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 "& ,| 35.00 30002701"& ,|EAP"& ,|CPT� 83150"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HOMOVANILLIC ACID (HVA)"& ,|1"& ,|244"& ,|244"& ,|TRUE"& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 30002702"& ,|EAP"& ,|CPT� 86695"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|HSV 1 GLYCOPRO G IGG"& ,|1"& ,|158"& ,|158"& ,|TRUE"& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 30002703"& ,|EAP"& ,|CPT� 86694"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|HSV 1+2 IGG ELISA"& ,|1"& ,|71.5"& ,|71.5"& ,|TRUE"& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 30002704"& ,|EAP"& ,|CPT� 86694"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|HSV 1+2 IGM ELISA"& ,|1"& ,|71.5"& ,|71.5"& ,|TRUE"& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 "& ,| 71.50 30002705"& ,|EAP"& ,|CPT� 86790"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|HTLV-I/II AB SCREEN"& ,|1"& ,|158"& ,|158"& ,|TRUE"& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 30002706"& ,|EAP"& ,|CPT� 86790"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HUMAN HERPES VIRUS 6"& ,|1"& ,|264"& ,|264"& ,|TRUE"& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 30002707"& ,|EAP"& ,|CPT� 88365"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|INTERPRETATION AND REPORT OF GENETIC TESTING"& ,|1"& ,|1,405.50"& ,|1,405.50"& ,|TRUE"& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 "& ,| 1,405.50 30002708"& ,|EAP"& ,|CPT� 87798"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|DETECTION TEST FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA)"& ,|1"& ,|428"& ,|428"& ,|TRUE"& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 "& ,| 428.00 30002709"& ,|EAP"& ,|CPT� 83491"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HYDROXYCORTICOSTEROI (17-OHCS)"& ,|1"& ,|552"& ,|552"& ,|TRUE"& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 "& ,| 552.00 30002710"& ,|EAP"& ,|CPT� 83498"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HYDROXYPROGESTERONE 17-D"& ,|1"& ,|498.5"& ,|498.5"& ,|TRUE"& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 "& ,| 498.50 30002711"& ,|EAP"& ,|CPT� 82787"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|IGA SUBCLASS 1 AND 2"& ,|1"& ,|97"& ,|97"& ,|TRUE"& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 30002712"& ,|EAP"& ,|CPT� 82784"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|IGA TOTAL"& ,|1"& ,|97"& ,|97"& ,|TRUE"& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 30002713"& ,|EAP"& ,|CPT� 82784"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|IGG SERUM"& ,|1"& ,|33.5"& ,|33.5"& ,|TRUE"& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 30002714"& ,|EAP"& ,|CPT� 82787"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|IGG SUBCLASSES"& ,|1"& ,|267"& ,|267"& ,|TRUE"& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 "& ,| 267.00 30002715"& ,|EAP"& ,|CPT� 86003"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|IMMUNOCAP-MILK"& ,|1"& ,|28"& ,|28"& ,|TRUE"& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 "& ,| 28.00 30002716"& ,|EAP"& ,|CPT� 86320"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|IAA DETECTION IMMUNOELECTROPHORESIS SERUM"& ,|1"& ,|340.5"& ,|340.5"& ,|TRUE"& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 "& ,| 340.50 30002717"& ,|EAP"& ,|CPT� 88346"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|IMMUNOFLUORESCENT STAIN, INITIAL"& ,|1"& ,|568"& ,|568"& ,|TRUE"& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 "& ,| 568.00 30002718"& ,|EAP"& ,|CPT� 82784"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|IMMUNOGLOBULIN IGA"& ,|1"& ,|210"& ,|210"& ,|TRUE"& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 30002719"& ,|EAP"& ,|CPT� 82784"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|IMMUNOGLOBULIN IGD"& ,|1"& ,|480"& ,|480"& ,|TRUE"& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 "& ,| 480.00 30002720"& ,|EAP"& ,|CPT� 82785"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|IMMUNOGLOBULIN IGE"& ,|1"& ,|434"& ,|434"& ,|TRUE"& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 "& ,| 434.00 30002721"& ,|EAP"& ,|CPT� 82784"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|IMMUNOGLOBULIN IGG"& ,|1"& ,|210"& ,|210"& ,|TRUE"& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 30002722"& ,|EAP"& ,|CPT� 82784"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|IMMUNOGLOBULIN IGM"& ,|1"& ,|210"& ,|210"& ,|TRUE"& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 30002723"& ,|EAP"& ,|CPT� 88342"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|IMMUNOHISTOCHEMISTRY"& ,|1"& ,|629.5"& ,|629.5"& ,|TRUE"& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 30002724"& ,|EAP"& ,|CPT� 87210"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|INDIA INK PREP"& ,|1"& ,|97"& ,|97"& ,|TRUE"& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 30002727"& ,|EAP"& ,|CPT� 83520"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|INFLIXIMAB/HACA"& ,|1"& ,|498"& ,|498"& ,|TRUE"& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 "& ,| 498.00 30002728"& ,|EAP"& ,|CPT� 87276"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|INFLUENZA A FA NASAL"& ,|1"& ,|306.5"& ,|306.5"& ,|TRUE"& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 30002729"& ,|EAP"& ,|CPT� 87275"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|INFLUENZA B FA NASAL"& ,|1"& ,|240"& ,|240"& ,|TRUE"& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 "& ,| 240.00 30002730"& ,|EAP"& ,|CPT� 86710"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|INFLUENZA A ANTIBODY IGG"& ,|1"& ,|73"& ,|73"& ,|TRUE"& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 30002731"& ,|EAP"& ,|CPT� 86710"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|INFLUENZA A ANTIBODY IGM"& ,|1"& ,|73"& ,|73"& ,|TRUE"& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 30002732"& ,|EAP"& ,|CPT� 87276"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|INFLUENZA A VIRUS"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002733"& ,|EAP"& ,|CPT� 87804"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|INFLUENZA A"& ,|1"& ,|125"& ,|125"& ,|TRUE"& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 "& ,| 125.00 30002734"& ,|EAP"& ,|CPT� 86710"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|INFLUENZA B ANTIBODY IGG"& ,|1"& ,|73"& ,|73"& ,|TRUE"& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 30002735"& ,|EAP"& ,|CPT� 86710"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|INFLUENZA B ANTIBODY IGM"& ,|1"& ,|73"& ,|73"& ,|TRUE"& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 "& ,| 73.00 30002736"& ,|EAP"& ,|CPT� 86684"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|INFLUENZA TYPE A ANTIBODY"& ,|1"& ,|152.5"& ,|152.5"& ,|TRUE"& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 30002737"& ,|EAP"& ,|HCPCS P9046"& ,|"& ,|0636 - DRUGS REQUIRING SPECIFIC IDENTIFICATION - DRUGS REQUIRING DETAILED CODING"& ,|Hchg Infusion, Albumin 25%-20ml"& ,|1"& ,|223"& ,|223"& ,|TRUE"& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 30002738"& ,|EAP"& ,|HCPCS P9047"& ,|"& ,|0636 - DRUGS REQUIRING SPECIFIC IDENTIFICATION - DRUGS REQUIRING DETAILED CODING"& ,|Hchg Infusion, Albumin 25%-50ml"& ,|1"& ,|272"& ,|272"& ,|TRUE"& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 "& ,| 272.00 30002739"& ,|EAP"& ,|HCPCS P9048"& ,|"& ,|0636 - DRUGS REQUIRING SPECIFIC IDENTIFICATION - DRUGS REQUIRING DETAILED CODING"& ,|Hchg Infusion, Albumin 5%-250ml"& ,|1"& ,|369.5"& ,|369.5"& ,|TRUE"& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 "& ,| 369.50 30002740"& ,|EAP"& ,|HCPCS P9041"& ,|"& ,|0250 - PHARMACY - GENERAL"& ,|Hchg Infusion, Albumin 5%-50ml"& ,|1"& ,|223"& ,|223"& ,|TRUE"& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 "& ,| 223.00 30002741"& ,|EAP"& ,|CPT� 88365"& ,|"& ,|0312 - LABORATORY PATHOLOGICAL - HISTOLOGY"& ,|INSITU HYBRIDIZATION"& ,|1"& ,|1,310.00"& ,|1,310.00"& ,|TRUE"& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 "& ,| 1,310.00 30002742"& ,|EAP"& ,|CPT� 83525"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|INSULIN"& ,|1"& ,|201.5"& ,|201.5"& ,|TRUE"& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 30002743"& ,|EAP"& ,|CPT� 86337"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|INSULIN ANTIBODY"& ,|1"& ,|210"& ,|210"& ,|TRUE"& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 30002745"& ,|EAP"& ,|CPT� 83520"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|INTERLEUKIN 6"& ,|1"& ,|345.5"& ,|345.5"& ,|TRUE"& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 30002747"& ,|EAP"& ,|CPT� 88173"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|INTERPRETATION AND REPORT"& ,|1"& ,|749.5"& ,|749.5"& ,|TRUE"& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 "& ,| 749.50 30002748"& ,|EAP"& ,|CPT� 84311"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|INTERPRETATION PORPHYRINS"& ,|1"& ,|103"& ,|103"& ,|TRUE"& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 "& ,| 103.00 30002749"& ,|EAP"& ,|CPT� 82397"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|INTRINSIC GROWTH FACTOR BP3"& ,|1"& ,|326.5"& ,|326.5"& ,|TRUE"& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 30002750"& ,|EAP"& ,|CPT� 86078"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|INVESTIGATE TRANSFUSION REACTION"& ,|1"& ,|491.5"& ,|491.5"& ,|TRUE"& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 "& ,| 491.50 30002752"& ,|EAP"& ,|CPT� 83540"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|IRON"& ,|1"& ,|166.5"& ,|166.5"& ,|TRUE"& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 "& ,| 166.50 30002753"& ,|EAP"& ,|CPT� 82190"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|IRON ANALYSIS FOR LIVER BIOPSY"& ,|1"& ,|657"& ,|657"& ,|TRUE"& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 "& ,| 657.00 30002754"& ,|EAP"& ,|CPT� 83550"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|IRON BINDING CAPACITY"& ,|1"& ,|210"& ,|210"& ,|TRUE"& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 30002755"& ,|EAP"& ,|CPT� 86341"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ISLET CELL ANTIBOLDY"& ,|1"& ,|172"& ,|172"& ,|TRUE"& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 30002756"& ,|EAP"& ,|CPT� 86886"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ISOHEMAGGLUTININ - A OR B TITE"& ,|1"& ,|137"& ,|137"& ,|TRUE"& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 "& ,| 137.00 30002757"& ,|EAP"& ,|CPT� 86940"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|ISOHEMAGGLUTININ TITER PANEL"& ,|1"& ,|140.5"& ,|140.5"& ,|TRUE"& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 "& ,| 140.50 30002760"& ,|EAP"& ,|CPT� 87177"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|ISOSPORA STOOL"& ,|1"& ,|172"& ,|172"& ,|TRUE"& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 "& ,| 172.00 30002761"& ,|EAP"& ,|CPT� 80177"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|KEPPRA (LEVETIRACETAM)"& ,|1"& ,|345.5"& ,|345.5"& ,|TRUE"& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 30002762"& ,|EAP"& ,|CPT� 82365"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CALCULI (STONE) ANALYSIS"& ,|1"& ,|171"& ,|171"& ,|TRUE"& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 30002763"& ,|EAP"& ,|CPT� 87220"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|KOH PREP"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002764"& ,|EAP"& ,|CPT� 83625"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LACT DEHYDROGENSE (LDH) ISOENZ"& ,|1"& ,|95"& ,|95"& ,|TRUE"& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 "& ,| 95.00 30002765"& ,|EAP"& ,|CPT� 82657"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LACTASE SUCRASE TISSUE"& ,|1"& ,|475"& ,|475"& ,|TRUE"& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 "& ,| 475.00 30002766"& ,|EAP"& ,|CPT� 82657"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ENZYME ACTIVITY IN, DUODENAL"& ,|1"& ,|306.5"& ,|306.5"& ,|TRUE"& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 30002767"& ,|EAP"& ,|CPT� 83605"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LACTATE CSF"& ,|1"& ,|463"& ,|463"& ,|TRUE"& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 "& ,| 463.00 30002768"& ,|EAP"& ,|CPT� 83605"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LACTATE/LACTIC ACID"& ,|1"& ,|377.5"& ,|377.5"& ,|TRUE"& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 "& ,| 377.50 30002769"& ,|EAP"& ,|CPT� 88184"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|LAD FLOW CYTOMETRY"& ,|1"& ,|307.5"& ,|307.5"& ,|TRUE"& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 30002770"& ,|EAP"& ,|CPT� 88185"& ,|"& ,|0311 - LABORATORY PATHOLOGICAL - CYTOLOGY"& ,|LAD MARKER EACH"& ,|1"& ,|620.5"& ,|620.5"& ,|TRUE"& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 "& ,| 620.50 30002771"& ,|EAP"& ,|CPT� 80175"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LAMOTRIGINE"& ,|1"& ,|171"& ,|171"& ,|TRUE"& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 30002772"& ,|EAP"& ,|CPT� 87147"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|LATEX AGGLUTINATION"& ,|1"& ,|76"& ,|76"& ,|TRUE"& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 30002773"& ,|EAP"& ,|CPT� 87147"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|LATEX AGGLUTINATION 2ND UNIT"& ,|1"& ,|76"& ,|76"& ,|TRUE"& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 30002774"& ,|EAP"& ,|CPT� 86003"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ALLERGEN LATEX IGE"& ,|1"& ,|149.5"& ,|149.5"& ,|TRUE"& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 30002775"& ,|EAP"& ,|CPT� 83615"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LDH"& ,|1"& ,|171"& ,|171"& ,|TRUE"& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 30002776"& ,|EAP"& ,|CPT� 83655"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LEAD"& ,|1"& ,|222"& ,|222"& ,|TRUE"& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 30002777"& ,|EAP"& ,|CPT� 83655"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LEAD-CAPILLARY"& ,|1"& ,|51"& ,|51"& ,|TRUE"& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 "& ,| 51.00 30002778"& ,|EAP"& ,|CPT� 82542"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LEFLUNOMIDE BY HPLC/MS"& ,|1"& ,|714"& ,|714"& ,|TRUE"& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 "& ,| 714.00 30002779"& ,|EAP"& ,|CPT� 87449"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|LEGIONELLA URINARY AGENT"& ,|1"& ,|195"& ,|195"& ,|TRUE"& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 30002780"& ,|EAP"& ,|CPT� 83520"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LEPTIN"& ,|1"& ,|331"& ,|331"& ,|TRUE"& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 "& ,| 331.00 30002781"& ,|EAP"& ,|CPT� 86720"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LEPTOSPIRA ANTIBODIES"& ,|1"& ,|97"& ,|97"& ,|TRUE"& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 30002782"& ,|EAP"& ,|CPT� 80176"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LIDOCAINE"& ,|1"& ,|383"& ,|383"& ,|TRUE"& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 30002783"& ,|EAP"& ,|CPT� 83690"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LIPASE"& ,|1"& ,|264"& ,|264"& ,|TRUE"& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 30002784"& ,|EAP"& ,|CPT� 80061"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LIPID PANEL"& ,|1"& ,|359"& ,|359"& ,|TRUE"& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 "& ,| 359.00 30002785"& ,|EAP"& ,|CPT� 80178"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LITHIUM"& ,|1"& ,|149.5"& ,|149.5"& ,|TRUE"& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 30002786"& ,|EAP"& ,|CPT� 86376"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT"& ,|1"& ,|274.5"& ,|274.5"& ,|TRUE"& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 30002787"& ,|EAP"& ,|CPT� 83540"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LIVER TISSUE IRON"& ,|1"& ,|578"& ,|578"& ,|TRUE"& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 "& ,| 578.00 30002788"& ,|EAP"& ,|CPT� 86403"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|LMEN GRP B STREP SCREEN"& ,|1"& ,|149.5"& ,|149.5"& ,|TRUE"& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 30002789"& ,|EAP"& ,|CPT� 86403"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|LMEN H INFLUENZAE SCREEN"& ,|1"& ,|149.5"& ,|149.5"& ,|TRUE"& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 30002790"& ,|EAP"& ,|CPT� 86403"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|LMEN NEIS C/W135 SCREEN"& ,|1"& ,|126.5"& ,|126.5"& ,|TRUE"& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 "& ,| 126.50 30002791"& ,|EAP"& ,|CPT� 86403"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|LMEN NEISS ACYW135 SCREEN"& ,|1"& ,|149.5"& ,|149.5"& ,|TRUE"& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 30002792"& ,|EAP"& ,|CPT� 86403"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|LMEN NEISS B/ECOLI SCREEN"& ,|1"& ,|149.5"& ,|149.5"& ,|TRUE"& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 30002793"& ,|EAP"& ,|CPT� 86403"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|LMEN STP PNEUMONIA SCREEN"& ,|1"& ,|149.5"& ,|149.5"& ,|TRUE"& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 "& ,| 149.50 30002794"& ,|EAP"& ,|CPT� 82784"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LOW LEVEL IGA"& ,|1"& ,|210"& ,|210"& ,|TRUE"& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 "& ,| 210.00 30002795"& ,|EAP"& ,|CPT� 83002"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LUTEINIZING HORMONE (LH)"& ,|1"& ,|510.5"& ,|510.5"& ,|TRUE"& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 "& ,| 510.50 30002796"& ,|EAP"& ,|CPT� 87476"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|LYME BY PCR"& ,|1"& ,|403.5"& ,|403.5"& ,|TRUE"& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 "& ,| 403.50 30002797"& ,|EAP"& ,|CPT� 86617"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|CONFIRMATION TEST FOR ANTIBODY TO BORRELIA BURGDORFERI (LYME DISEASE BACTERIA)"& ,|1"& ,|113"& ,|113"& ,|TRUE"& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 "& ,| 113.00 30002798"& ,|EAP"& ,|CPT� 86367"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|STEM CELLS COUNT, TOTAL"& ,|1"& ,|262"& ,|262"& ,|TRUE"& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 "& ,| 262.00 30002799"& ,|EAP"& ,|CPT� 86727"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LYMPHOCYTIC CHORIO"& ,|1"& ,|77"& ,|77"& ,|TRUE"& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 30002800"& ,|EAP"& ,|CPT� 86805"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|IMMUNOLOGIC ANAL LYMPHOCYTOTOXICITY W/TITER"& ,|1"& ,|860.5"& ,|860.5"& ,|TRUE"& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 "& ,| 860.50 30002801"& ,|EAP"& ,|CPT� 82657"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|LYSOSOMAL ENZYME"& ,|1"& ,|429"& ,|429"& ,|TRUE"& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 "& ,| 429.00 30002802"& ,|EAP"& ,|CPT� 85549"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|LYSOZYME BY RADIAL IMMUNODIF"& ,|1"& ,|54.5"& ,|54.5"& ,|TRUE"& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 "& ,| 54.50 30002803"& ,|EAP"& ,|CPT� 87556"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|M. TB BY PCR"& ,|1"& ,|357"& ,|357"& ,|TRUE"& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 30002804"& ,|EAP"& ,|CPT� 87556"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|MYCOBACTERIA TUBERCULOSIS BY PCR"& ,|1"& ,|943.5"& ,|943.5"& ,|TRUE"& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 "& ,| 943.50 30002805"& ,|EAP"& ,|CPT� 83735"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MAGNESIUM"& ,|1"& ,|201.5"& ,|201.5"& ,|TRUE"& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 "& ,| 201.50 30002806"& ,|EAP"& ,|CPT� 83735"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MAGNESIUM 24H U KID"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002807"& ,|EAP"& ,|CPT� 83735"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MAGNESIUM,RBC"& ,|1"& ,|156"& ,|156"& ,|TRUE"& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 "& ,| 156.00 30002808"& ,|EAP"& ,|CPT� 87207"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|MALARIA % ON SMEAR"& ,|1"& ,|187"& ,|187"& ,|TRUE"& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 "& ,| 187.00 30002809"& ,|EAP"& ,|CPT� 82657"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MALTASE"& ,|1"& ,|256.5"& ,|256.5"& ,|TRUE"& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 30002810"& ,|EAP"& ,|CPT� 83785"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MANGANESE, SERUM"& ,|1"& ,|33.5"& ,|33.5"& ,|TRUE"& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 30002813"& ,|EAP"& ,|CPT� 81408"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|MARFAN ISOLATION"& ,|1"& ,|6,969.50"& ,|6,969.50"& ,|TRUE"& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 "& ,| 6,969.50 30002817"& ,|EAP"& ,|CPT� 83825"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MERCURY"& ,|1"& ,|270"& ,|270"& ,|TRUE"& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 "& ,| 270.00 30002818"& ,|EAP"& ,|CPT� 83825"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MERCURY, QUANTITATIVE, BLOOD"& ,|1"& ,|33.5"& ,|33.5"& ,|TRUE"& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 30002819"& ,|EAP"& ,|CPT� 83825"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MERCURY, QUANTITATIVE, URINE"& ,|1"& ,|86"& ,|86"& ,|TRUE"& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 "& ,| 86.00 30002820"& ,|EAP"& ,|CPT� 87798"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|METAPNEUMOVIRUS BY PCR"& ,|1"& ,|511.5"& ,|511.5"& ,|TRUE"& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 "& ,| 511.50 30002821"& ,|EAP"& ,|HCPCS 80358"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|METHADONE"& ,|1"& ,|320"& ,|320"& ,|TRUE"& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 "& ,| 320.00 30002822"& ,|EAP"& ,|CPT� 83050"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|METHEMOGLOBIN QN"& ,|1"& ,|195"& ,|195"& ,|TRUE"& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 "& ,| 195.00 30002823"& ,|EAP"& ,|CPT� 80299"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|METHOTREXATE"& ,|1"& ,|264"& ,|264"& ,|TRUE"& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 30002824"& ,|EAP"& ,|CPT� 87999"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|MICRO SAVE SPEC"& ,|1"& ,|97.5"& ,|97.5"& ,|TRUE"& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 30002825"& ,|EAP"& ,|CPT� 82043"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|URINE MICROALBUMIN (PROTEIN) LEVEL"& ,|1"& ,|222"& ,|222"& ,|TRUE"& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 30002826"& ,|EAP"& ,|CPT� 86331"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|IMMUNOLOGIC ANALYSIS TECHNIQUE"& ,|1"& ,|82"& ,|82"& ,|TRUE"& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 30002827"& ,|EAP"& ,|CPT� 87207"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|MICROSPORIDIA STOOL"& ,|1"& ,|212.5"& ,|212.5"& ,|TRUE"& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 "& ,| 212.50 30002828"& ,|EAP"& ,|CPT� 88273"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|MOLECULAR CYTOGENETICS CHROMOSOMAL"& ,|1"& ,|1,329.50"& ,|1,329.50"& ,|TRUE"& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 30002829"& ,|EAP"& ,|CPT� 88271"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|MOL CYTO DNA PROBE"& ,|1"& ,|1,329.50"& ,|1,329.50"& ,|TRUE"& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 "& ,| 1,329.50 30002834"& ,|EAP"& ,|CPT� 81404"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MOLEC PATH EXTRAC/ISOLATION"& ,|1"& ,|4,719.50"& ,|4,719.50"& ,|TRUE"& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 "& ,| 4,719.50 30002836"& ,|EAP"& ,|CPT� 81241"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|GENE ANALYSIS (COAGULATION FACTOR V) LEIDEN VARIANT"& ,|1"& ,|453"& ,|453"& ,|TRUE"& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 "& ,| 453.00 30002837"& ,|EAP"& ,|CPT� 81404"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HBA1 HBA2 DUPLICATION DELETION"& ,|1"& ,|455.5"& ,|455.5"& ,|TRUE"& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 30002840"& ,|EAP"& ,|CPT� 86308"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|SCREENING TEST FOR MONONUCLEOSIS (MONO)"& ,|1"& ,|264"& ,|264"& ,|TRUE"& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 "& ,| 264.00 30002843"& ,|EAP"& ,|CPT� 86735"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTIBODY; MUMPS"& ,|1"& ,|406.5"& ,|406.5"& ,|TRUE"& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 "& ,| 406.50 30002844"& ,|EAP"& ,|CPT� 86735"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTIBODY; MUMPS"& ,|1"& ,|97"& ,|97"& ,|TRUE"& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 30002848"& ,|EAP"& ,|CPT� 81479"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MOLEC PATHOLOGY MUNC MOLECULAR ISOLAT/EXTRAC"& ,|1"& ,|6,539.50"& ,|6,539.50"& ,|TRUE"& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 "& ,| 6,539.50 30002850"& ,|EAP"& ,|CPT� 84378"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CARBOHYDRATE ANALYSIS"& ,|1"& ,|48"& ,|48"& ,|TRUE"& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 "& ,| 48.00 30002851"& ,|EAP"& ,|CPT� 80180"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MYCOPHENOLATE (MYCOPHENOLIC ACID) LEVEL"& ,|1"& ,|440.5"& ,|440.5"& ,|TRUE"& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 "& ,| 440.50 30002852"& ,|EAP"& ,|CPT� 87581"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|MYCOPLASMA DNA PROBE"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30002853"& ,|EAP"& ,|CPT� 86738"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTIBODY; MYCOPLASMA"& ,|1"& ,|41"& ,|41"& ,|TRUE"& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 "& ,| 41.00 30002854"& ,|EAP"& ,|CPT� 83873"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MYELIN BASIC PROTEIN (NERVE PROTEIN) LEVEL, SPINAL FLUID"& ,|1"& ,|152.5"& ,|152.5"& ,|TRUE"& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 "& ,| 152.50 30002855"& ,|EAP"& ,|CPT� 83874"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MYOGLOBIN (MUSCLE PROTEIN) LEVEL"& ,|1"& ,|244"& ,|244"& ,|TRUE"& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 30002856"& ,|EAP"& ,|CPT� 86235"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTIBODY MYOSITIS ANTI EJ"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002857"& ,|EAP"& ,|CPT� 83516"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|IMMUNOASSAY ANAL MYOSITIS ANTI JO 1"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002858"& ,|EAP"& ,|CPT� 86235"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTIBODY MYOSITIS ANTI KU"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002859"& ,|EAP"& ,|CPT� 86235"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTIBODY MYOSITIS ANTI MI2"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002860"& ,|EAP"& ,|CPT� 86235"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTIBODY MYOSITIS ANTI OJ"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002861"& ,|EAP"& ,|CPT� 86235"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTIBODY MYOSITIS ANTI PL 12"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002862"& ,|EAP"& ,|CPT� 86235"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTIBODY MYOSITIS ANTI PL 7"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002863"& ,|EAP"& ,|CPT� 86235"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTIBODY MYOSITIS ANTI PM SCL"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002864"& ,|EAP"& ,|CPT� 86235"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTIBODY MYOSITIS ANTI RO"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002865"& ,|EAP"& ,|CPT� 86235"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTIBODY MYOSITIS ANTI SRP"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002866"& ,|EAP"& ,|CPT� 86235"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTIBODY MYOSITIS ANTI U1RNP"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002867"& ,|EAP"& ,|CPT� 86235"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTIBODY MYOSITIS ANTI U2RNP"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002868"& ,|EAP"& ,|CPT� 87591"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PRETREATMENT OF SERUM FOR USE IN RED BLOOD CELL ANTIBODY ANALYSIS AND MEASUREMENT"& ,|1"& ,|120"& ,|120"& ,|TRUE"& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 "& ,| 120.00 30002869"& ,|EAP"& ,|CPT� 87184"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|NALIDIXIC ACID DISC TEST"& ,|1"& ,|32"& ,|32"& ,|TRUE"& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 30002871"& ,|EAP"& ,|CPT� 86316"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|SCREENING TEST FOR MONONUCLEOSIS (MONO)"& ,|1"& ,|345.5"& ,|345.5"& ,|TRUE"& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 "& ,| 345.50 30002872"& ,|EAP"& ,|CPT� 86790"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|NF1-REV.TRANSCRIPTION"& ,|1"& ,|97.5"& ,|97.5"& ,|TRUE"& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 "& ,| 97.50 30002873"& ,|EAP"& ,|CPT� 84591"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|VITAMIN MEASUREMENT"& ,|1"& ,|293.5"& ,|293.5"& ,|TRUE"& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 "& ,| 293.50 30002874"& ,|EAP"& ,|CPT� 86384"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT"& ,|1"& ,|629.5"& ,|629.5"& ,|TRUE"& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 "& ,| 629.50 30002875"& ,|EAP"& ,|CPT� 86352"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANALYSIS OF CELL FUNCTION AND ANALYSIS FOR GENETIC MARKER"& ,|1"& ,|1,469.00"& ,|1,469.00"& ,|TRUE"& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 "& ,| 1,469.00 30002876"& ,|EAP"& ,|HCPCS 80335"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTIDEPRESSANTS LEVELS, NORTRIPTYLINE"& ,|1"& ,|78"& ,|78"& ,|TRUE"& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 "& ,| 78.00 30002878"& ,|EAP"& ,|CPT� 82523"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|N-TELOPEPTIDE"& ,|1"& ,|357"& ,|357"& ,|TRUE"& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 "& ,| 357.00 30002883"& ,|EAP"& ,|CPT� 81406"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ALPHA BETA GENE SEQUENCE"& ,|1"& ,|455.5"& ,|455.5"& ,|TRUE"& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 "& ,| 455.50 30002885"& ,|EAP"& ,|CPT� 81401"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MOLEC PATH LEVEL 2 NUC MOLEC-ENZYME DIGEST NON CF"& ,|1"& ,|1,666.00"& ,|1,666.00"& ,|TRUE"& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 "& ,| 1,666.00 30002890"& ,|EAP"& ,|CPT� 83915"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|NUCLEOTIDASE 5' (ENZYME) LEVEL"& ,|1"& ,|306.5"& ,|306.5"& ,|TRUE"& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 "& ,| 306.50 30002891"& ,|EAP"& ,|CPT� 82270"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|STOOL ANALYSIS FOR BLOOD TO SCREEN FOR COLON TUMORS"& ,|1"& ,|94"& ,|94"& ,|TRUE"& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 30002892"& ,|EAP"& ,|CPT� 82271"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|OCCULT BLOOD OTHER SOURCE"& ,|1"& ,|97"& ,|97"& ,|TRUE"& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 30002895"& ,|EAP"& ,|CPT� 81408"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MOLEC PATH LEVEL 9 OI MOLECULAR ISOLAT/EXTRACT"& ,|1"& ,|3,614.00"& ,|3,614.00"& ,|TRUE"& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 "& ,| 3,614.00 30002899"& ,|EAP"& ,|CPT� 83916"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MEASUREMENT OF IMMUNE SUBSTANCE (OLIGOCLONAL BANDS)"& ,|1"& ,|97"& ,|97"& ,|TRUE"& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 "& ,| 97.00 30002900"& ,|EAP"& ,|CPT� 82542"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CHEM ANAL STABLE ISOTOPE SOL"& ,|1"& ,|207"& ,|207"& ,|TRUE"& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 "& ,| 207.00 30002901"& ,|EAP"& ,|CPT� 83918"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|ORGANIC ACID CSF"& ,|1"& ,|608.5"& ,|608.5"& ,|TRUE"& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 "& ,| 608.50 30002902"& ,|EAP"& ,|CPT� 83918"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ORGANIC ACID QUAL"& ,|1"& ,|609"& ,|609"& ,|TRUE"& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 "& ,| 609.00 30002903"& ,|EAP"& ,|CPT� 83935"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|OSMOLAL 24H UR KID"& ,|1"& ,|100"& ,|100"& ,|TRUE"& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 "& ,| 100.00 30002904"& ,|EAP"& ,|CPT� 83930"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|OSMOLALITY; BLOOD"& ,|1"& ,|222"& ,|222"& ,|TRUE"& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 "& ,| 222.00 30002905"& ,|EAP"& ,|CPT� 83935"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|OSMOLALITY URINE"& ,|1"& ,|256.5"& ,|256.5"& ,|TRUE"& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 30002906"& ,|EAP"& ,|CPT� 85555"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|OSMOTIC FRAGILITY"& ,|1"& ,|560.5"& ,|560.5"& ,|TRUE"& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 "& ,| 560.50 30002907"& ,|EAP"& ,|CPT� 83937"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|OSTEOCALCIN (BONE G1A PROTEIN)"& ,|1"& ,|232.5"& ,|232.5"& ,|TRUE"& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 "& ,| 232.50 30002908"& ,|EAP"& ,|CPT� 87177"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|OVA & PARASITES"& ,|1"& ,|94"& ,|94"& ,|TRUE"& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 "& ,| 94.00 30002909"& ,|EAP"& ,|CPT� 87181"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|OXACILLIN SUPPLEMENTAL TEST"& ,|1"& ,|32"& ,|32"& ,|TRUE"& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 "& ,| 32.00 30002910"& ,|EAP"& ,|CPT� 83945"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|OXALATE LEVEL"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002911"& ,|EAP"& ,|CPT� 80183"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MM OXCARBAZEPINE LEVEL"& ,|1"& ,|282"& ,|282"& ,|TRUE"& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 "& ,| 282.00 30002912"& ,|EAP"& ,|CPT� 82820"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|HEMOGLOBIN-OXYGEN AFFINITY MEASUREMENT"& ,|1"& ,|1,938.00"& ,|1,938.00"& ,|TRUE"& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 "& ,| 1,938.00 30002913"& ,|EAP"& ,|CPT� 85415"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|PAI-1-ACTIVITY-ASSAY"& ,|1"& ,|872"& ,|872"& ,|TRUE"& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 "& ,| 872.00 30002914"& ,|EAP"& ,|CPT� 82657"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MEASURE ENZYME PALATINASE"& ,|1"& ,|256.5"& ,|256.5"& ,|TRUE"& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 "& ,| 256.50 30002915"& ,|EAP"& ,|CPT� 81404"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PANC AMPLIFICATION SINGLE PAIR"& ,|1"& ,|2,130.00"& ,|2,130.00"& ,|TRUE"& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 "& ,| 2,130.00 30002917"& ,|EAP"& ,|CPT� 81479"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MOLEC PATHOLOGY PANC ISOLATION/EXTRACTION"& ,|1"& ,|9,475.50"& ,|9,475.50"& ,|TRUE"& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 "& ,| 9,475.50 30002922"& ,|EAP"& ,|CPT� 84378"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|PANCREATIC FLUID"& ,|1"& ,|599"& ,|599"& ,|TRUE"& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 "& ,| 599.00 30002923"& ,|EAP"& ,|CPT� 87279"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|PARAINFLUENZA FA 1,2,3"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002924"& ,|EAP"& ,|CPT� 82542"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|CHEM ANAL PARATHY HORM RELATED PEPTIDE"& ,|1"& ,|407.5"& ,|407.5"& ,|TRUE"& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 "& ,| 407.50 30002925"& ,|EAP"& ,|CPT� 87799"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|DETECTION TEST FOR ORGANISM"& ,|1"& ,|401.5"& ,|401.5"& ,|TRUE"& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 "& ,| 401.50 30002926"& ,|EAP"& ,|CPT� 86747"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTIBODY; PARVOVIRUS"& ,|1"& ,|105.5"& ,|105.5"& ,|TRUE"& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 "& ,| 105.50 30002927"& ,|EAP"& ,|CPT� 87205"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|PAS STAIN"& ,|1"& ,|256"& ,|256"& ,|TRUE"& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 "& ,| 256.00 30002931"& ,|EAP"& ,|HCPCS 80345"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|BARBITURATES LEVELS, PENTOBARBITAL"& ,|1"& ,|326.5"& ,|326.5"& ,|TRUE"& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 30002932"& ,|EAP"& ,|30002932"& ,|"& ,|0310 - LABORATORY PATHOLOGICAL - GENERAL"& ,|MISCELLANEOUS PATHOLOGY"& ,|1"& ,|565"& ,|565"& ,|TRUE"& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 "& ,| 565.00 30002933"& ,|EAP"& ,|CPT� 82800"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PH POC"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 30002934"& ,|EAP"& ,|CPT� 83986"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PH URINE KID STN"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002935"& ,|EAP"& ,|CPT� 83986"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|PH, FLUID"& ,|1"& ,|82"& ,|82"& ,|TRUE"& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 30002936"& ,|EAP"& ,|CPT� 83986"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PH, STOOL"& ,|1"& ,|82"& ,|82"& ,|TRUE"& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 30002937"& ,|EAP"& ,|CPT� 80184"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PHENOBARBITAL LEVEL"& ,|1"& ,|130"& ,|130"& ,|TRUE"& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 30002938"& ,|EAP"& ,|CPT� 84999"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|RED CELL WASH"& ,|1"& ,|33.5"& ,|33.5"& ,|TRUE"& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 "& ,| 33.50 30002939"& ,|EAP"& ,|CPT� 80185"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PHENYTOIN LEVEL"& ,|1"& ,|307.5"& ,|307.5"& ,|TRUE"& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 "& ,| 307.50 30002940"& ,|EAP"& ,|CPT� 84075"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PHOSPHATASE (ENZYME) LEVEL"& ,|1"& ,|171"& ,|171"& ,|TRUE"& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 "& ,| 171.00 30002941"& ,|EAP"& ,|CPT� 84080"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PHOSPHATASE (ENZYME) MEASUREMENT"& ,|1"& ,|173"& ,|173"& ,|TRUE"& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 "& ,| 173.00 30002942"& ,|EAP"& ,|CPT� 84100"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PHOSPHATE LEVEL"& ,|1"& ,|188"& ,|188"& ,|TRUE"& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 30002943"& ,|EAP"& ,|CPT� 84105"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PHOSPHORUS 24H U KID"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002944"& ,|EAP"& ,|CPT� 86331"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|IMMUNOLOGIC ANALYSIS FOR DETECTION OF ANTIGEN OR ANTIBODY"& ,|1"& ,|82"& ,|82"& ,|TRUE"& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 30002945"& ,|EAP"& ,|CPT� 87172"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|PINWORM PREP"& ,|1"& ,|131"& ,|131"& ,|TRUE"& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 "& ,| 131.00 30002946"& ,|EAP"& ,|CPT� 83520"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|PIVKA-II BY RIA"& ,|1"& ,|679.5"& ,|679.5"& ,|TRUE"& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 "& ,| 679.50 30002947"& ,|EAP"& ,|CPT� 86902"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|PLA-1 ANTIGEN TYPING (ARC)"& ,|1"& ,|914.5"& ,|914.5"& ,|TRUE"& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 "& ,| 914.50 30002948"& ,|EAP"& ,|HCPCS P9044"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|PLASMA CRYOPRECIPITATE REDUCED"& ,|1"& ,|448.5"& ,|448.5"& ,|TRUE"& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 "& ,| 448.50 30002949"& ,|EAP"& ,|CPT� 85421"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|PLASMINOGEN ANTIGEN"& ,|1"& ,|350.5"& ,|350.5"& ,|TRUE"& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 "& ,| 350.50 30002950"& ,|EAP"& ,|CPT� 85420"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|PLASMINOGEN ASSAY"& ,|1"& ,|383"& ,|383"& ,|TRUE"& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 "& ,| 383.00 30002951"& ,|EAP"& ,|CPT� 86023"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTIBODY ID, PLATELET DIRECT IGG"& ,|1"& ,|135.5"& ,|135.5"& ,|TRUE"& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 30002952"& ,|EAP"& ,|CPT� 86023"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|ANTIBODY ID, PLATELET DIRECT IGM"& ,|1"& ,|135.5"& ,|135.5"& ,|TRUE"& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 "& ,| 135.50 30002953"& ,|EAP"& ,|CPT� 85576"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|PLATELET AGGREGATION"& ,|1"& ,|144"& ,|144"& ,|TRUE"& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 "& ,| 144.00 30002954"& ,|EAP"& ,|CPT� 85049"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|PLATELET COUNT AUTO"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30002955"& ,|EAP"& ,|CPT� 85032"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|PLATELET COUNT MANUAL"& ,|1"& ,|165.5"& ,|165.5"& ,|TRUE"& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 "& ,| 165.50 30002956"& ,|EAP"& ,|CPT� 85597"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|PLATELET NEUTRALIZATION"& ,|1"& ,|952"& ,|952"& ,|TRUE"& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 "& ,| 952.00 30002957"& ,|EAP"& ,|CPT� 86022"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|ANTIBODY ID, CROSSMATCH"& ,|1"& ,|917"& ,|917"& ,|TRUE"& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 "& ,| 917.00 30002958"& ,|EAP"& ,|HCPCS P9035"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|PLATELETS PHERESIS LEUKOCYTE FOURTH"& ,|1"& ,|773.5"& ,|773.5"& ,|TRUE"& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 "& ,| 773.50 30002959"& ,|EAP"& ,|HCPCS P9035"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|PLATELETS PHERESIS LEUKOCYTE EACH UNIT"& ,|1"& ,|1,874.00"& ,|1,874.00"& ,|TRUE"& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 "& ,| 1,874.00 30002960"& ,|EAP"& ,|HCPCS P9035"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|PLATELETS PHERESIS LEUKOCYTE HALF UNIT"& ,|1"& ,|1,046.00"& ,|1,046.00"& ,|TRUE"& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 "& ,| 1,046.00 30002961"& ,|EAP"& ,|HCPCS P9037"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|PLATELETS PHERESIS LEUKOCYTE IRRADIATED"& ,|1"& ,|2,345.00"& ,|2,345.00"& ,|TRUE"& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 "& ,| 2,345.00 30002962"& ,|EAP"& ,|CPT� 85576"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|PLATELET FUNCTION SCREEN"& ,|1"& ,|423.5"& ,|423.5"& ,|TRUE"& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 "& ,| 423.50 30002963"& ,|EAP"& ,|CPT� 85598"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|PLATELET NEUTRALIZATION"& ,|1"& ,|117.5"& ,|117.5"& ,|TRUE"& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 "& ,| 117.50 30002964"& ,|EAP"& ,|HCPCS P9037"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|PLATELETS PHERESIS LEUKOREDUCED IRRADIATED VOL REDUCE FOURTH"& ,|1"& ,|900"& ,|900"& ,|TRUE"& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 "& ,| 900.00 30002965"& ,|EAP"& ,|HCPCS P9037"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|PLATELETS PHERESIS LEUKOREDUCED IRRADIATED VOL REDUCE HALF"& ,|1"& ,|1,611.50"& ,|1,611.50"& ,|TRUE"& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 "& ,| 1,611.50 30002966"& ,|EAP"& ,|HCPCS P9037"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|PLATELETS PHERESIS LEUKOREDUCED IRRADIATED VOL REDUCE"& ,|1"& ,|2,268.00"& ,|2,268.00"& ,|TRUE"& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 "& ,| 2,268.00 30002967"& ,|EAP"& ,|HCPCS P9037"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|PLATELETS PHERESIS LEUKOCYTE IRRADIATED FOURTH"& ,|1"& ,|1,164.00"& ,|1,164.00"& ,|TRUE"& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 "& ,| 1,164.00 30002968"& ,|EAP"& ,|HCPCS P9037"& ,|"& ,|0390 - BLOOD STORAGE AND PROCESSING - GENERAL"& ,|PLATELETS PHERESIS LEUKOCYTE IRRADIATED HALF"& ,|1"& ,|1,559.00"& ,|1,559.00"& ,|TRUE"& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 "& ,| 1,559.00 30002969"& ,|EAP"& ,|CPT� 86317"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|IAA DETECTION PNEUMOCOCCAL AB TYPE"& ,|1"& ,|77"& ,|77"& ,|TRUE"& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 "& ,| 77.00 30002970"& ,|EAP"& ,|CPT� 86317"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|IAA DETECTION PNEUMOCOCCAL ANTIBODY"& ,|1"& ,|19"& ,|19"& ,|TRUE"& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 "& ,| 19.00 30002971"& ,|EAP"& ,|CPT� 82803"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|POC ART BL GAS"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 30002973"& ,|EAP"& ,|CPT� 82330"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|POC CALCIUM IONIZED"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 30002974"& ,|EAP"& ,|CPT� 82803"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|POC CAP BL GAS"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 30002976"& ,|EAP"& ,|CPT� 82947"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|BLOOD GLUCOSE (SUGAR) LEVEL"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 30002977"& ,|EAP"& ,|CPT� 85014"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|POC HEMATOCRIT"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 30002978"& ,|EAP"& ,|CPT� 83605"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|POC LACTIC ACID LEVEL"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 30002979"& ,|EAP"& ,|CPT� 84132"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|POC BLOOD POTASSIUM LEVEL"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 30002980"& ,|EAP"& ,|CPT� 84295"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|POC BLOOD SODIUM LEVEL"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 30002981"& ,|EAP"& ,|CPT� 82948"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|POC STICK GLUCOSE"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 30002982"& ,|EAP"& ,|CPT� 82803"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|POC VEN BL GAS"& ,|1"& ,|0.01"& ,|0.01"& ,|TRUE"& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 "& ,| 0.01 30002987"& ,|EAP"& ,|CPT� 82657"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MEASURE ENZYME PORPHOBILINOGEN DEAMIN (PBG D)"& ,|1"& ,|301"& ,|301"& ,|TRUE"& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 "& ,| 301.00 30002988"& ,|EAP"& ,|CPT� 84110"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|URINE PORPHOBILINOGEN (METABOLISM SUBSTANCE) LEVEL"& ,|1"& ,|82"& ,|82"& ,|TRUE"& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 "& ,| 82.00 30002989"& ,|EAP"& ,|CPT� 84126"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|STOOL PORPHYRINS (METABOLISM SUBSTANCE) LEVEL"& ,|1"& ,|484.5"& ,|484.5"& ,|TRUE"& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 "& ,| 484.50 30002990"& ,|EAP"& ,|CPT� 84120"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|URINE PORPHYRINS (METABOLISM SUBSTANCE) MEASUREMENT"& ,|1"& ,|188"& ,|188"& ,|TRUE"& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 30002991"& ,|EAP"& ,|CPT� 84311"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PORPHYRINS, SERUM"& ,|1"& ,|51.5"& ,|51.5"& ,|TRUE"& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 "& ,| 51.50 30002992"& ,|EAP"& ,|CPT� 84133"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|POTASSIUM 24H U KID"& ,|1"& ,|102"& ,|102"& ,|TRUE"& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 "& ,| 102.00 30002993"& ,|EAP"& ,|CPT� 84132"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|BLOOD POTASSIUM LEVEL"& ,|1"& ,|158"& ,|158"& ,|TRUE"& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 "& ,| 158.00 30002994"& ,|EAP"& ,|CPT� 84133"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|POTASSIUM URINE"& ,|1"& ,|138"& ,|138"& ,|TRUE"& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 30002995"& ,|EAP"& ,|CPT� 84134"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PREALBUMIN (PROTEIN) LEVEL"& ,|1"& ,|188"& ,|188"& ,|TRUE"& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 "& ,| 188.00 30002996"& ,|EAP"& ,|CPT� 86331"& ,|"& ,|0302 - LABORATORY - IMMUNOLOGY"& ,|IMMUNOLOGIC ANALYSIS FOR DETECTION OF ANTIGEN OR ANTIBODY"& ,|1"& ,|274.5"& ,|274.5"& ,|TRUE"& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 "& ,| 274.50 30002997"& ,|EAP"& ,|CPT� 87088"& ,|"& ,|0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY"& ,|PRESUMPTIVE URINALYSIS ID"& ,|1"& ,|76"& ,|76"& ,|TRUE"& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 "& ,| 76.00 30003000"& ,|EAP"& ,|CPT� 81479"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|MOLEC PATHOLOGY PRF1 AMPLIFICATION SINGLE"& ,|1"& ,|8,199.50"& ,|8,199.50"& ,|TRUE"& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 "& ,| 8,199.50 30003003"& ,|EAP"& ,|CPT� 80188"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PRIMIDONE LEVEL"& ,|1"& ,|130"& ,|130"& ,|TRUE"& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 "& ,| 130.00 30003005"& ,|EAP"& ,|CPT� 80190"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PROCAINAMIDE LEVEL"& ,|1"& ,|313.5"& ,|313.5"& ,|TRUE"& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 "& ,| 313.50 30003006"& ,|EAP"& ,|CPT� 84144"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PROGESTERONE"& ,|1"& ,|326.5"& ,|326.5"& ,|TRUE"& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 "& ,| 326.50 30003007"& ,|EAP"& ,|CPT� 84146"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PROLACTIN"& ,|1"& ,|418.5"& ,|418.5"& ,|TRUE"& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 "& ,| 418.50 30003008"& ,|EAP"& ,|CPT� 85302"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|PROTEIN C ANTIGEN"& ,|1"& ,|336"& ,|336"& ,|TRUE"& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 30003009"& ,|EAP"& ,|CPT� 85303"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|PROTEIN C ASSAY"& ,|1"& ,|336"& ,|336"& ,|TRUE"& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 30003010"& ,|EAP"& ,|CPT� 84165"& ,|"& ,|0301 - LABORATORY - CHEMISTRY"& ,|PROTEIN MEASUREMENT, SERUM"& ,|1"& ,|244"& ,|244"& ,|TRUE"& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 "& ,| 244.00 30003011"& ,|EAP"& ,|CPT� 85306"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|PROTEIN S ANTIGEN FREE"& ,|1"& ,|155.5"& ,|155.5"& ,|TRUE"& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 30003012"& ,|EAP"& ,|CPT� 85306"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|PROTEIN S ANTIGEN TOTAL"& ,|1"& ,|128.5"& ,|128.5"& ,|TRUE"& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 "& ,| 128.50 30003013"& ,|EAP"& ,|CPT� 85305"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|PROTEIN S ANTIGEN TOTAL & FREE"& ,|1"& ,|155.5"& ,|155.5"& ,|TRUE"& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 "& ,| 155.50 30003014"& ,|EAP"& ,|CPT� 85305"& ,|"& ,|0305 - LABORATORY - HEMATOLOGY"& ,|PROTEIN S ASSAY"& ,|1"& ,|336"& ,|336"& ,|TRUE"& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 "& ,| 336.00 30003015"& ,|EAP"& ,|CPT� 84155"& ,|"& ,|0300 - LABORATORY - GENERAL"& ,|PROTEIN, TOTAL, EXCEPT, SERUM"& ,|1"& ,|138"& ,|138"& ,|TRUE"& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,| 138.00 "& ,|